Models of governance in multihospital systems. Implications for hospital and system-level decision-making

This study utilizes data from a national survey of 159 multihospital systems in order to describe the types of governance structures currently being utilized, and to compare the policy making process for various types of decisions in systems with different approaches to governance. Survey results indicate that multihospital systems most often use one of three governance models. Forty-one percent of the systems (including 33% of system hospitals) use a parent holding company model in which there is a system-wide corporate governing board and separate governing boards for each member hospital. Twenty-two percent of systems in the sample (but 47% of all system hospitals) utilize what we have termed a modified parent holding company model in which there is one system-wide governing board, but advisory boards are substituted for governing boards at the local hospital level. Twenty-three percent of the sampled systems (including 11% of system hospitals) use a corporate model in which there is one system-wide governing board but no other governing or advisory boards at either the divisional, regional or local hospital levels. A comparison of systems using these three governance approaches found significant variation in terms of system size, ownership and the geographic proximity of member hospitals. In order to examine the relationship between alternative approaches to governance and patterns of decision-making, the three model types were compared with respect to the percentages of systems reporting that local boards, corporate management and/or system-wide corporate boards have responsibility for decision-making in a number of specific issue areas. Study results indicate that, regardless of model type, corporate boards are most likely to have responsibility for decisions regarding the transfer, pledging and sale of assets; the formation of new companies; purchase of assets greater than $100,000; changes in hospital bylaws; and the appointment of local board members. In contrast corporate management is relatively uninvolved in these issues, again regardless of governance model type. There is substantial variation in the locus of decision-making responsibility by governance model type for a variety of other issues, however, including: hospital-level service additions and deletions; operating and capital budgets; medical staff privileges, hospital-level long-range planning; hospital CEO performance evaluation and the appointment of hospital CEOs.(ABSTRACT TRUNCATED AT 400 WORDS)     

疫情期间护士抗逆力水平及影响因素研究

目的 了解疫情期间非定点医疗救治医院护士抗逆力水平及其影响因素.方法 采用一般资料问卷,医护人员抗逆力评价量表、组织支持量表和家庭支持量表对唐山市1所三级综合性医院和3所二级综合性医院1660名护士进行调查.结果 护士抗逆力总分为(74.98±9.82)分;组织支持感总分(61.45±12.01)分,家庭支持得分(23...     

Improving community hospital board performance

There has been little focus on improving hospital governance as an approach to controlling costs and improving the quality of care in community hospitals. The author examines assumptions underlying such an approach, describes various proposals, and presents criteria to be used in evaluating them. The author recommends governing board involvement in goal setting and monitoring activities. This requires the development of standards on hospital performance and governing board performance, as well as methodology for external monitoring and external impact on the boards in these respects.     

Productivity and turnover in PCPs: the role of staff participation in decision-making

BACKGROUND: Efforts to redesign primary care practices are beginning to address how decisions are made in the practice setting. This study contributes to these efforts by examining associations between staff participation in decision-making, productivity, and turnover in primary care practices. The study is informed by organizational theories of participation that emphasize cognitive and affective influences on employee output and behavior. METHODS: This research used data collected from primary care practices involved in a national initiative sponsored by the Robert Wood Johnson Foundation. Cross-sectional survey data on organizational structures and attributes among 49 practices were analyzed. Regression analysis was used to examine associations among practice productivity, staff participation in decision-making, and formal structures such as staff meetings. Associations between staff turnover and participative decision-making were also examined. RESULTS: Staff participation in decisions regarding quality improvement, practice change, and clinical operations was positively associated with practice productivity, whereas formal structures such as staff meetings were not. In addition, higher levels of participation in decision-making were associated with reduced turnover among nonclinicians and administrative staff. CONCLUSION: Examination of organizational features is increasingly recognized as a key to improving primary care performance. Study findings suggest that one important strategy may be implementation of a participative model emphasizing greater staff involvement in practice decisions. This may enhance information-sharing, work satisfaction, and commitment to organizational decisions, all of which can lead to beneficial outcomes such as increased productivity and stability in primary care practices.     

