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1.
Artigo em Inglês | MEDLINE | ID: mdl-36673778

RESUMO

The main purpose of this study is to explore the application of the balanced scorecard (BSC) to service performance measurements of medical institutions using the analytic hierarchy process (AHP) and decision making and trial evaluation laboratory (DEMATEL). According to the concept of BSC, a total of four evaluation dimensions and twenty-two indicators of medical service performance measurements were developed. To collect data, this study delivered expert questionnaires to medical-related professional supervisors, deans, and heads of medical institutions in Taiwan. By combining the AHP and DEMATEL, the priority and causality of service performance standards in medical institutions were obtained. The results of this study show that the customer dimension is the most important service performance measurement dimension for medical institutions. The seven key service performance measurement indicators that are most important for medical institutions, in order, are "complete and comfortable equipment", "competitiveness of the medical profession", "continuity of patient-to-hospital treatment", "classification of medical profession according to customers (VIP system)", "complete medical service", "complete salary, remuneration, and policy", and "medical incomes of institutions". In terms of causality, provided the complete services of medical institutions are improved, the continuity of patient-to-hospital treatment, the competitiveness of the medical profession, and the medical incomes of institutions would be influenced.


Assuntos
Administração Hospitalar , Medicina , Humanos , Processo de Hierarquia Analítica , Hospitais , Inquéritos e Questionários
2.
BMC Health Serv Res ; 23(1): 19, 2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36624513

RESUMO

BACKGROUND: Very limited empirical research has been done on operational flexibility management in the healthcare industry, especially in hospital settings. This study aimed to propose a model of the effects of operational flexibility on hospital performance through management capability and employee engagement as mediating variables. METHODS: The proposed model is validated through an empirical study among 480 clinical and administrative staff from five hospitals in Jordan. Structural equation modeling and confirmatory factor analysis were the main techniques used to validate the model and examine the hypotheses. RESULTS: Operational flexibility was demonstrated to have a positively significant impact on hospital performance, management capability, and employee engagement. Employee engagement was demonstrated to positively impact hospital performance. Management capability had a significant result on hospital performance without having a clear impact. In addition, management capability and employee engagement played a major role as partial mediating effects between operational flexibility and hospital performance, and there is a role for employee engagement as a partial mediating effect between management capability and hospital performance. CONCLUSION: Significant progress has been achieved in hospital management, especially in terms of operational flexibility, management capability, and staff engagement.


Assuntos
Administração Hospitalar , Engajamento no Trabalho , Humanos , Hospitais , Jordânia
4.
Healthc Policy ; 18(2): 44-60, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36495534

RESUMO

This paper provides insights into the use of performance data by middle managerial staff in Ontario hospitals in 2019 and compares the results to a study conducted in Europe in the same year. A total of 236 managers working in 61 hospitals across Ontario provided responses to the survey. Compared to their European colleagues, Ontario respondents self-assessed using significantly more performance data for managerial decision making. The use of performance data in Ontario was mostly motivated by external accountability requirements, followed by internal quality improvement efforts. Ontario managers also reported accessibility, appropriateness and timeliness of data and human resources and engagement as the biggest barriers to further performance data utilization. Comparative studies, such as the one this paper is based on, provide the foundation for drawing lessons across jurisdictions. This paper also affirms the importance of hospital middle management in moving from quality assurance to quality improvement efforts and developing sustainable learning healthcare organizations and systems.


Assuntos
Administração Hospitalar , Humanos , Inquéritos e Questionários , Hospitais , Melhoria de Qualidade , Pessoal de Saúde , Ontário
5.
BMJ ; 379: o3017, 2022 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-36549678
6.
Front Public Health ; 10: 905054, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36408003

