Health Services Management

This study applies Porter's model of competitive advantage to the nursing home industry. Discriminant analysis is used to identify organizational and environmental characteristics associated with nursing homes which have demonstrated valued strategic outcomes, and to distinguish the more successful nursing homes from their rivals. The results of the discriminant analysis suggest that nursing homes with superior payer mix outcomes are distinguishable from their less successful rivals in areas associated with a focused generic strategy. The study suggests that nursing homes which are better staffed, of smaller size and lower price are more likely to achieve high levels of self-pay utilization. Independent living units, continuing care retirement communities in particular, are likely to act synergistically with nursing home organizational characteristics to enhance competitive advantage by linking the value chain of the nursing home to that of retirement housing. Nursing homes with...

Hospitalists, or specialists of hospital medicine, have long been practicing in Canada and Europe. However, it was not until the mid-1990s, when hospitals in the U.S. started widespread adoption of hospitalists. Since then, the number of hospitalists has grown exponentially in the U.S. from a few hundred to over 50,000 in 2016. Prior studies on hospitalists have well documented benefits hospitals gain from adopting this innovative staffing strategy. However, there is a dearth of research documenting predictors of hospitals' adoption of hospitalists. To fill this gap, this longitudinal study (2003-2015) purposes to determine organizational and market characteristics of U.S. hospitals that utilize hospitalists. Our findings indicate that private not-for-profit, system affiliated, teaching, and urban hospitals, and those located in higher per capita income markets have a higher probability of utilizing hospitalists. Additionally, large or medium, profitable hospitals, and those that treat sicker patients have a higher probability of adoption. Finally, hospitals with a high proportion of Medicaid patients have a lower probability of utilizing hospitalists. Our results suggest that hospitals with greater slack resources and those located in munificent counties are more likely to use hospitalists, while their under-resourced counterparts may experience more barriers in adopting this innovative staffing strategy.

Although healthcare managers make increasingly difficult decisions about health innovations, the way they may interact with innovators to foster health system sustainability remains underexplored. Drawing on the Responsible Innovation in Health (RIH) framework, this paper analyses interviews ( n=37) with Canadian and Brazilian innovators to identify: how they operationalize inclusive design processes; what influences the responsiveness of their innovation to system-level challenges; and how they consider the level and intensity of care required by their innovation. Our qualitative findings indicate that innovators seek to: 1) engage stakeholders at an early ideation stage through context-specific methods combining both formal and informal strategies; 2) address specific system-level benefits but often struggle with the positioning of their solution within the health system; and 3) mitigate staff shortages in specialized care, increase general practitioners’ capacity or patients and ...

In tune with much international practice, the English National Health Service has been striving to transform health care provision to make it more affordable in the face of rising demand. At the heart of a set of recent radical reforms has been the launch of ‘clinical commissioning’ using the vehicle of local groups of General Practitioners (GPs). This devolves a large portion of the total healthcare budget to these groups. National government policy statements make clear that the expectation is that the groups will ‘transform’ the organisation and provision of health services. In this article, we draw upon interviews, observations and analysis of internal documents to make an assessment of the extent to which clinical leaders have seized the opportunity presented by the creation of these groups to attempt transformative service redesign.

