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PURPOSE: This study aims to summarize studies that compared the performance of health-care institutions led by leaders with medical background versus those with no medical background. DESIGN/METHODOLOGY/APPROACH: A systematic search was conducted on three databases: PubMed, Ovid Medline and Google Scholar to identify relevant peer-reviewed studies using the keywords "performance," "impact," "physician," "medical," "doctor," "leader," "healthcare institutions" and "hospital." Only quantitative studies that compared the performance of health-care institutions led by leaders with medical background versus non-medical background were included. Articles were screened and assessed for eligibility before the relevant data were extracted to summarize, appraise and make a narrative account of the findings. FINDINGS: A total of eight studies were included, four were based in the USA, two in the UK and one from Germany and one from the Arab World. Half of the studies (n = 4) reported overall better health-care institutional performance in terms of hospital quality ranking such as clinical effectiveness and patient safety under leaders with medical background, whereas one study showed poorer performance. The remaining studies reported mixed results among the different performance indicators, especially financial performance. PRACTICAL IMPLICATIONS: While medical background leaders may have an edge in clinical competence to manage health-care institutions, it will be beneficial to equip them with essential management skills to optimize leadership competence and enhance organizational performance. ORIGINALITY/VALUE: The exclusive inclusion of quantitative empirical studies that compared health-care institutional performance medical and non-medical leaders provides a clearer link between the relationship between health-care institutional performance and the leaders' background.
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Administración de Instituciones de Salud , Liderazgo , Humanos , Instituciones de SaludRESUMEN
BACKGROUND: The increased recognition of governance, leadership, and management as determinants of health system performance has prompted calls for research focusing on the nature, quality, and measurement of this key health system building block. In low- or middle-income contexts (LMIC), where facility-level management and performance remain a challenge, valid tools to measure management have the potential to boost performance and accelerate improvements. We, therefore, sought to develop a Facility-level Management Scale (FMS) and test its reliability in the psychometric properties in three African contexts. METHODS: The FMS was administered to 881 health workers in; Ghana (n = 287; 32.6%), Malawi (n = 66; 7.5%) and Uganda (n = 528; 59.9%). Half of the sample data was randomly subjected to exploratory factor analysis (EFA) and Monte Carlo Parallel Component Analysis to explore the FMS' latent structure. The construct validity of this structure was then tested on the remaining half of the sample using confirmatory factor analysis (CFA). The FMS' convergent and divergent validity, as well as internal consistency, were also tested. RESULTS: Findings from the EFA and Monte Carlo PCA suggested the retention of three factors (labelled 'Supportive Management', 'Resource Management' and 'Time management'). The 3-factor solution explained 51% of the variance in perceived facility management. These results were supported by the results of the CFA (N = 381; χ2 = 256.8, df = 61, p < 0.001; CFI = 0.94; TLI = 0.92; RMSEA [95% CI] = 0.065 [0.057-0.074]; SRMR = 0.047). CONCLUSION: The FMS is an open-access, short, easy-to-administer scale that can be used to assess how health workers perceive facility-level management in LMICs. When used as a regular monitoring tool, the FMS can identify key strengths or challenges pertaining to time, resources, and supportive management functions at the health facility level.
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Administración de Instituciones de Salud , Encuestas y Cuestionarios , Humanos , Ghana , Malaui , Psicometría , Reproducibilidad de los Resultados , UgandaRESUMEN
Importance: Care of adults at profit vs nonprofit dialysis facilities has been associated with lower access to transplant. Whether profit status is associated with transplant access for pediatric patients with end-stage kidney disease is unknown. Objective: To determine whether profit status of dialysis facilities is associated with placement on the kidney transplant waiting list or receipt of kidney transplant among pediatric patients receiving maintenance dialysis. Design, Setting, and Participants: This retrospective cohort study reviewed the US Renal Data System records of 13â¯333 patients younger than 18 years who started dialysis from 2000 through 2018 in US dialysis facilities (followed up through June 30, 2019). Exposures: Time-updated profit status of dialysis facilities. Main Outcomes and Measures: Cox models, adjusted for clinical and demographic factors, were used to examine time to wait-listing and receipt of kidney transplant by profit status of dialysis facilities. Results: A total of 13â¯333 pediatric patients who started receiving maintenance dialysis were included in the analysis (median age, 12 years [IQR, 3-15 years]; 6054 females [45%]; 3321 non-Hispanic Black patients [25%]; 3695 Hispanic patients [28%]). During a median follow-up of 0.87 years (IQR, 0.39-1.85 years), the incidence of wait-listing was lower at profit facilities than at nonprofit facilities, 36.2 vs 49.8 per 100 person-years, respectively (absolute risk difference, -13.6 (95% CI, -15.4 to -11.8 per 100 person-years; adjusted hazard ratio [HR] for wait-listing at profit vs nonprofit facilities, 0.79; 95% CI, 0.75-0.83). During a median follow-up of 1.52 years (IQR, 0.75-2.87 years), the incidence of kidney transplant (living or deceased donor) was also lower at profit facilities than at nonprofit facilities, 21.5 vs 31.3 per 100 person-years, respectively; absolute risk difference, -9.8 (95% CI, -10.9 to -8.6 per 100 person-years) adjusted HR for kidney transplant at profit vs nonprofit facilities, 0.71 (95% CI, 0.67-0.74). Conclusions and Relevance: Among a cohort of pediatric patients receiving dialysis in the US from 2000 through 2018, profit facility status was associated with longer time to wait-listing and longer time to kidney transplant.
