Global ETD Search

1	Focused Factory ¡V A Novel Business Strategy for Specialty Hospitals in Taiwan J. Tseng, Charles 21 July 2004 (has links) Abstract English Abstract From small hospitals to large medical centers, the Taiwan healthcare organizations today are unable to significantly increase investments or generate more revenue due to the strict regulations of current National Health Insurance and Global Budget policies. This predicament is further complicated by the healthcare system¡¦s inability to change from its traditional mass production architecture and mentality. Mass customization (MC) and focused factories (FF) are being applied across many industries with great success ¡V achieving quality at low cost. These are new concepts that can bring significant customer value, allowing organizations¡¦ quality and profitability to improve from increasingly commoditized businesses. This consumer-centric transformation can be one way for Taiwan¡¦s healthcare organizations to get closer to patients¡¦ needs and step out of the traditional confines of the NHI and healthcare delivery. These novel ideas are so akin to the healthcare ideal, yet the traditional healthcare design and Taiwan¡¦s anti-market healthcare policies effectively impedes changes and progress in this direction. This paper intends to assert that MC and FF can be one effective solution to the problems in Taiwan¡¦s healthcare organizations ¡V specifically for the specialty community hospitals. In this way, these small hospitals can capture the value premiums of this new consumerism trend and transform itself into a competitive business, creating higher values for life and health for its customers. This paper will begin with an in-depth background and SWOT analysis of the Taiwan healthcare system and its participants. After an understanding of this industry, a pertinent literature review of the MC and FF concepts and mechanics will be done. A case comparison study of three specialty healthcare organizations will be done to evaluate their differences in competitive strategy, marketing orientation, operational effectiveness, human resources advantage, and organizational performance. The three organizations include a traditional specialty hospital (Gee-Tien Ear Nose & Throat Hospital), a single procedure-based focus factory (Shouldice Hospital), and a disease management focus factory (MedCath Corporation). Finally, a full discussion will ensue to assess the applicability of FF and MC concepts for specialty community hospitals in the Taiwan healthcare market. Keywords: Specialty Hospitals, Mass Customization, Focused Factory, Taiwan Healthcare Mass Customization Specialty Hospitals Taiwan Healthcare Focused Factory
2	Estratégia de produção considerando diferentes empresas abastecidas por uma mesma unidade fabril: aplicação em um caso Rossatto, João Paulo 04 January 2013 (has links) Submitted by Maicon Juliano Schmidt (maicons) on 2015-05-29T14:55:05Z No. of bitstreams: 1 João Paulo Rossatto.pdf: 1432439 bytes, checksum: 00cb253b82b90555ca8d5a475917397a (MD5) / Made available in DSpace on 2015-05-29T14:55:05Z (GMT). No. of bitstreams: 1 João Paulo Rossatto.pdf: 1432439 bytes, checksum: 00cb253b82b90555ca8d5a475917397a (MD5) Previous issue date: 2012-01-31 / Nenhuma / A globalização crescente, combinada com avanços da tecnologia da informação e com novas formas de organização da produção e do trabalho, pode ser denominada como a “nova economia”. Assim, a busca por um posicionamento estratégico insere, no ambiente empresarial, um conjunto de complexidades do ponto de vista da formatação e implantação da estratégia de produção, fazendo com que as empresas tenham que decidir que vantagem competitiva necessita atingir. Empresas líderes em seus respectivos mercados necessitam construir estratégias de negócio e de produção que tenham capacidade de atender um ambiente competitivo, caracterizado pela fabricação de produtos cada vez mais personalizados, com os atributos desejados pelo mercado consumidor. Portanto, o sistema produtivo da Empresa foco deste trabalho caracteriza-se pela complexidade da gestão da produção, gerada pelas diversas linhas de produtos fabricados e pelas características mercadológicas das empresas atendidas por ela. A partir deste cenário, o trabalho propôs um método genérico, para a concepção da estratégia de produção, baseado no conceito de Fábrica Focalizada e que pode ser aplicado em empresas com características similares as da Empresa foco. Para fábricas menos complexas, focadas em um nicho particular de mercado, o conceito de Fábrica Focalizada poderá obter alto desempenho em comparação a uma planta convencional. No entanto, em fábricas mais complexas, que atendem diferentes