Virtual audits of streetscapes by crowdworkers

Audits have been used to provide objective ratings of neighborhood environments. Physical audits, however, are time- and resource-intensive. This study examines the efficiency and reliability of virtual auditing using Google Street View and crowdsourcing to conduct walkability audits of streets in Japan. Overall, 830 street segments were physically and virtually audited by two trained auditors; 300 untrained crowdworkers also virtually audited 3 street segments. Statistical analysis found good inter-source and inter-rater reliability. This study helps establish crowdsourced virtual auditing as a valuable method of measuring neighborhood walkability, reducing audit costs as well as enabling large-scale auditor recruitment while maintaining reliability.     

医院内部审计风险成因及其防范措施

内部审计是医院经济管理的一部分,扮演着“经济警察”的角色,对医院的各项经济业务实施监督和评价,是医院风险防范和进行内部控制的重要环节。鉴于内部审计工作的重要性及审计风险的普遍性,结合自身工作实践,从审计风险的定义入手,针对目前大多数医院内部审计现状,分析了医院内部审计风险产生的原因,并从健全内部审计机构、完善内部审计制度、扩大审计人员规模、提高内审人员素质、促进审计信息化建设、创新内部审计模式等方面进一步阐述了如何降低内部审计风险,有针对性地提出了防范措施。     

Transparency about internal audit results to reduce the supervisory burden: A qualitative study on the preconditions of sharing audit results

Many working hours of healthcare professionals are spent on administrative tasks. Administrative burden is caused by political choices, legislation, the requirements of health insurers and supervisors. Coordination between the parties involved, is lacking. Therefore, we studied to what extent sharing internal audit results of hospitals with external supervisors is possible and the necessary preconditions. We interviewed 42 individuals from six hospitals and the Dutch Health and Youth Care Inspectorate.The interviewees expressed that there is no coordination in timing and content between internal audits and external supervision. They were in favour of sharing internal audit results with external supervisors to reduce the supervisory burden. They stated that internal audits give insight into quality problems and improvements, how hospital directors govern quality and safety, and the culture of improvement within healthcare provider teams. With this information, the inspectorate can judge to what extent hospitals are learning organisations. The interviewees mentioned the following preconditions for sharing audit results: reliable and risk-based information about quality and safety, collected by expert, trained auditors, and careful use of this information by the inspectorate in order to maintain openness among audited healthcare professionals.In conclusion, internal audit results can be shared conditionally with external supervisors. When internal audit results show that hospitals are open, learning and self-reflecting organisations, the healthcare inspectorate can reduce their supervisory burden.     

Hospital profitability and capital structure: a comparative analysis.

This article compares the financial performance of hospitals by ownership type and of five publicly traded hospital companies with other industries, using such indicators as profit margins, return on equity (ROE) and total capitalization, and debt-to-equity ratios. We also examine stock returns to investors for the five hospital companies versus other industries, as well as the relative roles of debt and equity in new financing. Investor-owned hospitals had substantially greater margins and ROE than did other hospital types. In 1982, investor-owned chain hospitals had a ROE of 26 percent, 18 points above the average for all hospitals. Stock returns on the five selected hospital companies were more than twice as large as returns on other industries between 1972 and 1983. However, after 1983, returns for these companies fell dramatically in absolute terms and relative to other industries. We also found investor-owned hospitals to be much more highly levered than their government and voluntary counterparts, and more highly levered than other industries as well.     

An empirical investigation of the effectiveness of contemporary managerial philosophies in a hospital operational setting

The new realities of the healthcare marketplace are forcing healthcare decision makers to implement innovative operational philosophies, techniques, and tools that were proven in other industries to enhance the effectiveness of their organization. This study examines the acceptance and effectiveness of these philosophies, techniques, and tools in a hospital operational setting. The impact of implementation on operational and strategic outcomes is examined for 108 hospitals. Overall, the results of this study appear to indicate that certain quality improvement philosophies, techniques, and tools have been successful when applied in a hospital operational setting.     