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Instituciones de Atención Ambulatoria , Accesibilidad a los Servicios de Salud , Fallo Renal Crónico , Trasplante de Riñón , Diálisis Renal , Listas de Espera , Adolescente , Instituciones de Atención Ambulatoria/economía , Instituciones de Atención Ambulatoria/organización & administración , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Niño , Preescolar , Femenino , Administración de Instituciones de Salud/economía , Administración de Instituciones de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Fallo Renal Crónico/economía , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/terapia , Trasplante de Riñón/economía , Trasplante de Riñón/estadística & datos numéricos , Masculino , Organizaciones sin Fines de Lucro/economía , Organizaciones sin Fines de Lucro/organización & administración , Organizaciones sin Fines de Lucro/estadística & datos numéricos , Propiedad/economía , Propiedad/estadística & datos numéricos , Diálisis Renal/economía , Diálisis Renal/estadística & datos numéricos , Estudios Retrospectivos , Factores de TiempoRESUMEN
The purpose is to strengthen Human Resources Management (HRM) through information management using Artificial Intelligence (AI) technology. First, the selection criteria of the applicant's resume during recruitment and the formulation standards of the contract salary are analyzed. Then, the resume information is extracted and converted into the data-type format. Besides, the salary forecast model in the HRM system (HRMS) is designed based on the Back Propagation Neural Network (BPNN), and network structure, parameter initialization, and activation function of the BPNN are selected and optimized. The experimental results demonstrate that the algorithm optimized by the Nadm has shown improved convergence speed and forecast effect, with 187 iterations. Moreover, compared with other regression algorithms, the designed algorithm achieves the best test scores. The above results can provide references for designing the AI-based HRMS.
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Algoritmos , Inteligencia Artificial , Atención a la Salud/normas , Administración de Instituciones de Salud/normas , Redes Neurales de la Computación , Recursos Humanos/organización & administración , HumanosRESUMEN
Introducción: El cambio climático se atribuye directa o indirectamente a la actividad humana, pues esta altera la composición de la atmósfera, de conjunto con la variabilidad natural del clima. De ahí que las instituciones hospitalarias, requieran de control y manejo de residuos y sustancias peligrosas durante la prestación de sus servicios. Objetivo: Valorar la implementación de buenas prácticas en el uso sostenible de los recursos hídrico, la energía eléctrica, la administración segura de sustancias peligrosas y el manejo razonable de los residuos que producen los servicios en el Hospital Pediátrico Provincial de Holguín para la gestión ambiental y de enfrentamiento al cambio climático. Métodos: Se realizó un estudio longitudinal a todos los procesos hospitalarios, mediante técnica de la investigación cualitativa y explicativa. Se empleó el estudio de caso como estrategia de investigación para desarrollar las fases de preparación y diagnóstico, seguido de una etapa de proyección de la implementación. Por último, se realizó la evaluación y mejora del problema identificado, con criterios de sostenibilidad desde la gestión organizacional según niveles de actividad hospitalarios. Resultados: Se obtuvo un considerable ahorro de agua (64 877 m3) y una disminución significativa en gastos al presupuesto (348 miles de pesos), así como un factor de potencia entre 0,92 y 1,0 que muestra la conversión de energía consumida en trabajo. Se obtuvo una reducción significativa de líquido fijador en estudios radiográficos y se mejoró el manejo de las sustancias peligrosas (líquido fijador de Rx). Conclusiones: Para dar respuesta a las necesidades de cambio en la forma de gestión de los procesos hospitalarios se precisa recurrir a herramientas de control de consumo, análisis, normas y procedimientos que permitan alcanzar su mejora, según los niveles de actividad en los servicios(AU)
