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Steve King

Process Improvement consulting services from Shaw Resources - 0 views

  • A methodical approach exists based on the Shaw patented method - Customer-Inspired Process Deployment®. The methodology starts with how an external customer experiences your organization and creates the structure of your organization as an assemblage of processes. This approach will most likely look quite different than your traditional organization chart. In fact, the organization chart really has little to do with how work gets done, in most cases. 
dhtobey Tobey

Varying Your Practice Moves May Help Improve Skills - 0 views

  • Varying the types of skills you work on in practice sessions engages a different part of the brain than the one you use when focusing on a single task, researchers say. The finding explains why variable practice improves the brain's memory of most skills better than working on just one type of task, according to the research team from the University of Southern California and the University of California, Los Angeles.In their study, published online recently in Nature Neuroscience, the investigators divided 59 volunteers into different groups. Some were asked to practice a challenging arm movement, while others did the arm movement and related tasks in a variable practice structure.The participants in the variable practice group learned the arm movement better than those who practiced only the arm movement, the study authors found.Among those in the variable practice group, the process of consolidating memory of the skill engaged a part of the brain called the prefrontal cortex, which is associated with higher level planning. Among those who practiced only the arm movement, the engaged part of the brain was the primary motor cortex, which is associated with simple motor learning, the authors explained."In the variable practice structure condition, you're basically solving the motor problem anew each time. If I'm just repeating the same thing over and over again as in the constant practice condition, I don't have to process it very deeply," study senior author Carolee Winstein, a professor of biokinesiology and physical therapy at the University of Southern California, said in a university news release.
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    Study with many implications for skill-based training, such as the National Security Academy.
Steve King

The Dynamics of Sensemaking, Knowledge, and Expertise in Collaborative, Boundary-Spanni... - 0 views

  • This ethnographic study investigates how a project group deals with the contradiction between distributed knowledge in boundary-spanning collaborative processes and the expectation that software systems will provide unified, codified knowledge. Group and individual activities were observed over a period of 18 months, to examine the ways knowledge was presented, recognized, shared, or otherwise managed during joint design of business process and IT systems change. The study explores how knowledge and expertise were translated across organizational boundaries, and identifies four stages in the development of group understanding of how to manage sensemaking and expertise across knowledge boundaries: focus on defining shared goals; acknowledging and sharing tacit knowledge about organizational practice; identifying external influences; and explicit knowledge generation.
Steve King

The duality of knowledge - 0 views

  • For Nonaka (1991) tacit and explicit knowledge are not separate but mutually complementary entities.  They interact with each other in the creative activities of human beings.  Nonaka calls the interaction of these two forms of knowledge the knowledge conversion process. This conversion process consists of four stages: socialization, externalization, combination and internalisation. 
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    .. four stages of tacit and explicit knowledge building .. old stuff but interesting
Steve King

e!sankey - show the flow / Good reasons to use e!Sankey - 0 views

  • Sankey diagrams are a specific type of flow chart, in which the width of the arrows is shown proportionally to the flow quantity. They are typically used to visualize energy or material transfers between processes. The flow arrows can be color-coded to indicate the type of the flow (energy, mass, costs, etc).
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    Sankey diagrams are a specific type of flow chart, in which the width of the arrows is shown proportionally to the flow quantity. They are typically used to visualize energy or material transfers between processes. The flow arrows can be color-coded to indicate the type of the flow (energy, mass, costs, etc).
Steve King

ProModel - Healthcare Solutions - 0 views

  • New Technology Evaluation and Implementation Hospitals and healthcare systems are under greater pressure than ever to improve patient care, increase staff satisfaction, control or reduce costs, and meet insurance and government regulations and live up to industry watchdog best practices. To help meet these demands, providers must continue to implement new technology as part of the solutions or risk obsolescence.
Steve King

free online templates, samples, examples, articles, resources and tools for business tr... - 0 views

  • free management and training templates, resources and tools
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    .. quality not certain.. quantity .. yes
Steve King

FM 90-7 Chapter 4. Obstacle Planning/Corps, Division/Brigade Levels - 0 views

  • Obstacle Planning at Corps, Division, and Brigade Levels Commanders and staffs consider the use of obstacles when planning offensive, defensive, and retrograde operations. This chapter describes obstacle planning as it applies at corps, division, and brigade levels. At these levels, concentration is on granting obstacle-emplacement authority or providing obstacle control. At corps and division level, commanders focus on developing obstacle zones and restrictions. At the brigade level, commanders focus on developing obstacle belts and restrictions. At all three levels, commanders may plan obstacle groups, but this is rare.
dhtobey Tobey

