Cost objects: How is your ED performing?

BACKGROUND: The aim of this study is to a propose a standardized methodology to identify a list of cost objects that can be used by any ED to compute costs considering that the resulting data must facilitate unit management by improving the information available for decision-making. METHODS: This study considers two stages, first, we analyzed the case-mix of two hospitals collecting their data to define and diagram their processes, activities and to obtain their cost objects, second, we used four additional hospitals to validate our initial findings. RESULTS: We recognized 59 cost objects. Hospitals may have all these cost objects or just a subset of them depending on the services they provide. CONCLUSIONS: Among the main benefits of our cost objects definition are: the possibility of tracing the processes generated by the services delivered by EDs, the economic sense in its grouping, the chance of using any costing methodology, the flexibility with other classification systems such as DRGs and ICDs, and the opportunity of costing for both diseases and treatments. Furthermore, cost comparison among hospitals using our final 59 cost objects list is more accurate and based on comparable units. In different EDs, each cost object will be the result of a similar combination of activities performed. We also present the results of applying this cost objects list to a particular ED. A total of 53 out of 59 cost objects were identified for that particular unit within a calendar year.

Indicadores de gestión para evaluar el desempeño de hospitales públicos: un caso de estudio en Chile y Ecuador / Assessing the performance of public hospitals using key indicators: a case study in Chile and Ecuador

Background: Continuous improvement, quality of care, and patient satisfaction demand the implementation of coordinated actions from all the healthcare personnel. They also require collaboration, management skills and attention to different dimensions to improve problems due to the lack of resources such as specialists, medical technology and infrastructure. Aim: To design and implement a model of indicators to evaluate the performance of hospitals. Material and Methods: The methodology used in this research included a review of the literature, data collection, conducting interviews, defining objectives and indicators, proposing a model of indicators, validating the set of indicators, implementing the indicators in a hospital, and analyzing the results. Results: The proposed model of 95 indicators was implemented in a hospital in Ecuador. The results indicate that 37 indicators meet the standard, 19 need to be reviewed, 10 show non-compliance and need serious improvements, and the remaining 29 were not informed by the hospital under study. Conclusions: The defined indicators are aimed to improve the performance of a hospital, are easily interpreted, can be measured without spending large amounts of money, and do not need excessive efforts to collect data, mainly if they are supported by information systems.

[Assessing the performance of public hospitals using key indicators: a case study in Chile and Ecuador]. / Indicadores de gestión para evaluar el desempeño de hospitales públicos: Un caso de estudio en Chile y Ecuador.

BACKGROUND: Continuous improvement, quality of care, and patient satisfaction demand the implementation of coordinated actions from all the healthcare personnel. They also require collaboration, management skills and attention to different dimensions to improve problems due to the lack of resources such as specialists, medical technology and infrastructure. AIM: To design and implement a model of indicators to evaluate the performance of hospitals. MATERIAL AND METHODS: The methodology used in this research included a review of the literature, data collection, conducting interviews, defining objectives and indicators, proposing a model of indicators, validating the set of indicators, implementing the indicators in a hospital, and analyzing the results. RESULTS: The proposed model of 95 indicators was implemented in a hospital in Ecuador. The results indicate that 37 indicators meet the standard, 19 need to be reviewed, 10 show non-compliance and need serious improvements, and the remaining 29 were not informed by the hospital under study. CONCLUSIONS: The defined indicators are aimed to improve the performance of a hospital, are easily interpreted, can be measured without spending large amounts of money, and do not need excessive efforts to collect data, mainly if they are supported by information systems.

Critical evaluation of international health programs: Reframing global health and evaluation.

Striking changes in the funding and implementation of international health programs in recent decades have stimulated debate about the role of communities in deciding which health programs to implement. An important yet neglected piece of that discussion is the need to change norms in program evaluation so that analysis of community ownership, beyond various degrees of "participation," is seen as central to strong evaluation practices. This article challenges mainstream evaluation practices and proposes a framework of Critical Evaluation with 3 levels: upstream evaluation assessing the "who" and "how" of programming decisions; midstream evaluation focusing on the "who" and "how" of selecting program objectives; and downstream evaluation, the focus of current mainstream evaluation, which assesses whether the program achieved its stated objectives. A vital tenet of our framework is that a community possesses the right to determine the path of its health development. A prerequisite of success, regardless of technical outcomes, is that programs must address communities' high priority concerns. Current participatory methods still seldom practice community ownership of program selection because they are vulnerable to funding agencies' predetermined priorities. In addition to critiquing evaluation practices and proposing an alternative framework, we acknowledge likely challenges and propose directions for future research.

National Healthcare Policies in Chile: An Ontological Meta-Analysis.

We present an ontological meta-analysis of the national healthcare policies in Chile. Using a logically constructed ontology based on the common body of knowledge as a lens, we map the 39 key policies. The ontological map provides a synoptic, systematic, and systemic view of the policies, and highlight their emphases and biases.