Objective: The purpose of this study was to evaluate nurse knowledge about the risks of exposure to patient bodily waste, nurse perceptions about procedures and reporting, and current levels of satisfaction with how risks of exposure to patient waste are managed. Patient bodily waste management impacts healthcare workers and healthcare organizations. For nurses and other healthcare workers, the risk of exposure to pathogens can have adverse health effects, increase stress, and reduce satisfaction with their job, potentially leading to issues related to retention. Evidence suggests that proper training and using devices to reduce exposure risks and improve shorter bedside toileting, may reduce stress, and improve work satisfaction. Reducing risk of increased healthcare associated infections of patients and healthcare workers may have a positive impact on the organization with reduced cost of care.Methods: A survey focused on nurses’ knowledge about their risk of exposure, nurse understanding of procedures and incident reporting, and morale and satisfaction with their job was conducted. Results. The findings suggest that there were conflicting responses related to the acknowledgement of risk, reporting incidents, and the use of personal protective equipment.Results: The findings suggest that there were conflicting responses related to the acknowledgement of risk, reporting incidents, and the use of personal protective equipment.Conclusions: Organizations benefit from addressing these concerns to improve morale and satisfaction, nurse retention, healthcare worker dignity, and the quality of patient care.
{"title":"The reality of patient bodily waste management: Nurse perceptions of current practice & staff safety","authors":"Debra Harris, Rodney X. Sturdivant, Anupama Kannan","doi":"10.5430/jha.v13n2p20","DOIUrl":"https://doi.org/10.5430/jha.v13n2p20","url":null,"abstract":"Objective: The purpose of this study was to evaluate nurse knowledge about the risks of exposure to patient bodily waste, nurse perceptions about procedures and reporting, and current levels of satisfaction with how risks of exposure to patient waste are managed. Patient bodily waste management impacts healthcare workers and healthcare organizations. For nurses and other healthcare workers, the risk of exposure to pathogens can have adverse health effects, increase stress, and reduce satisfaction with their job, potentially leading to issues related to retention. Evidence suggests that proper training and using devices to reduce exposure risks and improve shorter bedside toileting, may reduce stress, and improve work satisfaction. Reducing risk of increased healthcare associated infections of patients and healthcare workers may have a positive impact on the organization with reduced cost of care.Methods: A survey focused on nurses’ knowledge about their risk of exposure, nurse understanding of procedures and incident reporting, and morale and satisfaction with their job was conducted. Results. The findings suggest that there were conflicting responses related to the acknowledgement of risk, reporting incidents, and the use of personal protective equipment.Results: The findings suggest that there were conflicting responses related to the acknowledgement of risk, reporting incidents, and the use of personal protective equipment.Conclusions: Organizations benefit from addressing these concerns to improve morale and satisfaction, nurse retention, healthcare worker dignity, and the quality of patient care.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"61 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141808222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Regina Knowles, Carol Jones, Blake Webb, Deborah Welsh, Peter Mills
Objective: The study aims to determine the facilitators and barriers to conducting large-scale CRM-based training in a national health care system (VHA). While there are some studies on this topic, none review training in a federal system or provide data on changes within the system.Methods: Design: Focus Groups collecting qualitative data. Review Methods: We held focus-groups for Clinical Team Training (CTT) facility Points of Contact (POC) and CTT Master Trainers. Responses were collected live and presented to all participants in each focus group session to ensure participant comfort and accuracy. All subgroup leaders agreed on iteratively and qualitatively reviewing participant responses from the four open-ended and three poll questions. Each subgroup leader was assigned a question to conduct a preliminary review of participant responses. After the initial review, a second leader also reviewed the participant responses. Over multiple iterations, themes emerged and were formalized by the team.Results: The focus groups revealed that Leadership engagement in cultural change is imperative. The focus groups also identified that language and examples used in the curriculum may have inadvertently marginalized individuals by making some non-clinical team members feel excluded as part of the team. Our results support the need for highly visible leadership engagement, adequate time to undertake and complete projects, and overcoming skepticism. See table 1 for themes from each question.Conclusions: Qualitative analysis revealed that Leadership engagement in cultural change is imperative. Focus groups identified that specific language and examples used in the curriculum may have inadvertently marginalized individuals who do not have clinical backgrounds. In addition, some participants felt that the use of the term “Projects” created a negative connotation for the required quality improvement project on each unit and instead preferred the terms “micro-project,” “safety strategy,” or “quick wins.”Implemented changes: The program’s name has been rebranded to NCPS Team Training, taking the word clinical out to be more inclusive of all team members who engage in the care of a patient in the clinical setting. A complimentary video series was developed for facility Master Trainers to use as a supplement to their teaching or exclusively as the teaching tool as they facilitate the tabletop simulation exercises. Another change is that the Unit Based Safety Project has been renamed as Unit Based Safety Initiative (UBSI) to remove the stigma of a “project.”
