Standardization and strengthening the functionality of hospital management boards in central hospitals: Evidence of a developing economy

Zimbabwe’s public hospitals have been criticised for the declining standard of health service delivery for the past three decades with fingers pointed towards the hospital governance system. In response to the criticism, the government of Zimbabwe, through the Ministry of Health, has begun the process of making structural changes to the entire hospital governance system (Moyo, 2016; Sikipa, Osifo-Dawodu, Kokwaro, & Rice, 2019). The aim of the study is to examine the processes of appointing hospital management board (HMB) members in central hospitals of Zimbabwe. The study sought to explore the standardization, strengthening, and performance of HMBs in central hospitals of Zimbabwe with a focus on six central hospitals which include Harare, Chitungwiza, Parirenyatwa Group of Hospitals, United Bulawayo Hospitals (UBH), Mpilo, and Ingutsheni. The study employed a mixed-method design using the questionnaire and interviews to collect data. The target population included 66 board members. The census approach was used meaning that all members of the population formed the sample size. The study revealed that 67% of hospitals had functional HMBs with a quorum despite lacking a clear policy to evaluate their performance. The gaps identified required policy review to strengthen the appointment and performance of HMBs

Engaging Housestaff as Informatics Collaborators: Educational and Operational Opportunities

Background In academic hospitals, housestaff (interns, residents, and fellows) are a core user group of clinical information technology (IT) systems, yet are often relegated to being recipients of change, rather than active partners in system improvement. These information systems are an integral part of health care delivery and formal efforts to involve and educate housestaff are nascent. Objective This article develops a sustainable forum for effective engagement of housestaff in hospital informatics initiatives and creates opportunities for professional development. Methods A housestaff-led IT council was created within an academic medical center and integrated with informatics and graduate medical education leadership. The Council was designed to provide a venue for hands-on clinical informatics educational experiences to housestaff across all specialties. Results In the first year, five housestaff co-chairs and 50 members were recruited. More than 15 projects were completed with substantial improvements made to clinical systems impacting more than 1,300 housestaff and with touchpoints to nearly 3,000 staff members. Council leadership was integrally involved in hospital governance committees and became the go-to source for housestaff input on informatics efforts. Positive experiences informed members' career development toward informatics roles. Key lessons learned in building for success are discussed. Conclusion The council model has effectively engaged housestaff as learners, local champions, and key informatics collaborators, with positive impact for the participating members and the institution. Requiring few resources for implementation, the model should be replicable at other institutions.

Intention to Choose Syariah Compliant Hospital: The Role of Religiosity

Syariah Compliant Healthcare Services in a rather unique trend that emerged in Malaysia. It started in few decades ago when certain ‘Islamic’ hospitals started offering Syariah compliant services with the tag line “Ibadah Friendly Hospital”. Syariah Hospital of Islamic Hospital defined as hospital that provides health services in accordance with Syariah principles or in other words applying maqasid Syariah in hospital governance hospital. But a question remains, is there a necessity of Syariah compliant hospitals? And why it became a choice in the market. The research methodology used is qualitative based on content analysis technique to obtain data. This study seeks to find out the reason that motivates this choice by looking into the role of religiosity that is presumed to be the main reason for the choice. Based on the theory of reason action, a literature has been reviewed to construct tools to investigate Muslim attitude towards their intention to choose Syariah compliant hospital.

Strategies Australian Hospitals Utilize to Incorporate Patient Feedback in the Delivery and Measurement of Person-Centered Care: A Scoping Review

Patients are central to healthcare clinicians and organizations but often subsidiary to clinical expertise, knowledge, workplace processes, and culture. Shifting societal values, technology, and regulations have remoulded the patient-clinician relationship, augmenting the patient’s voice within the healthcare construct. Scaffolding this restructure is the global imperative to deliver person-centered care (PCC). The aim of the scoping review was to explore and map the intersection between patient feedback and strategies to improve the provision of PCC within acute hospitals in Australia. Database searches yielded 493 articles, with 16 studies meeting inclusion criteria. Integration of patient feedback varied from strategy design, through to multi-staged input throughout the initiative and beyond. Initiatives actioning patient feedback fell broadly into four categories: clinical practice, educational strategies, governance, and measurement. How clinicians can invite feedback and support patients to engage equally remains unclear, requiring further exploration of strategies to propel clinician-patient partnerships, scaffolded by hospital governance structures.

