The main changes within the third edition of the JEE tool include the split of the technical area National legislation, policy, and financing into two technical areas (Legal instruments and Financing); the drop of the technical area previously titled Reporting and the move of indicators to the technical area IHR coordination, National IHR Focal Point and advocacy; and the merging of two previous technical areas (Emergency preparedness and Emergency operations centre) into a single one named Health emergency management.

The answers to many of the dilemmas faced by the US healthcare system, such as increasing costs, inadequate access, and uneven quality, lie in organizational operations the nuts and bolts of healthcare delivery. Leading healthcare organizations have begun to employ the programs, techniques, and tools of operations improvement that industries outside of healthcare have successfully used for decades.


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Healthcare Operations Management aims to help healthcare management students and working professionals find ways to improve the delivery of healthcare, with its complex web of patients, providers, reimbursement systems, physician relations, workforce challenges, and intensive government regulation. Taking an integrated approach, the book puts the tools and techniques of operations improvement into the context of healthcare so that readers learn how to increase the effectiveness and efficiency of tomorrow's healthcare system.

Many industries outside healthcare have successfully used the programs, techniques, and tools of operations improvement for decades. Leading healthcare organizations have now begun to employ the same tools. Although numerous other operations management texts are available, few focus on healthcare operations, and none takes an integrated approach. Students interested in healthcare process improvement have difficulty seeing the applicability of the science of operations management when most texts focus on widgets and production lines rather than on patients and providers.

This book covers the basics of operations improvement and provides an overview of the significant trends in the healthcare industry. We focus on the strategic implementation of process improvement programs, techniques, and tools in the healthcare environment, with its complex web of reimbursement systems, physician relations, workforce challenges, and governmental regulations. This integrated approach helps healthcare professionals gain an understanding of strategic operations management and, more important, its applicability to the healthcare field.

The first part of the book, Introduction to Healthcare Operations, begins with an overview of the challenges and opportunities found in today's healthcare environment (chapter 1). We follow with a history of the field of management science and operations improvement (chapter 2). Next, we discuss two of the most influential environmental changes facing healthcare today: evidence-based medicine and value-based purchasing, or simply value purchasing (chapter 3). 

Supply chain management extends the boundaries of the hospital or healthcare system to include both upstream suppliers and downstream customers, and this is the focus of chapter 13. The need to bend the healthcare cost inflation curve downward is one of the most pressing issues in healthcare today, and the use of operations management tools to achieve this goal is addressed in chapter 14. 

We include abundant examples throughout the text of the use of various contemporary software tools essential for effective operations management. Readers will see notes appended to some of the exhibits, for example, that indicate what software was used to create charts, graphs, and so on from the data provided. Healthcare leaders and managers must be experts in the application of these tools and stay current with the latest versions. Just as we ask healthcare providers to stay up-to-date with the latest clinical advances, so too must healthcare managers stay current with basic software tools.

In the recent past, success for many organizations in the US healthcare system has been achieved by executing a few critical strategies: First, attract and retain talented clinicians. Next, add new technology and specialty care services. Finally, find new methods to maximize the organization's reimbursement for these services. In most organizations, new services, not ongoing operations, were the key to success.

However, that era is ending. Payer resistance to cost increases and a surge in public reporting on the quality of healthcare are forces driving a major change in strategy. The passage of the Affordable Care Act (ACA) in 2010 represented a culmination of these forces. Although portions of this law may be repealed or changed, the general direction of health policy in the United States has been set. To succeed in this new environment, a healthcare enterprise must focus on making significant improvements in its core operations.

This book is about improvement and how to get things done. It offers an integrated, systematic approach and set of contemporary operations improvement tools that can be used to make significant gains in any organization. These tools have been successfully deployed in much of the global business community for more than 40 years and now are being used by leading healthcare delivery organizations.

This chapter outlines the purpose of the book, identifies challenges that healthcare systems currently face, presents a systems view of healthcare, and provides a comprehensive framework for the use of operations tools and methods in healthcare. Finally, Vincent Valley Hospital and Health System (VVH), the fictional healthcare delivery system used in examples throughout the book, is described.

Many books cover operational improvement tools, and some focus on using these tools in healthcare environments. So why have we devoted a book to the broad topic of healthcare operations? Because we see a need for organizations to adopt an integrated approach to operations improvement that puts all the tools in a logical context and provides a road map for their use. An integrated approach uses a clinical analogy: First, find and diagnose an operations issue. Second, apply the appropriate treatment tool to solve the problem.

The field of operations research and management science is too deep to cover in one book. In Healthcare Operations Management, only those tools and techniques currently being deployed in leading healthcare organizations are covered, in part so that we may describe them in enough detail to enable students and practitioners to use them in their work. Each chapter provides many references for further reading and deeper study. We also include additional resources, case studies, exercises, and tools on the companion website that accompanies this book.

No system is ever completely stable. Each system's performance is modified and controlled by feedback (exhibit 1.3). Senge (1990, 75) defines feedback as "any reciprocal flow of influence. In systems thinking it is an axiom that every influence is both cause and effect." As shown in exhibit 1.3, increased salaries provide an incentive for employees to achieve improvement in performance level. This improved performance leads to enhanced financial performance and profitability for the organization, and increased profits provide additional funds for higher salaries, and the cycle continues. Another frequent example in healthcare delivery is patient lab results that directly influence the medication ordered by a physician. A third example is a financial report that shows an over-expenditure in one category that prompts a manager to reduce spending to meet budget goals. 

As healthcare leaders focus on improving their operations, they must understand the systems in which change resides. Every change will be resisted and reinforced by feedback mechanisms, many of which are not clearly visible. Taking a broad systems view can improve the effectiveness of change.

The five-part framework of this book (illustrated in exhibit 1.5) reflects our view that effective operations management in healthcare consists of highly focused strategy execution and organizational change accompanied by the disciplined use of analytical tools, techniques, and programs. An organization needs to understand the environment, develop a strategy, and implement a system to effectively deploy this strategy. At the same time, the organization must become adept at using all the tools of operations improvement contained in this book. These improvement tools can then be combined to attack the fundamental challenges of operating a complex healthcare delivery organization. 

In the end, any operations improvement will fail unless steps are taken to maintain the gains; chapter 15 contains the necessary tools to do so. The chapter also provides a detailed algorithm that helps practitioners select the appropriate tools, methods, and techniques to effect significant operational improvements. It demonstrates how our fictionalized case study healthcare system, Vincent Valley Hospital and Health System (VVH), uses all the tools presented in the book to achieve operational excellence. In this way, a future is envisioned in which many of the tools and methods contained in the book are widely deployed in the US healthcare system. 

This rapid review highlights the current global climate in health service management, the key priority areas, and current health management approaches being utilised to address these. The multitude of issues emerging demonstrate the complex and evolving role of health service management in the wider complex functioning of health systems globally in a changing healthcare landscape. Key themes of achieving high quality care and sustainable service delivery were apparent, often evidenced through health reforms [5]. The influence of technological innovation in both its opportunities and complexities is evident worldwide. In the context of changing healthcare goals and delivery approaches, health management is seeking to professionalise as a strategy to build strength and capacity. In doing so, health managers are questioning role scope and the skills and knowledge they need to meet the requirements of the role. be457b7860

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