Health Services Management

Pusekesmas Ngemplak I Sleman adalah salah satu puskesmas rawat inap yang ada di Kabupaten Sleman. Rawat inap di puskesmas Ngemplak I Sleman masih melakukan proses pencatatan rekam medis secara manual. Ada beberapa masalah yang muncul jika pencatatan dilakukan secara manual, seperti: memerlukan tempat atau ruangan yang besar dalam menyimpan data rekam medis pasien, pencarian data rekam medis pasien menjadi lama ketika banyaknya data rekam medis pasien, jika terjadi kesalahan pada pencatatan rekam medis pasien harus mengganti dengan yang baru. Pada penelitian ini akan dibahas mengenai proses pengembangan Sistem Informasi Manajemen Rawat Inap Puskesmas Ngemplak I. Sistem dikembangkan berbasis web dan dibangun dengan bahasa pemrograman PHP. Dari hasil pengujian sistem disimpulkan, bahwa tampilan sistem informasi rawat inap ini sudah cukup baik. Kemudian, data-data yang dimasukkan berdasarkan form perawatan sudah cukup sesuai dengan pelayanan yang ada di Puskesmas, data pasien, dan data ...

Rumah Sakit Daerah Mangusada Kabupaten Badung adalah salah satu rumah sakit di lingkungan Pemerintah Kabupaten Badung. Berdasarkan hasil observasi ditemukan bahwa masih terdapat kendala dalam pengoperasian sistem informasi manajemen rumah sakit ini yaitu sistem berjalan lambat dan koneksi internet yang kurang baik. Selain itu evaluasi terhadap SIMRS belum dilakukan. Tujuan penelitian ini adalah mengevaluasi SIMRS dengan metode HOT-FIT di RSD Mangusada Badung. Penelitian ini menggunakan rancang cros-sectional dengan pendekatan deskriptif kuantitatif. Sampel sebanyak 110 orang pengguna SIMRS. Dilihat dari komponen manusia pada SIMRS di Rumah Sakit Umum Daerah Mangusada mendapatkan skor 3,1 yang berarti sangat tinggi. Dilihat dari komponen organisasi pada SIMRS di Rumah Sakit Umum Daerah Mangusada mendapatkan skor 2,84 yang berarti sangat tinggi. Dilihat dari komponen teknologi pada SIMRS di Rumah Sakit Umum Daerah Mangusada mendapatkan skor 2,99 yang berarti sangat tinggi dan dilihat dari komponen net benefit di Rumah Sakit Umum Daerah Mangusada mendapatkan skor 3,03 yang berarti sangat tinggi. SIMRS RSD mangusada telah berjalan dengan baik sehingga pihak manajemen RSD mangusada perlu menjaga dan meningkatkan kinerja SIMRS lebih baik.

Teknologi Near Field Communication (NFC) memungkinkan ponsel dapat menyimpan data penting dengan aman dan terpercaya. Data tersebut dapat dikirim ke ponsel lain yang dilengkapi dengan NFC atau dibaca oleh NFC reader. Melalui aplikasi khusus data tersebut juga dapat ditambah, dikurangi, atau dimodifikasi. Kemampuan NFC ini memungkinkan ponsel dapat dikembangkan menjadi perangkat yang dapat menyimpan data penting semisal e-money atau rekam medis elektronik (RME). Pada penelitian ini telah dikembangkan sistem rekam medis berbasis Near Field Communication (NFC). Rekam medis elektronik berbasis NFC ini diharapkan dapat mengganti rekam medis konvensional. Keunggulan RME berbasis NFC adalah dibutuhkannya waktu yang lebih singkat dalam penggunaan, tidak tergantung pada akses internet, dan kemudahan dalam penyampaian RME ke pihak yang membutuhkan.

Laporan ini menyajikan hasil praktik lapangan yang berfokus pada implementasi dan integrasi sistem informasi dalam mendukung layanan kesehatan dan pendidikan klinik di RS PKU Muhammadiyah Gamping. Tujuan dari praktik ini adalah untuk mengkaji bagaimana teknologi digital digunakan dalam menunjang proses administrasi, pelayanan pasien, serta kegiatan pembelajaran bagi mahasiswa profesi kesehatan. Data diperoleh melalui observasi langsung, wawancara dengan tenaga kesehatan, dan telaah dokumen. Hasil menunjukkan bahwa rumah sakit telah menggunakan Sistem Informasi Manajemen Rumah Sakit (SIMRS) yang terstruktur untuk mendukung berbagai layanan seperti pendaftaran pasien, rekam medis, pelayanan farmasi, hingga koordinasi pendidikan klinik. Meskipun terdapat tantangan seperti gangguan teknis dan keterbatasan pelatihan pengguna, penerapan sistem digital terbukti meningkatkan efisiensi dan kualitas layanan. Laporan ini juga menekankan pentingnya desain sistem yang berpusat pada pengguna dan pelatihan berkala bagi staf untuk memastikan sistem berjalan optimal. Kesimpulannya, integrasi sistem informasi dalam pendidikan dan pelayanan kesehatan perlu ditingkatkan untuk mendukung kolaborasi akademik dan hasil klinis yang lebih baik.

