Hospital Administration - Science topic

Cronbach's alpha are different between factors dep and indep

teste de reliability

It is mandatory to collect the Ethical Approval letter from your Institution before starting the data collection from the Physicians.

The same Ethical Clearance letter or Ethical sanction letter from the respective academic institutions or any Government offices are concerned about the cross-sectional survey jurisdiction.

This will help when go for publication.

The Editor used to ask this Ethical Approval letter along with your manuscript.

There are many formalities while you want to approach on Publications. Especially funding, Conflict of Interest or Competing Interest, Ethical Approval letter etc have to be submitted to the Editor.

You will be safe if you will submit Ethical issues certificate as well as to protect you if any questions raised by the third parties.

Mostly researchers who are publishing in Scopus Indexed Journals, Web of Science Journals are strictly following these procedures.

Hope you will get more answers from the RG users.

You should mention type of regression ie linear or nonlinear -MR -https://www.statisticssolutions.com/free-resources/directory-of-statistical-analyses/multiple-regression/

As per Dr Blaine,

ordinal logistic regression might work.

The U.S. military utilized -es a paper system or at least partially (service treatment record), this colorcoded folder system is notorious for producing multiple "skeleton" or "shadow" copies as the service member traverses with record from clinic to clinic, base to base.

I agree with the afformentioned recommendations; start collecting, scanning and destroying the paper.

Otherwise, the age old tracers include pink-sheet signature cards, ID card exchange for check-out return, and newly utilized cell-phone or car key exchanges. The later mentioned make it difficult to leave with the file.

Remember, that record is property of and under the legal charge of the department.

Hope this helps...

i considered that data is not exist. it is privacy and secret for hospital due to protect data from decendants. so it will not be online

Thank you all for your diverse and informative answers. Dr.Paul Baker, myself and other members of the Society for Airway Management are putting together a paper on the concept of an Airway Lead. I was wondering what the level of interest would be generated by this publication. "Testing the waters" is a great service of the Research gate community. So thank you all. I have attached an Info-Graphic for our paper on Airway Lead can you let me know what you think? Clear or unclear? Too cute or the correct tone and style?

I would be very careful to pass judgement on a colleague's competency in a speciality other than my own. Are you qualified to judge? are you a trained surgeon?

What would you achieve by declining the case - are you protecting the patient, or yourself? If he is truly incompetent and you decline the case, will your place be taken by an anaesthesiologist who is unaware of the surgeon's incompetence? In this situation the patient might be in even greater peril.

Another issue is what are the results of the surgeon's incompetence? Is there an obvious problem such as increased mortality or morbidity - do his cases bleed more and more often require transfusions? How do you see his incompetence in the OR - is he clumsy, does he perform the wrong procedures? (assuming you would know what the correct ones are). Does he have an increased rate of emergency reopening? etc., etc.

You are potentially opening a can of worms. It is important that you share your concerns with a senior colleague.

This sort of situation is best dealt with quietly and confidentially by a hospital board of senior, experienced clinicians to whom you might express your concerns and seek advice.

Dear Gedion, 

I have done a search and you have 8 papers in Web-of-Science about that issue since 1990 until 2016.Please see the file attacehed. You have only 5 citations.

Have a nice time

Helena

Hi Aleef,

Good to see you after a long time. The mobilization of patients with EVD is very limited. In my practice setting as soon as the ICP is controlled the neurosurgeon allows us to clamp the EVD so we can start mobilizing the patient.  As long as the EVD is not clamped the mobilization of patient is limited to ROM only. Please email me at arshal.thomas@stmarysofmichigan.org.

Thank you,

Arshal Thomas.

Osama,

Forgot to enclose 2 scientific articles for your review.

They assess the decontamination levels:

1) with a dielectric liquid treating the upper side surface of the equipment (hopper and shredder) and bringing the needed field absorption data to the solid waste,

2) a very high density electromagnetic field in the microwave chamber turning the above liquid mixed to solid waste to heat and generating 165°C and a few bars pressure of steam.

The resulting waste has been divided by factor 5 in volume and can be recycled in bricks for insulation purpose, etc...

Cheers,

Laurent H. Selles

Dear Carrera,

Yes, my point is that  there is an enormous increase of duplicate paper work ,which puts abundance work pressure for the healthcare team, which should not be the case.At times some pay more attention to the paper than patient, this is irrespective  of doctors ,pharmacists,nurses etc.,

The patient safety is the foremost important factor in any treatment plan.

I think it would be useful for you to consider one or more discrete issues to focus on, e.g., emergency room crowding, misdiagnosis, poor teamwork leading to poor patient experiences, etc.  Though you may not find too much literature on the last, there is an extensive one on the first.  I'm attaching a recently published commentary on the subject that has a good set of references.

