International series in management science/operations research, Dec 23, 2018
Data Envelopment Analysis (DEA) is a non-parametric, optimisation-based benchmarking technique fi... more Data Envelopment Analysis (DEA) is a non-parametric, optimisation-based benchmarking technique first introduced by Charnes et al. (European Journal of Operational Research, 2(6), pp. 429–444, 1978), later extended by Banker et al. (Management Science 30(9), pp. 1078–1092, 1984), with many variations of DEA models proposed since. DEA measures the production efficiency of a so-called Decision Making Unit (DMU) which consumes inputs to produce outputs. DEA is a particularly useful tool when there are multiple measures to be analysed in terms of DMU (or organisation) performance, allowing it to benchmark and identify comparable peers. DEA can incorporate different measures of multi-dimensional activities thus allowing for DMU complexity and is particularly useful for more ingrained analyses when investigating the effects of contextual or environmental factors on organisations’ performance. DEA has been applied in numerous areas including banking, education, health, transport, justice, retail stores, auditing, fighter jet design, research and development to name a few.
International Journal of Pavement Research and Technology, 2021
Benchmarking has been adopted by private organisations in search of commercial efficiency gains a... more Benchmarking has been adopted by private organisations in search of commercial efficiency gains and public sector organisations in terms of efficiency, effectiveness and accountability. One such sector that has considerable potential to benefit from benchmarking is the transport sector. Focusing on the pavement management of road networks, this paper reviews a number of popular benchmarking techniques cited in the literature and undertakes a comparative analysis of their suitability with respect to a number of selection criteria. The audience for the paper is researchers and practitioners in pavement management and, consequently, the benchmarking techniques presented range from simple ratios or regression analyses to more complex frontier-based methods incorporating optimisation of weightings. Two of these frontier-based methods, Data Envelopment Analysis, a non-parametric data-orientated approach, and Stochastic Frontier Analysis, a parametric stochastic approach, are shown to be the most suitable for use in the pavement management sector. As the true level of efficiency is unknown in benchmarking, it is not possible to determine which technique is the best. Both have their advantages and disadvantages, however, we have stated a preference for Data Envelopment Analysis recognising that its non-parametric form offers a possible advantage in pavement management given the complexity and number of influencing variables.
Although “complexity” in health care is commonly associated with “tertiary” hospitals in many cou... more Although “complexity” in health care is commonly associated with “tertiary” hospitals in many countries, there is no accepted defini- tion of tertiariness or agreement on structural and funding arrange- ments. This paper attempts a conceptual analysis of complexity in tertiary hospitals in terms of clinical views, capability requirements and process-orientations. The main insight is that we need a de- mand- and process based concept of tertiariness because a supply- side concept is not operational. The paper also develops some ideas what such a demand-based concept would look like.
Purpose – Much health service delivery occurs within a network structure, with co-operation and c... more Purpose – Much health service delivery occurs within a network structure, with co-operation and competition coexisting. Leading change for successful outcomes is a difficult task even outside of this multi-layered complex context, with reports that up to two-thirds of change processes are unsuccessfully implemented. This can have a major impact on stress, effectiveness and efficiency. This paper aims to address these issues. Design/methodology/approach – Theories supporting a generic implementation system for managers were explored so that people placed into situations in which they needed to lead and manage change could access a systematic approach that enabled clarification of the network's goal(s), valid communication among members of the network, and performance measurement using indicators the network agrees are meaningful. Findings – The implementation pathway developed provides a change process leaders and managers of change can use within networks. Practical implications...
Meeting the needs of acute geriatric patients is often challenging, and although evidence shows t... more Meeting the needs of acute geriatric patients is often challenging, and although evidence shows that older patients need tailored care, it is still unclear which interventions are most appropriate. The objective of this study is to systematically evaluate the hospital-wide acute geriatric models compared with conventional pathways. The design of the study includes hospital-wide geriatric-specific models characterized by components including patient-centered care, frequent medical review, early rehabilitation, early discharge planning, prepared environment, and follow‐up after discharge. Primary and secondary outcomes were considered, including functional decline, activities of daily living (ADL), length-of-stay (LoS), discharge destination, mortality, costs, and readmission. A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A total of 20 studies reporting on 15 trials an...
