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1.
J Orthop Traumatol ; 22(1): 22, 2021 Jun 14.
Article in English | MEDLINE | ID: mdl-34128114

ABSTRACT

BACKGROUND: Periprosthetic fractures (PPFs) are a growing matter for orthopaedic surgeons, and patients with PPFs may represent a frail target in the case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The purpose of this study is to investigate whether hospital reorganisations during the most severe phase of the SARS-CoV-2 pandemic affected standards of care and early outcomes of patients treated for PPFs in Northern Italy. MATERIALS AND METHODS: Data were retrieved from a multicentre retrospective orthopaedics and traumatology database, including 14 hospitals. The following parameters were studied: demographics, results of nasopharyngeal swabs, prevalence of coronavirus disease 2019 (COVID-19), comorbidities, general health status (EQ-5D-5L Score), frailty (Clinical Frailty Scale, CFS), pain (visual analogue scale, VAS), anaesthesiologic risk (American Society of Anaesthesiology Score, ASA Score), classification (unified classification system, UCS), type of operation and anaesthesia, in-hospital and early complications (Clavien-Dindo Classification, CDC), and length of stay (LOS). Data were analysed by means of descriptive statistics. Out of 1390 patients treated for any reason, 38 PPFs were included. RESULTS: Median age was 81 years (range 70-96 years). Twenty-three patients (60.5%) were swabbed on admission, and two of them (5.3%) tested positive; in three patients (7.9%), the diagnosis of COVID-19 was established on a clinical and radiological basis. Two more patients tested positive post-operatively, and one of them died due to COVID-19. Thirty-three patients (86.8%) presented a proximal femoral PPF. Median ASA Score was 3 (range, 1-4), median VAS score on admission was 3 (range, 0-6), median CFS was 4 (range, 1-8), median EQ-5D-5L Score was 3 in each one of the categories (range, 1-5). Twenty-three patients (60.5%) developed post-operative complications, and median CDC grade was 3 (range, 1-5). The median LOS was 12.8 days (range 2-36 days), and 21 patients (55.3%) were discharged home. CONCLUSIONS: The incidence of PPFs did not seem to change during the lockdown. Patients were mainly elderly with comorbidities, and complications were frequently recorded post-operatively. Despite the difficult period for the healthcare system, hospitals were able to provide effective conventional surgical treatments for PPFs, which were not negatively influenced by the reorganisation. Continued efforts are required to optimise the treatment of these frail patients in the period of the pandemic, minimising the risk of contamination, and to limit the incidence of PPFs in the future. LEVEL OF EVIDENCE: IV.


Subject(s)
COVID-19 , Hospital Restructuring , Infection Control , Pandemics , Periprosthetic Fractures , Standard of Care , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/methods , Communicable Disease Control/standards , Communicable Disease Control/statistics & numerical data , Comorbidity , Female , Frailty/epidemiology , Hospital Restructuring/organization & administration , Hospital Restructuring/standards , Hospital Restructuring/statistics & numerical data , Humans , Incidence , Infection Control/methods , Infection Control/standards , Infection Control/statistics & numerical data , Italy/epidemiology , Male , Orthopedic Procedures/methods , Orthopedic Procedures/standards , Orthopedic Procedures/statistics & numerical data , Pandemics/statistics & numerical data , Periprosthetic Fractures/complications , Periprosthetic Fractures/epidemiology , Periprosthetic Fractures/surgery , Periprosthetic Fractures/therapy , Retrospective Studies , SARS-CoV-2 , Standard of Care/standards , Standard of Care/statistics & numerical data
3.
Nurs Health Sci ; 22(4): 1103-1110, 2020 Dec.
Article in English | MEDLINE | ID: mdl-32951294

ABSTRACT

Maintenance of professional identity, particularly during periods of organizational restructuring, is critical within modern complex healthcare systems as professional identity contributes to the psychological well-being of staff and leaders. This study aimed to evaluate change in professional identity of allied health staff associated with a major health network organizational restructuring in Australia. Data were collected from allied health staff in 2017 and 2019, before (n = 226) and after (n = 197) the restructuring. An online questionnaire including the 10-question Brown's Group Identification Scale that considers the strength of professional identity of the individual with their own professional group was used. Professional identity of allied health staff was high before and after the organizational restructuring, although several individual statements, and overall professional identity, declined significantly post-restructuring. It was difficult to attribute these changes solely to the restructuring due to some differences in demographic characteristics between the two cohorts. Future studies should seek to understand the effect of other workplace factors on the professional identity of allied health staff. Further research could also investigate allied health professional identity to understand its importance within contemporary healthcare.


