scholarly journals Digital Orientation of Health Systems in the Post-COVID-19 New Normal: Insights from a Cross-Sectional Survey Across the United States (Preprint)

2021 ◽  
Author(s):  
Jiban Khuntia ◽  
Xue Ning ◽  
Rulon Stacey
Keyword(s):  
United States ◽  
Health Systems ◽  
Digital Technology ◽  
Digital Technologies ◽  
The United States ◽  
Transformative Power ◽  
New Normal ◽  
High Burden ◽  
Major Teaching ◽  
Almost All

BACKGROUND How are health systems in the United States embracing digital technologies? Many health systems are overwhelmed. Others have tried to stay current with the dramatic changes of the past year by leapfrogging selected digital technologies during the COVID-19 pandemic. It appears that almost all health systems have developed some form of customer-facing digital technologies and worked to align those to their existing electronic health records to accommodate the surge in remote and virtual care deliveries. Still, others have developed analytics-driven decision-making capabilities. However, even with all these developments, there seems to yet a gap in health systems’ ability to integrate workflows with expanding technologies to spur innovation and futuristic growth. There is a lack of a reliable and reported estimate of the current digital orientation of health systems. Periodic assessments will provide imperatives to policy formulation and align efforts to yield the transformative power of emerging digital technologies. OBJECTIVE To explore and assess US health systems’ differences in digital orientations in the post-COVID-19 “new normal” in 2021. Differences were assessed in four dimensions: 1) Analytics and Intelligence Oriented Digital Technologies (AODT) 2) Customer Oriented Digital Technologies (CODT) 3) Growth and Innovation Oriented Digital Technologies (GODT), and 4) Futuristic and Experimental Digital Technologies (FEDT) The earlier two are foundational to health systems’ digital orientation, while the latter two will prepare for future disruptions. METHODS We surveyed a robust group of health system CEOs (total 625) across the United States during Feb-Mar 2021. Twenty-two percent of the CEOs (135) responded to our survey. We considered the above four broad digital technology orientations and ratified with experts’ consensus. Secondary data was collected from AHRQ Hospital Compendium, leading to the matched usable dataset for 124 health systems for analysis. We examined the relationship of adopting the four digital orientations to specific hospital characteristics and factors that were earlier reported widely as barriers or facilitators to technology adoption. RESULTS We found that health systems have a lower level of customer (CODT mean= 4.70) or growth (GODT mean= 4.54) orientations, compared to analytics and intelligence digital orientation (AODT mean= 5.03); while health systems have the least futuristic digital orientation (FEDT mean= 4.31). The ordered logistic estimation results provided nuanced insights. Medium (P<.001) and large-sized(P<.05), major teaching (P<.001), and systems with a high burden hospital (P<.001) are doing worse in AODT orientations, raising some concerns. Health systems with medium (P<.001) and large sizes (P<.05), major teaching (P<.1), high revenue (P<.05), and with a high burden hospital (P<.001) have less customer-oriented digital technology or CODT. Interestingly, we found that health systems in Midwest (P<.05) and South (P<.05) are more likely to adopt growth-orientated technologies, while high revenue (P<.01) and investor ownership (P<.05) deters from GODT. Health systems in with the medium size and are in Midwest (P<.001), South (P<.001), and West (P<.05) are more adept to FEDT; while medium (P<.001) and high revenue (P<.001), and those with a high discharge (P<.05) or high burden hospital (P<.01) have subdued FEDT orientations. CONCLUSIONS Not surprisingly, almost all health systems have some current foundational digital technological orientations to glean intelligence or service delivery to customers, with some notable exceptions of lower adoptions in some sets of health systems. Comparatively, fewer groups of health systems have growth or futuristic digital orientations. The transformative power of digital technologies can be leveraged ONLY by adopting futuristic digital technologies. Thus, the disparities across these orientations suggest that a holistic, consistent, and well-articulated digital orientation direction across the United States remains elusive. This lack of consistency exacerbates different outcomes across different health systems and regions in the United States. Accordingly, the authors suggest that a policy strategy and financial incentives are necessary to spur a well-visioned and articulated digital orientation for all health systems across the United States. In the absence of such a policy to collectively leverage digital transformations, differences in care across the country will continue to be a concern.

