Investigating Technology Implementation in Community Hospitals: A Resilience Engineering Approach

The increasing usage of cobot applications reshapes work environments and working conditions, requiring specific advancements in organizational practices for health and safety. Enterprises should shift from a technocentric risk management approach to considering cobot application as socio-technical systems, for which a resilience engineering approach is beneficial. This study presents an instantiation of the resilience analysis grid in cobot applications with the aim of measuring resilience potentials in terms of the four cornerstones of resilience engineering (respond, learn, monitor, and anticipate). The assessment has been provided via a questionnaire to 15 companies making use of cobot applications. Results revealed that companies mainly focus on the risk assessment of cobot applications with a traditional view of machine-centric safety, paying less attention to assessing contexts and process variables. This observation seems to arise mainly due to the lack of formally available safety methods or limited guidance from technical standards. Additionally, traditional industrial approaches to risk management lack monitoring of several risks that are essential for managing resilience, defined as the adaptive capacity of people, organizations, and human–machine systems. In addition, companies strongly rely on data from the cobot manufacturer for their safety assessment. The resilience analysis grid was confirmed as a valuable assessment tool for the participating companies to identify improvement areas and assess health and safety from a resilience engineering perspective.

ObjectiveThis study aimed to determine the potential cost-savings for implementing continuous vital sign monitoring in a hospital’s medical-surgical units.MethodsA cost-savings analysis was designed to calculate potential cost-savings for an average-sized U.S. community hospital (153 total beds) over a 1-year time horizon. Analysis parameters were extracted from national databases and previous studies that compared outcomes for patients receiving continuous vital sign monitoring (SpO2, HR, and RR) or standard of care (intermittent vital sign measurements) in medical-surgical units based on a targeted literature review. Clinical parameters and associated costs served as analysis inputs. The analysis outputs were costs and potential cost-savings using a 50% and 100% adoption rate of continuous monitoring technologies across the medical-surgical unit.ResultsPotential annual cost-savings for in-hospital medical-surgical stays were estimated at $3,414,709 (2022 USD) and $6,829,418 for a 50% and 100% adoption rate, respectively. The cost-savings for an adoption rate of 100% equated to a ∼14% reduction in the overall annual cost of medical-surgical unit stays for an average-sized hospital. The largest contribution to potential cost-savings came from patients that avoided serious adverse events that require transfer to the intensive care unit; this resulted in annual cost-savings from reduced average length of stay between $1,756,613 and $3,513,226 (50% and 100% adoption rate, respectively). Additional cost-savings can be attained from reductions in in-hospital cardiac arrest-associated hospitalizations and decreased rapid response team activation.ConclusionsOur findings demonstrate that there is the potential for cost-savings of over $6.8 million dollars per year in an average-sized US community hospital by improving patient outcomes through implementation of continuous monitoring technologies in medical-surgical units. Continuous vital sign monitoring technologies that increase patient mobility and facilitate recovery may further contribute to cost-savings and should be considered for economic analyses. Future research is needed to explore these health-related outcomes.

Duncan's article provides an insightful and comprehensive discussion of the nature, characteristics, and value of CHINs. CHINs would appear to provide great value to community efforts to improve the health status of their members. If the value is there, then why have so few CHIN efforts moved beyond the planning stages? According to Drazen and Staisor (1995), several factors interfere with CHIN development in a community: * The value has been difficult to quantify and has large externalities. The value often accrues more to the community than to the participating organizations. * Faced with the large capital requirements to establish a CHIN and unquantified benefits that have large externalities, organizations have been hesitant to redirect scarce capital and human resources to CHIN development. * Health care organizations are feeling competitive pressures that make it difficult for them to collaborate and to fund initiatives that benefit all rather than the organization differentially. * Organizations have difficulty resolving CHIN issues such as allocation of costs, data ownership, and governance structure. * Communities often lack a strong entity that can force collaboration and resolution of issues--for example, a strong, organized business coalition. CHIN DEVELOPMENT IN BOSTON Boston is such a community. The transformation of a community's culture and infrastructure to one that enables CHIN development can be a lengthy process. What can a community do in the interim to foster CHIN development and reduce the magnitude of the eventual task? One possibility is the pursuit of a strategy similar to the one currently underway in Boston--the creation of the Affiliated Health Information Networks of New England. The Affiliated Networks is sponsored by the Massachusetts Health Data Consortium (MHDC). MHDC is a not-for-profit organization dedicated to serving the needs of the community for health data collection and analysis. The Affiliated Networks Planning Committee is composed of the chief information officers (CIOs) of 21 managed care and provider organizations in the state. These organizations include academic medical centers, community hospitals, community health centers, HMOs, and insurance companies. The Planning Committee reports to a Governance Committee overseen by MHDC. The Governance Committee is composed of three provider and three payer representatives. The Planning Committee's charter is to initiate activities designed to: facilitate an effort to improve the state's healthcare information infrastructure by fostering the growth of a variety of health information in Massachusetts, building on systems already in place, while encouraging collaboration and standardization among those networks (MHDC 1994). To fulfill the charter, these activities should: * Address meaningful challenges faced by the participating organizations as they create their own health information * Leverage the power of numbers of organizations --that is, pursue initiatives where the collective pursuit of a challenge enhances the value of the solution or the ability to effect a solution * Address areas that the participating organizations do not view as a potential basis for competitive advantage * Not require the implementation of a specific technology or service. CHIN FOUNDATION INITIATIVES The Affiliated Networks have identified five joint initiatives: durable clinical data set, clinical data interchange standards, standardized provider dictionary, patient confidentiality, and electronic eligibility determination. Each initiative has a review board composed of members nominated by the participating organizations. DURABLE CLINICAL DATASET For any patient, there are a small number of clinical data elements that have long-term clinical utility--for example, allergies, chronic problems, and a precis of prior surgeries. …