GroupMind Express - Collaboration Software and Consulting for Decision Support - 2 views

  • We provide web-based tools and consulting services to support organizations and consultants. Our purpose is to help teams make decisions based on shared data, resulting in increased alignment and faster implementation.. Here are several standard organization needs, and how we can add value to your work   Your need Our value-add Surveys Shared results lead to group learning. Identify your areas of strength and weakness. Meetings Interactive meetings provide opportunities for buy-in and for gathering the group's intelligence. Hear from everyone.   Brainstorm or Delphi process Create better solutions and build improvement by using fast-cycle brainstorming to increase group understanding.
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    Steve and I looked at this platform this evening in prep for tomorrow's walk-thru and after reviewing the KE capabilities and customization limitations, this may be a better option. We should therefore postpone tomorrow's walk-through and see about getting a trial version of GroupMind to try out for Raytheon.
Steve King

Institute for Water Quality, Resources and Waste Management, TU Vienna - 0 views

  • STAN (short for subSTance flow ANalysis) is a freeware that helps to perform material flow analysis according to the Austrian standard Ă–Norm S 2096 (Material flow analysis - Application in waste management).
Steve King

Sankey Helper 2.4.1 by G.Doka - 0 views

  • Sankey Helper v2.4 helps you design Sankey diagrams from Excel data ... in Excel !
Steve King

What is a Sankey-Diagram? - 0 views

  • Intro What is a Sankey-Diagram? References Demo version Full version   Know-How Games Software Recommendations Pinchleni Software   What is a Sankey-Diagram? A Sankey diagram is a graphic illustration of flows, like energy, material or money flows. Usually the flows are illustrated as arrows. The width of the arrows is proportional to the size of the represented flow. Sankey diagrams are a better way to illustrate which flows represent advantages and what flows are responsible for waste and emission
Steve King

NEJM -- What's Keeping Us So Busy in Primary Care? A Snapshot from One Practice - 0 views

  • Primary care practices typically measure productivity according to the number of visits, which also drives payment.
    • dhtobey Tobey
       
      This study is directly related to the TrustNetMD mission, but could also be useful for other EBM-related and OBM-related community desktop solutions.
  • Several studies have estimated the amount of time that primary care physicians devote to nonvisit work.1,2 To provide a more detailed description, my colleagues and I used our electronic health record to count units of primary care work during the course of a year.
  • Greenhouse Internists is a community-based internal medicine practice employing five physicians in Philadelphia. In 2008, we had an active caseload of 8440 patients between 15 and 99 years of age.
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  • Our payer mix included 7.2% of payments from Medicaid (exclusively through Medicaid health maintenance organizations), 21.5% from Medicare (of which 14.0% were fee-for-service and 7.5% capitated), 64.7% from commercial insurers (34.5% fee-for-service and 30.2% capitated), and 6.5% from pay-for-performance programs.
    • dhtobey Tobey
       
      I wonder how this breakdown compares with national/urban averages? Also how are these trending? Is the pay-for-performance increasing dramatically? I would think so based on what we are hearing.
  • Throughout 2008, our physicians provided 118.5 scheduled visit-hours per week, ranging from 15 to 31 weekly hours each. We regard this schedule as equivalent to the work of four full-time physicians, with physicians typically working 50 to 60 hours per week. Our staff included four medical assistants, five front-desk staff, one business manager, one billing manager, one health educator (hired midyear), and two full-time clerical staff. Our staffing ratio was approximately 3.5 full-time support staff per full-time physician. We had no nurses or midlevel practitioners.
    • dhtobey Tobey
       
      From the little I know this is a typical primary care scenario - very poor leverage of professional staff, meaning no use of nurses or midlevel practitioners to leverage physician time and expertise.
  • We use an electronic health record, which we adopted in July 20043 and use exclusively to store, retrieve, and manage clinical information. Our electronic system came with 24 "document types" that function like tabs in a paper chart to organize documents, dividing clinical information into categories such as "office visit," "phone note," "lab report," and "imaging." Since all data about patients is stored in the electronic record (either as structured data or as scanned PDFs) and each document is signed electronically by a physician, we are able to measure accurately the volume of documents, which serve as proxies for clinical activities, in a given time period.
    • dhtobey Tobey
       
