Hospital Rankings Research Articles

Developing new methods for patient care pathway assessment for breast cancer patients in Hungary

Abstract Issue The idea of progressive healthcare models is to treat patients preferably in one location as close to their homes as possible. This contradicts the demands of efficiency: to centralise the availability of expensive procedures and highly specialised staff. Healthcare systems need to navigate between these challenges, especially in public health issues such as cancer care. Description of the problem Achieving the best possible health outcomes requires evidence-based policies that find balance between the demands of accessibility and efficiency. Therefore, we aimed to set up a methodology to review the healthcare model and assess patient movements across the system. We analysed the roaming paths of breast cancer patients diagnosed in Hungary in 2017. Inter-hospital roaming was represented as a graph: hospitals were the nodes, patient movements from one hospital to another were directed edges. This allowed us to apply network analysis: modularisation, weighted degrees calculation, etc. We then introduced the measure of terminality. A hospital is terminal in a given pathway if it is the last new one, i.e. all hospitals visited later had already been visited before. Terminality is defined as the proportion of terminal events among all pathways that cross a given hospital. The rationale of this is that the last hospital in cancer pathways is usually not the highest level one: after advanced treatments, patients are often referred back to local hospitals. Results Testing the method on Hungarian breast cancer patients we observed that results fit our prior expectations. The official ranking of hospitals on the progressivity scale (reflecting the availability of advanced treatments) shows sufficient agreement with terminality. Minor differences may point to situations where the healthcare system does not work fully according to regulations. Lessons Our methodology is recommended for system level patient pathway analysis in order to develop evidence-based healthcare policies. Key messages • Graph representation of inter-hospital patient roaming supports evidence-based policy developments for more efficient patient pathways in cancer care, regardless of the healthcare system design. • The applied new network analysis methodology can help assessing the real life processes of cancer care in a healthcare system through identifying the specifics of inter-hospital patient movements.

Relativity, Rank, and the US News Health's Cardiology, Heart, and Vascular Surgery Best Hospitals.

Virtually anything can be ranked; the US News and World Report (USNWR or US News) ranks the top 50 hospitals specializing in cardiology, heart, and vascular surgery. Here the authors propose validating the effectiveness of rankings by comparing differences among the USNWR metrics across the top 50 hospitals. The ranking system for the top 50 hospitals specializing in cardiology, heart, and vascular surgery was derived from 16 variant scores. Each hospital's scores were collected from the USNWR. Hospitals were categorized into quintiles consisting of 10 institutions (1-10, 11-20, etc). An analysis of variance/χ2 comprehensive statistical analysis was run alongside a Wilcoxon/Kruskal-Wallis test to compare statistical outcomes. A significant threshold was deemed to be P < 0.05. Significant differences were noted between quintiles for advanced technologies (P = 0.05), US News specialty score (P < 0.001), number of patient referrals (P = 0.004), and expert opinion (P < 0.001). Non-statistically significant differences were found among patient experience, public transparency, Society of Thoracic Surgery transparency, American College of Cardiology transparency, recognition as a magnet hospital, and nursing staffing. Interestingly, a large variance was noted in the average number of referrals between the first quintile (13,371) and the last (6690). Expert opinion plays a critical role in the reputation of the USNWR's top 10 hospitals in cardiology, heart, and vascular surgery. Although many have argued about the merits of USNWR hospital rankings, taken together, rankings fill a strong customer demand and are sticky.

The Children's National Hospital Outcomes Registry: a plea for a benchmarking tool that provides longitudinal outcomes for patients and families.

Surgical advancements in paediatric cardiovascular surgery have led to improved survival rates for those patients with the most complex CHDs leading to greater numbers of patients who are living well into adulthood. Despite this new era of long-term survival, our current reporting systems continue to focus largely on using short-term postoperative outcomes as the criteria to both rate and rank hospitals. Using such limited criteria to rate and rank hospitals may mislead the intended audiences: patients and families. The goal of this article is to describe the creation of a local benchmarking report which aims to retrospectively review long-term outcomes from our single centre. This report is updated annually and published on our cardiac surgery webpage in an effort to be as transparent as possible for our patient and family communities.

