A quantitative framework for health‐care service quality assessment in India

PurposeThe present situation of COVID-19 pandemic has put the health-care systems under tremendous stress and stringent tests for their ability to offer expected quality of health-care services, as it decides the sustainability and growth of health-care service providers. This study aims to deliver a quantitative framework for service quality assessment in the health-care industry by classifying the health-care service quality parameters into four balanced scorecard (BSC) perspectives.Design/methodology/approachTo determine the service quality for the Indian health-care system, decision-making trial and evaluation laboratory and analytical network process are integrated in a fuzzy environment to contemplate the interaction among BSC perspectives and respective performance measures.FindingsThe results indicate "internal processes” perspective assumes the key role within BSC perspectives, while performance measures "nursing staff turnover” and "staff training” play the key roles. The results also signify that "patient satisfaction” is the most vital issue and can be strongly influenced by measures belonging to the "learning and growth” perspective. In "learning and growth” perspective, "staff training” is the most decisive criteria, very highly influencing "patient satisfaction”, highly influencing "profitability,” "change of cost per patient (both in and out patients)” and "outpatient waiting time” while moderately influencing "staff satisfaction,” "bed occupancy” and "nursing staff turnover”. Moreover, "staff training” criteria have a positive influence on "nursing staff turnover.”Originality/valueThe contributions of this study are in two folds in the domain of quantification of service quality for the health-care system. First, it delivers an assessment framework for Indian health-care service quality. Second, it demonstrates an application of the framework for a case situation and validates the proposed framework.

Impact of COVID-19 on Phase I Clinical Activities

[...]to ensure a safe re-opening of the unit in alignment with rules set by the government, regulatory authorities, local hospitals, the local ethics committee and SGS's company policy, a COVID-19 risk implementation plan was created. Following evaluation, bed capacity was reduced by 20 beds, and plastic screens were put in place where applicable. [...]the number of monitors, visits, and the length of time in the monitoring room is limited to a minimum.

Steps Towards Diversity in Clinical Trials

Building authentic trust lays at the heart of creating more patient-centric trials While neither the lack of diversity in clinical research nor the need for patient centricity is new, recently, the clinical research community has been more determined than ever to ensure that we take steps now to increase both in the most impactful, effective way possible. If a patient or the patient's family doesn't trust the provider, or they don't trust the information from the provider, they're never going to 'buy in' to the treatment or medical advice." [...]there are no shortcuts if researchers truly want to be part of the change that will ultimately increase diversity in clinical research in a way that is sustaining and authentic.

The Evolution of Site Selection

Whether it was recognition, for a very long time pre-pandemic, that industry needed new ways to recruit and retain patients, or the success realized last year during the global SARS-CoV-2 vaccine trials, when pharma said we have no choice but to adopt in situ-or both reasons-the clinical trial industry is doing a 180, site-selection speaking. Syneos has the clinical trial networks;Elligo has access to Cerner and other EHR systems, said Maria Fotiu, executive vice president, decentralized solutions, Syneos Health. Healthcare, said Keith Fern, vice president, corporate development, Elligo, has become a heterogenous business. According to the Curebase website, its technology propelled the start of a COVID trial in two weeks.

You Can Do Hard Things

Can we move forward with the procedure? I work in the healthcare system myself and I deliver bad news every day. The staff quickly realized I worked in healthcare and that I was faculty at the university medical center. John was given a new badge and explicit instructions not to wander the hospital floors. When I stood, it felt like nothing was holding my insides in and I felt a huge rush of blood leave my body.

Hospital and Health System Finances: Interview with Health Care Expert Lisa Goldstein

Hospitals continue to experience negative margins, with hospital expenses decreasing slightly since the start of the pandemic, but not enough to address impacted volumes and revenues. As a result, issues regarding hospital and health system debt and financial sustainability weigh heavily on health care admini - strators. Hospital finances, and specifically, the management of bonds and debt, are of vital concern, particularly in light of the elimination of CARES Act funding and the forthcoming expiration of the federal Public Health Emergency COVID-19 plan. In this article and accompanying podcast episode, Nursing Economics Editorial Board Member Dr. Therese Fitzpatrick talks with leading health care expert Lisa Goldstein, MPA, about the rising pressures to maintain financial sustainability as hospital margins react to post-pandemic admissions and related adjustments.

