Empanelment of health care facilities under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) in India

Introduction

India’s Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the world’s largest health assurance scheme providing health cover of 500,000 INR (about USD 6,800) per family per year. It provides financial support for secondary and tertiary care hospitalization expenses to about 500 million of India’s poorest households through various insurance models with care delivered by public and private empanelled providers. This study undertook to describe the provider empanelment of PM-JAY, a key element of its functioning and determinant of its impact.

Methods

We carried out secondary analysis of cross-sectional administrative program data publicly available in PM-JAY portal for 30 Indian states and 06 UTs. We analysed the state wise distribution, type and sector of empanelled hospitals and services offered through PM-JAY scheme across all the states and UTs.

Results

We found that out of the total facilities empanelled (N = 20,257) under the scheme in 2020, more than half (N = 11,367, 56%) were in the public sector, while 8,157 (40%) facilities were private for profit, and 733 (4%) were private not for profit entities. State wise distribution of hospitals showed that five states (Karnataka (N = 2,996, 14.9%), Gujarat (N = 2,672, 13.3%), Uttar Pradesh (N = 2,627, 13%), Tamil Nadu (N = 2315, 11.5%) and Rajasthan (N = 2,093 facilities, 10.4%) contributed to more than 60% of empanelled PMJAY facilities: We also observed that 40% of facilities were offering between two and five specialties while 14% of empanelled hospitals provided 21–24 specialties.

Conclusion

A majority of the hospital empanelled under the scheme are in states with previous experience of implementing publicly funded health insurance schemes, with the exception of Uttar Pradesh. Reasons underlying these patterns of empanelment as well as the impact of empanelment on service access, utilisation, population health and financial risk protection warrant further study. While the inclusion and regulation of the private sector is a goal that may be served by empanelment, the role of public sector remains critical, particularly in underserved areas of India.

Predictors of patient safety culture in hospitals in Venezuela: A cross-sectional study

An organization's culture with regard to patient safety is important because it defines the beliefs and practices of the organization, and consequently its efficiency and productivity.Knowing the level of this and the factors that influence or not their dynamic represents a challenge, due to the degree of complexity and specificity of the elements involved.The aim of this study was to analyze predictors of patient safety culture in public and private hospitals and examining the factors that contribute to it, constructing a new and specific theoretical and methodological model.This study was carried out by reviewing medical records, detecting healthcare professionals directly involved in caring (N = 588), for patients in 2 public hospitals and 2 private hospitals in Venezuela (N = 566), conducting an "Analysis of Patient Safety Culture" questionnaire. The results were subsequently analyzed, derived 3 predictors factors and using a Patient Safety Culture Index (PSCI) for specific determination to evaluate patient safety culture level.The analysis showed that all hospitals had a "moderately unfavorable" PSCI (public = 52.96, private = 52.67, sig = 0.90). The PSCI was calculated by assessing the weight of the following factors in the index: occupational factors (factor loading = 32.03), communication factors (factor loading = 11.83), and organizational factors (factor loading = 9.10). Traumatology presented the lowest PSCI of all the care units, falling into the "unfavorable" category (36.48), and Laboratory the highest (70.02) (sig = 0.174), falling into the "moderately favorable" category. When analyzing professional groups, nurses had the highest PSCI, with a "moderately unfavorable" rating (PSCI = 61.1) and medical residents the lowest, falling into the "unfavorable" category (35.2). Adverse event reporting is determined by "management expectations and actions" (sig = 0.048) and "direct interaction with the patient" (sig = 0.049).The use of this theoretical and methodological approach in other contexts may provide a more objective system for identifying more specific needs and factors that influence in patient safety culture, and consequently, opportunities for improvement when constructing a patient safety culture in healthcare institutions. Efforts need to be made to improve safety culture in the hospitals studied, irrespective of whether they are public or private.

Acute stroke care algorithm in a private tertiary hospital in the Philippines during the COVID-19 pandemic: A third world country experience

BACKGROUND AND PURPOSE

Since the declaration of the Novel Coronavirus Disease (COVID-19) pandemic, ensuring the safety of our medical team while delivering timely management has been a challenge. Acute stroke patients continue to present to the emergency department and they may not have the usual symptoms of COVID-19 infection. Stroke team response and management must be done within the shortest possible time to minimize worsening of the functional outcome without compromising safety of the medical team.

METHODS

Infection control recommendations, emergency department protocols and stroke response pathways utilized prior to the COVID 19 pandemic within our institution were evaluated by our stroke team in collaboration with the multidisciplinary healthcare services. Challenges during the COVID-19 scenario were identified, from which a revised acute stroke care algorithm was formulated to adapt to this pandemic.

RESULTS

We formulated an algorithm that incorporates practices from internationally devised protocols while tailoring certain aspects to suit the available resources in our system locally. We highlighted the significance of the following: team role designation, coordination among different subspecialties and departments, proper use of personal protective equipment and resources, and telemedicine use during this pandemic.

CONCLUSIONS

This pandemic has shaped the stroke team's approach in the management of acute stroke patients. Our algorithm ensures proper resource management while optimizing acute stroke care during the COVID-19 pandemic in our local setting. This algorithm may be utilized and adapted for local practice and other third world countries who face similar constraints.

