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Article
Publication date: 3 October 2016

John Fard, Kathy O. Roper and Jeremy Hess

This study aims to evaluate home-hospital implications for facility management (FM) and, in particular, ED crowding. Home-hospital programs, in which select patients…

Abstract

Purpose

This study aims to evaluate home-hospital implications for facility management (FM) and, in particular, ED crowding. Home-hospital programs, in which select patients receive hospital-level care at home, can extend hospital facility capacity. Emergency department (ED) crowding, a sensitive hospital capacity indicator, is associated with unsafe operations and reduced quality of care.

Design/methodology/approach

The impact of a home-hospital program on crowding was analyzed with a discrete-event simulation model using one month of historical data from a case hospital. Time ED patients waited for inpatient beds was the primary endpoint. Five scenarios with different levels of patient suitability for home-hospital were each run 30 times. Differences were evaluated using paired t-tests.

Findings

Implementing home-hospital reduced ED crowding by up to 3 per cent. Additionally, the simulation yielded insights regarding advantages and limitations of various home-hospital arrangements, suggested which hospital types may be the best candidates for home-hospital and highlighted the role of bed-cleaning turnaround times and environmental services staffing schedules in operations.

Research limitations/implications

This research examined home-hospital and crowding at one hospital. Developing a model that accounts for all hospital types requires significant data and many hospital partnerships but could allow for more informed decisions regarding implementation of such programs.

Social implications

This research has implications for ensuring access to ED care, an important source of acute care generally and particularly for the underserved.

Originality/value

This research systematically evaluates home-hospital’s impact on ED crowding. Simulation modeling resulted in analytical results and allowed for evaluation of what-if scenarios providing recommendations for hospital FMs on their role in decreasing ED boarding.

Details

Facilities, vol. 34 no. 13/14
Type: Research Article
ISSN: 0263-2772

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Article
Publication date: 4 February 2014

Joshua Berman, Elizabeth Limakatso Nkabane, Sebaka Malope, Seta Machai, Brian Jack and William Bicknell

Hospital-based quality improvement (QI) programs are becoming increasingly common in developing countries as a sustainable method of strengthening health systems. The aim…

Abstract

Purpose

Hospital-based quality improvement (QI) programs are becoming increasingly common in developing countries as a sustainable method of strengthening health systems. The aim of this paper is to present the results and lessons learned from a QI program in a large, rural, district hospital in Lesotho, Southern Africa.

Design/methodology/approach

Over a 15-month period, a locally-relevant, hospital-wide QI program was developed and implemented. The QI program consisted of: planning meetings with district and hospitals staff; creation of multi-disciplinary QI teams; establishment of a QI steering committee; design and implementation of a locally appropriate QI curriculum; and monthly consultation from technical advisers. Initial QI programming was developed in three distinct areas: maternity care, out-patient care, and referral systems.

Findings

Partogram documentation in the maternity department increased by 78 percent, waiting time for critically ill patients in the out-patient department was reduced by 84 percent, and emergency referral times were reduced by 58 percent.

Originality/value

The design and early implementation of QI programs should focus on easily achievable, locally-relevant improvement projects. It was found that early successes helped to fuel further QI gains and the authors believe that the work building sustainable QI skill sets within hospital staff could be useful in the future when attempting to tackle larger national-level quality of care indicators. The findings add to the existing evidence suggesting that an increased use of locally-relevant quality improvement programming could help strengthen health care systems in low resource settings.

Details

International Journal of Health Care Quality Assurance, vol. 27 no. 1
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 5 August 2014

Rebecca Wood and Anne P.F. Wand

Consultation-liaison psychiatry (CLP) researchers have not yet developed accepted quality indicators to measure efficiency or effectiveness. The purpose of this paper is…

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Abstract

Purpose

Consultation-liaison psychiatry (CLP) researchers have not yet developed accepted quality indicators to measure efficiency or effectiveness. The purpose of this paper is to combine objective and subjective quality indicators to assess hospital-based CLP service utilisation, efficiency and effectiveness.

Design/methodology/approach

Service utilisation rate was calculated over the service's first four years. Patient characteristics and objective quality indicators relating to response timeliness in 2012 were examined. Totally, 41 staff and 52 consecutive patients completed evaluation surveys to subjectively evaluate effectiveness.

