Provider's Point Research Articles

Cost-benefit analysis of Intensive Care Unit with Activity-Based Costing approach in the era COVID-19 pandemic: A case study from Iran.

Providing intensive care to acute patients is a vital part of health systems. However, the high cost of Intensive Care Units (ICU) has limited their development, especially in low-income countries. Due to the increasing need for intensive care and limited resources, ICU cost management is important. This study aimed to analyze the cost-benefit of ICU during COVID-19 in Tehran, Iran. This cross-sectional study is an economic evaluation of health interventions. The study was conducted in the COVID-19 dedicated ICU, from the provider's point of view and within one-year horizon. Costs were calculated using a top-down approach and the Activity-Based Costing technique. Benefits were extracted from the hospital's HIS system. Benefit Cost ratio (BCR) and Net Present Value (NPV) indexes were used for cost-benefit analysis (CBA). A sensitivity analysis was performed to evaluate the dependence of the CBA results on the uncertainties in the cost data. Analysis was performed with Excel and STATA software. The studied ICU had 43 personnel, 14 active beds, a 77% bed occupancy rate, and 3959 occupied bed days. The total costs were $2,372,125.46 USD, of which 70.3% were direct costs. The highest direct cost was related to human resources. The total net income was $1,213,314.13 USD. NPV and BCR were obtained as $-1,158,811.32 USD and 0.511 respectively. Despite operating with a relatively high capacity, ICU has had high losses during the COVID-19. Proper management and re-planning in the structure of human resources is recommended due to its importance in the hospital economy, provision of resources based on needs assessment, improvement of drugs management, reduction of insurance deductions in order to reduce costs and improve ICU productivity.

Website Evaluation of DISPERDAG Section of the Average Price of Standard Needs Using the WEBQUAL 4.0 Method

DISPERDAG of Madiun City is one of the organizations that has utilized technology. The community can easily access and get price updates for basic necessities at Pasar Besar City of Madiun. The Internet helps support strong governance management, which benefits its effectiveness. Its functions include making it easier to get information, access public services, communicate with the public, and others. DISPERDAG aims to continue to provide quality services. The quality of services provided to the public must complement the implementation of website-based services so that the public continues to use SISKAPERBAPO services. To provide the best service to users, government institutions should prioritize service quality. Therefore, the success of the service quality of the SISKAPERBAPO website has not been known as long as the website is implemented. This is because there has never been an evaluation of website quality based on user satisfaction. It goes without saying that a website that is useful for assisting users in obtaining information must maintain quality in terms of information delivery and user interaction. Good service quality is offered from the user's point of view as well as the service provider's point of view.

Tính toán chi phí đầy đủ của gói tầm soát ung thư đường tiêu hóa tại bệnh viện đa khoa Phương Đông năm 2020

Objective: This study aims to "Calculate the full cost of the screening package for gastrointestinal cancer by 2020 at Oriental General Hospital". Method: Estimate the full cost from the service provider's point of view. The costs taken into account include the cost of depreciation of builidings and infratructure; equipment depreciation costs; personel costs; drugs cost, consumable supplies and chemicals; regular maintenancee cost; electricity and water costs, environmental sanitation, laundry, waste treatment and other recurrent expenses. Costs are divided into direct and indirect costs. The direct cost is calculated by aggregating the manpower cost; expenses for drugs, consumable supplies and chemicals; depreciation costs for direct infrastructure and equipment; direct recurrent costs of package execution procedures. Indirect costs include costs from indirect departments / departments that cannot directly allocate costs to activities using the appropriate allocation criteria for package delivery procedures. Results: The cost of the gastrointestinal cancer screening package is VND 2,463,917. The direct cost is l,693,946 VND (68.75%), of which the largest cost is the drugs cost, consumables (VTH), chemicals is 543,578 VND. Indirect costs are 769,971 VND (31.25%), of which the largest cost is salary, bonus, indirect departmental allowances is 486,906 VND. Conclusion: This study provides important evidence for hospital administrators to make appropriate, effective and timely business decisions, in order to develop reasonable incentive and promotional policies for the business of examination packages; and to develop strategies to well control the cost incurred but constantly improve service quality in order to creating competitive advantages with other hospitals in the region. Keywords: Cost, cost accounting, gastrointestinal cancer screening, Oriental Hospital.