Introduction: Climate change is attributed directly or indirectly to human activity, as this alters the composition of the atmosphere, in conjunction with the natural variability of the climate. Hence, hospital institutions require control and management of wastes and hazardous substances during the provision of their services. Objective: Assess the implementation of good practices in the sustainable use of water resources, electrical energy, the safe administration of hazardous substances and the reasonable management of waste produced by the services at the Provincial Pediatric Hospital of Holguín for environmental management and the fight against climate change. Methods: A longitudinal study was carried out on all hospital processes, using qualitative and explanatory research technique. The case study was used as a research strategy to develop the preparation and diagnosis phases, followed by a projection stage of implementation. Finally, the evaluation and improvement of the identified problem was carried out, with sustainability criteria from the organizational management according to hospital activity levels. Results: Considerable water savings were obtained (64 877 m3) and a significant decrease in budget expenses (348 000 pesos), as well as a power factor between 0.92 and 1.0 that shows the conversion into work of they energy consumed. A significant reduction in fixer fluid was obtained in radiographic studies and the handling of hazardous substances (Rx fixer liquid) was improved. Conclusions: To respond to the needs of change in the way hospital processes are managed, it is necessary to resort to consumption control tools, analysis, standards and procedures that allow them to be improved, according to the levels of activity in the services(AU)
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Humanos , Masculino , Femenino , Gestión de Riesgos , Cambio Climático , Administración de Instituciones de Salud , Estudios Longitudinales , CubaAsunto(s)
Vacunas contra la COVID-19 , Empleo , Administración de Instituciones de Salud , Personal de Salud , Programas Obligatorios , Política Organizacional , Vacunación , COVID-19/prevención & control , Transmisión de Enfermedad Infecciosa/prevención & control , Humanos , Administración de la SeguridadRESUMEN
Many university and college programs offer co-op placements or practicums as part of their curriculum, with the aim of providing real-world experience and opportunity for students to apply theory to practice. These practicums are not always grounded in the underlying management or policy theories the program teaches, instead they often focus on universal attributes such as task performance or general leadership. This case study describes how a University of Toronto Health Policy and Management student and an Executive from Ontario's Ministry of Health redesigned the student's practicum to be grounded in Kingdon's Multiple Stream Policy Framework. The case demonstrates how the theoretical framework was applied to enhance their weekly mentorship discussions, and organize the student's learnings relating to the Ministry's policy on hospital capacity during the COVID-19 pandemic by viewing the work through the framework's five streams.
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COVID-19/epidemiología , Administración de Instituciones de Salud/educación , Política de Salud , Neumonía Viral/epidemiología , Preceptoría , Curriculum , Humanos , Ontario/epidemiología , Pandemias , Neumonía Viral/virología , SARS-CoV-2RESUMEN
INTRODUCTION: The Australian Council on Healthcare Standards (ACHS) sponsored an expert-led, consensus-driven, four-stage process, based on a modified Delphi methodology, to determine a set of clinical indicators as quality measures of cancer service provision in Australia. This was done in response to requests from institutional health care providers seeking accreditation, which were additional and complementary to the existing radiation oncology set. The steering group members comprised multidisciplinary key opinion leaders and a consumer representative. Five additional participants constituted the stakeholder group, who deliberated on the final indicator set. METHODS AND RECOMMENDATIONS: An initial meeting of the steering group scoped the high level nature of the desired set. In stage 2, 65 candidate indicators were identified by a literature review and a search of international metrics. These were ranked by survey, based on ease of data accessibility and collectability and clinical relevance. The top 27 candidates were debated by the stakeholder group and culled to a final set of 16 indicators. A user manual was created with indicators mapped to clinical codes. The indicator set was ratified by the Clinical Oncology Society of Australia and is now available for use by health care organisations participating in the ACHS Clinical Indicator Program. This inaugural cancer clinical indicator set covers high level assessment of various critical processes in cancer service provision in Australia. Regular reviews and updates will ensure usability. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: This is the inaugural indicator set for cancer care for use across Australia and internationally under the ACHS Clinical Indicator Program. Multidisciplinary involvement through a modified Delphi process selected indicators representing both generic and specific aspects of care across the cancer journey pathway and will provide a functional tool to compare health care delivery across multiple settings. It is anticipated that this will drive continual improvement in cancer care provision.
