Search

Purpose The purpose of this paper is to test and measure the outcome of a community hospital in implementing the Affordable Care Act (ACA) through a co-management arrangement. RQ1: do the benefits of a co-management arrangement outweigh the costs? RQ2: does physician alignment aid in the effective implementation of the ACA directives set for hospitals? Design/methodology/approach A case study of a 350-bed non-profit community hospital co-management company. The quantitative data are eight quarters of quality metrics prior and eight quarters post establishment of the co-management company. The quality metrics are all based on standardized national requirements from the Joint Commission and Centers for Medicare and Medicaid Services guidelines. These measures directly impact the quality initiatives under the ACA that are applicable to all healthcare facilities. Qualitative data include survey results from hospital employees of the perceived effectiveness of the co-management company. A paired samples difference of means t-test was conducted to compare the timeframe before co-management and post co-management. Findings The findings indicate that the benefits of a co-management arrangement do outweigh the costs for both the physicians and the hospital ( RQ1). The physicians benefit through actual dollar payout, but also with improved communication and greater input in running the service line. The hospital benefits from reduced cost - or reduced penalties under the ACA - as well as better communication and greater physician involvement in administration of the service line. RQ2: does physician alignment aid in the effective implementation of the ACA directives set for hospitals? The hospital improved in every quality metric under the co-management company. A paired sample difference of means t-test showed a statistically significant improvement in five of the six quality metrics in the study. Originality/value Previous research indicates the potential effectiveness of co-management companies in improving healthcare delivery and hospital-physician relations (Sowers et al., 2013). The current research takes this a step further to show that the data do in fact support these concepts. The hospital and the physicians carrying out the day-to-day actions have shared goals, better communication, and improved quality metrics under the co-management company. As the number of co-management companies increases across the USA, more research can be directed at determining their overall impact on quality care. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to develop and validate an instrument that can measure distributed leadership (DL) as employees' active participation in DL tasks. The authors designate this as the distributed leadership agency (DLA). Design/methodology/approach Data were collected throughout all departments and occupational groups at a merged centralized hospital setting in Denmark. A total of 1,774 employees from 24 hospital departments and 16 occupational groups completed our survey. Structural equation model and confirmatory factor analyses were applied to identify appropriate items and a test for measurement invariance, predictive, discriminant and convergent validity, and ANOVAs were applied to analyse group differences in DLA. Findings The identified unidimensional questionnaire consists of seven items, as it is different from, but associated with, empowering leadership, organizational influence, attitude to participation and trust in management. As theoretically predicted, DLA is positively related to self-efficacy, job satisfaction and innovative behaviour. Chief physicians, permanent employees and employee representatives scored higher on the scale than the rest of their respective counterparts. Practical implications The survey offers a method to assess a distribution of leadership agency in hospital organizations. Such assessment may provide a basis for organizational and leadership development. Originality/value The present study provides a reliable and valid quantitative instrument that measures how much employees at all hierarchical levels are involved in concrete leadership activities in the hospital context. Taking a normative perspective the authors could show that DL - measured with the DLA-questionnaire - has positive effects on employees' behaviour. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to capture factors behind professional views of indicator usefulness as a common structure for assessing healthcare performance and their important characteristics to design limited key performance indicators (PIs) for holistic hospital management. Design/methodology/approach - Two surveys were conducted using self-administered questionnaires, in which hospital manager/staff respondents were asked to rate the 52 PIs' usefulness. In total, 228 manager and 894 staff responses were collected. Findings - Eight factors were elicited from manager and staff responses as performance measures with 72 percent cumulative variance accounted for. Hospital managers and staff showed similar performance measure perceptions: high-utility acknowledgment on safety, operational efficiency and patient/employee satisfaction but relatively low-employee development concerns. Manager indicator usefulness perceptions were rather homogeneous and significantly higher than staff for almost all performance measures. Practical implications - Homogeneous manager views mean that a single key PI set for hospital management may be established regardless of hospital attributes. The following aspects may be measures that should be managed in a healthcare organization based on their key PIs: patient/employee safety, operational efficiency, financial effectiveness and patient/employee satisfaction. Originality/value - This is a pilot study on hospital management PIs in Japan. The eight-dimensional factor structure and findings about healthcare provider perceptions may be useful for healthcare management. [ABSTRACT FROM AUTHOR]

