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Hospital costs in the USA are a large part of the national GDP. Medical billing and supplies processes are significant and growing contributors to hospital operations costs in the USA. This article aims to identify cost drivers associated with these processes and to suggest improvements to reduce hospital costs.

A Monte Carlo simulation model that uses @Risk software facilitates cost analysis and captures variability associated with the medical billing process (administrative) and medical supplies process (variable). The model produces estimated savings for implementing new processes.

Significant waste exists across the entire medical supply process that needs to be eliminated. Annual savings, by implementing the improved process, have the potential to save several billion dollars annually in US hospitals. The other analysis in this study is related to hospital billing processes. Increased spending on hospital billing processes is not entirely due to hospital inefficiency.

The study lacks concrete data for accurately measuring cost savings, but there is obviously room for improvement in the two US healthcare processes. This article only looks at two specific costs associated with medical supply and medical billing processes, respectively.

This study facilitates awareness of escalating US hospital expenditures. Cost categories, namely, fixed, variable and administrative, are presented to identify the greatest areas for improvement.

The study will be valuable to US Congress policy makers and US healthcare industry decision makers. Medical billing process, part of a hospital's administrative costs, and hospital supplies management processes are part of variable costs. These are the two major cost drivers of US hospitals' expenditures that were examined and analyzed.

The purpose of this paper is to clarify the effects of the Iranian Hospital Accreditation Program (IHAP) on hospital processes from the viewpoint of the staff charged with establishing the program.

This qualitative study is based on the data collected in semi-structured interviews conducted in 2016, which involved eight questions. Interviews were held with 70 staff members at 14 hospitals. Managerial staff were purposively interviewed based on their familiarity and involvement with the program. The hospitals were divided into five groups, comprising public, private, charity, military and social service hospitals. A thematic analysis was carried out using the collected data.

Three themes emerged from the data, which together comprise a process management cycle: the establishment, implementation, and control phases of the program. For each phase, various positive trends, as well as hurdles for establishing the program, declared which were framed two sub-themes as positive effects and challenges.

The findings contribute to the body of evidence used by policy-makers and hospital managers to improve the change management processes related to the Iranian IHAP. Although positive changes in the process management cycles at Iranian hospitals were noted, successful implementation of the program demands a thorough assessment of the hospitals’ technical and financial needs (taking into account disparities between hospitals), and there is an urgent requirement for a plan to meet these needs.

The purpose of this paper is to refine and expand technology adoption theory for a healthcare logistics setting by combining the technology–organization–environment framework with a business process management (BPM) perspective. The paper identifies and ranks factors impacting the decision to implement instances of technologies in healthcare logistics processes.

A multiple case study is carried out at five Danish hospitals to investigate the bed logistics process. A combined technology adoption and BPM lens is applied to gain an understanding of the reasoning behind technology adoption.

A set of 17 factors impacting the adoption of technologies within healthcare logistics was identified. The impact factors perceived as most important to the adoption of technologies in healthcare logistics processes relate to quality, employee work conditions and employee engagement.

This paper seeks to understand how managers can use knowledge about impact factors to improve processes through technology adoption. The findings of this study provide insights about the factors impacting the adoption of technologies in healthcare logistics processes. Differences in perceived importance of factors enable ranking of impact factors, and prioritization of changes to be implemented. The study is limited to five hospitals, but is expected to be representative of public hospitals in developed countries and applicable to similar processes.

The study contributes to the empirical research within the field of BPM and technology adoption in healthcare. Furthermore, the findings of this study enable managers to make an informed decision about technology adoption within a healthcare logistics setting.

In the OECD countries, hospitals face increased financial restrictions and competition. Process orientation is an essential means of remaining competitive. A wide range of theories and concepts relating to clinical process management already exists. When it comes to practical implementation, however, a comprehensive approach for the target‐oriented and consistent introduction of clinical process management throughout an entire hospital is missing. The purpose of this paper is to document the case of a German hospital that has realised a project of this kind and demonstrate the impacts on cooperation and on operational efficiency, which is understood as the degree to which a hospital is capable of steadily realising short lengths of stay.

The case shows the approach to implementing theories and concepts for managing clinical processes in practice as a consistent management system in the day‐to‐day use of process management and its impacts.

The effect of using clinical processes shown in the case is an additional net profit of several million euros a year – without a reduction in quality.

While the impacts of clinical pathways on hospitals are not country‐specific, the reasons are nonetheless subject to the political and economic conditions. Therefore, some findings are only valid for hospitals in German‐speaking countries. However, major effects (e.g. reduction in the length of stay) may exist everywhere.

The paper shows how process orientation in a medium‐sized hospital can be systematically implemented.

The purpose of this paper is to describe research which investigated the interdependencies between facility management performance and costs, and primary processes in hospitals. Through the implementation of the German diagnosis related grouping (DRG) system and the resulting cost pressure, the need for optimized use and operation of the spatial resources in hospitals is growing. In the DRG system, the provision of ready to use infrastructure is treated as a fixed cost and is allocated to patient cases by a single cost driver. In reality, very different services are needed to provide ready to use functional space.

A primary activity based cost model for facility management (FM) services in relation to functional space units in the hospital is developed. Using process and cost data of an empiric research study from four German hospitals, a model is developed for a key functional space unit in the hospital, the operation unit. The relevant FM services structured by a product‐oriented approach are determined by real data. For these services, process figures are derived and implemented in a basic cost estimation model. The cost estimation model is compared to the cost approach of the DRG system.