Investigating the Perceptions and Expectations of Technology Implementation in Community Hospitals: A Thematic Analysis

A common ground between resilience engineering (RE) and European Foundation for Quality Management (EFQM) model is to address safety issues. However, the advent of RE may adversely become inefficient or may be regarded redundant if there is no clear uniqueness with RE. This study aims to achieve a clear distinction between the perspectives of RE and EFQM model to address safety issues, using a questionnaire‐based comparative approach, in a large hospital. The paper contributes to the scientific field by enabling the comparison using an integrated approach of fuzzy analytical hierarchy process (AHP), simulated annealing (SA), and clustering techniques. Fuzzy AHP provides assessment scores of RE and EFQM. The SA identifies the RE items having the least correlation with the EFQM ones. Finally, the identified RE items are categorized by k‐means clustering into a set of unique healthcare‐focused RE factors to help healthcare practitioners have a clear understanding of RE concepts and principles.

An increasing number of hospitals are implementing electronic medical records and other information technology (IT), and national policy is focused on fostering expansion of these systems. In September 2004, a 100-bed acute care hospital in a rural community was awarded a grant to implement and evaluate an integrated hospital IT system. The evaluation used qualitative and quantitative methods, including examining data on patient outcomes, conducting surveys of staff, and interviewing leaders and staff about the implementation process. In the end, the hospital suffered a number of setbacks during the implementation that could provide lessons to other hospitals. The hospital was hindered by a lack of clinical leadership, staff skepticism, turnover in the executive team, an overly aggressive schedule, and a vendor whose products were not ready on time. The IT implementation was associated with a large increase in patient care errors, including medication errors, procedure errors, and patient falls. These patient errors might have been averted if the launch of the IT system had been better planned and implemented. The experience of this hospital exemplifies difficulties that can be encountered when implementing IT systems. IT implementation must have unbending support from the top level of management, strong clinical leadership, a proactive internal marketing campaign, a timeline and implementation approach that allow for learning and change, and a good IT partner. Careful planning and thoughtful perseverance are required to ensure a successful IT implementation that benefits patients.

Both public and private hospitals in Tailand seek to improve and increase service sufficiency as well as opportunities in an increasingly competitive healthcare services market in Thailand. One of these strategies is to adopt new technology into various functions in the hospital. This research aims to study IT implementation in the hospital supply chain. A qualitative survey of 20 community hospitals in Thailand is conducted providing information on IT –enabled development in Information Management, Data Standardization, Inventory Management, Purchasing Process and Transportation Management. The results show that most of the hospitals with poor performance tend to lack of functions responsible for new information technology implementation. When IT is applied effectively, results show that it brings about performance gains in inventory, purchasing and transportation functions of the studied hospitals.

Segmental bone defects caused by trauma and disease represent a major clinical problem worldwide. Current treatment options are limited and often associated with poor outcomes and severe complications. Bone engineering is a promising alternative solution, but a number of technical challenges must be addressed to allow for effective and reproducible construction of segmental grafts that meet the size and geometrical requirements needed for individual patients and routine clinical applications. It is important to devise engineering strategies and standard operating procedures that make it possible to scale up the size of bone-engineered grafts, minimize process and product variability, and facilitate technology transfer and implementation. To address these issues, we have combined traditional and modular tissue engineering approaches in a strategy referred to as Segmental Additive Tissue Engineering (SATE). To demonstrate this approach, a digital reconstruction of a rabbit femoral defect was partitioned transversally to the longitudinal axis into segments (modules) with discoidal geometry and defined thickness to enable protocol standardization and effective tissue formation in vitro. Bone grafts corresponding to each segment were then engineered using biomimetic scaffolds seeded with human induced pluripotent stem cell-derived mesodermal progenitors (iPSC-MPs) and a novel perfusion bioreactor with universal design. The SATE strategy enables the effective and reproducible engineering of segmental bone grafts for personalized skeletal reconstruction, and will facilitate technology transfer and implementation of a tissue engineering approach to segmental bone defect therapy.

