Hospital Efficiency Research Articles

STRATEGIES FOR IMPROVING OPERATIONAL EFFECTIVENESS IN THE CLINICAL LABORATORYAT KING FAHD ARMED FORCES HOSPITAL (KFAFH)

Background:Laboratory turnaround time is considered one of the most important indicators of work efficiency in hospitals. Physicians always need timely results to make effective clinical decisions, especially in the emergency department. These results can guide physicians to admit patients to the hospital, discharge them home, or do further investigations. Objectives:To reduce troponin turnaround time (TAT) to less than 60min using coordinated process improvement methods Methods: A retrospective study in the ED Laboratory at King Fahd Armed Forces Hospital (KFAFH). A team of lab specialists conducted a Root cause analysis with the Fishbone diagram and applied Focus PDCA to the process. The time taken from receiving the test to the release of results in minutes was considered the Turnaround time (TAT) for the Trop I test. Results:The average TAT time was brought down from 101 minutes to consistently less than 35 minutes by September 2019. Conclusion:With an interdisciplinary team of healthcare professionals, the Turnaround time for troponin Iwas successfully reduced in our Emergency Department by 70% in 2019.

Appraisal of regional hospital efficiency and healthcare quality in China: Impacts of subsidies and marketization

In the face of a rapidly ageing population, China's healthcare system is under mounting pressure to meet growing demand for more and better services. This paper aims to identify opportunities to improve the efficiency and quality of healthcare services in China. We first evaluate the healthcare performance of China's 31 provincial regions during the 2005–2019 period. The hospital efficiency is computed by using a window-based super-efficiency composite Data Envelopment Analysis model, while the healthcare quality is evaluated by using a window-based Technique for Order Preference by Similarity to an Ideal Solution method. Then, we investigate the impacts of socioeconomic factors, such as government subsidies, marketization, per capita Gross Domestic Product and demographic structure, on regional healthcare performance by use of regression analysis. The main findings include: 1) The nationwide healthcare performance has improved from 2005 to 2019 in part due to China's rapid economic growth, but more progress has been achieved in improving hospital efficiency than healthcare quality. 2) Government subsidies can improve both regional healthcare quality and hospital efficiency. While marketization can enhance hospital efficiency, private hospitals provide lower quality of care than public hospitals. 3) Regional hospital efficiency and healthcare quality are positively correlated, but a causal relationship cannot be established based on our empirical evidence. Based on our findings, we have the following recommendations for policymaking: 1) The government should increase subsidies to medical institutions in order to improve healthcare quality as well as hospital efficiency. 2) More subsidies should be allocated to regions having a high old-age dependency ratio. 3) More quality control and improvement efforts should be taken at private hospitals.

Artificial Insemination Pregnancy Program as a Type of Service and Level of Efficiency of Health Services

The purpose of this study is to look at the artificial insemination pregnancy program service as one of the services at Mutiara Bunda Mother and Child Hospital. In this context, it will also look at the perspective of its management efficiency. The pregnancy program with this method involves the age of female and male patients, endometrial thickness (EMT), post-washing total motile sperm count (PTMC), artificial insemination time, insemination frequency, and ovarian stimulation protocol which are compared between the pregnant group and the non-pregnant group to see any correlation. Then, hospital efficiency reflects the ratio of the value of health services provided, both quantity and quality of care to the resources used in health services. This study was conducted at Mutiara Bunda Mother and Child Hospital Padang. The results of the study state that procedurally and institutionally, the pregnancy program service with artificial insemination at RSIA Mutiara Bunda Padang is very good. Specialist doctors and other paramedics are well qualified to implement this service program. The Director of the Mother and Child Hospital includes effective leadership because the performance of staff or officers at the Mother and Child Hospital has worked well, with the motivation provided by the leadership. The hospital has adequate specialist doctors, both in terms of number and type of specialization in accordance with hospital specifications, namely Obgyn and Pediatric specialists. The artificial Insemination Pregnancy Program as a type of service is the first in Padang

