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The NHS review has implications for the funding of teaching hospitals and the relationship between them and the medical schools. The ring‐fencing of the Service Increment for Teaching and Research (SIFTR) and the need to develop contractual relationships for the provision of service facilities for teaching and research means that more information is needed on the nature and distribution of the service costs of these activities. The article describes research which informed the process of allocating SIFTR in a large teaching district. A methodology for developing rational SIFTR contracts is described and the implications for the future of medical education and research discussed. The local distribution of SIFTR must be well managed if teaching and research are not to suffer as a result of the financial pressures generated by the NHS review.

This research paper reports the findings of the first comprehensive survey of senior executives in Iran’s teaching hospitals. It is based on an analysis identifying the continuing professional development (CPD) needs of the total population of the two senior levels of teaching hospitals management‐presidents of physician‐managers and administrative‐managers. Four key areas of management knowledge were selected as the focus of the need identification: operational; financial; human resource; and organization change. The findings reveal a pent up demand for introductory level, formal knowledge in all four areas of management theory, to complement and extend the practical experience they have acquired in managing the complex environment of teaching hospitals. The paper goes on to propose a curriculum design and overall framework of provision to meet these genuinely felt CPD needs.

This paper aims to examine the challenges faced by health-care leadership in teaching hospitals in attaining accreditation for their institutions.

This paper is based on a study of current literature on health-care leadership, hospital accreditation and quality of patient care and identifies the challenges facing health-care leadership in attaining accreditation for teaching hospitals.

Based on a review and analysis of literature, infrastructure, finance, legal support, workforce recruitment and training, documentation and technology are identified as challenges faced by health-care leadership in teaching hospitals. The key challenges facing health-care leadership with respect to medical education and clinical research are found to be integration of education into hospital operations, compliance with all regulatory and professional requirements and adequacy of resources in executing research programs.

This study draws the attention of health-care leadership in teaching hospitals on the challenges they face in obtaining accreditation for their institutions so that they may develop appropriate strategies to overcome them.

As hospital costs continue to rise, increasing attention is being paid to the way these organizations are and should be managed. This attention typically comes in the form of focus on costs of services, quality (often measured through mortality rates) and length of stay. Hospital management has a broad array of choices at their disposal to address these challenges. As service operations, hospitals present a significant opportunity to apply the many tools and techniques from the field of operations strategy to this important industry. The objective of this paper is to use the operations strategy framework to assess the relationship between a set of operational elements and hospital performance in terms of average length of stay (ALOS), so that hospital managers improve the effectiveness and efficiency of patient care of their hospitals.

Using the structural and infrastructural operations strategy framework, this study examines the relationship between several strategic variables and hospital performance. To analyze these relationships the paper employs data from the population of hospitals in New York State. The performance measure is the ALOS for patients, adjusted for the mix and severity of cases in each hospital.

The paper finds that a direct relationship exists between the dependent variable and location, capacity, and teaching status, and failed to find a direct relationship for capital expenditures, salary, and staffing levels. However, the paper did find significant interaction effects between capital expenses and both salary and staffing levels.

There appear to be trade‐offs between capital expenditures and workforce decisions that have significant implications in light of current and expected hospital staffing shortages. The findings indicate that reductions in staff may not be perfectly replaced by corresponding increases in capital expenditures.

This paper further expands the body of research that addresses the important challenges hospitals face from an operations management perspective.

The purpose of this study is to examine the association of managerial incentives and political costs with hospital financial distress, recovery or closure. The Medicare Payment Advisory Commission has stated that hospital closures are important for evaluating the distribution of cost, quality and access to healthcare throughout the US. Using Logistic regression, we demonstrate that hospital closure is associated with low occupancy, return on investment, asset turnover, and lack of affiliation with a multihospital system. It is also significantly associated with urban location, teaching programs, high Medicare and Medicaid patient populations, and high debt. Essential access nonprofit hospitals are less likely to close, while this does not affect governmental and for-profit hospitals. Our research hypotheses are supported by these results.

Estimation of (in)efficiency became a popular practice that witnessed applications in virtually any sector of the economy over the last few decades. Many different models were deployed for such endeavors, with Stochastic Frontier Analysis (SFA) models dominating the econometric literature. Among the most popular variants of SFA are Aigner, Lovell, and Schmidt (1977), which launched the literature, and Kumbhakar, Ghosh, and McGuckin (1991), which pioneered the branch taking account of the (in)efficiency term via the so-called environmental variables or determinants of inefficiency. Focusing on these two prominent approaches in SFA, the goal of this chapter is to try to understand the production inefficiency of public hospitals in Queensland. While doing so, a recognized yet often overlooked phenomenon emerges where possible dramatic differences (and consequently very different policy implications) can be derived from different models, even within one paradigm of SFA models. This emphasizes the importance of exploring many alternative models, and scrutinizing their assumptions, before drawing policy implications, especially when such implications may substantially affect people’s lives, as is the case in the hospital sector.

