A multi-phase, multi-centre development and validation of two maturity tools assessing the implementation of the FlaQuM co-creation roadmap.

BACKGROUND: As part of the new Flanders Quality Model (FlaQuM) towards sustainable quality management systems, a co-creation roadmap with six primary drivers and 19 building blocks that guides healthcare organisations has been developed. Currently, no assessment tool is available to monitor hospitals' quality management systems implementation according to this co-creation roadmap. Therefore, we aimed to measure the maturity of the implementation of the FlaQuM co-creation roadmap in hospitals. METHODS: A three-phase approach in co-design with 19 hospitals started with defining the scope, followed by establishing content validity through a literature review, involvement of content experts (n=47), 20 focus groups with content experts (n=79) and a Delphi round with healthcare quality managers (n=19) to test the content validity index (CVI). Construct validity was assessed by confirmatory factor analyses and convergent validity by Spearman's ρ correlation coefficients. RESULTS: Based on 17 included existing maturity instruments and sub-components of content experts, two maturity tools were developed according to the implementation of the FlaQuM co-creation roadmap: 1) a maturity matrix with 52 sub-components and 2) a co-creation scan with 19 statements. The overall scale-CVI varied between 93.3% and 90.0% in terms of relevance and clarity, respectively. In a sample of 119 healthcare professionals, factor analyses revealed a 6-factor structure and 16 (84.2%) of the 19 hypothesis for testing convergent validity between both maturity tools were statistically significant. CONCLUSION: Measuring the implementation of the FlaQuM co-creation roadmap and monitoring its maturity over time should be feasible by using these comprehensive maturity tools in hospitals. Results of both tools should be able to describe the current state of hospitals' implementation of the co-creation roadmap as basis for strategic improvement plans and next steps.

Surgical waiting lists and queue management in a Brazilian tertiary public hospital.

BACKGROUND: Centralized management of queues helps to reduce the surgical waiting time in the publicly funded healthcare system, but this is not a reality in the Brazilian Unified Healthcare System (BUHS). We describe the implementation of the "Patients with Surgical Indication" (PSI) in a Brazilian public tertiary hospital, the impact on waiting time, and its use in rationing oncological surgeries during the COVID-19 Pandemic. METHODS: Retrospective observational study of elective surgical requests (2016-2022) in a Brazilian general, public, tertiary university hospital. We recovered information regarding the inflows (indications), outflows and their reasons, the number of patients, and waiting time in queue. RESULTS: We enrolled 82,844 indications in the PSI (2016-2022). The waiting time (median and interquartile range) in days decreased from 98(48;168) in 2016 to 14(3;152) in 2022 (p < 0.01). The same occurred with the backlog that ranged from 6,884 in 2016 to 844 in 2022 (p < 001). During the Pandemic, there was a reduction in the number of non-oncological surgeries per month (95% confidence interval) of -10.9(-18.0;-3.8) during Phase I (January 2019-March 2020), maintenance in Phase II (April 2020-August 2021) 0.1(-10.0;10.4) and increment in Phase III (September 2021-December 2022) of 23.0(15.3;30.8). In the oncological conditions, these numbers were 0.6(-2.1;3.3) for Phase I, an increase of 3.2(0.7;5.6) in Phase II and 3.9(1,4;6,4) in Phase III. CONCLUSION: Implementing a centralized list of surgical indications and developing queue management principles proved feasible, with effective rationing. It unprecedentedly demonstrated the decrease in the median waiting time in Brazil.

Preventing Healthcare-Associated Infections: Hand Disinfection Monitoring Using an Automated System in an Italian Neurological Hospital.

Hand hygiene plays a pivotal role in preventing Healthcare-Associated Infections (HAIs). Nevertheless, the quality of hand disinfection techniques remains suboptimal, and the reliability of assessment methodologies is notably lacking. This study aimed to evaluate hand disinfection techniques using an automated system in an Italian research hospital. Hospital employees underwent automated hand-disinfection technique assessment, according to the World Health Organization's six-step protocol, at a basal time and two further times. Detection was carried out with a scanner that evaluated the effective hand disinfectant coverage through a fluorescent dye present in the hydro-alcoholic gel rub. The hand-hygiene technique of 222 employees was analyzed by HandInScan®. At the initial assessment of hand coverage with the hydro-alcoholic gel, the mean palm coverage was 82.2%, mean back coverage was 66.8%, and overall mean hand coverage was 74.5%. Then, two measurements were performed in June (t1) and December 2022 (t2). The third measurement showed an increase in hand coverage, with a mean palm coverage of 97.2%, a mean back coverage of 91.8%, and a mean hand coverage of 94.5% (p < 0.05). Moreover, the mean coverage of the hand-back was lower than that of the hand-palm at all times (p < 0.001). The automated scanner provided evidence supporting its effectiveness in enhancing hand hygiene among hospital employees. These findings have motivated researchers to conduct long-term studies, given the potential effects on HAI prevention-including their impact on HAI trends.

