Patient experience in adult NHS services: improving the experience of care for people using adult NHS services: Last updated 17 June 2021

This guideline covers the components of a good patient experience. It aims to make sure that all adults using NHS services have the best possible experience of care.

Manual de organización y funciones: Departamento de Regulación, Acreditación y Control de Establecimientos de salud / Organization and functions manual: Department of Regulation, Accreditation and Control of Health Establishments

Un poco apagado, que dificulta un poco la lectura. Entre los diversos objetivos del reglamento, está la de servir de inducción al nuevo personal de la unidad, puesto que da sentido al trabajo, desde los aspectos: técnicos, administrativos y legales. Específicamente el objetivo general es: tener un documento técnico de gestión institucional que describa y establezca la organización, funciones generales y específicas de cada unidad y puesto de trabajo. Contiene la base legal del departamento en cuestión, así como los antecedentes del mismo; se describen además, su visión y misión, objetivos generales y específicos, así como las funciones del mismo. Incluye la estructura organizacional, organigrama, así como una detallada descripción de los puestos de mando, técnicos y administrativos. Otro tanto se hace con cada unidad del departamento.

Principales problemas en la gestión de establecimientos de salud en el Perú / Main problems in the management of health facilities in Peru

Introducción: Los directivos de las instituciones prestadoras de servicios de salud deben tomar decisiones oportunas y acertadas, e identificar de manera apropiada sus principales problemas, para proponer acciones de mejora de la gestión de sus instituciones. Objetivo: Identificar los problemas en la gestión de los establecimientos de salud en el Perú desde la perspectiva de sus directivos de acuerdo con la encuesta ENSUSALUD 2016. Métodos: Se realizó un análisis secundario descriptivo de la base de datos de la encuesta ENSUSALUD 2016. Se analizaron los datos correspondientes a personas que tenían un cargo directivo en las instituciones prestadoras de servicios de salud seleccionadas. Resultados: Se entrevistaron 366 personas con un cargo directivo en 184 instituciones prestadoras de servicios de salud peruanas del sector público y privado y de diferentes niveles de atención, de 25 regiones. El 68,03 por ciento de los entrevistados eran de sexo masculino y el 52,73 por ciento eran médicos. La edad promedio fue de 48,62 (± 11,10) y con un promedio de 11,7 (± 10,45) años trabajando en el centro de salud y 4,60 (± 6,63) asumiendo un cargo directivo. Casi la mitad de los directivos (43,7 por ciento) mencionaron que los principales problemas de gestión a nivel regional son el déficit de recursos humanos, el déficit presupuestal (38,2 por ciento) y el déficit de especialistas (34,7 por ciento). Conclusiones: Los principales problemas identificados por los directivos de los establecimientos de salud son la escasez de recursos humanos, la falta de insumos y medicamentos, la deficiente infraestructura y el déficit presupuestal. Estos resultados aportan conocimiento útil para los gestores y decisores en salud que tienen la responsabilidad de tomar decisiones adecuadas y oportunas para mejorar la calidad de los servicios y la satisfacción del usuario(AU)

Introduction: Managers of health service providers´ institutions must make timely and sound decisions, and appropriately identify their main problems, to propose improvement actions in the management of their institutions. Objective: Identify problems in the management of health facilities in Peru from the perspective of their managers according to the ENSUSALUD 2016 survey. Methods: A secondary descriptive analysis of the ENSUSALUD 2016 survey database was performed. Data of persons in a managerial position at selected health service providers´ institutions were analyzed. Results: 366 people with a management position were interviewed in 184 Peruvian public and private sector health service providers´ institutions and different levels of care, from 25 regions. 68.03 percent of respondents were male and 52.73 percent were doctors. The average age was 48.62 (±11.10) and with an average of 11.7 (±10.45) years working in the health institutions and 4.60 (±6.63) in a managerial position. Nearly half of managers (43.7 percent) mentioned that the main management problems at the regional level are the human resources deficit, the budget deficit (38.2 percent) and specialists deficit (34.7 percent). Conclusions: The main problems identified by managers of health facilities are the scarcity of human resources, the lack of inputs and medicines, the poor infrastructure and the budget deficit. These results provide useful knowledge for health managers and decision makers who have the responsibility to make informed and timely decisions to improve the quality of services and user´s satisfaction(AU)

Managerial competencies-A survey of healthcare managers in a tertiary hospital in Calabar, South-South Nigeria.

