1
|
Khatri RB, Durham J, Assefa Y. Investigation of technical quality of antenatal and perinatal services in a nationally representative sample of health facilities in Nepal. Arch Public Health 2022; 80:162. [PMID: 35787734 PMCID: PMC9252055 DOI: 10.1186/s13690-022-00917-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Access to routine antenatal and perinatal services is improved in the last two decades in Nepal. However, gaps remain in coverage and quality of care delivered from the health facilities. This study investigated the delivery of technical quality antenatal and perinatal services from health facilities and their associated determinants in Nepal.
Methods
Data for this study were derived from the Nepal Health Facility Survey 2015. The World Health Organization's Service Availability and Readiness Assessment framework was adopted to assess the technical quality of antenatal and perinatal services of health facilities. Outcome variables included technical quality scores of i) 269 facilities providing antenatal services and ii) 109 facilities providing childbirth and postnatal care services (perinatal care). Technical quality scores of health facilities were estimated adapting recommended antenatal and perinatal interventions. Independent variables included locations and types of health facilities and their management functions (e.g., supervision). We conducted a linear regression analysis to identify the determinants of better technical quality of health services in health facilities. Beta coefficients were exponentiated into odds ratios (ORs) and reported with 95% confidence intervals (CIs). The significance level was set at p-value < 0.05.
Results
The mean score of the technical quality of health facilities for each outcome variable (antenatal and perinatal services) was 0.55 (out of 1.00). Compared to province one, facilities of Madhesh province had 4% lower odds (adjusted OR = 0.96; 95%CI: 0.92, 0.99) of providing better quality antenatal services, while health facilities of Gandaki province had higher odds of providing better quality antenatal services (aOR = 1.05; 95% CI: 1.01, 1.10). Private facilities had higher odds (aOR = 1.13; 95% CI: 1.03, 1.23) of providing better quality perinatal services compared to public facilities.
Conclusions
Private facilities provide better quality antenatal and perinatal health services than public facilities, while health facilities of Madhesh province provide poor quality perinatal services. Health system needs to implement tailored strategies, including recruiting health workers, supervision and onsite coaching and access to necessary equipment and medicine in the facilities of Madhesh province. Health system inputs (trained human resources, equipment and supplies) are needed in the public facilities. Extending the safe delivery incentive programme to the privately managed facilities could also improve access to better quality health services in Nepal.
Collapse
|
2
|
Hargroves D, Lowe D, Wood M, Ray S. Networks for future healthcare. Future Healthc J 2022; 9:118-124. [DOI: 10.7861/fhj.2022-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
3
|
Crooks K, Tully B, Allan L, Gillham K, Durrheim D, Wiggers J. Development and implementation of a shared governance model in a mainstream health unit: a case study of embedding Aboriginal voices in organisational decision making. AUST HEALTH REV 2022; 46:178-184. [PMID: 34937653 DOI: 10.1071/ah20369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 07/27/2021] [Indexed: 11/23/2022]
Abstract
This case study focuses on the development and implementation of a governance structure and processes by a mainstream health unit that valued the principles of Aboriginal self-determination, empowerment and leadership by Aboriginal staff in organisational and service delivery decisions and elevated Aboriginal voices by embedding cultural inclusion in such decision making. Various models of embedding Aboriginal voices in the governance of the unit were developed and implemented over time. Ongoing review and reflection identified limitations and opportunities for improving the embedding of Aboriginal voices in organisational decision making. In 2017, Aboriginal staff and senior management implemented a joint governance model for providing strategic leadership of the unit with the objective of enhancing the delivery of culturally appropriate population health services for the benefit of Aboriginal communities. In its 3 years of operation to date, the model has provided strategic oversight of the organisation, implemented several strategic initiatives, including a cultural assessment process, maintaining and strengthening Aboriginal recruitment, monitoring employment vacancies, establishing a wellbeing leadership group, monitoring budget allocation and developing an Aboriginal data management protocol, and has provided additional professional development opportunities for Aboriginal staff. This case study demonstrates the feasibility, importance and benefits of engaging and embedding Aboriginal voices in the governance of a mainstream health service delivery unit, as well as the need for ongoing reflection and improvement. Further translation of the model to the operational levels of the unit is required. The governance model has the potential to be replicated in a tailored manner in other mainstream health units and organisations delivering services to Aboriginal peoples and communities. What is known about the topic? Aboriginal people continue to experience the poorest health outcomes of any population group in Australia. Closing the gap in Aboriginal health requires Aboriginal people to be active and equal participants in all levels of decision making. Governance of mainstream health organisations is predominantly positioned in the Western medical positivist paradigm, which fails to embed Aboriginal voices in organisational and service delivery decision making. What does this paper add? This case study describes the processes taken and the outcomes achieved thus far by a mainstream health service delivery unit developing and implementing a governance model that embedded Aboriginal perspectives in its decision making. It highlights that through commitment and persistence, as well as acknowledging the challenges of working between two worlds, it is possible to reconstruct existing governance models, allowing respectful and meaningful space for Aboriginal people to co-design and co-share the governance of health service delivery. This case study demonstrates the potential of the cultural governance model to be replicated and applied to other mainstream health service delivery units. What are the implications for practitioners? This case study highlights the need for health services to invest in employing and empowering Aboriginal people to co-develop and co-lead a shared approach to organisational governance through processes that are culturally safe, inclusive and appropriate.
