Public Hospital Management Research Articles

The burden of critical illness among adults in a Swedish region—a population-based point-prevalence study

BackgroundPatients with critical illness have a high risk of mortality. Key decision-making in the health system affecting the outcomes of critically ill patients requires epidemiological evidence, but the burden of critical illness is largely unknown. This study aimed to estimate the prevalence of critical illness in a Swedish region. Secondary objectives were to estimate the proportion of hospital inpatients who are critically ill and to describe the in-hospital location of critically ill patients.MethodsA prospective, multi-center, population-based, point-prevalence study on specific days in 2017–2018. All adult (> 18 years) in-patients, regardless of admitting specially, in all acute hospitals in Sörmland, and the patients from Sörmland who had been referred to university hospitals, were included. Patients in the operating theatres, with a psychiatric cause of admission, women in active labor and moribund patients, were excluded. All participants were examined by trained data collectors. Critical illness was defined as “a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and a potential for reversibility”. The presence of one or more severely deranged vital signs was used to classify critical illness. The prevalence of critical illness was calculated as the number of critically ill patients divided by the number of adults in the region.ResultsA total of 1269 patients were included in the study. Median age was 74 years and 50% of patients were female. Critical illness was present in 133 patients, resulting in an adult population prevalence of critical illness per 100,000 people of 19.4 (95% CI 16.4–23.0). The proportion of patients in hospital who were critically ill was 10.5% (95% CI 8.8–12.3%). Among the critically ill, 125 [95% CI 94.0% (88.4–97.0%)] were cared for in general wards.ConclusionsThe prevalence of critical illness was higher than previous, indirect estimates. One in ten hospitalized patients were critically ill, the large majority of which were cared for in general wards. This suggests a hidden burden of critical illness of potential public health, health system and hospital management significance.

A Systematic Review of Factors Influencing the Maintenance Management of Public Hospitals in Nigeria

A Systematic Review of Factors Influencing the Maintenance Management of Public Hospitals in Nigeria

Evaluation of clinical ethics in Iranian hospitals: Employing a 360° approach-A cross-sectional study.

Clinical ethics is defined as recognizing and resolving value conflicts that arise from providing care in medical centers. This study aimed to evaluate the practice of clinical ethics in Iranian hospitals with a 360° approach. The study was conducted by employing a descriptive-analytical method in 2019. The statistical population included staff, patients, and managers of public, private, and insurance hospitals in Mazandaran province. The sample size for each group was 317, 729, and 36, respectively. The data collection tool was a researcher-made questionnaire. The appearance and content validity of the questionnaire were confirmed by expert opinion and construct validity was confirmed by confirmatory factor analysis. The reliability was confirmed by Cronbach's alpha coefficient. Data were analyzed by one-way analysis of variance and Tukey's post-hoc test. We used SPSS software version 21 to analyse the data. The obtained mean score of clinical ethics from the perspective of service providers (0.56 ± 4.45) was higher than the perspective of service presenters (4.35 ± 0.65) and service recipients (0.79 ± 4.22), which was statistically significant (p < 0.05). Among the eight dimensions of clinical ethics, respect for the patient's right (0.68 ± 4.09) illustrated the highest score and medical error management (0.63 ± 4.33) presented the lowest score. Based on the findings of the study, the level of clinical ethics in the hospitals of Mazandaran province is favorable, and among the dimensions of clinical ethics, respect for patient rights gained the lowest score and communication with other colleagues gained the highest score. Therefore, informing and teaching medical professionals in the field of clinical ethics, formulating binding laws, and paying serious attention to this issue in ranking and accrediting hospitals are recommended.

Exploration of Centralized Purchasing Management Platform for Research Reagent Supplies Based on One-stop Service

The national requirements for the fund management of scientific research projects are becoming more stringent, so that it is convenient to carry out scientific research work and can strengthen the regulation of scientific research reagent procurement, so this study explores the standardization of the whole process of the procurement of scientific research reagent supplies in hospitals and new modes of management. By exploring the implementation of the centralized procurement management platform, we engage in full process supervision before, during, and after the event. Introduction of centralized procurement management platform for scientific research reagent supplies can normalize the procurement process, ensure the quality of procurement and improve the procurement efficiency on the basis of ensuring the quality of scientific research. The new model of centralized procurement of full process management based on one-stop service for scientific research reagent supplies is an important part of improving the fine scale management of public hospitals, and it is of great significance in improving the level of scientific research in China and avoiding scientific research corruption.

