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1
Bradley, Carol. "“Hospitable” Hospitals." Nursing Management (Springhouse) 31, no. 6 (June 2000): 25–26. http://dx.doi.org/10.1097/00006247-200006000-00008.
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Perdana P, Ricky, and Bulandari. "Overview Management Implementation Commitment and Occupational Health (OHS) at the Regional General Hospital Labuang Baji Makassar Year 2022." Formosa Journal of Science and Technology 2, no. 3 (March 30, 2023): 783–90. http://dx.doi.org/10.55927/fjst.v2i3.3004.
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Occupational accidents can occur in hospitals due to not optimal K3 management in hospitals. This study aims to find out how the Commitment to Implement Occupational Safety and Health (K3) Management in Hospitals is described. The research design used a descriptive qualitative method. The results of this study indicate that the commitment to implementing K3 management at Laburan Baji General Hospital Makassar has not been effective and has not been maximized. From the aspect of OHS Policy, the hospital is making an OHS policy, the hospital's OHS regulations and procedures are being improved, the hospital's OHS culture is not yet effective, the workforce's knowledge of hospital OHS is not maximized, and the hospital's OHS infrastructure is incomplete.
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Garthwaite, Craig, Tal Gross, and Matthew J. Notowidigdo. "Hospitals as Insurers of Last Resort." American Economic Journal: Applied Economics 10, no. 1 (January 1, 2018): 1–39. http://dx.doi.org/10.1257/app.20150581.
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American hospitals are required to provide emergency medical care to the uninsured. We use previously confidential hospital financial data to study the resulting uncompensated care, medical care for which no payment is received. Using both panel-data methods and case studies, we find that each additional uninsured person costs hospitals approximately $800 each year. Increases in the uninsured population also lower hospital profit margins, suggesting that hospitals do not pass along all uncompensated-care costs to other parties such as hospital employees or privately insured patients. A hospital's uncompensated-care costs also increase when a neighboring hospital closes. (JEL G22, I11, I13, L25)
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Everson, Jordan, Julia Adler-Milstein, Andrew M. Ryan, and John M. Hollingsworth. "Hospitals Strengthened Relationships With Close Partners After Joining Accountable Care Organizations." Medical Care Research and Review 77, no. 6 (December 13, 2018): 549–58. http://dx.doi.org/10.1177/1077558718818336.
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The strategies that hospitals participating in Medicare Accountable Care Organizations (ACOs) use to achieve quality and cost containment goals are poorly understood. One possibility is that participating hospitals could try to influence where their patients receive care. To test this hypothesis, we examined whether a hospital’s participation in a Medicare ACO was associated with changes in its patterns of patient sharing with other hospitals. Between 2010 and 2014, patient sharing across hospitals increased 23.3%. After controlling for hospital and regional factors, patient sharing increased 4.4% more at ACO hospitals than non-ACO hospitals ( p = .001 for difference). This increase occurred disproportionately among hospitals with which ACO hospitals already shared a high proportion of their patients prior to participation, and among hospitals in ACOs characterized as physician–hospital collaborations. The increased sharing of patients among closely affiliated hospitals may serve to achieve ACO quality and cost containment goals through increased interorganizational coordination.
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Kuruvilla, Abey, Suraj M. Alexander, and Xiaolin Li. "A Study of the Cascading Effects of Ambulance Diversion among Hospitals." International Journal of Information Systems in the Service Sector 3, no. 3 (July 2011): 60–70. http://dx.doi.org/10.4018/jisss.2011070104.
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This research effort is undertaken to determine the impact that one hospital’s diversion status has on other hospitals in a region and the strength of these interactions. The conditional probability of one hospital going on diversion given that another is already on diversion is evaluated. Based on this analysis, the strength of interactions among the hospitals is established. Through statistical analyses of historical data, the strength of the mutual effects of diversion among a collection of hospitals is determined. These effects are mutual if one hospital’s diversion status affected another’s, then the reverse was also true. The intensity of these interactions between hospitals is varied, some being stronger than others. The model illustrates an approach to studying the cascading effects of diversion among hospitals in a region. This is important, because the status of any hospital in a region can signal the likelihood of impending diversion in every other hospital in the region. This allows actions that might prevent the occurrence of diversion or mitigate the cascading effects of Emergency Medical Systems diversion.
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Giménez, Víctor, Diego Prior, and Jorge R. Keith. "Strategic alliances’ effects over hospital efficiency and capacity utilization in México." Academia Revista Latinoamericana de Administración 33, no. 1 (March 2, 2020): 128–46. http://dx.doi.org/10.1108/arla-11-2018-0248.
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PurposeThis paper aims to investigate the efficiency implications of belonging to a strategic hospital alliance (SHA) and measuring the effects over capacity utilization of such agreements in a Mexican healthcare context.Design/methodology/approachData Envelopment Analysis (DEA) is the nonparametric methodology used, which supports both objectives. Technological gaps ratios are calculated by using DEA-metafrontier approach to compare efficiency between SHA members and a hospital’s control group. Also, hospital capacity utilization ratios are used as the maximum rate of output possible from fixed inputs in a frontier setting using directional distance functions. Data were collected from an alliance called Consorcio Mexicano de Hospitales in México, which has 29 general private hospitals and a group of 47 hospitals with same characteristics from a database made by the Instituto Nacional de Estadística y Geografía for year 2014.FindingsThe results indicate that efficiency is better at hospitals that belong to an alliance; it also shows an improvement of installed capacity management for hospital alliances in México.Originality/valueThe results can be useful for both private health organization managers and regulators themselves to adopt management practices that may end up having a favorable impact on cost and prices containment. Additionally, there are no previous studies neither in Mexico nor in Latin America that analyze the impact of strategic hospitality alliances on the efficiency and utilization of the capacity of private hospitals.
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Abou Ramdan, Amal H., and Walaa M. Eid. "Toxic Leadership: Conflict Management Style and Organizational Commitment among Intensive Care Nursing Staff." Evidence-Based Nursing Research 2, no. 4 (October 8, 2020): 12. http://dx.doi.org/10.47104/ebnrojs3.v2i4.160.
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Context: Toxic leadership becomes a real problem in nursing administration. Its toxicity harms the nursing staff's progress and creates a challenging work environment full of struggles that, in turn, produce adverse outcomes on the nursing staff's commitment toward the organization.
Aim: This study envisioned to compare toxic leadership among intensive care nursing staff at Tanta University Hospital and El Menshawy hospital and assess its relation to their conflict management style used and organizational commitment at the two hospitals.
Methods: A descriptive, comparative, via cross-sectional research design was applied. All intensive care units at Tanta University Hospitals and El-Menshawy General Hospital were included. All available nurses (n=544) at Tanta University hospitals' ICUs (n=301) and El-Menshawy hospital's ICUs (n=243) was incorporated. Toxic leadership, conflict management styles assessment, and organizational commitment scales were utilized to achieve this study's aim.
Results: The nursing staff perceived that their leaders had high 10.6%, 11.5%, and moderate 12%, 11.9% overall toxic leadership levels at Tanta University Hospitals, and Elmenshawy Hospital, respectively. 43.9% of the nursing staff had a high level of using compromising style to manage conflict with their supervisors at Tanta University hospitals contrasted to 36.6% using competing style at El Menshawy hospital. 78.4% of the nursing staff had a low level of overall organizational commitment at Tanta University hospital's ICUs compared to 63% at El-Menshawy General hospital's ICUs.
Conclusion: Toxic leadership affected the nursing staff's choice of conflict management style used when handling conflict with toxic leaders at two hospitals and had a negative effect on affective and normative dimensions of organizational commitment in both hospitals. Therefore, improving leadership experiences is necessary by conducting a leadership development program to meet the nursing staff's expectations and improve their commitment. Also, adjusting the hospital's policies is vital to permit nursing staffs' involvement in leadership evaluation as a mean for early detection of leaders' toxic behaviors.
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Hodgson, Ashley, Paul Roback, Andrew Hartman, Erin Kelly, and Yujie Li. "The financial impact of hospital closures on surrounding hospitals." Journal of Hospital Administration 4, no. 3 (April 1, 2015): 25. http://dx.doi.org/10.5430/jha.v4n3p25.
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Objective: To test whether hospital closures hurt or help surrounding hospitals financially. Do hospital closures improve marketefficiency or do they merely shift the least profitable patients to hospitals that can better cross-subsidize them?Methods: Using California hospital data from 2000 to 2011, the analysis employed random-effect and fixed-effect models to testfor a change in operating margin before and after a series of 2004, 2007 and 2009 hospital closures (the highest volume years forclosures). The main independent variable was each hospital’s predicted percent increase in patient volume due to absorption fromclosing hospitals. We used 5-digit zip code and DRG patient flow data to predict the number of patients each open hospital wouldabsorb from nearby hospital closures.Results: Hospitals experiencing the biggest increase in patient volume due to nearby hospital closings saw a drop in operatingmargin following those closures. This drop could not be explained by changes in payer mix or reimbursement type for thosepatients.Conclusions: Our results suggest that hospital closures are shifting high cost patients to open hospitals, not necessarily improving efficiency in the market.
