1,986 research outputs found
Parámetros de calidad de las aguas de consumo humano en los reinos de España y Marruecos
No full textEn cualquier dieta humana junto con los nutrientes es esencial la ingesta
de agua y bebidas. Debido a la importancia social y económica del agua y a su
composición estrechamente vinculada con la calidad.
En esta memoria de tesis doctoral se han planteado los siguientes objetivos: 1) Desarrollar un método analítico de cromatografía iónica para la determinación y cuantificación de cationes y aniones en muestras de agua mineral natural envasada. 2) Analizar el contenido de cationes y aniones en aguas minerales procedentes de Marruecos y España, con distintos grados de mineralización. 3) Realizar la evaluación sensorial de parte de las aguas objeto de estudio mediante un panel analítico. 4) Evaluar la ingesta de nutrientes de la dieta, especialmente de cationes y aniones, a través del consumo de agua y de los alimentos en una muestra de población marroquí y española. 5) Estudiar la adherencia a la dieta mediterránea de las poblaciones de estudio mediante los índices de adherencia MDS y MDSS.Tesis Univ. Granada. Programa Oficial de Doctorado en: Nutrición y Ciencias de los alimento
Preprocessing Techniques for more Robust Deep Learning Models: Application to Biomedical and Satellite Images
No full textC omputer Vision (CV) is an Artificial Intelligence (AI) field that replicate the human eyes and
brain’s ability in perceiving images and understanding them. Deep learning (DL) models and
especially Convolutional Neural Networks (CNNs) have become the state-of-the-art in most complex
CV tasks. These models learn automatically to take decisions based on imagery data without being
explicitly programmed for this purpose as it is the case in self-driving cars or smartphones face recognition
systems.
CNNs consist in a huge number of interconnected Artificial Neural Networks (ANNs) with trainable
parameters widely inspired from the way the human brain neurons learn and transmit knowledge to
each other. Hence, training them for a specific task requires a large number of carefully annotated
images. However, for complex problems, such as those addressed in this thesis, creating high quality
training datasets is very expensive, requires a high level of expertise and a huge amount of work.
To overcome these limitations, the main adopted techniques in the literature are data preprocessing
and Transfer Learning (TL). In the latter, CNNs are firstly pretrained on available large natural images
datasets such as ImageNet, then retrained on target domain datasets containing less images. Whereas,
data preprocessing involves all the transformations applied to datasets in order to improve their size
and value. In this thesis, we proposed preprocessing techniques to improve the robustness of DL models
in two complex applications: biomedical and satellite images classification.
In the first application, we combined the state-of-the-art CNN, the most adequate data preproccesing
and transfer learning methods with the benchmark dataset used in that problem called BreakHis, to
elaborate an ideal automatic system for breast cancer diagnosis from both clinical and technical standpoints.
And our analysis has demonstrated that the complexity of this problem related to its data
quality and annotation, hugely affect the performance of the trained DL model even in a well built
methodological approach. In the second use case, we trained DL models on our own built dataset for
automatic Land Use/Land Cover (LULC) classification. To our knowledge, the dataset we proposed
called Sentinel2LULC, is the largest global high resolution and free satellite images dataset adapted for
DL usage in this problem. This dataset was carefully built using the big amount of remote sensing data
available nowadays on free platforms such as Google Earth Engine and a carefully designed methodology
to transform all these data into a high value dataset for this specific problem. The experimental
analysis in conjunction with DL models in this second scenario has achieved very promising results
and proved the dataset quality importance. The particular conclusion in each one of these two studies
allowed us to build our main conclusion of this thesis: even when the state-of-the-art models and
methods are adopted and combined, the data quality remains the major source gold for CNNs training
and constitute the key factor to reach a good performance in complex CV tasks.L a vision par ordinateur (CV) est un domaine de l’intelligence artificielle (AI) qui reproduit
la capacit´e des yeux et du cerveau humains `a percevoir les images et `a les comprendre. Les
mod`eles d’apprentissage profond (DL), et en particulier les r´eseaux de neurones convolutifs (CNNs),
sont devenus l’´etat de l’art pour les tˆaches du CV les plus complexes. Ces mod`eles apprennent
automatiquement `a prendre des d´ecisions en utilisant un ensemble d’images sans ˆetre explicitement
programm´es pour cette fin, notamment dans les voitures `a conduite autonome ou les syst`emes de
reconnaissance faciale des smartphones.
