Resource constraints and strategic change in a public hospital system.

It has been suggested that strategic management in public services tends to be oriented towards preserving and perpetuating current patterns of service provision, rather than changing priorities. However, faced with severe resource constraints combined with growing demand and rapidly developing technology, public hospitals in Canada have come under increasing pressure. Based on an empirical study of strategic management and change in 32 Montreal hospitals, this paper examines the relationship between financial adversity and the extent and nature of strategic change in these organizations. Strategic change indicators considered in the study include overall product mix, product diversity, product complexity, market demographics, efficiency, and revenue diversification. Results suggest that resource constraints have indeed stimulated changes within these organizations. In particular, hospitals suffering more severe financial difficulties have reduced their size and focused on a narrower range of services. Moreover, there is evidence that greater complementarity has been achieved among the entire sample of hospitals.     

医改背景下我国大型公立医院的负债经营研究:以辽宁省大连市某医院为例

在医疗服务市场化背景下,医院特别是大型公立医院进行负债经营是一种趋势。分析我国公立医院负债经营的背景和必要性,以辽宁省大连市某医院为分析案例,分析了我国医院进行负债经营在负债规模和结构等方面的特点,考察了医院负债与医院发展之间的相互联系,并得出了医院负债经营的合理区间。     

Turning over in their suites. At 15%, hospital CEO turnover has barely wavered in the past five years, and it's expected to stay that way for a while

Hospitals saw nearly the same rate of turnover among CEOs last year-15%-as they've experienced in the previous five years, according to the American College of Healthcare Executives. But some say that's too high, and the industry has begun taking some measures to retain their top execs. Consultant Jim Nelson, left, says recently he's seen more hospitals offering incentives for CEOs to stay than in all prior years.     

Long-term care and hospital collaboration. To survive in a reformed healthcare system, long-term care facilities can initiate hospital-based SNFs

Establishing relationships with hospitals may be critical for long-term care facilities facing financial pressures and uncertain futures. One option is to initiate collaborative efforts to develop hospital-based skilled nursing facilities (SNFs). Hospitals, under pressure to move patients to less intensive settings and to diversify, are naturally drawn to long-term care as a related business where they can make limited personnel and financial commitments and extend their continuum of care. Before approaching hospitals to initiate collaborative efforts, long-term care providers should understand how they think and what their strengths and weaknesses are. Long-term and acute care providers have many options for collaboration, including management contracts and joint ventures. In a traditional management contract, the long-term care provider furnishes the administrator and a few key staff in exchange for direct reimbursement for those staff plus a management fee. Another option is for the long-term care facility to provide all the staff for a fee or percentage of revenue. Joint venture options are to form a subsidiary corporation to renovate a floor of the hospital or to have the hospital buy a large percentage of the long-term care facility and share the profits. All these options have potential pitfalls, including differing financial expectations and the threat of unionization at the SNF. Nevertheless, for long-term care facilities struggling under reimbursement cutbacks and other pressures, the benefits may outweigh the risks.     

Difference in the incidence of Clostridium difficile among patients infected with human immunodeficiency virus admitted to a public hospital and a private hospital.

OBJECTIVE: To compare the occurrence of Clostridium difficile among inpatients infected with human immunodeficiency virus (HIV) in two different hospitals. DESIGN: Prospective, observational study. SETTING: Specialized HIV inpatient units. PATlENTS: HIV-infected inpatients at Cook County Hospital (CCH) and Rush Presbyterian St. Luke's Medical Center (RPSLMC). INTERVENTIONS: A clinical and epidemiologic assessment of patient risk factors for C. difficile was performed. C. difficile isolates found on stool, rectal, and environmental cultures were typed by pulsed-field gel electrophoresis. RESULTS: Twenty-seven percent of patients admitted to CCH versus 4% of patients admitted to RPSLMC had positive cultures for C. difficile (P = .001). At CCH, 14.7% of environmental cultures were positive versus 2.9% at RPSLMC (P = .002). Risk factors for C. difficile acquisition included hospitalization at CCH, more severe HIV, use of acyclovir and H2-blockers, and longer hospital stay. Patients admitted to CCH were taking more antibiotics, had longer hospital stays, and more frequently had a history of C. difficile infection. During the study, two strains (CD1A and CD4) extensively contaminated the CCH environment. However, only CD1A caused an outbreak. CONCLUSIONS: The C. difficile acquisition rate at CCH was sevenfold higher than that at RPSLMC, and CCH had a more contaminated environment. Differences in patient acquisition rates likely reflect a greater prevalence of traditional C. difficile risk factors and a concurrent outbreak at CCH. Although two strains heavily contaminated the environment at CCH, only one caused an outbreak, suggesting that factors other than the environment are important in initiating C. difficile outbreaks.     

Measurement of patient satisfaction in a public hospital in Ankara.

