Hospitals accreditation status in Indonesia: associated with hospital characteristics, market competition intensity, and hospital performance?

BACKGROUND: Hospital accreditation is widely adopted as a visible measure of an organisation's quality and safety management standards compliance. There is still inconsistent evidence regarding the influence of hospital accreditation on hospital performance, with limited studies in developing countries. This study aims to explore the association of hospital characteristics and market competition with hospital accreditation status and to investigate whether accreditation status differentiate hospital performance. METHODS: East Java Province, with a total 346 hospitals was selected for this study. Hospital characteristics (size, specialty, ownership) and performance indicator (bed occupancy rate, turnover interval, average length of stay, gross mortality rate, and net mortality rate) were retrieved from national hospital database while hospital accreditation status were recorded based on hospital accreditation report. Market density, Herfindahl-Hirschman index (HHI), and hospitals relative size as competition indicators were calculated based on the provincial statistical report data. Logistic regression, Mann-Whitney U-test, and one sample t-test were used to analyse the data. RESULTS: A total of 217 (62.7%) hospitals were accredited. Hospital size and ownership were significantly associated with of accreditation status. When compared to government-owned, hospital managed by ministry of defense (B = 1.705, p = 0.012) has higher probability to be accredited. Though not statistically significant, accredited hospitals had higher utility and efficiency indicators, as well as higher mortality. CONCLUSIONS: Hospital with higher size and managed by government have higher probability to be accredited independent to its specialty and the intensity of market competition. Higher utility and mortality in accredited hospitals needs further investigation.

Smoking is a Risk Factor for Generation Z, Too: The Evolution of the Attitudes.

Objectives: Generation Z, defined as "post-millennial," is considered to be the first generation that could end smoking. The objective is also to take into account the evolutionary aspect of the smoking and attitudes of the Generation Z. The aim of this study was to explore the willingness of Generation Z in Slovakia to comply with the legislation adopted in the field of anti-tobacco policy and to investigate some selected social factors-intention, subjective norm and percevied behavioral control-that contribute to a lower rate of compliance. Methods: Global Youth Tobacco Survey (GYTS) data on cigarette smoking among 3,557 adolescents (age range 13-15) in 2016 as well as on attitudes towards tobacco use and control measures were used to explore the level of compliance of adolescents with anti-tobacco regulations in Slovakia within the Framework Convention of Tobacco Control (FCTC). We used the concept of intention as explained in Ajzen's theory of planned behaviour (1985), focusing on the role of subjective norm and perceived behavioural control. Results: We found a decrease in ever smoking, current smoking and frequent smoking. We found that these adolescents start experimenting with dependence-causing substances, such as tobacco, regardless of existing rules. Conclusion: Adolescents were attracted to smoking, although they were aware of health effects of passive smoking, and a vast majority liked smoke-free places. They are also influenced by their peers and parental models.

Determinants of quality management systems implementation in hospitals.

OBJECTIVE: To identify the problems and facilitating factors in the implementation of quality management system (QMS) in hospitals through a systematic review. METHOD: A search strategy was performed on the Medline database for articles written in English published between 1992 and early 2006. Using the thesaurus terms 'Total Quality Management' and 'Quality Assurance Health Care', combined with the term 'hospital' and 'implement*', we identified 533 publications. The screening process was based on empirical articles describing organization-wide QMS implementation. Fourteen empirical articles fulfilled the inclusion criteria and were reviewed in this paper. RESULTS: An organization culture emphasizing standards and values associated with affiliation, teamwork and innovation, assumption of change and risk taking, play as the key success factor in QMS implementation. This culture needs to be supported by sufficient technical competence to apply a scientific problem-solving approach. A clear distribution of QMS function within the organizational structure is more important than establishing a formal quality structure. In addition to management leadership, physician involvement also plays an important role in implementing QMS. CONCLUSIONS: Six supporting and limiting factors determining QMS implementation are identified in this review. These are the organization culture, design, leadership for quality, physician involvement, quality structure and technical competence.