Collapse
Affiliation(s)
- K Crooks
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
| | - B Tully
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
| | - L Allan
- Office of the Secretary, NSW Department of Education, Tamworth, NSW, Australia
| | - K Gillham
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
| | - D Durrheim
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
| | - J Wiggers
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
| |
Collapse
|
4
|
Brouwers J, Cox B, Van Wilder A, Claessens F, Bruyneel L, De Ridder D, Eeckloo K, Vanhaecht K. The future of hospital quality of care policy: A multi-stakeholder discrete choice experiment in Flanders, Belgium. Health Policy 2021; 125:1565-1573. [PMID: 34689980 DOI: 10.1016/j.healthpol.2021.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/04/2021] [Accepted: 10/10/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Collaboration between policymakers, patients and healthcare workers in hospital quality of care policy setting can improve the integration of new initiatives. The aim of this study was to quantify preferences for various characteristics of a future quality policy in a broad group of stakeholders. MATERIALS AND METHODS 450 policymakers, clinicians, nurses, patient representatives and hospital board members in Flanders (Belgium) participated in five discrete choice experiments (DCE) on quality control, quality improvement, inspection, patient incidents and transparency. For each DCE, various attributes and levels were defined from a literature review and interviews with 12 international quality and patient safety experts. RESULTS For the attributes with the highest relative importance, participants exhibited a strong preference for quality control by an independent national organization and coordination of quality improvement initiatives at the level of hospital networks. The individual hospital was chosen over the government for setting up an action plan following patient complaints. Respondents also strongly preferred mandatory reporting of severe patient incidents and transparency by publicly reporting quality indicators at the hospital level. CONCLUSIONS A future quality model should focus on a multicomponent approach with external quality control, improvement actions on hospital network level and public transparency. DCEs provide an opportunity to incorporate the attitudes and views for individual components of a new policy recommendation.
Collapse
Affiliation(s)
- Jonas Brouwers
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Orthopaedics, University Hospitals Leuven, Belgium.
| | - Bianca Cox
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Astrid Van Wilder
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Fien Claessens
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Quality Improvement, University Hospitals Leuven, Belgium
| | - Kristof Eeckloo
- Department of Primary Care and Public Health, Ghent University, Belgium; Strategic Policy Unit, Ghent University Hospital, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Belgium; Department of Quality Improvement, University Hospitals Leuven, Belgium
| |
Collapse
|
5
|
Gur A. Customer trust and perceived service quality in the healthcare sector: Customer aggressive behaviour as a mediator. JOURNAL OF TRUST RESEARCH 2021. [DOI: 10.1080/21515581.2021.1927063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Amit Gur
- The Max Stern Yezreel Valley College, Health Care Systems Management, The Max Stern Academic College of Yezreel Valley
| |
Collapse
|
6
|
Alemu W, Girma E, Mulugeta T. Patient awareness and role in attaining healthcare quality: A qualitative, exploratory study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
7
|
Tweed J, Wallace LM. Guardians of public interest: the expectation and experience of non-executive directors in National Health Service commissioning boards in England. J Health Organ Manag 2020; ahead-of-print. [PMID: 33150780 DOI: 10.1108/jhom-10-2019-0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of the study is to examine how Non-Executive Directors (NEDs) in the English National Health Service (NHS) commissioning bodies experienced their role and contribution to governance. DESIGN/METHODOLOGY/APPROACH Semi-structured interviews were conducted with a purposive sample of 31 NEDs of Primary Care Trusts (PCTs) and 8 Clinical Commissioning Group (CCG) NEDs. Framework analysis was applied using a conceptualisation of governance developed by Newman, which has four models of governance: the hierarchy, self-governance, open systems and rational goal model. FINDINGS NEDs saw themselves as guardians of the public interest. NEDs' power is a product of the explicit levers set out in the constitution of the board, but also how they choose to use their knowledge and expertise to influence decisions for, as they see it, the public good. They contribute to governance by holding to account executive and professional colleagues, acting largely within the rational goal model. CCG NEDs felt less powerful than in those in PCTs, operating largely in conformance and representational roles, even though government policy appears to be moving towards a more networked, open systems model. ORIGINALITY/VALUE This is the first in-depth study of NEDs in English NHS local commissioning bodies. It is of value in helping to inform how the NED role could be enhanced to make a wider contribution to healthcare leadership as new systems are established in the UK and beyond.