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Atención a la Salud/normas , Oncología Médica , Indicadores de Calidad de la Atención de Salud/organización & administración , Acreditación/normas , Australia , Consenso , Instituciones de Salud/normas , Administración de Instituciones de Salud , HumanosRESUMEN
In 2017, 43.9% of US physicians reported symptoms of burnout. Poor electronic health record (EHR) usability and time-consuming data entry contribute to burnout. However, less is known about how modifiable dimensions of EHR use relate to burnout and how these associations vary by medical specialty. Using the KLAS Arch Collaborative's large-scale nationwide physician (MD/DO) data, we used ordinal logistic regression to analyze associations between self-reported burnout and after-hours charting and organizational EHR support. We examined how these relationships differ by medical specialty, adjusting for confounders. Physicians reporting ≤ 5 hours weekly of after-hours charting were twice as likely to report lower burnout scores compared to those charting ≥6 hours (aOR: 2.43, 95% CI: 2.30, 2.57). Physicians who agree that their organization has done a great job with EHR implementation, training, and support (aOR: 2.14, 95% CI: 2.01, 2.28) were also twice as likely to report lower scores on the burnout survey question compared to those who disagree. Efforts to reduce after-hours charting and improve organizational EHR support could help address physician burnout.
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Agotamiento Profesional , Registros Electrónicos de Salud , Administración de Instituciones de Salud , Médicos , Agotamiento Profesional/epidemiología , Administración de los Servicios de Salud , Humanos , Modelos Logísticos , Estados Unidos/epidemiología , Carga de TrabajoRESUMEN
BACKGROUND: On October 4, 2016, Hurricane Matthew struck southwest Haiti as a category 4 storm. The goal of this study was to evaluate the impact of the hurricane on tuberculosis (TB) services and patient outcomes in the three severely affected departments-Sud, Grand'Anse, and Nippes-of southwest Haiti. METHODS: We developed a standard questionnaire to assess a convenience sample of health facilities in the affected areas, a patient tracking form, and a line list for tracking all patients with drug-susceptible TB registered in care six months before the hurricane. We analyzed data from the national TB electronic surveillance system to determine outcomes for all patients receiving anti-TB treatment in the affected areas. We used logistic regression analysis to determine factors associated with treatment success. RESULTS: Of the 66 health facilities in the three affected departments, we assessed 31, accounting for 536 (45.7%) of 1,174 TB patients registered in care when Hurricane Matthew made landfall in Haiti. Three (9.7%) health facilities sustained moderate to severe damage, whereas 18 (58.1%) were closed for <1 week, and five (16.1%) for ≥1 week. Four weeks after the hurricane, 398 (73.1%) of the 536 patients in the assessed facilities were located. Treatment success in the affected departments one year after the hurricane was 81.4%. Receiving care outside the municipality of residence (adjusted odds ratio [aOR]: 0.46, 95% confidence interval [CI]: 0.27-0.80) and HIV positivity (aOR: 0.31, 95% CI: 0.19-0.51) or unknown HIV status (aOR: 0.49, 95% CI: 0.33-0.74) were associated with significantly lower rates of treatment success. CONCLUSIONS: Despite major challenges, a high percentage of patients receiving anti-TB treatment before the hurricane were located and successfully treated in southwest Haiti. The lessons learned and results presented here may help inform policies and guidelines in similar settings for effective TB control after a natural disaster.
