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1.
BMC Health Serv Res ; 19(1): 725, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638988

RESUMO

BACKGROUND: Patients are sometimes harmed in the course of receiving hospital care. Existing research has highlighted a positive association between board engagement in healthcare quality activities and healthcare outcomes. However, most research has been undertaken through surveys examining board engagement in a limited number of governance processes. This paper presents evidence of a comprehensive range of processes related to governing healthcare quality undertaken at the corporate governance level. This provides a more detailed picture than previously described of how corporate governance of healthcare quality is enacted by boards and management. METHODS: A comparative case study of eight Australian public hospitals was undertaken. Case studies varying is size and location were selected from two Australian states. Data collection included a review of key governance documentation, semi structured interviews with board members and senior management and an observation of a board quality committee meeting. Thematic analysis was undertaken to identify processes related to key tasks in governing healthcare quality. RESULTS: Two key tasks in the corporate governance of healthcare quality, evaluating healthcare quality and overseeing quality priorities, were examined. Numerous processes related to these two tasks were found. Case studies, while found to be similar in engagement on previously identified processes, were found to differ in engagement in these additional processes. While generally low levels of engagement in processes of overseeing quality priorities were found, cases differed markedly in their engagement in evaluating healthcare quality processes. Additional processes undertaken at some case studies represent innovative and mature responses to the need for effective corporate governance of healthcare quality. In addition, a group of processes, related to broader governance taskwork, were found to be important in enabling effective corporate governance of healthcare quality. CONCLUSION: The work of governing healthcare quality, undertaken at the corporate governance level, is redefined in terms of these more detailed processes. This paper highlights that it is how well these key tasks are undertaken that is important in effective governance. When processes related to key tasks are omitted, the rituals of governance may appear to be satisfied but the responsibility may not be met. Boards and managers need to differentiate between common approaches to governance and practices that enable the fulfilment of governance responsibilities. This study provides practical guidance in outlining processes for effective corporate governance of healthcare quality and highlights areas for further examination.


Assuntos
Conselho Diretor/organização & administração , Hospitais Públicos/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Austrália/epidemiologia , Estudos de Casos e Controles , Administração Hospitalar , Humanos , Qualidade da Assistência à Saúde/normas
2.
Int J Equity Health ; 18(1): 160, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640674

RESUMO

BACKGROUND: The motivation of health workers is a key concern of policy makers, practitioners and researchers. Public Service Motivation (PSM), defined as the altruistic desire to serve the common interest, to serve others and to help patients and their families regardless of financial or external rewards, has been shown to be key to the performance of public servants. Yet, limited attention has been paid to this kind of motivation in health care settings in low- and middle-income countries. Little is known about PSM and its contextual specificity in the Moroccan health system. We set out to qualitatively explore the meaning of PSM and its expression among health workers in four public hospitals. METHODS: We adopted a multiple embedded case study design to explore PSM in two well-performing and two poor-performing hospitals. We carried out 68 individual interviews, eight focus group discussions and 11 group discussions with different cadres (doctors, administrators and nurses). We carried out thematic analysis using NVivo 10. RESULTS: Our analysis shows that public service motivation is a notion that seems natural to the health workers we interviewed. Daily interactions with patients catalysed health providers' affective motives (compassion and self- sacrifice), a central element of PSM. It also provided them with job satisfaction aligned with their intrinsic motivation. Managers and administrative personnel express other PSM components: attraction to public policy making and commitment to public values. A striking result is that health workers expressed strong religious beliefs about expected rewards from God when properly serving patients. CONCLUSION: This study highlights the presence of PSM as a driver of motivation among health workers in four Moroccon hospitals, and the prominence of intrinsic motivation and compassion in the motivation of frontline health workers. Religious beliefs were found to shape the expression of PSM in Morocco.


