Improving hospital-based processes for effective implementation of Government funded health insurance schemes: evidence from early implementation of PM-JAY in India

Background Government-sponsored health insurance schemes (GSHIS) aim to improve access to and utilization of healthcare services and offer financial protection to the population. India’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is one such GSHIS. This paper aims to understand how the processes put in place to manage hospital-based transactions, from the time a beneficiary arrives at the hospital to discharge are being implemented in PM-JAY and how to improve them to strengthen the scheme’s operation. Methods Guidelines were reviewed for the processes associated with hospital-based transactions, namely, beneficiary authentication, treatment package selection, preauthorization, discharge, and claims payments. Across 14 hospitals in Gujarat and Madhya Pradesh states, the above-mentioned processes were observed, and using a semi-structured interview guide fifty-three respondents were interviewed. The study was carried out from March 2019 to August 2019. Results Average turn-around time for claim reimbursement is two to six times higher than that proposed in guidelines and tender. As opposed to the guidelines, beneficiaries are incurring out-of-pocket expenditure while availing healthcare services. The training provided to the front-line workers is software-centric. Hospital-based processes are relatively more efficient in hospitals where frontline workers have a medical/paramedical/managerial background. Conclusions There is a need to broaden capacity-building efforts from enabling frontline staff to operate the scheme’s IT platform to developing the technical, managerial, and leadership skills required for them. At the hospital level, an empowered frontline worker is the key to efficient hospital-based processes. There is a need to streamline back-end processes to eliminate the causes for delay in the processing of claim payment requests. For policymakers, the most important and urgent need is to reduce out-of-pocket expenses. To that end, there is a need to both revisit and streamline the existing guidelines and ensure adherence to the guidelines.

Factors Affecting Hospital Network Management in the Social Security Organization of Iran

Background: Hospitals are considered the most important consumer units in the health system. Based on the effect of the hospital network in optimal and efficient hospital management, this study aimed to identify and explain the role of factors influencing hospital network management in the Iranian Social Security Organization (ISSO). Methods: This study was conducted by a mixed method in 2018. First, variables and factors affecting the management of hospital networks were extracted from the literature review and through interviews with 15 experts, and a questionnaire with 40 questions was developed. Then, it was distributed among 448 experts in the healthcare section of the ISSO all over the country, and 405 questionnaires were completed and collected. Data were analyzed via exploratory and confirmatory factor analysis and structural equations using SPSS23 software and AMOS24 software. The validity of the questionnaire was determined via expert judgment (CVRs = 0.40) and reliability was estimated by Cronbach's alpha coefficient (α = 0.87). Results: Based on the confirmatory factor analysis, financing, monitoring and evaluation, accountability, strategic planning, and decision rights were identified as key factors affecting hospital network management. Financing with standard coefficients of 0.83 had the highest and decision rights with standard coefficients of 0.44 had the lowest effect on hospital network management of the ISSO. Conclusion: To efficient hospital network management of the ISSO, while emphasizing all identified factors, special attention should be paid to financing and modifying the method of budgeting and using suitable monitoring and evaluation mechanisms.

Improving hospital flow ‘Ensiab Project’

Emergency department (ED) boarding is an indicator of less efficient hospital flow and is associated with longer inpatient length of stay, higher readmission rates and increased risk of mortality and medical errors. In addition to being associated with poor patient and staff satisfaction.This article describes the efforts of six tertiary care governmental hospitals in the Kingdom of Saudi Arabia that have enrolled in a collaborative improvement project to reduce ED boarding time.The hospitals implemented a multifaceted system intervention that included forming multidisciplinary flow improvement teams, implementing the National Health Service (NHS) SAFER patient flow bundle, visual management system and multidisciplinary ED bed huddles.By the end of the project, all hospitals significantly reduced ED boarding time with a pooled mean difference of – 7.1 hours (16.6 before, 9.5 hours after, p<0.001), reaching a pooled average of 2 hours in March 2020.Furthermore, by the end of the third learning session, all hospitals were able to achieve a boarding time below 6 hours. The enrolled hospitals also experienced an improvement in hospital flow process measures without any increase in 30-day readmission rates or bed occupancy rates.Our project demonstrates that implementing multifaceted system-wide interventions improves hospital flow and ED boarding time. Additionally, our project demonstrates a significant correlation between improvements in ED boarding time, daily consultant-led rounds and early discharge from inpatient units and time till discharge.

Chronoprevention in hospital falls of older people: protocol for a mixed-method study

Background Accidental falls in hospitals are serious events concerning the safety of the patients. Recent studies demonstrated that the time of falls is a key factor to be considered in prevention. It has been shown that the time of day, the day of the week and the month of the year impact on the occurrence of falls. The aim of the study is to determine the effect of the application of a programme of preventive measures based on the temporal patterns of the risk factors on the hospital fall occurrence. Methods A mixed-method research design. The following three phases will be carried out: 1) Longitudinal prospective study in two parts: (a) audits and seminars of healthcare professionals focused on an effective and efficient hospital falls register. Multi-Component and Single Cosinor analyses will be performed to obtain the temporal patterns of hospital falls and their related variables and (b) implementation of a based-temporal patterns, multidimensional prevention programme. 2) Retrospective study of falls registered in institutional databases. 3) Qualitative study based on focus groups (physicians, nurses and nursing assistants). The study protocol was approved in 2018. Discussion With regard to the safety of patients, hospital falls are serious events. Recent studies have demonstrated that the time of falls is a key factor to be considered in prevention. It has been shown that the time of day, the day of the week and the month of the year impact on the occurrence of falls. It is imperative to study temporal patterns of hospital falls to effectively and comprehensively define the aetiology of falls and, therefore, design preventive strategies. A reduction of the number of in-hospital falls and related injuries is expected, as well as an improvement in the quality of life of patients. Considering temporal patterns and levels of mood and sleep of healthcare professionals will achieve an improvement in patient safety. Trial registration Retrospectively registered in ClinicalTrials.gov ID: NCT04367298.

