A comparative analysis on human resources among the specialized ophthalmic medical institutions in China.

BACKGROUND: This study compares perspectives on specialized ophthalmic medical institutions, identifies the gaps in property and geographic offerings, and explores the ways that ophthalmic medical institutions can better allocate resources. The results of this research will increase patient's access to equitable and high-quality ophthalmic care in China. METHODS: The data for this research was gathered from the Survey of China National Eye Care Capacity and Resource for the year 2015. The paper specified the number, professional level of expertise, and educational background of ophthalmic health personnel. The authors of the paper analyzed and compared the differences in ophthalmic care in public vs. private and urban vs. rural regions in China. Descriptive statistics were used. RESULTS: Of the 395 specialized ophthalmic hospitals surveyed, 332 were private medical institutions (84%), and 63 were public (16%). Of the 26 607 ophthalmic personnel surveyed, working in specialized ophthalmic hospitals, 17 561 were in private hospitals (66%) and 9 046 were in public ones (34%). Furthermore, 22 578 of those personnel worked in urban ophthalmic institutions (85%) and 4 029 worked in rural ones (15%). As for regional differences, 14 090 personnel were located in eastern China (53%), 8 828 in central regions (33%), and 3 689 in the western regions (14%). CONCLUSIONS: Public ophthalmic medical institutions still face challenges in providing equitable and widespread care. The availability of well-staffed health centers varies significantly by region. These variations impact resource allocation and directly lead to inequalities and inaccessibility of health services in certain regions of China.

General surgical foundation doctor: optimisation of daily practice.

INTRODUCTION: The role of a foundation year 1 (FY1) doctor has evolved over the years. Many doctors report significant anxiety and stress during this period. In this Quality Improvement Project, we looked at the difficulties FY1s face in their working day and if these issues could be resolved by implementing some structural changes. METHODS: The project was conducted in three cycles, each lasting 5 days (Monday to Friday), over three consecutive weeks. Week 1 consisted of shadowing of Surgical FY1s on wards observing daily routine (arrival, lunch and departure time), communication and handovers. Following this a number of interventions were made to the structure of their daily practice to improve productivity and performance. These improvements were measured in week 2 (as the new model was scaffolded into place) and week 3 (strictly observed). RESULTS: There was no significant difference in number of tasks between week 1, 2 and 3. In week 1, there was no set times for lunch, all of the FY1s lunches were interrupted, there was no structure for handovers and 100% of FY1s stayed at work beyond there contracted hours. In week 2 and 3 there was significant improvement in the number of uninterrupted lunches, amount of time spent beyond contracted hours, number and quality of handovers. The qualitative results collected also suggested positive impact on the working lives of those involved. CONCLUSION: The implementation of structural changes improved the quality of FY1s working day and increased the efficiency of service delivered on the surgical ward.

Assessment of time management practice and associated factors among primary hospitals employees in north Gondar, northwest Ethiopia.

BACKGROUND: Time management practice can facilitate productivity and success, contributing to work effectiveness, maintaining balance and job satisfaction. Thus, this study aimed to assess time management practices and associated factors among employees of primary hospitals in north Gondar. METHODS: An Institutional based cross-sectional study among primary hospital employees in north Gondar was conducted from March to April 2018. A structured and pre-tested questionnaire was used to collect the data. Simple random sampling technique was utilized to select 422 employees. Bivariate and multivariate logistic regression model were done to identify factors associated with time management practice. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was ascertained to show the strength and direction of association. RESULT: In this study, the prevalence of time management practice was 56.4% (95%CI: 49.3, 61.7). Being satisfied with organizational policies (AOR = 2.16; 95%CI: 1.02-4.68), performance appraisals (AOR: 2.11; 95%CI: 1.32-4.66), compensation and benefits (AOR: 4.18; 95%CI: 2.18-7.99), and planning (AOR: 2.86; 95% CI: 1.42-5.75) were statistically significant factors associated with time management practice. CONCLUSION AND RECOMMENDATION: The overall time management practice among the primary hospital employees was low. Planning, organizational policy, compensation and benefit, performance appraisal, and residence were factors significantly associated with hospital employee's time management practice. Thus managers and employees need to carry out interventions on significant factors to improve the employees' time management practice.