Assuntos
Atitude do Pessoal de Saúde , Hospitais Públicos/organização & administração , Motivação , Recursos Humanos em Hospital/psicologia , Adulto , Feminino , Grupos Focais , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Marrocos , Estudos de Casos Organizacionais , Recursos Humanos em Hospital/estatística & dados numéricos , Pesquisa Qualitativa , Adulto Jovem
3.
Artigo em Inglês | MEDLINE | ID: mdl-31484308

RESUMO

This paper aimed to investigate the relationships between participative leadership (PL), administrative quality (AQ), medical quality (MQ), and patient satisfaction (PS) using the Malcolm Baldrige National Quality Award Healthcare Criteria (MBNQA) criteria. The study further examined the intervening influence of administrative quality and medical quality on the relationship between participative leadership and patient satisfaction. The data was obtained from 123 public sector hospitals in Pakistan. We employed confirmatory factor analysis (CFA) and structural equation modeling (SEM) techniques to test the structural model. From the study results, we found significant and positive relationships between participative, administrative quality, medical quality, and patient satisfaction. In addition, our research found administrative quality and medical quality as potential mediators on PL-PS relation. Adopting participative leadership as an exogenous factor, and both administrative and medical quality as potential mediators of patient satisfaction, provided new insights into MBNQA criteria.


Assuntos
Hospitais Públicos/organização & administração , Liderança , Satisfação do Paciente , Humanos , Paquistão , Qualidade da Assistência à Saúde
4.
BMC Res Notes ; 12(1): 612, 2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31547843

RESUMO

OBJECTIVE: The objective of this study was to investigate documentation practice and factors affecting documentation practice among nurses working in public hospital of Tigray region, Ethiopia. RESULTS: In this study, there were 317 participants with 99.7% response rate. The result of this study shows that practice nursing care documentation was inadequate (47.8%). Inadequacy of documenting sheets AOR = 3.271, 95% CI (1.125, 23.704), inadequacy of time AOR = 2.205, 95% CI (1.101, 3.413) and with operational standard of nursing documentation AOR = 2.015, 95% CI (1.205, 3.70) were significantly associated with practice of nursing care documentation. To conclude, more than half of nurses were not documented their nursing care. Employing institutions should provide training on documentation of nursing care to enhance knowledge and create awareness on nurses' documentation to nursing directors and chief executive officer to access adequate documenting supplies besides employing more nurses.


Assuntos
Documentação/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Públicos/organização & administração , Registros de Enfermagem/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital/organização & administração , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Etiópia , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Inquéritos e Questionários
6.
Inquiry ; 56: 46958019872348, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31455126

RESUMO

Physicians play multiple roles in a health system. They typically serve simultaneously as the agent for patients, for insurers, for their own medical practices, and for the hospital facilities where they practice. Theoretical and empirical results have demonstrated that financial relations among these different stakeholders can affect clinical outcomes as well as the efficiency and quality of care. What are the physicians' roles as the agents of Chinese patients? The marketization approach of China's economic reforms since 1978 has made hospitals and physicians profit-driven. Such profit-driven behavior and the financial tie between hospitals and physicians have in turn made physicians more the agents of hospitals rather than of their patients. While this commentary acknowledges physicians' ethics and their dedication to their patients, it argues that the current physician agency relation in China has created barriers to achieving some of the central goals of current provider-side health care reform efforts. In addition to eliminating existing perverse financial incentives for both hospitals and physicians, the need for which is already agreed upon by numerous scholars, we argue that the success of the ongoing Chinese public hospital reform and of overall health care reform also relies on establishing appropriate physician-hospital agency relations. This commentary proposes 2 essential steps to establish such physician-hospital agency relations: (1) minimize financial ties between senior physicians and tertiary-level public hospitals by establishing a separate reimbursement system for senior physicians, and (2) establishing a comprehensive physician professionalism system underwritten by the Chinese government, professional physician associations, and major health care facilities as well as by physician leadership representatives. Neither of these suggestions is addressed adequately in current health care reform activities.


Assuntos
Reforma dos Serviços de Saúde/tendências , Hospitais Públicos/organização & administração , Planos de Incentivos Médicos/economia , Médicos/economia , China , Reforma dos Serviços de Saúde/economia , Hospitais Públicos/economia , Humanos
7.
Emerg Med J ; 36(10): 620-624, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31292206