Multilevel Analysis of the Relationship between Ownership Structure and Technical Efficiency Frontier in the Spanish National Health System Hospitals

Objective: To evaluate the relationship between the ownership structure of hospitals and the possibility of their being positioned on the frontier of technical efficiency in the economic crisis period 2010–2012, adjusting for hospital variables and regional characteristics in the areas where the Spanish National Health System (SNHS) hospitals are located. Methods: 230 National Health System hospitals were studied over the two-year period 2010–2012 according to their ownership structure—public hospitals, private hospitals and public–private partnership (PPP)—data envelopment analysis orientated to inputs was used to measure the overall technical efficiency, pure efficiency and efficiency of scale. A generalised linear mixed model (GLMM) with binomial distribution and logit link function was used to analyse the hospital and regional variables associated with positioning on the frontier. Results: There are substantial differences between the average pure technical efficiency of public, private and PPP hospitals, as well as a greater number of PPP models being positioned on the efficiency frontier (91.67% in 2012). The odds of being positioned on the frontier are 41.7 times higher in PPP models than in public hospitals. The average annual household income per region is related to the greater odds of hospitals being positioned on the frontier of efficiency. Conclusions: During the most acute period of recession in the Spanish economy, PPP formulas favoured hospital efficiency, by increasing the odds of being positioned on the frontier of efficiency when compared to private and public hospitals. The position on the frontier of efficiency of a hospital is related to the wealth of its region.

Factors influencing motivation of nurse leaders in a private hospital group in Gauteng, South Africa: A quantitative study

BACKGROUND

Nurse leadership is about aligning employees to a vision. This happens with buy-in, motivation and communication. When conducive environments are created by organisations, the motivation of nurse leaders will be enhanced, which will have a positive outcome on the organisation. Highly motivated nurse leaders accomplish more and are more productive. Nurse leadership is an essential source of support, mentorship and role modelling. These attributes tend to be more evident when nurse leaders are motivated.

OBJECTIVES

The objective of this study was to determine the factors that influence the motivation of nurse leaders.

METHOD

A quantitative, descriptive design and stratified sampling was used. Participants comprised unit managers (n = 49) from five hospitals in a private hospital group in South Africa. A self-administered questionnaire, namely, the Multidimensional Work Motivation Scale, was used to collect the data. Data were analysed using the IBM SPSS 22.0 program.

RESULTS

The results indicated that the nurse leaders in this study were intrinsically motivated. Their motivation was influenced by support, relatedness, autonomy and competence. No relationships were found between motivation and age, years in a management position, gender, qualifications and staff-reporting structure.

CONCLUSION

By implication, to understand what motivates nurse leaders and to keep them motivated, recommendations were proposed to nursing and human resources management. It is expected that the implementation of the recommendations will have a positive influence on patient outcomes, organisational success and the motivation and satisfaction of nurse leaders.

Private Hospital Workflow Optimization via Secure k-Means Clustering

Optimizing the workflow of a complex organization such as a hospital is a difficult task. An accurate option is to use a real-time locating system to track locations of both patients and staff. However, privacy regulations forbid hospital management to assess location data of their staff members. In this exploratory work, we propose a secure solution to analyze the joined location data of patients and staff, by means of an innovative cryptographic technique called Secure Multi-Party Computation, in which an additional entity that the staff members can trust, such as a labour union, takes care of the staff data. The hospital, owning location data of patients, and the labour union perform a two-party protocol, in which they securely cluster the staff members by means of the frequency of their patient facing times. We describe the secure solution in detail, and evaluate the performance of our proof-of-concept. This work thus demonstrates the feasibility of secure multi-party clustering in this setting.

Framing sustainable development through descriptive determinants in private hospitals - Orientation and organization

PURPOSE

To frame the sustainable development in private hospitals, based on descriptive determinants of orientation and organization from the past to the present.

DESIGN/METHODOLOGY/APPROACH

Based on an inductive approach, judgmental sampling was used to target relevant health care organizations. Informants were assessed according to their knowledge of their organizations' sustainability initiatives.

FINDINGS

Report the main determinants of orientation and organization revealed in relation to the hospitals' past and present sustainability initiatives, providing a foundation for describing their sustainable development.

RESEARCH LIMITATIONS/IMPLICATIONS

Reveals a selection of descriptive determinants of sustainable development in private hospitals, all of which offers a basis for assessing whether the evolution of organizational sustainability initiatives is major, minor or non-existent.

MANAGERIAL IMPLICATIONS

The sustainability orientation has changed from value-based initiatives to business-based ones. It has also resulted in the orientation changing from environmental initiatives to social ones, as well as a change from reactive initiatives to proactive ones.

ORIGINALITY/VALUE

Contributes to framing sustainable development through descriptive determinants in private healthcare organizations. It also divides these determinants into two categories, namely the orientation and organization of sustainability initiatives.

Improving patient satisfaction: the virtual breakthrough series collaborative

PURPOSE

The purpose of this paper is to improve the Siloam Hospitals' (SHs) patient satisfaction index (PSI) and overcome Indonesia's geographical barriers.

