Health Facility Managers Research Articles

Implementation of Management Policy for Healthcare Facility to Respond COVID-19 Pandemic in West Java

This research describes organisation, interpretation and application of the legal policies in healthcare management as the response to the COVID-19 pandemic in West Java. This research used a descriptive method with a qualitative approach. Data collection was carried out with a study of documentation and forum group discussions. Data analysis technique employed the interactive model by Miles, M. B. (process of collecting, condensing, and presenting data, as well as drawing conclusions). In response to the COVID-19 pandemic in West Java, it was carried out by forming the Healthcare Facility Management Division under Acceleration Task Force. The policy was interpreted by establishing a plan to assess the requirements for additional capacity and healthcare workers by referring to the prediction of the increased number of patients using the SimCOVID model. Implementation of management policy for healthcare facilities in West Java has been carried out through organisation, interpretation, and application.

Intensive care nurse managers' experiences during the first wave of the Covid-19 pandemic: Implications for future epidemiological crises.

Nurse managers play an important role in coordinating the multidisciplinary teamwork, which is specifically important in emergency and crises situations like the COVID-19 pandemic. The aim of this qualitative study is twofold: (1) to explore the experiences of the Intensive care units (ICU) nurse managers regarding their work during the first wave of the COVID-19 pandemic, and (2) to analyse what implications might be provided based on experiences of nurse managers for future possible epidemiological crises. In-depth phone interviews were conducted to explore the experiences of ward managers-nurses (n = 15) working in different hospitals across Poland. Interviews were taped and transcribed verbatim, and then qualitatively analysed. Three main categories were identified: (1) Challenge of working with the unknown, (2) Nurse managers' expectations, and (3) Methods of coping and received support. The COVID-19 pandemic strongly affected the work of ICU nurse managers and uncovered the malfunctioning of the healthcare system. It is important to improve the knowledge and competence of hospital management personnel through exercises and in-service training on how to handle emergencies in order to improve the management of healthcare facilities, increase the safety of patients and employees, and the quality of healthcare.

"I will never wish this pain to even my worst enemy": Lived experiences of pain associated with manual vacuum aspiration during post-abortion care in Kenya.

In Kenya, where abortion is legally restricted, most abortions are induced using unsafe procedures, and lead to complications treated in public health facilities. The introduction of Manual Vacuum Aspiration (MVA) to treat incomplete abortion has improved the management of abortion complications. However, this technology comes with pain whose management has been a challenge. This paper explores the lived experiences of pain (management) during MVA to document the contributing factors. We used an ethnographic approach to explore girls and healthcare providers' experiences in offering and accessing post-abortion care in Kilifi County, Kenya. The data collection approach included participant observation and informal conversations in public health facilities and neighboring communities, as well as in-depth interviews with 21 girls and young women treated for abortion complication and 12 healthcare providers. Our findings show that almost all patients described the MVA as the most painful procedure they have ever experienced. The unbearable pain was explained by various factors, including the lack of preparedness of health facilities to offer PAC services (i.e. lack of pain medicine, lack of training, inadequate knowledge and grasp of pain medication guidelines, and malfunctioning MVA kits). Moreover, the attitudes of healthcare providers and facilities management toward the MVA device limited the supply and replacement of MVA kits. Moreover, the scarcity of pain medicines also gave some providers the opportunity to abuse patients guided by their values, whereby they would deny patients pain medication as a form of "punishment" if they were suspected of inducing their abortion, especially adolescent girls. The study findings suggest the need for clearer guidelines on pain medication, value clarification and attitude transformation training for providers, systematizing the use of medical uterine evacuation using medical abortion drug and strengthening the supply chain of pain medication and MVA kits to reduce the pain and improve the quality of post-abortion care.

Retracted: A Spatial Spectrum Estimation Method for Optimization and Improvement of Resource Allocation and Management of Public Sport and Health Facilities.

[This retracts the article DOI: 10.1155/2022/3800237.].