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Antituberculosos/uso terapéutico , Tormentas Ciclónicas , Infecciones por VIH/tratamiento farmacológico , Administración de Instituciones de Salud/estadística & datos numéricos , Tuberculosis Pulmonar/tratamiento farmacológico , Adolescente , Adulto , Coinfección , Femenino , VIH/efectos de los fármacos , VIH/crecimiento & desarrollo , VIH/patogenicidad , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , Haití/epidemiología , Instituciones de Salud , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/crecimiento & desarrollo , Mycobacterium tuberculosis/patogenicidad , Estudios Retrospectivos , Encuestas y Cuestionarios , Resultado del Tratamiento , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/microbiologíaAsunto(s)
Personas con Discapacidad , Educación Médica , Política Organizacional , Accesibilidad Arquitectónica , Actitud del Personal de Salud , Personas con Discapacidad/legislación & jurisprudencia , Administración de Instituciones de Salud , Humanos , Prejuicio , Facultades de Medicina/organización & administración , Estados UnidosRESUMEN
INTRODUCTION: Coronavirus-19 is a global health challenge and need an immediate action. Thus, understanding client's knowledge about SARS-COV2 causes, roots of transmissions, and prevention strategies are urgently warranted. Although there were global studies reported knowledge and preventive practices of COVID-19, but the information is not representative and inclusive for Ethiopia. Thus, the current study is done to identify the knowledge and the prevention strategies for COVID-19 among clients in South Wollo, Ethiopia. METHODS: An institutional based cross-sectional study was conducted from May 21 to 30, 2020 among clients seeking service in Dessie town health facilities. A total of 81 clients were included from the selected health facilities with simple random sampling technique. We developed measuring tools by adopting from World Health Organization and center for disease prevention recommendation manual for assessing service providers' knowledge and preventive practices. For data entry Epi-data 3.1 version was employed and further data management and analysis was performed using STATA Version 14. Student T-test and one way ANOVA were computed to see the mean difference in knowledge and practice between and among the group. Chi-square test was also done to portray the presence of association between different co-variants with client's knowledge and preventive practices. RESULTS: Findings of the study showed that more than half (56.8%) of the participants had good knowledge about its symptoms, way of spread and prevention of the virus. Furthermore, 65.4% of clients demonstrated five or more preventive practice measures of COVID-19. The mean preventive practice score with standard deviation was (4.75±1.28 from 6 components). In the current study, knowledge had no significant difference among sex, education status, and monthly income. However, COVID-19 transmission knowledge was significantly higher among urban residents. Thus, clients who were knowledgeable about way of transmission and symptoms of COVID-19 had significantly higher COVID-19 preventive practice. CONCLUSION: Our findings revealed that clients' knowledge and preventive practice of COVID-19 were not optimal. Clients with good knowledge and urban residents had practiced better prevention measures of the pandemic, signifying that packages and programs directed in enhancing knowledge about the virus is useful in combating the pandemic and continuing safe practices.
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COVID-19/prevención & control , Administración de Instituciones de Salud , Conocimientos, Actitudes y Práctica en Salud , Pandemias/prevención & control , Adolescente , Adulto , COVID-19/epidemiología , Estudios Transversales , Demografía , Etiopía , Femenino , Instituciones de Salud/normas , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Población Urbana/estadística & datos numéricosAsunto(s)
Instituciones de Salud , Fuerza Laboral en Salud/estadística & datos numéricos , Atención Primaria de Salud , Instituciones de Salud/economía , Instituciones de Salud/legislación & jurisprudencia , Administración de Instituciones de Salud , Humanos , Patient Protection and Affordable Care Act , Atención Primaria de Salud/legislación & jurisprudencia , Asociación entre el Sector Público-Privado , Estados Unidos , United States Health Resources and Services AdministrationRESUMEN
The current COVID-19 pandemic has demonstrated the vulnerability of healthcare systems worldwide. When combined with natural disasters, pandemics can further strain an already exhausted healthcare system. To date, frameworks for quantifying the collective effect of the two events on hospitals are nonexistent. Moreover, analytical methods for capturing the dynamic spatiotemporal variability in capacity and demand of the healthcare system posed by different stressors are lacking. Here, we investigate the combined impact of wildfire and pandemic on a network of hospitals. We combine wildfire data with varying courses of the spread of COVID-19 to evaluate the effectiveness of different strategies for managing patient demand. We show that losing access to medical care is a function of the relative occurrence time between the two events and is substantial in some cases. By applying viable mitigation strategies and optimizing resource allocation, patient outcomes could be substantially improved under the combined hazards.
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COVID-19/epidemiología , Atención a la Salud , Instituciones de Salud , Administración de Instituciones de Salud/métodos , Desastres Naturales , Pandemias , Política de Salud , Humanos , Unidades de Cuidados Intensivos , Salud Pública , SARS-CoV-2/aislamiento & purificación , Estados UnidosRESUMEN
BACKGROUND: Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. METHODS: This study utilizes cross-sectional health facility (N = 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N = 1479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Component Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). RESULTS: Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. CONCLUSION: Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that using more nuanced measures of integration may (a) more accurately reflect true variation in integration within and across health facilities, (b) enable more precise measurement of the determinants or effects of integration, and (c) provide more tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.