Hospital admission, facility‐based isolation, and social distancing: An SEIR model with constrained medical resources

COVID‐19 is a highly contagious disease that has spread to most countries at unprecedented transmission speed. Medical resources and treatments provided by the healthcare system help reduce the mortality rate and spread of COVID‐19 by isolating infectious individuals. We introduce a modified SEIR model that considers individuals access to limited medical resources to characterize the central role of medical resources during the pandemic. We discuss how the three hospital admission policies (hierarchy, mixed, and Fangcang healthcare system) affect the spread of the disease and the number of deaths and infections. We find that the Fangcang system results in the least number of infections, deaths, and occupied beds. When hospital capacity is relatively high or the transmission rate of the mildly infected patient is not ignorable, a mixed system can lead to fewer infections and deaths than a hierarchy system, but greater numbers of occupied beds. This occurs by preventing disease transmission to a great extent. The results are confirmed by our surveys with healthcare workers in major hospitals in Wuhan, China. We also investigate the performance of the three healthcare systems under a social distancing policy. We find that the Fangcang system results in the largest reduction in infections and deaths, especially even when the medical capacity is small. Moreover, we compare a one‐time off policy with a bed trigger policy. We find that a one‐time off policy could achieve the similar performance as bed trigger policy when it is initiated neither too early nor too late.

Mortality Risk Stratification Helps Identify Patients With COVID-19 at Risk of Adverse Outcomes

Am J Manag Care. 2021;27(8):309-310. https://doi.org/10.37765/ajmc.2021.88721 _____ Takeaway Points * This study identifies a risk stratification tool that can help categorize hospitalized patients with COVID-19 into those at a higher risk of death, discharge to skilled nursing facility, or readmission, and those who are at low risk. * Patients at high risk should be monitored closely, with a greater allocation of resources for care during hospitalization and the postdischarge period. * The low-risk group of patients should be targeted for length-of-stay reduction strategies. _____ We are writing a follow-up to our original research article, "Mortality Risk Stratification Can Predict Readmissions but Not Length of Stay. The data for all adult patients discharged from 1 of 7 Trinity Health Michigan hospitals with a diagnosis of COVID-19 in 2020 were extracted as a report from the Epic electronic health record system (without identifying any patients) after obtaining institutional review board approval. Bundles of care interventions specific to patients' diagnoses (eg, COVID-19, congestive heart failure, acute myocardial infarction, chronic obstructive pulmonary disease) should be developed and used in a risk-stratified patient population to provide the highest value for the resources allocated.

