Greek Hospitals Research Articles

COVID-19 Disease and Vaccination: Knowledge, Fears, Perceptions and Feelings of Regret for Not Having Been Vaccinated among Hospitalized Greek Patients Suffering SARS-CoV-2 Infection.

Background: The development of vaccines against COVID-19 has greatly altered the natural course of this infection, reducing the disease’s severity and patients’ hospitalization. However, hesitancy against vaccination remains an obstacle in the attempt to achieve appropriate herd immunity that could reduce the spread of SARS-CoV-2. The aim of this study was to investigate the perceptions and attitudes of COVID-19 patients hospitalized during the fourth pandemic wave in two Greek hospitals and assess whether their experience had changed their intentions regarding vaccination against COVID-19. Methods: This is a cross-sectional, questionnaire-based survey, conducted from 31 August 2021 to 18 February 2022 in the COVID-19 departments of two tertiary care hospitals. The questionnaire included questions regarding the patients’ educational level, knowledge and beliefs regarding SARS-CoV-2, personal protection measures, beliefs regarding vaccination, vaccination status, reasons for not been vaccinated against SARS-CoV-2, feelings of regret for not been vaccinated, and willingness to be vaccinated in the future. All adult patients with COVID-19 were eligible, regardless of their vaccination status against SARS-CoV-2. Results: In total, 162 patients agreed and participated in the study, with 97% of them suffering severe COVID-19. Their median age was 56 years, and 59.9% (97 patients) were male. Among them, 43.8% had been vaccinated against COVID-19. When unvaccinated patients were asked the reasons for not being vaccinated, the most frequent responses were that they were waiting for more scientific data, due to uncertainty about long-term consequences of the vaccine, and their fear of thrombosis. When at discharge, unvaccinated hospitalized COVID-19 patients were asked whether they would get vaccinated if they could turn time back, and 64.7% of them replied positively. Conclusions: The study reveals several patients’ fears and misconceptions and suggests that there is room for implementing measures that could reduce knowledge gaps allowing for improvement of vaccination rates against COVID-19.

Exploring Nurses' Working Experiences during the First Wave of COVID-19 Outbreak.

During the COVID-19 outbreak, nurses employed in the clinical sector faced a number of difficulties associated with excessive workload, increased stress, and role ambiguity, which impacted nurses themselves and patient care. The aim of the present study was to investigate how Greek hospital nurses working in non-COVID units experienced the virus outbreak during the first wave of the pandemic. A descriptive qualitative research design was applied using a content analysis approach. To recruit the study participants a purposive sampling strategy was used. Ten nurses participated in the study. Data collection was conducted through semi-structured interviews. Content analysis revealed three themes namely, (a) emotional burden, (b) professional commitment, and (c) abrupt changes. Six subthemes were formulated and assimilated under each main theme respectively. Organizational changes, emotional burdens and feelings of fear and uncertainty, appeared to have a crucial effect on nurses and patient care. However, the professional commitment and the nurses’ effort to provide excellent nursing care remained high. Nurses demonstrated that despite the burdens caused by the COVID-19 outbreak, the pandemic era created opportunities for thoroughness and accuracy in nursing care.

Work engagement and job satisfaction in the medical sector

Work engagement and job satisfaction are among the aspects of psychological well-being. This study is an empirical investigation regarding the levels of work engagement and job satisfaction among doctors who work in Greek public hospitals. Moreover, the purpose of the paper is to examine the relationship between these two concepts. Results revealed that the concepts of work engagement and job satisfaction are strongly positively correlated, while work engagement appears to be a very important predictor of intrinsic satisfaction but it can also predict extrinsic satisfaction to some extent.

Assessing Internal Consistency of HAIS-Q: A Survey Conducted in Greek Hospitals.

Despite the prevailing perception that powerful software and hardware are adequate solutions to minimize information systems' security breaches, privacy remains at stake. Human factors play an important role in maintaining information security as it is evident that non secure practices applied by employees may increase the vulnerability of the systems and lead to privacy issues. Non secure practices found in literature are related to the use of Internet, the use of emails, password management, information handling and incidence reporting. For this purpose a survey was designed to be conducted in seven hospitals in Greece in order to record non secure practices applied by nursing staff and identify correlation factors. This paper presents the reliability test of the HAIS-Q tool which was applied in order to conduct the survey entitled: Examining the Nurses' non secure IT practices in Greek Hospitals as well as the preliminary results of the study.