Findings

The utilisation rate increased initially and then slightly declined to 1.03 per cent of all hospital admissions. In 2012, 91.5 per cent were seen on the same referral day and 99.4 per cent by the next day. The benchmark for urgent referrals was not met (77.4 per cent). Patients rated involvement with the CLP service a positive experience (90 per cent), but were less clear about follow-up plans (68 per cent). Staff believed that the service improved the patients’ hospital course (98 per cent) and was communicated well (93-95 per cent). Only 63 per cent agreed that relevant CLP education was provided and 76 per cent rated follow-up plans as clear.

Originality/value

This CLP service was evaluated by measuring utilisation rates, referral response timeliness and consumer feedback. Referral to contact time is a useful objective quality indicator but should be combined with subjective yet standardised measures surveying service recipients (patients and referring staff) to be comprehensive and meaningful.

Details

International Journal of Health Care Quality Assurance, vol. 27 no. 7
Type: Research Article
ISSN: 0952-6862

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Book part
Publication date: 26 October 2020

Michael D. Rosko

This chapter assessed internal and external environmental factors that affect variations in rural hospital profitability with a focus on the impact of the Patient…

Abstract

This chapter assessed internal and external environmental factors that affect variations in rural hospital profitability with a focus on the impact of the Patient Protection and Affordable Care Act regulations that resulted in the expansion of Medicaid eligibility, as well as four Medicare programs that target rural hospitals. A cross section of 2,114 rural US hospitals operating during 2015 was used. The primary source of data was Medicare Hospital Cost Reports. Ordinary least squares regression with correction for serial correlation, using total margin and operating margin as dependent variables, was employed to ascertain the association between profitability and its correlates.

The mean values for operating margin and total margin were −0.0652 and 0.0259, respectively. Hospital profitability was positively associated with location in a Medicaid expansion state, classification by Medicare as a Critical Access Hospital or Rural Referral Center (total margin only), hospital size, system membership, and occupancy rate. Profitability was negatively associated with average length of stay, government ownership, Medicare and Medicaid share of admissions, teaching status, and unemployment rate.

This chapter found that the Medicaid expansions provided modest help for the financial condition of rural hospitals. However, the estimates for the four targeted Medicare Programs (i.e., Critical Access Hospital, Medicare Dependent, Sole Community Critical Access Hospital, and Rural Referral Center) were either small or not significant (p > 0.10). Therefore, these specially targeted federal programs may have failed to achieve their goals of preserving the financial viability of rural hospitals. This chapter concludes with implications for practice.

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Article
Publication date: 1 December 2003

Carol Davies and Jeremy Dale

Previous studies of general practitioner views of paediatric home care have presented a rather negative view of such services. This study examines GPs’, nurses’ and…

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509

Abstract

Previous studies of general practitioner views of paediatric home care have presented a rather negative view of such services. This study examines GPs’, nurses’ and managers’ views of a new, acute paediatric hospital‐at‐home nursing service in Rugby. Methods used are qualitative and quantitative questionnaires and interviews, including Likert‐type scales and open questions. Contrary to the mixed and somewhat negative findings of previous studies, this study reports positive views on the impact of hospital‐at‐home in Rugby, in terms of acceptability and impact on the roles and responsibilities of GPs.

Details

International Journal of Health Care Quality Assurance, vol. 16 no. 7
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 1 June 1999

Paul Hattam and Alison Smeatham

Historically, provision of orthopaedic services has been hospital based with GPs referring patients for specialist opinion. Growing demands on the service have led to new…

Abstract

Historically, provision of orthopaedic services has been hospital based with GPs referring patients for specialist opinion. Growing demands on the service have led to new initiatives to reduce waiting times. One such initiative has been the introduction of orthopaedic assistants, usually physiotherapists, working with an extended scope of practice who see patients after referral to secondary care and determine the patients on‐going management. Studies to date have examined the effect of an orthopaedic assistant working alongside a consultant in the hospital environment. This study describes the impact on the management of the orthopaedic caseload in one general practice resulting from “screening” prior to referral to secondary care by a physiotherapist with an extended scope of practice. It demonstrates the successful management of the majority of patients within primary care.

Details

British Journal of Clinical Governance, vol. 4 no. 2
Type: Research Article
ISSN: 1466-4100

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Article
Publication date: 9 February 2015

Manimay Ghosh

– The purpose of this paper is to understand the different factors patients consider in choosing a hospital in a major city in India, prior to admission.

Abstract

Purpose

The purpose of this paper is to understand the different factors patients consider in choosing a hospital in a major city in India, prior to admission.