Staff nurse empowerment in line and staff organizational structures for chief nurse executives

OBJECTIVE: The authors tested a model linking chief nurse executive (CNE) organizational structures (line and staff) to staff nurse perceptions of workplace empowerment in 2 large Canadian hospitals. BACKGROUND: Kanter's theoretical constructs of empowerment (ie, access to information, support, resources and opportunity, and formal and informal power) were used to explore this phenomena. No published studies were found linking organizational structure to staff nurse empowerment. METHODS: Staff nurses (n = 256) were surveyed in 2 large teaching hospitals, one with a CNE in a line structure, the other with a CNE in a staff structure. Multiple regression analysis was used to test the proposed model. RESULTS: Staff nurses with a CNE in a line structure felt significantly more empowered in their access to resources than nurses with a CNE in a staff structure. Kanter's empowerment structures explained 63% of the variance in nurses' global empowerment in a line structure and 42% in the staff structure. Access to information, resources, and formal power was an important predictor of nurses' global empowerment in the line hospital, whereas only access to support was a significant predictor in the staff hospital. CONCLUSION: Support for the model tested in this study highlights the importance of the CNE in creating and sustaining healthy work environments for nurses.     

Descriptive analysis of critical care units in the United States.

OBJECTIVE: To gather data about available technology, staffing, administrative policies, and bed capacities of ICUs in the United States. DESIGN AND SETTING: On January 15, 1991, survey instruments were mailed to the administrators of 4,233 hospitals to gather information from the medical director of the institutions' respective ICUs for the purpose of developing a database on ICUs in the United States. The sampling frame for this study was based on all American Hospital Association (AHA) hospitals that stated they have ICUs. MEASUREMENTS: Census questionnaires solicited information on types of hospitals, types of ICUs, number of ICU beds open and closed, technology available to the unit, organizational structure and management of the ICU, as well as the staffing and certification of unit personnel. MAIN RESULTS: Data were obtained on 32,850 ICU beds with 25,871 patients from 2,876 separate ICUs in 1,706 hospitals in the United States. Census responses came from units in all sizes of hospitals within all ten census regions in the country, all states, and all types of hospital sponsorship (federal, state, and local government, private nonprofit and private for profit). The census response rate was 40% of the AHA hospitals that stated that they have ICUs, with specific ICU data on 38.7% of the nation's ICUs. The number of ICUs per hospital increases with overall hospital size. The smallest hospitals (less than 100 beds) usually had only one ICU. As hospital size increased, the single, all inclusive medical/surgical/coronary care units diminished, and in hospitals with greater than 300 beds, specialization of units became prevalent. In absolute terms, hospitals had the following number of ICUs: 1.04 +/- 0.20 (less than or equal to 100 beds); 1.30 +/- 0.65 (101 to 300 beds); 2.37 +/- 1.58 (301 to 500 beds); and 3.34 +/- 2.21 (greater than 500 beds). ICU beds averaged, nationally, 8.09% of hospital-licensed beds with a median of 6.98%. Generally, medical units, pediatric units, coronary care units (CCUs), and medical/surgical/CCUs reported an average of 10 beds per unit. Neonatal units averaged 21 beds, and surgical units averaged 12 beds. The average ICU size, nationally, was 11.7 +/- 7.8 beds per unit. Available technology within hospitals and individual units was increased as hospital size increased; surgical units tended to have more available technology than other unit types. A wide range of organizational arrangements within hospitals determines where the ICU appears in an organizational chart and to whom unit management is accountable. Thirty-six percent of the units were located organizationally within the hospital's department of medicine, while 23% were considered "free standing," having no departmental affiliation. Although units must have a medical director, the perception as to whether this director supervises the day-to-day operation was different in larger vs. smaller hospitals. In hospitals with less than or equal to 100 beds, 72% of the units were perceived to be supervised by the medical director, whereas in larger hospitals (greater than 500 beds), 81% of units were supervised. Study results indicated that medical directors in pediatric, neonatal, and burn units most often were perceived to supervise the unit. Presently, 63% of all ICUs responding are directed by an internist. The next largest group to direct ICUs were surgeons, followed by pediatricians. Pediatrician involvement tended to be exclusive in pediatric and neonatal units. Surgeons directed most surgical and neurologic units and were involved in 21% of mixed medical/surgical units. Internists predominated in medical units and in CCUs, as well as in combined medical/surgical/CCUs. Direction by anesthesiologists, although relatively infrequent, predominated in the surgical unit. Critical care medicine certification of the medical director and attending staff of the ICU increased as hospital size increased, although only 44% of all units stated that thei     