DESIGN/METHODOLOGY/APPROACH

The topic was selected for reasons guided by the Institute of Healthcare Improvement virtual breakthrough series collaborative (VBSC). Subject matter experts came from existing global quality development in collaboration with sales and marketing, and talent management agencies/departments. Patient satisfaction (PS) was measured using the SH Customer Feedback Form. Data were analysed using Friedman's test.

FINDINGS

The in-patient (IP) department PSI repeated measures comparison during VBSC, performed using Friedman's test, showed a statistically significant increase in the PSI, χ² = 44.00, p<0.001. Post hoc analysis with Wilcoxon signed-rank test was conducted with a Bonferroni correction applied, which resulted in a significant increase between the baseline and action phases ( Z=3.317, p=0.003) between the baseline and continuous improvement phases ( Z=6.633, p<0.001), and between the action and continuous improvement phases ( Z=3.317, p=0.003), suggesting that IP PSI was continuously increasing during all VBSC phases. Like IP PSI, the out-patient department PSI was also continuously increasing during all VBSC phases.

RESEARCH LIMITATIONS/IMPLICATIONS

The VBSC was not implemented using a control group. Factors other than the VBSC may have contributed to increased PS.

PRACTICAL IMPLICATIONS

The VBSC was conducted using virtual telecommunication. Although conventional breakthrough series might result in better cohesiveness and commitment, Indonesian geographical barriers forced an alternative strategy, which is much more cost-effective.

ORIGINALITY/VALUE

The VBSC, designed to improve PS, has never been implemented in any Indonesian private hospital group. Other hospital groups might also appreciate knowing about the VBSC to improve their PSI.

Patients' perceptions of healthcare quality in Ghana

PURPOSE

The purpose of this paper is to investigate the role of service quality (SQ), customer satisfaction (CS) and customer loyalty (CL) in Ghana's health sector and a comparative analysis of private and public hospital SQ.

DESIGN/METHODOLOGY/APPROACH

A convenient sample of 1,236 respondents was generated from both private and public hospitals. The study utilises an asymptotic distribution free estimation technique in CB-SEM using LISREL to test the relationships, while Wilcoxon-Mann-Whitney test was used to determine the differences in SQ performances between private and public hospitals.

FINDINGS

The study found a significant positive relationship between SQ and CS. Also, the study found a significant positive relationship between CS and CL. Finally, SQ was found to be better in private hospitals, resulting higher CS and CL.

PRACTICAL IMPLICATIONS

The study highlights the significant role SQ plays in generating CS and CL to guide healthcare provider policy decision making to improve healthcare delivery. It also serves as a guide to patients to make informed decisions regarding the choice of alternative hospitals.

ORIGINALITY/VALUE

The study provides a useful guide to strategy and policy formulation in the healthcare sector by exploring the potential viability of SERVQUAL-related model as a relevant tool for assessing SQ in Ghana's health sector. The results also identified SQ gap between private and public hospitals and thus have implications on how hospitals should strategise to improve their SQ.

Hospital Ownership and Hospital Institutional Change: A Qualitative Study in Guizhou Province, China

Objectives: To qualitatively compare the influence of different ownership which is considered as a kind of institutional environment in public hospitals, private hospitals, and mixed-ownership hospitals on hospital governance structure and organizational behavior. Design: Qualitative descriptive study, using semi-structured, in-depth interviews and thematic template analysis, theoretically informed by critical realism. Participants: 27 key informants including national policymakers in charge of the health sector, influential researchers, local administrators responsible for implementing policies, and hospital managers who are experienced in institutional change. Results: Hospital ownership has a significant influence on hospitals in terms of decision-making power allocation, residual ownership allocation, market entry level, accountability, and social functions. These five aspects in hospital organizational structure incentivize hospitals to adapt to the internal and external environment of the hospital organization-such as market environment, governance, and financing arrangements-affect the behavior of the hospital organization, and ultimately affect the efficiency of hospital operation and quality of service. The incentives under the public system are relatively distorted. Private hospitals have poor performance in failing their social functions due to their insufficient development ability. Compared to them, mixed ownership hospitals have a better performance in terms of incentive mechanism and organizational development. Conclusion: Public hospitals should improve the governance environment and decision-making structure, so as to balance their implementation of social functions and achieve favorable organizational development. For private hospitals, in addition to the optimization of the policy environment, attempts should be made to strengthen their supervision. The development of mixed-ownership hospitals should be oriented towards socialized governance.

Service quality: A subliminal pathway to service differentiation and competitive advantage in private healthcare marketing in Ghana

The study investigates the role of service quality in Ghana's private hospitals and its effect on patients' satisfaction and loyalty. A sample of 622 respondents was drawn using convenience sampling. Structural equation modeling using smart PLS was used to test the measures. The study found a significant positive relationship between service quality and patient satisfaction and also a significant positive relationship between patients' satisfaction and loyalty and that patients' satisfaction mediates the relationship between service quality and patients' loyalty. The study provides a useful guide to policy formulation for private healthcare practitioners.

How Should Nonprofit Hospitals' Community Benefit Be More Responsive to Health Disparities?

