Efficiency effects of public hospital closures in the context of public hospital reform: a multistep efficiency analysis.

In the wake of hospital reforms introduced in 2011 in Turkey, public hospitals were grouped into associations with joint management and some shared operational and administrative functions, similar in some ways to hospital trusts in the English National Health Service. Reorganization of public hospitals effect hospital and market area characteristics and existence of hospitals. The objective of this study is to examine the effect of closure on competitive hospital performances. Using administrative data from Turkish Public Hospital Statistical Yearbooks for the years 2005 to 2007 and 2014 to 2017, we conducted a three-step efficiency analysis by incorporating data envelopment analysis (DEA) and propensity score matching techniques, followed by a difference-in-differences (DiD) regression. First, we used bootstrapped DEA to calculate the efficiency scores of hospitals that were located near hospitals that had been closed. Second, we used nearest neighbour propensity score matching to form control groups and ensure that any differences between these and the intervention groups could be attributed to being near a hospital that had closed rather than differences in hospital and market area characteristics. Lastly, we employed DiD regression analysis to explore whether being near a closed hospital had an impact on the efficiency of the surviving hospitals while considering the effect of the 2011 hospital reform policies. To shed light on a potential time lag between hospital closure and changes in efficiency, we used various periods for comparison. Our results suggest that the efficiency of public hospitals in Turkey increased in hospitals that were located near hospitals that closed in Turkey from 2011. Hospital closure improves the efficiency of competitive hospitals under hospital market reforms. Future studies may wish to examine the efficiency effects of government and private sector collaboration on competition in the hospital market.

Implementation of a ketamine programme for treatment-resistant depression in the public health system: Lessons from the first Australian public hospital clinic.

One could argue that we are living through a period of innovation and change in psychiatry unlike that seen before, with repurposed medications emerging as novel treatments. However, despite evidence of enhanced clinical outcomes and potential medium-term savings, delivering these promising interventions is resource-intensive and perceived as difficult in the public sector. Consequently, they are generally only available in the private sector, often at great cost, effectively making them inaccessible to the 'Have Nots'. The arrival of these paradigm-shifting treatments has inadvertently highlighted a growing mental health inequity. The Royal Prince Alfred Hospital's Ketamine Treatment Clinic was the first public-sector ketamine treatment clinic for complex mood disorders in Australia. Based on 3 years' experience establishing, developing and running a public-sector ketamine treatment service, we review the progress, perils and pitfalls for clinicians and health services contemplating establishing a public-sector ketamine treatment service of their own.

Hospital governance accountability structure: a scoping review.

INTRODUCTION: Hospitals, as complex organizations with clinical, financial, and social functions, face different barriers to providing high-quality and safe services at reasonable costs. Various initiatives have been carried out in hospital governance to improve quality, safety, and accountability. This research aims to identify the structures and dimensions that make hospital governance accountable. METHODS: The research used Arksey and O'Malley's scoping review framework to examine the research literature on hospital governance structure and accountability. The literature review included PubMed, Web of Science, Embase, Scopus ProQuest, Google search engine, and Google Scholar databases from 2010 to 2023. Data were analyzed using the content analysis method. RESULTS: Excluding unrelated and duplicate sources, 40 articles and reports were included in the study. The studies were reviewed and analyzed based on organizational type, type of source, year of publication, objectives, and key findings. Accountable governance features were extracted from the selected articles and reports. The four main themes include inclusive governance, commitment to accountability, planning for accountability, and autonomous governance. Thirteen subthemes were extracted from the study literature. CONCLUSION: Various initiatives have been implemented regarding the reform of the governance structure of public hospitals in different countries. Many of these reforms aim to improve financial and clinical accountability. The study results could be used to identify the structures and dimensions that make hospital governance accountable.

The neurosurgical outpatient clinic: comparison between accesses in public and private activities.

