The worldwide coronavirus disease 2019 outbreak: Advice and recommendation on radiology management and infection control from makeshift hospitals in Wuhan

To describe and advise on management protocols and infection-protection experience of the radiology department in makeshift hospitals in Wuhan during the coronavirus disease 2019 (COVID-19) outbreak.Based on the literature review and the experience in the frontline, we retrospectively reviewed the configuration of the radiology department, human resource, personal protection, examination procedures for patients confirmed with COVID-19 in Wuhan fangcang shelter hospital.From February 11, 2020 to March 10, 2020, 2730 and 510 CT examinations were performed in the Hanjiang shelter hospital and Hanyang Sports School shelter hospital, respectively, including initial examinations and re-examinations. The maximum number of daily CT examinations reached 289. The CT scanned a patient approximately once every 13 mins.Fangcang shelter radiology department could be powerful components of both global and national responses to the COVID-19 pandemic.

Trainee Wellness and Safety in the Context of COVID-19: The Experience of One Institution

The COVID-19 pandemic has had significant ramifications for provider well-being. During these unprecedented and challenging times, one institution's Department of Surgery put in place several important initiatives for promoting the well-being of trainees as they were redeployed to provide care to COVID-19 patients. In this article, the authors describe these initiatives, which fall into 3 broad categories: redeploying faculty and trainees, ensuring provider safety, and promoting trainee wellness. The redeployment initiatives are the following: reframing the team mindset, creating a culture of grace and forgiveness, establishing a multidisciplinary wellness committee, promoting centralized leadership, providing clear communication, coordinating between departments and programs, implementing phased restructuring of the department's services, establishing scheduling flexibility and redundancy, adhering to training regulations, designating a trainee ombudsperson, assessing physical health risks for high-risk individuals, and planning for structured deimplementation. Initiatives specific to promoting provider safety are appointing a trainee safety advocate, guaranteeing personal protective equipment and relevant information about these materials, providing guidance regarding safe practices at home, and offering alternative housing options when necessary. Finally, the initiatives put in place to directly promote trainee wellness are establishing an environment of psychological safety, providing mental health resources, maintaining the educational missions, solidifying a sense of community by showing appreciation, being attentive to childcare, and using social media to promote community morale. The initiatives to carry out the department's strategy presented in this article, which were well received by both faculty and trainee members of the authors' community, may be employed in other departments and even outside the context of COVID-19. The authors hope that colleagues at other institutions and departments, independent of specialty, will find the initiatives described here helpful during, and perhaps after, the pandemic as they develop their own institution-specific strategies to promote trainee wellness.

Healthcare stakeholders' perceptions and experiences of factors affecting the implementation of critical care telemedicine (CCT): qualitative evidence synthesis

BACKGROUND

Critical care telemedicine (CCT) has long been advocated for enabling access to scarce critical care expertise in geographically-distant areas. Additional advantages of CCT include the potential for reduced variability in treatment and care through clinical decision support enabled by the analysis of large data sets and the use of predictive tools. Evidence points to health systems investing in telemedicine appearing better prepared to respond to sudden increases in demand, such as during pandemics. However, challenges with how new technologies such as CCT are implemented still remain, and must be carefully considered.

OBJECTIVES

This synthesis links to and complements another Cochrane Review assessing the effects of interactive telemedicine in healthcare, by examining the implementation of telemedicine specifically in critical care. Our aim was to identify, appraise and synthesise qualitative research evidence on healthcare stakeholders' perceptions and experiences of factors affecting the implementation of CCT, and to identify factors that are more likely to ensure successful implementation of CCT for subsequent consideration and assessment in telemedicine effectiveness reviews.

SEARCH METHODS

We searched MEDLINE, Embase, CINAHL, and Web of Science for eligible studies from inception to 14 October 2019; alongside 'grey' and other literature searches. There were no language, date or geographic restrictions.

SELECTION CRITERIA

We included studies that used qualitative methods for data collection and analysis. Studies included views from healthcare stakeholders including bedside and CCT hub critical care personnel, as well as administrative, technical, information technology, and managerial staff, and family members.

