Challenges In Healthcare Management Research Articles

Intervention strategies for management of comorbid depression among individuals with hypertension: a scoping review protocol

IntroductionHypertension and depression often coexisted, leading to poor health outcome and significant challenges in healthcare management. Since no guidelines or consensus are available for health professionals to manage this comorbidity,...

The prevalence of polypharmacy and hyper-polypharmacy among middle-aged vs. older patients in Saudi Arabia: a cross-sectional study.

Polypharmacy, the use of multiple medications, is a growing concern among middle-aged and older patients, posing potential risks and challenges in healthcare management. This study aimed to identify the prevalence of polypharmacy and hyper-polypharmacy among populations of middle-aged vs. older patients and identify its associated common comorbidities and prescribed medications in Qatif Central Hospital (QCH), Saudi Arabia. Patients aged 40 years or older who presented to an outpatient medical care clinic at QCH, Saudi Arabia, between 1 January and 31 December 2021 were included, and their comorbidities, prescribed medications, and recent clinical laboratory test results were collected. The Charlson comorbidity index (CCI) score was calculated to predict the risk of mortality. Logistic regression was used to compute the association between the prevalence of polypharmacy and patient characteristics. The results were presented as odds ratios (ORs) and 95% confidence intervals (95% CIs). A total of 14,081 patients were included; 31% of the cohort comprised older patients, and 66% of the cohort was identified with polypharmacy. The majority of the polymedicated patients were presented to an internal medicine care unit (34%). The prevalence of polypharmacy was positively associated with CCI (OR = 3.4, 95% CI 3.3-3.6), having a disease related to the musculoskeletal system (MSD) (OR = 4.2, 95% CI 3.8-4.7), and alimentary tract and metabolism (ATM) (OR = 3.8, 95% CI 3.4-4.2). Conversely, the prevalence of polypharmacy was negatively associated with age (OR = 0.9, 95% CI 0.89-0.91) and patients with cardiovascular diseases (OR = 0.6, 95% CI 0.5-0.7). Polypharmacy is still an ongoing concern. Patients, particularly those with diseases related to MSD or ATM, should be considered for reviewing prescriptions by pharmacists to reduce the risk of adverse drug reactions and future consequences of polypharmacy.

Users' Perceptions of Access to and Quality of Unified Health System Services in Brazil: A Cross-Sectional Study and Implications to Healthcare Management Challenges.

Evaluating the access to and quality of healthcare services from the users' perspective is an important assessment process to identify priorities. This study assessed the profile of health service usage and the views of the Unified Health System (SUS) users about the access to and quality of SUS public health services. A cross-sectional study was conducted with participants from the Coastal Lowlands Region of the Rio de Janeiro State/Brazil, between August and November 2023. The association between categorical variables was analyzed using the Pearson Chi-Square test, using R software 4.3. A total of 200 individuals were interviewed using a 66-question survey instrument. Participants who reported using SUS services more frequently rated this system as essential (p-value = 0.031). However, overall, 64% of participants rated the quality of care to be very bad/bad and 34.9% rated access as very bad/bad. Access was considered poor by respondents who used public services rarely or sometimes (p-value = 0.002). In terms of accessing SUS services consultations provided by specialists (e.g., neurologists), these were available only in another municipality (p-value = 0.001). Many participants were SUS dependent for health services, and gaps and weaknesses were observed regarding users' perspectives of the access to and quality of SUS health care. Policymakers should prioritize evaluations and dialogue with the community to make SUS services responsive and to optimize value-for-money in health service planning.

Challenges for healthcare Managers in 2023

Introduction: Managers in the field of healthcare face many challenges that are specific to this area and are caused by the dynamic and constantly changing healthcare environment. Research sample and research objective: The main research objective was to evaluate significant aspects of financing and organizing healthcare systems, summarize assumptions for the successful functioning of a healthcare system, assess factors influencing healthcare spending, and predict the challenges that healthcare managers will face in 2023 at both the micro (individual healthcare facilities) and macro (healthcare system in Slovakia) levels. The research sample was selected by deliberate selection and consisted of 109 respondents: healthcare managers (n=16), experts from the field of health management (n=15), experts from the field of human resources (n=19), directors of health facilities (n=10), medical (n=28) and paramedical staff (n=21). Methods: Statistical testing was carried out using the methods of inferential statistics: the independent samples t-test was used to compare mean scores between two groups (RQ1 and RQ2) and a one-way analysis of variance (ANOVA) to compare mean scores among three groups (RQ 3). Results: We found out there are no differences in the respondents’ opinions on the challenges for healthcare managers in 2023 based on their job titles, the type of health facility in which they work or according to the length of practice. Conclusion: According to the respondents, the most current trends and challenges for Slovak healthcare are: the need for qualified medical personnel, a focus on retaining employees and solving the growing costs of healthcare.

