Heads Of Clinical Departments Research Articles

A descriptive study on clinical department managers’ cognition of the Plan-Do-Check-Act cycle and factors influencing their cognition

BackgroundThe mastery and application of the “Plan-Do-Check-Act” (PDCA) cycle by hospital clinical department managers are essential for hospitals to carry out total quality management and continuously improve medical quality. This study investigated the degree of cognition of the PDCA cycle by clinical department managers and the factors affecting their cognition.MethodsA self-designed questionnaire was used to evaluate the cognition of clinical department managers regarding the PDCA cycle in 11 municipal public Class III Grade A hospitals in Western China.ResultsMore than 25% of clinical department managers in the surveyed hospitals are unaware or partially aware of the PDCA cycle. Logistic regression analysis showed that sex (P = 0.049), education (P < 0.001), duty (P < 0.001), and tenure (P = 0.002) had a significant influence on managers’ cognition of PDCA. Participants who were female (P < 0.001), undergraduate (P < 0.001), head nurses, or deputy head nurses (P < 0.001), with a tenure of 5–10 years (P = 0.024) had a better cognition of the PDCA cycle. In the daily management of the department, the vast majority of managers do not implement the Check and Action steps. Among the trained managers, only 65.44% applied the complete PDCA cycle in daily management. Nearly a third of managers thought PDCA was a response to hospital demands; 82.83% of the managers need to receive PDCA cycle training, and half of them indicated a preference for online training.ConclusionsThe cognition level of hospital clinical department managers regarding the PDCA cycle is relatively low, especially among the clinical department heads, and most of them are willing to accept PDCA cycle training.

PERSONAL GROWTH AND PERCEIVED ABILITY TO WORK OF HEADS OF DEPARTMENTS OF MEDICAL ORGANIZATIONS

Despite the need for the heads of departments to implement the labor functions of a clinician and manager, the study of personal growth and perceived ability to work in this category of medical workers was not carried out. determining the relationship of personal growth and perceived ability to work of heads of departments of medical organizations, as well as the impact on self-esteem of various characteristics of this category of respondents. A correspondence survey was conducted of 216 heads of clinical departments in the section «personal growth» of the questionnaire «psychological well-being of Riff» and the questionnaire «perceived ability to work» of the Institute of Social Research of the University of Michigan. The personal growth index is the average score according to the statements of the 1st questionnaire. The index of ability to work is the sum of points for each of the statements of the 2nd questionnaire. The average length of service is 23.1 ± 8.60 years, the average age is 47.9 ± 8.08 years. 123 (56.9%) men, 117 (54.2%) worked in a hospital, 114 (52.8%) worked in the «red zone», 111 (51.4%) have a second higher education, 138 (63.89%) have a qualification category, 63 (29.1%) have an academic degree. The Spearman correlation coefficients and the Student's criterion are calculated to assess the relationship and significance of differences between indices and characteristics. The personal growth index is 4.89 ± 0.818, the work ability index is 33.60 ± 4.564 points. Respondents aged 41-50 have significantly (p < 0.001) lower indices. There was no significant difference between the index of personal growth and the index of ability to work in respondents of different sexes (р = 0.864 and р = 0.951), those who worked in inpatient and outpatient settings (р = 0.834 and р = 0.848); those who worked in the «red zone» (р = 0.727 and р = 0.775), respondents with a qualification category (р = 0.543 and р = 0.404), with an academic degree (р = 0.871 and р = 0.898), with the second highest education (р = 0.443 and р = 0.588). There is an average direct correlation of personal growth indices and perceived ability to work (r = 0.6; p < 0.001). The relationship between personal growth indices and perceived ability to work, significantly lower indices in the group of 41-50 years and over 60 years must be taken into account to ensure the professional development of department heads.