Towards Reducing Risk of Injury in Nursing: Design and Analysis of a New Passive Exoskeleton for Torso Twist Assist

Nursing is among the most physically challenging occupations and involves intensive lifting activities often including twisting of torso while performing tasks such as patient handling. Frequent and repetitive twisting of the body is known to induce large demands on the musculature, which may lead to MSD with direct and indirect costs to the hospital governance. One solution proposed through this article includes an exoskeleton specifically designed to assist in twisting movements of the trunk. This involves a double-actuator fully passive system that assists in rotation of the torso with the help of mechanical springs and cable modules. Our study provides a conceptual design of the mechanism, and a preliminary analysis using the concepts of kinematics, dynamics, usability, wearability, and freedom of movement. Results show that the mechanism could offer freedom of rotation for the wearer’s torso up to 52, 25 and 22 degrees (with stationary hip joint) along the transverse, sagittal and coronal planes, respectively. Moreover, similar force generation (up to 80N) was obtained in both actuators for same rotation on transverse plane in both directions for a combination of spring stiffness (0.5 – 1 N/mm) and damping (0.1 - 0.5 N-sec/mm) parameters. Our proposed design could also be integrated to the current exoskeletons in the form of a module and could be beneficial in more general work settings.

Good Hospital Governance at the Indonesian Hospital

This study aims to describe the commitment of stakeholders in implementing the Good Hospital Governance policy at the Undata Regional General Hospital, Central Sulawesi Province, Indonesia. The method used is a qualitative exploratory approach with 13 (thirteen) informants who were determined by purposive sampling, the data analysis used was an interactive model data analysis from Miles and Huberman by triangulating methods and data sources. The results showed that the successful implementation of the Good Hospital Governance policy at Undata Hospital, Central Sulawesi Province which was viewed from 6 (six) supporting aspects of the implementation of the Van Metter and Van Horn policies had not been running properly. That is; aspects of resources, aspects of the characteristics of the executing agent, aspects of the attitudes/tendencies (dispositions) of the executing agents, and aspects of the external environment (economic, social, and political). Besides, an implementation must also be supported by the commitment of the owner, board of directors, and management as well as all hospital staff, to implement the principles of transparency, accountability, independence, responsibility, equality, and fairness.

Orthopedist involvement in the management of clinical activities: a case study

Background The rapid shift in hospital governance in the past few years suggests greater orthopedist involvement in management roles, would have wide-reaching benefits for the efficiency and effectiveness of healthcare delivery. This paper analyzes the dynamics of orthopedist involvement in the management of clinical activities for three orthopedic care pathways, by examining orthopedists’ level of involvement, describing the implications of such involvement, and indicating the main responses of other healthcare workers to such orthopedist involvement. Methods We selected four contrasting cases according to their level of governance in a Canadian university hospital center. We documented the institutional dynamics of orthopedist involvement in the management of clinical activities using semi-structured interviews until data saturation was reached at the 37th interview. Results Our findings show four levels (Inactive, Reactive, Contributory and Active) of orthopedist involvement in clinical activities. With the underlying nature of orthopedic surgeries, there are: (i) some activities for which decisions cannot be programmed in advance, and (ii) others for which decisions can be programmed. The management of unforeseen events requires a higher level of orthopedist involvement than the management of events that can be programmed. Conclusions Beyond simply identifying the underlying dynamics of orthopedists’ involvement in clinical activities, this study analyzed how such involvement impacts management activities and the quality-of-care results for patients.

Analysis of public hospital governance reforms: a case from a developing country

PurposeThe purpose of this paper is to explore the nature of governance reforms also called conceptual innovation for public hospitals in Malawi.Design/methodology/approachIt focuses on the reforms for central and district hospitals. It uses semi-structured interviews to collect data and thematic approach to analyse it.FindingsThe results show that the reforms for central hospitals are structurally well characterised as aimed at corporatisation though they are termed as automatisation. The terminological seems not to pose any harm on the direction of the reforms due to the thorough structural characterisation. On the other hand, reforms for district hospitals are vague as such implementation is retrogressive, in that, instead of progressively moving the hospitals towards greater autonomy the opposite is happening.Originality/valueThe paper highlights the significance of characterisation of the intended outcome on the direction of the reforms and proposes a framework to guide conceptual innovation for public hospitals in a devolution-mediated environment.