In 1956, the Internal Revenue Service created the expectation that nonprofit hospitals would offer uncompensated care for those unable to pay; this was the beginning of Community Benefit (CB). CB efforts tend to prioritize inpatient medical care over developing community-based health improvements, and few CB resources are directed toward responding to health disparities. Changes to federal policy should address these concerns by (1) requiring community partners' involvement in CB implementation strategies, (2) requiring that community health needs assessments (CHNAs) be completed every 5 years instead of every 3 years, (3) changing the Internal Revenue Code to recognize organizations' work on social determinants as CB, and (4) requiring CHNAs to describe a community's health disparities and clarify how their implementation strategies address them. These changes would likely promote hospitals' engagement with public health departments, collaboration with community-based nonprofit organizations, and greater focus on health equity.

Nursing staff perceptions regarding the clinical audit tool used for relicensing inspections within eThekwini private hospitals in South Africa

Purpose The purpose of this paper is to assess nursing staff perceptions regarding the clinical audit tool used for relicensing inspections within private hospitals in eThekwini district. Design/methodology/approach An exploratory sequential mixed method research design was used with a qualitative first phase involving a total population of 40 nurse managers through purposive sampling. Nurse managers ( n=24) were interviewed. This was followed by a quantitative phase in which a structured questionnaire was administered to nurses ( n=270) who were randomly sampled for the study from ( n=4) hospitals. Documentation review, a third phase was used to corroborate the findings of the first two phases of the study. Findings The results of the study showed that the participants perceptions of the selected private hospitals in eThekwini district is that they have not fully implemented the approach to practice standards and healthcare audits in relation to three clinical domains of the National Core Standards and the Batho Pele principles. These findings were significant and denoted the need for a standardised clinical audit tool for private hospitals in eThekwini district. Research limitations/implications This study was confined to an independent group of hospitals and the findings may not be suitable for generalising across all private hospitals in eThekwini district. Originality/value These findings led to the development of a clinical audit tool with measurements representing elements of care that are critical to the provision of safe, quality health care services.

Findings from Healthcare in Danger Project: Pakistan security assessment of a public and private tertiary care hospital in Karachi: Gaps and way forward

OBJECTIVE

To identify and compare security gaps in a public and private tertiary care hospital.

METHODS

The study was conducted in January 2016 using a tool adopted from Ingersoll Rand Security Technologies, Occupational Safety and Health Association and findings of baseline research carried out by Health Care in Danger Project at a public and private sector hospital in Karachi. The names of hospitals were kept confidential. Areas assessed included adequacy of workforce, existing institutional mechanisms and campus security. The tool was completed by interviewing administration, security department, and healthcare workers in wards and the emergency departments as well as patients, attendants and through observation visits.

RESULTS

The burden of doctors at the private-sector hospital was higher compared to the publicsector hospital (40 versus 22 patients per doctor per day) in the outpatient department. Privatesector hospital scored better than public-sector hospital with regards to compliance to security management standards (68% versus 50%), security perception of staff (90% versus 50%), security staffing (60% versus 50%), and visitor management (80% versus 40%). Campus security was better at private-sector hospital (56% versus 31%). Scores for employee orientation and training were low (30% and 20%), while scores for organisational partnerships were high in both hospitals (80% each). .

CONCLUSIONS

Four-pronged strategic framework is recommended that shall comprise restricting access of attendants/visitors/vendors, improving interaction between patients/healthcare workers/guards, mechanisms of reporting and responding to violent events, and maintaining sufficient resources for enhancing and improving security in hospitals.

Nursing Practices in Catholic Healthcare: A Case Study of Nurses in a Catholic Private Hospital

We aimed to investigate Catholic Identity and Mission communication specifically how nurses were expressing the Catholic healthcare values in practice. A mixed-methods, case study design was used and included non-participant observation, a mid-level manager focus group (n = 7) and online surveys (n = 144). Document and observational data analysis revealed the organisation's commitment to visible indication of Catholic values adherence. Focus group analysis revealed two themes, 'Catholic values in action' and 'taking the extra step'. The impact of Catholic Identity and Mission on nurses and nursing care recipients remains elusive and warrants further understanding.

Drug therapy problems identification by clinical pharmacists in a private hospital in Kuwait

OBJECTIVES

To report the types and frequency of drug therapy problems (DTPs) identified and the physician acceptance of the clinical pharmacist interventions in a private hospital in Kuwait.

METHODS

A retrospective cross-sectional study was conducted on 3500 patients admitted to the hospital between December 2010 and April 2013. A structured approach was used to identify DTPs and recommend interventions. Data were analyzed using MAXQDA version 11.

KEY FINDINGS

A total of 670 DTPs were identified and recommendations were proposed to treating physicians for each DTP. Overdosage was the most frequently identified drug therapy problem (30.8%), followed by low dosage (17.6%), unnecessary drug therapy (17.3%), need for additional drug therapy (11.6%), and need for different drug product (11.6%). The drug classes most frequently involved were anti-infectives (36.9%), analgesics (25.2%), and gastrointestinal agents (15.5%). More than two-third of the interventions (67.5%) were accepted and implemented by physicians. The most frequently accepted interventions were related to nonadherence, adverse drug reaction, monitoring parameters, inappropriate dosage, and need for additional drug therapy.

