1,211 research outputs found
Precision tracking with small-strip Thin Gap Chamber (sTGC): from Test Beam to ATLAS NSW Upgrade
No full textThe forthcoming luminosity upgrade of LHC to super - LHC (sLHC) will increase the e xpected background rate in the forward region of the ATLAS Muon Spectrometer by approximately a factor of five. Some of the present Muon Spectrometer components will fail to cope with these high rates and will have to be replaced. A development of the Th in Gap Chambers (TGC) has been tested during the last four years. The results of these tests , presented here, showed that the small strip Thin Gap Chambers (sTGC) provide a fast trigger and high precision muon tracking under sLHC conditions. In 2012, sTGC technology has been accepted as a part of the New Small Wheel (NSW)
Test-beam measurements of instrumented sensor planes for a highly compact and granular electromagnetic calorimeter
No full textThe LUXE experiment is designed to explore the strong-field QED regime in interactions of high-energy electrons from the European XFEL in a powerful laser field. One of the crucial aims of this experiment is to measure the production of electron-positron pairs as a function of the laser field strength where non-perturbative effects are expected to kick in above the Schwinger limit. For the positron energy measurements and multiplicity spectra, a tracker and an electromagnetic calorimeter are foreseen. Since the expected number of positrons varies over five orders of magnitude, and has to be measured over a widely spread low energy background, the calorimeter must be compact and finely segmented. The concept of a sandwich calorimeter made of tungsten absorber plates interspersed with thin sensor planes is developed. The sensor planes comprise a silicon pad sensor, flexible kapton printed circuit planes for bias voltage supply and signal transport to the sensor edge, all embedded in a carbon fibre support. The thickness of a sensor plane is less than 1 mm. As an alternative, gallium arsenide sensors are considered with integrated readout strips. Prototypes of both sensor planes were studied in an electron beam of 5 GeV at DESY. Results from this test beam are presented on the sensor response homogeneity, edge effects, signal sharing and embedded trace effect
Contribution à l'étude du calorimètre électromagnétique à cristaux de de l'expérience CMS au LHC
No full text
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).
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