BACKGROUND: Neurosurgical clinic assesses presence and extent of pathologies of central and peripheral nervous system or disorders affecting the spine, to identify most effective treatment and possible recourse to surgery. The aim of the study is to evaluate the appropriateness of request for a neurosurgical consult both in private and in public outpatient clinics. MATERIALS AND METHODS: We collected and analyzed all the reports of outpatient visits of public and private clinic over a period between January and December 2018. RESULTS: There were 0.62% real urgent visits in the public sector and 1.19% in the private sector (p = 0.05). Peripheral pathologies represented 12.53% and 6.21% of pathologies evaluated in public and private sector respectively (p < 0.00001). In addition, 15.76% of visits in public lead to surgery, while they represented 11.45% in private (p = 0.0003). CONCLUSIONS: No study is available comparing accesses of patients in neurosurgical outpatient clinics. In public clinic, visits are booked as urgent on the prescription of the general practitioner: in reality, only 5% of these visits were really confirmed as urgent by the specialist. Peripheral pathologies are more frequent in public clinic, while cranial pathologies are more frequent in private one. Patients with cranial pathologies prefer to choose their surgeon by accessing private clinic.

Observational assessment of hand hygiene compliance among healthcare workers in public hospitals of Northeastern Ethiopia.

This study examined the magnitude and predictors of hand hygiene compliance among 325 healthcare workers in three public hospitals of Northeastern Ethiopia using standardized observational tool. A multivariable logistic regression analysis was computed to identify factors associated with non-compliance. The overall proportion of observed hand hygiene non-compliance was 41.8% (95%CI: 36.6-48.1). Having <5 years of work experience (AOR = 1.5; 95%CI: 1.2-2.5), absence of hand washing soap (AOR = 3.1; 95%CI: 2.3-5.4), work overload (AOR = 2.5; 95%CI: 1.9-4.1), pipe water supply interruption (AOR = 2.8; 95%CI: 2.1-4.9), lack of hand hygiene training (AOR = 3.1; 95%CI: 2.2-4.4), and absence of infection prevention committee (AOR = 2.1; 95%CI: 1.5-4.9) were determinant factors for hand hygiene non-compliance. Therefore, regional health bureau and hospitals' managers should work towards the provision of regular hand hygiene trainings, uninterrupted piped water supply, hand washing soap, and establishment of functional infection prevention committee. Moreover, healthcare workers should be also committed to comply with hand hygiene.

Prevalence of Intestinal Parasitic Infections Among Pregnant Women: A Multi-Centre Survey.

BACKGROUND: Intestinal parasitic infection (IPI) is a serious public health challenge often neglected in most developing countries. Pregnant women are a high-risk population for these infections which can result in adverse pregnancy outcomes such as maternal anaemia, preterm delivery and low birth weight. OBJECTIVE OF THE STUDY: To assess the prevalence and factors associated with the risk of acquisition of intestinal parasitic infections among pregnant women attending antenatal clinics in selected public hospitals in Ibadan, South Western Nigeria. METHODS: A hospital-based cross-sectional study was carried out among 598 pregnant women attending antenatal clinics in selected public hospitals in Ibadan, South Western Nigeria. Five public hospitals were purposively selected based on their antenatal clinic client attendance before this study. Data was collected to assess sociodemographic characteristics, health-seeking behaviours, water sanitation and hygiene practices (WASH). Stool samples from each pregnant woman were examined for the presence of intestinal parasites by microscopy using the direct wet mount and Ziehl Neelsen staining technique. RESULTS: The overall prevalence of intestinal parasites was (96, 16.1%). Ascaris lumbricoides were the most prevalent parasites (68, 71.0%) followed by Enterobius vermicularis (16, 17.0%), Entamoeba histolytica (8,8.0%) and the least identified parasite was hookworm (4, 4.0%). At bivariate analysis level, level of education, maternal income and type of waste disposal system in use were significantly associated with IPI infection. Using multivariate logistic regression, the age range of 30-34 years (AOR= 0.24, CI 0.08, 0.70) and having a degree (AOR=0.21 CI 0.05-0.85) were independent predictors of IPIs. CONCLUSION: This study highlights a high prevalence of intestinal parasitic infection among pregnant women in our setting. The main predictive factors were the educational status and age of the pregnant women. There is therefore need for continuous health education to prevent intestinal parasitic infections in the at-risk population.