护士对医院管理工作的满意度调查

目的:通过调查护士对医院管理各方面的满意度,了解组织管理上的成绩与不足,以改善组织管理,提高护士的满意度和工作绩效。方法:以3家医院的护士为调查对象,就影响护士对医院管理工作满意度的相关因素进行调查。结果:护士对医院管理工作的总体满意度不高。影响满意度的因素有福利待遇、工作年限等方面。结论:医院管理者应注重护士不满意情绪的管理,完善管理制度,增加护士的培训机会与晋升空间,提高护士的工作稳定性,提升绩效考核管理的效力,提高护士工作的积极性。     

口腔医院医护人员对病人健康状况评估现状的调查与分析

目的了解口腔医院医护人员对病人健康状况的评估现状。方法选择我国5所三级甲等口腔医院的582名口腔医院医护人员进行问卷调查。结果48．63％的口腔医院医护人员在病人每次就诊前认真询问病人的病史；38．99％的医生每次记录病人病史；只有23．51％的医生每次询问病人的传染病病史并记录。结论口腔医院医护人员对病人健康状况的评估现状不容乐观，应加强口腔医院医护人员对就诊病人健康状况的评估教育，提高他们的防护意识，降低医院交叉感染发生率。     

Effects of hospital nurses' internalized dominant values,organizational silence,horizontal violence,and organizational communication on patient safety

Recent studies have identified common problems with patient safety in hospitals and medical institutions have responded, prioritizing service quality and performance, including patient safety. However, the factors influencing safety for hospital patients are still being examined and clarified. We aimed to investigate how hospital nurses' internalized dominant values, organizational silence, horizontal violence, and organizational communication satisfaction can affect patient safety and to construct and verify a hypothetical model describing the relationships between these factors. The participant sample included 301 hospital nurses from four large (≥500 beds) general hospitals in Gyeonggi-do, South Korea. Data were collected through questionnaires from October to November 2018 and analyzed using SPSS 25.0 and AMOS 22.0. Factors that had direct effects on patient safety were organizational silence (β = −.130, p < .05) and organizational communication satisfaction (β = .209, p < .001). Factors that had indirect effects on patient safety were internalized dominant values and horizontal violence. The explanatory power of these variables for patient safety was 7.9%. The results indicate that organizational silence, horizontal violence, and organizational communication satisfaction fully mediated the relationship between nurses' internalized dominant values and patient safety. Our findings may be useful to hospital administrators and managers in identifying and analyzing these organizational characteristics in their institutions. Further, the model described in the results may be used to inform the development of educational programs and strategies to improve patient safety by reducing organizational silence and horizontal violence and improving organizational communication.     

Public hospitals under contract management. An assessment of operating performance

Numerous changes in their operating environments have caused many public hospitals to experience serious fiscal deterioration. One increasingly common response to this situation is contracting with private organizations for the provision of total management services. This study examines the effects of these contract management arrangements on the operating performance of public hospitals. Three areas of performance are considered: operating efficiency, service structure, and Medicare/Medicaid case load. Eighty short-term public hospitals operating under contract management in 1980 are compared with 122 traditionally managed public hospitals and 74 hospitals 1-2 years prior to entering contract management. Controlling for a series of hospital and environmental variables, contract managed hospitals display several financial and organizational differences vis a vis the comparison groups. These findings are discussed in terms of their implications for policymakers, hospital managers, and researchers.     

Hospital organizational environment and staff satisfaction in China: A large‐scale survey

The aims of the study are to explore the satisfaction of health‐care staff in Chinese public hospitals with different aspects of their organizational environment and to identify factors affecting this satisfaction. The satisfaction of hospital staff members with organizational environment could be associated with the quality of patient care and patients' satisfaction. The design of the study is in the form of a survey. A questionnaire survey was performed from April to November 2008 to collect demographic characteristics of hospital staff members and analyse which organizational environment factors (hospital security policy and professional care, environmental security, safety of operations and management of human resources) influence staff satisfaction. Hospital members' satisfaction scores were high for hospital security policy and professional care but lower for safety of operations, the security of the environment and management of the human resources (lowest). Multivariate analysis identified that hospital size (large hospitals scoring highest), department (non‐clinical department such as administrative or logistics department), professional title (student), position (administration) and years of employment (<3 years) were independently positively associated with overall satisfaction with organizational environment (P < 0.05). These results indicated that in China, hospital staff members were mostly dissatisfied with the administration and management of human resources. The organizational environment of hospitals should be improved to improve staff satisfaction.     

