Health Studies / D. Litt. et phil. (Advanced Nursing Sciences)

This study investigated the attitudes and perceptions of nurse managers regarding cost containment issues in selected public hospitals in the Port Elizabeth metropole of the Eastern Cape. Four hospitals participated in the study, and 211 nurse managers completed questionnaires. The results obtained from the participants’ responses indicated that: ✦ Nurse managers are ill-prepared for many responsibilities regarding cost containment, and need appropriate orientation and preparation both during their initial formal, and during their nurse management and in service training in order to fulfil their “financial” or cost containment role more effectively. ✦ Nurse managers perceived the relationship between the productivity of staff and cost containment positively, but were reportedly unable to • prevent nurses from leaving their points of duty • curb the rate of absenteeism among nurses • reduce the number of resignations ✦ Nurse managers suggested that more effective hospital cost containment efforts should ensure that • effective security checks are performed to curb losses of stock and equipment • more public telephones are installed in hospitals • stricter controls regarding wheelchairs are implemented The rationalisation of staff and services, as well as specialised equipment among the four public hospitals could enhance these hospitals’ cost containment results. However, this would necessitate reorganising these hospitals’ services at provincial level. The nurse managers required more knowledge about hospitals’ financial management and cost containment issues. Guidelines for such a course were developed addressing: analysis of monthly variance reports; budgeting for manpower; balance statement; calculations for the supplies and expenses budget; income statements; the hospital’s budgetary cycle; break-even analysis; analysis of cost-effectiveness and cost-benefit analysis. / ADVANCED NURSING SCIENCES / D.Litt. et Phil.

Today, in 21st century healthcare at least 10% of hospitalised patients are subjected to some degree of unintended harm as a result of the treatment they receive. Despite the growing patient safety agenda there is little empirical evidence to demonstrate that patient safety is improving. Patient Safety Leadership Walk Rounds (PSLWR) were introduced to the UK, in March 2005, as a component of the Safer Patients Initiative (SPI), the first dedicated, hospital wide programme to reduce harm in hospital care. PSLWR are designed, to create a dedicated ‘conversation’ about patient safety, between frontline staff, middle level managers and senior executives. This thesis, explored the use of PSLWR, as a proactive mechanism to engage staff in patient safety discussion and detect patient harm within a Scottish healthcare system- NHS Tayside. From May 2005 to June 2006, PSLWR were held on a weekly basis within the hospital departments. A purposive sample, (n=38) of PSLWR discussions were analysed to determine: staff engagement in the process, patient safety issues disclosed; recognition of unsafe systems (latent conditions) and actions agreed for improvement. As a follow-up, 42 semi-structured interviews were undertaken to determine staff perceptions of the PSLWR system. A wide range of clinical and non-clinical staff took part (n=218) including medical staff, staff in training, porters and cleaners, nurses, ward assistants and pharmacists. Participants shared new information, not formally recorded within the hospital incident system. From the participants perspectives, PSLWR, were non threatening; were easy to take part in; demonstrated a team commitment, from the Board to the ward for patient safety and action was taken quickly as a result of the ‘conversations’. Although detecting all patient harm remains a challenge, this study demonstrates PSLWR can be a useful tool in the patient safety arsenal for NHS healthcare organisations.

Thesis (PhD)--Macquarie University, Macquarie Graduate School of Management, 2001. / Bibliography: leaves 288-310. / Introduction -- Introduction to research problem and methodology -- Study context -- Theoretical framework - Review of the literature -- Study design and methods -- Study sites, surgical procedures, and labour input to surgical production -- New intra-operative artefacts: goals, choices and consequences -- Conclusion. / Surgical technologies since the late 1980s have undergone substantial innovations that have involved ...the adoption of new machines, instruments, and related surgical materials... referred to throughtout this thesis as intra-operative artefacts... typically represents a commitment of substantial financial resources by the hospitals concerned. However, little is documented about the process whereby the decisions are made to adopt new intra-operative artefacts, and no previous research appears to have explored the work-related consequences of new intra-operative artefact adoption within operating theatre services. This thesis explores the reasons why new intra-operative artefacts are adopted, how the decisions are made, who are the participants in the decsion process and what are the expected and actual organisational consequences of new intra-operative artefact adoption. / Electronic reproduction. / xii, 347 leaves, bound : / Mode of access: World Wide Web. / Also available in print form

Health Studies / D. Litt. et phil. (Advanced Nursing Sciences)