Les CNNs sont constitu´es d’un grand nombre de r´eseaux neuronaux artificiels (ANNs) avec des
param`etres entraˆınables inspir´es de la fac¸on dont les neurones du cerveau humain apprennent et se
transmettent les connaissances entre eux; et leur entraˆınement n´ecessite un grand nombre d’images
soigneusement annot´ees. Cependant, pour des probl`emes complexes, tels que ceux abord´es dans
cette th`ese, la cr´eation d’un ensembles d’images d’entraˆınement de haute qualit´e est tr`es coˆuteuse et
exige une haut expertise. Pour surmonter ces limitations, les principales techniques adopt´ees dans
la litt´erature sont le pr´etraitement des donn´ees et l’apprentissage par transfert. Dans ce dernier, les
CNNs sont d’abord pr´e-entraˆın´es sur de grands ensembles d’images naturelles tels que ImageNet,
puis r´e-entraˆın´es sur des ensembles du domaine cible contenant moins d’images. Alors que le
pr´etraitement des donn´ees implique toutes les transformations appliqu´ees pour augmenter la taille
et am´eliorer la valeur des donn´ees. Dans cette th`ese, on propose des techniques de pr´etraitement
pour am´eliorer la robustesse des mod`eles du DL dans deux applications complexes : la classification
d’images biom´edicales et d’images satellitaires.
Dans la premi`ere application, nous avons combin´e avec l’ensemble de donn´ees appel´e BreakHis,
l’´etat de l’art CNN, ainsi que les m´ethodes de pr´etraitement et d’apprentissage par transfert les plus
ad´equates, afin de construire un syst`eme automatique id´eal pour le diagnostic automatique du cancer
du sein, tant du point de vue clinique que technique. Notre analyse a d´emontr´e que la complexit´e
de ce probl`eme, li´ee `a la qualit´e de ses donn´ees, affecte consid´erablement la performances du DL,
mˆeme avec m´ethodologie bien construite. Dans le deuxi`eme cas d’utilisation, nous avons entraˆın´e
des mod`eles DL sur notre propre ensemble de donn´ees appel´e Sentinel2LULC pour la classification
automatique de l’utilisation et couverture des sols. `A notre connaissance, Sentinel2LULC est le plus
grand ensemble d’images satellitaires `a ´echelle mondiale, `a haute r´esolution et gratuit adapt´ees au DL.
il a ´et´e soigneusement construit `a partir de la grande quantit´e de donn´ees de t´el´ed´etection disponibles
aujourd’hui sur les plateformes gratuites telles que Google Earth Engine avec une m´ethodologie
soigneusement conc¸ue pour r´esoudre ce probl`eme. L’analyse des mod`eles DL dans ce deuxi`eme
sc´enario a aboutit `a des r´esultats prometteurs et a prouv´e l’importance de la qualit´e des donn´ees.
La conclusion particuli`ere de chacune de ces deux applications nous a permis de formuler notre
conclusion principale de cette th`ese : mˆeme lorsque les mod`eles DL et m´ethodes de pointe sont
adopt´es et combin´es, la qualit´e initiale des donn´ees reste le facteur le plus imporatnt pour atteindre
une bonne performance dans les tˆaches complexes du CV.La visión por ordenador (CV) es un campo de la Inteligencia Artificial (AI) que replica la capacidad
de los ojos y el cerebro humanos para percibir imágenes y comprenderlas. Los modelos de aprendizaje
profundo (DL) y, en especial, las redes neuronales convolucionales (CNNs) se han convertido
en el estado del arte en las tareas más complejas de CV. Estos modelos aprenden automáticamente
a tomar decisiones en función de los datos sin necesidad de ser programados explícitamente para
ello, como ocurre en los coches autoconducidos o en los sistemas de reconocimiento facial de los
smartphones.