Planning Strategy Spatial Plan for the Province of Central Kalimantan

The background of this research is that since the stipulation of Regional Regulation Number 5 of 2015 concerning the RTRW of Central Kalimantan Province until now the implementation has not been as expected, this can be seen through the problems that occur starting from the determination of the area into an office area, settlement and for investment purposes in the construction stage in the forest area. Meanwhile, the purpose of this study is to analyze and find out the RTRW planning for Central Kalimantan Province which has not yet been optimally implemented, analyze and find out the inhibiting factors for Central Kalimantan Provincial RTRW planning and formulate the Central Kalimantan Provincial RTRW planning strategy. The focus of this research is to analyze the RTRW planning strategy of Central Kalimantan Province, and to formulate the RTRW planning strategy used by Central Kalimantan Province. This research uses qualitative research with descriptive method. The results show that there are two things that affect the regional spatial planning process, namely First, micro factors related to development both from the manager's point of view and from the provider's point of view, including technical, managerial management), Financial (finance), Economics, Environmental impact, Social and security. Second, macro factors, namely the government's problem to see the relationship between projects and government programs as a whole, which consists of the suitability of the location and regional economic development strategies. Third, Central Kalimantan the provincial RTRW planning strategy uses ASOCA's Internal and External Factors Strategy Analysis which results in other Agility to produce a more optimal RTRW planning strategy through the ASC Rahma Strategy. ASC Rahma's strategy is through a synoptic planning approach which consists of the first synoptic planning, procurement of forest areas based on the outline of regional needs, the second synoptic planning, encouraging RDTR to be immediately established as an operational implementation of investment activities on a micro scale, the third synoptic planning, supervising preparation of the RTRW so that it can be accepted by the community. All stakeholders, and the fourth synoptic planner, ensures that the RTRW planning does not experience difficulties in its implementation in the field.

Cloud Resource Scaling for Time-Bounded and Unbounded Big Data Streaming Applications

Recent advancements in technology have led to a deluge of big data streams that require real-time analysis with strict latency constraints. A major challenge, however, is determining the amount of resources required by applications processing these streams given their high volume, velocity and variety. The majority of research efforts on resource scaling in the cloud are investigated from the cloud provider's perspective with little consideration for multiple resource bottlenecks. We aim at analyzing the resource scaling problem from an application provider's point of view such that efficient scaling decisions can be made. This paper provides two contributions to the study of resource scaling for big data streaming applications in the cloud. First, we present a Layered Multi-dimensional Hidden Markov Model (LMD-HMM) for managing time-bounded streaming applications. Second, to cater to unbounded streaming applications, we propose a framework based on a Layered Multi-dimensional Hidden Semi-Markov Model (LMD-HSMM). The parameters in our models are evaluated using modified Forward and Backward algorithms. Our detailed experimental evaluation results show that LMD-HMM is very effective with respect to cloud resource prediction for bounded streaming applications running for shorter periods while the LMD-HSMM accurately predicts the resource usage for streaming applications running for longer periods.

Management of uncertainty in the diagnosis communication of psychogenic nonepileptic seizures in a South African context