Design/methodology/approach

A 20-item scale to identify various factors a patient considers in choosing a hospital was developed. A field survey was conducted on patients who were discharged in the recent past from a public or a private hospital. The data collected were analysed using multivariate techniques.

Findings

The data analysis highlighted several factors in the hospital choice selection process, namely quality of treatment, referral, transport convenience, cost, and safety and services.

Research limitations/implications

This research study was carried out in one of the four major metropolitan cities of India. Nonetheless, the study provides valuable insights into the hospital selection process in a developing country like India.

Practical implications

Hospital managers, in general, can use the study findings to improve the operating performance of their hospitals so that they are able to attract more patients in the future. Additionally, the information can be useful to the marketing managers for developing appropriate marketing strategies for their hospitals.

Originality/value

Majority of the empirical research on hospital choice process has been conducted in Europe and North America. Limited knowledge exists on the same in a developing nation like India. This research illustrates a comprehensive study to address that concern.

Details

International Journal of Health Care Quality Assurance, vol. 28 no. 1
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 1 April 2014

Hisahiro Ishijima, Eliudi Eliakimu, Shizu Takahashi and Noriyuki Miyamoto

The purpose of this paper is to identify factors that influence the implementation of the rollout of the 5S approach in public hospitals in Tanzania, and share the way to…

Abstract

Purpose

The purpose of this paper is to identify factors that influence the implementation of the rollout of the 5S approach in public hospitals in Tanzania, and share the way to scale this up for similar setting in developing countries.

Design/methodology/approach

The effect size was calculated from pre- and post-assessment results of Training of Trainers (ToT) to examine the effectiveness of ToT. A questionnaire with 14 explanatory variables was developed and completed based on information collected during Consultation visits (CVs) and progress report meetings (PRMs). Then, data were analysed to identify the influencing factors in relation to outcome variables (CV average score).

Findings

Among 14 explanatory variables, five explanatory variables showed statistical significant association with the CV average score. Those are: “Feedback and information sharing,” (p=0.031), “Quality Improvement Team roles and responsibility” (p=0.002), “5S knowledge,” “Involvement and commitment,” and “5S guidelines use and availability,” (p=0.000). When the explanatory variables were controlled by levels of hospitals; “involvement and commitment” was the only explanatory variable for national level hospitals. For regional referral hospitals, “QIT roles and responsibility” (p=0.02) and “5S knowledge” (p=0.03) were statistically significant. For district hospitals, “involvement and commitment” (p=0.01) and “availability of guideline (p=0.001)” were statistically significant.

Research limitations/implications

This study has the following limitations. The data were collected from existing reports and presentation materials only. There might be reporting bias, as PRM data is self-reported from the hospitals. Caution is therefore needed in extrapolating the study results to other settings. Despite these caveats, the findings will provide important insights for designing and implementing QI programs in Tanzania and in other African countries.

Originality/value

The authors' conceptual framework is based on the existing literature on the science of diffusion and scale up of innovation in the health sector. Few studies are known from resource constrain settings in Africa which assess the determinants of the process of nationwide scale-up of proven interventions.

Details

Clinical Governance: An International Journal, vol. 19 no. 2
Type: Research Article
ISSN: 1477-7274

Keywords

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Article
Publication date: 16 April 2018

Sasithorn Tangsawad and Surasak Taneepanichskul

The purpose of this paper is to study the efficacy of a district tuberculosis (TB) co-ordinating team on health service performance for suspected TB patients in a district…

Abstract

Purpose

The purpose of this paper is to study the efficacy of a district tuberculosis (TB) co-ordinating team on health service performance for suspected TB patients in a district hospital in northeastern Thailand.

Design/methodology/approach

A comparison study of pre- and post-evaluations of TB system improvement was conducted in a district hospital in northeastern Thailand between October 2016 and June 2017. Data collection reviewed the record of suspected TB cases reported in the district hospital in the past nine months as a base line for describing the health service performance in term of received investigation for TB diagnosis. Participants from a TB clinic, district health office and health center set up a TB co-ordinating team to explore situations and systematic gaps. The TB co-ordinating team gave recommendations of health service performance for suspected TB patients over a nine-month period. Records of suspected TB cases health service performance were collected nine months after intervention. Data analysis by descriptive statistics and to test the effect of intervention was performed.

