Tomi Malmström

Demand and Supply–Based Operating Modes—A Framework for Analyzing Health Care Service Production

CONTEXT The structure of organizations that provide services should reflect the possibilities of and constraints on production that arise from the market segments they serve. Organizational segmentation in health care is based on urgency and severity as well as disease type, bodily function, principal method, or population subgroup. The result is conflicting priorities, goals, and performance metrics. A managerial perspective is needed to identify activities with similar requirements for integration, coordination, and control. METHODS The arguments in this article apply new reasoning to the previous literature. FINDINGS The method used in this article to classify health care provision distinguishes different types of health problems that share generic constraints of production. CONCLUSIONS The analysis leads to seven different demand-supply combinations, each with its own operational logic. These are labeled demand and supply-based operating modes (DSO modes), and constitute the managerial building blocks of health care organizations. The modes are Prevention, Emergency, One visit, Project, Elective, Cure, and Care. As analytical categories the DSO modes can be used to understand current problems. Several operating modes in one unit create managerial problems of conflicting priorities, goals, and performance metrics. The DSO modes are constructed as managerially homogeneous categories or care platforms responding to general types of demand, and supply constraints. The DSO modes bring methods of industrial management to bear on efforts to improve health care.

The validity of the EQ-5D-3L items: an investigation with type 2 diabetes patients from six European countries

BackgroundMost previous studies concerning the validity of the EQ-5D-3L items refer to applications of only a single language version of the EQ-5D-3L in only one country. Therefore, there is little information concerning the extent to which the results can be generalised across different language versions and/or different countries. Here the validity of the EQ-5D-3L items is investigated for six different language versions in six different countries.MethodsData came from 1341 type 2 diabetes patients (England: 289; Finland: 177; Germany: 255; Greece: 165; the Netherlands: 354; Spain: 101). The relationships of the five EQ-5D-3L items with seven different test variables (age, gender, education, previous stroke, problems with heart, problems with lower extremities, problems with eyes), were analysed for each combination of item and test variable. For each combination two logistic regression models with the dichotomised EQ-5D-3L item as dependent variable were computed. The first model contained the test variable and dummy coded countries as independent variables, the second model additionally the terms for the interaction between country and test variable. Statistically significant better fit of the second model was taken as evidence for country specific differences regarding the relationship. When such differences could be attributed mainly to one country the analyses were repeated without the data from this country. Validity was investigated with the remaining data using results of the first models.ResultsDue to lack of variation in the Spanish data only 31 of the originally intended 35 interaction tests could be performed. Only three of these yielded a significant result. In all three cases the Spanish data deviated most. Without the Spanish data only 1 of the 35 interaction tests yielded a significant result. With 3 exceptions, the tendency of reporting problems increased with age, female gender, lower education, previous stroke, heart problems, problems with lower extremities and problems with eyes for all EQ-5D-3L items.ConclusionThe results concerning the European Spanish version are ambiguous. However, the items of the English, Finnish, German, Greek and Dutch versions of the EQ-5D-3L relate in substantially the same way to the test variables. Mostly, these relationships indicate the items’ validity.

Structured classification for ED presenting complaints - from free text field-based approach to ICPC-2 ED application

BackgroundAlthough there is a major need to record and analyse presenting complaints in emergency departments (EDs), no international standard exists. The aim of the present study was to produce structured complaint classification suitable for ED use and to implement it in practice. The structured classification evolved from a study of free text fields and ICPC-2 classification.MethodsPresenting complaints in a free text field of ED admissions during a one-year period (n=40610) were analyzed and summarized to 70 presenting complaint groups. The results were compared to ICPC-2 based complaints collected in another ED. An expert panel reviewed the results and produced an ED application of ICPC-2 classification. This study implemented the new classification into an ED.ResultsThe presenting complaints summarized from free text fields and those from ICPC-2 categories were remarkably similar. However, the ICPC-2 classification was too broad for ED; an adapted version was needed. The newly developed classification includes 89 presenting complaints and ED staff found it easy to use.ConclusionsICPC-2 classification can be adapted for ED use. The authors suggest a list of 89 presenting complaints for use in EDs adult patients.