The process of communicating a diagnosis of psychogenic nonepileptic seizures (PNES) is an integral part of the treatment process. Many international studies have therefore focused on the PNES diagnosis communication process, but to date, none with a specific focus on the South African context. This current study considered the factors that influence the patient's experience of uncertainty and the strategies employed to manage that uncertainty within the provider–patient communication. This was considered from the healthcare provider's point of view, within the specific context of diagnosis communication. We conducted 13 semi-structured interviews with providers, eliciting their perceptions related to the communication of a PNES diagnosis to patients. Data were analyzed using thematic analysis, and themes were grouped according to the main tenets of the interpersonal health communication theory of uncertainty management, which included, the experience, appraisal, and management of uncertainty.The results revealed medical, personal, and social forms of uncertainty. The social sources of uncertainty, which include challenges related to the South African healthcare system, cultural, and language variability within the South African context, as well as possible stigmatization, seemed to have the biggest influence not only on the other areas of uncertainty, but was also indicated as a barrier to effective uncertainty management by providers.Providers in this study identified the importance of building the provider–patient relationship and ensuring patient understanding, as the main strategies used to reduce uncertainty. There was some evidence to suggest varied emotional appraisals of uncertainty by patients, but because of the subjective nature of this information, further research would be needed to confirm these findings.These findings suggest that as providers, one cannot apply a one-size-fits-all approach when aiding in uncertainty management. Furthermore, it is pertinent to remain cognizant of the social realities of the South African context and its impact on the patient's uncertainty experience. More research is needed to understand patients' perceptions of uncertainty management within the context of PNES diagnosis communication, and how they align with the perceptions of the providers provided here.

The Effects of Discrete Work Shifts on a Nonterminating Service System.

Hospital emergency departments (EDs) provide around-the-clock medical care, and as such are generally modeled as nonterminating queues. However, from the care provider's point of view, ED care is not a never-ending process, but rather occurs in discrete work shifts and may require passing unfinished work to the next care provider at the end of the shift. We use data from a large, academic medical center ED to show that the patients' rate of service completion varies over the course of the physician shift. Further, patients that have experienced a physician handoff have a higher rate of service completion than non-handed off patients. As a result, a patient's expected treatment time is impacted by when in the physician's shift treatment begins. We also show that patients that have been handed off are more likely to revisit the ED within three days, suggesting that patient handoffs lower clinical quality. Lastly, we use simulation to show that shift length and new-patient cutoff rules can be used to reduce handoffs, but at the expense of system throughput.

The Medical Care of the Elderly from the Care Provider's Point of View

The aging of the population presents modern Western society with a variety of different challenges, especially in the areas of health and medicine. On the one hand, there is the demand of the elderly patients to receive medical treatments that are supposed to improve or preserve the existing quality of life and to prevent the extension of a life without quality, with suffering and pain. On the other hand, aging is accompanied by the appearance and exacerbation of chronic illnesses, reduces the treatment benefits of medical activities and increases the risks of irreversible physical dependence. Furthermore, the lack of consensus among the physicians regarding the willingness of treatment and the proper timing of the treatment of the elderly – pose questions about the quality of the treatment for the elderly. Thus, in the opinion of different care-providers and in comparison to other age groups in modern Western society, the elderly do not enjoy the treatment advantages of medical activities proven in the treatment of other age groups in society.

Rethinking Healthcare Performance Evaluation Systems towards the People-Centredness Approach: Their Pathways, their Experience, their Evaluation.

Patient experience should be the starting point to achieve a high quality of care. Coherently, healthcare performance evaluation systems, driving the change in line with the main strategic goals, should be designed considering the patient perspective. Instead, they are traditionally defined according to the healthcare service provider's point of view. Consequently, they reproduce a "silo-vision" characterized by a clear separation of responsibilities limited to a specific setting of care or to a single organization. This commentary discusses the importance of using patient-reported measures together with indicators based on administrative data to evaluate cross-setting healthcare services within a multidimensional healthcare performance evaluation system. The experience of the Tuscany regional healthcare Performance Measurement System (PMS), implemented more than 10 years ago and in continuous evolution, represents an innovative example of how to measure the quality of the whole care pathway including patient experience. This new approach is based on a systematic, systemic and standardized collection of patient-reported experience measures in several healthcare pathways and evaluating them using a coherent graphical representation. Targets, incentives and other managerial tools are fixed, overcoming organizational boundaries and integrating the patient point of view with the goal of moving the healthcare system towards a patient-centredness approach to care.

Telemonitoring in IVF/ICSI.

