Comparison of User-Oriented Information Services on the Websites of Large Hospitals in China and the United States: Cross-sectional Study

Background Many people use the internet to access health care information to support health care decisions, and hospital websites can be the first point of contact to provide health care information services for consumers. However, little is known about the current information services provided by the websites of large Chinese hospitals. Objective The aim of this study is to evaluate and compare the information services of the websites of large hospitals in China and the United States. We hope that our findings will benefit hospital managers worldwide in providing service information on the web. Methods This study adopted a cross-sectional analytical approach to evaluate the websites of large hospitals in China and the United States in 2020. A total of 300 large hospitals were randomly selected, of which half were in China and half were in the United States. Based on the 7Ps marketing mix, we identified 39 items that represent typical hospital website information services, covering the following seven dimensions: product, price, place, propagation, people, process, and physical evidence. Results Most of the items (34/39, 87%) related to information services offered by hospital websites were less covered in China than in the United States; however, 5 items (appointments by a third-party platform, mobile payment, hospital value, hospital environment display, and physicians’ profiles) had higher coverage in China. The average scores for hospital websites in China and the United States were 13.25 (SD 2.99) points and 23.16 (SD 2.76) points, respectively. Generally, high scores were given to the south areas of China and north areas of the United States. Conclusions Hospital websites in China lagged behind those in the United States with regard to information services offered. We recommend that hospital managers in China place more emphasis on the people, product, and propagation dimensions of the 7Ps marketing mix in the construction of information services on hospital websites. Through the comparison of the websites of large hospitals in China and the United States, our study findings can provide suggestions for forming standard hospital website construction guidelines worldwide.

Identification of root causes of clinical coding problems in Iranian hospitals

Background Improving the quality of coded data requires the identification and evaluation of the root causes of clinical coding problems to inform appropriate solutions. Objective The objective of this study was to identify the root causes of clinical coding problems. Method Twenty-one clinical coders from three cities in Iran were interviewed. The five formal categories in Ishikawa's cause-and-effect diagram were applied as pre-determined themes for the data analysis. Results The study indicated 16 root causes of clinical coding problems in the five main themes: (i) policies, protocols, and processes (lack of clinical documentation guidelines; lack of audit of clinical coding and feedback to clinical coders; the long interval between documentation and clinical coding; and not using coded data for reimbursement; (ii) individual factors (shortage of clinical coders; low-skilled clinical coders; clinical coders' insufficient communication with physicians; and the lack of continuing education; (iii) equipment and materials (incomplete medical records; lack of access to electronic medical records and electronic coding support tools; (iv) working environment (lack of an appropriate, dynamic, and motivational workspace; and (v) management factors (mangers' inattention to the importance of coding and clinical documentation; and to providing the required staff support. Conclusion The study identified 16 root causes of clinical coding problems that stand in the way of clinical coding quality improvement. Implications The quality of clinical coding could be improved by hospital managers and health policymakers taking these problems into account to develop strategies and implement solutions that target the root causes of clinical coding problems.

Addressing critical failure factors and barriers in implementing Lean Six Sigma in Italian public hospitals

Purpose During the past few decades, Lean Six Sigma (LSS) in the health-care sector has received increasing attention from both researchers and practitioners because it plays an imperative role in quality improvement and cost reduction initiatives. Although researchers have often focussed on evidence of model effectiveness through the study of performance indicators, too little attention has been given to the factors that lead to implementation failure and the causal relationships among them. This study aims to investigate the factors that may inhibit the successful implementation of the method by focussing on Italian public hospitals. Design/methodology/approach Through the use of the Delphi technique and fuzzy cognitive maps, this paper derives new and relevant results for researchers, hospital managers and policymakers. Findings The results show the factors with the greatest impact on LSS implementation and provide insight into the causal links and degrees of influence between critical failure factors and performance variables. Practical implications The findings could be considered useful, in particular, to hospital managers and policymakers, who could leverage the suggestions derived from the study to address LSS implementation. Originality/value This work overcomes a gap in the literature related to the absence of studies on the causal relationships between factors that determine the success or failure of LSS implementation.