Findings

The records from 324 and 379 suspected TB cases reported in the hospital from the 9 months preceding and 9 months, respectively, after intervention were reviewed. A TB co-ordinating team was set up to improve the system and health service performance in terms of investigation for TB diagnosis. The results revealed that health service performance in terms of complete microscopy and investigation in both chest radiography and microscopy increased after intervention. When comparing between pre- and post-intervention, suspected cases received both chest radiography and microscopy in 176 cases and 283 cases, respectively (p-value=0.001). There were 27 cases diagnosed for smear positive TB in pre-intervention and 51 cases diagnosed in post-intervention (p-value=0.011). There were 21 cases pre- and 36 cases post-intervention that had referral documents from health center with no statistically significant difference.

Originality/value

The TB co-ordinating team had the role to improve health service performance for suspected TB cases to enroll in investigation process for increase TB diagnosis in district hospital.

Details

Journal of Health Research, vol. 32 no. 3
Type: Research Article
ISSN: 2586-940X

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Article
Publication date: 4 April 2016

Rosa Hendijani and Diane P. Bischak

In order to decrease patient waiting time and improve efficiency, healthcare systems in some countries have recently begun to shift away from decentralized systems of…

Abstract

Purpose

In order to decrease patient waiting time and improve efficiency, healthcare systems in some countries have recently begun to shift away from decentralized systems of patient referral from general practitioners (GPs) to specialists toward centralized ones. From a queueing theory perspective, centralized referral systems can decrease waiting time by reducing the variation in the referral process. However, from a social psychological perspective, a close relationship between referring physician and specialist, which is characteristic of decentralized referral systems, may safeguard against high referral rates; since GPs refer patients directly to the specialists whom they know, they may be reluctant to damage that relationship with an inappropriate referral. The purpose of this paper is to examine the effect upon referral behavior of a relationship between physicians, as is found in a decentralized referral system, vs a centralized referral system, which is characterized by an anonymous GP-specialist relationship. In a controlled experiment where family practice residents made decisions concerning referral to specialists, physicians displaying high confidence referred significantly fewer patients in a close relationship condition than in a centralized referral system, suggesting that for some physicians, referral behavior can be affected by the design of the service system and will, in turn, affect system performance.

Design/methodology/approach

The authors used a controlled experiment to test the research hypotheses.

Findings

Physicians displaying high confidence referred significantly fewer patients in a close relationship condition than in a centralized referral system, suggesting that for some physicians, referral behavior can be affected by system attributes and will, in turn, affect system performance.

Research limitations/implications

The current study has some limitations, however. First, the sample consisted only of family practice residents and did not have the knowledge and experience of GPs regarding the referral process. Second, the authors used hypothetical patient case descriptions instead of real-world patients. Repeating this experiment with primary care physicians in real setting would be beneficial.

Practical implications

The study indicates that decentralized referral systems may act (rightly or wrongly) as a restraint on the rate of referrals to specialists. Thus, an implementation of a centralized referral system should be expected to produce an increase in referrals simply due to the change in the operational system setup. Even if centralized referral systems are more efficient and can facilitate the referral process by creating a central queue rather than multiple single queues for patients, the removal of social ties such as long-term social relationships that are developed between GPs and specialists in decentralized referral systems may act to counterbalance these theoretical gains.

Social implications

This study provide support for the idea that non-clinical factors play an important role in referrals to specialists and hence in the quality of provided care, as was suggested by previous studies in this area (Hajjaj et al., 2010; Reid et al., 1999). The design of the service system may inadvertently influence some doctors to refer too many patients to specialists when there is no need for a specialist visit. In high-utilization health systems, this may cause some patients to be delayed (or even denied) in obtaining specialist access. Healthcare systems may be able to implement behavioral-based techniques in order to mitigate the negative consequences of a shift to centralized referral systems. One approach would be to try to create a feeling of close relationship among doctors in centralized referral systems. High communication and frequent interaction among GPs and specialists can boost the feelings of teamwork and personal efficacy through social comparison (Schunk, 1989, 1991) and vicarious learning (Zimmerman, 2000), which can in turn motivate GPs to take control of the patient care process when appropriate, instead of referring patients to specialists.

Originality/value

The authors’ study is the first examining the effect of social relationships between GPs and specialists on the referral patterns. Considering the significant implications of referral decisions on patients, doctors, and the healthcare systems, the study can shed light into a better understanding of the social and behavioral aspects of the referral process.

Details

International Journal of Operations & Production Management, vol. 36 no. 4
Type: Research Article
ISSN: 0144-3577

Keywords

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