Valuing Diversity and Inclusion in Healthcare: Pathways to Equip Workforces in the Post-COVID-19 New Normal (Preprint)

2021 ◽  
Author(s):  
Jiban Khuntia ◽  
Xue Ning ◽  
Wayne Cascio ◽  
Rulon Stacey
Keyword(s):  
United States ◽  
Health System ◽  
Health Systems ◽  
The United States ◽  
Mediating Effect ◽  
New Normal ◽  
Diversity And Inclusion ◽  
Healthcare Workforce ◽  
The Us ◽  
Service Oriented

BACKGROUND The COVID-19 pandemic, with all its virus variants, remains a serious situation. Health systems across the United States are trying their best to respond. The healthcare workforce remains relatively homogenous, even though they are caring for a highly diverse array of patients (6-12). It is a perennial problem in the US healthcare workforce that has only been accentuated during the COVID-19 pandemic. Medical workers should reflect the variety of patients they care for and strive to understand their mindsets within the larger contexts of culture, gender, sexual orientation, religious beliefs, and socioeconomic realities. Along with talent and skills, diversity and inclusion (D&I) are essential for maintaining a workforce that can treat the myriad needs and populations that health systems serve. Developing hiring strategies in a post-COVID-19 “new normal” that will help achieve greater workforce diversity remains a challenge for health system leaders. OBJECTIVE Our primary objectives are (1) to explore the characteristics and perceived benefits of US health systems that value D&I; (2) to examine the influence of a workforce strategy designed to balance talent and D&I; and (3) to explore three pathways to better equip workforces and their relative influences on business- and service-oriented benefits: (a) improving D&I among existing employees (IMPROVE), (b) using multiple channels to find and recruit a workforce (RECRUIT), and (c) collaborating with universities to find new talent and establish plans to train students (COLLABORATE). METHODS During February–March 2021, we surveyed 625 health system chief executive officers, in the United States, 135 (22%) of whom responded. We assessed workforce talent and diversity-relevant factors. We collected secondary data from the Agency for Healthcare Research and Quality’s (AHRQ) Compendium of the US. Health Systems, leading to a matched data set of 124 health systems for analysis. We first explored differences in talent and diversity benefits across the health systems. Then, we examined the relationship between IMPROVE, RECRUIT, and COLLABORATE pathways to equip the workforce. RESULTS Health system characteristics, such as size, location, ownership, teaching, and revenue, have varying influences on D&I and business and service outcomes. RECRUIT has the most substantial mediating effect on diversity-enabled business- and service-oriented outcomes of the three pathways. This is also true of talent-based workforce acquisitions. CONCLUSIONS Diversity and talent plans can be aligned to realize multiple desired benefits for health systems. However, a one-size-fits-all approach is not a viable strategy for improving D&I. Health systems need to follow a multipronged approach based on their characteristics. To get D&I right, proactive plans and genuine efforts are essential.

Integration vs. Collaborative Redesign Strategies of Health Systems’ Supply Chains in the Post-COVID-19 New Normal using Cross-Sectional Survey Across the United States (Preprint)

2021 ◽  
Author(s):  
Jiban Khuntia ◽  
Frances Mejia ◽  
Xue Ning ◽  
Jeff Helton ◽  
Rulon Stacey
Keyword(s):  
United States ◽  
Supply Chain ◽  
Health System ◽  
Supply Chains ◽  
Health Systems ◽  
The United States ◽  
Supply Chain Integration ◽  
Strategic Choices ◽  
New Normal ◽  
Service Outcomes

BACKGROUND How are health systems shaping strategies to restore the supply chain disruptions in 2021? Do they want to improve the supply chain integration? Do they want to collaborate with new start-ups to revamp the supply chain? Given the widespread disruptions to supply chains in 2020 because of the COVID-19 pandemic, these questions are essential to have confidence in health systems’ supply chain model strategies. Plausibly, health systems have an opportunity for redesign, growth, and innovation by utilizing collaborative strategies now, compared to the usual strategies of integrating their existing supply chains to reduce inefficiencies. This study is focused on teasing out the nuance of supply chain integration vs. collaboration strategies for health systems in the post-COVID “new normal.” OBJECTIVE We focus on two research questions. First, we explore the impact of perceived supply chain challenges and disruptions on health systems’ supply chain integration (SC-INTEGRATION) and collaborative redesign (SC-REDESIGN) strategies. Second, we examine the outcomes of integration and collaborative redesign strategic choices on growth and service outcomes. METHODS We surveyed a robust group of health system chief executive officers (CEOs) (N=625) across the United States from February to March 2021. Twenty-two percent of the CEOs (135) responded to our survey. We considered supply chain relevant strategy and outcome variables from the literature and ratified them via expert consensus. We collected secondary data from the AHRQ Compendium of the U.S. Health Systems, leading to a matched data set from the 124 health systems. Then, we employed ordered logit model estimation to examine CEO preferences for partnership strategies to address current supply disruptions and the outcomes of strategy choices. RESULTS Health systems with higher disruptions would choose integration over redesign, indicating that they still trust the existing partners. Integration strategy is perceived to result in better service outcomes while collaborations are perceived to lead to greater growth opportunities; however, the role of integration on growth is not completely ruled out. Plausibly, some health systems would choose both integration and collaborative redesign models, which have a significant relationship with both service and growth, establishing the importance of mixed strategies for health systems. CONCLUSIONS The cost of healthcare continues to rise, and supply-related costs constitute a large portion of a hospital’s expenditure. Understanding supply chain strategic choices are essential for the success of a health system. Although collaborative revamp is an option; but still focusing on and improving existing integration dynamics is helpful to foster both growth and services for health systems.