Kata kunci: Sistem Informasi Kesehatan, Pelayanan Rumah Sakit, Pendidikan Kesehatan, Teknologi Kesehatan, RS PKU Muhammadiyah

Background: Health literacy has been attractive to policymakers since its inception. This study analyzed the agenda-setting process of health literacy-promoting policies in 7 selected countries using Kingdon's multiple streams model. Methods: This descriptive-comparative study was conducted using Kingdon's multiple streams model. This model has three streams: problem stream, policy stream and politics stream. They influence the public policymaking process and policy change occurs when these streams converge in a policy window. We selected the USA, Australia, South Africa, Chile, Turkey, Thailand and the Islamic Republic of Iran as samples. The content analysis of available policy documents, reports, and comparative tables was used. Results: Extensive studies were the main driver of the problem stream. Numerous conferences and health promotion programs were drivers of the policy stream. The desire and contribution of key persons and national authorities, the government's serious commitment, and political stability strengthened the politics stream. Ultimately, the simultaneous strengthening of three streams brought the issue onto the agenda. Conclusion: Although Kingdon's model considered three streams separately, they are not separate. As the findings show, the first step towards bringing health literacy to the agenda is understanding and introducing the issue at the policy space and community level. This strategy will further encourage policymakers to develop solutions. Drawing the support of influential people will also be very useful in this regard.

Although the use of PPPs is endorsed by agencies at the national and supranational levels, there is little guidance for decision-makers on what good outcomes look like and the circumstances in which such outcomes are likely to occur. Enhanced understanding of these issues can improve the governance of large-scale contracting in the health sector. Drawing on a narrative review of the available theoretical and empirical research, this paper evaluates: (1) the benefits that PPPs generate compared to alternative mechanisms of delivery; (2) their additional costs; and (3) the endogenous and exogenous factors that influence these outcomes. The evidence shows that PPPs hold promise for decision-makers who prioritise certainty. However, PPPs are also associated with additional transaction and financing costs. The key decision that policymakers and managers need to make about their use of the PPP model is, therefore, how much extra they are prepared to pay to achieve predictable cost, quality and service outcomes. How much they will have to pay is a function of a set of contextual variables which are readily amenable to policy action.

Although the use of public–private partnerships is endorsed by agencies at the national and supranational levels, there is little guidance for decision-makers on what good outcomes look like and the circumstances in which such outcomes are likely to occur. Enhanced understanding of these issues can improve the governance of large-scale contracting in the health sector. Drawing on a narrative review of the available theoretical and empirical research, this paper evaluates: (1) the benefits that public–private partnerships generate compared to alternative mechanisms of delivery; (2) their additional costs; and (3) the endogenous and exogenous factors that influence these outcomes. The evidence shows that public–private partnerships hold promise for decision-makers who prioritise cost- and time-certainty. However, public–private partnerships are also associated with additional costs – notably transaction and financing costs. The key decision that policymakers and managers need to make ...

IntroductionHospital supply chains are complex systems ensuring flow of products/services to satisfy patients. The aim of this exploratory study is to improve the Maltese health care system’s efficiency using supply chain management principles in three hospital settings. The theoretical basis underlying the study is the supply chain decision-making framework.MethodsUsing observation and focus groups, the following steps were undertaken: (i) mapping healthcare supply chain processes and identifying challenges; (ii) understanding competitive strategy through implied demand uncertainty; (iii) deriving supply chain strategies through supply chain drivers; (iv) optimizing healthcare supply chain (right balance between cost and responsiveness); (v) identifying critical success factors for healthcare supply chains.ResultsIn line with their competitive and supply chain strategies, the three settings have well-defined primary goals, stakeholders’ needs/demands/expectations, as well as clear-...

While health service utilization is a key indicator of health service delivery which many countries seek to improve, low health service utilization patterns characterize many urban settings in developing countries with a grave impact on the community. One such urban setting is Mbale Municipality in Mbale district, Uganda. A cross sectional descriptive study was carried in five wards of Mbale Municipality on the ninety-three ( ) respondents. The study aimed at investigating the determinants which influence utilization of health services in urban areas. The information was collected using questionnaires and semi structured interviews. The study findings showed that the procurement process resulted in delayed and inadequate supply of essential drugs and medical equipment' supply. Understaffing is high and untimely funding was also reported. Poor medical ethic or code of conduct of the health workers and negative perceptions of the community towards health services and health staff were cited as other influencing determinants to health services utilization in urban areas. In view of these findings, the authors propose a review of the procurement system to ensure timely and adequate supply of drugs and medical equipment, recruitment of more health staff, continuous professional development (CPD) of health workers in medical ethical code of conduct in handling patients, sensitization of the community to build trust on health workers, and sharing of responsibilities by couples while taking care of patients in admission.

Variation persists in the quality of board-level leadership of hospitals. The consequences of poor leadership can be catastrophic for patients. The year 2019 marks 50 years of public inquiries into healthcare failures in the UK. The aim of this article is to enhance our understanding of context-specific effectiveness of healthcare board practices, drawing on an empirical study of changes in hospital board leadership in England. The study suggests leadership behaviours that lay the conditions for better organisation performance. We locate our findings within the wider theoretical debates about corporate governance, responding to calls for theoretical pluralism and insights into the effects of discretionary effort on the part of board members. We conclude by proposing a framework for the ‘restless’ board from a multi-theoretic standpoint, and suggest a repertoire specifically for healthcare boards. This comprises a suite of board roles as conscience of the organisation, sensor, shock ...

