Factors that influence line managers' perceptions of hospital performance data.
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OBJECTIVE: To design and test a model of the factors that influence frontline and midlevel managers' perceptions of usefulness of comparative reports of hospital performance. STUDY SETTING: A total of 344 frontline and midlevel managers with responsibility for stroke and medical cardiac patients in 89 acute care hospitals in the Canadian province of Ontario. STUDY DESIGN: Fifty-nine percent of managers responded to a mail survey regarding managers' familiarity with a comparative report of hospital performance, ratings of the report's data quality, relevance and complexity, improvement culture of the organization, and perceptions of usefulness of the report. EXTRACTION METHODS: Exploratory factor analysis was performed to assess the dimensionality of performance data characteristics and improvement culture. Antecedents of perceived usefulness and the role of improvement culture as a moderator were tested using hierarchical regression analyses. PRINCIPAL FINDINGS: Both data characteristics variables including data quality, relevance, and report complexity, as well as organizational factors including dissemination intensity and improvement culture, explain significant amounts of variance in perceptions of usefulness of comparative reports of hospital performance. The total R2 for the full hierarchical regression model = .691. Improvement culture moderates the relationship between data relevance and perceived usefulness. CONCLUSIONS: Organizations and those who fund and design performance reports need to recognize that both report characteristics and organizational context play an important role in determining line managers' response to and ability to use these types of data. (+info)
Children's oral health in the medical curriculum: a collaborative intervention at a university-affiliated hospital.
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The purpose of this study was to 1) describe the structure of the oral health program in a university-affiliated hospital; 2) evaluate staff's knowledge and attitudes toward oral health; and 3) propose ways to strengthen the incorporation of oral health prevention for children into clinical medical education. Qualitative methods were used to evaluate the program. Structured interviews with seventeen medical center personnel were conducted, and clinic utilization reports provided ICD-9 diagnostic frequency and visits. Clinic staff, pediatric residents, dental and pediatric faculty, hospital administrators, and clinic directors were interviewed. The themes identified during these interviews were motivation, roles, operational and organizational issues, and integration into the larger medical care system. Integration of an early childhood caries prevention program into the clinical medical education curriculum can be accomplished. After implementation of the oral health program described in this paper, dental caries became the eleventh most common diagnosis seen in the clinic when previously it did not appear in the top forty. However, institutional and organizational barriers are significant. Barriers identified were 1) lack of clarity in defining leadership and roles regarding oral health, 2) time and work overload in a busy pediatric clinic, 3) a tracking system was not available to quickly determine which children needed caries prevention procedures and education, and 4) billing and medical record form changes could not be fully established prior to starting the program. (+info)
The culture of safety: results of an organization-wide survey in 15 California hospitals.
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OBJECTIVE: To understand fundamental attitudes towards patient safety culture and ways in which attitudes vary by hospital, job class, and clinical status. DESIGN: Using a closed ended survey, respondents were questioned on 16 topics important to a culture of safety in health care or other industries plus demographic information. The survey was conducted by US mail (with an option to respond by Internet) over a 6 month period from April 2001 in three mailings. SETTING: 15 hospitals participating in the California Patient Safety Consortium. SUBJECTS: A sample of 6312 employees generally comprising all the hospital's attending physicians, all the senior executives (defined as department head or above), and a 10% random sample of all other hospital personnel. The response rate was 47.4% overall, 62% excluding physicians. Where appropriate, responses were weighted to allow an accurate comparison between participating hospitals and job types and to correct for non-response. MAIN OUTCOME MEASURES: Frequency of responses suggesting an absence of safety culture ("problematic responses" to survey questions) and the frequency of "neutral" responses which might also imply a lack of safety culture. Responses to each question overall were recorded according to hospital, job class, and clinician status. RESULTS: The mean overall problematic response was 18% and a further 18% of respondents gave neutral responses. Problematic responses varied widely between participating institutions. Clinicians, especially nurses, gave more problematic responses than non-clinicians, and front line workers gave more than senior managers. CONCLUSION: Safety culture may not be as strong as is desirable of a high reliability organization. The culture differed significantly, not only between hospitals, but also by clinical status and job class within individual institutions. The results provide the most complete available information on the attitudes and experiences of workers about safety culture in hospitals and ways in which perceptions of safety culture differ among hospitals and between types of personnel. Further research is needed to confirm these results and to determine how senior managers can successfully transmit their commitment to safety to the clinical workplace. (+info)
Opinions of hospital administrators toward the prevalence of patient dumping in Taiwan.