Оценка применения гибких навыков заведующими отделениями

Successful management cannot take place without soft skills. The study was aimed to assess the frequency of using soft skills by heads of clinical departments based on feedback from physicians working at the departments. For that an online survey of 433 physicians was conducted with the use of the questionnaire taken from the 360 Sample Competencies Guide. The questionnaire included 20 statements divided into five items: self-awareness, drive for results, leadership, communication, teamwork. The respondents were given five response options per statement: from “always” to “never”. The clue referred the assessed individual to one of five groups based on the frequency of using soft skills: leaders, key management, typical management, underachievers, outsiders. Nonparametric methods of analysis were used for data processing. Based on the survey data, 8.6% of assessed individuals joined the group of leaders, while 15.8% were referred to the group of key management, 23.4% to the group of typical management, 30.3% to the group of underachievers, and 21.9% to the group of outsiders. The scores of items correlated with each other (0.973 ≤ R ≥ 0.967; р &lt; 0.001). The respondents’ age, years of service and gender (р &gt; 0.05), as well as the assessed individuals’ gender (р &gt; 0.05) provided no significant differences between the scores. The scores obtained for “communication”, “teamwork”, emotional control, setting challenging goals, and prioritizing work were lower in the hospital-based physicians than in those who worked in outpatient settings (р &lt; 0.05). The questionnaire can be recommended as a feedback tool. Soft skills of the department heads require further development. Soft skills that belong to the items “drive for results”, “leadership”, and “self-awareness” are worst affected.

Психологическое благополучие заведующих отделениями медицинских организаций

Increased workloads among heads of clinical departments that result from working as both clinicists and managers may lead to the significant decline in their psychological well-being. The study was aimed to assess psychological well-being of the clinical department heads. The online survey of 216 department heads aged 32–70 having a 8–51-year experience in heathcare was conducted using the Ryff's scales of psychological well-being adopted by Shevelenkova–Fesenko, sent by e-mail or posted on the distance learning portal. The survey involved 123 men (56.9%) and 93 women (43.1%%): among them 117 people (54.2%) worked in inpatient settings, 114 people (52.8%) worked in the red zone, 138 people (63.89%) were assigned a qualification category, 63 people (29.1%) had an academic degree. Mean values, percentage, Pearson correlation coefficient, Student's t-test were calculated with the IBM SPSS Statistics 23 software. Correlations and mean differences were considered significant at р &lt; 0.05. The average psychological well-being score was 378.67 ± 78.33; in 26 men (26%) and 28 women (43.1%) aged 36–55, the score was below standard values. Psychological well-being correlated with age (r = 0.2; p = 0.019) and years of service (r = 0.2; p = 0.008). No correlations were revealed between psychological well-being and gender (р = 0.798), type of organization (р = 0.642), the fact of having second higher education (р = 0.854), qualification category (р = 0.645), academic degree (р = 0.204), and the experience of working in the red zone (р = 0.926).Thus, more than a third of individuals aged 36–55 have psychological well-being scores below standard values. Psychological well-being of women is lower than that of men. Psychological well-being of men over the age of 35 decreases to a greater extent than standard values.

Evaluation of the Utility of Online Objective Structured Clinical Examination Conducted During the COVID-19 Pandemic.

BackgroundThe COVID-19 pandemic led to profound restrictions on the face-to-face learning and assessment in all educational institutions, particularly the medical schools. The College of Medicine and Medical Sciences of the Arabian Gulf University (CMMS-AGU) conducted the final exams, both theoretical and clinical components, for its MD students online. This study was conducted to evaluate the utility of online clinical exams held at CMMS-AGU.MethodsThis is a cross-sectional, mixed method study that included samples from final year medical students, examiners, and heads of clinical departments. Data were collected through surveys, structured interviews, documents’ review, and calculation of online examination’s psychometrics. Descriptive statistics were used. Quantitative data were presented in the form of means and standard deviations. Responses of heads of clinical departments in the structured interview were transcribed and analyzed thematically based on three pre-established themes.ResultsQuantitative and qualitative data on the utility (validity, reliability, acceptability, educational impact, and cost and feasibility) of online objective structured clinical examination (OSCE) were collected. Content validity of the online clinical examination was established through high mean scores of content representativeness, which was confirmed by the heads of clinical departments regarding the proper coverage of clinical skills. Criterion validity was established through a high correlation between clinical and theoretical exam results (r = 0.75). Reliability of the exam was established through an acceptable Cronbach’s alpha value (0.70 to 0.78) over the four days of the examinations. The examinations were perceived as highly acceptable by both students and examiners. High educational impact was inferred from students’ responses and review of documents. The examination was found to be feasible and of reasonable cost.ConclusionOnline OSCE might be a good alternative of conventional clinical assessments in times of crises and impossibility of having in-person contact between students, examiners, and patients. An important major drawback is still present in such initiatives, which is the inability to assess students’ physical examination skills.

