Strategic management and hospital performances in small and medium hospitals ---- From the viewpoint of Balanced Scorecard---- Abstract: ---------------------------------------------------------------------------------------------- The new era of National Health Insurance has impacted the management of the small and medium hospitals significantly. For the purpose of survival and maintaining good performance, the small and medium hospitals need to adopt a suitable strategic manage ment. The published literatures in the hospital performance are numerous but with more focus in the field of public and larger hospitals, very few of them discussed about the smaller hospitals. Previously ,the measurement of hospital performance has been mainly based on the financial guideline. In this work , we investigated the relationship between strategic management and hospital performance in the different scaled small and medium hospitals using the viewpoint of Balanced Scorecard(BSC). The purposes of this study are (1) to classify hospital strategies using the Miles & Snow¡¦s typology, (2) to investigate the effects of the hospital size on hospital strategies, and (3) to examine the relationships between these different strategies and hospital performance. This project was a cross-sectional and non-experimental study with a hospital as the unit of analysis. We used an eleven- items questionnaire (Conant, 1990) to classify hospitals into four different strategic types: prospector, defender, analyzer and reactor. (Miles & Snow,1978). We also used Kaplan & Norton¡¦s Balanced Scorecard to measure the hospital performance, which including 17- item questions for internal business process, innovation and learning, customer as well as financial perspectives. Four hundred and twenty three questionnaires were mailed to the hospital CEOs with 151 were returned, representing a response rate of 35.7%. Factor analysis, Chi-Square test, ANOVA and Scheffe¡¦s test were used for the statistical analysis. The distribution of bed size were 49.7% under 50-beds, 15.2% with 51-100 beds, 11.9% with 101-150 beds, 5.3% with 151-200 beds, 3.3% with 201-250 beds, as well as 14.6% with greater than 250 beds. The results showed that 37.7% of the hospitals were analyzer, followed by defender (26.5%), reactor (24.5%), and prospector (11.3%), respectively. From a factor analysis of 17 items related to the balanced scorecard, we obtained six measures of internal business perspective (£\=0.80), all six items had factor loading above 0.60 and eigenvalues above 1.0 derived from principal components analysis with varimax rotation. Innovation and learning perspective was measured by 5 measures (£\=0.76) with factor loading above 0.60 and eigenvalues greater than 1 . Customer perspective included 4 measures (£\=0.59) with factor loading above 0.50 and eigenvalues greater than 1. In addiction , we obtained two

ABSTRACT A Study of Key Decision-making Factors of Coping Global Budget System and Reformed Hospital Accreditation of a Regional Military Hospital Since the implementation of Global budget system in 2002, the constant controversy is continuous. In addition, the fulfillment of Reformed hospital accreditation is related to the amount of insurance payment. Under this double pressure, the medical institutions generally face the dilemma of operating difficulties. Besides these pressures, the Military hospital also has problems of budget and staff reducing. How to draft and execute the business strategy to achieve sustained development is a serious and important issue. In this study, a regional military hospital was chose as a research case. We point at analysis of medical industry environment , literatures review and ways of monitoring of Global budget system and Reformed hospital accreditation of research hospital. According to the characteristics of Global budget system and Reformed hospital accreditation, we adopted the Saaty¡¦s Analytic Hierarchy Process (AHP) to establish individual multi-estimate criteria models of the key decision-making factors of Global budget system and Reformed hospital accreditation of the hospital. And then by AHP qualitative and quantitative questionnaires, undertook research and analysis of various key decision-making factors. Finally, the Analytic Hierarchy Process was applied to calculate the weighting and to sequence the priority of these factors. To find out which hospital management operation system should be strengthen. The results of study showed that in light of coping Global budget system, the ¡§strategic management¡¨ is the most important key decision-making factors, which ¡§Cost control and financial management¡¨ and ¡§ Just distribution of reward¡¨ are the top priority. In addition, ¡§ Raise the medical quality of service¡¨ and ¡§quality of medical manpower¡¨ to fight for extra Global budget and own expense items are the important strategy of broadening resources. In the light of coping the Reformed hospital accreditation, the ¡§Decision making capacity¡¨ is the most important factors, particularly the ¡§leader¡¦s leadership of the decision-making¡¨. ¡§Reformed hospital accreditation progress-control table¡¨ and the ¡§Information system of management of Reformed hospital accreditation¡¨ can standardize the preparatory work as well as the control over the progress of preparations. ¡Ô

Objective: Globally, about 50 to 100 million patients are infected with dengue fever per year and the average mortality rate is about 3.5 to 5% in Asia. Because of appropriate geographic location and cultural factors, dengue fever has been the important subject of infectious disease that Taiwan faces. In order to control and prevent the spread of dengue fever effectively, how to diagnose the suspected case correctly by the clinical symptoms and to improve the early reporting rates become critical research questions. The purpose of this study is to explore the correlation between clinical symptoms and diagnosis of dengue fever, and the factors associated with being reported at the first outpatient visit among confirmed case by using Dengue Fever Survey Form, which including demographics, clinical symptoms, level of the first outpatient visit and whether the patient is reported at the first outpatient visit. Design: 593 virologically confirmed cases during 2006 Dengue endemics in Kaohsiung city were studied. The data were from Dengue Fever Survey Form, which were collected from January 1 to December 31,2006. Result: The mean age of cases was 46.45¡Ó19.06 years (range 2 years to 89 years). The most common symptoms were fever (97.3%), pain (75.2%), GI symptoms (74.7%), skin rash (49.2%), and thirsty/dry mouth (49.1%). Chi-square tests showed gender, age in group, viral type, whether dengue hemorrhagic fever or not, level of the first outpatient visit, pain and gastrointestinal symptoms were significantly associated with being reported at the first outpatient visit. The result of the analysis of logistic regression indicated that the significant predictors of being reported at the first outpatient visit were gender, age in group, viral type, level of the first outpatient visit, gastrointestinal symptoms and fatigue. Conclusion: Reporting of infectious disease is essential to detection of outbreaks, planning of control program and provision of appropriate treatment. Clinical symptoms of dengue fever and the level of the first outpatient visit will influence rates of being reported at the first outpatient visit. All medical providers involved in diagnosis and treatment of dengue fever should strengthen their knowledge by continuing learning in order to improve early identification rates. In addition, health department could try to improve the detection and reporting systems to make the reporting steps more convenient and advance early reporting rates.

Thesis (Ph. D.)--University of Washington, 2000. / Vita. Includes bibliographical references (leaves 57-62).

Thesis (Ph. D.)--University of Chicago, School of Social Service Administration, June 2001. / Includes bibliographical references. Also available on the Internet.

Thesis (doctoral)--University of London, 1991. / BLDSC reference no.: DX187130.

Thesis (M.S.)--University of Alabama at Birmingham, 2009. / Title from PDF title page (viewed Jan. 25, 2010). Includes bibliographical references (p. 59-60).

Project Thesis (D. Min.)--Denver Conservative Baptist Seminary, 1991. / Appendix includes coursework pamphlets mounted on numbered leaves. Includes bibliographical references (leaves 179-196).

Thesis (Ph. D.)--New York University, 1972. / Includes bibliographical references (leaves [69]-81).

Thesis (M. Arch.)--University of Hong Kong, 1997. / Includes special report study entitled: Complex circulation system. Includes bibliographical references.