Validation of Jarman’s method of calculation of hospital standardised mortality ratios

Objective. To compare Jarman-derived hospital standardised mortality ratios (HSMR) and Linkage-derived cumulative mortality ratios (CMR). Methods. HSMR and CMR values for four groups of hospitals were derived from four single-year cohorts of linked patient admissions and deaths, and compared; differences were explored and reasons for non-matching and discordance were suggested. Results. For the group of metropolitan teaching hospitals the Jarman-derived HSMR value of 0.95 (95% CI 0.93–0.97) was significantly lower than the Linkage-derived CMR value of 0.99 (95% CI 0.97–1.01). The opposite result was seen for the group of metropolitan non-teaching public hospitals: the Linkage-derived CMR of 0.81 (0.77–0.85) was significantly lower than the Jarman method HSMR of 1.03 (0.98–1.07). Unmatched deaths in the study resulted from a condition unique to the Jarman method. Besides there being fewer deaths based only on the hospital separation records, 593 of these records suggested wrongly diagnosed deaths, possibly due to erroneous coding. Also, 467 hospital separation records deemed not to have involved transfer in the Jarman method database were detected by the Linkage method. However, excluding these unmatched deaths did not result in total concordance for two-method hospital-related deaths. Conclusions. Incorrect deaths in the Jarman method can be overcome by using the Linked method. The Jarman method, unable to adjust for the contiguous transfers related to the death, apportioned excess deaths unfairly to the teaching hospitals group. What is known about the topic? HSMR based on hospital separation record information can reflect hospital performance if monitored over a regular period. Despite considerable variability, inter-hospital comparison league tables of hospitals based on such ratios have been published. What does this paper add? This study demonstrated that the Linkage-derived CMR, utilising valid details from the state death registry, more accurately ascertains number of deaths than does the Jarman method-derived HSMR. What are the implications for practitioners? Where data linkages are possible, dual death derivations by the Jarman method and the Linked method can identify any unmatched or discordant deaths. Detailed exploration may help identify any differing hospital discharge practices.

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Linking authentic leadership and management capability to public hospital performance: the role of work engagement

International Journal of Organizational Analysis ◽

10.1108/ijoa-10-2020-2436 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Mohammed Aboramadan ◽

Main Naser Alolayyan ◽

Mehmet Ali Turkmenoglu ◽

Berat Cicek ◽

Caterina Farao

Keyword(s):

Health Care ◽

Work Engagement ◽

Authentic Leadership ◽

Hospital Performance ◽

Public Hospitals ◽

Mediation Effect ◽

Leadership And Management ◽

Content Type ◽

Management Capability ◽

The Impact

Purpose This paper aims to propose a model of the effect of both authentic leadership and management capability on hospital performance. This model proposes work engagement as an intervening mechanism between the aforesaid links. Design/methodology/approach Data were collected from 380 medical staff working in Jordanian Public hospitals and were analysed using the structural equation modelling analysis technique. Findings The results suggest that both authentic leadership and management capability have a positive effect on hospital performance. Although positive, the direct effect of management capability on performance was not significant. Furthermore, work engagement demonstrated to play a full mediation effect between management capability and hospital performance and a partial mediation effect between authentic leadership and hospital performance. Practical implications This study may be of use for public medical services providers in general and other services sectors in terms of the role authentic leadership and management resources can play in contributing to positive work-related outcomes at the individual and organisational levels. Originality/value Considering the mainstream literature in health-care management, to the best of the authors’ knowledge, this is the first study to date to integrate the impact of both authentic leadership and management capabilities in the public health-care sector. Further, the research model has not previously been introduced when taking into account the role that work engagement can play between the examined variables.

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The double-edged sword of corporatisation in the hospital sector: evidence from Indonesia

Health Economics Policy and Law ◽

10.1017/s174413311600027x ◽

2016 ◽

Vol 12 (1) ◽

pp. 61-80 ◽

Cited By ~ 1

Author(s):

Asri Maharani ◽

Gindo Tampubolon

Keyword(s):

Regression Analysis ◽

Panel Data ◽

Financial Performance ◽

System Performance ◽

Hospital Performance ◽

Public Hospitals ◽

Health System Performance ◽

The Past ◽

Panel Data Regression ◽

Data Regression

AbstractHoping to improve their health system performance, many countries have corporatised their hospitals in the past 20 years. What this means for hospital performance remains as yet largely unknown. This study looks into the association of corporatisation and hospital performance in Indonesia. We apply panel data regression analysis to survey data on 54 public hospitals in East Java province. Our analysis suggests that corporatisation is associated with higher hospital income and expenditure, but fails to improve efficiency and equity. These findings suggest that hospital corporatisation policy in Indonesia should increase emphasis on efficiency and equity rather than on financial performance alone.

