Hospital performance management: A multi-criteria decision-making approach

Digitaler Reifegrad der Krankenhausversorgung – Ausgangssituation und Handlungsoptionen für eine forcierte digitale Transformation in österreichischen Krankenhäusern

Zielsetzung Die stationäre Patientenversorgung in österreichischen Krankenhäusern wird bestimmt durch arbeitsteilige, interdisziplinäre und komplexe Leistungsprozesse, die durch eine Vielzahl an unterschiedlichen Fachdisziplinen und Abteilungen erbracht werden. Die wissensbasierten Gesundheitsdienstleistungen werden dabei durch einen Mix aus Arbeitsleistungen sowie Hard- und Software-Einsatz dominiert. Aufgrund der verstärkten branchenübergreifenden Digitalisierung von Leistungsprozessen stellt sich die Frage: Wie sollte die Digitalisierung zur Verbesserung der zukünftigen Wertschöpfung und Ressourcennutzung in österreichischen Krankenhäusern aus Sicht der Entscheidungs- und Führungsverantwortlichen (Kollegiale Führung) ausgestaltet und weiterentwickelt werden?

Methodik Mittels einer semi-strukturierten Literaturrecherche sowie einer Online-Umfrage unter Entscheidungs- und Führungsverantwortlichen (Kollegiale Führung) in österreichischen Krankenhäusern (N=374; n=49, rr=13,1%) wurden der aktuelle Reifegrad sowie die unterschiedlichen Zielsetzungen, Herausforderungen und Lösungsansätze der Digitalisierung im Krankenhauswesen aus der Perspektive der Kollegialen Führung, erhoben und analysiert.

Ergebnisse Es wird deutlich, dass die übergreifende Digitalisierung im Krankenhaus durch eine Vielzahl an Akteuren, Professionen, Aktivitäten, Ressourceneinsätzen sowie wissensbasierten Dienstleistungen bestimmt sowie mit unterschiedlichen Herausforderungen konfrontiert wird. Der aktuelle Reifegrad der Digitalisierung im Krankenhaus erreicht nach Auffassung der befragten Entscheidungsverantwortlichen ein mittleres Niveau. Wesentliche Verbesserungspotenziale und Anwendungsmöglichkeiten werden insbesondere hinsichtlich der Nutzung von Big Data und Künstliche Intelligenz (KI)-Technologien, dem Asset-Tracking sowie der Anwendung von Mobile-Health-Lösungen gesehen.

Schlussfolgerungen Neben der Weiterentwicklung der wissensbasierten und qualifizierten medizinisch-pflegerisch-therapeutischen Patientenversorgung gilt es, zukünftig verstärkt die Digitalisierung im Krankenhaus zu forcieren. Ziel ist es, bei zunehmender Nachfrage und gesteigerten Patientenerwartungen sowie verstärkt limitierter Ressourcenverfügbarkeit, sowohl die Versorgungssicherheit (z. B. niederschwelliger, zeit- und wohnortnaher Zugang) als auch die Versorgungsqualität (z. B. Evidence Based Health Care), sicherzustellen.

A historical review of performance appraisal of public hospitals in China from the perspective of historical institutionalism

The government performance appraisal of public hospitals serves as an effective management tool to promote high-quality development. It is also an important means of realizing the "Healthy China" initiative. Since the founding of the People's Republic of China, changes in performance appraisal have been divided into the following four periods: the early stage of performance appraisal (1949-1977), the exploration period (1978-2008), the development period (2009-2018), and the integration period (2019-present). This clarifies the regional practice of public hospital performance and identifies the institutional factors of the evolution. It also demonstrates that administrative forces, market-driving forces, and mission-driving forces combine to bring about change in the public hospital performance appraisal system. However, problems such as insufficient application of performance appraisal and coordination between health administrative departments and medical insurance departments still loom large.

Privatization, Corporatization, and Public-Private Partnership in the Kingdom of Saudi Arabia

There are different governmental reasons and technologies for seeking public-private partnerships throughout the developed countries. Significant motives have been to improve efficiency and risk distribution in comparison to traditional financing techniques and to lessen budget and borrowing limits. In this study, the movement toward privatization enhancing the efficiency of MoH's hospitals has been assessed using Data Envelopment Analysis (DEA) from 1979 to 2020. Moreover, the efficiencies of the individual hospital were estimated through the DEA model, which includes: scale efficiency (SE), pure technical efficiency (PTE), and overall technical efficiency (OTE). In addition, factor affecting such efficiencies was analyzed through Tobit regression. The VRS results suggest that the numbers of hospitals benefiting from the complete corporatized phase are greater than those benefiting from the last phase (and vice versa in the case of DRS). The variance between inefficient hospitals in the less corporatized phase (2000-2020) was more prominent than in the fully corporatized phase (1988-1999). In conclusion, fully corporatized hospitals (on average) achieve relatively better overall efficiency. It is recommended that additional corporatization might be stimulated by a standardized set of performance measures, which cover both the quality criteria and economic efficiency measurements from a healthcare perspective.

Reduction of the Cycle Time in the Biopsies Diagnosis Through a Simulation Based on the Box Müller Algorithm

Anatomic pathology services study disease in hospitals on the basis of macroscopic and microscopic examination of organs and tissues. The focus of this research investigation was on improving clinical biopsy diagnosis times through simulation based on the Box-Muller algorithm to reduce the waiting time in the diagnosis of clinical biopsies. The data were provided by a hospital in San José (Costa Rica). They covered 5 years and showed waiting times for a pathological diagnosis that for some biopsies were close to 120 days. The correlation between the main causes identified and the cycle time in the biopsy diagnostic process was defined. A statistical analysis of the variables most representative of the process and of the waiting times was carried out. It followed the DMAIC structure (Define, Measure, Analyse, Improve, Control) for the continuous improvement of processes. Two of the activities of the process were identified as being the main bottlenecks. Their processing times had a normal distribution, for which reason a Box-Muller algorithm was used to generate the simulation model. The results showed that waiting times for a diagnosis can be reduced to 3 days, for a productive capacity of 8 000 biopsies per annum, optimizing the logistics performance of health care.

Health Reforms in Turkey: The Impact on the Perceived Performance Levels of Health Staff

In this study, the relationship between the levels of participation of hospital staff in health reforms and perceived performance levels were investigated. The data attained from 274 participants were evaluated. The level of participation of health professionals in health reforms was 3.23 and the level of perceived performance was found to be 3.91. When evaluated at the point that 5 represents the highest level, these average scores may be indicative of moderate performance and participation in reforms. It was concluded that there is a relationship between the level of participation in health reforms and performance (r = 0.563, p < 0.01).