BACKGROUND: Tertiary hospitals are specialized institutions that provide managed care for patients. It has been shown that the productivity of any organization/institution is as good as the performance of its managers. AIM: This study assessed the management knowledge of Healthcare Managers in a tertiary hospital in Calabar, Nigeria. METHODOLOGY: This was a descriptive cross-sectional study that employed a structured questionnaire (adapted from the Health Leadership Alliance competency directory). Data were analyzed using SPSS version 20. RESULTS: A total of 266 managers were included in this studywith a M: F ratio of 1.3:1. The knowledge rating of role of non-clinical professionals, regulatory agency standards, preparation of business communication, change process management and policy formulation and analysis varied significantly among the three levels of management (p < 0.05). Less than 50% of operational and middle managers rated themselves as experts in all the competency domains while majority (80%) of strategic managers rated themselves as more than proficient in most of the competency items. CONCLUSION: There is inadequate managerial knowledge at all levels of management in a typical tertiary hospital in Nigeria with the potential to impact negatively on quality healthcare delivery.

Relationship between leadership support and operational excellence in health care sector: A study of Indian health care managers.

BACKGROUND AND OBJECTIVE: Leadership communicates purpose and innovative ways to thrive for performance. Leadership support influences and impacts operational excellence in the health sector as a patient-centered operation, with effective management, excellence framework, challenges and constraints, teamwork and value stream mapping. It is hypothesized that: (1) perceived leadership support will positively correlate with perceived operational excellence (Patient-centered Operations, Effective Resource Management, Excellence framework, Eliminating Challenges or Constraints, Team Work, Value Stream Mapping) and (2) the correlation would be highest with Patient-centered Operations. The aim of this study was to examine the relationship between leadership support and operational excellence in the health care sector among a selected group of healthcare managers. MATERIALS AND METHOD: A correlation study between leadership support and operational excellence was designed for a group of health care managers (n=80) from eight hospitals in Kerala, South India. The selection of executives was from NABH accredited hospitals from districts with a minimum of four NABH accredited hospital. A survey was sent to a selected study sample. The respondents were cooperative and provided responses on perceived leadership support for operational excellence. RESULTS: Factors of leadership support correlated to operational excellence. CONCLUSION: In the health care sector, leadership support for patient-centered operations helps achieve operational excellence.

Supporting the use of research evidence in decision-making in crisis zones in low- and middle-income countries: a critical interpretive synthesis.

BACKGROUND: Decision-makers in crisis zones are faced with the challenge of having to make health-related decisions under limited time and resource constraints and in light of the many factors that can influence their decisions, of which research evidence is just one. To address a key gap in the research literature about how best to support the use of research evidence in such situations, we conducted a critical interpretive synthesis approach to develop a conceptual framework that outlines the strategies that leverage the facilitators and address the barriers to evidence use in crisis zones. METHODS: We systematically reviewed both empirical and non-empirical literature and used an interpretive analytic approach to synthesise the results and develop the conceptual framework. We used a 'compass' question to create a detailed search strategy and conducted electronic searches in CINAHL, EMBASE, MEDLINE, SSCI and Web of Science. A second reviewer was assigned to a representative sample of articles. We purposively sampled additional papers to fill in conceptual gaps. RESULTS: We identified 21 eligible papers to be analysed and purposively sampled an additional 6 to fill conceptual gaps. The synthesis resulted in a conceptual framework that focuses on evidence use in crisis zones examined through the lens of four systems - political, health, international humanitarian aid and health research. Within each of the four systems, the framework identifies the most actionable strategies that leverage the facilitators and address the barriers to evidence use. CONCLUSIONS: This study presents a new conceptual framework that outlines strategies that leverage the facilitators and address the barriers to evidence use in crisis zones within different systems. This study expands on the literature pertaining to evidence-informed decision-making.