nichos de mercado, que produzem diferentes produtos para outras empresas, percebe-se uma lacuna entre a estratégia de produção e a potencialidade de utilização do conceito de Fábrica Focalizada. Após a etapa de construção do método genérico, foi realizada a customização e a aplicação do método na Empresa foco, buscando avaliar a sua aplicabilidade em um ambiente empresarial. O método de pesquisa utilizado é o Design Researche a Empresa foco utilizada para a pesquisa e implantação do método proposto é integrante do setor moveleiro e está localizada na cidade de Bento Gonçalves (RS). Posteriormente, foi elaborada uma análise crítica da aplicação do caso, buscando avaliar o método proposto, a metodologia utilizada, os resultados obtidos com sua aplicação e oportunidades de melhoria visualizadas. Desta forma, a proposta desta pesquisa foi analisar de que forma a adoção do conceito de Fábrica Focalizada contribui para definição da estratégia de produção da Empresa foco que é caracterizada pela fabricação de diferentes linhas de produtos, para diferentes empresas em uma mesma unidade fabril. Além disso, a dissertação alerta para a necessidade de se aprofundar a análise acerca das questões associadas à estratégia de produção em empresas com sistemas de gestão de produção complexos. / Increasing globalization, combined with advances in information technology and new ways of organizing production and work, can be termed as the "new economy." Thus, the search for a strategic positioning inserts in the business environment a set of complexities in terms of formatting and layout of the production strategy, many companies have to decide what competitive advantages they need to achieve. Business leaders in their respective markets need to build business strategies and production that have the capacity to meet a competitive environment, characterized by the manufacture of increasingly personalized products, with the attributes desired by the consumer market. Therefore, the production system of the Company focus of this work is characterized by the complexity of the management of production, generated by various product lines manufactured by the characteristics of marketing of companies served by it. From this scenario, the paper proposed a generic method for designing the production strategy based on the concept of Focused Factory and can be applied to companies with similar characteristics to focus Company. For less complex factories, focused on a particular niche market, the concept of Focused Factory can get high performance compared to a conventional plant. However, for more complex factories which serve different market niches, which produce different products for other companies, there is a perceived gap between the manufacturing strategy and the potential use of the concept of Focused Factory. After the construction phase of the generic method, we performed the customization and implementation of the method in evaluating the Company seeking to focus its applicability in a business environment. The research method used is the Design Research and the Company in focus used for the search and implementation of the proposed method is part of the furniture sector and is located in the city of Bento Gonçalves (RS). Subsequently, we present a critical analysis of the application of the case, seeking to evaluate the proposed method, the methodology used, the results obtained with its implementation and improvement opportunities visualized. Thus, the purpose of this research was to examine how the adoption of the concept of Focused Factory contributes to defining the strategy of the Company production focus that is characterized by the production of different product lines for different companies in the same plant. Furthermore, the thesis also highlights the need to deepen the analysis of issues relating to the production strategy in business management systems with complex production. Estratégia de produção Fábrica Focalizada (FF) Método Production strategy Focused Factory (FF) Method