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Coiado, Olivia, Felipe Vergara, and Lizandra Vergara. "Noise Pollution in Hospitals and its Impacts on the Health Care Community and Patients." Journal of the Acoustical Society of America 152, no. 4 (October 2022): A190. http://dx.doi.org/10.1121/10.0015985.
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Noise pollution in hospitals is known to affect the health of patients, but it also impacts the staff. Most of a hospital’s environment is affected by the sounds of equipment and machines with high sound pressure levels (SPL). We directed the study of both quantitative aspects to reduce SPL and qualitative research which considers the soundscapes of hospitals and people's perceptions. The main goal of this study was to do an assessment of the noise pollution in hospitals in Brazil and USA to investigate the effects on the health care community and patients. The objectives were: 1) Implement a sound mapping, day and night, in different units of the hospital; 2) Characterize the variations of the SPL of the various noise sources in the hospital's care units; 3) Develop and apply a qualitative assessment based on the opinion of users of the hospital in relation to the noise perceived by them; 4) Establish/propose an analytical-experimental model based on correlations of objective data and subjective data. This study identified metrics that can be applied as an intervention plan and prevention to reduce noise pollution in hospitals in Brazil and in the USA that could be implemented by other institutions, locally and internationally.
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Ráczkevy-Deák, Gabriella. "Hospital Security: Hospitals and Terrorism." Belügyi Szemle 68, no. 2 (September 15, 2020): 85–96. http://dx.doi.org/10.38146/bsz.spec.2020.2.6.
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Hospitals are part of the critical infrastructure and are incredibly vulnerable. Unexpected events may hinder the functioning of institutions, causing severe damage and loss of asset value and quality of service. Every hospital should be prepared for such incidents with well-developed plans and strategies. A hospital can be an ideal target for a terrorist, because a lot of civilians are taken care of (and are open) 24 hours a day, seven days a week. Unfortunately, in recent years have taken place more and more terrorist acts. (eg: 13th November 2015 Paris, and 22nd March 2016., Brussels). How are hospitals prepared for these events in Hungary and abroad? Are the Hospitals Disaster Management Plans sufficient? What kind of terrorist attacks can occur in a hospital (e.g. cyber terrorism)? In my essay I am looking for the answers to these questions and introducing the concept of hospital safety and security.
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Boyce, John M. "Hospital Epidemiology in Smaller Hospitals." Infection Control and Hospital Epidemiology 16, no. 10 (October 1995): 600–606. http://dx.doi.org/10.2307/30141102.
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Hasan, Md Mahmudul, Md Noor-E-Alam, Xiaoyi Wang, E. David Zepeda, and Gary J. Young. "Hospital Readmissions to Nonindex Hospitals." Journal for Healthcare Quality 42, no. 1 (2020): e10-e17. http://dx.doi.org/10.1097/jhq.0000000000000199.
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Boyce, John M. "Hospital Epidemiology in Smaller Hospitals." Infection Control and Hospital Epidemiology 16, no. 10 (October 1995): 600–606. http://dx.doi.org/10.1086/647016.
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Dierkes, Andrew M., Kathryn Riman, Marguerite Daus, Hayley D. Germack, and Karen B. Lasater. "The Association of Hospital Magnet® Status and Pay-for-Performance Penalties." Policy, Politics, & Nursing Practice 22, no. 4 (October 22, 2021): 250–57. http://dx.doi.org/10.1177/15271544211053854.
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The Centers for Medicare and Medicaid Services’ Pay-for-Performance (P4P) programs aim to improve hospital care through financial incentives for care quality and patient outcomes. Magnet® recognition—a potential pathway for improving nurse work environments—is associated with better patient outcomes and P4P program scores, but whether these indicators of higher quality are substantial enough to avoid penalties and thereby impact hospital reimbursements is unknown. This cross-sectional study used a national sample of 2,860 hospitals to examine the relationship between hospital Magnet® status and P4P penalties under P4P programs: Hospital Readmission Reduction Program, Hospital-Acquired Conditions (HAC) Reduction Program, Hospital Value-Based Purchasing (VBP) Program. Magnet® hospitals were matched 1:1 with non-Magnet hospitals accounting for 13 organizational characteristics including hospital size and location. Post-match logistic regression models were used to compute a hospital's odds of penalties. In a national sample of hospitals, 77% of hospitals experienced P4P penalties. Magnet® hospitals were less likely to be penalized in the VBP program compared to their matched non-Magnet counterparts (40% vs. 48%). Magnet® status was associated with 30% lower odds of VBP penalties relative to non-Magnet hospitals. Lower P4P program penalties is one benefit associated with achieving Magnet® status or otherwise maintaining high-quality nurse work environments.
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Reilly, Michael, and David S. Markenson. "Education and Training of Hospital Workers: Who Are Essential Personnel during a Disaster?" Prehospital and Disaster Medicine 24, no. 3 (June 2009): 239–45. http://dx.doi.org/10.1017/s1049023x00006877.
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AbstractHospital plans often vary when it comes to the specific functional roles that are included in emergency and incident management positions.Bioterrorism coordinators and emergency managers for 31 hospitals in a seven-county region outside of a major metropolitan area, with urban, suburban, and rural demographics were surveyed to determine which specific functional roles were considered “essential” to their hospital's emergency operations plans. Furthermore, they were asked to estimate the percentage of their “essential” staff trained to perform the functional roles delineated in the hospital's plan. Responses were entered into a database and descriptive statistical computations were performed. Only three categories of hospital personnel were reported to be “essential” by all hospitals to their emergency preparedness plans: emergency department physicians, nurse, and support staff. Training for overall “essential” staff ranged by hospital 73.6–83.3%. Some hospitals reported that these staff members have received no training in their anticipated role based on the hospital emergency response plan. Allied health professionals and emergency medical technicians/paramedics (that are employed by hospitals) had the least amount of training on their role in the hospital preparedness and response plan, 33.3% and 22.2% respectively.Without improved guidance on benchmarks for preparedness from regulators and professional organizations, hospitals will continue to lack the capacity to effectively respond to disasters and public health emergencies.
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Akré, Ellesse-Roselee L., Deanna Chyn, Heather A. Carlos, Amber E. Barnato, and Jonathan Skinner. "Measuring Local-Area Racial Segregation for Medicare Hospital Admissions." JAMA Network Open 7, no. 4 (April 19, 2024): e247473. http://dx.doi.org/10.1001/jamanetworkopen.2024.7473.
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ImportanceConsiderable racial segregation exists in US hospitals that cannot be explained by where patients live. Approaches to measuring such segregation are limited.ObjectiveTo measure how and where sorting of older Black patients to different hospitals occurs within the same health care market.Design, Setting, and ParticipantsThis retrospective cross-sectional study used 2019 Medicare claims data linked to geographic data. Hospital zip code markets were based on driving time. The local hospital segregation (LHS) index was defined as the difference between the racial composition of a hospital’s admissions and the racial composition of the hospital’s market. Assessed admissions were among US Medicare fee-for-service enrollees aged 65 or older living in the 48 contiguous states with at least 1 hospitalization in 2019 at a hospital with at least 200 hospitalizations. Data were analyzed from November 2022 to January 2024.ExposureDegree of residential segregation, ownership status, region, teaching hospital designation, and disproportionate share hospital status.Main Outcomes and MeasuresThe LHS index by hospital and a regional LHS index by hospital referral region.ResultsIn the sample of 1991 acute care hospitals, 4 870 252 patients (mean [SD] age, 77.7 [8.3] years; 2 822 006 [56.0%] female) were treated, including 11 435 American Indian or Alaska Native patients (0.2%), 129 376 Asian patients (2.6%), 597 564 Black patients (11.9%), 395 397 Hispanic patients (7.8), and 3 818 371 White patients (75.8%). In the sample, half of hospitalizations among Black patients occurred at 235 hospitals (11.8% of all hospitals); 878 hospitals (34.4%) exhibited a negative LHS score (ie, admitted fewer Black patients relative to their market area) while 1113 hospitals (45.0%) exhibited a positive LHS (ie, admitted more Black patients relative to their market area); of all hospitals, 79.4% exhibited racial admission patterns significantly different from their market. Hospital-level LHS was positively associated with government hospital status (coefficient, 0.24; 95% CI, 0.10 to 0.38), while New York, New York; Chicago, Illinois; and Detroit, Michigan, hospital referral regions exhibited the highest regional LHS measures, with hospital referral region LHS scores of 0.12, 0.16, and 0.21, respectively.Conclusions and RelevanceIn this cross-sectional study, a novel measure of LHS was developed to quantify the extent to which hospitals were admitting a representative proportion of Black patients relative to their market areas. A better understanding of hospital choice within neighborhoods would help to reduce racial inequities in health outcomes.
