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Background/Objectives: Globally, healthcare systems face challenges in optimizing performance, particularly in the wake of the COVID-19 pandemic. This study focuses on the analysis and forecasting of key performance indicators (KPIs) for the County Emergency Clinical Hospital in Craiova, Romania. The study evaluates indicators such as average length of stay (ALoS), bed occupancy rate (BOR), number of cases (NC), case mix index (CMI), and average cost per hospitalization (ACH), providing insight into their dynamics and future trends. Methods: We performed statistical analyses on quarterly data from 2010 to 2023, employing descriptive statistics and stationarity tests (e.g., Dickey–Fuller), using ARIMA models to forecast each KPI, ensuring model validation through tests for autocorrelation, heteroscedasticity, and stationarity. The model selection prioritized Akaike and Schwarz criteria for robustness. Results: The findings reveal that ALoS and BOR demonstrate seasonality and are influenced by colder months, and it is expected that the ALoS will stabilize to around five days by 2025. Moreover, we predict that the BOR will range between 46 and 52%, reflecting these seasonal variations. The NC forecasts indicate a post-pandemic recovery but to below pre-pandemic levels, and we project the CMI to stabilize at around 1.54, suggesting a return to consistent case complexity. The ACH showed significant growth, particularly in the fourth quarter, driven by inflation and seasonal costs, and it is projected to reach more than RON 3000 by 2025. Conclusions: This study highlights the utility of ARIMA models in forecasting healthcare KPIs, enabling proactive resource planning and decision-making. The findings underscore the impact of seasonality and economic factors on hospital operations, offering valuable insights for improving efficiency and adapting to post-pandemic challenges. [ABSTRACT FROM AUTHOR]

In a dynamic healthcare industry, aligning the goals and objectives of hospitals and physicians through integration has been suggested to influence performance. Physicians' leadership and active involvement in governance can direct resource usage, Electronic Health Record (EHR) implementation, price negotiation, better coordination, and continuity of services for patients, thus affecting performance. This study aimed to examine the relationship between physician integration and hospital performance, investigating both financial and quality outcomes. We used a longitudinal study design. Our sample was hospital-level data from 2014 to 2019, which contained 6000 U.S. hospital-year observations. The dependent variables were quality outcomes (readmission rates) and financial outcomes (total and operating margins). The independent variable explored three dimensions of integration: high, low, and overall integration. Findings showed no impact of hospital–physician integration on quality outcomes and financial performance. High-integration hospitals did not show any significant relationships with quality outcomes and financial performance compared to hospitals that did not have high integration. Hospital–physician integration may have little potential to bring clinical integration even though vertical integration is present. A commitment to improving quality as a strategic priority may be vital in impacting quality outcomes, followed by financial performance. [ABSTRACT FROM AUTHOR]

Background: Providing high-quality healthcare services at low or no cost, especially in a densely populated country like India, is an enduring challenge. Thus, the efficacy of government-run hospitals and healthcare instructions has become critical for developing and developing countries. Aim: The current study aimed to investigate the relative performances under variable ownership patterns and scrutinise whether the differences in performances are significant or not to explore determinants of the performance of the hospitals. Methods: The study has been conducted in East and West Bardhaman, West Bengal, India. Data envelopment analysis measures hospitals' performance under variable ownership patterns. The Mann-Whitney U Test is employed to examine whether the performance differences among these hospitals are significant. Finally, Censored Tobit Analysis is used to gain insight into the determinants of their performance. Hospitals are categorized according to their ownership pattern: government hospitals owned by the state government, public hospitals owned by public sector undertakings, and private authorities. Results: Considering the input-output variables, relative performances have been measured. The hospitals under government ownership show the best performance, followed by public hospitals owned by public sector undertakings and private authorities. This performance level has significant determinants like the size of the hospital, bed occupancy rate, and the management and authority of the hospitals. Conclusion: In a developing or underdeveloped nation, all healthcare service providers need to be efficient enough to attain the health of the masses. This study has revealed that the vision of 'health for all' can be reached through the mission of 'healthcare inclusion' strategy by including all hospitals on the supply side regardless of their motive, ownership pattern, or other phenomenon. [ABSTRACT FROM AUTHOR]

Even though Indonesia has a large number of hospitals and has experienced significant progress in realizing Universal Health Coverage (UHC), service performance is still relatively low, so many patients seek treatment abroad. The performance of services and care systems in hospitals is often associated with low use of digital technology. The complexity of adopting digital technology in a hospital environment is not an easy thing to do, with the majority of users carrying out digital technology functions being health officers and professionals. This research aims to explore the influence of Digital Leadership in encouraging the adoption of digital technology and its influence on Hospital Performance. Survey data conducted on 285 leaders of Class C and D hospitals spread throughout Indonesia, through Structural Equation Modeling (SEM) analysis using Lisrel 8.80, it was found that there was a positive and significant influence on the role of Digital Adoption Capability as a mediation on Hospital Performance. It was found that Digital Leadership has a positive and significant influence on hospital performance both directly and through the mediation of Digital Adoption Capability. Environmental Dynamism factors have also been proven to significantly influence hospital management's desire to improve performance through the adoption of digital technology. The model resulting from this research provides a comprehensive view of hospital management in developing effective digital technology adoption strategies in facing an ever-changing environment. [ABSTRACT FROM AUTHOR]