Las CNNs consisten en un gran cantidad de redes neuronales artificiales (ANNs) interconectadas con
parámetros entrenables inspirados de la forma en que las neuronas del cerebro humano aprenden y se
transmiten conocimientos. Por lo tanto, entrenarlas para una tarea específica requiere un gran cantidad
de imágenes cuidadosamente anotadas. Sin embargo, para problemas complejos, como los que
se abordan en esta tesis, la creación de datos de entrenamiento de alta calidad es muy cara y requiere
un alto nivel de experiencia. Para superar estas limitaciones, las principales técnicas adoptadas en la
literatura son el preprocesamiento de datos y el aprendizaje por transferencia (TL). En este ´ultimo, las
CNNs se preentrenan primero en grandes conjuntos de datos de imágenes naturales como ImageNet,
y luego se reentrenan en datos del dominio de destino. Por su parte, el preprocesamiento de datos
implica todas las transformaciones aplicadas a los datos para mejorar su tamaño y valor. En esta tesis,
propusimos técnicas de preprocesamiento para mejorar la robustez de modelos DL en dos aplicaciones
complejas: la clasificación de imágenes biomédicas y de satélite.
En la primera aplicación, combinamos la CNN de última generación, los métodos de preprocesamiento
y de aprendizaje de transferencia más adecuados con el conjunto de datos de referencia utilizado en
ese problema llamado BreakHis, para elaborar un sistema automático ideal para el diagnóstico del
cáncer de mama tanto desde el punto de vista clínico como técnico. Y nuestro análisis ha demostrado
que la complejidad de este problema relacionada con la calidad de sus datos y su anotación, afecta
enormemente al rendimiento del modelo DL entrenado incluso en un enfoque metodológico bien
construido. En el segundo caso, entrenamos modelos DL con nuestro propio conjunto de datos para
la clasificación automática del uso y la cobertura del suelo (LULC). Hasta donde sabemos, el conjunto
de datos que propusimos, llamado Sentinel2LULC, es el mayor conjunto de datos global de imágenes
de satélite de alta resolución y gratuitas adaptado para el uso de DL. Este conjunto de datos fue
cuidadosamente construido utilizando la gran cantidad de datos de teledeteccón disponibles hoy en
plataformas gratuitas como Google Earth Engine (GEE) y una metodología cuidadosamente diseñada
para transformar todos estos datos en un conjunto de datos de alto valor. El análisis experimental con
los modelos DL en este segundo escenario ha logrado resultados muy prometedores y ha demostrado
la importancia de la calidad de datos. La conclusión particular en cada uno de estos estudios nos
permitió construir nuestra conclusión principal de esta tesis: incluso cuando se adoptan y combinan
los modelos y métodos más avanzados, la calidad de los datos sigue siendo el factor clave para alcanzar
un buen rendimiento en tareas complejas de CV.Tesis Univ. Granada.Proyecto de Investigaci´on ”Sistemas inteligentes para problemas complejos usando Deep Learning” Ref. A-TIC-458.UGR18, Proyectos I+D+i del Programa Operativo FEDER 2018. Este proyecto est´a financiado por la Junta de Andaluc´ıa y al Fondo Europeo de Desarrollo Regional (FEDER)National Grant of the Moroocan Ministry of Higher Education, Scientific Research and Executive Trainin
Test of spatial resolution and trigger efficiency of a combined Thin Gap and Fast Drift Tube Chambers for high-luminosity LHC upgrades
No full textThe forthcoming luminosity upgrade of LHC to super-LHC (sLHC) will increase the expected background rate in the forward region of the ATLAS Muon Spectrometer by approximately the factor of five. Some of the present Muon Spectrometer components will fail to cope with these high rates and will have to be replaced. The results of a test of a device consisting of Thin Gap Chambers (TGC) and a fast small-diameter Muon Drift Tube Chamber (sMDT) using the 180 GeV/c muons at the SPS-H8 muon beam at CERN are presented. The goal of the test was to study the combined TGC-sMDT system as tracking and triggering device in the ATLAS muon spectrometer after high-luminosity upgrades of the LHC. The analysis of the recorded data shows a very good correlation between the TGC and sMDT track position and inclination. This technology offers the combination of trigger and tracking and has good angular and spatial resolutions. The angular resolution is 0.4 mrad for each system individually. For the spatial resolution, the width of the track residual between TGC and sMDT is 104 μm at zero degree impact angle