Association of sleep duration and quality with immunological response after vaccination against severe acute respiratory syndrome coronavirus-2 infection.

SummaryGrowing evidence suggests that sleep could affect the immunological response after vaccination. The aim of this prospective study was to investigate possible associations between regular sleep disruption and immunity response after vaccination against coronavirus disease 2019 (COVID‐19). In total, 592 healthcare workers, with no previous history of COVID‐19, from eight major Greek hospitals were enrolled in this study. All subjects underwent two Pfizer–BioNTech messenger ribonucleic acid (mRNA) COVID‐19 vaccine BNT162b2 inoculations with an interval of 21 days between the doses. Furthermore, a questionnaire was completed 2 days after each vaccination and clinical characteristics, demographics, sleep duration, and habits were recorded. Blood samples were collected and anti‐spike immunoglobulin G antibodies were measured at 20 ± 1 days after the first dose and 21 ± 2 days after the second dose. A total of 544 subjects (30% males), with median (interquartile range [IQR]) age of 46 (38–54) years and body mass index of 24·84 (22.6–28.51) kg/m2 were eligible for the study. The median (IQR) habitual duration of sleep was 6 (6–7) h/night. In all, 283 participants (52%) had a short daytime nap. In 214 (39.3%) participants the Pittsburgh Sleep Quality Index score was >5, with a higher percentage in women (74·3%, p < 0.05). Antibody levels were associated with age (r = −0.178, p < 0.001), poor sleep quality (r = −0.094, p < 0.05), insomnia (r = −0.098, p < 0.05), and nap frequency per week (r = −0.098, p < 0.05), but after adjusting for confounders, only insomnia, gender, and age were independent determinants of antibody levels. It is important to emphasise that insomnia is associated with lower antibody levels against COVID‐19 after vaccination.

The Effect of COVID-19 on Hemoglobinopathy Patients’ Daily Lives While Quarantined: Four Greek Hospitals’ Experiences

During a pandemic, people are fearful of becoming infected with the virus, which causes anxiety, loss of purpose, and depression. This study aimed to evaluate the social and psychological impact, as well as the impact on homecare, of patients with hemoglobinopathies during the pandemic. Material and Methods: In total, 130 patients from four Thalassemia and Sickle Cell Disease Units of the National Health System of Greece Hospitals were examined via an anonymous questionnaire developed and distributed through stratified sampling. Results: Transfusion-dependent thalassemia, transfused sickle cell disease, and other hemoglobinopathies were represented by 130 patients. During the pandemic, the main concern of patients was the affordability of blood for transfusion. During the lockdown, patients’ moods varied, and their daily lives were disrupted by a lack of access to basic goods and communication with friends and family. Their eating habits, access to exercise, and, to a lesser extent, their financial situation have all been affected in their daily lives. It is crucial to highlight that while access to health services did not suffer in terms of medication and regular visits for their actual disease, it did suffer in terms of the systematic monitoring of complications.

Factors influencing the duration of hospitalization of patients with schizophrenia.

IntroductionSevere mental disorders represent an important and large proportion of healthcare resource utilization and are associated with increased hospitalization rates and costs. Given the high percentage of total hospital days and costs associated with caring for people with psychotic disorders, a better understanding of the factors that determine the duration of hospitalization of patients with such disorders is imperative.PurposeThe aim of the present study was to investigate socio-demographic, clinical and psychosocial characteristics of patients with schizophrenia, admitted to a Greek public psychiatric hospital, and the relationship between these characteristics and duration of hospitalization among these patients.MethodsThis is a cross-sectional study. The study sample consisted of 103 patients diagnosed with schizophrenia (F-20). The collection of data was performed by using the NEO-Five Factor Inventory, the Connor-Davidson Resilience Scale (CD-RISC25), Multidimensional Scale of Perceived Social Support, (MSPSS), Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning scale (GAF) for assessing key personality factors, psychological resilience, social support, symptom severity and the severity of the disease, respectively. Descriptive analyses and inferential statistic methods were applied. Correlation between socio-demographic, psychosocial or clinical characteristics with the length of stay were explored. In addition, linear regression analysis was performed in order to examine predicting factors for the duration of hospitalization. All statistical analysis was performed using SPSS v.25.ResultsThe mean age of the sample was 43.9 (SD = ±11.4) years, 67% of patients were men, and the mean length of hospitalization was 40.7 days. Factors found to be significantly associated with length of stay in the overall sample include the previous admissions (p=0.010), the type of admission (compulsory or voluntary) (p=0.017), bed rest (p=0.043) and duration of bed rest (p=0.002), and the existence of social support networks especially from friends (p=0.018).ConclusionsOur findings indicate that basic psychosocial and clinical factors were associated with the duration of hospital stay. Duration of hospitalization results from a complex interface between characteristics and activities of the health system, patient, and clinician’s influence on discharge timing, which requires additional study. Our findings further warrant the need for policymakers to consider socio-demographic status, psychosocial and clinical factors when allocating resources to hospitals caring for patients with severe mental disorders.