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L., J. F. "ADMINISTRATIVE COSTS IN U.S. HOSPITALS." Pediatrics 95, no. 5 (May 1, 1995): A46. http://dx.doi.org/10.1542/peds.95.5.a46.
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Background. Previous estimates of administrative costs in U.S. hospitals have been based on figures in California, and nationwide extrapolation has been controversial. If the costs of bureaucracy are high, major policy reforms may yield substantial savings. Methods. We obtained detailed data on hospital expenses for fiscal year 1990 from reports submitted to Medicare by 6400 hospitals. We calculated each hospital's administrative costs by summing expenses in the following Medicare cost-accounting categories: administrative and general, nursing administration, central services and supply (excluding the purchase cost of supplies), medical records and library, utilization review, and the salary costs of the employee benefits department. We classified costs in most other categories as clinical. Some small categories of expenses (e.g., gift shop) were excluded from both our clinical and administrative groupings, and for others (e.g., plant operations), a proportional share was allocated between the two groupings. Results. Nationwide, administration accounted for an average of 24.8 percent of each hospital's spending in fiscal 1990. Average hospital administrative costs ranged from 20.5 percent in Minnesota to 30.6 percent in Hawaii. Administrative salaries accounted for 22.4 percent of the average hospital's salary costs. Administrative costs were similar in states with high and low rates of enrollment in health maintenance organizations (HMOs). Conclusions. Hospital administrative costs in the United States are higher than previous estimates and more than twice as high as those in Canada. Greater enrollment in HMOs, with more competitive bidding by hospitals for managedcare contracts, an important element of proposed managed-competition health care reforms, does not seem to lower hospital administrative costs. N Engl J Med. 1993;329:400-3.
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AMORIM, Fábio J., Lincoln C. SANTOS, Fernando ARAÚJO-NETO, Lucimara M. ANDRADE, Dyego C. ARAÚJO, Izadora M. BARROS, and Divaldo P. LYRA-JR. "Good practices in the management of medical gases in teaching hospitals in Brazil: situational diagnosis." Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde 12, no. 4 (December 8, 2021): 685. http://dx.doi.org/10.30968/rbfhss.2021.124.0685.
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Objective: To characterize compliance with good practices in medical gas management in federal teaching hospitals in Brazil. Methods: A cross-sectional survey-type study, designed to perform a situational diagnosis of the pharmacy services in 40 federal teaching hospitals in Brazil linked to the Brazilian Hospital Services Company, with respect to compliance with good practices in gas management, through the application of the ABPGasMed 1.0 instrument. This instrument consists of 54 compliance standards divided into two sections (structure and process). The characterization of research participants and hospitals, and the classification of hospitals in terms of performance categories were expressed as absolute and relative values. Chi-square tests of independence were performed to investigate the association between the hospital’s performance category and the hospital’s geographic region and size. Results: In total, 87.5% of the invited hospitals participated in the study, and only 27.59% of the hospitals had a pharmacist responsible for medicinal gases. Pharmacovigilance was performed by pharmacists in 20.59% of the hospitals. Analyzing the hospitals by region of the country and size, statistically significant associations were found between the general classification of hospitals and the geographic region (x2(8)=18.936, p= 0.015), as well as the classification of the hospital and structure and size (x2(9)= 20.373, p= 0.016). Analyses of the adjusted standardized residues returned an association between the southeastern region and the satisfactory performance category when analyzing the entire instrument, and between the excellent performance category in the structure section and size of a small hospital. Conclusion: In most of the hospitals studied, management of medicinal gases did not show the desired performance, which indicates the need to comply with current healthcare legislations and improve the provided services. It is believed that compliance rates may evolve training of healthcare team members, with an emphasis on the pharmacist.
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Ristiono, Bambang, and Nizwardi Azkha. "REGULASI DAN PENERAPAN KESELAMATAN DAN KESEHATAN KERJA (K3) RUMAH SAKIT DI PROPINSI SUMATERA BARAT." Jurnal Kesehatan Masyarakat Andalas 4, no. 1 (September 1, 2009): 53–59. http://dx.doi.org/10.24893/jkma.v4i1.44.
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The study is related to the implementation of regulation’s policy on hospital safety and occupational health in West Sumatera. Hospital will implement regulation that local government established if there is effective mechanism. Regulation is an authoritative ride regarding to detail procedures that declare on local government policy.  The study aims to describe regulation policy of health department on behalf of Local Government for the implementation of hospital safety and occupational health in order to see effective regulation factors to make hospital obedient and will to implement regulation policy that established. Methods: The method of the study was case study with explorative descriptive. Dependent variable in the study was hospital safety and occupational health in West Sumatera, while the Independent variable was regulation policy of local government in implementing hospital safety and occupational health with factors in it, that cover sanction and reward, watch, regulation focus, human resource, financial, commitment, public control, and transparency. Objective: The study was obtained in Health Department and district hospital in West Sumatera that covers 6 district hospitals, ie. 2 hospitals with 12 accredited statuses, 2 hospitals with 5 accredited statuses, 2 hospitals with unaccredited status, and private hospital. Subject of the study was hospital manager and hospital manager in health Department of West Sumatera Province and district/city. Data were collected by dept. interview and spreading questionnaire that was obtained because of the difficulty of location and the busy of respondents. The result of the study shows that regulation of hospital safety and occupational health is weak, low commitment of hospital management toward hospital safely and occupational health, in order to make effective regulation of hospital safety and occupational health, it need the support of human resource, financial, sanction and reward, transparency, and public control. In order to make hospital safety and occupational health implemented well, health department of West Sumatera Province has to: complete the existing rule and socialized it to all hospitals, presence government and hospitals’ presence, increasing hospital's commitment and support to make effective regulation. The result of study wished to be used local government as a reference in implementing and maintaining regulation policy of hospital safety and occupational health, especially in West Sumatera in the future.
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Phuyal, Naveen, Sumana Bajracharya, Alisha Adhikari, Srijana Katwal, and Ashis Shrestha. "Development and update of hospital disaster preparedness and response plan of 25 hub hospitals of Nepal – process documentation." Journal of General Practice and Emergency Medicine of Nepal 10, no. 15 (August 30, 2023): 53–59. http://dx.doi.org/10.59284/jgpeman229.
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Hospital disaster preparation involves creating systems and processes to enhance a hospital's readiness for emergencies. The first step in crisis management is having a disaster management strategy, mandated by international agreements like the Sendai Framework. The 2015 Nepal earthquake highlighted hospitals' capacity concerns, leading to the inclusion of hub and satellite hospitals in disaster plans. Later, infectious disease management and lessons from COVID-19 were incorporated. The disaster plans for Nepal's 25 hub hospitals, collaborating with Health Emergency Operation Center (HEOC) and Provincial Health Emergency Center (PHEOC), were updated. Workshops aimed to empower participants to own hospital plans. The Hospital Disaster Preparedness and Response Plan (HDPRP) addresses preparedness, response, and recovery, including COVID-19 management. Developed through testing, the HDPRP, along with workshops and engagement strategies, bolsters hospitals' disaster response capabilities.
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Barzdins, Juris, Rita Konstante, Uldis Mitenbergs, and Maris Taube. "Transition to hospital process orientation: The case of regional hospitals in Latvia." Journal of Hospital Administration 5, no. 2 (December 13, 2015): 15. http://dx.doi.org/10.5430/jha.v5n2p15.
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Management of processes instead of functions has growing importance into the health care. Transition to hospital process orientation (HPO) changes the way physicians and other health professionals have used to practice before. Study was performed to explore factors affecting introduction of HPO in Latvian hospitals responding to significant external pressures during the years of economic crisis to detect the best practices used for process management implementation in clinical setting. To reach the research goal dissimilarities between current performance and management of hospitals were explored. As changes in hospital reimbursement system demand improved efficiency, hospital’s performance was measured by decrease in avoidable hospitalisations, and increase in usage of more cost effective alternatives to a full hospitalisation. A regression analysis was performed to evaluate correlations of hospitalisation rates in Latvian hospitals to various outpatient health services utilisation indicators. This was done to exclude influence of external factors on hospital performance and to prove the positive impact of HPO initiatives on hospitalisation rate. Afterward the performance of all regional hospitals was compared and the two most distinct hospitals were selected for further in depth analysis. Operational data of the selected hospitals and a set of structured interviews outlined the differences between both hospital’s managerial practices and factors affecting the introduction of process oriented initiatives. The theoretical research together with comparative analysis of approaches used in both hospitals served as a basis for elaboration of recommendations towards development of HPO and facilitation of the development of self-management competence of health professionals.
