Hospital administration

This article reports an evidence-based practice project using the Iowa Model of Evidence-Based Practice to Promote Quality Care for a common nursing procedure, nasogastric tube placement verification in children. Little research exists regarding the care of nasogastric tubes in children, and traditional verification methods prevail. Auscultation of air insufflation over the abdomen is still used to check placement in many settings, despite research dating back to the 1980s questioning this approach. X-ray remains the only certain way to verify placement, but getting an X-ray before each feeding would be costly and impractical. Additional bedside methods are needed. Project results demonstrate a decrease (93.3% to 46.2%) in the use of auscultation and improved use of other, more reliable methods to determine nasogastric tube placement. Changing practice can be challenging. However, with persistence and re-infusion, this project provides an important example of how the evidence-based ...

Our objective is to determine the effect of ownership type (for-profit, not-for-profit, government) on firm conduct in hospital markets. Secondary objectives include estimating hospital demand systems useful for market definition and merger simulation. To this end, we estimate a structural model of demand and pricing in the short term hospital industry in California, and then use the estimates to simulate the effect of a merger. Demand is modeled at the level of individual consumers using discrete choice techniques and micro data on individuals. Price in the demand equation is endogenous, and we use recently developed instrumental variables techniques to correct for this. We allow the behavior of for-profit and not-for-profit firms to differ, modeling these differences structurally following the relevant theory literature. We find that California hospitals in 1995 faced a downward-sloping demand for their products, with an average price elasticity of demand of-5.67. Not-for-profit hospitals face less elastic demand and have lower marginal costs. Their prices are lower, but markups are higher than those of for-profits. We simulate the effects of the 1997 merger of two hospital chains. In unconcentrated markets such as Los Angeles and San Diego, the merger has virtually no effect on prices. However, in San Luis Obispo County, where the merger creates a near monopoly, prices rise by up to 58%, and the predicted price increase would not be substantially smaller were the chains to be not-for-profit.

Regression to the mean (RTM) is a widespread statistical phenomenon. It is a group phenomenon that occurs whenever an extreme group is selected from a population based on the measurement of a particular variable. If a second measurement is then taken for the same group, the second mean will be closer to the population mean than the first measurement. This decrease (or increase) can be mistakenly attributed to a treatment effect; the conclusion can be drawn that an effect results from treatment when it in fact results from chance. Any intervention that is aimed at a group or characteristic that is very different from the average will appear to be successful because of RTM. It is therefore important that any genuine reductions because of the treatment are separated out from the effect of RTM. If the problem is ignored then this will lead to errors in the interpretation of results and, potentially, decisions made on the evidence of those results. This paper highlights the importance of the issue and its effects on many common clinical, public health and managerial decisions.

Objective: This review summarizes and synthesizes the evidence on follow-up activities regarding patient safety incidents reported in hospitals. Methods: Peer-reviewed papers were retrieved with electronic searches from CINAHL, Web of Science, PubMed and Scopus databases and with manual searches in most relevant journals and in the reference lists of included studies, limiting searches to papers published in English between 2014 and 2018. A systematic review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two authors extracted the data following a predefined extraction form. Results: All together 16 studies were selected for analysis. All studies described incidents and gave insight into problems, risks and unsafe situations which were responded to with recommended improvements. Recommended improvements in response to incidents involved guidelines, staff training, technical improvements and general safety improvements. ...

Haemovigilance was part of the reform of the French transfusion system. The haemovigilance network is now operational with approximately 4600 transfusion incidents reported annually. Immediate incidents observed within 8 days after transfusion account for 85 % of the reports. A cause cannot be identified in 41% of these, usually concerning minor clinical incidents with transient fever and /or shivers. An allergic reaction is described in 31% of transfusion reactions. Immunological conflicts account for 18% and bacteria associated transfusion reactions for 6%. The importance of bacteria associated transfusion reactions, the first identified cause of death associated with transfusion is one of the findings of haemovigilance. Improvement in the haemovigilance systems aims at obtaining better descriptions of transfusion incidents, standardisation of severity and imputability assessment and definitions of denominators such as the actual number of recipients. Delayed incidents will ultimately provide a true vision of post transfusion immunisation and infection The improvement of haemovigilance now considered as part of transfusion medicine practice is a continuous process. 01998 S. Karger AG, Basel 0042-9007/98/0746-044 1 S 1 5 .OO/O

