Nurses' views on hospital organizational characteristics.

BACKGROUND: Positive organizational characteristics are conducive to healthy work environments. Hospitals with positive organizational characteristics and healthy work environments attract nurses. In turn, positive organizational characteristics and healthy work environments in hospitals will result in positive nurse, patient, and organizational outcomes. AIM: The aim of this study was to assess hospital organizational characteristics from the viewpoint of registered nurses (RNs) in the country of Jordan. METHODS: The researcher used a survey method to conduct the study; the Revised Nursing Work Index (NWI-R) was used to collect data, utilizing a convenience sample of 308 RNs with a total response rate of 75%. FINDINGS: The strongest positive hospital organizational characteristic was the presence of adequate support services which allow nurses to spend time with their patients. The strongest negative hospital organizational characteristics were the nursing delivery systems-particularly in primary nursing where they result in nurses having to do things that are against their nursing judgment-and the limited opportunities and freedom over many aspects of nursing care and unit/ward decisions. CONCLUSIONS: Positive hospital organizational characteristics should be maintained because these produce positive nurse, patient, and organizational outcomes. Fostering a positive hospital organizational environment is a continuous effort. The results have implications for practice, research, and education.

Gestão em saúde na fronteira: revisão integrativa da imbricância para a assistência hospitalar / Gestión de la salud en la frontera: revisión integradora de su impacto en laatención hospitalaria / Health management in frontier: integrative review on its impact for hospital care

Objetivo: Identificar os subsídios propiciados pela produção científica à gestão hospitalar de saúde em áreas de fronteira. Métodos: Trata-se de uma revisão integrativa que explorou o universo de 24 artigos indexados na Biblioteca Virtual de Saúde, na base de dados Literatura Latino-Americanae do Caribe em Ciência da Saúde (LILACS). Resultados: Aspectos socioeconômicos da gestão em saúde na fronteira que evidenciaram a mobilidade de pessoas e a gestão dos serviços de saúde e; aspectos clínicos para a gestão em saúde na fronteira que destacou os aspectos do serviço e as características da clientela. Conclusão: A saúde em área de fronteira pela produção científica explorada subsidia a gestão hospitalar ao indicar os aspectos socioeconômicos como determinantes do processo saúde-doença. Determinação que acarreta na ampliação da demanda e da necessidade de tecnologia diagnóstica em saúde.

Objective: To identify the subsidies provided by scientific production to hospital health management in frontier areas. Methods: This is an integrative review that explored the universe of 24 articles indexed in the Virtual HealthLibrary, the database of Latin American and Caribbean Health Sciences (LILACS). Results: Socioeconomic health management aspects at the border that showed the mobility of people and the management of health services and; clinical aspects of health management at the border which highlighted aspects of service and customer characteristics. Conclusion: Health in the frontier area explored in scientific production subsidizes the hospital management to indicate the socioeconomic factors as determinants of the health-disease. Determination which results in increased demand and the need for health diagnostic technology.

Objetivo: Identificar subsidios propiciados por la producción científicade la gestión hospitalaria de salud en las zonas fronterizas. Métodos: Se trata de una revisión integradora que explora el universo de 24 artículos indexados en la Biblioteca Virtual en Salud, en la base de datos de América Latina y el Caribe de la Salud Ciencia (LILACS). Resultados: Aspectos socioeconómicos de Gestión de la Salud en la Frontera que demuestran la movilidad de las personas y la gestión de los servicios de salud y; Aspectos clínicos para la Gestión de la Salud en la Frontera que destacaron los aspectos de las características del servicio y atención al cliente. Conclusión: Salud en el área de frontera de producción científica explorado presentado subvenciona la gestión hospitalaria para indicar los aspectos socioeconómicos como determinantes de la salud-enfermedad. Determinación de que implica la expansión de la demanda y la necesidad de tecnología de diagnóstico en salud.

A New Approach of Measuring Hospital Performance for Low- and Middle-income Countries.