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Bergmark, Regan W., Ginger Jin, Robert S. Semco, Marc Santolini, Margaret A. Olsen, and Amar Dhand. "Association of hospital centrality in inter-hospital patient-sharing networks with patient mortality and length of stay." PLOS ONE 18, no. 3 (March 15, 2023): e0281871. http://dx.doi.org/10.1371/journal.pone.0281871.
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Objective The interdependence of hospitals is underappreciated in patient outcomes studies. We used a network science approach to foreground this interdependence. Specifically, within two large state-based interhospital networks, we examined the relationship of a hospital’s network position with in-hospital mortality and length of stay. Methods We constructed interhospital network graphs using data from the Healthcare Cost and Utilization Project and the American Hospital Association Annual Survey for Florida (2014) and California (2011). The exposure of interest was hospital centrality, defined as weighted degree (sum of all ties to a given hospital from other hospitals). The outcomes were in-hospital mortality and length of stay with sub-analyses for four acute medical conditions: pneumonia, heart failure, ischemic stroke, myocardial infarction. We compared outcomes for each quartile of hospital centrality relative to the most central quartile (Q4), independent of patient- and hospital-level characteristics, in this retrospective cross-sectional study. Results The inpatient cohorts had 1,246,169 patients in Florida and 1,415,728 in California. Compared to Florida’s central hospitals which had an overall mortality 1.60%, peripheral hospitals had higher in-hospital mortality (1.97%, adjusted OR (95%CI): Q1 1.61 (1.37, 1.89), p<0.001). Hospitals in the middle quartiles had lower in-hospital mortality compared to central hospitals (%, adjusted OR (95% CI): Q2 1.39%, 0.79 (0.70, 0.89), p<0.001; Q3 1.33%, 0.78 (0.70, 0.87), p<0.001). Peripheral hospitals had longer lengths of stay (adjusted incidence rate ratio (95% CI): Q1 2.47 (2.44, 2.50), p<0.001). These findings were replicated in California, and in patients with heart failure and pneumonia in Florida. These results show a u-shaped distribution of outcomes based on hospital network centrality quartile. Conclusions The position of hospitals within an inter-hospital network is associated with patient outcomes. Specifically, hospitals located in the peripheral or central positions may be most vulnerable to diminished quality outcomes due to the network. Results should be replicated with deeper clinical data.
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Tsagaankhuu, Sarnai, Xinping Zhang, and Enkh-Amar Ayush. "Characteristics of Hospitals That Adopt Hospital Information Systems in Mongolia And Its Impact on Patient Safety and Quality of Care." Central Asian Journal of Medical Sciences 4, no. 2 (June 25, 2018): 116–25. http://dx.doi.org/10.24079/cajms.2018.00.003.
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Objectives: Our objective was to determine the relationship between the adoption of hospital information system (HIS) in Mongolian tertiary and secondary care hospitals and the hospital’s organizational & geographical characteristics, its impact on patient safety & quality of healthcare. Methods: This wasa cross sectional study involving the executive directors and 39 quality managersat 39 hospitals. Data werecollected using questionnaire to determine the adoption rate of HIS and their hospital’s organizational & geographical characteristics. Results: The adoption of HIS signifi cantly affected by hospital size, ownership type, health maintenance organization penetration, and hospital location (urban versus rural). The adoption of HIS was found to partially impactpatient safety and quality of healthcare outcomes. Conclusion: In terms of theoretical implications, this study confi rms that hospital organizational & geographical characteristics (structure) impact the adoption of HIS (process) which in turn affects healthcare outcomes (outcome). These fi nding validate Avedis Donabedian’s “Structure-Process-Outcome” model. The present fi ndings also confi rm that hospitals with these structural attributes adopted more technologies.
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Manary, Matthew, Richard Staelin, William Boulding, and Seth W. Glickman. "Payer mix & financial health drive hospital quality: Implications for value-based reimbursement policies." Behavioral Science & Policy 1, no. 1 (April 2015): 77–84. http://dx.doi.org/10.1177/237946151500100110.
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Documented disparities in health care quality in hospitals have been associated with patients’ race, gender, age, and insurance coverage. We used a novel data set with detailed hospital-level demographic, financial, quality-of-care, and outcome data across 265 California hospitals to examine the relationship between a hospital's financial health and its quality of care. We found that payer mix, the percentage of patients with private insurance coverage, is the key driver of a hospital's financial health. This is important because a hospital's financial health influences its quality of care and patient outcomes. Government policies that financially penalize hospitals on the basis of care quality and/or outcomes may disproportionately impair financial performance and quality investments at hospitals serving fewer privately insured patients. Such policies could exacerbate health disparities among patients at greatest risk of receiving substandard care.
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Mujasi, Paschal N., and Zerish Z. Nkosi. "Factors Associated with Outsourcing Support Services by General Hospitals in Uganda." Open Public Health Journal 10, no. 1 (December 22, 2017): 283–93. http://dx.doi.org/10.2174/1874944501710010283.
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Background: The objective of this study was to identify factors associated with the decision, process and practices of outsourcing support services by general hospitals in Uganda. Methods: A cross sectional survey design was used; 32 hospitals were sampled using stratified random sampling. Trained research assistants distributed self-administered questionnaires to managers in the sampled hospitals. Wilcoxon-Mann-Whitney tests were performed on the collected data using SAS 9.3. Results: Majority (59%) of hospitals surveyed were rural; 41% were urban. More than half (n=23; 72%) reported to be outsourcing at least one support service. There was a significant difference in the proportion of rural and urban hospitals outsourcing and those not outsourcing (p=0.0033). While outsourcing, rural hospitals were more likely to report challenges with the availability of vendors (p= 0.0152); urban hospitals were more likely to report challenges with contractual issues (p=0.0056). Ministry of Health owned hospitals were more likely to report political interference in the outsourcing process (p= 0.0065). Rural hospitals were more likely to monitor the continued need for outsourcing compared to their urban counterparts (p=0.0358). We found no significant differences (p>0.05) in the hospital managers’ perceptions about the benefits of outsourcing, outsourcing risks, characteristics of services that need to be outsourced and outsourcing barriers among outsourcing and non-outsourcing hospitals. Conclusion: Hospital location and ownership have an influence on aspects of the outsourcing decision, process and practices by general hospitals in our study. However, the perceptions of the hospital managers regarding outsourcing have no influence on the hospital’s outsourcing decision and practices.
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Mwihia, Francis Kimani, James Machoki M’ Imunya, Germano Mwabu, Urbanus M. Kioko, and Benson B. A. Estambale. "Technical Efficiency in Public Hospitals in Kenya: A Two –Stage Data Envelopment Analysis." International Journal of Economics and Finance 10, no. 6 (May 9, 2018): 141. http://dx.doi.org/10.5539/ijef.v10n6p141.
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The paper uses the DEA technique to estimate efficiency scores in Kenyan public hospitals and then applies the Tobit regression to study inter-hospital variation in the scores. The DEA analysis reveals that small hospitals are more efficient than large hospitals, with efficiency levels ranging from 74-91% in small DMUs and from 57-78% in large DMUs. Tobit regression analysis shows efficiency scores are negatively correlated with the hospital’s distance from the manager’s residence and from the capital city. Internal and external supervisions are suggested as mechanisms for increasing performance of hospitals.
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Liu, Lu, Wei Nai, and Zan Yang. "Measuring the State Dependence Effect in Hospital Payment Adjustment." International Journal of Environmental Research and Public Health 19, no. 21 (October 28, 2022): 14110. http://dx.doi.org/10.3390/ijerph192114110.
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Since FY 2013, as a part of the Affordable Care Act (ACA) program, the Hospital Value-Based Purchasing (HVBP) program has adjusted Medicare’s payments to hospitals based on the total performance score of the hospital. First, the program reduces a portion of the hospital’s Medicare payments in a specific fiscal year, and then, by the end of the same fiscal year, the amount of the payment reductions will be awarded to the hospitals based on the total performance score; thus, the hospitals that do not receive the reward will lose the portion of money reduced by Medicare. In this research, we apply the theory of state dependence and use the dynamic random effect probit model to estimate this effect. The results show that the hospital payment adjustment dynamics have a very significant state dependence effect (0.341); this means that hospitals that received a reward in the previous year are 34.1% more likely to receive a reward this year than the ones that received a penalty in the previous year. Meanwhile, we also find that the state dependence effect varies significantly across hospitals with different ownership (proprietary/government owned/voluntary nonprofit), and the results show that voluntary nonprofit hospitals exhibit the largest effect of state dependence (0.370), while government-owned hospitals exhibit the lowest effect of state dependence (0.293), and proprietary hospitals are in the middle. Among the factors that influence the likelihood that a hospital receives a reward, we find that teaching hospitals with a large number of beds (>400) are less likely be rewarded; in terms of ownership, we find that voluntary nonprofit hospitals are more likely be rewarded; in terms of demographic factors, hospitals where the average household income are higher within the region are more likely be rewarded.
