Hospital survey shows improvements in patient experience

Hospitals are improving the inpatient care experience. A government survey that measures patients' experiences with a range of issues from staff responsiveness to hospital cleanliness-the Hospital Consumer Assessment of Healthcare Providers and Systems survey-is showing modest but meaningful gains. Using data from the surveys reported in March?2008 and March?2009, we present the first comprehensive national assessment of changes in patients' experiences with inpatient care since public reporting of the results began. We found improvements in all measures of patient experience, except doctors' communication. These improvements were fairly uniform across hospitals. The largest increases were in measures related to staff responsiveness and the discharge information that patients received.     

Quantifying culture gaps between physicians and managers in Dutch hospitals: a survey

Background

Estimating the supply of GPs into the future is important in forecasting shortages. The lengthy training process for medicine means that adjusting supply to meet demand in a timely fashion is problematic. This study uses Ireland as a case study to determine the future demand and supply of GPs and to assess the potential impact of several possible interventions to address future shortages.

Methods

Demand was estimated by applying GP visit rates by age and sex to national population projections. Supply was modelled using a range of parameters derived from two national surveys of GPs. A stochastic modelling approach was adopted to determine the probable future supply of GPs. Four policy interventions were tested: increasing vocational training places; recruiting GPs from abroad; incentivising later retirement; increasing nurse substitution to enable practice nurses to deliver more services.

Results

Relative to most other European countries, Ireland has few GPs per capita. Ireland has an ageing population and demand is estimated to increase by 19% by 2021. Without intervention, the supply of GPs will be 5.7% less than required in 2021. Increasing training places will enable supply to meet demand but only after 2019. Recruiting GPs from overseas will enable supply to meet demand continuously if the number recruited is approximately 0.8 per cent of the current workforce per annum. Later retirement has only a short-term impact. Nurse substitution can enable supply to meet demand but only if large numbers of practice nurses are recruited and allowed to deliver a wide range of GP services.

Conclusions

A significant shortfall in GP supply is predicted for Ireland unless recruitment is increased. The shortfall will have numerous knock-on effects including price increases, longer waiting lists and an increased burden on hospitals. Increasing training places will not provide an adequate response to future shortages. Foreign recruitment has ethical considerations but may provide a rapid and effective response. Increased nurse substitution appears to offer the best long-term prospects of addressing GP shortages and presents the opportunity to reshape general practice to meet the demands of the future.     

Optimizing sterilization logistics in hospitals

This paper deals with the optimization of the flow of sterile instruments in hospitals which takes place between the sterilization department and the operating theatre. This topic is especially of interest in view of the current attempts of hospitals to cut cost by outsourcing sterilization tasks. Oftentimes, outsourcing implies placing the sterilization unit at a larger distance, hence introducing a longer logistic loop, which may result in lower instrument availability, and higher cost. This paper discusses the optimization problems that have to be solved when redesigning processes so as to improve material availability and reduce cost. We consider changing the logistic management principles, use of visibility information, and optimizing the composition of the nets of sterile materials.     

Design of a retrospective patient record study on the occurrence of adverse events among patients in Dutch hospitals

Background  

Various international studies have shown that a substantial number of patients suffer from injuries or even die as a result of care delivered in hospitals. The occurrence of injuries among patients caused by health care management in Dutch hospitals has never been studied systematically. Therefore, an epidemiological study was initiated to determine the incidence, type and impact of adverse events among discharged and deceased patients in Dutch hospitals.     

轨道物流在综合性医院中的应用

目的:物流系统的应用是医院现代化标志之一,医院常用的物流系统有气动物流、轨道物流和智能小车系统等。轨道物流系统作为一个稳定、安全、快捷和发展性强的物流系统,在国内、外发展迅速。方法:以轨道物流系统在深圳市滨海医院应用为例,分析轨道物流技术在国内、外应用现状、应用前景及其技术特征。结果:轨道物流系统融合了数字化控制和光电控制技术的现代医院物流系统在医院中的应用,对医院物流系统的应用发展有十分重要的意义。从而提高了医院的工作效率,赢得了救护患者的宝贵时间。结论:轨道物流系统的应用是医院管理现代化的具体体现,并成为医院现代化的重要标志。     

Focus points for school health promotion improvements in Dutch primary schools

To enable improvements in school health promotion, this paper examines associations between the number of health-promotion issues addressed by primary school teachers in the Netherlands and factors thought to influence this behavior. The main factors studied are context characteristics and constructs of attitude, social influence, self-efficacy (SE) and perceived barriers. A total of 180 primary school teachers teaching 9- to 12-year olds (Grades 6, 7 and 8) participated in a cross-sectional survey. The results show that it is possible to differentiate between teachers addressing three or more health issues per year versus those who address fewer based on grade level (more health issues are addressed at higher grades), perceived disadvantages, SE and staff support. The latter seems to exert the greatest influence and may be one of the most promising focus points for improvements of school health promotion in the Netherlands.     

