Hospital management training for the Eastern Mediterranean Region: time for a change?

Working Hours, Job Burnout, and Subjective Well-Being of Hospital Administrators: An Empirical Study Based on China's Tertiary Public Hospitals

(1) Purpose: To analyze the role of job burnout in connection with working hours and subjective well-being (SWB) among hospital administrators in China’s tertiary public hospitals. (2) Methods: A multi-stage, stratified, cluster random sampling method was used to select 443 hospital administrators in six tertiary public hospitals for study. The data were collected and analyzed using the working hours measuring scale, Maslach burnout, and the subjective well-being schedule. Pearson correlation, structural equation model, and bootstrap tests were conducted to examine the association between job burnout, working hours, and SWB. (3) Results: Among the 443 respondents, 330 worked more than 8 h per day on average (76.2%), 81 had the longest continuous working time more than 16 h (18.7%), and 362 worked overtime on weekends (82.2%). The prevalence of job burnout in hospital administrators was 62.8%, among which, 59.8% have mild burnout and 3.00% have severe burnout. In the dimension of emotional exhaustion, depersonalization, and reduced personal achievement, the proportion of people in high burnout was 21.0% (91/433), 15.0% (65/433), and 45.3% (196/433), respectively. Job burnout has a mediating effect between working hours and SWB, which accounted for 95.5% of the total effect. (4) Conclusion: Plagued by long working hours and severe job burnout, the hospital administrators in China’s tertiary public hospitals may have low SWB. Working hours have a negative direct impact on job burnout and SWB, and an indirect impact on SWB through job burnout as a mediator. Targeted strategies should be taken to adjust working hours to promote the physical and mental health of hospital administrators.

Developing competent public hospital managers: a qualitative study from Iran

Purpose

Hospitals need highly trained and competent managers to be responsible for the strategic development, overall operation and service provision. The identification and confirmation of core management competency requirements is a fundamental first step towards developing the competent management workforce for sustainable hospital service provision. This paper reports on the finding of a recent study focusing on identifying managerial competencies required by middle and senior-level managers in the public hospitals in Iran.

Design/methodology/approach

The qualitative research design included position description analysis and focus group discussions with middle and senior-level public hospital managers in Iran. When analysing the identified knowledge, skills and attitudes, the validated MCAP framework was used to guide the grouping of them into associating management competencies.

Findings

The study identified 11 to 13 key tasks required by middle and senior-level managers and confirmed that the position descriptions used by current Iranian hospitals might not truly reflect the actual core responsibilities of the management positions. The study also confirmed seven core managerial competencies required to perform these tasks effectively. These core competencies included evidence-informed decision-making; operations, administration and resource management; knowledge of healthcare environment and the organisation; interpersonal, communication qualities and relationship management; leading people and organisation; enabling and managing change and professionalism.

Research limitations/implications

Competencies were identified based on managers' perceptions. Views and experiences of other stakeholders were not captured.

Practical implications

The seven core management competency identified in the current study provides a clear direction of competency development among senior and middle-level managers working at the Iranian public hospitals. The study also confirms that position descriptions do not reflect the actual responsibilities of current hospital managers, which are in need to urgent review.

Originality/value

This is the first study that has identified the core managerial competencies required by middle and senior-level hospital managers in Iran.

Leadership and Management Competencies for Hospital Managers: A Systematic Review and Best-Fit Framework Synthesis

OBJECTIVE

Competent managers are vital to the productivity and service quality of healthcare organizations and the sustainability of the healthcare system. To improve their management competence, understanding of management competency requirements is important. The purpose of this study was to synthesize the evidence related to the leadership and management competencies in healthcare organizations through the best-fit method.

METHODS

A systematic review of literature published between 2000 and 2020 was performed to identify studies focusing on confirming and/or identifying the competency requirements of hospital managers. The best-fit framework synthesis method was used to map the identified competencies and associated behavioral items against the validated management competency assessment program (MCAP) management competency framework.

RESULTS

Twelve studies were identified for inclusion in the review. The mapping of the identified competencies and behavioral items generated a competency model for hospital managers that can apply for different healthcare context. The new competency model includes the following seven core leadership and management competencies: evidence-informed decision-making, operations, administration and resource management, knowledge of healthcare environment and the organization, interpersonal, communication qualities and relationship management, leading people and organisation, enabling and managing change, and professionalism.

CONCLUSION

This review and the mapping of the competencies identified in previous studies against the validated MCAP framework has resulted in the recommendation for an extended leadership and management competency framework for health service managers. It provides guidance for the formulation of training and development directions for the health service management workforce in a different healthcare context.

Ana AE, Reynecke J, Al Husami I, Al Rubaiey A. Interprofessional Competency Framework for Health Service Managers in Oman: An e-Delphi Study

OBJECTIVES

This study aimed to develop the required interprofessional competencies for health service managers in Oman.

METHODS

Experts (n = 20) were selected based on their years' experience, position, fluency in English (both verbal and written), and who had completed higher education at either masters or doctorate levels in the relevant field. The data collection consisted of three rounds. Responses were collected and extracted from a web-based designed survey and subsequently analyzed.

RESULTS

Experts agreed on the nine interprofessional domains and 41 competencies based on the inclusion of means (M) 3 4.4, an interquartile distribution (IQD) ≤ 1.25, and > 80.0% agreement. Findings revealed that there were levels of agreement (90.0% to 95.0%) among the experts in the nine interprofessional competency domains namely: resilience (M = 4.7, IQD = 0.40), research leverage (M = 4.7, IQD = 0.60), interprofessional ethics (M = 4.7, IQD = 0.80), quality improvement (M = 4.7, IQD = 0.80), information technology (M = 4.6, IQD = 0.80), leadership (M = 4.5, IQD = 1.00), management skills (M = 4.5, IQD = 0.80), communication (M = 4.5, IQD = 1.00), and team dynamics (M = 4.5, IQD = 1.00).

