Institutional governance and responsiveness to antimicrobial resistance: a qualitative study of Australian hospital executives

ObjectivesDespite escalating antimicrobial resistance (AMR), implementing effective antimicrobial optimisation within healthcare settings has been hampered by institutional impediments. This study sought to examine, from a hospital management and governance perspective, why healthcare providers may find it challenging to enact changes needed to address rising AMR.DesignSemistructured qualitative interviews around their experiences of antimicrobial stewardship (AMS) and responsiveness to the requirement for optimisation. Data were analysed using the framework approach.SettingTwo metropolitan tertiary-referral hospitals in Australia.ParticipantsTwenty hospital managers and executives from the organisational level of department head and above, spanning a range of professional backgrounds and in both clinical and non-clinical roles, and different professional streams were represented.ResultsThematic analysis demonstrated three key domains which managers and executives describe, and which might function to delimit institutional responsiveness to present and future AMR solutions. First, the primacy of ‘political’ priorities. AMR was perceived as a secondary priority, overshadowed by political priorities determined beyond the hospital by state health departments/ministries and election cycles. Second, the limits of accreditation as a mechanism for change. Hospital accreditation processes and regulatory structures were not sufficient to induce efficacious AMS. Third, a culture of acute problem ‘solving’ rather than future proofing. A culture of reactivity was described across government and healthcare institutions, precluding longer term objectives, like addressing the AMR crisis.ConclusionThere are dynamics between political and health service institutions, as well as enduring governance norms, that may significantly shape capacity to enact AMS and respond to AMR. Until these issues are addressed, and the field moves beyond individual behaviour modification models, antimicrobial misuse will likely continue, and stewardship is likely to have a limited impact.

Critical Success Factors of Business Intelligence Implementation in Thai Hospitals

Business intelligence (BI) has become a popular among management executives of different industries. Many publications have mentioned Big Data and how to use data intelligently. However, little is known about how to successfully implement BI in the healthcare industry. The unique characteristic of this business, which focuses only on quality of care and patient safety, has a big impact on decision-making. This research is based on a literature review and empirical evidence collected from interviews with professionals involved in the healthcare industry. Twenty-four hospital executives and Information Technology staff who have direct or indirect experience with BI were interviewed. It investigates critical success factors for BI implementation in hospitals and provides insight into the healthcare industry in Thailand. The concept of grounded theory was applied for content analysis. Insights from this research contribute to academia and the healthcare industry by providing first-time evidence of specific factors for BI implementation and guidelines in hospitals.

Smart Hospital Management System

Information and Communication Technologies (ICTs) are commonly using in healthcare organizations worldwide. There are different kinds of healthcare applications developed in android Smartphone’s which help patients and their caregivers to reduce time and cost efficiency. Hospitals are the largest and most complex organizations where health care is provided. Safe and effective patient care services in hospitals depend on the efficient decisions made by hospital executives. The main task of hospital executives is to ensure the hospital can provide high quality patient care and services. This Android application used for displaying hospital performance metrics on a daily basis. This application allows hospital executives to review and monitor hospital operational data with ease of access and in a portable manner. Thus, reducing the effort of the hospital executives to perform their tasks. In this research work, an application is developed that locates the nearest hospital. The System is designed for Any Hospital to replace their existing manual, paper-based system. The new system is to control the following information; List of Hospitals, bed availability, Book Appointment, List of Doctors, Facilities and Book Ambulance. With the help of this application, a patient can find the nearest hospital according to specialized consultant availability.

Decision Making Surrounding IT Outsourcing within Ontario Hospitals

With the increases to healthcare expenditures and with technology playing a more critical role in hospitals, IT outsourcing has become an important topic for hospital executives. There has been a lack of research in Canadian healthcare on IT outsourcing within hospitals. This research explores the several factors associated with hospital CIOs and Managers in outsourcing their IT systems. Additionally, this research looks to identify the benefits, risks and alternatives to IT outsourcing within Canada, specifically within the province of Ontario. While transaction, agency and knowledge-based theories are discussed, they are not tested. They provide more of a guide and confirmation of these decision factors. Hospital CIOs and Managers were interviewed and recorded to determine the decision factors. Lacity et al (2010) IT Outsourcing decision model was used as a starting point for the decision factors and a Canadian model was developed from an adaption of Lacity et al work. This research provides a starting point for IT outsourcing research within the Ontario hospital sector.

Decision Making Surrounding IT Outsourcing within Ontario Hospitals

With the increases to healthcare expenditures and with technology playing a more critical role in hospitals, IT outsourcing has become an important topic for hospital executives. There has been a lack of research in Canadian healthcare on IT outsourcing within hospitals. This research explores the several factors associated with hospital CIOs and Managers in outsourcing their IT systems. Additionally, this research looks to identify the benefits, risks and alternatives to IT outsourcing within Canada, specifically within the province of Ontario. While transaction, agency and knowledge-based theories are discussed, they are not tested. They provide more of a guide and confirmation of these decision factors. Hospital CIOs and Managers were interviewed and recorded to determine the decision factors. Lacity et al (2010) IT Outsourcing decision model was used as a starting point for the decision factors and a Canadian model was developed from an adaption of Lacity et al work. This research provides a starting point for IT outsourcing research within the Ontario hospital sector.