Exploring the Link Between Factors in Musculoskeletal Oncology Surgery Fellowships and Industry Supplemental Income.

Introduction In the complex landscape of healthcare economics, the financial relationship between physicians and industry remains a topic of significant interest and reflection. While the dynamics of industry relationships in certain orthopedic subspecialties have been well documented, the intricacies of industry payments within musculoskeletal (MSK) oncology programs have yet to be thoroughly explored. In this study, we aim to examine the relationship between academic and industry productivity at the fellowship level. Additionally, we seek to identify the associations between the flow of industry supplemental income to orthopedic oncologists and the specific residency and fellowship training programs they are affiliated with. Methodology A comprehensive retrospective analysis was conducted using data from the Centers for Medicare and Medicaid Services, Scopus, and other relevant databases in 2023. This study included 19 fellowship programs across the United States, encompassing a total of 68 faculty physicians. Various variables were examined, including H-index, lifetime supplemental income, geographical location, residency affiliation, and association with top-ranked hospitals. Results A statistically significant correlation was found between academic and industry productivity at the individual faculty level (p = 0.003), but not at the fellowship level (p = 0.198). The top 10% of earners accounted for approximately 70% of the total lifetime supplemental income among all fellowship faculty. Additionally, there was no statistically significant association between lifetime supplemental income or academic productivity per fellowship and geographical region, nor with the ranking of affiliated residency programs or hospitals. Conclusions Industry productivity among individual faculty in MSK oncology fellowship programs in the United States is significantly associated with academic productivity; however, this association was not observed at the fellowship level. Furthermore, no statistically significant relationship was found regarding the region or the ranking of the affiliated residency programs or hospitals.

Leadership Practices, Organization Structure, and Other Factors Associated with Higher 2022-2023 US News and World Report Ranking.

U.S. News and World Report 2022-2023 hospital rankings were used to investigate the leadership practices and organizational structure of ranked healthcare institutions. Institutional variables including physician leadership status, executive board size, number of physician board members, type of physician practice, health system size, and for-profit status were collected. US News and World Report scores were used to create a comprehensive institutional rank order list. Strength of association was evaluated between these variables and the organization's US News and World Report rank. Our analysis included 546 institutions representing 1676 hospitals. Leadership under a physician CEO (OR 1.59 (95% CI 1.27, 2.00) P < 0.001), group practice (OR 1.25 (95% CI 1.01, 1.59) P = 0.042), and bed count of the institution's highest-ranking hospital (OR 1.001 (95% CI 1.0009, 1.0014) P < 0.001) were associated with higher US News and World Report ranking. For-profit status was negatively associated with institution ranking (OR 0.44 (95% CI 0.24, 0.78) P = 0.005). No significant association was demonstrated between number of physician executive board members, health system bed count, executive board size, or the number of hospitals in a health system and the institutional ranking. Physician leadership, organizational structure, size of the institution's flagship hospital, and tax status are significantly associated with an organization's US News and World Report rank.

Clinical Outcomes, Costs, and Value of Surgery Among Older Patients with Colon Cancer at US News and World Report Ranked Versus Unranked Hospitals