Objective: Nursing is considered a growing profession worldwide, but nurses in developing world like Pakistan face challenges for their empowerment within and inter professions. The overwhelming feeling of being oppressed shatters nurses’ confidence and self-esteem and hinders their growth and development of the profession as well.Methods: To guide professional growth and empowerment of nursing in Pakistan, a qualitative descriptive study was aimed to discover challenges, strategies and outcomes of empowerment of nurse leaders in Pakistan. Twelve nurses serving as leaders in nursing organization of Pakistan, who fulfilled inclusive criteria were interviewed about their perception of the challenges, strategies and outcomes of empowerment for Pakistani nurses.Results and Conclusions: Nurses in Pakistan are facing great turbulence regarding their professional empowerment, but nursing leaders are striving hard at personal, institutional and government levels to help nurse understand the...

is one of the largest medical institutions in Latin America. The complete process of prescribing and distributing medication at HCFMRP involves the following stages: prescribing (physicians); ordering (infirmary); separating and dispensing (main drugstore); verifying and administering (infirmary). This was a manual process, normally taking place in the morning. Bottlenecks were inevitable and the risk of errors was elevated. An information system (IS) was devised and implemented with a view to controlling such problems. This article addresses the construction of this system and reports on a survey in which different groups of users have evaluated the project.

Background Accurate childhood cancer burden data are crucial for resource planning and health policy prioritisation. Model-based estimates are necessary because cancer surveillance data are scarce or non-existent in many countries. Although global incidence and mortality estimates are available, there are no previous analyses of the global burden of childhood cancer represented in disability-adjusted life-years (DALYs). Methods Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 methodology, childhood (ages 0-19 years) cancer mortality was estimated by use of vital registration system data, verbal autopsy data, and population-based cancer registry incidence data, which were transformed to mortality estimates through modelled mortality-to-incidence ratios (MIRs). Childhood cancer incidence was estimated using the mortality estimates and corresponding MIRs. Prevalence estimates were calculated by using MIR to model survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated by multiplying age-specific cancer deaths by the difference between the age of death and a reference life expectancy. DALYs were calculated as the sum of YLLs and YLDs. Final point estimates are reported with 95% uncertainty intervals. Findings Globally, in 2017, there were 11•5 million (95% uncertainty interval 10•6-12•3) DALYs due to childhood cancer, 97•3% (97•3-97•3) of which were attributable to YLLs and 2•7% (2•7-2•7) of which were attributable to YLDs. Childhood cancer was the sixth leading cause of total cancer burden globally and the ninth leading cause of childhood disease burden globally. 82•2% (82•1-82•2) of global childhood cancer DALYs occurred in low, low-middle, or middle Socio-demographic Index locations, whereas 50•3% (50•3-50•3) of adult cancer DALYs occurred in these same locations. Cancers that are uncategorised in the current GBD framework comprised 26•5% (26•5-26•5) of global childhood cancer DALYs. Interpretation The GBD 2017 results call attention to the substantial burden of childhood cancer globally, which disproportionately affects populations in resource-limited settings. The use of DALY-based estimates is crucial in demonstrating that childhood cancer burden represents an important global cancer and child health concern. Funding Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities (ALSAC), and St. Baldrick's Foundation.