3	Gestão estratégica da produção: proposta de um método que recomenda técnicas de produção para alavancar as diferentes dimensões competitivas Kreling, Rafael 31 March 2016 (has links) Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2016-07-18T18:26:58Z No. of bitstreams: 1 Rafael Kreling_.pdf: 3132334 bytes, checksum: c0e4ea129a81ca3c0ede5f40c054bc30 (MD5) / Made available in DSpace on 2016-07-18T18:26:58Z (GMT). No. of bitstreams: 1 Rafael Kreling_.pdf: 3132334 bytes, checksum: c0e4ea129a81ca3c0ede5f40c054bc30 (MD5) Previous issue date: 2016-03-31 / Nenhuma / A literatura de Estratégia de Produção, que aborda desde o conceito de Unidades Estratégicas de Negócio (UEN), passando pelas diferentes Dimensões da Competição, evoluindo também para o conceito de Fábrica Focada de Skinner e culminando na definição das diferentes técnicas e práticas de produção que alavancam cada uma das Dimensões Competitivas, é ampla. Porém, quando o objetivo é determinar quais técnicas priorizar diante de um rol grande de opções, este tema já é mais restrito. A lacuna que existe pode ser resumida na seguinte pergunta: diante de uma situação real específica, haveria um método que auxiliasse na escolha da(s) técnica(s) mais adequada(s) a se adotar? Essa pesquisa propõe-se a preencher esta lacuna, sugerindo um método que direcione a tomada de decisão do usuário na definição das técnicas de produção mais adequadas a serem adotadas em sua realidade industrial específica. A pesquisa se concentrou no estudo literário individual das técnicas de produção que eram comuns aos autores que as estudaram, destacando as contribuições de Antunes Júnior (2013), Pacheco (2012) e Ghinato (2000). O método proposto teve a crítica de cinco especialistas acadêmicos/profissionais do tema, tendo posteriormente a aplicação junto a um gestor industrial de uma empresa. O método de pesquisa adotado foi o Design Research. O método final proposto, que auxilia na seleção das técnicas de produção mais alinhadas à realidade de aplicação, procurou avançar mais um passo no desdobramento da Estratégia de Produção, apoiando gestores industriais na adoção de técnicas e práticas, segundo suas principais demandas e condições específicas vividas. Esta customização de um pacote genérico de opções de técnicas e práticas para a realidade específica se demonstrou adequada na aplicação do método. Para trabalhos futuros, se recomenda a pesquisa de técnicas para os tipos de sistemas produtivos distintos aos direcionados desta pesquisa, assim como outras abordagens, às quais as técnicas pertencem, sejam incorporadas. / The manufacturing strategy literature is very wide and approaches concepts such as Strategic Business Units (SBU) and Competitive Dimensions, evolves towards the concept of Focused Factory by Skinner and culminates in the definition of different techniques, systems and tools that leverage each Competitive Dimension. However, the literature is much more restricted when it comes to determining which particular manufacturing technique should be adopted among different possibilities. Its gap can be summarized in the following question: in a given real situation, is there a method that could help choose the most appropriate technique(s) to adopt? This work aims at filling this gap by proposing a method which directs decision-making when one needs to define the most appropriate production technique(s) to be adopted within a specific industrial reality. The research focused on the individual literature review of the production techniques that were common to the authors that studied them, especially the contributions from Antunes Júnior (2013), Pacheco (2012) and Ghinato (2000). The proposed method underwent the critical analysis from five academic/professional specialists, followed by an experimental application carried out by an industrial manager. The research method adopted is called Design Research. The final method proposed assists its user to select the production techniques that are best aligned with a given application reality. It seeks to go one step further in unfolding Production Strategy by supporting industrial managers to adopt techniques and practices that meet their main demands and specific conditions experienced in their daily routines. This customization of a generic package of techniques and practices for the specific reality has proven to be suitable in the method application. For future studies, it is recommended research on techniques for different types of production systems not covered in this research, as well as other approaches, which the techniques belong to, should be incorporated. Estratégia de produção Unidades estratégicas de negócio Dimensões competitivas Fábrica focada Técnicas de produção Manufacturing strategy Strategic business units Competitive dimensions Focused factory Production techniques
