Hospital Stakeholders Research Articles

Attitudes towards antimicrobial stewardship: results from a large private hospital in Australia

Abstract Introduction An effective hospital-wide antimicrobial stewardship (AMS) program requires engagement with all healthcare professionals involved in antimicrobial use. It is therefore useful to consider attitudes and perceptions among clinical stakeholders in Australian private hospitals before introducingAMS in these facilities. The aim of this study was to describe perceptions and attitudes towards antimicrobial resistance, antimicrobial use, AMS interventions, and willingness to participate. Methods A 26-item attitudinal survey was distributed to visiting specialists, nurses and pharmacists at a large (500 bed) private hospital in Australia. Survey questions utilised ‘Yes/No' responses and a 7-point Likert scale ranging from ‘strongly agree' to ‘strongly disagree'. Descriptive analyses were performed and Chi-squared tests conducted. Results There were a total of 331 respondents (80 physicians, 58 surgeons, 78 anaesthetists, 105 nurses and 10 pharmacists). The response rate was 42% among clinicians, 100% among pharmacists and 13% among nurses. Only half of the respondents were willing to participate in proposed AMS interventions. A larger proportion of respondents believed that antimicrobial resistance was more of a serious problem in other Australian hospitals compared with the surveyed hospital (62% v. 45%, P Conclusions This study highlights the challenge of making antimicrobial resistance a relevant local issue in private hospitals and engaging key health professionals before implementing change.

The use of on-site visits to assess compliance and implementation of quality management at hospital level

ObjectiveStakeholders of hospitals often lack standardized tools to assess compliance with quality management strategies and the implementation of clinical quality activities in hospitals. Such assessment tools, if easy to use, could be helpful to hospitals, health-care purchasers and health-care inspectorates. The aim of our study was to determine the psychometric properties of two newly developed tools for measuring compliance with process-oriented quality management strategies and the extent of implementation of clinical quality strategies at the hospital level.DesignWe developed and tested two measurement instruments that could be used during on-site visits by trained external surveyors to calculate a Quality Management Compliance Index (QMCI) and a Clinical Quality Implementation Index (CQII). We used psychometric methods and the cross-sectional data to explore the factor structure, reliability and validity of each of these instruments.Setting and ParticipantsThe sample consisted of 74 acute care hospitals selected at random from each of 7 European countries.Main Outcome MeasuresThe psychometric properties of the two indices (QMCI and CQII).ResultsOverall, the indices demonstrated favourable psychometric performance based on factor analysis, item correlations, internal consistency and hypothesis testing. Cronbach's alpha was acceptable for the scales of the QMCI (α: 0.74–0.78) and the CQII (α: 0.82–0.93). Inter-scale correlations revealed that the scales were positively correlated, but distinct. All scales added sufficient new information to each main index to be retained.ConclusionThis study has produced two reliable instruments that can be used during on-site visits to assess compliance with quality management strategies and implementation of quality management activities by hospitals in Europe and perhaps other jurisdictions.

Deepening our understanding of quality improvement in Europe (DUQuE): overview of a study of hospital quality management in seven countries

Introduction and ObjectiveThis paper provides an overview of the DUQuE (Deepening our Understanding of Quality Improvement in Europe) project, the first study across multiple countries of the European Union (EU) to assess relationships between quality management and patient outcomes at EU level. The paper describes the conceptual framework and methods applied, highlighting the novel features of this study.DesignDUQuE was designed as a multi-level cross-sectional study with data collection at hospital, pathway, professional and patient level in eight countries.Setting and ParticipantsWe aimed to collect data for the assessment of hospital-wide constructs from up to 30 randomly selected hospitals in each country, and additional data at pathway and patient level in 12 of these 30.Main outcome measuresA comprehensive conceptual framework was developed to account for the multiple levels that influence hospital performance and patient outcomes. We assessed hospital-specific constructs (organizational culture and professional involvement), clinical pathway constructs (the organization of care processes for acute myocardial infarction, stroke, hip fracture and deliveries), patient-specific processes and outcomes (clinical effectiveness, patient safety and patient experience) and external constructs that could modify hospital quality (external assessment and perceived external pressure).ResultsData was gathered from 188 hospitals in 7 participating countries. The overall participation and response rate were between 75% and 100% for the assessed measures.ConclusionsThis is the first study assessing relation between quality management and patient outcomes at EU level. The study involved a large number of respondents and achieved high response rates. This work will serve to develop guidance in how to assess quality management and makes recommendations on the best ways to improve quality in healthcare for hospital stakeholders, payers, researchers, and policy makers throughout the EU.

