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The goal of this contribution is to shed light on the benefits for research in health care coming from the use of administrative data, especially in terms of measuring hospitals’ outcomes. The main approaches to health outcome evaluation are reviewed and the possible improvements deriving from the use of administrative data are highlighted. Administrative data may be an essential element in the process of gathering to the public true rankings of health care organizations, reducing the degree of asymmetric information that typically arises in health care. Patients will be more aware of the best institutions, which will induce most of them to demand to be admitted in them, taking into account the costs associated with distance and with the severity of the illness. This in turn may ask for a reorganization of the sector, closing some organizations and expanding others, having as final goal to improve the health status of the population, without income barriers. This is one of the first attempts to provide an overview of the advantages that administrative data may gather in health care.

Increased competition and resource scarcity have caused hospitals to seek internal efficiencies by restructuring their structures and processes. The purpose of this paper is to examine the effects of an organization's orientation toward control and learning and the use of process facilitators on perceived organizational consensus on outcomes related to cost, quality, and the ability to sustain implemented changes following a major hospital restructuring.

Data from 263 hospitals from across the USA were collected. Factor analysis was employed to develop scales measuring the organization's emphasis on learning, controls, and processes. Regression analysis then examined their relationship to the consensus on restructured outcomes.

The findings suggest a positive relationship between a learning orientation and processes with improved perceived agreement on restructuring outcomes. Hospitals with control orientations have a negative relationship with perceived organizational consensus.

The research has some limitations. The primary data for both the CEOs' and employees' perspectives comes from hospital CEOs. Also, the study is a cross‐sectional study and lacks longitudinal information. It also includes mostly not‐for‐profit hospitals, with 100 or more beds, in urban areas.

Hospitals will continue to feel pressures for the need to restructure and change. The findings suggest that hospitals achieve better results if they foster a learning orientation and put in place processes to facilitate the challenges of change. Although control systems are important, executives should realize that they might impede organizational efforts during organizational change. Hospitals may succeed in their change efforts by balancing adequate control and learning that are supported by processes to facilitate restructuring efforts.

The work provides an original study on the effects of an organization's orientation of learning and controls and change processes on the perceived consensus of restructuring outcomes. The dichotomy of learning and controls has not been applied to hospital consensus on outcomes. The research suggests that hospitals can improve their change efforts by implementing appropriate processes and greater learning mechanisms. During times of stress and change hospitals often become more control oriented, which may create greater misalignments and ineffective change. Managers should learn from the research that appropriate processes and learning will provide better consensus and more effective change.

The current policy context demands that health service providers demonstrate that services are effective, efficient, value for money and of good quality. Recent Government interest in intermediate care has increased pressure on day hospitals in particular to supply such evidence, because they face competition for their core services (such as rehabilitation care) from other community‐based providers. This review was conducted as part of a small study to evaluate a day hospital service in North London. Findings suggest that the outcomes of day hospital care are especially difficult to appraise because of the highly variable nature of both individual facilities and the needs and capabilities of patients attending. Traditional quantitative methods, such as randomised controlled trials or the use of standardised tools to assess treatment outcomes, face severe methodological problems owing to this variability. Three problems in particular would appear to hamper such research: comparability difficulties, owing to great variations in facilities and patient profiles; defining outcomes, because varying need may result in very different intended treatment outcomes, and determining complete costs, because patients rarely receive day hospital treatment in isolation from other health and social care services. The review suggests therefore that future researchers take a more user‐focused and qualitative research approach to the evaluation of day hospital care, such as by evaluating joint care plans with patients and staff, by assessing costs, by following small numbers of users through treatment and by studying users' and carers' views of (and preferences for) care.

The aim of this paper is the discussion and the dissemination of initiatives promoted by the Lombardy region for the construction of benchmarking systems between regional health structures of care utilizing administrative archives.

The paper focuses on relative effectiveness (specific effect of care on patients) in a benchmarking framework, considering the dimension of sentinel outcomes. From Lombardy Hospital Discharge Cards proxies of sentinel outcomes are identified, defined as “context indicators” useful for a benchmarking analysis.