Impact of scribes on emergency medicine doctors' productivity and patient throughput: multicentre randomised trial.

OBJECTIVES: To evaluate the changes in productivity when scribes were used by emergency physicians in emergency departments in Australia and assess the effect of scribes on throughput. DESIGN: Randomised, multicentre clinical trial. SETTING: Five emergency departments in Victoria used Australian trained scribes during their respective trial periods. Sites were broadly representative of Australian emergency departments: public (urban, tertiary, regional referral, paediatric) and private, not for profit. PARTICIPANTS: 88 physicians who were permanent, salaried employees working more than one shift a week and were either emergency consultants or senior registrars in their final year of training; 12 scribes trained at one site and rotated to each study site. INTERVENTIONS: Physicians worked their routine shifts and were randomly allocated a scribe for the duration of their shift. Each site required a minimum of 100 scribed and non-scribed shifts, from November 2015 to January 2018. MAIN OUTCOME MEASURES: Physicians' productivity (total patients, primary patients); patient throughput (door-to-doctor time, length of stay); physicians' productivity in emergency department regions. Self reported harms of scribes were analysed, and a cost-benefit analysis was done. RESULTS: Data were collected from 589 scribed shifts (5098 patients) and 3296 non-scribed shifts (23 838 patients). Scribes increased physicians' productivity from 1.13 (95% confidence interval 1.11 to 1.17) to 1.31 (1.25 to 1.38) patients per hour per doctor, representing a 15.9% gain. Primary consultations increased from 0.83 (0.81 to 0.85) to 1.04 (0.98 to 1.11) patients per hour per doctor, representing a 25.6% gain. No change was seen in door-to-doctor time. Median length of stay reduced from 192 (interquartile range 108-311) minutes to 173 (96-208) minutes, representing a 19 minute reduction (P<0.001). The greatest gains were achieved by placing scribes with senior doctors at triage, the least by using them in sub-acute/fast track regions. No significant harm involving scribes was reported. The cost-benefit analysis based on productivity and throughput gains showed a favourable financial position with use of scribes. CONCLUSIONS: Scribes improved emergency physicians' productivity, particularly during primary consultations, and decreased patients' length of stay. Further work should evaluate the role of the scribe in countries with health systems similar to Australia's. TRIAL REGISTRATION: ACTRN12615000607572 (pilot site); ACTRN12616000618459.

Health care risk managers' consensus on the management of inappropriate behaviors among hospital staff.

Medical errors are the third-leading cause of death in the United States. One of the problems is timely recognition and management of inappropriate health care worker behaviors that lead to intimidation and loss of staff focus, eventually leading to errors. The purpose of this qualitative modified Delphi study was to seek consensus among a panel of experts in hospital risk management practices on the practical methods for early detection of inappropriate behaviors among hospital staff, which may be used by hospital managers to considerably mitigate the risk of medical mishaps. High reliability theory guided the research process, utilizing the conceptual framework of the fair and just culture patient safety model. A single research question asked what level of consensus exists among hospital risk management experts as to the practical methods for early detection of inappropriate behavior among hospital staff, which managers may use to ultimately mitigate the risk of preventable medical mishaps. This study included nonprobability purposive sampling (n = 34) and three rounds of questionnaires. Consensus was reached on 8 factors: setting expectations, developing a culture of respect, holding staff accountable, enforcing a zero-tolerance policy, confidentiality of reporting, communicating expected behavior, open communication, and investigating inappropriate behaviors.

Data envelopment analysis for estimating efficiency of intensive care units: a case study in Iran.