Factors affecting the visitation and non-visitation to the courtyard gardens: Evaluation at three Malaysian Public hospitals

Being in a natural setting and viewing nature have a significant effect on mental health and well-being. Hospital courtyard gardens (HCG) is a common feature found in public hospitals in Malaysia. However, what factors influence the visitation and non-visitation to the HCG are less understood. This study attempts to investigate factors influencing the visit and non-visitation of patients, staff and visitors to the HCGs in three Malaysian public hospitals. The research findings were instrumental to the architects and landscape architects to make necessary improvements for future HCG design and the hospital managers to enhance and retrofit the existing HCG. Keywords: Courtyard Gardens; Visitation; Non-visitation, Public hospital eISSN: 2398-4287© 2021. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians/Africans/Arabians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v6i18.3085

Surgical Case-Mix and Discharge Decisions: Does Within-Hospital Coordination Matter?

How to Assess the Benefits of Coordination in Managing Hospital Resources In providing patient care, hospitals rely on multiple types of resources, such as operating rooms, recovery beds, labs, and diagnostic equipment, that are often controlled and managed as separate entities and by different decision makers. In “Surgical Case-Mix and Discharge Decisions: Does Within-Hospital Coordination Matter?” Hessam Bavafa, Lerzan Örmeci, Sergei Savin, and Vanitha Virudachalam focus on the interaction between “front-end’’ resources, such as operating rooms, and “backroom’’ resources, such as recovery beds, and compare hospital profitability under the fully coordinated, optimal approach to hospital resource management and under alternative decentralized approaches often encountered in practice. The paper identifies settings in which the benefits of coordination are likely to be high as well as settings in which those benefits are at best moderate. In a given hospital, only hospital managers are in a position to estimate with any degree of certainty potential costs of coordinated management of hospital resources, and the paper’s analysis of the benefits of coordination empowers hospital managers to make informed decisions on the desirability of replacing the often decentralized “status quo” by centralized resource management.

Prediction of total hospital expenses of patients undergoing breast cancer surgery in Shanghai, China by comparing three models

Background Breast cancer imposes a considerable burden on both the health care system and society, and becomes increasingly severe among women in China. To reduce the economic burden of this disease is crucial for patients undergoing the breast cancer surgery, hospital managers, and medical insurance providers. However, few studies have evidenced the prediction of the total hospital expenses (THE) for breast cancer surgery. The aim of the study is to predict THE for breast cancer surgery and identify the main influencing factors. Methods Data were retrieved from the first page of medical records of 3699 patients undergoing breast cancer surgery in one tertiary hospital from 2017 to 2018. Multiple liner regression (MLR), artificial neural networks (ANNs), and classification and regression tree (CART) were constructed and compared. Results The dataset from 3699 patients were randomly divided into training and test sets at a 70:30 ratio (2599 and 1100 records, respectively). The average total hospital expenses were 12520.54 ± 7844.88 ¥ (US$ 1929.20 ± 1208.11). MLR results revealed six factors to be significantly associated with THE: age, LOS, type of disease, having medical insurance, minimally invasive surgery, and receiving general anesthesia. After comparing three models, ANNs was the best model to predict THEs in patients undergoing breast cancer surgery, and its strong predictive performance was also validated. Conclusions To reduce the THEs, more attention should be paid to related factors of LOS, major and minimally invasive surgeries, and general anesthesia for these patient groups undergoing breast cancer surgery. This may reduce the information asymmetry between doctors and patients and provide more reliable cost, practical inpatient medical consumption standards and reimbursement standards reference for patients, hospital managers, and medical insurance providers ,respectively.

Collaborative model of intrapartum care: qualitative study on barriers and facilitators to implementation in a private Brazilian hospital