Immigrant Doctors and the Transnational Roots of Canadian Medicare

Immigrant Doctors and the Transnational Roots of Canadian Medicare Alex Myrick (bio) IN A RECENT FRONT-PAGE STORY published by the Telegram in St. John’s, Newfoundland, journalist Peter Jackson observed that only one 2021 Memorial University of Newfoundland medical school graduate has agreed to establish a practice in the province. Jackson states that this news comes at a time when “several existing family physicians” are reducing their practices or are retiring all together.1 According to Jackson, the lack of new doctors, and the retirement of the older ones, are adding to the province’s impending doctor shortage. During a recent visit to St. John’s, federal Immigration Minister Marco Mendicino stated “One of the ways that we can provide reinforcements to the front lines of the health care sector is through immigration.”2 Mendicino’s comment reflects the current federal government’s recognition of a much publicized doctor shortage, and that immigration may provide a solution.3 But while journalists are helping to raise awareness of this issue, the historic root causes are left unexamined. Fortunately, two of Canada’s most accomplished historians of medicine, Sasha Mullally of the University of New Brunswick and David Wright of McGill University, have published Foreign Practices: Immigrant Doctors and the History of Canadian Medicare. The central purpose of their text is to examine the immigration of foreign-trained doctors to Canada following the Second World War and the vital role they played in the delivery of health services during the transition to Medicare during the late 1960s and early 1970s.4 To frame this narrative, Mullally and Wright focus on the years between 1957 [End Page 117] and 1984 as immigrant physicians established themselves throughout Canada. Mullally and Wright primarily argue, as a result of their study of the links between immigration and health care, that universal health insurance in Canada was able to survive because of the influx of foreign-trained doctors, who bolstered the nation’s ability to deliver health services to an expanding population. Without immigrant physicians, Canada would have been unable to provide the number of doctors needed to make Medicare a success. By examining the statistics, the authors show that in the two-and-a-half decades after the passage of the 1957 Hospitalization Insurance and Diagnostic Services Act (HIDS Act) more than 15,000 foreign-trained doctors arrived in Canada. With this figure in mind, one of the authors’ goals is to observe the routes taken by international medical graduates as they migrated to and within the country.5 Because it concentrates mostly on Canada, Foreign Practices is also a national history as certain provinces and regions were affected by physician immigration more than others. According to Mullally and Wright, their text focuses, in particular, on the disparities that existed in the delivery of health services in “marginalized, rural, and remote communities,” the private or incorporated group practices, and the community health centres that were popular throughout these decades, as well as the growth of new Canadian medical schools. In analyzing these facets of health service delivery, the authors describe how immigrant physicians “fit into and exerted an influence on the economic and corporate structures” of Canadian health care. For example, as Mullally and Wright explain, the influx of foreign-trained doctors influenced the upper echelons of Canadian health care’s corporate structure as “a notable few of this generation of doctors” became “presidents of medical associations, heads of clinical departments, and deans of medical schools.” Yet, further down the corporate stratum, in rural or remote resource communities, “physicians’ health care practices” were restructured from “hierarchical to collaborative group practices” as a more democratic and equal working environment between physicians ensured higher rates of doctor retention in these difficult-to-service areas.6 Another contribution Mullally and Wright make is their analysis of the complex moral dilemmas surrounding the “brain drain,” which saw foreign-trained physicians leave developing nations in favour of opportunities in the developed world.7 And Mullally and Wright also present the problem of doctor [End Page 118] maldistribution that the Canadian federal and provincial governments tried to solve from time to time; this was done by forcing physicians to practise in...

