Swiss Acute Hospitals Research Articles

Social and Regional Factors Predict the Likelihood of Admission to a Nursing Home After Acute Hospital Stay in Older People With Chronic Health Conditions: A Multilevel Analysis Using Routinely Collected Hospital and Census Data in Switzerland.

If hospitalization becomes inevitable in the course of a chronic disease, discharge from acute hospital care in older persons is often associated with temporary or persistent frailty, functional limitations and the need for help with daily activities. Thus, acute hospitalization represents a particularly vulnerable phase of transient dependency on social support and health care. This study examines how social and regional inequality affect the decision for an institutionalization after acute hospital discharge in Switzerland. The current analysis uses routinely collected inpatient data from all Swiss acute hospitals that was linked on the individual level with Swiss census data. The study sample included 60,209 patients 75 years old and older living still at a private home and being hospitalized due to a chronic health condition in 199 hospitals between 2010 and 2016. Random intercept multilevel logistic regression was used to assess the impact of social and regional factors on the odds of a nursing home admission after hospital discharge. Results show that 7.8% of all patients were admitted directly to a nursing home after hospital discharge. We found significant effects of education level (compulsory vs. tertiary education OR = 1.16 (95% CI: 1.03–1.30), insurance class (compulsory vs. private insurance OR = 1.24 (95% CI: 1.09–1.41), living alone vs. living with others (OR = 1.64; 95% CI: 1.53–1.76) and language regions (French vs. German speaking part: OR = 0.54; 95% CI: 0.37–0.80) on the odds of nursing home admission in a model adjusted for age, gender, nationality, health status, year of hospitalization and hospital-level variance. The language regions moderated the effect of education and insurance class but not of living alone. This study shows that acute hospital discharge in older age is a critical moment of transient dependency especially for socially disadvantaged patients. Social and health care should work coordinated together to avoid unnecessary institutionalizations.

Economic Rationalities and Notions of ‘Good Cure and Care’

ABSTRACT The development of the health care system in Switzerland has recently been driven by different processes such as economic rationalization, bureaucratization, or digitalization, while maintaining professional notions of ‘good cure and care.’ Drawing on qualitative data from a Swiss acute hospital, we analyze how potentially market driven modes of governance manifest themselves in the everyday activities of nurses and physicians. We show how professional understandings of ‘good cure and care’ remain persistent and intermingle with logics that we call economic rationalities, manifesting in the four interrelated issues of financial pressure, bureaucratization, time pressure, and staff shortage.

Measures to reduce stress in the workplace – results from focus group interviews with health professionals / Maßnahmen zur Reduktion von Stress am Arbeitsplatz – Resultate aus Fokusgruppeninterviews mit Gesundheitsfachpersonen

AbstractIntroductionStress and poor working conditions can affect the health and satisfaction of health professionals. Until now, the perspective of the staff has not been sufficiently considered in the development of solutions. The aim was to capture the wishes and recommendations of health professionals that could contribute to an improvement of the work situation from their perspective.MethodSemistructured focus group interviews with health professionals (nurses, midwifes, medical-technical-therapeutic professions and physicians) were conducted and analyzed using knowledge mapping and a deductive approach.ResultsBetween June and November 2018, 128 health professionals from Swiss acute hospitals, psychiatric hospitals, nursing homes, and outpatient services participated in a total of 24 focus group interviews. They expressed the need to incorporate wishes into staff scheduling and to address vacation planning at an early stage. Other suggestions were to be able to take advantage of further training opportunities and to live a positive feedback and error culture, as well as to establish a clear division of roles and tasks.ConclusionsThe healthcare staff interviewed showed clear ideas about what should be improved to reduce workload. There is a great need for action in the general conditions as well as in leadership and management.

Negotiating social differences and power geometries among healthcare professionals in a Swiss hospital

In this article, we analyse two parallel processes taking place in the Swiss healthcare sector, namely differentiation and standardisation: On one hand, the health sector is increasingly characterised by differentiation that originates from the specialisation of training, the differentiation and academisation of nursing, the feminisation of medicine, the migration of healthcare personnel, and the entry of men into nursing professions. In addition, a new generation joining the health sector labour force is challenging taken-for-granted notions about health professions. On the other hand, healthcare organisations such as hospitals need to ensure they are functioning well by increasingly relying on standardisation processes such as checklists, standardised protocols, or ethical guidelines. For this paper, we have conducted an institutional ethnography of a Swiss acute hospital by employing an intersectional analysis. Based on interviews and shadowing, we argue that the social differences between and among nurses and physicians are constantly negotiated every day. We demonstrate that those differences lead to power imbalances along the intersectional axes of age, gender, place of education, and professional position. Our findings have implications for general debates in health-related fields; for management and organizational studies more in general; and in particular for feminist labour geographies, as they place debates on work-relations, power, hierarchy, and intersectional social differences into a specific organizational and spatial context.