Analysis of Density and Patient Wait Times in Terms of System Management in Turkish Hospitals: Setting A Pattern By Days and Hours of the Week

The time spent waiting is an important problem regarding patient satisfaction and hospital efficiency, and increases the need for evidence-based information for management to make decisions towards a solution. This study aims to examine the process flows in hospitals based on actual data with the intent to design a better service delivery system and set a pattern in terms of determining the congestion in the process and planning the necessary improvements. For this purpose, the data sets for 2016 pertaining to secondary and tertiary level hospitals in Turkey, which are stored in the central physician appointment system (CPAS), are investigated. The data is analyzed through pre-processing, cleaning and transformation stages. Congestion patterns are determined by days and hours spent in hospitals. Monday is found to be the day with the highest patient density and the longest wait time in Turkish hospitals. It is observed that wait times are shorter on Wednesday in the middle of the week, while they are longer on Friday, the last working day. Additionally, when analyzed by working hours, it is determined that the first 2 hours in the morning (9.00 a.m. to 11.00 a.m.) is the period when most patients are examined. The lunchtime (between 12.00 p.m. - 1.00 p.m.) and the afternoon from 4.00 p.m. to 5.00 p.m. are the times when patient density is the lowest, but average wait time is the longest. Turkish hospitals are found to be particularly congested on some days and during some hours regarding patient wait times. Thus, policy recommendations can be developed specifically to the days and times when congestion patterns are identified rather than suggesting a general policy. This study is the most comprehensive study conducted in Turkey through process data. The working model is reproducible in different countries and regions.

Relationship between Racial Diversity in Medical Staff and Hospital Operational Efficiency: An Empirical Study of 3870 U.S. Hospitals.

Demand for foreign nurses and medical staff is rapidly increasing due to the severe labor shortage in U.S. hospitals triggered by the COVID-19 pandemic. However, empirical studies on the effect of the racial diversity of medical staff on hospital operations are still lacking. This research gap is thus investigated based on the foreign medical staff working in 3870 U.S. hospitals. Results show that workforce racial diversity has a significantly positive relationship with hospital operational efficiency regarding occupancy rate, manpower productivity, capacity productivity, and case mix index. Notably, this study empirically supports that increasing the ratio of foreign nurses positively affects the overall operational efficiency of hospitals. In addition, the study results also indicate that the hospital location, size, ownership, and teaching status act as significant control variables for the relationship between racial diversity and hospital efficiency. These results imply that hospitals with these specific operating conditions need to pay more attention to racial diversity in the workplace, as they are structurally more sensitive to the relationship between racial diversity and operational efficiency. In short, the findings of this study suggest that hospital efficiency can be operationally improved by implementing workforce ethnic diversity. For this reason, hospital stakeholders and healthcare policymakers are expected to benefit from this study's findings. Above all, the results of this study imply that if an organization adapts to extreme external environmental changes (e.g., the COVID-19 pandemic) through appropriate organizational restructuring (i.e., expanding the workforce racial diversity by hiring foreign medical staff), the organization can gain a competitive advantage, a claim that is supported by contingency theory. Further, investors are increasingly interested in ESG, especially companies that embody ethical and socially conscious workplaces, including a diverse and inclusive workforce. Thereby, seeking racial diversity in the workforce is now seen as a fundamental benchmark for organizational behavior that predicts successful ESG business practices, a claim that is supported by stakeholder theory. Therefore, in conclusion, the findings of this study suggest that workforce racial diversity is no longer an optional consideration but should be considered as one of the essential determinants of competitive advantage in organizations, particularly in the healthcare sector.