CONTEXTE: Les infections parasitaires intestinales (IPI) représentent un grave problème de santé publique souvent négligé dans la plupart des pays en développement. Les femmes enceintes constituent une population à haut risque pour ces infections, qui peuvent entraîner des conséquences néfastes sur la grossesse, telles que l'anémie maternelle, l'accouchement prématuré et le faible poids à la naissance. OBJECTIF DE L'ÉTUDE: Évaluer la prévalence et les facteurs associés au risque d'acquisition d'infections parasitaires intestinales chez les femmes enceintes fréquentant les cliniques prénatales dans certains hôpitaux publics d'Ibadan, dans le sud-ouest du Nigéria. MÉTHODES: Une étude transversale hospitalière a été menée auprès de 598 femmes enceintes fréquentant les cliniques prénatales dans certains hôpitaux publics d'Ibadan, dans le sud-ouest du Nigéria. Cinq hôpitaux publics ont été sélectionnés de manière ciblée en fonction de la fréquentation de leur clinique prénatale avant cette étude. Des données ont été recueillies pour évaluer les caractéristiques sociodémographiques, les comportements de recherche de soins, l'assainissement de l'eau et les pratiques d'hygiène (WASH). Les échantillons de selles de chaque femme enceinte ont été examinés à la recherche de parasites intestinaux par microscopie, en utilisant la méthode du montage humide direct et la technique de coloration de Ziehl-Neelsen. RÉSULTATS: La prévalence globale des parasites intestinaux était de 96 (16,1 %). Les Ascaris lumbricoides étaient les parasites les plus prévalents (68, 71,0 %), suivis par les Enterobius vermicularis (16, 17,0 %), les Entamoeba histolytica (8, 8,0 %) et les Ankylostomes (4, 4,0 %). Au niveau de l'analyse bivariée, le niveau d'éducation, le revenu maternel et le type de système d'élimination des déchets utilisé étaient significativement associés aux infections parasitaires intestinales. Selon la régression logistique multivariée, la tranche d'âge de 30 à 34 ans (AOR = 0,24, CI 0,08, 0,70) et le fait d'avoir un diplôme (AOR = 0,21, CI 0,05-0,85) étaient des prédicteurs indépendants des IPI. CONCLUSION: Cette étude met en évidence une prévalence élevée d'infections parasitaires intestinales chez les femmes enceintes dans notre contexte. Les principaux facteurs prédictifs étaient le statut éducatif et l'âge des femmes enceintes. Il est donc nécessaire de poursuivre l'éducation sanitaire pour prévenir les infections parasitaires intestinales dans la population à risque. MOTS CLÉS: Femmes enceintes, infections parasitaires intestinales, hôpital public, Ibadan.

[The use of the DOS and Delirium Prevalence: a quantitative longitudinal study at a Swiss-German central hospital]. / Anwendung der DOS und Delirprävalenz.

The use of the DOS and Delirium Prevalence: a quantitative longitudinal study at a Swiss-German central hospital Abstract: Background: With a prevalence of 12-64%, delirium is a common complication in acute care, associated with negative outcomes such as increased mortality and prolonged length of stay. Many hospitals have guidelines to improve the delirium management. The Delirium Observation Screening Scale (DOS) Score is collected in the study hospital from all patients ≥ 70 years at each shift for at least 3 days. Delirium is diagnosed by a physician and coded according to ICD-10. Purpose: Evaluation of the delirium screening with the DOS according to internal guideline in terms of number of DOS assessments performed, prevalence of delirium (DOS score ≥ 3 points, CD-10 code delirium). Method: This retrospective quantitative single-centre longitudinal study used 2017 and 2018 data of 10046 cases. Statistical analysis methods were used to analyse prevalence of delirium and subgroup comparisons. Results: At least one DOS score was documented in 92% of cases aged ≥ 70-years (n = 5038). DOS implementation varied between 60% in the early, 49% in the late and 38% in the night shift. The prevalence of delirium was 12% according to DOS score ≥ 3 and 4% according to physician diagnosis of a delirium. Cases with a DOS score ≥ 3 were significantly older, more often female, had more comorbidities and were depressed. Conclusions: DOS is performed in most patients when indicated. The DOS implementation frequency varied depending on the shift.