Introduction: Bariatric surgery aims for optimal patient outcomes, often evaluated through the percentage total weight loss (%TWL). Quality registries employ funnel plots for outcome comparisons between hospitals. However, funnel plots are traditionally used for dichotomous outcomes, requiring %TWL to be dichotomized, potentially limiting feedback quality. This study evaluates whether a funnel plot around the median %TWL has better discriminatory performance than binary funnel plots for achieving at least 20% and 25% TWL. Methods: All hospitals performing bariatric surgery were included from the Dutch Audit for Treatment of Obesity. A funnel plot around the median was constructed using 5-year %TWL data. Hospitals positioned above the 95% control limit were colored green and those below red. The same hospitals were plotted in the binary funnel plots for 20% and 25% TWL and colored according to their performance in the funnel plot around the median. We explored the hospital's procedural mix in relation to %TWL performance as possible explanatory factors. Results: The median-based funnel plot identified four underperforming and four outperforming hospitals, while only one underperforming and no outperforming hospitals were found with the binary funnel plot for 20% TWL. The 25% TWL binary funnel plot identified two underperforming and three outperforming hospitals. The proportion of sleeve gastrectomies performed per hospital may explain part of these results as it was negatively associated with median %TWL (β = − 0.09, 95% confidence interval [− 0.13 to − 0.04]). Conclusion: The funnel plot around the median discriminated better between hospitals with significantly worse and better performance than funnel plots for dichotomized %TWL outcomes. [ABSTRACT FROM AUTHOR]

Assessing hospital performance during quality improvement initiatives relies heavily on statistical methodologies aimed at benchmarking. This multi-institutional study evaluates established statistical approaches for their applicability in improving healthcare quality. Using a dataset encompassing 48,521 patients undergoing craniotomy surgery from 2019 to 2023 across 180 hospitals, 6 statistical techniques were analyzed. Non-contraction methods included indirect standardization without hospital effects, with fixed effects, and direct standardization with fixed effects. Contraction methods comprised direct standardization with random effects, indirect standardization with random effects, and Exponential Smoothing methods. Adjusted rates, rankings, and performance outliers are the main emphasis of this study, which evaluates hospital performance concerning the rate of operation deaths and severe complications or deaths among approaches. Contraction methods significantly reduced inter-hospital variation in death rate(adjusted: 1%2%; observed: 0%-10%) and severe complications or death (observed: 3%-35%; adjusted: 7%-17%). Hospital rates were effectively brought closer to the collective mean using these techniques. Direct standardization with hospital random effects resulted in significant changes in death rate quintile rankings for 17% to 39% of hospitals when compared to fixed effects. Indirect standardization with random effects revealed no performance outliers for death rates in compact and moderate-sized hospitals, but logistic and fixed effect approaches revealed outliers. The choice of statistical approach has a considerable impact on hospital rankings and the identification of performance outliers. These insights are critical for appropriately evaluating the hospital's effectiveness in quality improvement initiatives. [ABSTRACT FROM AUTHOR]

Governing boards and executive leaders play important roles ensuring that their organizations work toward their missions and maintain their visions, while also meeting compliance and performance goals. The level of executive involvement in hospital governing boards varies across organizations, with little evidence to suggest whether and to what degree executive involvement influences hospital performance. The aim of this study is to determine the influence of executive involvement in governance on health system performance. The sample analyzed in this study were organizations responding to The Governance Institute's (TGI) Biennial Survey of Hospital and Health Systems in 2017. Bivariate and multivariate analyses were used to examine associations between self-reported executive leadership team involvement in governing boards and a composite metric of health system performance calculated by Truven Analytics as part of the "Top 100" program. Results indicate executive involvement is associated with several organizational characteristics, including whether an institution was defined as a hospital or health system, whether or not the board was appointed by the parent/system, and whether the board was accountable to the parent/system board. Although no significant direct relationship was found between executive team involvement in governance and overall health system performance, several promising pathways for future study were identified and are discussed, including examining specific organizational performance outcomes rather than composite measures. [ABSTRACT FROM AUTHOR]

Kamu hastanesi çalışanlarının ve yöneticilerinin oldukça yoğun bir iş yüküne ve bir o kadar da zor koşullarda çalışmaları sürdürülebilir performansa ulaşmalarını olanaksız hale getirmektedir. Hastane çalışanlarının ve yöneticilerinin beklentilerini karşılayabilmeleri, başarıya ulaşabilmeleri ve sürdürülebilir performansa ulaşabilmeleri için birbirleri ile iletişimin etkisi büyük önem taşıdığı için bu çalışmada da belli bir örneklemden hareketle iletişim konusunun incelenmesi esas alınmaktadır. Bu çalışmanın temel amacı da yöneticiler ve çalışanlar arasındaki iletişimin hastanenin performansına etkisini göstermektir. Burada performans-iletişim ilişkisi ele alınırken Likert ölçeğinden yararlanılmaktadır. Ayrıca analitik bulgular regresyon analizi sonuçları ile desteklenmektedir. Veriler İstanbul sınırları içinde yer alan üç kamu hastanesinde toplam 313 kişiyle anket yöntemiyle, yüz yüze görüşerek elde edilmiştir. Araştırmaya konu olan hastaneler karşılaştırmalı olarak analiz edildiğinde her üç hastanenin yönetici ve çalışanlarının dürüstlük ilkesini önemsediği; yine iletişim olgusunun hastane performansını daha da iyileştireceği algısını benimsedikleri anlaşılmaktadır. Çalışmanın Likert ölçeğine göre standardize edilmiş sonuçları kısaca şu şekilde sıralanabilir: Burada hastanelerde ayrımcılığa yer verilmediğini, iletişim olgusunun hastane performansını daha da iyileştireceğini, stres olgusunun ise hem yöneticiler hem de çalışanlar açısından bir sorun olarak görüldüğünü söylemek mümkündür.