Association of Balance with Somatosensory Loss of Lower Limb in Diabetic Patients

Background: Diabetes, a prevalent global health issue, notably in Pakistan, poses significant challenges in healthcare management due to its complications, including impaired balance and increased fall risk. Objective: This study aimed to investigate the association between balance impairment and somatosensory loss in diabetic patients, focusing on the impact of aging and gender differences. Methods: A cross-sectional study was conducted over six months at Akhtar Seed Trust Teaching Hospital, Lahore, involving 600 participants. The Berg Balance Scale (BBS) and Rivermead assessments were used to evaluate balance and somatosensory loss. Participants included males and females aged above 25, with stratification into positive and negative cases based on their balance and somatosensory status. Results: Of the 600 participants (224 males, 376 females), 150 were categorized as positive cases, showing significant balance impairment. The BBS assessment revealed that two-point discrimination was more affected compared to vibratory sense and proprioception. The study found a statistically significant association between somatosensory loss and balance impairment, irrespective of age and gender. Conclusion: The study concludes that there is a significant correlation between somatosensory loss and balance impairment in diabetic patients, with aging and gender playing a lesser role. These findings underscore the need for targeted balance and sensory training in diabetic care to reduce fall risks.

Healthcare Management Challenges and Opportunities during COVID Pandemic

This review aimed to analyze some problems and challenges that emerged from the COVID-19 pandemic since it has affected all global business sectors. During the pandemic, remote work was increased in response to social distance requirements to decrease the transmission of disease. In addition, increased delegation, teamwork, supply chains, sales activities, and business operations have all been disrupted. Many challenges have emerged in the management of organizations due to the pandemic including the lack of direct contact as the lockdown made many people work from home and placed restrictions on movement and travel and uncertainty about the future. The healthcare system was also affected by the COVID-19 pandemic and faced several difficulties including increased demand for medical supplies and personal protective equipment, a greater need for nurses and other skilled healthcare professionals, and increased pressure on healthcare facilities, emergency services, and critical care departments. These challenges have created some opportunities in the management systems of healthcare organizations and other sectors. It is recommended for leaders prepare and continuously work proactively to be ready for unexpected future crises. Risk management and planning for any unexpected situation are among the very important aspects of organizational management.

Spatio-temporal relative risks and priority areas for visceral leishmaniasis control in Brazil, between 2001 and 2020

Visceral leishmaniasis (VL) is a pressing public health problem in Brazil. The proper implementation of disease control programs in priority areas is a challenge for healthcare managers. The present study aimed to analyze the spatio-temporal distribution and identify high risk areas of VL occurrence in the Brazilian territory. We analyzed data regarding new cases with confirmed diagnosis of VL in Brazilian municipalities, from 2001 to 2020, extracted from the Brazilian Information System for Notifiable Diseases. The Local Index of Spatial Autocorrelation (LISA) was used to identify contiguous areas with high incidence rates in different periods of the temporal series. Clusters of high spatio-temporal relative risks were identified using the scan statistics. The accumulated incidence rate in the analyzed period was 33.53 cases per 100,000 inhabitants. The number of municipalities that reported cases showed an upward trend from 2001 onward, although there was a decrease in 2019 and 2020. According to LISA, the number of municipalities considered a priority increased in Brazil and in most states. Priority municipalities were predominantly concentrated in the states of Tocantins, Maranhão, Piauí, and Mato Grosso do Sul, in addition to more specific areas of Pará, Ceará, Piauí, Alagoas, Pernambuco, Bahia, São Paulo, Minas Gerais, and Roraima. The spatio-temporal clusters of high-risk areas varied throughout the time series and were relatively higher in the North and Northeast regions. Recent high-risk areas were found in Roraima and municipalities in northeastern states. VL expanded territorially in Brazil in the 21st century. However, there is still a considerable spatial concentration of cases. The areas identified in the present study should be prioritized for disease control actions.