Жіночий досвід у перинатальному періоді

Perinatal experience is an important stage in the life of every mother and her child. The childbirth process can be a source of emotional satisfaction and strengthen the bond between the mother and the newborn baby. However, a negative childbirth experience can create feelings of fear towards future deliveries, the need for cesarean section, the risk of developing post-traumatic stress and postpartum depression, as well as problems with breastfeeding. Purposе - to study the level of women’s satisfaction with childbirth in order to improve perinatal care. Materials and methods. A prospective cohort study was conducted involving 321 mothers who completed the satisfaction scale for childbirth and delivery. Descriptive statistics were utilized for data analysis. It was found that the data distribution deviates from the normal distribution. The median value (Me) and the interquartile range (Q I - Q III) were calculated for the dataset. Results. The satisfaction scale helped identify the advantages and disadvantages of the childbirth experience in four key aspects of vaginal delivery. 1. Own capacity: a) Advantages: 76% of women felt strong; 79.3% - felt confident; 67.4% - felt happy. b) Disadvantages: 54% - felt that their childbirth experience matched their plans; 76.2% - felt tired. 2. Professional support: a) Advantages: 86.8% - felt they received sufficient attention and information from their caregivers; 84.8% - felt a comfortable and warm atmosphere; 84.8% - felt their needs were understood; 89.3% - felt they received proper care and assistance; b) Disadvantages: None, as the majority of women felt satisfied with the professional support. 3. Perceived safety: a) Advantages: 86% - felt safe; 89% - had trust in the professional abilities of the healthcare team; 68% - had many positive memories, while 1% had many negative memories; b) Disadvantages: 31% - experienced a low level of anxiety, while 16% - experienced a high level of anxiety. 4. Participation: a) Advantages: 67% - had the opportunity to choose a pain relief method; 60% - had the opportunity to change positions, while 21% did not; 86% - felt they received sufficient attention and information from the medical team; b) Disadvantages: Some women did not have the opportunity to choose a pain relief method (33%) or change positions during childbirth (21%). Conclusions. The study of women’s satisfaction with childbirth indicated the need for improvement in the aspect of «perceived safety». «Own capability», «professional support», and «participation» demonstrate high satisfaction, indicating the quality of perinatal care. The level of satisfaction can become a key indicator of the quality of perinatal care, contributing to the improvement of hospital efficiency assessment and quality of medical services». The study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Local Ethical Committee of the institution specified in the work. Informed consent for participation in the study was obtained from the women. No conflict of interests was declared by the authors.

Interventions Using Wearable Activity Trackers to Improve Patient Physical Activity and Other Outcomes in Adults Who Are Hospitalized

Low levels of physical activity during hospitalization are thought to contribute to a range of poor outcomes for patients. Using wearable activity trackers during hospitalization may help improve patient activity, sedentary behavior, and other outcomes. To evaluate the association of interventions that use wearable activity trackers during hospitalization with patient physical activity, sedentary behavior, clinical outcomes, and hospital efficiency outcomes. OVID MEDLINE, CINAHL, Embase, EmCare, PEDro, SportDiscuss, and Scopus databases were searched from inception to March 2022. The Cochrane Central Register for Controlled trials, ClinicalTrials.gov, and World Health Organization Clinical Trials Registry were also searched for registered protocols. No language restrictions were imposed. Randomized clinical trials and nonrandomized clinical trials of interventions that used wearable activity trackers to increase physical activity or reduce sedentary behavior in adults (aged 18 years or older) who were hospitalized were included. Study selection, data extraction, and critical appraisal were conducted in duplicate. Data were pooled for meta-analysis using random-effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. The primary outcomes were objectively measured physical activity or sedentary behavior. Secondary outcomes included clinical outcomes (eg, physical function, pain, mental health), and hospital efficiency outcomes (eg, length of stay, readmission). Fifteen studies with a total of 1911 participants were included, representing various surgical cohorts (4 studies), stroke rehabilitation (3 studies), orthopedic rehabilitation (3 studies), mixed rehabilitation (3 studies), and mixed medical (2 studies). All studies were included in meta-analyses. There was a significant association between wearable activity tracker interventions with higher overall physical activity (standardized mean difference, 0.35; 95% CI, 0.15 to 0.54; I2 = 72%; P < .002) and less sedentary behavior (mean difference, -35.46 min/d; 95% CI, -57.43 to -13.48 min/d; I2 = 0; P = .002), and a significant association between wearable activity tracker interventions with improvements in physical function (standardized mean difference, 0.27; 95% CI, 0.08 to 0.46; I2 = 0; P = .006) compared with usual care. There was no significant association between wearable activity tracker interventions with pain, mental health, length of stay, or readmission risk. In this systematic review and meta-analysis, interventions that used wearable activity trackers with patients who are hospitalized were associated with higher physical activity levels, less sedentary behavior, and better physical functioning compared with usual care.