BackgroundUS News and World Report (USNWR) hospital rankings influence patient choice of hospital, but their association with surgical outcomes remains ill-defined. We sought to characterize clinical outcomes and costs of surgery for colon cancer among USNWR top ranked and unranked hospitals.MethodsUsing Medicare Standard Analytic Files, patients aged ≥65 years undergoing surgery for colon cancer were identified. Hospitals were categorized as ‘ranked’ or ‘unranked’ based on USNWR cancer hospital rankings. One-to-one matching was performed between patients treated at ranked and unranked hospitals, and clinical outcomes and costs of surgery were compared.ResultsAmong 50 ranked and 2522 unranked hospitals, 13,650 patient pairs were compared. Overall, 30-day mortality was 2.13% in ranked hospitals versus 3.68% in unranked hospitals (p < 0.0001), and the overall paired cost difference was $8159 (p < 0.0001). As patient risk increased, 30-day mortality differences became larger, with the ranked hospitals having 30-day mortality of 7.59% versus 11.84% for unranked hospitals among the highest-risk patients (p < 0.0001). Overall paired cost differences also increased with increasing patient risk, with cost of care being $72,229 for ranked hospitals versus $56,512 for unranked hospitals among the highest-risk patients (difference = $14,394; p = 0.02). The difference in cost per 1% reduction in 30-day mortality was $9009 (95% confidence interval [CI] $6422–$11,597) for lowest-risk patients, which dropped to $3387 (95% CI $2656–$4119) for highest-risk patients (p < 0.0001).ConclusionTreatment at USNWR-ranked hospitals, particularly for higher-risk patients, was associated with better outcomes but higher-cost care. The benefit of being treated at highly ranked USNWR hospitals was most pronounced among high-risk patients.

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Formulation of a CITE metric for evaluating the clinical implications of medical studies and their originating hospitals in China.

The number of medical research publications by Chinese clinical investigators has risen substantially, contributing to 14.63% of the global total in 2019; however, their tangible impact on clinical decision-making remains limited. Various evaluation methods have been developed to measure hospital research competence in China, such as Fudan University's China hospital ranking and Science and Technology Evaluation Metrics (STEM) ranking, which predominantly focuses on factors such as academic reputation, volume of publications and patents, and research resources. However, composite indices may not fully capture the actual clinical value generated by medical research. To address this gap, we introduced the "Clinical Influence and Timeliness Evaluation (CITE)" metric to assess both the clinical importance of a given medical research study and the clinical influence of the hospital where it originated. The methodology used relies on the premise that influential medical research would be referenced in clinical guidelines, which serve as critical resources for clinicians. The CITE metric was applied for 78,636 medical studies concerning chronic obstructive pulmonary disease (COPD) published between 2000 and 2020 and referenced in both Chinese and international clinical guidelines for COPD. Specific indexes and formulas were derived to quantify the clinical weight of a medical research study (W) and its timeliness (T), enabling a dynamic assessment of the clinical value of each study and the overall contribution of a particular hospital. In this analysis, we incorporated 499 hospitals in China and quantitatively identified their dynamic clinical influence in COPD from 2000 to 2020. Our findings offer objective and targeted evaluation metrics by focusing on clinical relevance and recognizing the collaborative nature of medical research. The CITE metric provides an innovative method to gauge the true impact of medical research in China, with potential applications across different medical specialties. CITE can serve as a useful tool for understanding the relationship between research input and practical clinical outcomes, ultimately promoting more clinically relevant research endeavors.

Hospital Rating Organizations' Quality and Patient Safety Scores: Analysis of Result Discrepancies.

In the USA, multiple organizations rate hospitals based on quality and patient safety data, but few studies have analyzed and compared the rating results. Compare the results of different US hospital-rating organizations. Observational data analysis of US acute care hospital ratings. Four rating organizations: Hospital Compare® (HC), Healthgrades® (HG), The Leapfrog Group® (Leapfrog), and US News and World Report® (USN). We analyzed the level of concordance (similar ranking), discordance (difference of 1 or more rankings), and severe discordance (difference of two or more rankings), as well as differences and correlations between the scores. From Feb 1 to Oct 3, 2023, we analyzed data from 2,384 hospitals. In Leapfrog, there were 688 hospitals (29%) with Grade A, 652 (27.3%) with B, 885 (37.1%) with C, 153 (6.4%) with D, and 6 (0.3%) with F. For HC, 333 hospitals (14%) had five stars, 676 (28.4%) four, 695 (29.2%) three, 502 (21.4%) two, and 171 (7.2%) one-star. In ratings between HC and Leapfrog, discordance was 70%, and severe discordance was 25.1%. USN ranked 469 hospitals (19.7%). Within the USN-ranked hospital group, there was a 62% discordance and 19.8% severe discordance between HC and Leapfrog. The analysis of orthopedic procedures from HG and USN showed discordance ranging from 48 to 61.2%. The rating organizations' reported metrics were highly discordant. A hospital's ranking by one organization frequently did not correspond to a similar ranking by another. The methodology and included timeline and patient population can help explain the differences. However, the discordant ratings may confuse patients and customers.