RESUMO

Objective: The rapid growth of the medical industry has resulted in a tremendous increase in medical record data, which can be utilized for hospital management, aiding in diagnosis and treatment, medical research, and other purposes. For data management and analysis, medical institutions require more qualified medical record information managers. In light of this, we conducted an analysis of the qualifications, abilities, and job emphasis of medical record information managers in order to propose training recommendations. Materials and methods: From online job posting sites, a sample of 241 job advertisements for medical record information management positions posted by Chinese healthcare institutions were collected. We conducted word frequency and keyword co-occurrence analysis to uncover overall demands at the macro level, and job analysis to investigate job-specific disparities at the micro level. Based on content analysis and job analysis, a competency framework was designed for medical record information managers. Results: The most frequent keywords were "code," "job experience," and "coding certification," according to the word frequency analysis. The competency framework for managers of medical record information is comprised of seven domains: essential knowledge, medical knowledge, computer expertise, problem-solving skills, leadership, innovation, and attitude and literacy. One of the fundamental skills required of medical record information managers is coordination and communication. Similarly, knowledge and skill requirements emphasize theoretical knowledge, managerial techniques, performance enhancement, and innovation development. Conclusion: According to organization type and job differences, the most crucial feature of the job duties of medical record information managers is cross-fertilization. The findings can be utilized by various healthcare organizations for strategic talent planning, by the field of education for medical record information managers for qualification and education emphasis adjustment, and by job seekers to enhance their grasp of the profession and self-evaluation.


Assuntos
Publicidade , Administração Hospitalar , Registros Médicos , Local de Trabalho , Liderança
7.
Front Public Health ; 10: 915317, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36339178

RESUMO

Background: Ethiopian public hospitals struggle to meet health care needs of the Ethiopian population, in part because of the persistent human resources crisis. The health reforms and tight human resource management (HRM) regulation of the government have resulted in limited progress toward addressing this crisis. This study aims to analyze how the strategic HRM practices adopted by Ethiopian public hospitals influence employee outcomes, organizational outcomes, and patient outcomes. Methods: Structured interviews were conducted with 19 CEOs and HR managers from 15 hospitals. Four focus groups were also conducted, with 38 participants (professionals and line managers). The transcripts were thematically analyzed using ATLAS.ti 8. Deductive coding was used based on the Contextual SHRM framework, while remaining open for codes that emerged. Results: Intended HR practices are influenced by mandatory strict government regulations. Nevertheless, some room for self-selected (bundles of) HR practices is perceived by hospitals. Employees perceive that governmental steered HR practices may not match its intentions due to implementation issues, related to lack of support and skilled management and HR professionals. These problems are leading to dissatisfaction, demotivation, moonlighting and turnover of skilled professionals and perceived to consequently negatively influence performance (i.e., patient satisfaction and waiting time). Conclusions: There are considerable contextual challenges for SHRM in Ethiopian public hospitals. Hospital management can benefit from having more leeway and from exploiting it more effectively to improve actual and perceived strategic human resource management practices. Adoption of commitment based practices, in addition to mandatory control oriented practices can help to motivate and retain health care professionals and consequently improve outcomes.


Assuntos
Administração Hospitalar , Hospitais Públicos , Humanos , Etiópia , Pessoal de Saúde , Recursos Humanos
8.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36367331

RESUMO

PURPOSE: This study aimed to describe facilitators and barriers in terms of regulation and financing of healthcare due to the implementation and use of person-centred care (PCC). DESIGN/METHODOLOGY/APPROACH: A qualitative design was adopted, using interviews at three different levels: micro = hospital ward, meso = hospital management, and macro = national board/research. Inclusion criteria were staff working in healthcare as first line managers, hospital managers, and officials/researchers on national healthcare systems, such as Bismarck, Beveridge, and mixed/out-of-pocket models, to obtain a European perspective. FINDINGS: Countries, such as Great Britain and Scandinavia (Beveridge tax-based health systems), were inclined to implement and use person-centred care. The relative freedom of a market (Bismarck/mixed models) did not seem to nurture demand for PCC. In countries with an autocratic culture, that is, a high-power distance, such as Mediterranean countries, PCC was regarded as foreign and not applicable. Another reason for difficulties with PCC was the tendency for corruption to hinder equity and promote inertia in the healthcare system. RESEARCH LIMITATIONS/IMPLICATIONS: The sample of two to three participants divided into the micro, meso, and macro level for each included country was problematic to find due to contacts at national level, a bureaucratic way of working. Some information got caught in the system, and why data collection was inefficient and ran out of time. Therefore, a variation in participants at different levels (micro, meso, and macro) in different countries occurred. In addition, only 27 out of the 49 European countries were included, therefore, conclusions regarding healthcare system are limited. PRACTICAL IMPLICATIONS: Support at the managerial level, together with patient rights supported by European countries' laws, facilitated the diffusion of PCC. ORIGINALITY/VALUE: Fragmented health systems divided by separate policy documents or managerial roadmaps hindered local or regional policies and made it difficult to implement innovation as PCC. Therefore, support at the managerial level, together with patient rights supported by European countries' laws, facilitated the diffusion of PCC.