Analysis of hospital efficiency determinants in Chile Background: The knowledge of variables influencing hospital efficiency is of paramount importance to carry out initiatives of management improvement and optimization. Aim: To explore on the hospital technical efficiency factors. Material and Methods: Data from 255,439 hospital discharges from 28 hospitals from May to October 2011 were analyzed. The efficiency index developed by Santelices et al was calculated. Proxy variables of hospital practices, human resource productivity, strategic performance, financing mechanisms, geographical territory and specialization, were considered. The analysis was carried out estimating econometric models. Results: The most significant variables to explain efficiency are the length of stay adjusted by complexity, the discharges per nurse and midwife and the performance of the Hospital Balanced Score Card. Conclusions: The suggested analysis contributes to identify hospital efficiency causes. The results suggest ways to improve performance of hospitals.

Using both graphical and geometric analyses, this paper examines the extent of inequity in healthcare finance among the Nigerian population. One of the acclaimed plans in healthcare in this teeming community is the mix method of financing but the system in practise is dominated with Object Oriented Programmings (OOPs) meanwhile the degree of income inequality still remain high. Using the Nigerian Living Standard Survey (NLSS) data conducted in 2004, the framework for this study relies on Kakwani Progressivity Index (KPI). A decomposition of the groups into lower and upper bound however, reveal that health payment for lower bound is regressive while payment for upper bound is progressive. Although, the upper bound result dominates the entire result which finally suggests a progressive system arising from the spending habit of the rich in seeking for healthcare services abroad.

Scheduling surgical specialties in a medical facility is a very complex process. The choice of schedules and resource availability impact directly on the number of patients treated by specialty, cancellations, wait times, and the overall performance of the system. In this paper we present a system-wide model developed to allow management to explore trade-offs between OR availability, bed capacity, surgeons’ booking privileges, and wait lists. We developed a mixed integer programming model to schedule surgical blocks for each specialty into ORs and applied it to the hospitals in a British Columbia Health Authority, considering OR time availability and post-surgical resource constraints. The results offer promising insights into resource optimization and wait list management, showing that without increasing post-surgical resources hospitals could handle more cases by scheduling specialties differently.

An appreciation of how human factors affect patient safety has led to development of safety climate surveys and recommendations that hospitals regularly assess safety attitudes among caregivers. A better understanding of variation in patient safety climate across units within hospitals would facilitate internal efforts to improve safety climate. A study was conducted to assess the extent and nature of variation in safety climate across units within an academic medical center. The Agency for Healthcare Research and Quality (AHRQ) Hospital Survey of Patient Safety was administered in 2008 to all nurses and attending physicians (N=4283) in a 900-bed acute care hospital (overall response rate, 69% [n=2961]). Responses were analyzed from the 2,163 physicians and nurses (73% of respondents) who could be assigned to one specific clinical unit. Results were examined for 57 units, categorized into six types. Ratings of various safety climate domains differed markedly across the 57 units, wit...

Background: although there is a wealth of information available about quality improvement tools and techniques in healthcare there is little understanding about overcoming the challenges of day-today implementation in complex organisations like hospitals. The 'Quality and Safety in Europe by Research' (QUASER) study will investigate how hospitals implement, spread and sustain quality improvement, including the difficulties they face and how they overcome them. The overall aim of the study is to explore relationships between the organisational and cultural characteristics of hospitals and how these impact on the quality of health care; the findings will be designed to help policy makers, payers and hospital managers understand the factors and processes that enable hospitals in Europe to achieve-and sustain-high quality services for their patients. Methods/design: in-depth multi-level (macro, meso and micro-system) analysis of healthcare quality policies and practices in 5 European countries, including longitudinal case studies in a purposive sample of 10 hospitals. The project design has three major features: • a working definition of quality comprising three components: clinical effectiveness, patient safety and patient experience • a conceptualisation of quality as a human, social, technical and organisational accomplishment • an emphasis on translational research that is evidence-based and seeks to provide strategic and practical guidance for hospital practitioners and health care policy makers in the European Union. Throughout the study we will adopt a mixed methods approach, including qualitative (in-depth, narrative-based, ethnographic case studies using interviews, and direct non-participant observation of organisational processes) and quantitative research (secondary analysis of safety and quality data, for example: adverse incident reporting; patient complaints and claims). Discussion: the protocol is based on the premise that future research, policy and practice need to address the sociology of improvement in equal measure to the science and technique of improvement, or at least expand the discipline of improvement to include these critical organisational and cultural processes. We define the 'organisational and cultural characteristics associated with better quality of care' in a broad sense that encompasses all the features of a hospital that might be hypothesised to impact upon clinical effectiveness, patient safety and/or patient experience.