Assessment of life satisfaction and impact of work on personal life among heads of clinical departments

Objective. To study life satisfaction and the impact of work on personal life among heads of clinical departments.&#x0D; Materials and methods. A correspondence survey of 216 heads of clinical departments was conducted using standardized questionnaires with the calculation of the life satisfaction index and the indices of interaction between work and personal life. The average age of the respondents was 47.9 8.08 years; the average length of service was 23.1 8.60 years.&#x0D; Results. The average life satisfaction index is 6.0 0.951. There is a weak inverse correlation of the index with age r = 0.2; p = 0.004 and length of service r = 0.2; p = 0.001. The values of the life satisfaction index do not depend on gender (t = 0.23, p = 0.818), place of work (t = 0.14; p = 0.886), availability of qualification category (t = 0.36; p = 0.722), academic degree (t = 1.8; p = 0.073), second higher education (t = 1.67; p = 0.097), work in "red zone" (t˂0,001; p = 1,000). The average index of negative interference of work in personal life is 1.59 0.474 and personal life in work is 1.04 0.123, positive influence of work on personal life is 2.64 0.897 and personal life on work is 3.35 0.882. There is a significant difference in the index of negative interference of personal life in work by respondents of different sexes (t = 3.24; p = 0.001) who worked in hospitals (t = 3.14; p = 0.002) and in the "red zone" (t = 3.29; p = 0.01). There is a negative weak correlation between the life satisfaction index and the index of the positive impact of personal life on work (r = 0.34; p˂0,001) and work on personal life (r = 0.37; p˂0,001).&#x0D; Conclusions. The life satisfaction index of department heads is high 6.0 out of 7. However, a decrease in the ratings of the positive interaction of work and personal life with an increase in the satisfaction index dictates the need to continue research.

An Obituary to Jacques Glowinski (1936–2020)

This is an obituary of Dr. Jacques Glowinski (1936-2020), one of the last «giants» of Neuropharmacology trained in the sixties in the laboratory of Julius Axelrod (Nobel Prize in 1970). He was a founding father of this discipline in France and his famous laboratory (INSERM Unit 114) at the Collège de France in Paris has trained for 40 years (1966-2006) generations of fellows who became leader neuroscientists in France and abroad. His most important scientific contributions completely revisited the regulatory mechanisms of central dopaminergic neurotransmission and its implications in neuropsychiatric disorders.

Sustainability of quality improvement teams in selected regional referral hospitals in Tanzania.

ObjectiveThe aim of this study was to determine the sustainability of hospital quality improvement teams and to assess factors influencing their sustainability in the regional referral hospital in Tanzania.DesignA cross-sectional study was conducted between April and August of 2018.Setting and participantsThe study was conducted in four selected regional referral hospitals in Tanzania. All members of the quality improvement teams available during the study period were recruited.InterventionQuality improvement teams and their activities.Main outcome measureThe primary outcome was sustainability total scores. The secondary outcomes were process, staff and organizational sustainability scores. The sustainability of quality improvement teams was assessed by using the National Health Service Institute for Innovation and Improvement Sustainability Model self-assessment tool.ResultsThe overall mean sustainability score was 59.08 (95% CI: 53.69–64.46). Tanga Regional Referral Hospital had the highest mean sustainability score of 66.15 (95% CI: 55.12–77.18). Mbeya Regional Referral Hospital obtained the lowest mean sustainability score of 52.49 (95% CI: 42.96–62.01). The process domain had the highest proportionate mean sustainability score of 22.46 (95% CI: 20.58–24.33) across four hospitals. The staff domain recorded the lowest proportionate sustainability score of 27.28 (95% CI: 24.76–29.80).ConclusionsPerceived less involvement of senior leadership (hospital management teams) and clinical leadership (heads of clinical departments) and infrastructure limitation appeared to negatively affect the sustainability of the hospital quality improvement teams. Our study underscores the importance of establishing a permanent and fully resourced Quality Improvement Unit—with team members employed as full-time staff.

P117: Procedural skills training in emergency medicine physicians within the Edmonton zone: a needs assessment

