Strategic Response by Providers to Specialty Hospitals, Ambulatory Surgery Centers, and Retail Clinics

Burns, Lawton R.; David, Guy; Helmchen, Lorens A.

doi:10.1089/pop.2010.0021

Cited by 14 publications

(9 citation statements)

References 29 publications

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“…13,33,35,36 Thus, a hybrid model has the potential to decrease the economic competiveness of the full-service hospital versus a specialty surgery hospital. Nonetheless, other strengths of the full-service hospital (such as economies of scale and scope, better care integration than can be provided at specialty surgical hospitals, the immediate availability of high-intensity resources, and advanced information systems) may render the full-service hospital that has a hybrid structure more competitive 28,35,37,38 than has previously been assumed. 30 Having a focused factory within a solution shop may also be beneficial for solution-shop patients.…”

Section: Exhibitmentioning

confidence: 99%

From ‘Solution Shop’ Model To ‘Focused Factory’ In Hospital Surgery: Increasing Care Value And Predictability

Cook

Thompson²,

Habermann

et al. 2014

Health Affairs

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The full-service US hospital has been described organizationally as a "solution shop," in which medical problems are assumed to be unstructured and to require expert physicians to determine each course of care. If universally applied, this model contributes to unwarranted variation in care, which leads to lower quality and higher costs. We purposely disrupted the adult cardiac surgical practice that we led at Mayo Clinic, in Rochester, Minnesota, by creating a "focused factory" model (characterized by a uniform approach to delivering a limited set of high-quality products) within the practice's solution shop. Key elements of implementing the new model were mapping the care process, segmenting the patient population, using information technology to communicate clearly defined expectations, and empowering nonphysician providers at the bedside. Using a set of criteria, we determined that the focused-factory model was appropriate for 67 percent of cardiac surgical patients. We found that implementation of the model reduced resource use, length-of-stay, and cost. Variation was markedly reduced, and outcomes were improved. Assigning patients to different care models increases care value and the predictability of care process, outcomes, and costs while preserving (in a lesser clinical footprint) the strengths of the solution shop. We conclude that creating a focused-factory model within a solution shop, by applying industrial engineering principles and health information technology tools and changing the model of work, is very effective in both improving quality and reducing costs. S urgical care in a hospital can be characterized by the term "complexity," driven in large part by the fact that most full-service hospitals operate as "solution shops." 1,2(p75) These shops are "structured to diagnose and recommend solutions to unstructured problems." 2(p xxiv) The solution-shop concept was originally used to describe manufacturing. However, it is particularly appropriate to hospital-based surgical care, in which decision making usually relies upon surgeons' specific training, intuition, and experience to define the course of care.Solution-shop thinking is imbedded in US physician culture and education and is a critical component of advanced care delivery. But systems engineering, process analysis, quality control, and manufacturing science 3 suggest that the uniform application of what amounts to a nineteenth-century craftsman model of medicine is insufficient to meet twenty-first-century health care needs.

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Section: Exhibitmentioning

confidence: 99%

From ‘Solution Shop’ Model To ‘Focused Factory’ In Hospital Surgery: Increasing Care Value And Predictability

Cook

Thompson²,

Habermann

et al. 2014

Health Affairs

View full text Add to dashboard Cite

show abstract

“…(5, 10) By offering convenience and lower costs for care of minor illnesses, retailers sought to take market share. (4) Now insurance companies promote retail clinic use for their enrollees due to the cost advantage and high patient satisfaction. (6, 16) It remains to be seen if retail clinics can offer a wider range of services and provide more complex care yet continue to maintain their value to consumers and insurance companies.…”

Section: Discussionmentioning

confidence: 99%

“…(2, 3) Retail clinics also represent a business threat for primary care physicians. For pediatricians, the acute upper respiratory conditions initially targeted by retail clinics represent up to 30% of office visits,(4, 5) and expansion of services at some retail clinics to include physical examinations, preventive care, and chronic disease care may further increase the business threat. (6–8)…”

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confidence: 99%

Pediatric Providers' Attitudes Toward Retail Clinics

Garbutt

Mandrell

Sterkel

et al. 2013

The Journal of Pediatrics

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Objective To describe pediatric primary care providers’ attitudes toward retail clinics and their experiences of retail clinics use by their patients. Study design A 51-item, self-administered survey from four pediatric practice-based research networks from the Midwestern United States, which gauged providers’ attitudes toward and perceptions of their patients’ interactions with retail clinics, and changes to office practice to better compete. Results A total of 226 providers participated (50% response). Providers believed that retail clinics were a business threat (80%) and disrupted continuity of chronic disease management (54%). Few (20%) agreed that retail clinics provided care within recommended clinical guidelines. Most (91%) reported that they provided additional care after a retail clinic visit (median 1–2 times per week) and 37% felt this resulted from suboptimal care at retail clinics “most or all of the time.” Few (15%) reported being notified by the retail clinic within 24 hours of a patient visit. Those reporting prompt communication were less likely to report suboptimal retail clinic care (OR 0.20, 95%CI 0.10 to 0.42) or disruption in continuity of care (OR 0.32, 95%CI 0.15 to 0.71). Thirty-six percent reported changes to office practice to compete with retail clinics (most commonly adjusting or extending office hours) and change was more likely if retail clinics were perceived as a threat (OR 3.70, 95%CI 1.56 to 8.76); 30% planned to make changes in the near future. Conclusions Based on the perceived business threat, pediatric providers are making changes to their practice to compete with retail clinics. Improved communication between the clinic and providers may improve collaboration.

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“…Burns et al defined that the retail clinics as an innovation disruptive of primary care physician practice. Such a clinic may be located at a mall, a drug store or retail store and is generally staffed by nurse practitioners 29 . Often computer guided imaging or surgical devices were associated with these innovations.…”

Section: Ict -Related Technologiesmentioning

confidence: 99%

Review of Adoption of Disruptive Innovative Practices in Medical Tourism in India

Sharma

Jain

Gupta³

et al. 2017

AJPRHC

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Strategic Response by Providers to Specialty Hospitals, Ambulatory Surgery Centers, and Retail Clinics

Cited by 14 publications

References 29 publications

From ‘Solution Shop’ Model To ‘Focused Factory’ In Hospital Surgery: Increasing Care Value And Predictability

From ‘Solution Shop’ Model To ‘Focused Factory’ In Hospital Surgery: Increasing Care Value And Predictability

Pediatric Providers' Attitudes Toward Retail Clinics

Review of Adoption of Disruptive Innovative Practices in Medical Tourism in India

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