Philosophical implications of Tarski's work

1988 ◽  
Vol 53 (1) ◽  
pp. 80-91 ◽  
Author(s):  
Patrick Suppes
Keyword(s):  
United States ◽  
English Translation ◽  
The United States ◽  
International Congress ◽  
Unity Of Science ◽  
Scientific Philosophy ◽  
Philosophical Texts ◽  
Concept Of Truth ◽  
Almost All ◽  
Philosophical Questions

In his published work and even more in conversations, Tarski emphasized what he thought were important philosophical aspects of his work. The English translation of his more philosophical papers [56m] was dedicated to his teacher Tadeusz Kotarbiński, and in informal discussions of philosophy he often referred to the influence of Kotarbiński. Also, the influence of Leśniewski, his dissertation adviser, is evident in his early papers. Moreover, some of his important papers of the 1930s were initially given to philosophical audiences. For example, the famous monograph on the concept of truth ([33m], [35b]) was first given as two lectures to the Logic Section of the Philosophical Society in Warsaw in 1930. Second, his paper [33], which introduced the concepts of ω-consistency and ω-completeness as well as the rule of infinite induction, was first given at the Second Conference of the Polish Philosophical Society in Warsaw in 1927. Also [35c] was based upon an address given in 1934 to the conference for the Unity of Science in Prague; [36] and [36a] summarize an address given at the International Congress of Scientific Philosophy in Paris in 1935. The article [44a] was published in a philosophical journal and widely reprinted in philosophical texts. This list is of course not exhaustive but only representative of Tarski's philosophical interactions as reflected in lectures given to philosophical audiences, which were later embodied in substantial papers. After 1945 almost all of Tarski's publications and presentations are mathematical in character with one or two minor exceptions. This division, occurring about 1945, does not, however, indicate a loss of interest in philosophical questions but is a result of Tarski's moving to the Department of Mathematics at Berkeley. There he assumed an important role in the development of logic within mathematics in the United States.

International Conference on Safety of Life at Sea

1914 ◽  
Vol 8 (4) ◽  
pp. 758-768
Author(s):  
Everett P. Wheeler
Keyword(s):  
United States ◽  
The United States ◽  
International Conference ◽  
Human Skill ◽  
Almost All

In these days of wars which have engulfed almost all Europe it is a satisfaction to recall that thirteen nations sent their delegates to an international conference relating to safety of life at sea, no longer ago than December, 1913, and that they signed on the 20th of January, 1914, a convention which has been adopted by many of the nations and which was transmitted to the Senate of the United States by the President on the 17th of March. All the resources of human skill and science are now being used to destroy life. It is a pleasure to reflect that man has at one time been engaged in a more humane and, shall we not add, a more Christian undertaking.

scholarly journals 677. Using a Multisectoral One Health Approach to Prioritize Zoonotic Diseases in the United States

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S244-S244
Author(s):  
Vikram Krishnasamy ◽  
Casey Barton Behravesh ◽  
Kate Varela ◽  
Grace Goryoka ◽  
Nadia Oussayef ◽  
...  
Keyword(s):  
United States ◽  
Health Systems ◽  
Disease Surveillance ◽  
One Health ◽  
The United States ◽  
Zoonotic Disease ◽  
Zoonotic Diseases ◽  
Health Systems Strengthening ◽  
Transmission Potential ◽  
Us Government