Foundation Trusts: economics in the 'postmodern hospital'

Foundation Trust Hospitals are community-controlled health care providers which have increased autonomy about how they produce outcomes for the British National Health Service. Although there is a literature on hospital economics it is unclear how these innovative providers will behave, if they have to compete for scarce resources with other hospitals. This paper reviews some of the earlier theories, such as the neoclassical theory of the firm, and discusses their relevance along with 'newer' economic theories such as the transaction costs and evolutionary theory of the firm, plus organizational and human resources theory, to the performance of Foundation Trusts. Much contemporary health care provision is shaped along modernist lines, using scientific endeavour to maximize the impact on health outcomes and technical and social efficiency. However, there is an increasingly postmodern standpoint--critical of modernity--being taken by both patients and hospital staff, to deconstruct processes in the organizations that serve them. Foundation Trusts are postmodern hospitals insomuch as they (to attract scarce resources in a competitive environment), need to marshal the diverse theories of the firm together in order to provide a mass-customized, quality experience, transparently and at least cost--whilst maintaining a stable organizational culture for staff.     

Out-of-hours medical cover in community hospitals: implications for palliative care

BACKGROUND: The new General Medical Services contract in England means many GPs have transferred out-of hours work to their primary care organization, with implications for continuity of palliative care in community hospitals. AIM: To examine existing arrangements for out-of-hours medical cover in community hospitals, focusing on palliative care. METHODS: Telephone survey of community hospital managers/senior nurses across England and Wales. RESULTS: Interviews (n = 62) revealed nursing staff were satisfied with existing out-of-hours care. Concern was expressed about the future of out-of-hours medical care from GPs as new services will cover larger areas, meaning unknown doctors may attend, taking longer to arrive. CONCLUSION: Arrangements for out-of-hours medical cover in community hospitals are in transition, threatening the continuity of care for dying patients.     

护士组织支持感与组织支持需求的调查

目的了解护士组织支持感现状及护士对组织支持的需求情况,为提高护士组织支持感提供理论依据。方法采用组织支持感量表,对山西省5所三级甲等医院的442名护士的护士组织支持感与组织支持需求进行调查。结果护士组织支持感得分为（2.900±0.770）分,护士对组织支持需求得分为（4.359±0.607）分。护士组织支持感与组织支持需求在情感性支持、工具性支持及总分上比较,差异具有统计学意义（均P〈0.001）。不同医院护士组织支持感比较,差异具有统计学意义（P〈0.01）。同一医院护士组织支持感与组织支持需求比较,差异具有统计学意义（均P〈0.001）。护士对组织支持需求排在前3位为医院关心我的福利、医院重视我的贡献和当我在工作中遇到困难时医院尽力帮助我。结论护士组织支持感水平相对较低,护士对组织支持的需求非常强烈。医院应采取各种对策,提高护士组织支持感,从而调动护士工作积极性,促进护理工作的发展。     

Nursing in the nineties: managing the uncertainty.

OBJECTIVE: This study examined qualitative data on nurses' work lives from 53 hospitals that participated in the National Institutes of Health (NIH)-funded Outcomes Research in Nursing Administration Project (ORNA). BACKGROUND: The ORNA project examines the impact of nursing unit organizational structure on outcomes. The information reported in this article amplifies the quantitative data with qualitative data that enhances understanding of nurses' work lives. METHODS: Site coordinators at all participating hospitals were requested to send monthly journal entries for 6 months. Data were documented according to an agreed-on content outline that consisted of critical incidents and implications. Data were collected from 53 of the 65 study site coordinators (response rate 81.5%). Content analysis of all collected data was conducted by the research team. RESULTS: Study site coordinators in 53 hospitals characterize the acute care environment as turbulent and uncertain. Contributing factors include: 1) work load (fluctuating census, staff preparation, turnover); 2) loss of workplace identity (unit consolidation, hospital buy-outs, and system mergers); and 3) re-engineering (skill mix, new equipment/system changes, new documentation systems, rumored changes). CONCLUSIONS: This study adds to the growing body of literature that portrays environmental uncertainty from the narrative perspective. Although there is an ongoing need for the employment of fiscally accountable, quality enhancing organizational/management strategies, all initiatives are at risk unless personnel needs are attended to and seen as unique in each care setting. Some strategies are offered to meet this dual imperative.     