Apremilast Survival and Reasons for Discontinuation in Psoriasis: Five-Year Experience From a Greek Tertiary Care Centre.

IntroductionDrug survival is an indirect measure of efficacy and safety and its post-marketing assessment using real-life data is invaluable.ObjectivesTo investigate the survival of apremilast in a cohort of psoriasis patients treated with apremilast in a Greek hospital.MethodsA retrospective cross-sectional study examined adult psoriasis patients receiving apremilast (March 2016 to January 2021). Primary endpoint was the cumulative survival probability at 52 weeks. Kaplan-Meier analysis was used to calculate survival probability. Cox regression analysis was performed to investigate potential risk factors for apremilast discontinuation.ResultsOne hundred and two patients (29.4% females) with a mean age of 55.9 years (standard deviation 15.21) were included. Sixty-five patients (63.7%) had discontinued treatment by lock date: 19 (18.6%) due to lack of efficacy, 24 (23.5%) due to loss of efficacy, 15 (14.7%) due to adverse reactions, and 7 (6.9%) due to other reasons. Cumulative survival probability at 52 weeks was 52.1%. Median survival time for all reasons for discontinuation was 58 weeks (95% Confidence Interval 40.02, 75.98).ConclusionsApproximately half of patients remained on apremilast after 1 year of treatment. Secondary drug failure was the most common reason for discontinuation.

M086 Screening of HIV infection: Five years experience of a tertiary care Greek hospital

M086 Screening of HIV infection: Five years experience of a tertiary care Greek hospital

Managing hospitalized patients with bacterial infections: the price-to-pay upon site of infection.

Infections impose a significant burden on healthcare costs worldwide. We aimed to explore antibiotic- and hospital-related costs of infections needing admission in a tertiary university hospital in Greece. We performed a prospective cohort study in the medical care unit of a tertiary university hospital in Greece, for the period May 2016 to May 2018. Patients admitted with respiratory, urinary, gastrointestinal tract, skin, soft tissue and bone infections or primary bacteremia were included in this study. Costs of hospitalization and unit cost of antibiotic regimen were retrieved from a database for Greek hospitals containing data for each International Classification of Diseases (ICD-10) code and the national formulary respectively, and manually calculated for each patient. Antibiotic costs represent approximately 14-40% of total hospital-related costs depending on infection studied. Skin, soft tissue and bone infections and primary bacteremia led hospital- and antibiotic-related costs, with median costs of &euro;6370 (interquartile range (IQR) 3330.90-11 503.90), &euro;2519.90 (IQR 431.50-8371.10), &euro;4418.10 (IQR 2335-8281.90) and &euro;1394.30 (IQR 519.12-6459.90), respectively. Antibiotic- and hospital-related costs significantly differs with site of infection (p<0.0001). Length of stay is strongly correlated with antibiotic- and hospital-related costs, while site of infection is moderately related to antibiotic cost (eta value 0.445), and hospital-related cost (eta value 0.387). Healthcare-related costs vary substantially depending on site of infection. Information about real-life costs can drive best decisions and help to reduce healthcare expenditures.