Subject(s)
Allied Health Personnel/psychology , Hospital Restructuring/methods , Organizational Innovation , Social Identification , Allied Health Personnel/statistics & numerical data , Attitude of Health Personnel , Hospital Restructuring/statistics & numerical data , Humans , Leadership , Surveys and Questionnaires , Victoria , Workplace/psychology , Workplace/standards
4.
J Health Organ Manag ; 25(2): 176-94, 2011.
Article in English | MEDLINE | ID: mdl-21845990

ABSTRACT

PURPOSE: Increased competition and resource scarcity have caused hospitals to seek internal efficiencies by restructuring their structures and processes. The purpose of this paper is to examine the effects of an organization's orientation toward control and learning and the use of process facilitators on perceived organizational consensus on outcomes related to cost, quality, and the ability to sustain implemented changes following a major hospital restructuring. DESIGN/METHODOLOGY/APPROACH: Data from 263 hospitals from across the USA were collected. Factor analysis was employed to develop scales measuring the organization's emphasis on learning, controls, and processes. Regression analysis then examined their relationship to the consensus on restructured outcomes. FINDINGS: The findings suggest a positive relationship between a learning orientation and processes with improved perceived agreement on restructuring outcomes. Hospitals with control orientations have a negative relationship with perceived organizational consensus. RESEARCH LIMITATIONS/IMPLICATIONS: The research has some limitations. The primary data for both the CEOs' and employees' perspectives comes from hospital CEOs. Also, the study is a cross-sectional study and lacks longitudinal information. It also includes mostly not-for-profit hospitals, with 100 or more beds, in urban areas. Practical implications - Hospitals will continue to feel pressures for the need to restructure and change. The findings suggest that hospitals achieve better results if they foster a learning orientation and put in place processes to facilitate the challenges of change. Although control systems are important, executives should realize that they might impede organizational efforts during organizational change. Hospitals may succeed in their change efforts by balancing adequate control and learning that are supported by processes to facilitate restructuring efforts. ORIGINALITY/VALUE: The work provides an original study on the effects of an organization's orientation of learning and controls and change processes on the perceived consensus of restructuring outcomes. The dichotomy of learning and controls has not been applied to hospital consensus on outcomes. The research suggests that hospitals can improve their change efforts by implementing appropriate processes and greater learning mechanisms. During times of stress and change hospitals often become more control oriented, which may create greater misalignments and ineffective change. Managers should learn from the research that appropriate processes and learning will provide better consensus and more effective change.


Subject(s)
Attitude of Health Personnel , Chief Executive Officers, Hospital , Hospital Restructuring/organization & administration , Cross-Sectional Studies , Efficiency, Organizational , Factor Analysis, Statistical , Hospital Restructuring/statistics & numerical data , Humans , United States
5.
J Health Care Finance ; 34(4): 52-65, 2008.
Article in English | MEDLINE | ID: mdl-21110481

ABSTRACT

An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification and divestiture, occasionally leading to closure or merger. Hospital diversification and its impact on the operating ratio are studied for 172 hospitals during the period 2002-2007. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as being jointly dependant. Institutional diversification is found to yield better financial position, and the better operating profits allow the institution the wherewithal to diversify. The impact of external government planning and hospital competition is also measured. Some services are in a growth phase, like bariatric weight loss surgery and sleep disorder clinics. Management's attitude concerning risk and reward is considered.