4	Fokusering av produktionslayouten på ett litet företag : En fallstudie på Svenska Maskinskyltfabriken / Focusing the production layout at a small company : A case study at Svenska Maskinskyltfabriken Bahadori, Kazem, Almroth Berg, Gustav January 2020 (has links) Detta examensarbete har haft till syfte att finna åtgärder för att genom ett mer logiskt stringent flöde kunna fokusera produktionen i ett mindre företag, Svenska maskinskyltfabriken (SMF-skylt). Då flödet genom fabriken ändrats under åren, med nya maskiner och produkter har ett behov av att se över och anpassa det till dagens förhållanden uppstått. Detta dels för att effektivisera flödet i sig, dels för att se hur det påverkar diverse konkurrensmedel som företaget idag kämpar med att höja. Då mindre företag ofta dras med små resurser avsatta till att göra förändringar i verksamheten har det varit viktigt att i detta arbete sätta upp en åtgärdsplan som öppnar upp för succesiva förbättringar, vilka kan implementeras i tur och ordning utan att produktionen behöver stå stilla en längre tid. Enligt befintlig teori kommer en fokuserad produktion med kortare transportsträcka och ökad flödeseffektivitet bidra till såväl bättre leveransprecision som kvalité. För att uppnå önskat resultat har diverse verktyg och metoder använts under projektets gång, exempelvis ”Learning to see”-map, korrelationsmatris, ABC-analys och spagettidiagram. Genom dessa har antalet flöden mellan olika maskiner systematiskt kunnat kartläggas och kortas med ett fokus på de mest frekvent förekommande. Störst bidrag i analyserna av resultatet har kunskapen om Lean, produktionssystem och hållbarhet gett, då dessa begrepp är vitala för arbetets syfte. Arbetet har förts framåt genom analys av denna bakomliggande vetenskapliga teori på området Operations Management, dock som anpassats till det verkliga fallet SMF-skylt. Utifrån detta har såväl dagsläge som ett antal framtida scenarion kunnat analyseras med likadana verktyg vilket gett en adekvat jämförelse dem emellan. Alla förändringar i företagets produktionslayout visualiseras i rapporten med pedagogiska kartor, oavsett om ändringen är en ny dörr eller en omflyttning av maskiner. Resultatet är de nya layouterna och kan jämföras med dagsläget i konkreta tal genom en jämförelse av den totala tillryggalagda sträckan för produkterna genom fabrikslokalen. Genom projektets åtgärder kan transportsträckorna sänkas med 21% mot dagsläget. Stor vikt bör läggas vid det förbättrade flödet som genom tydligare mönster hjälper företaget att komma till rätta med sitt produktionssystem och samtidigt ta ett steg mot Lean produktion. / This thesis aims to find some arrangements to achieve a more logical flow throughout the production area of a small company, Svenska Maskinskyltfabriken (SMF-skylt). The flow through the factory has changed during the past years with new products in the assortment and other equipment available. Therefore, a need to develop the layout to adjust it to the current flow has arisen. This is partly to make the flow itself more efficient, but also to improve the manufacturing outputs which they are struggling with today. Since the case company is in an unstable economic situation and not able to imperil the revenue, the recommended changes must be divided into smaller steps, each economically affordable and building on the previous one. With a successive order, it will lower the barriers to commence the development process and eliminate long term stops in the manufacturing. According to existing theory, a focused factory with shorter transports and improved flow efficiency will benefit the manufacturing outputs, delivery precision and quality. To achieve the desired results several tools and methods have been used, for example “Learning to see”-map, correlation matrix, ABC-analysis and spagettidiagram. Using these tools, the number of transports between different stations have been mapped and shortened with focus on the most frequent ones. To analyze the results knowledge about lean production, production systems and sustainability have been vital. The work has been carried forward by scientific theories within this field, Operations Management. Although some of the theories used in this project have been adapted to the specific case, they form the scientific basis of the work. This scientific basis is then used to analyze both current state at SMFskylt, future suggested scenarios and the comparison between current state and future scenarios. All changes in the company’s layout is visualized in the report with clear maps, either if the change means a new door or another placement of the equipment. The result of these improvements is presented as numeric values in terms of reduced transport distance through the production area. By implementing these changes, the distance has been shortened by 21%, compared to today´s situation. Great emphasis should be put upon the improved flow which, through clearer patterns, helps the company to rectify its production system and at the same time take a step towards Lean production. Production layout flow efficiency internal transport focused factory Production economics lean Produktionslayout flödeseffektivitet interntransport fokusera fabrik konkurrensmedel LEAN transportminimering Produktiosekonomi Business Administration Företagsekonomi