Hospital Performance Evaluation Checklist in Context of COVID-19 Pandemic: Design and Validation.

OBJECTIVE: Around the world, pandemics have been considered among the main hazards in the last 2 decades. Hospitals are 1 of the most important organizations responding to pandemics. The aim of this study was to design and develop a valid checklist for evaluating the hospitals' performance in response to COVID-19 pandemic, for the first time. METHODS: This study is a mixed method research design that began in February, 2020 and was conducted in 3 phases: Designing a conceptual model, designing a primary checklist structure, and checklist psychometric evaluation. Known-groups method has been used to evaluate construct validity. Two groups of hospitals were compared: group A (COVID-19 Hospitals) and group B (the other hospitals). RESULTS: The checklist's main structure was designed with 6 main domains, 23 sub-domains, and 152 items. The content validity ratio and index were 0.94 and 0.79 respectively. Eleven items were added, 106 items were removed, and 40 items were edited. Independent t-test showed a significant difference between the scores of the 2 groups of hospitals (P < 0.0001). Pearson correlation coefficient test also showed a high correlation between our checklist and the other. The internal consistency of the checklist was 0.98 according to Cronbach's alpha test. CONCLUSIONS: Evaluating the hospitals' performance and identifying their strengths and weaknesses, can help health system policymakers and hospital managers, and leads to improved performance in response to COVID-19.

Gestão de recursos das unidades de terapia intensiva em tempos de pandemia por COVID-19

Objetivo: Analisar aspectos de gestão em recursos das unidades de terapia intensiva (UTI) em tempos de COVID-19 na microrregião Cariri cearense. Método: Estudo descritivo do tipo transversal em quatro hospitais da microrregião do Cariri, com 91 profissionais da equipe interdisciplinar que atuam em UTI desde o início da pandemia. A pesquisa foi realizada através de e-mail, Instagram e/ou WhatsApp e os dados analisados em teste do qui-quadrado, teste-T e gráfico de clusters. Resultados: Acerca dos recursos humanos, 73,6 % dos profissionais realizaram curso de manejo do paciente em UTI durante a COVID-19 e 67,0 % sobre controle de infecções relacionados a serviços de saúde. Um 64,8 % conseguiram lidar como as dificuldades na UTI, 69,2 % foram remanejados de outros setores hospitalares para atender demandas da UTI e grande parte dos profissionais (76,9 %) não tiveram aporte psicológico para a pandemia. Nos recursos estruturais, 100 % dos leitos de UTI adulto foram ocupados durante a pandemia, apresentando diferença entre antes e durante, durante e após a crise com aumento exponencial da capacidade de leitos (p<0,001), e não apresentando diferenças significativas em momentos antes e após a pandemia (p=0,035). Recursos materiais estiveram em escassez e diminuição, como equipamentos de proteção individual, oxigênio, medicamentos, entre outros. Conclusão: Foi possível identificar a reorganização dos recursos humanos, materiais e estruturais dos hospitais da pesquisa. Houve aumento exponencial de leitos durante a crise pandêmica quando comparado a capacidade relatada pelos profissionais de momentos antes da pandemia. Portanto, esta pesquisa contribui para o conhecimento de gestão em saúde e reestruturação hospitalar em tempos de pandemia.

Objetivo: Analizar aspectos de la gestión de recursos de las unidades de cuidados intensivos (UCI) en tiempos de COVID-19 en la microrregión de Cariri, Ceará Método: Estudio descriptivo transversal en cuatro hospitales de la microrregión de Cariri, con 91 profesionales del equipo interdisciplinario que trabajan en UCI desde el inicio de la pandemia. La encuesta se realizó por correo electrónico, Instagram y/o WhatsApp y los datos se analizaron mediante la prueba chi-cuadrado, prueba T y gráfico de conglomerados Resultados: Respecto a los recursos humanos, el 73.6 % de los profesionales realizó un curso de manejo de pacientes en UCI durante la COVID-19 y el 67.0 % sobre control de infecciones relacionadas con los servicios sanitarios. El 64.8 % pudo hacer frente a las dificultades en la UCI, el 69,2 % fue reasignado de otros sectores hospitalarios para atender las demandas de la UCI y la mayoría de los profesionales (76.9 %) no tuvo apoyo psicológico para la pandemia. En cuanto a los recursos organizativos, el 100 % de las camas de la UCI de adultos estuvieron ocupadas durante la pandemia, con una diferencia entre antes y durante, durante y después de la crisis, con un aumento exponencial de la capacidad de camas (p<0,001), y sin diferencias significativas entre antes y después de la pandemia (p=0,035). Los recursos materiales escasearon y disminuyeron, como equipos de protección personal, oxígeno, medicamentos, entre otros Conclusión: Se pudo identificar la gestión de los recursos humanos, materiales y organizativos en los hospitales encuestados. Hubo un aumento exponencial de camas durante la crisis pandémica en comparación con la capacidad reportada por los profesionales antes de la pandemia. Por lo tanto, esta investigación contribuye al conocimiento de la gestión sanitaria y la reestructuración hospitalaria en tiempos de pandemia

