Cost Management Strategies Research Articles

Intrapreneurship amongst unit nurse managers at public hospitals

AIM: To improve conceptual clarity of the term commonly used in business intrapreneurship”, as it has potential for application in the public health care facility.Background: Intrapreurship is a term commonly used in the business world. However, the term is poorly understood within the nursing fraternity, yet there is potential for application in health care facilities. The daunting challenges facing public care organizations call for incorporation of innovative initiatives embodied within intrapreneurial principles. Therefore, the intrapreneurial unit nurse managers as frontline runners in the delivery of health care services are well positioned to influence the accomplishment of positive health outcomes.Design: A concept analysis.Data sources: The meaning of intrapreneurship was searched from different sources inclusive of dictionaries and thesauri. Literature from a range of disciplines was explored to better understand the concept, this included; business economics, psychology, and public management. Similarities and differences with other similar concepts such as ‘entrepreneurship’ were also established. Other surrogate terms that are usually confused with intrapreneurship, were also isolated and defined so that more clarity on the concept of interest can surface.Review method: Walker and Avant’s methodology guided the concept analysisDiscussion of findings: Attributes which best define intrapreneurship include; innovation, creativity and risk taking. Created model, borderline and contrary cases brought clarity on the expected intrapreneurial behavior by a unit nurse manager. The antecedents of intrapreneurship were categorized into three aspects namely; the external environment, intra-organizational and the individual factors. Consequences of intrapreneurship include; new business venture, innovative initiatives leading to self- renewal. The empirical referents of an intrapreneurial organization include aspects such as; effective cost management strategies, positive response to change, application of new skills and client/employee satisfaction.

Bioinformatic investigation of the cost management strategies of five oral microbes.

Some amino acids are more energetically costly to synthesize de novo, therefore many microbes have evolved to regulate the metabolic expenditure of the cell and reduce the energy burden of extracellular unrecyclable proteins. Several oral bacterial species take up amino acids and peptides obtained from proteolysis of host proteins and hence do not rely only on de novo synthesis. The aim of this study was to investigate if five oral bacterial species implement cost management strategies to reduce the energy burden of extracellular unrecyclable proteins. Since the relative de novo amino acid synthesis costs are proportional to the masses of the amino acids, the energy costs of producing proteins were assessed by calculating the mean amino acid mass for each protein. For Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Prevotella intermedia and Streptococcus sanguinis, the outer membrane/extracellular proteins are made up of a much larger percentage of lower average mass amino acids whereas cytoplasmic proteins are made up of a larger proportion of higher average mass amino acid residues. These results are consistent with the five oral bacterial species employing energy-saving mechanisms in the production of extracellular unrecyclable proteins. Interestingly, the P. gingivalis and S. sanguinis genomes exhibited significantly lower predicted mean amino acid masses compared with those of the genomes of the other three species, suggesting that this may provide them with an energy advantage with respect to protein biosynthetic cost.

Successful implementation of a cost management strategy for an outpatient oncology infusion center.

e17533 Background: According to the US Census Bureau, almost 1 million Americans were underinsured in 2009. Oncology medications present financial difficulties for both patients and infusion center...

A haemophilia disease management programme targeting cost and utilization of specialty pharmaceuticals

The high cost of clotting factor concentrate (CFC) used to treat haemophilia and von Willebrand disease (VWD) attracts health plans' attention for cost management strategies such as disease management programmes (DMPs). In 2004, Indiana's high risk insurance health plan, the Indiana Comprehensive Health Insurance Association, in partnership with the Indiana Hemophilia and Thrombosis Center developed and implemented a DMP for beneficiaries with bleeding disorders. This report evaluates the effectiveness of the DMP 5years post implementation, with specific emphasis on the cost of CFC and other medical expenditures by severity of disease. A pre/post analysis was used. The main evaluation measures were total cost, total outpatient CFC IU dispensed and adjusted total outpatient CFC cost. Summary statistics and mean and median plots were calculated. Overall, 1000 non-parametric bootstrap replicates were created and percentile confidence limits for 95% confidence intervals (CI) are reported. Mean emergency department (ED) visits and mean and median duration of hospitalizations are also reported. The DMP was associated with a significant decrease in mean annualized total cost including decreased CFC utilization and cost in most years in the overall group, and specifically in patients with severe haemophilia. Patients with mild and moderate haemophilia contributed little to overall programme expenditures. This specialty health care provider-administered DMP exemplifies the success of targeted interventions developed and implemented through a health care facility expert in the disease state to curb the cost of specialty pharmaceuticals in conditions when their expenditures represent a significant portion of total annual costs of care.

