Organizational Design for an Effective Health Care Performance: Case Study of a Tunisian Emergency Department

Author(s):  
Imen Mejri ◽  
Safa Bhar Layeb ◽  
Najla Aissaoui ◽  
Farah Zeghal ◽  
Chokri Hamouda ◽  
...  
2006 ◽  
Vol 197 ◽  
pp. 67-79 ◽  
Author(s):  
Gwyn Bevan

This paper examines problems of setting targets for health care performance in which the centre sets a uniform set of targets and levels of performance. The case study examined by the paper is from the system of performance assessment of ‘star ratings’ that was introduced from 2001 by the Department of Health to give each organisation in the NHS in England a single summary score from zero rating to three stars. Star ratings were directed at holding trusts' chief executives to account for the local delivery of national priorities through a process of ‘naming and shaming’, in which Chief Executives of zero-rated organisations were at risk of losing their jobs. This paper outlines the underlying model and its three underlying assumptions: the centre can determine a scoring system to prioritise what matters; failures of performance that are not reflected in the scoring system do not matter; and the advantages of a system of scoring on accountable targets outweigh the disadvantages of various types of gaming responses. This paper examines the application of the model of star ratings to a case study of Primary Care Trusts (PCTs), which are complex organisations with three diverse sets of responsibilities: delivering primary care, commissioning secondary care, and supervising public health. It outlines an alternative model and the issues this raises for governance of health care performance.


CJEM ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 532-538 ◽  
Author(s):  
Lucas B. Chartier ◽  
Antonia S. Stang ◽  
Samuel Vaillancourt ◽  
Amy H. Y. Cheng

ABSTRACTThe topics of quality improvement (QI) and patient safety have become important themes in health care in recent years, particularly in the emergency department setting, which is a frequent point of contact with the health care system for patients. In the first of three articles in this series meant as a QI primer for emergency medicine clinicians, we introduced the strategic planning required to develop an effective QI project using a fictional case study as an example. In this second article we continue with our example of improving time to antibiotics for patients with sepsis, and introduce the Model for Improvement. We will review what makes a good aim statement, the various categories of measures that can be tracked during a QI project, and the relative merits and challenges of potential change concepts and ideas. We will also present the Model for Improvement’s rapid-cycle change methodology, the Plan-Do-Study-Act (PDSA) cycle. The final article in this series will focus on the evaluation and sustainability of QI projects.


2012 ◽  
Vol 26 (1) ◽  
pp. 189-212 ◽  
Author(s):  
Dagmar Radin ◽  
Aleksandar Džakula

Over the past decade, public opinion surveys have shown that Croats are deeply dissatisfied with their health care system and asses it to be one of the most important issues. However, health care hardly makes it into any political discourse in Croatia. This study analyzes the results of a public opinion survey conducted before the 2007 parliamentary elections to find out what the public sentiment on health care performance in Croatia is and to analyze the reasons why health care is not addressed by political actors. Evidence suggests that while health care is the most salient issue today, the public often understands it poorly. Thus, in a political environment of competing issues, and given the complexity of tacking health care in the policy arena, politicians strategically avoid discussing the issue.


2007 ◽  
Vol 49 (5) ◽  
pp. 707-718 ◽  
Author(s):  
Alai Tan ◽  
Jean L. Freeman ◽  
Daniel H. Freeman

Kybernetes ◽  
2017 ◽  
Vol 46 (4) ◽  
pp. 706-727 ◽  
Author(s):  
E. Ertugrul Karsak ◽  
Melis Almula Karadayi

Purpose This paper aims to address performance measurement in the health-care sector, which gains increasing importance for most countries because growing health expenditures and increased quality and competition in the health sector require hospitals to use their resources efficiently. Health policy-makers and health-care managers stress the need for developing a robust performance evaluation methodology for health-care organizations. Design/methodology/approach This paper presents an imprecise data envelopment analysis (DEA) framework for evaluating the health-care performance of 26 districts in Istanbul, a metropolis with nearly 15 million inhabitants. The proposed methodology takes into account both quantitative and qualitative data represented as linguistic variables for performance evaluation. Moreover, this study reckons that weight flexibility in DEA assessments can lead to unrealistic weighting schemes for some inputs and outputs, which are likely to result in overstated efficiency scores for a number of decision-making units (in here, districts). To overcome this problem, a weight restricted imprecise DEA model that constrains weight flexibility in DEA is proposed. Findings The proposed imprecise DEA approach sets forth a more realistic decision methodology for evaluating the relative health-care performance and also enables to determine the best district in terms of health-care performance in Istanbul. Originality/value This paper includes the quality dimension, which has been overlooked in previous studies, into the health-care performance evaluation of districts. Moreover, it circumvents unrealistic weight flexibility which may distort the relative evaluation of health-care performance.


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