Introduction: Procedural skills are a key component of an emergency physician's practice. The Edmonton Zone is a health region that comprises eleven tertiary, urban community and rural community emergency departments (EDs) that represents over three hundred emergency physicians. We report the initial stakeholder and site leadership needs assessment used to inform the development of a comprehensive continuing professional development (CPD) procedural skills curriculum for the Edmonton Zone. Methods: A list of procedural skills was distributed to the two Edmonton Zone Clinical Department Heads of Emergency Medicine (EM). This list was based on a previous Canadian study that utilized procedures from the Objectives of Training in EM. Based on perceived needs, twenty-five procedures were chosen by consensus from zone leadership and study authors as the initial focus for a skills curriculum. This list was sent via survey to the physician site leads of all EDs in the zone. Each site lead was asked to indicate the fifteen procedure curriculum they felt would most benefit their respective physician groups. Responses were collated to look at all departments as a group and stratified by the type of ED (tertiary, urban and rural community). Results: Every site chief of Edmonton Zone EDs completed the survey (100% response rate). Cricothyrotomy and pediatric intubation were the two procedures prioritized by every site. One procedure (ultrasound guided central lines) was prioritized by 10/11 sites while three procedures (ultrasound guided central lines, adult intubation and chest tube insertion) were specified by 9/11 sites as needs. Two procedures (pericardiocentesis and thoracotomy) were named as priorities only by tertiary centers. Conversely, three procedures (extensor tendon repair, anterior and posterior nasal packing) were highlighted by all rural sites, but not consistently by any urban sites. Conclusion: Over the next few years, competency-based CPD will emerge for physicians in practice. Our preliminary needs assessment showed that while a common zone-wide curriculum will be possible, targeted curricula tailored to the unique needs of the various types of EDs will also be necessary. This has implications for the resources and teaching requirements needed to deliver effective and recurring CPD courses to an entire health region. A targeted needs assessment to all Edmonton Zone physicians will be the next step to verify and further elaborate on these preliminary results.

Optimization of internal quality control system of health care for children needing rehabilitation after neuroinfections

The results of the implementation of a three-tier system of internal quality control of medical care for children in need of rehabilitation after neuroinfections are presented. In 2015, a three-tier internal control system was developed at the clinic of the Children’s Research and Clinical Center for Infectious Diseases. The importance of introducing a new approach was determined by the severity of the patients at this clinic. The severity of the condition of children is due to the effects of neuroinfections. In addition, the quality of medical care is an essential element of improving the health care system in modern conditions. After the introduction of this system, the number of examinations carried out at the first level (heads of clinical departments) increased, at the second level (deputy chief physician for medical work and quality of medical care) decreased. The number of detected defects increased, but the quality factor of medical care turned out to be quite high and fell into the group of «insignificant deviations». The main defects are defects in filling in medical documentation and redundancy in laboratory and instrumental research. The leading position in the structure of defects is occupied by defects in filling in medical documentation with a specific weight of 32,4%. With the introduction of a new quality control system, the average length of stay of a patient in the rehabilitation department came close to the one prescribed in medical and economic standards. Revealed quite a large percentage of diagnostic studies that are not included in the medical and economic standards, that is, additional. This fact indicates the need to revise the medical and economic standards in the direction of expansion, taking into account the need. The third level of the internal control system is designed to assess the corrective actions taken as a result of audits at the first two levels of the internal control system. In general, the three-tier system has certainly improved the quality of care.

Adverse event reporting in Slovenia - the influence of safety culture, supervisors and communication.

The provision of safe healthcare is considered a priority in European Union (EU) member states. Along with other preventative measures in healthcare, the EU also strives to eliminate the “causes of harm to human health”. The aim of this survey was to determine whether safety culture, supervisors and communication between co-workers influence the number of adverse event reports submitted to the heads of clinical departments and to the management of an institution. This survey is based on cross-sectional analysis. It was carried out in the largest Slovenian university hospital. We received 235 completed questionnaires. Respondents included professionals in the fields of nursingcare, physiotherapy, occupational therapy and radiological technology. Safety culture influences the number of adverse event reports submitted to the head of a clinical department from the organizational point of view. Supervisors and communication between co-workers do not influence the number of adverse event reports. It can be concluded that neither supervisors nor the level of communication between co-workers influence the frequency of adverse event reporting, while safety culture does influence it from an organizational point of view. The presumed factors only partly influence the number of submitted adverse event reports, thus other causes of under-reporting must be sought elsewhere.

Towards the rational use of medicines.