Contribution a l'etude du calorimetre electromagnetique a cristaux de PbWO de l'experience CMS au LHC
No full text
Séminaire « Services écosystémiques culturels des animaux sauvages » à Tours le 25 mai 2018
No full textNous reproduisons ici l'annonce pour un séminaire abordant les relations aux animaux sauvages. Deux membres du collectif GATO y interviendront: Farid Benhammou parlera des grands carnivores en France et Guillaume Marchand proposera une réflexion sur la façon dont les populations riveraines de l'Amazone définissent la juste place des animaux sauvages. "Ce séminaire est fait dans le cadre d’un projet de recherche porté par Irstea et financé par la région Centre Val de Loire. COSTAUD (Contributi..
Parution autour des géographes et la nature
No full textLe numéro spécial du Bulletin de l'association des géographes français intitulé "Les géographes et la Nature: regards nouveaux" est désormais disponible en version papier mais aussi en ligne. Philippe Sierra, Farid Benhammou et moi-même y signons un article abordant la géographie animale française et sa façon de traiter l'objet "Nature". Je reproduis ici le résumé de l'article: "Au cours des vingt dernières années, on a assisté dans la géographie anglo-saxonne et secondairement chez les g..
Entrepreneurship in healthcare: Can physicians’ entrepreneurial skills and entrepreneurial interventions improve care and control cost?
No full textDespite physicians and healthcare providers delivering unprecedented healthcare improvements, the U.S. healthcare delivery system is still plagued with inefficiencies. The consequences of these preventable inefficiencies result in unnecessary patient health complications, fatalities, and waste of resources. This study is a systematic review that explored if physicians' entrepreneurial acumens can drive efficiencies in healthcare management to improve quality of care and lower cost. Considering the interconnected systems in U.S.healthcare, the author conducted this research within the framework of the systems theory. To complete this systematic review, the author collected 62articles—a combination of systematic reviews, qualitative, and quantitative articles—and followed the rigorous review process of Gough et al. (2012). Literature review shows healthcare management and decision-making lacks physicians ’participation.This study shows that when physicians—with their entrepreneurial skill—are integrated in management and the decision-making,hospitals delivered better quality patient care, increased efficiencies,and drove down cost.ENTREPRENEURSHIP IN HEALTHCARE 1
Entrepreneurship in Healthcare: Can Physicians’ Entrepreneurial Skills and
Entrepreneurial Interventions Improve Care and Control Cost?
By
Ennaji Benhammou
A Dissertation Completed in Fulfillment of the Graduate School of the
University of Maryland University College Requirements for the Degree of
Doctor of Business Administration
2020
ENTREPRENEURSHIP IN HEALTHCARE 2
Abstract
Despite physicians and healthcare providers delivering unprecedented healthcare improvements,
the U.S. healthcare delivery system is still plagued with inefficiencies. The consequences of
these preventable inefficiencies result in unnecessary patient health complications, fatalities, and
waste of resources. This study is a systematic review that explored if physicians' entrepreneurial
acumens can drive efficiencies in healthcare management to improve quality of care and lower
cost. Considering the interconnected systems in U.S. healthcare, the author conducted this
research within the framework of the systems theory. To complete this systematic review, the
author collected 62 articles—a combination of systematic reviews, qualitative, and quantitative
articles—and followed the rigorous review process of Gough et al. (2012). Literature review
shows healthcare management and decision-making lacks physicians’ participation. This study
shows that when physicians—with their entrepreneurial skill—are integrated in management and
the decision-making, hospitals delivered better quality patient care, increased efficiencies, and
drove down cost.
