Enterprise Systems Outsourcing “Behind the Curtain”

2013 ◽  
pp. 1-18
Author(s):  
Per Svejvig ◽  
Jan Pries-Heje
Keyword(s):  
Data Analysis ◽  
Cost Saving ◽  
Best Practice ◽  
Enterprise Systems ◽  
Cost Savings ◽  
Careful Analysis ◽  
Institutional Factors ◽  
High Tech ◽  
Management Consultants ◽  
Silver Bullet

Outsourcing is now a feasible means for enterprise systems (ES) cost savings, but does however increase the complexity of coordination substantially when many organizations are involved. We set out to study ES outsourcing in a large Scandinavian high-tech organization, SCANDI, a case setting with many inter-organizational partners, trying to answer the question: Why does SCANDI engage in these very complex outsourcing arrangements? To answer this question we have analyzed documents, observed meetings and gathered data from interviews in four parts of SCANDI. The first data analysis found just the rational front stage cost-saving explanation; but then, with a more careful analysis focusing on institutional factors, other backstage explanations “behind the curtain” were uncovered, such as management consultants with a “best practice” agenda, people promoting outsourcing, thereby being promoted themselves, and a belief in outsourcing as a “silver bullet”: a recipe to success, solving everything.

Enterprise Systems Outsourcing “Behind the Curtain”

2011 ◽  
Vol 7 (1) ◽  
pp. 1-17 ◽  
Author(s):  
Per Svejvig ◽  
Jan Pries-Heje
Keyword(s):  
Data Analysis ◽  
Cost Saving ◽  
Best Practice ◽  
Enterprise Systems ◽  
Cost Savings ◽  
Careful Analysis ◽  
Institutional Factors ◽  
High Tech ◽  
Management Consultants ◽  
Silver Bullet

Outsourcing is now a feasible means for enterprise systems (ES) cost savings, but does however increase the complexity of coordination substantially when many organizations are involved. We set out to study ES outsourcing in a large Scandinavian high-tech organization, SCANDI, a case setting with many inter-organizational partners, trying to answer the question: Why does SCANDI engage in these very complex outsourcing arrangements? To answer this question we have analyzed documents, observed meetings and gathered data from interviews in four parts of SCANDI. The first data analysis found just the rational front stage cost-saving explanation; but then, with a more careful analysis focusing on institutional factors, other backstage explanations “behind the curtain” were uncovered, such as management consultants with a “best practice” agenda, people promoting outsourcing, thereby being promoted themselves, and a belief in outsourcing as a “silver bullet”: a recipe to success, solving everything

scholarly journals A113 COST SAVINGS OF SEROLOGIC VERSUS BIOPSY PROVEN DIAGNOSIS OF PEDIATRIC CELIAC DISEASE

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 131-132
Author(s):  
M Wiepjes ◽  
H Q Huynh ◽  
J Wu ◽  
M Chen ◽  
L Shirton ◽  
...  
Keyword(s):  
Health Care ◽  
Celiac Disease ◽  
North America ◽  
Cost Saving ◽  
Health Care System ◽  
Cost Savings ◽  
Serologic Diagnosis ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Care System

Abstract Background Celiac disease (CD) affects approximately one percent of the population in Canada and the United States. At present, endoscopic diagnosis (ED) of CD remains the gold standard in North America, despite mounting evidence and validated European guidelines for serologic diagnosis (SD). Within publicly funded healthcare systems there is pressure to ensure optimal resource utilization and cost efficiency, including for endoscopic services. At Stollery Children’s Hospital, Edmonton, Canada, we have adopted serologic diagnosis as routine practice since 2016. Aims The aim of this study is to estimate cost savings, i.e. hard dollar savings and capacity improvements, to the health care system as well as impacts on families in regard to reduced work days lost and missing child school days for SD versus ED. Initial cost saving data is presented. Methods Micro-costing methods were used to determine health care resource use in patients undergoing ED or SD from 2017–2018. SD testing included anti-tissue glutaminase antibody (aTTG) ≥200IU/mL (on two occasions), human leukocyte antigen (HLA) DQA5/DQ2, blood sampling, transport and laboratory costs. ED diagnosis included gastroenterologist, anesthetist, OR equipment, staff, overhead and histopathology. Cost of each unit of resource was obtained from the schedule of medical benefits (Alberta) and reported average ambulatory cost for day hospital endoscopy for Stollery Children’s Hospital determined in 2016; reported in CAN$. Results Between March 2017-December 2018, 473 patients were referred for diagnosis of CD; 233 had ED and 127 SD. Estimated cost for ED was $1240 per patient; for SD was $85 per patient (6.8% of ED cost). Based on 127 patients not requiring endoscopy and a cost saving of $1155 per patient there was a total cost savings of $146,685 over 22 months. Conclusions A SD approach presents a significant cost savings to the public health care system. It also frees up valuable endoscopic resources, and limits exposure of children to the immediate and long-term risks associated with anesthesia and biopsy. SD also decreases time to diagnosis and the cost of the process to families (lost days of school/work, travel costs etc.). Our costing data can be used in combination with mounting evidence on the test performance of SD versus ED to determine cost-effectiveness of serological diagnosis for pediatric CD. Given the potential for cost saving and more efficient operating room utilization, SD for pediatric CD warrants further investigation in North America. Funding Agencies None