Prevalence and determinants of burnout among South African doctors during the COVID-19 pandemic.

Background: Burnout, resulting from chronic workplace stress that has been unsuccessfully managed, has previously been documented in doctors. The coronavirus disease 2019 (COVID-19) pandemic has increased occupational challenges faced by doctors, potentiating their risk for burnout. Aim: This study aimed to determine the prevalence and determinants of burnout among medical doctors during the COVID-19 pandemic. Setting: Three public sector hospitals in Gqeberha, South Africa. Methods: A cross-sectional study of 260 voluntary participants was conducted. Participants completed self-administered electronic questionnaires. Logistic regression analysis was performed to explore the determinants of burnout. Results: The prevalence of burnout in this study was 78%. Burnout was significantly associated with being a medical intern or community-service medical officer (adjusted odd ratio [AOR] = 6.72, 1.71-26.40), being in the lowest income band (AOR = 10.78, 2.55-45.49), and using alcohol to manage work-related stress (AOR = 3.01, 1.12-8.04). Job-related factors associated with burnout were experiencing high conflict at work (AOR = 5.04, 1.92-13.20) and high role ambiguity and role conflict (AOR = 4.49, 1.98-10.18). Low support at work (AOR = 9.99, 3.66-27.23), medium job satisfaction (AOR = 5.38, 2.65-10.93) and medium support at work (AOR = 3.39, 1.71-6.73) were positively associated with burnout. Participants with medium (AOR = 0.28, 0.10-0.80) and high levels of resilience (AOR = 0.08, 0.03-0.25) were protected against burnout. Coronavirus disease 2019-related factors were not significantly associated with burnout. Conclusion: The burnout prevalence among South African medical doctors at public hospitals during the COVID-19 pandemic was high and strongly associated with job stress factors. Contribution: Given the increased prevalence of burnout among doctors and the strong associations with job stress factors, mitigation of burnout requires targeted organisational interventions.

An Unconditional Cash Transfer Program for Low-Income New Yorkers Affected by COVID-19.

Early in the pandemic, New York City's public hospital system partnered with multiple philanthropic foundations to offer an unconditional cash transfer program for low-income New Yorkers affected by COVID-19. The $1000 cash transfers were designed to help people meet their most immediate health and social needs and were incorporated into healthcare delivery and contact tracing workflows as a response to the public health emergency. To better understand program recipients' experiences, researchers conducted 150 telephone surveys with randomly sampled cash transfer recipients and 20 in-depth qualitative interviews with purposefully sampled survey participants. Survey participants were predominantly Latinx (87%) and women (65%). The most common reported uses of the $1000 were food and rent. Most participants (79%) reported that without the $1000 cash transfer they would have had difficulty paying for basic expenses or making ends meet, with specific positive effects reported related to food, housing, and ability to work. The majority of survey participants reported that receiving the cash assistance somewhat or greatly improved their physical health (83%) and mental health (89%). Qualitative interview results generally supported the survey findings.

Construction and validation of a competency model for hospital operation assistant of public hospitals in China: a cross­sectional study.

BACKGROUND: Hospital operation assistant (HOA) plays an important role in promoting the operation effectiveness and efficiency of hospital. China, as a resource-poor country, urgently needs to train HOA talent. The purpose of this study is to construct and validate a competency model for HOA, which can be used as a tool to select and train HOAs. METHODS: Basic competency items were first constructed through literature review combined with the job analysis of HOA. Then, a questionnaire survey conducted on more than 300 hospital operation management-related staff was used to assess the importance of competency items. Exploratory factor analysis, structural equation model and second-order confirmatory factor analysis were used to construct and validate the competency model of HOA. RESULTS: A total of 23 items were identified as critical to HOA capability, which were further divided into three factors: professional skills, professional knowledge and personality traits. The structural equation model showed that the standardized path coefficients of the three factors were 0.86, 0.82 and 0.98. The competency model passed strict fitting effect tests in several aspects, including root-mean-square error of approximation (RMSEA) = 0.077 (< 0.080), standardized root mean square residual (SRMR) = 0.062 (< 0.080), comparative fit index (CFI) = 0.927 (> 0.900) and Tucker-Lewis index (TLI) = 0.918 (> 0.900), which showed that the fitting validity of the model was ideal. The composite reliability (CR), average variance extracted (AVE) and correlation coefficients of all factors were within the standard range, which showed that the construction validity and discrimination validity of the model were ideal. CONCLUSION: Our study indicates that the competency model of HOA is an instrument with appropriate fit validity, construct validity and discriminant validity, which can provide criteria for selecting and training HOAs.