Efficiency of the hospitals affects the price of health services. Health care payments have equity implications. Evidence on hospital performance can support to design the policy; however, the recent literature on hospital efficiency produced conflicting results. Consequently, policy decisions are uncertain. Even the most of evidence were produced by using data from high income countries. Conflicting results were produced particularly due to differences in methods of measuring performance. Recently a management approach has been developed to measure the hospital performance. This approach to measure the hospital performance is very useful from policy perspective to improve health system from cost-effective way in low and middle income countries. Measuring hospital performance through management approach has some basic characteristics such as scoring management practices through double blind survey, measuring hospital outputs using various indicators, estimating the relationship between management practices and outputs of the hospitals. This approach has been successfully applied to developed countries; however, some revisions are required without violating the fundamental principle of this approach to replicate in low- and middle-income countries. The process has been clearly defined and applied to Nepal. As the results of this, the approach produced expected results. The paper contributes to improve the approach to measure hospital performance.

Prevalence, Geographic Variation, and Trends in Hospital Services Relevant to the Care of Older Adults: Development of the Senior Care Services Scale and Examination of Measurement Properties.

BACKGROUND: The availability of hospital services for older adults nationwide is not well understood. OBJECTIVE: To present the development of the Senior Care Services Scale (SCSS) through: (1) identification of hospital services relevant to the care of older adults; (2) development of a taxonomy classifying these services; and (3) description of prevalence, geographic variation, and trends in service provision in US hospitals over time. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of US hospitals in 1999 and 2006 rounds of American Hospital Association Annual Survey of Hospitals (n=4998 and 4831 hospitals, respectively). Exploratory factor analysis was used to create the SCSS, and confirmatory factor analysis was used to examine services over time. The paper reports prevalence of services nationwide. RESULTS: The SCSS consisted of 2 service groups: (1) Inpatient Specialty Care (IP): geriatrics, palliative care, psychiatric geriatrics, pain management, social work, case management, rehabilitation, and hospice; and (2) Postacute Community Care (PA): skilled nursing, intermediate care, other long-term care, assisted living, retirement housing, adult day care, and home health services. Over time, hospitals offered more IP services and fewer PA services. The distribution of services did not mirror the distribution of where older adults reside in the United States. CONCLUSIONS: The development of the SCSS provides important information about senior care services before the passage of the Affordable Care Act. The apparent mismatch of hospital services and demographic trends suggests that many US hospitals may not provide a seamless continuum of care for an increasing population of older adults.

Evaluación económica de un programa de coordinación entre niveles para el manejo de pacientes crónicos complejos / Economic evaluation of a program of coordination between levels for complex chronic patients’ management

OBJETIVO: El programa del paciente crónico complejo (PCC) del Alt Penedès tiene por objetivo mejorar la coordinación asistencial. El objetivo del presente trabajo fue evaluar la relación entre los costes asociados al programa y sus resultados en forma de ingresos evitados. DISEÑO: Análisis coste-efectividad desde la perspectiva del sistema sanitario a partir de un estudio antes-después. Emplazamiento: Comarca del Alt Penedès. MEDICIONES PRINCIPALES: Los resultados en utilización de servicios hospitalarios (ingresos, urgencias, hospital de día) y visitas de primaria del programa PCC se compararon con los anteriores a su implementación. El coste asignado a cada recurso correspondió al concierto del hospital con CatSalut y las tarifas del ICS para atención primaria. Se llevó a cabo un análisis de sensibilidad a partir del método de bootstrapping. La intervención se consideró coste-efectiva si la ratio coste-efectividad incremental (RCEI) no superaba el coste de un ingreso (1.742,01 Euros). RESULTADOS: Se incluyó a 149 pacientes. Los ingresos se redujeron de 212 a 145. El RCEI fue 1.416,3 Euros (94.892.9 Euros/67). El análisis de sensibilidad mostró que en el 95% de los casos los costes podrían variar entre 70.847,3 Euros y 121.882,5 Euros, y los ingresos evitados entre 30 y 102. En el 72,4% de las simulaciones el programa fue coste-efectivo. CONCLUSIONES: El análisis de sensibilidad muestra que en la mayoría de situaciones el programa del PCC sería coste-efectivo, aunque en un porcentaje de casos el programa podría suponer un aumento global del coste de la atención, a pesar de suponer siempre una reducción en el número de ingresos