A Hybrid Multi-Criteria Approach to the Vendor Selection Problem for Sensor-Based Medical Devices.

Sensors for health are a dynamic technology and sensor-based medical devices (SMD) are becoming an important part of health monitoring systems in healthcare centers and ambulatory care. The rapid growth in the number, diversity and costs of medical devices and Internet of Things (IoT) healthcare platforms imposes a challenge for healthcare managers: making a rational choice of SMD vendor from a set of potential SMD vendors. The aim of this paper is to develop a hybrid approach that combines a performance evaluation model and a multi-objective model for the SMD vendor selection problem. For determining the criteria weights in the performance evaluation model, an original version of the best worst method (BWM) is applied, which we call the flexible best worst method (FBWM). The multi-objective model has two objective functions; one is to maximize the SMD performance and the other is to minimize the SMD cost. A case study for the application of the hybrid approach for SMD procurement in a healthcare center is analyzed. The hybrid approach can support healthcare decision makers in their SMD procurement decisions.

Challenges in Healthcare Management of Individuals with Special Needs in Malaysia: Perceptions of Caregivers.

A "caregiver" is responsible for managing the basic needs of others, including individuals with special needs (IWSNs). Caregivers play an important role in the well-being of IWSNs, though caring can lead to a decline in health and quality of life. This qualitative study aimed to investigate the perceived healthcare challenges faced by caregivers of IWSNs in Malaysia. Thirty-two primary caregivers were interviewed via audio-recorded semistructured focus group discussions to investigate their perceived barriers and challenges in caring for IWSNs. The qualitative data were then analyzed via thematic analysis. Thirty-two participants took part in a total of nine discussion sessions, where the majority were females (n = 29; 90.63%) and from the Malay race (n = 30; 93.75%). Most of the IWSNs under their care had autism (n = 11; 34.38%) and were between 6 and 10 years of age (n = 13; 40.63%). The main themes identified were related to healthcare services, support systems, caregivers' personal factors, and IWSN issues. Within the healthcare services domain, themes regarding the accessibility and appropriateness of healthcare facilities and the attitudes of staff were uncovered, whereas in the support system domain, themes pertaining to community and peer, family, and governmental support were discussed. In the domain of caregivers' personal factors, themes regarding stress with the burden of care and feelings of guilt were noted, and in the area of IWSN factors, the theme of behavioral difficulties exhibited by IWSNs was discussed. Primary caregivers in Malaysia face challenges with healthcare facilities and staff, gaining support from the community, family, and government, burning out, and feeling guilty as well as behavior issues of their IWSN. Thus, understanding these challenges is vital in providing healthcare services that cater to not only IWSNs but also their caregivers to ensure the success and well-being of all involved.

Phase-Type Survival Trees to Model a Delayed Discharge and Its Effect in a Stroke Care Unit

The problem of hospital patients’ delayed discharge or ‘bed blocking’ has long been a challenge for healthcare managers and policymakers. It negatively affects the hospital performance metrics and has other severe consequences for the healthcare system, such as affecting patients’ health. In our previous work, we proposed the phase-type survival tree (PHTST)-based analysis to cluster patients into clinically meaningful patient groups and an extension of this approach to examine the relationship between the length of stay in hospitals and the destination on discharge. This paper describes how PHTST-based clustering can be used for modelling delayed discharge and its effects in a stroke care unit, especially the extra beds required, additional cost, and bed blocking. The PHTST length of stay distribution of each group of patients (each PHTST node) is modelled separately as a finite state continuous-time Markov chain using Coxian-phase-type distributions. Delayed discharge patients waiting for discharge are modelled as the Markov chain, called the ‘blocking state’ in a special state. We can use the model to recognise the association between demographic factors and discharge delays and their effects and identify groups of patients who require attention to resolve the most common delays and prevent them from happening again. The approach is illustrated using five years of retrospective data of patients admitted to the Belfast City Hospital with a stroke diagnosis.

