scholarly journals Setting priorities for high-cost medications in public hospitals in Australia: should the public be involved?

2011 ◽  
Vol 35 (2) ◽  
pp. 191 ◽  
Author(s):  
Gisselle Gallego ◽  
Susan J. Taylor ◽  
Jo-anne E. Brien
Keyword(s):  
Decision Making ◽  
Public Hospital ◽  
Public Hospitals ◽  
Decision Makers ◽  
Healthcare Decision ◽  
Healthcare Resources ◽  
The Public ◽  
Area Health Service ◽  
Area Health

Aim. To explore healthcare decision makers’ perceptions about public involvement in setting priorities for high-cost medications (HCMs) in public hospitals in Australia. Methods. In-depth, semi-structured interviews were conducted with 24 decision-makers (executive directors of hospitals, area health service managers, directors of hospital pharmacy departments and senior medical doctors) in a Sydney Area Health Service. Interviews were digitally recorded, transcribed verbatim, thematically content analysed and coded. Results. The majority of participants perceived that the ‘rationing debate’ needs to happen in Australia. The community at large should be encouraged to understand that healthcare resources are limited and choices need to be made. The perspectives of the public, according to participants, were considered diverse (tax payers, patients, consumers). Owing to the complexities of the healthcare system, their involvement of the public in decision-making regarding access to HCMs in public hospitals was considered limited. For participants, the role of the public was likely to be at the macro level, deciding how much they were prepared to spend on healthcare. Conclusion. The role of the public in setting priorities for HCMs in public hospitals was perceived by these healthcare decision makers as limited. However since rationing is unavoidable, there should be an explicit debate about the principles and issues concerned. What is known about the topic? Recognition of the importance of engaging the public in healthcare decision making is increasing. However, there is only limited understanding of the role of citizens in current priority setting mechanisms for allocating scarce resources to high-cost technologies such as medications at the public hospital level. What does this paper add? This study describes how involving the public in setting priorities for HCMs can present specific challenges from the perspective of decision makers working in the public hospital system. What are the implications for practitioners? In a time when public awareness is increasing about medical advances the challenge is to find ways of informing and involving the public in the debate about the distribution of healthcare resources. The results from this study will be useful for policy makers working on ways to improve the legitimacy of decisions at the institutional level.

Supervisory board process: Evidence from French public hospitals

2018 ◽  
Vol 31 (3) ◽  
pp. 163-177 ◽  
Author(s):  
Radhoine Laouer
Keyword(s):  
Decision Making ◽  
Public Hospital ◽  
Supervisory Board ◽  
Public Hospitals ◽  
Board Structure ◽  
The Public ◽  
The Social ◽  
Supervisory Boards ◽  
Relationship Of ◽  
Use Of Knowledge

We mobilize theories of corporate governance and the theory of the social psychology of decision-making small groups to understand the operational process of the public hospital supervisory board. More precisely, we empirically test the mediation relationship of the decision-making process (effort norms, use of knowledge and skills, and conflict cognitive) between its structure (size, the composition, and diversity) and the performance of its roles (strategy, control, and service). A total of 320 questionnaires coming from members of the French public hospital supervisory board were collected. The aggregation of these individual answers generates a sample of 159 public hospital supervisory boards. The results of the tests of the assumptions of the research model confirm the fact that the structure of the supervisory board does not influence the performance of its roles. However, supervisory board effort norms positively affect the performance of its roles positively. Only effort norms and the use of knowledge and the skills partially play the role of mediator between the supervisory board structure and the performance of its roles. Practical and theoretical implications are exposed in the discussion.

scholarly journals Public policy failure in healthcare: The effect of salary reduction for new entrant consultants on recruitment in public hospitals

2019 ◽  
Vol 67 (2) ◽  
pp. 95-112
Author(s):  
Fiona Kiernan
Keyword(s):  
Public Policy ◽  
Decision Making ◽  
Public Sector ◽  
Financial Crisis ◽  
Irrational Beliefs ◽  
Public Hospital ◽  
Public Hospitals ◽  
The Public ◽  
Policy Failure ◽  
Self Interest

