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11	醫療產業中跨組織合作關係類型與管理機制之研究彭朱如 Unknown Date (has links) 有關策略管理領域中，合作策略已漸成為競爭策略的另一選擇，同時在資源統治結構方面，介於市場結構與層級結構間的跨組織合作關係，為近年來組織理論中的重要研究議題。本研究主要探討跨組織合作關係類型及所採用的管理機制，並選定以醫療產業進行研究，限定以醫院評鑑合格之不涉及股權的跨組織合作關係，採實證方式來驗證理論觀點。解釋跨組織合作關係之理論觀點，最常見者有資源依賴理論及交易成本理論，而此理論皆從經濟觀點出發，由於本研究所探討之醫療產業，其跨組織合作關係中多數係非以經濟觀點為考量，因此本研究補充社會交換理論加以闡述，期能從合作關係中投入與產出之明確性來區分經濟交換關係及社會交換關係。另因過去對於國內醫院間互動之相關研究指出，從醫院等級來看，發現醫院間的互動多為不同級之單向支援關係，同級醫院之合作很少，因此本研究捨棄醫院層級性角度，另外從每個合作關係之權力及互惠等實質面來觀察合作關係之對等性。另外對於跨組織合作關係之管理，一般多沿用組織內的管理控制方式。而文獻指出組織間的管理機制包括市場機制、科層機制及關係機制，此三種機制係採結合方式加以應用。本研究依文獻探討建立初步的研究架構，再經由個案實務分析加以修正，將跨組織合作關係依投入可明確衡量程度、產出可明確衡量程度及合作關係對等性三構面分成八類。另提出四種管理機制組合方式，包括：1.結合市場機制與科層機制。2.結合關係機制與科層機制。3.結合市場機制、關係機制與科層機制。4.單採用關係機制。本研究採問卷調查方式，針對八十六年度評鑑合格醫院之不涉及股權合作關係進行研究，採分層抽樣，其中醫學中心（10家）及區域醫院（38）全部抽樣，地區醫院（166家）抽樣30家，問卷寄發單位以醫院之科別部門為單位，共計回收有效樣本155筆。另外分別從理論推導及個案觀察提出六個研究假設，其中假設一至假設五為原理層次，主要從理論推導而得，採用多變量變異數分析法加以檢定，結果顯示假設一至假設五皆獲得支持；假設六為應用層次，又包括八個子假設，主要從個案實務觀察再配合理論推論而得。採用樣本比例分析法檢定，結果顯示八個子假設中，有三個得到支持，其他五個則未獲支持。依實證調查發現結果，對於跨組織合作關係類型及管理機制之關係，提出下列結論： 1.當跨組織合作關係的投入可衡量程度愈明確時，對於選擇市場機制的傾向大於選擇關係機制。 2.當跨組織合作關係的產出可衡量程度愈明確時，對於選擇市場機制的傾向大於選擇科層機制。而對於選擇市場機制的傾向亦大於選擇關係機制。 3.當跨組織合作為不對等關係時，對於選擇關係機制的傾向大於選擇市場機制。而對於選擇關係機制的傾向亦大於選擇科層機制。 4.當跨組織合作關係之投入與產出皆可明確衡量，且為不對等合作關係時，會傾向同時結合併用市場機制、科層機制與關係機制來管理。 5.當跨組織合作關係之投入不可明確衡量而產出可明確衡量，且為不對等合作關係時，會傾向同時結合併用市場機制、科層機制與關係機制來管理。 6.當跨組織合作關係之投入與產出皆不可明確衡量，且為不對等合作關係時，傾向單採用關係機制來管理。跨組織關係合作策略管理機制醫療產業 interorganizational relationship cooperative strategies management mechanisms health care industry
12	An Exploratory Study of Indian Medical Device Clinical Trials : Landscaping and Assessment of Challenges Rekha, G Naga January 2016 (has links) (PDF) The present day world has been experiencing rapid technological advancement on the one hand and increasing number of diseases afflicting the human beings on the other. To deal with the later, medical devices are innovated and introduced in to the market (making use of the technological advancements), on a continuous basis across the world. However, taking an innovated medical device to the market poses innumerable challenges and therefore, these have to be clinically trialled before its launch to ensure safety and efficacy. Of late, India has emerged as one of the preferred destinations to carry out clinical studies due to numerous advantages, primarily its diverse human gene pool and cost-competitiveness. However, there is very little understanding on the landscape of medical devices clinically trialled in India. It is to throw light on this critical issue with respect to the selection of participants in the clinical trial process, selection of locations and determination of trial duration that the present study has been carried out. In addition, the role of patents associated with the introduction of new medical devices in relation to the key challenges is examined. Furthermore, we studied the characteristics of clinical trials by industry and non-industry sponsors and between cardiovascular and other disease related trials. The present study has been carried out based on secondary data covering 108 medical device clinical trial registrations accessed from Clinical Trial Registry of India (CTRI) database pertaining to the period 2008-2014. At the outset, the pattern of trials related to the most prominent diseases such as cardiology and cardiovascular diseases and those which are invasive and non-invasive are examined. Our findings indicate that almost 50% of the trials are related to diseases of cardiology, cardiovascular diseases and those which are invasive in nature. For studying the patenting aspect, we proposed a conceptual grouping of sponsors as Incumbent, Potential Entrant and Supporter, based on their patent holdings in the domestic market and in PCT (Patent Cooperation Treaty) filings. Patents owned by Primary Sponsor (PS) showed significant variations in their clinical trial characteristics particularly the invasiveness of device, disease type, locations and participants. Three quantitative models are developed to identify the factors that influence the selection of number of participants, locations and time taken to execute medical device clinical trials using multivariate statistical techniques. The results of the three conceptual models on number of participants, locations and trial duration showed invasiveness of device and disease type playing significant roles in all the three models. The number of PCTs owned by PS was found to be influential in selecting the number of locations and participants but not the patents owned in IPO (Indian Patent Office). We also observed significant differences between industry and non-industry sponsors in terms of their clinical trial characteristics. The findings of the study formed the basis to understand the medical device clinical trial landscape and other pertinent issues in the Indian context, which enabled us to derive appropriate inferences and policy implications. Indian Health Care Industry Medical Device Patenting Medical Device Clinical Trail -India Indian Medical Devices Industry Medical Device Clinical Trials Medical Device Clinical Trial Landscape Management