CONCLUSION

The current findings expand the existing body of data by reporting on pharmacist recommendations of identified DTPs and importantly, their high rate of acceptance and implementation by the treating physician. These results could serve as a springboard to support further development and implementation of clinical pharmacy services in other healthcare settings in Kuwait.

Determinants of transient and persistent hospital efficiency: The case of Italy

In this paper, we extend the 4-random-component closed skew-normal stochastic frontier model by including exogenous determinants of hospital persistent (long-run) and transient (short-run) inefficiency, separated from unobserved heterogeneity. We apply this new model to a dataset composed by 133 Italian hospitals during the period 2008-2013. We show that average total inefficiency is about 23%, higher than previous estimates; hence, a model where the different types of inefficiency and hospital unobserved characteristics are not confounded allows us to get less biased estimates of hospital inefficiency. Moreover, we find that transient efficiency is more important than persistent efficiency, as it accounts for 60% of the total one. Last, we find that ownership (for-profit hospitals are more transiently inefficient and less persistently inefficient than not-for-profit ones, whereas public hospitals are less transiently inefficient than not-for-profit ones), specialization (specialized hospitals are more transiently inefficient than general ones; i.e., there is evidence of scope economies in short-run efficiency), and size (large-sized hospitals are better than medium and small ones in terms of transient inefficiency) are determinants of both types of inefficiency, although we do not find any statistically significant effect of multihospital systems and teaching hospitals.

Comprehensive Corporate Social Responsibility Health Programs: Providing Quality, Affordable and Accessible Healthcare for Financially - Chal- lenged Patients (Private Tertiary Hospital Setting)

In 2012 the Manila Doctors Hospital became the first hospital in the Philippines to launch and commit to a Social Vision. Since then, this Social Vision has served as a guide for good governance and a blueprint for its Corporate Social Responsibility (CSR) programs focusing on health, environment and gender. The goal of the Manila Doctors comprehensive CSR health program is to render the fundamental right to health care available to marginalized patients. Through our CSR programs, more than 20,000 financially challenged patients gain access to quality medical services annually. This directly contributed to the country's health development agenda 2016-2020 of achieving the health related SDG Targets of Financial Risk Protection, Better Health Outcomes and Responsiveness.

Lessons from New Zealand for England's NHS Foundation Trusts

The legislation to devolve responsibility for the management and operation of England's top-performing NHS hospitals to community-owned NHS Foundation Trusts raises several issues relating to the challenges posed to governance structures by private non-profit ownership and control of assets used to provide government-financed services. Building upon the lessons learned from devolution of public hospital governance in New Zealand to boards at arm's-length from central control during the 1990s, this paper analyses the English NHS hospital changes. Whilst local political accountability and competition between hospitals indicate that the English reforms may be more successful in meeting patients' needs more efficiently than the New Zealand reforms, the English proposals may be compromised by the ability of staff to become members of Trusts, boards bearing risks of decisions outside their control whilst simultaneously being insulated from the consequences of their decisions by a 'soft budget constraint', and conflicts of interest as boards simultaneously act as agents of both central regulators and local beneficiaries.

Patient satisfaction constructs

PURPOSE

The purpose of this paper is to examine the five-factor structure of patients' satisfaction constructs toward private healthcare service providers.

DESIGN/METHODOLOGY/APPROACH

This research is a cross-sectional study. A questionnaire-based survey was conducted with previous and current Bangladeshi patients. Exploratory factor analysis was employed to extract the underlying constructs.

FINDINGS

Five underlying dimensions that play a significant role in structuring the satisfaction perceived by Bangladeshi private healthcare patients are identified in this study. Practical implications - The main contribution of this study is identifying the dimensions of satisfaction perceived by Bangladeshi patients regarding private healthcare service providers.

ORIGINALITY/VALUE

Healthcare managers adopt the five identified underlying construct items in their business practices to improve their respective healthcare efficiency while ensuring overall customer satisfaction.

Analysis of the cost and efficiency relationship: experience in the Turkish pay for performance system

This paper analyzes the effects of the pay for performance (PFP) system on the efficiencies of public and private hospitals in Turkey. In order to evaluate these effects, we examine the relationship between hospital efficiency and health care costs in Turkey, and address the impact of the PFP system on the efficiencies of public and private hospitals. In an effort to analyze the efficiencies of public and private hospitals, this study uses data envelopment analysis. The Malmquist Productivity Index is also used to analyze the patterns of efficiency change for the study years from 2001 to 2008. This study shows that health care costs and hospital efficiency are negatively correlated for private hospitals, while they are positively correlated for public hospitals. In other words, increased health care costs might reduce efficiency in private hospitals in contrast to public hospitals. Our findings also indicate that average efficiencies of public hospitals tend to increase, particularly during the implementation period of PFP system. The efficiency trend of private hospitals, conversely, decreased in the latter periods of the PFP system. Suggestions for improvement are provided to the health care policy makers regarding the impact of health care reforms on public and private hospitals.

Did the corporatization of Portuguese hospitals significantly change their productivity?

