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ABSTRAmHealth care has undergone a number of radical changes during the past five years. These include increased competition, fixed-rate reimbursement systems, declining hospital occupancy rates, and growth in health maintenance organizations and preferred provider organizations. Given these changes in the manner in which health care is provided. contracted, and paid for, it is appropriate to review the past research on capacity management and to determine its relevance to the changing industry. This paper provides a review, Classification, and analysis of the literature on this topic. In addition, future research needs are discussed and specific problem arcas not dealt with in the pmious literature are targeted. Subject Amps: H d h Cam AaMnittrafion and Service Operations Managmenc. INTRODUCIIONHealth care managers are confronted with a number of crucial decisions regarding the management of operations. Rising health care costs result in pressure on health care providers to reduce costs through more effective resource management across the entire health care system. In addition, trends toward growth and integration in health care organizations have rendered invalid much of the earlier research performed during a time when health care essentially was characterized as a cottage industry. Given these changes in the health care environment, it seems appropriate to assess previous research on health care capacity planning and management and to determine its relevance to this changing industry. In addition, it is necessary to consider those features of the new environment which should be addressed in future research.Throughout the 1960s and early 197Os, national health policy fostered the expansion of the health care system in an effort to improve the availability of quality health care. During this time the federally sponsored Medicare and Medicaid programs were established, and employer-paid health benefits became the norm. The burden of health care costs was shifted to third parties who reimbursed health care providers under a cost-based system. Health care expenditures rapidly increased from 5 percent of the gross national product in 1965 to a current (1986) level of nearly 11 percent. The significant rise in health care costs also has been attributed to such factors as increased technological costs, an aging population with health problems, defensive medicine, excess capacity, and an increased number of well-trained specialists demanding higher wages. As a result of escalating health care costs, the government has enforced cost containment by implementing new fvced-price payment *This research was partially funded by a grant from the Operations Management Center. University of Minnesota. The authors would like to thank Roger Schroeder and John Anderson for comments on earlier versions of this paper. 889

Objective To examine doctors' perspectives about their experiences with handheld computers in clinical practice. Design Qualitative study of eight focus groups consisting of doctors with diverse training and practice patterns. Setting Six practice settings across the United States and two additional focus group sessions held at a national meeting of general internists. Participants 54 doctors who did or did not use handheld computers. Results Doctors who used handheld computers in clinical practice seemed generally satisfied with them and reported diverse patterns of use. Users perceived that the devices helped them increase productivity and improve patient care. Barriers to use concerned the device itself and personal and perceptual constraints, with perceptual factors such as comfort with technology, preference for paper, and the impression that the devices are not easy to use somewhat difficult to overcome. Participants suggested that organisations can help promote handheld computers by providing advice on purchase, usage, training, and user support. Participants expressed concern about reliability and security of the device but were particularly concerned about dependency on the device and over-reliance as a substitute for clinical thinking. Conclusions Doctors expect handheld computers to become more useful, and most seem interested in leveraging (getting the most value from) their use. Key opportunities with handheld computers included their use as a stepping stone to build doctors' comfort with other information technology and ehealth initiatives and providing point of care support that helps improve patient care.