Collapse
Affiliation(s)
- Joy Tweed
- University of Westminster, London, UK
| | | |
Collapse
|
8
|
De Regge M, Eeckloo K. Balancing hospital governance: A systematic review of 15 years of empirical research. Soc Sci Med 2020; 262:113252. [PMID: 32771874 DOI: 10.1016/j.socscimed.2020.113252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/24/2020] [Accepted: 07/22/2020] [Indexed: 01/23/2023]
Abstract
It is crucial that we gain a deeper understanding of the features of organizational governance and how they contribute to hospital performance. Health care governance research has traditionally had a strong focus on the size and composition (i.e., the attributes) of the governing bodies, but less attention has been given to the dynamics, processes, and roles. Furthermore, evidence regarding the interconnection between the board and the executive management is lacking. This systematic literature review is thus intended to give a detailed summary of the attributes, the dynamics, and the processes, as well as the roles of governing bodies, by synthesizing the findings of published empirical studies. The framework of Kane et al. (2009) was used to position the results, taking into account external constraints and outputs/performance. Sixty-three studies were included in the systematic review. The majority of these studies deal with attributes (n = 34) and roles (n = 27); the smallest number of studies (n = 11) focus on dynamics and processes. There is a lack of consistency in the research findings on attributes and there is too little research into the dynamics and processes of hospital governance. However, it has been shown that clinical participation on the hospital board and the focus on quality in hospital board roles can have a beneficial effect. The studies do not provide sufficient direction on what best practice for governing hospitals should be. For this reason, we here provide a useful framework for understanding the aspects of governance and their impact on performance in hospitals and compare these with general corporate governance literature. Therefrom we propose avenues for further research.
Collapse
Affiliation(s)
- Melissa De Regge
- Strategic Policy Cell, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Department of Marketing, Innovation and Organisation, Faculty of Economics and Business Administration, Ghent University, Tweekerkenstraat 2, 9000, Ghent, Belgium.
| | - Kristof Eeckloo
- Strategic Policy Cell, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Corneel heymanslaan 10, 9000, Ghent, Belgium.
| |
Collapse
|
9
|
Casha A, Casha R, Azzopardi Muscat N. Moving health professionals as an alternative to moving patients: The contribution of overseas visiting medical specialists to the health system in Malta. Health Policy 2020; 124:519-524. [PMID: 32265059 DOI: 10.1016/j.healthpol.2020.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
Cross-border healthcare has become a major policy issue in the past years across the European Union. Professional mobility, as a means of providing specialised health services has not been given sufficient attention in both the research and policy agendas. This paper presents a case study of the contribution made by visiting overseas medical specialists to the health system in Malta. Twenty-five semi-structured interviews were conducted. A grounded theory approach was utilised in view of the limited amount of literature available on the subject. Qualitative content analysis revealed one superordinate theme, being the value of the service, and three further subthemes, which include the quality of the service provided, its longevity and durability, as well as the critical contributions of expatriates. The service is an integral component of the local health service. This study makes an important contribution to the literature on cross-border healthcare. Lessons learnt may be transferable to other small island states and territories. The European Reference Networks being developed at EU level may need to focus more on the benefits that can accrue through short term professional mobility than has been the case to date. The findings also serve to propose several important features that need to be in place to increase the chances of longevity, sustainability, quality and cost effectiveness in cross border health care services.
