Health Services Management Research最新文献

Background: There is growing evidence of the relevance of designing organization of care around patient characteristics; this is especially true in the case of complex chronic diseases.Purpose: The goal of the paper - that focuses on the analysis of the clinical condition hemophilia in three different centers - is to address two different research questions:1. How can we define, within the same clinical condition, different patient profiles homogeneous in terms of intensity of service required (e.g. number of visits or diagnostics)? 2. What are the conditions to re-organize care around these patient profiles in a multidisciplinary and coordinated manner?Research design: The authors have used a multiple case study approach combining both qualitative and quantitative methodologies; in particularly the semi-structured interviews and the direct observation were aimed to map the process in order to come up with an estimate of the cost of the full cycle of care.Study sample: The research methodology has been applied consistently in three different centers. The selection of the structures has been based on two main different criteria: (i) high standards regarding both organizational and clinical aspects and (ii) willingness from management, nurses and physicians to provide data.Results: The study clearly shows that different patient profiles - within the same clinical condition - trigger a different set of diagnostic and therapeutic activities. It is, thus, important considering patient characteristics in the development and implementation of clinical pathways and this will imply relevant differences in terms of organizational and economic impact.Conclusions: These process-based analyses are very much critical especially if we want to move to a bundled and integrated payment system but, as shown by this study itself, require a lot of time and efforts since our healthcare information systems are still fragmented and vertically designed.

Life expectancy, quality of life and satisfaction of oncologic patients highly depend on access to adequate specialized services, that consider their conditions in a holistic way. The present study aims to evaluate the introduction of oncology services in an outpatient setting in a mountain village in Northern Italy. The initiative is evaluated using the three pillars of sustainability (social, economic and environmental) as dimensions that are often overlooked by healthcare policy makers. Using micro data on 18,625 interventions, we estimate the number of kilometers saved by patients (reduction of "travel burden" as indicator of social sustainability), the additional travel costs for the NHS (indicator of economic sustainability) and the implied reduction of CO₂ emissions (indicator of environmental sustainability). Over the period July 2016-2021, the decentralized health center delivered 2,292 interventions saving 218,566 km for a corresponding value of €131,140. The additional costs for the NHS was €26,152. The reduction of CO₂ emissions was 32.37 Tons (€5,989). Overall, the socio-economic benefit of reducing travel of care for the patients residing in this remote valley was €110,976. This study adds original understanding of the benefits of decentralizing oncologic care and shows its operational feasibility conditions. Given the modest number of similar projects, it provides evidence to policy makers and, especially, managers who are faced with the challenge to implement the decentralization of specialized services.

Background: Spanish primary care services are managed differently by each region's authorities. Catalonia started its services provision and design nearly two decades before other Spanish regions and developed nurses' roles and task shifting in primary care.

Purpose: This work identifies differences in the Europe PRICOV-19 study answers between Catalonia and those submitted from the rest of Spain regarding how primary care teams (PCT) were organised during the SARS-CoV-2-2019 pandemic, how tasks and roles changed, and the pandemic's impact on the care providers. Initially, we computed bivariate relationships and tested using contingency association and unpaired Wilcoxon.

Analysis: Still, we estimated multiple linear regressions controlling with a list of individual and GP practice characteristics and clustering standard errors at the kind of location.

Results: Main statistically significant differences were found in the adaptation to the new tasks, the ability to solve most health problems, and specific accessibilities to primary care. In Catalonia, satisfaction with the adaptation to the new tasks was higher (41.9% satisfied and 30.2% neutral) than in the rest of Spain (50.9% dissatisfaction). Also, GPs in Catalonia reported to a greater extent than the rest of Spain that chronic patients were listed for extensive follow-up. These differences may be related to Catalonia's strategy for empowering primary care professionals other than family doctors.

Conclusions: Considering future pandemics, demographic ageing, and professional shortages, we point out the potential benefits of these changes in PCT organisations and the need to review the centres's design.

In the highly competitive, perennially-changing healthcare industry, management prowess is vitally needed by those in positions of authority, but in isolation it is insufficient for delivering optimal results. Instead, management proficiencies must be complemented by leadership skills which amplify managerial efforts and outcomes. One avenue for building leadership acumen in healthcare organizations involves the establishment of leadership development programs. These programs generally assemble a range of opportunities permitting managers to learn about leadership and acquire associated proficiencies. Leadership development programs afford many benefits for healthcare providers, but in order to capitalize fully, thoughtful assembly is required. To shed light on this important topic, this article provides an overview of leadership development programs, noting a formal definition, stipulating associated benefits, and discussing options for assembly, all through the lens of Willis Knighton Health's leadership development initiatives and experiences.