Rational use of medicines remains to be one of the most challenging problems in health systems worldwide [1, 2]. ABC/VEN-analysis has been recommended for use by the World Health Organization (WHO) and has been used in health care practice globally since 1981. It represents the simple and effective method of analysis of medicine expenditures, identifying priority groups of medicines, the use of which, when improved, may provide the greatest clinical and economic impact. ABC analysis provides an accurate and objective picture of budget expenditures on medicines. VEN-analysis helps to prioritize between various medicines in their selection for procurement and use within a drug supply system [3-5]. To assess the impact of introduction of evidence-based principles in the practice of medicine procurement and use on budget expenditures on medicines of a multidisciplinary health facility for the period of four years (2011-2014). ABC/VEN analysis was carried out in a multidisciplinary health facility with over 1000 beds (an average number of beds for three years), which is responsible for provision of care to the population of about 1.4 million people. The analysis was carried out on the basis of information on medicine expenditures for 4 years: 2011 (1st year), 2012 (2nd year), 2013 (3rd year) and 2014 (4th year). When assigning VEN categories of medicines we used expert method: assignment of categories was carried out by clinical pharmacologists after reviewing all available evidence on effectiveness, safety and cost-effectiveness compared to other drugs in this group. In 2013, we implemented educational intervention, including detailed discussion of the results of the ABC/VEN-analysis for the years 2011-2012 from the standpoint of evidence-based pharmacology and recommendations for medicine procurement. In 2014, we delivered training workshop for the heads of clinical departments on evidence-based principles in clinical pharmacology and rational use of medicines. Medicines expenditures of the studied health facility for the year 2014 were less than for the year 2013, which was the important decrease reversing the trend of increasing medicines expenditures of the last three years: 2011 - 59,868,963 roubles; 2012 - 85,324,084 roubles, 2013 - 107 303 390 roubles, and 2014 - 74,416,692 roubles. The number of International Non-proprietary Names (INN) of medicines used in 2014 was 519, which was the highest number for the four years of the study: 2011 - 429 INN, 2012 - 432 INN, 2013 - 513 INN, and 2014 - 519 INN. Nearly 40% of the funds spent in 2014 on medicines have been used for Vital medicines: 2011 - 26%, 2012 - 39%, 2013 - 25%. Expenditures on Non-essential medicines in 2014 were about the same as in previous years - 14% of total medicine expenditures: 2011 - 16%, 2012 - 13%, 2013 - 15%. However in absolute numbers (roubles) expenditures on non-essential medicines decreased compared to the years 2013 and 2012: 2011 - 9,428,135 roubles, 2012 - 11,129,388 roubles, 2013 - 15,578,325 roubles, 2014 - 10,616,023 roubles.Expenditures on solutions for infusion (sodium chloride, Ringer's solution, dextran, glucose, hydroxyethyl starch) decreased as compared to the year 2013, but still remained high, thus indicating on the abuse of parenteral methods of drug administration. The portion of expenditures on isotonic sodium chloride solution and hydroxyethyl starch in 2014 decreased compared to the year 2013. We found a positive trend in the structure of expenditures on antibacterial agents: in 2014 expenditures on fluoroquinolones decreased nearly fivefold compared to 2013, expenditures on cephalosporins also decreased, but not so dramatically. However, there was a significant increase in expenditures on carbapenems, more than twofold compared with the year 2013. In 2014 we noted a twofold decrease in expenditures on medicines affecting blood, including antithrombotic agents, hemostatics and antianemic medicines, as compared to the values of the year 2013. In 2014 there was also a decrease in expenditures of cardio-vascular medicines, medicines affecting nervous system, alimentary tract and metabolism. Introduction of evidence-based principles through educational interventions at a multidisciplinary health facility resulted in a number of changes towards more rational medicine use. Regular educational interventions for practicing physicians and heads of clinical departments of health facilities that promote rational prescribing are needed.

Redesigning case selection methods to improve clinical review of inpatient medical records

BackgroundThe objective was to redesign selection criteria for readmission cases to improve pick up rates of adverse events* for clinical reviews of inpatient medical records using a new methodology.*Adverse events: An unintended injury or complication resulting in increased length of hospital stay, temporary/permanent disability/death, caused by healthcare management.Level 1 AE's: Unpreventable events only for information of clinical departments.Level 2 AE's: Preventable/potentially preventable events reported to Heads of clinical departments.1,2aTrigger tools: The use of “triggers”, or clues, to identify adverse events (AEs) is an effective method for measuring the overall level of harm in a health care organization.2bPDSA: An iterative four-step management method used for continuous improvement of processes.3 MethodsSelected screening criteria were applied in a series of quality improvement cycles with further modification to eliminate unnecessary cases. A checklist to simplify screening was implemented and a staff satisfaction survey conducted to check process efficacy. ResultsModification of selection criteria continuously improved review quality and accounted for better time management by the team. ConclusionThe project resulted in a significant increase in the total AE pick up rate of 94.23% as compared to the baseline of 80%. The level 1 and 2 AE rates also increased to 92.31% and 1.92% from the baseline rates of 75% and 0.2%.There was also noted to be a significant decrease of 80.98% in review time taken. These findings support the fact that an effective screening process for readmission review is beneficial and worth implementing.

