Healthcare managers’ perception of economies of scale

2017 ◽  
Vol 31 (3) ◽  
pp. 317-330 ◽  
Author(s):  
Anna Svarts
Keyword(s):  
Economies Of Scale ◽  
Healthcare Professionals ◽  
Scale Effects ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Small Sample ◽  
Fixed Cost ◽  
Fixed Costs ◽  
Content Type ◽  
The Impact

Purpose The purpose of this paper is to explore how healthcare managers perceive economies of scale and the underlying mechanisms for how scale/size affects performance. Design/methodology/approach Data were collected in 20 in-depth interviews with healthcare professionals from 13 healthcare delivery organizations and from a public authority that finances and contracts healthcare services. Data were coded and analysed using content analysis. Findings The study concludes that the impact of scale on performance is perceived by healthcare professionals to be different for different types of healthcare services: For surgery, significant scale effects related to spreading of fixed cost, the experience curve, and potential for process improvement. For inpatient care, moderate scale effects related to spreading of fixed costs and costs of doctors on on-call duty. For outpatient care, small or no scale effects. Research limitations/implications The small sample of interviewees from a single geographical region and healthcare system limits the applicability of the findings. Originality/value The paper provides insights into how healthcare managers experience scale effects and how they consider economies of scale when planning hospital configuration. Also, past studies of economies of scale in hospitals proffer mixed results and the findings in this paper indicate a possible explanation for this inconclusiveness, i.e. differences in service mix between different hospitals.

The impact of patient recovery flexibility on service experience in public healthcare

2019 ◽  
Vol 14 (2) ◽  
pp. 159-179 ◽  
Author(s):  
Pradeep Kumar
Keyword(s):  
Healthcare Professionals ◽  
Healthcare Delivery ◽  
Structured Interview ◽  
Public Healthcare ◽  
Contextual Influences ◽  
Service Experience ◽  
Content Type ◽  
The Public ◽  
Integrative Framework ◽  
The Impact

Purpose This study aims to identify the dimensions of patient recovery flexibility in the public healthcare context and its impact on the service experience. The study also explores the strategies and contextual influences to attain patient recovery flexibility. Design/methodology/approach This paper uses a case study method based on a semi-structured interview with healthcare professionals, observations and informal discussions. Findings In the present study, several dimensions of patient recovery flexibility are reported. Different internal and external strategies to exhibit patient recovery flexibility, as well as two contextual influences, are identified. An integrative framework is developed to establish the relationship of patient recovery flexibility with service experience in public healthcare. Research limitations/implications The study was conducted in a public healthcare setting in India. The sample size for the semi-structured interview was limited to healthcare professionals, and the patient’s perspective is missing. Originality/value This paper contributes to the growing need for patient recovery flexibility as a strategy in the public healthcare delivery system. It offers new insights to address the gap in the literature regarding the linkage of patient recovery flexibility and service experience. The study provides an integrative framework of dimensions of patient recovery flexibility, strategies, contextual influences and the impact on the service experience. The framework and propositions presented in the study will guide future research that is needed in this area. This study provides an overview to shape and redesign the after-service support from a flexibility perspective in public healthcare for the improved service experience.

When do job insecure employees adapt to change?

2019 ◽  
Vol 25 (3) ◽  
pp. 271-286 ◽  
Author(s):  
Kristi N. Lavigne ◽  
Victoria L. Whitaker ◽  
Dustin K. Jundt ◽  
Mindy K. Shoss
Keyword(s):  
Job Insecurity ◽  
Small Sample ◽  
Adaptive Performance ◽  
Work Behaviors ◽  
Content Type ◽  
Work Tasks ◽  
Main Effect ◽  
Low Levels ◽  
The Impact ◽  
The Relationship