RESUMO

OBJECTIVES: The last decade has seen rapid expansion of emergency care systems across Africa, although they remain underdeveloped. In Zambia, the Ministry of Health has taken interest in improving the situation and data are needed to appropriately guide system strengthening efforts. The Emergency Care Assessment Tool (ECAT) provides a context-specific means of measuring capacity of healthcare facilities in low- and middle-income countries. We evaluated Zambian public hospitals using the ECAT to inform resource-effective improvements to the nation's healthcare system. METHODS: The ECAT was administered to the lead clinician in the emergency unit at 23 randomly sampled public hospitals across seven of Zambia's 10 provinces in March 2016. Data were collected regarding hospitals' perceived abilities to perform a number of predefined signal functions - life-saving procedures that encompass the need for both skills and resources. Signal functions (36 for intermediate facilities, 51 for advanced) related to six sentinel conditions that represent a large burden of morbidity and mortality from emergencies. We report the proportion of procedures that each level of hospital was capable of, along with barriers to delivery of care. RESULTS: Across all hospitals, most of the level-appropriate emergency care procedures could be performed. Intermediate level (district) hospitals were able to perform 75% (95% CI 73.2 to 76.8) of signal functions for the six conditions. Among advanced level hospitals, provincial hospitals were able to perform 68.6% (67.4% to 69.7%) and central hospitals 96.1% (95% CI 93.5 to 98.7) Main failures in delivery of care were attributed to a lack of healthcare worker training and availability of consumable resources, such as medicines or supplies. CONCLUSION: Zambian public hospitals have reasonable capacity to care for acutely ill and injured patients; however, there is a need for increased training and improved supply chains.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Estudos Transversais , Países em Desenvolvimento , Serviços Médicos de Emergência/organização & administração , Tratamento de Emergência/estatística & dados numéricos , Recursos em Saúde/organização & administração , Recursos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitais Públicos/organização & administração , Humanos , Zâmbia
8.
J Health Organ Manag ; 33(4): 460-477, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31282817

RESUMO

PURPOSE: The purpose of this paper is to examine the extent to which the perception of crowding by medical staff and patients impacts patients' perceived service quality (SQ), overall satisfaction and emotional well-being. DESIGN/METHODOLOGY/APPROACH: Data were collected from 258 matched pairs of medical staff members and their patients at six public hospitals. FINDINGS: Medical staff-perceived crowding negatively influences patients' perceived SQ. The perceived SQ then impacts patients' overall satisfaction and emotional well-being. Patients' perceived crowding does not significantly impact their perceived SQ but increases the positive emotional well-being of patients. ORIGINALITY/VALUE: Scant research has investigated a matched pair of service providers and their customers. This study concentrates on how individuals' perceived human crowding and medical staff SQ affect consumers' emotional well-being. This research leads to the formulation of theoretical and public policy suggestions to improve the quality of interactive services with minimal cost and disruption.


Assuntos
Aglomeração , Prática de Saúde Pública , Qualidade da Assistência à Saúde , Adolescente , Adulto , Idoso , Atitude do Pessoal de Saúde , Aglomeração/psicologia , Ajustamento Emocional , Feminino , Hospitais Públicos/organização & administração , Hospitais Públicos/normas , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Prática de Saúde Pública/normas , Prática de Saúde Pública/estatística & dados numéricos , Vietnã , Adulto Jovem
9.
Cien Saude Colet ; 24(6): 1981-1990, 2019 Jun 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31269155

RESUMO

This paper aims to show a set of strategies and care management and organization actions that have been undertaken in what was conventionally called the Health Sector Reform of the Government of the Federal District in the period 2015-2018, which was based on the strengthening of primary health care, the organization of secondary care, the establishment of the health regulatory complex, the proposed regionalization and decentralization, the systematization of contracting and contractual implementation, and the proposal and establishment of a new management model for the main public hospital in Brasília.


Assuntos
Assistência à Saúde/organização & administração , Reforma dos Serviços de Saúde , Atenção Primária à Saúde/organização & administração , Brasil , Hospitais Públicos/organização & administração , Humanos , Atenção Secundária à Saúde/organização & administração
10.
Cien Saude Colet ; 24(6): 2053-2064, 2019 Jun 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31269164

RESUMO

The public health network of the Federal District, as in the rest of the Brazilian Unified Health System, suffers from inefficiencies related to the difficulty in hiring and managing professionals, as well as the implementation of supply and maintenance contracts. In Brasilia, a new management model was implemented in 2018 in its largest hospital. With the creation of the autonomous social service "Instituto Hospital de Base", a health unit in operation since 1960, the possibility of providing agility to these contracts was opened, in addition to establishing a management based on goals and outcome indicators, with expressive efficiency gains. This article reports the steps for the implementation of this decentralized model of hospital management, the alternatives considered, the difficulties faced and some of the first results of this new model. One can already verify and affirm the success of the legal-administrative model of "Instituto Hospital de Base", which can serve as a paradigm for other health units in the Federal District and in Brazil.


