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Hospital staff shortages: Environmental and organizational determinants and implications for patient satisfaction. Health Policy 2020; 124:380-388. [PMID: 31973906 DOI: 10.1016/j.healthpol.2020.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/03/2019] [Accepted: 01/02/2020] [Indexed: 11/21/2022]
Abstract
Recent discussions and previous research often indicate that German hospitals are affected by a shortage of healthcare personnel on the labor market. However, until now, research has provided only limited insights into how environmental and organizational factors explain variations in staff shortages, how staff shortage measures relate to staffing ratios, and what relevance staff shortages have for patients. Regression analyses based on survey data of 104 German hospitals from 2015 to 2016, combined with labor market and patient satisfaction data, show that several environmental and organizational factors are significantly related to hospital staff shortages, measured by self-reports, vacancies, and turnover. These three measures of staff shortage do not correlate to the same degree for physicians and nurses, and none of the three significantly relate to nursing ratios, which indicates that the latter is a distinct concept rather than a direct consequence of staff shortage. The analyses further show that hospital staff shortages relate significantly to patient satisfaction with physician and nursing care. The findings suggest that hospitals are, to a certain extent, able to influence the degree to which they are affected by staff shortages and that hospitals' decisions about staffing levels depend on more than staff availability.
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Kriegel J, Tuttle-Weidinger L, Schiefer L, Schwarz S. Management of support processes in Austrian hospitals: Integrated network of primary care processes and support processes. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2017. [DOI: 10.1080/20479700.2017.1343759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Johannes Kriegel
- School of Applied Health and Social Sciences, University of Applied Sciences Upper Austria, Linz, Austria
| | - Linda Tuttle-Weidinger
- School of Applied Health and Social Sciences, University of Applied Sciences Upper Austria, Linz, Austria
| | - Lisa Schiefer
- Department of Anesthesiology and Perioperative Medicine, University Hospital Salzburg, Salzburg, Austria
| | - Stefan Schwarz
- School of Applied Health and Social Sciences, University of Applied Sciences Upper Austria, Linz, Austria
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Terzic-Supic Z, Bjegovic-Mikanovic V, Vukovic D, Santric-Milicevic M, Marinkovic J, Vasic V, Laaser U. Training hospital managers for strategic planning and management: a prospective study. BMC MEDICAL EDUCATION 2015; 15:25. [PMID: 25889166 PMCID: PMC4355452 DOI: 10.1186/s12909-015-0310-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 02/17/2015] [Indexed: 05/28/2023]
Abstract
BACKGROUND Training is the systematic acquisition of skills, rules, concepts, or attitudes and is one of the most important components in any organization's strategy. There is increasing demand for formal and informal training programs especially for physicians in leadership positions. This study determined the learning outcomes after a specific training program for hospital management teams. METHODS The study was conducted during 2006 and 2007 at the Centre School of Public Health and Management, Faculty of Medicine, University of Belgrade and included 107 participants involved in the management in 20 Serbian general hospitals. The management teams were multidisciplinary, consisting of five members on average: the director of the general hospital, the deputy directors, the head nurse, and the chiefs of support services. The managers attended a training program, which comprised four modules addressing specific topics. Three reviewers independently evaluated the level of management skills at the beginning and 12 months after the training program. Principal component analysis and subsequent stepwise multiple linear regression analysis were performed to determine predictors of learning outcomes. RESULTS The quality of the SWOT (strengths, weaknesses, opportunities and threats) analyses performed by the trainees improved with differences between 0.35 and 0.49 on a Likert scale (p < 0.001). Principal component analysis explained 81% of the variance affecting their quality of strategic planning. Following the training program, the external environment, strategic positioning, and quality of care were predictors of learning outcomes. The four regression models used showed that the training program had positive effects (p < 0.001) on the ability to formulate a Strategic Plan comprising the hospital mission, vision, strategic objectives, and action plan. CONCLUSION This study provided evidence that training for strategic planning and management enhanced the strategic decision-making of hospital management teams, which is a requirement for hospitals in an increasingly competitive, complex and challenging context. For the first time, half of state general hospitals involved in team training have formulated the development of an official strategic plan. The positive effects of the formal training program justify additional investment in future education and training.
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Affiliation(s)
- Zorica Terzic-Supic
- Institute of Social Medicine, University of Belgrade, School of Medicine, Belgrade, Serbia.
| | - Vesna Bjegovic-Mikanovic
- Centre-School of Public Health and Management, University of Belgrade, School of Medicine, Belgrade, Serbia.
| | - Dejana Vukovic
- Institute of Social Medicine, University of Belgrade, School of Medicine, Belgrade, Serbia.
| | | | - Jelena Marinkovic
- Institute of Medical Statistics and Informatics, University of Belgrade, School of Medicine, Belgrade, Serbia.
| | - Vladimir Vasic
- Department of Statistics and Mathematics, Faculty of Economics, University of Belgrade, Belgrade, Serbia.
| | - Ulrich Laaser
- Section of International Public Health (S-IPH), Faculty of Health Sciences, University of Bielefeld, Bielefeld, Germany.