医院管理层和相关临床科室营养知识现状调查

目的:调查医院管理层和相关临床科室营养科普知识、营养专业知识、临床营养知识的现状。方法:选择山东省30所医院为研究对象,设计调查表,请各所医院的医院管理层和相关临床科室医护人员进行营养学知识问卷调查,调查内容包括一般情况,营养科普知识、营养专业知识、临床营养知识和知识来源及应用。结果:医院管理层和相关临床科室医护人员的临床营养学知识普遍不足,营养科普知识掌握好于营养专业知识和临床营养知识(P<0.01);不同类别医院之间知识掌握情况有显著性差异(P<0.01)。不同专业之间知识掌握有差异,内外科明显优于其他科室(P<0.05)。不同职称的医生之间营养学知识答题得分差异无显著性。不同学历之间营养知识的掌握有差异,博士与硕士高于本科及以下学历(P<0.01)。结论:我省三级医院管理群体及普通医护人员基础营养、临床营养知识不足,建议医学院校适当增加营养学课程学时,适当增加培训以提高医护人员营养学知识水平及整体医疗素质。     

Improving medical communication with facsimile (fax) transmission

Facsimile machines (fax) used intensely in business, send copies of documents from one location to another. The medical potential for fax has not been fully explored. A general background in fax and the potential uses for fax between hospitals and within hospitals are described. Fax permits small hospitals to share the resources of larger hospitals and permits a large hospital to share resources more efficiently among its departments. The cost of a fax unit is small compared with the amount of work and time it can save. Clinics and private physicians may also find fax units cost effective. Fax boards, which provide fax capability to personal computers, are also described. The use of fax could streamline the process of patient transfer, telephone patient consultation, medical records retrieval, ECG interpretation, central information distribution, retrieval of medical literature, inpatient pharmacy orders, etc.     

Towards the Evidence-Based Integration of Complementary Medicines into Hospital Settings

The use of complementary medicine products offers potential benefits to hospital patients, yet very little is currently known about their use in Western hospitals or the extent of their potential risks and benefits. Hospital patients may be at higher risk from adverse events from complementary medicines than the general population because they take more pharmaceutical preparations, have poorer health and are at much higher risk of bleeding complications. The potential risks associated with complementary medicine use in hospital patients raises concerns for patient safety, yet it appears that hospital patients often fall into the divide created between community use of complementary medicines, which is widespread, and the hospital system, which does not support this use. Very few hospitals have well developed policies or guidelines on complementary medicine use, and few hospital staff have the necessary training to evaluate the use of complementary medicines and make appropriate recommendations to patients. This is compounded by the fact that complementary therapists generally do not have practice rights within most hospitals and patient disclosure of complementary medicine use to hospital staff appears to be poor. There are a number of recommendations that may minimise risks and facilitate the evidence-based use of complementary medicines in hospital settings. Recommendations include (a) all hospital medical staff and general practitioners should ask patients about their use of complementary medicines, and this use should be documented in the medical record and care plans; (b) complementary medicine use in hospitals should be recorded on the medication chart and included in discharge summaries; and (c) adequate training is required to ensure hospital staff have the appropriate skill to advise patients about the safe and appropriate use of complementary medicines, and appropriate resources should be available to all staff members. If hospital medical staff advise against the use of complementary medicine, reasons for this recommendation should be clearly communicated to the patient and their carers and documented in the patient’s medical record. Hospitals should appoint a dedicated staff member, ideally with both mainstream and complementary medicine qualifications, to take a leadership role regarding maintaining and disseminating information about complementary medicine use. Where appropriate, hospital staff should communicate with patients’ usual healthcare practitioners, including naturopaths and herbalists, at admission and discharge. In cases where patients want to continue or initiate use of complementary medicine while in hospital, they should have access to an appropriately trained practitioner who is able to ensure their needs are met in a safe and appropriate way.