Assuntos
Administração Hospitalar , Humanos , Atenção à Saúde , Pessoal de Saúde , Europa (Continente) , Assistência Centrada no Paciente , Pesquisa Qualitativa
9.
Stud Health Technol Inform ; 299: 262-268, 2022 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-36325873

RESUMO

BACKGROUND: Hospitals are complex organizations that frequently need changes especially in service delivery processes, organizing, human resource management, monitoring and evaluation and technologies. Maintaining and improving productivity is a key requirement in hospital change management. Therefore, we need to develop and expand an appropriate model for management of changes in hospitals; which is the main purpose of this study. METHOD: A qualitative approach was used to conduct semi-structured interviews in 2019-2020 with 12 expert managers at Mashhad University of Medical Sciences, Mashhad, Iran. A pre-structured framework was applied for the data analysis. RESULTS: Four main themes and nine sub-themes were identified as the main phases or stages of the framework that can be used to manage changes that aim to improve efficiency in hospitals. The main themes were problem identification and initial support; studying, designing and planning; participation in implementation; considering executive requirements; and implementation, assessment, feedback and stabilization. CONCLUSION: Management of changes that aim to improve hospital efficiency requires a practical model that was specifically developed by this study. This model should consider all the key elements that were identified; and should consider the expectations of the key stakeholders and their contribution in implementing the change.


Assuntos
Gestão de Mudança , Administração Hospitalar , Humanos , Pesquisa Qualitativa , Hospitais , Irã (Geográfico)
10.
Front Public Health ; 10: 937338, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36159286

RESUMO

Objective: To explore the practice of medical quality and safety evaluation system based on annual score under the background of establishing modern hospital management system and strengthening national public hospital performance evaluation. Methods: Statistical analysis was used to study the improvement of medical quality and safety in hospitals after the implementation of score evaluation, and the existing problems were analyzed according to the actual situation and related requirements. Results: The hospital's medical quality and safety evaluation system ran smoothly, the evaluation indexes could be implemented, and the evaluation results were used properly. The improvement of hospital medical quality and operation efficiency has achieved good results. Conclusion: The evaluation system of medical quality and safety for physicians and medical technicians based on annual score can achieve the whole process, all-round, personalized and information-based evaluation, and promote the high-quality development of hospitals. It is necessary to further improve the range of evaluation and carry out the evaluation of the evaluation system by relevant personnel.


Assuntos
Administração Hospitalar , Médicos , Hospitais , Humanos , Qualidade da Assistência à Saúde
11.
Sci Rep ; 12(1): 14634, 2022 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-36030303

RESUMO

Hospital congestion is a common problem for the healthcare sector. However, existing approaches including hospital resource optimization and process improvement might lead to huge cost of human and physical structure changes. This study evaluated less disruptive interventions based on a hospital simulation model and offer objective reasoning to support hospital management decisions. This study tested a congestion prevention method that estimates hospital congestion risk level (R), and activates minimum intervention when R is above certain threshold, using a virtual hospital created by simulation modelling. The results indicated that applying a less disruptive intervention is often enough, and more cost effective, to reduce the risk level of hospital congestion. Moreover, the virtual implementation approach enabled testing of the method at a more detailed level, thereby revealed interesting findings difficult to achieve theoretically, such as discharging extra two medical inpatients, rather than surgical inpatients, a day earlier on days when R is above the threshold, would bring more benefits in terms of congestion reduction for the hospital.


