Optimizing surgical instrumentation may contribute to value-based care, particularly in commonly performed procedures. We report our experience in implementing a perioperative efficiency program in 2 types of orthopedic surgery (primary total-knee arthroplasty, TKA, and total-hip arthroplasty, THA). A comparative before-and-after study with 2 participating surgeons, each performing both THA and TKA, was conducted. Our objective was to evaluate the effect of surgical tray optimization on operating and processing time, cost, and waste associated with preparation, delivery, and staging of sterile surgical instruments. The study was designed as a prospective quality improvement initiative with pre- and postimplementation operational measures and a provider satisfaction survey. A total of 96 procedures (38 preimplementation and 58 postimplementation) were assessed using time-stamped performance endpoints. The number and weight of trays and instruments processed were reduced substantially after the optimization intervention, particularly for TKA. Setup time was reduced by 23% (6 minutes, P = .01) for TKA procedures but did not differ for THA. The number of survey respondents was small, but satisfaction was high overall among personnel involved in implementation. Optimizing instrumentation trays for orthopedic procedures yielded reduction in processing time and cost. Future research should evaluate patient outcomes and incremental/additive impact on institutional quality measures.

Interactive health coaching significantly lowered BMI among participants through 3, 6, and 12 months of follow-up.

Punctuated equilibrium theory serves as a main tenet for describing how changes will continue to push the USA towards a cultural tipping point. This paper contends that leaders and managers can succeed only by understanding and respecting both cultures and calls for improved theory development and research to help find creative ways to advance the new culture without trampling the old.

Purpose – This paper aims to present a two-decade effort to improve team functioning and patient outcomes in inpatient stroke rehabilitation settings. Design/methodology/approach – The principal improvement effort was conducted over a nine-year period in 50 Veterans Administration Hospitals in the USA. A comprehensive team-based model was developed and tested in a series of empirical studies. A leadership development intervention was used to improve team functioning, and a follow-up cluster-randomized trial documented patient outcome improvements associated with the leadership training. Findings – Iterative team and leadership improvements are presented in summary form, and a set of practice-proven development observations are derived from the results. Details are also provided on the leadership training intervention that improved teamwork processes and resulted in improvements in patient outcomes that could be linked to the intervention itself. Research limitations/implications – The practice-proven development observations are connected to leadership development theory and applied in the form of suggestions to improve leadership development and teamwork in a broad array of medical treatment settings. Practical implications – This paper includes suggestions for leadership improvement in medical treatment settings using interdisciplinary teams to meet the customized needs of the patient populations they serve. Originality/value – The success of the team effectiveness model and the team-functioning domains provides a framework and best practice for other health care organizations seeking to improve teamwork effectiveness.

International trade in di erentiated goods, nancial crisis and the gravity equation Udo Broll, Julia Jauer Tax revenues and aging in ex-communist EU countries Review, Vol. 1 (15), No. 2, 2015: 3-21 DOI: 10.18559/ebr.2015Abstract : Organizational change poses significant challenges. Change itself is changing; evolving in ways that present new rules, new strategies for winning, and more and more dynamic complexity. This paper presents the principal drivers of change as stand-alone entities and later discusses their interaction effects. Organizational Life Cycle Change, types of change, capacity for learning, and the common causes of change failures are explored to establish an understanding of the proclaimed enormity of the change-failure issue and our difficulty in quantifying it. The paper concludes with suggestions that will help organizational change agents improve their success rates.