This paper reports research into the specification and implementation of an Information Technology (IT) Route Map for supply chain systems development and deployment. The purpose of the Map is to enable rapid design and implementation of IT solutions, capable of semi-automating business processes within manufacturing supply chains. The Map helps structure transition processes involved in 'identification of key business strategies and design of business processes' and 'choice of supply chain systems and supporting implementation techniques'. Common limitations of current Enterprise Resource Planning (ERP) systems are observed and incorporated as IT Route Map implications and constraints. Scope of investigation is targeted at Small-to Medium-sized Enterprises (SMEs) that employ Engineer-To-Order (ETO) and Make-To-Order (MTO) business processes. In the course of the research a 'Business Strategy Driven IT (BSDIT) System Concept' was conceived and examined. Part-evaluation of the applicability and capabilities of the IT Route Map has been carried out by conducting industrial survey and case study work.

In mid-March, many schools in the United States were forced to stop teaching in-person classes and switch to an online format due to the COVID-19 pandemic; as a result, teachers had to quickly implement new technologies and instructional strategies in the classroom. This rapid pandemic response especially affected teachers and students in Aviation Maintenance Technology (AMT) programs around the country as AMT instruction is inherently hands-on in nature. This study conducted semi-structured interviews with 20 FAA Part-147 AMT instructors and administrators from around the country in order to investigate the challenges they faced during the rapid pandemic response and the strategies and technologies they used to address them. In addition to the interview, all participants completed a survey that provided demographic information and expanded on some of the key interview topics. Thematic coding of the interviews and analysis of the data from the surveys was then conducted based on the Resilience Engineering Framework, resulting in the following themes categorizing the schools' responses to COVID: Preemptive Course Adaptation to Pandemic Disruption, Rapid School Response to Pandemic Disruption, Short-Term Course Adjustment to Pandemic Disruption, Long-Term Course Adjustment to Pandemic Disruption, and Challenges Faced by School Regarding Implementation of Course Adjustment. These themes effectively summarize the different phases of the response of the AMT schools to the sudden demands placed on them to adapt their hands-on curriculum to a virtual format. Ultimately, results from this study may help FAA and AMT administrators recognize the need for improved training and increased implementation of technology in the AMT curriculum to better prepare students and instructors in the event of future major disruptions.

Generally, obstructions in the completion string are removed with chemical and mechanical means, depending on their nature. When the nature of obstruction is obscure, the rules of thumb, best practices, and lessons learned from the past are consulted. During the coil tubing milling operations to mill the cement and plug post workover, obstructions were encountered above the sand screens restricting the wellbore accessibility and restoring the production. Instead of another work-over, a resilient engineering approach spanning different steps was adopted to overcome the obstruction. The best practices and the lessons learned in reviving the well are the subject of discussion in this paper. Numerous techniques were adopted during the intervention operation to identify and bypass the nature of damage present downhole to access the sand screen. CT cleanout runs were devised but remained inconclusive in overcoming the downhole obstructions. Therefore, wellbore diagnostic was performed using downhole camera, which increased the understanding of actual downhole challenges. Based on the wellbore diagnosis, certain best practices and lesson learned were applied in subsequent cleanout / milling operation that allowed access to the sand screens and enabled removal of detritus which was obstructing hydrocarbon flow from the sand screens. The downhole tools and fluid selection played pivotal role in increasing the effectiveness of applied best practices. A combination of through tubing wellbore diagnosis, cleanout, and milling applied with best field practices restored access to the wellbore's total depth (TD), re-establishing the well's flowing potential. Wellbore diagnosis provided visuals to enable better understanding of the actual conditions unaccounted for in the initial intervention operations. The presence of scale, ID reduction and sluggish material in front of screens required a customized intervention approach. Accordingly, cleanout and milling runs were devised with contingencies to tackle any unforeseen circumstances. Wellbore diagnosis, cleanout, and milling are not novel and are frequently deployed in well- intervention operations. Nevertheless, the result of two operations under the same conditions differ due to the technicalities involved. The application of best practices and lessons learned, when combined with wellbore diagnosis, played a key role in the success of this operation. This paper will highlight those tools and techniques to reach a wider audience and avoid similar issues. Moreover, areas of further improvement and novel means of achieving "more with less" shall also be discussed for continuous improvement of intervention operations.