{"title":"Facilitators and barriers for high-reliability training in medical centers","authors":"Regina Knowles, Carol Jones, Blake Webb, Deborah Welsh, Peter Mills","doi":"10.5430/jha.v13n2p10","DOIUrl":"https://doi.org/10.5430/jha.v13n2p10","url":null,"abstract":"Objective: The study aims to determine the facilitators and barriers to conducting large-scale CRM-based training in a national health care system (VHA). While there are some studies on this topic, none review training in a federal system or provide data on changes within the system.Methods: Design: Focus Groups collecting qualitative data. Review Methods: We held focus-groups for Clinical Team Training (CTT) facility Points of Contact (POC) and CTT Master Trainers. Responses were collected live and presented to all participants in each focus group session to ensure participant comfort and accuracy. All subgroup leaders agreed on iteratively and qualitatively reviewing participant responses from the four open-ended and three poll questions. Each subgroup leader was assigned a question to conduct a preliminary review of participant responses. After the initial review, a second leader also reviewed the participant responses. Over multiple iterations, themes emerged and were formalized by the team.Results: The focus groups revealed that Leadership engagement in cultural change is imperative. The focus groups also identified that language and examples used in the curriculum may have inadvertently marginalized individuals by making some non-clinical team members feel excluded as part of the team. Our results support the need for highly visible leadership engagement, adequate time to undertake and complete projects, and overcoming skepticism. See table 1 for themes from each question.Conclusions: Qualitative analysis revealed that Leadership engagement in cultural change is imperative. Focus groups identified that specific language and examples used in the curriculum may have inadvertently marginalized individuals who do not have clinical backgrounds. In addition, some participants felt that the use of the term “Projects” created a negative connotation for the required quality improvement project on each unit and instead preferred the terms “micro-project,” “safety strategy,” or “quick wins.”Implemented changes: The program’s name has been rebranded to NCPS Team Training, taking the word clinical out to be more inclusive of all team members who engage in the care of a patient in the clinical setting. A complimentary video series was developed for facility Master Trainers to use as a supplement to their teaching or exclusively as the teaching tool as they facilitate the tabletop simulation exercises. Another change is that the Unit Based Safety Project has been renamed as Unit Based Safety Initiative (UBSI) to remove the stigma of a “project.”","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"132 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141115039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wen-Ta Chiu, Stanley Toy, Wan-Yi Lin, Yu-Tien Lin, Chia-Hsing Yeh, Kaveh Alfakian, Pei-Chen Pan, Chien-Yu Liu, Han-Kuan Bai, John Chon, Steve Giordano, Victor Lange, Su-yen Wu, Jonathan Wu
Objective: This retrospective study explores the strategic plan formulated by AHMC Health System in California, USA, to sustain and improve quality of care and emergency department (ED) efficiency during the COVID-19 pandemic. It also analyzes the plan’s outcomes.Background: The COVID-19 pandemic has posed challenges for both individuals and healthcare industries alike, impacting decision-making and access to care. AHMC faced staff and resource shortages, patient reluctance, and difficulties adapting to rapidly evolving public health guidelines. These challenges highlighted the critical need for effective plans to maintain or improve healthcare quality and ED performance.Methods: AHMC adopted a comprehensive three-layer strategic plan in 2020. The first layer, “Pandemic Response,” focused on leadership, staff training and education, infection control, new treatments, and employee vaccination rates. The second layer, “ED Throughput,” set objectives for metrics such as door-to-doctor (door-to-doc) time, ancillary turnaround time (TAT), ED length of stay (LOS), and the left-without-being-seen (LWBS) rates. Progress was monitored through monthly improvement meetings. The third layer, “Quality Excellence,” tracked improvements in COVID-adapted objectives on quality initiatives, based on CMS Quality Star Ratings, Leapfrog Hospital Safety Grades, and Yelp review scores.Results: By 2023, the three-layer strategic plan had led to many improvements in the quality of care and ED efficiency. AHMC identified 22,287 positive COVID-19 cases, expanded its ventilator inventory by 50%, and enhanced patient outcomes by applying updated treatments. Additionally, AHMC saw a 3% reduction in ED wait times and sustained its overall patient satisfaction rates, CMS Quality Star Rating, and Leapfrog Hospital Safety Grade scores.Conclusions: AHMC’s three-layer strategic plan showed effectiveness in maintaining quality of care and ED efficiency during the COVID-19 pandemic. By focusing on “Pandemic Response,” “ED Throughput,” and “Quality Excellence,” AHMC was able to adapt to the rapidly evolving public health guidelines, expand its capacity to treat COVID-19 patients and sustain its overall patient safety, satisfaction, and quality ratings. The implementation of this plan highlights the importance of proactive and comprehensive strategies in managing healthcare crises.
