Health Services Management

Despite a lack of conceptual clarity, the importance of cultural change to clinical governance is widely accepted. While generic measures of organisational performance, culture and climate are available, their relationship to clinical governance is unclear. Consequently, there is currently no valid and reliable measure of clinical governance climate. This study aimed to address the deficiency by reducing a pool of clinical governance climate indicators developed via prior qualitative research, describing a latent factor structure and assessing the internal consistency and external validity of the factor model. The resultant instrument, the Clinical Governance Climate Questionnaire (CGCQ), attained high internal consistency and external (discriminant and construct) validity in a study population of health care trust staff. It consists of sixty items distributed across six sub-scales of clinical governance: planned and integrated quality improvement; proactive risk management; absence of unjust blame and 1 punishment; working with colleagues; training and development; and organisational learning. The measure enables those charged with leading the clinical governance agenda in health care organisations to assess the progress of organisational development initiatives, highlighting areas requiring particular attention. They may also be of interest to those concerned about the negative unintended consequences of performance management. 2

We mobilize theories of corporate governance and the theory of the social psychology of decision-making small groups to understand the operational process of the public hospital supervisory board. More precisely, we empirically test the mediation relationship of the decision-making process (effort norms, use of knowledge and skills, and conflict cognitive) between its structure (size, the composition, and diversity) and the performance of its roles (strategy, control, and service). A total of 320 questionnaires coming from members of the French public hospital supervisory board were collected. The aggregation of these individual answers generates a sample of 159 public hospital supervisory boards. The results of the tests of the assumptions of the research model confirm the fact that the structure of the supervisory board does not influence the performance of its roles. However, supervisory board effort norms positively affect the performance of its roles positively. Only effort nor...

Within the past decade there has been an enormous growth of interest in the field of organisational communication. Numerous books, book chapters and journal articles have been devoted to this topic. However, much of this output has been at the level of common sense exhortation, has tended to be anecdotal, or at best has been based upon the personal experience of the authors. Certainly within the UK there has been little hard empirical research into the nature, flow and functions of communication within organisations. This paper proposes the introduction of a much more systematic methodology for the study of such communication, based upon what is known as the 'communication audit' approach. This approach is fully explained and the main methods employed in communication audits outlined, together with their relative advantages and disadvantages. It is also pointed out that audits are now widely employed to measure performance in other spheres of the organisation, such as financ...

Background: Policy analysis is the process of identifying problem, defining and analyzing process, qualitative and quantitative analysis, evaluation, recommendation, aiming to inform choices leading to an improved healthcare system. In developing country, the analysis of health policy has been given limited attention. As health is influenced by many external sectors and the dynamic in healthcare system, it is a challenging task in health policies analyses. The aim of this manuscript is focusing on health policy analysis in developing countries using the methodological approaches of theories, frameworks and study designs.

Although it is probably the best-known prospective hazard analysis (PHA) tool, failure mode and effects analysis (FMEA) is far from the only option available. This article introduces one of the alternatives: The structured what-if technique (SWIFT). SWIFT is a flexible, high-level risk identification technique that can be used on a stand-alone basis, or as part of a staged approach to make more efficient use of bottom-up methods like FMEA. In this article we describe the method, assess the evidence related to its use in healthcare with the use of a systematic literature review, and suggest ways in which it could be better adapted for use in the healthcare industry. Based on the limited evidence available, it appears that healthcare workers find it easy to learn, easy to use, and credible. Especially when used as part of a staged approach, SWIFT appears capable of playing a useful role as component of the PHA armamentarium.

