MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Health Services Management' source. Thu, 29 Dec 2011 02:54:54 +0100 http://www.medworm.com/index.php?rid=5372396&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F4%2F213%3Frss%3D1 There is no single intervention that will trigger or ensure innovation in health care, as the interaction between the innovation and the context of its introduction is necessarily complex and variable. Although academic attention has recently turned to the role of organizations in promoting and embedding innovation, this literature remains light on prescription, and tends to ignore the issue of substitution and disengagement. Innovation needs to be adapted as well as adopted into organizational contexts and receptive climates for innovation can only be developed incrementally over time. This paper identifies recommendations for increasing the readiness of health-care organizations for innovation. Key organizational strategies for embedding innovation include: development of incentives; sop... Health Services Management journals http://www.medworm.com/rss/comments.php?id=5372396 Mon, 31 Oct 2011 04:00:00 +0100 5372396 http://www.medworm.com/index.php?rid=5372395&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F4%2F203%3Frss%3D1 This study examined how membership of well-structured teams was associated with lower levels of strain, when testing a work stressors-to-strains relationship model across the three levels of team structure, namely well-structured, poorly structured (do not fulfill all the criteria of well-structured teams) and no team. The work stressors tested, were quantitative overload and hostile environment, whereas strains were measured through job satisfaction and intention to leave job. This investigation was carried out on a random sample of 65,142 respondents in acute/specialist National Health Service hospitals across the UK. Using multivariate analysis of variance, statistically significant differences between means across the three groups of team structure, with mostly moderate effect sizes, w... Health Services Management journals http://www.medworm.com/rss/comments.php?id=5372395 Mon, 31 Oct 2011 04:00:00 +0100 5372395 http://www.medworm.com/index.php?rid=5372394&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F4%2F196%3Frss%3D1 This paper reports on a training programme using action learning sets designed to enhance the management abilities of health-care managers. Numerous independent reports in Australia, and around the world, have related the lack of management systems and processes to substandard health-care delivery. This has suggested a need for better approaches to the education, training and ongoing development of health-care managers, and this paper reports on an action learning approach trialled over a three-year period. Participant managers reported significantly greater levels of empowerment and self-efficacy after participation in the year-long action learning sets intervention. While too early to measure the translation of these reported individual improvements into specific management practice, the... Health Services Management journals http://www.medworm.com/rss/comments.php?id=5372394 Mon, 31 Oct 2011 04:00:00 +0100 5372394 http://www.medworm.com/index.php?rid=5372393&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F4%2F190%3Frss%3D1 The future health-care workforce and the changing skill-mix within occupational teams is a current topic of discussion. This paper contributes to the skill-mix debate by focusing on UK primary care dentistry, revealing unintended as well as intended consequences of a modularized, technocratic view of dentistry. In part one, relevant literature about dental therapists and skill-mix in dentistry is organized into a framework used to review factors operating at macro, meso and micro levels. Part two considers the role that education and training may play in realizing skill-mix change. Part three synthesizes conditions required for modifying skill-mix in UK primary dental care and sets out the dimensions of seven factors: funding focus, the profession's response, workforce, the practice, denti... Health Services Management journals http://www.medworm.com/rss/comments.php?id=5372393 Mon, 31 Oct 2011 04:00:00 +0100 5372393 http://www.medworm.com/index.php?rid=5372392&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F4%2F182%3Frss%3D1 The National Health Service (NHS) in England, as with other health services worldwide, currently faces the need to reduce costs and to improve the quality of patient care. Evidence gathered through effective and appropriate measurement and evaluation, is essential to achieving this. Through interviews with service improvement managers and analysis of comments in a seminar of NHS staff involved in health service improvement, we found a lack of understanding regarding the definition and methodology of both measurement and evaluation, which decreases the likelihood that NHS staff will be competent to commission or provide these skills. In addition, we highlight the importance of managers assessing their organizations' ‘readiness’ to undergo change before embarking on a quality imp... Health Services Management journals http://www.medworm.com/rss/comments.php?id=5372392 Mon, 31 Oct 2011 04:00:00 +0100 5372392 http://www.medworm.com/index.php?rid=5372391&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F4%2F170%3Frss%3D1 This study invites further research to explore, implement and evaluate intervention strategies for prevention of occupational stress and improvement in QWL (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=5372391 Mon, 31 Oct 2011 04:00:00 +0100 5372391 http://www.medworm.com/index.php?rid=5372390&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F4%2F163%3Frss%3D1 This study utilized data collected between January 2007 and June 2008 from 32 hospitals representing a large, national private not-for-profit hospital system. The patient satisfaction survey included the Consumer Assessment of Healthcare Providers and Systems, Hospital version questionnaire items, and there are 31,471 cases. Two-stage multiple linear regression analyses were conducted with control variables (age, gender, perceived health, education and race). It was found that patients' highest priority is to be treated with courtesy and respect by nurses and physicians. An effective intervention programme to improve patient satisfaction would include a training programme, where care providers understand that patients want them to show courtesy and respect. Then, well-trained and empatheti... Health Services Management journals http://www.medworm.com/rss/comments.php?id=5372390 Mon, 31 Oct 2011 04:00:00 +0100 5372390 http://www.medworm.com/index.php?rid=5372389&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F4%2F161%3Frss%3D1 (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=5372389 Mon, 31 Oct 2011 04:00:00 +0100 5372389 http://www.medworm.com/index.php?rid=5123691&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F3%2F151%3Frss%3D1 The purpose of this study is to review the literature that discusses the relationship between strategic group membership and performance in the nursing home industry. This literature review examines the relationship between organizational structure and performance in the nursing home industry. Results from these studies suggest industry stability of segmentation; limitation of strategic choice due to high mobility barriers (as represented by facility, staffing and location variables); quality is controlled by the existing combinations of industry regulation and market competition; and the existence of performance differences among strategic groups. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=5123691 Thu, 11 Aug 2011 23:00:00 +0100 5123691 http://www.medworm.com/index.php?rid=5123690&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F3%2F142%3Frss%3D1 The purpose of this research was to consider why absenteeism in Health and Social Care is so high and to suggest proactive changes in organization activity to address this. The research took a multimethod approach with a quantitative emphasis; there were three parts: (i) quantitative survey questionnaire; (ii) analysis of absenteeism and related secondary data; and (iii) qualitative data from other questions in survey and discussion groups. The quantitative emphasis in the research is appropriate, given the gap identified in the literature. Perceived limitations are that the study considers just one part of the overall system. The research indicates that managers underestimate staff absence levels and almost half believe absenteeism cannot reduce. Professional managers were more negative a... Health Services Management journals http://www.medworm.com/rss/comments.php?id=5123690 Thu, 11 Aug 2011 23:00:00 +0100 5123690 http://www.medworm.com/index.php?rid=5123689&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F3%2F130%3Frss%3D1 Conclusions For many specialties, specialists do vary physician direct patient care utilization with patient overall illness burden. Accounting for patient overall health status is important to fairly compare specialists of certain specialties on utilization for health plan specialist network management. Additional study is required to evaluate health plan application of this methodology. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=5123689 Thu, 11 Aug 2011 23:00:00 +0100 5123689 http://www.medworm.com/index.php?rid=5123688&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F3%2F121%3Frss%3D1 This study provides empirical evidence that show how the dual roles of the moderator and mediator manipulated together by satisfaction, work to affect purchase intentions in hospital settings. In addition, the relationships between service quality and satisfaction are also clarified. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=5123688 Thu, 11 Aug 2011 23:00:00 +0100 5123688 http://www.medworm.com/index.php?rid=5123687&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F3%2F114%3Frss%3D1 This study demonstrates a persuasive linkage between assessed levels of Medical Engagement in secondary care organizations and independently gathered performance measures. Implications of executive leaders in promoting engagement are explored. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=5123687 Thu, 11 Aug 2011 23:00:00 +0100 5123687 http://www.medworm.com/index.php?rid=5123686&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F3%2F107%3Frss%3D1 A number of office system tools have been developed to improve the rates of preventive services and enhance the quality of medical care in practice settings. New approaches to measuring physician adherence to evidence-based standards of treatment, offer a unique opportunity to examine the link between the use of office system tools and evidence-based practices in primary care. Using episode-based profiling measures of adherence as the criterion, results from this investigation suggest that the application of simple physician reminders can be an effective technique for promoting evidence-based treatment. The data also reveal that the influence of health information technology (HIT) resources on adherence was not exclusively positive. Specifically, adherence to evidence-based standards was h... Health Services Management journals http://www.medworm.com/rss/comments.php?id=5123686 Thu, 11 Aug 2011 23:00:00 +0100 5123686 http://www.medworm.com/index.php?rid=4681795&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F2%2F96%3Frss%3D1 An inadequate supply of primary care providers is leading to a crisis in access. Pressures are being placed on primary care practices to increase panel sizes. The impact of these pressures on clinical processes, patient satisfaction and waiting times is largely unknown, although evidence from recent literature shows that longer waiting time results in higher mortality rates and other adverse outcomes. FY2004, Department of Veterans Affairs primary care patient data are used. GLIMMIX and other generalized linear model models illustrate how expanded panel sizes are correlated with clinical process indicators, patient satisfaction and waiting times, controlling for practice, provider and patient characteristics. We generally find that larger panel sizes are related to statistically significan... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4681795 Tue, 05 Apr 2011 23:00:00 +0100 4681795 http://www.medworm.com/index.php?rid=4681794&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F2%2F91%3Frss%3D1 This paper explores the health care complaints handling reforms enacted in Britain, Australia and Taiwan. A documentary search for policy documents, reports and studies related to the reforms of the health care complaints handling system was conducted. A keyword search was performed within PubMed and ProQuest for the period 1985–2009 to identify relevant articles. The study found that the major difference in health care complaints handling systems between countries, is the mechanism for running a complaints system. Both Britain and Australia have attempted to incorporate patient complaints into their national quality systems. Their intention was to set up mechanisms to create an effective bridge, at a national policy level, between the patient complaints management system and the qua... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4681794 Tue, 05 Apr 2011 23:00:00 +0100 4681794 http://www.medworm.com/index.php?rid=4681793&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F2%2F81%3Frss%3D1 Observations of surgical teams in the operating room (OR) and interviews with surgeons, circulating registered nurses (RNs), anaesthesiologists and surgical technicians reveal the importance of leadership, team member competencies and an enacted environment that encourages feelings of competence and cooperation. Surgical teams are more loosely coupled than intact and bounded. Team members tend to rely on expected role behaviours to bridge lack of familiarity. While members of the surgical team identified technical competence and preparation as critical factors affecting team performance, they had differing views over the role behaviours of other members of the surgical team that lead to surgical team performance. Observations revealed that the work climate in the OR can shape interpersonal... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4681793 Tue, 05 Apr 2011 23:00:00 +0100 4681793 http://www.medworm.com/index.php?rid=4681792&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F2%2F75%3Frss%3D1 Hospitals have been at the core of health care in most countries during past decades, in view of the importance and criticality of their services and absorbing the highest quota of health care financial resources. Specific problems associated with these organizations in developing countries, such as Iran, have further added to the attention they have received over the course of those years. Efficiency measurement of hospitals based on simple ratios has long been utilized to remedy these problems in Iran. However, application of data envelopment analysis as an advanced method for measuring efficiency of health care organizations is mostly unexplored in this country. The current study has applied this method to investigate technical efficiency of a group of provincial hospitals in Iran. The ... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4681792 Tue, 05 Apr 2011 23:00:00 +0100 4681792 http://www.medworm.com/index.php?rid=4681791&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F2%2F69%3Frss%3D1 This study examines scalable office-based health care for small business, where health care is delivered to the office floor. This delivery was tested in 18 individuals at a small business in Minneapolis, Minnesota. The goal was to deliver modular health care and mitigate conditions such as diabetes, hyperlipidaemia, obesity, sedentariness and metabolic disease. The modular health care system was welcomed by employees – 70% of those eligible enrolled. The findings showed that the modular health care deliverable was feasible and effective. The data demonstrated significant improvements in weight loss, fat loss and blood variables for at risk participants. This study leaves room for improvement and further innovation. Expansion to include offerings such as physicals, diabetes managemen... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4681791 Tue, 05 Apr 2011 23:00:00 +0100 4681791 http://www.medworm.com/index.php?rid=4681790&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F2%2F60%3Frss%3D1 This paper examines the quality and consistency of postregistration training and development for extended role activities undertaken by radiographers. Although the undergraduate curriculum has changed to some extent to accommodate expanded role requirements, much of the training does not, and cannot, take place until radiographers are qualified and are in post. While undergraduate programmes in radiography must be approved by the Health Professions Council, and are normally accredited by the radiographers’ professional body, the Society and College of Radiographers, much of the training provided for extended role activities is ad hoc and neither validated nor accredited. This paper reports the outcomes of a survey of imaging service managers and follow-up interviews with imaging serv... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4681790 Tue, 05 Apr 2011 23:00:00 +0100 4681790 http://www.medworm.com/index.php?rid=4681789&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F2%2F55%3Frss%3D1 This study shows no relationship between skill variety and psychological empowerment. With respect to demographics, age, work experience and tenure have an impact on psychological empowerment. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=4681789 Tue, 05 Apr 2011 23:00:00 +0100 4681789 http://www.medworm.com/index.php?rid=4423047&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F1%2F45%3Frss%3D1 This study aims to understand how mental health networks have been assembled in this context and the factors and motivations that have shaped their scope. By combining an analysis of policies with a survey of DMH directors, we have determined that DMHs have preferentially formed collaborative relationships with social service providers (local governments) and the voluntary sector. In contrast, relationships with substance abuse and addiction services and primary care providers were weak and stifled by a lack of trust and by conflict about respective contributions to mental care. We explore the reasons for this selectivity in interorganizational relationships and propose that a lack of targeted incentives in policy guidelines, on the one hand, and the existence of a mandated network leaders... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4423047 Tue, 01 Feb 2011 00:00:00 +0100 4423047 http://www.medworm.com/index.php?rid=4423046&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F1%2F37%3Frss%3D1 This paper develops a model that enables the health administrator to identify the balance that minimizes the projected cost of holding cash. Adopting the principles of mathematical expectation, the model estimates the expected total costs of adopting each of the several strategies concerning the cash balance that the organization might maintain. Expected total costs consist of anticipated short costs, resulting from a potential shortage of funds. Long costs are associated with a potential surplus of funds and an opportunity cost represented by foregone investment income. Of importance to the model is the potential for the health service organization to realize a surplus of funds during periods characterized by a net cash disbursement. The paper also develops an interactive spreadsheet that... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4423046 Tue, 01 Feb 2011 00:00:00 +0100 4423046 http://www.medworm.com/index.php?rid=4423045&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F1%2F29%3Frss%3D1 We examined the relationship between patient visit experience, cost perceptions and the two important aspects of quality of care, curing and interpersonal performance, and patients' loyalty to the hospital physicians. A total of 404 patients from an acute care hospital in Taiwan, Kaohsiung Medical University Hospital (KMUH), were investigated using a self-administered mailing survey. All measures including patient loyalty (PL), curing service quality (CSQ), interpersonal service quality (ISQ), visit experience (VE) and perceived switching costs (PSC), were adapted and modified from existing scales. Our results showed that the physician's CSQ and ISQ positively affected patients' loyalty to KMUH. The interaction between the main effects of service quality, patients' VE and three types of sw... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4423045 Tue, 01 Feb 2011 00:00:00 +0100 4423045 http://www.medworm.com/index.php?rid=4423044&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F1%2F19%3Frss%3D1 The paper describes how Hospital Episode Statistics (HES) data can be retrospectively analysed over a number of years to evaluate and monitor organizational change in National Health Service (NHS) trusts. A methodology based on joinpoint regression analysis and management control theory has been developed which is able to represent in a framework (called an ‘activity map’) the complexity of HES data in a more user-friendly way than the unwieldy and often overwhelming tables or spreadsheets that are typically utilized. The ‘activity map’ has been designed to provide a common frame of reference for health professionals from different backgrounds to visualize and interpret the actual patterns of hospital activity changes that have occurred over the years. The aim is to... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4423044 Tue, 01 Feb 2011 00:00:00 +0100 4423044 http://www.medworm.com/index.php?rid=4423043&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F1%2F8%3Frss%3D1 The purpose of the study was to estimate the demographic and socioeconomic determinants of utilization of the Greek primary and hospital health care services. Data were obtained from the cross-sectional nationwide household survey Hellas Health I (2006). The sample (N = 1005) was representative of the Greek adult population in terms of age and residency, and was selected by means of a three-stage, proportional-to-size sampling design. The presence of a family doctor was reported in a higher degree by participants of higher social classes and private insurance. After adjusting for self-perceived general health and chronic illness, contacts with health care professionals during the past four weeks were found less for residents of rural areas, while contacts with health care professionals dur... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4423043 Tue, 01 Feb 2011 00:00:00 +0100 4423043 http://www.medworm.com/index.php?rid=4423042&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F24%2F1%2F1%3Frss%3D1 This study investigates the initial effects of the government's prescription drug price reduction policies on outpatient hypertension treatment for the elderly in Taiwan. The National Health Insurance scheme has taken a number of steps in recent years to reduce drug prices. The data used in the study comprises the medical records of approximately 137,000 hypertension patients aged 65 and above. Regression analysis is used to determine whether the average cost of prescription drugs has declined as a result of the policy. In addition, the probit model is used to examine changes in physicians' prescribing behaviour for reduced-price and full-price drugs and the effect of drug substitution on health outcomes. We find that the average cost per prescription increased slightly despite the impleme... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4423042 Tue, 01 Feb 2011 00:00:00 +0100 4423042 http://www.medworm.com/index.php?rid=4185898&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F4%2F185%3Frss%3D1 The purpose of this research was to explore the effect work environment has on the intent to leave the profession for rural hospital bedside registered nurses (RNs). Subscales of autonomy, control over the practice setting, nurse–physician relationship and organizational support were incorporated into the analysis to determine which aspects of work environment directly affect the intent to leave the profession. An explanatory cross-sectional survey was distributed to 259 direct care bedside RNs employed at a rural system-affiliated hospital in Central Florida between February 2007 and June 2007. Anonymity was assured. A questionnaire containing demographic questions, the Nursing Work Index-Revised and Blau's intent to leave scale was distributed to all direct care nurses. A 32.8% res... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4185898 Fri, 19 Nov 2010 00:00:00 +0100 4185898 http://www.medworm.com/index.php?rid=4185897&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F4%2F181%3Frss%3D1 E-health, as well as its value and benefits, has been characterized as a concept defined in various ways depending on intended audience and use. Attempts to define, characterize and appreciate e-health inadvertently portray it as something out of main stream academia; thus, undermining the relevance and importance of the transformation capabilities of e-health on the practice of health care from the individual and organizational perspectives. In order to contribute towards an understanding and appreciation of e-health as a main stream concept, we propose the use of existing models, theories and principles in support of e-health. Specifically, the empowerment theory and the principles of quality health will be used to discuss the value proposition of e-health. An understanding of the e-heal... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4185897 Fri, 19 Nov 2010 00:00:00 +0100 4185897 http://www.medworm.com/index.php?rid=4185896&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F4%2F172%3Frss%3D1 In this paper, we aim to discuss the implications and lessons that can be learnt from the ongoing process of federalism affecting the Italian National Health System (INHS). Many countries are currently taking decisions concerning the decentralization or re-centralization of their health-care systems, with several key issues that are illustrated in the recent history of the INHS. The decentralization process of INHS has produced mixed results, as some regions took advantage of it to strengthen their systems, whereas others were not capable of developing an effective steering role. We argue that the mutual reinforcement of the decentralization and recentralization processes is not paradoxical, but is actually an effective way for the State to maintain control over the equity and efficiency o... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4185896 Fri, 19 Nov 2010 00:00:00 +0100 4185896 http://www.medworm.com/index.php?rid=4185895&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F4%2F166%3Frss%3D1 The primary health-care centre (PHCC) participating in the study has had financial problems for several years and it has been particularly difficult to recruit general practitioners (GPs). As a result, the access rate to the PHCC was low. The purpose of this study was to increase the access rate to the PHCC and to make the most efficient use of the staff by introducing a structured patient sorting system. All personnel were involved in the implementation process and participated regularly in interdisciplinary work-groups. A variety of Drop-in receptions were created and a manual for sorting patients by condition was introduced. The main finding was that the total access rate to the PHCC increased by 27% and that each staff member increased their personal access rate by an average of 13%. E... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4185895 Fri, 19 Nov 2010 00:00:00 +0100 4185895 http://www.medworm.com/index.php?rid=4185894&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F4%2F160%3Frss%3D1 This study examines the strategic planning models used by senior administrators to integrate diversity management for an institutional-wide agenda. A qualitative survey process was used for CEOs in the states of New York, Pennsylvania, New Jersey and Delaware. The key research questions dealt with what type of strategic plan approach senior administrators used for integrating diversity management and what rationale they used to pursue this. Significant differences were reported between three types of strategic plan modelling used by CEOs. Also, when comparing past and current practices over time, such differences existed. The need to integrate diversity management is underscored by this study. How senior hospital administrators apply strategic plan models and what impact these approaches h... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4185894 Fri, 19 Nov 2010 00:00:00 +0100 4185894 http://www.medworm.com/index.php?rid=4185893&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F4%2F154%3Frss%3D1 This study analysed the outstanding homogeneity of the German Diagnosis-Related Groups (G-DRG) using the reduction in variance (R2) of costs. Arbitrary increase in case groups, definition of additional charges and combination of several case groups in one DRG were considered as potential confounders. In 2009, the G-DRG-system offers an outstanding homogeneity with R2 of 83.5% in comparison to 2004 with R2 of 70.2%. The effect of an arbitrary increase in case groups is negligible. However, a simulation of the other confounders explains three-fourth of the increase in R2 between 2004 and 2009. The definition of additional charges attributes in particular to the outstanding homogeneity. The assessment of DRG-systems with R2 should be complemented with measures that are independent from a trim... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4185893 Fri, 19 Nov 2010 00:00:00 +0100 4185893 http://www.medworm.com/index.php?rid=4185892&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F4%2F147%3Frss%3D1 Our aim was to develop a tool to identify specific features of the business and financial management of practices that facilitate better quality care for chronic illness in primary care. Domains of management were identified, resulting in the development of a structured interview tool that was administered in 97 primary care practices in Australia. Interview items were screened and subjected to factor analysis, subscales identified and the overall model fit determined. The instrument's validity was assessed against another measure of quality of care. Analysis provided a four-factor solution containing 21 items, which explained 42.5% of the variance in the total scores. The factors related to administrative processes, human resources, marketing analysis and business development. All scores ... Health Services Management journals http://www.medworm.com/rss/comments.php?id=4185892 Fri, 19 Nov 2010 00:00:00 +0100 4185892 http://www.medworm.com/index.php?rid=3857304&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F3%2F139%3Frss%3D1 There is considerable international interest in the use of performance measurement and their public release in order to improve the quality of care. However, few studies have assessed stakeholders' awareness and use of performance data. Iranian hospitals have been graded annually since 1998 and hospital hotel charges vary by grade, but this system has never been evaluated. We conducted a cross-sectional survey of 104 outpatients at eight Teheran hospitals and 103 general practitioners (GPs) to assess the awareness of and attitudes towards hospital grading system. Only 5.8% of patients (95% CI: 1.3–10.3%) and 11.7% of GPs (95% CI: 5.5–17.9%) were aware of grading results. Patients' awareness was positively associated with their education level (P = 0.016). No patient used the gr... Health Services Management journals http://www.medworm.com/rss/comments.php?id=3857304 Wed, 11 Aug 2010 23:17:07 +0100 3857304 http://www.medworm.com/index.php?rid=3857303&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F3%2F128%3Frss%3D1 We present an empirically derived taxonomy of hospitals based on executive selection processes, structural and environmental characteristics, and organizational strategy based on the Porter framework. Based on the analyses, three types of hospitals are identified: (1) small, rural, cost leaders with limited selection processes; (2) large, urban, differentiators, with a plan; and (3) small, rural, caught in the middle muddlers. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=3857303 Wed, 11 Aug 2010 23:17:07 +0100 3857303 http://www.medworm.com/index.php?rid=3857302&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F3%2F121%3Frss%3D1 Delayed hospital discharges have been identified as a problem for the English National Health Service and have prompted several policy and service development responses in the last decade. However, bed-blocking is an issue surrounded by rival interpretations on how and why hospital delays occur and the way in which they are measured. To better understand this contested concept, this paper provides a brief description of the historical accounts that framed the emergence of delayed hospital discharges as a phenomenon. Three key features of the bed-blocking concept are also analysed: the reduction of patients' length of stay to improve efficiency, the intrinsic methodological difficulties of measuring hospital delays and the most common reasons for delayed discharges. A description of the cha... Health Services Management journals http://www.medworm.com/rss/comments.php?id=3857302 Wed, 11 Aug 2010 23:17:07 +0100 3857302 http://www.medworm.com/index.php?rid=3857301&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F3%2F116%3Frss%3D1 The aim of this study is to estimate the unexpected demand of Greek public hospitals. A multivariate model with four explanatory variables is used. These are as follows: the weekend effect, the duty effect, the summer holiday and the official holiday. The method of the ordinary least squares is used to estimate the impact of these variables on the daily hospital emergency admissions series. The forecasted residuals of hospital regressions for each year give the estimated stochastic demand. Daily emergency admissions decline during weekends, summer months and official holidays, and increase on duty hospital days. Stochastic hospital demand varies both among hospitals and over the five-year time period under investigation. Variations among hospitals are larger than time variations. Hospital ... Health Services Management journals http://www.medworm.com/rss/comments.php?id=3857301 Wed, 11 Aug 2010 23:17:07 +0100 3857301 http://www.medworm.com/index.php?rid=3857300&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F3%2F103%3Frss%3D1 To assess whether changes in length of wait are correlated (directly) with changes in size of list, i.e. whether census-, event- and enrolment-based estimates of the percentage that waited 0–2 months are valid measures. EyeNet Sweden supplied dates of extraction and enrolment for 1,061,246 cataracts extracted between 1992 and 2009 inclusive. Changes in size of list were calculated as enrolments minus extractions. Fifty-nine times out of 62 the enrolment-based measure reported an increase in length of wait when size of list increased or a decrease in length when size decreased (LB = 90%, 95% confidence interval = 80–100). But 47 times out of 62 the event-based measure reported a decrease in length of wait when size of list increased, or an increase in length when size decreased ... Health Services Management journals http://www.medworm.com/rss/comments.php?id=3857300 Wed, 11 Aug 2010 23:17:07 +0100 3857300 http://www.medworm.com/index.php?rid=3857299&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F3%2F97%3Frss%3D1 The aim of this study was to understand the environment of health care, and how clinicians and managers respond in terms of performance accountability. A qualitative method was used in a tertiary metropolitan teaching intensive care unit (ICU) in Sydney, Australia, including interviews with 15 clinical managers and focus groups with 29 nurses of differing experience. The study found that a managerial focus on abstract goals, such as budgets detracted from managing the core business of clinical work. Fractures were evident within clinical units, between clinical units and between clinical and managerial domains. These fractures reinforced the status quo where seemingly unconnected patient care activities were undertaken by loosely connected individual clinicians with personalized concepts o... Health Services Management journals http://www.medworm.com/rss/comments.php?id=3857299 Wed, 11 Aug 2010 23:17:07 +0100 3857299 http://www.medworm.com/index.php?rid=3510495&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F2%2F84%3Frss%3D1 This study identified the relationship between cost and risk factors of dialysis procedures for ESRD patients based on average variable costs for each dialysis treatment. The results show that certain risk factors (e.g. aged 75 and older, hypertension, bile-duct disease, cancer and high blood lipids) are associated with higher cost. The results from this study could enable health policy makers and the National Health Insurance Bureau to design a fairer and more convincible reimbursement system for dialysis procedures. This study also provides a better understanding of what risk factors play more influential roles in affecting ESRD patients to receive haemodialysis treatment. It will help policy makers and health-care providers in better control or even prevent the disease and manage the di... Health Services Management journals http://www.medworm.com/rss/comments.php?id=3510495 Tue, 27 Apr 2010 22:40:42 +0100 3510495 http://www.medworm.com/index.php?rid=3510494&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F2%2F76%3Frss%3D1 New public management accountability is increasingly being introduced into health-care systems throughout the world – albeit with mixed success. This paper examines the successful introduction of new management accounting systems among general practitioners (GPs) as an aspect of reform in the Italian health-care system. In particular, the study examines the critical role played by the novel concept of an ‘ethical budget’ in engaging the willing cooperation of the medical profession in implementing change. Utilizing a qualitative research design, with in-depth interviews with GPs, hospital doctors and managers, along with archival analysis, the present study finds that management accounting can be successfully implemented among medical professionals provided there is align... Health Services Management journals http://www.medworm.com/rss/comments.php?id=3510494 Tue, 27 Apr 2010 22:40:42 +0100 3510494 http://www.medworm.com/index.php?rid=3510493&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F2%2F66%3Frss%3D1 This study aimed to examine the trends and geographic variation of ACSC hospitalizations in US veterans health-care system, to identify factors associated with ACSC hospitalizations and to develop a quality indicator that can monitor access and effectiveness of primary care at hospital level. Using fiscal years 1997–2007 data, we found total ACSC hospitalizations per 1000 ACSC patients decreased by 58%; ACSC hospitalizations as percentage of total hospitalizations decreased 9%. However, significant geographic variations of ACSC hospitalizations remained and we found that adjustment of case-mix or confounding factors was essential in making meaningful comparisons among hospitals in a health-care system. Further, this study also reveals that low-income veterans still had higher ACSC ho... Health Services Management journals http://www.medworm.com/rss/comments.php?id=3510493 Tue, 27 Apr 2010 22:40:42 +0100 3510493 http://www.medworm.com/index.php?rid=3510492&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F2%2F60%3Frss%3D1 In conclusion, hospital managers are well advised to focus on improving nursing care first, and then staff care and environment in order to increase patient evaluation of hospital care and intention to recommend. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=3510492 Tue, 27 Apr 2010 22:40:42 +0100 3510492 http://www.medworm.com/index.php?rid=3510491&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F2%2F54%3Frss%3D1 The purpose of this exploratory study was to understand ‘hardiness’ as defined and operationalized by senior health executives, and to explore the options for increasing the hardiness of the health-care workforce. Previous research has shown that hardiness is important in the workplace as a means to reduce or avoid the negative impact of stress, which then has an association with the maintenance of individual health. Hardiness has been thought to play an important role in assisting health-care workers deal with emotional and stressful work environments. In depth interviews were conducted with senior managers in a Victorian health service to explore hardiness and determine whether the senior executives had identified hardiness as a factor related to performance, how they recogni... Health Services Management journals http://www.medworm.com/rss/comments.php?id=3510491 Tue, 27 Apr 2010 22:40:42 +0100 3510491 http://www.medworm.com/index.php?rid=3510490&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F2%2F47%3Frss%3D1 While there has been a recent squeeze on staff costs, it continues to be important to offer graduating clinical staff National Health Service (NHS) employment in order to maintain the long-term strength of the service. In addition, the experiences of the Canadian nursing profession suggest that complacency about an improving recruitment situation can lead to problems. Consequently, the objective of this study was to identify what influences allied health professionals' (AHPs) intention to work for the NHS. A postal survey was sent to members of four Allied Health Professions equally (N = 4800), targeting Stayers in, Leavers from, and Returners to, the NHS. One thousand nine hundred and thirty-nine questionnaires were returned giving an overall response rate of 40%. Stayers' intention to re... Health Services Management journals http://www.medworm.com/rss/comments.php?id=3510490 Tue, 27 Apr 2010 22:40:42 +0100 3510490 http://www.medworm.com/index.php?rid=3265928&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F1%2F42%3Frss%3D1 Data mining is highly profiled. It has the potential to enhance executive information systems. Such enhancement would mean better decision-making by management, which in turn would mean better services for customers. While the future of data mining as technology should be exciting, some are worried about privacy concerns, which make the future of data mining daunting. This paper examines why data mining is highly profiled – the imperative toward data mining, data mining models and processes. Additionally, the paper examines some of the benefits and challenges of using data mining processes within the health-care arena. We cast the future of data mining by highlighting two of the many data mining tools available – one commercial and one freely available. Subsequently, we discuss... Health Services Management journals http://www.medworm.com/rss/comments.php?id=3265928 Thu, 11 Feb 2010 23:07:45 +0100 3265928 http://www.medworm.com/index.php?rid=3265927&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F1%2F37%3Frss%3D1 The aim of this audit cycle is to measure the extent to which unregistered or wrongly classified studies (research, clinical audit, satisfaction surveys/service evaluations) are conducted within a National Health Service (NHS) Trust, and to ascertain whether promotion of the correct processes can improve the results. An anonymous questionnaire was sent to staff in a single NHS Trust via internal post and email concerning unregistered or wrongly classified studies being conducted. An information sheet was attached to the questionnaire, which gave a brief description and information relating to conducting different types of study. The audit was conducted before and after the introduction of a variety of promotional activities within the Research and Development (R&D) department. The perc... Health Services Management journals http://www.medworm.com/rss/comments.php?id=3265927 Thu, 11 Feb 2010 23:07:45 +0100 3265927 http://www.medworm.com/index.php?rid=3265926&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F1%2F30%3Frss%3D1 A lack of management capacity has been identified as the key stumbling block to attaining the goals of health for all in South Africa. As part of the overall management development process, this research aims to identify the skills that are important for health services management and to evaluate managers' self-assessed proficiency in each of these skills. We also examined the impact of past training on perceived competency levels. A cross-sectional survey using a self-administered questionnaire was conducted among 404 hospital managers in the South African public and private sectors. Respondents were asked to rate the level of importance that each proposed competency had in their job and to indicate their proficiency in each skill. Both public and private sector managers rated competencie... Health Services Management journals http://www.medworm.com/rss/comments.php?id=3265926 Thu, 11 Feb 2010 23:07:45 +0100 3265926 http://www.medworm.com/index.php?rid=3265925&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F1%2F25%3Frss%3D1 The Civil Contingencies Act (2004) requires UK primary care trusts (PCTs) to plan and respond to major health incidents. We carried out a cross-sectional survey of all PCTs in the north-west region of England using a telephone interview with a structured questionnaire. We assessed: (1) staff members responsible for emergency planning; (2) risk assessment; (3) training and exercises; and (4) the planned response to a major incident. Response rate was 61% (20/33). Twelve out of 20 employed an emergency planning officer. All responding PCTs had participated in a tabletop exercise in the previous year and nine of 20 in a live exercise in the previous three years. Nine provided major incident training to new staff. Fifteen had discussed major incident preparations with their local acute trust b... Health Services Management journals http://www.medworm.com/rss/comments.php?id=3265925 Thu, 11 Feb 2010 23:07:45 +0100 3265925 http://www.medworm.com/index.php?rid=3265924&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F1%2F18%3Frss%3D1 To demonstrate that the incomplete waits captured at the time and by means of a census may not have the same distribution as the completed waits captured as a result of admission during a specified calendar period, cataracts added to waiting lists in England, Scotland, Wales and Northern Ireland between 1 July 2003 and 31 December 2005, and admitted no more than two years after the date of their enrolment, were identified using Hospital Episode Statistics, Scottish Morbidity Records, the Admitted Patient Care database and the Hospital Inpatient System. Census- and event-based sampling produced two sets of records for each closed population in which the eventual outcome, and rules about suspension and deferral, were the same. The census-based sample (30 September 2005) yielded a smaller per... Health Services Management journals http://www.medworm.com/rss/comments.php?id=3265924 Thu, 11 Feb 2010 23:07:45 +0100 3265924 http://www.medworm.com/index.php?rid=3265923&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F1%2F12%3Frss%3D1 The study assessed the level of patient satisfaction at selected primary health-care facilities in Lori and Shirak provinces of Armenia. Self-administered questionnaires were distributed to 684 recent clients at primary health-care facilities. The majority of patients were satisfied with their provider (mean satisfaction score of 1.75 out of maximum 2). Most patients (89.0%) would visit the same provider again, and would recommend the provider to friends (85.6%). Satisfaction with other aspects of care, including waiting time, accessibility of services, confidentiality and cleanliness of the facility, was also high (mean score of 1.70 out of 2). Seventy-eight percent of respondents considered the care they received to be ‘excellent’ or ‘good’. The less educated and ... Health Services Management journals http://www.medworm.com/rss/comments.php?id=3265923 Thu, 11 Feb 2010 23:07:45 +0100 3265923 http://www.medworm.com/index.php?rid=3265922&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F1%2F5%3Frss%3D1 This study aims to investigate the nature and resolutions of patient complaints and further to explore the use of complaints to drive quality improvement in a selected hospital in Taiwan. A teaching hospital (i.e. the Case Hospital) in Taiwan was purposefully chosen for a case study. The author conducted the critical incident technique (CIT) using questionnaires to obtain information about the complaints and the process of their resolutions. To enhance the reliability of the study, the author also conducted non-participant observations as an outsider at the Case Hospital. In this study, 59 complainants registered 87 complaints. The CIT found that care/treatment, humaneness and communication were the most common causes of complaints. The response time of patient complaints averaged 1.76 day... Health Services Management journals http://www.medworm.com/rss/comments.php?id=3265922 Thu, 11 Feb 2010 23:07:45 +0100 3265922 http://www.medworm.com/index.php?rid=3265921&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F23%2F1%2F1%3Frss%3D1 This article shows how by speaking to the frontline staff, whose role it is to help people whose discharge is likely to be complex or problematic, they often have most insight into the solutions required to alleviate the situation. The learning in this article is that there is no one solution to improve the discharge process; however there are a number of small changes and improvements required, which if done consistently can have a significant impact. The findings here have been shared with Welsh government policy leads and health and social care executive teams to inform their planning and actions on how to resolve the challenge of reducing length of stay. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=3265921 Thu, 11 Feb 2010 23:07:45 +0100 3265921 http://www.medworm.com/index.php?rid=2942491&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F4%2F197%3Frss%3D1 Progress in research is dependent on many success factors. In this review, we evaluate the importance of effective scientific meetings to achieve this progress. We focus on aspects that determine effective communication, such as length, size, interpersonal interactions, structure, and variety of meetings or conferences. Furthermore, we introduce the technique of a Syntegration® that offers a new tool to communicate effectively among managers today. It is discussed whether this process can be a useful structure for research meetings and whether it has the potential to generate decision-making and goals within this field. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=2942491 Fri, 30 Oct 2009 00:09:30 +0100 2942491 http://www.medworm.com/index.php?rid=2942490&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F4%2F191%3Frss%3D1 The scope of this research has been to investigate the satisfaction of Greek patients hospitalized in a tertiary care university public hospital in Alexandroupolis, Greece, in order to improve medical, nursing and organizational/administrative services. It is a cross-sectional study involving 200 patients hospitalized for at least 24 h. We administered a satisfaction questionnaire previously approved by the Greek Health Ministry. Four aspects of satisfaction were employed (medical, hotel facilities/organizational, nursing, global). Using principal component analysis, summated scales were formed and tested for internal consistency with the aid of Cronbach's alpha coefficient. The non-parametric Spearman rank correlation coefficient was also used. The results reveal a relatively high degree ... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2942490 Fri, 30 Oct 2009 00:09:30 +0100 2942490 http://www.medworm.com/index.php?rid=2942489&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F4%2F184%3Frss%3D1 This paper evaluates the performance of 198 ambulatory surgery centres (ASCs) operating in the State of Pennsylvania during the fiscal year 2006. Performance is assessed from technical efficiency view using data envelopment analysis (DEA). Multi-input/output model included two inputs: number of operating rooms and labour, and patient surgical visits differentiated by age groups: 0–17, 18–64, 65+ as three outputs. Input oriented models were employed to assess various DEA efficiency models. Results show that about 48 (24%) of ASCs are efficient with a mean efficiency score of 0.60. The results also indicate that appropriate utilization of operating rooms and labour inputs are the main determinants of ASC efficiency. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=2942489 Fri, 30 Oct 2009 00:09:30 +0100 2942489 http://www.medworm.com/index.php?rid=2942488&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F4%2F176%3Frss%3D1 The purpose of this paper is to examine the utility of a qualitative ‘card sort’ research tool – when it is merged with traditional quantitative data gathering methods – to add to our understanding about the nature of competency-based approaches to leadership studies. The study demonstrates how a qualitative technique (card sort) was used for the task of testing a clinical leadership competencies model. All the steps in the card sort methodology are described through its application to the research problem. The paper concludes that card sort has considerable use in adding to the validity of research into the competency approach to leadership. The study reports only one single case. Therefore, the technique must be repeated to secure its validation as a testing techn... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2942488 Fri, 30 Oct 2009 00:09:30 +0100 2942488 http://www.medworm.com/index.php?rid=2942487&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F4%2F170%3Frss%3D1 An effective method of identifying operational factors that influence patient flow can potentially lead to improvements and thus have huge benefits on the efficiency of hospital departments. This paper presents a new inductive mixed-method approach to identify operational factors that influence patient flow through an accident and emergency (A&E) department. Preliminary explorative observations were conducted, followed by semi-structured interviews with key stakeholders. A questionnaire survey of all medical, nursing, porter and clerical staff was then conducted. The observations provided factors for further exploration: skill-mix, long working hours, equipment availability, lack of orientation programmes, inefficient IT use and issues regarding communication structures. Interviewees h... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2942487 Fri, 30 Oct 2009 00:09:30 +0100 2942487 http://www.medworm.com/index.php?rid=2942486&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F4%2F163%3Frss%3D1 In most industries of economy, the production structures evolved into activities characterized by a high division of labour between the business partners combined with specialization, the standardization of service components and extensive networking. In the health-care sector, the first signs of a similar development are beginning to crystallize. As a consequence, networkability, the ability to link up with other players on the basis of commonly agreed standards for the joint provisioning of patient-centred and cost-efficient health services will emerge to a key concept for future health service delivery. As not only technical but mainly organizational and behavioural issues are actually determining networkability of health-care organizations, a holistic model for analysis is needed. In t... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2942486 Fri, 30 Oct 2009 00:09:30 +0100 2942486 http://www.medworm.com/index.php?rid=2942485&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F4%2F158%3Frss%3D1 As Britain's population ages, health- and social-care systems face the challenge of continuing to provide high-quality care in the face of increased demand on services. Government policy has proposed meeting this challenge through integrated partnership working to enable people with complex, multiple needs to receive timely care closer to home. Co-morbid mental health needs, including dementia, are common in people with physical health issues, and must be addressed appropriately if systems are to provide the best possible all-round patient care. This paper describes how two senior clinical psychologists have developed an embedded living mental health resource within physical health care, and demonstrates how this has directly and positively impacted on both service performance indicators a... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2942485 Fri, 30 Oct 2009 00:09:30 +0100 2942485 http://www.medworm.com/index.php?rid=2942484&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F4%2F151%3Frss%3D1 The purpose of the research was to show how lean asset thinking can be applied to UK health-care facilities using different measures to compare the estates contribution to the business of health-care providers. The challenge to conventional wisdom matches that posed by ‘Lean Production’ to ‘Mass Manufacturing’. Data envelope analysis examined the income generated and patient-occupied area as outputs from the gross area of a NHS Trust's estate. The approach yielded strategic comparisons that conventional facilities management measures of cost per square metre hide. The annual cost of an excess estate is conservatively estimated at £600,000,000 (in England alone). Further research to understand the causes of the excess is needed. Meanwhile the research illustrat... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2942484 Fri, 30 Oct 2009 00:09:29 +0100 2942484 http://www.medworm.com/index.php?rid=2637097&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F3%2F140%3Frss%3D1 To gain and sustain competitive advantage, health-care providers have to continuously review and renovate their operational and information technology (IT) strategies through collaborative and cooperative endeavour with their supply chain channel members. This paper explores new ways of enhancing a health-care organization's responsiveness to changes and increasing its competitiveness through implementing strategic information technology alliances among channel members in a health-care supply chain network. An overview of issues and problems (e.g. bullwhip effect, negative externalities and free-riding phenomenon in multichannel supply chains) presented in the health-care supply chains is first delineated. This paper further goes over the issues of health-care supply chain coordination and... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2637097 Thu, 23 Jul 2009 23:00:00 +0100 2637097 http://www.medworm.com/index.php?rid=2637096&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F3%2F136%3Frss%3D1 This article lays out the challenges, highlights the impending issues and suggests a framework for moving forward. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=2637096 Thu, 23 Jul 2009 23:00:00 +0100 2637096 http://www.medworm.com/index.php?rid=2637095&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F3%2F129%3Frss%3D1 We present the key findings of the studies conducted in the National Health Services (NHS) trusts in England and Wales in 2006. These were a survey completed by risk managers for 351 trusts in England and Wales, three case studies including interviews with staff concerning an example of good practice feedback and an audit of 90 trusts clinical risk staff newsletters. We draw on an Expert Workshop that included 71 experts from the NHS, from regulatory bodies in health care, Royal Colleges, Health and Safety Executive and safety agencies in health care and high-risk industries (commercial aviation, rail and maritime industries). We draw recommendations of enduring relevance to the UK NHS that can be used by trust staff to improve their systems. The recommendations will be of relevance in gen... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2637095 Thu, 23 Jul 2009 23:00:00 +0100 2637095 http://www.medworm.com/index.php?rid=2637094&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F3%2F122%3Frss%3D1 This study aims to discover what these commitments are. From the research data, key individual and organizational commitments are identified. The individual commitments needed are (in rank order of significance): a personal commitment to the aim of the CoP; a commitment to knowledge-sharing with others; a commitment to knowledge-seeking from others; effective management of personal relationships with others in the CoP; and understanding of the roles of other members. At the organizational level, the commitments needed are a good fit between the purposes of the CoP and the aims of the organizations employing the CoP members, a commitment to research regarding the CoP's activities, sufficient funding of the work of CoP members, continuing practical and political support to the CoP and facili... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2637094 Thu, 23 Jul 2009 23:00:00 +0100 2637094 http://www.medworm.com/index.php?rid=2637093&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F3%2F115%3Frss%3D1 The paper describes the performance measurement system of the maternity pathway used in Tuscany by health care professionals, general managers and regional policy-makers. This system uses 19 indicators grouped in six dimensions: population's state of health; compliance with regional guidelines; efficiency and financial performance; clinical and health assessment; patient satisfaction; and employees' satisfaction. The results are represented on a spider diagram that summarizes the results on the different dimensions. The Tuscan performance measurement system of the maternity pathway has been used to identify best practice within, and their adoption throughout, the Tuscan public health care system. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=2637093 Thu, 23 Jul 2009 23:00:00 +0100 2637093 http://www.medworm.com/index.php?rid=2637092&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F3%2F101%3Frss%3D1 Many analysts characterize the health-care industry and health-care systems as complex adaptive organizations. New hybrid organizational forms are emerging that exhibit diverse relational-structural alliances between physicians, hospitals and/or insurers, over which administrators have limited control and restricted ability to predict or direct. Meeting the challenges in leading and managing health-care systems as complex adaptive organizations calls for additional competency in what theorists determine as ‘complex leadership’. This research study presents findings on complex leadership principles that augment those competencies that health-care administration education scholars recognize and recommend as necessary for future leaders in health care to master. The findings from ... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2637092 Thu, 23 Jul 2009 23:00:00 +0100 2637092 http://www.medworm.com/index.php?rid=2373533&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F2%2F92%3Frss%3D1 This longitudinal study sought to examine ways in which coaching and mentoring relationships impact on the professional development of nurses in terms of career and leadership behaviours, and evaluating the differences and similarities between those coaching and mentoring relationships. According to the UK government, leadership in nursing is essential to the improvement of service delivery, and the development and training of all nurses is vital in achieving effective change. A coaching and mentoring programme was used to explore the comparative advantages of these two approaches for the leadership development of nurses in acute, primary care and mental health settings. A longitudinal in-depth study was conducted to measure differences and similarities between the mentoring and coaching p... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2373533 Tue, 28 Apr 2009 04:00:00 +0100 2373533 http://www.medworm.com/index.php?rid=2373532&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F2%2F81%3Frss%3D1 Over the past few decades, there has been an increasing interest in the measurement of hospital efficiency in developing countries and in Iran. While the choice of measurement methods in hospital efficiency assessment has been widely argued in the literature, few authors have offered a framework to specify variables that reflect different hospital functions, the quality of the process of care and the effectiveness of hospital services. However, without the knowledge of hospital objectives and all relevant functions, efficiency studies run the risk of making biased comparisons, particularly against hospitals that provide higher quality services requiring the use of more resources. Undertaking an in-depth investigation regarding the multi-product nature of hospitals, various hospital functio... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2373532 Tue, 28 Apr 2009 04:00:00 +0100 2373532 http://www.medworm.com/index.php?rid=2373531&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F2%2F71%3Frss%3D1 One feature that characterizes the organization and delivery of health care is its inherent complexity. All too often, with so much information and so many activities involved, it is difficult for decision-makers to determine in an objective fashion an appropriate course of action. It would appear that a holistic rather than a reductionist approach would be advantageous. The aim of this paper is to review how formal systems thinking can aid decision-making in complex situations. Consideration is given as to how the use of a number of systems modelling methodologies can help in gaining an understanding of a complex decision situation. This in turn can enhance the possibility of a decision being made in a more rational, explicit and transparent fashion. The arguments and approaches are illus... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2373531 Tue, 28 Apr 2009 04:00:00 +0100 2373531 http://www.medworm.com/index.php?rid=2373530&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F2%2F62%3Frss%3D1 Few studies have investigated the effect of health-care facility ownership on the relationship between patient stressors and coping strategies. The purpose of this study was to investigate whether haemodialysis (HD) patient stressors and coping strategies differ by type of health-care facility ownership, and whether such ownership has a cross-level moderating effect between stressors and coping strategies. We used the Haemodialysis Stressor Scale and the Jalowiec Coping Scale; primary data were collected by interviewing 2642 HD patients 15 years or older on dialysis for at least three months from 27 HD centres. One-way analysis of variance and hierarchical linear modelling were used to attain the research purposes. HD patients from religious-based hospitals had higher stress related to the... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2373530 Tue, 28 Apr 2009 04:00:00 +0100 2373530 http://www.medworm.com/index.php?rid=2373529&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F2%2F51%3Frss%3D1 This paper reports the results of a state-level comparison of the performance of nursing homes. The results were obtained by applying data envelopment analysis (DEA) to data (obtained from OSCAR, the online survey, certification and reporting database [2004]) for all the skilled nursing facilities in each of the 50 states and the District of Columbia. DEA produces an efficiency score for each state that can serve as a single comprehensive measure of its overall performance. However, two DEA models were used in the analysis reported here so that each state could be given two efficiency scores, one for each of the two aspects of their performance – quality efficiency and operating efficiency. Eleven states were identified as being 100% efficient for both quality and operating efficienc... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2373529 Tue, 28 Apr 2009 04:00:00 +0100 2373529 http://www.medworm.com/index.php?rid=2148162&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F1%2F39%3Frss%3D1 We present a new methodology to measure cream skimming by hospitals. Our approach also provides a measure of a hospital's gain in productive efficiency by caring for patients with lower illness severity. Using a panel of Washington state hospitals, we find evidence that hospitals do practice cream skimming. However, we find little evidence to suggest that cream skimming varies by hospital size, profit status or time. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=2148162 Fri, 30 Jan 2009 05:00:00 +0100 2148162 http://www.medworm.com/index.php?rid=2148161&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F1%2F33%3Frss%3D1 The benefits of community partnerships have been well established in the health service literature. However, measuring these benefits and associated outcomes is relatively new. This paper presents an innovative initiative in the application of a balanced scorecard framework for measuring and monitoring partnership activity at the community level, while adopting principles of evidence-based practice to the partnership process. In addition, it serves as an excellent example of how organizations can apply scorecard methodology to move away from relationship-based partnerships and into new collaborations of which they can select – using a formal skill and competency assessment for partnership success. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=2148161 Fri, 30 Jan 2009 05:00:00 +0100 2148161 http://www.medworm.com/index.php?rid=2148160&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F1%2F27%3Frss%3D1 The aim of this research has been to make a contribution to deliberations concerning the relative costs of provision of domiciliary services for the elderly in local authorities in England and the implications for funding. The main services considered have been day-centre services and home-care services, and the particular cost areas investigated have been travel-related costs as associated with distances travelled by day-centre vehicles and care workers and with worker travelling hours. These costs are influenced by the population settlement and dispersion characteristics of the areas served and funding mechanisms are needed (and are in place) to compensate service providers. However, current mechanisms have been widely criticized and the research reported here reaches conclusions about w... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2148160 Fri, 30 Jan 2009 05:00:00 +0100 2148160 http://www.medworm.com/index.php?rid=2148159&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F1%2F17%3Frss%3D1 The objective of this study was to describe the development, utilization and utility of an ongoing evaluation of a system of coordinated services to persons living in two naturally occurring retirement communities (NORCs). The evaluation system includes service provision, service utilization and client satisfaction. It identifies trends in provided services and determines how services are utilized. A continuous monitoring system for reporting and quality improvement was developed with the four service agencies associated with the service provision system. The monthly data from each agency are compiled and distributed in the form of a report. The evaluation project was successful in tailoring the reporting system to each agency. Multiple issues arose with staff compliance in utilization of ... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2148159 Fri, 30 Jan 2009 05:00:00 +0100 2148159 http://www.medworm.com/index.php?rid=2148158&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F1%2F8%3Frss%3D1 Health service researchers, policy analysts and other commentators have overlooked the limitations of existing approaches to the estimation of waiting times. If urgent cases are given priority, there are no instances when census-based data can supply accurate estimates of the length of the prospective wait. But there are three occasions when event-based data supply accurate estimates of the prospective wait of those who chose to enrol and we can predict the direction of error when the relevant conditions are violated if we know whether the list was open or closed, and whether it grew in size or shrank. Without this additional information, we cannot determine whether the changes we observe over time or the differences we see between one list and the next are spurious or not. The period life... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2148158 Fri, 30 Jan 2009 05:00:00 +0100 2148158 http://www.medworm.com/index.php?rid=2148157&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F22%2F1%2F1%3Frss%3D1 We examined the impact of environmental factors on USA nursing homes' participation in the subacute care market. Findings suggest that the Balanced Budget Act of 1997 did not have a significant impact in the participation of nursing homes in the subacute care market from 1998 to 2000. However, there was a declining trend in the participation of nursing homes in the subacute care market after the implementation of Medicare prospective payment system (PPS). Furthermore, nursing homes with a higher proportion of Medicare residents were more likely to exit the subacute care market after PPS. Results also suggest that nursing homes have responded strategically to the environmental demand for subacute care services. Nursing homes located in markets with higher Medicare managed care penetration w... Health Services Management journals http://www.medworm.com/rss/comments.php?id=2148157 Fri, 30 Jan 2009 05:00:00 +0100 2148157 http://www.medworm.com/index.php?rid=1912253&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F4%2F276%3Frss%3D1 There are opportunities to improve quality and safety of care provided to adult patients. The Plummer Project of the Department of Medicine at the Mayo Clinic (Rochester, MN, USA) is an initiative to redesign outpatient practice. We used multidisciplinary teams to standardize the tasks essential to improve patient care. With the initiative to standardize the rooming process, patient care and safety improved with greater accuracy of the medication list. The standardization also improved physician efficiency because trained clinical assistants helped address the needs of the patient. Physicians were satisfied by the new process and the technology enhancements. Clinical assistants were also highly satisfied by the training process. The quality and safety of patient care can be significantly i... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1912253 Mon, 27 Oct 2008 04:00:00 +0100 1912253 http://www.medworm.com/index.php?rid=1912252&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F4%2F262%3Frss%3D1 The health-care field is undergoing rapid and significant transformation. This transformation has led to the breakdown of traditional career paths for managers in the patient care segment of the industry. To our knowledge, there has not been a systematic examination of how these changes have impacted on the career commitment of managers in this segment of the industry. Building on previous research, we examine the effects of employment-related conditions and career experiences on the career commitment of these managers while controlling for the influence of individual characteristics. Specifically we assess the relationship between employment-related conditions, such as job security, position tenure, industry segment, management level and the extent to which their current position meets th... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1912252 Mon, 27 Oct 2008 04:00:00 +0100 1912252 http://www.medworm.com/index.php?rid=1912251&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F4%2F248%3Frss%3D1 After fifteen years from the first of a series of reforms that introduced managerial paradigms and techniques into the Italian National Health System (INHS), it is possible to provide a critical assessment of the outcomes of such changes. The aim of this paper is to assess how these reforms have changed the INHS, to what extent they concurred to improve the system, where they failed and which issues are still in agenda. To do so we run through the recent history of the INHS and propose an interpretative framework to understand the grounds for its light and shade results. The basis for the analysis is triple. The study draws from researches, literature review, action-researches and field investigations conducted over the last 10 years in the INHS. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=1912251 Mon, 27 Oct 2008 04:00:00 +0100 1912251 http://www.medworm.com/index.php?rid=1912250&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F4%2F236%3Frss%3D1 This exploratory survey examines the relationship between selected dimensions of spirituality and self-perceived effective leadership practices of health-care managers. Kouzes and Posner's Leadership Practices Inventory and Beazley's Spiritual Assessment Scale were administered to a sample of health-care managers. Significant statistical relationships were found between and among the dimensions of both subscales. Analysis of variance revealed a statistically significant difference in three effective leadership practices by ‘more spiritual than non-spiritual’ managers. The confirmatory factor analysis of our theory-based model revealed a moderately positive correlation between spirituality and leadership (r = 0.50). The paper concludes with a conceptual theory postulating a rati... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1912250 Mon, 27 Oct 2008 04:00:00 +0100 1912250 http://www.medworm.com/index.php?rid=1912249&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F4%2F228%3Frss%3D1 This paper discusses the challenges that those living with complex chronic disease present to the Canadian health-care system. The literature suggests home care and the management of complex chronic disease can together ease many of the present and future pressures facing the health-care system in dealing with this new health-care phenomenon. A review of current literature and dialogue with key informants reveals that the current level of investment and the present policy environment are not sustainable to support the health-care system. In this paper, changes to policy and resource allocation to the home care sector are suggested to help manage complex chronic disease and thus improve the effectiveness of the Canadian health-care system. A case is made for a reorganization and increased c... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1912249 Mon, 27 Oct 2008 04:00:00 +0100 1912249 http://www.medworm.com/index.php?rid=1912248&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F4%2F211%3Frss%3D1 The purpose of this descriptive, co-relational and cross-sectional study was to gain a better understanding of the relationships between job satisfaction and organizational commitment of employees, and their impact on turnover intention at Isfahan Hospitals, Isfahan, Iran, in 2005. Data were collected by the distribution of two questionnaires among 629 employees of these hospitals through a stratified random sampling method. The results of the paper indicate that hospital employees are moderately satisfied with their jobs and committed to their organization. Employees' job satisfaction and organizational commitment were closely inter-related and correlated with turnover intention (P < 0.001). The positive correlation between the two was expected, but there was also unexpected correlatio... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1912248 Mon, 27 Oct 2008 04:00:00 +0100 1912248 http://www.medworm.com/index.php?rid=1646905&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F3%2F199%3Frss%3D1 In recent years in Italy, as in other European countries, profound changes have been introduced in health care both at central and regional levels. Most of them were oriented towards a shift from ‘hospital-centred’ health care to health care based more on primary care services. This transition pursues two objectives: giving more effective responses to citizens' needs and reducing public health expenditure. Changes that involve organizational structure must also be carried out with the introduction of measurement tools that can help in planning and can control the changes. The paper provides the results obtained through the experience of modelling a measurement system for primary care carried out in 2004 and 2005 by some territorial managers and controllers in the Tuscan Health ... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1646905 Tue, 22 Jul 2008 04:00:00 +0100 1646905 http://www.medworm.com/index.php?rid=1646904&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F3%2F192%3Frss%3D1 In production and manufacturing plants, Lean Thinking has been used to improve processes by eliminating waste and thus enhancing efficiency. In health care, Lean Thinking has emerged as a comprehensive approach towards improving processes embedded in the diagnostic, treatment and care activities of health-care organizations with cost containment results. This paper provides a case study example where Lean Thinking is not only used to improve efficiency and cost containment, but also as an approach to effective organizational change. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=1646904 Tue, 22 Jul 2008 04:00:00 +0100 1646904 http://www.medworm.com/index.php?rid=1646903&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F3%2F185%3Frss%3D1 This study was designed to verify the current status of EBM in health plans as viewed by their key administrative decision-makers in southern Brazil. We present and discuss participants' agreement to predefined statements about: their level of knowledge on EBM, practitioners' and consumers' behaviour regarding EBM, potential effects for health-care plans by implementing EBM, and attitudes and interest of health-care plans toward evidence-based guidelines. We conclude that there is a need to establish educational efforts oriented to health-care plan managers regarding EBM, considering its good acceptance by managers and an expectation that EBM can help solve several dilemmas faced by health-care plans in southern Brazil. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=1646903 Tue, 22 Jul 2008 04:00:00 +0100 1646903 http://www.medworm.com/index.php?rid=1646902&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F3%2F178%3Frss%3D1 This study is a qualitative examination of the production of HES in a small hospital in Guernsey, which is not part of the NHS. Interviews were conducted with key participants in the production of HES to determine how the data were created, and the strengths and weaknesses of this system. We found that face-to-face communication between administrative and clinical staff was felt to contribute to the accuracy of the HES codes, and that a lack of detail in the case-notes was felt to be more problematic than the accuracy of the coders themselves. These findings have implications for the comparison of HES between NHS Trusts, since the processes involved in producing the data will be different in larger hospitals with less contact between coders and clinicians. It is therefore important to bear... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1646902 Tue, 22 Jul 2008 04:00:00 +0100 1646902 http://www.medworm.com/index.php?rid=1646901&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F3%2F168%3Frss%3D1 Conclusion Directors of treatment organizations may improve treatment practices and political leverage by directly, but selectively, interacting with key external stakeholders. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=1646901 Tue, 22 Jul 2008 04:00:00 +0100 1646901 http://www.medworm.com/index.php?rid=1646900&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F3%2F161%3Frss%3D1 This paper examines the extent to which hospitals that are under external contract management engage in service duplication, as well as the degree to which the various services they offer contribute to or detract from community access. The study incorporates all USA hospitals using data from the American Hospital Association Annual Survey Database, supplemented by county level measures obtained from the area resource file (ARF). Using data on the 3794 hospitals classified as acute care facilities in 2002, we performed a set of logistic regressions that analyzed whether a hospital offered each of 74 distinct services. For each service (regression), key independent variables measured the number of other hospitals in the local market area that also offered the service. Local area market defin... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1646900 Tue, 22 Jul 2008 04:00:00 +0100 1646900 http://www.medworm.com/index.php?rid=1646899&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F3%2F155%3Frss%3D1 Situation Reports (SitReps) is an internal Department of Health performance data collecting system. Although intended primarily for internal use, the data are also used to answer parliamentary questions, brief ministers and to inform national performance indicators. This paper reviews the data collection system and data-set, and shows how it can be used to evaluate delays in hospital discharge under the Community Care (Delayed Discharges etc.) Act 2003. However, limitations in the data include the fact that the data have only recently been extended to National Health Service (NHS) non-acute settings and do not include NHS patients in the private acute sector. Further, as the data-set derives from a weekly aggregate return rather than from individualized person-based records, it cannot be u... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1646899 Tue, 22 Jul 2008 04:00:00 +0100 1646899 http://www.medworm.com/index.php?rid=1646898&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F3%2F141%3Frss%3D1 Achieving lasting performance improvement in health care is a demanding challenge. Service delivery processes are frequently fragmented with many symptoms of poor behaviour observable. Competing vested interests within the National Health Service (NHS) and experiences of muddled and muddied top–down government exhortation suggest the need for a balanced perspective in which the expectations of patients, staff, management and government can be considered, agreed and enabled. Our conclusion is that effective innovation is best achieved by establishing a ‘Train-Do–Train-Do’ cycle in which all ‘players’ in the system must be actively involved. The particular methodology of ‘managing by projects’ for effective bottom–up step-by-step innovati... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1646898 Tue, 22 Jul 2008 04:00:00 +0100 1646898 http://www.medworm.com/index.php?rid=1568356&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F2%2F131%3Frss%3D1 Over the past few years (2001–2007), the Italian National Health Service has been undergoing an important process of decentralization with a significant transfer of powers and responsibilities from the central government to the Regions. In this context, a particularly innovative example is represented by the case of Marche Region that extensively reformed its health-care system. For the analysis of this case, we used a theoretical framework that describes a health-care system in terms of components and goals. Policy-makers can act on the structural components of the system influencing the behaviour of individuals and organizations in order to lead the system towards the achievement of key performance goals. Marche regional Government was able to improve the system in crucial areas (c... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568356 Thu, 01 May 2008 04:00:00 +0100 1568356 http://www.medworm.com/index.php?rid=1568355&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F2%2F117%3Frss%3D1 Conclusion The study design was limited to participants working in single hospital; therefore, the conclusions made cannot yet be regarded categorically as generalizable. Leadership selection, development and education activities may not achieve their ultimate outcomes due to the subject identification problem associated with the competence approach. It might be necessary to reconsider the efficiency of human resource activities that rely solely on the competency approach. The conceptual basis of leadership competence in health services has been previously neglected. This research casts doubt on competency approaches to leadership if based on subject identification with pre-defined items. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568355 Thu, 01 May 2008 04:00:00 +0100 1568355 http://www.medworm.com/index.php?rid=1568354&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F2%2F106%3Frss%3D1 This study is an attempt to determine whether the implementation of the Global Budget (GB) as a method of health reform has improved cost containment and quality of care in Taiwan. Panel-data analysis is used to investigate cost containment and quality of care in Taipei municipal hospitals before and after the introduction of the GB. The results suggest that there is a trade-off effect. The post-GB data indicate that cost containment comes at the expense of health-care quality. It may, therefore, be the case that policy-makers can more effectively balance cost containment and quality by refining the GB so that reimbursements would be linked to standards of quality. Another way to enhance the reforms would be a more effective monitoring and review system. (Source: Health Services Management... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568354 Thu, 01 May 2008 04:00:00 +0100 1568354 http://www.medworm.com/index.php?rid=1568353&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F2%2F93%3Frss%3D1 Despite the criticality of nurse rostering practices, there is a surprising lack of attention paid to this managerial activity both in practice and in the health-service management literature. This paper reports the results of an inductive, empirical study of rostering practices in the UK National Health Service with a view to developing a shared understanding of roster planning processes and of what constitutes rostering effectiveness. A survey of rostering practices in 50 wards, followed by five in-depth, longitudinal case studies, revealed the complexity of rostering activities, and identified the main design parameters, which were used to specify rostering systems and to prepare periodic rosters. Rostering activities were perceived to directly impact upon service delivery, resource uti... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568353 Thu, 01 May 2008 04:00:00 +0100 1568353 http://www.medworm.com/index.php?rid=1568352&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F2%2F81%3Frss%3D1 To date, strategic management research in health care is largely confined to the acute care sector of the industry. This research examines the linkages among environmental scanning, competitive strategy and performance in physical therapy facilities. Nontrivial differences between acute and subacute care firms suggest the role of environmental scanning may change in non-acute care settings. Consistent with previous research, these results indicate that the frequency of internal and external scanning is related to the strategic orientation of physical therapy facilities. Contrary to the expectations, broader scope of scanning is positively related to an increasing market-focused and increasing efficiency strategic orientation. A key objective of the research is to test the impact of strateg... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568352 Thu, 01 May 2008 04:00:00 +0100 1568352 http://www.medworm.com/index.php?rid=1568351&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F2%2F71%3Frss%3D1 Traditionally, the balanced scorecard (BSC) has been an effective tool in linking measurement to strategy. However, what is least understood is how the BSC can be used to redefine organizational relationships, re-engineer fundamental processes and transform organizational culture, for superior performance in an organization with the same people, services and technology that previously delivered dismal performance. This paper highlights the process and uses York Central Hospital in Toronto, Ontario, Canada as an illustrative example. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568351 Thu, 01 May 2008 04:00:00 +0100 1568351 http://www.medworm.com/index.php?rid=1568362&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F1%2F60%3Frss%3D1 This study examines factors affecting the productive efficiency of primary care clinics. The empirical analysis uses a single-stage stochastic frontier regression model, in which factors affecting productive efficiency are specified as part of the inefficiency error component and estimated simultaneously with the production function. The study population includes primary care clinics in the US Military Health System from 1999 through 2003; the analytical data set is an unbalanced panel of 442 observations. The study's main results were that primary care clinics not associated with medical centres had significantly higher levels of productive efficiency than those associated with medical centres and that having proportionately more civilian staff (and thus less turnover) had a positive impa... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568362 Fri, 01 Feb 2008 05:00:00 +0100 1568362 http://www.medworm.com/index.php?rid=1568361&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F1%2F40%3Frss%3D1 The purpose of this study was to shed light on the individual socioeconomic status and demographic determinants of the demand for health care in a cross-comparison study of nine European Union countries. It focuses on the effects of individual employment status on alternative indicators of demand for health care that constitutes a largely unexplored area. The evidence supports the existence of an employment status-demand for health-care relationship, although it varies with respect to the type of health care examined and the institutional and environmental settings of the countries utilized in the study. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568361 Fri, 01 Feb 2008 05:00:00 +0100 1568361 http://www.medworm.com/index.php?rid=1568360&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F1%2F32%3Frss%3D1 Conclusion This study found limited evidence of sophisticated HRM practices among hospitals and hospital organizations in the State of Victoria, Australia. Despite the increasing evidence of a relationship among effective HRM and health-care outcomes, these hospitals reported limited performance management, training and development, and employee empowerment and decision-making. The authors suggest that it is unlikely that attempts to improve patient safety in this sector will be successful until the deficits in HRM are addressed. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568360 Fri, 01 Feb 2008 05:00:00 +0100 1568360 http://www.medworm.com/index.php?rid=1568359&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F1%2F23%3Frss%3D1 In conclusion, these results suggest that developing and emphasizing a teamwork culture may facilitate greater retention of health-care employees, especially nurses. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568359 Fri, 01 Feb 2008 05:00:00 +0100 1568359 http://www.medworm.com/index.php?rid=1568358&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F1%2F14%3Frss%3D1 Using descriptive statistics, this paper revealed that the prescription drug cost as a percentage of total health-care cost in Department of Veterans Affairs (VA) health-care system has outpaced the national trend. Given the fact that the national drug expenditure is the most fast-growing component in the health-care expenditure, the drug cost trend in VA commands further assessment for its financial and clinical impact. Furthermore, by applying simple log linear regression, we analysed the geographic variation in prescription drug use in the VA health-care system. We found a 30% deviation from the predicted drug cost at medical centre level and 15% deviation at Network level. Although this variation is relatively small compared with the variation in other medical service use, reduction of... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568358 Fri, 01 Feb 2008 05:00:00 +0100 1568358 http://www.medworm.com/index.php?rid=1568357&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F21%2F1%2F1%3Frss%3D1 Managed care strategies have been introduced into the South African private health sector a decade ago to help reduce medical costs in this sector. A cross-sectional survey using a self-administered questionnaire was conducted among primary care physicians in this sector to access their perceptions of these strategies and to analyse impact of these on their clinical behaviour. The results indicate that although insurers were not using these strategies extensively, doctors generally perceived them negatively. It was, however, pleasing to note that the newer generation of doctors, appear to be more accepting of this new philosophy of health-care delivery. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568357 Fri, 01 Feb 2008 05:00:00 +0100 1568357 http://www.medworm.com/index.php?rid=1568371&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F279%3Frss%3D1 (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568371 Thu, 01 Nov 2007 04:00:00 +0100 1568371 http://www.medworm.com/index.php?rid=1568370&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F270%3Frss%3D1 This paper explores nursing students' experiences and perceptions of negative behaviour and bullying in clinical placement measured against expectations at the start of their education. It explores their understanding and how they make sense of their circumstances and their experiences of negative behaviour, emphasizing socialization processes and factors which may prevent or reproduce negative behaviour and bullying. To this end, a focus group study was conducted, and this revealed that many students felt exploited, ignored or were made to feel unwelcome, although few reported personal experience of bullying. These frequent but less severe negative experiences appear to play a key role in institutionalizing an unwelcoming culture within which bullying could easily be triggered or take hol... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568370 Thu, 01 Nov 2007 04:00:00 +0100 1568370 http://www.medworm.com/index.php?rid=1568369&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F261%3Frss%3D1 The intensity of physician workload has been increasing with the well-documented changes in the financing, organization and delivery of care. It is possible that these stressors have reached a point where they pose a serious policy issue for the entire healthcare system through their diminution of physician's ability to effectively interact with patients as they are burned out, stressed and dissatisfied. This policy question is framed in a conceptual model linking workloads with five key outcomes (patient care quality, individual performance, absenteeism, turnover and organizational performance) mediated by physician stress and satisfaction. This model showed a good fit to the data in a structural equation analysis. Ten of the 12 hypothesized pathways between variables were significant and... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568369 Thu, 01 Nov 2007 04:00:00 +0100 1568369 http://www.medworm.com/index.php?rid=1568368&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F253%3Frss%3D1 The paper reports the results of a study on benchmarking activities undertaken by the procurement organization within the National Health Service (NHS) in Scotland, namely National Procurement (previously Scottish Healthcare Supplies Contracts Branch). NHS performance is of course politically important, and benchmarking is increasingly seen as a means to improve performance, so the study was carried out to determine if the current benchmarking approaches could be enhanced. A review of the benchmarking activities used by the private sector, local government and NHS organizations was carried out to establish a framework of the motivations, benefits, problems and costs associated with benchmarking. This framework was used to carry out the research through case studies and a questionnaire surv... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568368 Thu, 01 Nov 2007 04:00:00 +0100 1568368 http://www.medworm.com/index.php?rid=1568367&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F244%3Frss%3D1 In all industries, competition among businesses has long been encouraged as a mechanism to increase value for customers. In other words, competition ensures the provision of better products and services to satisfy the needs of customers. Various perspectives of competition, the nature of service quality, health-care system costs and customer satisfaction in health care are examined. A model of the relationship among these variables is developed. The model depicts customer satisfaction as an outcome measure directly dependent on competition. Quality of care and health-care system costs, while also directly dependent on competition, are considered as determinants of customer satisfaction as well. The model is discussed in the light of propositions for empirical research. (Source: Health Serv... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568367 Thu, 01 Nov 2007 04:00:00 +0100 1568367 http://www.medworm.com/index.php?rid=1568366&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F238%3Frss%3D1 A health-care organization simultaneously belongs to two different institutional value patterns: a professional and an administrative value pattern. At the administrative level, medical problem-solving processes are generally perceived as the efficient application of familiar chains of activities to well-defined problems; and a low task uncertainty is therefore assumed at the work-floor level. This assumption is further reinforced through clinical pathways and other administrative guidelines. However, studies have shown that in clinical practice such administrative guidelines are often considered inadequate and difficult to implement mainly because physicians generally perceive task uncertainty to be high and that the guidelines do not cover the scope of encountered deviations. The current... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568366 Thu, 01 Nov 2007 04:00:00 +0100 1568366 http://www.medworm.com/index.php?rid=1568365&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F227%3Frss%3D1 Attempts to improve health care have generally failed. Systems analysis urges addressing processes, such as learning, rather than isolated parts of a system. We apply learning curve theory to health care and then explicate the process of learning. Specific recommendations involve how we learn (and unlearn), who should learn, and what should be learned. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568365 Thu, 01 Nov 2007 04:00:00 +0100 1568365 http://www.medworm.com/index.php?rid=1568364&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F220%3Frss%3D1 This study aimed to examine the scope of activities performed by hospital volunteers. A survey was conducted on 3055 hospitals, randomly selected throughout Japan. Attention was also paid to the accident-prevention systems instituted by those facilities. Almost one-third (36.5%) of all hospitals had some hospital volunteers. About 60% (59.9%) of hospitals conducted volunteer activities more than once a week. Recreation (50.1%) was the most common role of the volunteers. The other activities in decreasing order were: conversation partners (45.8%), music and entertainment (43.7%), wheelchair pushing (41.8%) and helping administration (36.3%). Both direct and indirect contact between volunteers and patients was prevalent. Less than half of the hospitals had accident-prevention systems, such a... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568364 Thu, 01 Nov 2007 04:00:00 +0100 1568364 http://www.medworm.com/index.php?rid=1568363&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F20%2F4%2F211%3Frss%3D1 Health service managers have been criticized for placing more emphasis on the collection of data than on their use for the improvement of care. The present study examined how routine aggregate data on cancer services are perceived by management teams and how such data are used to inform strategic decision-making and planning. Semi-structured interviews were conducted with 19 members of four cancer network teams in England. The interviews were transcribed and thematically analysed independently by two researchers. Respondents said that routine aggregate data were not highly prioritized as an information resource, although their use had produced some beneficial impacts, such as reduced waiting times. Limited use of aggregate data appeared to relate to problems of accessibility, lack of resou... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568363 Thu, 01 Nov 2007 04:00:00 +0100 1568363 http://www.medworm.com/index.php?rid=1568378&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F20%2F3%2F203%3Frss%3D1 We propose reimbursement schemes based on patient classification systems (PCSs) that include adjustments for length of stay (LOS) and exceptional costs and are designed to minimize undesirable effects of economic incentives. In addition, a statistical approach to compare the schemes and the underlying PCSs is proposed, where costs and LOSs for two successive years are used. The first year data provides estimates of the class cost means and the next year's reimbursements which are compared with the second year's costs. This method focuses on the predictive power of a PCS and differs from the usual retrospective analyses based on the proportion of explained variance for single year data.The approach is applied to discharge data of Swiss hospitals where stays are grouped according to five PCS... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568378 Wed, 01 Aug 2007 04:00:00 +0100 1568378 http://www.medworm.com/index.php?rid=1568377&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F20%2F3%2F189%3Frss%3D1 In this study, a Care Process Self-Evaluation Tool (CPSET), based on the clinical pathway concept, for assessing the organization of the process of care has been developed and tested. Qualitative and quantitative methods, involving 885 professionals and patients, were used in the development and validation. The CPSET is a valid and reliable 29-item instrument for assessing how the process of care is organized. The CPSET has five subscales: patient-focused organization, coordination of care, communication with patients and family, cooperation with primary care and monitoring/follow-up of the care process. The CPSET can be used in the audit and accreditation of care processes and will help managers and clinicians to understand better how care processes are organized. (Source: Health Services... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568377 Wed, 01 Aug 2007 04:00:00 +0100 1568377 http://www.medworm.com/index.php?rid=1568376&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F20%2F3%2F183%3Frss%3D1 For measuring behaviour of National Health Service (NHS) staff, 360-degree assessment is a valuable tool. The important role of a clinical director as a medical leader is increasingly recognized, and attributes of a good clinical director can be defined. Set against these attributes, a 360-degree assessment tool has been designed. The job description for clinical directors has been used to develop a questionnaire sent to senior hospital staff. The views of staff within the hospital are similar irrespective of gender, post held or length of time in post. Analysis has shown that three independent factors can be distilled, namely operational management, interpersonal skills and creative/strategic thinking. A simple validated questionnaire has been developed and successfully introduced for the... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568376 Wed, 01 Aug 2007 04:00:00 +0100 1568376 http://www.medworm.com/index.php?rid=1568375&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F20%2F3%2F174%3Frss%3D1 While patient participation in treatment decisions is increasingly advocated in medical literature, patient demand has been considered to cause unnecessary prescribing. Using the concept of customer participation as discussed in services marketing and management literature as a theoretical base, the paper analyses the influence of patient participation on the medical service process and treatment decision-making. A qualitative, explorative study was conducted to investigate American and British physicians' views on patient participation in the treatment of osteoporosis and schizophrenia. It became evident that in the cases of both osteoporosis and schizophrenia, patients influence prescribing decisions despite the significant difference in their willingness and ability to participate. The ... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568375 Wed, 01 Aug 2007 04:00:00 +0100 1568375 http://www.medworm.com/index.php?rid=1568374&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F20%2F3%2F162%3Frss%3D1 This paper presents a conceptual framework and tool kit, generated from the evaluation of five primary care research networks (PCRNs) funded by the then London, National Health Service (NHS) Executive.We employed qualitative methods designed to match the most important characteristics of PCRNs, conducting five contextualized case studies covering the five networks. A conceptual evaluation framework based on a review of the organization science literature was developed and comprised the broad, but inter-related organizational dimensions of structure, processes, boundaries and network self-evaluation as input factors and strategic emphasis as epitomized by network objectives. These dimensions were comprised of more detailed subdimensions designed to capture the potential of the networks to c... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568374 Wed, 01 Aug 2007 04:00:00 +0100 1568374 http://www.medworm.com/index.php?rid=1568373&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F20%2F3%2F153%3Frss%3D1 Despite their rising numbers in the National Health Service (NHS), the recruitment, retention, morale and educational needs of staff and associate specialist hospital doctors have traditionally not been the focus of attention. A postal survey of all staff grades and associate specialists in NHS Scotland was conducted to investigate the determinants of their job satisfaction. Doctors in both grades were least satisfied with their pay. They were more satisfied if they were treated as equal members of the clinical team, but less satisfied if their workload adversely affected the quality of patient care. With the exception of female associate specialists, respondents who wished to become a consultant were less satisfied with all aspects of their jobs. Associate specialists who worked more sess... Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568373 Wed, 01 Aug 2007 04:00:00 +0100 1568373 http://www.medworm.com/index.php?rid=1568372&cid=s_37244_51_f&fid=37244&url=http%3A%2F%2Fhsmr.rsmjournals.com%2Fcgi%2Fcontent%2Fshort%2F20%2F3%2F141%3Frss%3D1 Collaborative networks have become a common organizational strategy to deal with uncertain and dynamic environments. Like their counterparts in the USA, Korean hospitals are establishing cooperative relationships with one another, with varying performance results. This paper analyses some of the sources of variation in hospital network performance and identifies some of the possible success factors. The study finds that the quality of cooperation and information sharing between network partners are critical. The paper concludes with a discussion of the implications for researchers and practitioners. (Source: Health Services Management) Health Services Management journals http://www.medworm.com/rss/comments.php?id=1568372 Wed, 01 Aug 2007 04:00:00 +0100 1568372