Research on the Experience of Influencing Elements and the Strategy Model of Children’s Outpatient Medical Services under the Guidance of Design Thinking

Faced with the generally poor experience in pediatric outpatient in China, under the guidance of design thinking, based on the analysis and research of the main elements affecting child outpatients’ medical service experiences, this study proposes a set of strategic models that can improve child outpatients’ medical service experiences. Specifically, this study takes Shanghai Xinhua Hospital as a research case, combined with SPSS data statistics software, and comprehensively uses preliminary field research methods, questionnaire descriptive analysis methods, questionnaire satisfaction analysis methods, and questionnaire principal component analysis (PCA) methods as well as the structured interview method; thus, the main elements affecting child outpatients’ medical service experiences were obtained. Then, according to the main elements, a set of child outpatient medical service strategy models is proposed to improve child outpatients’ medical service experiences. Finally, the effectiveness of the strategy model is tested through satisfaction analysis and simulation case verification. The model is a people-centered, sustainable strategic model. With the support of design thinking, the strategic model takes the experience of children as the core improvement point, which is able to fully protect the rights and demands of child patients. At the same time, this strategy model can also reduce the workload of doctors, improve the operational efficiency of hospitals, promote a more equal distribution of medical resources, and reduce medical service costs. More importantly, it also encourages patients and their families to communicate and express their opinions to medical professionals, which can greatly reduce the tension between doctors and patients and effectively avoid doctor–patient conflicts. This has important implications for the sustainability of healthcare. However, this strategy model is only a guiding strategy for improving outpatient care for children. It does not provide detailed solutions around certain specific issues and specific implementations. At the same time, it is not a complex engineering design system but only provides a reference for improving children’s medical services in terms of strategic logic.

The perception of competition in the hospital healthcare market of the Republic of Moldova

PurposeIdentifying the perception of competition between public and private providers in the national hospital market can help authorities to develop appropriate management strategies applicable to the hospital sector and increase the efficiency of public hospital institutions.Design/methodology/approachA mixed selective descriptive study including quantitative and qualitative components was carried out on in the Republic of Moldova between 12/2021 and 03/2022. The study included all hospitals in the country. The study revealed the hospital manager's perception of the hospital's competition as respondents to the questionnaire were only the directors and managers of hospital institutions. The concept of evaluation of the perception of competition was carried out through the lens of “Porter's 5 forces” from “Competitive strategies” by Michael E. Porter. The authors used a questionnaire as an instrument for studying the perception of competition. All study participants responded to both the quantitative and qualitative questionnaire.FindingsInterhospital competition perceived by managers using model framework of “Porter's 5 forces” reveals high danger from service providers and high perception of rivalry; hospital directors perceived as low: the patient's bargaining power; the danger of new competitors entering the market; the danger of substitution, which constitutes competitive advantages; the lack of autonomy in the selection of services and patients and legislative barriers are the main perceived dissensions. The perception of competition between public and private hospitals is one with high rivalry, especially in the country's municipalities.Originality/valueThe national public hospital system takes up to 65% of the health budget being extremely expensive, a fact that indicates a rather low competitiveness of them. The European average indicates figures of 30–40%. The private hospital sector is less developed compared to most European countries, being represented by 17 institutions, in comparison Romania has 104 private hospitals representing about 25% of the market share. Private hospitals also occupy a considerable part of the European hospital healthcare market, continuing to increase, reaching over 30% in Germany.

