Assessment for improving the performance of NICUs: The Italian experience

The managerial role of healthcare professionals in public hospitals: a time-driven analysis of their activities

BACKGROUND

New Public Management theory affected reforms of public sectors worldwide. In Italy, an important reform of the healthcare sector changed the profile of public hospitals, creating new management related positions in 1992. The reform defined the role of the clinician-manager: a hybrid figure, in charge of managing an entire unit. This paper aims to investigate how much clinician-managers feel like managers and how much they still feel like professionals, using time as a driver to conduct the analysis.

METHODS

A survey-questionnaire was administered to a set of 2,011 clinician-managers employed in public hospitals, with a response rate of 60.42%. The managerial role of healthcare professionals in public hospitals: A time-driven analysis of their activities. The questionnaire aimed to identify the difference between how much time clinician-managers actually spend on daily activities and how much time they would think be appropriate. To better cluster different type of management styles, subgroups were identified based on the type of organisations respondents work for, geographical location, and professional specialty.

RESULTS

Findings suggest that clinician-managers spend more time on clinical activities than management. Clear differences are found according to professional specialty, and there are fewer differences in geographical location and the type of organisation.

CONCLUSIONS

The absence of clear differences in the responses between different geographical areas implies that a shared organisational culture characterizes the whole sector. However, differences in how the clinician-manager role is perceived based on the professional specialty suggest that closer integration may be needed.

Dimensions of performance and related key performance indicators addressed in healthcare organisations: A literature review

INTRODUCTION

Performance measurement systems have become essential managerial tools for healthcare organisations in the last few decades. They allow hospital managers to pilot their institution and assess the development of the organisation in helping managers in decision-making and viewing the different impacts of these decisions. However, there is a need to investigate further the dimensions of performance those performance measurement systems address.

METHODS

A literature review was primarily conduced about performance measures in healthcare organisations. A comparative study was secondly made to identify the different performance dimensions that are present in the literature during the last decade. Forty-nine studies were considered and sixteen proposal frameworks were used to make the comparative analyses.

RESULTS

We classified dimensions depending on the frequency of mobilisation of their components in four categories: the stars, the first runners-up, the opportunists and the forgotten ones. For each of the dimensions presented in this classification, the main types of KPIs proposed in the theoretical frameworks are presented. A discussion on relevance and possible blind spots is then conducted.

CONCLUSION

Although they were a lot of proposal frameworks of KPI proposed in the last decades to assess healthcare organisations, some dimensions remain underrepresented. There is still a need to develop structure KPI and describe their links. To go further, the development of dashboards asks the question of the definition of KPI, the description of their interconnections and their temporality of driving, because static performance reporting systems are not able to completely satisfy healthcare manager's decision support needs.

Measuring the efficiency of the healthcare sector in Poland – a window-DEA evaluation

Purpose

The main aim of the study was to measure and assess the efficiency of the healthcare system in Poland.

Design/methodology/approach

An output-oriented Data Envelopment Analysis model with a 2-years window analysis extension was used between 2013 and 2018. The analysis was completed with a determination of the sources of productivity changes (between the first and last year of the study period) and factors that influence efficiency.

Findings

Efficient regions have been identified and the spatial diversity in their efficiency was confirmed. The study identified individual efficiency trends together with “all-windows” best and worst performers. Using panel modeling, it was confirmed that the efficiency of health protection is influenced by, among others, accreditation certificates, the length of the waiting list or the number of medical personnel.

Research limitations/implications

Although the analysis was conducted at the voivodeship level (NUTS2), which was fully justified, it would be equally important to analyze data with a lower aggregation level. It would be extremely valuable from the perspective of difficulties faced by the healthcare system in Poland.

Practical implications

The identification of areas and problems affecting the efficiency of the healthcare system in Poland may also be a hint for other countries with similar system solutions that also struggle with the same problems.

Originality/value

The paper explains the efficiency of the country's healthcare system while also paying attention to changes in its level, factors influencing it, spatial diversity and impact on the sector functioning.

Managerial features and outcome in neonatal intensive care units: results from a cluster analysis

Background

Healthcare organisations differ in performance even if they are located in the same country or region. Suitable managerial practices and organisational processes can lead to better health outcomes. As a result, hospitals are constantly looking for managerial arrangements that can improve outcomes and keep costs down. This study aims to identify different managerial models in neonatal intensive care units (NICUs) and their impact on a large number of outcomes.

Methods

The research was conducted in Italy, within the SONAR project. SONAR’s aim was to identify the characteristics of NICUs, monitor outcomes and promote best practices. This study includes 51 of the 63 NICUs that took part in the SONAR project. Questionnaires on the activities and managerial features were administered to doctors and nurses working in NICUs. A total of 643 questionnaires were analysed from doctors and a total of 1601 from nurses. A cluster analysis was performed to identify managerial models of NICUs.

Results

Three managerial models emerged from cluster analysis: traditional, collaborative and individualistic. In the “traditional” model the doctor is above the nurse in the hierarchy, and the nurse therefore has exclusively operational autonomy. The “collaborative” model has as key elements professional specialisation and functional coordination. The “individualistic” model considers only individual professional skills and does not concern the organisational conditions necessary to generate organisational effectiveness.

The results also showed that there is an association between managerial model and neonatal outcomes. The collaborative model shows best results in almost all outcomes considered, and the traditional model has the worst. The individualistic model is in the middle, although its values are very close to those of traditional model.

Conclusions

Health management needs to assess NICU strategically in order to develop models to improve outcomes. This study provides insights for management useful for designing managerial characteristics of NICUs in order to achieve better results. NICUs characterised by a collaborative model in fact show better neonatal outcomes.