In the dynamic environment of increasing regulations, increasing patient demand, decentralization of budgets and enforcement of efficiency, small sized healthcare institutions in the Netherlands are having a difficult time. Although these service providers are usually capable of flexibly delivering healthcare, the investment and overhead for implementing and executing on required quality management standards like ISO 9001 is difficult. In this paper we construct a method for the implementation of an IT-enabled quality management system for small sized healthcare institutions, which is applied through case study. The case organisation provides intra- and extramural care for mentally handicapped persons and young adults with a psychiatric disorder. The quality management system implementation is based on 1) a lightweight IT infrastructure (based at a secure data centre and accessible through remote login) implying secure storage of patients' medical and personal information. Furthermore, the Deming (Deming, 1982) cycle enabled processes and protocols are 2) described in an e-handbook and prototyped via an open source process management system which supports the quality regulation demanded for providing care to patients. The case study supports the validity of our method and the fact that small sized healthcare institutions are able to execute their care while adhering to ISO 9001-like standards, with limited initial costs and relatively low cost of ownership
Abstract Background: Many countries in Europe have implemented managed competition and patient choice during the last decade. With the introduction of managed competition, health insurers also became an important stakeholder. They purchase services on behalf of their customers and are allowed to contract healthcare providers selectively. It has, therefore, become increasingly important to take one's insurance into account when choosing a provider. There is little evidence that patients make active choices in the way that policymakers assume they do. This research aims to investigate, firstly, the role of patients in choosing a healthcare provider at the point of referral, then the role of the GP and, finally, the influence of the health insurer/insurance policies within this process. Methods: We videotaped a series of everyday consultations between Dutch GPs and their patients during 2015 and 2016. In 117 of these consultations, with 28 GPs, the patient was referred to another healthcare provider. These consultations were coded by three observers using an observation protocol which assessed the role of the patient, GP, and the influence of the health insurer during the referral. Results: Patients were divided into three groups: patients with little or no input, patients with some input, and those with a lot of input. Just over half of the patients (56%) seemed to have some, or a lot of, input into the choice of a healthcare provider at the point of referral by their GP. In addition, in almost half of the consultations (47%), GPs inquired about their patients' preferences regarding a healthcare provider. Topics regarding the health insurance or insurance policy of a patient were rarely (14%) discussed at the point of referral. Conclusions: Just over half of the patients appear to have some, or a lot of, input into their choice of a healthcare provider at the point of referral by their GP. However, the remainder of the patients had little or no input. If more patient choice continues to be an important aim for policy makers, patients should be encouraged to actively choose the healthcare provider who best fits their needs and preferences.
English: This living lab aims to support the creation, development and implementation of next generation concepts for sustainable healthcare logistics, with special attention for last mile solutions. Dutch healthcare providers are on the verge of a transition towards (more) sustainable business models, spurred by e.g., increasing healthcare costs, ongoing budget cuts, tight labor market conditions and increasing ecological awareness. Consequently, healthcare providers need to improve and innovate their business model and underlying logistics concept(s). Simultaneously, many cities are struggling with congestion in traffic, air quality and liveability in general. This calls for Last Mile Logistics (LML) concepts that can address challenges like effective and efficient resource planning, scheduling and utilization and, particularly, sustainability goals. LML can reduce environmental and social impact by decreasing emissions, congestion and pollution through effectively consolidating in-flows of goods and providing innovative solutions for care, wellbeing and related services. The research and initiatives in the living lab will address the following challenges: reducing the ecological footprint, reducing (healthcare-related) costs, improving service quality, decreasing loneliness of frail citizens and improving the livability of urban areas (reducing congestion and emissions). Given the scarcity and fragmentation of knowledge on healthcare logistics in organizations the living lab will also act as a learning community for (future) healthcare- and logistics professionals, thereby supporting the development of human capital. By working closely with related stakeholders and using a transdisciplinary research approach it is ensured that the developed knowledge and solutions deliver a contribution to societal challenges and have sound business potential.
English: This living lab aims to support the creation, development and implementation of next generation concepts for sustainable healthcare logistics, with special attention for last mile solutions. Dutch healthcare providers are on the verge of a transition towards (more) sustainable business models, spurred by e.g., increasing healthcare costs, ongoing budget cuts, tight labor market conditions and increasing ecological awareness. Consequently, healthcare providers need to improve and innovate their business model and underlying logistics concept(s). Simultaneously, many cities are struggling with congestion in traffic, air quality and liveability in general. This calls for Last Mile Logistics (LML) concepts that can address challenges like effective and efficient resource planning, scheduling and utilization and, particularly, sustainability goals. LML can reduce environmental and social impact by decreasing emissions, congestion and pollution through effectively consolidating in-flows of goods and providing innovative solutions for care, wellbeing and related services. The research and initiatives in the living lab will address the following challenges: reducing the ecological footprint, reducing (healthcare-related) costs, improving service quality, decreasing loneliness of frail citizens and improving the livability of urban areas (reducing congestion and emissions). Given the scarcity and fragmentation of knowledge on healthcare logistics in organizations the living lab will also act as a learning community for (future) healthcare- and logistics professionals, thereby supporting the development of human capital. By working closely with related stakeholders and using a transdisciplinary research approach it is ensured that the developed knowledge and solutions deliver a contribution to societal challenges and have sound business potential.