A New Scenario-Based Simulation Model for Cost Management of Healthcare Services through Improving the Efficiency of the Health Centers

There is a need for an appropriate decision-making approach and a precise costing method in order to make appropriate decisions that result in managing the resource utilization, improving the efficiency of healthcare systems and processes, increasing the patient consent, and reducing the costs of healthcare services. Therefore, this study is to develop a new method for estimating and reducing the services’ costs by assessing the scenarios intended for the improvement of departments using time-driven activity-based costing (TDABC) and simulation model with conditions of uncertainty. To investigate the application of this method, the lithotripsy department of a kidney center has been studied and attempted to investigate the effects of different scenarios of scheduling the technicians’ presence and scheduling patients’ appointments, alongside the effects of controlling the factors of patient cancellation in different stages of the treatment process on lowering the healthcare costs and waiting time and on improving the hospital efficiency. The results showed that significant improvements in costs, waiting time, human resource utilization, and overall system efficiency were emerged. The impact of patient appointment scheduling scenarios on the abovementioned indexes was found to be far more than other scenarios. Furthermore, the results from the costs determined indicate a difference of 0.60, 0.61, 0.67, 0.67, and 0.63 percent between these costs and the costs determined by the traditional approaches. Such differences among the costs determined by these two approaches mainly occur due to different methods of allocating indirect costs and existence of uncertainty in the costs and time of therapeutic activities.

Spatial dependence in patient migration flows

ABSTRACT This study analyses whether higher efficiency performance of Ecuadorian hospitals attracts larger inflows of interregional patients to a given hospital and assesses the existence of spatial dependence in the patient migration network. We develop an innovative two-stage approach. In the first stage, we use conditional order-m estimations to obtain robust hospital efficiency. In the second stage, we apply a spatial Durbin interaction model to estimate the effect of hospital efficiency on patient migration flows and disentangle the spillover effects. We identify the positive effect of specialized hospitals’ efficiency in attracting patients from other regions alongside spillover effects in the migration dyad.

A Network-DEA model to evaluate the impact of quality and access on hospital performance.

The relationship between efficiency, quality, and access in healthcare is far from being well defined. In particular, there is no consensus on whether there is a trade-off between hospital performance and its social dimensions, such as the care appropriateness, safety, and access to proper health care. This study proposes a new approach based on the Network Data Envelopment Analysis (NDEA) to evaluate the existence of potential trade-offs between efficiency, quality, and access. The aim is to contribute for the heated debate around this topic with a novel approach. The suggested methodology combines a NDEA model with the weak disposability of outputs to handle with undesirable outputs related to the poor quality of care or the lack of access to appropriate and safe care. This combination results in a more realistic approach that has not yet been used to investigate this topic. We utilised data of the Portuguese National Health Service from 2016 to 2019, with four models and nineteen variables selected to quantify the efficiency, quality, and access to public hospital care in Portugal. A baseline efficiency score was calculated and compared with the performance scores obtained under two hypothetical scenarios to quantify the impact of each quality/access-related dimension on efficiency. The first scenario considers that each variable, individually, is at its best situation (for example, absence of septicaemia cases), and the second one, at its worst (e.g., all seen inpatients had a septicaemia case). The findings suggest that there might exist meaningful trade-offs between efficiency, quality, and access. Most variables exhibited a considerable and negative impact on the overall hospital efficiency. That is, we may expect a trade-off between efficiency and quality/access.