"O presente é o espaço fugaz entre o não mais e o não ainda". (ARENDT, 2010) Para aqueles que precisam de "mapas" para andar, ofereço um guia: Estas páginas que se seguem devem ser lidas por aqueles que conseguem ler e ouvir histórias sem se preocupar em saber de onde elas vieram ou sobre quem estão falando ou, ainda, em que autores se referenciam para dizer o que dizem aqueles que escrevem. Se, com este alerta, a leitura se seguir, então será possível o conhecimento sobre as andanças de Gouche, apresentadas ao então residente especializando de pedagogia na área da saúde mental coletiva e sua preceptora 1 de núcleo durante a Residência Integrada Multiprofissional em Saúde Mental Coletiva. Este texto é o trabalho de conclusão de um programa de especilalização que se realiza em serviço, sob a modalidade de formação especializada em área profissional da saúde, como previsto pela Lei Federal nº 11.129, de 2005. Este texto foi escrito para exercer três funções básicas, a saber: Dar conta de um texto exigência para completar a formação em Saúde Mental Coletiva; escrever um texto que versasse sobre algum tema relacionado à formação em saúde mental; e apresentar um texto que, por meio dele, pudesse conversar com "leigos", ou pessoas "desavisadas" da temática e as propostas de Saúde Coletiva, da Saúde Mental e da Saúde Mental Coletiva. Talvez o mais pre(ten)cioso desejo com a escrita deste texto esteja nessa terceira "função" que, dita de outro modo, corresponde ao desejo de divertir àqueles que o escrevem, posto que um texto é re-escrito nos olhos daqueles que o lêem. Poderia dizer "satisfazer", mas um poeta satisfeito não satisfaz, como diz Mario Quintana. Ele, o poeta, abre espaços, fendas por onde passam, espreitam ou deslizam sensações e perguntas. Então, digo divertir: Viva a incompletude, Viva a falta! Apresentarei algumas trajetórias que, como tal, não trazem "verdades" ou "falsidades", são apenas descrições e impressões sobre o que vivi. Alerto aos leitores para que não percam tempo buscando "a verdade", preocupem-se com os encontros possíveis. Entreguem-se aos encontros, como uma criança que ouve histórias. Aviso que além de algumas citações "escancaradas", existem algumas impressões, assim como documentos oficiais e autores escondidos e que, por uma "tomada de liberdade" assim permaneceram. A exemplo das liberdades, da escolha singular e das fendas, começarei esta escrita por uma carta a minha preceptora de pedagogia, nas trilhas do livro Utopia. Minha preceptora foi Aromilda Grassotti Peixoto, pedagoga, mestre e doutora em Educação, conhecida como Neca. Trarei uma das conversas com Neca para dar acesso ao meu texto ou aos desejos de minha iniciativa. Diante de um texto meu, ela me pergunta como não coloquei uma palavra sobre atenção psicossocial ou sobre o trabalho de ou em Centros de Atenção Psicossocial. Agora vou falar desse lugar, mas talvez não haja neste texto presente nenhuma marca que diga "isto aqui é ficção"; "isto aqui eu vivi"; "esta outra parte é como deve ser, segundo a _______________ 1 Preceptor de núcleo é como chamamos àquele profissional que, em situação de acompanhamento de um aprendiz da mesma prática profissional, exerce acompanhamento docente-assitencial, ensina com a propriedade de quem faz, já fez ou sabe fazer em determinado campo profissional, quando aplicado a realidade de trabalho. Este trabalho mostra o circular pela saúde mental coletiva através de encontros e narrativas de um personagem por uma cidade chamada "Equis". Narrativa esta semelhante ao proposto por Morus em seu livro "A Utopia". O autor, nesta revisão de literatura, trás também reflexões sobre redes de cuidado e convoca para o pensar sobre os Serviços Público de Saúde, sobre o cuidar e o ser cuidado no espaço da cidade e da vida. Aponta utopias, como horizontes a buscar e compartilha cenas de cotidianos possíveis.

Although mammography screening significantly reduces breast cancer mortality, women could present different morphological characteristics that do not allow the correct vision of their breasts and the detection of cancer, resulting in a delay of diagnosis and an increase in the risk of mortality. The present study aims at analyzing potential areas of improvement of the current screening programs and then hypothesizing alternative technologies to use within the diagnostic phase, from an economic point of view. A Budget Impact Analysis approach was implemented, considering the Italian National Healthcare Service perspective, and representing the healthcare expenditure evolution, over three years. In the Budget Impact Analysis model, two distinct phases of the screening programs were considered: (1) the screening/diagnosis phase and (2) the phase related to cancer care and treatments of patients. The results provide clinicians and policy makers with a rational method to forecast economic resources in the screening programs in a general context of limited resources. In particular, results of the Budget Impact Analysis showed that, while the introduction of the ABUS InveniaTM technology into the screening programs would lead to an increase in the screening phase expenditure, it would generate an economic advantage related to the patients treatment and care.

Avaliação de intervenções de Gestão da Clínica na qualificação do cuidado e na oferta de leitos em um hospital público de grande porte Evaluation of clinical governance interventions on qualification of care and supply of beds in a large public hospital

Chapters 4 to 6 give specific and useful advice, on outreach to survivors, consultation with leaders, psychological debriefing with groups, and specific therapeutic approaches to posttraumatic stress and abnormal grief. The final chapter addresses the psychological and professional needs of disaster workers -including those whose task it is to deliver the psychosocial aftercare.

Chapters 4 to 6 give specific and useful advice, on outreach to survivors, consultation with leaders, psychological debriefing with groups, and specific therapeutic approaches to posttraumatic stress and abnormal grief. The final chapter addresses the psychological and professional needs of disaster workers -including those whose task it is to deliver the psychosocial aftercare.