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Abstract 167: Correlation of 30-day Hospital Readmission Rates by Payer and Penalty Status

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.167 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Neel M Butala ◽

Daniel B Kramer ◽

Jordan B Strom ◽

Kevin F Kennedy ◽

Robert W Yeh

Keyword(s):

Correlation Coefficients ◽

Weighted Kappa ◽

Hospital Performance ◽

Teaching Hospitals ◽

Kappa Statistics ◽

Medicare Beneficiaries ◽

Readmission Rates ◽

Hospital Readmission Rates ◽

Medicare Patients ◽

Group B

Background: Readmission rates for heart failure (HF), acute myocardial infarction (MI), and pneumonia (PNA) hospitalizations among Medicare beneficiaries are used to assess hospital quality and determine global reimbursement. However, whether these measures reflect readmission rates for other conditions or insurance groups is unknown. Methods: All hospitals with >30 index admissions for HF, MI or pneumonia in 2013 in the all-payer Nationwide Readmissions Database (NRD) were included. For each hospital, we estimated 30-day all-cause risk-standardized readmission rates (RSRRs) for 3 groups: (A) Medicare beneficiaries admitted with HF/MI/PNA, (B) Medicare beneficiaries admitted for other conditions, and (C) non-Medicare beneficiaries admitted for HF/MI/PNA. Pair-wise correlations of these measures were assessed using Spearman correlation coefficients. Hospitals were divided into quartiles based on their calculated RSRR for each group, and inter-rater agreement between groups was assessed using weighted kappa statistics. We then examined pair-wise Spearman correlations among subgroups based on hospital characteristics (size, ownership status, and teaching status). Results: Among 1,228 hospitals, wide variation in RSRRs was seen across conditions and insurance type. Groups A vs. B had moderate correlation and agreement (Spearman 0.631, quartile weighted kappa 0.440). However, A vs. C had only modest correlation and fair agreement (Spearman 0.399, quartile weighted kappa 0.243). Compared with their quartile rank for the publicly reported group A, 46% of hospitals were ranked in the same quartile for group B and 35% for group C (Figure). Correlations between groups A vs. B and A vs. C were strongest among metro teaching hospitals (Spearman 0.674 and 0.507, respectively). Conclusions: Risk-standardized readmission rates for HF/MI/PNA are generalizable measures of a hospital’s readmission rate for other conditions among Medicare-insured patients. However, publicly reported RSRRs for HF/MI/PNA among Medicare patients are less suitable measures of hospital performance for non-Medicare patients admitted for these conditions.

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Quality and Safety Performance in Teaching Hospitals

The American Surgeon ◽

10.1177/000313480607201113 ◽

2006 ◽

Vol 72 (11) ◽

pp. 1051-1054

Author(s):

Richard M. Knapp

Keyword(s):

Pay For Performance ◽

Surgical Care ◽

Hospital Performance ◽

Teaching Hospitals ◽

Improvement Project ◽

Specific Patient ◽

Surgical Services ◽

Surgical Care Improvement Project ◽

Care Improvement ◽

Hospital Compare

The Hospital Quality Alliance created a vehicle to display Hospital Performance data which is known as Hospital Compare. Overall, the data shows that teaching hospitals perform very well in the areas of Heart Failure and Heart Attack and not as well in Pneumonia care. Unique issues at teaching hospitals, such as timing for specific patient services, continue to be a concern in achieving high scores relative to their non-teaching peers. Most hospitals and specifically surgical services will be challenged in the upcoming years with the addition of the Surgical Care Improvement Project (SCIP) measures as we move into the pay-for-performance era.