Purpose - Missed appointments constitute a significant problem in the UK National Health Service (NHS) and this remains an area where improvements could yield substantial efficiency savings. The purpose of this paper is to suggest that nudge policies based on behavioural theories may help target interventions to improve patient motivation to attend appointments. Design/methodology/approach - The authors propose two policies to reduce missed appointments. The first attempts to empower patients through making the appointment system more individualised to them and utilising their intrinsic feelings of social responsibility. The second policy utilises a financial commitment given by the patient at the time of booking. The different mechanisms of influencing patient behaviour are based on two different views of what motivates individuals' actions. The first policy is based on individuals being "knights". They are altruistic and have well-intentioned values. The second policy option is constructed on the premise that an individual is governed by self-interest, and they are in fact "knaves". Findings - A policy, which avoids the use of financial penalties is likely to be more culturally acceptable within the NHS. It could also prevent the phenomenon of "crowding out" whereby the desire to act dutifully gets displaced by the motivation to avoid incurring a monetary fine. Originality/value - Testing both strategies would provide insight into patient attitudes towards health care and society. This would help optimise behavioural strategies which may influence not only appointment attendances but also have wider implications for encouraging rational health care consumption. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to understand the role of management group meetings (MGMs) in hospital organization by examining the social interaction in these meetings. Design/methodology/approach - This case study approaches social interaction from a structuration point of view. Social network analysis and qualitative content analysis are applied. Findings - The findings show that MGMs are mainly forums for information sharing. Meetings are not held for problem solving or decision making, and operational coordinating is limited. Meeting interaction is very much focused on the chair, and most of the discussion takes place between the chair and one other member, not between members. The organizational structures are maintained and reproduced in the meeting interaction, and they appear to limit discussion. Meetings appear to fulfil their goals as a part of the organization's information structure and to some extent as an instrument for management. The significance of the relational side of MGMs was recognized. Research limitations/implications - The results of this study provide a basis for future research on hospital MGMs with wider datasets and other methodologies. Especially the relational role of MGMs needs more attention. Practical implications - The goals of MGMs should be reviewed and MG members should be made aware of meeting interaction structures. Originality/value - The paper provides new knowledge about interaction networks in hospital MGMs, and describes the complexity of the importance of MGMs for hospitals. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to determine whether there were differences in clinical encounter time between patients who speak English and those who require an interpretation service in an ethnically diverse pediatric clinic. Design/methodology/approach - Encounter time with patients requiring interpretation was compared to encounter time with patients who spoke English. The sample consisted of 310 encounters at a pediatric orthopedic clinic where patients spoke over 18 primary languages. Data were analyzed using ANOVA to compare four types of encounters. Findings - Approximately 12 percent (n=38) required interpretation and encounters requiring interpretation took 30 percent (nine minutes) longer than those that did not, p < 0.01(25 vs 16 minutes). Furthermore, this difference was mainly among new patients: Approximately, 53 percent increase in time for new patient encounters requiring interpretation (36 vs 23 minutes) while only 25 percent increase in encounter time for established patients (20 vs 16 minutes) was detected. Research limitations/implications - Preventing problems due to language barriers requires time for interpretation which places demands on staff resources and presents clinical challenges. However, long-term benefits of quality health care outweigh the costs associated with interpretation service. Originality/value - To the knowledge, this is the first study to investigate actual encounter time differences in a pediatric clinical setting. The authors found that clinical encounters requiring interpretation took approximately nine minutes longer in general and four minutes longer for established patients. These findings could give much needed information for hospital administrators to allocate appropriate amounts of time and resources to care for those who need interpretation services. However, they also indicate a broader concern of the reduction of clinical encounter time for overall health care system in the country that might need further investigation. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to prioritize 21 healthcare wastes in public and private hospitals of United Arab Emirates (UAE). Design/methodology/approach - Seven healthcare wastes linked with lean management are further decomposed in to sub-criteria and to deal with this complexity of multi criteria decision-making process, analytical hierarchical process (AHP) method is used in this research. Findings - AHP framework for this study resulted in a ranking of 21 healthcare wastes in public and private hospitals of UAE. It has been found that management in private healthcare systems of UAE is putting more emphasis on the inventory waste. On the other hand, over processing waste has got highest weight in public hospitals of UAE. Research limitations/implications - The future directions of this research would be to apply a lean set of tools for the value stream optimization of the prioritized key improvement areas. Practical implications - This is a contribution to the continuing research into lean management, giving practitioners and designers a practical way for measuring and implementing lean practices across health organizations. Originality/value - The contribution of this research, through successive stages of data collection, measurement analysis and refinement, is a set of reliable and valid framework that can be subsequently used in conceptualization, prioritization of the waste reduction strategies in healthcare management. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to investigate the determinants of best management practices in an Australian state-run healthcare system, namely New South Wales (NSW), and studies the impact of a range of hospital factors in driving best management practices as a means of enhancing healthcare delivery. Design/methodology/approach - This study adapts a unique survey instrument globally tested to quantify the multi-dimensional nature of hospital management practices in 42 acute care public hospitals of NSW. The authors then analysed the role of hospital-specific characteristics in driving best management practices, namely hospital size (measured by the number of hospital beds, employees and doctors), level of skill and education, degree of hospital manager autonomy and organisational hierarchy. Findings - The findings of this study show the areas of strength and potential areas of improvement in NSW hospitals. The authors find a positive association between the adoption of better management practices and hospital size (measured by the number of hospital beds and employees), level of skills and education, degree of hospital manager autonomy and organisational hierarchy. However, hospital size as measured by the number of doctors did not have a statistically significant relationship. Practical implications - This paper is of interest to both hospital administrators, clinical doctors and healthcare policy-makers who want to improve and develop strategies for better management in the healthcare sector. Originality/value - This study provides an internationally comparable robust measure of management capability in public hospitals, and contributes to the evidence-base of management practices and performance in hospitals. [ABSTRACT FROM AUTHOR]

Purpose This paper presents the initial results of a project on organizational and professional cultures prevalent in hospital organizations. The purpose of this paper is to identify the cultural differences that make it possible to anticipate, with the aid of subsequent studies, consequences in the communication and coordination of the future integration of the Mexican public health system, which is currently fragmented.Design/methodology/approach A qualitative tool was used to identify the cultures in a secondary-level public hospital.Findings The diversity inherent to hospital organizations was confirmed.Originality/value The real value of the findings lies in the classification of the subcultures and their possible effects on human interaction and cooperation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to investigate the quality of management practices of public hospitals in the Australian healthcare system, specifically those in the state-managed health systems of Queensland and New South Wales (NSW). Further, the authors assess the management practices of Queensland and NSW public hospitals jointly and globally benchmark against those in the health systems of seven other countries, namely, USA, UK, Sweden, France, Germany, Italy and Canada.Design/methodology/approach: In this study, the authors adapt the unique and globally deployed Bloom et al. (2009) survey instrument that uses a "double blind, double scored" methodology and an interview-based scoring grid to measure and internationally benchmark the management practices in Queensland and NSW public hospitals based on 21 management dimensions across four broad areas of management - operations, performance monitoring, targets and people management.Findings: The findings reveal the areas of strength and potential areas of improvement in the Queensland