A obra retrata momentos que dizem respeito à implantação de duas estratégias de Redução de Danos (RD) relacionados ao uso de álcool e outras drogas na cidade de Barbacena, mais especificamente, dos Projetos Escola de Redutores de Danos (ERD) e Consultório de Rua (CR), apoiados pelo Ministério da Saúde (MS). Para tanto, são contemplados relatos de experiências vivenciadas por integrantes das equipes gestora e técnica do trabalho que foi realizado desde fins de 2011 até agosto de 2013. A publicação é dividida em duas partes: na Parte I, apresentam-se os relatos da equipe gestora dos Projetos, e na Parte II, os relatos da equipe técnica responsável pela operacionalização cotidiana deste trabalho. Tanto quanto possível, os relatos foram mantidos em sua originalidade, estilo e lógica de argumentação própria dos autores, para possibilitar a sistematização de um registro que advém do chão da vivência, compondo uma refinadíssima etnografia mundana. O texto escrito, neste sentido, compõe parte da memória desse processo, buscando, porém, reverberar seus efeitos para além da dimensão local que circunscreve as práticas relatadas.

The purpose of this descriptive, co-relational and cross-sectional study was to gain a better understanding of the relationships between job satisfaction and organizational commitment of employees, and their impact on turnover intention at Isfahan Hospitals, Isfahan, Iran, in 2005. Data were collected by the distribution of two questionnaires among 629 employees of these hospitals through a stratified random sampling method. The results of the paper indicate that hospital employees are moderately satisfied with their jobs and committed to their organization. Employees' job satisfaction and organizational commitment were closely inter-related and correlated with turnover intention (P , 0.001). The positive correlation between the two was expected, but there was also unexpected correlation with turnover intention. This may be due to external factors, such as job market conditions, which may influence perceived opportunities for career advancement elsewhere. The impact of such external factors is outside the scope of this study, but will have to be investigated in further research. As job satisfaction and organizational commitment have strong correlation with turnover, it is very important to reinforce them by applying the right human resource policies.

Background: Performance measurement is essential to the management of health care organizations to which efficiency is per se a vital indicator. Present study accordingly aims to measure the efficiency of hospitals employing two distinct methods.

RESUMO: RESUMO: RESUMO: RESUMO: RESUMO: O presente estudo teve como objetivo revisar a influência das teorias administrativas na organização dos serviços de saúde, enfocando a qualidade da assistência, como subsídio para uma reflexão do processo de trabalho em enfermagem. Contextualizou-se a influência das principais teorias administrativas na organização dos serviços de saúde, a partir de uma revisão bibliográfica sobre o tema, seguida de uma leitura exploratória do material, bem como sua análise e síntese. Concluiuse que, entre essas, as que exercem maior influência são as teorias taylorista, clássica, das relações humanas, burocrática e da qualidade total. Entretanto, apesar de suas contribuições, estas não contemplam as necessidades e subjetividades dos usuários e trabalhadores e não garantem a melhoria da qualidade do trabalho em saúde. Palavras-Chave Palavras-Chave Palavras-Chave Palavras-Chave Palavras-Chave:

The future health-care workforce and the changing skill-mix within occupational teams is a current topic of discussion. This paper contributes to the skill-mix debate by focusing on UK primary care dentistry, revealing unintended as well as intended consequences of a modularized, technocratic view of dentistry. In part one, relevant literature about dental therapists and skill-mix in dentistry is organized into a framework used to review factors operating at macro, meso and micro levels. Part two considers the role that education and training may play in realizing skill-mix change. Part three synthesizes conditions required for modifying skill-mix in UK primary dental care and sets out the dimensions of seven factors: funding focus, the profession's response, workforce, the practice, dentist's knowledge, dental therapist's motivations and patient attitude. A review of these factors could be used to inform the policy decisions of managers operating at the macro level, as well as more local staffing decisions. Without consideration of the complex interplay of these factors, skill-mix in dentistry will be slow to develop and could bring unwelcome consequences.

Given the limited studies on emergency care management, this study aimed to explore the relationships of emergency department (ED) culture values to certain dimensions of ED physicians' and nurses' work satisfaction and intent to leave. Four hundred and forty-two emergency medical professionals completed the employee satisfaction questionnaire across 119 hospital-based EDs, which had culture value evaluations filed, were used as unit of analysis in this study. Adjusting the personal and employment backgrounds, and the surrounded EDs' unit characteristics and environmental factors, multiple regression analyses revealed that clan and market cultures were related to emergency physicians' work satisfaction and intent to leave. On the other hand, adhocracy, market and hierarchical cultures were related to emergency nurses' work satisfaction. There do exist different patterns among various culture types on various work satisfaction dimensions and intent to leave of eme...