Dietary practice and associated factors among type 2 diabetic patients attending chronic follow-up in public hospitals, central Ethiopia, 2022.

BACKGROUND: Diabetes Mellitus (DM) is affecting numerous Ethiopian populations regardless of environmental and social status. Diabetic people all over the world are commonly urged to acquire a healthy eating habit, which necessitates lifelong changes in food habits, beliefs, and meal patterns. Dietary management is considered one of the cornerstones of diabetes care, as it is an important component of the overall treatment plan. Choosing and following a healthy diet is important for everyone, especially people with diabetes. OBJECTIVE: This study aims to assess dietary practices and associated factors among type 2 diabetes patients in the west Shewa Zone, Oromia Regional State, Ethiopia, in 2022. METHODS: A hospital-based cross-sectional study design was conducted in West Shewa Zone public hospitals among 421 randomly selected type 2 diabetic patients from February 1 to March 30, 2022. Data were collected using a structured and pre-tested interviewer-administered questionnaire. Descriptive, bivariate, and multivariate binary logistic regression analyses were done using SPSS. RESULTS: In this study, about 35.6% (95% CI: 30.9-39.9) of type 2 diabetes patients had good dietary practices. Diabetes knowledge (AOR 9 2; 95% CI 4.4-19.4), food-secured households (AOR 3.3; 95% CI 1.6-6.9), high self-efficacy (AOR 6.6; 95% CI 3.2-13.9), diabetes diet information from healthcare professionals (AOR 2.9; 95% CI 1.3-6.4), complete dietary change (AOR = 2.3; 95% CI 1.1-4.8), and female gender (AOR 3.6; 95% CI 1.6-8.1) were independent predictors of good dietary practice. CONCLUSION: The proportion of patients with type 2 diabetes, who attended follow-up at West Shawa Public Hospitals and practiced good dietary habits, was low. Patients' household food insecurity, diabetes knowledge, self-efficacy, source of information on the diabetic diet, complete dietary change after diabetes diagnosis, and gender were all significantly associated with type 2 diabetic patients' dietary practices. Thus, promoting the provision of continuous, modified, and comprehensive education and advice on the importance of diabetes self-management, particularly adherence to dietary recommendations, is fundamental to decreasing the burden of diabetes complications and massive health expenses among diabetic patients.

Is there any difference in organizational commitment between general hospitals and specialized hospitals? Empirical evidence from public hospitals in Beijing, China.

OBJECTIVE: The purpose of the study on the one hand is to see different hospital organization commitment have difference, including the overall score and various dimensions, on the other hand, due to the different hospital type, its function orientation is different, the factors of the doctor organization commitment may also exist differences, so the study of another purpose is to determine for different types of hospital doctor organization commitment the focus and key groups, provide reference for the doctor incentive strategy. METHODS: A total of 292 doctors in four large public hospitals in Beijing were investigated. Physicians' perceived organizational commitment was investigated using self-made electronic questionnaires. Data were analyzed by factor analysis, descriptive statistics, t-test, ANOVA, and multiple linear regression. RESULTS: In the large public hospital doctor perception of the hospital commitment status, Specialized hospitals had higher overall commitment behavior scores, it is 3.47 ± 0.86; General hospital commitment behavior scored low at 3.39 ± 0.91. In the regression results, department category, working years, administrative position, and entry mode are the influencing factors of the organizational commitment of doctors in general hospitals, while in specialized hospitals, in addition to whether to hold an administrative position, entry mode, and working hours, the influencing factors also include gender, professional title and overseas learning background. CONCLUSION: There are differences in the perceived organizational commitment by doctors in different types of public hospitals, and different factors influencing their organizational commitment.Hospital type directly influences physicians' organizational commitment and plays a moderating role in influencing other factors. A possible solution is general hospital specialization, encouraging general hospitals to develop the dominant discipline. These findings can help healthcare service hospital executives or government policymakers understand the impact of hospital specialization strategies and develop more efficient medical staff incentive systems.