Purpose The purpose of this paper is to examine the relationship between job insecurity and adaptive performance (AP), contingent on changes to core work tasks, which we position as a situational cue to employees regarding important work behaviors. Design/methodology/approach Employees and their supervisors were invited to participate in the study. Supervisors were asked to provide ratings of employees’ AP and changes to core tasks; employees reported on job insecurity. Findings As predicted, changes to core tasks moderated the relationship between job insecurity and AP. Job insecurity was negatively related to AP for those experiencing low levels of change, but was not related to AP for those experiencing high levels of change. Counter to expectations, no main effect of job insecurity was found. Research limitations/implications This study employed a fairly small sample of workers from two organizations, which could limit generalizability. Practical implications The study identifies changes to core tasks as a boundary condition for the job insecurity–AP relationship. Findings suggest that organizations may not observe deleterious consequences of job insecurity on AP when changes to core tasks are high. Originality/value Few researchers have examined boundary conditions of the impact of job insecurity on AP. Furthermore, inconsistent findings regarding the link between job insecurity and AP have emerged. This study fills the gap and expands upon previous research by examining changes to core tasks as a condition under which job insecurity does not pose an issue for AP.

Analytical redefinition of DOL and managerial investment decisions

2014 ◽  
Vol 40 (7) ◽  
pp. 734-754 ◽  
Author(s):  
Yoram Kroll ◽  
David Yechiam Aharon
Keyword(s):  
Large Scale ◽  
Investment Decision ◽  
Production Level ◽  
Fixed Cost ◽  
Theoretical Formulation ◽  
Optimal Production ◽  
Demand Shocks ◽  
Content Type ◽  
Operating Leverage ◽  
The Impact

Purpose – The purpose of this paper is to develop alternative analytical measures for the degree of operating leverage (DOL) that reflect the impact of uncertain demand shocks in the product's market on optimal production levels, sales and profits of the firm. Design/methodology/approach – The elasticity measures are constructed according to a theoretical formulation of optimal production level that corresponds to demand shocks for given predetermined levels of fixed cost. Findings – The paper suggests two main findings. First, the analytical marginal DOL is at least twice the traditional DOL depending on the structure of the shock, the production function and demand's elasticity. The traditional DOL is equal to the measure only when large-scale negative demand prompts the firm to abandon production. Second, the paper also provides an analytical measure of DOL in terms of elasticity of profit to sales rather than to production level. Both theoretically and empirically elasticity of profit to sales can be better measured and better reflects risk. Research limitations/implications – This paper should be extended to encompass multiple shocks on demand and supply while investigating the empirical multi variants distribution of the shocks. Practical implications – The model can be used by managers who are well informed about the fixed and variable costs of their firm. The model determines the mean profit- risk trade off which is an important factor in all investment decision problems. Originality/value – Surprisingly and according to the best knowledge, this paper is the first attempt in the literature for alternative analytical DOLs’ formulations that is coherent with basic economic theories of optimal production level under risk.

CEOs’ accounting-based attributes and earnings management strategies under mandatory IFRS adoption

2018 ◽  
Vol 19 (4) ◽  
pp. 608-625 ◽  
Author(s):  
Amel Kouaib ◽  
Anis Jarboui ◽  
Khaireddine Mouakhar
Keyword(s):  
Earnings Management ◽  
Small Sample Size ◽  
Small Sample ◽  
Moderating Effect ◽  
Audit Committees ◽  
Content Type ◽  
Ifrs Adoption ◽  
Experience Education ◽  
The Impact ◽  
The Relationship

Purpose The purpose of this paper is to focus on the moderating effect of mandatory International Financial Reporting Standards (IFRS) adoption on the relationship between chief executive officer (CEO) experience/education and earnings management in European companies. Design/methodology/approach Data from a sample of 302 European firms listed on Stoxx Europe 600 index and 596 CEOs from 2000 to 2014 are used to test the moderation model using moderation regression analysis. Findings Evidence reveals that CEO’s accounting-based attributes are negatively associated with accruals-based earnings management and positively associated with real earnings management (REM). Further, mandatory IFRS adoption significantly moderates the impact of CEO’s accounting-based traits on earnings-management activities. Research limitations/implications A small number of European firms were studied and, given the long study period, many firms with missing data were eliminated. To avoid a small sample size, countries with few observations were included, which leads to an uneven distribution between observations per country. Practical implications Findings from this paper can help: European firms to consider demographic traits when recruiting or promoting executives; the IASB to improve enforcement mechanisms and make IFRS implementation mandatory; and audit committees to effectively monitor REM. Originality/value This study is unique in providing European evidence for the moderating effect of mandatory IFRS adoption on the relationship between CEOs’ accounting experience/education and earnings management activities. This paper is also relevant as it addresses the effectiveness and efficiency of accounting literates.