Background and Objectives: To understand the relationship between Lean implementation in information technology (IT) departments and hospital performance, particularly with respect to operational and financial outcomes. Methods: Primary data were sourced from 1222 hospitals that responded to the National Survey of Lean (NSL)/Transformational Performance Improvement, which was fielded to 4500 general medical-surgical hospitals across the United States. Secondary sources included hospital performance data from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS). We performed 2 sets of multivariable regressions using data gathered from US hospitals, linked to AHRQ and CMS performance outcomes. We examined 10 different outcomes measuring financial performance, quality of care, and patient experience, and their associations with Lean adoption within hospital IT departments. We then focused only on those hospitals that adopted Lean in IT to identify specific practices associated with performance. Results: Controlling for other factors, adoption of Lean IT management was associated with lower length of stay (b= -0.098, P= .018) and inpatient expense per discharge (b= -0.112, P= .090). Specifically, use of visual management tools (eg, A3 storyboards, status sheets) was associated with lower adjusted inpatient expense per discharge (b= -0.176, P= .034) and higher earnings before interest, taxes, depreciation, and amortization margin (b= 0.124, P= .042). Such tools were also associated with hospital participation in bundled payment programs (odds ratio = 2.326; P= .046; 95% confidence interval, 0.979-5.527) and percentage of net revenue paid on a shared risk basis (b= 0.188, P= .031). Conclusions: Lean IT management was associated with positive financial performance, particularly with hospital participation in value-based payment. More detailed study is needed to understand other influential factors and types of work processes, activities, or mechanisms by which high-functioning IT can contribute to financial outcomes. [ABSTRACT FROM AUTHOR]

The effect of hospital participation in the Japan Nosocomial Infection Surveillance (JANIS) programme on surgical site infection (SSI) prevention is unknown. To determine if participation in the JANIS programme improved hospital performance in SSI prevention. This retrospective before–after study analysed Japanese acute care hospitals that joined the SSI component of the JANIS programme in 2013 or 2014. The study participants comprised patients who had undergone surgeries targeted for SSI surveillance at JANIS hospitals between 2012 and 2017. Exposure was defined as the receipt of an annual feedback report 1 year after participation in the JANIS programme. The changes in standardized infection ratio (SIR) from 1 year before to 3 years after exposure were calculated for 12 operative procedures: appendectomy, liver resection, cardiac surgery, cholecystectomy, colon surgery, caesarean section, spinal fusion, open reduction of long bone fracture, distal gastrectomy, total gastrectomy, rectal surgery, and small bowel surgery. Logistic regression models were used to analyse the association of each post-exposure year with the occurrence of SSI. In total, 157,343 surgeries at 319 hospitals were analysed. SIR values declined after participation in the JANIS programme for procedures such as liver resection and cardiac surgery. Participation in the JANIS programme was significantly associated with reduced SIR for several procedures, especially after 3 years. The odds ratios in the third post-exposure year (reference: pre-exposure year) were 0.86 [95% confidence interval (CI) 0.79–0.84] for colon surgery, 0.72 (95% CI 0.56–0.92) for distal gastrectomy, and 0.77 (95% CI 0.59–0.99) for total gastrectomy. Participation in the JANIS programme was associated with improved SSI prevention performance in several procedures in Japanese hospitals after 3 years. [ABSTRACT FROM AUTHOR]

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Background Although there have been studies that compared outcomes of patients with acute myocardial infarction (AMI) across countries, little focus has been placed on institutional variance of outcomes. The aim of the present study was to compare institutional variance in mortality following percutaneous coronary intervention (PCI) for AMI and factors explaining this variance across different health systems.Methods Data on inpatients who underwent PCI for AMI in 2016 were obtained from the National Health Insurance Data Sharing Service in Korea, the Diagnosis Procedure Combination (DPC) Study Group Database in Japan, and the National Health Insurance Research Database (NHIRD) in Taiwan. Multilevel analyses with inpatient mortality as the outcome and the hierarchical structure of patients nested within hospitals were conducted, adjusting for common patient-level and hospital-level variables. We compared the intraclass correlation coefficient (ICC) and the proportion of variance explained by hospital-level characteristics across the three health systems.Results There were 17 351 patients from 160 Korean hospitals, 29 804 patients from 660 Japanese hospitals, and 10 863 patients from 104 Taiwanese hospitals included in the analysis. Inpatient mortality rates were 6.3%, 7.3%, and 6.0% in Korea, Japan, and Taiwan, respectively. After adjusting for patient and hospital characteristics, Taiwan had the lowest variation in mortality (ICC, 1.8%), followed by Korea (2.2%) and then Japan (4.5%). The measured hospital characteristics explained 38%, 19%, and 9% of the institutional variance in Korea, Taiwan, and Japan, respectively.Conclusion Korea, Japan, and Taiwan had similarly uniform outcomes across hospitals for patients undergoing PCI for AMI. However, Japan had a relatively large institutional variance in mortality and a lower proportion of variation explainable by hospital characteristics, compared with Korea and Taiwan.

Background: This study demonstrates that digital maturity contributes to strengthened quality and safety performance outcomes in US hospitals. Advanced digital maturity is associated with more digitally enabled work environments with automated flow of data across information systems to enable clinicians and leaders to track quality and safety outcomes. This research illustrates that an advanced digitally enabled workforce is associated with strong safety leadership and culture and better patient health and safety outcomes. Objective: This study aimed to examine the relationship between digital maturity and quality and safety outcomes in US hospitals. Methods: The data sources were hospital safety letter grades as well as quality and safety scores on a continuous scale published by The Leapfrog Group. We used the digital maturity level (measured using the Electronic Medical Record Assessment Model [EMRAM]) of 1026 US hospitals. This was a cross-sectional, observational study. Logistic, linear, and Tweedie regression analyses were used to explore the relationships among The Leapfrog Group's Hospital Safety Grades, individual Leapfrog safety scores, and digital maturity levels classified as advanced or fully developed digital maturity (EMRAM levels 6 and 7) or underdeveloped maturity (EMRAM level 0). Digital maturity was a predictor while controlling for hospital characteristics including teaching status, urban or rural location, hospital size measured by number of beds, whether the hospital was a referral center, and type of hospital ownership as confounding variables. Hospitals were divided into the following 2 groups to compare safety and quality outcomes: hospitals that were digitally advanced and hospitals with underdeveloped digital maturity. Data from The Leapfrog Group's Hospital Safety Grades report published in spring 2019 were matched to the hospitals with completed EMRAM assessments in 2019. Hospital characteristics such as number of hospital beds were obtained from the CMS database. Results: The results revealed that the odds of achieving a higher Leapfrog Group Hospital Safety Grade was statistically significantly higher, by 3.25 times, for hospitals with advanced digital maturity (EMRAM maturity of 6 or 7; odds ratio 3.25, 95% CI 2.33-4.55). Conclusions: Hospitals with advanced digital maturity had statistically significantly reduced infection rates, reduced adverse events, and improved surgical safety outcomes. The study findings suggest a significant difference in quality and safety outcomes among hospitals with advanced digital maturity compared with hospitals with underdeveloped digital maturity. [ABSTRACT FROM AUTHOR]