Leadership competencies of primary healthcare managers: a cross-sectional quantitative study of high, medium and low performing district councils in Tanzania

Objectives: This research article examined the leadership competency of primary healthcare facility managers in the selected high, medium and low performing District Councils in Tanzania.
 Methods: The study was conducted in the selected high, medium and low performing District Councils in Tanzania. This research used cross sectional quantitative research design. A complete enumeration sampling strategy was employed to inquire data from 102 primary healthcare facility managers. Similarly, the Statistical Package for Social Sciences (SPSS version 25) was used to analyse the data. Ethically, the permission was granted by the University of Dodoma.
 Findings: Results revealed that, (72.55%), (66.45%) and (80.39%) of primary healthcare manager were competent and (27.45%), (33.55%), and (19.61%) were less than competent in leading people and teams, leading organisation, and leader quality respectively.
 Conclusions: The study concludes that primary healthcare managers exhibited competent and less than competent levels of leadership competency in all investigated constructs.

PENGARUH MANAJEMEN SARANA KESEHATAN TERHADAP KEPUASAN PASIEN DI KLINIK PRATAMA PTPN VII KANTOR DIREKSI BANDAR LAMPUNG

The purpose of conducting this research is to find out how much influence the management of health facilities has on patient satisfaction at PTPN VII Primary Clinic Office of the Board of Directors. The method used in this research is quantitative with the concept of cross-sectional study. The population in this research is all outpatient PTPN VII Pratama Clinic Office of the Board of Directors in 2022 and the sample collection method uses non-probability sampling with the accidental sampling method. So that a sample of 315 people was obtained. Based on the research results it is known that the P-Value simultaneously is 0.000. As for the partial infrastructure facilities (X1), location (X2), personnel (X3), and pharmacy (X4) variables have a P-Value 0.05, if the probability value is 0.05 so it can be concluded that infrastructure, location, personnel, and pharmacy influence simultaneously and partially on patient satisfaction (Y). Primary Clinics can maintain and improve aspects of manpower related to service and attitudes of officers such as through continuous briefings and outreach regarding a culture of responsive, mutual respect, and empathetic actions.

Assessing drivers of implementing "Scaling-up the Systems Analysis and Improvement Approach" for Prevention of Mother-to-Child HIV Transmission in Mozambique (SAIA-SCALE) over implementation waves.

The Systems Analysis and Improvement Approach (SAIA) is an evidence-based package of systems engineering tools originally designed to improve patient flow through the prevention of Mother-to-Child transmission of HIV (PMTCT) cascade. SAIA is a potentially scalable model for maximizing the benefits of universal antiretroviral therapy (ART) for mothers and their babies. SAIA-SCALE was a stepped wedge trial implemented in Manica Province, Mozambique, to evaluate SAIA's effectiveness when led by district health managers, rather than by study nurses. We present the results of a qualitative assessment of implementation determinants of the SAIA-SCALE strategy during two intensive and one maintenance phases. We used an extended case study design that embedded the Consolidated Framework for Implementation Research (CFIR) to guide data collection, analysis, and interpretation. From March 2019 to April 2020, we conducted in-depth individual interviews (IDIs) and focus group discussions (FGDs) with district managers, health facility maternal and child health (MCH) managers, and frontline nurses at 21 health facilities and seven districts of Manica Province (Chimoio, Báruè, Gondola, Macate, Manica, Sussundenga, and Vanduzi). We included 85 participants: 50 through IDIs and 35 from three FGDs. Most study participants were women (98%), frontline nurses (49.4%), and MCH health facility managers (32.5%). An identified facilitator of successful intervention implementation (regardless of intervention phase) was related to SAIA's compatibility with organizational structures, processes, and priorities of Mozambique's health system at the district and health facility levels. Identified barriers to successful implementation included (a) inadequate health facility and road infrastructure preventing mothers from accessing MCH/PMTCT services at study health facilities and preventing nurses from dedicating time to improving service provision, and (b) challenges in managing intervention funds. The SAIA-SCALE qualitative evaluation suggests that the scalability of SAIA for PMTCT is enhanced by its fit within organizational structures, processes, and priorities at the primary level of healthcare delivery and health system management in Mozambique. Barriers to implementation that impact the scalability of SAIA include district-level financial management capabilities and lack of infrastructure at the health facility level. SAIA cannot be successfully scaled up to adequately address PMTCT needs without leveraging central-level resources and priorities. ClinicalTrials.gov, NCT03425136 . Registered on 02/06/2018.