Occupational dermal exposure to cyclophosphamide in Dutch hospitals: a pilot study

INTRODUCTION: Several studies have shown that exposure to antineoplastic drugs can cause reproductive toxic effects as well as carcinogenic effects. Presence of these drugs in the urine of hospital personnel has been widely studied and some work has been done on exposure by inhalation. So far, assessment of dermal exposure to antineoplastic drugs has not been extensively studied. In this pilot study we assessed potential and actual dermal exposure for several common hospital tasks. Results were used to derive an optimal measurement strategy for a currently ongoing exposure survey. METHODS: Dermal exposure to cyclophosphamide was determined in three Dutch hospitals during five tasks (preparation, decanting urine, washing the patient, removing bed sheets and cleaning the toilet) using pad samples on 10 body locations. In addition, protective medical gloves (worn during the performance of these activities) were collected to estimate potential exposure of the hands. Subsequently, hands were washed to measure actual exposure of the hands. Bulk samples (i.e. application and body fluids) were collected and possible contact surfaces were monitored to assess the amount of cyclophosphamide potentially available for exposure. RESULTS: The results show that hospital personnel (i.e. pharmacy technicians and oncology nurses) are dermally exposed to cyclophosphamide during performance of their daily duties. Exposure occurred predominantly on the hands and sporadically on other body locations (i.e. forehead and forearms). Gloves used during preparation of cyclophosphamide were more contaminated than gloves used in other tasks, however, actual exposure of the hands (underneath the gloves) was highest during decanting of urine of treated patients. Glove samples correlated significantly with handwash samples (r = 0.57, P = 0.03, n = 15). The level of protection from gloves varied between tasks, being highest for gloves used during preparation (median = 98%) and lowest for gloves used during decanting urine (median = 19%). CONCLUSION: This pilot study demonstrated that dermal exposure to cyclophosphamide is common among hospital personnel. The results showed that hands, forearms and forehead accounted for 87% of the cyclophosphamide total body exposure. Glove samples together with handwash samples enabled estimation of glove efficiency, which appeared to vary strongly between tasks observed.     

Innovation in hospitals: a survey of the literature

The literature on innovation in hospitals is relatively extensive and varied. The purpose of this article is to conduct a critical survey, and in particular to highlight the functional and occupational bias that characterises it, whereby the sole object of innovation is medical care, and that innovation is essentially the work of doctors. In order to achieve this objective, four different (complementary or competing) concepts of the hospital are considered. In the first, the hospital is seen in terms of its production function, in the second, as a set of technical capacities, in the third, as an information system, and in the fourth, as a service provider and a hub in a wider system of healthcare. In the latter approach, hospitals are regarded as combinative providers of diverse and dynamic services, able to go beyond their own institutional boundaries by becoming part of larger networks of healthcare provision, which are themselves diverse and dynamic. This approach makes it possible to extend the model of hospital innovation to incorporate new forms of innovation and new actors in the innovation process, in accordance with the Schumpeterian tradition of openness.     

Feasibility first: developing public performance indicators on patient safety and clinical effectiveness for Dutch hospitals

This paper describes the development and implementation of the first national, public and obligatory set of hospital performance indicators in the Netherlands. Focusing on effectiveness and safety, the set was developed by the Dutch Health Care Inspectorate to improve the effectiveness and efficiency of their task: monitoring the quality of the care delivered by providers. In addition, the set would enhance the transparency of the hospital sector, and stimulate individual hospitals to improve their scores. Bridging some of the classic distinctions between 'internal' and 'external' indicators, the Inspectorate's vision was to rapidly produce a feasible set of indicators that would fulfill these aims, while maximally preventing 'side effects' such as misinterpretations, defensive or perverse reactions. Explicitly avoiding the trap of searching for exhaustive validity of the indicators, the inspectorate's motto was 'feasability first'. This paper describes how this simultaneously philosophical, political and pragmatic strategy played out successfully, and how the indicator set was ultimately embraced by all parties involved.     

Getting satisfaction. The CMS survey publicly revealing patient satisfaction with hospitals is one step closer to becoming a reality

Now that the 30-day comment period has ended for the CMS' H-CAHPS patient-satisfaction survey, it can start being used next year. Dan Varga, left, chief medical officer for Norton Healthcare in Louisville, Ky., is pleased to see the government catching up to efforts that Norton has used for years.     

Environmental factors and productivity on Dutch hospitals: a semi-parametric approach

This paper describes the efficiency of Dutch hospitals using the method of Data Envelopment Analysis (DEA). In particular the analysis focuses on explaining cost inefficiency measures due to each hospital’s operating environment. In previous works, the resulting DEA score is regressed on environmental factors via a Tobit approach. Previously, these approaches have been used (Simar and Wilson, J Prod Anal 7(1):63–80, 2000) but later these authors (Simar and Wilson 2007) demonstrated that bias is incurred since the efficiency score is a point estimate without a probability distribution around it that is required by the Tobit methodology. In this paper we use the Simar and Wilson bootstrapping techniques in order to obtain more efficient estimates of the environmental effects. It is shown that differences in estimated effects exist between the non-bootstrapped and bootstrapped models.     

Exploring a new type of alcoholism survey

A new type of method for surveying alcoholism and alcohol-abuse was tested in a way designed to cover about 20% of adults in a town of 50 000. The method proved able to identify types of alcohol-abuser which other survey techniques have difficulty with; it made no undue demands on respondents; and it is much more economical than conventional household surveys. However, more work is still needed on it, and for certain types of information the customary self-report is still going to be required.     

Direct medical costs of adverse events in Dutch hospitals

Background  

Up to now, costs attributable to adverse events (AEs) and preventable AEs in the Netherlands were unknown. We assessed the total direct medical costs associated with AEs and preventable AEs in Dutch hospitals to gain insight in opportunities for cost savings.     

市级医院后勤安全风险与管理

分析了医院日常运行中存在的安全风险,阐述了后勤安全管理的定义、特点与实施要点以及新形势下后勤安全管理的探索与实践。