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Open Access
Article
Publication date: 8 September 2021

Mari Liukka, Markku Hupli and Hannele Turunen

This paper aims to assess how patient safety culture and incident reporting differs across different professional groups and between long-term and acute care. The Hospital Survey…

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Abstract

Purpose

This paper aims to assess how patient safety culture and incident reporting differs across different professional groups and between long-term and acute care. The Hospital Survey On Patient Safety Culture (HSPOSC) questionnaire was used to assess patient safety culture. Data from the organizations’ incident reporting system was also used to determine the number of reported patient safety incidents.

Design/methodology/approach

Patient safety culture is part of the organizational culture and is associated for example to rate of pressure ulcers, hospital-acquired infections and falls. Managers in health-care organizations have the important and challenging responsibility of promoting patient safety culture. Managers generally think that patient safety culture is better than it is.

Findings

Based on statistical analysis, acute care professionals’ views were significantly positive in 8 out of 12 composites. Managers assessed patient safety culture at a higher level than other professional groups. There were statistically significant differences (p = 0.021) in frequency of events reported between professional groups and between long-term and acute care (p = 0.050). Staff felt they did not get enough feedback about reported incidents.

Originality/value

The study reveals differences in safety culture between acute care and long-term care settings, and between professionals and managers. The staff felt that they did not get enough feedback about reported incidents. In the future, education should take these factors into consideration.

Details

Leadership in Health Services, vol. 34 no. 4
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 11 August 2020

Roberta Sammut and Amanda Scicluna

The purpose of this paper is to compare the perceived transformational leadership practices of charge and staff nurses. Transformational leadership is effective in promoting…

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Abstract

Purpose

The purpose of this paper is to compare the perceived transformational leadership practices of charge and staff nurses. Transformational leadership is effective in promoting change in organisations, with the leader guiding followers towards a common vision.

Design/methodology/approach

A quantitative, descriptive, comparative survey design was used. All charge nurses (N = 151) and staff nurses (N = 1,950) in six health entities in Malta were included. A mixed mode survey design was used. Data were collected using the Leadership Practices Inventory and analysed using ANOVA and the Kruskal–Wallis test.

Findings

An overall response rate of 15% (n = 315) was achieved. Both staff and charge nurses perceived transformational leadership to be practiced. Charge nurses scored consistently higher than staff nurses. In long-term care environments, charge nurses are more likely to “model the way”, while in acute settings, they were more likely to “enable others to act”.

Research limitations/implications

Transformational leadership appears to be applied by charge nurses in Malta. The response rate achieved was low and may limit the generalisability of the results of the study.

Practical implications

Nurse managers need to adapt their transformational leadership style based on the context in which they work.

Originality/value

Regular feedback from nursing staff should be sought for charge nurses to be aware of the extent to which they are implementing transformational leadership.

Details

Leadership in Health Services, vol. 33 no. 4
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 28 October 2014

Jared Frank and Muhiuddin Haider

The purpose of this study is to conduct a comparative analysis of the Medicare patients discharged to a long-term (acute) care hospitals (LTCH), skilled nursing facility (SNF) or…

Abstract

Purpose

The purpose of this study is to conduct a comparative analysis of the Medicare patients discharged to a long-term (acute) care hospitals (LTCH), skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF) following an acute inpatient hospitalization under Medicare-severity diagnosis-related group (MS-DRG) 207. The likelihood of discharge by provider type was also examined to determine criteria informing patient discharge to a LTCH, SNF or IRF for treatment.

Design/methodology/approach

Retrospective cohort study, based on secondary data analysis, utilizing Medicare Provider Analysis and Review (MedPAR) File data collected by Centers for Medicare & Medicaid Services for fiscal year 2011, October 1, 2010, through September 30, 2011.

Findings

Numerous analyses were conducted upon those patients discharged to a LTCH, SNF or IRF following an acute inpatient hospitalization under MS-DRG 207. Concerning those patients discharged to LTCHs, patients were not significantly older, did not have the highest length of stay and had comparable diagnoses and diagnosis counts to those discharged to SNFs or IRFs. However, costs were significantly higher among discharges to LTCHs. Multinomial logistic regression analyses also indicated numerous associations between certain variables and discharge location.

Originality/value

With the aging of the US population and increasing costs of rendering services, both the Medicare population and Medicare expenditures, already at their highest levels in the history of the program, are projected to rise going forward (The Boards of Trustees, 2012). As such, recent research has focused on Part A hospitals/facilities and the variations in costs submitted and payments received for treatment/services provided. This study aims to address whether patients discharged to LTCHs, which receive higher payment(s) as a result of serving a higher proportion of medically complex beneficiaries, are more medically complex than those discharged to SNFs/IRFs.

