The objective of our research is the development of a modeling framework that permits decision makers to reengineer and evaluate their hospital supply chain. This research was first motivated by a strong collaboration with a Belgian hospital of 900 beds that is currently reengineering its logistical activities. The managers of this hospital intend to build a new logistical platform to group the clinical pharmacy, the sterilization and purchasing services in a same location. These units are currently situated in separated areas. The objectives of this reengineering project are the rationalization of expenses and the improvement of the quality of the care delivered to the patients. This new organization will change the current practices of the hospital in terms of purchasing, reception and distribution activities as well as in terms of inventory management. It will also impact the medico-technical units and the care services as well impact numerous human and technical resources. The new platform will manage a huge number of pharmaceutical references and should correctly collaborate with the different logistical units that have their different working rules. We therefore decide to focus our study on the pharmaceuticals (pharmaceuticals and medical materials) dedicated to two specified medico-technical units, the emergency rooms and the operating rooms. These units are indeed critical in the care process of patients and are major costs center of the hospital. We demonstrate that this reorganization will have an impact upon the product flow, the distribution and the inventory management. It will also have an influence upon the working of the medico-technical units. Because numerous people, products and care units are implied in this project, we need to have a framework to describe the working of the actual system, to diagnose its working and quantify the possible failure. Different solutions can be proposed thanks to optimization models and these ones should be evaluated through the performance indicators. These indicators should be established in accordance with a common and shared vision of the hospital performance, which one is not obvious to define due to the different stakeholders’ perspectives. The decision makers can then take the decision based on these indicators; they can evaluate the consequences of their decision in time and space before the implementation. We first readapt the definition of fundamental concepts as value and performance in healthcare supply chain context. We then propose an approach that should help the hospital managers to lead such reengineering project, as the reorganization of the supply chain, mainly the medical products supply chain, while taking into account the patients’ flow. The suggested framework will provide guidance to build a knowledge model based on the ASDI methodology and enriched with the value and performance definition. The knowledge model is aimed at understanding the working of the system, identifying the critical activities, defining the performance indicators to assess the system based on metrics in accordance with the value system of the hospital, describing processes and management rules and identifying resources. In a second phase, based on the knowledge gathered, we develop an optimization tool of the medical products flow while taking into account the patient’s flow. Because the demand patterns are very different in the two medico-technical units we consider, we propose two solutions. For the emergency room, we evaluate the implementation of an automated dispensing system and we propose a two-echelon inventory management model to control this new system. In the operating room, we propose a two-step approach. We determine the planning and scheduling of the surgical operations taking into account the resources constraints and then we apply a MRP approach based on a stochastic bill of resources. The performance indicators defined in a first step will serve to assess the proposed solutions. Different balanced score cards will suggested to capture the performance of the considered processes. Doing so, the proposed approach will ensure that the suggested changes improve the working of the pharmaceuticals supply chain and contribute to the global interest of the hospital. For illustration purposes, we experience our models on a pedagogical data set derived from a real life application encountered in the Belgian hospital mentioned above.

Although screening for breast cancer is broadly utilized in the United States, the optimal approach in terms of examination modality, frequency, and starting age is unclear. Furthermore, there is no consensus on the benefit from earlier, more frequent, or additional modes of screening for women with high-risk for breast cancer. This thesis explores methods for finding optimal screening strategies by modeling the costs and benefits of breast cancer screening programs through a simulation-based and a theoretical approach, which incorporate some ignored or unexplored components. For the general population, cost-effectiveness studies evaluating breast cancer screening have focused on mammography alone, and have not assessed the impact of its combination with clinical breast exam, a cheaper and more practical exam. Costs incurred beyond screening including costs for work-up, biopsy, and treatment have often been ignored. We account for these factors in a comprehensive microsimulation analysis by modeling the natural history of the disease including age-specific incidence, sojourn time, and exam sensitivity and specificity, and evaluate the cost-effectiveness of a set of screening programs on a simulated cohort of women. Similarly, we focus on a special case of high-risk women where we include screening programs that begin at an earlier age, have more frequent examinations, and include combinations of magnetic-resonance imaging, which has recently been recommended for women at high-risk for breast cancer. The most cost-effective approach depends on how much society is willing to pay to save a year of life. Finally, we take a theoretical approach which is motivated by the idea that other optimal screening programs may exist outside a set of predetermined strategies used in a simulation-based approach. While empirical studies give a better idea of which screening schedules are useful, a theoretical approach may uncover a true optimal schedule. We assume a nonstable disease model and account for costs of screening and dollar value of benefit in a utility function under two different frameworks to estimate the optimal number or ages of examinations given certain general assumptions. We show that a solution exists for these models and demonstrate in numerical studies that they will give reasonable results.

