Improve Hospital Performance Research Articles

Interplay between Networking Capability and Hospital Performance in Indonesia's Medical Tourism Sector.

Medical tourism is an industry that is currently developing, but research that focuses on the analysis of supply and institutions as a unit in Indonesia is sparse. This research aims to investigate the variables of digital transformation and resource integration that influence hospital performance, considering the expansion of hospitals' capacities for networking in medical tourism. A structural equation model is used to evaluate the hypothesis. According to our findings, digital transformation and resource integration both have a beneficial effect on networking capabilities. On the other hand, the implementation of digital transformation does not improve hospital performance. Digital transformation has a good link with hospital performance but has no statistically significant effect on hospital performance. In the meantime, the capabilities of resource integration and networking have a positive effect on the overall operation of hospitals. In a similar vein, the ecosystem of medical tourism helps to improve the connection between a hospital's networking capabilities and its overall performance. It is anticipated that the findings of this study will serve as a reference for those in the policymaking and healthcare industries to develop medical tourism.

A Novel Network-Based Metric of Surgical Team Consistency Opens Opportunities to Improve Hospital Performance and Care Value

Summary The Hospital for Special Surgery is a high-volume, tertiary musculoskeletal care center that performs more than 30,000 orthopedic surgical procedures annually. Attaining this volume while prioritizing patient outcomes requires optimizing surgical workflow efficiency, which is dependent on interactions among teams. It has been conjectured that consistency among surgical teams may contribute to better clinical outcomes for patients and may improve workflow and operative efficiency. However, little research has been conducted on quantifying surgical team consistency or its effects, and it is unknown whether any measures of such consistency are associated with surgical performance. Here, the authors describe the development and implementation of a novel network-based metric to measure how often different members of orthopedic surgical teams work with one another, using data on 38 surgeons and more than 500 members of hospital staff who were involved in total joint arthroplasty procedures between 2013 and 2017. The study was conceptualized in 2016, and data were extracted and validated between 2017 and 2019. Analyses performed in the second half of 2019, controlling for patient and physician factors, found that higher team consistency scores were significantly associated with decreased time to first incision, surgery duration, and operating room turnover time for both total hip and total knee arthroplasty procedures. Team consistency scores are a measure of interactions of surgeons, anesthesiologists, nurses, and associated staff involved in the procedure, quantified as the ratio of the number of times the principal surgeon worked with the index team members compared with the number of times that surgeon worked with any other staff in the prior 90 days. The consistency score was also significantly associated with decreased total operative time in total hip arthroplasty procedures but not with any increased complications after either type of total joint arthroplasty. The authors discuss how the use of this novel metric may provide insight into hospital performance and influence quality of care delivery through maximizing value.

Performance evaluation drives organizational change: a case-study from Tuscan Teaching Hospitals

Abstract The 1985 WHO recommendation on caesarean-section (CS) stated that CS rates over 10-15% might be clinically unnecessary. The Performance Evaluation System of Sant'Anna School of Advanced Studies systematically monitors the regional health performance of Tuscany, ITALY. CS rates in Pisa Teaching Hospital (TH) were the highest in Tuscany before 2018 (almost 30%), but then started to decrease, reaching the lowest values in Tuscany, around the WHO threshold (15%). We aimed to assess and demonstrate such performance improvement in Pisa TH, taking the other two THs of Tuscany as comparators. Our outcomes were NTSV CS rates (nulliparous, term pregnancy, singleton, vertex), total CS rates, Robson Class 1 CS rates, NTSV episiotomy rates, and operative delivery rates, computed annually from 2016 to 2020 in the three THs of Tuscany. We obtained data from regional administrative databases. We performed difference-in-differences to compare the average change from the pre- (2016-2017) to the post-period (2018-2020) in the outcomes between Pisa TH and the other two THs, assuming that Pisa TH implemented organizational changes at the end of 2017 to improve the hospital performance on CS. Comparing Pisa TH with the other two THs, we found a significant pre-to-post reduction in NTSV CS rates (p < 0.001), total CS rates (p = 0.016), Robson Class 1 CS rates (p = 0.039), and episiotomy rates (p = 0.059), while no significant change emerged for operative deliveries. As a result, after 2017, Pisa TH reached significantly lower NTSV CS rates (p < 0.001) and Robson Class 1 CS rates (p = 0.027) and non-significantly higher total CS rates and episiotomy rates compared to the other two THs. This case study proved beyond a mere descriptive assessment that a statistically significant performance improvement in CS and episiotomy rates occurred in Pisa TH after 2017 following organizational changes. Comparison with the pre-period trend and the other two THs of Tuscany made these findings robust and reliable. Key messages • The Performance Evaluation System allowed to benchmark the performance of Tuscan THs, revealing the worst practice of Pisa TH on CS, and fostering organizational changes to be explored qualitatively. • Such organizational changes improved hospital performance on CS rates and on the maternity pathway in general, eventually making Pisa TH the best performer on CS in Tuscany.

