Search results

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 purpose of this study is to examine the effects of health-care governance and ownership structure on the performance of hospitals in Ghana.

The study uses multiple regression models based on a sample of 132 hospitals in Ghana.

The results of the study indicate that hospitals with a governing board perform better than those without a governing board. The results of this study also suggest that board characteristics and ownership structure are important in explaining the performance of hospitals in Ghana. The results further indicate that mission-based and private hospitals with effective board governance structures exhibit better performance than public hospitals.

This study makes a number of new and meaningful contributions to the extant literature and the findings support managerialism, stakeholder and resource dependency theories. The findings also have important implications for the effective governance of hospitals.

This chapter draws on a study conducted in the mid 1990s to compare management differences between three different groups of South African hospitals, in order to understand how these differences might have affected hospital functioning. The groups were public hospitals; contractor hospitals publicly funded but privately managed; and private hospitals owned and run by private companies. Public sector structures made effective management difficult and were highly centralized, with hospital managers enjoying little autonomy. In contrast, contractor and private groups emphasised efficient management and cost containment. These differences appeared to be reflected in cost and quality differences between the groups. The findings suggest that in the context of a country such as South Africa, with a relatively well-developed private sector, there is potential for the government to profit from the management expertise in the private sector by identifying lessons for its own management structures, and by contracting-out service management.

The purpose of this paper is to propose a practical conceptualization of the balanced scorecard (BSC) to describe the mechanism producing creation of monetary value for hospitals in the territorial context of Lombardy region (Italy).

The authors propose a model‐building strategy that assigns key indicators to key performance areas, and identifies causal relationships between key performance areas. Second, the authors utilize a suitable statistical approach to estimate causal relationships among involved latent variables, taking into account the hierarchical structure of data. Utilizing a suitable data decomposition, the causal model is applied separately to the within data (hospitals) and to the between data (local health agencies).

In the measurement model a new latent construct (medical human capital) was found that resumes the amount of formal training and the performance of surgical staff in hospitals. The estimated causal models reflect the usual directional assumptions, supposed in a typical BSC causal scheme, with some differences. For local health agencies, fruits (financial measures) are strongly related to clinical processes (leaves) for which the medical human capital constitutes its unique trunk. However, for hospitals, fruits (financial measures) are directly linked to clinical processes and Patient Satisfaction.

The main limitations of this study are the lack of new independent data to validate the obtained causal structures and the limited number of indicators that reflect the deficiency of available information in regional administrative archives.

The present study may be useful to guide further efforts which attempt to conceptualize BSC in the health sector. As more information can be made available, other performance indicators can prove to be linked with this structure using the same methodology.

Examines the process of change in hospitals that has emerged following the introduction of the health quasi‐market in 1991. Blends empirical evidence with Greenwood and Hinings’ archetype and tracks of change concepts to analyse the process which is labelled quasi‐market transformation (QMT). Argues that, before 1991, hospitals tended to operate within structures and systems underpinned by an interpretive scheme. Represents these similarities of configuration as the directly‐managed (DM) hospital archetype. When change initiatives challenged this configuration, the outcomes were negotiated and resulted in “adjustmental” change. In contrast, shows the introduction of the quasi‐market to have involved the first transformation of the DM archetype’s interpretive scheme, systems and structures. Analyses four years of transition to reveal that QMT has been interpreted differently within hospitals. However, presents data to suggest that many hospitals now display significant similarities in terms of configuration. Represents these similarities within the emerging Trust hospital archetype.

Achieving integrated care is a key focus for health systems and has resulted in various structures between and within organisations. The reorganisation of the Irish health system into hospital networks/groups aims to encourage work across hospitals to integrate care. This study evaluated if collective leadership emerged over time through increased interaction and collaboration following the organisation of hospitals into a network. A secondary aim was to elucidate the potential for collective leadership, through understanding the barriers and enablers perceived by participants.

This study employed social network analysis and qualitative interviews. Leaders across the hospital group were invited to participate in an online network survey and interviews (analysed using thematic analysis) at three time points over an 18-month period.

Although there was evidence that some parts of network were beginning to operate collectively, the structures observed were more typical of a hierarchical network. Disruption in the network and uncertainty regarding permanence of the organisational structure had a negative impact on the potential for collective leadership. Yet, progress was evident in terms of establishing building blocks for collective leadership and integration, including developing trust, mutual understanding and creating space for change.

This study contributes to the literature by reflecting on the mechanisms and initiatives perceived as enabling/inhibiting collective leadership. Based on this research, it is important to communicate a clear and consistent message about the plans for the organisations involved and be clear regarding the roles and expectations for those involved in introducing new approaches to leadership and integration. Honest collaboration, openness and certainty in communication will likely be important in order to help create the contextual conditions to enable collective and system approaches to introduce “stepping stones” to change. These conditions include developing interpersonal relationships between leaders, creating time and space for deep and shared reflection, and enhancing trust among colleagues.

A key strength of this study is the linking of leadership-as-networks theory with social network methods to investigate collective leadership in practice. This study contributes to the literature by reflecting on the mechanisms and initiatives perceived as enabling/inhibiting collective leadership.