Details

International Journal of Pharmaceutical and Healthcare Marketing, vol. 8 no. 4
Type: Research Article
ISSN: 1750-6123

Keywords

Article
Publication date: 3 October 2018

Peter Nugus, Geetha Ranmuthugala, Josianne Lamothe, David Greenfield, Joanne Travaglia, Kendall Kolne, Julia Kryluk and Jeffrey Braithwaite

Health service effectiveness continues to be limited by misaligned objectives between policy makers and frontline clinicians. While capturing the discretion workers inevitably…

Abstract

Purpose

Health service effectiveness continues to be limited by misaligned objectives between policy makers and frontline clinicians. While capturing the discretion workers inevitably exercise, the concept of “street-level bureaucracy” has tended to artificially separate policy makers and workers. The purpose of this paper is to understand the role of social-organizational context in aligning policy with practice.

Design/methodology/approach

This mixed-method participatory study focuses on a locally developed tool to implement an Australia-wide strategy to engage and respond to mental health services for parents with mental illness. Researchers: completed 69 client file audits; administered 64 staff surveys; conducted 24 interviews and focus groups (64 participants) with staff and a consumer representative; and observed eight staff meetings, in an acute and sub-acute mental health unit. Data were analyzed using content analysis, thematic analysis and descriptive statistics.

Findings

Based on successes and shortcomings of the implementation (assessment completed for only 30 percent of clients), a model of integration is presented, distinguishing “assimilist” from “externalist” positions. These depend on the degree to which, and how, the work environment affords clinicians the setting to coordinate efforts to take account of clients’ personal and social needs. This was particularly so for allied health clinicians and nurses undertaking sub-acute rehabilitative-transitional work.

Originality/value

A new conceptualization of street-level bureaucracy is offered. Rather than as disconnected, it is a process of mutual influence among interdependent actors. This positioning can serve as a framework to evaluate how and under what circumstances discretion is appropriate, and to be supported by managers and policy makers to optimize client-defined needs.

Details

Journal of Health Organization and Management, vol. 32 no. 6
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 1 March 2016

Susan Camilleri and Kathleen Colville

Due to recent Affordable Care Act reforms, prevention of readmissions is a salient issue for hospitals that participate in Medicare, as they are now held accountable for patients…

Abstract

Due to recent Affordable Care Act reforms, prevention of readmissions is a salient issue for hospitals that participate in Medicare, as they are now held accountable for patients who receive post-acute care in facilities over which hospitals have little influence to monitor care. Using resource dependence and transaction cost economics to describe the theoretical advantages of hospital ownership of post-acute care facilities (PACs), we empirically test whether hospitals that own PACs experience reduced readmissions. Our findings indicate partial support for the predicted relationship between PAC ownership and readmission rates. We found that hospital ownership of a skilled-nursing facility (SNF) was related to a lower readmissions rate for some patients, while ownership of other types of PACs did not result in significant findings. Our results offer support for the theoretical advantages of ownership, however, the savings realized by ownership may not merit the ownership investment.

Details

International Journal of Organization Theory & Behavior, vol. 19 no. 2
Type: Research Article
ISSN: 1093-4537

Article
Publication date: 1 August 1997

This is an adaptation of the opening address given by Sister Elizabeth Davis to the Canadian Healthcare Association’s intramural session for its Distance Education programme. The…

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Abstract

This is an adaptation of the opening address given by Sister Elizabeth Davis to the Canadian Healthcare Association’s intramural session for its Distance Education programme. The intramural session is an intensive week of plenary and programme‐specific sessions, working groups and student presentations.

Details

Leadership in Health Services, vol. 10 no. 4
Type: Research Article
ISSN: 1366-0756

Keywords

Book part
Publication date: 7 February 2024

Nathan W. Carroll, Shu-Fang Shih, Saleema A. Karim and Shoou-Yih D. Lee

The COVID-19 pandemic created a broad array of challenges for hospitals. These challenges included restrictions on admissions and procedures, patient surges, rising costs of labor…

Abstract

The COVID-19 pandemic created a broad array of challenges for hospitals. These challenges included restrictions on admissions and procedures, patient surges, rising costs of labor and supplies, and a disparate impact on already disadvantaged populations. Many of these intersecting challenges put pressure on hospitals' finances. There was concern that financial pressure would be particularly acute for hospitals serving vulnerable populations, including safety-net (SN) hospitals and critical access hospitals (CAHs). Using data from hospitals in Washington State, we examined changes in operating margins for SN hospitals, CAHs, and other acute care hospitals in 2020 and 2021. We found that the operating margins for all three categories of hospitals fell from 2019 to 2020, with SNs and CAHs sustaining the largest declines. During 2021, operating margins improved for all three hospital categories but SN operating margins still remained negative. Both changes in revenue and changes in expenses contributed to observed changes in operating margins. Our study is one of the first to describe how the financial effects of COVID-19 differed for SNs, CAHs, and other acute care hospitals over the first two years of the pandemic. Our results highlight the continuing financial vulnerability of SNs and demonstrate how the factors that contribute to profitability can shift over time.

