Major Barrier For Implementation Research Articles

Overview of e-Health projects in The Netherlands: Barriers to implementation

Purpose eHealth projects in the Netherlands have various backgrounds. First, the number of persons aged 65 and over will have increased by 400,000 between 2008 and 20131. Over the same period, the potential workforce will have decreased from 4.2 persons at present to 3.6 persons for each 65 plus. Second, there is a shift from institutional care to care provided at home. The Dutch government promotes healthy behaviour and emphasises the importance of disease prevention2. People prefer to continue living in the community, even when their health is declining. Finally, Dutch policies stimulate the use of e-health in order to (i) support ageing-in-place (AiP), (ii) to enhance the quality of life of older adults, and (iii) to reduce the workload of professional carers. Method Vilans’ Centre of Excellence for Long-Term Care3 database of 85 projects was analyzed. The projects included in the database date from 2004 and after. Some of these projects have been completed and terminated; other projects are still ongoing. Although the database includes the majority of the projects, a complete coverage of all projects in The Netherlands is not guaranteed. To analyse the barriers, all projects were sorted according to one type of e-Health project (videoconferencing, activity monitoring, other types). In this study, basic, functional and economic values from the Model of Integrated Building Design4 were considered as relevant stakeholder values deemed necessary for a successful implementation. Results & Discussion Most projects in the database use e-Health for the support of older adults with (48 projects) or without (35 projects) care needs. In addition, dementia (19 projects), COPD and diabetes (both 11 projects) are the three health conditions that e-Health applications are most often used for. A major barrier for implementation is that only 11 out the 85 projects have a social business case. Another barrier is that requirements to building construction, building systems, e-Health applications or (building) services are hardly ever considered in the projects that also aim to support ageing-in-place. There are many stakeholders involved in the e-Health projects, and not all of the needs of these stakeholders are met in the design and implementation of the accompanying technologies. The execution of these projects seems to consist merely of an analysis of the technological applications with emphasis on the needs of the care recipient and other primary users. To date, e-Health projects in The Netherlands have not been fully implemented5. As well as a failure to include stakeholder needs and accounting for potential barriers, another reason may be that use of e-Health in care will imply innovating care protocols. Care provision shifting from a medical disease oriented model towards a care and wellbeing model. A structural exchange of knowledge and experience in functionalities and user needs will be necessary to take away barriers to a large-scale and successful implementation of e-Health in The Netherlands.

The effect of transhipment costs on the performance of intermodal line-trains

Intermodal line-trains with intermediate stops between start and end terminals are regularly advocated by intermodal transport researchers as a means to compete with all-road transport on small volumes and short distance markets. A prerequisite for line-trains are innovative transhipment technologies facilitating fast and efficient transhipments, which is likely to increase the terminal costs. The major implementation barrier of line-trains is the uncertainty regarding costs of these innovative terminals and their network benefits. The purpose of this article is to analyse the effect of terminal costs on the network performance of intermodal line-trains. The paper is based on a case study, which assesses the potential modal share for an intermodal line-train on a corridor in Sweden. The results confirm that in theory intermodal line-trains can provide competitive services on short and medium transport distances in case transhipment costs are kept low. Naturally, lower transhipment costs reduce the production costs, but of even greater importance is the ability to achieve higher load factors, which decreases the door-to-door transport costs per load unit. This opens business opportunities for operators and cost-saving potential for shippers in a market segment, which is dominated by road transport.

Under the knife: a national survey of six sigma programs in US healthcare organizations

Medical and policy literature reports many six sigma applications at specific healthcare organizations. However, there is a lack of studies that investigate the broader status of six sigma in US healthcare systems. The purpose of this paper is to present the results from a national survey of six sigma programs in US healthcare organizations. Through the design, distribution, and analysis of a nationwide survey, this paper assesses the implementation of six sigma in healthcare facilities. Two sets of surveys were designed based on whether an organization has adopted six sigma or not. Findings from this paper indicate the common six sigma projects implemented in healthcare organizations, typical implementation durations, cost benefits, and major barriers in implementation, and so on. This paper is limited by the low-response rate owing to time and budget constraints. Through the dissemination of this paper, it is hoped that more organizations will become interested in this subject and participate in future studies. This work is the first study to investigate the implementation status of six sigma in US healthcare systems. It will share experiences amongst six sigma institutions and promote its application in many institutions. The findings will provide instructive information to six sigma practitioners and researchers, and particularly to health care management.

Microcomputer usage in disaster preparedness and response

Microcomputers are being implemented in state and local emergency manage ment agencies. This paper summarizes field data gathered in five states (Flor ida, Louisiana, Pennsylvania, South Carolina and Virginia), and sixteen local jurisdictions within them, regarding the patterns of implementation for disas ter preparedness. Major implementation barriers, changes in use patterns, and organizational impacts are discussed. Primary uses during several actual dis aster responses are described as well as important uses and adaptations made after the disaster response.