A Scoping Review of Health Insurance Deductions in Hospitals: Root Causes and Solutions

Context: The issue of insurance deductions is one of the major problems that lead to the shortage of financial resources in hospitals. The present study was conducted to review the root causes of insurance deductions and propose solutions to reduce them in Iranian hospitals. Methods: This was a scoping review of the literature on health insurance deductions in hospitals in Iran within 2000 - 2023 to synthesize the findings of original Persian and English studies that focused on the causes of deductions and propose strategies to reduce them in Iranian hospitals. The relevant concepts and terminology in health insurance deductions were found through medical subject headings (MeSH). The articles were screened based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist. Analysis of research data (text of the articles) was carried out by the content analysis technique in MAXQDA software (version 10). Results: A total of 1121 publications were identified, of which 41 publications met the inclusion criteria and were reviewed. Based on the present analysis, most studies (61%) were published within 2016 - 2020, 12.2% of the included studies were qualitative, and 48.8% were performed in hospitals. Finally, 46 causes of deductions and 35 solutions to reduce insurance deductions were extracted. The leading causes of deductions were associated with service delivery, service registration, sending documents, and conversion of services into revenue. The most important causes of deductions in dimensions of providing and registering services were a lack of familiarity of service providers with insurance rules and regulations, coding and relative value book, extravagance and motivation of providers to earn more revenue, and lack of strong infrastructure to register services. Furthermore, strategies for reducing health insurance deductions were categorized into three groups, namely meta (ministries of health), macro (universities), and mezzo (hospitals). The top strategies to reduce health insurance deductibles were associated with several dimensions, such as providers, process modification, policy reform, and infrastructure modification. The most important strategies to reduce deductions in these four dimensions were teaching the documentation principles to all medical staff, familiarizing physicians with insurance laws and correct coding, continuous interaction between insurance companies and hospitals, and revisions in the repayment system. Conclusions: The causes of deductions could be determined through several dimensions. To manage and reduce the number of deductions, these causes should be carefully examined in the dimensions of service delivery, service registration, and document regulation and audit, and each hospital should use relevant strategies according to the weak points. However, solving the issue of deductions is not only related to hospitals; it is necessary for policymakers and health managers in the ministries of health, universities of medical sciences, and health insurance organizations to adopt necessary policies, especially in the field of hospital information management, to reduce deductions. According to the presented topics, the efficiency of hospitals and, ultimately, the quality of medical care can improve through a correct and more accurate understanding of the causes of deficits. It also prevents the waste of financial resources in hospitals, which is the main support in providing services and survival.

Experience of domestic and foreign healthcare by appointment of specialists without medical education to the head positions of medical institutions (literature review)

Following the special attention of foreign colleagues to appoint doctors as hospital managers, the issue &#x0D; of appointing specialists without medical education to the management of medical institutions in Russia is increasingly being looked at and discussed. &#x0D; The purpose of the study is to analyze historical and modern literary sources that highlight the experience of domestic and foreign healthcare by appointing specialists without medical education to the head positions of treatment and preventive medical institutions.&#x0D; The analysis of literary sources from 1940 to 2021 was carried out in electronic scientific libraries: Scopus, Web of Science, MedLine, eLibrary, CyberLeninka, Central scientific medical library and the Russian State Library by keywords: manager, physician, physician leadership, hospital CEO&#x0D; The article presents historical data on the formation in Russia since the beginning of the 18th century of the first medical institutions for the needs of the army and navy and the appointment of doctors to senior positions in them. From 1755 to 1908, the management of military hospitals was temporarily transferred to specialists without medical education, which led to numerous conflicts and a decrease in the efficiency of hospitals. Currently, in a number of foreign countries, in order to improve the quality of medical care, the issue of transferring managerial functions to doctors in hospitals is being actively discussed.&#x0D; The main reasons for the discussion about the expediency of appointing specialists to senior positions in medical institutions without medical education are: shorter terms of their training; health care activities in market conditions; the need for modern managers to possess leadership, managerial, economic and legal competencies.&#x0D; Conclusion. The work experience of domestic and foreign health care indicates the expediency of appointing doctors with leadership qualities and special training in the field of healthcare institutions and public health to senior positions in medical institutions. This contributes to the formation of a corporate culture in medical teams and improving the quality of medical care for the population.