This study analyses how both ambulatory care groups (ACGs) and physician characteristics explain the variability in health-service use among primary care patients in Spain. During the period 1996-1997, data derived from 52 152 patients and their 38 respective primary care physicians were collected. The response variables were as follows: number of visits; diagnostic tests requested; and referrals to a specialist. ACGs are an important variable that should be taken into account in order to explain health-service utilization. As for professionals, age and the post they hold are essential factors. Most of the unexplained variability is caused by patient characteristics.

This study applies Porter's model of competitive advantage to the nursing home industry. Discriminant analysis is used to identify organizational and environmental characteristics associated with nursing homes which have demonstrated valued strategic outcomes, and to distinguish the more successful nursing homes from their rivals. The results of the discriminant analysis suggest that nursing homes with superior payer mix outcomes are distinguishable from their less successful rivals in areas associated with a focused generic strategy. The study suggests that nursing homes which are better staffed, of smaller size and lower price are more likely to achieve high levels of self-pay utilization. Independent living units, continuing care retirement communities in particular, are likely to act synergistically with nursing home organizational characteristics to enhance competitive advantage by linking the value chain of the nursing home to that of retirement housing. Nursing homes with...

Hospitalists, or specialists of hospital medicine, have long been practicing in Canada and Europe. However, it was not until the mid-1990s, when hospitals in the U.S. started widespread adoption of hospitalists. Since then, the number of hospitalists has grown exponentially in the U.S. from a few hundred to over 50,000 in 2016. Prior studies on hospitalists have well documented benefits hospitals gain from adopting this innovative staffing strategy. However, there is a dearth of research documenting predictors of hospitals' adoption of hospitalists. To fill this gap, this longitudinal study (2003-2015) purposes to determine organizational and market characteristics of U.S. hospitals that utilize hospitalists. Our findings indicate that private not-for-profit, system affiliated, teaching, and urban hospitals, and those located in higher per capita income markets have a higher probability of utilizing hospitalists. Additionally, large or medium, profitable hospitals, and those that treat sicker patients have a higher probability of adoption. Finally, hospitals with a high proportion of Medicaid patients have a lower probability of utilizing hospitalists. Our results suggest that hospitals with greater slack resources and those located in munificent counties are more likely to use hospitalists, while their under-resourced counterparts may experience more barriers in adopting this innovative staffing strategy.

Direct and indirect costs of work-related stress can be measured in both humanistic and financial terms. In Hungary and the other Central and Eastern European countries chronic stress-related diseases, like depression, premature cardiovascular illnesses, and overall mortality rates are higher in comparison to western countries, primarily among men. The vast majority of the adult population is employed in some capacity and the average person spends more time working than in any other waking activity. Working conditions can exert influence on employee well-being. The present study aimed to explore the relationship between the perceived type of organizational culture (team, adhocracy, market, hierarchy) and employee well-being (perceived work-related stress, organizational identification, and turnover intention). Employees (N= 256) from different Hungarian companies (Study 1) and employees (N= 112) from Hungarian information technology firms (Study 2) completed a questionnaire battery ...

Although healthcare managers make increasingly difficult decisions about health innovations, the way they may interact with innovators to foster health system sustainability remains underexplored. Drawing on the Responsible Innovation in Health (RIH) framework, this paper analyses interviews ( n=37) with Canadian and Brazilian innovators to identify: how they operationalize inclusive design processes; what influences the responsiveness of their innovation to system-level challenges; and how they consider the level and intensity of care required by their innovation. Our qualitative findings indicate that innovators seek to: 1) engage stakeholders at an early ideation stage through context-specific methods combining both formal and informal strategies; 2) address specific system-level benefits but often struggle with the positioning of their solution within the health system; and 3) mitigate staff shortages in specialized care, increase general practitioners’ capacity or patients and ...

In tune with much international practice, the English National Health Service has been striving to transform health care provision to make it more affordable in the face of rising demand. At the heart of a set of recent radical reforms has been the launch of ‘clinical commissioning’ using the vehicle of local groups of General Practitioners (GPs). This devolves a large portion of the total healthcare budget to these groups. National government policy statements make clear that the expectation is that the groups will ‘transform’ the organisation and provision of health services. In this article, we draw upon interviews, observations and analysis of internal documents to make an assessment of the extent to which clinical leaders have seized the opportunity presented by the creation of these groups to attempt transformative service redesign.