Data-based decision-making at all managerial levels in health care: an integral part of evidence-based practice

While the critical role of an evidence base for policy decision-making in health care is obvious and well documented, the same cannot be said for daily decision making by health care managers at all levels of the system. The relevance for heads of clinical departments, chief nurses, and specialist units became clear when directing a University Hospital and later being part of the management of a similar institution some years later. To be clear, this is not related to clinical decisions but to those in the managerial role. Two issues were immediately clear - there was the inherent principle of the “I know” method of decision making -”don’t confuse me with facts”, and secondly that most heads of service departments had not received training in decision-making. It was taken for granted that that they knew how to do it. An additional issue was the lack of relevant information on issues that required a manager’s decision. There was a need to plan studies, completed in relatively short time periods, in order to allow for “real-time” decision making. On the basis of the above analysis, a course was designed for students within the framework of studies for the Master of Public Health or Master of Health Administration. The syllabus includes both models for administrative decision- making (adapted to health care) as well as a series of case studies that had been performed over the years and provided a practical basis for the managerial decision-making process. These included, amongst others: • The performance of unnecessary laboratory tests in the community - reasons for ordering, use of the results, and effect of intervention • The implication of low reliability of interpretation of radiological tests and their possible improvement • Inappropriate use of hospitalization days • The use of routine computerized data for quality assessment in hospitals All students were required to present assignments on defined issues. This included epidemiological data, need for additional manpower and its training and financial implications. The defined tasks included: • The need for additional manpower • The introduction of a new test or a change in method of performance • Rise in infant mortality in a defined region In addition a final project required the preparation of a detailed plan relating to a question requiring a decision in a health service. The course has been very positively evaluated over the years especially in having provided a defined approach to health managerial decision making.

Involvement of patients or their representatives in quality management functions in EU hospitals: implementation and impact on patient-centred care strategies.

ObjectiveThe objective of this study was to describe the involvement of patients or their representatives in quality management (QM) functions and to assess associations between levels of involvement and the implementation of patient-centred care strategies.DesignA cross-sectional, multilevel study design that surveyed quality managers and department heads and data from an organizational audit.SettingRandomly selected hospitals (n = 74) from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey).ParticipantsHospital quality managers (n = 74) and heads of clinical departments (n = 262) in charge of four patient pathways (acute myocardial infarction, stroke, hip fracture and deliveries) participated in the data collection between May 2011 and February 2012.Main Outcome MeasuresFour items reflecting essential patient-centred care strategies based on an on-site hospital visit: (1) formal survey seeking views of patients and carers, (2) written policies on patients' rights, (3) patient information literature including guidelines and (4) fact sheets for post-discharge care. The main predictors were patient involvement in QM at the (i) hospital level and (ii) pathway level.ResultsCurrent levels of involving patients and their representatives in QM functions in European hospitals are low at hospital level (mean score 1.6 on a scale of 0 to 5, SD 0.7), but even lower at departmental level (mean 0.6, SD 0.7). We did not detect associations between levels of involving patients and their representatives in QM functions and the implementation of patient-centred care strategies; however, the smallest hospitals were more likely to have implemented patient-centred care strategies.ConclusionsThere is insufficient evidence that involving patients and their representatives in QM leads to establishing or implementing strategies and procedures that facilitate patient-centred care; however, lack of evidence should not be interpreted as evidence of no effect.