OBJECTIVE: The complex chronic patient program (CCP) of the Alt Penedès aims to improve the coordination of care. The objective was to evaluate the relationship between the costs associated with the program, and its results in the form of avoided admissions. DESIGN: Dost-effectiveness analysis from the perspective of the health System based on a before-after study. LOCATION: Alt Penedès. MAIN MEASUREMENTS: Health services utilisation (hospital [admissions, emergency visits, day-care hospital] and primary care visits). CCP Program results were compared with those prior to its implementation. The cost assigned to each resource corresponded to the hospital CatSalut's concert and ICS fees for primary care. A sensitivity analysis using boot strapping was performed. The intervention was considered cost-effective if the incremental cost-effectiveness ratio (ICER) did not exceed the cost of admission (Euros 1,742.01). RESULTS: 149 patients were included. Admissions dropped from 212 to 145. The ICER was Euros 1,416.3 (94,892.9 Euros/67). Sensitivity analysis showed that in 95% of cases the cost might vary between Euros 70,847.3 and Euros 121,882.5 and avoided admissions between 30 and 102. In 72.4% of the simulations the program was cost-effective. CONCLUSIONS: Sensitivity analysis showed that in most situations the PCC Program would be cost-effective, although in a percentage of cases the program could raise overall cost of care, despite always reducing the number of admissions

A New Approach of Measuring Hospital Performance for Lowand Middle-income Countries

Efficiency of the hospitals affects the price of health services. Health care payments have equity implications. Evidence on hospital performance can support to design the policy; however, the recent literature on hospital efficiency produced conflicting results. Consequently, policy decisions are uncertain. Even the most of evidence were produced by using data from high income countries. Conflicting results were produced particularly due to differences in methods of measuring performance. Recently a management approach has been developed to measure the hospital performance. This approach to measure the hospital performance is very useful from policy perspective to improve health system from cost-effective way in low and middle income countries. Measuring hospital performance through management approach has some basic characteristics such as scoring management practices through double blind survey, measuring hospital outputs using various indicators, estimating the relationship between management practices and outputs of the hospitals. This approach has been successfully applied to developed countries; however, some revisions are required without violating the fundamental principle of this approach to replicate in low- and middle-income countries. The process has been clearly defined and applied to Nepal. As the results of this, the approach produced expected results. The paper contributes to improve the approach to measure hospital performance.

Variations in inpatient mortality among hospitals in different system types, 1995 to 2000.

BACKGROUND: Relatively few studies focused on the impact of system formation and hospital merger on quality, and these studies reported typically little or no quality effect. OBJECTIVE: To study associations among 5 main types of health systems--centralized, centralized physician/insurance, moderately centralized, decentralized, and independent--and inpatient mortality from acute myocardial infarction (AMI), congestive heart failure, stroke, and pneumonia. DATA AND METHODS: Panel data (1995-2000) were assembled from 11 states and multiple sources: Agency for Healthcare Research and Quality State Inpatient Database, American Hospital Association Annual Surveys, Area Resource File, HMO InterStudy, and the Centers for Medicare and Medicaid Services. We applied a panel study design with fixed effects models using information on variation within hospitals. RESULTS: We found that centralized health systems are associated with lower AMI, congestive heart failure, and pneumonia mortality. Independent hospital systems had better AMI quality outcomes than centralized physician/insurance and moderately centralized health systems. We found no difference in inpatient mortality among system types for the stroke outcome. Thus, for certain types of clinical service lines and patients, hospital system type matters. Research that focuses only on system membership may mask the impact of system type on the quality of care.

