Purpose
In the healthcare management domain, there is a lack of knowledge concerning the role of resilience practices in improving patient safety. The purpose of this paper is to understand the ...capabilities that enable healthcare resilience and how digital technologies can support these capabilities.
Design/methodology/approach
Within- and cross-case research methodology was used to study resilience mechanisms and capabilities in healthcare and to understand how digital health technologies impact healthcare resilience. The authors analyze data from two Italian hospitals through the lens of the operational failure literature and anchor the findings to the theory of dynamic capabilities.
Findings
Five different dynamic capabilities emerged as crucial for managing operational failure. Furthermore, in relation to these capabilities, medical, organizational and patient-related knowledge surfaced as major enablers. Finally, the findings allowed the authors to better explain the role of knowledge in healthcare resilience and how digital technologies boost this role.
Practical implications
When trying to promote a culture of patient safety, the research suggests healthcare managers should focus on promoting and enhancing resilience capabilities. Furthermore, when evaluating the role of digital technologies, healthcare managers should consider their importance in enabling these dynamic capabilities.
Originality/value
Although operations management (OM) research points to resilience as a crucial behavior in the supply chain, this is the first research that investigates the concept of resilience in healthcare systems from an OM perspective, with only a few authors having studied similar concepts, such as “workaround” practices.
PurposeThe nature and amount of data that public organizations have to monitor to counteract corruption lead to a phenomenon called “KPI overload”, consisting of the business analyst feeling ...overwhelmed by the amount of information and resulting in the absence of appropriate control. The purpose of this study is to develop a solution based on Artificial Intelligence technology to avoid data overloading and, at the same time, under-controlling in business process monitoring.Design/methodology/approachThe authors adopted a design science research approach. The authors started by observing a specific problem in a real context (a healthcare organization); then conceptualized, designed and implemented a solution to the problem with the goal to develop knowledge that can be used to design solutions for similar problems. The proposed solution for business process monitoring integrates databases and self-service business intelligence for outlier detection and artificial intelligence for classification analysis.FindingsThe authors found the solution powerful to solve problems related to KPI overload in process monitoring. In the specific case study, the authors found that the combination of Business Intelligence and Artificial Intelligence can provide a significant contribution to the detection of fraud, corruption and/or policy misalignment in public organizations.Originality/valueThe authors provide a big-data-based solution to the problem of data overload in business process monitoring that does not sacrifice any monitored Key Performance Indicators and that also reduces the workload of the business analyst. The authors also developed and implemented this automated solution in a context where data sensitivity and privacy are critical issues.
Business Intelligence (BI) has the potential to disrupt the processes through which healthcare services are offered. Despite this key role, most healthcare organizations fail in implementing or ...extending BI suites from the pilot niches in which these solutions are usually developed and tested to larger domains. In fact, healthcare practitioners lack comprehensive models that suggest the priorities to be followed for progressively developing a BI solution. This paper aims to start filling these gaps by developing a model through which: (i) to measure and increase the maturity of a BI solution within a healthcare organization; (ii) to enable extensive processes of benchmarking and continuous improvement.
•A business intelligence maturity model and the relative assessment questionnaire specific for healthcare are proposed.•Interdependencies between different dimensions of the maturity model are considered.•Maturity dimensions are prioritized based on their influence on harmonized business intelligence maturity improvement.•A roadmap is suggested for hospitals to reach the desired level of business intelligence maturity.
Purpose
We aimed to implement and to assess the impact of the antifungal stewardship programme (AFSp) on prescription appropriateness of antifungals, management and outcomes of candidaemia patients, ...and antifungal consumption and costs at our solid organ transplant (SOT) institute.
Methods
Local epidemiology of invasive fungal infections (IFIs) from 2009 to 2017 was analysed in order to prepare an effective AFSp, implemented in January 2018. It included suspension of empirical antifungal prescriptions after 72 hours (antifungal time‐out), automated alert and infectious disease (ID) consult for empirical prescriptions and for every patient with IFI, and indication for step‐down to oral fluconazole when possible. We used process measures and results measures to assess the effects of the implemented programme.
Results
The ASFp led to significant improvements in selection of the appropriate antifungal (40.5% in pre‐AFS vs 78.6% in post‐AFS), correct dosing (51.2% vs 79.8%), correct length of treatment (55.9% vs 75%) and better management of patients with candidaemia. Analysis of prescribed empirical antifungal revealed that defined daily doses (DDDs) per 100 patient days decreased by 36.7% in 2018 compared to the average of pre‐AFSp period, with important savings in costs.
Conclusion
This AFSp led to a better use of antifungal drugs in terms of appropriateness and consumption, with stable clinical and microbiological outcomes in patients with IFI.
Endoventricular thrombolytic procedure (ETP) has been used to treat continuous‐flow left ventricle assist device (CF‐LVAD) thrombosis. The study aims to investigate the occurrence of complications ...after ETP. Data were retrospectively reviewed and analyzed in a series of patients who underwent CF‐LVAD followed by ETP. Since November 2010, 20 patients underwent HeartWare CF‐LVAD implantation at our institute. Four patients (20%) developed pump thrombosis and underwent a total of nine ETPs with tissue plasminogen activator infused into the left ventricle. The mean age was 60.2 ± 9 years. ETP was performed via either the femoral (n = 6) or radial artery (n = 3). Five ETPs (55.5%) were complicated by left and right radial artery occlusion, two by groin hematomas, and one by femoral artery false aneurysm. ETP carries a strong risk of vascular access complications that, in CF‐LVAD patients, may add to the already complex clinical profile and economic burden; thus, a less invasive treatment is advisable whenever required.
