Financial issues in times of a COVID-19 pandemic in a tertiary hospital in Mali

BACKGROUND

This study examines how the functioning of healthcare providers during the COVID-19 pandemic was affected by the government financing response, which was shaped by existing healthcare financing systems.

METHODS

The study applied a single case study design at a tertiary hospital in Bamako during the 1st and 2nd waves of the COVID-19 pandemic. Data were gathered through 51 in-depth interviews with hospital staff, participatory observation, and reviewing media articles and hospital financial records.

RESULTS

The study revealed the disruptions experienced by hospital managers, human resources for health and patients in Mali during the early stages of the pandemic. While the government aimed to support universal access to COVID-19-related services, efforts were undermined by issues associated with complex public financing management procedures. The hospital experienced long delays in transferring government funds. The hospital suffered a decrease in revenue during the early stages of the pandemic. Government budgets were not effectively used because of complex, non-agile procedures that could not adapt to the emergency. The challenges faced by the hospitals led to the delays in the staff payments of salaries and promised bonuses, which created potential for unfair treatment of patients. Excluding some COVID-19 related items from the government funded benefit package created a financial burden on people receiving services. The managerial challenges experienced in the study hospital during the first wave continued in the second wave.

CONCLUSIONS

Pre-existent issues in healthcare financing and governance constrained the effective management of COVID-19-related services and created confusion at the front line of healthcare service delivery.

Exploring the Process of Policy Overreaction: The COVID-19 Lockdown Decisions

Policy overreaction is a common phenomenon, especially in complex and emergency situations where politicians are led to make decisions fast. In these emergency decisions, emotions run generally high and cognitive processes are often impaired. The conditions of policy overreaction are in place as emotions overwhelm decision makers' rational processes. Drawing on the response patterns of three countries to the COVID-19 pandemic, we develop a process model of policy overreaction which describes the effects of negative emotions and institutional isomorphism on policy decision-making. Our model highlights four critical stages: negative emotions buildup, propagation of fear, isomorphic decision-making, and leading to an intractable crisis. This article shows precisely how the cascading effect of negative emotions, particularly fear, is contagious and spreads to generate crowd effects, which bend considerably policy makers' ability to make rational decisions. Our theory provides a better understanding of the process by which policy overreaction takes place.

Air Pollution Management: A Multivariate Analysis of Citizens' Perspectives and Their Willingness to Use Greener Forms of Transportation

The present research aims to understand how air pollution can be managed by public authorities, both central and local, starting from citizens' perspectives on the issue. Air quality is a real problem, affecting people at multiple levels. Thus, we introduced the following variables to better understand the problem and to be able to formulate theoretical and practical implications for public management: the involvement of authorities in reducing air pollution; the involvement of citizens in reducing air pollution; financial incentives for citizens and companies for adopting behaviors that reduce air pollution; green investments in the city; the impact of air pollution on the community; and the need for independent bodies to monitor air pollution. The research methodology used is partial least squares structural equation modelling (PLS-SEM) and the required data were gathered from issuing a survey to citizens from the most important cities in Romania where pollution poses important challenges for the community and for the authorities. The results are useful to public managers in local and central institutions for creating better strategies meant to reduce air pollution, increase air quality, and improve the quality of the citizens' lives.

Integration of health care in the Basque Country during COVID-19: the importance of an integrated care management approach in times of emergency

The main objective of this study is to analyse the process of integration of health care implemented in the public health system (Osakidetza) of the Autonomous Community of the Basque Country (CAPV), and assess whether the steps taken to date have helped or hindered the work of health personnel in times of COVID-19. Based on a case study, an assessment is made of the way in which certain tools of the integration process have been applied, if they have worked well and if they have led to better management of the pandemic.For the purpose of this study, a qualitative methodology is chosen consisting of a case study and in-depth interviews with health personnel at the front line of the integration process and the fight against COVID-19.This study makes two fundamental contributions. First, it analyses the health integration process in recent years in the public health system of the Basque Country. Second, it gathers the perceptions of different agents related to the Basque Health System of the way in which the tools of the integration process implemented in recent years have worked during the pandemic, detailing the positive and negative perceptions in this regard.Our conclusions offer a series of strategic recommendations linked to comprehensive patient care and the use of tools related to teleconsulting: the unified medical record, electronic prescription, and non-face-to-face care channels.

Do different uses of performance measurement systems in hospitals yield different outcomes?

BACKGROUND

Inspired by the new public management movement, many public sector organizations have implemented business-like performance measurement systems (PMSs) in an effort to improve organizational efficiency and effectiveness. However, a large stream of the accounting literature has remained critical of the use of performance measures in the public sector because of the inherent difficulty in measuring output and the potential adverse effects of performance measurement. Although we acknowledge that PMSs may indeed sometimes yield adverse effects, we highlight in this study that the effects of PMSs depend on the way in which they are used.

PURPOSE

The aim of this study was to investigate various uses of PMSs among hospital managers and their effects on hospital outcomes, including process quality, degree of patient-oriented care, operational performance, and work culture.

METHODOLOGY

We use a survey sent to 432 Dutch hospital managers (19.2% response rate, 83 usable responses). For our main variables, we rely on previously validated constructs where possible, and we conduct ordinary least squares regressions to explore the relation between PMS use and hospital outcomes.

RESULTS

We find that the way in which PMSs are used is associated with hospital outcomes. An exploratory use of PMS has a positive association with patient-oriented care and collective work culture. Furthermore, the operational use of PMSs is positively related to operational performance but negatively related to patient-oriented care. There is no single best PMS use that positively affects all performance dimensions.