This article communicates the results of a patient satisfaction survey administered to 420 adults discharged from a major public hospital in Turkey. The direct measurement of patient satisfaction is a relatively new phenomenon for this country. A system was designed similar to those available in the US and was applied during an exit interview. Three areas of analysis were identified: accessibility and availability of services, perceived quality of patient care and organizational and administrative issues. Relationships and percentages within and among several variables are reported. Overall, most individuals were satisfied with direct patient care, although in some areas this varied significantly and was based on the education level of the respondent. In addition, many customers reported discontentment with organizational and administrative support services. We recommend that hospitals in Turkey adapt routine policies similar to those in the US for conducting these types of evaluations.     

Health in all policies, a challenge for public health in Spain. SESPAS report 2010

The objective of SESPAS Report 2010 is to enhance the incorporation of the principle of Health in all Policies in public health in Spain. The fundamental principle behind this slogan is very simple: Health is strongly influenced by the environment, how we live, work, eat, walk or enjoy our leisure time. Moreover, these living conditions depend not only on individual decisions but are determined by social, cultural, economic or environmental factor. Consequently, policy decisions that influence the health of people not just those related to services or health policy, but primarily those taken in other public, private, political and civic contexts. SESPAS Report 2010 has four parts. It begins with and introductory chapter on the challenges of incorporating the principle of Health in all Policies in public health. The second part consists of several articles of reflection on the relationship between the health care system and public health. The third part focuses on cross-sectoral public health policies. The report ends with several articles on cross-cutting issues such as public health education, information, research, evaluation and ethics in public health policies.     

Salmonella and Shigella gastroenteritis at a public teaching hospital in Nairobi, Kenya.

OBJECTIVE: To measure the proportion of nosocomial diarrhea cases associated with Salmonella and Shigella species. DESIGN: Prospective 6-month survey. SETTING: Tertiary care center in a developing country. PATIENTS: Pediatric and adult patients admitted with the previous 24 hours and all consenting adult or pediatric medical patients with nosocomial diarrhea. OUTCOME MEASURES: Prevalence of Salmonella and Shigella species isolated from rectal swabs at admission and among subjects with nosocomial diarrhea. RESULTS: Salmonella species and Shigella species were isolated from 3.0% and 2.5%, respectively, of 667 patients screened on admission. All admission Salmonella isolates were identified in children under 13 years of age; Shigella prevalence was similar for children and adults. Children with Salmonella at admission were significantly older and more likely to have diarrhea, fever, and some indicators of malnutrition than those from whom Salmonella was not isolated. Salmonella and Shigella were isolated from rectal cultures in 36 (10%) and 9 (2.5%) of 360 nosocomial gastroenteritis cases, respectively. Nosocomial cases occurred equally in adults and children. In adults, nosocomial Salmonella acquisition was associated with sharing a room with a diarrhea patient and previous institutionalization. In children, it was associated with recent antimicrobial therapy, crowding at home, and age between 6 months and 6 years. Nine (41%) of 22 nosocomial Salmonella cases in adults occurred in patients with human immunodeficiency virus-type 1 (HIV-1) infection, while none of 79 HIV-1-positive patients had Salmonella isolated at admission. CONCLUSIONS: Salmonella is a frequent cause of nosocomial gastroenteritis in this tertiary care institution in a developing country. Risk factors appear to differ for children and adults, and HIV-1-infected subjects may be at increased risk of acquisition. Control measures feasible for the limited resources available to such institutions require evaluation.     

Factors associated with cesarean sections in a public hospital in Rio de Janeiro, Brazil

Brazil has one of the world's highest cesarean section rates. Contributing factors include the organization of obstetric practice, physicians' attitudes, and women's preferences and decisions. This study aimed to identify factors associated with cesarean sections in a public maternity hospital in Rio de Janeiro. A case-control study was conducted with 231 cesarean sections (cases) and 230 vaginal deliveries (controls). Hierarchical logistic regression analysis was performed, based on a conceptual model. Factors associated with increased odds of cesarean section were: primiparity; mother's age 20-34; last birth by cesarean; cervical dilatation < 3cm at admission; patient request; daytime birth; male attending obstetrician; obstetrician on duty for more than 24 hours a week; obstetrician with private practice; gestational hypertension; non-cephalic presentation; and gestational age > 41 weeks. Factors associated with lower odds of cesarean were: gestational age < 37 weeks; leaving home with signs of labor, use of oxytocin; and amniotomy. In this hospital, interventions aimed to modify the above-mentioned factors can help lower the cesarean rate.     

Primary care. 'It's not about Americans in 10-gallon hats, it's about people who can deliver a high-quality service'

Central and Greater Derby PCTs contract with UnitedHealth Europe is one of the first times an in-hours GP service is being provided under an alternative provider medical services contract. Organisations must seek input from stakeholders before deciding what a tender should include. The PCTs say they chose UHE because it could best meet local people's needs.     

The crisis of the Los Angeles County public hospital system: a harbinger for the nation.

The public hospital system in Los Angeles County, California, is in the midst of a major fiscal crisis that has already led to a serious reduction of capacity and could continue to worsen. Given the importance of the public system in a county where 30 percent of the population is uninsured and private hospitals provide very little uncompensated care, what happens in L.A. County is a harbinger for other cities and counties in the United States. This article highlights the issue of the extent to which local taxpayers, as opposed to state or federal taxpayers, are responsible for the continued operation of public hospitals and safety-net facilities in their communities.