In an explorative study, the model provides an approach for a patient focused cost allocation of FM services for the operation unit. Depending on the time spectrum of operations great differences between this approach and the legal cost allocation approached in Germany can be determined. One way for hospitals to face the consequences may be the determination and optimization of relevant FM services according to a primary process portfolio.

The activity based cost model should be developed for further space units in the hospital. Thus, a holistic approach to FM and strategic planning of space and FM services could be achieved. Further, the explorative study should be enlarged to a greater database for the development of general key figures for FM in relation to the primary processes.

The model can be used by hospitals for strategic planning of the FM costs and services in relation to the capacity and utilization of the operation unit. The impact of changes of the primary performance portfolio on the utilization of corresponding infrastructure can be simulated. Thus, cost data can be made available to support strategic decisions.

There is no existing cost model for the hospital considering FM in a holistic way in relation to the primary processes.

Despite the continuation of hospital mergers in many western countries, it is uncertain if and how hospital mergers impact the quality of care. This poses challenges for the regulation of mergers. The purpose of this paper is to understand: how regulators and hospitals frame the impact of merging on the quality and safety of care and how hospital mergers might be regulated, given their uncertain impact on quality and safety of care.

This paper studies the regulation of hospital mergers in The Netherlands. In a qualitative study design, it draws on 30 semi-structured interviews with inspectors from the Dutch Health and Youth Care Inspectorate (Inspectorate) and respondents from three hospitals that merged between 2013 and 2015. This paper draws from literature on process-based regulation to understand how regulators can monitor hospital mergers.

This paper finds that inspectors and hospital respondents frame the process of merging as potentially disruptive to daily care practices. While inspectors emphasise the dangers of merging, hospital respondents report how merging stimulated them to reflect on their care practices and how it afforded learning between hospitals. Although the Inspectorate considers mergers a risk to quality of care, their regulatory practices are hesitant.

This qualitative study sheds light on how merging might affect key hospital processes and daily care practices. It offers opportunities for the regulation of hospital mergers that acknowledges rather than aims to dispel the uncertain and potentially ambiguous impact of mergers on quality and safety of care.

The aim of this study is to document and analyze experiences with building a new hospital guided by lean-led hospital design (LLHD) (Grunden and Hagood, 2012) and to investigate key mechanisms enhancing healthcare professionals' participation and collaboration in implementing this innovative approach.

An in-depth case study of the implementation of LLHD in a Dutch hospital was performed based on multiple data sources. The case hospital presented a unique opportunity since there was embedded access to the data by the first author.

Three mechanisms supporting participation and collaboration of staff for implementing LLHD were identified. (1) Freedom in translating a concept enables managers to balance it with variations in practice at the organizational level. (2) A set of key principles governing the design process appeared an important anchor on a managerial level in a changing environment. (3) Creation of a supportive attitude toward lean and lean facility design, with co-creation as a key element of LLHD.

By using the emerging mechanisms, managers/change agents can enlarge collaboration and participation of hospital staff when implementing organization-wide innovations.

This case study delivers a unique inside view on the dynamics evolving in the complex change processes at organizational, managerial and personal levels involved in implementing LLHD.

The purpose of this study is to examine the management perceptions towards calculative practices behind the reconstruction of a mandatory hospital accreditation (HA) system that transforms multiple facets of health-care quality into a single performance index.

This study contributes to the sociology of quantification mobilising the concept of commensuration as a social process to reflect on contemporary changes in managing HA systems. Data are collected adopting a case study of a Spanish public hospital drawing on semi-structured interviews, observation and documentary review.

Findings emphasise a shift from standards’ compliance to a more comprehensive view encouraging continuous quality improvement. Accreditation acts as a tin opener to facilitate external inspection removing contextual differences amongst hospitals and reducing organisational practices into controllable objects. It also reveals underlying ethical concerns as the system was built as a care quality measure that promptly developed into an attainment goal.

The valuable role of HA to enhance quality standards and the limitations resulting from its commensuration practices will be of interest to policymakers, organisational managers and researchers.

Despite a growing emphasis on audit and valuation practices in health care, accounting studies examining the capacity of public hospitals to manage quality improvement are scarce. This study inspires further research on accreditation to overcome commensuration flaws regarding external transparency, evaluation ambiguity and extra incentives.

The German health care system is in dire straits financially. The costs of stationary patient care in hospitals are prohibitive. Currently, 30 per cent of hospital costs are a result of facility related processes, a percentage representing the equivalent of more than €14bn annually. Optimising facility‐related processes in hospitals has the potential to incur major savings and improve medical processes at the same time ‐ meeting the strategic need to reduce health care costs without having a negative impact on the quality of the core competencies and processes of hospitals. This paper presents the findings of the OPIK research project, which analysed the interaction between primary (medical) and secondary (facility management) business processes in six hospitals, with a view to identifying a holistic approach and comprehensive framework for evaluating business processes to ensure their optimisation.

Patient process recognition and re‐engineering (PPR) has become a major concern of recent health care development and management. This paper discusses the position of the National Health Service (NHS) in the UK; where it is at present and where it aims to be. It suggests that the work of the current government in developing community care is central to the work of both the Leicester Royal Infirmary and the Peterborough Hospitals NHS Trust, when building relationships between primary (community) and secondary (hospital) health care provision. This paper aims to examine whether and how PPR can improve patient processes in the NHS. It does this through a case study of PPR in Peterborough Hospital.