Subject(s)
Hospital Restructuring/statistics & numerical data , Economic Competition/statistics & numerical data , Financial Management, Hospital/statistics & numerical data , Health Planning/statistics & numerical data , Health Services Research , Humans
6.
Psychiatr Serv ; 58(2): 221-6, 2007 Feb.
Article in English | MEDLINE | ID: mdl-17287379

ABSTRACT

OBJECTIVE: This study analyzed trends in suicides occurring after a psychiatric hospitalization during more than a decade of significant structural changes in mental health services in Finland-that is, deinstitutionalization, downsizing of inpatient care, and decentralization. METHODS: Retrospective register data on completed suicides and psychiatric inpatient treatments were collected for the periods 1985-1991 and 1995-2001, representing service provision before and after significant structural changes. The data were used to produce an estimate for a change in postdischarge suicide risk. RESULTS: In both periods, a fifth of suicide victims had been psychiatrically hospitalized within the preceding year. Among persons hospitalized, the risk of suicide was greater in 1985-1991 than in 1995-2001 for both one week after discharge (risk ratio [RR]=1.50, 95% confidence interval [CI]=1.38-1.62) and one year after discharge (RR=1.25, CI=1.19-1.30). When types of disorders were analyzed separately, the relative risk of suicide one year postdischarge for those hospitalized in the earlier period was greater for patients with schizophrenia (RR=1.26, CI=1.17-1.36) and patients with affective disorders (RR=1.60, CI=1.48-1.73). In parallel with general development of inpatient psychiatric services, in 1995-2001 the inpatient treatment periods preceding suicides were significantly shorter (a mean+/-SD of 45+/-340 days in 1995-2001, compared with a mean of 98+/-558 days in 1985-1991), the number of individual patients treated in the hospital for schizophrenia spectrum disorders was lower (26% compared with 36%), and the number treated for affective disorders was higher (45% compared with 35%). CONCLUSIONS: The restructuring and downsizing of mental health services was not associated with any increase in suicides immediately (one week) or one year postdischarge. Instead, the risk of these suicides decreased significantly between the two time periods among several diagnostic categories. Although the role of psychiatric hospitalization in general may have changed over time, patients who are hospitalized now may be less suicidal after discharge. Our results indicate, in terms of postdischarge suicides, that the downsizing of psychiatric hospitals has been a success. However, there is still a substantial need for better recognition of suicidal risk among psychiatric patients.


Subject(s)
Deinstitutionalization/trends , Mental Disorders/mortality , Patient Discharge/statistics & numerical data , Politics , Suicide/trends , Adult , Aged , Cause of Death , Cross-Sectional Studies , Deinstitutionalization/statistics & numerical data , Female , Finland , Hospital Restructuring/statistics & numerical data , Hospital Restructuring/trends , Hospitals, Psychiatric/statistics & numerical data , Hospitals, Psychiatric/trends , Humans , Male , Mental Disorders/rehabilitation , Middle Aged , Mood Disorders/mortality , Mood Disorders/rehabilitation , Registries , Retrospective Studies , Risk , Schizophrenia/mortality , Schizophrenia/rehabilitation , Suicide/statistics & numerical data
7.
Scand J Public Health ; 33(6): 439-46, 2005.
Article in English | MEDLINE | ID: mdl-16332609

ABSTRACT

BACKGROUND: During the last five years the Norwegian hospital sector has experienced massive reorganization efforts. The aim of this study is to establish whether two such initiatives - the introduction of ring fencing of elective surgery and activity-based budgets at department level - have had any effects on one of the most profiled objectives on the health political agenda: reduction in waiting time. METHODS: The sample studied includes 41 hospitals observed at two points of time, 1999 and 2001. Waiting time is expected to be a result of imbalance between demand and supply. Measures representing the supply side (ring fencing, activity-based budgets at departmental level, physician rate, share of emergency admissions, technical efficiency, and hospital type) and the demand side (living conditions and share of persons aged 67 or older) are included in the operationalized model. The model is estimated via stepwise OLS regression. RESULTS: The results document a negative relationship between ring fencing and waiting time, with the estimated waiting time reduction amounting to 22 days. Both the demand side variables also exert significant effects on waiting time. CONCLUSION: Although information on ring fencing, living conditions, and age distribution renders possible some predictions concerning waiting time, the current research topic should be revisited when a longer time period has elapsed. When the organizational changes have become more thoroughly embedded in the hospitals, more refined conclusions regarding hospital organizations' behaviour and effects of reorganization can be drawn.