Factors that determine parents’ satisfaction with the care given to their children in two Greek public hospitals

Background: Patient satisfaction is a valuable measure of the healthcare quality, which in turn is the most necessary condition for effective healthcare services. Aim: To evaluate the inpatient children’s parental satisfaction, in order to assess the quality and outcomes of the public healthcare services. Method and Material: A cross-sectional study was conducted, on a random sample of 120 parents of children who were hospitalized in the two major public pediatric hospitals of Athens, using the Greek version of the Swedish Pyramid Quality of Care Questionnaire - Parents version. Results: Parental satisfaction was at high levels (overall index 80.2%), mainly due the medical and nursing staff attitudes (93.11%), medical &amp; nursing care (92.32%) and information about the child’s illness / condition provided (84.75%). Low satisfaction observed due the accessibility of health services (66.16%) and the working environment of the staff (68.14%), and also in respect of waiting times for clinical and laboratory tests, in low-moderate severity cases. Conclusions: The high levels of parents' satisfaction with hospital pediatric care is a result of the attitudes, knowledge and skills of the medical and nursing staff.

Risk identification, assessment and management in the Greek public hospitals: The contribution of the board of directors and internal audit

Research Question: Our study examines the development of a reliable internal audit plan in the Greek public hospitals, focusing on how to identify, assess and evaluate the relevant risks by the Boards of Directors. Data: We use an exceptional database drawing information from a large sample of Greek hospitals based on a structured questionnaire for the period from September 1, 2015 to March 31, 2017. Tools: As our primary source of data we conduct interviews with CAEs of Greek hospitals’, while secondary data sources come from corporate governance codes, COSO framework for ERM, Greek corporate governance laws, regulations, best practices and published articles. Findings: Taking into account the financial crisis of the last ten years in Greece as well as the pathogenesis of the healthcare system, we note the poorly organized risk management in Greek hospitals. The results show that the financial crisis had a direct impact on the way risk management of public hospitals operates. Furthermore, we observe denial of the application and implementation in the form of formal guidelines to the members of the hospitals’ Board of Directors. Contribution: Research findings can have a catalytic effect on hospital management and those who implement public policies.

Changes in molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae in the intensive care units of a Greek hospital, 2018-2021.

The spread of multi-drug resistant (MDR) Gram-negative bacteria, including Klebsiella pneumoniae, constitutes a global threat. The most frequent mechanism of acquired carbapenem resistance is the production of carbapenemases, especially KPC, NDM, VIM, IMP and OXA-48. We analyzed the epidemiological trend of carbapenem resistance genes of carbapenem-resistant K. pneumoniae (CRKP) strains isolated from critically ill patients in a Greek tertiary hospital. The study included 150 CRKP isolates collected from 116 (77.4%) patients hospitalized in the adult ICU and 17 (11.3%) each in the pediatric and the two neonatal ICUs between March 2018 and March 2021. Identification and antimicrobial susceptibility testing were performed using VITEK-2. A multiplex lateral flow immunoassay was used for the detection of carbapenemases, while the detection of bla VIM, bla KPC, bla NDM, bla IMP and bla OXA-48-like genes was achieved by multiplex PCR. The bla NDM was mainly detected in adults (54/116, 46.9%), while in children the most often detected gene was bla KPC (24/34, 70.6%). The predominant carbapenem resistance gene during 2018-2019 was bla KPC alone or in combination with bla VIM, reaching 44.4% in 2019, while during 2020-2021 the detection of bla NDM prevailed significantly, reaching 45.5 and 60.7% for 2020 and 2021, respectively. A shift in the molecular epidemiology of CRKP was seen during 2018-2021, which is probably associated with the recent excessive empiric use of newer antimicrobials. Surveillance studies and proper and strict implementation of infection control measures are highly needed to decrease the spread of MDR bacteria, including CRKP.

ICU-Associated Gram-Negative Bloodstream Infection: Risk Factors Affecting the Outcome Following the Emergence of Colistin-Resistant Isolates in a Regional Greek Hospital.