Purpose As hospitals are the most costly service providers in every healthcare systems, special attention should be given to their performance in terms of resource allocation and consumption. The purpose of this paper is to evaluate technical, allocative and economic efficiency in intensive care units (ICUs) of hospitals affiliated by Yazd University of Medical Sciences (YUMS) in 2015. Design/methodology/approach This was a descriptive, analytical study conducted in ICUs of seven training hospitals affiliated by YUMS using data envelopment analysis (DEA) in 2015. The number of physicians, nurses, active beds and equipment were regarded as input variables and bed occupancy rate, the number of discharged patients, economic information such as bed price and physicians' fees were mentioned as output variables of the study. Available data from study variables were retrospectively gathered and analyzed through the Deap 2.1 software using the variable returns to scale methodology. Findings The study findings revealed the average scores of allocative, economic, technical, managerial and scale efficiency to be relatively 0.956, 0.866, 0.883, 0.89 and 0.913. Regarding to latter three types of efficiency, five hospitals had desirable performance. Practical implications Given that additional costs due to an extra number of manpower or unnecessary capital resources impose economic pressure on hospitals also the fact that reduction of surplus production plays a major role in reducing such expenditures in hospitals, it is suggested that departments with low efficiency reduce their input surpluses to achieve the optimal level of performance. Originality/value The authors applied a DEA approach to measure allocative, economic, technical, managerial and scale efficiency of under-study hospitals. This is a helpful linear programming method which acts as a powerful and understandable approach for comparative performance assessment in healthcare settings and a guidance for healthcare managers to improve their departments' performance.

Employee reactions to the use of management control systems in hospitals: motivation vs. threat.

OBJECTIVE: Management control systems (such as budgets or balanced scorecards) are formal procedures used by managers to promote employee behavior aligned with organisational objectives. Employees may react to these control systems by either becoming more motivated or perceiving them as a threat. The aim of this paper is to determine the extent to which hospital ownership (public or private), professional group (physician, nurse, pharmacist or administrative employee), type of contract (fixed or temporary), gender and tenure can condition employee reaction to management control systems. METHODS: We conducted the study in the three largest hospitals in the State of Santa Catarina (Brazil), two public (federal and state-owned) and one private (non-profit organisation). Physicians, nurses, pharmacists and administrative employees received a questionnaire between October 2013 and January 2014 concerning their current perceptions. We obtained 100 valid responses and conducted an ANOVA variance analysis. RESULTS: Our results show that the effect of management control systems on employees differs according to hospital ownership, professional group and type of contract. However, no significant evidence was found concerning gender or tenure. CONCLUSIONS: The results obtained contribute to creating specific knowledge on the reactions of employees to the use of management control systems in hospitals. This information may be important in adapting management control systems to the characteristics of the hospital and its employees, which may in turn contribute to reducing dysfunctional worker behavior.

Compassion Fatigue, Burnout, and Neonatal Abstinence Syndrome.

NICU nurses have seen a dramatic increase in cases of neonatal abstinence syndrome (NAS). The care needs of infants with NAS are highly demanding and can lead to feelings of frustration and emotional exhaustion among NICU nurses. Although studies have examined the experiences of nurses caring for NAS patients, none have specifically addressed the risk for compassion fatigue and burnout. Nurses need practical strategies to reduce their risk for compassion fatigue and burnout when caring for these patients. Improved education and implementation of self-care measures can help nurses more effectively manage stress and positively impact care of these infants and their families.

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.

Building Resilience and Organizational Readiness During Healthcare Facility Redevelopment Transitions: Is It Possible to Thrive?

OBJECTIVE: Hospital redevelopment constitutes a revolutionary change that can face strong resistance from employees. Few studies have examined how employee readiness for change relates to adjustment outcomes typically captured in post-occupancy evaluation (POE). The relationship between organizational readiness and employee adjustment is examined in the context of a POE conducted during a hospital redevelopment. BACKGROUND: Our study focuses on the redevelopment of a complex continuing care and rehabilitation hospital that underwent complete physical redevelopment and major shifts in operational and organizational processes. METHODS: Using a pretest-posttest quasi-experimental research design, staff organizational readiness was assessed using surveys at four time periods: 6 months prior to the move (n = 125), 2 months prior to the move (n = 84), 3 months after the move (n = 187), and 6 months after the move (n = 194). Measures included organizational readiness, workplace satisfaction, psychological factors (well-being and optimism), and sociodemographic information. RESULTS: Findings suggest readiness changes from pre- to post-move, with notable drops just prior (2 months) and just post (3 months) hospital move. Employees demonstrated significant increases in workplace satisfaction and interprofessional relationships from 6 months prior to the move to 6 months after. Results suggest that higher readiness is related to improved employee adjustment. CONCLUSIONS: A supportive change environment was found to encourage positive employee outcomes in the face of revolutionary change. It is recommended that change management activities be tailored not only to employee need but also to the timing of the change process.