Hospital at Home: Paying for What It's Worth

Am J Manag Care. 2021;27(9):369-371. https://doi.org/10.37765/ajmc.2021.88739 _____ Takeaway Points A framework centered around cost, quality, and equity is essential to define the value of hospital-at-home programs. * Validated disease-specific tools should be consistently used to measure process metrics, outcome metrics, quality-of-life measures, and caregiver satisfaction measures. * Equity-focused process metrics, care utilization measures, and risk-adjusted outcome metrics should be reported. * Total costs of care for hospital-at-home programs should be consistently measured through a time-driven activity-based costing method. * Personal, societal, technical, and allocative value should be considered when determining the value of hospital-at-home programs. _____ In recent years, home health care has grown to 3% of overall US health care spending.1 Investment in home health care delivery including telemedicine grew considerably during the COVID-19 pandemic.2 One area that has lagged in terms of growth has been the hospital-at-home model. For home health agencies (different from hospital-at-home programs, which provide more acute care services), CMS uses a more comprehensive Home Health Quality Reporting process to assess risk-adjusted process measures, outcomes measures, occurrences of adverse events, utilization of care measures, and cost measures.9 After the COVID-19 pandemic, similar reporting processes should be implemented for measuring the quality and outcomes of hospital-at-home programs. Because hospital-at-home programs share features of both inpatient hospital admissions and home health agencies, they are uniquely positioned to both treat the patient acutely and improve the living conditions and resources that led to the acute illness. The American Heart Association's Get With the Guidelines – Heart Failure, an in-hospital program, describes a comprehensive, robust set of quality measurements including process and outcome measurements for heart failure management.11 Process metrics include assessment of left ventricular ejection fraction, adherence to guideline-recommended medical therapy at discharge, and scheduled follow-up;process metrics correlate well to high-quality heart failure care.12 Outcome metrics include 30-day mortality and 30-day readmission rates.12 Although hospital-at-home programs have been associated with lower costs, these cost reductions are mostly due to reduced length of hospitalization,13 number of consultations,14 and clinical testing.13 It is yet unclear if the reduction in services utilized also leads to a reduction in value for the patient—either through fewer completed process metrics or significantly increased caregiver burden. Of 34 studies included in a meta-analysis comparing the costs of hospital at home with those of hospitalizations, 32 studies found hospital at home to cost less.3 For example, in a recent randomized controlled trial evaluating patients treated in a hospital-at-home program compared with those treated in a traditional hospital, the risk-adjusted cost reduction of home care management was 19%.15 In this trial, costs were calculated by summing the costs of labor, equipment, medications, laboratory tests, imaging tests, and transport during the period of hospitalization.15 In hospital-at-home models, cost savings are thought to be achieved due to reduced length of hospitalization,13 decreased number of consultations,14 reduced nursing labor costs,15 and decreased clinical testing.13 However, no uniform method exists to track and assess costs,16 and there is worry that the costs of hospital-at-home programs are underestimated.17 To fill this gap, these programs should report and analyze the total costs of care—including costs incurred by patients and their caregivers—rather than simply the reimbursement rates for care.

Potential Impact of Hospital at Home on Postoperative Readmissions

The first HAH programs in the United States were developed at Johns Hopkins Hospital in the late 1990s and were initially targeted toward geriatric patients with chronic medical problems.2 Follow-up studies focused on medical patients have been performed in multiple patient populations and health systems.3-9 These studies have demonstrated that for medically ill patients, admission to HAH offers significant benefits compared with inpatient admission, including fewer iatrogenic complications such as delirium, improved patient and caregiver satisfaction, decreased readmission rates, and, in some studies, decreased mortality. [...]diverting postoperative readmissions to at-home care has the unique benefit of freeing surgical beds, which can increase procedural capacity and therefore surgical access and hospital revenue. [...]we estimated the margin from new inpatient capacity that could be generated if the hospital avoided HAH-eligible readmissions and backfilled these beds with new medical-surgical admissions. [...]we estimated the potential financial impact on hospital margin of diverting surgical readmissions to an HAH program.