scholarly journals AB1343-HPR A QUALITATIVE REVIEW ASSESSING THEMATIC OUTCOMES FROM THE PHARMACY-LED ADALIMUMAB BIOSIMILAR SWITCH PLAN ACROSS 3 SPECIALITIES; RHEUMATOLOGY, GASTROENTEROLOGY AND DERMATOLOGY AT UNIVERSITY HOSPITALS OF COVENTRY AND WARWICKSHIRE (UHCW)

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1959.1-1960
Author(s):  
S. Gohil
Keyword(s):  
Cost Saving ◽  
Injection Site ◽  
Cost Savings ◽  
Latex Allergy ◽  
Foot Drop ◽  
Injection Site Pain ◽  
Patient Counselling ◽  
Qualitative Review ◽  
Patient Reported ◽  
Site Pain

Background:The advent of biosimilars has heralded a new era for cost effective biologic prescribing in the NHS. As patents expire for originator biologics, less expensive versions are now widely available as biosimilars. Non-medical switches (for reasons unrelated to a patient’s health) ensure prescribing of best value medicines, and cost savings can be redirected to patient care.1This practice resonates with recommendations from Lord Carter’s 2016 report regarding reducing unwarranted variation in the NHS and adopting cost saving opportunities.2In 2018/19, following loss of patent exclusivity for the expensive adalimumab originator biologic, UHCW worked in accordance with national directives to drive forward one of the largest non-medical biosimilar switches.Objectives:This qualitative review aims to explore the success of the adalimumab biosimilar switch and key themes associated with switch backs/refusals across the Rheumatology (R), Gastroenterology (G) and Dermatology (D) specialities at UHCW.Methods:The switch plan occurred between April-December 2019. 403 patients (R;189, G;176, D; 38) were eligible for switch. Patients were informed of the plan in advance via a patient information leaflet/hospital clinic visits. Switch refusals, withheld treatments and cancellations were documented and patients were advised to contact the hospital pharmacy/clinical teams if they encountered any concerns, adverse effects or lack of efficacy post switch. The clinician would then advise on subsequent management.Results:During April-December 2019, 264/403 patients had been successfully switched (R;122, G;109, D;33). 33/403 patients switched back to the originator biologic (R;22, G;10; D;1). Of the 22 rheumatology switch back patients; 6 patients reported injection site pain and variably headache, fatigue, disease relapse, gastrointestinal (GI) upset, erythema; 10=reported lack of efficacy and variably influenza-type symptoms, relapse in associated psoriasis, difficulty in walking/sleeping, hair loss, excessive perspiration, facial cellulitis, foot drop and GI upset; 1=blepharitis;1=latex allergy before injection; 3=later declined switch; 1=damaged two devices and did not wish to continue biosimilar. Of the 10 gastroenterology switch back patients; 1=injection site pain; 2=lack of efficacy; 1=developed needle phobia; 1=latex allergy before injection; 1=switch detrimental to health; 2=unstable disease; 1=insomnia; 1=pregnancy. The 1 dermatology switch back patient reported injection site pain and bleeding.38/403 patients refused the switch and remained on the originator biologic (R;11, G;27, D;0). 29/403 patients had treatment cancellations and were switched to an alternative biologic (R;17, G;9, D;3). 32/403 patients stopped treatment (R;13, G;19, D;0). Treatment was withheld for 7/403 patients (R;4, G;2, D;1).Conclusion:The UHCW adalimumab biosimilar switch plan succeeded in switching a total of 66% of patients; thus an annual cost saving of £73,020. Injection site pain, most likely due to the biosimilar citrate content, and lack of efficacy according to patient perception and subsequent clinical review, were the most predominant causative themes for switch backs. Gastroenterology patients accounted for 71% (27/38) of the total switch refusals. Additional data regarding patient refusals, identifies future opportunities to improve patient counselling and drive further cost savings.References:[1]Azevedo V, et al. Biosimilars: considerations for clinical practice. Considerations in Medicine. 2017;1(1):13–8[2]Lord Carter of Coles. (2016) Operational productivity and performance in English NHS Acute Hospitals: Unwarranted variations [Online]Acknowledgments:Mark Easter, Chief Pharmacist, Hardeep Bagga, Deputy Chief Pharmacist, UHCW Pharmacy Homecare Team, UHCW Specialist Clinical Teams.Disclosure of Interests:None declared