Traditionally, ovarian stimulation for IVF/intracytoplasmic sperm injection is performed by healthcare professionals, requiring the patient to make frequent visits to these centres. We describe the rationale, research findings and early clinical experience with home-based sonography for IVF patients. Published experience indicates that selected patients are able to procure video sequences themselves; they value the empowerment, discretion and decreased stress involved in these visits; partner involvement increases as well. Experience is still limited but consistently indicate patients' willingness and competence to procure sonograms; home sonography is positive from the patients' perspective but may be disruptive form the healthcare provider's point of view.

Parent-provider relationship in home visiting interventions

Home visiting, while a very popular method of early childhood intervention, is not effective for all eligible at-risk families. The relationship between the home visitor and the family is central to the success of this type of intervention. This study aims to investigate, through 1024 home visit case notes from a French home visiting program, the ways in which the home visitor-family relationship develops, and identify the obstacles to and facilitators of a good quality relationship from the provider's point of vue. Results from a qualitative analysis suggest that the factors associated to the quality of relationship are present within the very first moments of the intervention. Poor relationship quality was found to be significantly associated with the family's mistrust towards the home visitor and with poor social conditions that make the supporting relationship difficult to develop. Good relationship quality was found to be facilitated by the parents' high involvement in the intervention and associated with a feeling of isolation and an ability to form social bonds. The necessitation for home visitor training is discussed, together with a reflection on the risk of home visiting programs to increase social inequalities, when they are not flexible enough to meet families' needs.

A framework for cloud forensics evidence collection and analysis using security information and event management

A primary feature of cloud computing is the provision of a variety of transparent services with efficient resource utilization. However, there are concerns with cloud computing in terms of the user's data privacy and security, especially in evidence collection for forensics analysis, because the tangible resources and hardware are out of reach for users who own the data. This paper presents a framework using security information and event management SIEM, to address the issue of efficient evidence collection for crime investigation, such as that for cloud forensics, with respect to the cloud service provider. Indeed, evidence could be shared with cloud users when required. SIEM can be considered as a major player in terms of evidence collection in a virtualized environment. The proposed mechanism using SIEM focuses on passive attacks and provides a solution from the cloud administrator or service provider's point of view. The proposed framework can help in performing detailed cloud forensics in terms of efficient evidence building for crime investigations. Copyright © 2016 John Wiley & Sons, Ltd.

Total quality management in organized retail shop from service providers ’point of view

Organized retail shops that do not provide quality service, will not only be out of competition but also ultimately cease to exist. Fierce competition, shrinking market share, spiraling costs and rapid change are causing many executives to reassess critically the manner in which they operate and manage their organized retail shops. Quality management is recognized as the foundation of business competitiveness and it is proactively integrated with all business practices. Adoption of TQM is not a quick fix approach to improving management and productivity. It requires a transition from outcome oriented systems to a continuous improvement approach to problem identification and resolution of organization processes. Organized Retail covers supermarkets, hyper-markets, and malls managed by professionals and they offer variety of services and products under one roof and they operate on self-service model. Total Quality Management in Organized Retail Shop is important to attract and retain customers and also to provide job satisfaction to the employees. This survey (questionnaire)-based study is an attempt to identify the important factors of Total Quality in Organized Retail Shop, the relative importance of these factors from service provider's point of view and evaluation of these factors for statistical significance.

Cost-Optimized Joint Resource Allocation in Grids/Clouds With Multilayer Optical Network Architecture

The requirements for large-scale computing, storage, and network capabilities by the business and scientific communities have led to the development of the grid/cloud network. Grid network users can access a shared set of resources for scientific computing tasks. Cloud tenants are offered IT infrastructure through infrastructure as a service. An efficient resource scheduling mechanism across the network, as a result, will improve the resource utilization and also reduce the capital cost of scheduling in the cloud significantly. In this paper, we focus on the joint resource (processor, storage, and network) allocation in the grid/cloud environment. The multilayer optical network architecture is introduced to guarantee the reservation of the network bandwidth resource. We investigate the bandwidth guaranteed joint resource scheduling from the cloud provider's point of view, which is completing the resource scheduling with minimal capital expenditure. The mixed integer linear programming (MILP) formulations and heuristics (best-fit and tabu search) are developed to solve our problems. The results show that both MILP and heuristics work well to solve the problem, and the heuristics are much more time-efficient. In addition, the tabu search method achieves the optimal resource allocation and also reaches a lower blocking rate compared to the best-fit method.