Evaluation of iLead, a generic implementation leadership intervention: mixed-method preintervention-postintervention design.

OBJECTIVES: The present study aimed to evaluate the iLead intervention and to investigate whether or not transfer of training can be supported by contextualising the intervention (recruiting all managers from one branch of the organisation while focusing on one implementation case, as well as training senior management). DESIGN: A pre-evaluation-postevaluation design was applied using mixed methods with process and effect surveys and interviews to measure the effects on three levels. SETTING: Healthcare managers from Stockholm's regional healthcare organisation were invited to the training. PARTICIPANTS: 52 managers participated in the iLead intervention. Group 1 consisted of 21 managers from different organisations and with different implementation cases. Group 2, representing the contextualised group, consisted of 31 managers from the same organisation, working on the same implementation case, where senior management also received training. INTERVENTION: iLead is an intervention where healthcare managers are trained in implementation leadership based on the full-range leadership model. PRIMARY OUTCOME MEASURES: Reactions, knowledge and implementation leadership are measured. RESULTS: Quantitative and qualitative analyses indicate that iLead was perceived to be of high quality and capable of increasing participants' knowledge. Mixed effects were found regarding changes in behaviours. The contextualisation did not have a boosting effect on behaviour change. Hence, group 2 did not increase its active implementation leadership in comparison with group 1. CONCLUSIONS: iLead introduces a new approach to how implementation leadership can be trained when knowledge of effective leadership for implementations is combined with findings on the importance of environmental factors for the transfer of training. Even though managers reported general positive effects, transfer was not facilitated through the contextualisation of the intervention. There is a need to further develop approaches to help participants subsequently apply the learnt skills in their work environment.

Organização digital do Serviço de Cirurgia Plástica / Digital organization of Plastic Surgery Service

A atenção e zelo do médico no período pré e pós-operatório é de extrema importância para a manutenção da boa relação médico/paciente. A organização e o adequado registro documental, contribui para a obtenção de um bom vínculo e assegura importante ferramenta jurídica ao médico. Hoje, com os avanços tecnológicos, o prontuário eletrônico é uma forma segura e democrática de lidar com estas informações. Nas instituições públicas o governo tem buscado implementar este sistema, mas os resultados são ainda discretos, talvez pela falta principalmente de recursos para investimento nesta área. Diante deste cenário e da grande relevância de um prontuário médico prático, informativo e dinâmico, objetivamos apresentar a nossa experiência com o uso complementar de um recurso digital sem custos. Associado ao prontuário médico de uso habitual dos serviços, descreve-se um sistema complementar, utilizando-se uma plataforma digital de armazenamento de dados na "nuvem". Por meio desse sistema é possível fornecer informações adicionais sobre cada paciente, incluindo o seguimento ambulatorial, assim como o registro fotográfico do pré, intra e pós-operatório, além de viabilizar um acesso rápido, sincronizado e remoto por meio da internet. O sistema gera economia de recursos, planejamento cirúrgico e melhora na relação médico/paciente. Favorece maior integração da equipe médica, discussão dos casos e distribuição das cirurgias por preceptor e residente. Assim, é um recurso alternativo para incrementar os prontuários médicos com dados importantes para a atuação das equipes médicas, com especial atenção às peculiaridades da cirurgia plástica.

