Regulation on introducing process of the highly difficult new medical technologies: A survey on the current status of practice guidelines in Japan and overseas.

Since serious problematic cases regarding the technical safety of technically demanding operations were reported in Japan, the Ministry of Health, Labor and Welfare issued new regulations on June 10, 2016 requiring each hospital to check the status of informed consent, skill of surgery team and governance system of the surgical unit, when the highly difficult new medical technologies were introduced to a hospital. In order to firmly establish this new system for highly difficult new medical technologies, it is very important and informative to survey the current situation for guidelines and consensus regarding introduction of medical technology with special skills in Japan and overseas. Based on the survey of questionnaires, document retrieval, and expert interviews, we found that documentation related to the introduction process of highly difficult medical technologies is very rare, and the regulations were mainly issued by academic societies. Moreover, even if such documentation existed, the quality of the regulations is poor and not sufficient enough to perform surgical practice safely. Therefore, for medical practitioners, comprehensive and concrete regulations should be issued by the government or ministry to legally follow in regard to technically demanding operations. A new practice guideline was proposed by our special research group to regulate the introduction process of highly difficult new medical technologies in hospitals in Japan. This guideline, gained understanding from relevant academic societies, provided a comprehensive view on the interpretation of "high difficulty new medical technology" prescribed by the law and show the basic idea at a preliminary examination from the viewpoints of "Surgeon's requirement", "Guidance system", "Medical safety" , and "Informed consent". These efforts will contribute to the improvement of the quality of guidelines regarding "highly difficult new medical technology".

Co-management Strategies for Hospitals and Orthopedic and Neurosurgery Practices.

Co-management arrangements can be a very effective means of aligning physicians and their hospitals to gain care delivery efficiencies, control costs, and reduce variation in practices. In an era of value-based care delivery all aspects must be examined and the appropriate incentives put in place to reduce waste and optimize asset and resource utilization. This article will review legal considerations, define basic co-management structure and goals, and suggest examples of metrics used to achieve success.

Protecting Pregnant Workers while Fighting Sexism: Work-Pregnancy Balance and Pregnant Nurses' Resistance in Québec Hospitals: Protéger les travailleuses enceintes en luttant contre le sexisme: équilibre travail-grossesse et résistance d'infirmières enceintes dans des hôpitaux québécois.

Women's workplaces should guarantee healthy pregnancies while supporting pregnant women as workers. In Québec (Canada), a pregnant worker exposed to a "danger" for herself or her fetus may ask her employer to be reassigned to other work appropriate to her skills. This approach differs from other regulatory contexts in North America in that protection of fetal and maternal health is embedded in the health and safety legislation. The advantage is that the pregnant worker is guaranteed access to her full salary, but some may question whether specific provisions for pregnant women single out such women and produce risks for their careers or, conversely, pregnancy should receive even more special consideration. These questions are discussed using the results of a qualitative analysis of interviews with pregnant nurses, their supervisors, and their union representatives in ten hospitals in Québec. We think that the management of pregnancy under this legislation generally protects health, but that, in the absence of true employer commitment to the health of all workers, undue burdens may be placed upon other members of the work team. Résumé Les lieux de travail des femmes devraient garantir des grossesses saines tout en soutenant les femmes enceintes en tant que travailleurs. Au Québec (Canada), une travailleuse enceinte exposée à un danger pour elle-même ou son fœtus peut demander à son employeur d'être réaffectée à d'autres tãches sans danger et adaptéches à ses compétences. Cette approche diffère des autres contextes réglementaires en Amérique du Nord en ce sens que la protection de la santé foetale et maternelle est intégrée dans la législation sur la santé et la sécurité. Certains peuvent se demander si des dispositions spécifiques pour les femmes enceintes singularisent ces travailleuses et contribuent à la précarisation de leur emploi. Ou, à l'inverse, si la grossesse devrait recevoir une considération encore plus spéciale. Ces questions sont discutées à la lumière du récit d infirmières enceintes, de gestionnaires et de représentants syndicaux responsables des dossiers de conciliation travail-grossesse dans dix hôpitaux du Québec. Nous constatons que la gestion de la grossesse en vertu de cette législation est généralement protectrice de la santé, mais qu'en l'absence d'un véritable engagement de l'employeur envers la santé de tous les travailleurs, des charges excessives peuvent être imposées aux autres membres de l'équipe de travail.

[The Importance of Hospital Hygiene: Findings of a German Nationwide Survey]. / Der Stellenwert der Krankenhaushygiene ­ Erkenntnisse einer deutschlandweiten Befragung.

Aim of the study: The German legislature reacted to the increasing number of nosocomial infections with a set of laws to strengthen hospital hygiene. The aim of the study is to measure the current and future importance of hospital hygiene in Germany. Methods: CEOs and hygiene staff from German hospitals took part in a survey on 13 items regarding the current and future importance of hospital hygiene. Statistical analyses were conducted to identify significances regarding the professional groups. Results: The results of the study show that hospital hygiene is currently of high importance and will be rising in the future. Hospital hygiene has a high economic impact, especially as a competitive factor. The patients' fear to suffer from a nosocomial infection, especially caused by multi-resistant bacteria, is countered with intensive educational work. Conclusion: The results demonstrate that the legislators' efforts are taken note of in German hospitals and the future strategic impact of hospital hygiene in a pay-for-performance reimbursement system has become clear.

THE DESIGN OF PERFORMANCE MONITORING SYSTEMS IN HEALTHCARE ORGANIZATIONS: A STAKEHOLDER PERSPECTIVE.