Customer activity in service

Purpose – Customer activity in service has mainly been understood within the boundaries of interactions with service providers. This paper goes beyond this view to focus on the customer's independent activity, of which interaction is only a part. Moreover, the concept of customer activity remains largely unexplored and undefined. Hence, the purpose of this paper is to develop the concept of customer activity and to show how it can be applied in an empirical study. Design/methodology/approach – The paper reviews the concept of customer activity in service marketing. It then goes on to characterise and operationalise the concept, and finally apply it to an explorative study. The study contrasts customer activity from the provider's interaction-centric point of view with customer activity from the customer's own point of view. Findings – This paper defines customer activities as discrete sequences of behaviour that aim at creating or supporting some types of value in the customer's life or business. A customer-dominant perspective on customer activity allows companies to understand the role of their service in the various activities of different types of customers. Originality/value – The paper contributes to service research by bringing attention to the concept of customer activity and contrasting it with alternative concepts. The paper is the first to show how customers combine different activities (where service interaction is only one type) into systems, which they maintain to create value for themselves. By profiling customers according to activity systems, providers can understand their own role in the customer's network of value-creating activities.

3PL factories or lernstatts? Value‐creation models for 3PL service providers

PurposeThe purpose of this paper is to identify and systematically discuss generic forms of contract logistics services and their distinct underlying approaches for fulfilling their respective value propositions. A general frame of reference is developed that addresses the value proposition, as well as the value creation architecture that leads to generic business model configurations for contract logistics services. The framework is built upon the basic notions of service theory, competence research and the resource based view.Design/methodology/approachThe paper combines service theory with work of organizational theory and develops an analytical framework based on conceptual considerations. First empirical results are additionally used to support and illustrate the key outcomes.FindingsCombining the dimensions of integration power and intangible knowledge creation, the authors are able to specify generic types of contract logistics services. Thereby the authors deducted for every type the distinct requirements for service fulfilment and present this in a specific frame of reference.Research limitations/implicationsThe illustrated empirical results are still limited due to a limited sample size for the interviews. Additional empirical work on the whole third party logistics (3PL) market is suggested.Practical implicationsThe paper provides generic types of 3PL services and a characterization of properties and architectures of respective business models. Combined with first empirical results, the paper's results offer insights for practitioners to rethink their value propositions and potentially redesign their service architectures.Originality/valueThe paper delivers a set of distinct business models for 3PL services reflecting the customer's, as well as the service provider's point of view. It addresses specific aspects of the generation/production of required services that are so far mostly neglected.

Value networks in cloud computing

PurposeThe purpose of this paper is to examine value networks in cloud computing. It demonstrates the kinds of value offered by such networks to firms within a given network, and considers how and why the network may change over time.Design/methodology/approachThe paper reports on a longitudinal case study, including a total of seven semi‐structured open‐ended interviews, conducted with five informants from the case firm.FindingsIt was found that cooperation in value networks provides not merely financial benefits, but also knowledge, among other intangible benefits. Value networks should be evaluated as a whole, since there may be indirect connections – i.e. the value comes not directly from customers, but through the partners in the network. The study also shows the dynamic nature of value networks, as illustrated by changes in a network that were based on transformations in the market environment, and on product development.Originality/valueThis paper contributes to an understanding of value networks and their dynamics, and of cloud computing. In addition, the paper looks at a value network in cloud computing from the service provider's point of view – an aspect that has been neglected in previous studies.