Using All Patient Refined Diagnosis Related Group to Identify Cost-Management Targets

Background: Evaluate patterns in existing cost data for patients with respiratory illness managed in a large academic Pediatric Intensive Care Unit (PICU), with the goal to identify targets for potential cost-management strategies. Methods: Retrospective, observational study of patients admitted to a 34-bed multidisciplinary PICU from October 2011 to September 2012. Study design: Variable direct costs (VDC) for each All Patient Refined Diagnosis Related Group (APR DRG) were obtained from the Decision Support Group and detailed analysis was performed for top respiratory APR DRGs. Results: During the study period, 1,999 patients were admitted to the PICU equating to 17,053 PICU days. Medical critical care patients accounted for 54% of all admissions and 46% PICU days. The top 5 respiratory-related APR DRGs accounted for almost 45% of all PICU medical admissions. Non-asthma respiratory-related APR DRGs accounted for 23% of medical admission and 18% of medical PICU days. Of the total VDC for this subgroup, 54% and 20% was attributed to nursing and respiratory care respectively, with a significant minority (<10% ) on pharmacy and laboratory services. Further analysis of the VDC for respiratory care indicated one-third of all costs are incurred for pulmonary hygiene care, another third for delivery of bronchodilator therapy, and just 16.4% for mechanical ventilation. Conclusion: Analysis of VDC in context of APR DRG can indicate areas for potential cost management strategies. A high percentage of respiratory care costs accounted for pulmonary clearance interventions. This type of cost analysis may identify potential targets for cost-management interventions in various PICU populations.

Product Cost Management via the Kaizen Costing System: Perception of Accountants

Managing cost of production is at the heart of survival of present day corporations, as increased competition, uncertainty and risk present in the operating environment pose challenges for 21st century managers. This empirical paper examines product cost management strategies by adopting and implementing the Kaizen Costing System. The sample size of the study was 60 respondents comprising accountants distributed across product and service sector organisations in Anambra State, south-eastern Nigeria. Three hypotheseswere formulated and tested in the study. In addition to descriptive statistics, Mann-Whitney U, Kolmogorov-Smirnoff and Multivariate Analysis of Variance (MANOVA) were used in analyzing the primary data. The results ofthe data analysis showed that implementing a Kaizen Costing System would provide managers with strategies for reducing material procurement and usage costs, and also reduce labour utilization cost. Respondents also perceived a link between cost reduction strategies at the minimal batch production phase and the maximum batch production phase. Based on this, the study recommends that Nigerian manufacturing firms should adoptand implementthe Kaizen Costing System, this should however not be done in isolation as such a system would require corporate strategy overhaul and alignment, a kaizen culture was suggested as counterpart in the system implementation for incorporation at the strategic level.

Abstract 261: Predicting Inpatient Hospital Length of Stay for Acute Health Failure Patients

