EHR downtime events pose patient safety hazards, and we highlight critical areas for downtime procedure improvement.

Purpose – Healthcare costs have increased considerably over the past decades around the world. Major contributors to this trend are expensive medical technologies. The purpose of this paper is to use a case study approach to understand how organizational and country level factors influence hospital investment behavior. Design/methodology/approach – The paper developed a conceptual framework based upon decision theory and institutional theory from which key questions were derived. The paper conducted semi-structured group interviews with relevant stakeholders in six hospitals located in five countries (Germany, India, Thailand, South Korea, USA). Findings – The paper found that the investment decisions of the interviewed hospitals are primarily affected by the healthcare system, the socio-economic and cultural context, and the organization's mission. Most of the interviewed hospitals consider multiple criteria in their decision-making framework and share similar organizational processes. Practical implications – The paper identified an international best practice approach to investment decision making at one of the hospitals. The other hospitals, despite being leading institutions in their respective countries, do not have sufficiently advanced and objective assessment approaches and would benefit from a more data-driven and systematic decision process. Originality/value – Prior research has documented that investment decisions at hospitals are driven by organizational factors. This paper shows how, in addition, country level factors – in particular healthcare system and cultural aspects – affect hospital decision-making behavior.

In systems engineering, verification activities evaluate the extent to which a system under development satisfies its requirements. In large systems engineering projects, multiple firms are involved in the system development, and hence verification activities must be coordinated. Self-interest impedes the implementation of verification strategies that are beneficial for all firms while encouraging each firm to choose a verification strategy beneficial to itself. Incentives for verification activities can motivate a single firm to adopt verification strategies beneficial to all firms in the project, but these incentives must be offered judiciously to minimize unnecessary expenditures and prevent the abuse of goodwill. In this paper, we use game theory to model a contractor-subcontractor scenario, in which the subcontractor provides a component to the contractor, who further integrates it into their system. Our model uses belief distributions to capture each firm’s epistemic uncertainty in their component’s state prior to verification, and we use multiscale decision theory to model interdependencies between the contractor and subcontractor’s design. We propose an incentive mechanism that aligns the verification strategies of the two firms and using our game-theoretic model, we identify those scenarios where the contractor benefits from incentivizing the subcontractor’s verification activities.

No abstract

Verification activities increase an engineering team’s confidence in its system design meeting system requirements, which in turn are derived from stakeholder needs. Conventional wisdom suggests that the system design should be verified frequently to minimize the cost of rework as the system design matures. However, this strategy is based more on experience of engineers than on a theoretical foundation. In this paper, we develop a belief-based model of verification of system design, using a single system requirement as an abstraction, to determine the conditions under which it is cost effective for an organization to verify frequently. We study the model for a broad set of growth rates in verification setup and rework costs. Our results show that verifying a system design frequently is not always an optimal verification strategy. Instead, it is only an optimal strategy when the costs of reworking a faulty design increase at a certain rate as the design matures.