This paper explores the objective of increased competition and considers whether different types of competition are likely to lead to desirable market outcomes. Potential sources of market failure, and hence inefficiency, are examined. The paper then considers what type and degree of regulation may be necessary if the forces of unrestrained competition cannot be expected to achieve desirable outcomes. A number of different options, ranging from minimal regulation to central pricing schedules, are then discussed. Consideration is given to whether openness in costing and/or pricing is necessary and desirable in both short and long term. The paper raises a number of practical problems which may be faced and suggests ways in which incentives can be created to mimic the characteristics of a competitive market.

IntroductionHospital supply chains are complex systems ensuring flow of products/services to satisfy patients. The aim of this exploratory study is to improve the Maltese health care system’s efficiency using supply chain management principles in three hospital settings. The theoretical basis underlying the study is the supply chain decision-making framework.MethodsUsing observation and focus groups, the following steps were undertaken: (i) mapping healthcare supply chain processes and identifying challenges; (ii) understanding competitive strategy through implied demand uncertainty; (iii) deriving supply chain strategies through supply chain drivers; (iv) optimizing healthcare supply chain (right balance between cost and responsiveness); (v) identifying critical success factors for healthcare supply chains.ResultsIn line with their competitive and supply chain strategies, the three settings have well-defined primary goals, stakeholders’ needs/demands/expectations, as well as clear-...

Background: This article examines the usage of various theories in the perspective of health planning. Accounts of transformation initiatives often reveal little about past organisational and contextual planning conditions that contributed to success. This article aims to explain the historical usage of planning theories by aligning them to the current healthcare system. Materials and Methods: A scoping review of literature using electronic database of PubMed, ScienceDirect, Google Scholar was done with special attention given to three specified planning theory in relation to health care planning. A total of 30 articles, reports and theses were selected and analysed. The analysis and findings are presented based on three different theories that has been selected which are the rational planning model, incremental planning theory and mix scanning planning theories. Result: Rational planning model is a process of understanding the problem followed by establishing and evaluating plannin...

In order to achieve and monitor success in the NHS internal market, it is important that information related to health care objectives is developed and used. The paper argues that these objectives are not always easy to specify but that four groups can be identified: efficiency, equity, quality and accountability/responsiveness. Although information management specialists have emphasised the construction and use of appropriate frameworks for planning information flows, whether appropriate information is used depends on the existence of incentives for its supply. Using concepts from game theory, the paper offers a non-technical examination of the incentives that the contracting environment imposes on the development of new information. The article concludes by suggesting that, for a variety of reasons, the incentives to produce information which would help monitor medical outcomes and related objectives, as distinct from inputs or activities, are often weak and sometimes perverse.

The purpose of this study is to shed light on the individual socioeconomic status (SES) and demographic determinants of the demand for health care in a crosscomparison study of nine E.U. countries. It focuses on the effects of the individual employment status on alternative indicators of demand for health care that constitutes a largely unexplored area. The evidence supports the existence of an employment status-demand for health care relationship although it varies with respect to the type of health care examined and the institutional and environmental settings of the countries utilised in the study.

Instruments & Methods This cross-sectional descriptive study was conducted on 5 hospitals, including Shahid Beheshti, Shahid Rajaei, and Emam-Sajjad Yasuj hospitals, and Shahid Rajaei Hospital in Gachsaran and Emam-Khomeini Hospital in Dehdasht affiliated to Yasuj University of Medical Sciences in 2011-2018. Bed Occupancy Rate (BOR), Bed Turnover (BTR) and Average Length of Stay (ALS) were collected through hospital information system and analyzed according to Pabon Lasso model and compared with the standard levels. Findings The mean BTR (98.76 times per year), ALS (2.12 days) and BOR (70.9%) in hospitals in 2011-2018 were favorable. ALS was 15.24 days in Shahid Rajaei hospital in Yasuj. Shahid Beheshti hospital was in zone 3 in all years. Emam-Sajjad hospital was in zone 3 in all years except 2014.

The diffusion of the Web 2.0 has made it possible for patients to exchange on online health communities, defined as computer-mediated communities dedicated to health topics, wherein members can build relationships with other members. It is now acknowledged that online health communities provide users not only with medical information but also with social support with no time or geographical boundaries. However, in spite of their considerable interest, there is still a paucity of research as to how online health communities alter the patient-physician relationship. This research aims at filling this gap and examines how online health communities, while providing users with computer-mediated social support and empowerment, impact the patient-physician relationship. Six hypotheses are proposed and tested. A survey was developed and 328 responses were collected from online patient groups in Canada in 2016. The data were analysed using structural equation modelling. All but one hypothesis are validated. The results show that user computer-mediated social support positively influences user empowerment and participation during the consultation, which in turn determines user commitment to the relationship with the physician. Importantly and contrary to our expectations, user empowerment is found to be significantly but negatively related to user commitment with the physician.