scholarly journals Interprofessional collaborative learning in the workplace: a qualitative study at a non-governmental organisation in Durban, South Africa

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sarentha Chetty ◽  
Varsha Bangalee ◽  
Petra Brysiewicz
Keyword(s):  
South Africa ◽  
Collaborative Learning ◽  
Healthcare Professionals ◽  
Qualitative Content Analysis ◽  
Small Sample Size ◽  
Healthcare Delivery ◽  
Small Sample ◽  
Rapid Progression ◽  
Research Site ◽  
Company Culture

Abstract Background The rapid progression of diseases and the complex, changing landscape of healthcare has increased the awareness that interprofessional collaboration is essential in ensuring safe and effective healthcare delivery. However, to develop a “collaborative practice-ready” workforce, organisations need to invest in the application of alternative approaches to the training of healthcare professionals. Purpose of the study To describe the perceptions of healthcare professionals attending an HIV interprofessional collaborative initiative at a non-governmental organization research site in South Africa and to provide suggestions regarding the improvement of this educational programme. Methods Focus group discussions (December 2018 to January 2019), were conducted on a purposeful sample (N = 21) consisting of healthcare professionals (clinicians, pharmacists, pharmacy assistants, and nurses), and clinical trial staff (recruiters, administrators, QC officers, psychologists, counsellors) based at a research site, who were invited to attend a continuing medical education initiative on the pathogenesis and treatment of HIV. Qualitative content analysis was carried out to identify meaning units, which were then condensed and labelled with a code. This was further grouped to form categories. Results Five categories emerged: learning something new, acquiring from each other, promoting company culture, needing company buy-in and teaching methods matter. Interprofessional collaborative learning improved technical capacity, work relationships and company culture. The diversity in learning needs of the different professionals requires a structuring of a curriculum to meet the needs of all. The success of this initiative requires company buy-in/investment and recognition from leaders and higher management with regards to time and resources. Suggestions for improvement included: formalizing the training, introducing more lectures and pitching each topic at different levels i.e. basic, intermediate or advanced, thus ensuring maximum benefit for all. Conclusion Inter-professional learning was perceived as highly valuable. This initiative has the potential to develop further but requires resources and company buy-in. All staff working (clinical and non-clinical) at the NGO site were represented in the interviews, thus ensuring a richer understanding of all perspectives relevant to the study site. The small sample size confined to a single research site, however, prevents these findings from being generalized and limits the applicability of its findings.

Effect of infiltrant-related parameters on mechanical performance for 3DP technology

2020 ◽  
Vol 26 (9) ◽  
pp. 1647-1656
Author(s):  
Weiwei Wu ◽  
Zhouzhou Wang ◽  
Shuang Ding ◽  
Aiping Song ◽  
Dejia Zhu
Keyword(s):  
Compressive Strength ◽  
Influencing Factors ◽  
Mechanical Performance ◽  
Small Sample ◽  
Partial Least Square ◽  
Materials Testing ◽  
Time Interval ◽  
Post Processing ◽  
Content Type ◽  
The Impact

Purpose The effects of infiltrant-related factors during post-processing on mechanical performance are fully considered for three-dimensional printing (3DP) technology. The factors contain infiltrant type, infiltrating means, infiltrating frequency and time interval of infiltrating. Design/methodology/approach A series of printing experiments are conducted and the parts are processed with different conditions by considering the above mentioned four parameters. Then the mechanical performances of the parts are tested from both macroscopic and microscopic papers. In the macroscopic view, the compressive strength of each printed part is measured by the materials testing machine – Instron 3367. In the microscopic view, scanning electron microscope and energy dispersion spectrum are used to obtain microstructure images and element content results. The pore size distributions of the parts are measured further to illustrate that if the particles are bound tightly by infiltrant. Then, partial least square (PLS) is used to conduct the analysis of the influencing factors, which can solve the small-sample problem well. The regression analysis and the influencing degree of each factor are explored further. Findings The experimental results show that commercial infiltrant has an outstanding performance than other super glues. The infiltrating action will own higher compressive strength than the brushing action. The higher infiltrating frequency and inconsistent infiltrating time interval will contribute to better mechanical performance. The PLS analysis shows that the most important factor is the infiltrating method. When compare the fitted value with the actual value, it is clear that when the compressive strength is higher, the fitting error will be smaller. Practical implications The research will have extensive applicability and practical significance for powder-based additive manufacturing. Originality/value The impact of the infiltrating-related post-processing on the performance of 3DP technology is easy to be ignored, which is fully taken into consideration in this paper. Both macroscopic and microscopic methods are conducted to explore, which can better explain the mechanical performance of the parts. Furthermore, as a small-sample method, PLS is used for influencing factors analysis. The variable importance in the projection index can explain the influencing degree of each parameter.