Keyword terms: entrepreneurship in healthcare, entrepreneurship in delivering healthcare,
intrapreneurship in healthcare, cost of healthcare, waste in healthcare, stakeholders and
healthcare practices, quality of healthcare, innovation in healthcare.
ENTREPRENEURSHIP IN HEALTHCARE 3
© Copyright by
Ennaji Benhammou
2020
ENTREPRENEURSHIP IN HEALTHCARE 4
Dedication
I want to celebrate reaching this milestone by thanking my family and friends. Without their
support, I would not have had the might to embark on this journey and the strength to keep up
with its challenges. Special thanks to my wife Shimako for her encouragements when they were
needed the most and deep appreciation to my children, Touria and Faridah, for their patience
with me in the past three years. I want to take this opportunity to thank my Mom for her support
and pay special tribute to my late father for motivating me always to pursue knowledge and
education. He didn’t get to celebrate this major achievement with us. I also want to give a shout
out to my siblings and their children for their support and recognition.
This journey was paved by many friends who were generous with their time, academic, clinical,
and professional advice from their extensive and rich experience. Thank you, Dr. Faroque A.
Khan, Dr. Tanveer Mir, Dr. Isma Chaudhry, Dr. Olajid Oladipo, Dr. Rosanna Perotti, Dr. Unni
Mooppan, Dr. David Berman, and Mr. Faroque Khawaja. To my cohort that became close
friends, thank you for everything!
To UMGC’s faculty, thank you for facilitating challenging and rewarding courses. I want to
acknowledge with great appreciation my professors, Dr. Booth, Dr. Breckon, Dr. Vernon, Dr.
Drasin, Dr. Blaney, Dr. Marbury, and Dr. De Jong. To my advisor, Dr. Laura Witz, I can’t thank
you enough for your support, encouragement, diligence, rigor, and your pedagogical ways of
guiding me through this journey.
Thank you!!!
ENTREPRENEURSHIP IN HEALTHCARE 5
Table of Contents
Abstract .......................................................................................................................................... 2
Dedication ...................................................................................................................................... 4
Table of Contents ............................................................................................................................ 5
List of Tables ................................................................................................................................. 7
List of Figures ................................................................................................................................ 8
Chapter 1: Introduction and Overview of the Management Problem ............................................. 9
Physicians as employees ....................................................................................................... 17
The Research Question ............................................................................................................. 18
Organization of the Dissertation ............................................................................................... 18
Chapter 2: Scoping Literature Review and Theoretical Framework ............................................ 19
Physicians and Healthcare Spending .................................................................................... 24
Entrepreneurism Defeats Waste ............................................................................................ 24
Reclaiming Lost Entrepreneurial Skills ................................................................................ 27
Desirable Outcomes of Entrepreneurship ............................................................................. 29
Healthcare ............................................................................................................................. 31
Theoretical Framework ............................................................................................................. 35
Chapter 3: Method ........................................................................................................................ 39
The Evidence-Based Research Framework .............................................................................. 39
Stages of the Systematic Review .............................................................................................. 40
Review Initiation—Subject Matter Experts (SMEs) ................................................................ 41
Review Question & Methodology ............................................................................................ 41
Search Strategy ......................................................................................................................... 42
Description of Study Characteristics ........................................................................................ 45
Quality and Relevance Appraisal.............................................................................................. 46
Synthesis .................................................................................................................................. 48
Using Reviews .......................................................................................................................... 49
Chapter 4: Analysis and Findings ................................................................................................. 51
Subject Matter Experts (SMEs) Feedback and Guidance ......................................................... 51