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BACKGROUND: The purposes of this paper were to examine whether patient dumping has occurred under the National Health Insurance and to explore hospital administrators' attitudes toward the practice of patient dumping in Taiwan. METHODS: The study subjects were administrators in general hospitals that were accredited by the Taiwan Joint Commission on Hospital Accreditation as medical centers, regional hospitals, or district teaching hospitals in the years 2000 and 2001. A self-administered postal survey was conducted using a structured questionnaire mailed to 128 administrators in general hospitals. RESULTS: Of the respondents, 83 of 99 (83.8%) administrators perceived that patient dumping did occur in their service areas to a certain degree regardless of their hospital location, hospital level, or hospital ownership. A total of 67 of 74 (90.5%) administrators who attempted to answer the question on the prevalence of patient dumping perceived that different percentages (mean=13.27%) of hospitals transferred patients solely on economic considerations in their service areas. In addition, this study found that no statistically significant relationships existed between the administrators' perceived percentage of emergency patients received by their hospitals and hospital characteristics. However, there was a statistically significant relationship between the perceived percentage of inpatients received and hospital level (p = 0.007). CONCLUSION: According to the results of this study, we concluded that patient dumping is a serious and widespread problem in the healthcare industry in Taiwan. Patient dumping can jeopardize patient health and impair the financial integrity of receiving hospitals. Implementation of a case payment system may worsened the situation in Taiwan. (+info)
Awareness and attitudes of healthcare professionals in Wuhan, China to the reporting of adverse drug reactions.
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BACKGROUND: A voluntary procedure for reporting adverse drug reactions (ADRs) was formally put in place in 1989. However, only a small proportion of ADR reports are actually forwarded to the national monitoring center. To identify the reasons for underreporting, the authors investigated the awareness and attitudes of healthcare professionals (doctors, nurses, and administrators) toward the ADR system in China. In addition, the authors sought to formulate approaches to improve the current ADR reporting system. METHODS: Structured interviews were carried out in 16 hospitals selected from 27 municipal hospitals in Wuhan, Hubei Province, China. A questionnaire survey of a stratified random sample of approximately 15% of healthcare professionals in each selected hospital was conducted during February to March 2003. RESULTS: The response rate of this survey was 85%. One thousand six hundred and fifty-three questionnaires were used in the final analysis. Only 2.7% of the healthcare professionals had a correct understanding to the definition of ADR. Eighty-nine point two percent of the healthcare professionals had encountered ADRs. Ninety-four percent of them were aware of the need to report these to the ADR monitoring center. However, only 28.5% of doctors, 22.8% of nurses, and 29.7% of administrators actually submitted a report. For the most part, they reported ADRs to the hospital pharmacy (66.0%), to other departments in the hospital (72.5%), and to the pharmaceutical industry (23.0%), rather than to the national monitoring center (2.9%) or regional monitoring center (9.5%). Severe or rare ADRs and ADRs to new products were generally perceived to be significant enough to report. Sixty-two point one percent of the healthcare professionals had encountered ADRs, yet not reported them to anybody. The major reasons for not reporting included no knowledge of the reporting procedure (71.4%), unavailability of the reporting center mailing address (67.9%), unavailability of the ADR report form (60.4%), lack of knowledge of the existence of a national ADR reporting system (52.2%), and belief that the ADR in question was already well known (44.1%). CONCLUSIONS: Healthcare professionals in Wuhan, China have little basic knowledge of ADR and of the voluntary reporting system. The main reasons for underreporting were lack of basic knowledge about ADRs and the voluntary reporting procedure. Education and training of healthcare professionals is needed to improve the current ADR reporting system. (+info)
Competing values of emergency department performance: balancing multiple stakeholder perspectives.