Objective: The Danish hospital sector faces a significant rebuilding program driven by recent regional reform and guidelines for acute admission hospitals. Within the next 5-10 years, the number of public hospitals offering acute admission will be reduced from 35 to approximately 20 larger hospitals. As the administrative data may be biased during the middle of a restructuring process our objective was to analyze whether the configuration of Danish public hospitals was subject to economies of scale and scope prior to the restructuring plans. Methods: We estimated a quadratic cost function using panel data on the total costs for somatic treatment, casemix adjusted DRG-production values, and other cost drivers for the three years before the 2007 reforms. A short-run cost function was used to derive estimates of a long-run cost function by applying the envelope condition. Next, we estimated economies of scale and scope. Results: We identified moderate-to-significant economies of scale and scope. This indicates that the Danish hospital sector was characterized by unexploited gains from consolidation. Conclusions: Our results suggest that the proposed plans have the potential to result in hospitals that are more efficient. However, post-restructuring studies elsewhere show that the strategy of horizontal integration has failed.

This study used a qualitative research design to explore hospital policies and practices and the assumption of female heterosexuality. The assumption of heterosexuality is a product of discursive practices that normalize heterosexuality and individualize lesbian sexual identities. Literature indicates that the assumption of female heterosexuality is implicated in both the invisibility and marked visibility of lesbians as service users. This research adds to existing literature by shifting the focus of study from individual to organizational practices and, in so doing, seeks to uncover hidden truths, explore the functional power of language, and allow for the discovery of what we know and--equally as important--how we know.

Indonesia's current hospital bed to population ratio of 6.3/10,000 compares unfavourably with a global average of 30/10,000. Despite low hospital bed-to-population ratio and a significant "double burden" of disease, bed occupancy rates range between 55% -60% in both government and private hospitals in Indonesia, compared with over 80% hospital bed occupancy rates for the South-East Asian region. Annual inpatient admission in Indonesia is, at 140/10,000 population, the lowest in the South East Asian region. Despite currently low utilisation rates, Indonesia's Human Resources for Health Development Plan 2011-2025 has among its objectives the expansion of hospital bed numbers to 10/10,000 population by 2014. The authors examined the reasons for the paradox and analysed the following contributory factors; health system's shortcomings; epidemiological transition; medical tourism; high out-of-pocket payments; patronage of traditional medical practitioners, and increasing use of outpatient care. Suggestions for addressing the paradox are proposed.

Delirium, an acute decline in attention and cognition, occurs among hospitalized patients at rates estimated to range from 14% to 56% and increases the risk for morbidity and mortality. The purpose of this systematic review was to evaluate the effectiveness and safety of in-facility multicomponent delirium prevention programs. A search of 6 databases (including MEDLINE, EMBASE, and CINAHL) was conducted through September 2012. Randomized, controlled trials; controlled clinical trials; interrupted time series; and controlled before-after studies with a prospective postintervention portion were eligible for inclusion. The evidence from 19 studies that met

In this article, we outline a study method with which structural changes to clinical communication were achieved within a local intensive care unit (ICU). The study method involved in-depth, round-the-clock observation, interviewing, and video filming of how intensivists conducted their practices, as well as showing selected footage to the clinicians for feedback. This feedback component iteratively engaged clinicians in problem-solving their own communication difficulties. The article focuses on one such feedback meeting and describes changes to the morning ward round and planning meeting that this feedback process catalyzed: greater time efficiency, a greater presence of intensivists in the ICU, more satisfied nursing staff, and a handover sheet to improve the structure of clinical information exchanges. We argue that in embodying not a descriptive but an interventionist approach to health service provision, this video-ethnographic method has great significance for enhancing clinicians' and researchers' understanding of the rising complexity of in-hospital practices, and for enabling them to intervene in these practices.