{"title":"Quality of care and emergency department throughput during the COVID-19 pandemic in a community health system Pandemic in a Community Health System","authors":"Wen-Ta Chiu, Stanley Toy, Wan-Yi Lin, Yu-Tien Lin, Chia-Hsing Yeh, Kaveh Alfakian, Pei-Chen Pan, Chien-Yu Liu, Han-Kuan Bai, John Chon, Steve Giordano, Victor Lange, Su-yen Wu, Jonathan Wu","doi":"10.5430/jha.v13n1p34","DOIUrl":"https://doi.org/10.5430/jha.v13n1p34","url":null,"abstract":"Objective: This retrospective study explores the strategic plan formulated by AHMC Health System in California, USA, to sustain and improve quality of care and emergency department (ED) efficiency during the COVID-19 pandemic. It also analyzes the plan’s outcomes.Background: The COVID-19 pandemic has posed challenges for both individuals and healthcare industries alike, impacting decision-making and access to care. AHMC faced staff and resource shortages, patient reluctance, and difficulties adapting to rapidly evolving public health guidelines. These challenges highlighted the critical need for effective plans to maintain or improve healthcare quality and ED performance.Methods: AHMC adopted a comprehensive three-layer strategic plan in 2020. The first layer, “Pandemic Response,” focused on leadership, staff training and education, infection control, new treatments, and employee vaccination rates. The second layer, “ED Throughput,” set objectives for metrics such as door-to-doctor (door-to-doc) time, ancillary turnaround time (TAT), ED length of stay (LOS), and the left-without-being-seen (LWBS) rates. Progress was monitored through monthly improvement meetings. The third layer, “Quality Excellence,” tracked improvements in COVID-adapted objectives on quality initiatives, based on CMS Quality Star Ratings, Leapfrog Hospital Safety Grades, and Yelp review scores.Results: By 2023, the three-layer strategic plan had led to many improvements in the quality of care and ED efficiency. AHMC identified 22,287 positive COVID-19 cases, expanded its ventilator inventory by 50%, and enhanced patient outcomes by applying updated treatments. Additionally, AHMC saw a 3% reduction in ED wait times and sustained its overall patient satisfaction rates, CMS Quality Star Rating, and Leapfrog Hospital Safety Grade scores.Conclusions: AHMC’s three-layer strategic plan showed effectiveness in maintaining quality of care and ED efficiency during the COVID-19 pandemic. By focusing on “Pandemic Response,” “ED Throughput,” and “Quality Excellence,” AHMC was able to adapt to the rapidly evolving public health guidelines, expand its capacity to treat COVID-19 patients and sustain its overall patient safety, satisfaction, and quality ratings. The implementation of this plan highlights the importance of proactive and comprehensive strategies in managing healthcare crises.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"84 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141122880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Zakari, Aurora Tafili, H. Hamadi, Mei Zhao, D. R. Haley, Aaron Spaulding
Objective: This study investigated the differential association between nurse staffing in safety-net hospitals (SNHs) and non-SNHs.Methods: This retrospective cross-sectional study utilized multilevel mixed-effects linear regression models and included data from 1,228 hospitals.Results: The results showed that SNHs in the top quartile of disproportionate share hospital (DSH) payments had lower nurse staffing ratios (β = -0.86; p-value < .001), indicating a lower nurse-to-patient ratio, compared to non-SNHs. This association persisted even after adjusting for the county and hospital factors.Conclusions: These findings suggest that nurse staffing in SNHs may be impacted by the financial challenges associated with providing uncompensated care to vulnerable populations. Understanding the differences in nurse staffing between SNHs and non-SNHs can provide insights for improving quality of care. Further research is required to explore the impact of nurse staffing on patient outcomes in SNHs.