This study aims to develop a performance evaluation system that can facilitate performance evalua... more This study aims to develop a performance evaluation system that can facilitate performance evaluation at region, hospital, and department levels to enable better cost management for sustainable development. A multi-level system of performance evaluation informs a hierarchical assessment of cost management from regions to hospitals to departments using diagnosis-related group (DRGs). Various metrics are developed employing the variances between targets and actuals where targets are determined from two perspectives: benchmarking using external regional prices and change management using internal data. Targets for the latter are statistically based and specifically incorporate variability. The model is applied to two hospitals, twenty departments, nine DRGs and 1071 inpatients. The analyses indicate that the approach can provide a practical evaluation tool that allows for particular characteristics at multiple levels. The system provides macro-micro and external-internal perspectives i...
INTRODUCTION Outreach Immunisation Services (OIS) enable children who have not been immunised on ... more INTRODUCTION Outreach Immunisation Services (OIS) enable children who have not been immunised on time at general practice to be immunised in the community, thereby improving immunisation coverage and reducing equity gaps. AIM To identify the most effective service delivery models and make recommendations for more effective and cost-efficient OIS delivery in New Zealand. METHODS Data collection and thematic analysis through a detailed review of OIS contracts and service specifications, an online survey and in-depth interviews with stakeholders and providers, and an analysis of cost data was conducted. RESULTS In total, 28 OIS providers completed survey questionnaires, 28 OIS staff were interviewed, and cost effectiveness data were obtained from 11 providers. The surveys and interviews identified key themes around identifying clients with the highest needs, effective engagement strategies, staffing requirements, and service challenges. On average, each OIS referral costs NZ$361 (media...
Journal of medical Internet research, Jan 13, 2018
Socially assistive robots are being developed for patients to help manage chronic health conditio... more Socially assistive robots are being developed for patients to help manage chronic health conditions such as chronic obstructive pulmonary disease (COPD). Adherence to medication and availability of rehabilitation are suboptimal in this patient group, which increases the risk of hospitalization. This pilot study aimed to investigate the effectiveness of a robot delivering telehealth care to increase adherence to medication and home rehabilitation, improve quality of life, and reduce hospital readmission compared with a standard care control group. At discharge from hospital for a COPD admission, 60 patients were randomized to receive a robot at home for 4 months or to a control group. Number of hospitalization days for respiratory admissions over the 4-month study period was the primary outcome. Medication adherence, frequency of rehabilitation exercise, and quality of life were also assessed. Implementation interviews as well as benefit-cost analysis were conducted. Intention-to-tre...
Supported Discharge Teams aim to help with the transition from hospital to home, whilst reducing ... more Supported Discharge Teams aim to help with the transition from hospital to home, whilst reducing hospital length-of-stay. Despite their obvious attraction, the evidence remains mixed, ranging from strong support for disease-specific interventions to less favourable results for generic services. To determine whether older people referred to a Supported Discharge Team have: (i) reduced length-of-stay in hospital; (ii) reduced risk of hospital readmission; and (iii) reduced healthcare costs. Randomised controlled trial with follow-up to 6 months; 103 older women and 80 men (n = 183) (mean age 79), in hospital, were randomised to receive either Supported Discharge Team or usual care. Home-based rehabilitation was delivered by trained Health Care Assistants up to four times a day, 7 days a week, under the guidance of registered nurses, allied health and geriatricians for up to 6 weeks. Participants randomised to the Supported Discharge Team spent less time in hospital during the index ad...
Radical prostatectomy is the most common treatment for localised prostate cancer in New Zealand. ... more Radical prostatectomy is the most common treatment for localised prostate cancer in New Zealand. Active surveillance was introduced to prevent overtreatment and reduce costs while preserving the option of radical prostatectomy. This study aims to evaluate the cost-effectiveness of active surveillance compared to watchful waiting and radical prostatectomy. Markov models were constructed to estimate the life-time cost-effectiveness of active surveillance compared to watchful waiting and radical prostatectomy for low risk localised prostate cancer patients aged 45-70 years, using national datasets in New Zealand and published studies including the SPCG-4 study. This study was from the perspective of the Ministry of Health in New Zealand. Radical prostatectomy is less costly than active surveillance in men aged 45-55 years with low risk localised prostate cancer, but more costly for men aged 60-70 years. Scenario analyses demonstrated significant uncertainty as to the most cost-effectiv...