Based on the social capital theory, this study argues that intellectual capital, defined as knowledge and capabilities within the organization, significantly affect hospital performance. This study examines the impact of intellectual capital on four key hospitals' performance metrics, i.e. quality, productivity, length of stay, and satisfaction. Using a sample of 34 hospital facilities' operational reports to construct hospital performance and individual-level survey of 143 individuals across these 34 facilities to construct intellectual capital during 2018, this study finds that intellectual capital significantly increases employee productivity and reduces patient stay length. This study contributes to the literature by providing evidence that intellectual capital plays an important role in reducing bottleneck for hospitals to meet increasing demand in healthcare services. [ABSTRACT FROM AUTHOR]

OBJECTIVE Evaluation of the operational and financial results of the National Health System (NHS) hospitals for the period 2010-2020 is attempted up to the COVID-19 (coronavirus) era. METHOD The web-based application ESY.net/BI forms of the Ministry of Health for the period 2010-2020 was used as the basis for the collection of financial and operational data. The data include the identity of NHS hospitals (type, size, region, health region, etc.), financial (expenditure by category, revenue), patient (hospitalizations, visits to outpatient departments [TEI], departments of emergency services [ΤEP], evening clinics) and staff data. From the aforementioned data a number of indicators were produced, such as average length of stay, average cost of hospitalisation, annual revenue per bed (YRPB), annual cost per bed (YCPB) etc. and their evolution over time. For the evaluation and assessment of these data, they were initially processed and statistically analyzed using the Statistical Package for Social Sciences (SPSS), version 20.0 software. At the same time, the relevant literature was utilized. RESULTS The results related to the longitudinal analysis and evaluation of the above data over the period 2010-2020 and the influence of economic, health and institutional conditions on their formation. CONCLUSIONS Continuous and systematic monitoring, evaluation and utilization of operational and financial data of hospitals in order to impose corrective actions are fundamental factors for their economic and operational upgrading and the development of an effective strategic planning. [ABSTRACT FROM AUTHOR]

Abstract Background Very limited empirical research has been done on operational flexibility management in the healthcare industry, especially in hospital settings. This study aimed to propose a model of the effects of operational flexibility on hospital performance through management capability and employee engagement as mediating variables. Methods The proposed model is validated through an empirical study among 480 clinical and administrative staff from five hospitals in Jordan. Structural equation modeling and confirmatory factor analysis were the main techniques used to validate the model and examine the hypotheses. Results Operational flexibility was demonstrated to have a positively significant impact on hospital performance, management capability, and employee engagement. Employee engagement was demonstrated to positively impact hospital performance. Management capability had a significant result on hospital performance without having a clear impact. In addition, management capability and employee engagement played a major role as partial mediating effects between operational flexibility and hospital performance, and there is a role for employee engagement as a partial mediating effect between management capability and hospital performance. Conclusion Significant progress has been achieved in hospital management, especially in terms of operational flexibility, management capability, and staff engagement.

Background and purpose: This research was conducted with the aim of determining the relationship between the implementation of the strategic plan and the performance of the hospital. The importance of knowing the factors affecting the implementation of the strategic plan and its identification leads to better planning and the correct implementation of the strategic planning process. Methods: The current research is a descriptive analytical research, in terms of cross-sectional time and practical results, and it was carried out in 2018. The research population is all the people who have played a role in the drafting of the strategic plan. This research has used the census, which filled the questionnaire in a high percentage of the statistical population. After collecting the data, the information was entered into the software and SPSS version 16 software was used to analyze the data. Findings: The relationship between the implementation of the strategic plan and the performance of the hospital is direct and strong. Among all parts of the strategic plan, customer management plays a more important role than other parts of the strategic plan in improving the performance of the hospital. Conclusion: In order to have optimal performance in a hospital, we need detailed strategic planning, and this plan must be implemented carefully and properly monitored so that it can bring us optimal performance.

Nordic comparative health economics research stands out internationally both by its access to excellent patient data and its long-time commitment to rigorous analyses. In this article, we present the methodological foundations and the results from two types of performance analyses – comparative analyses of health care outcomes and costs at hospital level and similar analyses at the disease level. In the concluding part, we discuss strength and weaknesses of the Nordic comparative analyses, and how we should develop Nordic comparative health economics research further.

BackgroundThe healthcare system of Saudi Arabia has evolved radically into an institution that is adaptive to global change and is abreast with new advances in medical field to meet Saudi Vision 2030. The concept and practice of the dimensions of learning organization could provide a framework to significantly improve organizational performance. This study explores the practice of the seven dimensions of LO and determines their utilization toward enhanced performance at hospitals in Hail, Kingdom of Saudi Arabia (KSA). The findings of this study will help improve organizational (hospital) performance.MethodThis cross-sectional study included 117 nurse respondents from various government and private hospitals in the Hail region. Staff nurses were surveyed using the Dimensions of Learning Organization Questionnaire (DLOQ), and supervisors and managers were interviewed.ResultsCreation of continuous learning opportunities, team learning and collaboration, and strategic leadership in learning were perceived to be very satisfactorily utilized. Promotion of dialogue and inquiry, systems to capture and share learning, and empowerment and connection of the organization to the community were perceived to be satisfactorily utilized. Furthermore, the dimensions were found to be directly correlated, evidently signifying a strong relationship.ConclusionOverall, hospitals in the Hail region were found to be learning organizations. The dimensions of learning organization were utilized very satisfactorily, and the culture of learning was strongly embedded in the hospitals' systems and practices.