Can shared leadership enhance clinical team management? A systematic review

2019 ◽  
Vol 32 (2) ◽  
pp. 309-335 ◽  
Author(s):  
Lisa Aufegger ◽  
Omair Shariq ◽  
Colin Bicknell ◽  
Hutan Ashrafian ◽  
Ara Darzi
Keyword(s):  
Shared Leadership ◽  
Controlled Trial ◽  
Healthcare Delivery ◽  
Performance Outcomes ◽  
Small Sample ◽  
Patient Treatment ◽  
Healthcare Team ◽  
Content Type ◽  
Healthcare Teams ◽  
Acute Healthcare

Purpose Research in psychology or management science has shown that shared leadership (SL) enhances information sharing, fosters participation and empowers team members within the decision-making processes, ultimately improving the quality of performance outcomes. Little has been done and, thus, less is known of the value and use of SL in acute healthcare teams. The purpose of this study is to (1) explore, identify and critically assess patterns and behaviour of SL in acute healthcare teams; and (2) evaluate to what extent SL may benefit and accomplish safer care in acute patient treatment and healthcare delivery. Design/methodology/approach The authors conducted a review that followed the PRISMA-P reporting guidelines. A variety of sources were searched in April 2018 for studies containing primary research that focused on SL in acute healthcare teams. The outcome of interest was a well-specified assessment of SL, and an evaluation of the extent SL may enhance team performance, lead to safer patient care and healthcare delivery in acute healthcare teams. Findings After the study selection process, 11 out of 1,383 studies were included in the review. Studies used a qualitative, quantitative or mixed-methods approach. Emerging themes based on behavioural observations that contributed to SL were: shared mental model; social support and situational awareness; and psychological safety. High-performing teams showed more SL behaviour, teams with less seniority displayed more traditional leadership styles and SL was associated with increased team satisfaction. Research limitations/implications Evidence to date suggests that SL may be of benefit to improve performance outcomes in acute healthcare team settings. However, the discrepancy of SL assessments within existing studies and their small sample sizes highlights the need for a large, good quality randomized controlled trial to validate this indication. Originality/value Although studies have acknowledged the relevance of SL in healthcare service and delivery, a systematic, evidence-based and robust evaluation of behavioural patterns and the benefits of SL in this field is still missing.

Greek gynecology healthcare professionals towards quality management systems

2019 ◽  
Vol 32 (1) ◽  
pp. 164-175
Author(s):  
Konstantinos Dinas ◽  
Eleftherios Vavoulidis ◽  
Georgios Chrysostomos Pratilas ◽  
Alexandros Basonidis ◽  
Anastasios Liberis ◽  
...  
Keyword(s):  
Quality Management ◽  
Healthcare Professionals ◽  
Healthcare Services ◽  
Management Systems ◽  
Quality Management Systems ◽  
Content Type ◽  
Healthcare Facilities ◽  
Critical Gap ◽  
Management Objectives ◽  
Greek Hospitals

Purpose Today, quality management systems (QMS) are a promising candidate for the improvement of healthcare services. The purpose of this paper is to investigate the opinions/attitudes of gynecology healthcare professionals toward quality and quality management in healthcare facilities (HFs) in Greece. Design/methodology/approach An anonymous self-administered questionnaire was distributed to healthcare professionals, asking for opinions on quality objectives associated with the everyday workflow in HFs (e.g. management of patients, resources, etc.) and on QMS. The study was conducted in Hippokration Hospital of Thessaloniki, including 187 participants. Statistical assessment and analysis of the questionnaires were carried out. Findings Although 87.5 percent recognized the importance of potential QMS implementation and accreditation, over 50 percent believed that it would lead rather to increased workload and bureaucracy than to any considerable quality improvement. More than 60 percent were completely unaware of the implementation of quality objectives such as quality handbook, quality policy, audit meetings and accreditation status in their HFs. This unawareness was also reported in terms of patient, data, human and general resources management. Finally, awareness over medical malpractice and positive attitude toward official reporting were detected. Originality/value Most respondents acknowledged the significance of quality, QMS implementation and accreditation in Greek hospitals. However, there was a critical gap in knowledge about quality management objectives/processes that could be possibly resolved by expert teams and well-organized educational programs aiming to educate personnel regarding the various quality objectives in Greek HFs.