{"title":"Comparison of nursing staffing ratio in selected safety net and non-safety net hospitals in the United States","authors":"N. Zakari, Aurora Tafili, H. Hamadi, Mei Zhao, D. R. Haley, Aaron Spaulding","doi":"10.5430/jha.v13n1p25","DOIUrl":"https://doi.org/10.5430/jha.v13n1p25","url":null,"abstract":"Objective: This study investigated the differential association between nurse staffing in safety-net hospitals (SNHs) and non-SNHs.Methods: This retrospective cross-sectional study utilized multilevel mixed-effects linear regression models and included data from 1,228 hospitals.Results: The results showed that SNHs in the top quartile of disproportionate share hospital (DSH) payments had lower nurse staffing ratios (β = -0.86; p-value < .001), indicating a lower nurse-to-patient ratio, compared to non-SNHs. This association persisted even after adjusting for the county and hospital factors.Conclusions: These findings suggest that nurse staffing in SNHs may be impacted by the financial challenges associated with providing uncompensated care to vulnerable populations. Understanding the differences in nurse staffing between SNHs and non-SNHs can provide insights for improving quality of care. Further research is required to explore the impact of nurse staffing on patient outcomes in SNHs.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"117 42","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140985643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
George A. Gellert, Glynn Stanton, Michael Paulemon, Mark Roberts, Robert Hardcastle, Sean P. Kelly
Objective: To qualitatively describe a use case at Yale New Haven Health System (YNHHS) illustrating the need for and effective deployment of innovative technologies to manage an enterprise-owned shared device (EOSD) management program. EOSD management provides clinicians with secure, rapid access to enterprise mobile devices and applications, maintains devices in functional, use ready condition for clinicians, and enables enterprise tracking and reduced loss of devices.Methods: Executive leaders in clinical information technology and informatics management at YNHHS were interviewed through written and telephonic communication. Qualitative data was gathered through communications between clinical and information technology executives and the implementation support team of a leading identity and access management (IAM) solutions and EOSD management solution provider. Use case information was gathered, integrated and shared with health system executives and health IT/informatics leaders to verify the description of unmet needs, solution objectives and impact/value delivered after implementation of the EOSD management solution.Results: Benefits realized from implementation of an enterprise-shared mobility management solution included establishment of a cohesive and comprehensive enterprise-owned, shared device management strategy. This included effective monitoring and dynamic management of the system’s mobile device fleet, and better IT resource management with reduced mobile device loss. The IT administrative burden was reduced. While not surveyed systematically, improved clinician experience and satisfaction were reported to IT leaders anecdotally. EOSD management solution deployment was rapid, as was the time to improved clinician mobile experience and clear demonstration of value.Conclusions: A leading US health system was able to rapidly deploy a shared mobile device management solution that enabled effective monitoring and dynamic management of the enterprise mobile device fleet, with easier and faster clinician device access and workflows, and reduced IT administrative demand and costs. While the complexities associated with increased clinical mobility in healthcare will likely continue to grow, issuing future device and mobile management challenges that require effective hospital system response, technologies have emerged that enable more effective, efficient and satisfactory organizational mobility performance.
目标：定性描述耶鲁大学纽黑文卫生系统（YNHHS）的一个使用案例，说明企业自有共享设备（EOSD）管理项目对创新技术的需求和有效部署。EOSD 管理为临床医生提供了安全、快速地访问企业移动设备和应用程序的途径，使设备保持功能正常、随时可供临床医生使用的状态，并实现了企业跟踪和减少设备丢失：方法：通过书面和电话沟通的方式，对云南省卫生厅临床信息技术和信息管理的行政领导进行了访谈。通过临床和信息技术管理人员与一家领先的身份和访问管理（IAM）解决方案和 EOSD 管理解决方案提供商的实施支持团队之间的沟通，收集定性数据。收集、整合用例信息，并与医疗系统高管和医疗信息技术/信息学领导分享，以核实未满足需求的描述、解决方案目标以及实施 EOSD 管理解决方案后产生的影响/价值：结果：通过实施企业共享移动管理解决方案实现的效益包括建立了一个有凝聚力的、全面的企业自有共享设备管理战略。这包括对系统的移动设备群进行有效监控和动态管理，以及通过减少移动设备丢失来改善 IT 资源管理。减轻了 IT 管理负担。虽然没有进行系统的调查，但临床医生的体验和满意度都得到了改善，IT 部门的领导对此也有耳闻。EOSD 管理解决方案的部署非常迅速，临床医生移动体验的改善和价值的明确体现也非常迅速：美国一家领先的医疗系统能够快速部署共享移动设备管理解决方案，从而实现对企业移动设备群的有效监控和动态管理，使临床医生的设备访问和工作流程更加方便快捷，并降低了 IT 管理需求和成本。随着医疗保健领域临床移动性的增加，相关的复杂性很可能会继续增加，从而带来未来设备和移动管理方面的挑战，需要医院系统做出有效的应对。