Motivation and job satisfaction among hospital nurses in Bulgaria: A cross-sectional study

Introduction/Objective. The competitive healthcare market is focused on quality health services and the search for effective methods to improve the quality of these services represents a continuing challenge for healthcare managers. It has been found that satisfaction with the work of nurses directly affects the quality of care and patient satisfaction. The aim of this study was to examine the factors influencing the motivation and job satisfaction of hospital nurses. Methods. A cross-sectional study in private and public hospitals of Plovdiv region (second largest region in Bulgaria), established as training and teaching bases for nurses was conducted. The sample comprised of nurses employed in internal wards, surgical wards, intensive care units, and neurology ward settings. Results. Most of the participants 55 (67.1%) are working in public hospitals and 27 (32.9%) in private ones. All of the respondents were women with a mean age of 50.57 ? 11.6 years. Only 40.3% of nurses were satisfied with their job and employees in public hospitals were generally more dissatisfied, although both sectors have identified ?payment? and ?working conditions? as being an important source of dissatisfaction. Conclusion. Motivation and job satisfaction studies play an important role in providing appropriate medical care in the healthcare sector. The results of this study demonstrate the importance of good job salary, good working conditions, and co-workers? support for job satisfaction.

Policy Making in Health-care Management: Issues and Challenges

Kerala has become a success and a model for the country, especially in increasing life expectancy as well as reducing infant and maternal mortalities. However, there exists a wide disparity in health-care spending in the country. This disparity can be mainly attributed to the social, political, and economic circumstances prevailing in the states of India. The contribution of Missionary hospitals in addressing this equity gap is noteworthy. An organized movement in health-care sector was initiated by the missionary churches by establishing a variety of health-care formats in Kerala. Among the various stakeholders, the policymakers and leaders have a very relevant and challenging responsibility in envisioning and innovating policies, strategies, and finding creative ways of management and sustainability. This is a descriptive cross-sectional study, done among the missionary hospitals under Catholic Church in Kerala which are registered under CHAI Kerala. The study is limited to ten hospitals from five zones. The data are collected through questionnaire from fifty policymakers of ten hospitals spread all over the State of Kerala. The study shows that there is a significant difference in the satisfaction of policymakers with the health-care management based on their age and association with the institution. There is difference in the leadership quality exhibited by policymakers based on gender. Moreover, there is a significant difference in service quality based on their tenure of association with the institution. Along with sociodemographics, policies, and regulations, social responsibilities were the other factors found as major challenges in health-care management for the policymakers.

Strategies for controlling violence against health care workers: Application of fuzzy analytical hierarchy process and fuzzy additive ratio assessment.

The present study aimed to identify and prioritize control measures of violence against health care workers (HWs) using the fuzzy analytical hierarchy process (FAHP) and fuzzy additive ratio assessment (ARAS-F). Occupational violence is a pervasive problem in health care centres. Reducing violence against staff is one of the challenges for health care managers. At the first stage, the most common criteria and control options for violence against HWs were identified and extracted using a review of previous studies. At the next stage, criteria for selection of control measures were prioritized using the FAHP. Finally, control measures of workplace violence were prioritized using the ARAS-F method. Results of the FAHP indicated that safety and efficiency were the most important criteria. Results of the ARAS-F also revealed that 'increasing number of security personnel' and 'training staff' were the best recommendations for controlling violence against HWs. Based on expert's opinions, administrative measures are the optimal ways to control violence at health centres; therefore, it is suggested that violence control programmes should be more focused on administrative measures. These results could assist nursing management to take best strategies for controlling occupational violence based on multi-criteria decision-making methods.

Partnering with patients in quality improvement: towards renewed practices for healthcare organization managers?