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Lee, Youngsu, Joonhwan In, and Seung Jun Lee. "Social media engagement, service complexity, and experiential quality in US hospitals." Journal of Services Marketing 34, no. 6 (May 25, 2020): 833–45. http://dx.doi.org/10.1108/jsm-09-2019-0359.
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Purpose As social media platforms become increasingly popular among service firms, many US hospitals have been using social media as a means to improve their patients’ experiences. However, little research has explored the implications of social media use within a hospital context. The purpose of this paper is to investigate a hospital’s customer engagement through social media and its association with customers’ experiential quality. Also, this study examines the role of a hospital’s service characteristics, which could shape the nature of the interactions between patients and the hospital. Design/methodology/approach Data from 669 hospitals with complete experiential quality and demographic data were collected from multiple sources of secondary data, including the rankings of social media friendly hospitals, the Hospital Compare database, the Center for Medicare and Medicaid (CMS) cost report, the CMS impact file, the Healthcare Information and Management Systems Society Analytics database and the Dartmouth Atlas of Health Care. Specifically, the authors designed the instrumental variable estimate to address the endogeneity issue. Findings The empirical results suggest a positive association between a hospital’s social media engagement and experiential quality. For hospitals with a high level of service sophistication, the association between online engagement and experiential quality becomes more salient. For hospitals offering various services, offline engagement is a critical predictor of experiential quality. Research limitations/implications A hospital with more complex services should make efforts to engage customers through social media for better patient experiences. The sample is selected from databases in the US, and the databases are cross-sectional in nature. Practical implications Not all hospitals may be better off improving the patient experience by engaging customers through social media. Therefore, practitioners should exercise caution in applying the study’s results to other contexts and in making causal inferences. Originality/value The current study delineates customer engagement through social media into online and offline customer engagement. This study is based on the theory of customer engagement and reflects the development of mobile technology. Moreover, this research may be considered as pioneering in that it considers the key characteristics of a hospital’s service operations (i.e., service complexity) when discovering the link between customers’ engagement through a hospital’s social media and experiential quality.
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Siti Latifah Hanum, Destanul Aulia, and Kintoko Rochadi. "Patient Decision Making in the Choice of a Referral Hospital in Hospital of Subulussalam City in 2018." Britain International of Exact Sciences (BIoEx) Journal 2, no. 1 (February 9, 2020): 368–76. http://dx.doi.org/10.33258/bioex.v2i1.166.
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The choice of referral hospital from Hospital of Subulussalam City based on a preliminary survey is varies. Inpatients are referred to Class A hospitals are on average 65%, Class B hospitals are 30%, and Class C hospitals are 5%, while outpatients are referred to Class A hospitals are on average 49%, Class B hospitals are 28%, class C hospitals are 23%. This type of research is qualitative with a phenomenological approach obtained by conducting in-depth interviews with 13 informants consisting of 3 specialist doctors, 3 general practitioners, 3 patients, 3 patient's family and 1 BPJS verifier in Hospital of Subulussalam City. The study was conducted from February to October 2018. The results showed that during the referral hospital decision-making process there was an interaction between the doctor, the patient and the patient's family, the final decision was on the patient and bearing down the consequences if the hospital's choice was not recommended by the doctor. The determinants of decision making for referral hospitals consist of perceived quality in the form of referral hospitals accepting patients referred from Hospital of Subulussalam City, emergency conditions for patients by choosing the closest hospital, facilities in the form of supporting tests and complete medical devices and additional facilities, the availability of specialist doctors and subspecialty according to the patient's condition, geographical constraints due to the long distance to the referral hospital, references from doctors to patients and vice versa, learning in the form of doctor and patient experience in the previous referral process, not all doctors consider peer relations to be a determinant of choosing a referral hospital due to the BPJS system, social factors in the form of a family in the area of a referral hospital, the same religion and culture as a patient in a referral hospital area make the patient feel comfortable. Suggestions in this study is the management of Hospital of Subulussalam City to confirm and coordinate the referral hospital and make a referral MOU.
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Lee, Jinhyung, and Sung J. Choi. "Hospital Productivity After Data Breaches: Difference-in-Differences Analysis." Journal of Medical Internet Research 23, no. 7 (July 6, 2021): e26157. http://dx.doi.org/10.2196/26157.
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Background Data breaches are an inevitable risk to hospitals operating with information technology. The financial costs associated with data breaches are also growing. The costs associated with a data breach may divert resources away from patient care, thus negatively affecting hospital productivity. Objective After a data breach, the resulting regulatory enforcement and remediation are a shock to a hospital’s patient care delivery. Exploiting this shock, this study aimed to investigate the association between hospital data breaches and productivity by using a generalized difference-in-differences model with multiple prebreach and postbreach periods. Methods The study analyzed the hospital financial data of the California Office of Statewide Health Planning and Development from 2012 to 2016. The study sample was an unbalanced panel of hospitals with 2610 unique hospital-year observations, including general acute care hospitals. California hospital data were merged with breach data published by the US Department of Health and Human Services. The dependent variable was hospital productivity measured as value added. The difference-in-differences model was estimated using fixed effects regression. Results Hospital productivity did not significantly differ from the baseline for 3 years after a breach. Data breaches were not significantly associated with a reduction in hospital productivity. Before a breach, the productivity of hospitals that experienced a data breach maintained a parallel trend with control hospitals. Conclusions Hospital productivity was resilient against the shocks from a data breach. Nonetheless, data breaches continue to threaten hospitals; therefore, health care workers should be trained in cybersecurity to mitigate disruptions.
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Barahmani, Nadia, Andrea Parriott, Erin Epson, Genie Tang, and N. Neely Kazerouni. "Findings from healthcare-associated infections data validation attestation in California general acute-care hospitals." Antimicrobial Stewardship & Healthcare Epidemiology 2, S1 (May 16, 2022): s65—s66. http://dx.doi.org/10.1017/ash.2022.183.
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Background: Accurate and complete hospital healthcare-associated infection (HAI) data are essential to inform facility-level HAI prevention efforts and to ensure the validity and reliability of annual public reports. We implemented a validation attestation survey to assess and improve the HAI data reported by California hospitals via NHSN. Methods: The California Department of Public Health (CDPH) HAI Program invited all 401 general acute-care hospitals in California to participate in an annual HAI validation attestation survey in 2021. The survey was designed to be completed by the person with primary responsibility for HAI surveillance and reporting consistent with NHSN protocols and California laws. Survey questions addressed HAI reporting knowledge and practices and surgical procedures performed, and they included 3 hypothetical scenarios evaluating hospital application of HAI surveillance, decision making, and reporting methods. Results: We received responses from 345 hospitals (86%). For the 3 hypothetical scenarios, 171 hospitals (49.6%) correctly answered all 3 questions, 110 hospitals (31.9%) answered 2 questions correctly, 52 (15.1%) hospitals answered 1 question correctly, and 12 hospitals (3.5%) answered zero questions correctly. We did not detect a statistically significant association between facility type (ie, acute-care hospital, critical access hospital, long-term acute-care hospital, or rehabilitation hospital or unit) and the probability of getting all questions correct (Fisher exact P = .42). Of the 303 hospitals (88.0%) that perform at least 1 of the 28 surgical procedures reportable in California, 269 (88.8%) apply CDPH-recommended postoperative ICD-10 diagnosis flag codes to identify records that might indicate a possible surgical site infection (SSI). Moreover, ~289 (84.0%) hospitals confirmed that someone at their facility reviews CDPH quality assurance–quality control reports to verify the accuracy and completeness of their hospital’s reported HAI data. In 321 hospitals (93.0%) decisions about which infections are reported to NHSN are made solely by the infection preventionists or hospital epidemiologists, who are thoroughly familiar and follow NHSN protocol, definitions, and criteria. Conclusions: Most hospitals reported following best practices for evaluating records for SSIs; however, only half responded correctly to all 3 hypothetical scenarios. Our results highlight the need for ongoing education on HAI surveillance, decision making and reporting methods, and external HAI data validation in hospitals. This survey could serve as a model for other states that work with hospitals to improve HAI surveillance data and to ensure the integrity of public reports. Future research will link the results of this survey to NHSN validation audits.Funding: NoneDisclosures: None
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Wang, Yue, Jie Chen, Han Dong, Ruilin Ma, Ying Zou, Wei Wang, Qingmei Zheng, et al. "The Disparity in the Management of Polycystic Ovary Syndrome between Obstetrician-Gynecologists in Different-Level Hospitals under the Hierarchical Medical System." BioMed Research International 2022 (September 15, 2022): 1–12. http://dx.doi.org/10.1155/2022/9778678.