Healthcare delivery is currently undergoing major structural reform, and the Learning Health System (LHS) has been proposed as an aspirational model to guide healthcare transformation. As efforts to build LHS take considerable investment from health systems, it is critical to understand their leaders' perspectives on the rationale for pursuing an LHS and the potential benefits for doing so. This paper describes the qualitative analysis of semi-structured interviews (n = 17) with health system leaders about their general perceptions of the LHS, description of key attributes and potential benefits, and perception of barriers to and facilitators for advancing the model. Participants universally endorsed the goal of the local health system aspiring to become an LHS. Participants identified many recognized attributes of LHS, though they emphasized unique attributes and potential benefits. There was also heterogeneity in participants' views on what to prioritize, how to structure the local LHS within existing initiatives, and how new initiatives should be implemented. Improving conceptual clarity of attributes of the LHS would improve its potential in guiding future reform.

Effective quality leadership is identified as a critical factor for organisational success. Leadership style has an important role in the implementation of quality management. This systematic review describes the characteristics of leadership in quality management in healthcare, and analyses their association with successful or unsuccessful quality management by using content analysis. Papers published in peer-reviewed journals between 2011 and June 2023 were selected by exploring the Abi/Inform, Business Source Complete, Cinahl, Pubmed and Web of Science electronic databases. Altogether 3014 records were found. PRISMA-protocol was used for selection of studies. 12 original and three review articles were included. Six leadership characteristics were identified that were linked to successful or unsuccessful implementation of quality management. The six categories were strategic, knowledge-oriented, value-based, supportive, participatory and communicative leadership. Supercategories and subcategories of successful and unsuccessful implementation are described. The results can be used to identify the leadership characteristics that promote successful quality management in healthcare organisations. In education for leaders and managers, attention should be in the characteristics and style of leadership and their impact on the effectiveness of quality management.

Healthcare organizations are reliant on cadres of managers to oversee operations, ensuring the delivery of excellent patient care and accomplishment of institutional missions. These managers obviously must be well versed in the principles of management, but they also must be proficient in leadership. As leadership can take many different forms, healthcare organizations must take care in their associated leadership development efforts to ensure that they have a firm grasp on the precise leadership qualities needed within their given organizations. Achieving this knowledge can be greatly facilitated by developing leadership expectations statements. This article profiles leadership expectations statements, presents a recent statement developed by Willis Knighton Health, and outlines the steps required for assembling and using them in any healthcare institution.

This article delves into the multifaceted realm of dental tourism, scrutinizing patient incentives, economic ramifications, and ethical aspects. An in-depth 2023 analysis discerns research gaps, underscoring the necessity for a more exhaustive investigation to enrich the understanding of the global oral healthcare landscape. Utilizing bibliometric analysis method, the study examines the worldwide trajectory of scientific publications on dental tourism. Employing Scopus, it dissects document types, annual production, authorship, and international collaborations. The results spotlight microvariables derived from Saxena, Deheriya, Datla's macrovariables, unveiling influencers on dental tourism, ranging from social and economic to cultural factors. The study advocates for defined bilateral agreements to ensure quality care and stresses ethical considerations, emphasizing shared standards and legal implications. Economic ramifications, both positive and negative, are discussed, with an expanding global focus on dental tourism evident. In conclusion, the study accentuates micro variables, signaling avenues for future research.

Background: Non-communicable diseases (NCDs) represent a global health challenge that requires coordination across various healthcare settings.Purpose: This study in Tuscany, Italy, investigates professional integration between primary care physicians (PCPs) and specialists in NCD management.Research Design: A self-developed survey was used to explore professionals' views on clinical and organizational collaboration, accountability, and service improvement.Study Sample: The study involved primary care physicians (PCPs) and specialists working in the field of NCD management.Data Collection and/or Analysis: The survey gathered data on professionals' perceptions of clinical protocol use, care integration effectiveness, and other aspects of collaboration in NCD management.Results: Findings reveal disparities between PCPs and specialists in clinical protocol use and care integration effectiveness.Conclusions: The study emphasizes the need to reduce bureaucratic obstacles and enhance information sharing. Promoting peer relationships and innovative performance evaluation tools is vital for improving chronic disease management. This survey contributes valuable insights for the development of integrated care models, aiding healthcare decision-makers in enhancing chronic care system performance.

Purpose: A routine preoperative assessment is considered both ineffective and inefficient. Despite the widespread application of lean thinking in healthcare, there is little evidence of successful experiences in preoperative admissions in order to reduce "No value added" activities. A conceptual framework reporting the drivers (clinic, tools, innovation, organization, and governance) and impacts (patient, efficiency, sustainability, time, learning and growth) was developed. Methodology: Drawing on the experience of an Italian high complexity hospital, this paper analyzes the case study by reporting evidence on how to implement lean in preoperative assessment and how to evaluate the positive results obtained. Results: Applying lean principles, the identification of value improved the appropriateness of care by creating 40 personalized pathways; the value stream resulted in a reduction of "No Value Added Time" from 37% to 28%, chest X-rays from 41% to 14% and cardiac visits from 49% to 37%; the pursuit of continuous flow through innovation contributed to increase the use of digitalization; the new pull organization helped to reduce the average time spent per year by 1.5 h; the continuous improvement was ensured through the governance of results. Conclusion: The proposed framework should be used to improve the quality of care in preoperative admissions by adopting the lean drivers for successful implementation and reporting the impacts.