Telehealth adoption in hospitals: an organisational perspective.

PURPOSE: The purpose of this study is to explore the influence of hospitals' organisational characteristics on telehealth adoption by health-care centres involved in the extended telehealth network of Quebec (French acronym RQTE) DESIGN/METHODOLOGY/APPROACH: The article is based on a review of the literature and a questionnaire, which was administered via telephone interviews to the 32 hospitals involved in the Extended Telehealth Network of Quebec. Contingency analyses were performed to determine which organisational factors have influenced telehealth adoption. Subsequently, a multiple case study was conducted among nine hospitals representative of different categories of telehealth adopters. In-depth interviews with various actors involved in telehealth activities have permitted a deepening of one's understanding of the impact of clinical and administrative contexts on telehealth adoption. FINDINGS: The results from both the questionnaire and interviews support the observation made by Whitten and Adams in 2003 that telehealth programs are not isolated, but located within larger health organisations. Moreover, health-care organisations are also positioned in a larger geographical, economical and socio-political environment. Therefore, it is important to investigate the context in which telehealth projects are taking place prior to experimentation. ORIGINALITY/VALUE: This study has highlighted the relevance of considering the characteristics and the dynamics of health-care organisations at each stage of telehealth implementation in order to take their specific needs into account.

Understanding hospital readiness for computerized physician order entry.

BACKGROUND: Many hospitals in the United States are in early stages of decision making and planning to implement computerized physician order entry (CPOE) to improve patient safety and quality of care. The targeted processes and the software for CPOE are complex, and implementation is a large-scale change effort for most hospitals. Hospitals can increase the likelihood of success by understanding and addressing gaps in CPOE readiness. ASSESSING CPOE READINESS: A CPOE readiness assessment tool was developed that includes several different components: external environment; organizational leadership, structure, and culture; care standardization;, order management; access to information; information technology composition; and infrastructure. The presence or absence of these indicators in a particular hospital was determined by on-site interviews, walkarounds with direct observations, and document review. RESULTS: Assessment results for the first 17 hospitals (bed size, 75-906 beds) indicated that the lowest average component score was in care standardization, while the highest average component score was in organizational structure and function. Organizational culture and the order management process also had low average scores. CONCLUSIONS: This CPOE readiness assessment revealed significant gaps in all the hospitals examined. Identifying these gaps and addressing them before CPOE implementation can reduce risks. Organizations need to develop expertise at accomplishing and sustaining change; understanding and building CPOE readiness is an important first step.

An examination of the relationship between strategic group membership and hospital performance.

Membership in a particular strategic group, where a strategic group can be defined as groups of firms in an industry following similar competitive approaches and having similar market positions, defines the essentials of a firm's strategy. This study longitudinally examines the relationship between strategic group membership and performance in the hospital industry.

The best of the bunch. 100 top hospitals are more likely to employ practices that improve quality of care while also boosting the bottom line.

When it comes to employing the best practices in striving for high quality of care, top patient satisfaction and solid business management, the 100 Top Hospitals simply do it better. A comparison study shows the top hospitals have many advantages, clinical and financial.

A matter of life and death. New research adds to evidence showing higher nurse-to-patient numbers can have a significant impact on mortality rates.

Evidence continues to mount indicating that higher nurse to patient staffing can have lifesaving effects in the hospital. A study involving nearly 2,200 hospitals shows that nurse staffing can indeed be a reliable predictor of risk-adjusted mortality.

Pioneers in prevention. 100 top hospitals are far ahead of the curve in their work to eliminate costly mistakes in the delivery of medical care.

Complications from medical errors are enormously costly to America's healthcare system, both in terms of lives lost and the financial price tag of medical care necessitated by clinical mistakes. The 100 Top Hospitals are far head of the curve in their prevention programs.