A Deeper Look at Proposed Surveillance of Superficial Incision Surgical Site Infections (SSISSIs)

Although the National Healthcare Safety Network (NHSN) recommends the reporting of superficial incisional SSIs, the standardized infection ratio (SIR) models used by the NSHN exclude superficial incisional SSIs cases. Yet, some superficial incisional SSIs may lead to serious adverse patient outcomes. We previously proposed a new category of such infections: serious superficial incisional surgical site infections (SSISSIs), defined as a superficial incisional SSI that (1) required debridement in an operating room and/or (2) led to a hospital readmission within 30 days of surgery. The objective of our study was to determine the prevalence of SSISSIs in a large network of community hospitals and compare hospital rankings of SSI rates of organ/space and deep SSIs (complex SSIs) with and without SSISSIs. We performed a retrospective descriptive analysis of prospectively collected data on 35 NHSN surgical categories in 47 community hospitals within the Duke Infection Control Outreach Network (DICON) from 1/1/2013-12/31/2022. All hospitals used standardized surveillance and data collection strategies throughout the study period. The Wilcoxon rank-sum was used to test for differences in performance rankings of hospitals sorted by rates of complex SSIs alone compared to complex and SSISSI rates. A two-tailed P value of .05 or less was considered significant. Overall, 11,617 SSIs occurred after 1,272,257 surgeries (0.91 SSIs/100 procedures). Out of 3,996 superficial SSIs, 2,038 (17.5% overall, 51.0% of superficial incisional) met criteria for SSISSI. 112 (5.5%) were diagnosed during the current admission and required takeback to the OR for infection; 1,926 (94.5%) were diagnosed during a readmission; and 3841 (33.1%) were diagnosed during readmission and returned to the OR. (Table1) The highest proportion of SSISSIs was diagnosed in patients who underwent gastrointestinal surgery (32.0%) or orthopedic surgery (24.0%). (Table2) Performance ranking of individual hospitals based on rates of complex SSIs, differed significantly when including SSISSIs (p= 0.02). (Table3) Discussion Our findings suggest that SSISSIs make up a moderate but important proportion of SSIs in community hospitals. SSISSIs can be identified through established database surveillance looking at objective measures of returning to the OR for debridement and/or readmission within 30 days. Hospital rankings differed significantly when SSISSIs were added to complex SSIs to calculate SSI rates. As such, including SSISSIs likely provides a more accurate depiction of SSIs with important outcomes and is not as subjective to surveillance bias. Next steps would be specifically to look at outcomes data for complex SSIs compared to SSISSIs to fully evaluate theDisclosure: Jessica Seidelman: UptoDate- Section Editor; BoneSupport- Consultant

Integrating Social Drivers of Health into Hospital Ratings with Application to the 100 Top Hospitals Study.

The objective was to investigate the relationship between social drivers of health (SDOH) and hospital performance within the 100 Top Hospitals study, exploring methods to recognize hospitals serving marginalized communities. Publicly available data sourced from the Centers for Medicare and Medicaid Services and the 2023 100 Top Hospitals study was used. The study employed multivariable hierarchical generalized linear regression models to assess the association between an SDOH composite variable derived using principal component analysis and overall hospital performance measures within the 100 Top Hospitals study. The analysis revealed a statistically significant association between SDOH factors and study ranking results. The SDOH composite variable is a significant predictor of performance within the 100 Top Hospitals study. Accounting for SDOH is essential to recognize high-performing hospitals serving marginalized communities. The findings suggest a need for broader considerations of SDOH in hospital ranking methodologies across various industry programs.