This study investigated the attitudes and perceptions of nurse managers regarding cost containment issues in selected public hospitals in the Port Elizabeth metropole of the Eastern Cape. Four hospitals participated in the study, and 211 nurse managers completed questionnaires. The results obtained from the participants’ responses indicated that: ✦ Nurse managers are ill-prepared for many responsibilities regarding cost containment, and need appropriate orientation and preparation both during their initial formal, and during their nurse management and in service training in order to fulfil their “financial” or cost containment role more effectively. ✦ Nurse managers perceived the relationship between the productivity of staff and cost containment positively, but were reportedly unable to • prevent nurses from leaving their points of duty • curb the rate of absenteeism among nurses • reduce the number of resignations ✦ Nurse managers suggested that more effective hospital cost containment efforts should ensure that • effective security checks are performed to curb losses of stock and equipment • more public telephones are installed in hospitals • stricter controls regarding wheelchairs are implemented The rationalisation of staff and services, as well as specialised equipment among the four public hospitals could enhance these hospitals’ cost containment results. However, this would necessitate reorganising these hospitals’ services at provincial level. The nurse managers required more knowledge about hospitals’ financial management and cost containment issues. Guidelines for such a course were developed addressing: analysis of monthly variance reports; budgeting for manpower; balance statement; calculations for the supplies and expenses budget; income statements; the hospital’s budgetary cycle; break-even analysis; analysis of cost-effectiveness and cost-benefit analysis. / ADVANCED NURSING SCIENCES / D.Litt. et Phil.

Estudos de futuro e construção de cenários prospectivos são recursos que se destacam na formulação da estratégia empresarial. No caso da área da saúde, em que o cenário presente pode ser alterado de forma rápida, por força de políticas governamentais, regulamentações, avanços tecnológicos, aspectos econômicos ou sociais, a modelagem de cenários se torna mais importante ainda, face as incertezas que se apontam. Neste ínterim, os hospitais estão muito comprometidos, pois são a referência para a população quando se trata de saúde. Este estudo teve como objetivo construir cenários prospectivos para o setor hospitalar, para um horizonte temporal de 10 anos, considerando a limitação geográfica do Estado do Rio Grande do Sul. O método utilizado foi uma pesquisa aplicada, exploratória e descritiva, e, quanto à abordagem do problema, a pesquisa pode ser classificada como qualitativa-quantitativa. Os dados foram obtidos junto a especialistas, oriundos do setor hospitalar, sendo que foi adotado o método Grumbach na modelagem de cenários e a utilização do software PUMA. Os objetivos deste estudo, além da própria modelagem dos cenários, foi identificar as variáveis que influenciam os cenários propostos, levantar a opinião de especialistas sobre estas variáveis, aplicar o software adequado e instrumentar as organizações hospitalares com elementos para a formulação de novas estratégias. Os resultados deste trabalho são os próprios cenários para o setor hospitalar nas condições geográficas e temporais estipuladas. / Submitted by Marcelo Teixeira (mvteixeira@ucs.br) on 2014-06-05T16:41:35Z No. of bitstreams: 1 Dissertacao Jaime Gil Bernardes.pdf: 1851187 bytes, checksum: 5bb7b2d739648c8b8ca2f72b70af5b0f (MD5) / Made available in DSpace on 2014-06-05T16:41:35Z (GMT). No. of bitstreams: 1 Dissertacao Jaime Gil Bernardes.pdf: 1851187 bytes, checksum: 5bb7b2d739648c8b8ca2f72b70af5b0f (MD5) / Studies and construction of future scenarios are features that stand out in the formulation of business strategy. In the case of health, the scenario where this can be changed quickly, under government policies, regulations, technological advances, economic or social aspects, the modeling scenario becomes even more important, given the uncertainties which points. Meanwhile, hospitals are very committed, as are the reference for the population when it comes to health. This study aimed to construct scenarios for the hospital sector, for a time horizon of 10 years, given the geographical limitations of the State of Rio Grande do Sul. The method used was an applied research, exploratory and descriptive, and how to approach the research problem can be classified as qualitative and quantitative. Data were obtained from experts, from the hospital sector, and Grumbach method was adopted to model scenarios and the use of software. The objectives of this study, besides the modeling of the scenarios was to identify the variables that influence the scenarios proposed to raise the opinion of experts on these variables, apply the appropriate software instrument and hospital organizations with elements for the formulation of new strategies. These results are their own scenarios for the hospital sector in the geographical and temporal conditions stipulated.