Many healthcare scholars have applied institutional theories to the study of management accounting systems (MAS) change. However, little attention has been devoted to MAS change within groups. Kostova et al. highlight the limitations of traditional institutional frameworks in studying groups since they are characterised not only by the existence of external institutional environments but also by intra-organisational (meso-level) ones. Given this background, the research question is: how does the meso-level institutional environment affect MAS change in healthcare groups? We use a longitudinal multiple-case study design to understand the role of headquarters in shaping local MAS change. We would expect companies to adopt similar MAS. However, we argue that the relationship between external institutions and MAS change cannot be wholly understood without taking into consideration the role of headquarters. Our analysis shows how hospitals facing the same external institutional environment implement different MAS as a consequence of different parenting styles. From a scientific perspective, our article contributes to broaden traditional institutional theoretical frameworks.

Many healthcare scholars have applied institutional theories to the study of management accounting systems (MAS) change. However, little attention has been devoted to MAS change within groups. Kostova et al. highlight the limitations of traditional institutional frameworks in studying groups since they are characterised not only by the existence of external institutional environments but also by intra-organisational (meso-level) ones. Given this background, the research question is: how does the meso-level institutional environment affect MAS change in healthcare groups? We use a longitudinal multiple-case study design to understand the role of headquarters in shaping local MAS change. We would expect companies to adopt similar MAS. However, we argue that the relationship between external institutions and MAS change cannot be wholly understood without taking into consideration the role of headquarters. Our analysis shows how hospitals facing the same external institutional environme...

In recent years in Italy, as in other European countries, profound changes have been introduced in health care both at central and regional levels. Most of them were oriented towards a shift from 'hospital-centred' health care to health care based more on primary care services. This transition pursues two objectives: giving more effective responses to citizens' needs and reducing public health expenditure. Changes that involve organizational structure must also be carried out with the introduction of measurement tools that can help in planning and can control the changes. The paper provides the results obtained through the experience of modelling a measurement system for primary care carried out in 2004 and 2005 by some territorial managers and controllers in the Tuscan Health system, and the main issues in measuring primary care services emerging from this pilot experience focused on integrated home care services.

In recent years in Italy, as in other European countries, profound changes have been introduced in health care both at central and regional levels. Most of them were oriented towards a shift from ‘hospital-centred’ health care to health care based more on primary care services. This transition pursues two objectives: giving more effective responses to citizens' needs and reducing public health expenditure. Changes that involve organizational structure must also be carried out with the introduction of measurement tools that can help in planning and can control the changes. The paper provides the results obtained through the experience of modelling a measurement system for primary care carried out in 2004 and 2005 by some territorial managers and controllers in the Tuscan Health system, and the main issues in measuring primary care services emerging from this pilot experience focused on integrated home care services.

In order to improve the quality and efficiency of hospitals, they can be viewed as a logistical system in which integration is a critical factor for performance. This paper describes the results of a scoping study that identifies the logistical parameters mentioned in international research on hospitals and indicates whether literature reflects system integration. When subsystems collaborate in order to accomplish the task of the entire organization, there is integration. A total number of 106 logistical parameters are identified in our study. In addition, the flow type-patients, materials and staff-and hospital subsystems were registered. The results presented in international literature show that logistics is highly fragmented in hospitals. Studies also show integration, although this takes place mainly within the subsystems of hospitals. A multi-agent perspective on hospitals is proposed, following the view that both integration and differentiation are essential for effective organizational performance. Given the widely recognised importance of controlling hospital costs and the potential of logistics to help in this process, it is important to gain more knowledge of hospitals as network organizations, as well as knowledge regarding the degree of integration and the logistical parameters that are required for better hospital performance.

This study comprehensively evaluated the links between systems of High Performance Work Practices and firm performance. Results based on a national sample of nearly one thousand firms indicate that these practices have an economically and statistically significant impact on both intermediate employee outcomes (turnover and productivity) and short-and long-term measures of corporate financial performance. Support for predictions that the impact of High Performance Work Practices on firm performance is in part contingent on their interrelationships and links with competitive strategy was limited. The impact of human resource management (HRM) policies and practices on firm performance is an important topic in the fields of human resource management, industrial relations, and industrial and organizational psychology (Boudreau, 1991; Jones & Wright, 1992; Kleiner, 1990). An increasing body of work contains the argument that the use of High Performance Work Practices, including comprehensive employee recruitment and selection procedures, incentive compensation and performance management systems, and extensive employee involvement and training, can improve the knowledge, skills, and abilities of a firm's current and potential employees, increase their motivation, reduce shirking, and enhance retention of quality employees while encouraging nonperformers to leave the firm (Jones & Wright, 1992; U.S. Department of Labor, 1993). I am very grateful to Brian Becker for his many helpful comments on this article and for his direction and guidance on the dissertation on which it is based. I would also like to thank