Objective: To analyze resource management aspects in intensive care units (ICU) in times of COVID-19 in Cariri microregion of Ceará. Methods: Descriptive cross-sectional study in four hospitals in the Cariri microregion, with 91 professionals from interdisciplinary teams who have been working in the ICU since the beginning of the pandemic. Research was conducted through email, Instagram and/or WhatsApp and the data were analyzed in the chi-square test, T-test and cluster chart Results: Regarding human resources, 73.6 % of professionals took a course on patient management in ICU during COVID-19 and 67.0 % on control of healthcare-associated infections. Of these professionals, 64.8 % were able to deal with the difficulties in the ICU, 69.2 % were relocated from other hospital sectors to meet ICU demands and most professionals (76.9 %) did not have psychological support for the pandemic. In structural resources, 100 % of adult ICU beds were occupied during the pandemic, presenting a difference between before and during, during and after the crisis with an exponential increase in bed capacity (p<0.001), and showing no significant differences in moments before and after the pandemic (p=0.035). Material resources were in short supply and decreased, such as personal protective equipment, oxygen, medicines, among others Conclusion: Identifying the reorganization of human, material and structural resources was possible in the researched hospitals. There has been an exponential increase in beds during the pandemic crisis when compared to the capacity reported by staff from moments before the pandemic. Therefore, this research contributes to the knowledge of health management and hospital restructuring in pandemic times

Predictors of prolonged treatment time intervals in oral cavity cancer.

OBJECTIVES: Delays in treatment time intervals have been associated with overall survival in oral cavity squamous cell carcinoma (OCSCC). The aim of this study was to identify bottlenecks leading to prolonged treatment intervals. MATERIAL AND METHODS: A retrospective analysis was conducted using a cohort of OCSCC patients who underwent surgery and adjuvant radiation therapy. The endpoints of interest were prolonged treatment intervals. Multivariable logistic regression was used to adjust for patient and tumour characteristics. RESULTS: Median diagnosis-to-treatment interval (DTI) and surgery to initiation of postoperative radiation therapy interval (S-PORT) were 39 days (IQR 30-54) and 64 days (IQR 54-66), respectively. Prolonged DTI was associated with older age, worse Charlson Comorbidity index scores and worse T stages. Patients with prolonged DTI had longer times to preoperative imaging reports (25 vs 9 days; P < 0.01). Time to preoperative pathology did not differ. Prolonged S-PORT was associated with longer times to pathology report (28 vs 18 days; P < 0.01), to maxillofacial consult (38 vs 15 days; P < 0.01) and to maxillofacial approval of radiation (50 vs 28 days; P < 0.01). In patients requiring medical oncology consults, those with prolonged S-PORT had longer waiting times until consultation (58 vs 38 days; P = 0.02). Multivariate analysis showed independent predictors of prolonged DTI: time to preoperative imaging; and prolonged S-PORT: time to pathology report, time to maxillofacial consult, and time to medical oncology consult. CONCLUSIONS: Strategies targeting these organizational bottlenecks may be effective for shortening treatment time intervals, hence representing potential opportunities for improving oncological outcomes in OCSCC patients.

Cost structure in specialist mental healthcare: what are the main drivers of the most expensive episodes?