"O presente é o espaço fugaz entre o não mais e o não ainda". (ARENDT, 2010) Para aqueles que precisam de "mapas" para andar, ofereço um guia: Estas páginas que se seguem devem ser lidas por aqueles que conseguem ler e ouvir histórias sem se preocupar em saber de onde elas vieram ou sobre quem estão falando ou, ainda, em que autores se referenciam para dizer o que dizem aqueles que escrevem. Se, com este alerta, a leitura se seguir, então será possível o conhecimento sobre as andanças de Gouche, apresentadas ao então residente especializando de pedagogia na área da saúde mental coletiva e sua preceptora 1 de núcleo durante a Residência Integrada Multiprofissional em Saúde Mental Coletiva. Este texto é o trabalho de conclusão de um programa de especilalização que se realiza em serviço, sob a modalidade de formação especializada em área profissional da saúde, como previsto pela Lei Federal nº 11.129, de 2005. Este texto foi escrito para exercer três funções básicas, a saber: Dar conta de um texto exigência para completar a formação em Saúde Mental Coletiva; escrever um texto que versasse sobre algum tema relacionado à formação em saúde mental; e apresentar um texto que, por meio dele, pudesse conversar com "leigos", ou pessoas "desavisadas" da temática e as propostas de Saúde Coletiva, da Saúde Mental e da Saúde Mental Coletiva. Talvez o mais pre(ten)cioso desejo com a escrita deste texto esteja nessa terceira "função" que, dita de outro modo, corresponde ao desejo de divertir àqueles que o escrevem, posto que um texto é re-escrito nos olhos daqueles que o lêem. Poderia dizer "satisfazer", mas um poeta satisfeito não satisfaz, como diz Mario Quintana. Ele, o poeta, abre espaços, fendas por onde passam, espreitam ou deslizam sensações e perguntas. Então, digo divertir: Viva a incompletude, Viva a falta! Apresentarei algumas trajetórias que, como tal, não trazem "verdades" ou "falsidades", são apenas descrições e impressões sobre o que vivi. Alerto aos leitores para que não percam tempo buscando "a verdade", preocupem-se com os encontros possíveis. Entreguem-se aos encontros, como uma criança que ouve histórias. Aviso que além de algumas citações "escancaradas", existem algumas impressões, assim como documentos oficiais e autores escondidos e que, por uma "tomada de liberdade" assim permaneceram. A exemplo das liberdades, da escolha singular e das fendas, começarei esta escrita por uma carta a minha preceptora de pedagogia, nas trilhas do livro Utopia. Minha preceptora foi Aromilda Grassotti Peixoto, pedagoga, mestre e doutora em Educação, conhecida como Neca. Trarei uma das conversas com Neca para dar acesso ao meu texto ou aos desejos de minha iniciativa. Diante de um texto meu, ela me pergunta como não coloquei uma palavra sobre atenção psicossocial ou sobre o trabalho de ou em Centros de Atenção Psicossocial. Agora vou falar desse lugar, mas talvez não haja neste texto presente nenhuma marca que diga "isto aqui é ficção"; "isto aqui eu vivi"; "esta outra parte é como deve ser, segundo a _______________ 1 Preceptor de núcleo é como chamamos àquele profissional que, em situação de acompanhamento de um aprendiz da mesma prática profissional, exerce acompanhamento docente-assitencial, ensina com a propriedade de quem faz, já fez ou sabe fazer em determinado campo profissional, quando aplicado a realidade de trabalho. Este trabalho mostra o circular pela saúde mental coletiva através de encontros e narrativas de um personagem por uma cidade chamada "Equis". Narrativa esta semelhante ao proposto por Morus em seu livro "A Utopia". O autor, nesta revisão de literatura, trás também reflexões sobre redes de cuidado e convoca para o pensar sobre os Serviços Público de Saúde, sobre o cuidar e o ser cuidado no espaço da cidade e da vida. Aponta utopias, como horizontes a buscar e compartilha cenas de cotidianos possíveis.

Although mammography screening significantly reduces breast cancer mortality, women could present different morphological characteristics that do not allow the correct vision of their breasts and the detection of cancer, resulting in a delay of diagnosis and an increase in the risk of mortality. The present study aims at analyzing potential areas of improvement of the current screening programs and then hypothesizing alternative technologies to use within the diagnostic phase, from an economic point of view. A Budget Impact Analysis approach was implemented, considering the Italian National Healthcare Service perspective, and representing the healthcare expenditure evolution, over three years. In the Budget Impact Analysis model, two distinct phases of the screening programs were considered: (1) the screening/diagnosis phase and (2) the phase related to cancer care and treatments of patients. The results provide clinicians and policy makers with a rational method to forecast economic resources in the screening programs in a general context of limited resources. In particular, results of the Budget Impact Analysis showed that, while the introduction of the ABUS InveniaTM technology into the screening programs would lead to an increase in the screening phase expenditure, it would generate an economic advantage related to the patients treatment and care.

Avaliação de intervenções de Gestão da Clínica na qualificação do cuidado e na oferta de leitos em um hospital público de grande porte Evaluation of clinical governance interventions on qualification of care and supply of beds in a large public hospital

Chapters 4 to 6 give specific and useful advice, on outreach to survivors, consultation with leaders, psychological debriefing with groups, and specific therapeutic approaches to posttraumatic stress and abnormal grief. The final chapter addresses the psychological and professional needs of disaster workers -including those whose task it is to deliver the psychosocial aftercare.