{"title":"Challenges and opportunities in achieving secure hospital clinical mobility management: An illustrative use case","authors":"George A. Gellert, Glynn Stanton, Michael Paulemon, Mark Roberts, Robert Hardcastle, Sean P. Kelly","doi":"10.5430/jha.v13n2p1","DOIUrl":"https://doi.org/10.5430/jha.v13n2p1","url":null,"abstract":"Objective: To qualitatively describe a use case at Yale New Haven Health System (YNHHS) illustrating the need for and effective deployment of innovative technologies to manage an enterprise-owned shared device (EOSD) management program. EOSD management provides clinicians with secure, rapid access to enterprise mobile devices and applications, maintains devices in functional, use ready condition for clinicians, and enables enterprise tracking and reduced loss of devices.Methods: Executive leaders in clinical information technology and informatics management at YNHHS were interviewed through written and telephonic communication. Qualitative data was gathered through communications between clinical and information technology executives and the implementation support team of a leading identity and access management (IAM) solutions and EOSD management solution provider. Use case information was gathered, integrated and shared with health system executives and health IT/informatics leaders to verify the description of unmet needs, solution objectives and impact/value delivered after implementation of the EOSD management solution.Results: Benefits realized from implementation of an enterprise-shared mobility management solution included establishment of a cohesive and comprehensive enterprise-owned, shared device management strategy. This included effective monitoring and dynamic management of the system’s mobile device fleet, and better IT resource management with reduced mobile device loss. The IT administrative burden was reduced. While not surveyed systematically, improved clinician experience and satisfaction were reported to IT leaders anecdotally. EOSD management solution deployment was rapid, as was the time to improved clinician mobile experience and clear demonstration of value.Conclusions: A leading US health system was able to rapidly deploy a shared mobile device management solution that enabled effective monitoring and dynamic management of the enterprise mobile device fleet, with easier and faster clinician device access and workflows, and reduced IT administrative demand and costs. While the complexities associated with increased clinical mobility in healthcare will likely continue to grow, issuing future device and mobile management challenges that require effective hospital system response, technologies have emerged that enable more effective, efficient and satisfactory organizational mobility performance.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"90 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140665314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dan Petrovici, Walfried M. Lassar, Attila J Hertelendy, Madhaven Parthasarathy
Objective: Recent increases in per capita income and longevity in Central and Eastern European counties (CEECs), alongside a slow-changing soviet-era public healthcare system, has led to the emergence of private hospitals. This paper investigates the differential patient service quality perceptions for private versus public hospitals, as well as for three types of healthcare services: primary, ambulatory, and inpatient care.Methods: Data from 1,673 patients of private and public hospitals in the capital of Romania were collected in face-to-face interviews. Analysis of covariance and partial-least-squares techniques were used to examine the relationships between perceived service quality, hospital ownership status and the type of health service patients received.Results: Over 70% of women prefer private health facilities to public hospitals (compared to less than 30% of men). While private hospitals rank higher than public hospitals on most attributes, the interaction effect of gender and hospital type reveals that assurance and empathy are the only significant attributes in driving women to private hospitals. (Physical facilities and staff appearance) as well as intangible dimensions of service quality (assurance, responsiveness, reliability, and empathy) have a positive impact on perceived overall service quality of healthcare. Improvements in perceptions of hospital’s tangibles, staff’s responsiveness and empathy have the greatest potential to enhance perceived overall service quality.Conclusions: This paper demonstrates the importance of breaking down health services into various sub-categories both in terms of perceived healthcare attributes and in terms of tangible healthcare facilities, such as public and private hospitals.