The coronavirus infection COVID-19 killed millions of people around the world in 2019-2022. Hospitals were in the forefront in the battle against the pandemic. This paper proposes a novel approach to assess the effectiveness of hospitals in saving lives. We empirically estimate the production function of COVID-19 deaths among hospital inpatients, applying Heckman's two-stage approach to correct for the bias caused by a large number of zero-valued observations. We subsequently assess performance of hospitals based on regression residuals, incorporating contextual variables to convex quantile regression. Data of 187 hospitals in England over a 35-week period from April to December 2020 is divided in two sub-periods to compare the structural differences between the first and second waves of the pandemic. The results indicate significant performance improvement during the first wave, however, learning by doing was offset by the new mutated virus straits during the second wave. While the elderly patients were at significantly higher risk during the first wave, their expected mortality rate did not significantly differ from that of the general population during the second wave. Our most important empirical finding concerns large and systematic performance differences between individual hospitals: larger units proved more effective in saving lives, and hospitals in London had a lower mortality rate than the national average. [ABSTRACT FROM AUTHOR]

Performance management in the public sector is both multifaceted and convoluted. This is particularly pertinent in hospitals, which are complex institutional organizations. Our paper explores the key drivers compelling Irish public acute‐care hospitals to monitor their performance. The context of our study is located against the unique historical backdrop of the Irish health service, whose evolution over time reflects religious control, underfunding by the State and reliance on a decentralized structure up until the early 2000s. This study was conducted during 2009–2010, in the aftermath of the financial crisis of 2008–2009. Interviews were conducted with members of the hospital executive management team, comprising clinical and nonclinical senior managers, using the framework of Kelly et al. (2015) to explore and analyze respondent perspectives. We propose that a combination of key forces, emanating from new public management, the institutional environment, and its constituent elements spurs hospitals to monitor their performance. The confluence of these forces reveals a perceived change in the institutional logic underpinning hospital performance management. This change involved the substitution of autonomous clinical decision‐making for a more team‐based managerial logic whereby clinicians engaged as part of a multidisciplinary executive unit and accepted responsibility for hospital performance. This paper contributes to the literature on performance management in public services and, more specifically, builds on and addresses the paucity of research on Irish acute‐care hospitals. [ABSTRACT FROM AUTHOR]

An essential characteristic of an effective healthcare system is the responsiveness to patients' legitimate expectations. Maintaining the responsiveness of health organizations at a high level requires constant evaluation of their situation as perceived by patients. The aim of this study was to assess the perceived responsiveness of inpatients of public healthcare facilities in the South Tongu District, Ghana. This study used a convenient sampling approach to collect data from a total of 200 inpatients who were selected systematically at the time of their discharge. The World Health Organization's (WHO) responsiveness questionnaire was used as the research tool to assess responsiveness. T-test and ANOVA was used for comparing the mean values. More than half of the hospitalized patients ranked the general responsiveness as good (73%). Our results ranked the different levels of responsiveness perceived by patients and revealed the areas that require further attention for improvement. [ABSTRACT FROM AUTHOR]

COVID-19 is a disease caused by SARS-CoV-2, which has spread worldwide since the beginning of 2020. Several pharmaceutical and non-pharmaceutical strategies were proposed to contain the virus, including vaccination and lockdowns. One of the consequences of the pandemic was the denial or delay of access to convenient healthcare services, but also potentially the increase in adverse events within those services, like the number of hospital infections. Therefore, the main question here is about what happened to the performance of Portuguese public hospitals. The main goal of this work was to test if the Portuguese public hospitals' performance has been affected by the SARS-CoV-2 pandemic. We used the Benefit-of-Doubt method integrated with the Malmquist Index to analyze the performance evolution over time. Then, we employed a multiple regression model to test whether some pandemic-related variables could explain the performance results. We considered a database of 40 Portuguese public hospitals evaluated from January 2017 to May 2022. The period 2017 to 2019 corresponds to the baseline (pre-pandemic), against which the remaining period will be compared (during the pandemic). We also considered fourteen variables characterizing hospital quality, divided into three main performance definitions (efficiency and productivity; access; safety and care appropriateness). As potential explanatory variables, we consider seven dimensions, including vaccination rate and the need for intensive care for COVID-19-infected people. The results suggest that COVID-19 pandemic features help explain the drop in access after 2020, but not the evolution of safety and appropriateness of care, which surprisingly increased the whole time. [ABSTRACT FROM AUTHOR]

Many countries have introduced competition among hospitals aiming to improve their performance. We evaluate the introduction of competition among hospitals in the Netherlands over the years 2008–2015. The analysis is based on a unique longitudinal data set covering all Dutch hospitals and health insurers, as well as demographic and geographic data. We measure hospital performance using Data Envelopment Analysis and distinguish three components of competition: the fraction of freely negotiated services, market power of hospitals, and insurer bargaining power. We present new methods to define variables for each of these components which are more accurate than previously developed measures. In a multivariate regression analysis, the variables explain more than half of the variance in hospital efficiency. The results indicate that competition between hospitals and the relative fraction of freely negotiable health services are positively related to hospital efficiency. At the same time, the policy measure to steadily increase the fraction of health services contracted in competition may well have resulted in a decrease in hospital efficiency. The models show no significant association between insurer bargaining power and hospital efficiency. Altogether, the results offer little evidence that the introduction of competition for hospital care in the Netherlands has been effective. [ABSTRACT FROM AUTHOR]

AimsThirty-day risk standardized readmission and mortality rates (RSRR, RSMR) are key determinants for hospital performance for cardiovascular conditions such as acute myocardial infarction (AMI) and heart failure (HF). We evaluated whether individual hospitals in the USA perform similarly for HF and AMI over time based on readmission and mortality metrics.Methods and resultsA total of 1950 hospitals in the USA with continuous participation in the Centers for Medicare and Medicaid Services (CMS) public reporting programme between 2010 and 2016 were identified. Latent mixture modelling was used to define performance trajectory groups. Overall, there were consistent declines in the RSMR (16.1-14.0%) and RSRR (20.3-16.6%) for AMI from 2010 to 2016. For HF, RSRR declined over time (25.1-21.7%), while there was a modest increase in RSMR (11.3-12.0%); parallel findings were observed across performance trajectory groups. The proportion of best performing centres for HF care that were also best performers for AMI care based on the 30-day RSMR and 30-day RSRR metric was 54% and 35%, respectively. Furthermore, the discordance rate between the best and worst performers for both conditions was low (