5	Aplicação de modelos de redes de filas abertas no projeto e planejamento de sistemas discretos de manufatura. / Application of open queueing network models for the design and planning of discrete manufacturing systems. Silva, Claudio Rogerio Negri da 29 April 2005 (has links) Made available in DSpace on 2016-06-02T19:50:27Z (GMT). No. of bitstreams: 1 TeseCRNS.pdf: 1772351 bytes, checksum: 17b2dc82dae0e985204bfa2fd68f873b (MD5) Previous issue date: 2005-04-29 / Universidade Federal de Minas Gerais / The management of manufacturing systems have become more complex, once that new products are arising, product demands are uncertain, life cycles get shorter, and a wide variety of products compete for common resources. This thesis deals with the design and planning of discrete manufacturing systems, based on open queueing network models to support the decision making of capacity allocation. As manufacturing systems may be represented by generalized queueing networks, and there are no exact solution methods, here is employed the decomposition approximate method to evaluate the performance of systems under different configurations. It is shown in the thesis how these approximations are suitable and effective to estimate the work-in-process (WIP) and the production leadtime of an actual metallurgical industry queueing network. It is also shown that discrete capacity allocation models, based on the approximations, are effective to evaluate and optimize the performance of the case study under different configurations. Trade-off curves between capacity investment and WIP are generated and are useful not only to support a manager to estimate how much capacity he/she should allocate, but also to decide where it should be allocated in the queueing network. These curves also support the decision making in terms of capacity, if the variability of the external arrivals, the product mix and/or the throughput for the network change. Besides adding capacity, partitioning the facility is another alternative to reduce the system complexity. This thesis also approaches the focused factory design problem, involving the partition of the facility into smaller shops and the capacity allocation in each shop. Again, the decomposition approximations were employed to evaluate the system performance. Despite its importance, this problem has rarely been reported in the literature. In this thesis, the goal is to reduce the system complexity either from the product management point of view or from the workstation management point of view. From the product management point of view, a model whose complexity constraint is na upper limit on the production leadtime variance of the products passing through the network was studied. From the workstation management point of view, the complexity constraint of the model keeps constant the expected waiting time of a product at a workstation, once it waits for being served. It is shown through these models for some instances that the partition of the facility into smaller shops decreases the complexity system without necessary capacity additional investments. Futhermore, sometimes it is possible to keep the network performance (or even to improve it), partitioning the network into smaller shops which need less capacity than the original configuration with a single shop. / A gestão de sistemas de manufatura tem se tornado mais complexa na medida em que novos produtos estão surgindo, a demanda de produtos é incerta, os ciclos de vida são mais curtos e uma grande variedade de produtos competem pelos mesmos recursos. Esta tese trata o projeto e planejamento de sistemas discretos de manufatura, baseados em modelos de redes de filas abertas, para auxiliar no processo de tomada de decisões. Porque sistemas de manufatura podem ser representados por redes de filas genéricas, e não existem métodos exatos de solução, aqui é empregado o método aproximado de decomposição para avaliar o desempenho dos sistemas em diferentes configurações. Mostra-se nesta tese que estas aproximações são adequadas e efetivas para estimar os estoques em processo (WIP) e o leadtime de produção de uma rede de manufatura real de uma indústria metal-mecânica. Mostra-se ainda que os modelos de alocação de capacidade discreta, baseados nestas aproximações, também são efetivos para avaliar e otimizar o desempenho da rede do estudo de caso em diferentes configurações. Curvas de trade-off entre investimento em capacidade e WIP são geradas e são úteis não somente para auxiliar um gerente a estimar quanto alocar de capacidade, mas também para decidir onde alocá-la na rede de filas. As curvas também auxiliam a tomada de decisões em termos de capacidade, se