The Essential Role of Population Health During and Beyond COVID-19

Am J Manag Care. 2021;27(3):123-128. https://doi.org/10.37765/ajmc.2021.88511 _____ Takeaway Points Robust population health management integrates analytics and agile clinical programs and is adaptable to optimize outcomes and reduce risk during population-level crises. * The coronavirus disease 2019 pandemic revealed the tenuousness of care delivery based on fee-for-service reimbursement models. * Population-level data and care management facilitate identification of demographic-based disparities and community outreach. * Telemedicine and integrated behavioral health have ensured primary care and specialty access, and mobile health and postacute interventions shifted site of care and optimized hospital utilization. * Beyond the pandemic, population health is a cornerstone of a resilient health system and can improve public health while mitigating risk in a value-based paradigm. _____ Prior to the coronavirus disease 2019 (COVID-19) pandemic, the US health care system was in the midst of major transformation—shifting away from the inefficiencies of fee-for-service toward value and patient-centeredness. [...]registries for hypertension, diabetes, and chronic kidney disease identified the highest-risk patients to receive laboratory monitoring or medical procedures, prioritizing those who were likely to need dialysis in the near future.5,6 Similarly, a registry of patients with frailty, defined by the Johns Hopkins ACG System, was used to identify patients for augmented home-based care and goals of care outreach.7,8 Care Management: Delivering Public Health to High-risk Patients and Addressing Disparities For the last decade, the integrated care management program (iCMP) has been an essential component of PHS population health to coordinate care, improve outcomes, and reduce cost for high-risk patients by leveraging a dedicated nurse, social worker, or community health worker.9,10 This team was utilized as a public health workforce to provide outreach to patients at increased risk for adverse outcomes, including elderly patients, frail patients, and those with complex health conditions. The Home Hospital program provides inpatient level of care to low-acuity patients in their homes, and the Mobile Integrated Health (MIH) program uses paramedics to further support home-based care delivery.12 During the pandemic, these programs expanded capacity to prevent potential COVID-19 exposure in patients requiring hospital care and to monitor patients with COVID-19 who were recovering at home, reducing inpatient utilization and preserving higher-acuity resources.13 Within the first 46 days of MIH expansion, teams evaluated 102 patients with confirmed or suspected COVID-19, with 92.2% of patients able to continue care at home. Postacute care is critical to identify safe locations for patients with and without COVID-19 to recover and to maintain inpatient hospital capacity.14 PHS mobilized an existing collaborative of long-term acute care hospitals and skilled nursing facilities (SNFs) to address the surge in postacute capacity by creating unified admission plans, creating COVID-19–specific SNFs, and supporting personal protective equipment (PPE) provision to facilities.15 This team's expertise was extended to support the creation of a 1000-bed field facility called Boston Hope Medical Center, with a dual focus on respite care for homeless populations and postacute care for those recovering from COVID-19.16 The University of Washington also collaborated with postacute partners to develop a comprehensive strategy for COVID-19, which included establishing clear criteria for facility admission, providing PPE training, equipping testing supplies, and developing isolation plans.17 Population-based postacute strategies during the pandemic helped prevent delays in discharge, spread of infection, and overwhelmed facilities to mitigate the effects of the public health crisis.14,18 Behavioral Health: Providing Psychological Support at a Time of Great Need COVID-19 has brought numerous mental health challenges due to elevated stress, financial insecurity, and exposure to traumatic events.19 To address these needs, we adapted existing programs in behavioral health management, substance use disorders, and digital health.

Adoption of Telemedicine Services in India During Covid-19: Key Lessons

This exploratory study examines the acceptance of telemedicine services among people in India. The study uses the Unified Theory of Acceptance and Use of Technology (UTAUT) model with additional constructs to investigate perceived service quality (PSQ) in telemedicine services and its effect on attitude towards use, intention to use (IU), and usage behavior (UB). It signifies one of the first attempts to develop a linkage among UTAUT model dimensions, PSQ, attitude, intention and usage behavior. The results indicate that performance expectancy (PE), effort expectancy (EE), social influence (SI) and PSQ are the determinants of attitude towards use of telemedicine services. It is observed that attitude towards use has a positive influence on IU and subsequently on UB towards telemedicine services. The study results show that people are interested in availing telemedicine services and therefore, educational programs and awareness campaigns should be conducted by the government to encourage people to use these services.