The policy makers ( central authorities) should principally agree or be convinced that implementation of PV system will not only include ADR monitoring but also  prescription monitoring, medication errors, promote rational use of medicines, implement and adhere to standard treatment guidelines.

This all will result into cost saving and improve health care services with optimal use of country's resources.

Dear Hilary,

Are you familiar with the Danish record label Quiet Please, which has been developing optimal relaxing music with doctors? This music has been used widely e.g. in ambulances. The record is “15 Minutes of Peace”, and it can be found on Spotify. There is some information about this project on the internet, but I am not sure if there is any in English.

Best regards

Anne

I suggest a lean organization supported by a continuous improvement culture may be worth considering.

Dr Syed

I took my PhD in nanomedcine drug synthesised by green nanotechnology and i think is a good & new field of research and if you need any help in it i can offer it.

Dear Ron,

For better participation, could you please write in full, ER in your question.

Different meanings would have been guessed. E.g. electronic records, etc. 

Dear Gedion,

 I think your question is really interesting!

From my experience as a hospital director at public hospitals in Sweden, but also from research in health care services (Nordgren 2003, 2015, Nylinder 2012) I will underpin that the budget process at hospitals has to be managed as a creative and thrusted dialogue between those in management and those at the clinical level as well as with the hospital board and it has to be communicated all the time. There are many reasons for this co-creation of the budget.

The first reason is to create understanding of the conditions and context, i.e. the contingencies for the budget as well as for the hospital. In what economic situation is the hospital situated and how does the compensation system work? There are many contingencies that affect the budget control process. Therefore the budget Control process has become matched with circumstances concerning the specific environment where the hospital operates.

The second reason is to communicate and discuss openly the vision and goal for the hospital in terms which are understood of all people working at the hospital. So the language of communication is important.

The third reason is to work with quality and service as management concepts and tools in order to co-create value for patients and stakeholders and moreover to create good financial conditions for the hospital.

Fourthly it should be pinpointed that those professionals, which ‘have’ the highest positions and status at the clinical level influence the budget control process and the use of resources. Therefore they are positioned as responsible and have authority in exercising budget decisions. In this meaning the system could be described as decentralized. The role of central management is to exercise control of the total budget.   

There is a tendency of people to be influenced by the previous highest (or best) level of a factor in the budget process. This tendency means that it is quite hard to bring change into a budget. The focus is therefore often on minor changes since most of the budget is predetermined from previously decisions.

At last, In Sweden the professionals as a rule participate in the budget process and are perceived as responsible.

Hello, in theory it must be the same management in private and public hospitals. I recommend making a systematic search of Next link. greetings and good luck.

Do you mean structural, organizational and quality standards? In case, I can send you the hospital standards sanctioned by the Italian government and the nursing homes standards used in Lombardy (Italy), but … all written in Italian.

I also think that retrospective analysis is the only option. Is it accurate to limit failure to rescue to cardiac arrest? Perhaps one of the early warning system frameworks (EWS; http://www.ihi.org/resources/Pages/ImprovementStories/EarlyWarningSystemsScorecardsThatSaveLives.aspx) could be used to expand the conceptualization of "failure to rescue" . It seems that failure to respond, or a delay in response, at any point when the evidence (i.e., vital signs, O2 sat) suggests an intervention could be on a continuum of failure to rescue.  

How are you Besho.

In our scenario we explain the cost of complication if we are anticipating it, or the case is a high risk. If the patient is well covered with insurance then we can explain as and when the need arise

Hello Dean,

valuable resources you had sent me. I appreciate this a lot. 

Thanks

Dear Farzana

Daylight is still a factor affecting the state of mind of a patient. Who says beneficent light cure said said life. Should that light is not intense to avoid dazzling patients inevitably it is interesting to translucent materials

Greetings,

The document below might be of interest to you. It represents a collected body of operating room crisis checklists and is available for download as PDF free of charge.

All too often, I find that even directed searches return a plethora of useless or unrelated articles and other publications. It may be a good idea to put together a resource like the one referenced above for all to download and use.

Regards,

Stan.

Hi Ariel,

In my studied sample of hospitals, sometimes the extreme values of the indicators ALOS, BTO and BOR may be caused by reasons that do relate to efficiency, like unnecessary long stays for example, or unnecessary admissions. and such problems, when diagnosed, can be modified to improve efficiency, this is what I am proposing in my research.

Do you have any recommendations for an efficiency measure that is as simple as Pabon Lasso and doesn't need too much data? because I'm a little bit restricted to the limitation of data availability in the hospitals of my sample.

LISI is the abbreviation of "Levels of Information Systems Interoperability".

In theoritical phase you should design a framework and define some criteria that demonstrate a conceptual model of your evaluation.