Successful implementation of responsible business practice

Purpose – The main aim of this paper is to introduce the articles of this issue. Design/methodology/approach – A critical content analysis of the papers selected for the issue was undertaken. Findings – The final articles for this issue examine a range of responsible business practices within hospitality and tourism businesses in diverse country settings. In addition, each article is followed by a commentary from an industry representative who reflects on the key message and/or value of the article for industry practice. Research limitations/implications – Although only one article examined the role of education specifically, collectively the articles in this special theme edition point to the critical role of education in implementing responsible business practices in the near future, as well as for ensuring the sustainability of these practices in the years to come. Additionally, these articles highlight the need for greater cooperation between different hospitality and tourism stakeholders in the development and implementation of responsible business practices. Originality/value – The current theme issue explores emerging issues in the implementation of responsible business practice in the context of hospitality and tourism industries in different country contexts.

Responsible tourism in Cyprus: the rhetoric and the reality

Purpose– This paper aims to provide an overview of the approaches that industry stakeholders follow towards responsible tourism in Cyprus and to address the challenges that responsible tourism management faces in a mass tourism destination.Design/methodology/approach– In doing so, the paper discusses the concept of responsible tourism and its application in the hospitality and tourism industry. A qualitative research approach was followed whereby roundtable discussions between industry leaders and hospitality educators were initiated in order to identify key challenges. In addition, secondary research was performed with relevant data presented in the paper being previously collected by the CSTI (Cyprus Sustainable Tourism Initiative).Findings– Findings reveal that responsible tourism adoption in Cyprus is minimal. Several challenges have been identified as barriers to adoption and successful implementation including poor understanding of the concept, lack of awareness, limited budget, lack of coordination of activities and the absence of an integrated system to ensure cooperation and of a monitoring mechanism.Practical implications– The paper will be of immense value to industry practitioners as it represents a holistic understanding of the challenges facing hospitality and tourism industry stakeholders in terms of the implementation of responsible tourism practice. Propositions are made regarding the maximisation of the benefits of responsible tourism.Originality/value– The paper draws on sustainability issues in an attempt to shed light on the role of responsible tourism in the hospitality and tourism industry in Cyprus and consequently advances knowledge on responsible tourism management offering value to academics practitioners and students alike.

Managing the health risks of extreme weather events by managing hospital infrastructure

Purpose – A predicted increase in climate change-related extreme weather events will present hospitals with new health-related and physical risks which were not originally anticipated in building and infrastructure designs. Markus et al.'s building systems model is used to analyse a range of adaptive strategies to cope with such events. The paper aims to discuss these issues. Design/methodology/approach – Focus group interviews were conducted with a wide range of hospital stakeholders across three case study hospitals in Australia and New Zealand which have experienced extreme weather events. Findings – It is concluded that effective adaptive strategies must balance responses across different organisational sub-systems. Contrary to previous research, the findings indicate that hospital managers do see hospital infrastructure as an important component of disaster response. However, it is the least adaptable of all response subsystems, making other options more attractive in the heat of a crisis. Research limitations/implications – A focus on three case studies allowed the researchers to explore in-depth the experiences of stakeholders who had experienced extreme weather events. While producing highly valid results, the inherent limitation of this approach is the lack of breath. So further case studies are needed to generalise from the results. Practical implications – Recommendations are made to improve the adaptive capacity of healthcare facilities to cope with the future health challenges of climate change risk. Originality/value – By acknowledging that no one group holds all the knowledge to deal with extreme weather events, this paper capture the collective knowledge of all key stakeholders who have a stake in the process of responding effectively to such an event. It shows that hospital adaptation strategies cannot be considered in isolation from the surrounding emergency management systems in which a hospital is imbedded.