This chapter investigates whether signing more hospital contracts with Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), hospital affiliation in a system, having more system hospital members located in the same area, and increased competition from area hospitals, contributes to improvements in the cost efficiency of U.S. Midwestern hospitals. Hospitals may offer HMOs and PPOs discounts on contracts to provide health care services to firm employees enrolled in HMOs and PPOs (discounts would lead to smaller price mark-ups over costs for hospital services). Enacting policies to enhance cost efficiency may help hospitals maintain a specified level of profits.

The most challenging aspect of hospital design is the creation of an environment that heals rather than the one acting as a barrier to healing. Much has not been done in the aspect of ascertaining the level of impact “indoor environmental quality (IEQ)” has on building occupants in healthcare facilities. Therefore, this study aims to investigate the impact of IEQ on patients' health and well-being.

The study investigates the hypothesis that four IEQ parameters (thermal quality, acoustic quality, lighting quality and indoor air quality [IAQ]) influence patients' overall satisfaction with the performance of hospital wards. Questionnaire responses were sought from the patients as the main occupants of hospital ward buildings. A proposed weighted structural model for IEQ establishing the relationship between IEQ parameters, patients' overall satisfaction and patients' health outcome was analyzed using structural equation modeling (SEM).

The most influential IEQ parameters on patients' overall satisfaction with IEQ in hospital wards are thermal quality, IAQ and lighting quality. The findings from this study revealed that the parameters of influence on patients' overall satisfaction and health outcomes vary with hospital ward orientation and design configuration.

This study has explored the need for the integration of all factors of IEQ at the building design stage towards providing a hospital environmental setting that reflects occupants' requirements and expectations and also promotes patient healing processes. This should be the focus of architects and healthcare managers and providers.

Hospitals are all required to be prepared against crisis, while according to studies, most hospitals are not prepared enough to encounter disaster problems. Therefore, each hospital should have an established programme to face earthquake and other catastrophes. This paper aims to investigate this issue.

This descriptive study was carried out in teaching hospitals of Iran University of Medical Sciences. Data collection was done using a checklist including general information, as well as information on demography, security, supplies and equipment, evacuation and communication. This procedure was done through observation and interview with hospital managers, etc. and the data were analyzed by SPSS software.

In the hospitals four dimensions of planning were studied and the following mean scores were obtained. On security, Hazrat Rasul hospital scored the highest (88.4) while Navab Safavi, Haftome Tir and Ali Asghar hospitals scored the lowest (51.4). On supplies and equipment, Navab Safavi and Haftome Tir hospitals obtained the highest score (66.6) and Hasheminejad, Shafa Yahyaeian, Firoozgar and Hazrat Rasul hospitals got the lowest score (60.0). On evacuation, Hazrat Rasul and Haftome Tir hospitals scored the highest and lowest respectively (64.2), (47.0). On communication, Hasheminejad hospital scored the highest (63.2) while Firoozgar hospital scored the lowest (36.6). In general from among ten hospitals under study the most and the least prepared hospitals were Hazrat Rasul and Navab Safavi respectively (65.65), (54.3).

The paper shows that most hospitals under study were not prepared enough against crisis and communication is found to be the weakest aspect although it is regarded as a basic principle in planning. Hazrat Rasul hospital was well prepared against crisis due to its disaster plan.

Purpose – In the last decades, Italian healthcare organisations have been subject to important normative changes, aimed at increasing their efficiency. As a response, performance measurement and evaluation (PME) systems have been introduced. The present study attempts to examine PME system changes as institutional processes. In studying such processes the healthcare literature acknowledges the presence of two logics: managerial and professional, as peculiar to healthcare settings, whose convergence or divergence can explain the success of any institutional process.

Design/methodology/approach – We adopt Busco et al.'s (2007) framework as an approach for unbundling PME system change into four relevant coordinates, namely: (1) the object (PME system), (2) the subjects (institutional forces), (3) the place and time of change (the managerial and professional logics) and (4) the how and why change happens (change as an institutional process). We conducted a longitudinal case study at a large teaching hospital in Southern Italy, directed to interpret PME system changes during the period from 1998 until 2009.

Findings – Our observation distinguishes episodes of successful institutional processes, where the introduced innovations are transformed into objectivated practices, from episodes of missed institutionalisation, where new procedures were rapidly abandoned.

Research and social implications – This theoretical framework can be useful for interpreting the PME system changes in different institutional contexts.

Originality – The Busco et al.'s framework allows us to understand PME system changes by integrating the perspectives from Neo-Institutional Sociology, representing healthcare organisational responses to external institutional pressures, and Old-Institutional Economics, conceptualising PME system changes as an institutionalisation process.