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Macinati MS, Anessi-Pessina E. Management accounting use and financial performance in public health-care organisations: evidence from the Italian National Health Service. Health Policy 2014; 117:98-111. [PMID: 24767311 DOI: 10.1016/j.healthpol.2014.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 01/14/2014] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
Reforms of the public health-care sector have emphasised the role of management accounting (MA). However, there is little systematic evidence on its use and benefits. To fill this gap, we propose a contingency-based model which addresses three related issues, that is, whether: (i) MA use is influenced by contextual variables and MA design; (ii) top-management satisfaction with MA mediates the relationship between MA design and MA use; and (iii) financial performance is influenced by MA use. A questionnaire was mailed out to all Italian public health-care organisations. Structural equation modelling was performed to validate the research hypotheses. The response rate was 49%. Our findings suggest that: (i) cost-containment strategies encourage more sophisticated MA designs; (ii) MA use is directly and indirectly influenced by contingency, organisational, and behavioural variables; (iii) a weakly significant positive relationship exists between MA use and financial performance. These findings are relevant from the viewpoint of both top managers and policymakers. The former must make sure that MA is not only technically advanced, but also properly understood and appreciated by users. The latter need to be aware that MA may improve performance in ways and along dimensions that may not fully translate into better financial results.
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Affiliation(s)
- Manuela S Macinati
- Università Cattolica del Sacro Cuore, Facoltà di Economia, Largo F. Vito, 1, 00168 Roma, Italy.; Cerismas-Università Cattolica, 1 Largo Gemelli, 20123 Milano, Italy..
| | - E Anessi-Pessina
- Università Cattolica del Sacro Cuore, Facoltà di Economia, Largo F. Vito, 1, 00168 Roma, Italy.; Cerismas-Università Cattolica, 1 Largo Gemelli, 20123 Milano, Italy..
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Naranjo Gil D. El uso del cuadro de mando integral y del presupuesto en la gestión estratégica de los hospitales públicos. GACETA SANITARIA 2010; 24:220-4. [DOI: 10.1016/j.gaceta.2010.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 02/03/2010] [Accepted: 02/08/2010] [Indexed: 11/17/2022]
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Supic ZT, Bjegovic V, Marinkovic J, Milicevic MS, Vasic V. Hospital management training and improvement in managerial skills: Serbian experience. Health Policy 2010; 96:80-9. [PMID: 20116126 DOI: 10.1016/j.healthpol.2010.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 12/19/2009] [Accepted: 01/03/2010] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The purpose of this study was to analyze the improvement of managerial skills of hospitals' top managers after a specific management training programme, and to explore possible predictors and relations. METHODS The study was conducted during the years 2006 and 2007 with cohort of 107 managers from 20 Serbian general hospitals. The managers self-assessed the improvement in their managerial skills before and after the training programme. RESULTS After the training programme, all managers' skills had improved. The biggest improvement was in the following skills: organizing daily activities, motivating and guiding others, supervising the work of others, group discussion, and situation analysis. The least improved were: applying creative techniques, working well with peers, professional self-development, written communication, and operational planning. Identified predictors of improvement were: shorter years of managerial experience, type of manager, type of profession, and recognizing the importance of the managerial skills in oral communication, evidence-based decision making, and supervising the work of others. CONCLUSIONS Specific training programme related to strategic management can increase managerial competencies, which are an important source of competitive advantage for organizations.
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Affiliation(s)
- Zorica Terzic Supic
- Institute of Social Medicine, School of Medicine, University of Belgrade, Dr Subotica 15, Belgrade, Serbia.
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Hayashida K, Imanaka Y, Otsubo T, Kuwabara K, Ishikawa KB, Fushimi K, Hashimoto H, Yasunaga H, Horiguchi H, Anan M, Fujimori K, Ikeda S, Matsuda S. Development and analysis of a nationwide cost database of acute-care hospitals in Japan. J Eval Clin Pract 2009; 15:626-33. [PMID: 19522724 DOI: 10.1111/j.1365-2753.2008.01063.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Understanding of hospital cost is crucial to achieve an ideal balance between the assurance and improvement of patient safety and quality, and efficient use of finite resources. However, neither a standardized calculation methodology nor a large-scale database of costs in acute-care hospitals exists in Japan. This study aims to develop a standardized methodology, construct a nationwide cost database in Japan, analyse the characteristics of the database and examine the relationship between the cost and the charge from the viewpoint of an appropriate reflection of the cost to the price. METHOD We designed the costing framework, gathered the data for patients discharged from 139 acute-care hospitals in Japan between July 2004 and October 2004 and constructed a database containing information on 284,730 patients. The characteristics of the database and the relationship between the cost and the charge were investigated. RESULTS In the nationwide database we constructed, a wide range in the average cost per hospitalization and average cost per diem was observed. A wide variation of cost components was seen across major diagnostic categories. Moreover, there was a high correlation between the cost and the charge (Correlation coefficient = 0.94). CONCLUSIONS After designing a costing framework, a nationwide database comprised of individual case-level costs with components for acute-care hospitals in Japan was successfully developed. We hope this study contributes to appropriate decision making and helps motivate further research geared towards efficient hospital management and a rational payment system in Japan.