Chapters 4 to 6 give specific and useful advice, on outreach to survivors, consultation with leaders, psychological debriefing with groups, and specific therapeutic approaches to posttraumatic stress and abnormal grief. The final chapter addresses the psychological and professional needs of disaster workers -including those whose task it is to deliver the psychosocial aftercare.

This paper explores the objective of increased competition and considers whether different types of competition are likely to lead to desirable market outcomes. Potential sources of market failure, and hence inefficiency, are examined. The paper then considers what type and degree of regulation may be necessary if the forces of unrestrained competition cannot be expected to achieve desirable outcomes. A number of different options, ranging from minimal regulation to central pricing schedules, are then discussed. Consideration is given to whether openness in costing and/or pricing is necessary and desirable in both short and long term. The paper raises a number of practical problems which may be faced and suggests ways in which incentives can be created to mimic the characteristics of a competitive market.

IntroductionHospital supply chains are complex systems ensuring flow of products/services to satisfy patients. The aim of this exploratory study is to improve the Maltese health care system’s efficiency using supply chain management principles in three hospital settings. The theoretical basis underlying the study is the supply chain decision-making framework.MethodsUsing observation and focus groups, the following steps were undertaken: (i) mapping healthcare supply chain processes and identifying challenges; (ii) understanding competitive strategy through implied demand uncertainty; (iii) deriving supply chain strategies through supply chain drivers; (iv) optimizing healthcare supply chain (right balance between cost and responsiveness); (v) identifying critical success factors for healthcare supply chains.ResultsIn line with their competitive and supply chain strategies, the three settings have well-defined primary goals, stakeholders’ needs/demands/expectations, as well as clear-...

Background: This article examines the usage of various theories in the perspective of health planning. Accounts of transformation initiatives often reveal little about past organisational and contextual planning conditions that contributed to success. This article aims to explain the historical usage of planning theories by aligning them to the current healthcare system. Materials and Methods: A scoping review of literature using electronic database of PubMed, ScienceDirect, Google Scholar was done with special attention given to three specified planning theory in relation to health care planning. A total of 30 articles, reports and theses were selected and analysed. The analysis and findings are presented based on three different theories that has been selected which are the rational planning model, incremental planning theory and mix scanning planning theories. Result: Rational planning model is a process of understanding the problem followed by establishing and evaluating plannin...

In order to achieve and monitor success in the NHS internal market, it is important that information related to health care objectives is developed and used. The paper argues that these objectives are not always easy to specify but that four groups can be identified: efficiency, equity, quality and accountability/responsiveness. Although information management specialists have emphasised the construction and use of appropriate frameworks for planning information flows, whether appropriate information is used depends on the existence of incentives for its supply. Using concepts from game theory, the paper offers a non-technical examination of the incentives that the contracting environment imposes on the development of new information. The article concludes by suggesting that, for a variety of reasons, the incentives to produce information which would help monitor medical outcomes and related objectives, as distinct from inputs or activities, are often weak and sometimes perverse.

The purpose of this study is to shed light on the individual socioeconomic status (SES) and demographic determinants of the demand for health care in a crosscomparison study of nine E.U. countries. It focuses on the effects of the individual employment status on alternative indicators of demand for health care that constitutes a largely unexplored area. The evidence supports the existence of an employment status-demand for health care relationship although it varies with respect to the type of health care examined and the institutional and environmental settings of the countries utilised in the study.

Instruments & Methods This cross-sectional descriptive study was conducted on 5 hospitals, including Shahid Beheshti, Shahid Rajaei, and Emam-Sajjad Yasuj hospitals, and Shahid Rajaei Hospital in Gachsaran and Emam-Khomeini Hospital in Dehdasht affiliated to Yasuj University of Medical Sciences in 2011-2018. Bed Occupancy Rate (BOR), Bed Turnover (BTR) and Average Length of Stay (ALS) were collected through hospital information system and analyzed according to Pabon Lasso model and compared with the standard levels. Findings The mean BTR (98.76 times per year), ALS (2.12 days) and BOR (70.9%) in hospitals in 2011-2018 were favorable. ALS was 15.24 days in Shahid Rajaei hospital in Yasuj. Shahid Beheshti hospital was in zone 3 in all years. Emam-Sajjad hospital was in zone 3 in all years except 2014.

The diffusion of the Web 2.0 has made it possible for patients to exchange on online health communities, defined as computer-mediated communities dedicated to health topics, wherein members can build relationships with other members. It is now acknowledged that online health communities provide users not only with medical information but also with social support with no time or geographical boundaries. However, in spite of their considerable interest, there is still a paucity of research as to how online health communities alter the patient-physician relationship. This research aims at filling this gap and examines how online health communities, while providing users with computer-mediated social support and empowerment, impact the patient-physician relationship. Six hypotheses are proposed and tested. A survey was developed and 328 responses were collected from online patient groups in Canada in 2016. The data were analysed using structural equation modelling. All but one hypothesis are validated. The results show that user computer-mediated social support positively influences user empowerment and participation during the consultation, which in turn determines user commitment to the relationship with the physician. Importantly and contrary to our expectations, user empowerment is found to be significantly but negatively related to user commitment with the physician.