Does competition improve hospital performance: a DEA based evaluation from the Netherlands

Many countries have introduced competition among hospitals aiming to improve their performance. We evaluate the introduction of competition among hospitals in the Netherlands over the years 2008–2015. The analysis is based on a unique longitudinal data set covering all Dutch hospitals and health insurers, as well as demographic and geographic data. We measure hospital performance using Data Envelopment Analysis and distinguish three components of competition: the fraction of freely negotiated services, market power of hospitals, and insurer bargaining power. We present new methods to define variables for each of these components which are more accurate than previously developed measures. In a multivariate regression analysis, the variables explain more than half of the variance in hospital efficiency. The results indicate that competition between hospitals and the relative fraction of freely negotiable health services are positively related to hospital efficiency. At the same time, the policy measure to steadily increase the fraction of health services contracted in competition may well have resulted in a decrease in hospital efficiency. The models show no significant association between insurer bargaining power and hospital efficiency. Altogether, the results offer little evidence that the introduction of competition for hospital care in the Netherlands has been effective.

COMPARISON BETWEEN THE ROLES OF THE MEDICAL AND NURSING COMMITTES IN THE MARKETING SYSTEM TO IMPROVE THE REGIONAL GENERAL HOSPITAL PERFORMANCE OF MUNA REGENCY, SOUTHEAST SULAWESI PROVINCE

Background: Based on the Health Profile from 2012 to 2019, the performance of Regional General Hospitals in Indonesia, especially in Muna Regency, Southeast Sulawesi Province as measured by the Bed Occupancy Rate (BOR)is below 60%. Similarly, the marketing implementation is relatively weak, while the roles and functions of the medical and nursing committees in accordance with Law No. 44 of 2009 concerning Hospitals, are also not optimal. Therefore, this study aims to develop and examine the role of professional committees (medical and nursing) in the marketing system to improve hospital performance. Methods: This study was conducted using a pre-experimental design, namely pre-test before treatment, and further post-test on 30 respondents. The population was 32 members of the Professional Committee (Medical and Nursing) determined using the Yamane Slovin Uma Sekaran formula (2013) and probability sampling technique. Furthermore, SEM (Structural Equation Modeling) analysis was used based on Partial Least Square (PLS) variance to determine the magnitude of the Medical and Nursing Committees' roles. A t-test was also performed to assess the difference between the roles of these Committees in the marketing system to improve hospital performance before and after the intervention. Result: Theinferential statistical analysis proved that the medical and nursing committees play significant roleswhichdirectlyaffect the marketing system (orientation and marketing strategy) andimprove hospital performance. Conclusion: Based on the results, the medical and nursing committees play an important role in improving the marketing system and hospital performance. Therefore, it is recommended that the local governments through the Director of Regional General Hospitals empower these. committees to play a role in the marketing system and improve the hospital performance in the future.

Factors Influencing the Efficiency of Public Hospitals in Saudi Arabia: A Qualitative Study Exploring Stakeholders' Perspectives and Suggestions for Improvement.