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Background. PCOS is a prevalent endocrine and metabolic disorder in women characterized by abnormal blood glucose, dyslipidemia, and abnormal mental health. To improve patient care, the goal of our study is to find out if there are differences in how PCOS patients are treated at different hospital levels within the hierarchical medical system. Methods. Obstetricians and gynecologists from primary, secondary, and tertiary hospitals were the participants in the survey. The responses provided and collected were analyzed using various statistical techniques like the chi-square test, Fisher exact test, and logistic regression with multiple variables. Results. The investigation examined 2298 survey replies (13.1% primary hospitals, 52.4% secondary hospitals, and 34.5% tertiary hospitals). As hospital grade increases, more participants inquire about a patient’s history of unfavorable pregnancies concerning hormone evaluation; the better the hospital’s grade, the greater the number of participants who would undergo AMH and androgen-related tests. The higher the hospital level, the more participants would pick the oral glucose tolerance test (OGTT) to determine insulin resistance, the BMI Asian criteria for defining obesity, and blood lipids. Participants in primary (odds ratio OR = 0.383 , 95% confidence interval (CI) 0.282-0.520) and secondary ( OR = 0.607 , 95% confidence interval (CI) 0.481-0.765) hospitals were significantly less likely to select OGTT than those in tertiary hospitals. Comparatively, fewer primary hospitals chose to do lipid profiling than tertiary hospitals (OR 0.689, 95% CI 0.523-0.909). With the increase in hospital level, participants were more knowledgeable about the multiple efficacies and dose alternatives of metformin and selected letrozole and assisted reproduction more frequently. Conclusion. Our study uncovered differences in the endocrine evaluation, metabolic screening, and management of PCOS patients across obstetrics and gynecology at various hospital levels. Simultaneously, it underlines the need to improve the hierarchical medical system and close the knowledge gap across hospitals.
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Portela, Maria Conceição A. Silva, Ana Santos Camanho, Diogo Queiroz Almeida, Luiz Lopes, Sofia Nogueira Silva, and Ricardo Castro. "Benchmarking hospitals through a web based platform." Benchmarking: An International Journal 23, no. 3 (April 4, 2016): 722–39. http://dx.doi.org/10.1108/bij-07-2014-0067.
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Purpose – In a context of international economic crisis the improvement in the efficiency and productivity of public services is seen as a way to maintain high-quality levels at lower costs. Increased productivity can be promoted through benchmarking exercises, where key performance indicators (KPIs), individually or aggregated, are used to compare health units. The purpose of this paper is to describe a benchmarking platform, called Hospital Benchmarking (HOBE), where hospital’s services are used as the unit of analysis. Design/methodology/approach – HOBE platform includes a set of managerial indicators through which hospital services’ are compared. The platform also benchmarks services through aggregate service indicators, and provides an aggregate measure of hospital’s performance based on a composite indicator of the service’s performances. These aggregate indicators were obtained through data envelopment analysis (DEA). Findings – Some results are presented for Portuguese hospitals for the trial years of 2008 and 2009, for which data is publicly available. Details for the service-level analysis are provided for a sample hospital, as well as details on the aggregate performance resulting from services performances. Practical implications – HOBE’s features and outcomes show that the platform can be used to guide management actions and to support the design of health policies by administrative authorities, provided that good quality and timely data are available, and that hospitals are involved in the design of the KPIs. Originality/value – The platform is innovative in the sense that it bases its analysis on hospital’s services, which are in general more comparable among hospitals than indicators of hospital overall performance. In addition, it makes use of DEA to aggregate performance indicators, allowing for user choice in the inputs and outputs to be aggregated, and it proposes a novel model to aggregate service’s efficiencies into a single measure of hospital performance.
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Qadir, Dr Murad, Dr Rafat Murad, and Dr Naveed Faraz. "HOSPITAL WASTE MANAGEMENT; TERTIARY CARE HOSPITALS." PROFESSIONAL MEDICAL JOURNAL 23, no. 07 (July 1, 2016): 802–6. http://dx.doi.org/10.17957/tpmj/16.3281.
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Boge, Knut, and Anjola Aliaj. "Albania vs Norway – FM at two university hospitals." Facilities 35, no. 7/8 (May 3, 2017): 462–84. http://dx.doi.org/10.1108/f-07-2016-0079.
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PurposeGiven the premise of de facto universal standards for FM, this paper aims to investigate development of facilities management (FM) at an Albanian and a Norwegian university hospital through examination of two hypotheses: the university hospital has recognised FM and established a designated FM organisation (H1) and the university hospital provides adequate food and catering services at ward kitchens and buffets (H2). Design/methodology/approachThis is an exploratory and descriptive comparative case study based on a diverse cases’ designs. FindingsThere is limited and strong support for H1 at the Albanian and Norwegian university hospitals, respectively. Both the Albanian and the Norwegian university hospitals rely on in-house production of facilities services, but the Albanian university hospital has outsourced food and catering services. FM and provision of facilities services are deeply integrated within the Norwegian university hospital’s core activities. There is also limited and strong support for H2 at the Albanian and Norwegian university hospitals, respectively. Hence, the Albanian Ministry of Health and the Albanian university hospital’s top management have a comprehensive, but not impossible, task, if the aim is to catch up with the Norwegian university hospital concerning FM. Research limitations/implicationsThis is an exploratory and descriptive comparative case study. Large N studies should be carried out both in Albania and Norway and preferably also in other countries to corroborate and develop the findings. Originality/valueThis is the first comparative study of FM at an Albanian and a Norwegian university hospital.
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Ham, C. "Hospitals within hospitals." BMJ 338, may05 1 (May 5, 2009): b1787. http://dx.doi.org/10.1136/bmj.b1787.
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Pylypchuk, Yuriy, Chad D. Meyerhoefer, William Encinosa, and Talisha Searcy. "The role of electronic health record developers in hospital patient sharing." Journal of the American Medical Informatics Association 29, no. 3 (December 6, 2021): 435–42. http://dx.doi.org/10.1093/jamia/ocab263.
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Abstract Objective To determine whether hospital adoption of a new electronic health record (EHR) developer increases patient sharing with hospitals using the same developer. Materials and Methods We extracted data on patients shared with other hospitals for 3076 US nonfederal acute care hospitals from the 2011 to 2016 Centers for Medicare & Medicaid Services Physician Shared Patient Patterns database. We calculated the ratio of patients shared with hospitals outside of the focal hospital’s network that use the same EHR developer as the focal hospital, and estimated difference-in-differences models to compare same-developer patient sharing among hospitals that switched to a new developer with those that did not switch developer. Results Switching to a new EHR developer increased the ratio of patients shared with other hospitals having the same EHR developer by 4.1–19.3%, depending on model specification. The magnitude of this effect varied by EHR developer and was increasing in developer market share. Discussion Consolidation in the EHR industry has led to higher patient sharing among hospitals with the same EHR developer. Contributing factors could include the growth of developer-based health information exchanges, customizable referral management systems, and provider preferences for easy and reliable data exchange. However, hospital transfers that are significantly influenced by EHR developer could lead to poor patient-provider matches. Conclusion Hospitals’ choice of EHR developer impacts the flow of patients across hospitals, which could have both desirable and undesirable effects on patient care. Future research should investigate whether health outcomes decline with greater same-developer patient sharing.
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Lahijanian, Behshad, and Michelle Alvarado. "Care Strategies for Reducing Hospital Readmissions Using Stochastic Programming." Healthcare 9, no. 8 (July 26, 2021): 940. http://dx.doi.org/10.3390/healthcare9080940.