Background: Very limited data have been published about the design of medication safety programmes in hospitals.

Objective: To describe a template for the structure and operation of a medication safety programme in an acute tertiary setting.

Methods/results: A model of an ideal medication safety programme was developed by combining the lessons learnt by the lead author in the role of medication safety officer in an acute teaching hospital for 7 years with the published accounts of best practice from the literature.

Conclusions: Given the limited guidance currently available regarding the structure and operation of such programmes, this template goes some way towards addressing a gap in the current patient safety literature. It should be of practical value to healthcare organisations considering either introducing a medication safety programme for the first time or expanding an existing system.

Hastane Organizasyon Yapısı
Hospital Organization Structure
Main administrative structure of hospitals
Medical committees of hospitals
Organization of medical services
Organization of paramedical services
Administrative, financial and support services in hospitals

Background: Patient care guidelines are usually implemented one at a time, yet patients are at risk for multiple, often preventable, adverse events simultaneously. Objective: This study aimed to test the effect of the SAFE or SORRY? programme on the incidence of three adverse events (pressure ulcers, urinary tract infections and falls). This paper describes Part I of the study: the effect on the incidence of adverse events. Design: A cluster randomised trial was conducted between September 2006 and November 2008. After a three-month baseline period the intervention was implemented followed by a nine-month follow-up period. Settings: Ten wards from four hospitals and ten wards from six nursing homes were stratified for institute and ward type and then randomised to intervention or usual care group. Participants: During baseline and follow-up, patients (18 years) with an expected length of stay of at least five days, were asked to participate. Methods: The SAFE or SORRY? programme consisted of the essential recommendations of guidelines for the three adverse events. A multifaceted implementation strategy was used for the implementation: education, patient involvement and feedback on process and outcome indicators. The usual care group continued care as usual. Data were collected on the incidence of adverse events and a Poisson regression model was used to estimate the rate ratio of the adverse events between the intervention and the usual care group at follow-up. Results: At follow-up, 2201 hospital patients with 3358 patient weeks and 392 nursing home patients with 5799 patient weeks were observed. Poisson regression analyses § This paper won the European Academy of Nursing Science's Rosemary Crow award 2010, sponsored by the International Journal of Nursing Studies. The award is open to current doctoral students or recent graduates of the academy's programme.

Patients with inadequate health literacy often have poorer health outcomes and increased utilization and costs. The Institute of Medicine has recommended that health literacy assessment be incorporated into health care information systems, which would facilitate large-scale studies of the effects of health literacy, as well as evaluation of system interventions to improve care by addressing health literacy. As part of the Health Literacy Screening (HEALS) study, a Brief Health Literacy Screen (BHLS) was incorporated into the electronic health record (EHR) at a large academic medical center. Changes were implemented to the nursing intake documentation across all adult hospital units, the emergency department, and three primary care practices. The change involved replacing previous education screening items with the BHLS. Implementation was based on a quality improvement framework, with a focus on acceptability, adoption, appropriateness, feasibility, fidelity and sustainability. Supp...

Participation in the Australian Council on Hospital Standards' accreditation program provides one of the important stimuli for change in Australian hospitals. This article analyses the impact of the accreditation program upon a random sample of 23 Australian hospitals which were monitored for two years. At the conclusion of the study, those hospitals which had applied for accreditation were compared and contrasted with those hospitals which had not applied. It was found that those hospitals which applied could be differentiated from those hospitals which had not by significant changes in six areas. The areas which showed the least change were those most directly associated with the medical staff. 'Nursing Organisation' and 'Physical Facilities and Safety' were the areas most affected by accreditation.