“Money is not an issue!”: Hospital CFOs’ narratives about handling a sudden shift in managerial focus

The sustained political and managerial focus on cost containment and efficiency in hospitals has been altered by COVID-19-related concerns about public health. Through a novel qualitative study in Denmark, we explore CFOs’ narratives of their experiences during a sudden shift in managerial logic. All of the CFOs describe engagement in key operational procedures and change management that was fostered by the constant search for stability that strongly depended on bottom-up decision-making and flexibility. During this process, the existing competing logics of managerialism and medical professionalism vanished. The CFOs describe new forms of dynamic and collaborative approaches. The possibility of adhering to the core logic of administrative accounting techniques combined with urgency and emotional encounters appears to enable this approach. Thus, we document a moment when well-known opposing logics were suspended by exogenous urgency. This finding suggests possibilities for moving beyond deep-rooted views on established public administration structures and logics. Points for practitioners Financial managers show administrative skills that are useful for public administration changes in both administration and daily operations. These managers appear to have a strong core identity and willingness to dynamically engage with and facilitate acute frontline operational issues. In an emergency situation such as COVID-19, we find co-dependency across subject fields (administration and medical professions) which enables collaborations.

Hospital cost efficiency: an examination of US acute care inpatient hospitals.

The use of stochastic frontier models for inference on hospital efficiency is complicated by the inability to fully control for quality differences across hospitals. Additionally, the potential existence of cross-sectional dependence due to the presence of unobserved common factors leads to endogeneity problems that can bias both cost function and efficiency estimates. Using a panel consisting of 1518 hospitals for the years 1996-2013 (T=18), I adopt techniques for dealing with long, cross-sectionally dependent panel data in order to estimate cost parameters and hospital specific efficiency. In particular, I employ the estimation technique proposed by Bai (Econometrica 77(4):1229-1279, 2009), which assumes that the unobservable heterogenous effects have a factor structure. I find evidence of considerable scale economies and that hospital cost inefficiencies have been increasing during the period of 1996-2013, and that the growth in expenditures is, in part, driven by spending that increases patient satisfaction, but that does not significantly contribute to improved patient health outcomes.

Health care policy that relies on poor measurement is ineffective: Lessons from the hospital readmissions reduction program.

Health care policy that relies on poor measurement is ineffective: Lessons from the hospital readmissions reduction program.

Social and economic aspects of treatment of patients with medium (W2) and large (W3) postoperative ventral hernias

The article describes social and economic aspects of the treatment of patients with medium and large postoperative ventral hernias . The study was based on the results of treatment of 181 patients operated by endovideosurgical and open methods for postoperative ventral hernias . The stratification of patients was carried out on the basis of the mod ern classification of postoperative hernias of the EHS approved in the national clinical guidelines . The first main group of patients who underwent laparoscopic hernioplasty using the IPOM+ technique ( intraperitoneal onlay mesh ) consisted of 47 people . The second main group included 12 patients operated using the preperitoneal eTEP technique ( extended total extraperitoneal plasty ). The control group consisted of 122 patients with postoperative ventral hernias who underwent traditional ( open ) hernioplasty : using the techniques of onlay – 35 patients , inlay – 12, sublay – 75. Preoperative examination before planned minimally invasive hernioplasty included routine laboratory and instrumental examinations . The exceptions were patients with stage II and III obesity , as well as large postoperative ventral hernias , patients who underwent computed tomography with abdominometry . The economic efficiency of the treated patients was calculated using standardized formulas . It has been established that the complete e- TEP operation statistically reliably allows to get a significant economic effect compared to the laparoscopic IPOM surgery . IPOM endovideohernioplasty can be used in patients with a combined surgical disease of the abdominal organs in the case of simultaneous intervention . Traditional hernioplasty in patients with large and giant hernias with reduction of abdominal volume are the operations of choice and significantly increase the economic efficiency of the medical hospital . A modern surgical hospital should be able to perform any variants of both traditional and endovideosurgical hernioplasty in order to provide effective medical care and achieve optimal economic performance in any of the existing health insurance systems .