DATA COLLECTION AND ANALYSIS

We extracted data using a predetermined extraction sheet. We used the Critical Appraisal Skills Programme (CASP) qualitative checklist to assess the methodological rigour of individual studies. We followed the Best-fit framework approach using the Consolidated Framework for Implementation Research (CFIR) to inform our data synthesis.  We classified additional themes not captured by CFIR under a separate theme. We used the GRADE CERQual approach to assess confidence in the findings.

MAIN RESULTS

We found 13 relevant studies. Twelve were from the USA and one was from Canada. Where we judged the North American focus of the studies to be a concern for a finding's relevance, we have reflected this in our assessment of confidence in the finding. The studies explored the views and experiences of bedside and hub critical care personnel; administrative, technical, information technology, and managerial staff; and family members. The intensive care units (ICUs) were from tertiary hospitals in urban and rural areas. We identified several factors that could influence the implementation of CCT. We had high confidence in the following findings: Hospital staff and family members described several advantages of CCT. Bedside and hub staff strongly believed that the main advantage of CCT was having access to experts when bedside physicians were not available. Families also valued having access to critical care experts. In addition, hospital staff described how CCT could support clinical decision-making and mentoring of junior staff.  Hospital staff greatly valued the nature and quality of social networks between the bedside and CCT hub teams. Key issues for them were trust, acceptance, teamness, familiarity and effective communication between the two teams. Interactions between some bedside and CCT hub staff were featured with tension, frustration and conflict. Staff on both sides commonly described disrespect of their expertise, resistance and animosity. Hospital staff thought it was important to promote and offer training in the use of CCT before its implementation. This included rehearsing every step in the process, offering staff opportunities to ask questions and disseminating learning resources. Some also complained that experienced staff were taken away from bedside care and re-allocated to the CCT hub team. Hospital staff's attitudes towards, knowledge about and value placed on CCT influenced acceptance of CCT. Staff were positive towards CCT because of its several advantages. But some were concerned that the CCT hub staff were not able to understand the patient's situation through the camera. Some were also concerned about confidentiality of patient data. We also identified other factors that could influence the implementation of CCT, although our confidence in these findings is moderate or low. These factors included the extent to which telemedicine software was adaptable to local needs, and hub staff were aware of local norms; concerns about additional administrative work and cost; patients' and families' desire to stay close to their local community; the type of hospital setting; the extent to which there was support from senior leadership; staff access to information about policies and procedures; individuals' stage of change; staff motivation, competence and values; clear strategies for staff engagement; feedback about progress; and the impact of CCT on staffing levels.

AUTHORS' CONCLUSIONS

Our review identified several factors that could influence the acceptance and use of telemedicine in critical care. These include the value that hospital staff and family members place on having access to critical care experts, staff access to sufficient training, and the extent to which healthcare providers at the bedside and the critical care experts supporting them from a distance acknowledge and respect each other's expertise. Further research, especially in contexts other than North America, with different cultures, norms and practices will strengthen the evidence base for the implementation of CCT internationally and our confidence in these findings. Implementation of CCT appears to be growing in importance in the context of global pandemic management, especially in countries with wide geographical dispersion and limited access to critical care expertise. For successful implementation, policymakers and other stakeholders should consider pre-empting and addressing factors that may affect implementation, including strengthening teamness between bedside and hub teams; engaging and supporting frontline staff; training ICU clinicians on the use of CCT prior to its implementation; and ensuring staff have access to information and knowledge about when, why and how to use CCT for maximum benefit.

Effective clinical supervision of allied health professionals: a mixed methods study

BACKGROUND

Clinical supervision is recommended for allied health professionals for the purpose of supporting them in their professional role, continued professional development and ensuring patient safety and high quality care. The aim of this mixed methods study was to explore allied health professionals' perceptions about the aspects of clinical supervision that can facilitate effective clinical supervision.

METHODS

Individual semi-structured interviews were conducted on a purposive sample of 38 allied health professionals working in a metropolitan public hospital. Qualitative analysis was completed using an interpretive description approach. To enable triangulation of qualitative data, a quantitative descriptive survey of clinical supervision effectiveness was also conducted using the Manchester Clinical Supervision Scale (MCSS-26).