BACKGROUND: Mental disorders are one of the costliest conditions to treat in Norway, and research into the costs of specialist mental healthcare are needed. The purpose of this article is to present a cost structure and to investigate the variables that have the greatest impact on high-cost episodes. METHODS: Patient-level cost data and clinic information during 2018-2021 were analyzed (N = 180,220). Cost structure was examined using two accounting approaches. A generalized linear model was used to explain major cost drivers of the 1%, 5%, and 10% most expensive episodes, adjusting for patients' demographic characteristics [gender, age], clinical factors [length of stay (LOS), admission type, care type, diagnosis], and administrative information [number of planned consultations, first hospital visits, interval between two hospital episode]. RESULTS: One percent of episodes utilized 57% of total resources. Labor costs accounted for 87% of total costs. The more expensive an episode was, the greater the ratio of the inpatient (ward) cost was. Among the top-10%, 5%, and 1% most expensive groups, ward costs accounted for, respectively, 89%, 93%, and 99% of the total cost, whereas the overall average was 67%. Longer LOS, ambulatory services, surgical interventions, organic disorders, and schizophrenia were identified as the major cost drivers of the total cost, in general. In particular, LOS, ambulatory services, and schizophrenia were the factors that increased costs in expensive subgroups. The "first hospital visit" and "a very short hospital re-visit" were associated with a cost increase, whereas "the number of planned consultations" was associated with a cost decrease. CONCLUSIONS: The specialist mental healthcare division has a unique cost structure. Given that resources are utilized intensively at the early stage of care, improving the initial flow of hospital care can contribute to efficient resource utilization. Our study found empirical evidence that planned outpatient consultations may be associated with a reduced health care burden in the long-term.

Midwifery Practice Leaders' Experiences of Practice Changes Early in the COVID-19 Pandemic: A Qualitative Exploration.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic generated considerable upheaval in all sectors of the US health care system, including maternity care. We focused this inquiry on midwifery practice leaders' experiences and perspectives on changes that occurred in their practices early in the pandemic. METHODS: This was a qualitative descriptive study using thematic analysis. The data were responses to an open-ended question in a survey of pandemic-related employment and clinical practice changes. Findings are presented from a constructivist perspective, describing the experiences and perspectives of a group of US midwifery practice leaders during the initial phase of the COVID-19 pandemic. RESULTS: Two main themes emerged from the analysis: demands on midwives and driving forces. Demands on midwives were 3-fold: clients' needs, modification of care, and midwives' needs. These encompassed the psychological, physical, and emotional toll that caring for women during the pandemic placed on midwives. Driving forces were those entities that spurred and directed change and included regulations, institutions, financial logistics, and team dynamics. Survey respondents in community (home and birth center) practices reported substantial increases in inquiries and client volume, and many respondents expressed concern about withdrawal of students from clinical placements. DISCUSSION: Midwifery practices experienced profound changes in their work environments during the COVID-19 pandemic, with both positive and negative characteristics. These challenges in providing birth care were similar to those reported in other countries. Results indicated existing guidance for maternity care during emergencies did not meet clients' needs. Coordinated planning for maternity care in future prolonged health emergencies should incorporate best practices and include midwives in the process.

Improving Patient Outcomes Through Effective Hospital Administration: A Comprehensive Review.

This comprehensive review delves into the critical role of effective hospital administration in shaping patient outcomes within the healthcare ecosystem. Exploration of key components, strategies, measurement methodologies, and future trends elucidates the multifaceted nature of hospital administration. Key findings underscore the profound impact of administrative decisions and practices on patient safety, satisfaction, and overall well-being. The review highlights the importance of patient-centred care and interdisciplinary collaboration for enhancing patient outcomes. It emphasises the significance of data-driven measurement and benchmarking, which are instrumental in assessing hospital performance and fostering continuous improvement. Looking ahead, emerging technologies, evolving healthcare policies, and persistent challenges are drivers of change in healthcare administration. However, amidst these transformations, the overarching message remains consistent: effective hospital administration is integral to improving patient outcomes. The conclusion calls for a collective commitment from healthcare leaders and policymakers to prioritise the development of capable administrators, invest in technology, promote value-based care, and address healthcare disparities. This collaborative effort ensures that the pursuit of better patient outcomes remains at the forefront of healthcare administration, ultimately shaping the future of healthcare for generations to come.

Role of communication in successful outpatient attendance in a New Zealand hospital: a qualitative study.

BACKGROUND: There are significant implications for both patients and providers when patients do not attend outpatient specialist appointments. Nonattendance has an impact on the efficiency of health care, provider resources and patient health outcomes. AIMS: In this qualitative study we aimed to gather insights on how Dunedin Hospital notifies patients about their appointments, the implications for the hospital and for patients and how the system could be improved. METHODS: We interviewed 13 hospital staff members and nine patients who volunteered to participate because they had missed appointments as a result of communication problems. Interviews were transcribed and analysed thematically using NVivo software. RESULTS: Dunedin Hospital relies heavily on posted letters to inform people about their appointments, with some also receiving reminder texts closer to the time of the appointment. Frustration with the current system was a common theme among both patients and staff. Almost all patients had missed an appointment because of a letter not arriving. While most patients found that the text reminders were helpful, most said they were sent too late and did not allow enough time for arrangements to be made for their appointments. Almost all patients experienced treatment delays, which caused distress. Most patients believed a self-booking system would improve the ability to attend their appointments, and most of them wanted to be notified of appointments via email. CONCLUSIONS: We recommend that a patient-oriented approach to communication should be implemented, and alternative methods of communication should be explored.