Assuntos
Administração Hospitalar , Alta do Paciente , Análise Custo-Benefício , Hospitais , Humanos , Pacientes Internados
12.
Front Public Health ; 10: 922597, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35784214

RESUMO

Objective: Despite an extensive literature on efficiency, qualitative evidence on the drivers of hospital efficiency is scant. This study examined the factors that influence the efficiencies of health service provision in public hospitals in the Kingdom of Saudi Arabia (KSA) and their potential remedies. Design: We employed a qualitative design involving semi-structured interviews conducted between July and September 2019. Participants were purposively selected and included policymakers and hospital managers drawn from districts, regional and national levels. Data were analyzed in Nvivo 12 based on a thematic approach. Setting: Key informants of Ministry of health in the KSA. Results: Respondents identified a range of different factors across the community, facility and the wider health system that influence inefficiencies in public hospitals in KSA. Ineffective hospital management, lack of strategic planning and goals, weak administrative leadership, and absence of monitoring hospital performance was noted to have a profound impact on hospital efficiency. The conditions of healthcare staff in respect to both skills, authority and psychological factors were considered to influence the efficiency level. Further, lack of appropriate data for decision making due to the absence of an appropriate health informatics system was regarded as a factor of inefficiency. At the community level, respondents described inadequate information on the healthcare needs and expectations of patients and the wider community as significant barriers to the provision of efficient services. To improve hospital efficiencies, respondents recommended that service delivery decisions are informed by data on community health needs; capacity strengthening and effective supervision of hospital staff; and judicious resource allocation. Conclusion: The study demonstrates that inefficiencies in health services remain a critical challenge in public hospitals in KSA. Extensive awareness-raising and training on efficient resource utilization among key health systems stakeholders are imperative to improving hospital performance. More research is needed to strengthen knowledge on hospital efficiency in light of the limited data on the topic in KSA and the wider Gulf region.


Assuntos
Administração Hospitalar , Hospitais Públicos , Humanos , Pesquisa Qualitativa , Alocação de Recursos , Arábia Saudita
13.
Archiv. med. fam. gen. (En línea) ; 19(2): 15-23, jul. 2022. tab
Artigo em Espanhol | LILACS | ID: biblio-1391783

RESUMO

La pandemia por SARS-CoV-2 puso de forma abrupta al sistema de salud en la agenda pública. Evidenciando sus problemas y requiriendo acciones de emergencia para poder dar cuenta del desafío de responder social y sanitariamente a esta crisis. La respuesta hospitalaria fue el eje y centro de atención de la pandemia, casi con exclusividad. Relegando las otras posibilidades o dispositivos asistenciales, como el primer nivel de atención y la salud comunitaria. Por lo tanto, nos proponemos reflexionar sobre esta organización sanitaria, tan arraigada en el modelo médico social y el marco del enfoque de derechos. Definiremos el hospital, describiremos sus antecedentes, sus características y propondremos como repensarlo críticamente para aportar a su crecimiento en el marco del enfoque de derechos. La salud como derecho es el marco legal, político y teórico que proponemos para abordar esta reflexión y al hospital, tanto como singularidad histórica como pluralidad o multiplicidad de organizaciones en función de cada contexto donde se desarrolla, como una organización social y sanitaria que formar parte de un conjunto de organizaciones y políticas destinadas a garantizar ese derecho (AU)


The SARS-CoV-2 pandemic abruptly put the health system on the public agenda. Evidencing their problems and requiring emergency actions to be able to account for the challenge of responding socially and healthily to this crisis. The hospital response was the axis and center of attention of the pandemic, almost exclusively. Relegating the other possibilities or assistance devices, such as the first level of care and community health. Therefore, we intend to reflect on this health organization, so rooted in the social medical model and the framework of the rights approach. We will define the hospital, describe its background, its characteristics and propose how to rethink it critically to contribute to its growth within the framework of the rights approach. Health as a right is the legal, political and theoretical framework that we propose to address this reflection and the hospital, both as a historical singularity and as a plurality or multiplicity of organizations depending on each context where it is developed, as a social and health organization that is part of a set of organizations and policies aimed at guaranteeing that right (AU)


Assuntos
Direito à Saúde , Política de Saúde , Administração Hospitalar , Hospitais
14.
Rev. baiana saúde pública ; 46(1): 283-293, 20220707.
Artigo em Português | LILACS | ID: biblio-1379953