Critical success factors of smart card technology in South African public hospitals

Background: Even though the government has set several admirable targets for raising the standard of healthcare, as highlighted by communities and media reports, public health institutions' services continue to fall short of patients' expectations and basic standards of care. For this reason, the general public has lost faith in the healthcare system. The public healthcare system in South Africa is completely dysfunctional and urgently needs to be transformed to serve the majority of those who use public hospitals. Objectives: The study aimed to improve healthcare for the majority of South Africans by investigating the critical success factors (CSFs) that influence the adoption of smart card technology (SCT) in South African public hospitals. Methods: A thorough review of peer-reviewed literature was conducted to determine potential barriers to adopting SCT. Furthermore, a hybrid model that combines the Health Unified Technology of Acceptance Theory (HUTAUT) model, DeLone and McLean IS success model (D&M) and the diffusion of innovation (DOI) theory will be developed, validated and tested to identify the CSFs adoption of SCT in public hospitals in South Africa. Results: The validated research model has been developed to be adopted by nurses at public hospitals. Conclusion: This research will contribute to the development of a new framework that identifies the CSFs for SCT adoption in South African public hospitals. Contribution: The study's results will make a special contribution to the body of knowledge in the fields of health informatics, particularly e-health.

Moderating Role of Cost Accounting Information Quality on the Relationship Between the COVID‐19 Pandemic and Budgeting in Public Hospitals

Based on new public management, information processing theory and contingency theory, this study investigates the impact of the COVID‐19 pandemic on budgeting in public hospitals, focusing on budget use. The research hypotheses were tested using a survey of 82 responses from hospital CFOs. The results show that the organisations that were most affected by the pandemic increased their use of budgets for planning, resource allocation and control, compared to those that were less affected. This study also highlights the moderating role of cost accounting information quality in the relationship between crises and budget use. We find that public hospitals that have been most affected by the pandemic and have simultaneously better cost accounting information have increased their use of budgets for planning, resource allocation and cost control more than those whose costing system does not provide superior cost data.

Exploring the challenges for medical tourism in the United Arab Emirates during the Covid-19 pandemic era: a stakeholder perspective

PurposeThis paper explores medical tourism development challenges in the United Arab Emirates (UAE) pre- and during Covid-19. Medical tourism is becoming a dynamic, rapid growth area and an engine of economic development.Design/methodology/approachIn-depth interviews were conducted with medical tourism professionals. Fourteen medical tourism stakeholders were interviewed from 1 January to 31 January 2020. Qualitative thematic analysis was applied on medical tourism challenges before and during the pandemic.FindingsThe major themes indicated concerns for medical tourism in the UAE and they included higher medical services costs and a shortage of highly qualified medical expertise. The emerging themes related to the challenges of coping with Covid-19 and strategies to attract medical tourists.Originality/valueThis study contributes towards (1) the theory of medical tourism, (2) the related limited prior published work on this topic relating to the UAE and (3) the importance of medical tourism in today's tourism industry. Additionally, there are theoretical and practical implications for medical tourism stakeholders in terms of attracting inbound medical tourists to the UAE from other countries during the Covid-19 crisis and in the post-pandemic situation.

Championing Nursing Workforce Through Innovative Dialogues and Collaborations

Cumulatively, it has had a hand in the great resignation, pushed hospitals profit margins into the nether regions, and reached into the ranks of nursing students, as well as their faculty, the academic workforce (Leaver et al., 2022). [...]the public, while grateful at least in the most difficult days of the pandemic, not only failed to translate these actions into strong policies that would result in much tangible change on a national level (Aiken et al., 2022), they have seemingly turned their own frustrations with health care delivery upon their former heroes, nurses themselves, resulting in episodes of nurse-directed assaults and violence, with an average of two nurses assaulted each hour in the United States (Press Ganey, 2022). According to Becker's Hospital Review (2022), an industry news source, "hospital margins are collapsing, and some organizations wonder if it's even possible to make money in the acute care space." Left unabated, shortages will result in patients receiving less face time with health care workers, lengthening current delays in diagnosis, reducing quality of care, burdening the health system (and patients) with our medical errors, and regretfully, increasing disparities and failure to adequately address social determinants of health.