Hospital-level variation in costs of elective nonruptured abdominal aortic aneurysm repair

BackgroundWith the aging population in the United States, the incidence of abdominal aortic aneurysms is shifting to older ages. Given changing demographic characteristics and increasing health care expenditures, the present study evaluated the degree of center-level variation in the cost of elective abdominal aortic aneurysm repair. MethodsWe identified all adult (≥18 years) hospitalizations for elective repair of nonruptured abdominal aortic aneurysms in the 2017 to 2020 Nationwide Readmissions Database. Hierarchical mixed-effects models were used to rank hospitals based on risk-adjusted costs. The interclass coefficient was used to calculate the amount of variation attributable to hospital-level characteristics. High-cost hospitals were classified as centers in the top decile of costs. The association of high-cost hospitals status with outcomes of interest was examined. ResultsAn estimated 62,626 patients underwent abdominal aortic aneurysm repair, and 5,011 (8.0%) were managed at high-cost hospitals. Compared with non–high-cost hospitals, high-cost hospitals were more commonly large (52.6% vs 48.3%) metropolitan (78.3% vs 66.9%) teaching centers (all P < .001). The interclass coefficient found that 28% of the observed variation in cost is attributable to hospital factors. After adjustment, high-cost hospitals were associated with increased odds of gastrointestinal (adjusted odds ratio = 1.42; 95% CI, 1.05–1.90) and infectious (adjusted odds ratio = 1.35; 95% CI, 1.14–1.59) complications. Finally, the Elixhauser index (β = +$2,700/unit; 95% CI, $2,500–$3,000) and open repair (β = +$4,100; 95% CI, $3,100–$5,200) were associated with increased costs. ConclusionWe observed significant variation in cost attributable to center-level differences. Our findings have implications for reimbursement paradigms and the establishment of quality and cost benchmarks in the elective repair of abdominal aortic aneurysm.

Impact of Program Region and Prestige on Industry Supplemental Earnings for Pediatric Orthopedic Surgery Fellowships in the United States: A Retrospective Analysis

Introduction: With the passage of the Physician Payment Sunshine Act, there has been increased transparency regarding the industrial financial relations that physicians have. Orthopedic surgeons have been highly studied in this domain with approximately 50% of all orthopedic surgeons engaging in industrial financial relationships. Furthermore, an increasing number of orthopedic surgeons are seeking fellowship training with pediatric fellowship programs gaining popularity in recent years. The purpose of this study is to evaluate the impact various pediatric orthopedic fellowship programs have on industry earnings and academic productivity. Methods: Pediatric orthopedic fellowship programs were identified via the Orthopedic Society of North America (POSNA) website. Information on individual fellowship programs was obtained from their respective websites. Academic productivity was measured via an aggregate of all employed physicians’ H-index at a specific fellowship as found on the Scopus website. The Open Payments Database (OPD) website was used to assess lifetime industry earnings. Other variables such as Newsweek or Doximity ranking were taken directly from relevant websites. Statistical analysis was performed using a Kruskal–Wallis test with Bonferroni correction and Mann–Whitney U-test. Results: A total of 43 pediatric orthopedic surgery fellowships in the United States were identified with a total of 392 physicians as fellowship faculty. Complete OPD and H-index information were available for 336 of those physicians (85.7%). On average, there were 7.81 ± 5.18 physicians and 1.56 ± 0.93 fellows per program. The mean combined physician H-index was 117.23 ± 122.51, and the mean combined physician lifetime supplemental earnings in dollars was $646,684.37 ± $1,159,507.17. There was no significant relationship between region of pediatric orthopedic fellowship, Newsweek ranking of affiliated hospital, Doximity ranking of affiliated hospital, presence of MBA program, type of program (public, private, mixed), and the lifetime industry earnings or academic productivity of program graduates. Conclusions: Despite the observed lack of statistical significance, there were clear trends observed with fellowship programs in the northeast and west coast regions being the highest earning and fellowship programs with top 10 Newsweek ranking of affiliated hospital having by far the greatest industry earnings. Sample size limitations likely prevented the detection of statistical significance. Future studies should examine if any relation exists when accounting for type of industry payment received and case volume per fellowship program.