In this paper, we explore the application of motif discovery (i.e., the discovery of short characteristic patterns in a time series) to the clinical challenge of predicting intensive care unit (ICU) mortality. As part of the Physionet/CinC 2012 challenge, we present an approach that identifies and integrates information in motifs that are statistically over-or under-represented in ICU time series of patients experiencing in-hospital mortality. This is done through a three step process, where ICU time series are first discretized into sequences of symbols (by segmenting and partitioning them into periods of low, medium and high measurements); the resulting sequences of symbols are then searched for short subsequences that are associated with in-hospital mortality; and the information in many such clinically useful subsequences is integrated into models that can assess new patients. When evaluated on data from the Physionet/CinC 2012 challenge, our approach outperformed existing clini...

Many healthcare scholars have applied institutional theories to the study of management accounting systems (MAS) change. However, little attention has been devoted to MAS change within groups. Kostova et al. highlight the limitations of traditional institutional frameworks in studying groups since they are characterised not only by the existence of external institutional environments but also by intra-organisational (meso-level) ones. Given this background, the research question is: how does the meso-level institutional environment affect MAS change in healthcare groups? We use a longitudinal multiple-case study design to understand the role of headquarters in shaping local MAS change. We would expect companies to adopt similar MAS. However, we argue that the relationship between external institutions and MAS change cannot be wholly understood without taking into consideration the role of headquarters. Our analysis shows how hospitals facing the same external institutional environment implement different MAS as a consequence of different parenting styles. From a scientific perspective, our article contributes to broaden traditional institutional theoretical frameworks.

Many healthcare scholars have applied institutional theories to the study of management accounting systems (MAS) change. However, little attention has been devoted to MAS change within groups. Kostova et al. highlight the limitations of traditional institutional frameworks in studying groups since they are characterised not only by the existence of external institutional environments but also by intra-organisational (meso-level) ones. Given this background, the research question is: how does the meso-level institutional environment affect MAS change in healthcare groups? We use a longitudinal multiple-case study design to understand the role of headquarters in shaping local MAS change. We would expect companies to adopt similar MAS. However, we argue that the relationship between external institutions and MAS change cannot be wholly understood without taking into consideration the role of headquarters. Our analysis shows how hospitals facing the same external institutional environme...

IntroductionTargeted, tailored interventions to test high-risk individuals for HIV and hepatitis C virus (HCV) are vital to achieving HIV control and HCV microelimination in Africa. Compared with the general population, people who inject drugs (PWID) are at increased risk of HIV and HCV and are less likely to be tested or successfully treated. Assisted partner services (APS) increases HIV testing among partners of people living with HIV and improves case finding and linkage to care. We describe a study in Kenya examining whether APS can be adapted to find, test and link to HIV care the partners of HIV-positive PWID using a network of community-embedded peer educators (PEs). Our study also identifies HCV-positive partners and uses phylogenetic analysis to determine risk factors for onward transmission of both viruses.MethodsThis prospective cohort study leverages a network of PEs to identify 1000 HIV-positive PWID for enrolment as index participants. Each index completes a questionna...

In recent years in Italy, as in other European countries, profound changes have been introduced in health care both at central and regional levels. Most of them were oriented towards a shift from 'hospital-centred' health care to health care based more on primary care services. This transition pursues two objectives: giving more effective responses to citizens' needs and reducing public health expenditure. Changes that involve organizational structure must also be carried out with the introduction of measurement tools that can help in planning and can control the changes. The paper provides the results obtained through the experience of modelling a measurement system for primary care carried out in 2004 and 2005 by some territorial managers and controllers in the Tuscan Health system, and the main issues in measuring primary care services emerging from this pilot experience focused on integrated home care services.

In recent years in Italy, as in other European countries, profound changes have been introduced in health care both at central and regional levels. Most of them were oriented towards a shift from ‘hospital-centred’ health care to health care based more on primary care services. This transition pursues two objectives: giving more effective responses to citizens' needs and reducing public health expenditure. Changes that involve organizational structure must also be carried out with the introduction of measurement tools that can help in planning and can control the changes. The paper provides the results obtained through the experience of modelling a measurement system for primary care carried out in 2004 and 2005 by some territorial managers and controllers in the Tuscan Health system, and the main issues in measuring primary care services emerging from this pilot experience focused on integrated home care services.

In order to improve the quality and efficiency of hospitals, they can be viewed as a logistical system in which integration is a critical factor for performance. This paper describes the results of a scoping study that identifies the logistical parameters mentioned in international research on hospitals and indicates whether literature reflects system integration. When subsystems collaborate in order to accomplish the task of the entire organization, there is integration. A total number of 106 logistical parameters are identified in our study. In addition, the flow type-patients, materials and staff-and hospital subsystems were registered. The results presented in international literature show that logistics is highly fragmented in hospitals. Studies also show integration, although this takes place mainly within the subsystems of hospitals. A multi-agent perspective on hospitals is proposed, following the view that both integration and differentiation are essential for effective organizational performance. Given the widely recognised importance of controlling hospital costs and the potential of logistics to help in this process, it is important to gain more knowledge of hospitals as network organizations, as well as knowledge regarding the degree of integration and the logistical parameters that are required for better hospital performance.