The need for health information management professionals in Malawi health facilities.

Health information management (HIM) is at the core of health organisations, providing essential information. In Malawi, there is a substantial deficit of qualified personnel, specifically health information managers, who can properly manage health information in electronic and paper-based formats. The nation has no higher education institution offering an academic programme in HIM. To investigate the need for HIM professionals in Malawi government health facilities, to determine the kinds of data managed by data users; competencies of HIM workers and challenges associated with the current HIM system. A cross-sectional research design was adopted, with a qualitative approach to gather data from data users and key informants, using two focused interview guides. Data were collected from 13 participants from 6 government health facilities representing the primary, secondary and tertiary healthcare delivery levels. Data were analysed thematically. Data users handled a diverse range of data, the majority having moderate skills in HIM. Both data users and key informants reported experiencing challenges in dealing with the existing HIM system. Findings also revealed key challenges associated with the absence, or inadequacy, of a well-trained HIM professional workforce in Malawi health facilities. Introducing a training programme in HIM would improve data management in health facilities in Malawi. Well-managed data would improve the delivery of health care services.

Examining the responsiveness of the National Health Insurance Fund to people living with hypertension and diabetes in Kenya: a qualitative study

ObjectivesTo assess the responsiveness of the National Health Insurance Fund (NHIF) Supa Cover benefit package to the needs of individuals with diabetes and hypertension in Kenya.Design, setting and participantsWe carried...

Exploring Supportive Supervision of Nurses in the Health Care Facilities in Volta Region, Ghana

The study sought to examine supportive supervision of nurses in the health care facilities in Volta Region of Ghana. The study employed descriptive survey of the qualitative approach and targeted all the management of health care facilities in Volta Region. Purposive sampling was adopted in selecting three (3) management members from various health care facilities in Volta Region. The primary data was obtained from the responses and information from the interview guide administered to the nurse supervisors. Credibility and trustworthiness were ensured to enhance the quality of data and ethical consideration such as anonymity, informed consent, privacy and confidentiality were ensured. Data from interviews were transcribed, edited, coded and analysed thematically with the help of research objectives. The study found that the role of nurse managers in support supervision it to monitor, supervise, teach or support nurses to provide appropriate and quality health care delivery to patients. The institution’s management assist support supervision by provided needed equipment and environment for transfer of knowledge and skills from supervisors or nurse managers to young nurses. The motive of support supervision was to provide confidence in the young nurses, to improve upon the performance and quality health care delivery and to minimize errors. Participants were not familiar with any strategy that can be used to support supervision. Challenges associated with support supervision included; inadequate resources and equipment, inadequate training, time issues and administrative challenges. It was suggested that support supervision should be encouraged in the health sector due to its numerous benefits and significance to both the health personnel and the patients as a whole. Institutions management should continue to provide needed tools, equipment, resources and the enabling environment for transfer of knowledge and skills among health personnel.

Applying a Risk-Based Approach to Health Facility Management

The article discusses potential applications of a risk-based approach to health facility management. The study analyzed various management models, as well as process-oriented and project-oriented management systems, the use of risk management, quality management standards, lean technologies (lean manufacturing), and scorecard interfaces (score ratings). The article presents the results of applying risk analysis, which was developed using balanced scorecard approach that describes activities of a health facility. It was found that the balanced scorecard approach and scoring calculations enable risk level assessment in a health facility to classify risks by work areas and take suitable measures to mitigate or prevent them.

Stakeholder perceptions and experiences from the implementation of the Gratuité user fee exemption policy in Burkina Faso: a qualitative study