13	A utilização da tecnologia da informação e a criação de valor nas estratégias de negócios na indústria da saúde. / The use of information technology and the value creation in the business strategies in the health care sector. Macir Bernardo de Oliveira 03 January 2008 (has links) O objetivo deste trabalho é analisar situações em que a tecnologia da informação (TI) contribui para o desenvolvimento de estratégias de negócios, envolvendo interrelação e cooperação entre empresas no setor da saúde. O estudo baseia-se na análise das operações de serviços em uma rede de valor (grupo determinado de empresas) no setor da saúde. Esta análise é realizada por meio de técnicas estratégicas, buscando compreender como e por que a tecnologia da informação pode ser utilizada como um fator diferenciador e decisivo na escolha de estratégias de negócios. As estratégias de negócios obtêm vantagem competitiva na medida em que criam valor, aumentando a eficiência e/ou eficácia das empresas. Este valor pode ser mais bem percebido e até aferido ao se analisar as interações em uma rede de valor em que a empresa está inserida. O levantamento de dados deste trabalho tem respaldo no método exploratório cuja função, entre outras, é obter informações sobre possibilidades práticas de realização de pesquisas em situações de vida real. Utilizam-se, ainda, de levantamento bibliográfico, pesquisas de documentos e dados em geral, tendo como fonte principal um estudo de caso múltiplo, englobando empresas de uma rede de valor no setor da saúde. Os resultados da pesquisa demonstram que o uso da TI permite ampliar os pontos fortes da empresa, além de suas oportunidades no ambiente externo e propicia também formas alternativas de atuação das empresas no mercado, gerando possibilidades para o desenvolvimento de novas estratégias ou modelos de negócios. / The purpose of this study is the analysis of cases where information technology (IT) helps the development of business strategies. It involves the inter-relation and cooperation among companies in the health care sector. This study is based on the analysis of service operations in the health care sector (a particular group of companies) by means of strategic techniques. It addresses the reasons why information technology may be used as a decisive differentiating factor in the selection of business strategies. Business strategies result in competitive advantages as they create value and thus increase business efficiency and/or effectiveness. Such value may be perceived and measured when the chain of values, the value system, the supply chain, and most of all, the network of values where the company is encased, are analyzed. Data collection for this study is supported by the exploratory method whose function,among others, is getting information about the practical possibilities of carrying out researches in real life conditions. This study also makes use of bibliographic research, documents research and generic data. The main source of data is a multi-case study encompassing health care enterprises. Data obtained in this research show that IT application may amplify the company strong points as well as its business opportunities in the market. It also opens up alternative forms of market actuation and raises new possibilities for the development of new strategies and business models. Criação de valor Estratégias de negócios Indústria da saúde Operações de serviços Tecnologia da informação Business strategy Creation of value Health care industry Information technology Service operations
