The Association between Board Composition, Board Governance, and Charity Care Provided by Nonprofit Hospitals

In this study, we examine the association between board composition, board governance and charity care provided by nonprofit hospitals. Using nonprofit hospitals' 990 tax return data, we first investigate whether the composition of nonprofit hospital boards of directors is associated with board governing decisions related to patients' eligibility for charity care. Then, we examine whether these same board governing decisions are associated with the reported amount of charity care provided by hospital management. These research questions are motivated by legislators' and regulators' interest in understanding how nonprofit hospitals behave in terms of their charitable missions (Kennedy, Burney, Troyer and Stroup 2010). Overall, at the board governance level, we find the percentage of medical doctors on the board is positively associated with governing decisions affecting patients' eligibility for free charity care. Related, we find that percentage of healthcare administrators on the board is also positively associated with governing decisions affecting patients' eligibility for both free and discounted charity care. At the social performance level, we find that board governing decisions related to patients' eligibility for free and discounted charity care are both positively associated with the amount of charity care provided by hospital management.

A Board Level Intervention to Develop OrganisationWide Quality Improvement Strategies: Cost-Consequences Analysis in 15 Healthcare Organisations

Background: Hospital boards have statutory responsibility for upholding the quality of care in their organisations. International research on quality in hospitals resulted in a research-based guide to help senior hospital leaders develop and implement quality improvement (QI) strategies, the QUASER Guide. Previous research has established a link between board practices and quality of care; however, to our knowledge, no board-level intervention has been evaluated in relation to its costs and consequences. The aim of this research was to evaluate these impacts when the QUASER Guide was implemented in an organisational development intervention (iQUASER). Methods: We conducted a ‘before and after’ cost-consequences analysis (CCA), as part of a mixed methods evaluation. The analysis combined qualitative data collected from 66 interviews, 60 hours of board meeting observations and documents from 15 healthcare organisations, of which 6 took part on iQUASER, and included direct and opportunity costs associated with the intervention. The consequences focused on the development of an organisation-wide QI strategy, progress on addressing 8 dimensions of QI (the QUASER challenges), how organisations compared to benchmarks, engagement with the intervention and progress in the implementation of a QI project. Results: We found that participating organisations made greater progress in developing an organisation-wide QI strategy and became more similar to the high-performing benchmark than the comparators. However, progress in addressing all 8 QUASER challenges was only observed in one organisation. Stronger engagement with the intervention was associated with the implementation of a QI project. On average, iQUASER costed £23 496 per participating organisation, of which approximately 44% were staff time costs. Organisations that engaged less with the intervention had lower than average costs (£21 267 per organisation), but also failed to implement an organisation-wide QI project. Conclusion: We found a positive association between level of engagement with the intervention, development of an organisation-wide QI strategy and the implementation of an organisation-wide QI project. Support from the board, particularly the chair and chief executive, for participation in the intervention, is important for organisations to accrue most benefit. A board-level intervention for QI, such as iQUASER, is relatively inexpensive as a proportion of an organisation’s budget.

Identifying and Evaluating Operating Room Hazards in Shahid Beheshti Hospital in Kashan using the JSA Technique and its Relationship with Prioritized Engineering and Managerial Controls

Introduction: The operation room is one of the most complex working environments in the health care system and the chance of accidents happening there is high. Studies show more than 50 identified dangers in the surgery room, which can potentially hurt the workers and patients there while many of these errors can be prevented. The aim of the current study is to identify and evaluate operating room dangers using the JSA technique and its correlation with prioritized engineering and managerial controls to prevent errors and decrease its consequences. Methods: The current applied study has a descriptive-analytical design and was implemented with a cross-sectional design in the operating rooms of Shahid Beheshti Hospital in Kashan in 2017. The population of the study was the university faculty members, HSE experts, managers, surgeons and anesthesiologists, seasoned nurses, and the supervisors at Shahid Beheshti Hospital in Kashan and sampling was conducted via a census. The identification and evaluation of dangers was conducted using the JSA method and managerial and engineering approaches were determined using panel discussions. results: In the initial identification and evaluation of hazards in the operating room, 25 hazards were identified and evaluated using the JSA technique and after implementing the prioritized engineering and managerial controls, five of the identified hazards were controlled. Lifting heavy objects and unsuitable postures had the highest risk decrease (decreasing to 10 from 15), which was followed by facing chemical disinfectants and detergents (decreasing to 12 from 16), and touching sharp objects and catching infectious illnesses (decreasing to 12 from 15). Conclusion: The results of the current study showed that the JSA technique can be effective in identifying and presenting control approaches. Furthermore, with greater focus on risk management on behalf of hospital boards to develop health quality and create a safe environment for the workers and patients is necessary. Adopting policies and programs for the monitoring of risk management in hospitals must be seriously consistent.