Developing online medical service quality indicators in China from the perspective of online and offline integration: a modified Delphi-analytic hierarchy process study.

Online medical services (OMSs) are developing rapidly worldwide, and policies encourage the integrated development of online and offline services in China. However, there is a lack of comprehensive and systematic quality indicators for OMSs to ensure patients' safety. This study aimed to construct a set of quality indicators from the perspective of online and offline integration to provide a basis for the evaluation and management of OMS quality. Based on the literature review, we included 53 potential indicators. In two rounds of consultations, we invited 21 and 19 experts, respectively, to rate the importance and feasibility of each indicator via email. We used the modified Delphi method and analytic hierarchy process to determine the final indicators and their weights. We used experts' positive coefficient, authority coefficient, and opinion coordination degree to test the reliability and validity of experts. After two rounds of Delphi consultation, the experts' positive coefficients were 90.48% and 89.47%, respectively, and the authoritative coefficients were both >0.7. An OMS quality index system for public hospitals in China was developed with 4 primary indicators, 13 secondary indicators, and 34 tertiary indicators. Among the primary indicators, the weights of structure, process, outcome, and integration quality were 0.22, 0.26, 0.34, and 0.18, respectively. We constructed the first set of OMS quality indicators for public hospitals in China from the perspective of online and offline integration. It could be applied as a standardized and meaningful guide for OMS evaluation and quality development.

A systematic review to identify the challenges to achieving effective patient flow in public hospitals.

This systematic review aims to uncover the challenges related to patient flow from a whole public hospital perspective and identify strategies to overcome these challenges. A search in Medline, Emcare and PubMed was conducted and 24 articles published in English, from 2015 to 2020, were selected in relation to patient flow challenges and strategies. Analysis of the articles was completed using a thematic approach to identify common themes in relation to the area of focus. Strategies from the literature were then aligned with the challenges to inform areas of potential improvement in relation to patient flow. The themes generated included Teamwork, Collaboration and Communication; Public Hospitals as complex systems; Timely discharge; Policy, Process and Decision-making; and Resources-capacity and demand. The key finding is that a whole system approach is required to improve patient flow in public hospitals. When effective patient flow is achieved, demand and capacity are matched, increasing patient access to the health service and enabling the resources required to provide high quality patient care. The findings will create a better understanding of improving patient flow in public hospitals.

Performance evaluation index system in public hospitals: The Delphi technique in nursing.

AIMS: To establish a general performance evaluation index system for nursing managers in public hospitals of Wenzhou city. BACKGROUND: Head nurses' performance plays a critical role in the development and operation of hospitals. Owing to the lack of accuracy and defects in the current evaluation system in Mainland China, there is an urgent need to develop a systematic performance evaluation index system for nursing managers. METHODS: A systematic review of literature, two rounds of expert consultation using the Delphi techniques, and empirical analyses were performed. In this study, a total of 20 experts in nursing-related fields were invited to provide reliable comments on the evaluation system. The index system was modified twice during the Delphi consultation, followed by a questionnaire (n = 113) to test the suitability of the system created for public hospitals in Wenzhou. RESULTS: Both rounds of the consultation showed high response rates of 20 experts. A consensus of over 70% was reached for most indicators in the first round, while a 100% consensus was achieved for the modified index system in the second round. The results of the questionnaire for the modified index system were 100%, 98.23%, 100%, 96.46%, and 93.80% in terms of scientificity, public welfare, importance, measurability, and feasibility, respectively. CONCLUSION: A suitable index system with 4 first-level indicators, 10 second-level indicators, and 37 third-level indicators was generated to assess head nurses' performance in public hospitals, thereby enhancing their cohesion and competitiveness. IMPLICATIONS FOR NURSING MANAGEMENT: The modified performance evaluation index system serves as the cornerstone for the successful development of public hospitals and the provision of high-quality services for patients.