The application of the repertory grid technique made it possible to capture the mental categorization by which maternity care services are judged. Conceptualization of the expectation standard, defined as estimates of anticipated performance, led to the identification of 14 attributes. These include: reliability, responsiveness, competence, access, courtesy, communication, credibility, security, relationship, tangibles, control, cost, naturalness and quality. The definitions made use of the prospective consumer's own verbal labels. In addition, it was found that maternity care services were not perceived as one continuous process. Three distinct categorizations were identified, that is: before, during, and after the birth of the baby. This suggests that prospective consumers employ the service quality attributes, according to one of the above.

This study comprehensively evaluated the links between systems of High Performance Work Practices and firm performance. Results based on a national sample of nearly one thousand firms indicate that these practices have an economically and statistically significant impact on both intermediate employee outcomes (turnover and productivity) and short-and long-term measures of corporate financial performance. Support for predictions that the impact of High Performance Work Practices on firm performance is in part contingent on their interrelationships and links with competitive strategy was limited. The impact of human resource management (HRM) policies and practices on firm performance is an important topic in the fields of human resource management, industrial relations, and industrial and organizational psychology (Boudreau, 1991; Jones & Wright, 1992; Kleiner, 1990). An increasing body of work contains the argument that the use of High Performance Work Practices, including comprehensive employee recruitment and selection procedures, incentive compensation and performance management systems, and extensive employee involvement and training, can improve the knowledge, skills, and abilities of a firm's current and potential employees, increase their motivation, reduce shirking, and enhance retention of quality employees while encouraging nonperformers to leave the firm (Jones & Wright, 1992; U.S. Department of Labor, 1993). I am very grateful to Brian Becker for his many helpful comments on this article and for his direction and guidance on the dissertation on which it is based. I would also like to thank

The purpose of this paper is to study the relationship between rewards, and performance of Health Centre IV workers in greater Mbarara District. The constructs of rewards include; salary, performance bonus, recognition and promotion. This study used cross-sectional, explanatory and correlational approaches. Health center IV workers data were collected by means of a questionnaire survey from a sample of 200 health workers from 11 health centres from greater Mbarara district. Structural equation modelling was used to test the hypotheses. Results show that rewards significantly affect health workers' performances. Therefore, once health centres IV have appropriate reward strategies for their health workers in health facilities, they are likely to work hard by meeting deadlines, being available at their work station and they would eventually enhance on job performance. It is further recommended that all health policy makers and implementators at both Ministry of health and central government should always emphasize the general wellbeing of all health workers in every health facility.

The Implementation of National Health Insurance (NHI) has been started in Indonesia since 2014. BPJS Health has been appointed as the organizer of NHI and First-rate Health Facilities as the implementers of NHI. In its implementation, FRHF will obtain direct payment from BPJS which will be paid in advance without taking into account the type and amount of health services provided known as NHI capitation fund. The utilisation and management of NHI capitation funds by FRHF municipal government of Kotamobagu in its implementation encountered several obstacles that impact on health services. The purpose of this research is to analyze the implementation process of utilization and financial management of NHI capitation fund by FRHF municipality and to analyse any constraints encountered in the implementation of utilisation and management of NHI capitation fund by FRHF Kotamobagu. This research is a qualitative exploratory study. The object of this research was the local government of Kotamobagu and its BPJS Health office. Data were obtained through indepth interviews, observations, and documentation studies. The informants were selected purposively in order to obtain the correct and accurate information. Interviews were conducted using semi-structured in-depth interviews. The triangulation method was used in testing the validity or credibility of data or sources. Transcribed data from interview result was analyzed by using the content analysis method and then giving themes/coding and finally by conceptualisation. The results of the interpretation are summarised in the narrative text. The result of the research shows that the process of implementation and administration of financial utilisation of NHI capitation fund by FRHF in Kotamobagu has been implemented in accordance with regulation/guidance.