Collapse
Affiliation(s)
- Annalise Casha
- Department of Health Services Management, Faculty of Health Sciences, University of Malta c/o MSD 2090, Msida Malta.
| | - Ramon Casha
- Department of General Internal Medicine and Infectious Diseases, Mater Dei Hospital, Malta
| | - Natasha Azzopardi Muscat
- Department of Health Services Management, Faculty of Health Sciences, University of Malta c/o MSD 2090, Msida Malta; Islands and Small States Institute, University of Malta, Malta
| |
Collapse
|
10
|
Brown A. Understanding corporate governance of healthcare quality: a comparative case study of eight Australian public hospitals. BMC Health Serv Res 2019; 19:725. [PMID: 31638988 PMCID: PMC6805556 DOI: 10.1186/s12913-019-4593-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/09/2019] [Indexed: 11/17/2022] Open
Abstract
Background Patients are sometimes harmed in the course of receiving hospital care. Existing research has highlighted a positive association between board engagement in healthcare quality activities and healthcare outcomes. However, most research has been undertaken through surveys examining board engagement in a limited number of governance processes. This paper presents evidence of a comprehensive range of processes related to governing healthcare quality undertaken at the corporate governance level. This provides a more detailed picture than previously described of how corporate governance of healthcare quality is enacted by boards and management. Methods A comparative case study of eight Australian public hospitals was undertaken. Case studies varying is size and location were selected from two Australian states. Data collection included a review of key governance documentation, semi structured interviews with board members and senior management and an observation of a board quality committee meeting. Thematic analysis was undertaken to identify processes related to key tasks in governing healthcare quality. Results Two key tasks in the corporate governance of healthcare quality, evaluating healthcare quality and overseeing quality priorities, were examined. Numerous processes related to these two tasks were found. Case studies, while found to be similar in engagement on previously identified processes, were found to differ in engagement in these additional processes. While generally low levels of engagement in processes of overseeing quality priorities were found, cases differed markedly in their engagement in evaluating healthcare quality processes. Additional processes undertaken at some case studies represent innovative and mature responses to the need for effective corporate governance of healthcare quality. In addition, a group of processes, related to broader governance taskwork, were found to be important in enabling effective corporate governance of healthcare quality. Conclusion The work of governing healthcare quality, undertaken at the corporate governance level, is redefined in terms of these more detailed processes. This paper highlights that it is how well these key tasks are undertaken that is important in effective governance. When processes related to key tasks are omitted, the rituals of governance may appear to be satisfied but the responsibility may not be met. Boards and managers need to differentiate between common approaches to governance and practices that enable the fulfilment of governance responsibilities. This study provides practical guidance in outlining processes for effective corporate governance of healthcare quality and highlights areas for further examination.
Collapse
Affiliation(s)
- Alison Brown
- Public Service Research Group, School of Business, University of New South Wales, Canberra, Australia.
| |
Collapse
|
11
|
Mackie BR, Mitchell M, Marshall AP. Patient and family members' perceptions of family participation in care on acute care wards. Scand J Caring Sci 2018; 33:359-370. [PMID: 30507038 DOI: 10.1111/scs.12631] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/26/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hospital leaders, policymakers and healthcare professionals are realising the benefits of delivering care that promotes family participation because it is known to enhance the quality of care, and improve patient satisfaction. AIM The aim of this study was to explore, from the perspective of patients and family members within an adult acute care ward: (a) their beliefs and attitudes towards family participation in patient care and (b) staff behaviours that support or hinder family participation in patient care. DESIGN AND METHODS A naturalistic approach with an exploratory sequential design was used in a medical assessment and planning unit of a regional referral hospital in Australia. Purposeful maximum variation sampling was used to recruit patients and family members who differed in age, ethnicity, relationship to patient and gender. Observer-as-participant observation data and semi-structured interviews were undertaken. Following separate inductive content analysis, data were triangulated. RESULTS Thirty-two patients and 26 family members were recruited. Thirty hours of observational data were gathered. Eighteen patients and 15 family members were interviewed. Analysis uncovered two contrasting categories: (a) disconnected communication and (b) family influence quality. CONCLUSION The findings of our study demonstrated that most patients and families perceived staff communication as disconnected and inadequate, which constrained them from engaging in care processes or decision-making. However, when family felt empowered and participated in patient care, the quality of health care was enhanced. Healthcare professionals can use these findings to make informed evidence-based changes to the way they practice and communicate to ensure family participation in patient care is optimised in the acute care setting.
Collapse
Affiliation(s)
- Benjamin R Mackie
- School of Nursing, Midwifery and Paramedicine, Menzies Health Institute Queensland, University of the Sunshine Coast and Griffith University, Maroochydore, DC, QLD, Australia
| | - Marion Mitchell
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University and Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, and Gold Coast Health, Southport, QLD, Australia
| |
Collapse
|