Abstract Background Emerging and endemic zoonoses continue to have adverse global impacts. One Health approaches promoting multisectoral, transdisciplinary collaboration are important methods to address zoonoses threats through disease surveillance, prevention, control, and response. We conducted a One Health Zoonotic Disease Prioritization (OHZDP) workshop in the United States (US) to identify zoonotic diseases of greatest national concern that should be jointly addressed by the Centers for Disease Control (CDC), US Department of Agriculture (USDA), Department of the Interior, and partners. Methods We used CDC’s OHZDP tool to prioritize zoonoses. Workshop participants selected criteria for prioritization, and developed questions and weights for each criterion. Questions were answered using available literature and expert opinion with subsequent scoring resulting in a ranked zoonotic disease list. After agreeing on a final prioritized disease list, participants used components of the One Health Systems Mapping and Analysis Resource Toolkit, developed by USDA and University of Minnesota, to review multidisciplinary coordination processes for the prioritized zoonotic diseases. Results Participants selected epidemic or pandemic potential, disease severity, economic impact, introduction or increased transmission potential, and national security as criteria to prioritize 56 zoonoses. The eight prioritized zoonotic diseases for the US were zoonotic influenzas, salmonellosis, West Nile virus, plague, emerging coronaviruses (e.g., SARS, MERS), rabies, brucellosis, and Lyme disease. Agencies then discussed recommendations to enhance One Health approaches to surveillance, response, prevention, and control of the prioritized zoonoses. Key themes and next steps for further implementation of One Health approaches were identified. Conclusion This OHZDP workshop represents the first use of a One Health approach to zoonotic disease prioritization in the United States. It is a critical step forward in US government agency collaboration using One Health approaches. Further, the workshop created a foundation for future US government One Health systems strengthening for the prioritized zoonoses. Disclosures All authors: No reported disclosures.

scholarly journals A Critical Analysis of Mercosur Countries’ Trade Relationships with the United States and China

2016 ◽  
Vol 10 (1) ◽  
pp. 163
Author(s):  
M. Anaam Hashmi
Keyword(s):  
United States ◽  
International Trade ◽  
Trade Deficit ◽  
The United States ◽  
Data Series ◽  
The European Union ◽  
Full Member ◽  
Strategic Goals ◽  
Almost All ◽  
Export Industries

The Mercosur trade alliance formed in 1991 is composed of six full member countries. Historically, Mercosur member countries have been engaged in international trade with the United States, Japan, and the European Union, but recently, China has become a dominant player in the region, with increased foreign direct investment and international trade. Chinese commercial and trade involvement was followed by a visit to the region by President Jiang Zemin in 2001; therefore, this study relied on a 2000–2015 data series. Chinese enterprises are competing well with U.S. corporations in almost all Mercosur member countries. A majority of Mercosur members had a trade deficit with China in recent years, suggesting that Mercosur members cannot leverage their export industries and are losing their competitiveness. The future of the Mercosur-China trade relationship is bright because both sides require each other’s products. Future involvement also depends on the Chinese government’s strategic goals, and the competitiveness of U.S. corporations.

scholarly journals Use of Digital Technology to Enhance Tuberculosis Control: Scoping Review

10.2196/15727 ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. e15727 ◽  
Author(s):  
Yejin Lee ◽  
Mario C Raviglione ◽  
Antoine Flahault
Keyword(s):  
United States ◽  
Resource Management ◽  
Treatment Adherence ◽  
Scoping Review ◽  
Digital Technology ◽  
Digital Health ◽  
The United States ◽  
Data Services ◽  
The World ◽  
And Control

