Making a "Happy Hospital": Emotional Investment and Professional Identity Amongst Anglo-American Hospital Administrators

This article examines the place of emotion in modern hospital administration and the relationship between professional identities and emotional landscapes in the healthcare field. The focus is a broad emotional and philosophical investment that many administrators made in their work. In the United States and then in Britain, amidst rapid change in the practice and provision of health services, a new sense of professional identity emerged. This was often underpinned by a kind of emotional investment, one which had to be constructed and cultivated. Here formal training and education, collective identities, and a shared understanding of the kind of personal qualities required were important. The extent to which developments in Britain were influenced by best practice in the US is also striking. This process might best be understood as the further drawing out of established beliefs and ways of working rather than an abstract transfer of ideas and practices across the Atlantic, but there was a distinct Anglo-American dimension to the development of hospital administration.

Change Management in Hospitals: A Framework Analysis

BACKGROUND

Hospitals are complex organizations that frequently need changes especially in service delivery processes, organizing, human resource management, monitoring and evaluation and technologies. Maintaining and improving productivity is a key requirement in hospital change management. Therefore, we need to develop and expand an appropriate model for management of changes in hospitals; which is the main purpose of this study.

METHOD

A qualitative approach was used to conduct semi-structured interviews in 2019-2020 with 12 expert managers at Mashhad University of Medical Sciences, Mashhad, Iran. A pre-structured framework was applied for the data analysis.

RESULTS

Four main themes and nine sub-themes were identified as the main phases or stages of the framework that can be used to manage changes that aim to improve efficiency in hospitals. The main themes were problem identification and initial support; studying, designing and planning; participation in implementation; considering executive requirements; and implementation, assessment, feedback and stabilization.

CONCLUSION

Management of changes that aim to improve hospital efficiency requires a practical model that was specifically developed by this study. This model should consider all the key elements that were identified; and should consider the expectations of the key stakeholders and their contribution in implementing the change.

["Follow up" strategy in the management of hospital stay]

BACKGROUND

In countries with emerging economies, the adequate and efficient management of resources is a priority, through strategies to reduce prolonged stay, increase the availability of beds, maximize profitability and reduce iatrogenic complications.

OBJECTIVE

The purpose of the study was to evaluate the effect of the "Follow up" strategy (FU) on the main indicators of the hospitalization process.

MATERIAL AND METHODS

A cross-sectional, comparative study was developed to evaluate the impact of the FU strategy on the indicators: hospital admissions and discharges, average days of hospital stay (DEH), percentage of hospital occupancy (OH), bed substitution interval (ISC), bed turnover rate (CRI) and prolonged hospital stay (EHP).

RESULTS

The FU was associated with a reduction in DEH [5.7 (5.5-6.1) vs. 6.5 days (6.1-6.9), p = 0.01]; ISC [0.6 (0.4-0.8) vs. 1.2 (0.8-1.3), p = 0.01] and EHP [23.6 (21.6-24.7) vs. 26.3% (24.4-28.7), p = 0.02] compared to the control group, with an increase in existence [1436 (1381-1472) vs. 1347 patient days (1280-1402), p = 0.02], respectively. There was no significant difference in the number of admissions, discharges or in the IRC.

CONCLUSIONS

The FU reduces the average number of days of hospital stay, the rate of bed substitution and prolonged stay.

[First steps of medical administration at the IMSS]

The creation of an institution as large as the Instituto Mexicano del Seguro Social (IMSS) required a lot of planning to manage all the benefits provided to the population. Thus, it is necessary to have health personnel with knowledge and experience in health services administration. This manuscript is an acknowledgment to doctors Manuel Barquín Calderón, Antonio Ríos Vargas and Carlos Zamarripa Torres, pioneers and recognized protagonists in the planning and organization (administration) of the IMSS medical services between 1945 and 1955, who also had rational initiatives and constructive, doing their duty. On the other hand, the Institute exposed and projected that medical-administrative activities were a complex task, and that its practice required specialized knowledge that could not be left to chance, empiricism, good will, beliefs or nonobjective imagination.

Quality of Care Indicators for Hospital Physical Therapy Units: A Systematic Review

OBJECTIVE

The purpose of this review was to identify quality indicators described in the literature that may be used as quality measures in hospital physical therapy units.