Assuntos
Hospitais Públicos/organização & administração , Modelos Organizacionais , Programas Nacionais de Saúde/organização & administração , Saúde Pública , Brasil , Humanos , Indicadores de Qualidade em Assistência à Saúde , Serviço Social/organização & administração
11.
Cien Saude Colet ; 24(6): 2147-2154, 2019 Jun 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31269173

RESUMO

Since its creation in 1988, major changes have been made to Brazil's public health system in response to the epidemiological transition and the country's changing economic context and demographics. This article describes the recent healthcare reform implemented in the federal district's public hospital system. Guided by evidence-based management and a series of regulatory instruments, the reform organized hospital emergency services and secondary outpatient care, regulated health services, and remodeled the organizational structure of the Department of Health. These changes were aimed at promoting integration between health professionals across different levels of care and ensuring the provision of continuing comprehensive care. This approach guarantees efficiency gains in patient treatment, since multifocal and focal professionals work in an integrated manner. By reorganizing work processes and ensuring adequate planning, it was possible to redesign the care model to promote knowledge management and improve access to information and interactivity, thus helping to ensure the provision of quality, value-added care.


Assuntos
Assistência à Saúde/organização & administração , Reforma dos Serviços de Saúde , Hospitais Públicos/organização & administração , Saúde Pública , Brasil , Serviço Hospitalar de Emergência/organização & administração , Medicina Baseada em Evidências , Humanos , Modelos Organizacionais , Programas Nacionais de Saúde/organização & administração , Recursos Humanos em Hospital/normas
12.
BMC Health Serv Res ; 19(1): 412, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234858

RESUMO

BACKGROUND: To increase patient safety, so-called Critical Incident Reporting Systems (CIRS) were implemented. For Austria, no data are available on how CIRS is used within a healthcare facility. Therefore, the aim of this study was to present the development of CIRS within one of the biggest hospital providers in Austria. METHODS: In the province of Styria, CIRS was introduced in 2012 within KAGes (holder of public hospitals) in 22 regional hospitals and one tertiary university hospital. CIRS is available in all of these hospitals using the same software solution. For reporting a CIRS case an overall guideline exists. RESULTS: As of 2013, 2.504 CIRS cases were reported. Predominantly, CIRS-cases derived from surgical and associated disciplines (ranging from 35 to 45%). According to the list of hazards (also called "risk atlas"), errors in patient identification (ranging from 7 to 12%), errors in management of medicinal products (ranging from < 5 to 9%), errors in management of medical devices (ranging from < 5 to 10%) and errors in communication (ranging from < 5 to 6%) occurred most frequently. Most often, a CIRS case was reported due to individual error-related reasons (48%), followed by errors caused by organization, team factors, communication or documentation failures (34%). CONCLUSIONS: In summary, CIRS has been used for 5 years and 2.504 CIRS-cases were reported. There is a steady increase of reported CIRS cases per year. It became also obvious that disregarding guidelines or standards are a very common reason for reporting a CIRS case. CIRS can be regarded as a helpful supportive tool in clinical risk management and supports organizational learning and thereby collective knowledge management.


Assuntos
Hospitais Públicos/organização & administração , Gestão de Riscos/organização & administração , Gestão de Riscos/estatística & dados numéricos , Áustria , Comunicação , Humanos , Erros Médicos/estatística & dados numéricos , Segurança do Paciente
13.
Implement Sci ; 14(1): 65, 2019 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-31217028

RESUMO

BACKGROUND: Each year, 2.2 million intrapartum-related deaths (intrapartum stillbirths and first day neonatal deaths) occur worldwide with 99% of them taking place in low- and middle-income countries. Despite the accelerated increase in the proportion of deliveries taking place in health facilities in these settings, the stillborn and neonatal mortality rates have not reduced proportionately. Poor quality of care in health facilities is attributed to two-thirds of these deaths. Improving quality of care during the intrapartum period needs investments in evidence-based interventions. We aim to evaluate the quality improvement package-Scaling Up Safer Bundle Through Quality Improvement in Nepal (SUSTAIN)-on intrapartum care and intrapartum-related mortality in public hospitals of Nepal. METHODS: We will conduct a stepped wedge cluster randomized controlled trial in eight public hospitals with each having least 3000 deliveries a year. Each hospital will represent a cluster with an intervention transition period of 2 months in each. With a level of significance of 95%, the statistical power of 90% and an intra-cluster correlation of 0.00015, a study period of 19 months should detect at least a 15% change in intrapartum-related mortality. Quality improvement training, mentoring, systematic feedback, and a continuous improvement cycle will be instituted based on bottleneck analyses in each hospital. All concerned health workers will be trained on standard basic neonatal resuscitation and essential newborn care. Portable fetal heart monitors (Moyo®) and neonatal heart rate monitors (Neobeat®) will be introduced in the hospitals to identify fetal distress during labor and to improve neonatal resuscitation. Independent research teams will collect data in each hospital on intervention inputs, processes, and outcomes by reviewing records and carrying out observations and interviews. The dose-response effect will be evaluated through process evaluations. DISCUSSION: With the global momentum to improve quality of intrapartum care, better understanding of QI package within a health facility context is important. The proposed package is based on experiences from a similar previous scale-up trial carried out in Nepal. The proposed evaluation will provide evidence on QI package and technology for implementation and scale up in similar settings. TRIAL REGISTRATION NUMBER: ISRCTN16741720 . Registered on 2 March 2019.