scholarly journals Cost Analysis of a High Support Housing Initiative for Persons with Severe Mental Illness and Long-Term Psychiatric Hospitalization

2018 ◽  
Vol 63 (7) ◽  
pp. 492-500 ◽  
Author(s):  
David Rudoler ◽  
Claire de Oliveira ◽  
Binu Jacob ◽  
Melonie Hopkins ◽  
Paul Kurdyak
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Cost Saving ◽  
Cost Analysis ◽  
Severe Mental Illness ◽  
Inpatient Care ◽  
Cost Savings ◽  
Support Housing ◽  
High Support

Objective: The objective of this article was to conduct a cost analysis comparing the costs of a supportive housing intervention to inpatient care for clients with severe mental illness who were designated alternative-level care while inpatient at the Centre for Addiction and Mental Health in Toronto. The intervention, called the High Support Housing Initiative, was implemented in 2013 through a collaboration between 15 agencies in the Toronto area. Method: The perspective of this cost analysis was that of the Ontario Ministry of Health and Long-Term Care. We compared the cost of inpatient mental health care to high-support housing. Cost data were derived from a variety of sources, including health administrative data, expenditures reported by housing providers, and document analysis. Results: The High Support Housing Initiative was cost saving relative to inpatient care. The average cost savings per diem were between $140 and $160. This amounts to an annual cost savings of approximately $51,000 to $58,000. When tested through sensitivity analysis, the intervention remained cost saving in most scenarios; however, the result was highly sensitive to health system costs for clients of the High Support Housing Initiative program. Conclusions: This study suggests the High Support Housing Initiative is potentially cost saving relative to inpatient hospitalization at the Centre for Addiction and Mental Health.

Proposed guidance on cost-avoidance studies in pharmacy practice

2021 ◽  
Author(s):  
Asad E Patanwala ◽  
Sujita W Narayan ◽  
Curtis E Haas ◽  
Ivo Abraham ◽  
Arthur Sanders ◽  
...  
Keyword(s):  
Clinical Pharmacy ◽  
Best Practice ◽  
Pharmacoeconomic Analysis ◽  
Pharmacy Practice ◽  
Cost Savings ◽  
Sensitivity Analyses ◽  
Cost Assessment ◽  
Potential Consequence ◽  
Cost Avoidance ◽  
Pharmacist Interventions

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Cost-avoidance studies of pharmacist interventions are common and often the first type of study conducted by investigators to quantify the economic impact of clinical pharmacy services. The purpose of this primer is to provide guidance for conducting cost-avoidance studies pertaining to clinical pharmacy practice. Summary Cost-avoidance studies represent a paradigm conceptually different from traditional pharmacoeconomic analysis. A cost-avoidance study reports on cost savings from a given intervention, where the savings is estimated based on a counterfactual scenario. Investigators need to determine what specifically would have happened to the patient if the intervention did not occur. This assessment can be fundamentally flawed, depending on underlying assumptions regarding the pharmacists’ action and the patient trajectory. It requires careful identification of the potential consequence of nonaction, as well as probability and cost assessment. Given the uncertainty of assumptions, sensitivity analyses should be performed. A step-by-step methodology, formula for calculations, and best practice guidance is provided. Conclusions Cost-avoidance studies focused on pharmacist interventions should be considered low-level evidence. These studies are acceptable to provide pilot data for the planning of future clinical trials. The guidance provided in this article should be followed to improve the quality and validity of such investigations.

scholarly journals Cost-Effectiveness Analysis of the Daily HIV Pre-Exposure Prophylaxis in Men who Have Sex with Men in Barcelona