Background: Hospital length of stay (LOS) is a primary driver of costs of care for hospitalized Acute Health Failure (AHF). A predictive model of LOS associated with AHF hospitalized patients would be beneficial in identifying potential high risk patients that may benefit from more intensive interventions. Objective: To develop predictive models for the length of inpatient hospital stay based on information available upon admission for AHF. Methods: A retrospective study using the MarketScan Hospital Drug Database identified patients with an index admission event with an acute heart failure primary discharge diagnosis (ICD-9 code 428.XX) and diagnosis reference group (DRG),(DRG 127, 291,292 or 293) for hospital admissions between 2006 and 2010. Index hospitalization was identified as the first AHF admission with no admissions in the preceding 90 days. Patient demographics, admission source, hospital characteristics (total number of beds, teaching status, urban-rural), geographic location, Charlson Comorbidity Score (CCI) and select comorbidities were identified within the index admission and served as potential input variables to model the index admission LOS. Variable selection was informed by univariate negative binomial regression models and regression tree models. Final predictive models took the form of full and stepwise negative binomial regression models (predicting LOS) and logistic regression models to predict short (≤ 2 days, approximately 20th percentile) and long (≥8 days, approximately 80th percentile) LOS. Results: 23,629 distinct admissions were identified with mean LOS 5.5 days. The three strongest predictors of LOS in both the univariate models and the regression tree model were CCI score, nephropathy and cardiac dysrhythmia. The negative binomial model shows that comorbid cardiac dysrhythmias, anemia, nephropathy, thromboembolic disease, COPD and high CCI score were associated with increased LOS. For the logistic regression models predicting the probability of long LOS (concordance=67.3-67.5%), the most important variables were cardiac dysrhythmia, index year, and CCI score. For the logistic regression models predicting the probability of short LOS (concordance=66.3-66.5%), patients with cardiac dysrhythmia, anemia, increasing age and high CCI score were less likely to have LOS≤2 days. Conclusion: Across multiple modeling methods and different outcome variable definitions, it was consistently observed that AHF patients with comorbid cardiac dysrhythmia, nephropathy, anemia, higher CCI scores and older patients tended to have increased lengths of inpatient stay for their index hospitalization. Clinicians may use this information in identifying patients with higher risk of longer hospitalizations to optimize inpatient healthcare decisions and cost management strategies.

Obstructive Sleep Apnea and Health Benefits Purchasing: An Employer Perspective

Obstructive Sleep Apnea and Health Benefits Purchasing: An Employer Perspective

GRP-015 An Overview of Hospital Pharmaceutical Expenditure in Greece Over the Last Two Years

BackgroundUnder the burden of the economic crisis in Greece, a series of cost containment measures for hospitals’ operating costs have been implemented, with the emphasis put on limiting the money...

Absorption of engineering knowledge in management – context of the cost leadership strtegy

In this study, the authors found it appropriate to demonstrate the role, place and importance of engineering knowledge in the management practice of managing with a manufacturing plant, considering these issues from the perspective of the cost leadership strategy. When elaborating on engineering knowledge, special attention here should be paid to the development and analysis of the quality of products, based on a study of customer expectations, and to express these expectations by defining the relevant parameters of quality and technology. Taking up the discussion on the issues of organizational learning, the authors formulated the hypothesis corresponding to the adopted goals of this development: The cost leadershipstrategy, which is the result of the organization learning process is an important factor affecting the growth of the implemented product. Therefore, managing with managerial- -engineering knowledge is a key factor in engineering management strategy, including the cost management strategies.

Cost Management in Project Alliancing: An Exploratory Investigation

This study aims to explore cost management strategies and supporting techniques used in project alliancing. Survey results show that cost management in project alliancing has most features of target costing. More importantly, it was found that cost management in project alliancing, supported by a sophisticated risk/reward arrangement, aligns contracting parties’ interests toward the achievement of owner’s project objectives and links contracting parties’ financial pain/gain with both cost and non-cost areas of performance.

Strategic Cost Management and Institutional Changes in Hospitals

Accounting research raises the concern that firms in the health care and defence contracting industries, when facing a dual payment system with both cost-based and fixed-rate payments, have an incentive to reallocate overhead costs through increasing inputs used in cost-based operations. However, prior literature reports contradictory empirical evidence regarding such real activity manipulation. Drawing on the institutional perspective, we hypothesise that firms' market power and interorganisational dependence affect their cost-management strategies and choice of overhead allocation in response to dual payment systems. Analysing the data of California hospitals from 1980 to 1991, we find that when facing a dual payment system, dominant (strong market position) hospitals adopt a cost-revenue-enhancing strategy, increasing direct costs for cost-based services without containing costs in fixed-rate services. In contrast, nondominant hospitals choose a cost-reduction strategy and improve operation efficiency on fixed-rate services. We also find that nondominant hospitals shift more overhead costs away from fixed-rate services to cost-based services by reclassifying the allocation bases across services; combining this cost shifting with the cost-reduction strategy, nondominant hospitals demonstrate the compliance with the regulation expectation of cost containment.