The role of people management in public network hospitals in Brazil

Planning the practice of management by processes is currently defended as essential for organizations and its use is suitable for the health segment. For the elaboration of this research, a qualitative approach was used based on the ideas and definitions discussed with authors who research the same theme. The elaboration procedure was developed through bibliographical research, in which a significant range of scientific sources was consulted, consisting of works such as books, articles, and reports related to the theme addressed here. The general objective of this article is to understand the current role of management and its challenges in the Brazilian hospital environment. It is clear, at the end of this research, how much more people management in the hospital environment needs to advance, especially about dealing with and leading everyone who makes up the hospital community. Cohesive, well-structured management, with well-understood objectives and mission, will provide greater chances of achieving success within the Brazilian hospital landscape.

Factors associated with quality of life in outpatient with type 2 diabetes at Ha Dong General Hospital

Objective: To describe some associated factors with the quality of life in outpatient with type 2 diabetes at Ha Dong General Hospital in 2020 Method: A cross-sectional study was conducted in 327 outpatient with type 2 diabetes at Ha Dong General Hospital, in 2020. This study used a Vietnamese version of the Asian Diabetes Quality of Life. Results: Results showed a statistically significant difference (p&lt;0.05) between the quality of life (QOL) and some factors such as gender, economic status, time to detect, treatment, and complications. Regarding mental health, there was a difference in age (p=0.028). The quality of life in patients with diabetes who had time to detect for under 5 years was lower than that of whose had time to detect for 5 years or more (p=0.000). The quality of health in patients in poor/near-poor households was significantly lower than that in the other (p=0.000). Conclusion: Our findings can be evidence to assist public health policymakers and hospital managers develop strategies to improve patient QOL.

Effects of and Prospects for the Hierarchical Medical Policy in Beijing, China.

Hierarchical medical policies are widely used worldwide to reduce healthcare costs, rationalize the use of healthcare resources, and improve accessibility and fairness of healthcare services. However, few case studies have evaluated the effects and prospects of such policies. Medical reform efforts in China have distinct goals and characteristics. Therefore, we investigated the effects of a hierarchical medical policy in Beijing and assessed the future potential of the policy to yield insights for other countries, especially developing countries. Different methods were used to analyze multidimensional data from official statistics, a questionnaire survey of 595 healthcare workers from 8 representative public hospitals in Beijing, a questionnaire survey of 536 patients, and 8 semi-structured interview records. The hierarchical medical policy had strong positive effects on improving access to healthcare services, balancing the workload of healthcare workers in various levels of public hospitals, and improving the management of public hospitals. The remaining obstacles include severe job stress among healthcare workers, the high cost of some healthcare services, and the need for improvement in the development level and service capacity of primary hospitals. This study provides useful policy recommendations regarding the implementation and extension of the hierarchical medical policy, including the need for governments to improve the hospital assessment system and for hospitals to actively participate in developing medical partnerships.

Influence of public hospital reform on public health: Evidence from a quasi-natural experiment in China.

Public health is an important symbol of national wealth and prosperity. At present, China's public health is hindered by the poor management of public hospitals, which impacts the demographic structure and socioeconomic development. Therefore, taking the implementation of public hospital reform in China as a quasi-natural experiment, this study employed the time-varying DID model and the mediating effect to evaluate the influence of public hospital reform on public health. The results were as follows: (1) Public hospital reform can significantly improve public health, and a series of robustness tests have also confirmed the effects; (2) Government's financial support is a transmission mechanism for public hospital reform to promote public health; (3) After taking control variables into consideration, the effect of public hospital reform is stronger in the western region with a poorer economy. This research provides a vital policy reference for promoting the scope of reform and improving the health of the general public.

International experience of using report forms for hospital-based health technology asssessment

Hospital-based health technology assessment (HB-HTA) is one of the components of public management and support hospital managers to science-based decision-making regarding the implementation of new and innovative health technologies (HT). HB-HTA includes the processes and methods used to make HTA reports in and for hospitals. Ukraine has already started implementing hospital-based HTA, but a number of steps are still needed to fully implement HTA at the hospitals. One of them is the choice of HB-HTA report form, which will be appropriate to use in the practical activities of hospitals in Ukraine.&#x0D; The purpose of the study is to analyse the international experience of using different HB-HTA report form with the aim of selecting the optimal HB-HTA report form for hospitals in Ukraine. There were analysed different forms of HTA reports in Ukraine regulatory framework, international scientific literature, the AdHopHTA handbook, which included the following countries: Norway, Finland, Turkey, Spain, Austria, Italy, Estonia, Denmark, Switzerland, in international HTA database INAHTA, Canadian and Kazakhstan report databases. The methods of content analysis, systematization and generalization were used.&#x0D; Making managerial decisions about investment or disinvestment in health technology requires information that meets the hospital stakeholders needs. Such scientifically based information is provided by HB-HTA report form.&#x0D; There are a wide range of HB-HTA reports forms in terms of content, subject matter, structure and resources (time and staff). Each is based on the EUnetHTA HTA core model. For introducing a hospital-based HTA, the countries of the world most often choose the mini-HTA form. Mini-HTA supports hospital managers to make science-based strategic decisions of the introduction of new treatment methods, new indications for the use of existing technology, medical equipment, medical devices, or stopping the usage of health technology. The choice between performing a mini-HTA or a more comprehensive hospital-based HTA often requires a balance between the quality and thoroughness and the necessary speed of assessment in a specific situation.&#x0D; From the authors' point of view, the most applicable to Ukrainian context is the mini-HTA form. Adapting mini-HTA and approving it as a recommended report form at the state level will provide an opportunity to more widely HTA usage by hospitals in Ukraine.