While health service utilization is a key indicator of health service delivery which many countries seek to improve, low health service utilisation patterns characterize 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 nine three (93) 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 inadequate 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 utilisation 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.

As in most advanced economies all over the world, the German health care system has faced rapidly increasing expenditure within recent decades. As a result of these cost pressures and in order to avoid an explicit rationing of health care services, German governments have tried to solve the problem with a number of health care reforms which were introduced to stabilise the contribution rate. In addition, the aim of these reforms was to increase efficiency of health care provision and, thereby, increase the overall level of patient care . In particular, the last German major reform program, the 1992/1993 Health Structure Act ("Gesundheitsstrukturgesetz -GSG") and subsequent pieces of legislation have introduced new mechanisms to improve cost efficiency in the health care sector. With this Act, global budget caps for various health care sectors were introduced which were allowed to rise only but in proportion to the income received by the sickness funds from members' contribut ions .

Dış kaynak kullanımı devlet hastanelerinde temel bir strateji haline gelmekte ve son zamanlarda tanınırlığı artmaktadır. Türkiye'de bu trendi oluşturan itici güç, özel sektördeki baskıların ve rekabetin kamu sektörünü daha verimli kılacağı gerçeğine dayanarak Sağlık Bakanlığı tarafından başlatılmıştır. Bu çalışmanın amacı, sistematik analiz yoluyla Türkiye'deki hastanelerde dış kaynak kullanımı konusunda elde edilen farklı araştırma bulgularını karşılaştırmak, bütünleştirmek ve gelecekteki araştırmalara yönelik öneride bulunmaktır. Analizde 2005 ve 2011 yılları arasında yayınlanmış toplam 15 çalışma (8 tez, 7 makale) kapsama alınmıştır. Bu çalışmaların sonuçlarına göre, dış kaynak kullanımının maliyetleri azalttığı, verimliliği ve hizmetlerin kalitesini artırdığı bulunmuştur. Sadece bir çalışmada dış kaynak kullanımının hastane maliyetlerine etkisi hastane kayıtlarına dayalı olarak incelenmiştir. Başka bir çalışmada ise hastane çalışanlarının memnuniyet düzeyi düşük bulunmuştur. Sonuç olarak, Türkiye'deki kamu ve özel hastanelerde dış kaynaklardan yararlanılarak verilen hizmetlerin etkilerini belirleyen objektif kalite, verimlilik ve maliyet indikatörlerine dayalı ampirik araştırmalara gereksinim duyulduğu söylenebilir.

The purpose of this descriptive, co-relational and cross-sectional study was to gain a better understanding of the relationships between job satisfaction and organizational commitment of employees, and their impact on turnover intention at Isfahan Hospitals, Isfahan, Iran, in 2005. Data were collected by the distribution of two questionnaires among 629 employees of these hospitals through a stratified random sampling method. The results of the paper indicate that hospital employees are moderately satisfied with their jobs and committed to their organization. Employees' job satisfaction and organizational commitment were closely inter-related and correlated with turnover intention ( P < 0.001). The positive correlation between the two was expected, but there was also unexpected correlation with turnover intention. This may be due to external factors, such as job market conditions, which may influence perceived opportunities for career advancement elsewhere. The impact of such ...

The purpose of this descriptive, co-relational and cross-sectional study was to gain a better understanding of the relationships between job satisfaction and organizational commitment of employees, and their impact on turnover intention at Isfahan Hospitals, Isfahan, Iran, in 2005. Data were collected by the distribution of two questionnaires among 629 employees of these hospitals through a stratified random sampling method. The results of the paper indicate that hospital employees are moderately satisfied with their jobs and committed to their organization. Employees' job satisfaction and organizational commitment were closely interrelated and correlated with turnover intention (P , 0.001). The positive correlation between the two was expected, but there was also unexpected correlation with turnover intention. This may be due to external factors, such as job market conditions, which may influence perceived opportunities for career advancement elsewhere. The impact of such external factors is outside the scope of this study, but will have to be investigated in further research. As job satisfaction and organizational commitment have strong correlation with turnover, it is very important to reinforce them by applying the right human resource policies.