First, the authors present outcomes and covariates at different levels (patient and healthcare structure) extracted from the Lombardy Hospital Discharge Cards for a benchmarking analysis. Second, empirical results show a consistent quota of outcome variability between structures of care and weak agreement between estimated rankings for context indicators. Finally, a slicing approach is suggested in order to apply an equitable comparison among healthcare structures.

The paper provides regional stakeholders with practical implications regarding available strategies (outcomes, statistical methodology, risk adjustment) for consistent processes of evaluation, in a benchmarking framework, based on existing regional administrative data.

After having presented available information contained in regional archives for a benchmark analysis, empirical results were discussed about context indicators, presenting indications and strategies for a refinement of the approach. From a methodological point of view, the utilization of multilevel models (improving methodological strategies adopted by international agencies) in large administrative databases is proposed.

The most challenging aspect of hospital design is the creation of an environment that heals rather than the one acting as a barrier to healing. Much has not been done in the aspect of ascertaining the level of impact “indoor environmental quality (IEQ)” has on building occupants in healthcare facilities. Therefore, this study aims to investigate the impact of IEQ on patients' health and well-being.

The study investigates the hypothesis that four IEQ parameters (thermal quality, acoustic quality, lighting quality and indoor air quality [IAQ]) influence patients' overall satisfaction with the performance of hospital wards. Questionnaire responses were sought from the patients as the main occupants of hospital ward buildings. A proposed weighted structural model for IEQ establishing the relationship between IEQ parameters, patients' overall satisfaction and patients' health outcome was analyzed using structural equation modeling (SEM).

The most influential IEQ parameters on patients' overall satisfaction with IEQ in hospital wards are thermal quality, IAQ and lighting quality. The findings from this study revealed that the parameters of influence on patients' overall satisfaction and health outcomes vary with hospital ward orientation and design configuration.

This study has explored the need for the integration of all factors of IEQ at the building design stage towards providing a hospital environmental setting that reflects occupants' requirements and expectations and also promotes patient healing processes. This should be the focus of architects and healthcare managers and providers.

Background – Reliable and valid hospital nurse staffing measures are a major requirement for health services research. As the use of these measures increases, discussion is growing as to whether current nurse staffing measures adequately meet the needs of health services researchers.

Objective – This study assesses whether the measures, sampling frameworks, and data sources meet the needs of health services research in areas such as staffing assessment; patient, nurse, and financial outcomes; and prediction of staffing.

Methods – We performed a systematic review of articles from 1990 through 2007, which use hospital nurse staffing measures in original research, or which address the validity, reliability, and availability of the measures. Taxonomies of measures, sampling frameworks, and sources were developed. Articles were analyzed to assess what measures, sampling strategies, and sources of data were used and to ascertain whether the measures, samples, and sources meet the needs of researchers.

Results – The review identified 107 articles that use hospital nurse staffing measures for original research. Multiple types of measures, some of which are used more often than others and some of which are more valid than others, exist in each of the following categories: staffing counts, staffing/patient load ratios, and skill mix. Sampling frameworks range from hospital units to all hospitals nationally, with all hospitals in a state being the most common. Data sources range from small-scale surveys to national databases. The American Hospital Association Annual Survey is the most frequently used data source, but there are limitations with its nurse staffing measures. Arguably, the multiplicity of measures and differences in sampling and data sources are due, in part, to data availability. The limitations noted by other researchers and by this review indicate that staffing measures need improvements in conceptualization, content, scope, and availability.

Discussion – Recommendations are made for improvements to research and administrative practice and to data.

This paper examines the relationship between human resource practices in 173 hospitals in the United Kingdom and four organizational outcome categories – clinical, financial, employee attitudes and perceptions, and patient attitudes and perceptions. The overarching proposition set forth and examined in this paper is that human resource management (HRM) practices and delivery of care practices have varied effects on each of these outcomes. More specifically, the authors set forth the proposition that specific practices will have positive effects on one outcome category while simultaneously having a negative effect on other performance outcomes, broadly defined.