Management practices in hospitals: A public-private comparison.

We use information on management practices in 1,183 hospitals in 7 different countries, collected in 2010 within the "World Management Survey" initiative, to estimate the role of public ownership on different management dimensions, such as monitoring performance, setting targets and incentivizing employees. A significant variation in management practices both between countries and, within countries, across hospitals is found. We show that managers in public sector hospitals tend to underperform, relative to private hospitals, in all the countries considered. Larger hospitals appear to be better managed, while there is no difference between teaching and other type of hospitals. Publicly owned hospitals appear less efficient in the provision of incentive schemes to promote and reward highly motivated employees, or remove poor performers. Overall, public ownership is associated with a reduction of about 10% in management score, which corresponds approximately to a half-standard deviation.

Assessing performance using maturity model: a multiple case study of public health supply chains in Nigeria

PurposeThis study aims to determine the factors and dynamic systems behaviour of essential medicine stockout in public health-care supply chains. The authors examine the constraints and effects of mental models on medicine stockout to develop a dynamic theory of medicine availability towards saving patients’ lives.Design/methodology/approachThis study uses a mixed-method approach. Starting with a survey method, followed by in-depth interviews with stakeholders within five health-care supply chains to determine the dynamic feedback leading to stockout and conclude by developing a network mental model for medicines availability.FindingsThe authors identified five constraints and developed five case mental models. The authors develop a dynamic theory of medicine availability across cases and identify feedback loops and variables leading to medicine availability.Research limitations/implicationsThe need to include mental models of stakeholders like manufacturers and distributors of medicines to understand the system completely. Group surveys are prone to power dynamics and bias from group thinking. This survey’s quantitative output could minimize the bias.Originality/valueThis study uniquely uses a mixed-method of survey method and in-depth interviews of experts to assess the essential medicine stockout in Nigeria. To improve medicine availability, the authors develop a dynamic network mental model to understand the system structure, feedback and behaviour driving stockouts. This research will benefit public policymakers and hospital managers in designing policies that reduce medicine stockout.

Practical Model of Infection Prevention and Control in Intensive Care Units for Iran

Background and Objectives: Nosocomial infections, especially in intensive care units as well as increased mortality and costs associated with them are considered as one of the major health problems in the communities so that successful control of them requires awareness on their problems in the hospitals and a precise planning. This study was conducted to "provide a model for prevention and control of nosocomial infections in intensive care units". Methods and Materials: This qualitative study was conducted through purposeful sampling strategy on 21 healthcare providers selected via purposive sampling from various medical subgroups, including: anesthesiologist, nurse manager, supervisors, faculty members, head nurses, and hospital managers. The data were collected using semi-structured interviews and conventional content analysis method was used for data analysis. In the second phase, a comparative study of the situation of our country and targeted countries was conducted and in the third phase a practical model is designed. Results: The results of qualitative content analysis using conventional approach in the field of staff's experiment regarding the model of prevention and control of nosocomial infections in intensive care units, revealed 3 main themes: "barriers (human factors, environmental factors, personal factors and complexity)", "facilitating factors (organizational, external and internal stimuli) ", and "concepts of the model (effectiveness of infection control training process in ICU, the systematic nature of the process of infection control, public hospital management, resource management and organizational leadership)". After a comparative study, the applied model of control and prevention of nosocomial infection in the ICU was designed with seven models, including standards (caring-curing and structural), monitoring and supervision, education and training, logistic resources, modern technologies, translation and knowledge transfer and evidence-based practice. Conclusion: Identifying the barriers and facilitating factors of nosocomial infection control and the use of especial measures in ICU promote the patient's safety and enhance the quality of care. Prevention of these infections requires a comprehensive and integrated controlling program. This model can be applied to resolve existing gaps and cause maximum integrity between the concepts.