IN-PATIENT COSTS OF CORONAVIRUS DISEASE 2019 WITH FINANCIAL REGULATIONS AND HEATH ECONOMY

Introduction: Coronavirus Disease 2019 (COVID-19) is an emerging disease that infects patients, who have critical and complex health problems, that need to be treated in hospitals. The financial regulations and heath economy to management efficiency in hospitals is an important indicator for hospital administrators to make decisions for efficient health service provision.Then, the purposes were to: analyze the cost of in-patient with COVID-19 per day and per admission, and compare COVID-19 severity with the cost of in-patient.Methods: This retrospective study using secondary data from the standard data set HOSxP data system program 43 folders of 18 , between 2021 and 2022 was conducted. The total hospital costs was analyzed from the 4191 samples of in-patients with COVID-19 on the 18 community hospital in Sakon Nakhon Province, Thailand.Results:The majority of samples were females 52.6%, age group between 30 - 39 of 26.0 %, the insurance type was Social Security Scheme 60.9% (average sleeping days 11 days), lived in Sakon Nakhon province, Thailand 77.7%, no medical conditions 97.7 %, the severity of disease was asymptomatic and mild symptoms 80.5%. In addition, the cost of an in-patient COVID-19 ward was 104.1 USD per day. The cost of complication diseases resulted from 1,063.3 USD - 1,681.1 USD per admission, moderate symptoms and pneumonia were 1,681.1 USD per admission, and mild symptoms were 1,063.3 USD per admission, which was higher than the standard cost (p&lt;0.015). Furthermore, the cost of mild symptoms was 1,063.3 USD per admission was higher than the estimated cost (p&lt;0.05), and the cost of moderate symptoms with pneumonia was 1,681.1 USD per admission, higher than the estimated cost (p&lt;0.001). Conclusions: As a consequence, the various levels of clinical severity and the cost of an in-patient with COVID-19 is higher than the standard cost and estimated cost. However, there is still no suitable fiscal legislation.

Mediating Role of Teamwork in the Influence of Team Role on Team Performance

As an important hospital task, the quality and efficiency of nursing practice directly affect the medical quality and sustainable development of the hospital. Increasing attention is now paid by managers to nursing teamwork. From the level of the nursing team, this study explored the relationship between team roles, using teamwork as the intermediate variable, and team performance to provide a theoretical foundation for the human resource management of nursing managers. Taking 29 general inpatient areas of a tertiary general hospital in Beijing as research objects, a questionnaire survey was used to collect basic information on nursing staff, teamwork, team roles and team performance. The collected data were analysed. A pathway analysis based on a multiple regression analysis was used to interpret the effect of each team role on teamperformance. ①The mean and maximum value of emotional type (Teamworker and Finisher) were the largest in the role combination of nursing team. In the team role combination, the average value of emotional type was 12.58 ± 1.48, with significant difference (P<0.001). ② The average level of emotion, thinking and decision of team role combination is positively correlated with work performance; The average level and maximum value of emotion have a positive correlation with team cooperation; The average level of willingness was negatively correlated with team cooperation, job performance and satisfaction (P<0.05). ③ Teamwork plays a certain intermediary role in the mean value of emotion to improve level of team satisfaction and performance. This study identified the important roles of different types of nursing staff in work performance and used a pathway analysis to create a path showing each role. Increasing the emotional-type nursing staff in a team can not only improve the mean level of team emotion but also effectively improve both teamwork and work performance.