{"title":"Patient perceptions of healthcare service quality in Romania: Public versus private hospitals – Implications for developed and developing healthcare systems","authors":"Dan Petrovici, Walfried M. Lassar, Attila J Hertelendy, Madhaven Parthasarathy","doi":"10.5430/jha.v13n1p16","DOIUrl":"https://doi.org/10.5430/jha.v13n1p16","url":null,"abstract":"Objective: Recent increases in per capita income and longevity in Central and Eastern European counties (CEECs), alongside a slow-changing soviet-era public healthcare system, has led to the emergence of private hospitals. This paper investigates the differential patient service quality perceptions for private versus public hospitals, as well as for three types of healthcare services: primary, ambulatory, and inpatient care.Methods: Data from 1,673 patients of private and public hospitals in the capital of Romania were collected in face-to-face interviews. Analysis of covariance and partial-least-squares techniques were used to examine the relationships between perceived service quality, hospital ownership status and the type of health service patients received.Results: Over 70% of women prefer private health facilities to public hospitals (compared to less than 30% of men). While private hospitals rank higher than public hospitals on most attributes, the interaction effect of gender and hospital type reveals that assurance and empathy are the only significant attributes in driving women to private hospitals. (Physical facilities and staff appearance) as well as intangible dimensions of service quality (assurance, responsiveness, reliability, and empathy) have a positive impact on perceived overall service quality of healthcare. Improvements in perceptions of hospital’s tangibles, staff’s responsiveness and empathy have the greatest potential to enhance perceived overall service quality.Conclusions: This paper demonstrates the importance of breaking down health services into various sub-categories both in terms of perceived healthcare attributes and in terms of tangible healthcare facilities, such as public and private hospitals.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"125 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140369942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
George A. Gellert, Kacper Kuszczyński, Natalia Marcjasz, Jakub Jaszczak, Tim Price, Piotr M. Orzechowski
Objective: Compare the triage care referral accuracy of artificial intelligence (AI) based virtual triage (VT) to rules-based triage protocols (RBTP) live telephonic triage.Methods: Clinical vignettes were selected for a comparison of care referral accuracy of RBTPs with a widely utilized AI-based VT solution. Vignettes (149) included patient complaints, expected triage and urgency assessment. Triage levels were mapped to three triage categories (urgent care, non-emergent care and self-care). Each vignette was evaluated/completed using AI-based VT and RBTP triage modalities by a total of four physicians in series, with independent assessment for errors and inconsistencies. Triage assessment precision was analyzed by matching the expected triage assessment, sensitivity and F1 scores (harmonic mean of precision and recall).Results: Both modalities achieved > 70% triage accuracy, and safety performance was identical at 91%. AI-based VT was more accurate in care referral for emergency and non-emergency care and overtriaged to emergency care 50% less frequently than RBTP, but was less accurate than RBTP in self-care vignettes (neither statistically significant). Both modalities demonstrated decreased sensitivity as care urgency/acuity decreased, more pronounced in AI-based VT than RBTP. AI-based VT captured four times as much information and data as RBTP.Conclusions: AI-based VT and RBTP were comparable in care referral accuracy and disposition safety. While AI-based VT provides accurate and safe triage recommendations at a lower total cost, care organizations should assess how AI-based VT compares to a live clinical triage capability with respect to organizational priorities, budgetary considerations, characteristics of the patient/member population served, and the existing technological environment.
{"title":"A comparative performance analysis of live clinical triage using rules-based triage protocols versus artificial intelligence-based automated virtual triage","authors":"George A. Gellert, Kacper Kuszczyński, Natalia Marcjasz, Jakub Jaszczak, Tim Price, Piotr M. Orzechowski","doi":"10.5430/jha.v13n1p8","DOIUrl":"https://doi.org/10.5430/jha.v13n1p8","url":null,"abstract":"Objective: Compare the triage care referral accuracy of artificial intelligence (AI) based virtual triage (VT) to rules-based triage protocols (RBTP) live telephonic triage.Methods: Clinical vignettes were selected for a comparison of care referral accuracy of RBTPs with a widely utilized AI-based VT solution. Vignettes (149) included patient complaints, expected triage and urgency assessment. Triage levels were mapped to three triage categories (urgent care, non-emergent care and self-care). Each vignette was evaluated/completed using AI-based VT and RBTP triage modalities by a total of four physicians in series, with independent assessment for errors and inconsistencies. Triage assessment precision was analyzed by matching the expected triage assessment, sensitivity and F1 scores (harmonic mean of precision and recall).Results: Both modalities achieved > 70% triage accuracy, and safety performance was identical at 91%. AI-based VT was more accurate in care referral for emergency and non-emergency care and overtriaged to emergency care 50% less frequently than RBTP, but was less accurate than RBTP in self-care vignettes (neither statistically significant). Both modalities demonstrated decreased sensitivity as care urgency/acuity decreased, more pronounced in AI-based VT than RBTP. AI-based VT captured four times as much information and data as RBTP.Conclusions: AI-based VT and RBTP were comparable in care referral accuracy and disposition safety. While AI-based VT provides accurate and safe triage recommendations at a lower total cost, care organizations should assess how AI-based VT compares to a live clinical triage capability with respect to organizational priorities, budgetary considerations, characteristics of the patient/member population served, and the existing technological environment.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"5 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139153724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Salwa Alrashidi, Wafa Alenezi, Afaf M. Alrimali, Mashael Alshammari
Objective: Leadership’s impact in healthcare is crucial as it notably shapes the experiences and performance of nursing staff. This study explores the dominant leadership styles among nurse managers in Hail, Saudi Arabia, as experienced by their nursing staff. The inquiry also examines how these leadership approaches directly influence critical organizational outcomes, including leader effectiveness, employee satisfaction, and staff’s willingness to exert extra effort.Methods: A cross-sectional design involving participants recruited via convenience sampling from four government hospitals in Hail, Saudi Arabia. Data were collected using the 45-item Likert-type Multifactor Leadership Questionnaire (MLQ) and analyzed using SPSS Statistics.Results: Among the 372 nurses analyzed, transformational leadership (2.56 ± 0.75) significantly outscored other styles (p < .001) and had the highest correlation with the leadership outcomes of effectiveness, extra effort, and satisfaction (R2 of 0.828, 0.786, and 0.760, respectively) compared to the transactional and laissez-faire leadership styles. Additionally, linear regression analysis revealed that transformational leadership explained 69% of effectiveness, 61.7% of extra effort, and 58% of satisfaction variances. Within the transformational framework, “inspirational motivation” strongly correlated with positive outcomes.Conclusions: This study emphasizes transformational leadership’s essential role in healthcare, urging nurse leaders to embrace this style, with a focus on strategies that boost motivation. It also recommends that healthcare institutions initiate targeted programs to develop their leaders’ transformational leadership characteristics.