and NSW Health hospital management practices when compared with public hospitals in seven countries, namely, USA, UK, Sweden, France, Germany, Italy and Canada. Together, Queensland and NSW Health hospitals perform best in operations management followed by performance monitoring. While target management presents scope for improvement, people management is the sphere where these Australian hospitals lag the most.Practical Implications: This paper is of interest to both hospital administrators and health care policy-makers aiming to lift management quality at the hospital level as well as at the institutional level, as a vehicle to consistently deliver sustainable high-quality health services.Originality/value: This study provides the first internationally comparable robust measure of management capability in Australian public hospitals, where hospitals are run independently by the state-run healthcare systems. Additionally, this research study contributes to the empirical evidence base on the quality of management practices in the Australian public healthcare systems of Queensland and NSW. [ABSTRACT FROM AUTHOR]

Purpose: The WHO Eastern Mediterranean Regional Office has emphasized health system strengthening among the top five strategic priorities. One of the integral elements of health systems are the hospitals. The purpose of this paper is to review the need for formalized training in hospital management to improve the quality of care.Design/methodology/approach: Literature review and hands on experience of conducting a regional training in hospital management for Eastern Mediterranean Region (EMR) countries.Findings: Majority of patients in EMR bypass Primary Health Care facilities due to inadequate quality of services and prefer seeking specialized care at a tertiary level. There is mounting evidence of mediocre to poor patient satisfaction due to inefficient health care practices in hospitals of EMR. Strengthening the management capacity of the hospitals through a formal training programme is therefore necessary for improving the performance of health care delivery and the overall health system. Hospital management encompasses hospital planning and operational activities including development and implementation of organizational strategies to ensure adequate numbers and quality of trained human resources and effective financial management, disaster management, health management information system utilization, support services, biomedical engineering, transport and waste management. Such training will prepare health care professionals with leadership skills to deliver quality hospital services.Originality/value: This is one of the first papers emphasizing the need for a formal structured regional training in hospital management for the countries of EMR. A modular incremental training approach developing an EMR Credit Transfer and Accumulation system is proposed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to investigate connections and overlaps between health lean management (HLM) and clinical risk management (CRM) understanding whether and how these two approaches can be combined together to pursue efficiency and patient safety improvements simultaneously.Design/methodology/approach: A systematic literature review has been carried out. Searching in academic databases, papers that focus not only on HLM, but also on clinical errors and risk reduction, were included. The general characteristics of the selected papers were analysed and a content analysis was conducted.Findings: In most of the papers, pursing objectives of HLM and CRM and adopting tools and practices of both approaches, results of quality and, particularly, of safety improvements were obtained. A two-way arrow between HLM and CRM emerged but so far, none of the studies has been focused on the relationship between HLM and CRM.Originality/value: Results highlight an emerging research stream, with many useful theoretical and practical implications and opportunities for further research. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to analyze the implementation of an organizational change initiative--Studer Group®'s Evidence-Based Leadership (EBL)--in two large, US health systems by comparing and contrasting the factors associated with successful implementation and sustainability of the EBL initiative.Design/methodology/approach: This comparative case study assesses the responses to two pairs of open-ended questions during in-depth qualitative interviews of leaders and managers at both health systems. Qualitative content analysis was employed to identify major themes.Findings: Three themes associated with success and sustainability of EBL emerged at both health systems: leadership; culture; and organizational processes. The theme most frequently identified for both success and sustainability of EBL was culture. In contrast, there was a significant decline in salience of the leadership theme as attention shifts from success in implementation of EBL to sustaining EBL long term. Within the culture theme, accountability, and buy-in were most often cited by interviewees as success factors, while sense of accountability, buy-in, and communication were the most reported factors for sustainability.Originality/value: Cultural factors, such as accountability, staff support, and communication are driving forces of success and sustainability of EBL across both health systems. Leadership, a critical factor in several stages of implementation, appears to be less salient as among factors identified as important to longer term sustainability of EBL. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to review how patient and public involvement (PPI) can contribute to quality improvement functions and describe the levels of PPI in quality improvement functions at hospital and departmental level in a sample of European hospitals. Design/methodology/approach – Literature review and cross-sectional study. Findings – PPI takes multiple forms in health care and there is not a single strategy or method that can be considered to reflect best practice. The literature reveals that PPI can serve important functions to support quality improvement efforts. In contrast, the assessment of actual PPI in quality improvement shows that PPI is low. Research limitations/implications – Findings are not representative of hospitals in the EU. Practical implications – A diverse set of methods and tools that can be employed to realize PPI. Service providers should consider PPI at all stages, in particular in setting quality standards and criteria and in evaluating the results. Originality/value – Contextualization of empirical findings with case studies from the literature that inform further practice and research on PPI. [ABSTRACT FROM AUTHOR]

Purpose – Because stereotypically masculine behaviors are required for effective leadership, examining female chairs’ leadership in academic medicine can provide insight into the complex ways in which gender impacts on their leadership practices. The paper aims to discuss this issue. Design/methodology/approach – The author interviewed three female clinical chairs and compared the findings to interviews with 28 of their faculty. Grounded theory analysis of the subsequent text gathered comprehensive, systematic, and in-depth information about this case of interest at a US top-tier academic medical center. Findings – Four of five themes from the faculty were consistent with the chair’s narrative with modifications: Prior Environment (Motivated by Excellence), Tough, Direct, Transparent (Developing Trust), Communal Actions (Creating Diversity of Opinion), and Building Power through Consensus (an “Artful Exercise”) with an additional theme, the Significance (and Insignificance) of a Female Chair. While faculty members were acutely aware of the chair’s gender, the chairs paradoxically vacillated between gender being a “non-issue” and noting that male chairs “don’t do laundry.” All three female chairs in this study independently and explicitly stated that gender was not a barrier, yet intuitively used successful strategies derived from the research literature. Originality/value – This study suggests that while their gender was highlighted by faculty, these women dismissed gender as a “non-issue.” The duality of gender for these three female leaders was both minimized and subtly affirmed. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe an international survey of hospital executives and administrators’ perspectives on the contributions of their affiliation with a Ronald McDonald House (RMH) as an example of accommodation in family-centered care to the hospital’s mission, operations and patient experience. Design/methodology/approach – RMHs worldwide provided the names and e-mail addresses of the people holding key leadership positions in their main hospital partner, who in turn were invited to complete an internet-based survey (530 participants; response rate of 54.5 percent). Findings – Hospital leaders reported very positive opinions about the contributions of their RMHs affiliation to their ability to serve seriously ill children and their families. This included such important outcomes as increasing family integrity and family participation in care decisions; and decreasing psychosocial stress and hospital social work resource burdens associated with lodging, food, transportation and sibling support. Hospital chief executive offices (CEOs) and medical directors reported very strong and positive opinions regarding the value-added of their RMHs affiliation in many areas, including enhanced marketing of hospital specialty services and reduced length of stay. Research limitations/implications – Survey response bias is a limitation, although the results are still useful in terms of identifying multiple ways in which RMHs are perceived as contributing to hospitals’ operations and provision of family-centered care. Practical implications – Overall, the results suggest that, internationally, hospital leaders believe that RMHs play a key and valued role in their provision of family-centered care to seriously ill children and their families. Social implications – Family accommodation is more than the simple provision of lodging and plays an integral role how hospitals approach family-centered care. Originality/value – This international study contributes to the general literature on the role of family accommodation in hospitals’ provision of family-centered care and the specific and very sparse literature on RMHs in particular. [ABSTRACT FROM AUTHOR]