This study comprehensively evaluated the links between systems of High Performance Work Practices and firm performance. Results based on a national sample of nearly one thousand firms indicate that these practices have an economically and statistically significant impact on both intermediate employee outcomes (turnover and productivity) and short-and long-term measures of corporate financial performance. Support for predictions that the impact of High Performance Work Practices on firm performance is in part contingent on their interrelationships and links with competitive strategy was limited. The impact of human resource management (HRM) policies and practices on firm performance is an important topic in the fields of human resource management, industrial relations, and industrial and organizational psychology (Boudreau, 1991; Jones & Wright, 1992; Kleiner, 1990). An increasing body of work contains the argument that the use of High Performance Work Practices, including comprehensive employee recruitment and selection procedures, incentive compensation and performance management systems, and extensive employee involvement and training, can improve the knowledge, skills, and abilities of a firm's current and potential employees, increase their motivation, reduce shirking, and enhance retention of quality employees while encouraging nonperformers to leave the firm (Jones & Wright, 1992; U.S. Department of Labor, 1993). I am very grateful to Brian Becker for his many helpful comments on this article and for his direction and guidance on the dissertation on which it is based. I would also like to thank

The application of the repertory grid technique made it possible to capture the mental categorization by which maternity care services are judged. Conceptualization of the expectation standard, defined as estimates of anticipated performance, led to the identification of 14 attributes. These include: reliability, responsiveness, competence, access, courtesy, communication, credibility, security, relationship, tangibles, control, cost, naturalness and quality. The definitions made use of the prospective consumer's own verbal labels. In addition, it was found that maternity care services were not perceived as one continuous process. Three distinct categorizations were identified, that is: before, during, and after the birth of the baby. This suggests that prospective consumers employ the service quality attributes, according to one of the above.

This study comprehensively evaluated the links between systems of High Performance Work Practices and firm performance. Results based on a national sample of nearly one thousand firms indicate that these practices have an economically and statistically significant impact on both intermediate employee outcomes (turnover and productivity) and short-and long-term measures of corporate financial performance. Support for predictions that the impact of High Performance Work Practices on firm performance is in part contingent on their interrelationships and links with competitive strategy was limited. The impact of human resource management (HRM) policies and practices on firm performance is an important topic in the fields of human resource management, industrial relations, and industrial and organizational psychology (Boudreau, 1991; Jones & Wright, 1992; Kleiner, 1990). An increasing body of work contains the argument that the use of High Performance Work Practices, including comprehensive employee recruitment and selection procedures, incentive compensation and performance management systems, and extensive employee involvement and training, can improve the knowledge, skills, and abilities of a firm's current and potential employees, increase their motivation, reduce shirking, and enhance retention of quality employees while encouraging nonperformers to leave the firm (Jones & Wright, 1992; U.S. Department of Labor, 1993). I am very grateful to Brian Becker for his many helpful comments on this article and for his direction and guidance on the dissertation on which it is based. I would also like to thank

The purpose of this paper is to study the relationship between rewards, and performance of Health Centre IV workers in greater Mbarara District. The constructs of rewards include; salary, performance bonus, recognition and promotion. This study used cross-sectional, explanatory and correlational approaches. Health center IV workers data were collected by means of a questionnaire survey from a sample of 200 health workers from 11 health centres from greater Mbarara district. Structural equation modelling was used to test the hypotheses. Results show that rewards significantly affect health workers' performances. Therefore, once health centres IV have appropriate reward strategies for their health workers in health facilities, they are likely to work hard by meeting deadlines, being available at their work station and they would eventually enhance on job performance. It is further recommended that all health policy makers and implementators at both Ministry of health and central government should always emphasize the general wellbeing of all health workers in every health facility.

Latar Belakang : Jumlah dana sisa yang menumpuk di rekening puskesmas akan menimbulkan berbagai dampak terutama munculnya dana yang tidak termanfaatkan atau dana sisa. Dana kapitasi ini sifatnya sangat rawan untuk disalahgunakan sehingga perlu adanya keahlian yang khusus terkait pengelolaan dana kapitasi ini. Metode : Jenis penelitian adalah penelitian kualitiatif dengan wawancara semi-terstruktur, telaah dokumen dan observasi dengan jumlah informan 9 orang yang terdiri dari Bupati, DPRD, Dinas Kesehatan dan 2 Puskesmas sampel. Hasil : Hasil analisis berdasarkan pendekatan sistem menunjukkan bahwa pengelolaan dana kapitasi oleh puskesmas di Kabupaten Pasaman Barat yaitu sebagai berikut: komponen input yaitu tenaga yang belum berkompeten, dan sarana prasarana pendukung yang belum memadai. Komponen proses yaitu perencanaan menjadi lebih fleksibel namun pelaksanaan menjadi tidak lancar akibat kebijakan yang masih baru. Komponen output yaitu, ekuitas atau pelayanan kesehatan yang diberi...