RESULTS

Three main themes emerged from qualitative analysis: Allied health professionals reported that clinical supervision was most effective when their professional development was the focus of clinical supervision; the supervisor possessed the skills and attributes required to facilitate a constructive supervisory relationship; and the organisation provided an environment that facilitated this relationship together with their own professional development. Three subthemes also emerged within each of the main themes: the importance of the supervisory relationship; prioritisation of clinical supervision relative to other professional duties; and flexibility of supervision models, processes and approaches to clinical supervision. The mean MCSS-26 score was 79.2 (95%CI 73.7 to 84.3) with scores ranging from 44 to 100. MCSS-26 results converged with the qualitative findings with participants reporting an overall positive experience with clinical supervision.

CONCLUSIONS

The factors identified by allied health professionals that influenced the effectiveness of their clinical supervision were mostly consistent among the professions. However, allied health professionals reported using models of clinical supervision that best suited their profession's role and learning style. This highlighted the need for flexible approaches to allied health clinical supervision that should be reflected in clinical supervision policies and guidelines. Many of the identified factors that influence the effectiveness of clinical supervision of allied health professionals can be influenced by health organisations.

Health Impact of Hurricanes Irma and Maria on St Thomas and St John, US Virgin Islands, 2017-2018

Objectives. To assess the health impact of Hurricane Irma and Hurricane Maria on St Thomas, US Virgin Islands.Methods. We collected data from interviews conducted 6 and 9 months after the hurricanes, a review of 597 randomly selected emergency department (ED) encounters, and administrative records from 10 716 ED visits 3 months before, between, and 3 months after the hurricanes.Results. Informants described damaged hospital infrastructure, including flooding, structural damage, and lost staff. The greatest public health impact was on the elderly and persons with chronic diseases. In the setting of loss of the electronic medical record system, ED chart reviews were limited by problems with missing data. ED administrative data demonstrated that posthurricane patients, compared with prehurricane patients, were older and had less severe complaints. There was a significant increase in patients being seen for diabetes-related and respiratory complaints, especially asthma. Suboptimal recordkeeping for medical evacuees limited the ability to assess outcomes for patients with severe illnesses.Conclusions. Hurricanes Irma and Maria caused major disruptions to health care on St Thomas. Emphasis should be given to building a resilient health care system that will optimally respond to future hurricanes.

The provision of seven day multidisciplinary staffing in Scottish acute medical units: a cross-sectional study

BACKGROUND

Acute medical units (AMUs) are a central component of the admission pathway for the majority of medical patients presenting to hospital in the United Kingdom and other international settings. Detail on multidisciplinary staffing provision on weekdays and weekends is lacking. Equity of staffing across 7 days is a strategic priority for national health services in the United Kingdom.

AIM

To evaluate weekday compared with weekend multidisciplinary staffing in a national set of AMUs.

DESIGN

Cross-sectional survey.

METHODS

Twenty-nine Scottish AMUs were identified and all were included in the study population. Data were collected by semi-structured interviews with nursing, pharmacy, therapy, non-consultant medical and consultant staff. Staffing was quantified in staff hours. A correction factor of 0.5 was applied to non-dedicated staff. The percentage of weekend/weekday staffing was calculated for each unit and the mean of these percentages was calculated to give a summary measure for each professional group.

RESULTS

As a percentage of weekday staffing levels, weekend staffing across the units was 93.8% for nursing staff; 2.2% for pharmacy staff; 13.1% for therapy staff; 69.6% for non-consultant staff and 65.0% for consultant staff.

CONCLUSIONS

There is a contrast between weekday and weekend staffing on the AMU, with reductions at weekends in total staff hours, the proportion of dedicated vs. undedicated staff and the seniority of nursing staff. The weekday/weekend difference was far more pronounced for allied healthcare professional staff than any other group. These findings have potential implications for patient outcomes, quality of care, hospital flow and workforce planning.