Monitoring hospitals performance is evolving over time in search of more efficiency by integrating additional levels of care, reducing costs and keeping staff up-to-date. To fulfill these three potentially divergent aspects and to monitor performance, healthcare administrators are using dissimilar management control tools. To explain why, we suggest to go beyond traditional contingent factors to assess the role of the different stakeholders that are at the heart of any healthcare organization. We rely first on seminal studies to appraise the role of the main healthcare players and their influence on some organizational attributes. We then consider the managerial awareness and the perception of a suitable management system to promote a strategy-focused organization. Our methodology is based on a qualitative approach of twenty-two case studies, led in two heterogeneous environments (Belgium and Lebanon), comparing the managerial choice of a management system within three different healthcare organizational structures. Our findings allow us to illustrate, for each healthcare player, his positioning within the healthcare systems. Thus, we define how his role, perception and responsiveness manipulate the organization's internal climate and shape the design of the performance monitoring systems. In particular, we highlight the managerial role and influence on the choice of an adequate management system.

Investigating motivating factors for sound hospital waste management.

UNLABELLED: Sustainable management of hospital waste requires an active involvement of all key players. This study aims to test the hypothesis that three motivating factors, namely, Reputation, Liability, and Expense, influence hospital waste management. The survey for this study was conducted in two phases, with the pilot study used for exploratory factor analysis and the subsequent main survey used for cross-validation using confirmatory factor analysis. The hypotheses were validated through one-sample t tests. Correlations were established between the three motivating factors and organizational characteristics of hospital type, location, category, and size. The hypotheses were validated, and it was found that the factors of Liability and Expense varied considerably with respect to location and size of a hospital. The factor of Reputation, however, did not exhibit significant variation. In conclusion, concerns about the reputation of a facility and an apprehension of liability act as incentives for sound hospital waste management, whereas concerns about financial costs and perceived overburden on staff act as disincentives. IMPLICATIONS: This paper identifies the non economic motivating factors that can be used to encourage behavioral changes regarding waste management at hospitals in resource constrained environments. This study discovered that organizational characteristics such as hospital size and location cause the responses to vary among the subjects. Hence a policy maker must take into account the institutional setting before introducing a change geared towards better waste management outcomes across hospitals. This study covers a topic that has hitherto been neglected in resource constrained countries. Thus it can be used as one of the first steps to highlight and tackle the issue.

Readmissions, Observation, and the Hospital Readmissions Reduction Program.

BACKGROUND: The Hospital Readmissions Reduction Program, which is included in the Affordable Care Act (ACA), applies financial penalties to hospitals that have higher-than-expected readmission rates for targeted conditions. Some policy analysts worry that reductions in readmissions are being achieved by keeping returning patients in observation units instead of formally readmitting them to the hospital. We examined the changes in readmission rates and stays in observation units over time for targeted and nontargeted conditions and assessed whether hospitals that had greater increases in observation-service use had greater reductions in readmissions. METHODS: We compared monthly, hospital-level rates of readmission and observation-service use within 30 days after hospital discharge among Medicare elderly beneficiaries from October 2007 through May 2015. We used an interrupted time-series model to determine when trends changed and whether changes differed between targeted and nontargeted conditions. We assessed the correlation between changes in readmission rates and use of observation services after adoption of the ACA in March 2010. RESULTS: We analyzed data from 3387 hospitals. From 2007 to 2015, readmission rates for targeted conditions declined from 21.5% to 17.8%, and rates for nontargeted conditions declined from 15.3% to 13.1%. Shortly after passage of the ACA, the readmission rate declined quickly, especially for targeted conditions, and then continued to fall at a slower rate after October 2012 for both targeted and nontargeted conditions. Stays in observation units for targeted conditions increased from 2.6% in 2007 to 4.7% in 2015, and rates for nontargeted conditions increased from 2.5% to 4.2%. Within hospitals, there was no significant association between changes in observation-unit stays and readmissions after implementation of the ACA. CONCLUSIONS: Readmission trends are consistent with hospitals' responding to incentives to reduce readmissions, including the financial penalties for readmissions under the ACA. We did not find evidence that changes in observation-unit stays accounted for the decrease in readmissions.

Preparing for the introduction of hospital autonomy in Laos: an assessment of current situation and suggestions for policy-making.

The National Assembly of Lao People's Democratic Republic (Laos) approved the Health Sector Reform Strategy in 2012, which called for an assessment as to whether Laos should introduce hospital autonomy, and if so, in which ways. The purpose of this study is to assess the status quo of hospital governance in Laos and propose policy suggestions for hospital autonomy in the country. We formulated an analytic framework for hospital autonomy based on previous work by other researchers, collected qualitative data through key informant interviews and focus group discussions, and also performed secondary data analysis. Public hospitals in Laos enjoyed some informal autonomy with little accountability and Laos is facing key challenges of hospital governance. As a result, introducing hospital autonomy in Laos could bring risks, benefits and debates. Before Laos decides on granting autonomy to its public hospitals, we strongly suggest that the government do pilot in selected public hospitals with well-regulated governance framework first and conduct rigorous evaluations to examine whether the granted autonomy leads to the intended social goals of equity, quality, efficiency and sustainability. We recommend residual claimants should be monitored by the government and by the society with open and transparent approach, and active measures should be taken to improve performance and ensure social functions. The study findings may also provide some suggestions for low- and middle-income countries, which are contemplating the introduction of hospital autonomy in the public sector. Copyright © 2015 John Wiley & Sons, Ltd.