14	Snakes and ladders: human resources in nursing McIntosh, Bryan, Watt, S. January 2012 (has links) McIntosh and Watt focus on a recent research that many female registered nurses who return from a career break at a lower grade relative to their experience and training. They note that the reintegration of the most highly trained and experience registered nurses will not only reduce the need and cost of training but will critically enhance the quality of delivery. The NHS must make greater use of these highly skilled and experienced registered nurses, not just for sound economic reasons but for improved health outcomes as well. Patients and clients all deserve the most skilled, experienced and able registered nurses, regardless of their life circumstances.; Many female registered nurses return from a career break at a lower grade relative to their experience and training, which has a detrimental implication for the National Health Service in terms of operational efficiency. It is imperative that human resources are used to the maximum benefit of the nursing service. Adapted from the source document. Staff Development - methods Human resources Professional training Nursing Health care industry Career breaks Training Nurses
15	跨國企業在台灣實行企業社會責任之探討--以醫藥產業為例 / Exploring the CSR practices of Leading MNCs' subsidiaries in Taiwan -- Insights from pharmaceutical industry 鍾宜玲, Chung, Yi Ling Unknown Date (has links) 在「全球化」的浪潮席捲之下，讓跨國企業的「企業社會責任」議題，成為當今企業管理不容忽視的焦點。醫藥產業在全球經濟體中扮演的角色，是研發和生產創新的產品，來拯救人類的生命和促進健康。而身為一個企業組織，也同時擔負有創造利潤的責任。然而大眾卻經常質疑這些企業過度哄抬產品價格，並認為人人都有權利無限制的獲得醫藥資源。醫藥企業必須面對強大的壓力以及高度複雜的利害關係人，特別是跨國公司，負擔更是沉重。就如同其他產業一樣，「企業社會責任」的議題對醫藥企業能否具有競爭力和永續經營而言，也愈來愈重要。近年來，許多的研究指出「企業社會責任」的策略和競爭優勢有關，而且必須整合至企業的核心事業，才能確保永續的成功。許多跨國藥廠他們的營業績效表現亮眼，而且在台灣已經耕耘超過十年了，因此，本研究首度嚐試去檢視在台的領先跨國醫藥企業，他們的CSR動機、決策過程和CSR作為表現，以及其經理人對CSR的管理思維。本研究的目的是希望能學習跨國領先藥廠在台灣的經驗，並鼓勵「策略型CSR」的作為以及企業與社會的「共享價值」。我們使用「多重個案分析法」，利用問卷、次級資料的分析和深入訪談來研究十家個案公司。所有的受訪經理人都表示他們是依據企業總部的指導綱領，而自行決定在台灣執行的CSR的活動。研究結果發現，絕大多數的個案公司，因為在台灣只是一個業務功能的角色，資源和能力都有限，所以多關注在客戶關係的議題上，並多半執行「回應式CSR」而非「策略型CSR」。此外，我們也發現其CSR策略和企業的屬性、社會責任觀點及領導有關。這些經理人並承認他們沒有系統性的方法來評估CSR表現和影響。他們主要追求的是企業的聲譽，而面對的最大挑戰是，如何透過CSR來發展企業競爭優勢。本研究並舉出幾個成功案例，鼓勵策略型思考以及將社會觀點融入商業策略的核心架構中。 / Under the sweep of globalization, the corporate social responsibility (CSR) of multinational corporations (MNCs) has now become a focus that cannot be ignored in business management. The health care industry’s role in the global economy is to research, develop and manufacture innovative products to save people’s lives and improve health. At the same time, as corporations, they have a duty to increase profits. However, the industry is often challenged for its overcharge of the products and there should be unlimited access to medicines. The health care companies face a great pressure and a highly complex stakeholder universe especially for multinational companies. As in many industries, corporate social responsibility becomes increasingly critical to competitive success and sustainability of multinational health care companies. Recent studies point out that CSR strategies are associated with competitive advantages and should integrate CSR into the core business to lead to sustainable success. Many Multinational pharmaceutical companies are doing very good business and have been operating in Taiwan for over 10 years. Therefore, we attempt to gain a better understanding of the factors that influence the CSR involvement of MNCs’ subsidiaries and the aspects of their strategies as well as the managerial insight of the managers dealing with CSR from leading health care companies. The aim of this study is to encourage strategic CSR and shared value of business and society and to learn the experiences from multinational pharmaceutical companies in Taiwan. The analysis is based on a multiple case study that includes surveys coupled with careful review of relevant documents and web sites and in-depth interviews with managers from 10 case companies. All the managers interviewed mentioned that CSR activities are implemented at the local level within the framework of global guidance. The findings indicate that most of the subsidiaries focus on customer relations and are doing 「responsive CSR」 rather than 「strategic CSR」because of their sales-oriented function and limited resources and skills. We also found that their CSR strategies depend on the characters of the companies, CSR views and the leadership. All the managers admitted having no systematic way of measuring the outputs, tangible impacts or functionality of their CSR interventions. The key benefit they want to gain is the company reputation and the major challenge for the managers is to develop competitive advantages through CSR. Success stories are provided to encourage strategic thinking and the integration of social perspective into the core frameworks of value chain and competitive context. 企業社會責任跨國企業醫藥產業競爭優勢策略型企業社會責任 Corporate social responsibility (CSR) Health care industry Multinational corporations(MNC) Competitive advantages Strategic CSR
16	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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