Cost-effectiveness of terlipressin for hepatorenal syndrome: the United States hospital perspective.

BACKGROUND: Hepatorenal syndrome (HRS) is characterized by severely reduced renal perfusion that precipitates rapid morbidity and mortality. Terlipressin is the only US Food and Drug Administration-approved treatment to improve kidney function for adults with HRS with a rapid reduction in kidney function. Prior to the approval of terlipressin, unapproved vasoconstrictive agents used in HRS treatment were octreotide/midodrine and norepinephrine with albumin. METHODS: A cohort decision-tree model representing a US hospital perspective assessed the clinical outcomes and direct medical costs (based primarily on hospital charges) of treating HRS with terlipressin + albumin (ALB) versus midodrine/octreotide (MID/OCT)+ALB, or norepinephrine (NorEp)+ALB. Treatment efficacy was defined by clinical response (complete/HRS reversal, partial, or no response) based on change of serum creatinine derived from published clinical trial reports. The proportions of patients with complete response were: terlipressin + ALB (36.2%), NorEp + ALB (19.1%), and MID/OCT + ALB (3.1%). Model outcomes included utilization of HRS-related healthcare resources (hospital and intensive care, outpatient and emergency department, dialysis, and transplantations), adverse events, and HRS-related mortality. Outcomes were assessed for the initial hospitalization in the base case and at 30, 60, and 90 days post-discharge. RESULTS: Total costs incurred over the initial hospitalization with terlipressin + ALB were lower vs NorEp + ALB, primarily due to higher ICU costs with NorEp + ALB ($7,433 vs $61,897). TER + ALB was associated with higher total costs vs MID/OCT + ALB due to higher pharmacy costs with terlipressin + ALB. The cost per complete response achieved of terlipressin + ALB ($451,605) was half that of NorEp + ALB ($930,571) and one-tenth that of MID/OCT + ALB ($4,942,123). CONCLUSIONS: HRS patients treated with terlipressin experienced better clinical outcomes and a lower cost per treatment response vs other unapproved treatments. ICU days and pharmacy costs were key cost drivers distinguishing the treatment groups. These outcomes suggest that terlipressin is cost-effective on the basis of total cost per response achieved.

Hepatorenal syndrome (HRS) is a rare and sudden life-threatening complication of the liver. Patients with HRS should receive immediate treatment with a drug that narrows blood vessels known as a vasoconstrictor. Terlipressin is the most common vasoconstrictor used for patients with HRS. Other common vasoconstrictors are midodrine with octreotide and norepinephrine. This study aimed to compare the cost of terlipressin with those of midodrine with octreotide and norepinephrine while also considering how well each of them worked to reverse HRS. This was done using an economic model. This economic model assessed the costs of the vasoconstrictor drugs and the costs of treating HRS, including costs attributable to drug acquisition, adverse events, organ transplantation, dialysis, and institutional encounters (i.e. hospitalization, ICU, emergency department, and outpatient visits). The magnitude of these costs depends on how well each drug reversed HRS. Based on inputs derived from their respective clinical trials, 36% of patients who were given terlipressin had a complete response (HRS was reversed), 19% of patients who were given norepinephrine had a complete response, and 3% of patients who were given midodrine with octreotide had a complete response. The total cost per patient was approximately $163,481 for terlipressin, $177,298 for norepinephrine, and $155,030 for midodrine with octreotide. When the costs were evaluated against how well the drugs worked to reverse HRS, the lowest cost per HRS reversal was $451,605 when treated with terlipressin. The cost per reversal for norepinephrine was $930,571 and for midodrine with octreotide was $4,942,123. These results show that terlipressin works well and is more cost-effective for US hospitals compared with the other unapproved treatment options for HRS with rapid reduction in kidney function.

Successful Large Hospital Evacuation With 11 350 Patients Transferred in the 2021 Zhengzhou Flood.