CONCLUSIONS

The development of interprofessional competencies for health service managers is an impetus to strengthen the human resources capabilities, sustain a high level of quality patient outcomes, and to achieve the Ministry of Health's Health Vision 2050.

Evidence-based management - healthcare manager viewpoints

Purpose Hospital manager decisions can have a significant impact on service effectiveness and hospital success, so using an evidence-based approach can improve hospital management. The purpose of this paper is to identify evidence-based management (EBMgt) components and challenges. Consequently, the authors provide an improving evidence-based decision-making framework. Design/methodology/approach A total of 45 semi-structured interviews were conducted in 2016. The authors also established three focus group discussions with health service managers. Data analysis followed deductive qualitative analysis guidelines. Findings Four basic themes emerged from the interviews, including EBMgt evidence sources (including sub-themes: scientific and research evidence, facts and information, political-social development plans, managers' professional expertise and ethical-moral evidence); predictors (sub-themes: stakeholder values and expectations, functional behavior, knowledge, key competencies and skill, evidence sources, evidence levels, uses and benefits and government programs); EBMgt barriers (sub-themes: managers' personal characteristics, decision-making environment, training and research system and organizational issues); and evidence-based hospital management processes (sub-themes: asking, acquiring, appraising, aggregating, applying and assessing). Originality/value Findings suggest that most participants have positive EBMgt attitudes. A full evidence-based hospital manager is a person who uses all evidence sources in a six-step decision-making process. EBMgt frameworks are a good tool to manage healthcare organizations. The authors found factors affecting hospital EBMgt and identified six evidence sources that healthcare managers can use in evidence-based decision-making processes.

Evaluation of the district health management fellowship training programme: a case study in Iran

OBJECTIVE

To evaluate the district health management fellowship training programme in the north-west of Iran.

DATA SOURCES/STUDY SETTING

The programme was introduced to build the managerial capacity of district health managers in Iran. Eighty-nine heads of units in the province's health centre, district health managers and the health deputies of the district health centres in the north-west provinces of Iran had registered for the district health management fellowship training programme in Tabriz in 2015-2016.

STUDY DESIGN

This was an educational evaluation study to evaluate training courses to measure participants' reactions and learning and, to a lesser extent, application of training to their job and the organisational impact.

DATA COLLECTION/EXTRACTION METHODS

Valid and reliable questionnaires were used to assess learning techniques and views towards the fellowship, and self-assessment of health managers' knowledge and skills. Also, pretest and post-test examinations were conducted in each course and a portfolio was provided to the trainees to be completed in their work settings.

PRINCIPAL FINDINGS

About 63% of the participants were medical doctors and 42.3% of them had over 20 years of experience. Learning by practice (scored 18.37 out of 20) and access to publications (17.27) were the most useful methods of training in health planning and management from the participants' perspective. Moreover, meeting peers from other districts and the academic credibility of teachers were the most important features of the current programme. Based on the managers' self-assessment, they were most skilful in quality improvement, managing, planning and evaluation of the district. The results of the post-test analysis on data collected from district health managers showed the highest scores in managing the district (77 out of 100) and planning and evaluation (69) of the courses.

CONCLUSION

The results of this study indicated that training courses, methods and improvement in managers' knowledge about the health system and the skills necessary to manage their organisation were acceptable.

Health Care Managers' Perspectives on the Sources of Evidence in Evidence-Based Hospital Management: A Qualitative Study in Iran

BACKGROUND

Evidence-based management (EBMgt) has been developed as a management framework for improving the quality of management decisions. To use that, we need to identify the source of evidence in decision-making. Therefore, the purpose of this study was to identify the sources of evidence in managing hospitals.

METHODS

Qualitative methods were used to explore the sources of evidence and to identify hospital managers' attitudes towards evidence-based management. A series of semi-structured interviews (n=48), with a purposive sample of 48 participants, were conducted in 2016. Also, four focus group discussions (FGDs) were conducted with health managers and specialists in the field of management. A questionnaire was used for collection of demographic characteristics and managers' perspectives.

RESULTS

Six main themes emerged from the interviews including: scientific and research evidence, facts and information of hospital, political-social development plans, managers' professional expertise and ethical-moral evidence. Also, the results showed that the majority of participants believed to use the evidence-based hospital management (95.83%).

CONCLUSIONS

Our study suggested that a full evidence-based hospital manager someone who is using all the sources of evidence for making hospital decisions. Using hexagon of evidence sources, managers can identify the best available evidence for hospital decisions and to make the best decision in the process of evidence-based decision making.

Schools of public health in low and middle-income countries: an imperative investment for improving the health of populations?

BACKGROUND

Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005-2008) strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges.

MAIN TEXT

The challenges faced by LMICs include rapid urbanization, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs).

CONCLUSION

SPHs in LMICs can contribute to overcoming several public health challenges being faced by LMICs, including achieving SDGs. Most importantly they can develop cadres of competent and well-motivated public health professionals: educators, practitioners and researchers who ask questions that address fundamental health determinants, seek solutions as agents of change within their mandates, provide specific services and serve as advocates for multilevel partnerships. Funding support, human resources, and agency are unfortunately often limited or curtailed in LMICs, and this requires constructive collaboration between LMICs and counterpart institutions from high income countries.