BackgroundAround the world, many healthcare organizations engage patients as a quality improvement strategy. In Canada, the University of Montreal has developed a model which consists in partnering with patient advisors, providers, and managers in quality improvement. This model was introduced through its Partners in Care Programs tested with several quality improvement teams in Quebec, Canada. Partnering with patients in quality improvement brings about new challenges for healthcare managers. This model is recent, and little is known about how managers contribute to implementing and sustaining it using key practices.MethodsIn-depth multi-level case studies were conducted within two healthcare organizations which have implemented a Partners in Care Program in quality improvement. The longitudinal design of this research enabled us to monitor the implementation of patient partnership initiatives from 2015 to 2017. In total, 38 interviews were carried out with managers at different levels (top-level, mid-level, and front-line) involved in the implementation of Partners in Care Programs. Additionally, seven focus groups were conducted with patients and providers.ResultsOur findings show that managers are engaged in four main types of practices: 1-designing the patient partnership approach so that it makes sense to the entire organization; 2-structuring patient partnership to support its deployment and sustainability; 3-managing patient advisor integration in quality improvement to avoid tokenistic involvement; 4-evaluating patient advisor integration to support continuous improvement. Designing and structuring patient partnership are based on typical management practices used to implement change initiatives in healthcare organizations, whereas managing and evaluating patient advisor integration require new daily practices from managers. Our results reveal that managers at all levels, from top to front-line, are concerned with the implementation of patient partnership in quality improvement.ConclusionThis research adds empirical support to the evidence regarding daily managerial practices used for implementing patient partnership initiatives in quality improvement and contributes to guiding healthcare organizations and managers when integrating such approaches.

Contextual ambidexterity and innovation in healthcare in India: the role of HRM

PurposeThe purpose of this paper is to examine innovation in the resource-constrained context of India’s healthcare industry. It is argued that the process of innovation in addressing healthcare management challenges in such a context occurs through organisational ambidexterity and that human resource management (HRM) plays an important role.Design/methodology/approachA qualitative research methodology is applied to explore the role of HR practices in facilitating contextual ambidexterity and subsequent innovations in healthcare in India. The unit of analysis is the “case” of healthcare providers in India and in-depth interview and documentary data in two case sites are analysed to reveal the role of HRM in facilitating contextual ambidexterity and innovation. Data analysis was undertaken first at a within-case and then at a cross-case analysis level using interpretive manual coding based on how the data explained the role of HRM in delivering innovative outcomes and supporting organisational ambidexterity.FindingsThe authors found evidence of the use of sets of high-involvement HRM practices for exploration of new ideas and efficiency-driven HRM practices for creating contextual ambidexterity in the case organisations. Further, managerial/leadership style was found to play an important role in creating cultures of trust, openness, risk-taking and employee empowerment, supported by an appropriate mix of intrinsic and extrinsic rewards. Finally, training was also reported as being central to creating an ambidextrous context for delivering on various innovations in these healthcare providers.Originality/valueThis study represents an exploration of innovation in the context of India’s healthcare sector through intersecting literatures of ambidexterity, innovation and HRM practices. In light of the emerging economy research context, an important empirical contribution is palpable. Moreover, through a study design which included collecting data from multiple informants on the role of human resources in facilitating innovative outcomes, the authors reveal the role of HR-related initiatives, beyond formal HR practices in creating contextual ambidexterity. This study also reveals the degree to which contextual idiosyncrasies enhance our understanding of the role of HR in facilitating innovation in emerging economies.

Sequential simulation used as a novel educational tool aimed at healthcare managers: a patient-centred approach.

A new challenge for healthcare managers is to improve the patient experience. Simulation is often used for clinical assessment and rarely for those operating outside of direct clinical care. Sequential simulation (SqS) is a form of simulation that re-creates care pathways, widening its potential use. Numbers, outcome measures and system profiling are used to inform healthcare decisions. However, none of these captures the personal subtleties of a patient's experience. 56 students attended a teaching module using SqS and facilitated workshops as part of their induction week on an MSc International Health Management course. The workshop was voluntary and was offered as an opportunity for the students to gain an insight into the UK health system through the medium of simulation. An evaluation survey incorporating quantitative and qualitative student feedback was conducted. Descriptive statistics were generated from the quantitative data, and thematic analysis was undertaken for the qualitative data. There was strong agreement for the acceptability of the workshop approach in relation to the aims and objectives. Likert scale (1--5) mean total=4.49. Participants responded enthusiastically (revealed through the qualitative data) with ideas related to perspectives sharing, understanding healthcare management and processes and the consideration of feasibility and practicalities. They also suggested other applications that SqS could be used for. The SqS approach has demonstrated that simulation has a wider potential than for clinical assessment alone. Further studies are required to determine its potential uses and affordances beyond its current format.