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A hospital readmission occurs when a patient has an unplanned admission to a hospital within a specific time period of discharge from an earlier or initial hospital stay. Preventable readmissions have turned into a critical challenge for the healthcare system globally, and hospitals seek care strategies that reduce the readmission burden. Some countries have developed hospital readmission reduction policies, and in some cases, these policies impose financial penalties for hospitals with high readmission rates. Decision models are needed to help hospitals identify care strategies that avoid financial penalties, yet maintain balance among quality of care, the cost of care, and the hospital’s readmission reduction goals. We develop a multi-condition care strategy model to help hospitals prioritize treatment plans and allocate resources. The stochastic programming model has probabilistic constraints to control the expected readmission probability for a set of patients. The model determines which care strategies will be the most cost-effective and the extent to which resources should be allocated to those initiatives to reach the desired readmission reduction targets and maintain high quality of care. A sensitivity analysis was conducted to explore the value of the model for low- and high-performing hospitals and multiple health conditions. Model outputs are valuable to hospitals as they examine the expected cost of hitting its target and the expected improvement to its readmission rates.
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Yohanes Firmansyah and St. Laksanto Utomo. "A Hospital's Legal Responsibility For Patient Rights During The Covid-19 Pandemic - A Review From The Health Sector's Law Regulations." Jurnal Indonesia Sosial Sains 2, no. 8 (August 21, 2021): 1392–406. http://dx.doi.org/10.36418/jiss.v2i8.392.
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The hospital's legal responsibility to fulfill the patient's rights cannot be separated from the hospital's obligations to the patient, according to the law. This is governed by the Health Law, the Hospital Law, and the Law on Medical Practice. Various statutory provisions were also applied during the Covid-19 pandemic, which was declared a public health emergency, including the Infectious Disease Outbreak Law, the Health Quarantine Law, Presidential Decree No. 11 of 2020 concerning the Determination of the Corona Virus Disease 2019 (Covid-19) Public Health Emergency, and Permenkes No. 4 of 2018 concerning Hospital Obligations and Patience. In practice, the growing number of Covid-19 cases in Indonesia has resulted in hospitals being unable to accommodate patients in need of treatment, particularly those with severe and critical conditions who require intensive care units. With bed occupancy rates (BOR) exceeding 85 percent in almost all hospitals, the community must understand that hospitals must prioritize care for patients with moderate, severe, or life-threatening conditions. In any case, the Covid-19 pandemic had an effect on the quality of hospital care provided to patients. The study used normative juridical research methods and empirical evidence to examine hospitals' legal responsibility for upholding patient rights during the Covid-19 pandemic. The study's findings indicate that, despite limitations in providing excellent health care to patients, hospitals must uphold patient rights to safety and security during hospitalization. As a result, it is necessary to establish a legal framework that protects the rights of health care workers and hospitals providing services to patients during this pandemic, particularly the protection of work standards, occupational health and safety standards, and labor social security standards. In terms of facilities and infrastructure, the government must assist by increasing the number of emergency hospitals to accommodate the anticipated increase in Covid-19 patients.
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Amanda Pinta, Tatyana, Dumilah Ayuningtyas, and Rhinza Seputra M. Simanjuntak. "Potential Hospital Strategic Planning in the COVID-19 Era: A Systematic Review." Jurnal Ilmu Kesehatan Masyarakat 13, no. 1 (March 31, 2022): 1–13. http://dx.doi.org/10.26553/jikm.2022.13.1.1-13.
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The COVID-19 pandemic has had a negative impact on hospitals. Hospitals have to survive and make various modifications in an effort to adapt to uncertain conditions, even transform the hospital's strategic plan that has been made previously. This study aims to re-evaluate various hospital strategic plans and evaluate aspects that often change during a pandemic, as well as determine the potential for strategic planning that can be used. We initially conducted an English literature search using the electronic database, PROQUEST, Scopus, Pubmed, Science Direct, 2020-2021. After that, the study quality assessment and data extraction were carried out. A total of 1951 eligible articles were identified, The remaining 18 studies were screened. Subsequently, 10 articles were removed after a full-text review. Finally, 8 articles met the inclusion criteria for this review. Most of the hospitals in the sample show increasing and decreasing returns to scale. The inefficiency stems from the hospital's suboptimal scale, not from a lack of management ability to convert inputs into outputs. Public health centers develop systems for office support, infection control, hospital coordination, and outsourced inventory control. The impact of COVID-19 that can be felt by the community in the field of health services is the lack of availability of hospitals that can accommodate COVID-19 patients and non-COVID-19 patients. There are still many hospitals that still accept non-COVID-19 patients who have comorbidities, while hospitals also accept COVID-19 patients, one of which is asymptomatic people (OTG) who are difficult to detect. Efforts to respond to the pandemic from the start and then implement strategic measures are highly dependent on the resilience of hospitals. Strategic planning transformation can be a solution for hospital organizations to remain resilient and advanced in an uncertain era.
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Spatz, Erica S., Haikun Bao, Jeph Herrin, Vrunda Desai, Sriram Ramanan, Lynette Lines, Rebecca Dendy, et al. "Quality of informed consent documents among US. hospitals: a cross-sectional study." BMJ Open 10, no. 5 (May 2020): e033299. http://dx.doi.org/10.1136/bmjopen-2019-033299.
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ObjectiveTo determine whether informed consent for surgical procedures performed in US hospitals meet a minimum standard of quality, we developed and tested a quality measure of informed consent documents.DesignRetrospective observational study of informed consent documents.Setting25 US hospitals, diverse in size and geographical region.CohortAmong Medicare fee-for-service patients undergoing elective procedures in participating hospitals, we assessed the informed consent documents associated with these procedures. We aimed to review 100 qualifying procedures per hospital; the selected sample was representative of the procedure types performed at each hospital.Primary outcomeThe outcome was hospital quality of informed consent documents, assessed by two independent raters using an eight-item instrument previously developed for this measure and scored on a scale of 0–20, with 20 representing the highest quality. The outcome was reported as the mean hospital document score and the proportion of documents meeting a quality threshold of 10. Reliability of the hospital score was determined based on subsets of randomly selected documents; face validity was assessed using stakeholder feedback.ResultsAmong 2480 informed consent documents from 25 hospitals, mean hospital scores ranged from 0.6 (95% CI 0.3 to 0.9) to 10.8 (95% CI 10.0 to 11.6). Most hospitals had at least one document score at least 10 out of 20 points, but only two hospitals had >50% of their documents score above a 10-point threshold. The Spearman correlation of the measures score was 0.92. Stakeholders reported that the measure was important, though some felt it did not go far enough to assess informed consent quality.ConclusionAll hospitals performed poorly on a measure of informed consent document quality, though there was some variation across hospitals. Measuring the quality of hospital’s informed consent documents can serve as a first step in driving attention to gaps in quality.
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Emma Rachmawati, Yuyun Umniyatun, Deni Wahyudi Kurniawan, Mochamad Iqbal Nurmansyah, Mukhaer Pakkanna, Husnan Nurjuman, Slamet Budiarto, and Virgo Sulianto Gohardi. "ANALYSIS OF THE MARKET STRUCTURE OF HOSPITAL INDUSTRY IN INDONESIA." Jurnal Administrasi Kesehatan Indonesia 12, no. 1 (June 14, 2024): 37–48. http://dx.doi.org/10.20473/jaki.v12i1.2024.37-48.
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Background: Over the past decade, private investments in health care including hospital have grown significantly, more than doubling. As the number of hospitals in Indonesia increases, a competitive business environment develops. Identifying hospital market structure can help various stakeholders to optimize the hospital's performance. Aims: This study analyzed the market structure and concentration of the hospital industry in Indonesia. Methods: This study used hospital characteristics data from Ministry of Health of Indonesia that retrieved in October 2020. Market concentration is determined by the number of industry players operating in a market, the distribution of services, and the types of services offered. The hospital market concentration was identified by measuring the Concentration Ratio (CR) and the Herfindahl–Hirschman index (HHI). Results: The results showed that the market share of hospitals in Indonesia was still dominated by government hospitals, which represent 51.4% of the market share. The concentration ratio of four companies (CR4) remains <40, indicating that competition remains relatively open among private hospitals at the national level. Conclusion: Several cities have established hospital markets that are characterized by robust competition, whereas in other cities, the hospital industry remains oligopolistic or monopolistic. It is important to note, however, that this does not imply that the market structure is ineffective on account of competition; rather, it is the result of a scarcity of hospitals in a number of Indonesian cities. Keywords: Concentration ratio, Economic competition, Herfindahl–Hirschman Index, Hospital market
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Yang, Annie, Susan Chimonas, Peter B. Bach, David J. Taylor, and Allison Lipitz-Snyderman. "Critical Choices: What Information Do Patients Want When Selecting a Hospital for Cancer Surgery?" Journal of Oncology Practice 14, no. 8 (August 2018): e505-e512. http://dx.doi.org/10.1200/jop.17.00031.