Estudos de futuro e construção de cenários prospectivos são recursos que se destacam na formulação da estratégia empresarial. No caso da área da saúde, em que o cenário presente pode ser alterado de forma rápida, por força de políticas governamentais, regulamentações, avanços tecnológicos, aspectos econômicos ou sociais, a modelagem de cenários se torna mais importante ainda, face as incertezas que se apontam. Neste ínterim, os hospitais estão muito comprometidos, pois são a referência para a população quando se trata de saúde. Este estudo teve como objetivo construir cenários prospectivos para o setor hospitalar, para um horizonte temporal de 10 anos, considerando a limitação geográfica do Estado do Rio Grande do Sul. O método utilizado foi uma pesquisa aplicada, exploratória e descritiva, e, quanto à abordagem do problema, a pesquisa pode ser classificada como qualitativa-quantitativa. Os dados foram obtidos junto a especialistas, oriundos do setor hospitalar, sendo que foi adotado o método Grumbach na modelagem de cenários e a utilização do software PUMA. Os objetivos deste estudo, além da própria modelagem dos cenários, foi identificar as variáveis que influenciam os cenários propostos, levantar a opinião de especialistas sobre estas variáveis, aplicar o software adequado e instrumentar as organizações hospitalares com elementos para a formulação de novas estratégias. Os resultados deste trabalho são os próprios cenários para o setor hospitalar nas condições geográficas e temporais estipuladas. / Studies and construction of future scenarios are features that stand out in the formulation of business strategy. In the case of health, the scenario where this can be changed quickly, under government policies, regulations, technological advances, economic or social aspects, the modeling scenario becomes even more important, given the uncertainties which points. Meanwhile, hospitals are very committed, as are the reference for the population when it comes to health. This study aimed to construct scenarios for the hospital sector, for a time horizon of 10 years, given the geographical limitations of the State of Rio Grande do Sul. The method used was an applied research, exploratory and descriptive, and how to approach the research problem can be classified as qualitative and quantitative. Data were obtained from experts, from the hospital sector, and Grumbach method was adopted to model scenarios and the use of software. The objectives of this study, besides the modeling of the scenarios was to identify the variables that influence the scenarios proposed to raise the opinion of experts on these variables, apply the appropriate software instrument and hospital organizations with elements for the formulation of new strategies. These results are their own scenarios for the hospital sector in the geographical and temporal conditions stipulated.

Le calcul des coûts des séjours et des pathologies peut être abordé selon différentes perspectives :les coûts à charge des systèmes sociaux, des patients ou des hôpitaux. La thèse est centrée sur cette dernière approche.<p>Les DRGs représentent la tentative la plus récente de maîtriser la croissance des dépenses des hôpitaux en introduisant une médicalisation partielle des mécanismes de financement.<p>La connaissance des coûts des pathologies peut permettre aux hôpitaux de participer à l’élaboration des tarifs par pathologie en faisant partie d’un échantillon de référence des coûts hospitaliers. En cas de financement basé sur les pathologies, les hôpitaux doivent pouvoir comparer le coût des séjours au chiffre d’affaires octroyé et s’y adapter. Cet intérêt s’accroît en cas de financement forfaitaire, évolution qui semble se profiler en Belgique tout comme dans d’autres pays. En décrivant une méthodologie de calcul des coûts par pathologie et en indiquant la manière dont ceux-ci pourraient contribuer à la création d’une échelle de cost-weights, notre thèse incite les hôpitaux à adopter une politique proactive dans le domaine du financement des hôpitaux. <p>Les comparaisons de coûts hospitaliers pour évaluer la gestion sont pratiquées depuis de nombreuses années. Cependant, ce « benchmarking » est imparfait car il ne prend pas en compte la lourdeur des patients pris en charge. La standardisation des coûts sur base du case-mix de l’hôpital suppose un préalable important :l’existence d’une échelle de cost-weights issue d’un échantillon représentatif d’hôpitaux. Si cette situation n’est pas encore totalement rencontrée en Belgique, il est néanmoins possible de suggérer une voie de réflexion. La simulation inspirée de la méthodologie suisse à partir d’un échantillon de quatre hôpitaux belges présentée dans le cadre de cette thèse, est une première avancée en ce sens. <p>Un des problèmes majeurs de la gestion hospitalière est d’intéresser les prescripteurs et les prestataires à un contrôle de gestion essentiellement financier. Depuis quelques années, de nombreux efforts visent à intégrer de nouveaux indicateurs de performance dans les tableaux de bord. L’analyse des coûts des pathologies et de la variabilité des cas permet d’entamer un dialogue entre gestionnaire et corps médical. En abordant différentes études (apport des nomenclatures dans le calcul des coûts par pathologie, mesure des coûts associés aux bactériémies nosocomiales, analyse des facteurs médico-sociaux expliquant les surcoûts des patients outliers, analyse de la relation entre le coût et la sévérité des cas, comparaison des coûts de production et des pratiques médicales), nous avons voulu montrer l’importance d’associer une approche médicalisée à des raisonnements économiques. Si elle se développe, cette approche est susceptible de représenter un moyen de communication idéal entre le personnel médical et soignant et le monde de la gestion. <p>Comme nous le rappelions au début de cette thèse, les concepteurs des DRGs (Fetter et Thompson) ont regretté le manque d'intérêt manifesté par les gestionnaires d'hôpitaux pour l'utilisation de leur concept dans le management hospitalier. Au terme de cette thèse, nous pensons que, si l'analyse des coûts par pathologie reste encore d'un abord difficile, elle peut rendre d'importants services en associant médecins et managers à l'élaboration d'un contrôle de gestion enfin adapté à la spécificité de leurs institutions.<p> / Doctorat en Sciences de la santé publique / info:eu-repo/semantics/nonPublished

MPH / Department of Public Health / See the attached abstract below