The paper introduces a broader stakeholder framework for assessing the HR–performance relationship in the healthcare setting. This multi-dimensional framework incorporates the effects of human resource practices on customers (patients), management, and frontline staff and can also be applied to other sectors such as manufacturing. This approach acknowledges the potential for incompatibilities between stakeholder performance objectives. In the healthcare industry specifically, our framework broadens the notion of performance.

Overall, our results provide support for the proposition that different stakeholders will be affected differently by the use of managerial practices. We believe that the findings reported in this paper highlight the importance of examining multiple stakeholder outcomes associated with managerial practices and the need to identify the inherent trade-offs associated with their adoption.

Public reports of provider-specific patient outcomes aim to help consumers select suppliers of medical services. Yet, in an environment of rapidly changing medical technology and increasingly heterogeneous patient populations, and because they necessarily reflect the experience of other patients who received care in the past, such reports may be of limited value in helping patients forecast the probability of an adverse outcome for each provider they are considering. I propose that providers underwrite insurance policies that promptly pay patients a predetermined sum after an adverse outcome. Patients can use such outcome warranties to infer quality differences among providers easily and reliably. In addition, outcome warranties efficiently reward both providers and patients for reducing the risk of adverse outcomes and thereby improve the safety and affordability of health care. As such, outcome warranties help advance four important goals of health care management: reduction of financial risk, recruitment and retention of physicians, remediation of adverse outcomes, and raising the provider's reputation.

This paper aims to extend the consideration of distributed leadership in health-care settings. Leadership is typically studied from the classical notion of the place of single leaders and continues to examine distributed leadership within small teams or horizontally. The purpose is to develop a practical understanding of how distributed leadership may occur vertically, between different layers of the health-care leadership hierarchy, examining its influence on health-care outcomes across two hospitals.

Using semi-structured interviews, data were collected from 107 hospital employees (including executive leadership, clinical management and clinicians) from two hospitals in Australia and the USA. Using thematic content analysis, an iterative process was adopted characterized by alternating between social identity and distributed leadership literature and empirical themes to answer the question of how the practice of distributed leadership influences performance outcomes in hospitals?

The perceived social identities of leadership groups shaped communication and performance both positively and negatively. In one hospital a moderating structure emerged as a leadership dyad, where leadership was distributed vertically between hospital hierarchal layers, observed to overcome communication limitations. Findings suggest dyad creation is an effective mechanism to overcome hospital hierarchy-based communication issues and ameliorate health-care outcomes.

The study demonstrates how current leadership development practices that focus on leadership relational and social competencies can benefit from a structural approach to include leadership dyads that can foster these same competencies. This approach could help develop future hospital leaders and in doing so, improve hospital outcomes.

Rapidly rising healthcare costs, partially due to preventable medical errors, have led hospitals to redouble their process improvement (PI) efforts. The purpose of this paper is to examine how PI initiatives mediate the effect of medical error sources to enhance three hospital outcomes (patient safety, operational effectiveness, and competitiveness).

Drawing from Dynamic Capabilities Theory, the authors develop a framework to explore three PI initiatives: Continuous Quality Improvement (CQI), Six Sigma Initiatives (SSI), and Lean Management Initiatives (LMI). Hierarchical regression analysis is employed to test the proposed model, using data from a nationwide survey of 210 US hospitals.

For enhancing patient safety outcomes, it was found that CQI and LMI were significant in mediating hospital error sources; however, SSI was not significant after accounting for the other two PI types. For improving organizational effectiveness, CQI and SSI were significant; whereas LMI was not significant over and above the other two PI types. Finally, only SSI was significant for superior sustainable competitive advantage.

The paper provides insight into which PI initiatives were most effective for various hospital outcomes. The findings can benefit healthcare practitioners as they select among different PI programs for enhancing healthcare results. Limitations of the study include the use of perceptual measures, relatively small sample size, and potential alternate relationships relevant to the outcome variables.

This is the first study to explore the mediating effects of three PI programs for the impact of medical errors on each of three hospital outcomes.