The attention and enthusiasm of doctors in the pre- and postoperative period is of extreme importance in maintaining good doctor/patient relationships. An adequate organization and documentary record contributes to achieving a good relationship and ensures an important legal tool for physicians. With current technological advances, the electronic medical record is a secure and democratic way to deal with this information. The government has sought to implement this system in public institutions; however, results are still modest, perhaps mainly due to the lack of resources for investment in this area. In light of this, and given the relevance of practical, informative, and dynamic medical records, we aim to present our experience with the use of a complementary digital resource that is commonly associated with medical records and uses a free of cost digital platform for storing data in the "cloud". This system can provide additional information about each patient, including outpatient follow-up, as well as photographic records of the pre-, intra-, and post-operative periods, and also facilitates quick, synchronized, and remote access through the internet. The system generates optimization of resources, surgical planning, and improvement in patient/ doctor relationships. It also leads to greater integration of the medical team, particularly in the discussion of cases and distribution of surgeries by preceptors and residents. Thus, it is an alternative resource to improve medical charts with important data regarding the performance of medical teams, paying special attention to the peculiarities of plastic surgery.

Partnering with patients in quality improvement: towards renewed practices for healthcare organization managers?

BACKGROUND: Around the world, many healthcare organizations engage patients as a quality improvement strategy. In Canada, the University of Montreal has developed a model which consists in partnering with patient advisors, providers, and managers in quality improvement. This model was introduced through its Partners in Care Programs tested with several quality improvement teams in Quebec, Canada. Partnering with patients in quality improvement brings about new challenges for healthcare managers. This model is recent, and little is known about how managers contribute to implementing and sustaining it using key practices. METHODS: In-depth multi-level case studies were conducted within two healthcare organizations which have implemented a Partners in Care Program in quality improvement. The longitudinal design of this research enabled us to monitor the implementation of patient partnership initiatives from 2015 to 2017. In total, 38 interviews were carried out with managers at different levels (top-level, mid-level, and front-line) involved in the implementation of Partners in Care Programs. Additionally, seven focus groups were conducted with patients and providers. RESULTS: Our findings show that managers are engaged in four main types of practices: 1-designing the patient partnership approach so that it makes sense to the entire organization; 2-structuring patient partnership to support its deployment and sustainability; 3-managing patient advisor integration in quality improvement to avoid tokenistic involvement; 4-evaluating patient advisor integration to support continuous improvement. Designing and structuring patient partnership are based on typical management practices used to implement change initiatives in healthcare organizations, whereas managing and evaluating patient advisor integration require new daily practices from managers. Our results reveal that managers at all levels, from top to front-line, are concerned with the implementation of patient partnership in quality improvement. CONCLUSION: This research adds empirical support to the evidence regarding daily managerial practices used for implementing patient partnership initiatives in quality improvement and contributes to guiding healthcare organizations and managers when integrating such approaches.

Healthcare middle managers' experiences of developing capacity and capability: a systematic review and meta-synthesis.

BACKGROUND: Healthcare middle managers play a central role in reducing harm, improving patient safety, and strengthening the quality of healthcare. The aim of this systematic review was to identify the present knowledge and critically discuss how healthcare middle managers experienced to develop the capacity and capability for leadership in a healthcare system characterized by high complexity. METHODS: This comprehensive systematic review provided evidence of healthcare middle managers' experiences in developing the capacity and capability for leadership in public healthcare. The three-step literature search was based on six databases and led by a PICo question. The review had a critical hermeneutic perspective and was based on an a priori published, protocol. The methods were inspired by the Joanna Briggs Institute and techniques from Kvale and Brinkmann. The results were illustrated by effect size, inspired by Sandelowski and Barroso. RESULTS: Twenty-three studies from four continents and multiple contexts (hospitals and municipal healthcare) published from January 2005-February 2019 were included. Based on experiences from 482 healthcare middle managers, 2 main themes, each with 2 subthemes, were identified, and from these, a meta-synthesis was developed: Healthcare middle managers develop capacity and capability through personal development processes empowered by context. The main themes included the following: 1. personal development of capacity and capability and 2. a need for contextual support. From a critical hermeneutic perspective, contrasts were revealed between how healthcare middle managers experienced the development of their capacity and capability and what they experienced as their typical work situation. CONCLUSIONS: This review provides evidence of the need for a changed approach in healthcare in relation to criticisms of present organizational structures and management methods and suggestions for how to strengthen healthcare middle managers' capacity and capability for leadership in a healthcare system characterized by high complexity. Evidence of how leadership development affected the clinical context and, thus, the quality of healthcare was found to be a field requiring further research. PROSPERO REGISTRATION NUMBER: CRD42018084670.