Development of a Trauma-based Continuing Care Model for Enhancing Care Outcomes in Social Unrest Area: A Case Study

Background: Improving care outcomes in trauma patients is regarded as important and linked to an appropriate model of care particularly in social unrest area where there are limited resources and accessibility after discharge. To facilitate prompt management to improve patient recovery or quality of life and decrease some complications, a specific model of continuing care for those trauma survivors is required. Objective: This participatory action research (PAR) aimed to develop the trauma-based continuing care model (TCCM) for enhancing care outcomes in trauma patients affected from Social Unrest area. Method: A three-phase of PAR design was implemented with stakeholders in both hospital and community services related to care for trauma survivors and their families. In the first phase, 11 trauma survivors were interviewed and 3 focus group discussions with nurses and related health care staff were conducted to identify existing systems and problems encountered. The second phase consisted of two workshops, involving 20 key informants and allied health staff for the purpose of developing the model. The final phase evaluated the initial effects of the model after implementing with 20 patients by measuring the care process and outcomes such as nurses’satisfaction, patients’quality of life, patients’self care ability, caregivers’ ability to care. Data were analyzed using descriptive statistics for care outcomes and content analysis for the care process. Result: The model consisted of a) trauma-care process through a trauma nurse-initiated discharge planning program b) patient-family follow up. With the PAR process, the following steps included 1) preparing the multidisciplinary health care team including patient and family caregivers, 2) organizing the system, identifying individual role and function for continuing care, and 3) collaborating with community support network for patient and family management. The main strategies to drive all process were teamwork involvement, care coordination, and staff education. The model could enhance both health care staff and family caregivers in providing better care. In this study, most patients were able to manage themselves. Twenty patients and 10 family caregivers were satisfied with the care process and obtained better outcomes regarding health status and quality of life. In addition, the developed trauma nurse-initiated discharge planning program was also discussed for further implication. Conclusion: The key success was derived from trauma nurse-initiated discharge planning process and collaborating with community support network. To enhance the sustainability of the model, care managed by enhancing networking of community nurse, patient and family after discharge needs to be further explored.

A case report in health information exchange for inter-organizational patient transfers.

To provide a case report of barriers and promoters to implementing a health information exchange (HIE) tool that supports patient transfers between hospitals and skilled nursing facilities. A multi-disciplinary team conducted semi-structured telephone and in-person interviews in a purposive sample of HIE organizational informants and providers in New York City who implemented HIE to share patient transfer information. The researchers conducted grounded theory analysis to identify themes of barriers and promoters and took steps to improve the trustworthiness of the results including vetting from a knowledgeable study participant. Between May and October 2011, researchers recruited 18 participants: informaticians, healthcare administrators, software engineers, and providers from a skilled nursing facility. Subjects perceived the HIE tool's development a success in that it brought together stakeholders who had traditionally not partnered for informatics work, and that they could successfully share patient transfer information between a hospital and a skilled nursing facility. Perceived barriers included lack of hospital stakeholder buy-in and misalignment with clinical workflows that inhibited use of HIE-based patient transfer data. Participants described barriers and promoters in themes related to organizational, technical, and user-oriented issues. The investigation revealed that stakeholders could develop and implement health information technology that technically enables clinicians in both hospitals and skilled nursing facilities to exchange real-time information in support of patient transfers. User level barriers, particularly in the emergency department, should give pause to developers and implementers who plan to use HIE in support of patient transfers. Participants' experiences demonstrate how stakeholders may succeed in developing and piloting an electronic transfer form that relies on HIE to aggregate, communicate, and display relevant patient transfer data across health care organizations. Their experiences also provide insights for others seeking to develop HIE applications to improve patient transfers between emergency departments and skilled nursing facilities.