This paper aims to investigate if the market structure reforms in the Portuguese health system have improved hospital performance and productivity. A robust non-parametric Malmquist index is applied to measure group performance. The significance of the results achieved is examined using a conditional and non-conditional subsampling bootstrapped-based methodology, enhanced by the likelihood cross validation criterion based on the k-nearest neighbors method. The sample contains information about 216 non-corporatized and 176 corporatized Portuguese hospitals for the period 2002–2009. Five models were applied, based on three study dimensions (internment, emergencies and doctor visits). The results show that although corporatized hospitals presented the highest efficiency consistency, they had also the lowest levels of productivity, while the hospitals under the traditional administrative public management system were the ones with the best average performance. However, several best practices were also found in all groups, being the limited companies were often dominated by both noncorporatized and public enterprise entities. Consistent output ranges where all groups present dominance over the others were also identified. It was possible to conclude that the more autonomy the hospital had from the Ministry of Health, the lower was its productivity.

PRIVATE SECTOR IN HEALTH CARE DELIVERY: A REALITY AND A CHALLENGE IN PAKISTAN

Under performance of the public sector health care system in Pakistan has created a room for private sector to grow and become popular in health service delivery, despite its questionable quality, high cost and dubious ethics of medical practice. Private sector is no doubt a reality; and is functioning to plug many weaknesses and gaps in health care delivery to the poor people of Pakistan. Yet, it is largely unregulated and unchecked due to the absence of writ of the state. In spite of its inherent trait of profit making, the private sector has played a significant and innovative role both in preventive and curative service provision. Private sector has demonstrated great deal of responsiveness, hence creating a relation of trust with the consumers of health in Pakistan, majority of who spend out of their pocket to buy 'health'. There is definitely a potential to engage and involve private and non-state entities in the health care system building their capacities and instituting regulatory frameworks, to protect the poor's access to health care system.

Can We Improve Workflows in the OR? A Comparison of Quality Perceptions and Preoperative Efficiency across Institutions in Spine Surgery

INTRODUCTION

Cost containment and surgical inefficiencies are major concerns for hospitals in this era of declining resources. The primary aim of this investigation was to understand subjective perceptions of perioperative spine surgical quality across three practice settings and to identify potential factors contributing to these perceptions. Subsequently, we objectively evaluated factors that influence the duration of time in which the patient is in the operating room (OR) prior to the surgical incision and assessed the influence of fluoroscopy technician expertise on radiation dose and imaging efficiency.

METHODS

One hundred and eight medical device representatives with at least 1 year of OR experience were surveyed at a national conference. Three distinct healthcare facilities were identified: university, small volume, and large volume private hospitals. Respondents rated facilities on a five-point scale for staff quality; size and consistency of surgical teams; and overall likelihood of recommending the facility. Separately, 140 posterior lumbar procedures from two institutions were retrospectively reviewed. Two time periods were quantified for each surgical case: patient arrival in the OR to induction of anesthesia (T1) and induction to surgical incision (T2). T1 and T2 were compared between university and large private hospital settings using t tests and multivariate analysis. For 44 separate lumbar spine surgical procedures, practice setting, patient BMI, number of vertebral levels requiring imaging, number of localizing fluoroscopy images taken, total fluoroscopy time, total radiation dose, fluoroscopy machine, and whether the fluoroscopist could correctly state his or her role, which was to obtain a lateral lumbar localizing image, were recorded. T-tests were used to compare cases in which the fluoroscopist could and could not correctly state the task.

RESULTS

Survey ratings for surgeons were not significantly different across university, large private, and small private hospitals. Fewer circulating nurses were rated as excellent or good in university versus private hospitals (p < 0.001). Small volume private hospital surgical teams were more likely to have worked together before than university teams (p < 0.05), and university teams were larger (p < 0.05). Respondents were more likely to recommend a university or large private hospital for complex instrumentation cases (p < 0.001). On objective measures, university patients were older, less obese, and had higher mean ASA scores (2.5 versus 2.2, p < 0.001). Compared to the university setting, private hospital cases had significantly shorter Time 1 (8 versus 37 min, p < 0.001) and Time 2 (23 versus 30 min, p < 0.001), even after adjusting for ASA score, BMI, and age. Cases in which the fluoroscopist knew the imaging purpose were associated with significantly fewer images (mean 1.8 versus 3.4 images, p < 0.0001) and shorter total exposure times (2.3 versus 4.0 sec, p < 0.001). Operations performed in the university setting were associated with significantly more images (2.7 versus 1.8 images, p < 0.001), longer total exposure times (3.2 versus 2.3 sec, p = 0.0027), and total radiation dose (27.8 versus 53.3 rad, p < 0.001) when compared with those performed in the private setting. The university practice setting was associated with significantly more images (2.7 versus 1.8 images, p < 0.001), longer total exposure times (3.2 versus 2.3 sec, p = 0.003), and total radiation dose (27.8 versus 53.3 rad, p < 0.001) when compared with non-university settings.