ObjectiveDespite an extensive literature on efficiency, qualitative evidence on the drivers of hospital efficiency is scant. This study examined the factors that influence the efficiencies of health service provision in public hospitals in the Kingdom of Saudi Arabia (KSA) and their potential remedies.DesignWe employed a qualitative design involving semi-structured interviews conducted between July and September 2019. Participants were purposively selected and included policymakers and hospital managers drawn from districts, regional and national levels. Data were analyzed in Nvivo 12 based on a thematic approach.SettingKey informants of Ministry of health in the KSA.ResultsRespondents identified a range of different factors across the community, facility and the wider health system that influence inefficiencies in public hospitals in KSA. Ineffective hospital management, lack of strategic planning and goals, weak administrative leadership, and absence of monitoring hospital performance was noted to have a profound impact on hospital efficiency. The conditions of healthcare staff in respect to both skills, authority and psychological factors were considered to influence the efficiency level. Further, lack of appropriate data for decision making due to the absence of an appropriate health informatics system was regarded as a factor of inefficiency. At the community level, respondents described inadequate information on the healthcare needs and expectations of patients and the wider community as significant barriers to the provision of efficient services. To improve hospital efficiencies, respondents recommended that service delivery decisions are informed by data on community health needs; capacity strengthening and effective supervision of hospital staff; and judicious resource allocation.ConclusionThe study demonstrates that inefficiencies in health services remain a critical challenge in public hospitals in KSA. Extensive awareness-raising and training on efficient resource utilization among key health systems stakeholders are imperative to improving hospital performance. More research is needed to strengthen knowledge on hospital efficiency in light of the limited data on the topic in KSA and the wider Gulf region.

Balanced Scorecard-Based Hospital Performance Measurement Framework: A Performance Construct Development Approach.

IntroductionDespite the critical importance of hospital performance measurement, empirically validated hospital performance frameworks lack. The balanced scorecard is considered one of the most influential contributions in the performance measurement literature. Since the introduction of the balanced scorecard in the early 90s, many scholars have used a balanced scorecard to enable hospital performance measurement and improvement. Therefore, this study aimed to construct and validate a balanced scorecard-based hospital performance framework. Additional to the original four perspectives, the quality of care is added as a perspective for the balanced hospital scorecard. It reflects one of the key strategic objectives in any healthcare organization.MethodsThe study adopted a two-phase model to validate the framework empirically. The first is the exploratory phase, where feedback from academicians and professionals helped finalize the framework in the form of scale. In the second phase, the scale was tested for dimensionality, reliability, and validity.ResultsA total of 200 (81 responded, RR= 40%) senior managers working in Hamad Medical Corporation (HMC), the largest healthcare provider in Qatar, were surveyed. The content, convergent, and discriminant validities were established. The study conducted composite reliability and Cronbach's alpha tests for the reliability, and all variables were found to have alpha and composite reliability higher than 0.7.ConclusionThe findings suggest that senior managers in HMC make a meaningful distinction between the five attributes of hospital performance. Findings, contributions, limitations, directions for future research, and managerial implications are all discussed.

HIS Implementation in Small Hospital

Background: Budi Rahayu Hospital at Magelang City has implemented HIS in partnership with the SIMKES FKKMK laboratory of Gadjah Mada University since April 2021. During the initial four months of implementation, Budi Rahayu Hospital experienced various challenges. For understanding and overcome the challenges, it is necessary to construct a strategy of HIS implementation, and then offer a proper recommendation based on study.Methods: This study is a descriptive qualitative with action research design that describe four stages of action research i.e Diagnosing, Planning, Action, and Evaluation. On the Diagnosing stage, Author arrange an interview and discussion with Hospital Team. Next, Author plan a strategy to generate suitable recommendations for the successful implementation of HIS. In the Action stage, author conduct an implementation review and assistance. Author also manage an UAT as a evaluation stage distributed to respondents using a questionnaire. The study is performed by observing of HIS implementation from September – December 2021. The subject of this study is chosen purposively from departments involved, with total 20 end-users respondents on multiple service units to capture data in a real environtment when HIS is used for healthcare services to patients.Results: Strategic actions for smooth implementation is active involvements and collaboration from developer team and hospital team monitored by regional health services. the hospital team and developer team formed an online communication group as a place to discuss the problems encountered. There are monitoring activities that involved by regional health services, so the timeline that has been set runs according to the target and the hospital gets optimal benefits of HIS implementation. System acceptance is important for the further development of HIS. The score of HIS acceptance at Budi Rahayu Hospital is 70% based on 85% scenario that execute successfully. Based on system performance, continues maintenance and communication among implementation team, HIS can be accepted with condition of continuous improvement and adjustment.Conclusions: Active involvements and collaboration from developer team and hospital team, performance improvement and availability of the system is very crucial for user acceptance, satisfaction and overall success of HIS implementation. Keywords: HIS, Implementation, UAT

