From the November/December 2013 of Industrial Management
Coordinating healthcare integration for optimal results
Integration is at the heart of many healthcare reform concepts, such as care coordination, modified payment systems and harnessing IT. But when does more or less integration improve hospital performance?
The authors’ recent work theorizes that inconsistencies in the literature about integration and performance are caused by three factors: a focus on how integration improves efficiency as opposed to quality, a lack of understanding for the relationship among types of integrative practices (i.e., formal coordination, informal cooperation, formal centralization), and the failure to account for differences in departmental characteristics.
Our empirical study of 31 departments in a medium-sized community hospital, presented at the 2013 Industrial and Systems Engineering Research Conference (ISERC), suggests the following recommendations:
Choose integrative practices that make the greatest impact on your targeted performance outcome. Studies commonly include one to two integrative practices as a proxy for integration, which provides only pieces of the integration picture. Our study examined the impact that formal centralization (e.g., centralized decision making), formal coordination (e.g., official cross-departmental meetings and performance measures), and informal cooperation (e.g., unofficial social communication between departments) had on departmental quality performance. Formal coordination significantly improved quality performance, while the other two options did not. So while centralized decision making improves efficiency, cross-departmental meetings, performance measures and procedures may improve quality more. Thus, managers should consider their desired performance outcome before implementing integrative practices.
Understand the complexity of your work environment before integrating with others. To improve quality via inter-departmental integrative practices, managers must understand how each department differs. Specifically, we found that complex departments working in more unpredictable environments, such as pediatric surgery, benefited more from formal coordination than departments with more predictable environments, such as endocrinology. Our findings suggest that a department with high environmental uncertainty, such as a "solution shop" of multidisciplinary specialists, might need formal reinforcement via cross-departmental meetings, performance measures and procedures to increase the quality of care. In contrast, in more predictable arenas, such as certain laboratory departments, formal coordination only bolsters previously established knowledge, minimally improving quality or even hindering progress.
— Qing Li is in the industrial and systems engineering program at Georgia Institute of Technology. Wiljeana Glover is an assistant professor of technology, operations and information management at Babson College. Eitan Naveh is an industrial engineering and management professor at Technion – Israel Institute of Technology. Michael Gross is from HaEmek Medical Center, Israel.
SEMS increases recognition opportunities for students
SEMS formed its Student Initiatives (SI) Committee in 2011 to increase and improve student-oriented services while retaining and increasing student membership. Back then, students constituted 41 percent of SEMS membership. Two years later, students represent nearly 49 percent of the SEMS community. The 8 percent increase suggests that the initiative is on the right track, which motivates us to continue.
Originally, we worked across five distinct student initiatives to advise students on the state of practice and engineering applications. As a secondary benefit, we hoped that this would retain students. We reached out to students by different means: virtually through webinars; electronically through SEMS newsletters; and directly through face-to-face Industrial and Systems Engineering Research Conference networking events, panel discussions and, more recently, the student paper competition sponsored by Transformation Systems Inc.
As a former SI volunteer and now SEMS board member, I am happy to step out as a leader of the student initiative. My colleagues (Janaina Costa, Arsalan Safari, Wiljeana Glover and Fernando Aleu) and I are pleased to announce our goals and strategies for the upcoming term. We narrowed the scope of our goals based on the valuable feedback we received through interactions with students and have focused our efforts in two main areas: outreach and networking opportunities for student members to industry and academic professionals, and supplemental training opportunities for students.
To these aims, we have a series of webinars related to practice and application areas suggested by students at ISERC 2013. Topics range from "what students need to know" when they enter the working world to sharing professional knowledge and advice with the next generation of engineering management professionals.
The student paper competition will remain dedicated to recognizing the outstanding academic work of our students. In addition to what we have done in the past, this year we are expanding the opportunities for recognition. For the 2014 competition, the SI committee will submit the winners’ work for publication in Industrial Engineer or Industrial Management magazines pending review by IIE staff.
These types of opportunities look great on a resume. We believe that participating in the 2014 student paper competition is a wonderful way for students to kick off professional or academic careers. Students can click on the "student" section of the SEMS website (www.iienet.org/SEMS) if interested in this or any other SEMS-SI activity. Spread the word about the 2014 competition, and we look forward to this and many other events for our SEMS students.
— Cecilia Martinez is assistant professor of engineering management at Clarkson University School of Business. If you are interested in collaborating, sharing student or local university news, or have questions, contact her at email@example.com.
For previous "SEMS Says" columns, visit the archived content page for Industrial Management.