The environment and its effects on our physiological health and well-being have long been essential components of medical treatment regimes. Though many of these regimes may have experienced only short-lived success as products of trends in popular culture, the complex relationship between environmental exposure and cure is one that is fundamental to the understanding of the medical sciences. The endeavor to more fully understand its complexities continues even in the light of what modern advances in medical technology have revealed to us. This thesis addresses the need to rethink the use of environmental qualities in medical facilities, looking to and expanding upon how they were used in past paradigms.

After Taiwan National Health Insurance implemented in 1995, health care management systems of hospitals in Taiwan had gradually turned in financial-oriented. On the other hands, people had paid less attention and little mention to basic ethics-oriented topics. Ethics of Health Care Administration (EHA) combined business ethics and medical ethics and extended a broader connotation within it. Except general guidelines of medical ethics, EHA was extended to considerations for management and policy conducts. This research has surveyed the EHA implementation in hospitals in Taiwan and influenced investigated the relationships amoung the differences of hospitals characteristics, the superintendents¡¦ characteristics, and the superintendents¡¦ perceptions toward EHA. A cross-sectional study with structured self-completion questionnaires had been done. Questionnaires were distributed during May and August, 2009, and 135 were returned, with a response rate of 27.89%. Responses were gathered from superintendents of hospitals at a district level or higher. Results delivered by two sections in this research: Quantitative Section: 1. Superintendents with different hospitals characteristics had positive attitude and identifications toward the EHA implementation degree in hospitals. 2. Superintendents with older age or deeper experiences had higher appraisal of the EHA implementation degree in hospitals. 3. Responses for the EHA implementation degree in hospitals, the scores in themselves-hospitals were higher than the scores in others-hospitals. 4. Responses with higher satisfaction with present health care environment could with a higher EHA implementation degree in their hospitals. Qualitative Section: 1. Responses for the perceptions of internal operations in health care institutions were more focused on positive ways of operational management in health care institutions, included the agreements of human-based management, health care quality, cost control, sustainable development under the specific operating model by a certain hospital. 2. Responses for the perceptions of external environment of health care institutions were more focused on policies and systems within medical or health care field included the regard for the possibility of health care policies¡¦ and health care insurances¡¦ reforms. Ethics of health care administration can be implemented with a well conduct health care infrastructure and policy supported management system.

<p> The Filipino culture recognizes the elderly as part of its human resources. As a culture that considers family as a basic unit of society, the elderly play a central role. When elderly Filipinos, those that are 65 years of age and older, migrate to the United States, they expect that their families are able to take care of them. However, work demands and living situations among family members prevent them from receiving proper care.</p><p> With the increasing population of elderly Filipinos in Palm Springs, demand for a new Residential Care Facility for the Elderly (RCFE) is important. Agbayani's Residential Care Facility for Elderly Filipinos in Palm Springs, CA will offer supportive, quality, and long-term care for institutionalizing family in the facility. This business plan will show how Agbayani's RCFE intends on providing elderly Filipinos the quality of service and community they are accustomed to while maintaining a viable business.</p>