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OBJECTIVE: To describe the performance interests of multiple stakeholders associated with the management and delivery of emergency department (ED) care, and to develop a performance framework and set of indicators that reflect these interests. STUDY SETTING: Stakeholders (1,100 physicians, nurses, managers, home care providers, and prehospital care personnel) with responsibility for ED patients in hospitals in the Canadian province of Ontario. STUDY DESIGN: Sixty-two percent of stakeholders responded to a mail survey regarding the importance of 104 potential ED performance indicators. Descriptive and inferential statistics are used to explore the interests of each stakeholder group and to compare interests across the five groups. PRINCIPAL FINDINGS: Emergency department stakeholders are primarily interested in indicators that focus on their role and capacity to provide care. Key differences exist between hospital and nonhospital stakeholders. Physicians mean ratings of the importance on ED performance measures were lower than mean ratings in the other stakeholder groups. CONCLUSIONS: Emergency department performance interests are not homogeneous across stakeholder groups, and evaluating performance from the perspective of any one stakeholder group will result in unbalanced assessments. Community-based stakeholders, a group frequently excluded from commenting on ED performance, provide important insights into ED performance related to the external environment and the broader continuum of care. (+info)
Setting priorities in health care organizations: criteria, processes, and parameters of success.
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BACKGROUND: Hospitals and regional health authorities must set priorities in the face of resource constraints. Decision-makers seek practical ways to set priorities fairly in strategic planning, but find limited guidance from the literature. Very little has been reported from the perspective of Board members and senior managers about what criteria, processes and parameters of success they would use to set priorities fairly. DISCUSSION: We facilitated workshops for board members and senior leadership at three health care organizations to assist them in developing a strategy for fair priority setting. Workshop participants identified 8 priority setting criteria, 10 key priority setting process elements, and 6 parameters of success that they would use to set priorities in their organizations. Decision-makers in other organizations can draw lessons from these findings to enhance the fairness of their priority setting decision-making. SUMMARY: Lessons learned in three workshops fill an important gap in the literature about what criteria, processes, and parameters of success Board members and senior managers would use to set priorities fairly. (+info)
Achieving progress through clinical governance? A national study of health care managers' perceptions in the NHS in England.
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BACKGROUND: A national cross sectional study was undertaken to explore the perceptions concerning the importance of, and progress in, aspects of clinical governance among board level and directorate managers in English acute, ambulance, and mental health/learning disabilities (MH/LD) trusts. PARTICIPANTS: A stratified sample of acute, ambulance, and mental health/learning disabilities trusts in England (n = 100), from each of which up to 10 board level and 10 directorate level managers were randomly sampled. METHODS: Fieldwork was undertaken between April and July 2002 using the Organisational Progress in Clinical Governance (OPCG) schedule to explore managers' perceptions of the importance of, and organisational achievement in, 54 clinical governance competency items in five aggregated domains: improving quality; managing risks; improving staff performance; corporate accountability; and leadership and collaboration. The difference between ratings of importance and achievement was termed a shortfall. RESULTS: Of 1916 individuals surveyed, 1177 (61.4%) responded. The competency items considered most important and recording highest perceived achievement related to corporate accountability structures and clinical risks. The highest shortfalls between perceived importance and perceived achievement were reported in joint working across local health communities, feedback of performance data, and user involvement. When aggregated into domains, greatest achievement was perceived in the assurance related areas of corporate accountability and risk management, with considerably less perceived achievement and consequently higher shortfalls in quality improvement and leadership and collaboration. Directorate level managers' perceptions of achievement were found to be significantly lower than those of their board level colleagues on all domains other than improving performance. No differences were found in perceptions of achievement between different types of trusts, or between trusts at different stages in the Commission for Health Improvement (CHI) review cycle. CONCLUSIONS: While structures and systems for clinical governance seem well established, there is more perceived progress in areas concerned with quality assurance than quality improvement. This study raises some uncomfortable questions about the impact of CHI review visits. (+info)