Impacts of the medical arms race on medical expenses: a public hospital-based study in Shenzhen, China, during 2009-2013.

BACKGROUND: Has the medical arms race (MAR) increased healthcare expenditures? Existing literature has yet to draw a consistent conclusion. Hence, this study aims to reexamine the relationship between the MAR and medical expenses by the data from public hospitals in Shenzhen, China, during the period of 2009 to 2013. METHODS: This study's data were collected through panel datasets spanning 2009 to 2013 from the Shenzhen Statistical Yearbook, Shenzhen Health Statistical Yearbook, and annual reports from the Shenzhen Municipal Health Commission. The Herfindahl-Hirschman index and hierarchical linear modeling were combined for empirical analysis. RESULTS: The MAR's impact on medical examination fees differed during the inpatient and outpatient stages. Further analysis verified that the MAR had the most significant impact on outpatient examination fees. Due to the characteristics of China's medical system, government regulations in the healthcare market may consequently accelerate the MAR among public hospitals. Strict government regulations on the medical system have also promoted increased medical examination costs to some extent. Once medical service prices are under strict administrative control, only drug and medical examination fees are the primary forms of extra income for hospitals. After the proportion of drug fees is further regulated, medical examinations will then become another staple method to generate extra revenue. These have distorted Chinese public hospitals' medical fees, which completely differ from those in other countries. CONCLUSION: The government should confirm that they have allocated sufficient financial investments for public hospitals; otherwise, the competition among hospitals will transfer the burden to patients, and especially to those who can afford to pay for care. A core task for public hospitals involves providing safer, less expensive, and more reliable medical services.

Patient preferences and choices as a reflection of trust-A cluster analysis comparing postsurgical perceptions in a private and a public hospital.

BACKGROUND: Active participation of patients in managing their medical treatment is a major component of the patient empowerment process and may contribute to better clinical outcomes. Patient perceptions and preferences affect the patient-physician encounter in a variety of dimensions, such as patient autonomy, freedom of choice and trust in the healthcare system. The Israeli healthcare system is mostly publicly funded, with additional private healthcare services for surgery and other medical treatments. The aim of this study was to compare the perceptions and preferences of patients in the public and private hospitals in Israel. METHODS: A cross-sectional study among 545 individuals who had surgical procedures at two hospitals in Israel (one public and one private). A structured questionnaire comprising 23 items was used to collect perceptions via personal telephone interviews. The responses were categorized into five clusters and compared by type of health services provider (public vs. private) and sociodemographic characteristics (gender, age and education level). RESULTS: A hierarchical cluster analysis methodology identified five conceptual groups: trust, concern towards medical errors, dialogue between medical staff and the patient/patient's family, confidentiality and staff bias towards more informed patients, or those with supportive families. Four main themes that highlight patients' preferences were found: physical conditions, personal empowerment and perceived autonomy, patient experience and patient-provider encounter communication. Significant differences between the private and the public healthcare systems were found in four clusters: trust and patient care, patient's concerns, the extent of explanation and medical staff's commitment. Differences secondary to sociodemographic parameters were noticed: patients treated at the private hospital scored significantly higher items of trust, medical staff caring and the importance of choosing their treating surgeon, while patients treated at the public hospital scored higher staff commitment to the patient than those treated at the private hospital. CONCLUSIONS: The study revealed the perceptions underlying the decisions of patients to undergo surgical procedures in public or private hospitals. Mutual learning could pave the way to better patient-physician encounters. PATIENT OR PUBLIC CONTRIBUTION: Patients from the two hospitals were involved in this study by responding to the questionnaire. The data presented is based on the patient's responses.

Waiting time and its associated factors in patients presenting to outpatient departments at Public Hospitals of Jimma Zone, Southwest Ethiopia.