Dealing with resistance in temporary agency nurses. The role of fear in identity-building processes.

PURPOSE: The purpose of this paper is to interpret employees' resistance using the perspective of a Foucaultian/post-structuralist approach in critical management studies. The authors examine the relationship between management of diversity, based on employment contract, emotional construction of identity and processes of resistance. The authors explore the ways in which temporary agency nurses understand and experience their contract, respond to tensions regarding temporary employment, develop collective emotions and show processes of resistance. DESIGN/METHODOLOGY/APPROACH: The study adopted an interpretive and qualitative approach. The authors analysed empirical material collected in the Haematology Department of a hospital in Naples, Italy, to illustrate actual experiences in the workplace. FINDINGS: Fear turns out to be the discursive resource through which resistance is actually exerted. Through emotions, temporary nurses build a community of coping and enhance their collective identity. They use fear to develop solidarity and to mobilize collective resistance in the workplace. Although no traditional resistance behaviours are reported, they aim to undermine the reputation of top managers and challenge and re-write the prevailing discourses of the organization. ORIGINALITY/VALUE: The paper contributes to the critical literature because the authors analysed a relationship that is rarely theoretically and empirically examined in literature, that between employment contract, collective identity-building dynamics and processes of resistance. We showed that the creation of a community of coping enabled minorities to voice their distance from and opposition to management.

Illusion or delusion--Lean management in the health sector.

PURPOSE: There has been considerable interest in the implementation of practices imported from manufacturing into healthcare as a solution to rising healthcare spending and disappointing patient safety indicators. One approach that has attracted particular interest is Lean management and the purpose of this paper is to engage with this topic. DESIGN/METHODOLOGY/APPROACH: Secondary research. FINDINGS: Despite widespread enthusiasm about the potential of Lean management processes, evidence about its contribution to higher organisational performance remains inconsistent. RESEARCH LIMITATIONS/IMPLICATIONS: This paper engages with the major Lean concepts of operations management and human resource management, including just-in-time, total quality management, total productive maintenance and does not engage in-depth with concepts related to employee empowerment, and training PRACTICAL IMPLICATIONS: This paper contributes to the organisational management literature in healthcare by showing that although Lean management seems to have the potential to improve organisational performance it is far from a panacea against under performing hospitals. SOCIAL IMPLICATIONS: It informs policy making by suggesting that a progressive managerial philosophy has a stronger impact on healthcare performance than the adoption of practices from any particular managerial approach. ORIGINALITY/VALUE: This paper provides a critical evaluation of the impact of Lean practices in informing healthcare policy. The paper contributes to the organisational management literature in healthcare by showing that even though Lean management in healthcare appears to have the potential to improve organisational performance; there remain problems with its application.

Needs of labor and delivery nurses caring for women undergoing pregnancy termination.

OBJECTIVE: To explore the psychosocial, educational, and administrative support needs of labor and delivery (L&D) nurses who care for women undergoing pregnancy termination. DESIGN: A qualitative, descriptive design. SETTING: This study was conducted on a L&D unit at a large, university-affiliated hospital in Quebec, Canada. PARTICIPANTS: A convenience sample of 10 L&D nurses participated in this study. Ages of participants ranged from 25 to 55 years, and experience on the unit ranged from 1 to 30 years. METHODS: One-time, face-to-face interviews were conducted with each participant. Audio-recorded interviews were transcribed verbatim and analyzed using inductive content analysis. RESULTS: Participants valued interpersonal support from nurse colleagues and guidance from experienced nurses in managing the emotional aspect of this care. They raised concerns about the effect of nursing workload and patient-to-nurse ratios on patient care. Nurses noted a desire for knowledge and skill-building through access to evidence-based literature, continuing education sessions, and workshops. They also expressed a need for more information regarding the genetic counseling process and community resources available to women undergoing pregnancy termination. CONCLUSION: Ensuring continuity of care through knowledge sharing related to genetic counseling and community resources creates the context for holistic patient care. Increased attention to the particular needs of L&D nurses providing care to women undergoing termination may enhance the quality and safety of care for this unique population.