RESUMO

Este estudo tem o objetivo de relatar a experiência vivenciada pela equipe de apoio institucional do Ministério da Educação (MEC) no estado da Bahia em relação à supervisão acadêmica no contexto da pandemia de covid-19, no período de 2020 a 2021. Trata-se de uma pesquisa descritiva, do tipo relato de experiência, tendo como referência a atuação do apoio institucional frente à supervisão acadêmica no processo de trabalho dos médicos do Programa Mais Médicos para o Brasil (PMMB). Foram descritas as ações estratégicas e educacionais construídas pela supervisão acadêmica do PMMB no estado da Bahia, no período da pandemia pelo novo coronavírus, relacionadas às potencialidades e fragilidades encontradas no processo de trabalho nesse cenário. O contexto da pandemia impôs um grande desafio para os atores envolvidos no processo da supervisão acadêmica. Enfatiza-se, diante do cenário pandêmico, a importância da comunicação e articulação das instâncias do Sistema Único de Saúde (SUS) na organização do processo de trabalho nas unidades básicas de saúde e no enfrentamento da covid-19.


This study reports on the experience lived by the Institutional Support team from the Ministry of Education (MEC) in the state of Bahia, Brazil, concerning Academic Advising during the COVID-19 pandemic, from 2020 to 2021. This descriptive experience report concerns the institutional performance within Academic Advising in the work process of doctors from the Mais Médicos Program for Brazil (PMMB). It describes the strategic and educational actions built by the PMMB academic advising in Bahia during the pandemic caused by the new coronavirus, regarding the potentialities and weaknesses found in the work process in this context. The pandemic imposed a great challenge for the actors involved in the academic advising process. Given the pandemic scenario, the communication and articulation of instances from the Unified Health System (SUS) in organizing the work process in basic health units and in the fight against COVID-19 is of essence.


Este estudio describe la experiencia vivida por el equipo de apoyo institucional del Ministerio de Educación (MEC) en el estado de Bahía (Brasil) con relación a la supervisión académica en el contexto de la pandemia de Covid-19 en el período de 2020 a 2021. Se trata de un estudio descriptivo, de tipo informe de experiencia con referencia al desempeño institucional frente a la supervisión académica en el proceso de trabajo de los médicos del Programa Más Médicos para Brasil (PMM). Se describieron las acciones estratégicas y educativas construidas por la supervisión académica del PMMB en el estado de Bahía en el período de la pandemia provocada por el nuevo coronavirus, relacionadas con las fortalezas y debilidades encontradas en el proceso de trabajo en este contexto. El contexto de la pandemia ha impuesto un gran desafío para los actores involucrados en el proceso de supervisión académica. Ante este escenario, se destaca la importancia de la comunicación y articulación de las instancias del Sistema Único de Salud (SUS) en la organización del proceso de trabajo en las unidades básicas de salud y en el combate al Covid-19.


Assuntos
Médicos , Pessoal de Saúde , Coronavirus , Consórcios de Saúde , Pandemias , COVID-19 , Administração Hospitalar
16.
Rev Esc Enferm USP ; 56: e20210333, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35551576

RESUMO

The limited resources allocated to the health area and the growing demands require leaders' qualified and committed performance in hospital management. In this perspective, the objective of this study is to reflect on the management practices that can be applied to hospital facilities to achieve better care and financial results. Among them, process-based management proposes an approach for continuous process improvement to achieve desired results; the method Lean Six Sigma allows identifying and eliminating waste in production processes; the continuous improvement model combines practical knowledge with the knowledge of how the system to be improved works, through observations and changes that allow its results measurement; and cost management and value-based healthcare provides for care mapping, from beginning to end, to assess what actually adds value to patients. The contributions of implementing these practices are recognized worldwide; using them, processes can be increased, improving efficiency, reducing waste, adding value to the business, increasing its revenue, and resulting in savings that can be passed on to the consumer, by improving quality.