[Comparison through a prospective and randomized study of two replenishment methods at polyvalent hospitalization units with two-bin storage systems]

OBJECTIVE

Two-bin storage systems increase nursing staff satisfaction and decrease inventories, but the implications that logistic staff would determine the needs of replenishment are unknown. This study aimed to evaluate whether entrust to logistics staff this responsibility at the polyvalent hospitalization units with two-bin storage is associated with higher risk of outstanding orders.

METHODS

This was a prospective randomized experiment whit masking. Outstanding orders were considered variable response, those corresponding to assessments of the logistics staff were included in the control group and those corresponding to the nursing staff in the control group. Concordance between observers was analyzed using the Bland-Altman method; the difference between groups, with the U of Mann-Whitney and the cumulative incidence of outstanding orders and their relative risk was calculated.

RESULTS

The mean amount requested by the logistic and nursing staff was 29.9 (SD:167.4) and 36 (SD:190) units respectively, the mean difference between observers was 6.11 (SD:128.95) units and no significant differences were found between groups (p = 0.430). The incidence of outstanding orders was 0.64% in the intervention group and 0.15% in the control group; the relative risk, 2.31 (0.83 - 6.48) and the number of cases required for an outstanding order, 516.

CONCLUSIONS

Outstanding order relative risk is not associated with the category of the staff that identifies the replenishment needs at the polyvalent hospitalization units.

Safe Practice Recommendations for the Use of Copy-Forward with Nursing Flow Sheets in Hospital Settings

BACKGROUND

In early 2016 the Partnership for Health IT Patient Safety released safe practice recommendations for the use of copy-paste for electronic health record (EHR) documentation. These recommendations do not directly address nurses' use of copy-forward to document patient assessments in flow sheet software in hospital settings. Similar to clinicians' use of copy-paste and copy-forward with progress notes, concerns exist about patient safety issues from the use of potential inaccurate or outdated information to achieve increased efficiency of documentation.

METHODS

A multiple-methods approach-which included a literature review, litigation search, stakeholder analysis, and consensus opinion from experts from multiple disciplines-was employed.

RESULTS

Four recommendations correspond closely with copy-paste guidance for EHR documentation from the Partnership: (1) Provide a mechanism to make copied-forward content easily identifiable, (2) Ensure that the provenance of copied-forward content is readily available, (3) Ensure adequate staff training and education regarding the appropriate and safe use of copy-forward in flow sheet software, if available, and (4) Ensure that copy-forward practices are regularly monitored, measured, and assessed. A fifth additional recommendation is made to improve the efficiency of data entry mechanisms, which may reduce patient safety risk. Emerging promising areas for innovation are to optimize interface usability and flow sheet content, use templates, use digital photographs, and eliminate work-flow steps with better methods for authentication and data entry.

CONCLUSIONS

A thoughtful and measured approach to safe use of copy-forward in flow sheets by nurses in hospital settings is expected to result in improvements in efficiency of documentation, work flow, and accuracy of information.

Predictors of job satisfaction among nurses working in Ethiopian public hospitals, 2014: institution-based cross-sectional study

BACKGROUND

Nurses play a pivotal role in determining the efficiency, effectiveness, and sustainability of health care systems. Nurses' job satisfaction plays an important role in the delivery of quality health care. There is paucity of studies addressing job satisfaction among nurses in the public hospital setting in Ethiopia. Thus, this study aimed to assess job satisfaction and factors influencing it among nurses in Jimma zone public hospitals, southwestern Ethiopia.

METHODS

An institution-based census was conducted among 316 nurses working in Jimma zone public hospitals from March to April, 2014. A structured self-administered questionnaire based on a modified version of the McCloskey/Mueller Satisfaction Scale was used. Data were entered using Epi Info version 3.5.3 statistical software and analyzed using SPSS version 20 statistical package. Mean satisfaction scores were compared by independent variables using an independent sample t test and ANOVA. Bivariate and multivariable linear regressions were done.

RESULTS

A total of 316 nurses were included, yielding a response rate of 92.67%. The overall mean job satisfaction was (67.43 ± 13.85). One third (33.5%) of the study participants had a low level of job satisfaction. Mutual understandings at work and professional commitment showed significant and positive relationship with overall job satisfaction, while working at an inpatient unit and work load were negatively associated.