Introduction Hospital 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. Methods Using 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. Results In line with their competitive and supply chain strategies, the three settings have well-defined primary goals, stakeholders’ needs/demands/expectations, as well as c...

Employee turnover is a critical concern, particularly for hospitals, because they face a very tight labour market for hiring replacements, and high turnover itself may have substantial negative effects on the continuity and quality of patient care. Hospitals with a stronger teamwork culture may experience lower turnover but this has not been formally studied. Research on determinants of employee turnover has not separated out resignations from the larger, more inclusive definition of turnover that includes retirement. This study investigated the relationship between the teamwork culture of hospitals and physician and nurse resignation rates. The study setting was the Veterans Health Administration (VHA). Each hospital was assessed on teamwork culture based on a survey of current employees. Hospital-level resignation rates were obtained for physicians and nurses. Separate multivariate regression models on physicians and nurses were employed. The models included hospital-level characteristics and labour market variables. Analysis of covariance was also performed to attempt to further reveal effects in high versus low teamwork culture hospitals. Teamwork culture was negatively associated with nurse and physician resignation rates, but was statistically significant in the nurse resignation model only. Additional analyses indicated a 0.47 standard deviation (SD) difference in nurse resignation rates and a 0.40 SD difference in physician resignation rates between hospitals in the top and bottom quartiles of the distribution for teamwork culture. In conclusion, these results suggest that developing and emphasizing a teamwork culture may facilitate greater retention of health-care employees, especially nurses.

The objectives of this paper are to use data envelopment analysis to measure hospital inefficiency in a way that accounts for patient outcomes and to study the association between organizational factors, such as hospital-physicians integration level and teaching status, and market competition with hospital inefficiency. We apply the robust data envelopment analysis approach to a sample of private (both not-for-profit and for-profit) hospitals operating in the United States. Our data envelopment analysis model includes mortality and readmission rates as bad outputs and admissions, surgeries, emergency room, and other visits as good outputs. Therefore, our measurement of hospital inefficiency accounts for quality. We then use a subsampling regression analysis to determine the predictors of hospital inefficiency. For-profit, fully integrated and teaching hospitals were more efficient than their counterparts. Also hospitals located in more competitive markets were more efficient than th...

This research sequel employs collaborative governance framework with the aim to ascertain whether HIV/AIDS collaborative governance still works in Broward and Palm Beach Counties of South Florida within the context of efforts to provide care and treatment to target populations. The study uses interviews, observations, and document reviews to garner data from all relevant sources of the Councils and focuses on 2000-2006 and 2009-2013 time frames. The collected data was subjected to integration of themes and concepts based on category analysis. The analysis reveals representation and participation of target populations, service providers, non-elected community leaders and other relevant stakeholders in decision making enable collective problem solving. The research contributes to theory and praxis by highlighting collaborative governance presents public managers the viable option of serving as advocates of various interests in society.

Background: During the two years of implementation of the National Health Insurance (JKN), many national and district regulations have been published and revised. However, there is no clear regulation in the management of unutilized capitation fund. The high actual capitation in line with the low utilization ratio, which means it could potentially lead unutilized capitation. Financial management in the district that has not been integrated with unutilized capitation become a challenge for the Puskesmas to accommodate the operational requirements of service.

Objective: To analyze the potential and the management of unutilized capitation of JKN program at the Puskesmas and its determinant factors

Method: This is a case study using cross sectional design and implementation research approach. A total of 492 samples in 13 regionals and 26 districts were selected using multistage random sampling. Primary data were collected through series of interviews and FGDs using a standardized questionnaire. Variables that become secondary data (2014-2015) were collected from Puskesmas and BPJS Kesehatan database. Qualitative data were analyzed using thematic approach and quantitative data were analyzed descriptively and analytically using test for comparison and correlation.