Background: In China, disparities in the quality of stroke care still exist and implementing quality improvement is still a challenge. Aim: The aim of the study was to determine whether the intervention by Shanghai Stroke Service System (4S) has helped improve adherence to stroke care guidelines and patient outcome. Methods: The 4S is a regional stroke network with real-time data extraction among its 61 stroke centers in Shanghai. A total of 11 key performance indicators (KPIs) were evaluated. The primary outcomes were a composite measure and an all-or-none measure of adherence to 11 KPIs. The secondary outcomes were length of hospital stay and in-hospital mortality. Results: The study enrolled 92,395 patients (mean age 69.0 ± 12.5 years, 65.2% men) with acute ischemic stroke hospitalized within 7 days of onset in Shanghai from January 2015 to December 2020. More patients received guideline recommended care between 2018 and 2020 than those between 2015 and 2017 (composite measure 87.1% vs 83.6%; absolute difference 2.9%, 95% confidence interval (CI) = [2.7%, 3.2%], p < 0.001; all-or-none measure 49.2% vs 44.8% patients; absolute difference 3.5%, 95% CI = [2.7%, 4.2%], p < 0.001). Further analysis of individual KPIs showed an absolute increase in six KPIs ranging from 3.4% to 8.9% (p < 0.001 for all comparisons). Compared with 2015–2017, hospital length of stay was shorter (10.95 vs 11.90 days; absolute difference –1.08, 95% CI = [–1.18, –0.99], p < 0.001), and in-hospital mortality was significantly reduced (risk ratio (RR) = 0.88, 95% CI = [0.79, 0.98], p = 0.01) in 2018–2020. Conclusion: The 4S intervention was associated with increased adherence to the stroke care guidelines, which further translated to improved clinical outcomes. Trial registration: ClinicalTrials.gov identifier: NCT02735226. [ABSTRACT FROM AUTHOR]

In this study, it is aimed to determine whether innovative leadership, management capability and work engagement have an effect on hospital performance or not. Although there are configurations of various systems that address these concepts separately, few studies exist on their interaction with innovative leadership, management capability, work engagement, and hospital performance, particularly in healthcare. The universe of the research consists of health workers working in public and private health institutions in Gaziantep. Data were obtained from 281 healthcare workers by using the simple random sampling method, one of the random sampling methods, and the survey application. In the study, it was determined that innovative leadership and management capability had a positive effect on both work engagement and hospital performance. In addition, it has been observed that work engament has a positive effect on hospital performance. In the research, it has been determined that work engagement has a partial mediating role in the effect of innovative leadership and management capability on hospital performance. It can be effective in health care organisations performances, innovative leadership, management capability and work engagement. In the future, researchers should investigate whether other variables (for example organizational commitment, collective efficacy, participatory sense-making) have an effect on the factors used in this study. It is thought that this will contribute to the literature. [ABSTRACT FROM AUTHOR]

This study aims to examine the impact of emergency clinic assets and its reputation on the operation of health clinics that provide health facilities for the community. The unit of analysis in this study is a medical clinic in West Kalimantan, Indonesia. The unit of perception is executives of a medical clinic. The perceptions were taken in one shoot time, particularly in 2021. The population covered 36 general hospitals from various classes, and the samples were taken from as many as 30 hospitals. The examination procedure for the exploration targets in this study used partial least squares. The experimental outcomes support the speculation that clinic assets and medical clinic reputation significantly affect clinic performance either all the while or somewhat. However, emergency clinic reputation has a more prominent commitment to emergency clinic performance, contrasted with emergency clinic assets. The findings of this review provide administrative ramifications to the medical clinic executives with an end goal to further develop emergency clinic performance with endeavors that depend on the improvement of the organization’s standing and upheld by the advancement of emergency clinic assets. Hospital reputation development needs to be prioritized and supported, especially hospital reliability aspect, as well as trustworthiness, credibility, and responsibility should be increased. Hospital resource development needs to be carried out by prioritizing organizational resources, which are upheld by improving human resources and tangible assets. AcknowledgmentThe authors would like to thank the health administrations in several hospitals as officers in charge of hospital management in West Kalimantan helped complete the various data and information needed.

Abstract Background People in Taiwan enjoy comprehensive National Health Insurance coverage. However, under the global budget constraint, hospitals encounter enormous challenges. This study was designed to examine Taiwan medical centers' efficiency and factors that influence it. Methods We obtained data from open sources of government routine publications and hospitals disclosed by law to the National Health Insurance Administration, Ministry of Health and Welfare, Taiwan. The dynamic data envelopment analysis (DDEA) model was adopted to estimate all medical centers' efficiencies during 2015–2018. Beta regression models were used to model the efficiency level obtained from the DDEA model. We applied an input-oriented approach under both the constant returns-to-scale (CRS) and variable returns-to-scale (VRS) assumptions to estimate efficiency. Results The findings indicated that 68.4% (13 of 19) of medical centers were inefficient according to scale efficiency. The mean efficiency scores of all medical centers during 2015–2018 under the CRS, VRS, and Scale were 0.85, 0.930, and 0.95,respectively. Regression results showed that an increase in the population less than 14 years of age, assets, nurse-patient ratio and bed occupancy rate could increase medical centers' efficiency. The rate of emergency return within 3-day and patient self-pay revenues were associated significantly with reduced hospital efficiency (p