The relevance, feasibility and benchmarking of nursing quality indicators: A Delphi study.

To identify indicators of nursing care performance by identifying structures, processes, and outcomes that are relevant, feasible and have the potential for benchmarking in Swiss acute hospitals. A modified Delphi-Consensus Technique. We examined 19 indicators based on the current evidence and that were pre-selected by nursing scientists. Between August-October 2019, a consortium of experts (representatives of different cantons, hospitals, and healthcare roles in Switzerland) determined the relevance, feasibility, and suitability for benchmarking these indicators in two-round modus of digital survey. Consensus was defined a priori by at least 75% agreement on the highest level of a 3-point Likert-type scale. The response rate was 70.4% in the first and 68.4% in the second round. In round one consensus was reached for three indicators on relevance but for none of the indicators regarding feasibility or potential for benchmarking. For round two, the experts suggested two additional indicators (new total of 21 indicators). Of 21 indicators, consensus was reached on twelve regarding relevance, seven regarding feasibility, and two regarding the potential for benchmarking. A national expert consortium defined 12 of 21 nursing care indicators as relevant. Feasibility, however, was estimated only among seven indicators and a consensus on suitability for benchmarking was reached for two nursing-sensitive indicators. The results show how the indicators to evaluate nursing care performance, which have been identified as priority by Canadian nursing scientists, are assessed in a different setting. There are many overlaps, but also some differences in the assessment of the indicators between the different settings. Different health systems prioritize the indicators to evaluate nursing care performance differently, which is why national surveys are important for the compilation of their own (priority) indicator sets.

Analytical and Methodological Disruptions: Implications of an Institutional Ethnography in a Swiss Acute Hospital

Leseprobe ----- Bibliographie: Ammann, Carole/Richter, Marina/Thieme, Susan: Analytical and Methodological Disruptions: Implication of an Institutional Ethnography in a Swiss Acute Hospital, ZDfm – Zeitschrift für Diversitätsforschung und -management, 1-2020, S. 71-75. https://doi.org/10.3224/zdfm.v5i1.08

Prevalence, influencing factors, screening and diagnosis of delirium at stationary hospitalised patients in a Swiss acute Hospital. A pilot study

Background: Deliria have a massive effect on patients, from increased duration of hospitalization to higher mortality. Risk factors such as age, deprivation of substances, immobility as well as stress are known among others. Particularly in vulnerable persons minor factors can lead to a delirium. European studies report a prevalence rate between 17 % and 22 %, but can’t be compared to the Swiss hospital system. No national delirium prevalence data in acute hospitals is known. Aim: On the one hand to measure the delirium prevalence in an acute hospital, to elaborate patient characteristics of delirium patients based on group comparison and to test sensitivity and specifity of the applied instruments, on the other hand to get information about the practicality of the study execution. Method: Delirium point prevalence measurement has been conducted in a prospective cross-sectional study. On one determined day data of patients have been collected by nurses in an acute hospital. Results: A prevalence point rate of 14 % (6 / 43) based on CAM has been identified. Significant differences were found between the groups in respect of age, discipline, number of ICD diagnoses, care dependency and in all the three delirium instruments. Delirium patients were not only longer hospitalized but had almost twice as many ICD diagnosed, were high-maintenance patients and mostly didn’t claim to be in pain. Conclusion: This is the first prevalence study in a Swiss acute hospital. The utilized instruments are reliable and the study execution is practicable and could be conducted with a larger sample. Most known risk factors were confirmed.

New growth platform framework for Swiss acute hospitals: An empirical study for the development of dynamic capabilities

Swiss health care is confronted with fundamental changes. On the one hand, there are increasing costs in patient treatments, caused by innovative technology with new high-capacity medical devices, and a lack of effectiveness and efficiency in the organization of a hospital. On the other hand, hospitals do have decreasing revenues with the introduction of the new patient classification and tariff system DRG (Diagnosis Related Groups) by 2012. For every DRG, hospitals will receive a fixed price, separate from the actual costs of the patient treatment. In this paper it was explored the case of 13 successful Swiss private acute hospitals which are also confronted with these pressures to reduce their costs of patient treatment and therefore to optimize their processes of care. This research focuses on dynamic capabilitie of the hospitals. Although dynamic capabilities are idiosyncratic in their details and path dependent in their emergence, they have significant 'best practise' across firms (Eisenhardt and Martin, 2000). The research is started with the evaluation of new trends, key customers' needs, and capabilities, with questionnaires for attending physicians and hospital managers. The NGP approach gives hospital managers the enough crucial information for a strategy formulation in fundamental changing environments, which is the key contribution of this manuscript.