2021 ◽  
Author(s):  
Francesc López Seguí ◽  
Unai Oyon Lerga ◽  
Laura Laguna Marmol ◽  
Pep Coll ◽  
Angels Andreu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Time Horizon ◽  
Cost Savings ◽  
Health Indicators ◽  
Hiv Infections ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
Oral Prep

Introduction: Pre-Exposure Prophylaxis (PrEP) for HIV prevention has been implemented in several countries. Previous literature has shown that its cost-effectiveness (and, under some specifications, cost-saving character) is dependent on the reduction in price due to generics, the time-horizon and its effectiveness. The intervention has never been studied in Catalonia, a territory with extensive implementation. Methods: Economic evaluation of the implementation of HIV pre-exposition prophylaxis using administrative data from Men who have Sex with Men (MSM) who receive the treatment (at the generic price). A deterministic compartmental model and a social perspective with a micro-costing approach over the time horizon 2022-2062 are used. A baseline 86% effectiveness of PrEP is assumed. Results: Daily oral PrEP is found to be cost-saving: discounted savings in costs are attained after 16 years, and after 40 years they reach 81 million euros. In terms of health indicators, 10,322 additional discounted QALYs are generated by the intervention. Results are sensitive to sexual behavioral patterns among MSM, the price of PrEP (reduced if offered on-demand), its effectiveness and the discount rate. Conclusions: The use and promotion of PrEP in Catalonia is predicted to result in substantial health and monetary benefits because of reductions in HIV infections. Short-term investments in the promotion of PrEP will result in important cost-savings in the long term.

scholarly journals A Comparison of Three Ridesharing Cost Savings Allocation Schemes Based on the Number of Acceptable Shared Rides

Energies ◽  
2021 ◽  
Vol 14 (21) ◽  
pp. 6931
Author(s):  
Fu-Shiung Hsieh
Keyword(s):  
Air Pollution ◽  
Cost Saving ◽  
Comparative Study ◽  
Cost Savings ◽  
Research Community ◽  
Transportation Mode ◽  
Strong Incentive ◽  
Shared Mobility ◽  
Develop Theory ◽  
The Cost

Shared mobility based on cars refers to a transportation mode in which travelers/drivers share vehicles to reduce the cost of the journey, emissions, air pollution and parking demands. Cost savings provide a strong incentive for the shared mobility mode. As cost savings are due to cooperation of the stakeholders in shared mobility systems, they should be properly divided and allocated to relevant participants. Improper allocation of cost savings will lead to dissatisfaction of drivers/passengers and hinder acceptance of the shared mobility mode. In practice, several schemes based on proportional methods to allocate cost savings have been proposed in shared mobility systems. However, there is neither a guideline for selecting these proportional methods nor a comparative study on effectiveness of these proportional methods. Although shared mobility has attracted much attention in the research community, there is still a lack of study of the influence of cost saving allocation schemes on performance of shared mobility systems. Motivated by deficiencies of existing studies, this paper aims to compare three proportional cost savings allocation schemes by analyzing their performance in terms of the numbers of acceptable rides under different schemes. We focus on ridesharing based on cars in this study. The main contribution is to develop theory based on our analysis to characterize the performance under different schemes to provide a guideline for selecting these proportional methods. The theory developed is verified by conducting experiments based on real geographical data.

Service Patterns for Enterprise Information Systems

2005 ◽  
pp. 201-224 ◽  
Author(s):  
Constantinos Constantinides ◽  
George Roussos
Keyword(s):  
Information Systems ◽  
Software Engineering ◽  
Best Practice ◽  
Enterprise Systems ◽  
Enterprise Information ◽  
Enterprise Information Systems ◽  
Practice Guide ◽  
Service Patterns ◽  
Starting Point

This chapter introduces service patterns for SOA-based enterprise systems. The authors believe that the deployment of such patterns would be of considerable value both as a best-practice guide for practitioners as well as a starting point for further research in their role in software engineering. A comprehensive catalog of service patterns is included in this chapter. In the catalog, each pattern is discussed in the context of selected examples and in terms of a brief description of its role, functionality, and deployment. For each pattern there are recommendations on implementation and a practical usage scenario.