Multimodal Quality Initiatives in Sepsis Care: Assessing Impact on Core Measures and Outcomes.

Providing timely and effective care for patients with sepsis is challenging due to delays in recognition and intervention. The Surviving Sepsis Campaign has developed bundles that have been shown to reduce sepsis mortality. However, hospitals have not consistently adhered to these bundles, resulting in suboptimal outcomes. To address this, a multimodal quality improvement sepsis program was implemented from 2017 to 2022 in a large urban tertiary hospital. The aim of this program was to enhance the Severe Sepsis and Septic Shock Management Bundle compliance and reduce sepsis mortality. At baseline, the Severe Sepsis and Septic Shock Management Bundle compliance rates were low, at 25%, with a sepsis observed/expected mortality ratio of 1.14. Our interventions included the formation of a multidisciplinary committee, the appointment of sepsis champions, the implementation of sepsis alerts and order sets, the formation of a Code Sepsis team, real-time audits, and peer-to-peer education. By 2022, compliance rose to 62%, and the observed/expected mortality ratio decreased to 0.73. Our approach led to improved outcomes and hospital rankings. These findings underscore the efficacy of a comprehensive sepsis care initiative, emphasizing the importance of interdisciplinary collaboration. A multimodal hospital-wide sepsis performance program is feasible and can contribute to improved outcomes. However, further research is necessary to determine the specific impact of individual strategies on sepsis outcomes.

An inversion-based clustering approach for complex clusters

BackgroundThe choice of an appropriate similarity measure plays a pivotal role in the effectiveness of clustering algorithms. However, many conventional measures rely solely on feature values to evaluate the similarity between objects to be clustered. Furthermore, the assumption of feature independence, while valid in certain scenarios, does not hold true for all real-world problems. Hence, considering alternative similarity measures that account for inter-dependencies among features can enhance the effectiveness of clustering in various applications.MethodsIn this paper, we present the Inv measure, a novel similarity measure founded on the concept of inversion. The Inv measure considers the significance of features, the values of all object features, and the feature values of other objects, leading to a comprehensive and precise evaluation of similarity. To assess the performance of our proposed clustering approach that incorporates the Inv measure, we evaluate it on simulated data using the adjusted Rand index.ResultsThe simulation results strongly indicate that inversion-based clustering outperforms other methods in scenarios where clusters are complex, i.e., apparently highly overlapped. This showcases the practicality and effectiveness of the proposed approach, making it a valuable choice for applications that involve complex clusters across various domains.ConclusionsThe inversion-based clustering approach may hold significant value in the healthcare industry, offering possible benefits in tasks like hospital ranking, treatment improvement, and high-risk patient identification. In social media analysis, it may prove valuable for trend detection, sentiment analysis, and user profiling. E-commerce may be able to utilize the approach for product recommendation and customer segmentation. The manufacturing sector may benefit from improved quality control, process optimization, and predictive maintenance. Additionally, the approach may be applied to traffic management and fleet optimization in the transportation domain. Its versatility and effectiveness make it a promising solution for diverse fields, providing valuable insights and optimization opportunities for complex and dynamic data analysis tasks.

Optimizing Interhospital Transfers in Orthopedics and Trauma Surgery: Challenges, Insights, and Proposals for Standardized Care in Germany.