Subject(s)
Efficiency, Organizational , Hospital Administration , Hospital Restructuring , Waiting Lists , Economics, Hospital , Efficiency, Organizational/economics , Efficiency, Organizational/statistics & numerical data , Hospital Administration/economics , Hospital Administration/statistics & numerical data , Hospital Restructuring/economics , Hospital Restructuring/statistics & numerical data , Humans , Norway , Organizational Innovation/economics
8.
Gesundheitswesen ; 67(2): 112-6, 2005 Feb.
Article in German | MEDLINE | ID: mdl-15747198

ABSTRACT

In many health care institutions (eg, hospitals), employees' health and satisfaction are not the main concern. However, if health and productivity are affected by high sickness rates and low motivation, health and satisfaction of the employees become important. This applies especially to hospitals engaged in acute patient care. We showed that a complete reorganisation of the central O. R. resulted in employees' working satisfaction, low illness rates (- 70 %) and increased motivation. In addition, the new structure increased the efficacy (> 500 operations more per year), improved the economy (savings of 500,000 annually) and increased patient satisfaction as expected and desired.


Subject(s)
Efficiency, Organizational/economics , Health Promotion/methods , Health Promotion/organization & administration , Hospital Restructuring/methods , Hospital Restructuring/organization & administration , Occupational Health , Operating Rooms/organization & administration , Efficiency, Organizational/statistics & numerical data , Germany , Health Promotion/statistics & numerical data , Hospital Restructuring/statistics & numerical data , Operating Rooms/statistics & numerical data , Patient Satisfaction
9.
J Healthc Manag ; 47(5): 321-33; discussion 333-4, 2002.
Article in English | MEDLINE | ID: mdl-12325254

ABSTRACT

Rural hospitals are actively pursuing various strategic alternatives to confront the dramatic changes taking place in the delivery, organization, and financing of healthcare. One of these strategic alternatives is involvement in provider-sponsored managed care organizations. Studies have argued that this form of managed care would enhance public trust and might improve the performance of hospitals. The changing healthcare environment has also increased the importance of the competence and composition of hospital boards. This article examines the effect of the governing board's composition on rural hospitals' involvement in provider-sponsored managed care organizations. The study sample consisted of 140 rural hospitals in Iowa and Nebraska whose CEOs responded to a survey conducted by the Center for Health Services Research at the University of Iowa between June and December 1997. The principal finding was that the likelihood of a hospital owning any form of managed care organization increases with the number of community leaders and health professionals on the board. The number of business leaders had no effect on the likelihood of involvement in such an arrangement. Other factors that affected the likelihood of owning a managed care organization were the health status of the population and ownership type. Key recommendations to managers are to (1) revisit the hospital board's composition before actively pursuing a strategic action, (2) examine the compatibility of the type of strategic activity pursued with the background of board members and the interests of the populations they represent, and (3) use the governing board as a resource in determining which new strategic activities to undertake.


Subject(s)
Governing Board/organization & administration , Hospital Restructuring/statistics & numerical data , Hospitals, Rural/organization & administration , Managed Care Programs/organization & administration , Provider-Sponsored Organizations/organization & administration , Attitude of Health Personnel , Chief Executive Officers, Hospital/psychology , Chief Executive Officers, Hospital/statistics & numerical data , Data Collection , Decision Making, Organizational , Health Services Research , Hospitals, Rural/statistics & numerical data , Humans , Iowa , Logistic Models , Managed Care Programs/statistics & numerical data , Nebraska , Ownership/statistics & numerical data , Probability , Provider-Sponsored Organizations/statistics & numerical data
10.
Todo hosp ; (188): 445-450, jul. 2002. tab, graf
Article in Es | IBECS | ID: ibc-37878

ABSTRACT

El Servicio de Calidad Asistencial y Acreditación de la Dirección General de Recursos Sanitario puso en marcha, en 1999, un proyecto de seguimiento de los puntos de mejora pendientes de los hospitales acreditados favorablemente. En este trabajo se pone de manifiesto la evaluación de las mejoras y la situación actual (AU)