Result: Allocation in the utilization of capitation funds, distribution of membership, geographical aspects, service time, the ratio of doctors to the participants, contact rate, total revenue from the Puskesmas have correlation to the unutilized capitation and performance indicators. Planning, budgeting, and disbursement of unutilized capitation follow the budget mechanism of APBD, either early budget document or the mid-year budget document; so it can not be used directly by Puskesmas without submission, reconciliation, and the budget approval from the district government. Nevertheless, the majority of Puskesmas do not manage unutilized capitation because there are no local regulations and technical guidelines for managing unutilized capitation fund.

Conclusion: Intervention should consider the variables that had a significant correlation value, both on unutilized capitation and performance indicators. It is necessary to evaluate the fund channeling; and also the strengthening of the regulation should also be followed by optimizing the role BPJS Kesehatan, Health Office, and other stakeholders to support the implementation of the concept of strategic purchasing.

Keywords: unutilized fund, capitation, JKN

Medicines are important in health care services delivery. Frequent stock outs of medicines have been a major challenge in public health facilities in low-and middle-income countries like Kenya. This research aimed at determining the influence of procurement process on availability of medicines in Bungoma County, Kenya. Descriptive cross sectional research design with mixed approach methods was applied. The target population included the county pharmacist, sub county pharmacists, medical superintendents, procurement officers, health administrative officers, the county procurement officer and the chief officer for health and sanitation. All the nine sub county hospitals were sampled and a census method used to sample four staff from each of the sub county that is the sub county pharmacists, medical superintendents, procurement officers and health administrative officers in all the nine sub counties of the county hence 36 respondents. This was achieved through G-power Priori power analysis. Additionally, the county procurement officer, the chief officer for health and sanitation and the county pharmacist were purposively sampled, making the total number of respondents to be 39. Semi structured questionnaires: in-depth interview guides and a checklist were the study data collection tools. Qualitative and quantitative data analysis methods were applied. Analysis of quantitative data was done using descriptive statistics while Chi square was used as appropriate. Data was presented in tables. Qualitative data was categorized into specific themes and reported in narrative form together with quantitative presentation. 81.2% of respondents reiterated that procurement processes were followed as compared to 18.8% who indicated that in some cases, laid down procurement procedures were not followed. Health administrative officers were a majority of those who reported adherence to these procedures while all the pharmacists and procurement officers said they had full adherence. An analysis of the different carders of health workers involved in this study revealed that there was no significant relationship between adherence to procurement procedures and the cadre of the health professional involved (χ 2 =2.230: p= 0.534). On the same note, it was shown that there was a significant relationship between adherence to procurement procedures and the work experience of the health professional involved (χ 2 = 11.24: p= 0.003). A significant relationship between adherence to procurement procedures and the incidences of discrepancies between received quantities and quantities on the delivery notes (χ2= 6.28: P= 0.025) was established. 87.5% of all respondents noted that their respective health facilities used direct tendering as a method of procuring medicines. Open tendering was said to be in use by only 3.1% of respondents while request for quotation was by 9.4%. Adherence to procurement procedures seemed to have a greater influence on the availability of medicines (OR=4.194, P=0.002). Those involved in the procurement process were health facilities in chargesnurses or clinical officers for rural health facilities or pharmaceutical personnel for hospitals who generate orders. The county pharmacist, county procurement officer, chief officer health & sanitation are involved in sending orders to suppliers and subsequently making payments. Inadequate funding for medicines procurement, inadequate procurement personnel and long procurement process were cited as the main challenges relating to procurement of medicines. The government needs to streamline the procurement process for medicines in order to ensure availability of medicines.

