A Knowledge Map for Hospital Performance Concept: Extraction and Analysis: A Narrative Review Article

BACKGROUND

Performance is a multi-dimensional and dynamic concept. During the past 2 decades, considerable studies were performed in developing the hospital performance concept. To know literature key concepts on hospital performance, the knowledge visualization based on co-word analysis and social network analysis has been used.

METHODS

Documents were identified through "PubMed" searching from 1945 to 2014 and 2350 papers entered the study after omitting unrelated articles, the duplicates, and articles without abstract. After pre-processing and preparing articles, the key words were extracted and terms were weighted by TF-IDF weighting schema. Support as an interestingness measure, which considers the co-occurrence of the extracted keywords and "hospital performance" phrase was calculated. Keywords having high support with "hospital performance" are selected. Term-term matrix of these selected keywords is calculated and the graph is extracted.

RESULTS

The most high frequency words after "Hospital Performance" were "mortality" and "efficiency". The major knowledge structure of hospital performance literature during these years shows that the keyword "mortality" had the highest support with hospital performance followed by "quality of care", "quality improvement", "discharge", "length of stay" and "clinical outcome". The strongest relationship is seen between "electronic medical record" and "readmission rate".

CONCLUSION

Some dimensions of hospital performance are more important such as "efficiency", "effectiveness", "quality" and "safety" and some indicators are more highlighted such as "mortality", "length of stay", "readmission rate" and "patient satisfaction". In the last decade, some concepts became more significant in hospital performance literature such as "mortality", "quality of care" and "quality improvement".

The First Stages of Liberalization of Public Hospitals in Iran: Establishment of Autonomous Hospitals and the Barriers

BACKGROUND

Liberalization and decentralization of public sector has been triggered in some developing countries and in Iran by the Ministry of Health and Medical Education (MOHME) that granted autonomy to 54 public hospitals. However, establishment of such a complex organizational reform was rather unsuccessful. We aimed to explore the obstacles and barriers caused such a failure and their mechanisms.

METHODS

Using a qualitative approach in 2013, we consulted key informants at the autonomous hospitals and their affiliating universities. Data collection was done within two phases: (i) 276 unstructured questionnaires asking respondents of barriers, and (ii) 23 semi-structured interviews from the first phase's key respondents. The first phase data were analyzed using thematic analysis and the second's by framework approach based on the frame shaped at the first phase.

RESULTS

Nine obstacles were recognized including "autonomous hospitals' board composition", "delay in announcing autonomous hospitals' charges by the MOHME", "lack of financing by the committed organizations", "poor follow up for implementation of the reform", "irregular board meetings", "lack of an external overseer", "shortage of full-time physicians", "lack of management stability", and "health insurance organizations' delayed payments".

CONCLUSION

The MOHME and insurance organizations did not pay the reform expenses. There were some competing motives as well to slow the reform or to shut it down. The stages of policy formulation and implementation were done separately in Iran, so this big organizational reform encountered serious obstacles.