Intensive care unit patients may present infections by difficult-to-treat-resistant Gram-negative microorganisms. Colistin resurfaced as a last resort antibiotic for the treatment of multi-drug-resistant Gram-negative bacteria. However, colistin might not improve survival, particularly after the emergence of colistin-resistant isolates. We aimed to (1) examine the first Gram-negative-associated-bloodstream infection (GN-BSI) effect on 28-day mortality and (2) distinguish mortality risk factors. From 1 January 2018 to 31 December 2019, we retrospectively studied all adult patients admitted for more than 48 h in the critical care department of a regional Greek hospital, with prevalent difficult-to-treat Gram-negative pathogens. We examined the patient records for the first GN-BSI. The local laboratory used broth microdilution to evaluate bacterial susceptibility to colistin. Seventy-eight patients fulfilled the entry criteria: adult and first GN-BSI. They developed GN-BSI on day 10 (6–18), while the overall mortality was 26.9%. Thirty-two and 46 individuals comprised the respective colistin-resistant and colistin-sensitive groups. The admission Acute Physiology Assessment and Chronic Health Evaluation II score was associated with acquiring colistin-resistant GN-BSI in the multivariable logistic regression analysis (οdds ratio (CI), 1.11 (1.03–1.21)). Regarding mortality, the index day sequential organ failure assessment score was solely associated with the outcome (hazard-ratio (CI), 1.23 (1.03–1.48), Cox proportional hazard analysis). GN-BSI was often caused by colistin-resistant bacteria. Concerning our data, sepsis severity was the independent predictor of mortality regardless of the colistin-resistance phenotype or empirical colistin treatment.

Internal Quality and Job Satisfaction in Health Care Services.

(1) Background: The main purpose of this study was to evaluate the health services’ internal quality level in Greek public hospitals and to investigate whether there is a relation between internal quality and health care professionals’ job satisfaction. (2) Material and Methods: A cross-sectional study was conducted in six public hospitals (four general and two specialized hospitals). The following tools were used to collect data: (a) the SERVQUAL questionnaire, which is designed to measure service quality through five dimensions, and (b) the Job Satisfaction Survey (JSS) questionnaire, which is designed to measure employees’ job satisfaction. Convenience sampling was used as a sampling technique. (3) Results: The level of internal quality service was found to be low as regards the dimensions of: reliability, assurance, responsiveness, and empathy, while the “tangibles” dimension was the only one which was assessed as having a satisfactory internal quality level. Τhe results also revealed a positive correlation between the job satisfaction subscales and the quality dimensions. Regarding demographic characteristics and their effect on employees’ perceptions of internal quality dimensions, the study found that the gender and the educational factor had no effect while younger employees have a more positive perception of the quality of responsiveness dimension in the health organizations where they work. In terms of profession, administrative staff had a lower perception of the quality of tangibles dimension than doctors and nurses. Concerning years of experience, the results indicated that employees with more previous working experience had a worse perception of the quality of reliability, responsiveness, and assurance dimensions. (4) Conclusions: According to the results, establishing a sense of trust and understanding between management and health professionals through effective communication, transparent evaluation, and reward is critical to developing, enhancing, and promoting an internal quality culture in a hospital setting.

Job satisfaction and support in the medical profession: The foundations of efficient organizational healthcare performance

PurposeThe purpose of the paper is to examine the levels of job satisfaction among doctors who work in Greek public hospitals, to determine the factors that may influence their satisfaction, to examine the contribution that staff support makes to job satisfaction and to investigate the potential impact that an economic recession might have on job satisfaction.Design/methodology/approachThe sampling process used was stratified sampling and it was applied to all health regions in Greece. An official request to carry out the study was sent to 45 hospitals for the approval of their management. Through random sampling, 5% of the doctors' population was selected from each participating hospital, with the resulting sample consisting of 458 doctors from all the health regions of Greece. An anonymous questionnaire was administered to the sample of medical doctors to gather data on their perception of the work they do in public hospitals.FindingsEmpirical results showed that (1) the most important factor in doctors' job satisfaction appears to be the nature of their job and the high levels of autonomy that they have, and (2) doctors' level of commitment is maintained by enhancing their positive emotions and sense of professional well-being.Originality/valueA deeper understanding of important concepts of an organization's behavior such as job satisfaction, staff support and their connection with internal organizational structures will facilitate policy makers and those who make decisions on the strategic management of medical staff in public hospitals.

The role of leadership–member exchange relationships in the implementation of the International Public Sector Accounting Standards by Greek public hospitals

PurposeThis paper aims to examine the quality of relations within upper-level management in Greek public hospitals (GPHs), as well as to specify the extent to which these facilitate or hinder the forthcoming International Public Sector Accounting Standards (IPSAS) adoption and implementation.Design/methodology/approachA survey was conducted on a sample of 143 upper-management professionals drawn from across the 125 GPHs. A multivariate structural equation model (SEM) is used to investigate the degree of interdependence of the level of convenience of implementation under the view of the leader-member exchange (LMX) scale.FindingsThe findings suggest that the established leader-member relations in the GPHs facilitate reforms. However, these relationships are of little benefit to IPSAS adoption and implementation mainly due to the low degrees of competence and commitment to IPSAS. The passive adoption of IPSAS is the most likely outcome.Originality/valueThe study recontextualizes the LMX model to public sector research. The findings have value to hospital leadership and to policymakers, as well as to researchers studying the difficulties of IPSAS adoption and implementation.