An Updated Model to Enhance Knowledge Sharing among Stakeholders in Jordanian Hospitals Using Social Networks

Survival of any organization heavily depends on knowledge sharing, however, the variables that enhance or dissuade knowledge sharing behaviors in the Jordanian hospitals has not been poorly recognized. Therefore, this paper is aimed at determining the obstacles that prevent stakeholders in Jordanian hospitals from sharing their knowledge; and furthermore we have developed a conceptual model, based on Theory of Planned Behavior (TPB) and Technology Acceptance Model (TAM), to improve our understanding in terms of the factors, which affect knowledge sharing behaviors of knowledge workers in the Jordanian hospitals. To achieve the objective of examining the barriers that hinder the stakeholders from knowledge sharing in Jordanian hospitals, we have conducted an interview survey with the stakeholders in the Jordanian hospitals, to get their viewpoints. Therefore, we interviewed 15 of the workers in the various sectors in Jordanian hospitals and we have analyzed the results, which showed that, 18 out of 36 universal barriers are affecting the knowledge sharing behavior. By comparing these results with previous studies, we developed a conceptual model, to improve and encourage stakeholders to share knowledge, among them.

Teaching hospital performance: Towards a community of shared values?

This paper explores the performance dimensions of Italian teaching hospitals (THs) by considering the multiple constituent model approach, using measures that are subjective and based on individual ideals and preferences. Our research replicates a study of a French TH and deepens it by adjusting it to the context of an Italian TH. The purposes of this research were as follows: to identify emerging views on the performance of teaching hospitals and to analyze how these views vary among hospital stakeholders. We conducted an in-depth case study of a TH using a quantitative survey method. The survey uses a questionnaire based on Parsons' social system action theory, which embraces the major models of organizational performance and covers three groups of internal stakeholders: physicians, caregivers and administrative staff. The questionnaires were distributed between April and September 2011. The results confirm that hospital performance is multifaceted and includes the dimensions of efficiency, effectiveness and quality of care, as well as organizational and human features. There is a high degree of consensus among all observed stakeholder groups about these values, and a shared view of performance is emerging. Our research provides useful information for defining management priorities to improve the performance of THs.

Structural holes in hospital organisations

Purpose – The delivery of high quality healthcare services to the community requires the integration of information from a wide range of sources within a complex and highly dynamic environment. Using structural holes theory the challenges and opportunities of integration are explored from a facilities management (FM) perspective. Design/methodology/approach – Using a critical realism methodology, structured interviews with hospital stakeholders are undertaken in a case study of a large tertiary hospital in Australia. Data are analysed using social network analysis to explore the existence of structural holes. Findings – Effective FM in the health sector requires intrapreneurial skills to broker connections between functionally and culturally distinct actors located in a highly disconnected communication network structure. Originality/value – This research reveals, for the first time, the detailed communication structure of relationships among FM services in a hospital. By identifying the existence of structural holes in hospital organisations, it illuminates significant untapped brokerage potential of facilities managers in facilitating greater integration. These insights into communication structure have important implications for the practice of FM in better supporting healthcare service delivery.

Revisiting hospitality internship practices: A holistic investigation

Hospitality internships are integral part of almost all reputable hospitality programs worldwide. Despite their universal recognition as an essential component of hospitality education, their value is often superseded by the challenges facing hospitality stakeholders in providing such an experience for the next generation of hospitality professions. The purpose of this paper is to investigate—with the utilization of structural equation modeling and after a thorough investigation of the existing literature—the causal relationships of the key issues that define modern hospitality internships and the practice's perceived impact on students' intention to pursue a hospitality career upon graduation. Crucial elements before, during, and after the experience were accounted for, as well as students' overall internship perceptions. Findings prove to be of considerable interest to hospitality stakeholders by confirming some theoretical notions pertaining to the efficacy of the practice, as well as by enhancing understanding and opening new research horizons for those wishing to advance our collective knowledge of the experience.

Understanding public drug procurement in India: a comparative qualitative study of five Indian states

ObjectiveTo perform an initial qualitative comparison of the different procurement models in India to frame questions for future research in this area; to capture the finer differences between the state...