Purpose – The perpose of this paper is to analyse recent changes in the management of French public hospitals, following a reform enacted in 2009 and aimed at bolstering the managerial roles of doctors. Design/methodology/approach – The paper is exploratory and is based on both the analysis of French literature dealing with the results of the 2009 reform, and ten semi-directed interviews with clinical managers and top leaders in the public hospital sector. Findings – The author reports on the major hospital management reforms of 2009 and analyse the implications for the medical profession and management. The author shows that the involvement of the classical clinical leaders has become less regulated as the units no longer have a clear legal basis. The governance of the newly introduced “medical poles” appears to be shaped by various factors: there is high correlation between centrality, prestige and “clan involvement”, which suggests that professionals holding new responsibilities obtain power and legitimacy by consolidating pre-existing networks. While it is often argued that high-quality clinical leadership is a key factor of organisational success, the findings suggest that the performance of clinical managers relies on this network and legitimacy acquired from it. Originality/value – Drawing on the “sociology of translation” and actor-network theory (Callon and Latour, 1991), this paper provides a new conceptual framework for the analysis of the transformation of the role of clinical leaders, arguing that this transformation depends highly on their abilities to build and use networks. The findings challenge the French tradition of public management that presupposes a clear division of power between doctors and administrative staff. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to evaluate the relative importance of attributes for patient selection of a medical institution and to quantitatively evaluate the impact of different types of organizational forms upon the patient's selection of a medical institution. Design/methodology/approach – By using a conjoint analysis, evaluation criteria in patient selection of a medical institution were examined. The paper assumed the selection of a medical institution under the situation of "being given a diagnosis of suspected diabetes with a physical examination and then visiting a medical institution". The attributes included in the questionnaire were: quality of the medical institution, distance to the hospital, amount paid at the initial visit, amount paid at hospitalization for examinations, and organizational form of the hospital. Relative importance of the attributes and relative importance of organizational form were assessed. A total of 140 people were requested to respond to the questionnaire by way of researchers who have a connection with the authors. Completed responses were obtained from 111 subjects (79 per cent). Findings – The results of the conjoint analysis revealed that the most important attribute was quality of the medical institution. Organizational form was the attribute with the lowest importance. The utility value of being a public hospital was the highest within the organizational form attribute for all respondents and being a private hospital was the lowest. The quality of the medical institution was considered the most important factor in selecting a medical institution and the type of organizational form was considered least important. Regarding organizational form, being a public hospital was most preferred and being a hospital managed by a company and a private hospital were least preferred respectively among healthcare professionals and other occupations. Originality/value – The paper provides a relative evaluation of the factors thought to be important for patients in Japan when selecting a medical institution. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to outline the problem of sepsis and a global initiative to reduce the burden of this disease. Design/methodology/approach – This is a summary description of the strategy being applied by the Global Sepsis Alliance (GSA) and its partners to deal with sepsis. Findings – The paper outlines the problem of sepsis, primary goals of the GSA, early indicators of the outcome from initiatives and proposes strategies for the future. The key initiative was WSD (World Sepsis Day), which succeeded in creating public and stakeholder awareness via the use of focused and informal meetings, use of the media and the internet. Practical implications – Tackling the problem of sepsis requires a two pronged approach that creates public and stakeholder awareness that prompts action as well as focused research efforts that address the key clinical challenges in sepsis. Social implications – The importance of community education and support for initiatives that change attitudes and behavior are highlighted. Originality/value – The proposed initiatives for sepsis that have been implemented as outlined in this paper are novel for the field and have proven to be successful. On-going supports for such initiatives are warranted. [ABSTRACT FROM AUTHOR]