Details

Research and Theory to Foster Change in the Face of Grand Health Care Challenges
Type: Book
ISBN: 978-1-83797-655-3

Keywords

Article
Publication date: 1 June 2001

Sally Jacobs and Caroline Glendinning

This paper reviews evidence about the relationships between NHS services and nursing and residential homes in England and Wales. Since the transfer in 1993 of responsibility for…

Abstract

This paper reviews evidence about the relationships between NHS services and nursing and residential homes in England and Wales. Since the transfer in 1993 of responsibility for funding nursing and residential home care for less affluent older people to local authority social services departments, nursing and residential care has been widely assumed to constitute part of ‘social care’ services. This obscures the fact that residents of nursing and residential care homes frequently have substantial and complex healthcare needs. While some of these healthcare needs may be met through the care provided within homes themselves, most will require substantial contributions from NHS medical, nursing, pharmaceutical and other services. The National Service Framework for Older People (Department of Health, 2001) prioritises reinvestment in intermediate care services, building on the expectation in The NHS Plan (Department of Health, 2000a) that residential and nursing homes will play a major role in the development of these services. This expectation has been further reinforced by the Concordat with the private and voluntary healthcare provider sector (Department of Health, 2000b). However there is little evidence about the NHS services which are currently provided to nursing and residential homes, nor about the capacity of mainstream NHS services to meet the projected development of intermediate care services within the independent institutional sector. This paper reviews the evidence which is available and highlights some of the priorities which primary care groups in England (local health groups in Wales) will need to consider if they are to develop integrated and good quality services for frail older people.

Details

Quality in Ageing and Older Adults, vol. 2 no. 2
Type: Research Article
ISSN: 1471-7794

Keywords

Case study
Publication date: 20 January 2017

Kenneth M. Eades and Nili Mehta

This case is best taught in a first-year MBA finance course and with a series of cases based on cash flow analysis. Its primary objective is to portray the major differences in…

Abstract

This case is best taught in a first-year MBA finance course and with a series of cases based on cash flow analysis. Its primary objective is to portray the major differences in project analysis for nonprofit organizations compared to for-profit companies and to highlight the unique issues relevant in a health care environment. Students must decide, based on cash flow analysis and nonfinancial factors, whether or not to propose a long-term acute care hospital (LTAC) project to the board of directors of the U. Va. Health System. Students must use the assumptions outlined in the case to create a cash flow analysis and then compute a net present value (NPV) calculation and internal rate of return (IRR) for the project. After assessing the base-case results and sensitivity analysis of the assumptions driving those results, students must decide if the project should be taken to the board of directors.

Details

Darden Business Publishing Cases, vol. no.
Type: Case Study
ISSN: 2474-7890
Published by: University of Virginia Darden School Foundation

Keywords

Article
Publication date: 27 January 2012

Halim Boussabaine, Samer Sliteen and Orlando Catarina

This paper aims to examine for the first time the impact of the intensity of hospital bed occupancy on healthcare facilities operational costs in France.

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Abstract

Purpose

This paper aims to examine for the first time the impact of the intensity of hospital bed occupancy on healthcare facilities operational costs in France.

Design/methodology/approach

Research methodology is based on empirical data collection from 19 short‐stay care acute and long‐term care hospital facilities in Paris, France, carried out during 2008. Statistic analysis was conducted to investigate the impact of bed occupancy on operational cost of health facilities. The purpose of the analysis is to determine the best practices and provide recommendations to the decision makers for operational cost budgeting purposes.

Findings

The main findings are the relationship between bed usage and operational costs of acute hospital facilities in France. An analysis of annual O&M (operation and maintenance) cost clearly indicated that type of medical activities had a major impact on O&M cost when the influence of all other potential factors, particularly, morphology, quality of construction and age, were excluded.

Research limitations/implications

Data sample is limited to hospitals in the Paris region. Hence, extrapolation from the generated results to other regions in France is limited. Other facilities operational cost drivers, such as conditional surveys of buildings, need to be considered alongside the performance measures included in this study.

Practical implications

The results will help in establishing best practices and benchmarking operational costs in heath care facilities in France. They will also assist in developing and planning strategic heath care operational budgets. One of the most important implications of the results is in assisting decision makers to develop facilities management improvement strategies.

Originality/value

The research described in this paper represents significantly advances in the understanding of the impact of medical activities on operation and maintenance costs of healthcare facilities in France.

Details

Facilities, vol. 30 no. 1/2
Type: Research Article
ISSN: 0263-2772

Keywords

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