In all industries, competition among businesses has long been encouraged as a mechanism to increase value for customers. In other words, competition ensures the provision of better products and services to satisfy the needs of customers. Various perspectives of competition, the nature of service quality, health-care system costs and customer satisfaction in health care are examined. A model of the relationship among these variables is developed. The model depicts customer satisfaction as an outcome measure directly dependent on competition. Quality of care and health-care system costs, while also directly dependent on competition, are considered as determinants of customer satisfaction as well. The model is discussed in the light of propositions for empirical research.

Within the past decade there has been an enormous growth of interest in the field of organisational communication. Numerous books, book chapters and journal articles have been devoted to this topic. However, much of this output has been at the level of common sense exhortation, has tended to be anecdotal, or at best has been based upon the personal experience of the authors. Certainly within the UK there has been little hard empirical research into the nature, flow and functions of communication within organisations. This paper proposes the introduction of a much more systematic methodology for the study of such communication, based upon what is known as the 'communication audit' approach. This approach is fully explained and the main methods employed in communication audits outlined, together with their relative advantages and disadvantages. It is also pointed out that audits are now widely employed to measure performance in other spheres of the organisation, such as financ...

Background There are limited data on HIV and hepatitis C virus (HCV) epidemiology among people who inject drugs (PWID) in Croatia. This study aims to provide data on HIV and HCV prevalence and sexual and injecting risk behaviours among PWID in Zagreb, Split, and Rijeka.
Methods  Using respondent-driven sampling (RDS) we recruited from November 2014 to February 2015 a total of 176 PWID in Zagreb, 255 in Rijeka and 399 in Split. Participants provided biological specimens for HIV and HCV testing and completed a behavioural questionnaire.
Results The proportion of female PWID ranged from 19.5% in Zagreb to 26.0% in Split. In the month before the survey, 2.5% of PWID in Split, 5.6% in Rijeka and 8.0% in Zagreb reported sharing non-sterile needles and syringes. Many PWID injected opioid substitution therapy (OST) in the month before the survey (57.0% in Zagreb and 57.5% in Split and Rijeka, respectively). Among PWID who had a casual sexual partner in the past 12 months (ranging from 39.2% in Split to 44.4% in Rijeka) condom use was low. Although HIV prevalence was low (0.2% in Rijeka and Zagreb, 0.3% in Split), HCV antibody prevalence was considerable (29.1% in Zagreb, 31.5% in Rijeka, 38.3% in Split). HIV and HCV testing coverage in the past 12 months was insufficient (6.8% and 7.0% in Split; 13.2% and 13.5% in Zagreb; 20.2% and 21.5% in Rijeka, respectively).
Conclusion We found a low-level HIV epidemic and a sizable HCV epidemic among PWID in Zagreb, Split and Rijeka. There is a need to develop a comprehensive approach to harm reduction and scale up the coverage with needles and syringes exchange programmes, OST and HIV and HCV testing services, as well as to strengthen sexual health interventions due to the presence of high-risk sexual behaviours.

Introduction Hospital 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. Methods Using 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. Results In line with their competitive and supply chain strategies, the three settings have well-defined primary goals, stakeholders’ needs/demands/expectations, as well as c...

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...

The research described in this article was concerned primarily with identifying the criteria of managerial/leadership effectiveness applying at the middle and front line levels of management within an NHS Trust Hospital using critical incident technique and factor analysis methods. The findings suggest that the self-perceptions of managers and the perceptions of superiors and subordinates are very similar, and only differ on a limited number of criteria. This challenges the 'perspective-specific' models of managerial effectiveness advocated by some researchers. The results are compared against those from a near identical study carried out by the author within one part of the British Civil Service, and the results from a different but comparable factor analytic study carried out by other researchers elsewhere in the NHS. The results suggest the existence of generalized criteria of managerial effectiveness, which lend considerable support to the notion of the 'universally ...