BackgroundIn 2016, the Gratuité policy was initiated by the Government of Burkina Faso to remove user fees for maternal, newborn, and child Health (MNCH) services. Since its inception, there has not been any systematic capture of experiences of stakeholders as it relates to the policy. Our objective was to understand the perceptions and experiences of stakeholders regarding the implementation of the Gratuité policy.MethodsWe used key informant interviews (KIIs) and focus group discussions (FGDs) to engage national and sub-national stakeholders in the Centre and Hauts-Bassin regions. Participants included policymakers, civil servants, researchers, non-governmental organizations in charge of monitoring the policy, skilled health personnel, health facility managers, and women who used MNCH services before and after the policy implementation. Topic guides aided sessions, which were audio recorded and transcribed verbatim. A thematic analysis was used for data synthesis.ResultsThere were five key themes emerging. First, majority of stakeholders have a positive perception of the Gratuité policy. Its implementation approach is deemed to have strengths including government leadership, multi-stakeholder involvement, robust internal capacity, and external monitoring. However, collateral shortage of financial and human resources, misuse of services, delays in reimbursement, political instability and health system shocks were highlighted as concerns that compromise the government's objective of achieving universal health coverage (UHC). However, many beneficiaries were satisfied at the point of use of MNHC services, though Gratuité did not always mean free to the service users. Broadly, there was consensus that the Gratuité policy has contributed to improvements in health-seeking behavior, access, and utilization of services, especially for children. However, the reported higher utilization is leading to some perceived increased workload and altered health worker attitude.ConclusionsThere is a general perception that the Gratuité policy is achieving what it set out to do, which is to increase access to care by removing financial barriers. While stakeholders recognized the intention and value of the Gratuité policy, and many beneficiaries were satisfied at the point of use, inefficiencies in its implementation undermines progress. As the country moves towards the goal of realizing UHC, reliable investment in the Gratuité policy is needed.

Resilience of front-line facilities during COVID-19: evidence from cross-sectional rapid surveys in eight low- and middle-income countries.

Responsive primary health-care facilities are the foundation of resilient health systems, yet little is known about facility-level processes that contribute to the continuity of essential services during a crisis. This paper describes the aspects of primary health-care facility resilience to coronavirus disease 2019 (COVID-19) in eight countries. Rapid-cycle phone surveys were conducted with health facility managers in Bangladesh, Burkina Faso, Chad, Guatemala, Guinea, Liberia, Malawi and Nigeria between August 2020 and December 2021. Responses were mapped to a validated health facility resilience framework and coded as binary variables for whether a facility demonstrated capacity in eight areas: removing barriers to accessing services, infection control, workforce, surge capacity, financing, critical infrastructure, risk communications, and medical supplies and equipment. These self-reported capacities were summarized nationally and validated with the ministries of health. The analysis of service volume data determined the outcome: maintenance of essential health services. Of primary health-care facilities, 1,453 were surveyed. Facilities maintained between 84% and 97% of the expected outpatient services, except for Bangladesh, where 69% of the expected outpatient consultations were conducted between March 2020 and December 2021. For Burkina Faso, Chad, Guatemala, Guinea and Nigeria, critical infrastructure was the largest constraint in resilience capabilities (47%, 14%, 51%, 9% and 29% of facilities demonstrated capacity,respectively). Medical supplies and equipment were the largest constraints for Liberia and Malawi (15% and 48% of facilities demonstrating capacity, respectively). In Bangladesh, the largest constraint was workforce and staffing, where 44% of facilities experienced moderate to severe challenges with human resources during the pandemic. The largest constraints in facility resilience during COVID-19 were related to health systems building blocks. These challenges likely existed before the pandemic, suggesting the need for strategic investments and reforms in core capacities of comprehensive primary health-care systems to improve resilience to future shocks.

Artificial Intelligence has a Role in Medical Treatments and Associated Research?

I encourage the growth of artificial intelligence and similar methods in health and medical care for the purpose of continuously improving processes included in this field. By focusing on the growth on data analytics, statistics, applied mathematics, and computer methods including machine learning, the future of health-care methods will change. The development of computerized methods and the growth of data systems produce ample materials for artificial intelligence to develop and to bring physician assistance programs to enable continuous improvement resulting in superior health and medical care. This includes applications in intensive care as well as diagnostic therapies. The focus is on examples in the use of the promising developments in data science methods, the accumulation of medical and research data. With quality and continuous improvement in process control applications where one determines the usefulness of data analytics, there are great possibilities of change in the improvement in medical applications as well as the management of hospital and other health-care facilities.