PRACTICE IMPLICATIONS

The way in which managers use PMSs is related to hospital outcomes. Therefore, hospital managers should critically reflect on how they use PMSs and whether their type of use is in line with the desired hospital outcomes.

The Secretary Shall . . . : Implementing the Affordable Care Act's Private Insurance Expansions

The federal bureaucracy played a critical role in implementing most aspects of the Affordable Care Act's private insurance coverage expansion. Through brief case studies, the authors review three dimensions of this role: the development of the Center for Consumer Information and Insurance Oversight, rulemaking in the formulation of the essential health benefits package, and the implementation of the federal website. They relate these to themes in the public administration literature. Politics-both through state decisions and through continuing congressional action (and inaction)-pervaded the implementation process. The challenges of staffing and situating the new bureaucracy effectively changed vertical boundaries within the Department of Health and Human Services, with long-lasting consequences. Finally, the complex design of the policy itself made passage of the legislation easier but implementation much more difficult. Ultimately, however, implementation was remarkably successful, achieving improvements in coverage consistent with the Congressional Budget Office's projections.

Realization of the EU's Cohesion Policy in Health Care in the Visegrad Group Countries in the Perspective 2014-2020

A key objective of the European Union is to strengthen regional cohesion by addressing development disparities, particularly by targeting less-favored regions (1). Initiatives related to leveling development differences in the field of health care are recognized as a one of priorities in the European Union. Therefore, when implementing cohesion policy, decisions have been made to mobilize structural funds for sectoral activities. The aim of this paper is to present the European Union's cohesion policy in the field of health care and to indicate the most important actions of the implemented programmes/projects in selected countries: Poland, the Czech Republic, the Slovak Republic and Hungary—the Visegrad Group–VG4—in the period of 2014–2020. Analysis covers programmes, funding sources, and activities undertaken in achieving cohesion policy objectives in health care in the VG4.

The Effects of Leadership and Job Autonomy on Vitality: Survey and Experimental Evidence

Vitality refers to the experience of having energy available to one's self. Vital employees are full of positive energy when they work, and feel mentally and physically strong. Such employees often show higher job performance and lower stress than their less vital colleagues. Despite the importance of vitality, few public administration studies have studied vitality. More generally, by focusing on vitality, we aim to bring a "positive psychology" perspective into the domain of public administration. We analyze whether two important job characteristics (leader's task communication and job autonomy) affect vitality. We use a multi-method design. A large-scale survey (N = 1,502) shows that leader's task communication and job autonomy are positively related to vitality. A lab experiment (N = 102) replicated these findings, showing cause-and-effect relationships. In conclusion, public organizations can potentially increase employee vitality (a) by increased task communication from leaders and (b) by providing employees with greater job autonomy.

Working with layers: The governance and regulation of healthcare quality in an institutionally layered system

Institutional arrangements used to steer public policies have increasingly become layered. Inspired by the literature on institutional layering and institutional work, this paper aims to make a contribution to our understanding of institutional layering. We do so by studying an interesting case of layering: the Dutch hospital sector. We focus on the actors responsible for the internal governance (Board of Directors and Supervisory Boards) and the external regulation (the Healthcare Inspectorate) of hospitals. In the paper, we explore the institutional work of these actors, more specifically how institutional work results from and is influenced by institutional layering and how this in turn influences the institutional makeup of both healthcare organizations and their institutional context. Our approach allowed us to see that layering changes the activities of actors in the public sector, can be used to strengthen one's position but also presents actors with new struggles, which they in turn can try to overcome by relating and using the institutionally layered context. Layering and institutional work are therefore in continuous interaction. Combining institutional layering with a focus on the lived experiences of actors and their institutional work makes it possible to move into the layered arrangement and better understand its consequences.

The impact of regional policies on emergency department management and performance: the case of the regional government of Sicily

BACKGROUND

Improvement in healthcare, seeking the correct balance between quality and costs, is an ongoing concern in many countries. Many countries have developed and implemented improvement programmes in health care, particularly in emergency departments (ED), which play a key role in terms of hospital resources and planning. The regional government of Sicily implemented a project 2010-2012 to improve ED care quality and patient safety.

PURPOSE

This paper aims to evaluate improvements implemented by the Regional Health Authority of Sicily in the 20 main EDs.

METHOD

Performance analysis of EDs was conducted on three levels: care quality (standard Joint Commission International evaluation), efficiency in terms of resources and output (by way of interviews and document analysis) and the role of management in efficiently promoting change (presence of a performance monitoring system).

FINDINGS

The results show improvements in all areas and improved performance in all EDs. There is, however, room for improvement in certain areas, and improvement was not uniformly distributed.

PRACTICAL IMPLICATIONS

The quality of local policy and management are key aspects of efficient promotion of performance improvement. Copyright © 2015 John Wiley & Sons, Ltd.

Policy entrepreneurship in UK central government: The behavioural insights team and the use of randomized controlled trials

What factors explain the success of the UK Cabinet Office's Behavioural Insights Team? To answer this question, this article applies insights from organizational theory, particularly accounts of change agents. Change agents are able-with senior sponsorship-to foster innovation by determination and skill: they win allies and circumvent more traditional bureaucratic procedures. Although Behavioural Insights Team is a change agent-maybe even a skunkworks unit-not all the facilitating factors identified in the literature apply in this central government context. Key factors are its willingness to work in a non-hierarchical way, skills at forming alliances, and the ability to form good relationships with expert audiences. It has been able to promote a more entrepreneurial approach to government by using randomized controlled trials as a robust method of policy evaluation.