{"title":"Exploring the leadership styles of nurse managers in Hail, Saudi Arabia: A cross-sectional analysis","authors":"Salwa Alrashidi, Wafa Alenezi, Afaf M. Alrimali, Mashael Alshammari","doi":"10.5430/jha.v13n1p1","DOIUrl":"https://doi.org/10.5430/jha.v13n1p1","url":null,"abstract":"Objective: Leadership’s impact in healthcare is crucial as it notably shapes the experiences and performance of nursing staff. This study explores the dominant leadership styles among nurse managers in Hail, Saudi Arabia, as experienced by their nursing staff. The inquiry also examines how these leadership approaches directly influence critical organizational outcomes, including leader effectiveness, employee satisfaction, and staff’s willingness to exert extra effort.Methods: A cross-sectional design involving participants recruited via convenience sampling from four government hospitals in Hail, Saudi Arabia. Data were collected using the 45-item Likert-type Multifactor Leadership Questionnaire (MLQ) and analyzed using SPSS Statistics.Results: Among the 372 nurses analyzed, transformational leadership (2.56 ± 0.75) significantly outscored other styles (p < .001) and had the highest correlation with the leadership outcomes of effectiveness, extra effort, and satisfaction (R2 of 0.828, 0.786, and 0.760, respectively) compared to the transactional and laissez-faire leadership styles. Additionally, linear regression analysis revealed that transformational leadership explained 69% of effectiveness, 61.7% of extra effort, and 58% of satisfaction variances. Within the transformational framework, “inspirational motivation” strongly correlated with positive outcomes.Conclusions: This study emphasizes transformational leadership’s essential role in healthcare, urging nurse leaders to embrace this style, with a focus on strategies that boost motivation. It also recommends that healthcare institutions initiate targeted programs to develop their leaders’ transformational leadership characteristics.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139235993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Previous studies had found that rest breaks can not only prevent or improve negative reactions to stress in healthcare staff, but also reduce turnover in understaff conditions, improve work performance, and ultimately improve patient outcomes. As a result, many inpatient units had implemented a nursing position called a Break Nurse, whose sole purpose was to provide rest breaks. However, the implementation of a Break Nurse and its effectiveness was not reported in literature. Therefore, this quality improvement QI project proposed to implement Break Nurses on an acute care unit of impatient setting and investigate its effectiveness on nursing staff.Methods: The selected unit previously utilizing a Break-Buddy model for securing rest breaks was able to start a two 8-hour shift Break Nurse model. The hypothesis is that the Two-Break-Nurse model, when compared with the Break-Buddy model, will better secure rest breaks, reduce burnout symptoms experienced by nursing staff. The validated tool used to measure burnout is the Maslach Burnout Inventory. The study utilized pre- and post-implementation self-report survey statistical analysis to report outcomes.Results: In the end, 14 individuals had responded to both pre- and post implementation surveys. The results show that there was statistically significant improvement of Emotional Exhaustion. Due to the small sample size, the measurement of Depersonalization and Personal Accomplishment did not show statistically significant improvement.Conclusions: The Two-Break-Nurse model is effective at reducing emotional exhaustion for nursing staff. Further studies are needed to measure in a larger scale the effectiveness of break nurse model on other aspects of burnout and the improvement of clinical outcomes.