This study looks at board governance in Ontario hospitals.

We conducted a research of the hospitals’ websites and a survey of board directors to study the board structure and examine governance practice in Ontario hospitals.

The findings suggest that the board structure and process in Ontario hospitals are in compliance with Accreditation Canada’s Governance Standards, and such administrative controls are appropriate. Ontario hospital boards, in general, have fulfilled their key functions of governance in terms of working as an effective board; developing a clear direction; supporting the organization to achieve its mandate; maintaining positive relationships with external stakeholders; and being accountable and achieving sustainable results. Building knowledge through information is an area where improvement is needed.

Ontario hospitals have implemented appropriate administrative controls in terms of board composition and committee structure. The results of a survey of 99 board directors from over 25 hospitals suggest that directors, in general, have a good understanding of their governance role and relationship with senior management as well as the government. The findings are also supportive of good governance practice where executives manage and nonexecutive directors monitor the performance of the executives. According to the respondents, Ontario’s hospital boards are actively involved in setting the mission, strategic goals and objectives of their organizations, and they take appropriate steps to ensure that risk management, client safety, and quality improvements are incorporated in their governance and strategic planning process. In order to discharge their fiduciary duty effectively, respondents would like to have more information from different sources. This is an area where management accounting professionals can become involved such that relevant information from a variety of sources, especially external sources, are provided to board directors for decision making.

Ontario’s hospital sector has undertaken initiatives through research and publications to promote good governance practice. Such leadership is critical to ensure that directors have the competence and skills to discharge their duties and responsibilities diligently. Hospital boards should focus on renewal while ensuring that board directors are equipped for the challenging task of governing through professional development and continuing education.

Limitations related to the use of questionnaire applies to this research study. Self-selection bias and low response rate limit the generalizability of the findings. Future research can examine the behavior of directors in the boardroom and the impact of governance variables on hospital performance, such as quality of care and patient safety.

The purpose of this paper is to examine the nature of governance structures in Ghanaian hospitals by comparing the governance systems in public and private hospitals.

This study employs a comparative case methodology. It compares the governance structures in private hospitals to that of public hospitals in Ghana to ascertain whether they exhibit different or similar governance systems. The results obtained are analyzed and discussed to ascertain the extent to which the governance structures in these hospitals conform to Taylor's principles of good governance.

The results of the study revealed numerous differences in the governance structures in private and public hospitals in Ghana. From the review of Taylor's principles of good governance and the comparative case analysis, it was observed that some of the principles are not present in the current hospital governance systems.

The findings of this paper have important implications for proper governance and management of the Ghanaian health institutions.

The purpose of this paper is to analyse the framework of hospital governance in order to understanding the persistence of dysfunctions that have caused the deterioration of the image and quality of Moroccan public hospital services.

The analysis of the hospital governance model has used a conceptual framework examining four dimensions: institutional, financial, accountability and decision-making dimensions. This framework operationalization was highlighted through a documentary review of the main regulatory and legal texts as well as multiple case studies, using semi-structured interviews with the key stakeholders, considering their expertise and implication in the governance process.

The study was able to highlight that the governance structure of Moroccan public hospitals has been subject to numerous legislative provisions and modern management instruments. However, the limited autonomy, the resources shortage, dilapidated equipment, the chronic budget deficit, staff demotivation, the lack of accountability mechanisms have led to the deterioration of the quality of care and, hence, to patient's dissatisfaction.

The analysis formed the basis for a series of recommendations. These were mainly aimed at rethinking the current governance model by setting up an institutional policy to improve the current governance structures and monitoring mechanisms of hospitals, as well as revising the instruments for planning and evaluating the provision of care and services according to the real needs of the population, taking into account the financial limits.

The hospital governance framework is proving to be a powerful tool for identifying the problems contributing to sub-optimal hospital performance, and calls for policy interventions to improve the organisation organization and delivery of hospital services with greater patient involvement.

This study was the first to analyse the Moroccan hospital governance model, using a comprehensive and structured evaluation methodology designed for public hospitals and supported by extensive data collection which made it possible to offer a broad and in-depth view of the actual functioning of these institutions.

The purpose of the paper is to examine the levels of job satisfaction among doctors who work in Greek public hospitals, to determine the factors that may influence their satisfaction, to examine the contribution that staff support makes to job satisfaction and to investigate the potential impact that an economic recession might have on job satisfaction.

The sampling process used was stratified sampling and it was applied to all health regions in Greece. An official request to carry out the study was sent to 45 hospitals for the approval of their management. Through random sampling, 5% of the doctors' population was selected from each participating hospital, with the resulting sample consisting of 458 doctors from all the health regions of Greece. An anonymous questionnaire was administered to the sample of medical doctors to gather data on their perception of the work they do in public hospitals.

Empirical results showed that (1) the most important factor in doctors' job satisfaction appears to be the nature of their job and the high levels of autonomy that they have, and (2) doctors' level of commitment is maintained by enhancing their positive emotions and sense of professional well-being.

A deeper understanding of important concepts of an organization's behavior such as job satisfaction, staff support and their connection with internal organizational structures will facilitate policy makers and those who make decisions on the strategic management of medical staff in public hospitals.