BACKGROUND: The healthcare landscape is changing at a pace that traditional management structures are ill equipped to handle. In response to demands for accountability and greater value, service line management (SLM), a popularized concept in the 1980s, has recently gained renewed attention as an organizational tool for improving hospital-physician relationships, coordinating care, and aligning organizational goals, resources, and strategies. OBJECTIVES: The aim is to systematically review the literature on SLM to evaluate its effects on quality and efficiency in healthcare organizations and to identify factors that may affect success. After evaluating its impact and the potential factors affecting success, this paper will explore SLM’s generalizability and applicability in Hong Kong’s public healthcare system. METHODS: Using key words, a systematic search of EBSCO, Medline (OvidSP), ProQuest, and PubMed databases was conducted. The reference lists of the literature were further examined to find more articles. The extracted data was evaluated for strengths, weaknesses, opportunities, and threats (SWOT analysis). This analysis was used to identify and explain the organizational and environmental factors influencing SLM. RESULTS: The initial search yielded 1049 citations. After applying exclusion criteria and reviewing reference lists, 17 articles were identified. The review found that a variety of management structures could be use to achieve organizational objectives. Since each healthcare organization is unique, the structure must be tailored to its internal and external context. Success depends on multiple factors. The internal positive factors or strengths of SLM include enhanced care coordination, communication among staff, multidisciplinary collaboration, leadership, cost finding and planning, integration of information, and greater resource allocation to SLs. The internal negative factors or weaknesses include resistance to organizational change, lack of buy-in among key constituents, lack of internal readiness, inappropriate organizational structures, inadequate leadership skills, difficulties in identifying priority SL, disruptions due to the implementation process, and decreases in funding for non-prioritized areas. Positive external factors or opportunities include the potential for developing a market advantage, identifying improvement areas, enhancing patient safety, and improved public perception. Negative external factors or threats include funding cuts, alterations in reimbursement schemes, advancements in technology, and changes in market forces. CONCLUSION: Despite the hopeful results and discussions presented in the reviewed articles, there is a lack of strong evidence to support implementation and to identify factors affecting success. This is largely due to the variety of ways in which SLM have been implemented and tailored to the diverse organizational and environmental factors. Despite difficulties in comparing various SLs, hospitals and health systems that fully embrace service line management are finding success. Using the service line approach may create opportunities and confer benefits, but it may also disrupt the provision of care. Thus, physicians and managers must consider the positive and negative impacts and implications of SLM before moving forward. / published_or_final_version / Public Health / Master / Master of Public Health

There are many problems associated with the number of auditory warnings in hospital environments such as the Intensive Care Unit. As the amount of medical technology used to monitor a patient's condition increases, there is a concomitant increase in the number of auditory warnings. Each piece of equipment has its own alarm and often the sounds used are inappropriate. For example, the sounds are often too loud, too insistent and are irritating to staff, distracting them from other tasks. A further feature of sounds used for auditory alarms is that there is, at present, no agreement between manufacturers on the types of sounds used. This means that the same item of equipment can have different alarms if produced by different manufacturers. Subsequently there is the potential for confusion between alarms to occur if sounds are similar. The research presented in this thesis aims to investigate the psychological dimension of confusion between alarm sounds and the correct identification of a set of twelve auditory warnings currently in use in the I.C.U. Derriford Hospital, Plymouth. Hence, the first set of experiments examines the learning and retention of the set of auditory warnings in a laboratory setting. However, the many problems regarding auditory warnings should not be considered in isolation and in order to determine the types of activities undertaken by staff in the I.C.U. environment when alarms are activated, two observational studies were undertaken. The first study used a video camera and the second study involved direct observation using two observers. A series of tasks were developed that used the multiple resources literature as a framework and also represented tasks undertaken in the environment of the I.C.U. In the second experiment, participants were again required to learn and retain the set of auditory warnings. The tasks were introduced during the return stage of the experiment in order to examine first, whether there was an effect on the primary task of correctly identifying the sounds and whether the confusions between sounds increased or changed, and second to examine performance on the secondary tasks. The results showed that for all experiments in general participants required few trials to learn the sounds and the information was retained for a period of over one week. The results also showed that features of some sounds were easier to learn than other sounds and that certain sounds were consistently confused during each experiment. When the tasks were introduced performance on the primary task remained fairly constant, with no overall change or increase in the number of confusions between sounds. However, there was a decrement in the performance of the secondary tasks, as predicted by the dual-task literature. In conclusion, the results suggest that identification of sounds may depend on a global, overall label for a sound, such as a 'melodic' sound or a 'continuous' sound, with the more intricate details undetected by participants. The results also suggest that participants in the laboratory may alter their strategies to maintain performance on the primary task, by either responding more rapidly to task demands or by consciously deciding not to respond to one of the secondary tasks.

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Thesis (Ph.D.)--University of Melbourne, Dept. of Surgery,Faculty of Medicine,Dentistry and Health Sciences, 2006. / Typescript. Includes bibliographical references (leaves 155-162).

Thesis (Ph. D.)--Villanova University, 2008. / Nursing Dept. Includes bibliographical references.

Thesis (Ph. D.)--Ohio State University, 1976. / Includes bibliographical references (leaves 327-335). Available online via OhioLINK's ETD Center.

Thesis (M. Sc.)--University of Hong Kong, 2005. / Also available in print.

Thesis (M Nursing)--Montana State University--Bozeman, 2008. / Typescript. Chairperson, Graduate Committee: Rita E. Cheek. Includes bibliographical references (leaves 55-63).

Thesis (Ph. D.)--Henry W. Bloch School of Business and Public Administration and Dept. of Economics. University of Missouri--Kansas City, 2007. / "A dissertation in public affairs and administration and education." Advisor: Robert D. Herman. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed July 30, 2008 Includes bibliographical references (leaves 86-90). Online version of the print edition.

Thesis (doctoral)--Universität Hamburg, [1920?]. / Original in Special Collections, Teachers College Library. Typescript. Bibliography: leaves 203-207.