Using cloud computing to manage costs

AbstractThe growing availability of cloud computing provides opportunities to manage costs—by effectively outsourcing selected information technology (IT) functions. But like all other outsourcing decisions, you must conduct a careful analysis—to ensure that potential savings outweigh both costs and the risks of ceding control to an outside vendor. This article provides guidance for managers considering cloud computing as a cost management strategy. © 2012 Wiley Periodicals, Inc.

Taking the complexity out of managing the expense line—general and administrative (G&amp;amp;A) cost-management strategies for LNG and CSG projects

Cost management is often viewed as a financial issue, but the leading organisations are driving cost-management cultures across their whole businesses. In the world of complex LNG and CSG capital projects, it is those companies that avoid cost escalation and will outperform their competitors. In the early stages of a project, the G&amp;A expense line often gets disregarded as the focus is getting through FEED to FID and beyond. Experience shows that without rigorous processes and systems, G&amp;A costs can grow significantly, often without real transparency of the activity that is driving these costs and from where they are being driven. The lack of transparency in the burdening of G&amp;A costs can lead to an operator having to absorb tens of millions of dollars of un-budgeted expense or the non-op JV’s being burdened with higher costs. This extended abstract highlights some of the leading practices and examines some of the issues facing the LNG and CSG industry: Why do G&amp;A costs get out of control so quickly on major capital projects? What can be done to ensure there are processes and systems in place to support a no-loss, no-gain cost-management philosophy? What are the key enablers to building a cost culture? What key performance indicators can operators use to help manage G&amp;A costs during the major capital projects phase, to first gas and beyond?

Carbon Footprint Assessment of a Residential Development Project

Buildings account for roughly one third of all green house gas emissions globally. Identifying the sources of these emissions and understanding their relations to the construction phase is essential in climate change mitigation. This study evaluates the carbon emissions caused by a residential construction project in Finland. The research method is modified tiered hybrid life cycle assessment. The study shows that the carbon emissions of a 220 homes development project are around 60 000 tons of which 90 percent initiates from actual buildings and ten percent from the supporting infrastructure. The sources of the carbon emissions are divided into numerous categories without any single dominant category. Thus, reducing the emissions requires a holistic management approach, as there are no single dominant materials in terms of carbon emissions. Also, the costs were found to poorly correlate with the carbon emissions, which implies that the traditional cost management strategy used in project management cannot directly deal with carbon management challenge. In addition, the results indicate that because of the rapid and high carbon spike of construction, the construction phase emissions are much more significant regarding the climate change than their share of the buildings' life cycle emissions would suggest. The study also shows that a generic LCA data model can be used to roughly estimate the emissions of a development project, but that a more detailed project specific data is needed for more accurate results. The difference between a generic and a project specific model were calculated to be roughly 20 percent. The results of the study may be applied to the evaluations of similar construction projects. The research method may also be used in future research as well as in further development of hybrid LCA methods.

Cost-Containment and Cost-Management Strategies

1partner and president, Applied Management Systems, Inc., Burlington, Massachusetts 2senior vice president, COO, Norwood Hospital, Norwood, Massachusetts For more information on the concepts in this column, please contact Mr. Goldberg at [email protected]