AbstractPolicies fail or succeed for many reasons. These reasons include the decisionmaking process, which depends on the interplay of interests, as well as ideology and information. While bearing in mind that perception is often allimportant in deciding if a policy is a success or failure, this paper examines the policy failure of the 2012 decision to reduce salaries for new entrant consultants in Irish public hospitals. This salary reduction resulted in difficulties recruiting and retaining hospital consultants in the public sector. Firstly, the timeline and context of the decision are explored, taking into account the financial crisis at the time. This leads on to an examination of why this decision was made. It appears likely that self-interest on the part of the Minister for Health was a factor, and that self-interest on the part of the medical unions prevented reasonable discourse. The ideology of austerity was a predominant theme of government budgets in 2012; however, this ideology was also influential in creating an environment that allowed blame for public sector pay to be focused predominantly at public hospital consultants. Finally, I find problems with the information used in decision-making for the policy. This is evident from the irrational beliefs held by policymakers on the likelihood of recruiting consultants with lower salaries.

Influence of Web Application Technology on the Public Hospital Reform in China

2013 ◽  
Vol 859 ◽  
pp. 613-618
Author(s):  
Qian Ran He ◽  
Mi Hua Xian
Keyword(s):  
Web Application ◽  
Public Hospital ◽  
Public Hospitals ◽  
Application Technology ◽  
Role Of Government ◽  
The Public ◽  
Hospital Reform ◽  
Internal And External Factors ◽  
Public Hospital Reform

Web application technology is system which is linked with each other by many hypertext systems, through the Internet access and plays an important role in public hospital reform. Public hospital reformist carried out in the complicated political and economic environment and will be affected and restricted by internal and external factors. On the macro, the role of government, guiding theories of reform, value orientation, economic and technical factors and so on engender a significant influence on the reform; on the micro, the interest game between stakeholders of public hospital also affects the implementation of the reform of public hospitals

scholarly journals Accessing the public workforce: Organisational recruitment practices and the inclusion or exclusion of individuals of immigrant origin

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Christine Lang
Keyword(s):  
Decision Making ◽  
Qualitative Case Study ◽  
Ethnic Discrimination ◽  
German State ◽  
The Public ◽  
Ethnic Stereotypes ◽  
Recruitment Practices ◽  
Public Workforce

AbstractOrganisations are important gatekeepers in the labour market inclusion of immigrants and their children. Research has regularly documented ethnic discrimination in hiring decisions. Aiming to further our understanding of the role of organisations in influencing the professional trajectories of individuals of immigrant origin, this paper investigates the recruitment practices of public administrations. Drawing on approaches from organisational sociology and a qualitative case study of public administrations in the German state of Berlin, the article identifies three crucial elements of organisational decision-making affecting the recruitment of staff of immigrant origin: decisions regarding advertisement strategies, formal criteria, and individual candidates. Further, the article shows the underlying decision-making rationalities and the role of organisational contexts and ethnic stereotypes for recruitment-related decisions.

scholarly journals Impact of pre-dialysis nephrology care engagement and decision-making on provider and patient action toward permanent vascular access

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Vanessa Grubbs ◽  
Bernard G. Jaar ◽  
Kerri L. Cavanaugh ◽  
Patti L. Ephraim ◽  
Jessica M. Ameling ◽  
...  
Keyword(s):  
Decision Making ◽  
Public Hospital ◽  
Veterans Administration ◽  
Engagement In Care ◽  
Vascular Surgeon ◽  
Patient Level ◽  
Nephrology Care ◽  
Record Review ◽  
Retrospective Medical Record Review