From prescription to guidance: a European framework for generic competencies

In postgraduate medical education, required competencies are described in detail in existing competency frameworks. This study proposes an alternative strategy for competency-based medical education design, which is supported by change management theories. We demonstrate the value of allowing room for re-invention and creative adaptation of innovations. This new strategy was explored for the development of a new generic competency framework for a harmonised European curriculum in Obstetrics and Gynaecology. The generic competency framework was developed through action research. Data were collected by four European stakeholder groups (patients, nurses, midwives and hospital boards), using a variety of methods. Subsequently, the data were analysed further in consensus discussions with European specialists and trainees in Obstetrics and Gynaecology. These discussions ensured that the framework provides guidance, is specialty-specific, and that implementation in all European countries could be feasible. The presented generic competency framework identifies four domains: ‘Patient-centred care’, ‘Teamwork’, ‘System-based practice’ and ‘Personal and professional development’. For each of these four domains, guiding competencies were defined. The new generic competency framework is supported by European specialists and trainees in Obstetrics and Gynaecology, as well as by their European stakeholders. According to change management theories, it seems vital to allow room for re-invention and creative adaptation of the competency framework by medical professionals. Therefore, the generic competency framework offers guidance rather than prescription. The presented strategy for competency framework development offers leads for implementation of competency-based medical education as well as for development of innovations in postgraduate medical education in general.

HUBUNGAN LAMA HARI RAWAT DENGAN TANDA DAN GEJALA SERTA KEMAMPUAN PASIEN DALAM MENGONTROL HALUSINASI

Dampak adanya halusinasi dapat mengakibatkan seseorang mengalami ketidakmampuan untuk berkomunikasi atau mengenali realitas yang menimbulkan kesukaran dalam kemampuan seseorang untuk berperan sebagaimana mestinya dalam kehidupan sehari-hari. Dampak bagi keluarga halusinasi sulit diterima oleh masyarakat, individu dan dipandang negatif oleh lingkungan.Mengetahui hubungan lama hari rawat dengan tanda dan gejala serta kemampuan pasien dalam mengontrol halusinasi di RSJ Grhasia Yogyakarta. Penelitian ini menggunakan menggunakan Desain penelitian studi korelasional (Corrrelation study). Penelitian ini menggunakan teknik total sampling, Sampel yang digunakan dalam penelitian ini berjumlah 45 pasien halusinasi yang ada diruang inap Rumah Sakit Jiwa Grhasia Yogyakarta. Metode analisis yang digunakan adalah uji statistik menggunakan kendal Tau. Hasil penelitian ini menunjukkan bahwa berdasarkan lama hari rawat pasien halusinasi Di RSJ Grhasia Yogyakarta didapatkan paling banyak lebih dari 30 hari sebanyak 42 responden, tanda dan gejala pasien halusinasi Di RSJ Grhasia Yogyakarta didapatkan paling banyak kategori kurang sebanyak 30 responden, dan kemampuan pasien dalam mengontrol halusinasi Di RSJ Grhasia Yogyakarta didapatkan paling banyak kategori cukup sebanyak 27 responden.Tidak ada hubungan lama hari rawat dengan tanda dan gejala dilihat dari nilai p-value sebesar 0,170<0,05, dan terdapat hubungan lama hari rawat dengan kontrol halusinasi dilihat dari nilai p-value sebesar 0,030<0,05 dengan nilai keeratan hubungan 0,325 dalam kategori rendah. Bagi pimpinan RS agar memberikan pengembangan pelayanan kesehatan pada pasien dalam meningkatkan kualitas pelayanan, khususnya dalam lama hari rawat dengan tanda dan gejala kemampuan pasien dalam mengontrol halusinasi. Alahkah baiknya ada perbandingan antara tanda dan gejala sebelum di teliti dan sesudah di teliti. Kata kunci: Lama hari rawat, tanda dan gejala, kemampuan mengontrol halusinasi THE CORRELATION BETWEEN INPATIENT DURATION, AND SIGNS, SYMPTHOMS AND PATIENT’S ABILITY TO CONTROL HALLUCINATIONS ABSTRACTHallucinations can cause disability to communicate or recognize the reality that creates difficulties to act properly in everyday life. The impact of hallucinations on the family is hard to accept by society and individuals, and it is viewed as negative thing by the environment. The study aims to identify the correlation between inpatient duration and signs, symptoms and patient's ability to control the hallucinations at Grhasia Mental Hospital of Yogyakarta. This study used correlational study design. This study used total sampling technique. The samples were 45 hallucination patients at impatient wards at Grhasia Mental Hospital of Yogyakarta. The analytical method used statistical test using Tau constraints. The results of this study indicated that based on the hallucination of inpatient duration at Grhasia Mental Hospital of Yogyakarta, there were 42 respondents who had 30 days of inpatient duration; there were 30 respondents of hallucination patients at Grhasia Mental Hospital of Yogyakarta who have signs and symptoms in low category; there were 27 respondents at Grhasia Mental Hospital of Yogyakarta who had the ability in controlling hallucinations in moderate category. There was not any correlation between inpatient duration and signs and symptoms that can be seen from the p-value of 0.170 <0.05, and there was correlation between the inpatient duration and the control of hallucinations that can be seen from the p-value of 0.030 <0.05 with the closeness value 0.325 in low category. Hospital boards are suggested to provide the development of health services to patients in improving the quality of care, especially about inpatient duration and signs and symptoms of the patient's ability to control hallucinations. Is it better to have a comparison between the signs and symptoms before and after being studied. Keywords: Inpatient Duration, signs and symptoms, ability to control hallucinations