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Strikes by Physicians in Public Hospitals in India

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180100904043 ◽

2000 ◽

Vol 9 (4) ◽

pp. 460-469 ◽

Cited By ~ 2

Author(s):

SUNIL K. PANDYA

Keyword(s):

Health Insurance ◽

National Health Service ◽

Public Sector ◽

Health Service ◽

Medical Care ◽

National Health ◽

Public Hospitals ◽

Teaching Hospitals ◽

Tertiary Healthcare ◽

The Subject

Can strikes by resident doctors training to become consultants in Indian public-sector teaching hospitals be ethical? These hospitals were established for the medical care of the very poor in a country where health insurance and a national health service are nonexistent. In such a situation, the paralysis of tertiary healthcare centers by striking doctors runs contrary to the raison d'être of the profession. It also violates the first dictum of medicine: Primum, non nocere. And although there is some discussion in the Western literature on strikes by doctors, authorities in India are silent on the subject.

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Forging clinical collaborations and cooperation in overcoming challenges for non–COVID-19 patients during COVID-19 times: Surgical case studies requiring a multidisciplinary and inter-agency approach in Malaysia

Proceedings of Singapore Healthcare ◽

10.1177/20101058211055515 ◽

2021 ◽

pp. 201010582110555

Author(s):

Muhammad 'Abid Amir ◽

M Juffri Samsuddin ◽

Shah Jumaat Md Yusoff ◽

Saufee Ismail ◽

Juliana Abd Latiff

Keyword(s):

Global Health ◽

Case Studies ◽

Healthcare Systems ◽

Public Hospitals ◽

Healthcare Resources ◽

Private Partnership ◽

Surgical Case ◽

National Healthcare ◽

Patient Admissions ◽

Global Pandemic

The COVID-19 pandemic has brought global health services to a standstill. National healthcare systems and medical staffing in many countries have reached crisis levels due to the phenomenal outbreak. Healthcare resources have been strained to meet the unprecedented numbers of patient admissions with a significant amount of funding and manpower being channelled towards tackling this global pandemic. Despite the rollout of vaccinations, the development of new viral strains has now presented a new challenge. With the inevitable conversion of tertiary public hospitals to specialized COVID-19 centres with ‘Full Covid Status’ and the mobilization of its doctors from all specialities to care for these patients, the non–COVID-19 patients are becoming more neglected. The lack of elective surgeries performed and non-emergent admissions due to the unavailability of beds and personnel to care for this group of patients are concerning. As most of the focus and resources are now aimed at COVID-19 patients, the need to forge collaborations and cooperation between hospitals, agencies and healthcare systems are pertinent to ensure the provision of quality treatment for those suffering from non–COVID-19 diseases. To highlight this effort in Malaysia, we would like to present 2 case studies of non–COVID-19 patients undergoing elective surgeries through intergovernmental ministerial collaborations and a public–private partnership.

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Intensive Care Unit Services Preparedness for the Pandemic: An Efficiency Analysis

Health Services Insights ◽

10.1177/11786329211037527 ◽

2021 ◽

Vol 14 ◽

pp. 117863292110375

Author(s):

Songul Cinaroglu

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Health Resources ◽

Public Hospitals ◽

Teaching Hospitals ◽

Efficient Management ◽

Study Results ◽

Before And After ◽

The Difference

Intensive care unit (ICU) services efficiency and the shortage of critical care professionals has been a challenge during pandemic. Thus, preparing ICUs is a prominent part of any pandemic response. The objective of this study is to examine the efficiencies of ICU services in Turkey right before the pandemic. Data were gathered from the Public Hospital Statistical Year Book for the year 2017. Analysis are presented at hospital level by comparing teaching and non-teaching hospitals. Bootstrapped data envelopment analysis procedure was used to gather more precise efficiency scores. Three analysis levels are incorporated into the study such as, all public hospitals (N = 100), teaching (N = 53), non-teaching hospitals (N = 47), and provinces that are providing high density of ICU services through the country (N = 54). Study results reveal that average efficiency scores of ICU services obtained from teaching hospitals (eff = 0.65) is higher than non-teaching (eff = 0.54) hospitals. After applying the bootstrapping techniques, efficiency scores are significantly improved and the difference between before and after bootstrapping results are statistically significant ( P < .05). Province based analysis indicates that, ICU services efficiencies are high for provinces located in southeast part of the country and highly populated places, such as İstanbul. Evidence-based operational design that considers the spatial distribution of health resources and effective planning of critical care professionals are critical for efficient management of intensive care. Study results will be helpful for health policy makers to deeply understand dynamics of critical care.