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Affiliation(s)
- Kenshi Hayashida
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Naranjo-Gil D. Management information systems and strategic performances: The role of top team composition. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT 2009. [DOI: 10.1016/j.ijinfomgt.2008.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Djellal F, Gallouj F. Innovation in hospitals: a survey of the literature. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2007; 8:181-93. [PMID: 17186204 DOI: 10.1007/s10198-006-0016-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Accepted: 09/22/2006] [Indexed: 05/13/2023]
Abstract
The literature on innovation in hospitals is relatively extensive and varied. The purpose of this article is to conduct a critical survey, and in particular to highlight the functional and occupational bias that characterises it, whereby the sole object of innovation is medical care, and that innovation is essentially the work of doctors. In order to achieve this objective, four different (complementary or competing) concepts of the hospital are considered. In the first, the hospital is seen in terms of its production function, in the second, as a set of technical capacities, in the third, as an information system, and in the fourth, as a service provider and a hub in a wider system of healthcare. In the latter approach, hospitals are regarded as combinative providers of diverse and dynamic services, able to go beyond their own institutional boundaries by becoming part of larger networks of healthcare provision, which are themselves diverse and dynamic. This approach makes it possible to extend the model of hospital innovation to incorporate new forms of innovation and new actors in the innovation process, in accordance with the Schumpeterian tradition of openness.
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Affiliation(s)
- Faridah Djellal
- Clersé, Ifrési-CNRS, Faculty of Economics and Sociology, University of Lille 1, Bâtiment SH1, 59 655, Vileneuve d'Ascq Cedex, France
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Naranjo-Gil D, Hartmann F. How CEOs use management information systems for strategy implementation in hospitals. Health Policy 2007; 81:29-41. [PMID: 16781001 DOI: 10.1016/j.healthpol.2006.05.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Revised: 05/03/2006] [Accepted: 05/07/2006] [Indexed: 11/24/2022]
Abstract
Institutional and market changes seem to force hospitals across the Western world to revitalize their corporate strategies towards more cost efficiency on the one hand, and more flexibility towards customer demands on the other hand. Hospitals, however, apparently differ in the extent to which they are able to implement such strategies effectively. This paper explores whether these different levels of effectiveness depend on how hospitals' top managers' use of the available management information systems (MIS). Based on data obtained from the 218 CEOs of public hospitals in Spain, we analyze how CEOs' professional and educational backgrounds affect their use of MIS, and how the use of the MIS subsequently supports or inhibits the implementation of these strategic goals. The results indicate that CEOs with a predominant clinical background focus more on non-financial information for decision-making and prefer an interactive style of using MIS, which together support flexibility strategies. CEOs with a predominant administrative background seem more effective in establishing cost-reduction strategies, through their larger inclination to emphasize financial information in combination with a diagnostic use of the MIS. Implications for the strategic management of hospitals are outlined.
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Cardinaels E, Roodhooft F, van Herck G. Drivers of cost system development in hospitals: results of a survey. Health Policy 2004; 69:239-52. [PMID: 15212870 DOI: 10.1016/j.healthpol.2004.04.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2003] [Indexed: 11/21/2022]
Abstract
While many hospitals are under pressure to become more cost efficient, new costing systems such as activity-based costing (ABC) may form a solution. However, the factors that may facilitate (or inhibit) cost system changes towards ABC have not yet been disentangled in a specific hospital context. Via a survey study of hospitals, we discovered that cost system development in hospitals could largely be explained by hospital specific factors. Issues such as the support of the medical parties towards cost system use, the awareness of problems with the existing legal cost system, the type of contract for the physician's internal financial agreement, should be considered if hospitals refine their cost system. Conversely, ABC-adoption issues that were found to be crucial in other industries are less important. Apparently, installing a cost system requires a different approach in hospital settings. Especially, results suggest that hospital management should not underestimate the interest of the physician in the process of redesigning cost systems.
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Affiliation(s)
- Eddy Cardinaels
- Faculty of Economics and Business Administration, Universiteit van Tilburg, P.O. Box 90153, 5000 LE Tilburg, The Netherlands.
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