      Each of these document types could become a "LivingPaper" creating a "LivingRecord" vs. the current EHR... Steve have you discussed something like this with TNMD?
  • The volume and types of documents that we receive, process, and create are listed in Table 1
  • Each physician reviewed 19.5 laboratory reports per day, including those ordered through our office (which are delivered to us through an electronic interface and are automatically posted to the database of the electronic health record as numerical values) and those ordered outside our office (which enter our chart as scanned PDFs and are not posted as numerical values). The work cycle of responding to a laboratory result includes interpretation by telephone, letter, or e-mail. (Our office sent 12,541 letters communicating test results, about a third of which were sent by e-mail.) For noninterfaced laboratories, we must decide which values need to be entered manually into the electronic health record by a staff person; the values of scanned results cannot be graphed or searched without this step. Laboratory results frequently trigger a review or adjustment of a medication, which requires access to accurate, current medication lists with doses.
    • dhtobey Tobey
       
      How difficult would it be to integrate LivingPaper with existing EHRs and/or lab systems. Since EHRs are still in the "early adopter" phase, perhaps we can address some of the most critical needs making EHR use unnecessary, or perhaps this is a HUGE joint opportunity with Microsoft's healthcare division.
  • Of these calls, 35.7% were for an acute problem, 26.0% were for administrative purposes
  • Physicians averaged 16.8 e-mails per day. Of these electronic communications, 59.3% were for the interpretation of test results, 21.7% were for response to patients (either initiated by patients through the practice's interactive Web site or as part of an e-mail dialogue with patients), 9.3% were for administrative problems, 5.0% were for acute problems, 2.8% were for proactive outreach to patients, and 1.9% were for discussions with consultants.
    • dhtobey Tobey
       
      60% for interpretation of test results!!! Opinion management ranks as the highest use of electronic communications. THIS IS OUR SWEET SPOT! We need to find this type of data for research scientists.
    • Steve King
       
      this is a a perfect source document for HC CD
  • Telephone calls that were determined to be of sufficient clinical import to engage a physician averaged 23.7 per physician per day, with 79.7% of such calls handled directly by physicians.
    • dhtobey Tobey
       
      Wow! I never would have guessed that telephone calls were such a significant part of the physician day. Does the EHR provide a CRM for call-logging?
  • Each physician reviewed 11.1 imaging reports per day, which usually required communication with patients for interpretation. Such review may require updating problem lists (e.g., a new diagnosis of a pulmonary nodule) or further referral (e.g., fine-needle aspiration for a cold thyroid nodule), which generates additional work, since results and recommendations are communicated to patients and consultants.
  • Each physician reviewed 13.9 consultation reports per day. Such reports from specialists may require adjustments to a medication list (if a specialist added or changed a medication), changes to a problem list, or a call or e-mail to a patient to explain or reinforce a specialist's recommendation. Some consultation or diagnostic reports relate to standard quality metrics (e.g., eye examinations for patients with diabetes) and need to be recorded in a different manner to support ongoing quality reporting and improvement.5
  • Before our practice had an electronic health record, we employed a registered nurse. After the implementation of the electronic health record system, much of the work that the nurse performed could be done by staff who did not have nursing skills, and by 2008, we no longer employed a registered nurse. However, on the basis of the analysis described here, we have hired a registered nurse to do "information triage" of incoming laboratory reports, telephone calls, and consultation notes — a completely different job description than what we had before.
    • dhtobey Tobey
       
      Most interesting! This is the conclusion we came to and presented to TNMD as a business plan concept -- become the triage service through outsourcing/insourcing RNs supported by the community desktop system.
  • Our practice is participating in a multipayer Patient Centered Medical Home demonstration project7 (which allowed us to hire our health educator). This project is overseen by the Pennsylvania governor's office and funded by the three largest commercial insurers and all three Medicaid insurers in our region
    • dhtobey Tobey
       
      Monetization is with the insurers -- just as we expected.
dhtobey Tobey

University Physicians Healthcare - UPH Executive Bios - 0 views

  • Lawrence Aldrich President and Chief Executive Officer (CEO) Larry Aldrich is an attorney with over 25 years of proven leadership abilities in diverse business positions. As President and CEO he is responsible for various corporate departments at UPH, including Legal/Risk, Information Systems, Electronic Medical Records, Marketing/Business Development/Contracts Administration and Facilities. Prior to joining UPH, Larry was the founding Chief Operating Officer at The Critical Path Institute (C-Path), a non-profit medical research organization focused on improving the safety and efficacy of the drug development process through the U.S. Food and Drug Administration. He also served as the president and CEO of Tucson Newspapers. Larry received his law degree from Tulane Law School and his civil engineering degree from Georgia Institute of Technology.
    • dhtobey Tobey
       
      Aldrich is the former head of Tucson Ventures. Scott is arranging presentation after our presentation development call with Jeanine.
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