Assuntos
Administração Hospitalar , Atenção à Saúde , Humanos , Melhoria de Qualidade
17.
Coimbra; s.n; maio 2022. 131 p. tab, ilus.
Tese em Português | BDENF - Enfermagem | ID: biblio-1400922

RESUMO

Enquadramento: A segurança do doente conquistou um lugar de destaque no setor da saúde. É reconhecida como um tema fundamental na prestação de cuidados de saúde de qualidade. O erro de medicação é um dos temas prioritários e o enfermeiro gestor tem um papel importante na sua redução. Objetivos: Definiu-se como objetivo geral identificar quais as estratégias que poderão ser implementadas pelo enfermeiro gestor para diminuir a ocorrência de erros de medicação, percecionados pelos enfermeiros de um SU português. Como objetivos específicos definiram-se: caracterizar os erros associados à gestão de medicação; identificar a incidência de erro nas diferentes fases do processo de gestão de medicação; identificar as causas precipitantes do erro na gestão de medicação; identificar as medidas de mitigação de dano realizadas pelos profissionais; identificar se ocorreu a notificação do erro; identificar as medidas preventivas propostas pelos profissionais; perceber a importância do papel do enfermeiro gestor na garantia das melhores práticas profissionais de forma a reduzir a ocorrência de erros de medicação; e analisar a influência das variáveis sociodemográficas e profissionais na perceção dos enfermeiros, sobre o papel do enfermeiro gestor na implementação de estratégias para diminuir a ocorrência de erros de medicação. Metodologia: Desenvolveu-se um estudo transversal, quantitativo, descritivo-correlacional tratando-se de uma investigação por questionário. A amostra é constituída por 63 enfermeiros. O estudo decorreu num Hospital Público da região Norte de Portugal. Os dados foram analisados no IBM SPSS Statistics versão 28. Resultados: A formação em serviço e a implementação de políticas, diretrizes e protocolos clínicos são as estratégias que poderão ser implementadas pelo enfermeiro gestor de forma a diminuir a ocorrência de erros de medicação no SU. O incidente sem dano foi o erro de medicação mais reportado (68%) seguido do near miss (24%). A fase do processo de gestão de medicação mais referenciada foi a fase de administração (49%), seguida da fase de preparação (33%). O ambiente de trabalho (59%) seguido dos fatores individuais (43%) foram as causas precipitantes do erro na gestão de medicação mais reportadas. Quanto às medidas de mitigação de dano realizadas pelos profissionais quando confrontados com um erro de medicação, 86% vivenciaram e aprenderam com o erro individualmente, 54% aumentou a vigilância do doente e 35% notificou o enfermeiro responsável. Apenas 14% notificou o erro na plataforma da DGS Notific@. A identificação inequívoca do doente (65%) seguida da preparação de terapêutica antes da sua administração (56%) foram as medidas preventivas propostas pelos profissionais. Quando analisamos a influência das variáveis sociodemográficas e profissionais na perceção dos enfermeiros, sobre o papel do enfermeiro gestor na implementação de estratégias para diminuir a ocorrência de erros de medicação, verificamos através dos dados que apenas a hipótese relacionada com a idade dos enfermeiros foi confirmada, apesar de ser uma correlação fraca e negativa. Conclusão: Uma boa gestão dos erros é tão importante como reduzi-los. A experiência do erro pode desenvolver as capacidades adaptativas dos enfermeiros às diversas situações e, também, pode constituir uma forma de aprendizagem, com valor pedagógico e um marco para o desenvolvimento do conhecimento. Assim, conclui-se que é importante a implementação de estratégias pelo enfermeiro gestor de forma a diminuir a sua ocorrência.


Assuntos
Enfermagem , Serviços Médicos de Emergência , Segurança do Paciente , Administração Hospitalar , Erros de Medicação
18.
BMC Health Serv Res ; 22(1): 510, 2022 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-35428249