The purpose of this descriptive, co-relational and cross-sectional study was to gain a better understanding of the relationships between job satisfaction and organizational commitment of employees, and their impact on turnover intention at Isfahan Hospitals, Isfahan, Iran, in 2005. Data were collected by the distribution of two questionnaires among 629 employees of these hospitals through a stratified random sampling method. The results of the paper indicate that hospital employees are moderately satisfied with their jobs and committed to their organization. Employees' job satisfaction and organizational commitment were closely inter-related and correlated with turnover intention (P , 0.001). The positive correlation between the two was expected, but there was also unexpected correlation with turnover intention. This may be due to external factors, such as job market conditions, which may influence perceived opportunities for career advancement elsewhere. The impact of such external factors is outside the scope of this study, but will have to be investigated in further research. As job satisfaction and organizational commitment have strong correlation with turnover, it is very important to reinforce them by applying the right human resource policies.

The paper describes the performance measurement system of the maternity pathway used in Tuscany by health care professionals, general managers and regional policy-makers. This system uses 19 indicators grouped in six dimensions: population's state of health; compliance with regional guidelines; efficiency and financial performance; clinical and health assessment; patient satisfaction; and employees' satisfaction. The results are represented on a spider diagram that summarizes the results on the different dimensions. The Tuscan performance measurement system of the maternity pathway has been used to identify best practice within, and their adoption throughout, the Tuscan public health care system.

There are opportunities to improve quality and safety of care provided to adult patients. The Plummer Project of the Department of Medicine at the Mayo Clinic (Rochester, MN, USA) is an initiative to redesign outpatient practice. We used multidisciplinary teams to standardize the tasks essential to improve patient care. With the initiative to standardize the rooming process, patient care and safety improved with greater accuracy of the medication list. The standardization also improved physician efficiency because trained clinical assistants helped address the needs of the patient. Physicians were satisfied by the new process and the technology enhancements. Clinical assistants were also highly satisfied by the training process. The quality and safety of patient care can be significantly improved by practice redesign. This practice redesign was satisfying for all, especially the patients, physicians and support team in our practice.

Health-care managers have to address many aspects of the organization, and patient satisfaction is clearly one of the critical aspects for managers. To respond to the need of health-care managers, there have been many patient satisfaction studies. However, these studies focus on which attributes (factors such as nursing care and physician care) are more influential; they do not provide specific aspects for each attribute. In order to develop an effective intervention programme to improve patient satisfaction, more specific research outcomes are needed. This study utilized data collected between January 2007 and June 2008 from 32 hospitals representing a large, national private not-for-profit hospital system. The patient satisfaction survey included the Consumer Assessment of Healthcare Providers and Systems, Hospital version questionnaire items, and there are 31,471 cases. Two-stage multiple linear regression analyses were conducted with control variables (age, gender, perceived hea...

The model of monopolistic competition is appropriate for describing the behavior of the health care sector in the United States. Uncertainty about quality of medical and related services promotes product differentiation especially when consumers do not bear the full costs of care. New technologies can be used to signal quality even when their clinical usefulness is unproven. Recent cost containment measures may reduce employment of ineffective technologies but may also inhibit the adaptation of genuinely useful developments.

We propose reimbursement schemes based on Patient Classification Systems (PCS) that include adjustments for length of stay and exceptional costs and are designed to minimize undesirable effects of economic incentives. In addition, a statistical approach to compare the schemes and the underlying PCSs is proposed, where costs and length of stays for two successive years are used.

The United Kingdom National Health Service is continuing to experience recruitment and retention problems of nursing and allied health profession staff. Consequently, the need to study and understand the key factors that encourage or dissuade people to work for the NHS remains a major research and policy issue. This study provides well focused, independent research to explore how the NHS can be made more attractive for potential new recruits and possible returners. The views of potential recruits and returners interested in working for the NHS as either a qualified nurse, physiotherapist or radiographer were explored through a postal questionnaire survey which achieved a response rate of 23%. Analysis of the results indicate that the strongest predictor of intention to work for the NHS in one of the three professions was the attitude held by respondents. These attitudes in turn, were most influenced by the extent to which people perceived that NHS work as a qualified nurse, physiotherapist or radiographer offered positive features i.e. rewarding career, teamwork, and a chance to help people and to get to know them. The views of family and friends regarding working for the NHS were also important as was the belief in one's ability to secure an NHS job.