Hospital network performance: A survey of hospital stakeholders’ perspectives

Hospital networks are an emerging organizational form designed to face the new challenges of public health systems. Although the benefits introduced by network models in terms of rationalization of resources are known, evidence about stakeholders’ perspectives on hospital network performance from the literature is scanty. Using the Competing Values Framework of organizational effectiveness and its subsequent adaptation by Minvielle et al., we conducted in 2009 a survey in five hospitals of an Italian network for oncological care to examine and compare the views on hospital network performance of internal stakeholders (physicians, nurses and the administrative staff). 329 questionnaires exploring stakeholders’ perspectives were completed, with a response rate of 65.8%. Using exploratory factor analysis of the 66 items of the questionnaire, we identified 4 factors, i.e. Centrality of relationships, Quality of care, Attractiveness/Reputation and Staff empowerment and Protection of workers’ rights. 42 items were retained in the analysis. Factor scores proved to be high (mean score>8 on a 10-item scale), except for Attractiveness/Reputation (mean score 6.79), indicating that stakeholders attach a higher importance to relational and health care aspects. Comparison of factor scores among stakeholders did not reveal significant differences, suggesting a broadly shared view on hospital network performance.

Y-ers, X-ers and Boomers: Investigating the multigenerational (mis)perceptions in the hospitality workplace

Today’s hospitality workforce is more diverse than ever with the symbiotic co-existence of three different generations; Generation Y, Generation X and Baby Boomers. This co-existence poses numerous challenges for an industry that strives to achieve inter-generational comfort, thus avoiding conflict, an impediment to the effectiveness of even its most sophisticated organizations. Adopting a quantitative methodology, this article explores the occupational similarities and differences of the three prevailing generations, currently active in the diverse hospitality workplace, as well as investigating how each generation cohort is perceived by its own members in comparison to members of other generations. Findings, which provide invaluable insights of interest to hospitality stakeholders, confirm the vast perceptual inter-generational differences within a plethora of work-related issues.

Sustainability in Hospitality and Tourism Education: Towards an Integrated Curriculum

The growing importance of sustainability to the hospitality and tourism industry has resulted in an increased pedagogical discussion pertaining to how to incorporate sustainability into the undergraduate curriculum. The previous discussion has largely focused on the need to teach sustainability within the hospitality and tourism curriculum (Deale et al., 2009), and determining hospitality and tourism stakeholders' attitudes towards teaching sustainability in the curriculum (Barber et al., 2011). Despite the strong interest in sustainability, Deale et al. (2009) article reveals that sustainability is rarely taught within the curriculum. This study moves the discussion away from should sustainability be taught within the hospitality and tourism curriculum towards a discussion of how to best teach sustainability within the curriculum. This article suggests that an integrated sustainability curriculum will provide students with a better education and better preparation for the hospitality and tourism profession than limiting its inclusion to specific classes or majors. Part of this recommendation for integration of sustainability into the hospitality and tourism curriculum is a proposed model that demonstrates the need to view sustainability as the ultimate context of focus and hospitality and tourism as a subcomponent of this focus. Having sustainability as the end goal of hospitality and tourism will result in natural integration of sustainability into the curriculum because sustainability is the main context of interest. The difficulties and challenges of integrating sustainability into the curriculum are also discussed, as well as, suggestions to help facilitate the process.

Research on stakeholders of public hospital in China

Objective To confirm the connotation, constitution and classification of the stakeholders in public hospital. Methods The stakeholders of public hospital were proposed through the brainstorm method and literature search. On this basis, the expert consultation scale was developed by using the score-based approach for reference The stakeholders of public hospital were confirmed and classified through two-round expert consultation. Results The research confirms 16 stakeholders of public hospital on the 80% level of support ratio by experts. There were 10 core stakeholders, 5 latent stakeholders and 1 marginal stakeholder. Conclusion Appropriate stakeholder management strategy should be taken for different types of stakeholders. Key words: Public hospital; Stakeholder