Hospital system works to ensure risk management, quality of care

A health care corporation that includes several hospitals and other related health services conducts a wide variety of institutional and corporate activities and programs of risk management and quality assurance. Some of these efforts include board review of medical staff organization and privileges, medical and nursing audits, patient care evaluation, a risk manager and steering committee, patient education, equipment maintenance, and safety programs.     

Barriers to automation in health care settings

Health information systems have changed little since the 1970s, and most are incapable of meeting the information demands of either their organization or outside organizations. Through literature reviews, interviews with staff in three hospitals, and a vendor study, the staff of Kunitz and Associates, Inc. examined barriers to implementing automated systems in hospitals. These barriers were found to be technical, organizational, and operational in nature and to involve issues of communication within the health care environment and between information system vendors and health care staff. Resolving these issues is dependent upon efforts by both the health care and technical communities.     

风险导向模型在公立医院内部审计中的应用研究

文章简要分析了公立医院内部审计实施风险导向审计的必要性,参照国际国内风险评估框架,结合公立医院风险管理现状,建立了公立医院风险导向模型和应用内涵,以指导公立医院进行内部风险导向审计,为今后深入开展内部审计工作提供借鉴。     

我国医院质量管理现状——基于五省调研

本研究通过对5个省开展实地调研,发现我国三级医院、县级医院、民营医院之间医疗质量管理的发展水平有很大差距。三级医院的质量管理体系最为健全;县级医院由于人力资源匮乏和运营压力而无力完善薄弱的质量管理体系;民营医院的医疗质量管理水平则呈现两极分化的趋势。其中存在的具体问题包括:省级质量监管机构监管能力薄弱,运行缺乏保障;医院内部质量管理组织架构不完善,专业质管人员缺乏,人员培训不足;医院信息化发展程度不均衡,信息共享不足。针对上述问题,本文建议:提升第三方监管机构的隶属层次,加强对质控中心的运行保障;完善县级医院、民营医院内部质量管理组织架构,保障人员配置,加大经费投入,开展全员质量管理培训;制定医院信息化建设的基本框架,加强对县级医院、民营医院信息化建设的经费补贴,尽快颁布全国统一的疾病编码,促进医院信息共享。     

我国民营医院医务人员稳定性状况分析

目的了解我国民营医院医务人员稳定性状况,并对其相关影响因素进行实证研究。方法以我国东、南、西、北、中5个省份的20家民营医院作为调查对象,收集2011年医务人员的年离职率,并对其所有在职医务人员进行离职意愿、原因及工作中的具体感受、思想状态的问卷调查。结果 2011年民营医院医务人员年离职率为36.6%;共收集有效问卷1 269份,其中有离职意愿的占全部在职医务人员总数的47.7%;医务人员收入低下（2011年平均年收入28 452元）、个人发展受限以及人性化管理重视不足是影响民营医院医务人员稳定性的重要原因。结论我国民营医院医务人员稳定性低下已经成为了制约其可持续性发展的重要原因。     

Study rates U.S. hospitals vs. other nations, industries

American hospitals generally are further along with their total quality management programs than their Canadian counterparts but lag behind companies in other U.S. industries, according to a comprehensive international study that examined four industries--healthcare, automotive, banking and computer--in four countries--the United States, Canada, Germany and Japan.     

Nursing audit: identifying notions and method

The present study aimed at identifying and analyzing the opinions of auditing experts who work within the context of nursing and systematizing trends regarding the notion, methods and purposes of nursing audits at present and over the next five years. In terms of methodology, the study was structured using the Delphi technique, type of prospective and consensual evaluation of trends, performed by experts on the theme under investigation. Results demonstrated that the current notion of nursing audits focuses on the accounting and financial elements, the financial maintenance of the hospital being kept in mind as well as the controlling activity of trying to identify incorrect hospital bills. In the future, however, the notion of auditing is expected to become associated with evaluating the quality of care, with the involvement of other areas that have an impact on it.     

Effectiveness in professional organizations: the impact of surgeons and surgical staff organizations on the quality of care in hospitals.