The View from the Other Side [From the Editor

Last summer, my wife and I found ourselves spending a lot of time in physicians' offices and hospital outpatient facilities. These ranged from our local 36-bed rural community hospital to major internationally known medical centers. We were not there as clinical biomedical engineering researchers but as patients. In my case, much time was spent being connected to technology that we as biomedical engineers develop. Even more time was spent interacting with the bureaucracy of scheduling and paying for services, but that is another issue. Although I would not encourage anyone to become a patient if it isn't necessary, there are advantages for those of us who design and evaluate medical devices to experience them from the patient's rather than the developer's and provider's point of view.

Critical Issues Confronting the Blindness Field: Can Providers and Consumers Agree?

Recently, I was invited to speak to a gathering of providers about issues confronting the field of visual impairment and blindness from a consumer's perspective--a perspective that I believe is very different from my own views, even though I am blind myself. Although I am a in the field of blindness and visual impairment, I am visually impaired and therefore simultaneously hold the perspective of a and that of a consumer. In preparing my remarks, I decided to contrast and compare my observations of the critical issues based on my own point of view as a provider with my point of view as a blind person. The following views, which are adapted from that speech, are mine, but they also reflect what I have heard from other providers and blind consumers. I have done no surveys and conducted no research, although I asked the blind professionals working at the American Foundation for the Blind for their points of view. I have based my opinion on my observations and the reactions I have received to the talks I have given over the last 20 years on my views of the critical issues confronting our field. It should be noted that in this discussion of critical issues, I do not make reference to personal issues, such as service providers never make enough money; nor will I attempt to represent the views of people who have not yet undergone rehabilitation services, whose critical issues may be very different from the ones identified below. THE SERVICE PROVIDER'S POINT OF VIEW In no particular order, the following are my view of the five most critical issues affecting the field of visual impairment and blindness from the provider's point of view. Personnel shortages and encroaching outsiders We in the blindness field have always believed that direct services should be provided by specially trained personnel who know about the needs of visually impaired people and how to meet those needs. The field is experiencing a severe personnel shortage among orientation and mobility instructors, vision rehabilitation therapists, educators of students who are visually impaired, and low vision specialists. We are witnessing encroachment by outside professionals, such as occupational therapists and special educators, many of whom do not possess backgrounds in working with people who are blind or visually impaired. Should we fight them or welcome them? Should we offer them training and assistance or ignore them? By my use of the word encroachment, you might infer that I believe these outsiders are bad for our field. In fact, I believe it might be in our best interests to welcome and offer training to them. All of us, as stakeholders and supporters of the Medicare Low Vision Rehabilitation Demonstration Project, are striving to prove that our disciplines are well-suited for the rehabilitation of individuals with low vision and deserve Medicare funding. We should continue to support our university preparation programs and certification through the Academy for Certification of Vision Rehabilitation and Education Professionals. Through means such as these, the numbers of professionals serving visually impaired individuals will grow. Consumers who are blind generally do not view personnel shortages as one of the five major issues confronting the field of visual impairment and blindness. Some blind people would say, As long as a trainer is visually impaired, he or she is qualified. Others would object to the emphasis of the term professional in this context and feel that such titles are overrated. Thus, consumers in general, and perhaps naturally, are not as concerned with issues as we providers might be. Demographics Most prognosticators project a dramatic increase in the numbers of visually impaired people, especially among newborns and the older population. If providers are having trouble serving the current number of people who are visually impaired, how will we be able to serve greater numbers in the future? …

Valuing wireless data services solutions for corporate clients using real options

The paper deals with wireless data services and their importance in the enterprise world. Provisioning in difficult-to-reach areas of tall buildings is challenging. To extend coverage, operators deploy ad-hoc solutions that are usually costly. Four alternative deployment cases from both the corporate customer's as well as service provider's point of view are proposed and quantified using real options. The objective is to maximise revenue and reduce risk for operators while improve customer satisfaction levels within the budget constraints of the customer. Analysis suggests that savings due to improvements in productivity are much higher than revenues perceived by the service provider.