Prediction and Optimization of the Cost of Energy Resources in Greek Public Hospitals

The continuous operation and the specialized conditions needed for safely delivering healthcare services make hospitals among the most expensive buildings. Several studies in different countries have investigated the potential role and contribution of macroscopic indices of hospitals in total energy requirements. In this work, we tried to investigate the energy requirements of Greek hospitals in terms of cost. We collected data from all public hospitals in Greece over a 2 year period (2018–2019) and evaluated the contribution of various factors in the total energy cost. The data revealed large variability by region and by hospital, even regarding structures of the same category and size. The analysis also showed that structural and operational data of each hospital differently influence the hospitals’ energy requirements. Using regression methods, we developed two models for calculating annual energy costs. One only contains hospital structural data (number of beds, type of hospital, number of employees, and the non/use of alternative energy sources such as natural gas), and it reached an R² of 0.84. The second model contains not only structural but also operational data from each hospital (number of the internal patients, number of surgeries and number of medical imaging tests), and it reached an R² of 0.87. The former model is easier to compute since it only relies on data that can be easily gathered, but the latter has slightly better performance. These tools can help the Ministry of Health and hospitals’ management to identify the factors that contribute to the energy cost in order to plan targeted interventions, be well-prepared regarding budgeting, and be able to progressively measure, monitor, and improve the environmental footprint of hospitals by investing in renewable energy resources.

Greek health system efficiency and productivity: A window DEA and Malmquist method measurement

To calculate the change in the values of efficiency and productivity of public hospitals in Greece during the period 2015 to 2019. The calculation of the efficiency values includes the technical, pure and scale efficiency using the window-DEA method and the productivity change using the Malmquist index. The source of the data used to calculate the change in the efficiency of Greek public hospitals is the statistical databases of the Greek Ministry of Health that have resulted from the collection of data through Information Systems in combination with data provided by the Greek Statistical Authority (ELSTAT). The design of the study was based on the realization of a Window DEA study and the calculation of the Malmquist index with its components. The study was designed to measure the change in efficiency and productivity but over a relatively long period of time. The data were obtained from the databases of both financial and operational data of Greek Public Hospitals held by the Greek Ministry of Health and located on the Ministry’s website. Also, additional data were requested and obtained from ELSTAT. The data were examined and those which were appropriate for the conduct of the study were selected. The technical efficiency of Greek hospitals follows a slightly upward trend with ups and downs. Their pure efficiency follows a steady course with ups and downs. Scale efficiency is on an upward course. Productivity exhibits an overall negligible change. The research’s fluctuation of the inputs and outputs determines the change in the values of efficiency and, in combination with technological change, of productivity. During the period under study, the best placement of Greek hospitals on the scale is achieved in terms of their size. Hospital management cannot achieve better utilization of resources. A parallel increase of some of the inputs and outputs prevents increase in the values of technical and pure efficiency. The change in efficiency constrains the change in productivity.

Assessing Earnings Quality of Greek Public Hospitals

Purpose: This paper examines the factors that affect the Net Income of Greek public hospitals for the period 2015-2018. The main objective is to explore whether there is evidence for accounting principles violation. Methodology: A representative sample of 107 public hospitals which accounts almost the 85% of the total, is chosen to construct a dataset that contains information about the type of hospital, the number of hospitalized patients and other variables that are taken from the financial statements. Furthermore, this study adopts the OLS method in order to draw relative conclusions. Findings: We conclude that differences in the applied accounting policies from the Greek Public Hospitals significantly affect their Net Income. Specifically, we observe that hospitals who apply a more conservative receivables accounting do not seem to be significantly affected by the government policies, while hospitals apply less conservative accounting policies significantly affected by government policies. Originality: This study is the first one to examine the effect of the government decision to grant Greek Public Hospitals in 2016 on their earnings. Furthermore, as accounting data is publicly available relatively recently (2011) accounting research regarding Greek Public Hospitals is scarce.