Ashley Y. Metcalf

Keep Your Friends Close? Supply Chain Design and Disruption Risk

In this article, we evaluate the relationship between supply chain design decisions and supply chain disruption risk. We explore two supply chain design strategies: (i) the dispersion of supply chain partners to reduce supply chain disruption risk versus (ii) the co-location of supply chain partners to reduce supply chain disruption risk. In addition, we assess supply chain disruption risk from three perspectives: the inbound material flow from the supplier (supply side), the internal production processes (internal), and the outbound material flow to the customer (customer side) as a disruption can occur at any of these locations. We measure disruption risk in terms of stoppages in flows, reductions in flow, close calls (disruptions that were prevented at the last minute), disruption duration (time until normal operation flow was restored), and the spread of disruptions all the way through the supply chain. We use seemingly unrelated regression (SUR) to analyze our data, finding that lead times, especially supply side lead times, are significantly associated with higher levels of supply chain disruption risk. We find co-location with suppliers appears to have beneficial effects to the reduction of disruption duration, and, overall supply side factors have a higher impact when it comes to supply chain disruption risk than comparable customer side factors.

Patterns and Factors Associated With Respiratory Care Protocol Use

BACKGROUND: Organizational factors associated with adoption and use of respiratory care protocols have received little attention. This study examines patterns of protocol use and features of a hospital and providers that are associated with respiratory care protocol use. METHODS: Forty-four hospitals and their health-care providers responded to an online survey regarding perceived outcomes of protocol use and their level of support for using protocols. Hospital features (ie, size, teaching status, and use of information systems) were also assessed. Descriptive statistics and multivariate logistic regression were used for analysis. RESULTS: Of the 9 types of respiratory care protocols assessed (ie, asthma, COPD, ARDS, hypoxemia, pneumonia, noninvasive ventilation therapy, supplemental oxygen titration and discontinuation, ventilator weaning, and bronchopulmonary hygiene), the most commonly used were for oxygen titration and ventilator weaning. Large hospitals (> 350 beds) used protocols more widely than smaller hospitals (P = .01). Respondents felt that use of protocols enhanced cost and quality of care. Finally, hospital features that were associated with overall protocol use were stakeholder support for protocol use and use of high-quality hospital information systems. CONCLUSIONS: The study extends prior research by clarifying features of hospitals and providers associated with use of respiratory care protocols. Validation in future hypothesis-testing samples will further advance this knowledge.

The impact of quality practices and employee empowerment in the performance of hospital units

Healthcare is a unique services environment with increasing demand for services coupled with widely diverse patient needs. In addition, hospitals are under increased pressure to provide quality care yet simultaneously decrease associated costs. This study examines how the use of quality practices and employee empowerment impact hospital unit outcomes. Specifically, the sociotechnical theory is used to explain the relationship of quality practices and employee empowerment in respiratory care services. Utilising data from 101 different hospital units, survey responses from managers and physicians within the same hospital units are used to test the impact on quality and cost of care performance metrics via path modelling. The results show the social side of improvement programs, i.e. employee empowerment, may be a critical component to true quality improvement in hospital units. Furthermore, while respiratory care managers feel that employee empowerment reduces costs of patient care, physicians felt that there was no impact on costs. The implications of these findings and differing perspectives are discussed.

Inventory management of surgical supplies and sterile instruments in hospitals: a literature review

ABSTRACT Operating rooms are considered a significant revenue source, as well as the main source of waste and cost, among the hospital’s departments. Any cost savings in operating rooms will have a broad financial impact. Over the last decades, many researchers and practitioners have conducted studies to deal with the issue of managing surgical supplies and instruments, which are highly affected by surgeons’ preferences. The purpose of this article is to present an up-to-date review of research in the field of inventory management of surgical supplies and instruments. We have analysed the literature in a systematic manner and organised the identified papers into two groups: the papers that were published by scientific researchers and developed optimisation techniques and the papers that were published by practitioners and reported their observations of the current issues in the operating room. We also identify the future research directions leading to operating room inventory cost reduction.