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Purpose: Access to comparative information on hospitals’ quality of cancer care is limited. Patients’ interest in using this information when selecting a hospital for cancer surgery and the specific data they would desire are unknown. This study gauges patients’ demand for comparative information on hospitals’ quality of cancer surgery. Methods: We conducted a cross-sectional, national survey of 3,334 US residents who had received cancer surgery. The outcomes were patients’ reported likelihood of using a list of best hospitals for cancer surgery and patients’ reported interest in information about specific clinical outcomes, including 4-year survival after surgery, 30-day mortality after surgery, and rate of complications from surgery. Results: Two thirds of patients (68%) reported being actively involved in selecting a hospital for their surgery, and two thirds (65%) reported that their physician was involved in or made this decision. When asked what information might have helped them to choose a hospital, participants identified the hospital’s reputation (55%), patient satisfaction (44%), and the number of cancer surgeries performed at the hospital (36%). Approximately three quarters (73%) reported being likely to use a list of best hospitals for cancer surgery when selecting a hospital. Approximately 40% expressed interest in having information on at least one clinical outcome. Conclusion: Widespread interest exists among patients with cancer for comparative information on hospital quality as well as on clinical outcomes and hospitals’ reputation for cancer surgery. Policy reforms and additional research should address the unmet need for transparent, comprehensive data on the quality of hospitals’ cancer care.
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Li, Jialing, Guiju Zhu, Xinya Hu, Ruqian Fei, Dan Yu, and Dong Wang. "Study on the evolutionary strategy of upward patient transfer in the loose medical consortia." Mathematical Biosciences and Engineering 20, no. 9 (2023): 16846–65. http://dx.doi.org/10.3934/mbe.2023751.
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<abstract> <p>Medical institutions in loose medical consortia tend to have poor cooperation due to fragmented interests. We aim to explore any issues associated with patient upward transfer in a loose medical consortium system consisting of two tertiary hospitals with both cooperative and competitive relationships. A two-sided evolutionary game model was constructed to assess the stability of equilibrium strategy combinations in the process of interaction between game players under different cost-sharing scenarios and different degrees of penalties when running patient upward transfer between super triple-A hospitals (STH) and general triple-A hospitals (GTH). We found that a hospital's stabilization strategy was related to its revenue status. When a hospital has high/low revenues, it will treat patients negatively/positively, regardless of the strategy chosen by the other hospital. When the hospital has a medium revenue, the strategy choice will be related to the delay cost, delay cost sharing coefficient, government penalty and the strategic choice of the other hospital. Delay cost-sharing coefficient is an important internal factor affecting the cooperation in a medical consortium for patient upward transfer. External interventions, such as government penalty mechanisms, can improve the cooperation between hospitals when hospitals have moderate revenue.</p> </abstract>
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Wang, Yi-Wei, and Ja-Ling Wu. "A Privacy-Preserving Symptoms Retrieval System with the Aid of Homomorphic Encryption and Private Set Intersection Schemes." Algorithms 16, no. 5 (May 9, 2023): 244. http://dx.doi.org/10.3390/a16050244.
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This work presents an efficient and effective system allowing hospitals to share patients’ private information while ensuring that each hospital database’s medical records will not be leaked; moreover, the privacy of patients who access the data will also be protected. We assume that the thread model of the hospital’s security is semi-honest (i.e., curious but honest), and each hospital hired a trusted medical records department administrator to manage patients’ private information from other hospitals. With the help of Homomorphic Encryption- and Private Set Intersection -related algorithms, our proposed system protects patient privacy, allows physicians to obtain patient information across hospitals, and prevents threats such as troublesome insider attacks and man-in-the-middle attacks.
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Roy, PhD, Shreya, Sarbinaz Bekmuratova, PhD, Sharon Medcalf, PhD, Harlan Sayles, MS, Wael ElRayes, MD, PhD, FACHE, Jeanne S. Ringel, PhD, and Ronald J. Shope, PhD. "Emergency preparedness: Interviews with senior leadership in Nebraska hospitals." Journal of Emergency Management 18, no. 5 (September 1, 2020): 399–409. http://dx.doi.org/10.5055/jem.2020.0488.
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Objective: The objective of this study was to explore perceptions of senior leadership in hospitals on the motivations, cost, benefits, barriers, and facilitators of investment in emergency preparedness. Study design: This is a qualitative study which used a grounded theory approach to develop a theory of hospital emergency preparedness. Setting and study participants: A purposive sample of hospital leaders (n = 11) in the US state of Nebraska were interviewed.Results: Results showed that the environmental risk associated with the hospital location, the hospital’s position in the community, and the preparedness requirements of the Centers for Medicare and Medicaid Services contribute to investment decisions. Rural hospitals face unique challenges in preparing for disasters, for example, lack of trained personnel. Facilitators of disaster preparedness include the availability of federal funds, the commitment of leadership, and an organizational mission aligned toward emergency preparedness. Hospitals invest in hazard vulnerability assessments; partnerships with other organizations in the community; staff trainings and infrastructure.Conclusions: The authors concluded that hospitals in Nebraska are committed toward investing in preparedness activities. The theory of hospital emergency preparedness developed will be used in a subsequent study to develop a decision-support framework for hospital investment in preparedness.
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Alsingery, Ban R., Dunya A. Alabbawy, and Hassan Khaleel Almahmood. "Assessment of Wastewater Characteristics of Treatment Units in some Hospitals in the City of Basra." IOP Conference Series: Earth and Environmental Science 1215, no. 1 (July 1, 2023): 012051. http://dx.doi.org/10.1088/1755-1315/1215/1/012051.
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Abstract This paper presents the results of the flowing water characteristics from the sanitation system studied in targeted hospitals in the city of Basra, Iraq, in four sites from the 1st of December 2021 to the 1 st of March 2022, including two major sites for government hospitals and two main sites for private hospitals. Statistical analysis of a set of physicochemical water quality parameters of flowing water collected directly from hospitals and water flowing before mixing with public sewage was conducted to investigate the efficiency of a hospital wastewater treatment plant in Basra, Iraq. The study concluded that the operational capacity in the selected treatment stations is commensurate with the hospital’s absorptive capacity and that all stations from different global origins operate as efficiently. The efficiency of removing Al–Saadi Hospital is 44.7% higher than other hospitals (Al–sader teaching, Al Mawanee, and Al–Mawadda) the efficiency of removing was (43.06%, 41.35%, 37.73%) respectively that have been studied. It is necessary to provide government and private hospitals with biological treatment stations to achieve the water environment in a city that suffers from severe pollution of water resources.
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Peyravi, MD, PhD, Mahmoudreza, Milad Ahmadi Marzaleh, PhD Candidate, Fatemeh Gandomkar, MSc, Aman Allah Zamani, PhD Candidate, and Amir Khorram-Manesh, MD, PhD. "Hospital Safety Index analysis in Fars Province hospitals, Iran, 2015-2016." American Journal of Disaster Medicine 14, no. 1 (January 1, 2019): 25–32. http://dx.doi.org/10.5055/ajdm.2019.0313.
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Background and objectives: Hospitals are the vital part of disaster management and their functionality should be maintained and secured. However, it can be the target of natural and man-made disasters. In Iran, Fars Province is prone to major incidents and disasters in its hospitals at any time during the course of a year. This study aimed to examine the Hospital Safety Index (HSI) in all hospitals (public and private) affiliated to Shiraz University of Medical Sciences (SUMS).Materials and methods: This cross-sectional study was conducted during 2015-2016, using the World Health Organization’s HSI checklist. All 58 hospitals in Fars Province affiliated to SUMS were included. The hospital assessment team was formed to collect the data retrospectively and by visiting and interviewing hospital’s authority based on the checklist. The collected data were analyzed using Microsoft Excel.Results: The results showed that in the abovementioned years, the structural safety of hospitals reached the highest optimal level, whereas functional safety reached the lowest level. The results of the studies conducted in 2016 showed that during this year, the overall hospital safety level improved (6 and B).Conclusion: Although safety in hospitals located in Fars Province has improved due to continuous disaster mitigation and preparedness activities, there is still space for more improvement to achieve and maintain higher levels of safety in hospitals. Paying attention to this, the authors recommend that proper policies, legislation, and intra- and inter-institutional coordination are the requirements for a successful outcome.
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Abasi Sanjdari, Zeinab, Iravan Masoudi asl, Katayuon Jahangiri, and Leila Riahi. "A comparison of hospital quality management systems in Tehran hospitals and European hospitals." MEDICAL SCIENCES JOURNAL 28, no. 2 (June 1, 2018): 136–44. http://dx.doi.org/10.29252/iau.28.2.136.
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Westert, Gert P., Anna P. Nieboer, and Peter P. Groenewegen. "Variation in duration of hospital stay between hospitals and between doctors within hospitals." Social Science & Medicine 37, no. 6 (September 1993): 833–39. http://dx.doi.org/10.1016/0277-9536(93)90377-g.
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