<p> Continuous changes within the health care industry and continuing medical education regulations within the United States (US) provide opportunities for Accreditation Council for Continuing Medical Education (ACCME) accredited providers to enhance the continuing medical education provided to the physicians. Blended CME, Inc.&rsquo;s sole purpose is to allow accredited providers an opportunity to enhance physician knowledge, competence, and performance in order to narrow professional practice gaps and to produce measurable improvement in patient outcomes. This business plan shows how Blended CME intends to provide quality consulting services to accredited providers, while at the same time being a profitable organization. Blended CME utilizes a rigorous educational planning process that draws on the experience of multi-disciplinary experts in physician education, practice-based learning, and system-based practice.</p>

<p> In this study, the effectiveness of customer service training was estimated using Donald Kirkpatrick&rsquo;s Evaluation Model and the Learning Transfer Model. There were 105 Human Resource Leaders and Trainers that completed an online study concerning the training requested and provided within non-profit community healthcare organizations. The study found that The Learning Training Model, when used with Kirkpatrick&rsquo;s Evaluation model provided adequate information to suggest a roadmap for designing strategies to achieve improved customer service in non-profit community healthcare sectors.</p>

<p> Aging Well Day Care Center is a start-up company designed to offer an affordable alternative care for seniors living alone. The services offered will be equally beneficial for families caring for their aging parents. Recent legislation has emphasized the importance of developing daycare centers to handle the rapidly growing population of elder Americans that relies upon the federal insurance programs to help manage their long-lasting medical conditions which can be treated but not cured. The objective of this business plan is to illustrate the need for adult day care services within this region and that adequate resource are available to build and maintain a financially solvent organization.</p>

<p> Within the health care system, patient safety outcomes have been criticized for many years. Medical malpractice, common errors, and nosocomial infections (i.e., hospital-acquired infections) are safety concerns, and represent a public health problem. Since the Institute of Medicine (1999) published To Err is Human: Building a Safer Health System in 1999, changes have been made to improve the use of technology and leverage advancements in research that improve patient safety. Nurse leaders can also help to facilitate process improvements in the patient safety culture. The purpose of this capstone project was to explore the nursing leader role in improving patient safety in a hospital setting. The method utilized for this study was a literature review. Prominent articles identifying the role of nursing leadership were included. Seven drivers of patient safety were identified (Sammer, Lyken, Singh, Mains, &amp; Lackan (2011), and subsequently informed this project. The targeted populations were patients, families, nurses, nurse administrators, and medical personnel. Findings regarding the nurse leader role, patient improvements, and barriers to improvements were reviewed. Nurse leaders were found to be of critical importance to patients, medical personnel, and the health care system. The limitations of this review and implications for policy and practice are discussed. </p>

<p> Accountability in healthcare tends to dominate discussions focused on improving the quality of care, the experience of patients, pay-for-performance, and engaging employees to produce positive performance outcomes. Organizational leaders are held to answer to external regulatory agencies about performance outcomes based on prescribed standards. Frequently, these agencies adopt a punitive approach by imposing rewards and penalties for achieving or failing to meet the performance standards. Furthering the challenges, organizational leaders are expected to model accountability, hold employees accountable, and be a source for inspiration and motivation. The purpose of this qualitative action research study was to examine person-centered accountability (PCA), or the use of positive leadership, positive practices, and positive emotions, as a complementary approach to regulatory-centered accountability (RCA). Six workshops influenced by appreciative inquiry, a practice period, participant journals, interviews and the use of a portable biofeedback device to measure positive emotions were all utilized to develop an understanding of participant&rsquo;s experiences and perceptions about the value of PCA and RCA. Participants were clinical and non-clinical leaders at a Midwest medical center. Results from this study revealed the participants&rsquo; perception about the holistic and interdependent nature of PCA and RCA. Integrating PCA and RCA requires a change in philosophies as well as day-to-day accountability practices. Leaders and employees need to use both PCA and RCA to improve performance outcomes, therefore, it is important to create an organizational reset to change beliefs about accountability, build leadership capacity, and invest in employees. Future research is needed to evaluate the long-term impact of PCA and RCA on performance outcomes in and out of healthcare.</p>