Hospital management practices in county-level hospitals in rural China and international comparison

Background Although management is important in healthcare, low- and middle-income countries (LMICs) have little experience measuring the competence of hospital management. While improving hospital management is the main focus of hospital reform in China, few studies have empirically documented the baseline situation to inform policy design. Methods We assessed the management practices of county-level hospitals in Guizhou in southwest China during 2015. We used the Development World Management Survey (D-WMS) instrument to interview 273 managers in 139 hospitals. We scored the management practices of the sampled hospitals, overall and in four dimensions (operations, monitoring, targets, personnel management) and three processes (implementation, usage, monitoring). We then converted the scores to the WMS scale and compared these with data from two other LMICs and seven high-income countries (HICs). Results On a scale of 1 (‘worst practice’) to 5 (‘best practice’), the mean (SD) hospital D-WMS scores were 2.57 (0.46) overall; 2.71 (0.48), 2.64 (0.58), 2.40 (0.64), and 2.56 (0.40) for operation, monitoring, target, and personnel, respectively; and 2.43 (0.48), 2.62 (0.48), and 2.66 (0.47) for implementation, usage, and monitoring, respectively. After conversion to WMS scores, China ranked seventh of 10 countries, after six HICs and higher than one HIC and two other LMICs (Brazil and India). China ranked higher than the two LMICs in each of the four dimensional scores. Conclusions Chinese county-level hospitals should improve their low quality of management by prioritizing target-setting and process implementation, particularly in personnel management. Meanwhile, modern management training should be given to most clinical managers.

Kuala Lumpur train collision during the COVID-19 pandemic

Background Two city trains collided in an underground tunnel on 24 May 2021 at the height of COVID-19 pandemic near the Petronas Towers, Kuala Lumpur, Malaysia, immediately after the evening rush hours. We aim to evaluate the management of this mass casualty incident highlighting the lessons learned to be used in preparedness for similar incidents that may occur in other major cities worldwide. Methods Information regarding incident site and hospital management response were analysed. Data on demography, triaging, injuries and hospital management of patients were collected according to a designed protocol. Challenges, difficulties and their solutions were reported. Results The train's emergency response team (ERT) has shut down train movements towards the incident site. Red zone (in the tunnel), yellow zone (the station platform) and green zone (outside the station entrance) were established. The fire and rescue team arrived and assisted the ERT in the red zone. Incident command system was established at the site. Medical base station was established at the yellow zone. Two hundred and fourteen passengers were in the trains. Sixty-four of them were injured. They had a median (range) ISS of 2 (1–43), and all were sent to Hospital Kuala Lumpur (HKL). Six (9.4%) patients were clinically triaged as red (critical), 19 (29.7%) as yellow (semi-critical) and 39 (60.9%) as green (non-critical). HKL's disaster plan was activated. All patients underwent temperature and epidemiology link assessment. Seven (10.9%) patients were admitted to the hospital (3 to the ICU, 3 to the ward and 1 to a private hospital as requested by the patient), while the rest 56 (87.5%) were discharged home. Six (9.4%) needed surgery. The COVID-19 tests were conducted on seven patients (10.9%) and were negative. There were no deaths. Conclusions The mass casualty incident was handled properly because of a clear standard operating procedure, smooth coordination between multi-agencies and the hospitals, presence of a 'binary' system for 'COVID-risk' and 'non-COVID-risk' areas, and the modifications of the existing disaster plan. Preparedness for MCIs is essential during pandemics.

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

Analisis Tata Kelola Teknologi Informasi Untuk Mendefinisikan Arsitektur Informasi Dengan Framework COBIT 4.1 (Studi Kasus Instalasi Rawat Jalan RSUD Prov. NTB)

Treatment for outpatient installations (IRJA) NTB provincial hospitals have used hospital management information systems, but this is still not effective. The information system is not effective because registration centred in the main hall. The centralized registration caused the accumulation of patient queues that occurred in each IRJA polyclinic, and this was due to the absence of an integrated queue number between registrations carried out in the main hall and IRJA polyclinics. Therefore, the governance of information architecture processes needs to be applied to optimize information systems. We use COBIT 4.1 to conduct governance. The aim is to get existing and expected outpatients from Prov. NTB Hospital. So, it can help to manage information architecture to perform quality and competitive outpatient services. The results showed the IT processes selected in PO2 (Determine Information Architecture) and AI4 (Activate and Use). We reach the maturity level of all IT processes at level 3 (the specified process) for conditions as they are and 5 (optimized) for conditions that will occur. The level of maturity can help the NTB Provincial Hospital to improve its services.