CONCLUSIONS

One third of nurses had a low level of job satisfaction. Professional commitment, workload, working unit, and mutual understanding at work predicted the outcome variable.

Health care provider outcomes during and shortly after acute care restructuring in Newfoundland and Labrador

Objectives

To monitor changes in human resource indicators during six years of restructuring in Newfoundland and Labrador, and to measure providers’ perceptions of reform impact and attitudinal and behavioural reactions comparing changes in the St John's region, where hospital aggregation occurred, to other regions.

Methods

Data on human resource indicators from 1995/96 to 2001/02 were obtained and analysed. The Employee Attitude Survey was sent to acute care staff (n=5353) to assess perceptions of reform impact on workplace conditions, work-related attitudes, turnover intentions and personal characteristics. The response rate for 2000 and 2002 was approximately 42% (n=1222 and 1034, respectively). Only respondents to both surveys (n=589) were used in the analysis.

Results

Increases in average employee and full-time equivalent numbers occurred in the St John's region, despite hospital closure and aggregation. Increases in staff dislocation and turnover were observed, but paid sick hours decreased. Sick leave and overtime costs increased. Although perceived workplace conditions, and attitudes and behaviours were generally negative, there was evidence of improvement over time, especially in St John's. Few significant regional or provider group differences were observed on most study variables.

Conclusions

Aggregation of hospitals in StJohn's did not lead to a decrease in employee counts, or deterioration in human resource indicators or attitudes. However, province-wide initiatives are needed to promote more positive work environments and increase organizational effectiveness.

Getting a Handle on Staff Turnover

Keep staff turnover in the single digits for peak performance.

The ambiguous role of healthcare providers: a new perspective in Human Resources Management

BACKGROUND AND AIM

A strategic Human Resources Management approach, that overcomes anadministrative Personnel Management, is becoming crucial for hospital organizations. In this sense, the aimof this work was to examine the figure of healthcare provider using the concept of role, as expected behaviourin term of integration in the organizational culture.

METHOD

The instrument used to analyse the healthcareprovider figure was "role mapping". Particularly, semistructured interviews were conducted and involved to36 health professionals of four units in order to examine the behaviour expectations system towards thehealthcare providers.

RESULTS

The analysis revealed that the expectations of different professionals relatedto the healthcare provider were dissimilar. Physicians' expectations referred to technical preparation and efficiency,while nurses and nurse coordinators required collaboration in equip work and emotional support forpatients. In all Operating Units, directors were perceived as missing persons with vague expectations of efficiency.Differences concerned also the four Units. For example, in intensive care Unit, the role of healthcareprovider was clearer and this figure was perceived as essential for patients' care and for the equip teamwork.On the contrary, in Recovery Unit the healthcare provider was underestimated, the role was ambiguous andnot integrated in the equip even if there was a clear division of tasks between nurses and healthcare providers.

CONCLUSION

The "role mapping" instrument allows to identify healthcare provider profile and find possible roleambiguity and conflicts in order to plan adequate human resources management interventions.

The value of employees in a value-based care system

To be successful under value-based payment, hospitals will require a healthy communication culture in which workers in the trenches are committed, engaged, and focused. In such a culture, employees should feel free to express their fears and doubts, accept and apply constructive feedback, and participate creatively. Mistakes should be seen not as cause for disciplinary action but as learning opportunities. New hires should have a willingness to continually learn and work independently, be unafraid of making mistakes, and be committed to adding value through the delivery of improved care and enhanced outcomes.

Evaluating Pharmacists' Motivation and Job Satisfaction Factors in Saudi Hospitals

High turnover rate among healthcare professionals is a very expensive price that healthcare organizations might pay if they don't have the proper strategies for motivating and satisfying their employees. Healthcare organizations should be able to identify areas that require more attention. Many studies discussed the vital link that bonds job satisfaction with motivation, which has a major impact on productivity, innovation, and overall organizational performance. Our study explored the level of job satisfaction and factors that motivate pharmacists in Saudi hospitals using mixed quantitative and qualitative methods. From pharmacy managers' point of view; financial rewards are more important than non-financial incentives and benefits. This contradicts with pharmacists' opinions; who ranked recognition, promotion, job satisfaction, job feedback, autonomy and task significance among the most influential motivators to pharmacists. These results show that managers need to revise their plans and provide further attention to ensure that effective motivation and retention strategies are put in place.