Investigating burden of informal caregivers in England, Finland and Greece: an analysis with the short form of the Burden Scale for Family Caregivers (BSFC-s)

ABSTRACT Objectives: The burden of informal caregivers might show itself in different ways in different cultures. Understanding these differences is important for developing culture-specific measures aimed at alleviating caregiver burden. Hitherto, no findings regarding such cultural differences between different European countries were available. In this paper, differences between English, Finnish and Greek informal caregivers of people with dementia are investigated. Methods: A secondary analysis was performed with data from 36 English, 42 Finnish and 46 Greek caregivers obtained with the short form of the Burden Scale for Family Caregivers (BSFC-s). The probabilities of endorsing the BSFC-s items were investigated by computing a logit model with items and countries as categorical factors. Statistically significant deviation of data from this model was taken as evidence for country-specific response patterns. Results: The two-factorial logit model explains the responses to the items quite well (McFaddens pseudo-R-square: 0.77). There are, however, also statistically significant deviations (p < 0.05). English caregivers have a stronger tendency to endorse items addressing impairments in individual well-being; Finnish caregivers have a stronger tendency to endorse items addressing the conflict between the demands resulting from care and demands resulting from the remaining social life and Greek caregivers have a stronger tendency to endorse items addressing impairments in physical health. Conclusion: Caregiver burden shows itself differently in English, Finnish and Greek caregivers. Accordingly, measures for alleviating caregiver burden in these three countries should address different aspects of the caregivers’ lives.

Five focus strategies to organize health care delivery

PURPOSE The focused factory is one of the concepts that decision-makers have adopted for improving health care delivery. However, disorganized definitions of focus have led to findings that cannot be utilized systematically. The purpose of this paper is to discuss strategic options to focus health care operations. DESIGN/METHODOLOGY/APPROACH First the literature on focus in health care is reviewed revealing conceptual challenges. Second, a definition of focus in terms of demand and requisite variety is defined, and the mechanisms of focus are explicated. A classification of five focus strategies that follow the original idea to reduce variety in products and markets is presented. Finally, the paper examines managerial possibilities linked to the focus strategies. FINDINGS The paper proposes a framework of five customer-oriented focus strategies which aim at reducing variety in different characteristics of care pathways: population; urgency and severity; illnesses and symptoms; care practices and processes; and care outcomes. RESEARCH LIMITATIONS/IMPLICATIONS Empirical research is needed to evaluate the costs and benefits of the five strategies and about system-level effects of focused units on competition and coordination. PRACTICAL IMPLICATIONS Focus is an enabling condition that needs to be exploited using specific demand and supply management practices. It is essential to understand how focus mechanisms differ between strategies, and to select focus that fits with organizations strategy and key performance indicators. ORIGINALITY/VALUE Compared to previous more resource-oriented approaches, this study provides theoretically solid and practically relevant customer-oriented framework for focusing in health care.

The impact of travel distance, travel time and waiting time on health-related quality of life of diabetes patients: An investigation in six European countries

AIMS The effects of travel distance and travel time to the primary diabetes care provider and waiting time in the practice on health-related quality of life (HRQoL) of patients with type 2 diabetes are investigated. RESEARCH DESIGN AND METHODS Survey data of 1313 persons with type 2 diabetes from six regions in England (274), Finland (163), Germany (254), Greece (165), the Netherlands (354), and Spain (103) were analyzed. Various multiple linear regression analyses with four different EQ-5D-3L indices (English, German, Dutch and Spanish index) as target variables, with travel distance, travel time, and waiting time in the practice as focal predictors and with control for study region, patients gender, patients age, patients education, time since diagnosis, thoroughness of provider-patient communication were computed. Interactions of regions with the remaining five control variables and the three focal predictors were also tested. RESULTS There are no interactions of regions with control variables or focal predictors. The indices decrease with increasing travel time to the provider and increasing waiting time in the providers practice. CONCLUSIONS HRQoL of patients with type 2 diabetes might be improved by decreasing travel time to the provider and waiting time in the providers practice.

Constructing a framework to manage high utilizers in health and social care

In health and social care highly skewed consumption of expenditures are reported, where 10% of the population consume over 80% of the total care costs. This research aims to understand the high utilization of combined social and health services more profoundly and identify what should be taken into account when planning services for high utilizers. Varied demographic details and variations in the persistence suggest that efforts to curb high utilization should be diverse and specific towards thing they want to prevent. Finding feasible solutions for high use is a multidisciplinary task that requires timely use of information in a service delivery system that promotes proactivity.