Social responsibility of hospitals: an Indian context

PurposeThe purpose of this paper is to explore the perceived responsibilities of five not‐for‐profit hospitals in Bangalore, India, towards society.Design/methodology/approachThe method used is qualitative design with some quantitative elements. Data were collected through a survey of 79 physicians and 104 managers and other stakeholders of the hospitals.FindingsThe analysis reveals the existence of highly significant differences in the perception about workplace responsibilities between the doctors and other stakeholders. It also highlights the importance of top management involvement with various stakeholders in effectively carrying out the overall social responsibilities of the hospitals. It was found that the hospitals must take into account the social, cultural and financial characteristics of the patients while fulfilling societal obligations. Training needs, environmental impact audit and encouragement for employees to join local voluntary organizations are the immediate needs for improving the CSR activities of the hospitals.Research limitations/implicationsThe study had a small sample and referred only to the perceptions of physicians/management personnel. Further studies should be done with larger samples, comparing different cohorts of stakeholders and, more importantly, patients/their carers.Practical implicationsThe study draws attention to issues that emerge from the social responsibilities of healthcare organizations. Its findings provide new insights into the meaning of social responsibility in the healthcare sector in an Indian context from a stakeholder perspective.Originality/valueThe paper is based on an original study that addresses the current gap in the understanding of issues related to social responsibility by the various stakeholders of hospitals. It is particularly valuable for both the internal and external stakeholders of the healthcare organizations.

Leadership styles and burnout: is there an association?

PurposeThe primary purpose of this paper is to investigate the association between leadership styles and burnout among hospitality managers currently working in the industry of Cyprus. Specifically, transformational, transactional and passive/avoidance are to be investigated in order to establish which leadership style is more prone to burnout effects.Design/methodology/approachAdopting a quantitative approach, the multifactor leadership questionnaire (MLQ 5X‐Short) was utilized to allow research participants to describe their leadership style as they perceive it. In addition, the most widely acknowledged tool for measuring burnout, the Maslach burnout inventory (MBI), was also incorporated in the questionnaire, which was then distributed to 500 hospitality managers in Cyprus. A number of hypotheses, reflecting the primary objective of the study, were postulated.FindingsThe findings suggest that transformational leadership has a significant positive association with personal accomplishment and is negatively related to emotional exhaustion and depersonalization. In addition a positive relationship exists between passive avoidance leadership and emotional exhaustion and depersonalization. Finally, individuals with a passive avoidance leadership style exhibited higher levels of burnout.Research limitations/implicationsIt is well documented in the literature that surveys measuring sensitive issues, such as leadership styles and burnout levels, have inbuilt limitations. With regards to leadership, the authors acknowledge that they were not able to replicate the original nine‐factor solution of the MLQ 5X, therefore, findings should be viewed with caution. The second limitation is the small sample size (n=131) and the homogeneity of the sample, which limit the generalizability of the findings.Practical implicationsThe findings have a practical relevance to both hospitality stakeholders and academic scholars who wish to further explore the leadership‐burnout association. In addition, human resources practitioners could utilize the findings when developing strategies for recruiting and developing leaders.Originality/valueThe paper adds to existing knowledge by investigating an issue presented in just a few hospitality‐related studies. While burnout and leadership separately have captured the attention of hospitality researchers, studies investigating their association are ubiquitous by their absence. The insights derived from this paper are of value to academic scholars wishing to build on this exploratory investigation.

Creation of a Temperature Stability Database for Refrigerated Medications

ABSTRACTAimTo create a database of refrigerated medications along with comprehensive data on their stability when stored outside the recommended conditions; and to develop an educational tool for managing cold chain emergencies at the hospital.MethodPhase 1: a searchable database was created with fields on product stability, stored temperatures and storage conditions. Phase 2: the database was populated with the products' stability data from various sources, such as literature searches, approved product information and pharmaceutical companies. Phase 3: focus groups were held with the hospital's stakeholders (nurses, pharmacists, pharmacy technicians) to develop an educational tool for managing cold chain emergencies.ResultsOf the 36 pharmaceutical companies contacted, 29 responded (response rate 81%) and provided ‘extra’ stability data for 28 products (n = 150; 19%). Pursuant to issues raised by the pharmaceutical companies about concerns of breaching the registration conditions of their products and misinterpretation of the provided in‐house stability data, a stakeholder meeting was held with the Therapeutic Goods Administration. At the meeting, the need for short‐term ‘end of shelf life’ real‐time stability studies for refrigerated products was discussed. An educational tool was designed based on a survey of local practices at the hospital pertaining to monitoring refrigerators used to store medications.ConclusionCreation of the database has resulted in a critical analysis of the existing stability data on refrigerated medications. Hospital staff lack guidance on the selection, monitoring and maintenance of refrigerators used to store medications, and to manage cold chain emergencies. There is an opportunity for professional pharmacy organisations to provide this guidance.