Non-reimbursable Financing of Health Projects in Romania

Health is our fundamental right as citizens and, therefore, it must occupy a priority place in government programs. Despite the progress of recent years, Romania is still in the last places at the EU level in terms of the financing of the health system and its results. As a result, health financing is a priority even in the current period. Non-reimbursable financing, whether it is European funds or funds from the national budget, or other non-reimbursable sources, is the key to investments for the development and modernization of the health system. Ensuring a high degree of absorption of European funds dedicated to the health field in the period 2021-2027 and using these funds as an additional source of funding for the Romanian health system, represents a solution for investment in this field. Funds from the European Union can be used both for improving health, for faster recovery from the Covid-19 crisis, and for reducing health inequalities. The paper also includes a study on the contribution of funding from non-refundable funds to the modernization of the Moinesti Municipal Emergency Hospital, Bac&acaron;u County, a hospital that is in the top 10 nationally in terms of medical services. The focus is on the projects implemented over the years at the unit level and their impact on the medical activity.

Trust and knowledge sharing among hospitals during COVID-19: the compound effect of four barriers to organisational trust for knowledge sharing: Very Informal Newsletter on Library Automation

PurposeCOVID-19 highlighted the potential value of improving knowledge sharing (KS) processes among hospital estates and facilities management (HEFM) departments. Organisational trust (OT) is a recognised predictor of KS interactions, but the interplay of impersonal and interpersonal OT components is yet to be investigated fully. In response to recent calls, this study aims to explore the effect of organisational features on personal trust and OT components required for KS episodes, in the context of the English National Health Service (NHS).Design/methodology/approachA qualitative, exploratory grounded theory approach was selected, using primary data from 22 semi-structured interviews and secondary data from grey literature. A model of trust for KS among employees from geographically distributed units with pooled interdependence was synthesised from a review of the literature and used to connect the organisational features to different trust mechanisms.FindingsThis study identifies four organisational features with a compound barrier-effect on impersonal-based OT, interpersonal-based OT and personal trust for KS interactions: lack of professional development, inappropriate reward and incentive systems, reorganisations/organisational change and benchmarking.Research limitations/implicationsThis study sought to generate theory about the interplay of organisational barriers and trust components required for KS, not to describe HEFM KS across the entire NHS. Future studies with more comprehensive data collections can build on this exploratory study by quantitatively testing the compound barrier effect of the organisational features.Practical implicationsPractitioners can benefit from the insights into the barriers inhibiting trust mechanisms required for effective KS processes. These can inform policymakers in English and potentially other health-care systems in designing enhanced collaborative arrangements, which are required as future crises, e.g. pandemics and climate change hazards, will require increasingly complex solutions.Originality/valueThis study addresses the interplay between personal trust, impersonal OT and interpersonal OT for KS by identifying the compound barrier effects of underlying organisational barriers common to personal trust and OT.

The impact of ethical climate and the LMX relationship on nurses' burnout in hospitals in Serbia *

Burnout contributes to the emergence of numerous negative organisational phenomena. Nurses are exposed to high stress working conditions every day, making it important to study burnout among nurses in health care systems. The aim of the paper is to investigate the impact of ethical climate and the LMX relationship on burnout among nurses, as well as to examine the effects of the three moderators (gender, self-awareness and social skills among nurses) on the observed relationships. The sample consists of 326 nurses from 23 hospitals in Serbia. Standardised questionnaires were used, while correlation analysis and hierarchical regression analysis were employed for statistical processing. The dimensions of the ethical climate and LMX relationship have statistically significant impacts and predictive effects on the burnout dimensions. Raising the level of the ethical climate and LMX relationship positively affects burnout: it reduces emotional exhaustion and depersonalisation, and increases personal accomplishment and involvement. An adverse ethical climate and unfavourable LMX relationships among men cause greater emotional exhaustion. For nurses with high self-awareness and high social skills, a favourable ethical climate and positive LMX relationships reduce emotional exhaustion, and increase personal accomplishment. For nurses with low self-awareness and low social skills, a favourable ethical climate and positive LMX relationships reduce depersonalisation. Recommendations are made for improving the ethical climate and LMX relationships in hospitals in Serbia.