IntroductionA collaborative (midwife-obstetrician) model of intrapartum care (CMIC) is associated with lower caesarean section (CS) rates than physician-led models. In 2019, the largest private maternity hospital in Latin America (14.000 deliveries/year, 89% CS) created a quality improvement initiative to optimise intrapartum care and safely reduce CS in low-risk women managed by its internal team of healthcare providers (HCP). We conducted formative research to identify potential barriers and facilitators to the implementation of a CMIC.MethodsThree groups of stakeholders participated in focus groups and interviews: hospital managers and clinical coordinators, HCP working in labour/delivery wards and pregnant women intending to give birth in the hospital. We explored participants’ views about the acceptability of implementing a CMIC where a nurse-midwife (NM) on shift would be the main intrapartum HCP, with continuous support/supervision of a dedicated, in-house, obstetrician-gynaecologist (OB-GYN). A thematic analysis approach was used.Results12 HCPs, 5 clinical coordinators, 2 hospital managers and 7 women participated. OB-GYNs, coordinators and managers highlighted health system, organisational and structural factors (NMs’ limited experience/skills, professional roles, financial reimbursement) as potential barriers. NMs identified logistical and human resources as additional barriers. Women viewed the CMIC with perplexity and insecurity because of cultural beliefs about the dominant role of OB-GYNs, and limited information about NM’s capabilities. All professionals agreed that women’s acceptance of a CMIC will require educational interventions and communication strategies to inform potential users about the advantages and safety of this model.ConclusionThere are important barriers and facilitators to implement a CMIC in a private Brazilian maternity hospital. Factors related to health system structure and organisation may have the greatest impact. A CMIC is more likely to succeed if stakeholders’ concerns about responsibilities, power and financial revenues are addressed, and educational interventions targeted at users are deployed prior to its implementation.

Who Cares What the Doctor Feels: The Responsibility of Health Politics for Burnout in the Pandemic

Modern health has become a defining facet of contemporary life managed by health policy. The COVID-19 pandemic has significantly affected mental health, resulting in stress and anxiety in doctors’ professional and private life. Since the beginning of the pandemic, doctors have been facing chronic stress, which was reported to the hospital managers and health-care agencies, but nothing was done in the practice to protect them. Although doctors are trained to stay emotionally restrained, a large number of patients in intensive care, along with the personal concerns for their families, has led to burnout. This article highlights the need for health politics to take responsibility for dealing with burnout in health-care workers with a new approach that should help doctors recognize, understand, and manage work-related stress with additional support in the pandemic.

Change Management Perceptions in Portuguese Hospital Institutions Through ITIL

Organizations function in complex, dynamic and unpredictable environments. Implementing changes must therefore be well planned, managed, and evaluated as such ongoing efforts link organizational performance to peer competitiveness and sustainability. In an era challenged with technological innovations, it is crucial to understand how new changes can leverage traditional methodologies and services supported by information and technology systems. As information-intensive organizations such as hospitals are highly dependent on changing information and technological systems, this understanding is key to evolve next generation hospitals. Specifically, this study analyzes how hospital managers in Portugal relate change to information systems’ management based on Information Technology Infrastructure Library methodology. The relationship between change and information technologies services is not sufficiently clarified and constitutes an excellent opportunity to increase knowledge in the field of information systems.

Stakeholder Participation in the Strategic Plan Developing Process: A Survey from the Hospital Setting

Background: One of the most important requirements for developing a strategic plan is the effective participation of various stakeholders in plan formulation. The aim of present study was the evaluation of stakeholder participation in the strategic plan developing process in selected hospitals in Tehran. Methods: This is a cross-sectional study. This study was conducted in selected hospitals at Tehran in 2015. The data collection tool was a researcher made questionnaire consisting of 3 parts: demographic data, stakeholder participation, and attention to the strategic plan's components. The validity of questionnaire was confirmed by experts, and its reliability was confirmed by Cronbach's Alpha test (α = 0.8). The SPSS18 software was used for data analysis. Descriptive statistics (means, standard deviations, and percentages) were calculated. Results: The findings showed that the highest (42.9) and lowest (34.7) mean score of stakeholder participation in the strategic planning formulation was related to "provision required information for planning" and" presentation of gathering and documentation of the plan, "respectively. Hospital managers (91 percent) had the highest involvement, and external stakeholders had the least participation (1.7 percent) in the strategic planning formulation. The least attention is devoted to evaluating the proposed strategies' feasibility, identifying competitive and strategic differentiation, and identifying stakeholders' concerns and needs, respectively. Conclusion: Stakeholders' involvement in the formulation of the hospitals' strategic plan was not favorable, and hospitals were unable or unwilling to benefit from their participation in the program.