Primary health care management challenges for childhood atopic eczema as experienced by the parents in a Gauteng district in South Africa

The goal of this study was to explore and describe the experience of parents regarding the primary health care (PHC) managementof their children's atopic eczemain a Gauteng district. A qualitative, explorative, descriptive, contextual embedded single case study design was employed. Data were collected through semi-structured individual interviews, field notes and direct observation until saturation occurred; analysed according to Tesch's steps of descriptive data analysis. Trustworthiness and ethical measures were used and were employed.Three themes were identified. Management challenges, the second theme with subthemes: drug management, knowledge levels of PHC clinicians, health education andfinancial challenges, will be discussed.

Value based e-health care – a case study of Tata Memorial Centre

Subject area The subject areas are strategy, general management, health-care management, change management and inclusive growth model and application of technology to manage health care. Study level/applicability The case can be used to teach challenges in managing change in a health-care facility. Case overview Tata Memorial Centre (TMC) is dedicated to provide best health-care services in the field of cancer cure. TMC established its credentials for service, education and research, which contributed to it being rated among the ten best hospitals year on year. Starting from humble moorings, TMC has grown to an institution of high repute from an 80-bed hospital to a 700-bed hospital. TMC held a number of pioneering efforts, which included bone marrow transplantation, external beam radiotherapy (linear accelerator), tumor tissue bank and bio-imaging to name a few. The management team of TMC had ensured that the growth had been orderly and appropriate to the changing needs of the community. Managing a hospital with disparate skill sets in the face of ever-increasing demand for services had always been a challenge in itself. As a government-run facility and well funded by the trust, TMC offered excellent services and post-operative care to the patients. So, it became imperative for the hospital to adopt technology to improve its hospital services and maintain transparency. Patients came to the hospital from different states in India and across the globe. TMC registered international and national patients online. Online medical reports were checked before the patients visited the hospital. TMC has developed an e-system that will allow patients around the world to send their tissue samples that are suspected to be cancerous for medical advice to the hospital. This case study is developed to provide insights into the transformation of TMC into an e-health-care service and explains the process of change management. Expected learning outcomes They are to provide insights into the challenges in health-care management, to illustrate the challenges faced by organization in implementing information and communication technology- managing change and to bring about best practices in the case organization and find solutions to the following questions: What are challenges faced by health-care officials in providing health care using new technological innovations? How can hospitals equip themselves with new technology? With the advent of improved and modern communication methods, medical practices and cases are more easily shared. Cases are discussed, recorded and, in many cases, put up for general public viewing through the electronic media. How can hospitals manage change? How can hospital administrators manage speed of delivery, quality healthcare, innovation and brand image? Supplementary materials Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes. Subject code CSS:11 Strategy.

From knowledge to decision – a case study of sales and operations planning in health care

One of the most important challenges in health care management is balancing resources with fluctuating and uncertain demand. This study examines whether introducing a standardised process for sales and operations planning at a large university hospital improved specialty department managers’ knowledge of planning conditions and if so, whether decisions were made based on this knowledge. Using responses from a survey of 30 specialty department managers at Sahlgrenska University Hospital in Sweden, the analyses indicate that operational knowledge strengthens insights about the needs for strategic decisions, and vice versa. Moreover, knowledge is a necessary, but not sufficient, condition for making decisions at the department level. An overall planning and decision structure is required and should be implemented first at the hospital level to effectively allocate resources.

Healthcare management challenges in two university hospitals

The economic downturn in developed countries has had implications in the field of healthcare. In Finland, public hospitals have been forced to improve their production efficiency while coping with limited resources. In this study, 14 interviewees from two Finnish University hospitals were interviewed. The aim of the study was to shed light on today's work process, change, information, medical technology, and lean management challenges. Both hospitals had recently undergone rigorous renovation and relocation projects. The employees and patients were happy with the hospital management. However, there were several improvements needed regarding hospital hierarchy, bureaucracy, communication, ICT technology, logistics, safety, teamwork, personnel structure and outsourcing. The managements at both hospitals desired to improve their work processes, employee well-being and patient care, and also develop the lean work processes. Several functions were praiseworthy, and those in need of improvement were transparently discussed by the hospital management.