A novel ethical approach to moral distress during COVID 19 in New York

The initial surge of COVID19 patients in New York, created a surge of unprecedented numbers in the largest integrated hospital system of the New York City and surrounding Long Island region. Due to innovation and clinician ingenuity ventilator allocation was going to have an easier solution than alleviating the moral distress of overworked and understaffed clinicians. Through the innovative work of clinicians, leadership and the leadership of Governor Cuomo and hospital executives, the need for triaging ventilators did not become a reality. Yet the need for ethicists to support and aid clinicians in the discernment and need for escalation for scarce ICU resources and personnel was key. The transition from an allocation strategy of ventilators organically occurred as rapidly as the surge of COVID19 as it became clear that addressing clinician distress was imperative to maintain the level of human capital. An allocation strategy was envisioned that would assess the urgency of need for intensive care resources utilizing established decision aid calculators. In a mixed method quantitative and qualitative review, this article utilizes descriptive data to illustrate the lessons learned from utilizing ethics consultants to review pandemic decision making and alleviate clinician moral distress.

The role of storytelling in a nonhostile takeover

PurposeWhy did a powerful department of hospital doctors support a merger with a rival hospital that they knew would ruin their beloved workplace?Design/methodology/approachThis ethnographic study draws on 12 months of fieldwork consisting of 24 one-on-one interviews as well as 26 h of observations, informal conversations and archival records research to answer its research question. Grounded theory and the discourse analysis were employed to analyze all data.FindingsData reveal how participants' belief in a “merge or go bankrupt” narrative contributed to widespread support for a merger that seemed unthinkable on the surface. Although each doctor believes the merger will jeopardize or ruin their workplace culture, none resisted the merger nor did any ask hospital executives to provide evidence in support of their claims regarding the benefits of the merger (namely, that it would save their organization from inevitable bankruptcy).Research limitations/implicationsThe author relied on a family relative to introduce the author to and gain entry into this workplace. One potential consequence is biased interpretations of data. To address this, the author constantly revisited the data and compared the author’s interpretations with interviewees' words (i.e. “grounded” theory).Originality/valueThis study provides empirical and theoretical contributions to organizational storytelling scholarship.

Balancing COVID-19 preparedness and ‘business as usual’ in hospitals: lessons from executives in China, Norway and the UK

BackgroundDuring the first wave of COVID-19 pandemic, hospitals were forced to cancel or postpone non-COVID-19 care. With new outbreaks emerging, hospitals are now figuring out how to balance preparedness for future COVID-19 waves with their elective and regular services. This report discusses how four hospital systems deal with these dual responsibilities in China, Norway and the UK.ReflectionsBased on the experiences and combined reflections of hospital executives, we have formulated five strategic and leadership lessons for hospitals as they manage these dual responsibilities. (1) Redesign organisation to separate COVID-19 and non-COVID-19 services both within and across hospitals. (2) Expand virtual care strategies to improve access. (3) Use data-driven models to allocate resources across COVID-19 and non-COVID-19 units. (4) Invest in programmes to promote frontline staff well-being. (5) Secure financial support to continue to deliver on the dual responsibilities.ConclusionThe COVID-19 pandemic gives rise to leadership challenges that have fuelled organisational change and new approaches to healthcare delivery. Leading hospitals during the pandemic is a balancing act—providing care for both patients with COVID-19 and non-COVID-19, while at the same time preparing for the next waves of the pandemic.

An Integrated Model to Accelerate Patient Satisfaction Improvement

Patient satisfaction is gaining traction in the strategic direction and daily operations of hospital executives. The financial penalty/incentive tied to patient satisfaction scores creates a burning platform to accelerate progress. Previous studies have shown the effectiveness of various improvement strategies including leadership rounding and employee training, among others. There has not been a study utilizing an integrated model that incorporates known best practices into a holistic approach. The integrated model included service excellence training, nursing unit-specific action plans, and weekly leadership rounding. Implementation of the model led to significant and sustainable improvements in patient satisfaction in the community hospital setting. This approach can be leveraged and scaled in other organizations to accelerate the pace of change.

Paying attention to personnel in organizational changes: the impact of hospital mergers

Background The importance of paying attention to personnel satisfaction for the well-being of an organization is clearly stated also in healthcare organization. The trend of mergers of healthcare organizations represents an evident case of organizational change that could undermine personnel satisfaction if not adequately managed. The aim of our study was to investigate the impact of hospital merger on personnel perceptions and satisfaction. Methods A systematic review of the literature was carried out by querying scientific databases and grey literature. A search string was built using keywords including: merger, healthcare, personnel, satisfaction and synonyms. Inclusion criteria were primary studies reporting the outcome of interest and set in hospitals that has undergone a merger. Studies characteristics such country setting, design and time frame of the study, number and role of personnel interviewed and main findings were extracted and narratively synthesized. Results Search resulted in 3662 studies of which 9 were finally included in the analysis. Studies were mainly represented by post-merger qualitative research (77.8%) of which 55.6% semi and 54.4% structured interviews. Sample size ranged from 14 to 3119 and was represented by unspecified employees (55.6%), nurses and hospital executives (22.2% both). Findings showed that hospital executives consider merger positively especially regarding increased negotiation skills and costs reduction. Conversely, the other personnel mainly expressed critical issues as differences in organization of hospitals merged, goals and confirmation uncertainty, communication impairment and especially no involvement in follow-up in the post-merger phase. Conclusions The merger process strongly impacts healthcare personnel satisfaction, depending on the role played in the organization. If an initial enthusiasm and staff engagement in pre-merger phase is seen, this is not generally followed by their proper involvement over time. Key messages As personnel satisfaction and perceptions are strongly related to healthcare quality, they represent a central point in the merger process of healthcare organization. More attention must be paid to follow-up staff satisfaction after the merger in a continuous staff engagement to ensure the success of merger process as well as that of all organizational changes.