Assuntos
Hospitais Públicos/organização & administração , Pacotes de Assistência ao Paciente , Assistência Perinatal/normas , Melhoria de Qualidade , Países em Desenvolvimento , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Mortalidade Materna , Monitorização Fisiológica/normas , Nepal , Gravidez , Ressuscitação/normas
14.
BMC Res Notes ; 12(1): 319, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174606

RESUMO

OBJECTIVE: To assess the level of job satisfaction and associated factors among nurses in Bahir Dar city, Northwest Ethiopia, 2017. RESULTS: The overall proportion of nurses' job satisfaction was 43.6%. From motivational factors, advancement (AOR = 2.64; 95% CI [1.17, 5.96]) and recognition (AOR = 2.56; 95% CI [1.08, 6.08]) were the main determinants of nurses' job satisfaction. Among hygienic factors, work security (AOR = 4.88; 95% CI [1.13, 21.03]) was positively associated with nurses' job satisfaction. In conclusion, the nurses' job satisfaction was low in this study setting. Modifiable factors such as advancement, recognition and work security positively affect job satisfaction of nurses. Therefore, the current study recommended that the health care system administers should work on improvement of advancement, security, and recognition in the facilities.


Assuntos
Hospitais Públicos/organização & administração , Satisfação no Emprego , Motivação , Profissionais de Enfermagem/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Adulto , Cidades , Estudos Transversais , Etiópia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem/economia , Recursos Humanos de Enfermagem no Hospital/economia , Recompensa , Fatores Socioeconômicos
15.
Hosp Top ; 97(3): 73-79, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31116689

RESUMO

This study examines the relationships between of nurses' perception of their authentic leadership, intention to quit, and employee performance. The implementation part of the study was conducted with nurses working in a public hospital in the city of Yozgat, Turkey. The data were collected in December 2017 from 189 participants. The results of the analyses showed that relationships between authentic leadership dimensions and intention to quit were not significant. While the all dimensions of authentic leadership explained 6.8% of the variance for the employee performance; explained 3.7% of the variance for the intention to quit. According to these results, improving authentic leadership perception of nurses will improve nurse performance.


Assuntos
Satisfação no Emprego , Liderança , Enfermeiras e Enfermeiros/psicologia , Desempenho Profissional/normas , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Hospitais Públicos/organização & administração , Hospitais Públicos/estatística & dados numéricos , Humanos , Intenção , Masculino , Enfermeiras e Enfermeiros/estatística & dados numéricos , Análise de Regressão , Inquéritos e Questionários , Turquia , Desempenho Profissional/estatística & dados numéricos
16.
BMC Health Serv Res ; 19(1): 292, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31068156