Review of the Research Question ............................................................................................. 53
Analysis of the Existing Evidence ............................................................................................ 53
Results of the Quality Appraisal of Selected Articles .............................................................. 57
ENTREPRENEURSHIP IN HEALTHCARE 6
Theme 1: Physicians Face Challenges in Leading Patient Care ........................................... 60
Theme 2: Physicians Suffer Financial Hardships When Operating Under Managed Care
Models.................................................................................................................................. 62
Theme 3: Clinical Entrepreneurship and Innovation are Essential to Successful Medical
Practice ................................................................................................................................. 65
Theme 4: Data Analytics Can Reveal Areas Needing Clinical Entrepreneurship ................ 68
Chapter 5: Conclusions and Implications ..................................................................................... 72
Discussion and Conclusion ................................................................................................... 73
Limitations ............................................................................................................................ 81
Future Research .................................................................................................................... 82
Conclusion ............................................................................................................................ 83
References .................................................................................................................................... 85
Appendix A. ............................................................................................................................... 104
Appendix B. ............................................................................................................................... 110
ENTREPRENEURSHIP IN HEALTHCARE 7
List of Tables
Table 2.1 Waste in healthcare spending by category 25
Table 3.1 List of deductive codes for thematically organizing collected data 46
Table 4.1 String-search results from UMGC OneSearch 54
ENTREPRENEURSHIP IN HEALTHCARE 8
List of Figures
Figure 2.1 Physicians as connectors 36
Figure 3.1 Common stages in a systematic review 40
Figure 4.1 The article selection process 55
Figure 4.2 The appraisal process of the selected articles. 59
ENTREPRENEURSHIP IN HEALTHCARE 9
Chapter 1: Introduction and Overview of the Management Problem
This study is a systematic review designed to answer the research question, “How can
physicians’ entrepreneurial skills and entrepreneurial interventions contribute to improved
medical practice, coordination of care, and cost-effectiveness?” The purpose of the study is to
explore the use of entrepreneurial skills in a clinical setting. The aim of the study is to determine
the value, if any, of entrepreneurial skills and entrepreneurial interventions to medical
practitioners, specifically physicians.
Healthcare is a consumer/retail business where individuals in need of preventative, acute,
and chronic medical care, voluntarily and involuntarily, become part of a healthcare delivery
system and value chain. In the United States healthcare delivery system, third-party payers, such
as health insurance companies, pay most, if not all, of the medical bills generated by patients.
Consequently, a simple patient visit may involve a physician, diagnostics laboratory, radiology,
pharmacy, and a health insurance provider. This is an example of how healthcare is made up of
multiple constituents that are interconnected and dependent upon each other for healthcare
provisions to take place.
Physicians are at the focal point of the U.S. healthcare delivery system. In the United
States, healthcare is unlike any other consumer-based business. For example, the patient cannot
prescribe his/her medication or medical intervention; a physician is needed for that. What makes
healthcare a system is that healthcare providers and third-party payers all intersect in response to
meeting a patient’s need. The constituents converge to provide care by diagnosing the patient’s
condition, exploring intervention options, selecting and implementing the best option, and
supporting the financial obligations of all involved in the system.
ENTREPRENEURSHIP IN HEALTHCARE 10
The Federal, Food, Drug, and Cosmetic Act (as amended through P.L. 116–22, enacted
June 24, 2019) mandates that in order to have access to a prescription drug, patients need to have
either a physician or medical practitioner’s written prescription. Sage & Hyman (2014) estimated
that physicians, due to their position in the healthcare delivery system, drive two-thirds of
healthcare spending within the United States.
The influence physicians have on the quality of care and its cost evolved with the way
medicine is practiced. Physicians are instrumental in providing effective and safe care to patients
(Dressler et al., 2014; Holak, Kaslow, & Pagel, 2010); however, the ecosystem where care takes
place is complex (Darling, 2006; Wickramasinghe, 2003). In today’s healthcare system,
delivering care to patients is beyond the traditional physician individual care due to advances in
medicine, innovation, technology, escalating costs, and regulators stepping in to ensure quality
and to control cost (Harris, Holm, & Inniger, 2015; Larson et al., 2004; O’Connor, Solberg, &
Baird, 1998).