Evaluating the decentralization of public hospitals in Turkey in terms of technical efficiency: data envelopment analysis and Malmquist index

PurposeDecree Law No. 663 introduced a decentralized organizational structure and administration pertaining to Turkish public hospitals in November 2011. This study aims to explore the effects of the public hospital unions (PHUs), which were a result of Decree Law No. 663, on the efficiency and productivity of public hospitals.Design/methodology/approachData envelopment analysis (DEA) and DEA-based Malmquist total factor productivity (TFP) index were used from 2011 to 2016. Raw materials and supply expenses, salaries and fringe benefits, other service costs, general administrative expenses, total number of beds, number of specialists, number of residents, number of general practitioners, number of nurses and midwives and other medical officials were used as input variables. Working capital turnover, number of inpatients, number of outpatients and number of surgical operations for Groups A, B and C were used as output variables.FindingsAccording to the DEA scores, the percentage of efficient hospitals showed a declining trend from 2011 to 2016. The TFP results also showed a decreasing trend from 2011 to 2016.Practical implicationsProviding administrative and financial autonomy to public hospital managers may cause efficiency and productivity losses, which is contrary to expectations.Originality/valueThis study is the first to reveal the impact of decentralization of public healthcare providers on their performance levels in Turkey.

Strategies for Reducing Induced Demand in Hospitals Affiliated with Iran University of Medical Sciences: A Qualitative Study

Background: Induced demand is a major challenge for health systems worldwide. It increases costs, especially for patients. The purpose of this study is to identify strategies for reducing induced demand for health care in hospitals affiliated with the Iran University of Medical Sciences (IUMS).&#x0D; Methods: This was a qualitative study conducted in 2018. The authors conducted in-depth, semi-structured interviews with 20 participants, including IUMS faculty members, physicians, public hospital managers, patients, and researchers with academic and practical experience. Inductive content analysis was used to analyze data. Data analysis was performed in MAXQDA10.&#x0D; Results: Overall, the authors extracted 24 subthemes from the interviews and classified them into the health system, insurer, healthcare provider, and healthcare recipient. They are key factors regarding the induced demand for healthcare in the public hospitals under study.&#x0D; Conclusion: Reducing induced demand for healthcare requires concerted actions by health policymakers and managers at the level of the health system, insurers, healthcare providers, and healthcare recipients. Therefore, policymakers and managers of the health system should take appropriate measures such as the development of guidelines and protocols by different departments, especially the emergency department, classification (primary, secondary, and tertiary care), and referral system. They expand the monitoring role of insurance companies (transforming the payment system into the global diagnosis-related group) to reduce the induced demand for health.

Internal Audit and Operational Performance in Public Teaching Hospitals in Oyo State Nigeria

The paper examined the effect of internal audit on operational performance in public teaching hospitals in Oyo state Nigeria. The study proxy health performance which is dependent variable by medical equipment utilization and internal audit which is independent variable was proxy by internal audit independence, staff competence, management involvement and the scope of work. The data was collected through the administration of questionnaire directly to the ninety nine (95) respondents. Data collected was analysed using percentage counts, Pearson correlation analysis and multiple linear regression technique. The result showed that internal audit is significant to the operational performance of public teaching hospital in Oyo State Nigeria. It was recommended that the management of public teaching hospital should make fund available for internal audit department to carry out their duties as deem fit and public teaching hospitals should be required by law to allow government information to be publicly published.

Influencing Factors and Symbiotic Mechanism of the Integration of Medical Care and Disease Prevention during the COVID-19 Pandemic: A Cross-Sectional Survey of Public Hospital Employees.

Background: The COVID-19 outbreak has accelerated the huge difference between medical care and disease prevention in Chinese medical institutions. This study aimed to investigate the relationship between the symbiotic units, environments, models, and effects of the integration of medical care and disease prevention. Methods: This cross-sectional study involved 762 employees of public hospitals in 11 cities in Zhejiang Province by random stratified sampling. We analyzed the influence paths of elements in the mechanism of integration of medical care and disease prevention and the mediating effect of symbiotic models among symbiotic units, symbiotic environments, and effects on this integration. Results: The path coefficient of the symbiotic unit on the symbiosis model was 0.46 (p < 0.001), the path coefficient of the symbiotic environment on the symbiosis model was 0.52 (p < 0.001). The path coefficient of the symbiotic unit and the environment was 0.91 (p < 0.001). The symbiotic models exhibited a partial mediation effect between symbiotic units and the effect of this integration. Sobel test = 3.27, β = 0.152, and the mediating effect accounted for 34.6%. Conclusions: It is suggested that health policymakers and public hospital managers should provide sufficient symbiotic units, establish collaborative symbiotic models, and improve the effects of integration of medical care and disease prevention in public hospitals.