Objective: To describe the initial outcomes of an incentive driven medical home and navigation program on preventive services among healthcare system employees. Methods: Quasi-experimental design examining participation, use of preventive services and adherence to medical guidelines and emergency room use in a five hospital integrated health system. Employees were required to complete a health risk assessment (HRA), visit a Primary Care Provider (PCP) and submit PCP visit screening and biometric results in order to be eligible for the financial incentives. Subsidized lifestyle change intervention and navigation programs were also offered to participants. Descriptive statistics and Chi Square were used to analyze results for the 5,435 employee participants and 3,623 non-participants during thee 1-year intervention. Results: Preventive care visits for participants increased by 35% compared to an increase of 3% for non-participants. Nonadherence to medical guidelines decreased 7% for participants and increased 18% for non-participants. Inappropriate emergency room use overall decreased from 20% to 14%. Conclusions: One year after introduction of the wellness program, preventive visits increased, compliance with medical care increased and inappropriate emergency room visits were reduced.

Multiple factors contribute to the tendency to develop drug addictions, including social or psychological and occupational stressors. Most studies examining causes of and treatments for drug addiction have been conducted in Western developed nations. Here we used phenomenological research approach to explore the neurobiological explanation of drug addiction and to investigate attitudes towards drug use amongst individuals working with medical waste. Data were collected in Dhaka, the capital of Bangladesh, using a variety of techniques based on formal representative sampling for fixed populations and adaptive sampling for roaming populations. We found that over half of participants interviewed reported using illicit substances to cope with occupational stress. Self-reported disease symptoms related to stress were reported by most of the respondents. Working with horrifying waste contributes to increased stress among the participants. These results indicate that in the case of these workers, workplace stressors along with cultural and socio-economic context uniquely contribute to, and exacerbate, tendencies toward drug addiction.

The Latino Healthcare Professionals Project (LHPP) is a privately-funded initiative to provide healthcare management training to first-generation educated Latino bilingual and bicultural upper division university stu- dents planning careers in healthcare. This unique curriculum, scholar- ship, and mentorship program is based in the Healthcare Administration (HCA) Program at California State University Long Beach (CSULB). Initially funded by The Sisters of

The number of patients seeking complementary and alternative medicines combined with conventional treatments has grown considerably over the past decade. To meet the growing demand, a dedicated oncology integrative medicine program was initiated in the Beaumont Health System to address the needs of this patient population. Due to its resounding success and patient satisfaction, as evidenced by patient utilization and testimonials and physician referrals, the program was expanded across the healthcare system to every medical specialty. This study outlines how the program was implemented and its business model.

Workplace violence (WPV) is a serious threat to the nursing workforce. WPV results in decrease morale, job dissatisfaction, and increase nurse turnover and intentions to leave the profession. WPV has been associated with decrease in the quality of care rendered and could negatively affect patient safety. Given the direct and indirect financial consequences of WPV, it is critical that nursing leaders take actions to reduce WPV by establishing violence prevention programs. Nursing leaders should also reach out to the public, their professional health organization, and the scientific community to provide education and craft regulation to reduce this threat on the nursing workforce and change the perception that violence is part of the job.    

The benefits of day surgery are supported internationally by the provision of standards. However, standards from one health jurisdiction are not readily transferable to others as national health strategy, policy and funding are influencing factors.

By the close of the 19th century, there was a strong possibility that the Maori race might not survive, and the government was advised by a Dr Featherston: 'Our plain duty is to smooth down their dying pillow. Then history will have nothing to reproach us with' (Newman, 1881). Muskets, infectious diseases, alcohol and starvation contributed to the reduction of the population from an estimated 200 OOO (pre-European contact) to 42 OOO (1906 census). Dr Featherston's prediction may well have come true, had it not been for the energies and adaptability of a relatively small group of youthful Maori leaders who launched a revival movement that in 50 years turned the 'dying race' into a highly virile one. Today the Maori population is in excess of 390000, and makes up 12 per cent of the total population. It is youthful, over 65 per cent being under the age of 25 (non-Maori 40 per cent), but only 3.9 per cent over age 60 (non-Maori 14.9 per cent). Maori fertility is at a higher level (2.6) than that of non-Maori (1.9), and Maori babies make up over 13 per cent of all births.