Germany's high density of under-equipped hospitals and anticipated surge in orthopedic and trauma surgery-related diseases by 2030, combined with personnel shortages, are expected to increase patient transfers between hospitals, an issue that urgently needs standardized protocols. Despite some existing cooperative agreements, such as between joint-replacement centers or within the Trauma Network DGU®, these measures do not adequately address the full range of patient-transfer cases, including those due to a lack of specialization or staff shortages, resulting in delayed treatment and potential health risks. This study aims to dissect the intricacies of interhospital transfers in orthopedics and trauma surgery across Germany, focusing on understanding the underlying reasons for transfers, comparing the operational structures of small and large hospitals, and laying the groundwork for future standardized protocols to enhance patient care. A cross-sectional study was conducted in the form of an online survey via SoSci Survey, which was directed at orthopedic surgeons and trauma surgeons working in hospitals in Germany. The 22-question survey gathered information on participants' clinic roles, departmental details, transfer processes, frequent diagnoses, perceptions of transfer quality, and improvement areas. The survey was sent to orthopedic and trauma surgeons in Germany by the specialist society. The data were analyzed using descriptive and inferential statistics to ensure a comprehensive insight into interhospital transfer practices. The study involved 152 participants from various hospital ranks and located in different hospital sizes and types across rural and urban areas. A significant difference was observed between the care structures of basic/regular care and central/maximum care hospitals, especially regarding the available facilities and specialties. These findings suggest improvements such as better patient documentation, increased digital communication, optimized patient distribution, and standardization of transfer requests, among others. This study highlights the urgent need for improved protocols and resource allocation to eliminate inequalities in transfers between hospitals in orthopedics and trauma surgery in Germany.

Nurse Manager Practice Environment and Its Influencing Factors: A Multicenter Cross-Sectional Study

Objective. This study aimed to evaluate the current status and related factors of practice environments of nurse managers in China. Background. Insufficient nurse staffing and poor working environment directly increase the burnout and turnover of nurse leaders. Nurse managers play a pivotal role in healthcare organizations, and their performance has been inextricably linked to achieving optimal patient, staff, and healthcare organizational outcomes. However, there are few studies exploring the influencing factors of nurse manager practice environment. Methods. A cross-sectional study was undertaken to examine a sample of 405 nursing managers who were selected from 10 hospitals located across three provinces in China. The general characteristics questionnaire, the Nurse Manager Practice Environment Scale, the Perceived Stress Scale, and the Career Growth Scale were used. Data were analyzed by descriptive statistics, univariate analysis, and multiple stepwise linear regression. Results. The total scores of the nurse manager practice environments were 236.71 ± 27.635 (with 270 being the highest possible score), which was at a generally high level. The three lowest scores were adequate budgeted resources, fair and manageable workload, and nurse manager-physician relationships. Nurse manager practice environment was predicted by hospital geographic location, having (or not) training experience in higher ranked hospitals, levels of perceived stress, and career growth scores. Conclusion. Chinese nursing managers reported a relatively favorable nursing practice environment. Policymakers should pay more attention to the practice environment of nursing managers in small city hospitals, and they could regularly evaluate, monitor, and promote practice environment determinants that are sensitive to disparities between different hospitals. In addition, hospital managers can take action by implementing diversity training programs, developing stress-reduction initiatives, and creating robust career development programs for nurse managers to support nurse managers better. Implications for nursing management: a better understanding of the current practice environment of nursing managers is beneficial for improving nursing managers’ work environment, which in turn will promote the quality of care delivered and nursing management work. For nurse managers, the characteristics of the management and work environment of the small city hospitals should be benchmarked and learned against the district capital hospitals. Also, hospital administrators were required to adopt strategies to foster psychological support of nurse managers and create pathways and opportunities for professional growth to create a supportive working environment.

Fuzzy‐AHP methodology for ranking of hospitals based on waste management practices: A study of Gwalior City

AbstractWithin the scope of this research, the fuzzy‐analytical hierarchy process (F‐AHP) method is applied to assess the waste management approaches adopted by various hospitals in the city of Gwalior, India. Fuzzy‐AHP, as an alternative to traditional AHP, accommodates uncertainty and imprecision, offering a decision‐making method that is more adaptable and realistic. The F‐AHP methodology, delineated in a seven‐step process, incorporates pairwise comparisons, fuzzy mathematics, and linguistic variables to compute fuzzy weights for waste management criteria, encompassing physical, biological, social, and economic aspects. Hospital 1, with a weight value of 0.406 and strict adherence to the Bio‐medical Waste Management (Amendment), 2018 rules and regulations of the Government of India, emerges as the most promising sustainability hospital based on the F‐AHP analysis findings. Conversely, Hospital 5 exhibits the poorest waste management practices among the surveyed hospitals, earning the lowest possible ranking. While the proposed F‐AHP method provides valuable insights, the study is limited to a specific geographic area (Gwalior) and potential variations based on environmental factors. Additionally, the practical implications extend beyond the general emphasis on continuous monitoring to include specific actions for hospitals to enhance their waste management systems.