The essential skills for physicians to deliver medical care are clinical and academic. To
operate and deliver quality care in the current healthcare environment, physicians need to adopt
new technologies, products, and skills; adapt to changes in the sector; and drive change by
negotiating and coordinating care (Groves, 2011; Harris et al., 2015; Saxton, Pawlson, &
Finkelstein, 2013). These skills are characteristics of entrepreneurship. Guo (2006) defines
entrepreneurship in healthcare as being able to generate innovation and drive activities that
improve sustainability. Yarzebinski (1992) views entrepreneurs as agents and/or champions of
change, and they remain proactive to stay ahead of market competitive conditions.
Physicians can act entrepreneurially in the clinical environment. For example, in 2015 a
cardiologist and a physician assistant of nuclear medicine (PANM) financed a start-up mobile
ENTREPRENEURSHIP IN HEALTHCARE 11
nuclear stress test practice. This business venture could be considered as a stress test clinic on
wheels that travels to physicians’ offices. The main component of the business is the imaging
equipment. With the advent of technology, the equipment, a treadmill-type machine, is small
enough to fit in a small truck and can be wheeled in and out of a medical practice. The PANM
administers the test. The use of this innovative way of administering stress tests improved access
to this diagnostic service for patients, opened new revenue streams to medical practices without
having to invest in the equipment, and opened up a new business opportunity to its founders
(physician entrepreneurs).
Physicians receive rigorous training in clinical and academic skills (Ekman & Krasner,
2017; Schuetz, Mann, & Everett, 2010); however, they lack training in entrepreneurial skills that
capitalize on opportunities. Opportunities, such as the nuclear medicine stress test example,
could improve patient care, and lower the costs that impact clinical stakeholders (Büchler,
Martin, Knaebel, & Büchler, 2006; Miron-Shatz, Shatz, Becker, Patel, & Eysenbach, 2014;
Saxton et al., 2013). To influence efficiency, quality, and cost, authors Pepicello & Murphy
(1996) highlighted the importance of taking action on operational complexity. Studies show that
there are opportunities for physicians’ entrepreneurial skills to positively influence patient care
and its costs (Gibelman & Demone, 2002; Guo, 2006; Jacobson, Wasserman, Wu, & Lauer,
2015).
Certainly, physicians’ entrepreneurial skills should leverage innovation and technology
to improve the healthcare delivery process, patient care, and cost. Clearly, advances in medicine,
innovative ways to deliver care, and personalized biomedical treatments are providing a wide
range of patient care options for physicians to choose from (Büchler et al., 2006). However,
physicians also have a fiduciary responsibility to control costs, as well as a mandate to improve
ENTREPRENEURSHIP IN HEALTHCARE 12
the quality of the care delivery process (Bauchner & Fontanarosa, 2019; Wanke et al., 2015).
Guo (2006) described entrepreneurship as “acts of innovation. It is a multidimensional process
involving the environment, organizations and individuals, and profitability” (Guo, 2006, p. 505).
Physicians’ entrepreneurial skills—those driving efficiency and affordability—are becoming just
as important as their clinical and academic skills.
To deliver patient care, physicians rely on diagnostics, radiology, and other tools to
identify the root causes of patients’ symptoms and to decide on treatment. The costs of such
diagnostic tools have been increasing and driving healthcare spending to surpass 3.5 trillion per
year (Bauchner & Fontanarosa, 2019), and weighing on the U.S. gross domestic product (GDP)
by as much as 17.8% (Papanicolas, Woskie, & Jha, 2018). These increasing costs and the burden
on the U.S. GDP are not sustainable. Something must be done to interrupt and redirect the
current trend; physicians are in an ideal position to act as change agents.