Background Tuberculosis (TB) is the leading cause of death from a single infectious agent, with around 1.5 million deaths reported in 2018, and is a major contributor to suffering worldwide, with an estimated 10 million new cases every year. In the context of the World Health Organization’s End TB strategy and the quest for digital innovations, there is a need to understand what is happening around the world regarding research into the use of digital technology for better TB care and control. Objective The purpose of this scoping review was to summarize the state of research on the use of digital technology to enhance TB care and control. This study provides an overview of publications covering this subject and answers 3 main questions: (1) to what extent has the issue been addressed in the scientific literature between January 2016 and March 2019, (2) which countries have been investing in research in this field, and (3) what digital technologies were used? Methods A Web-based search was conducted on PubMed and Web of Science. Studies that describe the use of digital technology with specific reference to keywords such as TB, digital health, eHealth, and mHealth were included. Data from selected studies were synthesized into 4 functions using narrative and graphical methods. Such digital health interventions were categorized based on 2 classifications, one by function and the other by targeted user. Results A total of 145 relevant studies were identified out of the 1005 published between January 2016 and March 2019. Overall, 72.4% (105/145) of the research focused on patient care and 20.7% (30/145) on surveillance and monitoring. Other programmatic functions 4.8% (7/145) and electronic learning 2.1% (3/145) were less frequently studied. Most digital health technologies used for patient care included primarily diagnostic 59.4% (63/106) and treatment adherence tools 40.6% (43/106). On the basis of the second type of classification, 107 studies targeted health care providers (107/145, 73.8%), 20 studies targeted clients (20/145, 13.8%), 17 dealt with data services (17/145, 11.7%), and 1 study was on the health system or resource management. The first authors’ affiliations were mainly from 3 countries: the United States (30/145 studies, 20.7%), China (20/145 studies, 13.8%), and India (17/145 studies, 11.7%). The researchers from the United States conducted their research both domestically and abroad, whereas researchers from China and India conducted all studies domestically. Conclusions The majority of research conducted between January 2016 and March 2019 on digital interventions for TB focused on diagnostic tools and treatment adherence technologies, such as video-observed therapy and SMS. Only a few studies addressed interventions for data services and health system or resource management.

scholarly journals A FRESH LOOK AT KNOWLEDGE MANAGEMENT STRATEGIES DURING THE CRISIS

2021 ◽  
Author(s):  
Marharyta Chepeliuk
Keyword(s):  
United States ◽  
Digital Technology ◽  
Management Strategies ◽  
The United States ◽  
Office Work ◽  
Remote Work ◽  
High Recovery ◽  
The Social ◽  
Employment Rates ◽  
Near Future

The pandemic has enhanced the social function of digital technologies and services. It is solely through digital technology that a massive shift to remote work has been possible during the most difficult period of the pandemic. All over the world, the philosophy of office work is changing, and there is a transition to permanent and conditional-permanent remote work. For example, Transport Canada is planning to move to telecommuting as a key employment model for its employees. In the near future, telecommuting will continue for most of the 6,000 employees in the agency. In China, widespread use of WeChat, Tencent, and Ding digital working applications began in late January 2020, when isolation measures were introduced. In Switzerland, COOVID-19 Remote Work and Study Resources provides free resources for remote operation and distance learning. Zoom and Google Meet videoconferencing, remote workplaces, and new social platforms run remote work almost immediately, and this trend is likely to continue after the lifting of the quarantine. Trends in staff employment worldwide are rather mixed. According to LinkedIn, it is possible to track changes in the employment rates of seven key economies – Australia, China, France, Italy, Singapore, Great Britain and United States. In France and Italy, the decline was more pronounced at -70% and -64.5% respectively by mid-April 2020. Since then, employment has been gradually recovering, and most of the seven key economies for which these figures have been analysed tend to change by 0 per cent year on year. By July 1, 2020, China, France, and the United States had seen the largest rebound in relative recruitment – -6% or -7%. At the end of September 2020, the countries with a high recovery in employment were China (22 per cent), Brazil (13 per cent), Singapore (8 per cent) and France (5 per cent). In these economies, hiring so far seems to compensate for months in which no new personnel have been recruited, indicating some stabilization of the labor market.

scholarly journals Cyber space – risks to children and young people - research results

2018 ◽  
Vol 189 (4) ◽  
pp. 46-59
Author(s):  
Marian Kopczewski ◽  
Agnieszka Napieralska
Keyword(s):  
Physical Activity ◽  
Digital Technology ◽  
Virtual World ◽  
Digital Technologies ◽  
Free Time ◽  
The Internet ◽  
Social Psychological ◽  
Children And Young People ◽  
Cyber Space ◽  
Almost All

The 21<sup>st</sup> century is undoubtedly a period of enormous progress in the field of digital technology, a period in which the boundary between the real world and the virtual world becomes less and less visible. The Internet has undeniably become a facilitation of everyday life, since it is a tool of work, communication or a way to spend free time for many users. The virtual world is present in almost all areas of our lives, and people spend more and more time in front of the computer screens, operating websites, e-mails or social networks. Highly developed digital technology is a boon of the 21st century, but despite its numerous advantages, negative aspects are also visible. Virtual knowledge displaces physical interpersonal contacts; physical activity is replaced by spending free time in front of a computer monitor. Various threats (social, psychological, psychological, ethical and moral) resulting from modern digital technologies and the increasing degree of dependence on them are extremely significant. The authors of this article present the results of own research, aiming at making the reader aware that there are both positive and negative aspects of the virtual world.

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