BACKGROUND: Waiting time is defined as the total time that a patient spends in a facility from arrival at the registration desk until the time she/he leaves the facility or last service. In Ethiopia, the waiting time in the hospitals particularly in the outpatient department is lengthy. Studies at Jimma University specialized hospital indicated patients are forced to wait an average of 4.5 waiting hours to get service. Even there are many hospitals found in the zone, there is a paucity of information regarding waiting time and associated factors. Hence, this study is aimed to assess waiting time and associated factors at outpatient departments in Public Hospitals of Jimma zone, southwest Ethiopia. METHODS: An institution-based cross-sectional study design was used from March 22 to June 3, 2020. A total of 422 study subjects were included in the study and systematic random sampling methods were used. The data were collected by observing the whole service points of each patient. The exit interview was made at the last point of the service unit. Descriptive statistics, bi-variable and multi-variable logistic regressions were used. RESULTS: The whole waiting time patients spent in the hospitals before getting service was a minimum of 41 and a maximum of 185 min. Patients who came far from the hospitals were 1.93 times (AOR = 1.93; 95% CI, 1.16, 3.21) more likely to spend longer waiting time as compared to those who came from the hospital's area. Patients visited on Monday were 2.64 times (AOR = 2.64; 95% CI, 1.45, 4.79) more likely to spend longer waiting time than those who visited the hospital on Friday. Patients who arrived early in the morning were 3.22 times (AOR = 3.22; 95% CI, 1.32, 7.86) more likely to spend longer waiting time than those who arrived in the afternoon. CONCLUSIONS: The mean waiting time was higher than the average recommended time by Business Process Reengineering (BPR) and more than five out of every ten clients spent long waiting time at outpatient departments Waiting time was affected by Educational status, residence, arrival time, and date of the visit.

How to improve hospital employees' health and well-being: a staff consultation.

OBJECTIVE: Explore perspectives from healthcare workers in a large public hospital (11,000 staff) on employers supporting their health and well-being. METHODS: Heads of departments/services were invited to convene focus groups, facilitated by a moderator using a semi-structured discussion guide.  RESULTS: Over 450 members of staff participated in 28 focus groups. Themes identified were: 1)unique nature of working in a large hospital, 2)hospital management agenda and relationship with staff, 3)working environment, and 4)staff health and well-being initiatives. CONCLUSIONS: Optimal uptake of health-promoting initiatives was hindered in part due to lack of staff awareness and a range of barriers. Key requirements for improving staff health were perceived to be sufficient staffing, time and space to work safely and comfortably. Engaging with staff to hear their views, build trust and identify their needs is an essential first step.

Resource management framework using simulation modeling and multi-objective optimization: a case study of a front-end department of a public hospital in Thailand.

BACKGROUND: The overcrowded patients, which cause the long waiting time in public hospitals, become significant problems that affect patient satisfaction toward the hospital. Particularly, the bottleneck usually happens at front-end departments (e.g., the triage and medical record department) as every patient is firstly required to visit these departments. The problem is mainly caused by ineffective resource management. In order to support decision making in the resource management at front-end departments, this paper proposes a framework using simulation and multi-objective optimization techniques considering both operating cost and patient satisfaction. METHODS: To develop the framework, first, the timestamp of patient arrival time at each station was collected at the triage and medical record department of Thammasat University Hospital in Thailand. A patient satisfaction assessment method was used to convert the time spend into a satisfaction score. Then, the simulation model was built from the current situation of the hospital and was applied scenario analyses for the model improvement. The models were verified and validated. The weighted max-min for fuzzy multi-objective optimization was done by minimizing the operating cost and maximizing the patient satisfaction score. The operating costs and patient satisfaction scores from various scenarios were statistically compared. Finally, a decision-making guideline was proposed to support suitable resource management at the front-end departments of the hospital. RESULT: The three scenarios of the simulation model were built (i.e., a real situation, a one-stop service, and partially shared resources) and ensured to be verified and valid. The optimized results were compared and grouped into three situations which are (1) remain the same satisfaction score but decrease the cost (cost decreased by 2.8%) (2) remain the same satisfaction score but increase the cost (cost increased up to 80%) and (3) decrease the satisfaction score and decrease the cost (satisfaction decreased up to 82% and cost decreased up to 59%). According to the guideline, the situations 1 and 3 were recommended to use in the improvement and the situation 2 was rejected. CONCLUSION: This research demonstrates the resource management framework for the front-end department of the hospital. The experimental results imply that the framework can be used to support the decision making in resource management and used to reduce the risk of applying a non-improvement model in a real situation.