RESUMO

BACKGROUND: In 2010, Israel intensified its adoption of Procedure-Related Group (PRG) based hospital payments, a local version of DRG (Diagnosis-related group). PRGs were created for certain procedures by clinical fields such as urology, orthopedics, and ophthalmology. Non-procedural hospitalizations and other specific procedures continued to be paid for as per-diems (PD). Whether this payment reform affected inpatient activities, measured by the number of discharges and average length of stay (ALoS), is unclear. METHODS: We analyzed inpatient data provided by the Ministry of Health from all 29 public hospitals in Israel. Our observations were hospital wards for the years 2008-2015, as proxies to clinical fields. We investigated the impact of this reform at the ward level using difference-in-differences analyses among procedural wards. Those for which PRG codes were created were treatment wards, other procedural wards served as controls. We further refined the analysis of effects on each ward separately. RESULTS: Discharges increased more in the wards that were part of the control group than in the treatment wards as a group. However, a refined analysis of each treated ward separately reveals that discharges increased in some, but decreased in other wards. ALoS decreased more in treatment wards. Difference-in-differences results could not suggest causality between the PRG payment reform and changes in inpatient activity. CONCLUSIONS: Factors that may have hampered the effects of the reform are inadequate pricing of procedures, conflicting incentives created by other co-existing hospital-payment components, such as caps and retrospective subsidies, and the lack of resources to increase productivity. Payment reforms for health providers such as hospitals need to take into consideration the entire provider market, available resources, other - potentially conflicting - payment components, and the various parties involved and their interests.


Assuntos
Grupos Diagnósticos Relacionados/economia , Eficiência Organizacional , Hospitais Públicos/economia , Reembolso de Seguro de Saúde/economia , Gastos em Saúde , Hospitais Públicos/organização & administração , Humanos , Israel , Sistema de Pagamento Prospectivo , Estudos Retrospectivos
17.
Int J Health Policy Manag ; 8(4): 199-210, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31050965

RESUMO

BACKGROUND: The Government of Romania commissioned international technical assistance to help unpacking the causes of arrears in selected public hospitals. Emphases were placed on the governance-related determinants of the hospital performance in the context of the Romanian health system. METHODS: The assessment was structured around a public hospital governance framework examining 4 dimensions: institutional arrangements, financing arrangements, accountability arrangements and correspondence between responsibility and decision-making capacity. The framework was operationalized using a 2-pronged approach: (i) a policy review of broader health system governance arrangements influencing hospital performance; and (ii) a series of 10 casestudies of public hospitals experiencing financial hardship. Data were collected during 2016-2017 through key informant interviews with central authorities and hospital management teams, exhaustive semi-structured questionnaires filled in by hospitals, as well as the review of documentary sources where feasible. RESULTS: Overall, the governance landscape of Romanian public hospitals includes a large number of seemingly modern legislative provisions and management instruments. Over the past 30 years substantial efforts have been made to put in place standardised hospital classification, hospital governance structures, management and service purchasing contracts with key performance indicators, modern reimbursement mechanisms based on diagnosis-related groups (DRGs), and regulatory requirements for accountability, including internal and external audit. Nevertheless, their application appears to have been challenging for a range of reasons, pointing to the misalignment between the responsibility and decisionmaking capacity given to hospitals in a questionably conducive context. Incoherent policy design, outdated and often disjointed regulatory frameworks, and cumbersome administrative procedures limit managerial autonomy and obstruct efficiency gains. In a context of chronic insufficient funding, misaligned incentives, and overly rigid service procurement processes, hospitals seem to struggle to adjust service baskets to the population's health needs or to overcoming financial hardship. External challenges, combined with the limited strategic, operational, and financial management capacity within hospitals, make it difficult to exhibit good financial and general performance. CONCLUSION: Existing governance arrangements for Romanian public hospitals appear conducive to poor financial performance. The suggested framework for hospital governance assessment has proved a powerful tool for identifying system and hospital-specific challenges contributing to sub-optimal hospital performance.


Assuntos
Governança Clínica , Assistência à Saúde/organização & administração , Hospitais Públicos/organização & administração , Tomada de Decisões , Administração Hospitalar , Humanos , Romênia , Responsabilidade Social
18.
Artigo em Inglês | MEDLINE | ID: mdl-31022966

RESUMO

Objectives: To qualitatively compare the influence of different ownership which is considered as a kind of institutional environment in public hospitals, private hospitals, and mixed-ownership hospitals on hospital governance structure and organizational behavior. Design: Qualitative descriptive study, using semi-structured, in-depth interviews and thematic template analysis, theoretically informed by critical realism. Participants: 27 key informants including national policymakers in charge of the health sector, influential researchers, local administrators responsible for implementing policies, and hospital managers who are experienced in institutional change. Results: Hospital ownership has a significant influence on hospitals in terms of decision-making power allocation, residual ownership allocation, market entry level, accountability, and social functions. These five aspects in hospital organizational structure incentivize hospitals to adapt to the internal and external environment of the hospital organization-such as market environment, governance, and financing arrangements-affect the behavior of the hospital organization, and ultimately affect the efficiency of hospital operation and quality of service. The incentives under the public system are relatively distorted. Private hospitals have poor performance in failing their social functions due to their insufficient development ability. Compared to them, mixed ownership hospitals have a better performance in terms of incentive mechanism and organizational development. Conclusion: Public hospitals should improve the governance environment and decision-making structure, so as to balance their implementation of social functions and achieve favorable organizational development. For private hospitals, in addition to the optimization of the policy environment, attempts should be made to strengthen their supervision. The development of mixed-ownership hospitals should be oriented towards socialized governance.