Patient perceptions of healthcare service quality in Romania: Public versus private hospitals – Implications for developed and developing healthcare systems

Objective: Recent increases in per capita income and longevity in Central and Eastern European counties (CEECs), alongside a slow-changing soviet-era public healthcare system, has led to the emergence of private hospitals. This paper investigates the differential patient service quality perceptions for private versus public hospitals, as well as for three types of healthcare services: primary, ambulatory, and inpatient care.Methods: Data from 1,673 patients of private and public hospitals in the capital of Romania were collected in face-to-face interviews. Analysis of covariance and partial-least-squares techniques were used to examine the relationships between perceived service quality, hospital ownership status and the type of health service patients received.Results: Over 70% of women prefer private health facilities to public hospitals (compared to less than 30% of men). While private hospitals rank higher than public hospitals on most attributes, the interaction effect of gender and hospital type reveals that assurance and empathy are the only significant attributes in driving women to private hospitals. (Physical facilities and staff appearance) as well as intangible dimensions of service quality (assurance, responsiveness, reliability, and empathy) have a positive impact on perceived overall service quality of healthcare. Improvements in perceptions of hospital’s tangibles, staff’s responsiveness and empathy have the greatest potential to enhance perceived overall service quality.Conclusions: This paper demonstrates the importance of breaking down health services into various sub-categories both in terms of perceived healthcare attributes and in terms of tangible healthcare facilities, such as public and private hospitals.

Performance Evaluation of Hospitals under Data Uncertainty: An Uncertain Common-Weights Data Envelopment Analysis.

In the context of healthcare systems, the performance evaluation of hospitals plays a crucial role in assessing the quality of healthcare systems and facilitating informed decision-making processes. However, the presence of data uncertainty poses significant challenges to accurate performance measurement. This paper presents a novel uncertain common-weights data envelopment analysis (UCWDEA) approach for evaluating the performance of hospitals under uncertain environments. The proposed UCWDEA approach addresses the limitations of traditional data envelopment analysis (DEA) models by incorporating the uncertainty theory (UT) to model the inherent uncertainty in input and output data. Also, by utilizing a common set of weights (CSW) technique, the UCWDEA method provides a more robust and reliable assessment of hospital performance. The main advantages of the proposed UCWDEA approach can be succinctly summarized as follows. Firstly, it allows for the comparison of all hospitals on a consistent basis to calculate a realistic efficiency score, rather than an overly optimistic efficiency score. Secondly, the uncertain common-weights DEA approach exhibits linearity, enhancing its applicability. Thirdly, it possesses the capability to extend its utility under various other prevalent uncertainty distributions. Moreover, it enhances the discriminatory power of results, facilitates the ranking of hospitals in the presence of data uncertainty, and aids in identifying the sensitivity and stability levels of hospitals towards data uncertainty. Notably, in order to showcase the pragmatic application and efficacy of the uncertain common-weights DEA model, a genuine dataset has been utilized to evaluate the efficiency of 20 public hospitals in Tehran, all of which are affiliated with the Iran University of Medical Sciences. The results of the experiment demonstrate the efficacy of the UCWDEA approach in assessing and ranking hospitals amidst uncertain conditions. In summary, the research outcomes can offer policymakers valuable insights regarding hospital performance amidst data uncertainty. Additionally, it can provide practical recommendations on optimizing resource allocation, benchmarking performance, and formulating effective policies to augment the overall efficiency and effectiveness of healthcare services.