Health care is increasingly being provided by collaborative teams that involve multiple health care providers at multiple locations. To date, most of that collaboration is on an ad-hoc basis via phone calls, faxes, and paper based documentation. However, Internet and wireless technologies provide an opportunity to improve this situation via electronic data sharing. These new technologies make possible new ways of working and collaboration but it can be difficult for health care organizations to understand how to adopt new technologies while still ensuring that their policies and objectives are being met. It is also important to have a systematic approach to validate that e-health processes deliver the performance improvements that are expected. Using a case study of a palliative care patient receiving home care from a team of collaborating healthcare providers and organizations, we introduce a framework for assessing health care information systems based on requirements engineering. Key concerns and objectives were identified and modeled. Business processes which will use the new health care information system are modeled in terms of these concerns and objectives to assess their impact and ensure that electronic data sharing is well regulated and effective. The work in the thesis is design-oriented research to show the utility of our proposed requirement engineering framework compared to existing evaluation approaches for healthcare IT. The approach is evaluated based on a set of criteria drawn from our literature review and a gap analysis of our case study for palliative care.

Supply chains for time-sensitive products, and, in particular, for perishable products, pose specific and unique challenges. By definition, a perishable product has a limited lifetime during which it can be used, after which it should be discarded (Federgruen, Prastacos, and Zipkin (1986)). In this dissertation, I contribute to the analysis, design, and management of supply chain networks for perishable products with applications to healthcare. Specifically, I construct generalized network frameworks to capture perishable product supply chains in healthcare operating under either centralized or decentralized decision-making behavior. The dissertation is motivated by applications ranging from blood supply chains to pharmaceuticals, such as vaccines and medicines. The novelty of the modeling and computational framework includes the use of arc multipliers to capture the perishability of the healthcare product(s), along with waste management costs, and risk. The first part of the dissertation consists of a literature review of perishable product supply chains with a focus on healthcare along with an overview of the relevant methodologies. The second part of the dissertation formulates supply chains in healthcare operating under centralized decision-making behavior. In this part, I focus on both the operations management of and the sustainable design of blood supply chains and construct models for regionalized blood banking systems as belonging to the Red Cross. The third part of the dissertation considers competitive behavior, with a focus on the pharmaceutical industry. I construct an oligopoly supply chain network model, with differentiated brands to capture the competition among producers of substitutable drugs using game theory and variational inequality theory. Furthermore, using a case study based on real-world scenarios of a highly popular cholesterol-reducing branded drug, the impact of patent rights expiration of that brand is explored which coincides the time when its equivalent generic emerges into the markets. The calculated results are then compared to the observations from the real-word problem. Finally, the projected dynamical system formulation of the pharmaceutical network oligopoly model is derived. This dissertation is based on the following papers: Nagurney, Masoumi, and Yu (2012), Nagurney and Masoumi (2012), and Masoumi, Yu, and Nagurney (2012) as well as additional results and conclusions.

Recent marketplace realities and trends have forced health care institutions to adopt strategic orientations that stress a customer focus. Central to such strategic orientations is the effective utilization of service quality practices and philosophies. Toward that end, this research offers health care institutions an affordable methodology. A real-life application of the rapid assessment methodology (RAM) in a health care operational setting is presented. Finally, a framework to guide the implementation of the RAM methodology is outlined and explored.

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In this dissertation I explore the cultures of death and dying in medical institutions, hospices and funeral work. I argue that not only are there competing cultures of death and dying in American society, but within these institutions that produce tension and conflict, sometimes among the workers, other times between the workers and those they serve, and other times between the institution and outside organizations. Medical institutions, by medicalizing death and dying, constructed a “death as enemy” orientation in which doctors fight death with the use of medical technology, practice detached concern from their patients, and marginalize religion and spirituality. On the other hand, a “suffering as enemy” orientation has also emerged, primarily in the form of palliative medicine, in which needless suffering is considered worse than death, therefore life-saving technology is removed, doctors empathize with patients and families, and spirituality is incorporated. Hospice started as a social movement to change how dying patients were treated at the end of life, addressing patients' physical, spiritual and emotional pain. However, the bureaucratization of hospice, particularly the Medicare Hospice Benefit, has led to a compromise of the social movement's ideals and these competing orientations shape how hospice workers, particularly nurses and social workers, express frustrations with their work. Funeral directors assert their jurisdictional claims of the right to handle the corpse and assuage the grief of the bereaved, through embalming, informal grief counseling and the funeral performance, but funeral directors encounter resistance from large funeral corporations and the funeral societies. Large corporations centralize embalming, turning the corpse from a craft to a product, recruit other professionals to practice grief counseling, and sell standardized funeral packages. Funeral societies challenge the necessity of embalming and funeral directors' expertise in grief counseling, and focusing on the value of simple, dignified and affordable funerals. I conclude this dissertation by showing how orientations toward death and dying vary in American society and these institutions because of tension between experts who espouse a particular orientation and challenges from within and outside these institutions.

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