Key audit matters: insight from audit experts

2019 ◽  
Vol 27 (3) ◽  
pp. 472-494 ◽  
Author(s):  
Milton Segal
Keyword(s):  
Design Methodology ◽  
Academic Research ◽  
Small Sample ◽  
Content Type ◽  
Interpretive Approach ◽  
Management Policies ◽  
Audit Reports ◽  
The Impact ◽  
The Relationship ◽  
Complete Account

Purpose Key audit matters (KAM) and their impact on the auditor is a relatively understudied area. The purpose of this study is to analyse whether auditors perceive that the recent requirement for auditors of listed companies to report KAMs has enhanced the transparency of audit reports or not, what additional risks they now face, how the risk is being managed and its impact on the relationship with their clients. Design/methodology/approach The paper uses an interpretive approach for detailed interviews with some of South Africa’s leading audit experts to highlight their perspective of the impact of KAM on audit reporting and the audit environment. Findings The experts have various perceptions of what makes a matter “key”. These vary from materiality, to subjectivity and difficulty, as well as incorporating a time-based consideration. Concerns identified include a significant increase in cost and an increase in potential liability, triggering the need for thorough internal risk management policies. The audit experts conclude that KAM has ultimately failed to achieve its goal of greater transparency, with clients virtually ignoring KAM reports. Research limitations/implications The research relies on a relatively small sample of subject experts and may not provide a complete account of the view of all audit professionals and KAM reports issued. It analyses the impact of KAM from the preparers’ perspective. Originality/value This study contributes to the research conducted in this topical area. Although there has been research on KAM focusing on pre-implementation consequences, there is virtually no formal academic research on the impact KAM has had on audit partners and firms in South Africa post implementation. It may also serve as a basis for the IAASB to consider going forward.

Mindfulness-based wellbeing for socio-economically disadvantaged parents: a pre-post pilot study

2015 ◽  
Vol 10 (1) ◽  
pp. 17-28 ◽  
Author(s):  
Catrin Eames ◽  
Rebecca Crane ◽  
Eluned Gold ◽  
Sophie Pratt
Keyword(s):  
Risk Factors ◽  
Parental Stress ◽  
Economically Disadvantaged ◽  
Short Form ◽  
Small Sample ◽  
Stress Index ◽  
Post Intervention ◽  
Content Type ◽  
Mindfulness Skills ◽  
The Impact

Purpose – Behavioural parent training (PT) interventions partially mediate risk factors for the development of child behavioural problems. Mindfulness skills could have benefit in alleviating the impact of these risk factors for parents who are socio-economically disadvantaged. The paper aims to discuss these issues. Design/methodology/approach – A pre-post single group comparison of disadvantaged mothers attending the Mindfulness-Based Wellbeing for Parents (MBW-P) programme. Findings – Changes were observed in facets of parental stress (Parenting Stress Index-Short Form; Abidin, 1995), depression (Beck Depression Inventory-II; Beck et al., 1996) and brooding (Ruminative Responses Scale; Nolen-Hoeksema and Morrow, 1991), with moderate to large effect sizes and incidences of clinical change. Research limitations/implications – The research design, although pragmatic, includes a small sample and no control or long-term comparison group. Social implications – Mothers considered as the “hardest to reach” group in terms of vulnerability, risk factors and being likely to gain from intervention demonstrated positive shifts post-intervention. A targeted mindfulness-based intervention, delivered pragmatically within a health service context, may have benefit in reducing the impact of risk factors on parental wellbeing. Originality/value – To the authors’ knowledge, this is the first evaluation of a targeted mindfulness group delivered within routine health care settings, in identified “high risk” areas, by routine staff.

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