This dissertation studies the effects of physicians’ involvement from one aspect:
physicians’ entrepreneurial skills’ impact on patient quality care and operational cost efficiency
(Sage & Hyman, 2014). De Koning et al. (2006) concluded that if nothing is done about the
inefficiencies of our healthcare system, its cost, and the lack of entrepreneurial exploitation of
technical advances in medicine, this sector will have an even heavier weight on the U.S.
economy in the future. It is assumed that physicians have the ability to drive quality
improvements and costs, given their central role in the healthcare system (ordering diagnostic
tests, prescribing treatments, etc.). This is especially important in light of the ever-increasing
medical needs of a growing and aging population.
ENTREPRENEURSHIP IN HEALTHCARE 13
Problem Statement and Significance of the Problem
The business problem addressed in this study is that physicians lack the entrepreneurial
skills and interventions needed to improve medical practice, coordination of care, and cost-effectiveness.
Despite physicians and healthcare providers delivering unprecedented healthcare
improvements, the U.S. healthcare delivery system is still plagued with inefficiencies, including
medical errors that lead to patient health complications and fatal outcomes (Abbas, Quince,
Wood, & Benson, 2011; Larson, 2004; Schroeppel, Fischer, Magnotti, Croce, & Fabian, 2009). It
is estimated that healthcare inefficiencies contribute to waste in excess of 760 billion every year
(Bauchner & Fontanarosa, 2019). The contributing factors of this waste are failure of care
delivery, failure of care coordination, overtreatment or low-value care, pricing failure, fraud,
abuse, and administrative complexity (Bauchner & Fontanarosa, 2019; Clarke, Bourn, Skoufalos,
Beck, & Castillo, 2017; J. M. Hughes, 1998). There are estimates that more than 250,000
patients lose their lives each year while under the care of healthcare facilities (Abbasi, 2016;
Makary & Daniel, 2016). The study uses an evidence-based systematic review to answer the
research question, “How can physicians’ entrepreneurial skills and entrepreneurial interventions
contribute to improved medical practice, coordination of care, and cost effectiveness?”
Deficiencies in the U.S. healthcare system are impacting patient care (Clarke et al., 2017;
James, 2005; Larson, 2004). The deficiencies are defined as the medical service process, medical
service logistical support, administrative support services, and a fragmented healthcare delivery
system (de Koning, Verver, van den Heuvel, Bisgaard, & Does, 2006; Papanicolas et al., 2018;
Randa, 2010). The consequences of these deficiencies are captured in a report issued by The
Joint Commission Company, a nonprofit tax-exempt 501 organization that accredits more than
22,000 U.S. healthcare organizations and programs. Annually, approximately 700 women die
ENTREPRENEURSHIP IN HEALTHCARE 14
from pregnancy-related complications that could have been prevented (The Joint Commission,
Oct 2019). In the first six months of 2018 alone, 350 sentinel events were reported (Palmer,
2018). Sentinel events are defined by The Joint Commission as “an unexpected occurrence
involving death or serious physical or psychological injury, or the risk thereof. Serious injury
specifically includes loss of limb or function. The phrase ‘or the risk thereof’ includes any
process variation for which a recurrence would carry a significant chance of a serious adverse
outcome.” (Thejointcommission.org, 2012). After including other conditions such as hospital-acquired
pressure injury, that number jumped to as much as 2.5 million cases a year (Shieh et al.,
2018).
Recent innovati
Rappel sur l'épistémologie de la géographie animale sur Géoconfluences
No full textFarid Benhammou a publié il y a quelques temps déjà un petit texte sur l'épistémologie de la géographie animale sur le site Géoconfluences. Outre sa présentation des différents auteurs français travaillant sur cette question, ce texte a notamment le mérite de replacer la géographie dans le champ plus large des études animales avec, en prime, des indications bibliographiques indispensables pour qui souhaiterait se lancer dans une recherche sur les relations anthropozoologiques. Voici le lie..
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