METHODS

The following sources were searched for quality indicators or articles: Web of Science, MEDLINE, IBECS, Latin American and Caribbean Health Sciences Literature, Cumulative Index of Nursing and Allied Health, Academic Search Complete, SportDiscus, SciELO, PsychINFO, Consejo Superior de Investigaciones Cientificas, and Scopus databases; the Agency for Healthcare Research and Quality, National Health System Indicator Portal, Joint Commission on Accreditation of Healthcare Organizations, and Organisation for Economic Co-operation and Development websites; and the National Quality Forum's measures inventory tool. Search terms included "quality indicator," "quality measure," "physiotherapy," and "physical therapy." Inclusion criteria were articles written in English, Spanish, French, or Portuguese aimed at measuring the quality of care in hospital physical therapy units. Evidence-based indicators with an explicit formula were extracted by 2 independent reviewers and then classified using the structure-process-outcome model, quality domain, and categories defined by a consensus method.

RESULTS

Of the 176 articles identified, only 19 met the criteria. From these articles and from the indicator repository searches, 178 clinical care indicators were included in the qualitative synthesis and presented in this paper. Process and outcome measures were prevalent, and 5 out of the 6 quality domains were represented. No efficiency measures were identified. Moreover, structure indicators, equity and accessibility indicators, and indicators in the cardiovascular and circulatory, mental health, pediatrics, and intensive care categories were underrepresented.

CONCLUSIONS

A broad selection of quality indicators was identified from international resources, which can be used to measure the quality of physical therapy care in hospital units.

IMPACT

This review identified 178 quality of care indicators that can be used in clinical practice monitoring and quality improvement of hospital physical therapy units. The results highlight a lack of accessibility, equity, and efficiency measures for physical therapy units.

The Cost of Not Training a Surgical Resident

OBJECTIVE

To quantify surgical trainees' direct financial impact on an academic medical center (AMC) by modeling the cost of replacing them.

DESIGN

The authors developed a model that estimates the financial costs to an AMC if surgical residents were replaced with surgical first assistants (SFAs) and physician assistants (PAs).

SETTING

One AMC providing tertiary level clinical care.

PARTICIPANTS

The model accounts for the training, work hours, and salary differential of residents, as well as other factors that are specific to education and support of residents, SFAs, and PAs.

RESULTS

After accounting for the expenses of surgical residents and the replacement providers in our model, the authors determined that the net cost of replacing 30 surgical residents with PAs and SFAs at one institution is $1,728,628 or $57,621 annually per resident.

CONCLUSIONS

Without considering other larger and arguably more important issues of educational value or population needs, we provide a reproducible model of financial considerations regarding residents in an AMC. The costs (and foregone benefits) of not training residents may provide additional support for the funding of graduate medical education and finding the optimal balance of graduate medical education and other providers.

Characteristics of the ideal hospitalist inpatient care program: perceptions of Canadian health system leaders

Background

Despite the growing prevalence of hospitalist programs in Canada, it is not clear what program features are deemed desirable by administrative and medical leaders who oversee them. We aimed to understand perceptions of a wide range of healthcare administrators and frontline providers about the implementation and necessary characteristics of a hospitalist service.

Methods

We conducted semi-structured interviews with a range of administrators, medical leaders and frontline providers across three hospital sites operated by an integrated health system in British Columbia, Canada.

Results

Most interviewees identified the hospitalist model as the ideal inpatient care service line, but identified a number of challenges. Interviewees identified the necessary features of an ideal hospitalist service to include considerations for program design, care and non-clinical processes, and alignment between workload and physician staffing. They also identified continuity of care as an important challenge, and underlined the importance of communication as an important enabler of implementation of a new hospitalist service.

Conclusions

Most hospital administrators and frontline providers in our study believed the hospitalist model resulted in improvements in clinical processes and work environment.

[Cancellations of Elective Surgeries on the Day of the Operation in a Portuguese Hospital: One Year Overview]

INTRODUCTION

Cancellations of elective operations on the day of the surgery reflect the efficiency and quality within organisations, and have a significant clinical, social and economic impact, not only for the patient and their families, but also for healthcare institutions. This study assesses the extent of these cancellations in one public Portuguese hospital, through case quantification and identification of the causes, origin, as well as its predictability according to the sociodemographic variables of the patient and interventions used to decrease it.

MATERIAL AND METHODS

Non-experimental descriptive quantitative methodology - longitudinal and retrospective - of operation cancellation cases on the day of the surgery, from the 1st of January to the 31st of December 2018.

RESULTS

The rate of cancellations of elective surgeries on the same day of the operation was 2.9% with variations among different surgical specialties; cancelled operations are more frequent in female patients, in patients aged between 50 and 80 years old, physical status classified as II or III according to the American Society of Anesthesiology, and without anaesthetic pre assessment or preoperative consultations; the three most relevant causes for cancellations are: lack of operative time, scarcity of beds and/or medical equipment, and changes in health status; most of which can be avoided and are the responsibility of the institution.

