Health Services Management Research current issue

A revised approach to performance measurement for health-care estates

May, D., Price, I. — Thu, 29 Oct 2009 17:09:29 PDT

The purpose of the research was to show how lean asset thinking can be applied to UK health-care facilities using different measures to compare the estates contribution to the business of health-care providers. The challenge to conventional wisdom matches that posed by ‘Lean Production’ to ‘Mass Manufacturing’. Data envelope analysis examined the income generated and patient-occupied area as outputs from the gross area of a NHS Trust's estate. The approach yielded strategic comparisons that conventional facilities management measures of cost per square metre hide. The annual cost of an excess estate is conservatively estimated at £600,000,000 (in England alone). Further research to understand the causes of the excess is needed. Meanwhile the research illustrates the power of an alternative way of assessing facilities performance. The authors are not aware of the lean asset perspective previously being applied to health-care facilities. The research shows the underlying fallacy of relying on cost per square metre as the primary measure of asset performance. The results and discussion will be particularly useful to senior estates and facilities managers wishing to use new measures to define strategic estates targets.

Everybody's business: from policy to lived practice - the benefits of embedding specialist mental health workers in physical health-care systems

Read, J., Andrews, T. — Thu, 29 Oct 2009 17:09:30 PDT

As Britain's population ages, health- and social-care systems face the challenge of continuing to provide high-quality care in the face of increased demand on services. Government policy has proposed meeting this challenge through integrated partnership working to enable people with complex, multiple needs to receive timely care closer to home. Co-morbid mental health needs, including dementia, are common in people with physical health issues, and must be addressed appropriately if systems are to provide the best possible all-round patient care. This paper describes how two senior clinical psychologists have developed an embedded living mental health resource within physical health care, and demonstrates how this has directly and positively impacted on both service performance indicators and patient experience.

An analysis of the factors influencing networkability in the health-care sector

Mettler, T., Rohner, P. — Thu, 29 Oct 2009 17:09:30 PDT

In most industries of economy, the production structures evolved into activities characterized by a high division of labour between the business partners combined with specialization, the standardization of service components and extensive networking. In the health-care sector, the first signs of a similar development are beginning to crystallize. As a consequence, networkability, the ability to link up with other players on the basis of commonly agreed standards for the joint provisioning of patient-centred and cost-efficient health services will emerge to a key concept for future health service delivery. As not only technical but mainly organizational and behavioural issues are actually determining networkability of health-care organizations, a holistic model for analysis is needed. In this paper, the main variables leading to an increase in this networkability are identified and compiled into a comprehensible procedure model for health-care practitioners.

Using mixed methods to identify factors influencing patient flow

Van Vaerenbergh, C. — Thu, 29 Oct 2009 17:09:30 PDT

An effective method of identifying operational factors that influence patient flow can potentially lead to improvements and thus have huge benefits on the efficiency of hospital departments. This paper presents a new inductive mixed-method approach to identify operational factors that influence patient flow through an accident and emergency (A&E) department. Preliminary explorative observations were conducted, followed by semi-structured interviews with key stakeholders. A questionnaire survey of all medical, nursing, porter and clerical staff was then conducted. The observations provided factors for further exploration: skill-mix, long working hours, equipment availability, lack of orientation programmes, inefficient IT use and issues regarding communication structures. Interviewees highlighted several factors, including availability of medical supervision and senior nursing staff, nursing documentation issues, lack of morale due to overcrowding, personality differences and factors relating to the department layout. The questionnaire respondents strongly supported the importance of the previously identified factors. This paper demonstrates an effective mixed-method approach that can be replicated by other health-care managers to identify factors influencing patient flow. Further benefits include increased volume and quality of data, increased staff awareness for the influence of internal factors on patient flow and enhancing the evidence base for future decision making when prioritizing A&E projects.

Use of card sort methodology in the testing of a clinical leadership competencies model

Jahrami, H., Marnoch, G., Gray, A. M. — Thu, 29 Oct 2009 17:09:30 PDT

The purpose of this paper is to examine the utility of a qualitative ‘card sort’ research tool – when it is merged with traditional quantitative data gathering methods – to add to our understanding about the nature of competency-based approaches to leadership studies. The study demonstrates how a qualitative technique (card sort) was used for the task of testing a clinical leadership competencies model. All the steps in the card sort methodology are described through its application to the research problem. The paper concludes that card sort has considerable use in adding to the validity of research into the competency approach to leadership. The study reports only one single case. Therefore, the technique must be repeated to secure its validation as a testing technique. The card sort method is proven to be a viable tool to ascertain the individual subjects perceptions regarding competencies. The methodology is described in sufficient detail so as to enable its replication and application by professionals and academic researchers alike. Both groups will find this methodology useful and interesting. The paper seeks to improve upon existing methods for studying leadership competencies. By addressing the limitations of different methods, and also by merging different independent approaches, this project provides an innovative integrated knowledge that can be of significant value.

Performance evaluation of ambulatory surgery centres: an efficiency approach

Iyengar, R. N, Ozcan, Y. A — Thu, 29 Oct 2009 17:09:30 PDT

This paper evaluates the performance of 198 ambulatory surgery centres (ASCs) operating in the State of Pennsylvania during the fiscal year 2006. Performance is assessed from technical efficiency view using data envelopment analysis (DEA). Multi-input/output model included two inputs: number of operating rooms and labour, and patient surgical visits differentiated by age groups: 0–17, 18–64, 65+ as three outputs. Input oriented models were employed to assess various DEA efficiency models. Results show that about 48 (24%) of ASCs are efficient with a mean efficiency score of 0.60. The results also indicate that appropriate utilization of operating rooms and labour inputs are the main determinants of ASC efficiency.

Patient satisfaction questionnaire and quality achievement in hospital care: the case of a Greek public university hospital

Matis, G. K, Birbilis, T. A, Chrysou, O. I — Thu, 29 Oct 2009 17:09:30 PDT

The scope of this research has been to investigate the satisfaction of Greek patients hospitalized in a tertiary care university public hospital in Alexandroupolis, Greece, in order to improve medical, nursing and organizational/administrative services. It is a cross-sectional study involving 200 patients hospitalized for at least 24 h. We administered a satisfaction questionnaire previously approved by the Greek Health Ministry. Four aspects of satisfaction were employed (medical, hotel facilities/organizational, nursing, global). Using principal component analysis, summated scales were formed and tested for internal consistency with the aid of Cronbach's alpha coefficient. The non-parametric Spearman rank correlation coefficient was also used. The results reveal a relatively high degree of global satisfaction (75.125%), yet satisfaction is higher for the medical (89.721%) and nursing (86.432%) services. Moreover, satisfaction derived from the hotel facilities and the general organization was found to be more limited (76.536%). Statistically significant differences in participant satisfaction were observed (depending on age, gender, citizenship, education, number of previous admissions and self-assessment of health status at the first and last day of patients' stay) for the medical, nursing and hotel facilities/organizational dimension, but not for global satisfaction. The present study confirms the results of previously published Greek surveys.

Do effective meetings determine progress in research?

Scholz, T., Koehler, C., Evans, G. R D — Thu, 29 Oct 2009 17:09:30 PDT

Progress in research is dependent on many success factors. In this review, we evaluate the importance of effective scientific meetings to achieve this progress. We focus on aspects that determine effective communication, such as length, size, interpersonal interactions, structure, and variety of meetings or conferences. Furthermore, we introduce the technique of a Syntegration^® that offers a new tool to communicate effectively among managers today. It is discussed whether this process can be a useful structure for research meetings and whether it has the potential to generate decision-making and goals within this field.