Exploring why and how encounters with the Norwegian health-care system can be considered culturally unsafe by North Sami-speaking patients and relatives: A qualitative study based on 11 interviews.

BACKGROUND: Citizens of Norway have free and equal access to healthcare. Nurses are expected to be culturally sensitive and have cultural knowledge in encounters with patients. Culturally safe care is considered both a process and an outcome, evaluated by whether the patients feel safe, empowered and cared for, or not. All patients request equal access to quality care in Norway, also Sami patients. OBJECTIVES: The aim of the study is to identify whether Sami patients and relatives feel culturally safe in encounters with healthcare, and if not, what are the main concerns. METHODS: This qualitative study used semi-structured interviews in the North Sami language, with 11 North Sami participants.The transcribed data were analysed through a lens of cultural safety by content analysis. FINDINGS: Data analysis explicated themes including: use of Sami language, Sami identity and cultural practices, connections to positive health outcomes to enhance cultural safe care and well-being for North-Sami people encountering the Norwegian health-care system. CONCLUSION: Culturally safe practices at the institutional, group and individual levels are essential to the well-being of Sami people. An engagement in culturally safe practices will facilitate (or) fulfil political and jurisdictional promises made to the Sami people, consequently improving positive impact of healthcare.

CQI approaches for evaluating management development programs: A case study with health service managers from geographically remote settings.

Health systems are known for being complex. Yet, there is a paucity of evidence about programs that successfully develop competent frontline managers to navigate these complex systems. There is even less evidence about developing frontline managers in areas of contextual complexity such as geographically remote and isolated health services. This study used a customised management development program containing continuous quality improvement (CQI) approaches to determine whether additional levels of evaluation could provide evidence for program impact. Generalisability is limited by the small sample size; however, the findings suggest that continuous improvement approaches, such as action learning workplace-based CQI projects not only provide for real-world application of the manager's learning; they can potentially produce the type of data needed to conduct evaluations for organisational impact and cost-benefits. The case study contributes to the literature in an area where there is a scarcity of empirical research. Further, this study proposes a pragmatic method for using CQI approaches with existing management development programs to generate the type of data needed for multi-level evaluation.

Development and pilot of a multicriteria decision analysis (MCDA) tool for health services administrators.

INTRODUCTION: Health administration is complex and serves many masters. Value, quality, infrastructure and reimbursement are just a sample of the competing interests influencing executive decision-making. This creates a need for decision processes that are rational and holistic. METHODS: We created a multicriteria decision analysis tool to evaluate six fields of healthcare provision: return on investment, capacity, outcomes, safety, training and risk. The tool was designed for prospective use, at the beginning of each funding round for competing projects. Administrators were asked to rank their criteria in order of preference. Each field was assigned a representative weight determined from the rankings. Project data were then entered into the tool for each of the six fields. The score for each field was scaled as a proportion of the highest scoring project, then weighted by preference. We then plotted findings on a cost-effectiveness plane. The project was piloted and developed over successive uses by the hospital's executive board. RESULTS: Twelve projects competing for funding at the Royal Brisbane and Women's Hospital were scored by the tool. It created a priority ranking for each initiative based on the weights assigned to each field by the executive board. Projects were plotted on a cost-effectiveness plane with score as the x-axis and cost of implementation as the y-axis. Projects to the bottom right were considered dominant over projects above and to the left, indicating that they provided greater benefit at a lower cost. Projects below the x-axis were cost-saving and recommended provided they did not harm patients. All remaining projects above the x-axis were then recommended in order of lowest to highest cost-per-point scored. CONCLUSION: This tool provides a transparent, objective method of decision analysis using accessible software. It would serve health services delivery organisations that seek to achieve value in healthcare.

Perils of Professionalization: Chronicling a Crisis and Renewing the Potential of Healthcare Management.