a variabilidade das chegadas externas, o mix de produtos e/ou a taxa de produção da rede mudam. Além de adicionar capacidade, a partição da instalação é outra alternativa para reduzir a complexidade do sistema. Esta tese também aborda o problema de projeto de fábrica focalizada, envolvendo a partição da instalação em subplantas e a alocação de capacidade em cada estação das subplantas. Novamente, as aproximações por decomposição foram utilizadas para avaliar e otimizar o desempenho do sistema. Apesar de sua importância, este problema tem sido muito pouco reportado em literatura. Nesta tese, o objetivo é reduzir a complexidade do sistema do ponto de vista da gestão do produto, ou do ponto de vista da gestão da estação. Do ponto de vista da gestão do produto, é apresentado um modelo cuja restrição de complexidade é um limitante superior para a variância do leadtime dos produtos na rede. Do ponto de vista da gestão da estação, a restrição de complexidade do modelo fixa o tempo médio de espera de um produto na estação, quando há espera. Mostra-se, por meio destes modelos para alguns casos que, a partição da instalação em subplantas reduz a complexidade do sistema, sem necessidade de investimentos adicionais em capacidade. Além disso, algumas vezes, é possível manter (ou até melhorar) o desempenho da rede, particionando-a em subplantas que necessitam de menos capacidade do que a configuração original com uma planta única. Pesquisa operacional Fábrica focalizada Rede de filas aberta Modelos de otimização Projeto de sistema de manufatura Focused Factory Manufacturing System Design Performance Evaluation Models Open Queueing Network Optimization Models Trade-off Curves ENGENHARIAS::ENGENHARIA DE PRODUCAO
6	Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital Lucas, D. Pulane 24 April 2013 (has links) Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs. Disruptive Disruptive Innovation Theory Disruptive Transformations Disruptive Innovation Innovation Technology Technological Innovation Medical Innovation Medical Technology Medical Advancement Laparoscopy Laparoscopic Surgery open surgery appendectomy cholecystectomy bariatric surgery weight loss surgery appendectomies cholecystectomies inpatient outpatient ambulatory ambulatory surgery ambulatory surgery center acute care general hospital hospital acute care hospital general hospital health care healthcare hospital industry health care industry Clayton Christensen Clayton M Christensen Michael Porter Harvard Business School Virginia Commonwealth University CMS Health policy public policy public administration organizational theory organization theory Population Ecology Theory Competitive Strategy policy analysis John Kimberly Organization Size Structural Inertia liability of smallness health spending health care cost specialty medical facility open system niche width dynamic outpatient department technology shift surgical setting surgical setting shift medical facility shift substitution threat health system system level analysis Ecological Approach hospital trends ambulatory surgery trends reimbursement rate Medicare CMS coverage decision P J DiMaggio DiMaggio and Powell w w Powell Hannan and Freeman M T Hannan Organizational change minimally invasive surgery less invasive surgery Prospective Payment System Outpatient Prospective Payment System entreprenuerial physician health care organization health care management Roice Luke Carl Ameringer new technology surgical utilization elective surgery Medicare Payment Advisory Commission MedPAC coverage decision trends in surgery abdominal surgery surgical variation physician-owned physician ownership physician autonomy outpatient clinic utilization trends unnecessary surgery Pfeffer Salancik technology diffusion redefining health care interdisciplinary research health care delivery panel design diffusion of hospital technology state variation regional variation local health care market government intervention medical facility health care capacity focused factory advances in health care physician organization relationship hospital competition medical specialization hospital expansion medical arms race integrated care integrated health system J E Wennberg health care transformation reimbursement scheme surgical volume Florida Wisconsin policy making health policy analysis competitive dynamics center of excellence intervening factor service line competition service-line competition surgical reimbursement innovative business model innovative technology environmental influence established firm new market entrant patient safety sophisticated technology Harvard Divinity School Social and Behavioral Sciences

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