OBJECTIVES: This is a case report of a huge hospital evacuation with 11 350 inpatients in the 2021 Zhengzhou flood in China, using a mixed methods analysis. METHODS: The qualitative part was a content analysis of semi-structured interviews of 6 key hospital staff involved in evacuation management. The evacuation experience was reviewed according to the 4 stages of disaster management: prevention, preparation, response, and recovery. RESULTS: Because of unprecedented torrential rain, the flood exceeded expectations, and there was a lack of local preventive measures. In preparation, according to the alert, the evacuation was planned to reduce the workload on inpatients and to accept the surge of medical needs by the flood. In response, the prioritization of critically ill patients and large-scale collaboration of hospital staff, rescue teams, and accepting branch made it possible to successfully transfer all 11 350 inpatients. In recovery, restoring medical services and a series of activities to improve the hospital's vulnerability were carried out. CONCLUSIONS: A hospital evacuation is one of the strategies of the business continuity plan of a hospital. For the evacuation, leadership and collaboration were important. Challenges such as prolonged roadway flooding and the infrastructure issues were needed to be addressed throughout the evacuation process.

Narrative review of mathematical and psychological studies of staff scheduling for holidays as applicable to anesthesiologists and nurse anesthetists.

We performed a narrative review of articles applicable to anesthesiologists' and nurse anesthetists' choices of who works each statutory holiday for operating room and non-operating room anesthesia. We include search protocols and detailed supplementary annotated comments. Studies showed that holiday staff scheduling is emotional. Working on holidays often is more stressful and undesirable than comparable workdays. Intrinsic motivation may overall, among practitioners, be greater by preferentially scheduling practitioners who choose to work on holidays, for compensation, before mandating that practitioners who would prefer to be off must work on holidays. Granting each practitioner (who so desires) at least one major holiday off can depend on identifying and scheduling other clinicians who want to work holidays for monetary compensation or extra compensatory time off. Scheduling holidays by random priority (i.e., a lottery choosing who gets to pick their holiday[s] first, second, etc.) is inefficient, resulting in fewer practitioners having their preferences satisfied, especially for small departments or divisions (e.g., cardiac anesthesia). No article that we reviewed implemented a random priority mechanism for staff scheduling. The selection of practitioners to take turns in choosing their holidays is perceived to have less fairness than a selection process that collects each participants' preferences. Although holidays often are scheduled separately from regular workdays and weekends, doing so will not increase efficiency or fairness. Holidays can, in practice, be scheduled simultaneously with non-holidays. Models can explicitly include fairness as an objective. For example, fairness can be based on the difference between the maximum and minimum number of holidays for which practitioners of the same division are scheduled. Holidays can be given greater weights than other shifts when estimating fairness. Staff scheduling for holidays, when done simultaneously with regular workdays, nights, and weekends, can also use personalized weights, specifying practitioners' preferences to be satisfied if possible.

Making a "Happy Hospital": Emotional Investment and Professional Identity Amongst Anglo-American Hospital Administrators.

This article examines the place of emotion in modern hospital administration and the relationship between professional identities and emotional landscapes in the healthcare field. The focus is a broad emotional and philosophical investment that many administrators made in their work. In the United States and then in Britain, amidst rapid change in the practice and provision of health services, a new sense of professional identity emerged. This was often underpinned by a kind of emotional investment, one which had to be constructed and cultivated. Here formal training and education, collective identities, and a shared understanding of the kind of personal qualities required were important. The extent to which developments in Britain were influenced by best practice in the US is also striking. This process might best be understood as the further drawing out of established beliefs and ways of working rather than an abstract transfer of ideas and practices across the Atlantic, but there was a distinct Anglo-American dimension to the development of hospital administration.

Text Analysis of Trends in Health Equity and Disparities From the Internal Revenue Service Tax Documentation Submitted by US Nonprofit Hospitals Between 2010 and 2019: Exploratory Study.