An empirical investigation of performance assessment of Indian healthcare industry

PurposeThe purpose of the study is to measure the performance of Indian hospitals, both operationally and financially, by using hospital KPI's. The assessment is predominantly done by linking it to the existing Lean practices in Indian hospitals.Design/methodology/approachAn empirical study based on cross-sectional survey of hospital managers and specialists in various private healthcare facilities across India was conducted to validate the proposed Lean framework. From an extensive literature survey, the authors identified quality, delivery, efficiency, accessibility and patient centeredness to be the main operational performance (OP) indicators for hospitals. Business or financial performance was measured based on parameters which are average revenue per occupied bed (ARPOB), earnings before interest, tax, depreciation and amortization (EBITDA) and operating revenue. Confirmatory Factor Analysis (CFA) was carried out using a specialized technique, called Structural Equation Modelling(SEM) and an explicit factor structure was hypothesized.FindingsManagement commitment towards Lean in hospitals is statistically proven to have impacted operational and financial performance. However, leanness in technology and business processes showed no statistical significance on either operational or financial performance parameters. Hospital stakeholders showed statistical significance on though it had no impact on the financial performance. Results obtained from the statistical analysis indicate a positive impact of hospital Lean practices on timely delivery of services and improved service quality. Efficiency, accessibility of services and patient centered behavior in hospital operations could not be statistically proven to have impacted the financial performance.Social implicationsEffectiveness of Lean management (LM) principles in improving hospital operations is largely dependent on patient centered behavior. Empowered employees who are trained to add value from a customer view point, make hospital operations safe and improved. Properly trained and communicated employees who are committed to quality improvements can make a positive impact on patients' quality of life and thus positively impact the society. The study lists ways to attain the required outcomes.Originality/valueThis paper is among the very few that has attempted to suggest ways to link implementation of Lean practices more effectively in Indian hospitals to improve hospital performance at operational and financial levels.

Relationship between human resources strategies and organizational performance based on the balanced scorecard in a public hospital in Iran: a cross-sectional study

BackgroundToday, due to the complex environment and rapidly changing of health industry, hospitals should optimize their organizational performance to achieve a competitive advantage. One of the important factors for achieving a competitive advantage is effective human resource management through the application of appropriate human resources strategies. This study investigated the relationship between human resources strategies and organizational performance based on balanced scorecard.MethodsA cross-sectional study was conducted among clinical and administrative staff in a public hospital in Isfahan province, Iran. All eligible staff entered the study (n=200). Data were collected using two self-reported questionnaires during July 2018. The main questionnaire contained 32 items that investigated human resources strategies (including seven types of strategies) and organizational performance based on the balanced scorecard approach. Data were analyzed via Pearson correlation coefficient and multivariate regression using SPSS/21 software (P<0.05).ResultsIn this study, 154 questionnaires were completed and returned (return rate=77%). Human resources strategies and organizational performance were evaluated at the intermediate level. There was a significant positive correlation between human resources strategies and organizational performance (r=0.73, p=0.001). The organizational performance in learning & growth perspective had the highest correlation (r=0.669, p=0.001) with human resources strategies while the financial perspective had the lowest (r=0.455, p=0.001). Multivariate regression analysis showed that all human resources strategies were effective on organizational performance (R=0.998, R2=0.997, ADJ.R2=0.997). Staff training and development strategy (Beta=0. 265, p=0.000), staff compensation & reward strategy (Beta =0.212, p= 0.000) and recruitment strategy (Beta = 0.208, B, P=0.000) had the greatest impact on organizational performance, respectively.ConclusionsTo improve hospital performance (especially in non financial perspectives), the development of human resources strategies (especially staff training and development strategy, staff compensation & reward strategy, and compensation strategy) can be considered by hospital managers. The findings of this study can be used for developing hospital performance in a similar context.

