The Impact of Performance Enhancement on Value of Care in Hospitals.

Hospitals are facing big challenges: decreasing reimbursements are going alongside increasing costs and the necessity of investments. At the same time occurring, excellent quality of care, and high-patient satisfaction have to be assured. The dilemma of providing both with decreasing rather than increasing resources cannot be solved only by striving for economies of scale, but by optimizing supply chain management, or reduction of overhead. Possible effects of these measures most often are already exhausted and seldom have a positive impact on the quality of care or patient satisfaction. Management is tempted to use its best-known instruments to reduce costs, while medical staff's focus is on quality of care and often battle against management as a perceived enemy. The solution to this dilemma lies in focusing on medical core processes that are directly linked to patients' treatments and, thereby improving all the parameters of Michael Porter's value equation: costs, outcome, and patient satisfaction. This approach of performance enhancement presumes understanding, acceptance, and constructive collaboration of two usually separated worlds: The medical-scientific world involved in patient care and the financial world of management. In this article, the authors explain performance enhancement for optimized delivery of care and how the dilemma mentioned above can be solved. The authors explain how performance enhancement can be achieved in daily clinical practice, which kind of obstacles have to be overcome, which changes are necessary within a hospital, how medical staff can be motivated, and how the value of care equation can be influenced.

Hospitalization costs of coronaviruses diseases in upper-middle-income countries: A systematic review.

BACKGROUND: COVID-19, SARS and MERS are diseases that present an important health burden worldwide. This situation demands resource allocation to the healthcare system, affecting especially middle- and low-income countries. Thus, identifying the main cost drivers is relevant to optimize patient care and resource allocation. OBJECTIVE: To systematically identify and summarize the current status of knowledge on direct medical hospitalization costs of SARS, MERS, or COVID-19 in Upper-Middle-Income Countries. METHODS: We conducted a systematic review across seven key databases (PubMed, EMBASE, BVS Portal, CINAHL, CRD library, MedRxiv and Research Square) from database inception to February 2021. Costs extracted were converted into 2021 International Dollars using the Purchasing Power Parity-adjusted. The assessment of quality was based on the protocol by the BMJ and CHEERS. PROSPERO 2020: CRD42020225757. RESULTS: No eligible study about SARS or MERS was recovered. For COVID-19, five studies presented cost analysis performed in Brazil, China, Iran, and Turkey. Regarding total direct medical costs, the lowest cost per patient at ward was observed in Turkey ($900.08), while the highest in Brazil ($5,093.38). At ICU, the lowest was in Turkey ($2,984.78), while the highest was in China ($52,432.87). Service care was the most expressive (58% to 88%) cost driver of COVID-19 patients at ward. At ICU, there was no consensus between service care (54% to 87%) and treatment (72% to 81%) as key burdens of total cost. CONCLUSION: Our findings elucidate the importance of COVID-19 on health-economic outcomes. The marked heterogeneity among studies leaded to substantially different results and made challenging the comparison of data to estimate pooled results for single countries or regions. Further studies concerning cost estimates from standardized analysis may provide clearer data for a more substantial analysis. This may help care providers and policy makers to organize care for patients in the most efficient way.

Positive environmental impact of remote teleconsultation in urology during the COVID-19 pandemic in a highly populated area.

INTRODUCTION: Greenhouse gas (GHG) emissions are a serious environmental issue. The healthcare sector is an important emitter of GHGs. Our aim was to assess the environmental cost of teleconsultations in urology compared to face-to-face consultations. MATERIALS AND METHODS: Prospective study of all patients who had a remote teleconsultation over a 2-week period during COVID-19 pandemic. Main outcome was the reduction in CO2e emissions related to teleconsultation compared to face-to-face consultation and was calculated as: total teleconsultation CO2e emissions-total face-to-face consultation CO2e emissions. Secondary outcome measures were the reduction in travel distance and travel time related to teleconsultation. RESULTS: Eighty patients were included. Face-to-face consultations would have resulted in 6699km (4162 miles) of travel (83.7km (52 miles) per patient). Cars were the usual means of transport. CO2e avoided due to lack of travel was calculated at 1.1 tonnes. Teleconsultation was responsible for 1.1kg CO2e while face-to-face consultation emitted 0.5kg of CO2e. Overall, the total reduction in GHGs with teleconsultation was 1141kg CO2e, representing a 99% decrease in emissions. Total savings on transport were 974 € and savings on travel time were 112h (1.4h/patient). CONCLUSIONS: Teleconsultation reduces the environmental impact of face-to-face consultations. The use of teleconsultation in our urology departments resulted in the avoidance of more than 6000km of travel, equivalent to a reduction of 1.1 tonnes of CO2e. Teleconsultation should be considered for specific indications as the healthcare system attempts to become greener. LEVEL OF EVIDENCE: 3.

How to lead health care workers during unprecedented crises: A qualitative study of the COVID-19 pandemic in Connecticut, USA.