Assuntos
Administração Hospitalar , Hospitais Privados/organização & administração , Hospitais Públicos/organização & administração , Propriedade , China , Tomada de Decisões , Humanos , Pesquisa Qualitativa
19.
Int J Health Care Qual Assur ; 32(2): 332-346, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-31017057

RESUMO

PURPOSE: Hospital evaluations create competition between healthcare providers. In this study, a multi criteria decision-making (MCDM) method is used to evaluate criteria that affect hospital service quality. The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH: Criteria affecting hospital service quality are identified. Four Iranian public hospitals are evaluated using these criteria. Four hybrid methods, including modified digital logic-technique for order of preference by similarity to an ideal solution, analytical hierarchy process-technique for order of preference by similarity to an ideal solution, analytical hierarchy process-elimination and choice expressing reality and modified digital logic-elimination and choice expressing reality are used to evaluate hospital service quality. Results are aggregated using the Copeland method and final ranks are determined. FINDINGS: The four main criteria for evaluating hospital service quality are: environment; responsiveness; equipment and facilities; and professional capability. Results suggest that professional capability is the most important criterion. The Copeland method, used to integrate four MCDM hybrid methods, provides the final hospital ranks. PRACTICAL IMPLICATIONS: The criteria the authors identified and their weight help hospital managers to achieve comprehensive organizational growth and more efficient resource usage. Moreover, the decision matrix helps managers to identify their strengths and weaknesses. ORIGINALITY/VALUE: New and comprehensive criteria are proposed for hospital quality assessments. Moreover, a new hybrid MCDM approach is used to achieve final hospital rankings.


Assuntos
Hospitais Públicos/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Inquéritos e Questionários/normas , Competência Clínica , Tomada de Decisões , Meio Ambiente , Ambiente de Instituições de Saúde/normas , Hospitais Públicos/normas , Humanos , Irã (Geográfico) , Indicadores de Qualidade em Assistência à Saúde , Qualidade da Assistência à Saúde/normas , Reprodutibilidade dos Testes
20.
Int J Health Care Qual Assur ; 32(3): 645-652, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-31018792

RESUMO

PURPOSE: The purpose of this paper is three-fold: first, to assess nurse satisfaction levels with working environment (known as favourability) in five Greek public hospitals using the practice environment scale (PES); second, to compare perceptions among nurses employed in surgical and medical departments; and third, to examine relationships between perceptions and nurse educational level and experience. DESIGN/METHODOLOGY/APPROACH: In total, 532 nurses from five major public hospitals in Greece completed the PES. Descriptive statistics, t-tests and Spearman correlations were employed to analyse the data. FINDINGS: Nurses perceived their work settings as unfavourable in all five hospitals, with collegial nurse-physician relations emerging as the only positive factor. Compared to medical wards, surgical departments emerged as slightly more positive working environments. Work department notwithstanding, in some cases, education and experience levels affected their perceptions on management, poor care quality, limited nurse involvement in hospital affairs and nursing shortage. PRACTICAL IMPLICATIONS: Hospital managers do not provide sufficient support for Greek nurses in their working environments. ORIGINALITY/VALUE: The authors attempted to evaluate nursing practice environments in Greek hospitals, viewed from nurse perspectives. The authors identified insufficient support for nurses' working in these hospitals.


Assuntos
Hospitais Públicos/organização & administração , Satisfação no Emprego , Recursos Humanos de Enfermagem no Hospital/organização & administração , Recursos Humanos de Enfermagem no Hospital/psicologia , Local de Trabalho/psicologia , Adulto , Atitude do Pessoal de Saúde , Escolaridade , Feminino , Grécia , Administradores Hospitalares/organização & administração , Departamentos Hospitalares/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Cultura Organizacional , Reorganização de Recursos Humanos , Relações Médico-Enfermeiro , Qualidade da Assistência à Saúde/organização & administração , Adulto Jovem
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