Meta-regulation meets Deliberation: Situating the Governor within NHS Foundation Trust Hospitals

NHS Foundation Trust (FT) hospitals in England have complex internal governance arrangements. They may be considered to exhibit meta-regulatory characteristics to the extent that governors are able to promote deliberative values and steer internal governance processes towards wider regulatory goals. Yet, while recent studies of NHS FT hospital governance have explored FT governors and examined FT hospital boards to consider executive oversight, there is currently no detailed investigation of interactions between these two groups. Drawing on observational and interview data from four case-study sites, we trace interactions between the actors involved; explore their understandings of events; and consider the extent to which the proposed benefits of meta-regulation were realised in practice. Findings show that while governors provided both a conscience and contribution to internal and external governance arrangements, the meta-regulatory role was largely symbolic and limited to compliance and legitimation of executive actions. Thus while the meta-regulatory ‘architecture’ for governor involvement may be considered effective, the soft intelligence gleaned and operationalised may be obscured by ‘hard’ performance metrics which dominate resource-allocation processes and priority-setting. Governors were involved in practices that symbolised deliberative involvement but resulted in further opportunities for legitimising executive decisions.

Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service

BackgroundHealthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis’ typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England.MethodsWe conducted fieldwork over a 30-month period as part of an evaluation in six healthcare provider organisations in England. Our data comprised board member interviews (n=54), board meeting observations (24 hours) and relevant documents.ResultsTwo organisations transformed their processes in a way that was consistent with the objectives of the intervention, and one customised the intervention with positive effects. In two further organisations, the intervention was only loosely coupled with organisational processes, and participation in the intervention stopped when it competed with other initiatives. In the final case, the intervention was corrupted to reinforce existing organisational processes (a focus on external regulatory requirements). The organisational response was contingent on the availability of ‘slack’—expressed by participants as the ‘space to think’ and ‘someone to do the doing’—and the presence of a functioning board.ConclusionsUnderperforming organisations, under pressure to improve, have little time or resources to devote to organisation-wide quality improvement initiatives. Our research highlights the need for policy-makers and regulators to extend their focus beyond the choice of intervention, to consider how the chosen intervention will be implemented in public sector hospitals, how this will vary between contexts and with what effects. We provide useful information on the necessary conditions for a board-level quality improvement intervention to have positive effects.