Hardwiring diagnostic stewardship using electronic ordering restrictions for gastrointestinal pathogen testing

2019 ◽  
Vol 40 (6) ◽  
pp. 668-673 ◽  
Author(s):  
Jasmine R. Marcelin ◽  
Charlotte Brewer ◽  
Micah Beachy ◽  
Elizabeth Lyden ◽  
Tammy Winterboer ◽  
...  
Keyword(s):  
Best Practice ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Poisson Model ◽  
Panel Testing ◽  
Period 2 ◽  
Gastrointestinal Pathogen ◽  
Pathogen Testing ◽  
The Impact

AbstractObjective:To evaluate the impact of a hard stop in the electronic health record (EHR) on inappropriate gastrointestinal pathogen panel testing (GIPP).Design:We used a quasi-experimental study to evaluate testing before and after the implementation of an EHR alert to stop inappropriate GIPP ordering.Setting:Midwest academic medical center.Participants:Hospitalized patients with diarrhea for which GIPP testing was ordered, between January 2016 through March 2017 (period 1) and April 2017 through June 2018 (period 2).Intervention:A hard stop in the EHR prevented clinicians from ordering a GIPP more than once per admission or in patients hospitalized for >72 hours.Results:During period 1, 1,587 GIPP tests were ordered over 212,212 patient days, at a rate of 7.48 per 1,000 patient days. In period 2, 1,165 GIPP tests were ordered over 222,343 patient days, at a rate of 5.24 per 1,000 patient days. The Poisson model estimated a 30% reduction in total GIPP ordering rates between the 2 periods (relative risk, 0.70; 95% confidence interval [CI], 0.63–0.78; P < .001). The rate of inappropriate tests ordered decreased from 21.5% to 4.9% between the 2 periods (P < .001). The total savings calculated factoring only GIPP orders that triggered the hard stop was ∼$67,000, with potential savings of $168,000 when factoring silent best-practice alert data.Conclusions:A simple hard stop alert in the EHR resulted in significant reduction of inappropriate GIPP testing, which was associated with significant cost savings. Clinicians can practice diagnostic stewardship by avoiding ordering this test more than once per admission or in patients hospitalized >72 hours.

scholarly journals A case of misalignment: the perspectives of local and national decision-makers on the implementation of psychological treatment by telephone in the Improving Access to Psychological Therapies Service

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kelly Rushton ◽  
Claire Fraser ◽  
Judith Gellatly ◽  
Helen Brooks ◽  
Peter Bower ◽  
...  
Keyword(s):  
Focus Group ◽  
Best Practice ◽  
Psychological Treatment ◽  
Cost Savings ◽  
Clinical Effectiveness ◽  
Service Level ◽  
Patient Choice ◽  
Decision Makers ◽  
Normalisation Process Theory ◽  
Access To Treatment

Abstract Background Psychological treatment delivered by telephone is recommended by the National Institute for Health and Care Excellence (NICE) for mild to moderate depression and anxiety, and forms a key part of the Improving Access to Psychological Therapy (IAPT) programme in the UK. Despite evidence of clinical effectiveness, patient engagement is often not maintained and psychological wellbeing practitioners (PWPs) report lacking confidence and training to deliver treatment by telephone. This study aimed to explore the perspectives of professional decision makers (both local and national) on the barriers and facilitators to the implementation of telephone treatment in IAPT. Methods Sixteen semi-structured qualitative telephone interviews and one focus group were carried out with decision makers (n = 21) who were involved locally and nationally in policy, practice and research. The interviews and focus group were coded thematically, and then mapped onto the four core constructs of Normalisation Process Theory (NPT). Results The use of telephone for psychological treatment was universally recognised amongst participants as beneficial for improving patient choice and access to treatment. However, at service level, motives for the implementation of telephone treatments are often misaligned with national objectives. Pressure to meet performance targets has become a key driver for the use of telephone treatment, with promises of increased efficiency and cost savings. These service-focussed objectives challenge the integration of telephone treatments, and PWP acceptance of telephone treatments as non-inferior to face-to-face. Ambivalence among a workforce often lacking the confidence to deliver telephone treatments leads to reluctance among PWPs to ‘sell’ treatments to a patient population who are not generally expecting treatment in this form. Conclusions Perceptions of a need to ‘sell’ telephone treatment in IAPT persist from top-level decision makers down to frontline practitioners, despite their conflicting motives for the use of telephone. The need for advocacy to highlight the clinical benefit of telephone treatment, along with adequate workforce support and guidance on best practice for implementation is critical to the ongoing success and sustainability of telephone treatment in primary care mental health programmes.

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