International series in management science/operations research, Dec 23, 2018
Data Envelopment Analysis (DEA) is a non-parametric, optimisation-based benchmarking technique fi... more Data Envelopment Analysis (DEA) is a non-parametric, optimisation-based benchmarking technique first introduced by Charnes et al. (European Journal of Operational Research, 2(6), pp. 429–444, 1978), later extended by Banker et al. (Management Science 30(9), pp. 1078–1092, 1984), with many variations of DEA models proposed since. DEA measures the production efficiency of a so-called Decision Making Unit (DMU) which consumes inputs to produce outputs. DEA is a particularly useful tool when there are multiple measures to be analysed in terms of DMU (or organisation) performance, allowing it to benchmark and identify comparable peers. DEA can incorporate different measures of multi-dimensional activities thus allowing for DMU complexity and is particularly useful for more ingrained analyses when investigating the effects of contextual or environmental factors on organisations’ performance. DEA has been applied in numerous areas including banking, education, health, transport, justice, retail stores, auditing, fighter jet design, research and development to name a few.
International Journal of Pavement Research and Technology, 2021
Benchmarking has been adopted by private organisations in search of commercial efficiency gains a... more Benchmarking has been adopted by private organisations in search of commercial efficiency gains and public sector organisations in terms of efficiency, effectiveness and accountability. One such sector that has considerable potential to benefit from benchmarking is the transport sector. Focusing on the pavement management of road networks, this paper reviews a number of popular benchmarking techniques cited in the literature and undertakes a comparative analysis of their suitability with respect to a number of selection criteria. The audience for the paper is researchers and practitioners in pavement management and, consequently, the benchmarking techniques presented range from simple ratios or regression analyses to more complex frontier-based methods incorporating optimisation of weightings. Two of these frontier-based methods, Data Envelopment Analysis, a non-parametric data-orientated approach, and Stochastic Frontier Analysis, a parametric stochastic approach, are shown to be the most suitable for use in the pavement management sector. As the true level of efficiency is unknown in benchmarking, it is not possible to determine which technique is the best. Both have their advantages and disadvantages, however, we have stated a preference for Data Envelopment Analysis recognising that its non-parametric form offers a possible advantage in pavement management given the complexity and number of influencing variables.
Although “complexity” in health care is commonly associated with “tertiary” hospitals in many cou... more Although “complexity” in health care is commonly associated with “tertiary” hospitals in many countries, there is no accepted defini- tion of tertiariness or agreement on structural and funding arrange- ments. This paper attempts a conceptual analysis of complexity in tertiary hospitals in terms of clinical views, capability requirements and process-orientations. The main insight is that we need a de- mand- and process based concept of tertiariness because a supply- side concept is not operational. The paper also develops some ideas what such a demand-based concept would look like.
Purpose – Much health service delivery occurs within a network structure, with co-operation and c... more Purpose – Much health service delivery occurs within a network structure, with co-operation and competition coexisting. Leading change for successful outcomes is a difficult task even outside of this multi-layered complex context, with reports that up to two-thirds of change processes are unsuccessfully implemented. This can have a major impact on stress, effectiveness and efficiency. This paper aims to address these issues. Design/methodology/approach – Theories supporting a generic implementation system for managers were explored so that people placed into situations in which they needed to lead and manage change could access a systematic approach that enabled clarification of the network's goal(s), valid communication among members of the network, and performance measurement using indicators the network agrees are meaningful. Findings – The implementation pathway developed provides a change process leaders and managers of change can use within networks. Practical implications...
Meeting the needs of acute geriatric patients is often challenging, and although evidence shows t... more Meeting the needs of acute geriatric patients is often challenging, and although evidence shows that older patients need tailored care, it is still unclear which interventions are most appropriate. The objective of this study is to systematically evaluate the hospital-wide acute geriatric models compared with conventional pathways. The design of the study includes hospital-wide geriatric-specific models characterized by components including patient-centered care, frequent medical review, early rehabilitation, early discharge planning, prepared environment, and follow‐up after discharge. Primary and secondary outcomes were considered, including functional decline, activities of daily living (ADL), length-of-stay (LoS), discharge destination, mortality, costs, and readmission. A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A total of 20 studies reporting on 15 trials an...