This paper critically examines efforts to "professionalize" the field of healthcare management and its corresponding costs. Drawing upon the scholarly critiques of professionalization in medicine and the broader field of management, this paper seeks to explore the symbolic role professionalization might play in the psyche of its constituents, and specifically its function as a defense against uncertainty and anxiety. This psychodynamic heuristic is then deployed to put forth the hypothesis that an ongoing crisis of professional identity continues to both propel and impede professionalization efforts in healthcare management, giving rise to a litany of standardization pressures that ultimately limit the field's potential. To mitigate these pressures, the call is made for rekindling healthcare management's moral, political, and existential aspects. Specifically, this entails engaging with the deeper themes that flow through the field: the experience of illness and what it means to suffer, the experience of life and what it means to have hope, and the experience of death and dying. It also entails squarely confronting questions of power, poverty and disease, and the pursuit of justice.

Retos del sistema general de seguridad social y salud: prospectiva para el desarrollo social en la Costa Atlántico de Colombia / Challenges of the general system of social security and health: Prospective for social development in the Atlantic Coast of Colombia

Introducción: Concepción interdisciplinaria de la gestión del sistema de salud en el contexto latinoamericano, de acuerdo con lo establecido por la Organización Mundial de la Salud/ Organización Panamericana de la Salud. El artículo propone una estrategia prospectiva de desarrollo social en la Costa Atlántica de Colombia, para afianzar el funcionamiento, desde lo preventivo y asistencial, del Sistema General de Seguridad Social y Salud colombiano. Objetivo: Definir, desde una visión prospectiva para el desarrollo social colectivo, los retos del Sistema General de Seguridad Social y Salud colombiano. Método: Estudio exploratorio, fundamentado en el análisis teórico conceptual que permite derivar el sistema de relaciones de las categorías: gerencia del sistema de salud y desarrollo social colectivo. Se aplica la prospectiva estratégica, mediante el componente empírico-analítico, a través del cual se visualizan escenarios futuros que direccionen el desarrollo del sistema de salud a partir de la interacción entre sus actores representativos. Resultados: Se determinaron debilidades relacionadas con la gestión integral del Sistema General de Seguridad Social y Salud colombiano, específicamente en la Costa Atlántica. En esta región del país el escaso uso de técnicas prospectivas debilita la estrategia gerencial y minimiza la posibilidad de asumir retos y prever incertidumbres en uno de los sistemas que, a través de la efectividad de servicios de salud y calidad de vida, supone un indicador de desarrollo social colectivo. Conclusiones: Necesidad de visionar retos y escenarios para modelar la gestión del Sistema General de Seguridad Social y Salud en la Costa Atlántica de Colombia para afianzar la equidad, la inclusión y la calidad de vida e incrementar los estándares de gestión de la salud en colectivos y comunidades vulneradas(AU)

Introduction: There is an interdisciplinary basis conceived for the management of the health system in the Latin American context, in accordance with the provisions of WHO/PAHO and that is linked with related disciplines, such as management and education. This article proposes a prospective strategy of social development in the Atlantic Coast of Colombia to consolidate its functioning from the preventive and welfare perspectives in the Colombian's General System of Social Security and Health (SGSSS, by its acronym in Spanish). Objective: To define the challenges of the SGSSS from a prospective point of view for the collective social development. Method: An exploratory study, based on the conceptual, theoretical analysis to derive the relations´ system of the following categories: management of the health system, and collective social development. Strategic prospective is used by the empirical-analytical component to visualize future scenarios of probable occurrence that address the development of the health system from the interaction between its representative actors. Results: The weaknesses identified were related to the comprehensive management of the Colombian SGSSS, specifically on the Atlantic Coast, where the limited use of prospective techniques weakens the management strategy and minimizes the possibility of assuming challenges and anticipating uncertainties in one of the systems that through the effectiveness of health services and quality of life warrants responding to collective social development. Conclusions: There is a need to view challenges and scenarios for modeling the management of the SGSSS on the Atlantic Coast of Colombia to strengthen the equity, inclusion and quality of life, and to increase the standards of health management in vulnerable groups and communities(AU)

Health Information Infrastructure for People with Intellectual and Developmental Disabilities (I/DD) Living in Supported Accommodation: Communication, Co-Ordination and Integration of Health Information.