Impact Of Balanced Scorecard Implementation On Financial And Non-Financial Aspects In Private Hospital: A Literature Review

Background: Hospital progress in a health system is essential to achieve the goal of health services, i.e., access to comprehensive health for all people. Hospitals play a pivotal role in achieving the goal. One of the issues preventing hospitals from making satisfactory development in terms of performance and productivity includes the difficulty in measuring the services provided. Therefore, the Balanced Scorecard (BSC) was created to overcome this problem. Objective: This study aims to determine the impact of implementing the Balanced Scorecard (BSC) on financial and non-financial aspects in private hospitals. Research Method: The researcher employed a systematic search strategy to identify the keywords "Balanced Scorecard" AND "Hospital" in 5 databases (Pubmed, Taylor&Francis Online, Wiley, Springer, and Emerald). The five databases were screened from the title, the essence, to the entire paper. The researcher also examined whether the journals were Scopus-indexed or not. Furthermore, there were three journals being reviewed. Results: After conducting a screening process, a total of 2,396 journals were found, and only three academic papers matched the inclusion and exclusion criteria of this study. Those journals were from Ohio Summa Hospital, Barberton Citizen Hospital, and several private hospitals in Taiwan. The journals investigated the impact of implementing the BSC on financial and non-financial aspects. Conclusion: The three journals demonstrate that the implementation of BSC in hospitals can improve hospital performance in terms of financial and non-financial aspects. The BSC implementation in hospitals could provide clear direction in determining policies, managing resources and routine activities, and building systems in each hospital unit.

Research on the Relationship Between Brand Distribution Pattern and Market Performance (Kaimu Hospital of Mashade City in 2021)

Introduction: Personality of a brand is known as the core and the closest variable in customer’s decision to choose. Branding is a new phenomenon in the sector of health care services. This study aims to determine the relationship between branding and performance in Qa’em hospital of Mashhad city. Study Method: The type of this study is correlation – cross sectional and has been carried out in the second half of 2008. Data on the created hotelling brands were collected by attending the hospital, interviewing authorities, observing the changes in study place, and studying performance indicators with the help of the statistics center of hospital and by studying the gathered materials. The data were analyzed using statistical software SPSS12 and Paires-Sample T-Test. Findings: No significant statistical relation was observed between branding and the mean value of variations in the number of patients (p= 0.453). There were significant statistical relations between the performed hotelling branding and variations in the mean value of bed occupancy percent (p= 0.000), bed circulation (p= 0.016), and emptiness ratio (p= 0.012). Discussion: Branding is effective in the improvement of hospital performance in the competitive environments in which they seek to attract selective patients.

Effects of Hospital Information System on the Performance of Management Units in Public Hospitals Analysis in Southwestern Iran

: The current study examines the effects of a hospital information system (HIS) on the performance of management units in Ahvaz public hospitals, Iran. The HIS supports hospital activities at practical, tactical, and strategic levels. In other words, this system establishes a connection between patient care and administrative information in all hospital activities. This descriptive-analytic research was an applied study with a correlational method. The hypotheses were tested by correlation model, structural equation modeling, one-sample t-test, one-way analysis of variance, and one-sample Kolmogorov-Smirnov test using the SPSS software version 20 and LISREL. The findings of this study indicated that an automated HIS can be a powerful tool helping managers with the process of hospital management and decision-making, leading to significantly improved hospital performance. Therefore, continuous training courses are beneficial in enhancing information quality and modern technology usage, which in turn improve the quality of services offered to patients and clients and make them less time-consuming. As a result, an effective step is taken in improving health services. The present study showed that the characteristics of HIS, including user-friendliness, speed, quality, being up-to-date, conformity with working conditions, and proficiency, have positive and significant impacts on the performance of management units.

DeepDRG: Performance of Artificial Intelligence Model for Real-Time Prediction of Diagnosis-Related Groups.