Avaliação de intervenções de Gestão da Clínica na qualificação do cuidado e na oferta de leitos em um hospital público de grande porte Evaluation of clinical governance interventions on qualification of care and supply of beds in a large public hospital

Objective: To identify in the existing literature, publications that address the theme of management actions of nurses in the emergency room. Method: An exploratory study of literature with a qualitative approach, where journals were uncovered relevant to research in the years 2000 to 2007. These were shown through the Virtual Health Library (VHL) in the SciELO database. Results: 2321 products were found, and 15 publications were selected that met the research criteria. Results: Three categories emerged: management theories in nursing work, nursing management, and management and organization of nursing care in the emergency room. Conclusion: Nurses must constantly seek out actions that help management, creating opportunity for qualified assistance, identifying data and aspects relating to that industry and users. Adopting a reflection on the social and organizational context, in which it is immersed, leads to the possibility of becoming critical. To this end, the need to invest in training is highlighted, in continuing education, in order to facilitate interpretations of crystallized positions in daily life.

The application of the repertory grid technique made it possible to capture the mental categorization by which maternity care services are judged. Conceptualization of the expectation standard, defined as estimates of anticipated performance, led to the identification of 14 attributes. These include: reliability, responsiveness, competence, access, courtesy, communication, credibility, security, relationship, tangibles, control, cost, naturalness and quality. The definitions made use of the prospective consumer's own verbal labels. In addition, it was found that maternity care services were not perceived as one continuous process. Three distinct categorizations were identified, that is: before, during, and after the birth of the baby. This suggests that prospective consumers employ the service quality attributes, according to one of the above.

This article presents the results of a study on the introduction of sessional fees remuneration for physicians working in Quebec long-term care hospitals. More generally, this research was concerned with the determinants of the capacity of an organization to implement an innovation. Both a political and a structural model of analysis were empirically probed. We found strong support for the political model and moderate support for the structural model. This article contributes to the understanding of the relative contribution of structural and political determinants in the implementation of changes in organizations.

Resumo A partir de etnografia realizada com equipe de Consultório na Rua da cidade do Rio de Janeiro em seus encontros com pessoas em cenas de uso de crack, apresentam-se: seu modo de funcionamento por meio de princípios; as consequências desse modo sobre as pessoas que busca atender; e outros saberes acerca do crack que emergem a partir desse encontro entre um serviço de saúde e usuários de tal substância. Conclui-se que o Consultório na Rua instaura aberturas para que aquelas pessoas que se tornam suas usuárias o transformem, fazendo-o acolher vidas cada vez mais heterogêneas. Dessa forma, torna-se capaz de ampliar o acesso ao Sistema Único de Saúde, calcando um caminho para que este seja cada vez mais permeável às diferenças.

The relationship between the volume of work undertaken in a hospital and the outcome of care has assumed increasing importance in recent years. A review of the literature reveals that most studies have been carried out in the USA and have largely been confined to six specific areas of health care. There is evidence that better outcomes are obtained at higher volumes for several surgical operations, cardiac catheterisation and care of the severely injured. As yet there is no clear association for coronary, neo-natal and burn care. There are two competing hypotheses to explain any association — ‘practice-makes-perfect’ and ‘selective referral’. These are discussed and implications for the future provision of hospital services considered.

  Background: Hospitals need a system for evaluating and monitoring performance for promotion the efficiency and effectiveness of their services and outcomes. Pabon Lasso model is a graphical chart that can be used to identify the current status and performance level of hospitals by combining hospital indicators, simultaneously.  Therefore, this study aimed to evaluate the performance of Hormozgan University of Medical Sciences (HUMS) hospitals during a six-year period using this model. Methods: This descriptive study includes all teaching and non-teaching hospitals affiliated with the HUMS. After gathering the required information related to three indices: Bed Occupancy Rate, Bed Turnover Rate and Average Length of Stay for the years 2009 to 2014 from the statistical systems and yearbooks, the situation of hospitals in terms of indices by drawing Pabon Lasso graphical charts using SPSS version 16, were analyzed. Results: The results showed that during a six-year period, on average,...

IntroductionTargeted, tailored interventions to test high-risk individuals for HIV and hepatitis C virus (HCV) are vital to achieving HIV control and HCV microelimination in Africa. Compared with the general population, people who inject drugs (PWID) are at increased risk of HIV and HCV and are less likely to be tested or successfully treated. Assisted partner services (APS) increases HIV testing among partners of people living with HIV and improves case finding and linkage to care. We describe a study in Kenya examining whether APS can be adapted to find, test and link to HIV care the partners of HIV-positive PWID using a network of community-embedded peer educators (PEs). Our study also identifies HCV-positive partners and uses phylogenetic analysis to determine risk factors for onward transmission of both viruses.MethodsThis prospective cohort study leverages a network of PEs to identify 1000 HIV-positive PWID for enrolment as index participants. Each index completes a questionna...