DISCUSSION

Different reasons for cancellation of elective operations reflect a variety of upstream and downstream processes causing cancellation of surgeries and whose origin/imputability is related to both the institution and patients.

CONCLUSION

The rate of cancellations of elective surgeries on the same day of the operation is relatively low, but the causes are often preventable, thus justifying the generalization of cancellation reduction strategies.

[Projection in the health sector 2018-2024, analysis and consequences]

Health is not only a biological condition; it is configured as a social, cultural and legal good that the state can´t promote, improve or protect without the participation of health professionals, states and educational and research institutions; but, above all, it must have the active intervention of all citizens. The aim is for services to be carried out with equity, quality and social protection.

Care Variation Reduction Going Nowhere? Used Strategically, a HEIP Might Help

HEIP stands for hospital efficiency improvement program. It is a legal contract outlining specific initiatives where physician-driven variance can be improved across specialties and departments. For organizations with a good strategy to reduce care variation, a HEIP can provide the jolt of incentive that generates real improvement.

Usability Evaluation of Three Admission and Medical Records Subsystems Integrated into Nationwide Hospital Information Systems: Heuristic Evaluation

Introduction:

Usability is one of the quality criteria for information systems and its weakness is one of the main barriers to the adoption of these systems. The purpose of this study was to evaluate the usability of admission and medical records module of three widely used hospital information systems (HISs).

Methods:

In this descriptive study the usability of admission and medical records module of three HISs (HIS1, HIS2, and HIS3) was evaluated using heuristic evaluation method. For each HIS, three expert users of the same system assessed the user interface independently, completed a usability evaluation checklist, and rated severity of each identified problem. The checklist was based on Nielsen’s heuristics. For each HIS, three heuristics that have the highest and lowest problem rates and greatest severity of problems were categorized into three separate groups. The results were analyzed using descriptive statistics.

Results:

Although HIS1 and HIS2 were used in more hospitals than HIS3, the results showed that the usability problem rates of them were significantly higher than HIS3. The heuristics of “help and documentation”, “flexibility and efficiency of use”, and “visibility of system status” in the three HISs were categorized into the “highest rate of problems”, “lowest rate of problems”, and “highest severity of problems” groups, respectively. The heuristics of “diagnose and recover from errors”, “error prevention”, and “help and documentation” in HIS1 and HIS2 were categorized into the “highest rate of problems” group.

Conclusions:

The results of this study and previous studies show that the most common usability problems with HISs are related to heuristics of “help and documentation”, “error prevention”, and “help users recognize, diagnose and recover from errors.” Also, the large number of hospitals using one HIS does not demonstrate its high usability to others.

A Survey of Managers' Access to Key Performance Indicators via HIS: The Case of Iranian Teaching Hospitals

BACKGROUND

The challenges of using health information systems in developing countries are different from developed countries for various reasons such as infrastructure and data culture of organizations.

OBJECTIVE

The aim of this study is to assess managers' access to key performance indicators (KPI) via Hospital Information System (HIS) in teaching hospitals of Iran.

METHODS

All managers (Census method) of the four teaching hospitals affiliated to Hormozgan University of Medical Sciences (HUMS) were included in this study. KPIs which are linked to the strategic objectives of organizations were adopted from the strategic plan of HUMS. The questionnaire used in this study included three categories: Financial, Human Resources and clinical. One-sample t-test was used and the significant difference score was calculated for the acceptable level.

RESULTS

We found that HIS cannot facilitate access to KPIs for managers in the main categories, but it was effective in two subcategories of income (p = 0.314) and salary (P = 0.289)).

CONCLUSION

A study of barriers to the use of managers of HIS in hospitals is suggested.

E-HOSPITAL - A Digital Workbench for Hospital Operations and Services Planning Using Information Technology and Algebraic Languages

In this paper, we describe the development of a unified framework and a digital workbench for the strategic, tactical and operational hospital management plan driven by information technology and analytics. The workbench can be used not only by multiple stakeholders in the healthcare delivery setting, but also for pedagogical purposes on topics such as healthcare analytics, services management, and information systems. This tool combines the three classical hierarchical decision-making levels in one integrated environment. At each level, several decision problems can be chosen. Extensions of mathematical models from the literature are presented and incorporated into the digital platform. In a case study using real-world data, we demonstrate how we used the workbench to inform strategic capacity planning decisions in a multi-hospital, multi-stakeholder setting in the United Kingdom.