Abstract Background While catheters are often thought the result of emergency hemodialysis (HD) initiation among patients with little or no pre-dialysis nephrology care, the role of patient level of engagement in care and modality decision-making have not been fully explored. Methods This is a retrospective medical record review of adults (age 18–89 years) who received care in academically affiliated private practice, public hospital, or Veterans Administration settings prior to initiating HD with a catheter between 10/1/2011 and 9/30/2012. Primary predictors were level of patient engagement in nephrology care within 6 months of HD initiation and timing of modality decision-making. Primary outcomes were provider action (referral) and any patient action (evaluation by a vascular surgeon, vein mapping or vascular surgery) toward [arteriovenous fistula or graft, (AVF/AVG)] creation. Results Among 92 incident HD patients, 66% (n = 61) initiated HD via catheter, of whom 34% (n = 21) had ideal engagement in care but 42% (n = 25) had no documented decision. Providers referred 48% (n = 29) of patients for AVF/AVG, of whom 72% (n = 21) took any action. Ideal engagement in care predicted provider action (adjusted OR 13.7 [95% CI 1.08, 175.1], p = 0.04), but no level of engagement in care predicted patient action (p > 0.3). Compared to patients with no documented decision, those with documented decisions within 3, 3–12, or more than 12 months before initiating dialysis were more likely to have provider action toward AVF/AVG (adjusted OR [95% CI]: 9.0 [1.4,55.6], p = 0.2, 37.6 [3.3423.4] p = 0.003, and 4.8 [0.8, 30.6], p = 0.1, respectively); and patient action (adjusted OR [95% CI]: 18.7 [2.3, 149.0], p = 0.006, 20.4 [2.6, 160.0], p = 0.004, and 6.2 [0.9, 44.0], p = 0.07, respectively). Conclusions Timing of patient modality decision-making, but not level of engagement in pre-dialysis nephrology care, was predictive of patient and provider action toward AVF/AVG Interventions addressing patients’ psychological preparation for dialysis are needed.

The role of agency in project initiation decisions

2014 ◽  
Vol 7 (3) ◽  
pp. 518-535 ◽  
Author(s):  
Mark Mullaly
Keyword(s):  
Decision Making ◽  
Decision Rules ◽  
Personal Characteristics ◽  
Decision Makers ◽  
Organizational Dynamics ◽  
Substantive Theory ◽  
Content Type ◽  
The Subject ◽  
Board Level

Purpose – The purpose of this paper is to explore the role of decision rules and agency in supporting project initiation decisions, and the influences of agency on decision-making effectiveness. Design/methodology/approach – The study this paper is based upon used grounded theory methodology, and sought to understand the influences of individual decision makers on project initiation decisions within organizations. Data collection involved 28 participants who were involved in project initiation decisions within their organizations, who discussed the process of project initiation in their organization and their role within that process. Findings – The study demonstrates that the overall effectiveness of project initiation decisions is a product of agency, process effectiveness or rule effectiveness. The employment of agency can have a direct influence on decision-making effectiveness, it can compensate for organizational inadequacies of a process or political nature, and it can be constrained in the evidence of formal and effective organizational practices. Research limitations/implications – While agency was recognized by all participants, there are clearly circumstances where actors perceive the ability to exercise agency to be externally constrained. The study is exploratory, contributing to the development of substantive theory. Theory testing as well as a more in-depth investigation of the underlying drivers of agency would be valuable. Practical implications – The study provides executives and individuals supporting the initiation of projects with insights on how to effectively influence the effectiveness of project initiation decisions, and the degree to which personal characteristics influence organizational dynamics. Originality/value – Most discussions of agency has been framed the subject as an executive- or board-level phenomenon. The current study demonstrates that agency is in fact being perceived and operationalized at all levels. Those demonstrating agency in the majority of instances in this study do so in exercising stewardship behaviours. This has important implications for how agency is perceived by executives, and by how agency is exercised by actors at all levels of the organization.

scholarly journals Novel Parameterized Distance Measures on Hesitant Fuzzy Sets with Credibility Degree and Their Application in Decision-Making

Symmetry ◽  
2018 ◽  
Vol 10 (11) ◽  
pp. 557 ◽  
Author(s):  
Jiaru Li ◽  
Fangwei Zhang ◽  
Qiang Li ◽  
Jing Sun ◽  
Janney Yee ◽  
...  
Keyword(s):  
Decision Making ◽  
Fuzzy Sets ◽  
Cardinal Number ◽  
Decision Makers ◽  
Distance Measures ◽  
Hesitant Fuzzy Set ◽  
Hesitant Fuzzy Sets ◽  
The Subject ◽  
The Relationship

The subject of this study is to explore the role of cardinality of hesitant fuzzy element (HFE) in distance measures on hesitant fuzzy sets (HFSs). Firstly, three parameters, i.e., credibility factor, conservative factor, and a risk factor are introduced, thereafter, a series of novel distance measures on HFSs are proposed using these three parameters. These newly proposed distance measures handle the relationship between the cardinal number and the element values of hesitant fuzzy set well, and are suitable to combine subjective and objective decision-making information. When using these functions, decision makers with different risk preferences are allowed to give different values for these three parameters. In particular, this study transfers the hesitance degree index to a credibility of the values in HFEs, which is consistent with people’s intuition. Finally, the practicability of the newly proposed distance measures is verified by two examples.