RESUMO

BACKGROUND: The Quality Improvement Regulation was introduced to the Norwegian healthcare system in 2017 as a new national regulatory framework to support local quality and safety efforts in hospitals. A research-based response to this, was to develop a study with the overall research question: How does a new healthcare regulation implemented across three system levels contribute to adaptive capacity in hospital management of quality and safety? Based on development and implementation of the Quality Improvement Regulation, this study aims to synthesize findings across macro, meso, and micro-levels in the Norwegian healthcare system. METHODS: The multilevel embedded case study collected data by documents and interviews. A synthesizing approach to findings across subunits was applied in legal dogmatic and qualitative content analysis. SETTING: three governmental macro-level bodies, three meso-level County Governors and three micro-level hospitals. PARTICIPANTS: seven macro-level regulators, 12 meso-level chief county medical officers/inspectors and 20 micro-level hospital managers/quality advisers. RESULTS: Based on a multilevel investigation, three themes were discovered. All system levels considered the Quality Improvement Regulation to facilitate adaptive capacity and recognized contextual flexibility as an important regulatory feature. Participants agreed on uncertainty and variation to hamper the ability to plan and anticipate risk. However, findings identified conflicting views amongst inspectors and hospital managers about their collaboration, with different perceptions of the impact of external inspection. The study found no changes in management- or clinical practices, nor substantial change in the external inspection approach due to the new regulatory framework. CONCLUSIONS: The Quality Improvement Regulation facilitates adaptive capacity, contradicting the assumption that regulation and resilience are "hopeless opposites". However, governmental expectations to implementation and external inspection were not fully linked with changes in hospital management. Thus, the study identified a missing link in the current regime. We suggest that macro, meso and micro-levels should be considered collaborative partners in obtaining system-wide adaptive capacity, to ensure efficient risk regulation in quality improvement and patient safety processes. Further studies on regulatory processes could explore how hospital management and implementation are influenced by regulators', inspectors', and managers' professional backgrounds, positions, and daily trade-offs to adapt to changes and maintain high quality care.


Assuntos
Administração Hospitalar , Atenção à Saúde , Instalações de Saúde , Hospitais , Humanos , Melhoria de Qualidade
19.
Front Public Health ; 10: 830102, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35359774

RESUMO

Background: Measuring hospital efficiency is a systematic process to optimizing performance and resource allocation. The current review study has investigated the key input, process, and output indicators that are commonly used in measuring the technical efficiency of the hospital to promote the accuracy of the results. Methods: To conduct this systematic review, the electronic resources and databases MEDLINE (via PubMed), Scopus, Ovid, Proquest, Google Scholar, and reference lists of the selected articles were used for searching articles between 2010 and 2019. After in-depth reviews based on the inclusion and exclusion criteria, among 1,537 studies, 144 articles were selected for the final assessment. Critical Appraisal Skills Programme (CASP) Checklist was used for evaluating the quality of the articles. The main findings of studies have been extracted using content analysis. Results: After the final analysis, the Context/Input indicators that were commonly considered by studies in analyzing hospital technical efficiency include different variables related to Hospital Capacity, Structure, Characteristics, Market concentration, and Costs. The Process/Throughput indicators include different variables related to Hospital Activity or services-oriented process Indicators, Hospital Quality-oriented process indicators, and Hospital Educational processes. Finally, the Output/Outcome indicators include different variables related to Hospital Activity-related output variables and Quality-related output/outcomes variables. Conclusion: This study has identified that it is necessary to mix and assess a set of input, process, and output indicators of the hospital with both quantitative and qualitative indicators for measuring the technical efficiency of hospitals comprehensively.


Assuntos
Eficiência , Administração Hospitalar , Alocação de Recursos , Hospitais , Humanos
20.
Health Policy ; 126(7): 603-612, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35487802

RESUMO

As co-production approaches to quality improvement (QI) gain importance in healthcare, hospital leaders and managers are expected to organise and support such efforts. Yet, patient and public involvement (PPI) can be challenging. Hospital organisations, emphasising knowledge and evidence domains, are characterised by operational-professional rather than patient-preference led management. Thus, PPI adds aspects of influence and responsibility that are not clearly defined or understood, with limited knowledge about how it can be orchestrated. This study, therefore, aimed to explore hospital leaders' and managers' contextualised experiences of managing QI efforts involving patients, by comparing two European hospitals. The study draws on field observations and qualitative interviews with a total of 21 QI team leaders and hospital managers in a Swedish and a Dutch hospital organisation. The data were subjected to thematic analysis with a critical realist approach. Results define seven themes, or areas, in which mechanisms are at play: (1) patient involvement in hospital QI, and (2) improving outcomes for patients, originating from the strategic view of achieving the hospital vision. Furthermore, (3) societal influence, (4) knowledge and evidence, (5) complexity, (6) individual resources, and (7) cooperation are areas in which mechanisms operate in the process. These areas are equally relevant for both hospitals, yet the mechanisms involved play out differently depending on contextual structure and local means of action.


Assuntos
Administração Hospitalar , Melhoria de Qualidade , Hospitais , Humanos , Participação do Paciente , Suécia
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