INTRODUCTION:
Healthcare utilisation, assesses the consumption of healthcare resources, i.e. a health system’s capacity.

This study aimed to survey utilisation patterns of local chronic disease sufferers, and derive determinants underlying provider selection; to explore reforms to enhance the capacity to address future challenges of the global chronic diseases epidemic.

OBJECTIVES:
The primary objective was to scope for patterns of healthcare utilisation among subjects by comparing frequency of services uptake across various service domains.

The secondary objective was to evaluate the association of theoretical constructs and demographic factors with the choice of sector for services utilisation.

METHODS:
In this cross-sectional survey, the study population were chronic disease patients aged forty or above, and were recruited by purposive sampling via personal, medical and societal connections. Pencil-and-paper questionnaires were interviewer- or self-administered.

Frequency measures were compared using the Wilcoxon Signed-Rank, and constructs’ associations were analysed using logistic regression.

RESULTS:
One-hundred-and-seventy respondents (age=60.3110.718years, meanstandard deviation) were recruited. The public sector was mainly visited (74.4%), and more significantly frequently utilised for diagnostic exams, chronic disease care and screening (all p<0.001). This trend held for consultations, but not significantly (p=0.086).

From multivariable analysis, adjusted odds ratio (AOR)<1 indicated the association towards the public sector. Significant predictors were; age [p=0.010;AOR(95%CI)=0.930(0.889-0.972)], physicians’ performance [p=0.025;AOR(95%CI)=39.995(1.596-1000.100)], staff-patient relationships [p=0.016;AOR(95%CI)=0.074 (0.009-0.618)], coverage [p=0.001;AOR(95%CI)=56.886(4.978-650.028)], and waiting time [p<0.001;AOR(95%CI)=112.495(10.937-1157.064)].

CONCLUSIONS:
Results indicated a greater burden on the public sector and suggested some underlying determinants. Further studies and policy analyses should be considered to reroute patients to the private sector to improve the efficaciousness of local healthcare services delivery.

Numerous policy papers and academic contributions across a range of countries emphasise the importance of clinical leadership in health services. This is seen as especially vital at a time of simultaneous resource constraints and rising demand. Most of the literature in this topic area concerns itself with conceptual clarification of types of leadership and with delineation of requisite competences. But other work on leadership has emphasized the importance of attending to practice in concrete situations in order to identify the dynamics at play and the nature of the challenges. The purpose of this article is to contribute to this latter task by drawing upon a set of data which reveals crucial aspects of the problems facing potential clinical leaders of service redesign. The paper reports on the nature and extent of the challenges as identified by clinicians of different types as well as managers and commissioners.

Introduction: Immunization is considered as the most effective public health strategy that aims to prevent children from infectious diseases. The aim of this paper is to examine rural parents' perspective of social determinants affecting childhood vaccinations in Oro Bay rural in Oro Province, Papua New Guinea (PNG).

Over the past few years (2001)(2002)(2003)(2004)(2005)(2006)(2007), the Italian National Health Service has been undergoing an important process of decentralization with a significant transfer of powers and responsibilities from the central government to the Regions. In this context, a particularly innovative example is represented by the case of Marche Region that extensively reformed its health-care system. For the analysis of this case, we used a theoretical framework that describes a health-care system in terms of components and goals. Policy-makers can act on the structural components of the system influencing the behaviour of individuals and organizations in order to lead the system towards the achievement of key performance goals. Marche regional Government was able to improve the system in crucial areas (clinical appropriateness and economic equilibrium) by intervening on institutional arrangements (particularly on the number and dimension of health-care delivery organizations) and on key control knobs (particularly planning and control mechanisms and the information system). Some conditions have allowed Marche policy-maker to successfully carry out this extensive process of reforms, particularly: (1) a shared sense of urgency; (2) agreement on the identification of problems and on the relative reform strategies to adopt; (3) coordination of all change strategies through a precise and clear long-term plan aimed at developing an integrated health-care delivery network.