Collaborative Practice: A Strategy to Improve the Relevance of Health Services Research

2002 ◽  
Vol 15 (3) ◽  
pp. 18-24 ◽  
Author(s):  
Kevin Brazil ◽  
Stuart MacLeod ◽  
Brian Guest
Keyword(s):  
Decision Making ◽  
Health Services Research ◽  
Health Services ◽  
Research Evidence ◽  
Collaborative Practice ◽  
Decision Makers ◽  
Healthcare Decision ◽  
Services Research ◽  
Collaborative Relationships

Health services research has emerged as a tool for decision makers to make services more effective and efficient. While its value as a basis for decision making is well established, the incorporation of such evidence into decision making remains inconsistent. To this end, strengthening collaborative relationships between researchers and healthcare decision makers has been identified as a significant strategy for putting research evidence into practice.

scholarly journals Longitudinal Evaluation on the Operation Index Applied to Public Hospitals in Pudong New District of Shanghai, China

2018 ◽  
Vol 55 ◽  
pp. 004695801879059
Author(s):  
Shanshan Liu ◽  
Jiaoling Huang ◽  
Yanting Li ◽  
Jincheng Fan ◽  
Hong Liang ◽  
...  
Keyword(s):  
Financial Risk ◽  
Public Hospital ◽  
Risk Index ◽  
Condition Index ◽  
Public Hospitals ◽  
Operating Index ◽  
The Public ◽  
Management Condition ◽  
Service Operation ◽  
Public Hospital Reform

The public hospital reform has lasted 5 years in China; however, the operation development status and trends of public hospitals have not been systematically evaluated in Pudong New District. We first applied the technology of longitudinal index to assess the development of public hospitals there. The quantitative data were mainly gathered by taking health statistics database from 2009 to 2014. The results showed that overall operating index presented a down-up trend, with the highest point in 2014 and the lowest point in 2012. Overall operating index, development foundation index, and management condition index were found to be statistically different ( P = .010, P = .016, P = .031) in different years, whereas the service operation index and financial risk index were not so ( P = .543, P = .228). Moreover, the results demonstrated that no obvious difference was observed in the overall operating index between the general and specialized hospitals ( P = .327), which was the same in the 4 first-class indexes. However, there were statistical differences in the overall operating index and development foundation index among these 5 years ( P = .018, P = .036), but none in the service operation index, management condition index, and financial risk index ( P = .503, P = .062, P = .177). No interaction effects were discovered between year and hospital categories in the current study ( P = .673, P = .375, P = .885, P = .152, P = .288).

Framing Information Technology Governance in the Public Sector: Opportunities and Challenges

2015 ◽  
Vol 11 (4) ◽  
pp. 89-101 ◽  
Author(s):  
Khalifa Al-Farsi ◽  
Ramzi EL Haddadeh
Keyword(s):  
Decision Making ◽  
Information Technology ◽  
Public Sector ◽  
It Governance ◽  
Decision Makers ◽  
The Public ◽  
Technology Governance ◽  
Support Organizations ◽  
Information Technology Governance ◽  
Decision Making Processes

Information technology governance is considered one of the innovative practices that can provide support for decision-makers. Interestingly, it has become increasingly a de facto for organizations in seeking to optimise their performance. In principle, information technology governance has emerged to support organizations in the integration of information technology (IT) infrastructures and the delivery of high-quality services. On the other hand, decision-making processes in public sector organisations can be multi-faceted and complex, and decision makers play an important role in implementing technology in the public sector. The aim of this paper is to shed some light on current opportunities and challenges that IT governance is experiencing in the context of public sector services. In this respect, this paper examines the factors influencing the decision-making process to fully appreciate IT governance. Furthermore, this study focuses on combining institutional and individual perspectives to explain how individuals can take decisions in response to institutional influences.

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