BACKGROUND: Many US hospitals are classified as nonprofits and receive tax-exempt status partially in exchange for providing benefits to the community. Proof of compliance is collected with the Schedule H form submitted as part of the annual Internal Revenue Service Form 990 (F990H), including a free-response text section that is known for being ambiguous and difficult to audit. This research is among the first to use natural language processing approaches to evaluate this text section with a focus on health equity and disparities. OBJECTIVE: This study aims to determine the extent to which the free-response text in F990H reveals how nonprofit hospitals address health equity and disparities, including alignment with public priorities. METHODS: We used free-response text submitted by hospital reporting entities in Part V and VI of the Internal Revenue Service Form 990 Schedule H between 2010 and 2019. We identified 29 main themes connected to health equity and disparities, and 152 related key phrases. We tallied occurrences of these phrases through term frequency analysis, calculated the Moran I statistic to assess geographic variation in 2018, analyzed Google Trends use for the same terms during the same period, and used semantic search with Sentence-BERT in Python to understand contextual use. RESULTS: We found increased use from 2010 to 2019 across all the 29 phrase themes related to health equity and disparities. More than 90% of hospital reporting entities used terms in 2018 and 2019 related to affordability (2018: 2117/2131, 99.34%; 2019: 1620/1627, 99.57%), government organizations (2018: 2053/2131, 96.33%; 2019: 1577/1627, 96.93%), mental health (2018: 1937/2131, 90.9%; 2019: 1517/1627, 93.24%), and data collection (2018: 1947/2131, 91.37%; 2019: 1502/1627, 92.32%). The themes with the largest relative increase were LGBTQ (lesbian, gay, bisexual, transgender, and queer; 1676%; 2010: 12/2328, 0.51%; 2019: 149/1627, 9.16%) and social determinants of health (958%; 2010: 68/2328, 2.92%; 2019: 503/1627, 30.92%). Terms related to homelessness varied geographically from 2010 to 2018, and terms related to equity, health IT, immigration, LGBTQ, oral health, rural, social determinants of health, and substance use showed statistically significant (P<.05) geographic variation in 2018. The largest percentage point increase was for terms related to substance use (2010: 403/2328, 17.31%; 2019: 1149/1627, 70.62%). However, use in themes such as LGBTQ, disability, oral health, and race and ethnicity ranked lower than public interest in these topics, and some increased mentions of themes were to explicitly say that no action was taken. CONCLUSIONS: Hospital reporting entities demonstrate an increasing awareness of health equity and disparities in community benefit tax documentation, but these do not necessarily correspond with general population interests or additional action. We propose further investigation of alignment with community health needs assessments and make suggestions for improvements to F990H reporting requirements.

Do hospitals need to establish multiple hospital districts? A hospital-based perspective on the benefits of scale.

Background: During the fight against COVID-19, China's public hospitals played the main role in taking on the most urgent, dangerous and arduous medical treatment and work. Therefore, in order to promote the high-quality development of hospitals, it is necessary to support some potential public hospitals to build and develop a "One Hospital with Multiple Campuses System" (OHMC) based on controlling the size of single hospitals, and to quickly convert their functions in the event of a severe epidemic. Methods: The Cobb-Douglas production function and log-transformed production function were used to measure the appropriate hospital size for 22 public hospitals in a region of China. Results: The eight OHMC hospitals that planned to be build are basically qualified to handle the conditions and potential of multi-districts from the perspective of economy of scale. The OHMC hospitals in operation appear to have weakened incremental scale rewards, because they are in the process of development, but they are still higher than the overall level of single-campus hospitals. Conclusion: The expansion of hospital scale may bring the advantages of group development, but it may also bring about problems including rising hospital cost, increasing management and operation cost, inefficient allocation of medical resources and unbalanced development.

Competencies of hospital managers - A systematic scoping review.

Hospital managers around the world work under constant pressure to adapt their organizations to new challenges and health policy goals. This requires a comprehensive set of competencies. The objective of this scoping review was to identify, map, and systematize the literature on hospital manager competencies. The review involved six steps: (1) defining research questions; (2) identifying relevant literature; (3) selecting publications; (4) data extraction; (5) data analysis and result reporting; and (6) consultations. A total of 57 full-text publications were included (46 empirical studies, six literature reviews, four expert opinions/guidelines, and one dissertation). Interest in this topic has grown in recent years, with most of the identified studies published since 2015. The empirical studies fall into three major groups: 34.8% (16/46) examined hospital managers' competencies in terms of their types or classifications; 30.4% (14/46) focused on their measurement; and 30.4% (14/46) examined both aspects. In majority of studies, both 'hard competencies,' such as specific technical knowledge or skills acquired through practical training, and 'soft competencies,' e.g., adaptability, leadership, communication, teamwork, are echoed for effective hospital management. These point out the importance of both 'external' formal education trainings as well as 'internal' peer-support and/or coaching as complementary competency improvement approaches. This scoping review helps build a knowledge base around the topic and provides implications for future research. The latter can involve: a targeted systematic review addressing the methods for measuring the level of competence of hospital managers or studies focused on identifying the need for new types of competencies.

Engaging physicians and nurses in balanced scorecard evaluation-An implication at Palestinian hospitals and recommendations for policy makers.