Purpose – The rate of turnover of hospital managers has been high in Sweden. Hospitals are regarded to be difficult to manage, which is connected with different discourses and action logics such as politics, medicine, care and management creating complex conditions for hospital management. The purpose of this paper is to analyse hospital managers' management conditions in conjunction with hospital mergers. Design/methodology/approach – Two case studies concerning hospital mergers illustrate these management conditions by means of analysing how different actions are communicated by politicians, county council directors, and hospital managers. The author's own experiences as a hospital manager have been made use of, as have document studies. In the analysis, conducted with the support of several theoretical perspectives, certain themes emerge which touch upon these management conditions. Findings – In connection with hospital mergers, leading hospital actors carry out communicative games controlled by different action logics. No one wants to get stuck with the losing card. The article demonstrates the difficulties of implementing radical organizational changes in hospitals. A challenge for hospital managers lies in creating a shared dialogue and a consensus with the professions, the politicians and the media. The crucial position of power held by the politicians and the professions in critical situations has to be dealt with. Otherwise the hospital manager has to resign. Originality/value – The paper aims to clarify under which management conditions the hospital manager acts. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to integrate the ISO 9001:2008 and blueprints by using a process approach, to have systematic regulation in hospital quality management. Design/methodology/approach – This study promotes a process approach when developing, implementing, and improving the effectiveness of hospital service quality to enhance patients' satisfaction by meeting their requirements. This study completes the hospital's blueprints with the process approach by using case study research methods such as in-depth interviews with relevant personnel, on-site observations, and experts' advice. Findings – The results of hospital blueprints described in this study comprise five-plane lines to have systematic regulations. The ISO 9001:2008 process approach and service blueprint are not merely a technological application for medical healthcare services, but rather a fully patient-driven, technologically integrated, and diligently implemented programme. Practical limitations – Because of organisational financial confidentiality, this study does not consider the financial performance of the case hospital, and the results of blueprints may be revised afterward. Originality/value – This paper promotes the adoption of a process approach when developing, implementing, and improving the effectiveness of a hospital outpatient service management system, to enhance outpatients' satisfaction by meeting their requirements. [ABSTRACT FROM AUTHOR]

Purpose |!|#8211; In the OECD countries, hospitals face increased financial restrictions and competition. Process orientation is an essential means of remaining competitive. A wide range of theories and concepts relating to clinical process management already exists. When it comes to practical implementation, however, a comprehensive approach for the target-oriented and consistent introduction of clinical process management throughout an entire hospital is missing. The purpose of this paper is to document the case of a German hospital that has realised a project of this kind and demonstrate the impacts on cooperation and on operational efficiency, which is understood as the degree to which a hospital is capable of steadily realising short lengths of stay. Design/methodology/approach |!|#8211; The case shows the approach to implementing theories and concepts for managing clinical processes in practice as a consistent management system in the day-to-day use of process management and its impacts. Findings |!|#8211; The effect of using clinical processes shown in the case is an additional net profit of several million euros a year |!|#8211; without a reduction in quality. Research limitations/implications |!|#8211; While the impacts of clinical pathways on hospitals are not country-specific, the reasons are nonetheless subject to the political and economic conditions. Therefore, some findings are only valid for hospitals in German-speaking countries. However, major effects (e.g. reduction in the length of stay) may exist everywhere. Originality/value |!|#8211; The paper shows how process orientation in a medium-sized hospital can be systematically implemented. [ABSTRACT FROM AUTHOR]

Purpose – Guidelines have been produced in nearly all developed countries to provide cost-effective hospital care. The study's purpose, therefore, was to determine whether a London hospital's anti-microbial guidelines conform to this principle. Design/methodology/approach – The paper's approach was a literature search to determine anti-microbial therapies for certain diseases and comparing outcomes with what hospital guidelines recommend. Findings – There are significant discrepancies in the hospital anti-microbial guidelines and what is recommended in the literature. Research limitations/implications – Local microbial patterns for these diseases were not studied as they were not formally available and these could have had an impact on guidelines recommendations. Practical implications – Local guidelines influence day-to-day hospital clinical practice and their robustness is important. They need to comply with national and/or international guidelines. Deviations from these guidelines need appropriate comments within the documents to highlight their validity. Such an approach would facilitate medical students and junior doctor training who depend on these guidelines for good clinical practice. Originality/value – The study provides an important contribution to developing hospital clinical guidelines. [ABSTRACT FROM AUTHOR]