Health Care Leaders (HCLs) faced unprecedented challenges during the initial phases of the COVID-19 pandemic. Leaders played an important role in shaping the experiences of Health Care Workers (HCWs) during this time. However, research is needed on how HCWs experienced and characterized HCLs' response and support. The aim of our study was to examine HCWs' experiences with leadership and to identify aspects of HCLs' response that were effective in supporting HCWs in their roles during the early phases of the pandemic. This was a qualitative study based on open-ended semi-structured interviews conducted (June 1- July 18, 2020) with frontline HCWs during the first wave of the COVID-19 pandemic in Connecticut, USA. Participants (N = 45) included physicians, nurses, respiratory therapists and patient care assistants who worked in inpatient and outpatient settings in various specialties, roles and 3 health systems across Connecticut, USA during the COVID-19 pandemic. Participants were offered a $25 gift card as an incentive for participation. We used inductive techniques derived from grounded theory to develop themes. We identified 6 main themes related to leadership response and support of HCWs during the pandemic namely: 1) Effective communication and transparency; 2) Prioritizing their health and safety; 3) Employee scheduling considerations: autonomy, assignment support and respite; 4) Appreciation- financial and nonfinancial; 5) Showing up and listening and 6) Stepping up with resources. Our findings can inform leadership responses to future pandemics and other unanticipated crises leading to strengthening of the health care system as a whole.

COVID-19 rapid response in a limited resource setting (notes from the field): Chinhoyi Provincial Hospital, Mashonaland West Province, Zimbabwe.

COVID-19 has impacted health systems globally with varying impacts across regions. In Zimbabwe, a country with perennial problems of shortage of healthcare workers and resources, the pandemic has caused substantial strain on the public health system. The ability to share experiences on what has worked and what has not can be valuable as scientists, policymakers, and others determine steps forward and reflect backward to determine lessons learned in the pandemic response. We describe the setup and function of a COVID-19 rapid response team in the context of a limited resource setting. The response had to be tailored to make maximal use of the resources available and manage the outbreak. In this article, we share notes from the field and discuss the process of setting up a rapid response protocol in a limited resource provincial hospital, the challenges encountered, improvised interventions and recommendations for managing a COVID-19 resurgence and future similar pandemics.

Impact of COVID-19 on Neurosurgery in Brazil's Health System: The Reality of a Developing Country Affected by the Pandemic.

BACKGROUND: The coronavirus disease identified in 2019 (COVID-19) pandemic changed neurosurgery protocols to provide ongoing care for patients while ensuring the safety of health care workers. In Brazil, the rapid spread of the disease led to new challenges in the health system. Neurooncology practice was one of the most affected by the pandemic due to restricted elective procedures and new triage protocols. We aim to characterize the impact of the pandemic on neurosurgery in Brazil. METHODS: We analyzed 112 different types of neurosurgical procedures, with special detail in 11 neurooncology procedures, listed in the Brazilian Hospital Information System records in the DATASUS database between February and July 2019 and the same period in 2020. Linear regression and paired t-test analyses were performed and considered statistically significant at P < 0.05. RESULTS: There was an overall decrease of 21.5% (28,858 cases) in all neurosurgical procedures, impacting patients needing elective procedures (-42.46%) more than emergency surgery (-5.93%). Neurooncology procedures decreased by 14.89%. Nonetheless, the mortality rate during hospitalization increased by 21.26%. Linear regression analysis in hospitalizations (Slope = 0.9912 ± 0.07431; CI [95%] = 0.8231-1.159) and total cost (Slope = 1.03 ± 0.03501; CI [95%] = 0.9511-1.109) in the 11 different types of neurooncology procedures showed a P < 0.0001. The mean cost per type of procedure showed an 11.59% increase (P = 0.0172) between 2019 and 2020. CONCLUSIONS: The COVID-19 pandemic has increased mortality, decreased hospitalizations, and therefore decreased overall costs, despite increased costs per procedure for a variety of neurosurgical procedures. Our study serves as a stark example of the effect of the pandemic on neurosurgical care in settings of limited resources and access to care.

The World after COVID-19: Reflections on Global Health and Policy.

COVID-19 has infected hundreds of millions of people across the globe. The pandemic has also inflicted serious damages on global and regional governing political structures to a degree meriting a revisit of their own raison d'etre. The global economic fallout is also unprecedented as the flows of goods and people got severely disrupted while lockdowns hit the transport, services and retail industries, among others. We argue that three realities need to be genuinely addressed for building a post COVID-19 order that has to be amply equipped to deal with the next global crisis, as well as the ones on-going for decades. First, there is need to shelf-away the hitherto practiced doctrine that global crises and problems are confronted through local responses. Second, the COVID-19 pandemic has cautioned us on the need to (re)invest in basic, many may consider naïve and simple, public health functions such as sanitation as well as transparent national and global health monitoring. Third, the pandemic is a clear reprimand to discard the mantra that privatization of healthcare delivery system is the solution in favor of viewing health as a public good that needs to be managed and executed by the state and its public sector, be it national, sub-regional or local. It is critical that we learn from such pandemic and advance our societies to become stronger.