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Management Practices and Performance of Public hospitals in Uganda

THE INTERNATIONAL JOURNAL OF MANAGEMENT SCIENCE AND BUSINESS ADMINISTRATION ◽

10.18775/ijmsba.1849-5664-5419.2014.17.1002 ◽

2015 ◽

Vol 1 (7) ◽

pp. 22-29

Author(s):

John Bosco Kakooza ◽

Immaculate Tusiime ◽

Hojops Odoch ◽

Vincent Bagire

Keyword(s):

Management Practices ◽

Health Sector ◽

Hospital Performance ◽

Management Style ◽

Public Hospitals ◽

Management Decision ◽

Policy Makers ◽

Policy Practice ◽

Management Decision Making ◽

And Performance

The Daily Monitor publications ran serialized articles showing the awful state of government hospitals across the country. While the Ministry of Health insists that the problem is not as bad as it is depicted, the level of service delivery in public hospitals has come under serious public scrutiny espousing the cause for concern about policy, practice and research. There should be glaring gaps in management practices as a possible explanation. In this study, we investigated impact of management decision making, structure, processes, communication and management style on hospital performance. The study has emphasized good management as the determinant of better performance of hospitals in the Ugandan context. Findings of this study challenges policy makers to strengthen management processes in addition to mobilizing financial, human and capital resources for hospitals. The study extends the debate on application of management theory with practice in the health sector in the Ugandan context.

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TO EVALUATE THE PERFORMANCE OF A TEACHING HOSPITAL BY COMBINING THE HOSPITAL INDICES USING THE PABON LOSSO MODEL DURING THE SURVEILLANCE BY AUTHORITIES:HAWTHORNE EFFECT

10.36106/ijsr/1625869 ◽

2021 ◽

pp. 75-77

Author(s):

C. Narender Kumar

Keyword(s):

Teaching Hospital ◽

Public Hospital ◽

Quality Care ◽

Hospital Performance ◽

Cross Sectional Study ◽

Public Hospitals ◽

Hawthorne Effect ◽

Cross Sectional ◽

Policy Makers ◽

The Public

BACKGROUND:The patients' health care choice is diverting from the private health provider to the public hospital due to introduction of various schemes and incentives by the policy makers. The limited resources are posing a challenge to the hospital administrator in escalating demands, diversity and complexity of diseases of patients. The hospital performance enhances steadily by the monitoring authorities' surveillance. It is an effective method for improving quality care in the public hospital. The Hawthorne effect is a term referring to the tendency of people to work harder and increases in effectiveness of organization when they are being observed. OBJECTIVES: 1. To assess the performance of a teaching hospital during surveillance by calculating the hospital indices, using the Pabon Losso Model. 2. To evaluate whether the Hawthorne effect is the cause of the increase in the effectiveness of hospital. MATERIALS AND METHODS: The study was a prospective and record based cross-sectional study and conducted at Government teaching hospital over a period of 18 months. RESULTS: st A total of 18 months period census report was recorded from January 2016 to June 2017and hospital indices were estimated. The 1 phase of surveillance (January- 2016 to May -2016), where immense supervision was present, with performance feed- back, BOR was 88.65, nd ALOS was 3.932, BTR was 7.074 and BTI was 0.54, 2 phase of surveillance which was intensied with communication and committee meetings rd (June-2016 to October- 2016), BOR was 95.59, ALOS was 3.49, BTR was 7.03 and BTI was 0.886, 3 phase weaning period, where a little th supervision (November -2016 to February-2017) BOR was 87.8, ALOS was 4.1, BTR was 6.413 and BTI was 0.5725 and 4 phase self sustain stage or no observations phase, BOR was 92.6, ALOS was 3.47, BTR was 6.547 and BTI was 0.28. CONCLUSION: The surveillance of higher authorities over the hospital had increased the performance. Hospital efciency is reected by increased hospital indices. The cause and effect is the “Hawthorne effect”. Therefore it is concluded that the surveillance increases the performance and efciency of the public hospitals.

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