GUIDELINE /SAJCC Background. In South Africa (SA), intensive care is faced with the challenge of resource scarcity as well as an increasing demand for intensive care unit (ICU) services. ICU services are expensive, and practitioners in low-to middle-income countries experience daily the consequences of limited resources. Critically limited resources necessitate that rationing and triage (prioritisation) decisions are frequently necessary in SA, particularly in the publicly funded health sector. Purpose. The purpose of this consensus statement is to examine key questions that arise when considering the status of ICU resources in SA, and more specifically ICU admission, rationing and triage decisions. The accompanying guideline in this issue is intended to guide frontline triage policy and ensure the best utilisation of intensive care in SA, while maintaining a fair distribution of available resources. Fair and efficient triage is important to ensure the ongoing provision of high-quality care to adult patients referred for intensive care. Recommendations. In response to 14 key questions developed using a modified Delphi technique, 29 recommendations were formulated and graded using an adapted GRADE score. The 14 key questions addressed the status of the provision of ICU services in SA, the degree of resource restriction, the efficiency of resource management, the need for triage, and how triage could be most justly implemented. Important recommendations included the need to formally recognise and accurately quantify the provision of ICU services in SA by national audit; actively seek additional resources from governmental bodies; consider methods to maximise the efficiency of ICU care; evaluate lower level of care alternatives; develop a triage guideline to assist policy-makers and frontline practitioners to implement triage decisions in an efficient and fair way; measure and audit the consequence of triage; and promote research to improve the accuracy and consistency of triage decisions. The consensus document and guideline should be reviewed and revised appropriately within 5 years. Conclusion. In recognition of the absolute need to limit patient access to ICU because of the lack of sufficient intensive care resources in public hospitals, recommendations and a guideline have been developed to guide policy-making and assist frontline triage decision-making in SA. These documents are not a complete plan for quality practice but rather the beginning of a long-term initiative to engage clinicians, the public and administrators in appropriate triage decision-making, and promote systems that will ultimately maximise the efficient and fair use of available ICU resources.

Background Absence of better financing mechanism results in higher out of pocket expenditure and catastrophe, which leads to impoverishment and poverty especially among low- and middle-income countries like India. This paper examines the major characteristics associated with the higher out of pocket expenditure and provides an insight from Andersen’s behavioural model that how predisposing, enabling and need factors influence the level and pattern of out of pocket expenditure in India. Methods Data has been extracted from three rounds of nationally representative consumer expenditure surveys, i.e. 1993–1994, 2004–2005 and 2011–2012 conducted by the Government of India. States were categorized based on regional classification, and adult equivalent scale was used to adjust the household size. Multiple Generalized-Linear-Regression-Model was employed to explore the relative effect of various socio-economic covariates on the level of out of pocket expenditure. Results The gap has widene...

Health is an important component for achieving physical peace and happiness of an individual. The present study has focused on the health status of women by considering the maternal mortality rates as an indicator in selected district of Assam. Purposive sampling technique has been used to select the desired sample population. This study is based on both primary and secondary sources. The predetermined objective of the study has been fulfilled by using descriptive statistical tools and techniques. We have observed that besides the health related factors some social occurrences like religious belief, economic conditions, food habits, social customs, early motherhood, effective marriage age, educational attainment of pregnant women are accountable for the growing maternal deaths.

Transitional care management (TCM) is a novel strategy for reducing costs and improving clinical outcomes after hospitalization but remains under-utilized. An economic analysis was performed on a hospital-based transition of care clinic (TCC) open to all patients regardless of payor status. TCC reduced re-hospitalization and emergency department (ED) utilization at six-month follow up. A cost-consequence analysis based on real world data found the TCC intervention to be cost effective relative to usual care. Hospital managers should consider adoption of TCC to improve patient care and reduce costs.

Background: Public health center financing has increasedsince the implementation of JKN. The operational budget whichis managed by public health center is so different after theimplementation of National Health Insurance, the increasing isvery drastic. On the other hand, the local government budgetfunds is decreasing and the portion is smaller than before. Objective: To describe the financial management of publichealth center before and after the implementation of nationalhealth insurance in Banyuwangi district. Methods: The study was a descriptive case study with usequalitative data and quantitative data. Informants in this studywere 36 persons consist of 6 persons from the district healthdepartment, 3 persons from other cross sectors, and 27 personsfrom the public health centers. Those samples were taken bypurposive sampling technique. Results: There were several things that distinguish thefinancing management of public health center after theimplementation of JKN. They were the c...