No disponible


Subject(s)
Humans , Accreditation/trends , Hospitals/standards , 51706 , Technology Assessment, Biomedical , Process Optimization , Hospital Restructuring/statistics & numerical data , Hospitalization/trends , Health Facility Environment/standards
12.
Health Care Manage Rev ; 27(1): 7-20, 2002.
Article in English | MEDLINE | ID: mdl-11765897

ABSTRACT

This article examines hospital reorganization and restructuring activities following merger for two study periods: 1983-1988 and 1989-1996. In both periods, hospitals rated strengthening hospital financial position as the most important reason for merger. There were also similarities in reorganizing actions, especially reductions in service duplication, consolidation of departments and programs, reductions in medical and support FTEs, and reductions in administrative staffing. Hospital mergers during 1989-1996, however, focused increasingly on reducing nursing FTEs and less on converting acquired hospitals to new service lines.


Subject(s)
Health Facility Merger/statistics & numerical data , Hospital Restructuring/statistics & numerical data , Centralized Hospital Services , Data Collection , Economic Competition , Health Facility Merger/organization & administration , Health Services Research , Hospital Restructuring/trends , Humans , Motivation , Nursing Staff, Hospital/supply & distribution , Personnel Downsizing , Product Line Management , United States
13.
Health Policy ; 58(2): 151-73, 2001 Nov.
Article in English | MEDLINE | ID: mdl-11551664

ABSTRACT

An era of managerialism in health care delivery systems is now well ensconced throughout the nations of the OECD. This development has occurred, in large part, as a response to funding pressures in institutionally based health care delivery imposed by principal third party insurers. In the case of publicly funded hospitals, the more traditional concerns for stewardship and appeasement of professional groups is being replaced by a greater emphasis on cost consciousness and corporate-style leadership as these organizations seek to reposition themselves in new funding and regulatory environments. While institutional theory and strategic management perspectives help illuminate these issues, this paper argues that a place-based perspective is also needed to understand the changes currently underway in health care delivery and publicly funded human services more generally. This is illustrated with reference to developments in the strategic management of public hospitals in the province of Ontario. Evidence from a survey of senior administrators of public hospitals, distributed at the height of these policy reform initiatives, is examined to shed light on local level management responses to changing policy and fiscal pressures. The data suggest that the latest policy directions in the province of Ontario will 'encourage' hospital executives in particular community settings to steer their organizations in very unfamiliar directions. The findings suggest a need for greater attention to context and setting in health services research and policy.


Subject(s)
Health Care Reform/statistics & numerical data , Hospital Restructuring/statistics & numerical data , Hospitals, Public/organization & administration , Organizational Innovation , Canada , Decision Making, Organizational , Financing, Government , Health Services Research , Hospitals, Public/economics , Hospitals, Public/statistics & numerical data , Humans , International Agencies , Leadership , Ontario , Organizational Culture , Planning Techniques , Surveys and Questionnaires
14.
Home Health Care Serv Q ; 19(3): 19-33, 2001.
Article in English | MEDLINE | ID: mdl-11436404

ABSTRACT

This article explores the role of hospitals in providing geriatric services and identifies associated community and hospital characteristics. The sample is 4571 community hospitals responding to the 1995 American Hospital Association (AHA) Annual Survey. Most hospitals offer some geriatric services; the mean is 3.3. The dependent variable is an index of 13 geriatric services created from the AHA data. Independent variables are taken from the AHA survey, Area Resource File, and census data. Regression analysis explains fifteen percent of the variance. Hospital characteristics predicting provision of geriatric services are non-profit tax status, hospital bed size and system membership. Community characteristics predicting provision of geriatric services included higher population density, high percentage of county aged, and county nursing facility beds. Hospital characteristics yielded slightly higher predictive ability than did community characteristics. The findings suggest policies to increase hospital leadership in providing access to senior services require a multi-dimensional approach.