{"title":"Exploring the effects of break nurses on nursing staff burnout","authors":"Danjie Zheng","doi":"10.5430/jha.v12n2p38","DOIUrl":"https://doi.org/10.5430/jha.v12n2p38","url":null,"abstract":"Objective: Previous studies had found that rest breaks can not only prevent or improve negative reactions to stress in healthcare staff, but also reduce turnover in understaff conditions, improve work performance, and ultimately improve patient outcomes. As a result, many inpatient units had implemented a nursing position called a Break Nurse, whose sole purpose was to provide rest breaks. However, the implementation of a Break Nurse and its effectiveness was not reported in literature. Therefore, this quality improvement QI project proposed to implement Break Nurses on an acute care unit of impatient setting and investigate its effectiveness on nursing staff.Methods: The selected unit previously utilizing a Break-Buddy model for securing rest breaks was able to start a two 8-hour shift Break Nurse model. The hypothesis is that the Two-Break-Nurse model, when compared with the Break-Buddy model, will better secure rest breaks, reduce burnout symptoms experienced by nursing staff. The validated tool used to measure burnout is the Maslach Burnout Inventory. The study utilized pre- and post-implementation self-report survey statistical analysis to report outcomes.Results: In the end, 14 individuals had responded to both pre- and post implementation surveys. The results show that there was statistically significant improvement of Emotional Exhaustion. Due to the small sample size, the measurement of Depersonalization and Personal Accomplishment did not show statistically significant improvement.Conclusions: The Two-Break-Nurse model is effective at reducing emotional exhaustion for nursing staff. Further studies are needed to measure in a larger scale the effectiveness of break nurse model on other aspects of burnout and the improvement of clinical outcomes.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"44 14","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135819581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ian Atherton, Douglas Doust, Sally Burrows, Deepan Krishnasivam
Objective: To review “triggers” for deteriorating patients who required intervention by a medical emergency response team (MET). In addition, to assess whether these “triggers” differed by medical or surgical governance of these patients. A secondary objective was to report laboratory investigations performed via the MET, with particular interest in tests duplicating haemoglobin (Hb) values and their degree of concordance within the context of low-cost, high value inpatient care.Methods: This quality improvement initiative involved a prospective observational cohort of inpatients, who were attended to by the MET at Royal Perth Hospital in Perth, Western Australia over a 2-year period between 2020 and 2022.Results: The mean number of MET calls for inpatients under surgical governance was slightly higher than for those patients under medical governance (1.34 vs. 1.25 calls respectively p = .03). Hypotension triggered a MET call in 184 (40.9%) surgical patients compared to 154 (28%) under medical governance (p < .001). Comparing haemoglobin values obtained from FBP and VBG, Lin’s concordance correlation coefficient (CCC) was found to be 0.986, 95%CI: 0.983, 0.989. The Bland-Altman limits of agreement suggest that the haemoglobin value on a VBG ranges from 9.55 g/L higher than the FBP to 4.7 g/L lower than the FBP.Conclusions: Significant differences in the frequency of triggers for patients under medical vs surgical governance highlight the need for proactive planning around hypotension management of patients under surgical governance. In addition, understanding the nuances between haemoglobin values obtained from FBP and VBG can help with value-based health care and efficiencies in patient care, since measuring haemoglobin values is one of the key components in hypotension management.
{"title":"High value healthcare analysis of “triggers” in deteriorating patients","authors":"Ian Atherton, Douglas Doust, Sally Burrows, Deepan Krishnasivam","doi":"10.5430/jha.v12n2p30","DOIUrl":"https://doi.org/10.5430/jha.v12n2p30","url":null,"abstract":"Objective: To review “triggers” for deteriorating patients who required intervention by a medical emergency response team (MET). In addition, to assess whether these “triggers” differed by medical or surgical governance of these patients. A secondary objective was to report laboratory investigations performed via the MET, with particular interest in tests duplicating haemoglobin (Hb) values and their degree of concordance within the context of low-cost, high value inpatient care.Methods: This quality improvement initiative involved a prospective observational cohort of inpatients, who were attended to by the MET at Royal Perth Hospital in Perth, Western Australia over a 2-year period between 2020 and 2022.Results: The mean number of MET calls for inpatients under surgical governance was slightly higher than for those patients under medical governance (1.34 vs. 1.25 calls respectively p = .03). Hypotension triggered a MET call in 184 (40.9%) surgical patients compared to 154 (28%) under medical governance (p < .001). Comparing haemoglobin values obtained from FBP and VBG, Lin’s concordance correlation coefficient (CCC) was found to be 0.986, 95%CI: 0.983, 0.989. The Bland-Altman limits of agreement suggest that the haemoglobin value on a VBG ranges from 9.55 g/L higher than the FBP to 4.7 g/L lower than the FBP.Conclusions: Significant differences in the frequency of triggers for patients under medical vs surgical governance highlight the need for proactive planning around hypotension management of patients under surgical governance. In addition, understanding the nuances between haemoglobin values obtained from FBP and VBG can help with value-based health care and efficiencies in patient care, since measuring haemoglobin values is one of the key components in hypotension management.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"99 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135477094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：