Strategic Cost Management and Institutional Changes in Hospitals

Accounting research raises the concern that firms in the health care and defence contracting industries, when facing a dual payment system with both cost-based and fixed-rate payments, have an incentive to reallocate overhead costs through increasing inputs used in cost-based operations. However, prior literature reports contradictory empirical evidence regarding such real activity manipulation. Drawing on the institutional perspective, we hypothesise that firms’ market power and interorganisational dependence affect their cost-management strategies and choice of overhead allocation in response to dual payment systems. Analysing the data of California hospitals from 1980 to 1991, we find that when facing a dual payment system, dominant (strong market position) hospitals adopt a cost-revenue-enhancing strategy, increasing direct costs for cost-based services without containing costs in fixed-rate services. In contrast, nondominant hospitals choose a cost-reduction strategy and improve operation efficiency on fixed-rate services. We also find that nondominant hospitals shift more overhead costs away from fixed-rate services to cost-based services by reclassifying the allocation bases across services; combining this cost shifting with the cost-reduction strategy, nondominant hospitals demonstrate the compliance with the regulation expectation of cost containment.

Reaching customers at the base of the pyramid—a two‐stage business strategy

AbstractTwo‐thirds of the world's population make less than $2,000 a year. There is increasing attention paid to how private firms can play a role in improving the quality of life of people at the bottom of the economic pyramid in ways that are mutually beneficial. But despite the promise of mutual benefit, many firms have not been able to serve very poor customers profitably. In this article, we present a two‐stage business strategy that will help firms to serve customers at the base of the pyramid. We suggest that in the first stage, firms need a deep cost management strategy, involving a focus on core customer value, and holistic operations reengineering. In the second stage, we suggest that firms need to consider a deep benefit management strategy, involving value reengineering, partnering for excellence, and creating inclusive channels. We support our ideas with examples of successful and unsuccessful cases of firms that have tried to serve the poor. © 2010 Wiley Periodicals, Inc.

The simple modelling method for storm- and grey-water quality management applied to Alexandra settlement

Discharges from informal settlements cause numerous adverse water quality impacts on urban areas and on receiving waters. These problems reflect local conditions with respect to economic development, level of environmental protection (including theassociated infrastructure), institutional arrangements and public awareness. Development of comprehensive tools for selectionof drainage management interventions, even at planning levels, is still at its early stages in South Africa. Municipalities in South Africa face many challenges in identifying, assessing and selecting the right interventions and/or strategies to address the impacts of land use on receiving waters. A spreadsheet-based model was developed in this study specifically to assist in identifying, selecting and evaluating interventions to manage storm- and grey-water quality. The model also consists of modules: to quantify water quality management objectives (load reduction targets) of pollutants of concern, to formulate implementation strategies by combining different mixes of interventions at different levels of implementation, and to cost and select theoptimum management strategy. In the Alexandra settlement investigated, the identified interventions to achieve managementobjectives optimally consist of educational programmes, erosion and sediment control, street sweeping, removal of sanitation system overflows, impervious cover reduction, downspout disconnections, removal of illicit connections to storm drains, establishment of riparian buffers, use of rainwater tanks and exfiltration systems.

Variation in Resistance to Pyrethroids in &lt;I&gt;Helicoverpa armigera&lt;/I&gt; From Benin Republic, West Africa

Pyrethroid resistance in Helicoverpa armigera (Hübner) field populations was investigated in Benin over several years by using third- and fourth-instar larval topicalbioassays. H. armigera was resistant to pyrethroids tested as cypermethrin, deltamethrin, bifenthrin, and fenvalerate. Pretreatment with piperonyl butoxide significantly decreased the LD50 value of cypermethrin and deltamethrin, and the resistance suppression by this synergist effect was observed. No significant decrease in the LD50 value was obtained when S,S,S-tributyl phosphoro-trithioate was applied before deltamethrin. In the field, cypermethrin's LD50 value varied, and the highest LD50 values were observed during the rainy season, the cotton, Gossypium hirsutum L., crop period, when pyrethroids are extensively used. In the dry season when there was no cotton cultivation, the lowest LD50 values were obtained. However, reversion was never total in the field; resistance did not revert to the level we observed in the susceptible strain. In the laboratory, when field populations were reared in insecticide-free conditions, resistance decreased and total reversion was observed. Results are discussed with regard to insecticide resistance fitness cost and resistance management strategies.