Introduction: Healthcare workers (HCWs) are seldom involved in balanced scorecard (BSC) deployments. This study aims to incorporate Palestinian HCWs in the BSC to create health policy recommendations and action plans using BSC-HCW1, a survey designed and validated based on BSC dimensions. Methodology: In this cross-sectional study, the BSC-HCW1 survey was delivered to HCWs in 14 hospitals from January to October 2021 to get them involved in PE. The differences between physicians' and nurses' evaluations were assessed by the Mann-Whitney U-test. The causal relationships between factors were analyzed using multiple linear regression. The multicollinearity of the model was checked. Path analysis was performed to understand the BSC strategic maps based on the Palestinian HCWs' evaluations. Results: Out of 800 surveys, 454 (57%) were retrieved. No evaluation differences between physicians and nurses were found. The BSC-HCW1 model explains 22-35% of HCW loyalty attitudes, managerial trust, and perceived patient trust and respect. HCWs' workload time-life balance, quality and development initiatives, and managerial performance evaluation have a direct effect on improving HCWs' loyalty attitudes (ß = 0.272, P < 0.001; ß = 0.231, P < 0.001; ß = 0.199, P < 0.001, respectively). HCWs' engagement, managerial performance evaluation, and loyalty attitudes have a direct effect on enhancing HCWs' respect toward managers (ß = 0.260, P < 0.001; ß = 0.191, P = 0.001; ß = 0.135, P = 0.010, respectively). Quality and development initiatives, HCWs' loyalty attitudes, and workload time-life balance had a direct effect on improving perceived patient respect toward HCWs (ß = 254, P < 0.001; ß = 0.137, P = 0.006, ß = 0.137, P = 0.006, respectively). Conclusion: This research shows that it is important to improve low-performing indicators, such as the duration of time HCWs spend with patients, their knowledge of medications and diseases, the quality of hospital equipment and maintenance, and the inclusion of strengths and weaknesses in HCWs' evaluations, so that HCWs are more loyal and less likely to want to leave. For Palestinian hospital managers to be respected more, they must include HCWs in their action plans and explain their evaluation criteria. Patients will respect Palestinian HCWs more if they prioritize their education and work quality, spend more time with patients, and reflect more loyalty. The results can be generalized since it encompassed 30% of Palestinian hospitals from all categories.

Inovações na enfermagem do hospital israelita albert einstein refletem os desafios, conquistas e resultados alcançados com a designação magnet / Innovations in nursing at albert einstein hospital reflect the challenges, achievements and results acquired due to the magnte designation / Las innovaciones en enfermería del hospital israelita albert einstein reflejan los desafios, logros y resultados alcanzados con la designación magnet

Objetivo: Relatar experiências durante toda a jornada que levou o Hospital Israelita Albert Einstein à conquista da designação Magnet. Métodos: relato da implementação das principais ações no HIAE para o alcance dos padrões de excelência exigidos na Enfermagem. Resultados: O processo permitiu o engajamento dos pares, a padronização das boas práticas, o uso dos recursos e a avaliação periódica para mudanças necessárias. Conclusão: Em julho de 2022 o Einstein foi designado com o selo Magnet, considerado o maior reconhecimento pela excelência de práticas e estratégias de Enfermagem no mundo pela American Nurse Credentialing Center. Parte do processo ocorreu durante a pandemia de COVID-19, na qual o atendimento de excelência e o cuidado com o paciente nunca foram deixados de lado. (AU)

Objective: to relate experiences during the whole journey that took Hospital Israelita Albert Einstein to get the Magnet designation. Methods: implementation report of the main actions in HIAE to achieve the required nursing excellence patterns. Results: the process allowed the staff engagement, the standardization of best practices, the use of resources and the periodic evaluation to necessary changes. Conclusion: in July 2022, HIAE was designated a Magnet institution by the American Nurse Credentialing Center, known as the best recognition for excellence in nursing practices and strategies in the world. Part of this process occurred during the COVID19 pandemic, in which the excellence and the patient care were never left out. (AU)

Objetivo: Relatar experiencias a lo largo de la trayectoria que llevó al Hospital Israelita Albert Einstein a obtener la designación Magnet. Métodos: Informe sobre la implementación de las principales acciones en el HIAE para lograr los estándares de excelencia requeridos en Enfermería. Resultados: El proceso permitió la participación de pares, la estandarización de buenas prácticas, el uso de recursos y la evaluación periódica de los cambios necessários. Conclusión: En julio de 2022, Einstein fue designada con el sello Magnet, considerado el mayor reconocimiento a la excelencia en las prácticas y estrategias de Enfermería en el mundo por el American Nurse Credentialing Center. Parte del proceso se dio durante la pandemia del COVID-19, en el que nunca se dejó de lado la excelencia en la atención y el cuidado del paciente. (AU)