Nowadays, the use of diagnosis-related groups (DRGs) has been increased to claim reimbursement for inpatient care. The overall benefits of using DRGs depend upon the accuracy of clinical coding to obtain reasonable reimbursement. However, the selection of appropriate codes is always challenging and requires professional expertise. The rate of incorrect DRGs is always high due to the heavy workload, poor quality of documentation, and lack of computer assistance. We therefore developed deep learning (DL) models to predict the primary diagnosis for appropriate reimbursement and improving hospital performance. A dataset consisting of 81,486 patients with 128,105 episodes was used for model training and testing. Patients’ age, sex, drugs, diseases, laboratory tests, procedures, and operation history were used as inputs to our multiclass prediction model. Gated recurrent unit (GRU) and artificial neural network (ANN) models were developed to predict 200 primary diagnoses. The performance of the DL models was measured by the area under the receiver operating curve, precision, recall, and F1 score. Of the two DL models, the GRU method, had the best performance in predicting the primary diagnosis (AUC: 0.99, precision: 83.2%, and recall: 66.0%). However, the performance of ANN model for DRGs prediction achieved AUC of 0.99 with a precision of 0.82 and recall of 0.57. The findings of our study show that DL algorithms, especially GRU, can be used to develop DRGs prediction models for identifying primary diagnosis accurately. DeepDRGs would help to claim appropriate financial incentives, enable proper utilization of medical resources, and improve hospital performance.

Abstract 10740: Improving Diabetes Care Through a Hospital Award Program: Implementation Challenges, Strategies, and Opportunities

Background: Guideline recognition programs are known to drive hospital performance improvement, yet rapid translation of guidelines into practice continues to be a challenge. This analysis identifies guideline implementation challenges and strategies following the introduction of a new guideline recognition program for diabetes care of patients with heart failure and/or stroke. Methods: Hospitals participating in American Heart Association’s (AHA) Get With The Guidelines (GWTG)-Stroke and/or GWTG-Heart Failure modules are asked to document adherence to guidelines for diabetes care. Representatives from 21 GWTG-Stroke and GWTG-Heart Failure hospitals were invited to take part in virtual focus groups. Four focus groups with 21 participants were conducted in March 2021. Participants shared their attitudes, strategies, and challenges related to the diabetes recognition program. Transcripts were coded and analyzed for common themes with NVivo 12. Results: Participants consistently reported positive attitudes towards national recognition and guideline recognition programs. Improved team-based care, care coordination, and antihyperglycemic medication education were consistently reported as diabetes-guideline implementation opportunities. Standard protocols following diabetes diagnosis varied, as did hospital practices for ensuring adherence to treatment guidelines and complete data documentation. Conclusion: These findings demonstrated consistency in both positive attitudes towards recognition and opportunities for improved guideline-implementation. Variability in established diabetes-treatment protocols and strategies for ensuring guideline adherence suggests the need for increased best practice sharing and guideline-implementation support. These results may be used to inform successful implementation of future guideline-based award programs to improve the care of those with diabetes and CVD.

Association of Hospital Public Quality Reporting With Electronic Health Record Medication Safety Performance

Despite billions spent in public investment, electronic health records (EHRs) have not delivered on the promise of large quality and safety improvement. Simultaneously, there is debate on whether public quality reporting is a useful tool to incentivize quality improvement. To evaluate whether publicly reported feedback was associated with hospital improvement in an evaluation of medication-related clinical decision support (CDS) safety performance. This nonrandomized controlled trial included US hospitals that participated in the Computerized Provider Order Entry (CPOE) Evaluation Tool in the Leapfrog Hospital Survey, a national quality reporting program that evaluates safety performance of hospital CDS using simulated orders and patients, in 2017 to 2018. A sharp regression discontinuity design was used to identify the association of receiving negative feedback with hospital performance improvement in the subsequent year. Data were analyzed from January through September 2020. Publicly reported quality feedback. The main outcome was improvement from 2017 to 2018 on the Leapfrog CPOE Evaluation Tool, using regression discontinuity model estimates of the association of receiving negative publicly reported feedback with quality improvement. A total of 1183 hospitals were included, with a mean (SD) CPOE score of 59.3% (16.3%) at baseline. Hospitals receiving negative feedback improved 8.44 (95% CI, 0.09 to 16.80) percentage points more in the subsequent year compared with hospitals that received positive feedback on the same evaluation. This change was driven by differences in improvement in basic CDS capabilities (β = 8.71 [95%CI, 1.67 to 18.73]) rather than advanced CDS (β = 6.15 [95% CI, -9.11 to 26.83]). In this nonrandomized controlled trial, publicly reported feedback was associated with quality improvement, suggesting targeted measurement and reporting of process quality may be an effective policy lever to encourage improvement in specific areas. Clinical decision support represents an important tool in ensuring patient safety and decreasing adverse drug events, especially for complex patients and those with multiple chronic conditions who often receive several different drugs during an episode of care.

