The continued advance of the nation's space program is directly dependent upon the development and use of new technology. Technology is the foundation for every aspect of space missions and ground operations. The improvements in technology that will enable future advances are not only in device and system performance, but also in permitting missions to be carried out more rapidly and at lower c…
This high volume of errors was recently affirmed by some with first- hand knowledge of errors—practicing physicians, patients, and their families. Fully 35 percent of practicing physicians and 42 percent of members of the American public responding to a 2002 national survey reported having experienced an error either in their own care or in that of a family member. Moreover, 18 percent of the…
Seven years ago, the Institute of Medicine (IOM) Committee on the Quality of Health Care in America released its first report, To Err Is Hu- man, finding that an estimated 44,000 to 98,000 Americans may die an- nually due to medical errors. If mortality tables routinely included medical errors as a formal cause of death, they would rank well within the ten leading killers (IOM 2000). Two years …
This volume reports on discussions among multiple stakeholders about ways they might help transform health care in the United States. The U.S. healthcare system consists of a complex network of decentralized and loosely associated organizations, services, relationships, and participants. Each of the healthcare system’s component sectors—patients, healthcare profes- sionals, healthcare deliv…
The rapid pace of scientific discovery and technological innovation over the last several decades is unprecedented and raises the prospect of achieving dramatic improvements in the nation’s health and well-being. Yet stakeholders from across the healthcare system, from patients to practitioners to payers, are demanding fundamental improvements to a system that is seen as costly, fragmented, a…
Clinical effectiveness research (CER) serves as the bridge between the development of innovative treatments and therapies and their productive application to improve human health. Building on efficacy and safety determinations necessary for regulatory approval, the results of these investigations guide the delivery of appropriate care to individual patients. As the complexity, number, and diver…
Because of their potential to enable the development of new knowledge and to guide the development of best practices from the growing sum of individual clinical experiences, clinical data represent the resource most central to healthcare progress (Arrow et al., 2009; Detmer, 2003). Whether captured during product development activities such as clinical research trials and studies, or as a part …
The fundamental notion of the learning healthcare system—continuous improvement in effectiveness, efficiency, safety, and quality—is rooted in principles that medicine shares with engineering. In particular, the fields of systems engineering, industrial engineering, and operations research have long experience in the systematic design, analysis, and improvement of complex systems, notably i…
The Institute of Medicine’s Committee on Optimizing Graduate Medi- cal Trainee (Resident) Hours and Work Schedules to Improve Patient Safety evaluated the literature concerning (1) the impact of current residents’ duty hours on patient safety and (2) the relationship of hours of work and sleep to performance. The principal aim of residency training in the United States is to prepare young d…
The United States has the highest per capita spending on health care of any industrialized nation—50 percent greater than the second highest and twice as high as the average for Europe (Peterson and Burton, 2009). Current U.S. healthcare costs are projected at nearly $2.5 trillion, about 17 percent of the entire economy (Sisko et al., 2009). The Congressional Budget Office estimated that Medi…
The Institute of Medicine’s Roundtable on Value & Science-Driven Health Care has been convened to help transform the way evidence on clinical effec- tiveness is generated and used to improve health and health care. Participants have set a goal that, by the year 2020, 90 percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect t…
Slight variations in genetic composition can contribute greatly to the diversity which we see amongst individuals, from determining eye color and height to increasing the risk of developing breast cancer or heart disease. Numerous gene–disease associations are now known, and genetic/genomic testing is a relatively common laboratory approach for diagnosing presymp- tomatic genetic disorders, c…
The prosperity of a nation is tied fundamentally to the health and well-being of its citizens. It follows, then, that citizens—each one a past, current, or future patient—should represent both the healthcare system’s unwavering focus, and its fully engaged agents for change. This precept has several major implications. It means that the quality of health care should not be judged solely b…
Increasing global interconnectivity, population, and economic growth, and the mutual interdependence of economic and ecological systems, can serve both to reduce vulnerability and to amplify disaster risks (high confidence). Global development pathways are becoming a more important factor in the management of vulnerability and disaster risk. [7.2.1]
Clinicians can no longer stay abreast of the rapidly expand- ing knowledge bases related to health. The number of random- ized controlled trials published in MEDLINE (a medical literature database) grew from 5,000 per year in 1978–1985 to 25,000 per year in 1994–2001. Furthermore, contentions that much of the literature may be biased and not applicable to important subsets of target populat…
These Guidelines cover the main aspects of devising a policy on the use of derivative. It is based very closely on the „Supervisory Standard on the use Derivatives by Insurance Companies‟ as issued by the International Association of Insurance Supervisors. The implementation of the Guidelines needs to be tailored to the particular circumstances of individual companies. For example, the Cen…
This article explores how top management teams can increase the robustness of their strategies by attending to important concepts emerging from the stakeholder literature. Analysis of three themes emanating from this literature leads to the development of a method composed of three techniques which elaborates how stakeholder management concepts can be applied in practice. The research, which sp…
TechnoVision, I’m pleased to represent, is one such exception. Designed and developed with a keen appreciation for the fundamentals and core domains of today’s business technology landscape, we’ve seen this body of intellectual capital and actionable references align and respond well to the continued pace of emerging technologies, and the business disruptions and innovations they enable. …
It should be able to stand up by a chair by the tenth month, and be able to walk alone at the end of the first year. It is important that parents should know this, since not knowing what a normal baby ought to be able to do, cases of birth palsy, or even an attack of paralysis due to teething, are not infrequently overlooked, not only by the mother, but even by the doctor, who attributes the in…
It is the cry which despairing, deluded humanity, in the darkness of its frenzied ignorance, has flung back hopelessly to heaven since first the spirit of an Infinite Intelligence brooded upon the race. It is the appeal of man's immortal unity to the All-Father, from age to age, for knowledge sufficient for its hourly needs, since ever, back in the far dim ages of the earth, primeval man, beetl…
Recognition is growing that the clinical trials enterprise (CTE)2 in the United States faces substantial challenges impeding the efficient and effective conduct of clinical research to support the development of new medicines and evaluate existing therapies. A gap has been identified between the desired state where medical care in the United States is provided solely based on high-quality evide…
“How can we help you today?” Each of us would like to hear these words when seeking health care assistance for ourselves, for our families, or for others. It should not only be our wish, but our expectation. Health care that implements a “How can we help you today?” philosophy is care that is patient centered, takes full advantage of what has been learned about systems strategies for ma…
This paper analyses 26 years of strategic management research published in Academy of Management Journal, Academy of Management Review, Administrative Science Quarterly and Strategic Management Journal. Through a content analysis, it studies the relationships between the subfields of strategic management. A multiple correspondence analysis provides a map of keywords and authors, and a frame…
Courts have long recognized that people with mental illnesses have the right to be free from the improper use of seclusion and restraint. In the landmark 1982 case Youngberg v. Romeo, the Supreme Court recognized that the use of restraint is a drastic deprivation of personal liberty, holding that “[t]he right to be free from undue bodily restraint is the core of the liberty interest protected…
Motivated by the finding that existing literature and research on risk management misses the focus on small and medium sized enterprises (SME), the aim of this thesis was to propose a mean for SME to manage their internal financial risks. Similar to large companies, SME do also face business risks, which in worst case can cause financial distress and lead to bankruptcy. However, although SME a…