CONCLUSION

Large private and university hospitals had higher surgeon ratings. The university setting was associated with larger and less consistent surgical teams and lower nurse ratings. Surgical staff awareness of the procedure and attention to preoperative tasks specific to the procedure reduced pre-operative time spent in the OR as well as fluoroscopy radiation. These data suggest that nurses and support staff make substantial contributions to overall quality of care, and that leadership and interpersonal coordination are especially important within large teams at teaching hospitals.

Operating private hospitals in Mexico

Mexico is one of the richest countries in Latin America and over the last several decades there have been many changes in the healthcare delivery systems, from universal healthcare coverage for all Mexicans to the fast paced expansion of private healthcare. Like many countries, Mexico has both private and public health systems and hospital administrators are facing challenges on multiple fronts in addition to facing exciting new opportunities. In this article you will get a bird's eye view of this ever changing panorama. How the new growing middle class consumerism has impacted physicians, health insurance and private healthcare industry.

[Approach of Private Hospitals to Support Individuality-respected Community Living]

The government has taken a variety of measures to actualize the basic philosophy of the policy for"shifting medical treatment under hospitalization to regional medical treatment". The problems associated with mental disorders requiring long-term psychiatric treatment and reducing psychiatric beds have been discussed from various viewpoints. Although the transfer of psychiatric medical treatment to regional medical treatment is taking place, it is true that some large barriers exist. According to research on the actual situation in 1954, 1,300,000 psychiatric disorders were estimated, including 350,000 disabilities requiring hospitalization, and mental beds available increased up to a maximum of 350,000 with government subsidies. In 1987, mental bed availability was controlled according to the local healthcare program. As a result, periods of psychiatric hospitalization became prolonged due to factors including social prejudice and the inadequacy of rehabilitation centers; it was called "social hospitalization". Nevertheless, it is true that private psychiatric hospitals have successfully provided various psychiatric medical services in order for people with disabilities to be able to live in the community. The Program for Dissolution of Social Hospitalization of Psychiatric Disabilities in 2000 started in Osaka. The Ministry of Health, Labour and Welfare started the Program for Hospital Discharge Promotion of Psychiatric Disabilities as a model program in 2003. This program was included in the Regional Life Support Program in Prefectural and City Governments, and expanded throughout Japan in 2006. The Regional Shift Support Special Action Program of Psychiatric Disabilities was started in 2008. The report of the "Symposium for Ideal Future Psychiatric Medical Welfare" as compiled in September 2009, and the target value was indicated there. Various measures were implemented in order to promote the basic philosophy for "shifting medical treatment under hospitalization to living in the community". In 2012, the Japan Psychiatric Hospitals Association, joined by the private psychiatric hospitals responsible for medical treatment under hospitalization, set forth their basic polity for "shifting medical treatment under hospitalization to regional medical treatment and medical care" as part of "Future Vision of Psychiatric Medical Treatment".

Project Possibility: A model of care and the politics of change

As a strategy to counter the current crisis of recruitment and retention in nursing a new model of care designed to introduce the second and third level of nurse into what was previously an almost exclusively registered nurse workforce, has been implemented in collaboration with clinicians, educators and managers, at a leading private hospital. This paper articulates the salientfeatures of the model, key processes involved in the model's introduction to the staff and explores the complex politics surrounding its implementation and ongoing evaluation.

A medication safety model: a case study in Thai hospital

Reaching zero defects is vital in medication service. Medication error can be reduced if the causes are recognized. The purpose of this study is to search for a conceptual framework of the causes of medication error in Thailand and to examine relationship between these factors and its importance. The study was carried out upon an in-depth case study and survey of hospital personals who were involved in the drug use process. The structured survey was based on Emergency Care Research Institute (ECRI) (2008) questionnaires focusing on the important factors that affect the medication safety. Additional questionnaires included content to the context of Thailand's private hospital, validated by five-hospital qualified experts. By correlation Pearson analysis, the result revealed 14 important factors showing a linear relationship with drug administration error except the medication reconciliation. By independent sample t-test, the administration error in the hospital was significantly related to external impact. The multiple regression analysis of the detail of medication administration also indicated the patient identification before administration of medication, detection of the risk of medication adverse effects and assurance of medication administration at the right time, dosage and route were statistically significant at 0.05 level. The major implication of the study is to propose a medication safety model in a Thai private hospital.

Nursing workforce planning: insights from seven Malaysian hospitals

In 2010, the Royal College of Nursing asked: 'What is the optimal level and mix of nurses required to deliver quality care as cost-effectively as possible?' This question implies there is a relationship between staffing levels, quality of care and financial efficiency. This paper examines the relationship between the staff budget, the number of staff required to achieve a target level of care and the actual number of staff employed in seven hospitals in Malaysia. It seeks to critically evaluate local challenges arising from staff budgeting/planning procedures, identify general issues that apply beyond Malaysian healthcare institutions and, finally, to propose a model that combines finance, staffing and level of care.