Examining the Relationship Between the Lean Management System and Quality Improvement Care Management Processes.

The United States has an underperforming health care system on both cost and quality criteria in comparison with other developed countries. One approach to improving system performance on both cost and quality is to use the Lean Management System based on the Shingo principles originally developed by Toyota in Japan. Our objective was to examine the association between hospital use of the Lean Management System and evidence-based or recommended quality improvement care management processes. A cross-sectional analysis of data from 223 hospitals that responded to both the 2017 National Survey of Healthcare Organizations and Systems and the 2017 National Survey of Lean/Transformational Performance Improvement in Hospitals was conducted. Controlling for hospital organizational and market characteristics, the number of years using Lean was positively associated with use of electronic health record-based decision support, use of quality-focused information management, use of evidence-based guidelines, and support for care transitions at the P < .05 level. The degree of education and training in Lean methods and processes was also positively associated ( P < .05) with greater support for care transitions. The number of years using Lean was marginally associated with screening for clinical conditions at the P < .10 level. There was an unexpected negative association between education and training scores and screening for clinical conditions. Greater experience in using the Lean Management System is positively associated with several evidence-based and/or recommended quality improvement care management processes.

Same-day discharge after elective coronary angioplasty: a single-center initial experience

Percutaneous coronary intervention (PCI) is usually a procedure based on patient's hospitalization. However, the increasingly widespread use of radial access, the technical evolution of the devices employed and current pharmacotherapy standards have simplified this procedure with satisfying outcomes and significantly reduced complications. It can be assumed that overnight hospitalization may not impact patient safety. The purpose of this study is to describe the experience of a single center in the same-day discharge of elective patients undergoing PCI. A retrospective analysis of the cath-lab database was carried out for the years 2016-2019. All elective PCI patients discharged on the same day were identified. All were observed in a hospital setting for at least 6 h and then, after discharge, interviewed by telephone within 24 h and at 30 days. During the time interval examined, 36 patients (mean age 66 ± 10 years) who had procedural same-day discharged were identified. From 2016 to 2019, they represented 1.69%, 1.79%, 5.78% and 5.90%, respectively, of the patients electively admitted for PCI annually. All suffered from chronic coronary syndrome, were on dual antiplatelet therapy and treated with radial approach for single-vessel (88.8%) or multivessel (12.2%) PCI. Two in-hospital access site bleedings, no adverse events in the first 24 h and a new readmission, due to gastrointestinal bleeding, at 30-day follow-up were reported. The results of this initial experience help to confirm that the same-day discharge after a PCI is possible and safe for the patient. If this strategy could be the standard of care to increase patient satisfaction, to improve hospital performance by reducing costs and to increase efficiency without adversely affecting procedural outcomes should be confirmed in larger and unselected groups of patients.

RELATIONSHIP BETWEEN THE COST LEADERSHIP STRATEGY AND THE QUALITY OF HEALTH SERVICES IN KENDARI CITY HOSPITAL

Background: A hospital in Kendari is tracing the problems namely about interactions with employees. Also the information about the strategies which is used to improve hospital performance has not been clearly stated. The efforts to improve services are still relatively routine in nature. The use of strategic terms is still relatively traditional, so the strategic position of this hospital is unclear. The purpose of this study is to analyse the relationship between the cost leadership strategy and the quality of health services in Kendari City Hospital. Methods: This research is quantitative study with a cross sectional approach. The research location was in the Kendari City Regional Hospital and was conducted from February to March 2021. The population was 456 people and a sample of 95 people was all employees of the Kendari City Regional Hospital. The sampling technique used the Proportive Random Sampling. Results: There is a relationship between Cost leadership strategy with Service Quality, it is known that the value of chi square ( X2 count is greater than X2table, and a value of Phi is 0.239 or it lies between 0.20-0.399. This means that there is a weak relationship. Conclusion: Offensive Strategy or Growth is a strategy that is recommended to improve the quality of services in the Kendari City Regional Hospital.

Potential of community-based risk estimates for improving hospital performance measures and discharge planning

BackgroundRisk-adjusted rates of hospital readmission are a common indicator of hospital performance. There are concerns that current risk-adjustment methods do not account for the many factors outside the hospital setting...