Prescribing behavior on a clinical department leadership level in public hospitals

Purpose – The aim of this paper is to investigate the prescribing behavior and applied practices of doctors who are the heads of clinical departments in the National Health System in Greece. Moreover, this paper aims to evaluate a set of factors influencing them in this conduct through both their scientific and managerial status. Design/methodology/approach – The sample consisted of 123 clinical department-heads in 15 hospitals and a questionnaire specifically designed for the purposes of this research effort was used. Prescribing criteria were divided into three categories: scientific, functional and behavioral. Demographic data were also included. The data were processed using SPSS17 statistical package. Multivariate Analysis of Variance (MANOVA) of the mean of the parameters identified was applied. Findings – The survey assessed, revealed and evaluated the most important factors affecting the selection process of selecting pharmaceuticals on a department head level. Existing gaps in scientific information and rational management of procedure implementation were detected. Different perceptions of doctors-department heads towards prescribing criteria emanating from their previous experience on decision-making positions, age and hospital spatial characteristics (urban-provincial) were also highlighted. Originality/value – The results of this survey provide both researchers and health policy makers with a better insight of the factors influencing prescribing behavior, and decision-making processes of doctors-department heads in the context of a Public Health Care System.

Employment of 360-degree evaluation and performance report evaluation

Objective To search for a scientific and feasible system for performance appraisal of hospital management staff, and enhance the level of hospital management. Methods The 360-degree evaluation and improved performance report evaluation are called into play to examine such staff. Examiners include the superiors, peers (heads of clinical and technical departments and those of administrative departments), inferiors and others (representatives of the faculty congress and staff congress). Results Outcomes of the two evaluation methods found 8 of the top ten as overlapping, and 8 of the bottom ten as overlapping as well. 80% overlapping between the two prove the results as highly similar, and a relativity analysis found the general results of the two methods as highly consistent. Conclusion United applic of the two methods can effectively examine the management staff and improve their management capabilities. Key words: 360-degree evaluation; Performance report evaluation; Hospital management staff; Examination

Doing mini–health technology assessments in hospitals: A new concept of decision support in health care?

The purpose of this project was to evaluate local decision support tools used in the Danish hospital sector from a theoretical and an empirical point of view. The use of local decision support was evaluated through questionnaires sent to all county health directors, all hospital managers, and all heads of clinical departments in cardiology, orthopedic surgery, and intensive care. In addition, respondents were asked to submit whatever decision support tools they were using (including mini-HTAs, other forms or checklists, and special procedures for decision making concerning new health technologies). A theoretical analysis of the decision support tools (decision theory) was performed as well as a comparison with the business case method used in private companies. Finally, the Danish mini-HTA was compared with foreign production and use of HTA and HTA-like assessments as local decision support. The response rate was high (87 percent, 94 percent, 85 percent, respectively). We collected sixty different forms (of which forty-nine were mini-HTAs) and twenty variants of written procedures. We found theoretical and empirical evidence that local involvement in the process of making the HTA could be important for the use of the results from the HTA and for the process of implementing the new technology. Doing mini-HTA in hospitals seems to balance the need for quality and depth with the limited time and resources for assessment.

University and workplace cultures: their impact on the development of lifelong learners

Purpose: Literature has shown the importance of lifelong learning in the education of today's workforce and the crucial role of Higher Education in preparing graduates for lifelong learning. A national study on lifelong learning in the medical radiation science (MRS refers to all aspects of diagnostic imaging and radiation therapy) profession in Australia and undergraduate courses was conducted in 1999. Based on the results of this study, this paper focuses on the relationship between university and workplace culture and evaluates how these cultures impact on the development of lifelong learners in the profession. Methods: Both qualitative and quantitative approaches were used to determine the importance of lifelong learning amongst stakeholders in the universities and the workplace. These included conducting a survey of heads of MRS schools, focus group discussion and interviews with MRS academics, and nationwide surveys of MRS students, practitioners and heads of clinical departments. Results: While Australian MRS schools are supportive of lifelong learning in terms of their course objectives, teaching approaches and assessment methods, the workplace culture in MRS for lifelong learning was not supportive. This is evidenced in the failure to provide a supportive learning environment, inadequate support for research initiatives and the exclusion of lifelong learning attributes from the job selection criteria for new graduates entering the workforce. Conclusions: The discrepancy between university and workplace culture represents a major obstacle in the development of lifelong learning attributes amongst MRS students and practitioners. Universities assume a vital role in the development and promotion of lifelong learning among students. However, it is equally important that the workplace culture also provides an environment that supports lifelong learning.