In practical phase you could develop a software for testing any interoperability levels of your model. In this way some existed modules could be usable such as HL7 and other international communication standards/frameworks.

Read this book for more information:

In health domain, HIMSS recommendations and toolkits are usable. Try this:

Firstly, bench mark professional standards independently (of sector). Parametize the key issues in terms of SMART goals. Monitor these over a sufficiently representative time period. Then obtain customer satisfaction feedback. Only then compare the price. Is the outsourced service providing a better service at same price. But  if more expensive and better are the extra benefits worth the extra expense?  

Thank you Ariel for your answer which makes sense to me for sure.

actually, and frankly, what made me ask this question is that I am writing up a thesis on measuring the efficiency of some local hospital using Pabon Lasso model, and my academic supervisor told me that there are such standards, or maybe some specifications rather than standards, and I have searched for that and couldn't find any.

A graduate student of mine and I analyzed ambulance log data and hospital ER statistics to determine the effect of ER capacity on ambulance crew and patient waiting times. Some  variables of interest were: 1) waiting time from arrival to admission to ER bed; 2) ambulance diversions due to ER capacity limitations; and 3) ER capacity measures. Ambulance log data should be available from the emergency transportation provider and hospital ER measures are usually avialable form the ERs.

SBAR is a tool originated from the US Navy and was adapted for use in healthcare for preparation for transfer of a patient to a different hospital setting, hopefully to get the specialized care they need.  Transfer of accountability (TOA) from nurse to nurse requires a slightly different approach.  Valera is correct in stating that "a formal protocol/policy in place that is followed consistently on every unit regarding what information needs to be communicated to the receiving RN".  Using the nursing Kardex, RN's should be able to report on the patient name, age, diagnosis, any allergies, previous hospital admissions and medical history, and of course a pertinent head-to-toe body systems assessment. Tests results, outstanding remaining issues, and family updates/concerns are reported lastly.  A well documented nursing Kardex is an invaluable tool.

Hi Laura,  Thanks for your reply.  I'm now leaning towards month of birth as my method of allocation.  Glen.

I am not an expert in healthcare only an interested researcher in understanding and solving problems in this critical area.  My expertise lies in something called “theory of constraints (TOC)”.  While it sounds horribly complex TOC is quite simple and easily applied.  In TOC we use the five focusing steps to continually improve a system‘s ability to produce goal units (in your case treated patients).  The five focusing steps are one of three processes on ongoing improvement (buffer management, frequently used in healthcare, and the change question sequence are the other two processes.). These five focusing steps are:

1. IDENTIFY the system's constraint(s).

2. Decide how to EXPLOIT the system's constraint(s).

3. SUBORDINATE everything else to the above decision.

4. ELEVATE the system's constraint(s).

5. WARNING!!!! If in the previous steps a constraint has been broken, go back to step 1, but do not allow INERTIA to cause a system's constraint.

I recently coauthored (Cox, Robinson, Maxwell; Sept/Oct 2014) an article in the Journal of Family Practice Management illustrating the application of these steps to an 11-provider practice.  I recommend this article if you want to see how to apply this focusing process in healthcare.  It is a quite simple example; just common sense. 

In your case the market (the patients coming into the emergency room) is the constraint most of the time.  Normally you are able to treat incoming patients in a standard manner.  BUT then you occasionally have overloads where you use up the protective capacity of the emergency department and a backup of untreated patients occurs.  Some of this backup occurs because there is no place to offload treated patients immediately so that the provider can move to the next untreated patient.  This situation might be caused by the hospital’s focusing on minimizing staffing in hospital wards to save money.   The TOC solution would be to add a space buffer behind the constraint (between the emergency department and the specialized wards (the UK system calls this department an assessment ward, a holding area as such).  Treated patients are released to this space buffer where trained staff (maybe some removed from the specialized wards) manage patient care until the treated patients are transferred to the wards.  This approach allows emergency department providers to focus on incoming patients instead of managing already treated patients until they can be transferred to wards thus increase the capacity of the emergency room. In academic terms this space buffer aggregates the statistical fluctuations of the various wards thus having less deviations (reduced standard deviation at the assessment ward than at the sum of the specialized wards).  

Several presentations of the TOC basic concepts and applications of the concepts in various industries are available on the TOCICO (Theory of Constraints International Certification Organization) website for free viewing.  See specifically the healthcare portal web link listed below:

There are seven videos available on this link for free viewing.  An annotated bibliography of healthcare presentations is available on this link also.  