The Implementation of National Health Insurance (NHI) has been started in Indonesia since 2014. BPJS Health has been appointed as the organizer of NHI and First-rate Health Facilities as the implementers of NHI. In its implementation, FRHF will obtain direct payment from BPJS which will be paid in advance without taking into account the type and amount of health services provided known as NHI capitation fund. The utilisation and management of NHI capitation funds by FRHF municipal government of Kotamobagu in its implementation encountered several obstacles that impact on health services. The purpose of this research is to analyze the implementation process of utilization and financial management of NHI capitation fund by FRHF municipality and to analyse any constraints encountered in the implementation of utilisation and management of NHI capitation fund by FRHF Kotamobagu. This research is a qualitative exploratory study. The object of this research was the local government of Kotamobagu and its BPJS Health office. Data were obtained through indepth interviews, observations, and documentation studies. The informants were selected purposively in order to obtain the correct and accurate information. Interviews were conducted using semi-structured in-depth interviews. The triangulation method was used in testing the validity or credibility of data or sources. Transcribed data from interview result was analyzed by using the content analysis method and then giving themes/coding and finally by conceptualisation. The results of the interpretation are summarised in the narrative text. The result of the research shows that the process of implementation and administration of financial utilisation of NHI capitation fund by FRHF in Kotamobagu has been implemented in accordance with regulation/guidance.

Avaliação de intervenções de Gestão da Clínica na qualificação do cuidado e na oferta de leitos em um hospital público de grande porte Evaluation of clinical governance interventions on qualification of care and supply of beds in a large public hospital

Objective: To identify in the existing literature, publications that address the theme of management actions of nurses in the emergency room. Method: An exploratory study of literature with a qualitative approach, where journals were uncovered relevant to research in the years 2000 to 2007. These were shown through the Virtual Health Library (VHL) in the SciELO database. Results: 2321 products were found, and 15 publications were selected that met the research criteria. Results: Three categories emerged: management theories in nursing work, nursing management, and management and organization of nursing care in the emergency room. Conclusion: Nurses must constantly seek out actions that help management, creating opportunity for qualified assistance, identifying data and aspects relating to that industry and users. Adopting a reflection on the social and organizational context, in which it is immersed, leads to the possibility of becoming critical. To this end, the need to invest in training is highlighted, in continuing education, in order to facilitate interpretations of crystallized positions in daily life.

The application of the repertory grid technique made it possible to capture the mental categorization by which maternity care services are judged. Conceptualization of the expectation standard, defined as estimates of anticipated performance, led to the identification of 14 attributes. These include: reliability, responsiveness, competence, access, courtesy, communication, credibility, security, relationship, tangibles, control, cost, naturalness and quality. The definitions made use of the prospective consumer's own verbal labels. In addition, it was found that maternity care services were not perceived as one continuous process. Three distinct categorizations were identified, that is: before, during, and after the birth of the baby. This suggests that prospective consumers employ the service quality attributes, according to one of the above.

Penelitian ini bertujuan untuk mengetahui implementasi pengelolaan Dana BPJS di Puskesmas Kabila Kabupaten Bone Bolango. Penelitian ini menggunakan jenis kualitatif deskriptif, teknik pengumpulan data dengan metode wawancara, observasi dan dokumentasi. Hasil penelitian menunjukkan bahwa Implementasi pengelolaan dana BPJS yaitu dana kapitasi melalui proses perencanaan Dan terdapat kendala, adanya proses pemotongan dana yang tersisa di bulan kemarin.

Tujuan Pembagian jasa pelayanan dana kapitasi di Pekanbaru diatur dalam Perwako No 26 tahun 2016, belum memenuhi kepuasan petugas. Penelitian ini bertujuan untuk mengetahui tentang pembagian jasa pelayanan kapitasi di Puskesmas Senapelan Kota Pekanbaru tahun 2018. Metode Penelitian ini merupakan penelitian kualitatif pendekatan deskriptif. Pengambilan data dengan wawancara mendalam dan telaah dokumen. Penelitian dilakukan pada bulan Januari – Juni 2019. Penentuan informan dengan cara purposive sampling. Informan penelitian sebanyak 8 orang. Analisa data dilakukan dengan triangulasi teknik dan sumber. Hasil Hasil penelitian menunjukkan bahwa petugas Puskesmas Senapelan sudah mengetahui tentang 6 indeks dalam pembagian jasa pelayanan. Indeks resiko kerja belum sesuai dengan kebutuhan dan keadaan petugas. Pembagian jasa pelayanan di Puskesmas Senapelan belum sesuai dengan Perwako yaitu pada indeks resiko kerja dan capaian kinerja. Kesimpulan Pembagian jasa pelayanan dana kapitasi di pu...

This chapter explores the applications, contributions, limitations, and challenges of data envelopment analysis (DEA) in healthcare management. DEA, a non-parametric method used for evaluating the efficiency of decision-making units, has found extensive applications in healthcare sectors such as hospital management, nursing, and outpatient services. The review consolidates findings from a broad range of studies, highlighting DEA's significant contributions to efficiency measurement, benchmarking, resource allocation and optimization, and performance evaluation. However, despite DEA's robust applications, the chapter also identifies several limitations and challenges, including the selection of inputs and outputs, sensitivity to outliers, inability to handle statistical noise, lack of inherent uncertainty measures, homogeneity assumption, and the static nature of traditional DEA models. These challenges underscore the need for further research and methodological advancements in applying DEA in healthcare management.