Towards Digital Twin Maintenance Management of Health Facilities in Nigeria: The Need for Maintenance Documentation

The COVID-19 pandemic that recently broke forth revealed the waning state of a considerable number of healthcare facilities, especially in unindustrialized territories. This is of great concern, and it has become pertinent to identify determinants of efficient maintenance management in developing countries. There is an inefficient maintenance management of hospital buildings due to a low level of maintenance documentation, which otherwise would have facilitated the adoption of digital twin (DT) technology. The existing maintenance management frameworks and models have not explored and evaluated maintenance documentation as an all-inclusive construct. Hence, this study was aimed at emphasizing the significance of maintenance documentation for its adoption as one of the main determinants of efficient maintenance management, with a view to attaining the DT maintenance management of hospital buildings in Nigeria. After a theoretical review on existing studies around documentation, the software documentation concept was used to conceptualise this observed gap in maintenance management models for public hospital buildings in developing countries. This critical review, which forms part of an ongoing study, asserts that maintenance documentation is a major construct for efficient maintenance management and a prerequisite for the adoption of DT in the management of healthcare constructed facilities in developing countries.

Charge midwives' awareness of and their role in promoting respectful maternity care at a tertiary health facility in Ghana: A qualitative study.

Evidence suggests that the implementation of respectful maternity care (RMC) interventions is one of the surest and most effective means of minimising mistreatment during intrapartum care services. However, to ensure the successful implementation of RMC interventions, maternity care providers would have to be aware of RMC, its relevance, and their role in promoting RMC. We explored the awareness and role of charge midwives in promoting RMC at a tertiary health facility in Ghana. The study adopted an exploratory descriptive qualitative study design. We conducted nine interviews with charge midwives. All audio data were transcribed verbatim and exported to NVivo-12 for data management and analyses. The study revealed that charge midwives are aware of RMC. Specifically, ward-in-charges perceived RMC as consisting of showing dignity, respect, and privacy, as well as providing women-centred care. Our findings showed that the roles of ward-in-charges included training midwives on RMC and leading by example, showing empathy and establishing friendly relationships with clients, receiving and addressing clients' concerns, and monitoring and supervising midwives. We conclude that charge midwives have an important role to play in promoting RMC, which transcends simply providing maternity care. Policymakers and healthcare managers should ensure that charge midwives receive adequate and regular training on RMC. This training should be comprehensive, covering aspects such as effective communication, privacy and confidentiality, informed consent, and women-centred care. The study also underscores a need for policymakers and health facility managers to prioritise the provision of resources and support for the implementation of RMC policies and guidelines in all healthcare facilities. This will ensure that healthcare providers have the necessary tools and resources to provide RMC to clients.

Exploring communication and implementation challenges of the HIV/AIDS policy change to test-and-treat-all in selected public health facilities in Lusaka District, Zambia

BackgroundThe World Health Organization has promoted a shift towards the test-and-treat-all strategy to accelerate the elimination of HIV/AIDS. Zambia was one of the early African countries to adopt this strategy as the policy change was officially announced on national television by the republican president on 15th August 2017. This study explored the communication and implementation challenges of the HIV/AIDS policy change to test-and-treat-all in selected public health facilities in Lusaka District, Zambia.MethodsA qualitative case study design was employed with a purposeful sample of policy makers, international partners, National AIDS Council representatives, health facility managers, and frontline health providers in selected tertiary, secondary and primary health facilities in the Lusaka District, Zambia. Thematic data analysis was performed using NVivo 12 Pro software.ResultsIn total, 22 key informant interviews and 3 focus group discussions were conducted. The government relied on formal and informal channels to communicate the test-and-treat-all policy change to health providers. Whilst HIV policy changes were reflected in the National HIV/AIDS Strategic Framework, there was little awareness of this policy by the frontline providers. The use of informal communication channels such as verbal and text instructions affected health providers’ implementation of the test-and-treat-all. Electronic and print media were ineffective in communicating the test-and-treat-all policy change to some sections of the public. Top-down stakeholder engagement, limited health worker training, and poor financing negatively affected the implementation of the test-and-treat-all policy change. Acceptability of the test-and-treat-all policy change was shaped by positive provider perceptions of its benefits, limited sense of policy ownership, and resistance by the non-treatment-ready patients. Furthermore, unintended consequences of the test-and-treat-all policy change on human resources for health and facility infrastructure were reported. ConclusionEffective test-and-treat-all policy change communication is vital for successful policy implementation as it enhances interpretation and adoption among health providers and patients. There is a need to enhance collaboration among policy makers, implementers and the public to develop and apply communication strategies that facilitate the adoption of the test-and-treat-all policy changes to sustain gains in the fight against HIV/AIDS.