Amaç: Bu araştırmanın amacı, Akdeniz Bölgesi’nde faaliyet gösteren kamu hastanelerinin göreceli teknik etkinlik düzeylerini belirlemektir. Yöntem: Araştırmada, hastanelerin performanslarının belirlenmesinde Veri Zarflama Analizi (VZA), Analitik Hiyerarşi Prosesi (AHP) ve Pabon Lasso Modeli (PLM) kullanılmıştır. İlk olarak ağırlık kısıtlaması olmadan VZA, daha sonra AHP ile elde edilen ağırlıklı VZA modeli uygulanmıştır. En son aşamada yatak kullanım performasını belirlemede PLM kullanılmıştır. Bulgular: VZA modeline göre hastanelerin %34’ü teknik düzeyde verimlidir. Girdi ve çıktıların ağırlıkları dikkate alınarak yapılan VZA’ya göre hastanelerin %12,8’inin teknik düzeyde verimli olduğu tespit edilmiştir. PLM’ye göre hastanelerin %31,9’unun en verimli bölgede (3. Bölge) yer aldığı saptanmıştır. Özgünlük: Bu araştırmada hastane verimliliklerini belirlemede hibrit yöntem olan Veri Zarflama Analitik Hiyarşi Prosesi (VZAHP) ve PLM yöntemleri birlikte ele alınmıştır. Hibrit yöntemlerin birlikte kullanılarak hastanelerin performansına yönelik kanıta dayalı bilgiler sunulması, yapılan çalışmanın özgünlüğü ortaya koymakta ve literatürdeki eksikliği dolduracağı öngörülmektedir.

BACKGROUND:Readmissions after hospitalization for acute myocardial infarction (AMI) are common. However, the few currently available AMI readmission risk prediction models have poor-to-modest predictive ability and are not readily actionable in real time. We sought to develop an actionable and accurate AMI readmission risk prediction model to identify high-risk patients as early as possible during hospitalization. METHODS AND RESULTS:We used electronic health record data from consecutive AMI hospitalizations from 6 hospitals in north Texas from 2009 to 2010 to derive and validate models predicting all-cause nonelective 30-day readmissions, using stepwise backward selection and 5-fold cross-validation. Of 826 patients hospitalized with AMI, 13% had a 30-day readmission. The first-day AMI model (the AMI "READMITS" score) included 7 predictors: renal function, elevated brain natriuretic peptide, age, diabetes mellitus, nonmale sex, intervention with timely percutaneous coronary intervention, and low systolic blood pressure, had an optimism-corrected C-statistic of 0.73 (95% confidence interval, 0.71-0.74) and was well calibrated. The full-stay AMI model, which included 3 additional predictors (use of intravenous diuretics, anemia on discharge, and discharge to postacute care), had an optimism-corrected C-statistic of 0.75 (95% confidence interval, 0.74-0.76) with minimally improved net reclassification and calibration. Both AMI models outperformed corresponding multicondition readmission models. CONCLUSIONS:The parsimonious AMI READMITS score enables early prospective identification of high-risk AMI patients for targeted readmissions reduction interventions within the first 24 hours of hospitalization. A full-stay AMI readmission model only modestly outperformed the AMI READMITS score in terms of discrimination, but surprisingly did not meaningfully improve reclassification.

Background: Very limited empirical research has been done on operational flexibility management in the healthcare industry, especially in hospital settings. This study aimed to propose a model of the effects of operational flexibility on hospital performance through management capability and employee engagement as mediating variables. Methods: The proposed model is validated through an empirical study among 480 clinical and administrative staff from five hospitals in Jordan. Structural equation modeling and confirmatory factor analysis were the main techniques used to validate the model and examine the hypotheses. Results: Operational flexibility was demonstrated to have a positively significant impact on hospital performance, management capability, and employee engagement. Employee engagement was demonstrated to positively impact hospital performance. Management capability had a significant result on hospital performance without having a clear impact. In addition, management capability and employee engagement played a major role as partial mediating effects between operational flexibility and hospital performance, and there is a role for employee engagement as a partial mediating effect between management capability and hospital performance. Conclusion: Significant progress has been achieved in hospital management, especially in terms of operational flexibility, management capability, and staff engagement. [ABSTRACT FROM AUTHOR]

Background: In 2019, the COVID-19 pandemic emerged. Variation in COVID-19 patient outcomes between hospitals was later reported. Purpose: This study aims to determine whether sustainers—hospitals with sustained high performance on Hospital Value-Based Purchasing Total Performance Score (HVBP-TPS)—more effectively responded to the pandemic and therefore had better patient outcomes. Methodology: We calculated hospital-specific risk-standardized event rates using deidentified patient-level data from the UnitedHealth Group Clinical Discovery Database. HVBP-TPS from 2016 to 2019 were obtained from Centers for Medicare & Medicaid Services. Hospital characteristics were obtained from the American Hospital Association Annual Survey Database (2019), and county-level predictors were obtained from the Area Health Resource File. We use a repeated-measures regression model assuming an AR(1) type correlation structure to test whether sustainers had lower mortality rates than nonsustainers during the first wave (spring 2020) and the second wave (October to December 2020) of the pandemic. Results: Sustainers did not have significantly lower COVID-19 mortality rates during the first wave of the pandemic, but they had lower COVID-19 mortality rates during the second wave compared to nonsustainers. Larger hospitals, teaching hospitals, and hospitals with higher occupancy rates had higher mortality rates. Conclusion: During the first wave of the pandemic, mortality rates did not differ between sustainers and nonsustainers. However, sustainers had lower mortality rates than nonsustainers in the second wave, most likely because of their knowledge management capabilities and existing structures and resources that enable them to develop new processes and routines to care for patients in times of crisis. Therefore, a consistently high level of performance over the years on HVBP-TPS is associated with high levels of performance on COVID-19 patient outcomes. Practice Implications: Investing in identifying the knowledge, processes, and resources that foster the dynamic capabilities needed to achieve superior performance in HVBP might enable hospitals to utilize these capabilities to adapt more effectively to future changes and uncertainty. [ABSTRACT FROM AUTHOR]