The Influence of Organizational Climate and Public Service Motivation on the Performance of Nurses at the Haji Hospital in South Sulawesi Province

This research is a quantitative study using an observational study with a cross-sectional study design on the influence of organizational climate, Public Service Motivation and nurse performance from 182 samples of nurse respondents at Haji Hospital, South Sulawesi Province, Indonesia. The aim is to identify the current organizational climate of the Haji Hospital, increase awareness of the mission of the Haji Hospital and identify motivational factors. The results showed that the influence of organizational climate on nurse performance was (0.000). The results showed that there was an effect of Public Service Motivation on Nurse Performance of (0.000). The results showed that the organizational climate variable had the most influence on the performance of nurses at the Haji Hospital, South Sulawesi Province. It is recommended to the management of the Hajj Hospital to improve teamwork by immediately resolving conflicts such as achieving the goals set by the Hajj Hospital Management. Hajj Hospital management seems to have to include flexibility; for example, team convenience might come with more flexible policies such as conducting tutoring and training via online video. It is recommended that after watching the video, nurses then write solutions to resolve conflicts in the organizational climate. Their papers will be reviewed and given written instructions by the leadership to nurses. Following the group discussion and later each nurse presented their views. The Hajj Hospital management provides appropriate incentives and praise for the successful performance of nurses.

Pemodelan Ancaman Sistem Keamanan E-Health menggunakan Metode STRIDE dan DREAD

The Hospital Management Information System (SIMRS) functions as a medium for hospital information and hospital management. There are patient medical record data, which is the result of interactions between doctors and sufferer. Medical records are sensitive data so that the security of the hospital management information system needs to be improved to convince users or patients that the data stored on SIMRS is safe at attackers. There are several ways to improve system security, one of which is by threat modeling. Threat modeling aims to identify vulnerabilities and threats that exist in SIMRS. In this paper, threat modeling will use the STRIDE-model. The recognition with the STRIDE-model will then be analyzed and sorted according to the modeling with the STRIDE method. After the analysis is complete, it will be calculated and given a rating based on the DREAD method's assessment. The STRIDE method's results show that there are several threats identified, such as there is one threat on the user side, the webserver is five threats, and the database is three threats. The level of the threat varies from the lowest-level (LowL) to the highest-level (HiL). Based on the threat level, it can be a guide and sequence in improving and improving the security system at SIMRS, starting from the LowL to the HiL.

Current Status of Out-of-Hospital Management of Cancer Patients and Awareness of Internet Medical Treatment: A Questionnaire Survey

Objective: To explore the current situation of the out-of-hospital management of patients with cancer and evaluate the feasibility of Internet medical intervention outside the hospital in China.Methods: The questionnaire was designed based on the investigators' clinical experience, literature data, and the Anderson Symptom Scale, and adopted a cross sectional survey method.Results: Totally 1,171 qualified questionnaires were analyzed. The results showed that 92.7% of patients with cancer experienced varying degrees of out-of-hospital symptoms after treatment, and a third of them needed clinical intervention. Abnormal blood test results outside the hospital were basically consistent with the events that occurred during the hospitalization. One third of patients with cancer could not identify abnormal results. The primary approaches to solve these abnormalities were to seek guidance from the physician in charge or from nearby hospitals, but only 6.75% patients sought help online. More than half of the life or work of patients with cancer are still greatly affected under the current management model. 92% of respondents required medical help outside the hospital, and 65% ones were willing to pay for the out-of-hospital management.Conclusions: Out-of-hospital management model needs to be improved. Most users are willing to accept Internet cancer management with fees. The survey has a positive effect on guiding future Internet cancer management practices in China to a certain extent.