Network security vulnerabilities and personal privacy issues in Healthcare Information Systems: a case study in a private hospital in Turkey

Healthcare industry has become widely dependent on information technology and internet as it moves from paper to electronic records. Healthcare Information System has to provide a high quality service to patients and a productive knowledge share between healthcare staff by means of patient data. With the internet being commonly used across hospitals, healthcare industry got its own share from cyber threats like other industries in the world. The challenge is allowing knowledge transfer to hospital staff while still ensuring compliance with security mandates. Working in collaboration with a private hospital in Turkey; this study aims to reveal the essential elements of a 21st century business continuity plan for hospitals while presenting the security vulnerabilities in the current hospital information systems and personal privacy auditing standards proposed by regulations and laws. We will survey the accreditation criteria in Turkey and counterparts in US and EU. We will also interview with medical staff in the hospital to understand the needs for personal privacy and the technical staff to perceive the technical requirements in terms of network security configuration and deployment. As hospitals are adopting electronic transactions, it should be considered a must to protect these electronic health records in terms of personal privacy aspects.

Competition among Turkish hospitals and its effect on hospital efficiency and service quality

The level of competition among hospitals in Turkey was analyzed for the years 1990 through 2006 using the Herfindahl-Hirschman Index (HHI). Multiple and simple regression analyses were run to observe the development of competition among hospitals over this period of time, to examine likely determinants of competition, and to calculate the effects of competition on efficiency and quality in individual hospitals. This study found that the level of competition among hospitals in Turkey has increased throughout the years. Also, competition has had a positive effect on the efficiency of hospitals; however, it did not have a significant positive effect on their quality. Moreover, there are important differences in the level of competition among hospitals that vary according to the geographical region, the type of ownership, and the type of hospital. This study is one of the first to evaluate the effects of health policies on competition as well as the effects of increasing competition on hospital quality and efficiency in Turkey.

Assessing hospital disaster preparedness in Shiraz, Iran 2011: teaching versus private hospitals

BACKGROUND

In disasters, hospitals play a crucial role in supplying essential medical care to the society but there is no standardized checklist for assessing hospital disaster preparedness.

OBJECTIVES

The objective of this study was to recognize and compare almost all the components of disaster preparedness between teaching and private hospitals in Shiraz, Iran, focusing on incident command systems (ICS), communications, surge capacity, human resources, supply management, logistic service, case management, surveillance, laboratory and operating room management.

METHODS

From May to August 2011, we assessed the preparedness of teaching and private hospitals in Shiraz, using the 10-key component World Health Organization checklist.

RESULTS

Twenty four out of 31 hospitals responded. The scores for preparedness of ICS, communication, surge capacity and human resources was 73.9 percent, 67.3 percent, 49 percent, and 52.6 percent respectively. The preparedness scores for supply management and logistic services were 68.5 percent and 61.8 percent. While the levels of preparedness of laboratory and operating room management were low, preparedness of the surveillance system and case management were 66.7 percent and 70.8 percent, respectively. The average total preparedness of all hospitals was 59.5 percent, with scores of 62.2 percent in teaching hospitals and 55 percent in private hospitals.

CONCLUSION

At the time of our study, the total preparedness among hospitals was at the intermediate level, but in some key components such as operating room management, surge capacity, and human resources, the total preparedness was very limited and at an early stage of development, therefore, requiring urgent attention and improvement.

Assessing the impact of privatizing public hospitals in three American states: implications for universal health coverage

Many countries with universal health systems have relied primarily on publicly-owned hospitals to provide acute care services to covered populations; however, many policymakers have experimented with expansion of the private sector for what they hope will yield more cost-effective care. The study provides new insight into the effects of hospital privatization in three American states (California, Florida, and Massachusetts) in the period 1994 to 2003, focusing on three aspects: 1) profitability; 2) productivity and efficiency; and 3) benefits to the community (particularly, scope of services offered, price level, and impact on charity care). For each variable analyzed, we compared the 3-year mean values pre- and postconversion. Pre- and postconversion changes in hospitals' performance were then compared with a nonequivalent comparison group of American public hospitals. The results of our study indicate that following privatization, hospitals increased operating margins, reduced their length of stay, and enjoyed higher occupancy, but at some possible cost to access to care for their communities in terms of higher price markups and loss of beneficial but unprofitable services.

"We are talking about saving lives": the welfare state, health care policy, and nongovernability--a case study of an Israeli Hospital

Literature about welfare states worldwide, and specifically in Israel, emphasizes economic and political variables and the importance of ideology in explaining a given social policy in those societies. According to this literature, ideology and strategic long-term goals account for the waning of the Israeli welfare state since the 1970s. At the same time, for upwards of a decade, the literature dealing with Israeli public policy has emphasized that Israeli society suffers from a crisis of "nongovernability" and a political culture that is characterized by illegality. The author defines nongovernability as the inability to formulate public policy and implement it effectively over time. In such an environment, long-term strategic considerations based on a coherent ideology take a back seat to short-term considerations in the conduct of the various players in the public policy arena. The author discusses the building of a hospital in Ashdod as a case study in nongovernability. The hospital's construction was steeped in political intrigue based wholly on short-term considerations and was built in a political culture characterized by either illegality or outright rejection of the law. This behavior is characteristic of Israeli politicians, bureaucrats, and interest groups. The author maintains that the creation of this hospital is emblematic of the Israeli health care policy overall, a policy shaped by bottom-up processes whose defining characteristic is a political culture based on illegality and narrow, short-term interests.