A Review of Electronic Hand Hygiene Monitoring: Considerations for Hospital Management in Data Collection, Healthcare Worker Supervision, and Patient Perception

Healthcare-associated infections (HAIs) in U.S. acute care hospitals lead to a burden of $96-$147 billion annually on the U.S. health system and affect 1 in 20 hospital patients (Marchetti & Rossiter, 2013). Hospital managers are charged with reducing and eliminating HAIs to cut costs and improve patient outcomes. Healthcare worker (HCW) hand hygiene (HH) practice is the most effective means of preventing the spread of HAIs, but compliance is at or below 50% (McGuckin, Waterman, & Govednik, 2009). For managers to increase the frequency of HCW HH occurrences and improve the quality of HH performance, companies have introduced electronic technologies to assist managers in training, supervising, and gathering data in the patient care setting. Although these technologies offer valuable feedback regarding compliance, little is known in terms of capabilities in the clinical setting. Less is known about HCW or patient attitudes if the system allows feedback to be shared. Early-adopting managers have begun to examine their experiences with HH technologies and publish their findings. We review peer-reviewed research on infection prevention that focused on the capabilities of these electronic systems, as well as the related research on HCW and patient interactions with electronic HH systems. Research suggests that these systems are capable of collecting data, but the results are mixed regarding their impact on HH compliance, reducing HAIs, or both and their costs. Research also indicates that HCWs and patients may not regard the technology as positively as industry or healthcare managers may have intended. When considering the adoption of electronic HH monitoring systems, hospital administrators should proceed with caution.

Human resource crises in German hospitals--an explorative study

BACKGROUND

The complexity of providing medical care in a high-tech environment with a highly specialized, limited labour force makes hospitals more crisis-prone than other industries. An effective defence against crises is only possible if the organizational resilience and the capacity to handle crises become part of the hospitals' organizational culture. To become more resilient to crises, a raised awareness--especially in the area of human resource (HR)--is necessary. The aim of this paper is to contribute to the process robustness against crises through the identification and evaluation of relevant HR crises and their causations in hospitals.

METHODS

Qualitative and quantitative methods were combined to identify and evaluate crises in hospitals in the HR sector. A structured workshop with experts was conducted to identify HR crises and their descriptions, as well as causes and consequences for patients and hospitals. To evaluate the findings, an online survey was carried out to rate the occurrence (past, future) and dangerousness of each crisis.

RESULTS

Six HR crises were identified in this study: staff shortages, acute loss of personnel following a pandemic, damage to reputation, insufficient communication during restructuring, bullying, and misuse of drugs. The highest occurrence probability in the future was seen in staff shortages, followed by acute loss of personnel following a pandemic. Staff shortages, damage to reputation, and acute loss of personnel following a pandemic were seen as the most dangerous crises.

CONCLUSIONS

The study concludes that coping with HR crises in hospitals is existential for hospitals and requires increased awareness. The six HR crises identified occurred regularly in German hospitals in the past, and their occurrence probability for the future was rated as high.

A Hospitalwide Approach to AIDS—Recommendations of the Advisory Committee on Infections Within Hospitals American Hospital Association

As with any serious disease whose etiology is not understood, acquired immunodeficiency syndrome (AIDS) is currently causing considerable concern throughout the United States. Stories about individual cases and about research progress in unraveling the etiology and control of AIDS, appear in the news media almost daily.

Effective implementation of electronic medical records and health information technologies

Information technology (IT) capabilities are necessary for realizing the full promise of health information technologies in improving health care delivery process. In this study, three key IT capabilities for health care organizations are identified and their relationship with 30-day mortality rate from heart attack examined in a national sample of U.S. hospitals. The findings indicate that the negative relationship of IT capabilities with mortality rate from heart attack is mediated by effort/flexibility putforth by health care workers.