Another related link to TOC in healthcare is provided by Alex Knight (also describes his work on the TOC link above) .  Alex has been implementing TOC in emergency rooms, hospitals and the healthcare supply chain for two decades.  He has been able to move hospitals as measured by responsiveness from the bottom of 500 hospitals to the top 10 in a matter of a few months.  He recently authored a novel (Pride and Joy) describing the application of TOC in hospitals (Similar to Eli Goldratt’s The Goal did in manufacturing in the 1980’s). Alex’s consulting organization provides significant educational materials on TOC in healthcare.  This link below is to articles on applying TOC in healthcare.  On the left of this page below are links to case studies (mostly hospitals) and testimonials.

More generally TOC is a management philosophy that focuses attention on the constraint (the leverage point) in any system and how to increase system throughput.  It is not a cost-cutting approach and provides better responsiveness and healthcare.    

I hope this is helpful.  Jim

This is a very difficult study design, you should have standards criteria helping you the access stress related to working place, to be able to establish causal inference of the the patient outcomes. this would require a reference hospital which will help you to compare your findings. as you know there is a huge diversity in standard of care across hospital and countries, even by region. i will recommend you to consult the HME website and seek advise from statistician

thank you

Hi Sultan,

Hospitals in different parts of the world implement different degrees of risk management activities. The presence of regulations that control quality and safety in hospitals play an important role in reducing risk events e.g. Accreditation programs or state regulations. However, the Health secretary in the Uk has claimed recently that Hospitals are wasting up to £2.5bn a year of the NHS’s budget through poor care and medical errors. 

Many studies has shown that good communication among staff and with patients as well as team work can reduce medical mistakes resulting from miscommunication among care-givers, as well as reducing medical malpractice lawsuits resulting from miscommunication between patients and care-providers.

AT the end, leadership vision and commitment, at all levels, play an important role in improving patient safety and reducing sentinel events.

Regards,

Muna 

One additional to all above is the variance in the stay of the similar type of patients.

This will help the patient to understand the quaity of procedures.

Having taught in a number of executive and MBA programs for physicians, my opinion is that further management education is a must for division chiefs, chairs, deans and those physicians in executive jobs.  However, it must include other skills, especially epidemiology.  For primary care it must take place at the senior resident or division chief level.  Once they get out time pressures to bill are too great. Specialists can wait until later in their careers. 

Average length of stay (ALOS): This measure refers to the average number of days that a patient stays in a hospital. It is calculated using the following formula:

ALOS= (Inpatient days)/Admissions (1)

Bed occupancy rate (BOR): The occupancy rate is a measure of utilization of the available bed capacity. It indicates the percentage of beds occupied by patients in a defined period of time, usually a year. It is computed using the following formula:

BOR= (Inpatient days)/(Bed days) ×100 (2)

Where,

Inpatient days = admissions × ALS, and bed days in the year = number of beds × 365

Bed turnover ratio (BTR): The turnover ratio is a measure of productivity of hospital beds and represents the number of patients treated per bed in a defined period of time (usually a year). It is computed as follows:

BTR= (Total patient admissions)/(Number of beds) (3)

 

With big interest I read the question and contributions and thank you all very much. Hugo Simkin, has your study been published (how could I get it?)? It converges with studies we have been conducting in Germany in clinics or departments of psychiatry and psychotherapy.

Cf. Eunmi Lee, Klaus Baumann, German Psychiatrists' Observation and Interpretation of Religiosity/ Spirituality, in: Evidence-Based Complementary and Alternative Medicine (2013), http://dx.doi.org/10.1155/2013/280168 (15.11.2013).

and Lee, Eunmi / Zahn, Anne / Baumann, Klaus: “Religion in Psychiatry and Psychotherapy?” A Pilot Study: The Meaning of Religiosity/Spirituality from Staff’s Perspective in Psychiatry and Psychotherapy. Religions 2 (2011), 525-535; doi:10.3390/rel2040525

(both open access)

A patient study is about to being published.

In my opinion, spiritual care should not be reduced either to palliative care (as field) or to chaplains ("pastoral care") but as part of a professional competence and attitude of nursing staff and physicians likewise. Due to the troubled relationships between religion(s) and science(s), the exciting task is to find adequate standards and training elements which aim at the benefit of the patients in a wholistic way. It is a joy to read similar viewpoints in this discussion.

The Quality in any Hospital can be measured through two means: (i) Stakeholders perspective and (ii) Customer perspective. Moreover, relying on factual data (KPIs) is most important. To incorporate these, a viable option is to develop a new software that will automatically capture both managerial and clinical indictors.

I think bioMerieux has a product or couple of products which could help you in Infection Control (Observa & Vigiguard), i am not sure if they are still being marketed though.

I do not know what your study is about, but such a concept matters only if a patient need (cognitive, procedural, technological) is not met by the available physicians and equipment. Coming to a hospital during hours or after hours does not matter if what is needed to help a patient cannot be done.

Werner, so do hospitals in Germany change linen like curtains on a routine basis?