This study aims to develop a performance evaluation system that can facilitate performance evalua... more This study aims to develop a performance evaluation system that can facilitate performance evaluation at region, hospital, and department levels to enable better cost management for sustainable development. A multi-level system of performance evaluation informs a hierarchical assessment of cost management from regions to hospitals to departments using diagnosis-related group (DRGs). Various metrics are developed employing the variances between targets and actuals where targets are determined from two perspectives: benchmarking using external regional prices and change management using internal data. Targets for the latter are statistically based and specifically incorporate variability. The model is applied to two hospitals, twenty departments, nine DRGs and 1071 inpatients. The analyses indicate that the approach can provide a practical evaluation tool that allows for particular characteristics at multiple levels. The system provides macro-micro and external-internal perspectives i...
INTRODUCTION Outreach Immunisation Services (OIS) enable children who have not been immunised on ... more INTRODUCTION Outreach Immunisation Services (OIS) enable children who have not been immunised on time at general practice to be immunised in the community, thereby improving immunisation coverage and reducing equity gaps. AIM To identify the most effective service delivery models and make recommendations for more effective and cost-efficient OIS delivery in New Zealand. METHODS Data collection and thematic analysis through a detailed review of OIS contracts and service specifications, an online survey and in-depth interviews with stakeholders and providers, and an analysis of cost data was conducted. RESULTS In total, 28 OIS providers completed survey questionnaires, 28 OIS staff were interviewed, and cost effectiveness data were obtained from 11 providers. The surveys and interviews identified key themes around identifying clients with the highest needs, effective engagement strategies, staffing requirements, and service challenges. On average, each OIS referral costs NZ$361 (media...
Journal of medical Internet research, Jan 13, 2018
Socially assistive robots are being developed for patients to help manage chronic health conditio... more Socially assistive robots are being developed for patients to help manage chronic health conditions such as chronic obstructive pulmonary disease (COPD). Adherence to medication and availability of rehabilitation are suboptimal in this patient group, which increases the risk of hospitalization. This pilot study aimed to investigate the effectiveness of a robot delivering telehealth care to increase adherence to medication and home rehabilitation, improve quality of life, and reduce hospital readmission compared with a standard care control group. At discharge from hospital for a COPD admission, 60 patients were randomized to receive a robot at home for 4 months or to a control group. Number of hospitalization days for respiratory admissions over the 4-month study period was the primary outcome. Medication adherence, frequency of rehabilitation exercise, and quality of life were also assessed. Implementation interviews as well as benefit-cost analysis were conducted. Intention-to-tre...
Supported Discharge Teams aim to help with the transition from hospital to home, whilst reducing ... more Supported Discharge Teams aim to help with the transition from hospital to home, whilst reducing hospital length-of-stay. Despite their obvious attraction, the evidence remains mixed, ranging from strong support for disease-specific interventions to less favourable results for generic services. To determine whether older people referred to a Supported Discharge Team have: (i) reduced length-of-stay in hospital; (ii) reduced risk of hospital readmission; and (iii) reduced healthcare costs. Randomised controlled trial with follow-up to 6 months; 103 older women and 80 men (n = 183) (mean age 79), in hospital, were randomised to receive either Supported Discharge Team or usual care. Home-based rehabilitation was delivered by trained Health Care Assistants up to four times a day, 7 days a week, under the guidance of registered nurses, allied health and geriatricians for up to 6 weeks. Participants randomised to the Supported Discharge Team spent less time in hospital during the index ad...
Radical prostatectomy is the most common treatment for localised prostate cancer in New Zealand. ... more Radical prostatectomy is the most common treatment for localised prostate cancer in New Zealand. Active surveillance was introduced to prevent overtreatment and reduce costs while preserving the option of radical prostatectomy. This study aims to evaluate the cost-effectiveness of active surveillance compared to watchful waiting and radical prostatectomy. Markov models were constructed to estimate the life-time cost-effectiveness of active surveillance compared to watchful waiting and radical prostatectomy for low risk localised prostate cancer patients aged 45-70 years, using national datasets in New Zealand and published studies including the SPCG-4 study. This study was from the perspective of the Ministry of Health in New Zealand. Radical prostatectomy is less costly than active surveillance in men aged 45-55 years with low risk localised prostate cancer, but more costly for men aged 60-70 years. Scenario analyses demonstrated significant uncertainty as to the most cost-effectiv...
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Papers by Paul Rouse