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Prestación Integrada de Atención de Salud , Servicios de Planificación Familiar , Administración de Instituciones de Salud , Programas de Inmunización , Servicios de Salud Reproductiva , Adulto , Niño , Preescolar , Estudios Transversales , Prestación Integrada de Atención de Salud/organización & administración , Prestación Integrada de Atención de Salud/normas , Servicios de Planificación Familiar/organización & administración , Servicios de Planificación Familiar/normas , Servicios de Planificación Familiar/provisión & distribución , Femenino , Instituciones de Salud/normas , Administración de Instituciones de Salud/métodos , Administración de Instituciones de Salud/normas , Indicadores de Salud , Humanos , Programas de Inmunización/organización & administración , Programas de Inmunización/normas , Programas de Inmunización/provisión & distribución , Lactante , Recién Nacido , Masculino , Nigeria/epidemiología , Embarazo , Salud Reproductiva/normas , Servicios de Salud Reproductiva/organización & administración , Servicios de Salud Reproductiva/normas , Servicios de Salud Reproductiva/provisión & distribución , Encuestas y Cuestionarios , Población Urbana/estadística & datos numéricos , Vacunación/métodos , Vacunación/estadística & datos numéricosRESUMEN
Few studies have assessed the efficiency and quality of HIV services in low-resource settings or considered the factors that determine both performance dimensions. To provide insights on the performance of outpatient HIV prevention units, we used benchmarking methods to identify best-practices in terms of technical efficiency and process quality and uncover management practices with the potential to improve efficiency and quality. We used data collected in 338 facilities in Kenya, Nigeria, Rwanda, South Africa, and Zambia. Data envelopment analysis (DEA) was used to estimate technical efficiency. Process quality was estimated using data from medical vignettes. We mapped the relationship between efficiency and quality scores and studied the managerial determinants of best performance in terms of both efficiency and quality. We also explored the relationship between management factors and efficiency and quality independently. We found levels of both technical efficiency and process quality to be low, though there was substantial variation across countries. One third of facilities were mapped in the best-performing group with above-median efficiency and above-median quality. Several management practices were associated with best performance in terms of both efficiency and quality. When considering efficiency and quality independently, the patterns of associations between management practices and the two performance dimensions were not necessarily the same. One management characteristic was associated with best performance in terms of efficiency and quality and also positively associated with efficiency and quality independently: number of supervision visits to HIV units.
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Instituciones de Atención Ambulatoria/organización & administración , Eficiencia Organizacional , Infecciones por VIH/prevención & control , Administración de Instituciones de Salud/métodos , África del Sur del Sahara , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Prueba de VIH/estadística & datos numéricos , Humanos , Pacientes AmbulatoriosRESUMEN
Healthcare is a complex adaptive system with multiple stakeholders and dynamic environments. Therefore, healthcare organizations must continuously learn, innovate, adapt, and co-evolve to be successful. This article describes a systematic, comprehensive, and holistic performance management framework that healthcare managers can use to achieve these goals. The framework involves the ongoing assessment, modification, or replacement of current programs or services aimed at adapting successfully to achieve the organization's strategic objectives. This is engendered by the presence of a culture that is premised on continuous learning and innovation. The foundation of the framework is based on accountability, the organization's strategy, and its culture. This then acts as the basis for an ongoing process of measurement, disconfirmation, contextualization, implementation, and routinization that enhances learning, innovation, adaptation, and sustainability within the healthcare organization.
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Administración de Instituciones de Salud , Aprendizaje , Modelos Organizacionales , Innovación Organizacional , COVID-19 , Eficiencia Organizacional , Difusión de la Información , Úlcera por Presión/prevención & control , SARS-CoV-2RESUMEN
We adopt a holistic-micro, meso, macro-approach to health leadership ethics to examine how low- and middle-income countries have responded to the COVID-19 pandemic. Healthcare delivery happens within complex settings in low- and middle-income countries and high-income countries. These settings are riddled with systemic political and economic challenges which, in some instances, make it difficult for health leaders to be ethical. These challenges, however, are not unique to low- and middle-income countries. Globally, countries can learn from ethical health leadership missteps that occurred during low- and middle-income countries' responses to COVID-19. We discuss the implications of problematic ethics in health leadership on managing pandemics in low- and middle-income countries, using Zimbabwe as an example. We offer suggestions on what can be done to improve ethical health leadership in response to future health crises in both high-income and low- and middle-income nations.