People with intellectual and/or developmental disability (I/DD) commonly have complex health care needs, but little is known about how their health information is managed in supported accommodation, and across health services providers. This study aimed to describe the current health information infrastructure (i.e., how data and information are collected, stored, communicated, and used) for people with I/DD living in supported accommodation in Australia. It involved a scoping review and synthesis of research, policies, and health documents relevant in this setting. Iterative database and hand searches were conducted across peer-reviewed articles internationally in English and grey literature in Australia (New South Wales) up to September 2015. Data were extracted from the selected relevant literature and analyzed for content themes. Expert stakeholders were consulted to verify the authors' interpretations of the information and content categories. The included 286 sources (peer-reviewed n = 27; grey literature n = 259) reflect that the health information for people with I/DD in supported accommodation is poorly communicated, coordinated and integrated across isolated systems. 'Work-as-imagined' as outlined in policies, does not align with 'work-as-done' in reality. This gap threatens the quality of care and safety of people with I/DD in these settings. The effectiveness of the health information infrastructure and services for people with I/DD can be improved by integrating the information sources and placing people with I/DD and their supporters at the centre of the information exchange process.

Magnet hospital recognition in hospital systems over time.

BACKGROUND: Magnet hospitals are recognized for nursing excellence and high-value patient outcomes, yet little is known about which and when hospitals pursue Magnet recognition. Concurrently, hospital systems are becoming a more prominent feature of the U.S. health care landscape. PURPOSE: The aim of the study was to examine Magnet adoption among hospital systems over time. APPROACH: Using American Hospital Association surveys (1998-2012), we characterized the proportion of Magnet hospitals belonging to systems. We used hospital level fixed-effects regressions to capture changes in a given system hospital's Magnet status over time in relation to a variety of conditions, including prior Magnet adoption by system affiliates and nonaffiliates in local and geographically distant markets and whether these relationships varied by degree of system centralization. RESULTS: The proportion of Magnet hospitals belonging to a system is increasing. Prior Magnet adoption by a hospital within the local market was associated with an increased likelihood of a given system hospital becoming Magnet, but the effect was larger if there was prior adoption by affiliates (7.4% higher likelihood) versus nonaffiliates (2.7% higher likelihood). Prior adoption by affiliates and nonaffiliates in geographically distant markets had a lesser effect. Hospitals belonging to centralized systems were more reactive to Magnet adoption of nonaffiliate hospitals as compared with those in decentralized systems. CONCLUSIONS: Hospital systems take an organizational perspective toward Magnet adoption, whereby more system affiliates achieve Magnet recognition over time. PRACTICE IMPLICATIONS: The findings are relevant to health care and nursing administrators and policymakers interested in the diffusion of an empirically supported organizational innovation associated with quality outcomes, particularly in a time of increasing hospital consolidation and system expansion. We identify factors associated with Magnet adoption across system hospitals and demonstrate the importance of considering diffusion of organizational innovations in relation to system centralization. We suggest that decentralized system hospitals may be missing potential benefits of such organizational innovations.

[Public health services: reading their available reports]. / Los servicios de salud pública: una lectura de los informes disponibles.

The objective of this study is to analyze the performance of regional public health services in Spain using the information accessible in their annual reports. A search of these was conducted, and 9 were obtained from the 17 Autonomous Communities. Their analysis shows some variation in the structure of the organizations providing public health services, as well as in the published contents and in the indicators used for management. The service portfolio, annual objectives and resources allocated are not always detailed. If the evaluation of public services and its dissemination are basic for transparency and quality management, there is much room for improvement. The compilation of annual reports by public health services is not systematic, and those that exist provide insufficient information for a comparative analysis of their activity, effectiveness and efficiency.