Challenges and potential improvements in hospital patient flow: the contribution of frontline, top and middle management professionals

PurposeThis study aims to describe and understand the contributions of frontline, middle and top management healthcare professionals in detecting areas of potential improvement in hospital patient flow and proposing solutions.Design/methodology/approachThis is a qualitative interview study. Semistructured interviews were conducted with 22 professionals in the orthopedic department of a 250-bed academic teaching hospital. Data were analyzed through a thematic framework analytical approach by using an a priori framework. The Consolidated Criteria for Reporting Qualitative (COREQ) checklist for qualitative studies was followed.FindingsWhen dealing with a hospital-wide process, the involvement of all professionals, including nonhealth professionals, can reveal priority areas for improvement and for services integration. The improvements identified by the professionals largely focus on covering major gaps detected in the technical and administrative quality.Research limitations/implicationsThis study focused on the professional viewpoint and the connections between services and further studies should explore the role of patient involvement. The study design could limit the generalizability of findings.Practical implicationsImproving high-quality, efficient hospital patient flow cannot be accomplished without learning the perspective of the healthcare professionals on the process of service delivery.Originality/valueFew qualitative studies explore professionals' perspectives on patient needs in hospital flow management. This study provides insights into what produces value for the patient within a complex process by analyzing the contribution of professionals from their particular role in the organization.

Pemilihan Model Scrum Dalam Pengembangan Sistem Monitoring Dengan Menggunakan Metode Agile Untuk Evaluasi Clinical Pathway

Hospitals as health care institutions are always required to provide quality, effective and acute services. PERSI forms a guideline for developing service standards so that it supports more accountable and efficient hospital health services called clinical pathways. Clinical pathways are used to systematically record each intervention given to patients. In its implementation, the clinical pathway does not always work perfectly, this is caused by various things such as the lack of resources (equipment and other health facilities), also caused by the negligence of technical implementers such as doctors, nurses, nutritionists, and pharmaceuticals. The clinical pathway monitoring system is important to know the obstacles that arise. The monitoring system can support the evaluation process to be faster. In this study, the system was developed using the agile method with the scrum model. The study was conducted at Harapan Harapan General Hospital in Tegal City involving those who played a direct role in using the system, Patient Care Management (MPP). The functional test results are divided into three, the first system quality results as much as 76% according to its function. Second, the assessment of the quality of information, the value of the quality of information produced as much as 68% according to its function. The three assessments of service quality obtained results as much as 63% according to its function.

A high efficient hospital emergency responsive mode is the key of successful treatment of 100 COVID-19 patients in Zhuhai

BackgroundSince December 2019, Coronavirus Disease 2019 (COVID-19) emerged in Wuhan city and rapidly spread throughout China. The mortality of novel coronavirus pneumonia (NCP) in severe and critical cases is very high. Facing this kind of public health emergency, high efficient administrative emergency responsive mode in designated hospital is needed.MethodAs an affiliated hospital of Sun Yat-sen University, our hospital is the only designated one for diagnosis and treatment of COVID-19 in Zhuhai, a medium-sized city. Novel coronavirus pneumonia department, which is administrative led by the president of hospital directly, has been established at early stage of epidemic crisis in my hospital. In NCP department, there are core members of Pulmonary and Critical Care Medicine (PCCM) specialist and multidisciplinary team. Don’t stick to national guidelines of NCP, based on professional opinion by respiratory professor and expert group, we focused on individualized treatment and timely adjustment of treatment and management strategies in working about COVID-19 patients.Results1. High working efficiency: By Mar 02, 2020, we have completed 2974 citywide consultations and treatment of 366 inpatients, including 101 patients diagnosed with COVID-19. 2. Excellent therapeutic effect: Among 101 hospitalized patients with confirmed COVID-19, all were cured and discharged, except for one death. No secondary hospital infection, no pipeline infection and no pressure sore were found in all patients. 3. Finding and confirming person-to-person transmission characteristic of COVID-19 prior to official release conference: Strengthened protection is key point to zero infection in healthcare group and medical faculty and lower rate of second generation infectious patients. 4. Timely adjustment management and treatment strategy prior to guideline update: The first evidence of digestive tract involvement in COVID-19 has been found, and the earliest clinical trial of chloroquine in the treatment of COVID-19 has been carried out in our hospital.ConclusionsIn our hospital, establishment of NCP department, which is administratively led by the president of hospital directly and specialized conduct by respiratory professor, is the key to success in management and treatment of COVID-19 patients. This hospital emergency responsive mode could provide reference for other hospitals and cities in epidemic situation.