Subject(s)
Continuity of Patient Care/organization & administration , Health Services for the Aged/supply & distribution , Hospital Restructuring/statistics & numerical data , Hospitals/classification , Aged , Catchment Area, Health/statistics & numerical data , Community-Institutional Relations , Day Care, Medical , Health Care Surveys , Health Services for the Aged/classification , Hospital Bed Capacity , Hospitals, Voluntary , Humans , Leadership , Motivation , Multi-Institutional Systems , Nursing Homes , Regression Analysis , Role , United States
15.
Med Care Res Rev ; 58(2): 194-228; discussion 229-33, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11398646

ABSTRACT

In the recent past, a number of managerial innovations--including product line management, total quality management, and reengineering--have swept through the hospital industry. Given their pervasiveness and their cost, understanding the mix of factors that influences their adoption is of theoretical interest and practical relevance. The research reported here focuses on this general question by examining influences on the adoption and extensiveness of a particular managerial innovation, hospital reengineering. The results suggest that while economic and institutional factors have influenced the adoption and extensiveness of hospital reengineering, institutional forces play a more important role. The greater influence of institutional forces may be attributed to the high degree of uncertainty in health care, the causal ambiguity of the innovation, and the anticipatory actions of hospitals attempting to position themselves in a rapidly changing environment.


Subject(s)
Decision Making, Organizational , Diffusion of Innovation , Hospital Administration , Hospital Planning/organization & administration , Hospital Restructuring/statistics & numerical data , Organizational Innovation , Health Services Research , Hospital Administration/economics , Hospital Administration/trends , Hospital Restructuring/organization & administration , Humans , Marketing of Health Services , Organizational Policy , United States
17.
Health Care Manag Sci ; 3(4): 299-307, 2000 Sep.
Article in English | MEDLINE | ID: mdl-11105416

ABSTRACT

In national health services, where there is a tendency towards a lack of resources and a continuous increase in demand, it is necessary to implement decisions that promote efficiency. In this paper we focus on potential diversification economies as a strategy to increase efficiency levels. We evaluate the change in efficiency in Catalan hospitals between 1987 and 1992, and analyse the presence of possible diversification economies in each hospital. We use Data Envelopment Analysis, which does not need information on either input or output prices. The results are that the majority of hospitals could increase their efficiency and reduce their costs by diversification to the output-mix offered. Potential productivity gains are between 29% and 46%.


Subject(s)
Efficiency, Organizational , Hospital Restructuring/economics , Hospitals, General/statistics & numerical data , Hospitals, Special/statistics & numerical data , Medical Laboratory Science/organization & administration , Models, Econometric , Benchmarking , Health Services Needs and Demand/economics , Health Services Needs and Demand/statistics & numerical data , Health Services Research , Hospital Restructuring/statistics & numerical data , Hospitals, General/economics , Hospitals, Special/economics , Humans , Spain
19.
J Nurs Adm ; 30(1): 11-20, 2000 Jan.
Article in English | MEDLINE | ID: mdl-10650431

ABSTRACT

OBJECTIVES: A study was undertaken to determine the relationships among organizational culture, organizational commitment, and organizational readiness in a sample of employees participating in a hospital-wide redesign process. METHODS: Employees of an organization undergoing patient-focused redesign were surveyed after a 6-month period of preparation and before the initiation of the new care delivery model. RESULTS: Organizational readiness, a variable rarely described in organizational change literature, was the strongest predictor of employee commitment to the organization. Constructive culture also was predictive, but less so than readiness for change. CONCLUSIONS: Additional research is needed to clarify how an organization's history and culture of change contribute to employee willingness to work for the goals of the organization. Findings suggest that when change is seen as a positive characteristic of the environment, employees are more likely to commit to the work of the institution.


Subject(s)
Nursing Staff, Hospital/organization & administration , Nursing Staff, Hospital/psychology , Organizational Culture , Adult , Female , Hospital Restructuring/organization & administration , Hospital Restructuring/statistics & numerical data , Humans , Male , Middle Aged , Midwestern United States , Nursing Staff, Hospital/statistics & numerical data , Organizational Innovation , Patient-Centered Care/organization & administration , Patient-Centered Care/statistics & numerical data , Psychometrics , Surveys and Questionnaires
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