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Background and purpose: This research was conducted with the aim of determining the relationship between the implementation of the strategic plan and the performance of the hospital. The importance of knowing the factors affecting the implementation of the strategic plan and its identification leads to better planning and the correct implementation of the strategic planning process. Methods: The current research is a descriptive analytical research, in terms of cross-sectional time and practical results, and it was carried out in 2018. The research population is all the people who have played a role in the drafting of the strategic plan. This research has used the census, which filled the questionnaire in a high percentage of the statistical population. After collecting the data, the information was entered into the software and SPSS version 16 software was used to analyze the data. Findings: The relationship between the implementation of the strategic plan and the performance of the hospital is direct and strong. Among all parts of the strategic plan, customer management plays a more important role than other parts of the strategic plan in improving the performance of the hospital. Conclusion: In order to have optimal performance in a hospital, we need detailed strategic planning, and this plan must be implemented carefully and properly monitored so that it can bring us optimal performance. [ABSTRACT FROM AUTHOR]

Abstract Background The Hospital Readmissions Reduction Program (HRRP), established by the Centers for Medicare and Medicaid Services (CMS) in March 2010, introduced payment-reduction penalties on acute care hospitals with higher-than-expected readmission rates for acute myocardial infarction (AMI), heart failure, and pneumonia. There is concern that hospitals serving large numbers of low-income and uninsured patients (safety-net hospitals) are at greater risk of higher readmissions and penalties, often due to factors that are likely outside the hospital’s control. Using publicly reported data, we compared the readmissions performance and penalty experience among safety-net and non-safety-net hospitals. Methods We used nationwide hospital level data for 2009-2016 from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare program, CMS Final Impact Rule, and the American Hospital Association Annual Survey. We identified as safety-net hospitals the top quartile of hospitals in terms of the proportion of patients receiving income-based public benefits. Using a quasi-experimental difference-in-differences approach based on the comparison of pre- vs. post-HRRP changes in (risk-adjusted) 30-day readmission rate in safety-net and non-safety-net hospitals, we estimated the change in readmissions rate associated with HRRP. We also compared the penalty frequency among safety-net and non-safety-net hospitals. Results Our study cohort included 1915 hospitals, of which 479 were safety-net hospitals. At baseline (2009), safety-net hospitals had a slightly higher readmission rate compared to non-safety net hospitals for all three conditions: AMI, 20.3% vs. 19.8% (p value

Background and Aim: With the outbreak of the COVID-19 pandemic, the performance of hospitals were affected, and changes were made in the utilization of hospital services. Analyzing hospital performance data during the COVID-19 pandemic can provide insights into service utilization patterns and care outcomes for managers and policymakers. This study was conducted to investigate the impact of COVID-19 on selected outcome indicators in the hospitals of Shahid Beheshti University of Medical Sciences, Tehran. Materials and Methods: This research was descriptive-analytical and of the time series analysis type. Six outcome indicators were considered: hospitalization rate, bed occupancy rate, the average length of stay, emergency visits, laboratory tests, and imaging requests. Related data from 12 affiliated hospitals from 2017-2019 (pre-COVID) and 2020 (post-COVID) were obtained from the hospital's intelligent management system. The data were analyzed using R software's interrupted time series analysis method. Results: The hospitalization rate (P=0.015), bed occupancy rate (P=0.04), and the number of laboratory tests (P=0.003) significantly increased immediately after the outbreak of the pandemic. In contrast, emergency visits (P=0.034) have significantly decreased. The bed occupancy rate and the number of imaging requests showed no significant change. The decrease in emergency room visits within one year after the pandemic was significant, but the changes in other outcome indicators were non-significant (P>0.05). Conclusion: Understanding the changes and impact of a major event on hospital outcome indicators is necessary for decision-makers to effectively plan for resource allocation and effective pandemic response. The outbreak of COVID-19 has caused a change in performance and hospital outcomes by affecting the supply and demand of services. In a year after the pandemic's beginning, except for emergency visits, the other indicators have not experienced significant changes. Preservation of essential services such as emergency room visits is recommended in the strategy of rapid response to an epidemic outbreak and public campaigns to encourage people to seek medical care if needed in future waves of the pandemic.

ImportancePatient satisfaction is a crucial indicator for assessing quality of care in healthcare settings. However, patient satisfaction benchmark for cancer hospitals in China is not established.ObjectiveTo examine patient satisfaction levels in tertiary cancer hospitals in China, and inter-hospital variations after case-mix adjustment.DesignA nationwide cross-sectional hospital performance survey conducted from January to March 2021.SettingsAt 30 tertiary cancer hospitals in China.ParticipantsA total of 4,847 adult inpatients consecutively recruited at 30 tertiary cancer hospitals were included.ExposuresPatient characteristics included demographic characteristics (sex, age, education, and annual family income), clinical characteristics (cancer type, cancer stage, self-reported health status, and length of stay), and actual respondents of questionnaire.Main outcomes and measuresPatient satisfaction was measured using 23 items covering five aspects, administrative process, hospital environment, medical care, symptom management, and overall satisfaction. Responses to each item were recorded using a 5-point Likert scale. Patient satisfaction level for each aspect was described at individual and hospital levels. Using multilevel logistic regression, patient characteristics associated with patient satisfaction were examined as case-mix adjusters and inter-hospital variation were determined.ResultsThe satisfaction rates for symptom management, administrative process, hospital environment, overall satisfaction, and medical care aspects were 74.56, 81.70, 84.18, 84.26, and 90.86% with a cut-off value of 4, respectively. Significant predictors of patient satisfaction included sex, age, cancer type, cancer stage, self-reported health status, and actual respondent (representative or patient) (all P < 0.05). The ranking of the hospitals' performance in satisfaction was altered after the case-mix adjustment was made. But even after the adjustment, significant variation in satisfaction among hospitals remained.Conclusions and relevanceThis study pointed to symptom management as a special area, to which a keen attention should be paid by policymakers and hospital administrators. Significant variation in satisfaction among hospitals remained, implying that future studies should examine major factors affecting the variation. In review, target interventions are needed in low-performing hospitals.