The study evaluates the meaning of comfort and explores factors that enhance it from the perspective of patients who received treatment at private healthcare facilities in Cross River State, Nigeria. The evaluation is focused on patients, patients' family members, and providers. The Delphi method was used with 15 participants: three providers, four family members, and seven patients. Data was collected within one week with two focus group meetings at a private medical facility. Content and descriptive analysis were used for the analysis of qualitative data. The instrument used for the two sessions of the focus group meetings was open questions, which were based on items to be evaluated by the participants. after the sessions, items in which consensus was obtained were again presented to participants so that participants could have enough time to re-evaluate what they said and their understanding. This promoted feedback. Content and thematic analysis produced seven categories: Meaning of comfort, Presence of family members, Communication on disease management Affordable cost of care, Staff behaviour towards patients, Privacy and confidentiality and Reduced treatment time in hospital The patients' treatment journey in private healthcare facilities in Cross River State can be enhanced if the management of healthcare facilities improves on not only environmental factors in the hospitals but also psychosocial components of care such as appropriate communication, provision of information to patients, privacy, reduce noise, caring staff physical behaviours towards patients, affordable cost of care and inclusion of family members in the care equation.

Kapitasi Berbasis Pemenuhan Komitmen Pelayanan (KBPKP) adalah penyesuaian besaran tarif kapitasi berdasarkan hasil penilaian pencapaian indikator pelayanan kesehatan perseorangan yang disepakati berupa komitmen pelayanan Fasilitas Kesehatan Tingkat Pertama (FKTP) dalam rangka meningkatkanefisiensi dan efektifitas penyelenggaraan pelayanan kesehatan di FKTP. Pencapaian target indikator Kapitasi Berbasis Pemenuhan Komitmen Pelayanan (KBPKP) di Puskesmas Rumbai  Pekanbaru belum memuaskan. Sepanjang tahun 2019 pencapaian indikator KBPKP sebahagian besar berada pada kondisi tidak aman dengan rentang pembayaran kapitasi berkisar 90% - 95%. Tujuan penelitian untuk menganalisis upaya pencapaian indikator Kapitasi Berbasis Pemenuhan Komitmen Pelayanan (KBPKP) Di Puskesmas Rumbai Kota Pekanbaru Tahun 2019. Cara pemelihan  informan menggunakan snowball sampling Kriteria informan yang dipilih dalam penelitian ini berdasarkan ketersediaan untuk diwawancarai, mengetahui  permasalahan dengan jelas...

In the mental health field, the creation of networks that can guarantee the smooth coordination of services and organizations across sectors is a priority in the policy agenda of several countries. In Italy, Departments of Mental Health (DMHs) have been designated responsible for the system of specialist mental health services, and also mandated as the conveners and leaders of interorganizational and cross-sectoral networks, by a system-wide reform. This study aims to understand how mental health networks have been assembled in this context and the factors and motivations that have shaped their scope. By combining an analysis of policies with a survey of DMH directors, we have determined that DMHs have preferentially formed collaborative relationships with social service providers (local governments) and the voluntary sector. In contrast, relationships with substance abuse and addiction services and primary care providers were weak and stifled by a lack of trust and by conflict abou...

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We here argue that study of governance systems within increasingly pluralist health care systems needs to be broadened beyond traditionally public sector orientated literature. We develop an initial typology of multiple governance systems within the English health care sector and derive exploratory questions to inform future empirical investigation. We add to existing literature by considering the coexistence of - and possible tensions between - multiple governance systems in a pluralised health and social care system.

This article presents the results of a study on the introduction of sessional fees remuneration for physicians working in Quebec long-term care hospitals. More generally, this research was concerned with the determinants of the capacity of an organization to implement an innovation. Both a political and a structural model of analysis were empirically probed. We found strong support for the political model and moderate support for the structural model. This article contributes to the understanding of the relative contribution of structural and political determinants in the implementation of changes in organizations.

In tune with much international practice, the English National Health Service has been striving to transform health care provision to make it more affordable in the face of rising demand. At the heart of a set of recent radical reforms has been the launch of ‘clinical commissioning’ using the vehicle of local groups of General Practitioners (GPs). This devolves a large portion of the total healthcare budget to these groups. National government policy statements make clear that the expectation is that the groups will ‘transform’ the organisation and provision of health services. In this article, we draw upon interviews, observations and analysis of internal documents to make an assessment of the extent to which clinical leaders have seized the opportunity presented by the creation of these groups to attempt transformative service redesign.