Self vs. Other Raters’ Assessment of Emotional Intelligence in Private and Public Hospitals: A Comparative Study

This study aims to investigate the levels of emotional intelligence for managers in public and private hospitals in Jordan for the purpose of identifying the relative practice of emotional intelligence dimensions by managers in each sector. The research will also look into the differences (gaps) in self- and other-assessed emotional intelligence for managers in both public and private hospitals. As such, the theoretical importance of this research lies in its ability to contribute to filling the missing gap in the literature while forming the basis for or being the object of reference for any future research in the field. The researchers adopted a quantitative research design. Data were collected using a 360-degree questionnaire, in which managers’ self-assessments, and the assessments of two other raters (supervisors, peers, or subordinates), were used to measure the levels of managers’ emotional intelligence in both public and private hospitals. A total of 179 managers and 358 raters participated in our study. The results of the study revealed that differences between managers’ self-assessments and others’ assessments might be an indicator of inflated managers’ self-assessments. Differences between managers’ self-assessments and others’ assessments were larger in public hospitals compared with those in private hospitals. Hence, our study provides valuable recommendations and implications to enhance the practice of emotional intelligence among managers both in public and private hospitals in Jordan.

A Study on the Impact of Management Accounting Application on the Management Efficiency of Public Hospitals in Thanh Hoa Province, Vietnam

Based on the actual situation of Public Hospitals in Thanh Hoa Province and the role of Management Accountants in performing the management function of managers, the authors conduct a study on the relationship between accounting application management to management efficiency in Public Hospitals in Thanh Hoa Province to find out the relationship between the application of management accounting to the operation management of the hospital, thereby making necessary recommendations for the application of Management Accounting. Management accounting in hospitals is reasonable and appropriate, bringing a positive impact on management in Public Hospitals in the current context of Financial Autonomy.

Determinants of Inventory Management in Public Hospitals in Mombasa County, Kenya

Sound inventory control and management facilitate several actions and desired results that would increase the performance level of an organization to great heights. This study sought to investigate the determinants of effective inventory management in public hospitals in Mombasa County, Kenya. The specific objectives were to determine the effects of information technology, material handling, staff competencies, and storage facilities on inventory management. The study was guided by Resource Based View Theory. The study adopted a descriptive survey design. The sample size for the study was 41 members of staff from Public Hospitals. The study established that increase in the staff competencies and storage facility results in an increase in effective inventory management. Further, increase in information technology and materials handling results in a decrease in effective inventory management. The study recommended that public hospitals should consider both academic qualification and experience in hiring its staff, automating material handling techniques to enhance the safety of materials, and must ensure maximum security and safety of stores and hospitals at large. Top management in public hospitals must embrace and attain the required standards of knowledge on matters of inventory control and management. The hospital management and leadership must and should embrace the use of technology to enhance most effective and efficient delivery of services to the public.

Strategic human resource management and performance in public hospitals in Ethiopia.

Ethiopian public hospitals struggle to meet health care needs of the Ethiopian population, in part because of the persistent human resources crisis. The health reforms and tight human resource management (HRM) regulation of the government have resulted in limited progress toward addressing this crisis. This study aims to analyze how the strategic HRM practices adopted by Ethiopian public hospitals influence employee outcomes, organizational outcomes, and patient outcomes. Structured interviews were conducted with 19 CEOs and HR managers from 15 hospitals. Four focus groups were also conducted, with 38 participants (professionals and line managers). The transcripts were thematically analyzed using ATLAS.ti 8. Deductive coding was used based on the Contextual SHRM framework, while remaining open for codes that emerged. Intended HR practices are influenced by mandatory strict government regulations. Nevertheless, some room for self-selected (bundles of) HR practices is perceived by hospitals. Employees perceive that governmental steered HR practices may not match its intentions due to implementation issues, related to lack of support and skilled management and HR professionals. These problems are leading to dissatisfaction, demotivation, moonlighting and turnover of skilled professionals and perceived to consequently negatively influence performance (i.e., patient satisfaction and waiting time). There are considerable contextual challenges for SHRM in Ethiopian public hospitals. Hospital management can benefit from having more leeway and from exploiting it more effectively to improve actual and perceived strategic human resource management practices. Adoption of commitment based practices, in addition to mandatory control oriented practices can help to motivate and retain health care professionals and consequently improve outcomes.