Delivery of healthcare facility management services: A literature review

The delivery of healthcare services around the world has changed significantly over the past 25 years. Governments have realized that in order to achieve social and economic success in their countries, their health services should be improved, and these services should be sustainable. The World Health Organization (WHO) presents various approaches for people to access quality and adequate healthcare. Within this approach, the importance of hospitals in creating healthy societies is increasing. Healthcare facilities differ from any other facilities. These facilities, with their own characteristics, produce and offer complex and interdisciplinary services. Each country has its own unique and different approaches for its healthcare system, which are related to the level of development and to the cultural structure. Although there are different approaches to healthcare facility management (HFM) in various countries, it has been concluded that an HFM application model can emerge in all circumstances with a good understanding of the main components of HFM that this study describes. Today, the scope and service range of HFM in modern hospitals has expanded considerably, and the execution of these services depends on a wide variety of components, such as unique features, standards, codes, technological developments, planning of services, and operational management. In this study, the current components of HFM are explained by conducting a literature review of published studies on HFM. The main characterizing components of HFM are described in detail, and current trends are discussed within this framework.

Determinants of Integrated Pharmaceutical Logistics System Performance in Ethiopian Public Health Facilities at Harari Regional State, Ethiopia

The well-functioning pharmaceutical logistics system to deliver medicines, vaccines and other health products are critical to the provision of health services. The study aims to determine the association and magnitude of determinant factors with performance of integrated pharmaceuticals logistics system among public health facilities in Harari Regional State of Ethiopia. The study used cross-sectional descriptive study and explanatory research designs and structured questionnaire were adapted from Logistics Indicator Assessment Tool (LIAT) to collect data. Descriptive statistics was used to describe the public health facility performance data and binary logistics regression was done by using SPSS version 27. Data were complemented with documentary analysis, description of internal processes and logistics registrations. Findings from this study indicate that management ownership level of the system with β value 3.961, [AOR -19.373 in 95% CI (3.765, 116.271), P = 0.001], and health facility staff skill level with β of value 2.109, [AOR - 8.241, 95% CI (3.703, 81.336), P = 0.005], have positive associations with integrated pharmaceuticals logistics system performance. But, the health facility service volume has no significant association with the performance of integrated pharmaceutical logistics system. The hypothesis proposed were accepted for both health facility staff’s skills and management ownership of the system while the hypothesis proposed for health facility service volume is rejected as it has no significant effect on the performance. The study found that the health facility staff skill and management ownership have significant effect on integrated pharmaceutical logistics system implementation. The major factors for health professional under optimal skill were poor management support, staff insufficiency, and a poor skill transfer mechanism.

Analyzing Water Use Embodied in the Initial Construction and Life Cycle Management of Healthcare Facilities

Most research on the environmental sustainability of buildings often centers on reducing energy use and may overlook an equally crucial aspect of freshwater use. Buildings consume 1/5th of global fresh water in their construction as embodied water (EW) that must be reduced for long-term sustainability. Like embodied energy (EE), the EW of a facility is composed of a direct component used in construction processes and an indirect component that includes water used in manufacturing construction materials. An equally important component rarely covered in EW calculations is the energy-related embodied water (EREW), which comes from different energy sources that are consumed as EE, each of which depletes a significant amount of water in its generation, refinement, and transmission/transportation. This paper presents a macroeconomic model to compute and analyze not only the direct and indirect EW but also EREW of healthcare facilities. A wide variation is observed in calculated EW values associated with facilities’ initial construction (1,010-38,750 gallons/m²) and life cycle management (1,335-51,250 gallons/m²). The findings further show that EREW may represent 7.7% and 6% (average 6.7%) of the total EW of healthcare facilities relating to their initial construction and facilities management, respectively, including interior and exterior maintenance, repairs, and replacement activities. The significance of these findings is twofold. First, it shows that reducing EE may not help decrease most EW of a facility, and additional measures must be applied to decrease water use holistically. Second, it highlights the urgency of decreasing the water footprint of both renewable and non-renewable energy sources.