Creating a culture for value measurement

OSF HealthCare's executive dashboard provides: A detailed view of top-level measures to frame OSF's mission and vision for all stakeholders. An easily understood, holistic snapshot of performance An assessment of relationships among system goals, initiatives, and results. Explicit understanding of the organization's priority performance measures and the extent to which they need to improve. A vehicle for transitioning to a value-based business model.

Operational readiness: an integral part of the facility planning process

Large capital building projects benefit from an operational readiness strategy prior to new facility occupancy. St. Joseph's Healthcare used a structured approach for their readiness planning that included individual work plan meetings, tools for ensuring integration across programs and services and process improvement support to ensure a smooth transition. Over 1100 staff were oriented using a Train-the-Trainer model. Significant effort was required to co-ordinate the customized training, which involved "staffing up" to ensure sufficient resources for backfill. Operational readiness planning places additional demands on managers, requiring support and assistance from dedicated resources both prior to occupancy and several months post-move.

Practical aspects of change management at the Obstetrics and Gynecology Clinic at the University Hospital of Medical Sciences in Poznań, Poland

INTRODUCTION AND OBJECTIVES

Recent changes to the Polish healthcare system have forced healthcare managers and administrators to implement modern instruments for strategic and operations management. The main aim of the study was to analyze the effect of managerial decisions in the area of human resources, resulting from the adopted restructuring program, on the economic situation of the OGCH, PUMS.

MATERIAL AND METHODS

The research material comprised of secondary sources on finance, accounting and human resources data: financial statements, analysis of costs incurred by individual hospital departments, reports on the implementation of NHF contracts for providing health services and on hospital workforce at the time of the study, as well as the results of patient satisfaction survey at the OGCH, PUMS.

RESULTS

After implementation of the restructuring program all clinics apart from one - Surgical Gynecology Clinic - reached better beds occupancy rates in 2012 as compared to 2009, as well as significantly improved profit/per hospital bed. Over the course of three years, since the launch of the hospital restructuring program, a significant (20%) increase in the revenues from selling healthcare services and a simultaneous decrease (2%) of the operating cost was observed.

CONCLUSIONS

Inclusion of department heads into the decision making processes of managerial accounting seems to be necessary to improve the overall financial condition of a hospital. However, it requires a more flexible hospital structure, what can be achieved by implementing a divisional organizational structure, which grants individual organizational units a certain autonomy in the process of making medical-financial decisions.

Leadership effectiveness: a supervisor's approach to manage return to work

PURPOSE

To investigate adaptive leadership in relation to personnel sickness absence (SA). In situational leadership, supervisors are effective if they adapt their leadership style appropriately to a given situation.

METHODS

A managerial reorganization in a Dutch hospital with reassignment of supervisors provided the opportunity to compare SA in the same wards while under the leadership of different supervisors. Leadership effectiveness was measured with the Leader Effectiveness and Adaptability Description (LEAD). Personnel SA was retrieved from employer's records and cumulated at the individual level, distinguishing between short-term (1-7 day) and long-term (>7 days) SA. Cumulated SA days and mean SA lengths before and after managerial reorganization were compared at the individual level by using non-parametric paired statistical analyses. Employer's costs to compensate sick-listed employees' salaries before and after reorganization were cumulated and compared at ward level by using non-parametric statistics.

RESULTS

6 wards (N = 403) retained the same supervisor, 6 wards (N = 504) were assigned more effective supervisors, and 4 wards (N = 184) got less effective supervisors than the ones before reorganization. Cumulated short-term SA days and lengths did not change with leadership effectiveness. Employees who got more effective supervisors had fewer long-term SA days and shorter long-term SA lengths than before reorganization. More effective supervisors saved an average of 21,368 Euros per ward, particularly due to less long-term SA.

CONCLUSIONS

Long-term SA was shorter after employees got more effective supervisors. Adaptive supervisors can facilitate return to work and save SA costs by providing the right type of support to sick-listed employees.