In this research, we examine the relative importance of different structural units in a professional organization, the hospital, as they affect organizational effectiveness. The difficulties of measuring effectiveness in a complex professional organization are discussed, and an adjusted measure of surgical outcome is developed. Data are drawn from a prospective study of over 8,000 surgical patients treated by more than 500 surgeons in 15 hospitals throughout the nation. Two different types of analyses are presented, both indicating that hospital features have more impact on surgical outcomes than do surgeon characteristics. The second analysis assesses the relative importance of specific attributes of the hospital, surgical staff organization, and surgeon characteristics on surgical outcomes.     

Operating efficiency in inpatient care: An exploratory analysis of teaching hospitals in Rajasthan,India

This article reports on the results of an exploratory attempt towards the measurement of operational efficiency within hospitals. This microanalysis focuses attention on the departments of general surgery within four teaching hospitals in the State of Rajasthan in India. The analysis involves devising a costliness index, which then permits a ranking of hospitals according to their relative efficiencies. It is observed, generally, that all the study hospitals exceed their normative cost estimates on inpatient care. This is especially the case for two of the four hospitals, in respect of both fixed and variable costs. In the case of higher fixed costs, the cause seems to be a misallocation of resources resulting from high staffing levels, i.e. on the salaries of teaching or nursing staff. The variable costs are higher either on account of the high expenditure on supplies or on salary costs of common services. A further analysis was conducted to determine the presence or otherwise of inter-unit efficiencies within the departments of general surgery, it revealed that inter-unit differentials were mostly insignificant. More significantly, the study does suggest that expenditure efficiency on public health-care in the hospitals studied could be enhanced through better budgetary management and cost control. This could be achieved, for instance, by enhancing the productivity of (human) resources, by checking wastages and leakages by means of appropriate monitoring, and through adoption as well as experimentation with methods of peer review and quality assurance.     

医院零星维修工程内部审计的构建与实施

因医院内部审计主体和零星维修工程各自的专业特性,医院零星维修工程的内部审计应量体裁衣、因事制宜,既要分门别类、合理搭配,又要阶段考量、职能分明。在审计方法、审计技巧、审计范围、审计人力搭配、审计成果运用等方面要创新巧妙,盘活现有审计资源,有效实施审计监督。通过基础性的审查,找准切入点,逐步转向管理审计、效益审计等,以期发挥更大效力。     

Service quality in the public sector hospitals: a study in India

Most studies on service quality have been conducted in the context of the private sector of the economy. In fact, in the healthcare setting, for a long time, public-sector hospitals were not expected to excel in the provision of service quality. In a country such as India, even now, public-sector hospital staffs enjoy relatively higher salaries, flexible work schedules, and secure employment until retirement. Because patients do not pay for most services, normally they are concerned only about the quality of the core product. The authors indicate that, even in the public sector context, the quality of the physician and that of the clinical support staff significantly impact patient satisfaction. However, the quality of nonclinical support staff is not found to have any significant effect on patient satisfaction.     

HIPAA security: compliance in radiology--an academic radiology department's plan contrasted with a small private practice

In complying with the HIPAA security regulations, the large, multi-site academic radiology department is quite different from the small, private radiology practice. This article compares and contrasts the methods each of these two model organizations use to achieve compliance. In common between the two organizations is that complete documentation of the procedures and processes involved in data management must be prepared and reviewed. Although not required in the regulations, having the documentation conform to the regulation allows for easy monitoring, auditing, and certification of compliance by future independent bodies. The level to which each organization must secure their data, perform threat assessments, and implement security procedures and intrusion detection systems are very different. The regulations do not specify what level of due diligence is required. This must be determined by each organization using their own common-sense dictum. Although the solutions used by these two types of organizations may not be the same as those adopted by other radiology departments and practices, the approaches may still serve as useful templates to guide compliance efforts by others.     

Rural recruitment

Physician and nurse shortages are a fact of life for rural hospitals. This foldout section details the scope of the problem and shows how rural hospitals must increasingly compete with their urban counterparts to attract clinical staff.