Scaling up Maternal and Child Healthcare Delivery among Mission Hospitals in Southeast Nigeria: An Empirical Application of Data Envelopment Analysis for Setting Benchmarks and Targets.

The health system in many parts of Nigeria has been dysfunctional in several domains including financing, human resources, infrastructure, health management information system and hospital services. In an attempt to scale up Maternal and Child Health (MCH) services and ensure efficiency, Ebonyi State Government in Southeast Nigeria provided funding to mission hospitals across the State as a grant. This study used nonparametric method to assess the effect of this public financing on the efficiency of the mission hospitals. Operational cost and number of hospital beds were used as the input variables, while antenatal registrations, number of immunization doses and hospital deliveries were the output variables. The hospitals were disaggregated into 15 hospital-years. The mean overall technical efficiency of the mission hospitals was 84.05 22.45%. The mean pure technical efficiency was 95.56±6.9% and the scale efficiency was 88.05±22.20%. About 46.67% of all the hospital-years were technically and scale efficient. Although, 55.33% were generally inefficient, only 33.33% of hospital-years exhibited pure technical inefficiency. Low immunization coverage was the major cause of inefficiency. The study showed increased maternal health service output as result of public funding or intervention; however, the mission hospitals could have saved 16% of input resources if they had performed efficiently. It also shows that data envelopment analysis can be used in setting targets/benchmarks for relatively inefficient health facilities, and in monitoring impact of interventions on efficiency of hospitals over-time.

Family planning service provision in Illinois religious hospitals: Racial/ethnic variation in access to non-religious hospitals for publicly insured women.

OBJECTIVES: To identify religious affiliations of hospitals and access to family planning (FP) care available to publicly insured women in Cook County, Illinois. DESIGN: We analyzed Illinois public insurance enrollment data and family planning service claims (2015-2018) for women 18-45. RESULTS: Eighty-five percent of Black/Hispanic women were enrolled in Medicaid managed care plans with a higher percentage of Catholic healthcare than Cook County as a whole compared to 75% of White women (p<0.0001). There were fewer FP services at Catholic (IRR 0.072, 95% CI 0.068-0.076) and Christian non-Catholic (IRR 0.55, 95% CI 0.53-0.56) compared to non-religious hospitals. CONCLUSIONS: Medicaid managed care plans may restrict family planning care by limiting patients to religious hospitals.

St. Michael's Improvement Program - A Collaborative Approach to Sustainable Cost Savings.

In response to a challenging financial environment and increasing patient demand, St. Michael's Hospital needed to find long-term sustainable solutions to continue to provide high-quality patient care and invest in key priorities. By conducting Operational Reviews in focused areas, the hospital achieved $7.4 million of in-year savings in the first year, found standardizations, process efficiencies and direct cost savings that positioned itself for success in future funding models. Initiatives were grounded in evidence and relied heavily on the effective execution by the leadership, front-line staff and physicians. As organizations face similar challenges, this journey can provide key learnings.

Governance Resilience: The Presbyterian Journey.

Presbyterian Healthcare Services, based in Albuquerque, New Mexico, is the state's only private, not-for-profit integrated healthcare system. It was founded in 1908 as a sanitorium for tuberculosis patients who came to the arid Southwest in search of a cure. Today, Presbyterian is thriving as a twenty-first-century integrated healthcare system, serving one in three New Mexicans in its statewide hospital system; it also includes a 440,000-member health plan and a 700-plus provider medical group. Presbyterian remains dedicated to its singular purpose of improving the health of the patients, members, and communities it serves. Just as Presbyterian has progressed and grown during its 106-year history, its governance system has evolved over time. Presbyterian has always believed that the New Mexico communities it serves deserve not just good governance but great governance and relies on strong structure and processes to lead it to superior outcomes. The ebb and flow of change, our ability to learn from trial and error, and our commitment to success in spite of obstacles make up the story of Presbyterian's strong governance system.

Tubal ligation in Catholic hospitals: a qualitative study of ob-gyns' experiences.

OBJECTIVE: Tubal sterilization remains one of the most commonly requested contraceptive methods in the United States. Catholic hospital policy prohibits all sterilizations, but this ban is not uniformly enforced. We conducted this study to assess obstetrician-gynecologists' beliefs and experiences with tubal ligation in Catholic hospitals. STUDY DESIGN: We interviewed 31 obstetrician-gynecologists geographically dispersed throughout the US who responded to a national survey and agreed to be contacted for a follow-up interview or who were referred by colleagues from the survey sample. Twenty-seven had experienced working in a Catholic hospital. Interviews were open ended and guided by a semistructured instrument. Transcripts were thematically analyzed. RESULTS: Obstetrician-gynecologists disagreed with strict prohibition of sterilizations, especially when denying a tubal ligation placed the patient at increased medical risk. Cesarean delivery in Catholic hospitals raised frustration for obstetrician-gynecologists when the hospital prohibited a simultaneous tubal ligation and, thus, sent the patient for an unnecessary subsequent surgery. Obstetrician-gynecologists described some hospitals allowing tubal ligations in limited circumstances, but these workarounds were vulnerable to changes in enforcement. Some obstetrician-gynecologists reported that Catholic policy posed greater barriers for low-income patients and those with insurance restrictions. CONCLUSION: Obstetrician-gynecologists working in Catholic hospitals in this study did not share the Church's beliefs on sterilization. Research to understand patients' experiences and knowledge of their sterilization options is warranted in order to promote women's autonomy and minimize risk of harm. IMPLICATIONS STATEMENT: Tubal sterilization, even when medically indicated or in conjunction with cesarean delivery, is severely restricted for women delivering in Catholic hospitals. For women whose only access to hospital care is at a Catholic institution, religious policies can prevent them from receiving a desired sterilization and place them at risk for future undesired pregnancy.