Search results

This article looks at the alignment of performance management system with the strategy, structure, and organizational outcome in Canadian health care organizations. In this study, balanced scorecard is the framework adopted for assessing the health care organization's performance management system (PMS) and outcome. CEO and clinical unit managers were surveyed for their perceptions on their organization's strategy, autonomy structure, PMS, and organizational performance. Path analysis was the methodology used in examining the relationship about the above organizational variables. The results indicate that patient satisfaction is the primary and most significant perspective of the depicted balanced scorecard in organizational performance. Patient satisfaction and research criteria, on the other hand, are the significant perspectives of a balanced scorecard in an organization's PMS, which are linked to strategy, autonomy structure, and organizational performance. Moreover, the results show that the strategy/structure links operated as suggested. Surprisingly, strategy on service innovation has a negative impact on the organizational outcome of patient satisfaction. Uncertainty from continuous development and organizational change in pursuing service innovation and cost-cutting measures in response to fiscal constraints are plausible explanations of the adverse impact reported.

The article features a study based on postal questionnaires and structured interviews, targeting senior members of the hospital pharmacy profession. The aim was to examine the potential of practice and performance benchmarking as a means of improving competence and capabilities within the clinical pharmacy service of NHS Trust hospitals. Postulation of models and analysis of data is followed by discussion of results. This leads to a number of suggestions and conclusions with respect to the potential role of benchmarking including an assessment of its suitability, limitations, and implementation issues associated with this particular service sector.

This study aims to investigate the hybridization practices that medical managers engage with to promote accounting and performance measurement in the hybrid setting of healthcare. In doing so, the authors explore how medical managers enact and become practitioners of hybridity.

The authors adopt a practice lens to conceptualize hybridization as an emergent, situated practice and capture the micro-activities that medical managers engage with when they enact hybridity. The authors conducted semi-structured interviews with medical managers, business managers and coding professionals and collected documents at an English National Health Service (NHS) hospital over the course of five years.

The findings accentuate two emergent practices through which medical managers instill hybridity to individuals who are hesitant or resistant to hybridization. Medical managers engage in equivocalizing and de-stigmatizing practices to broaden the understandings, further diversify or reconcile the teleologies of clinicians in non-managerial roles. In doing so, the authors signal the merits of accounting in improving care outcomes and remove the stigma associated to clinical engagement with costs.

The study contributes to hybridization and practice theory literature via capturing how hybridity is enacted in practice in a healthcare setting. As medical managers engage with and promote accounting information and performance measurement technologies in their practice environment, they transcend professional boundaries and hybridize the professional spaces that surround them.

This study aims to unravel the dynamic nature of the process of self-regulated learning (SRL) of medical specialists as it actually unfolds over time in the authentic clinical environment.

A longitudinal multiple case-study design was used, combining multiple data-collection techniques. Long-term observations offered evidence on overt SRL strategies. Physicians’ observed behaviours were used as cues for in loco stimulated recall interviews, asking about covert SRL strategies and their thoughts regarding a situation at hand. Field notes and audiotaped stimulated recall interviews were transcribed verbatim and integrated in a longitudinal database to map SRL as it actually unfolds moment-by-moment. The transcripts were analysed from an inter- and intra-individual perspective using Nvivo 12.

Results show a variety of strategies that initiate, advance and evaluate the process of SRL. Different SRL strategies not included in contemporary frameworks on SRL are found and classified as a new category which the authors labelled “learning readiness”. Exemplary for an SRL strategy in this category is awareness of learning needs. Results show that SRL in the clinical environment is found as an interrelated, dynamic process unfolding in time with feedback loops between different SRL strategies. Performance is found to play a leading role in driving SRL.

This study contributes empirically to the conceptual understanding of SRL in the clinical environment. The use of a situated, longitudinal methodology, which goes beyond the common path of retrospective self-report questionnaires, adds to the disentanglement of the process of SRL as it actually unfolds in the work environment.

The purpose of this paper is to assess the performance measurement in the UK NHS ambulance service documenting various unintended consequences of the current performance framework and to suggest a future research agenda.

The paper reviews the literature on ambulance performance targets and documents several unintended consequences of the current performance system through an in‐depth case study analysis based on interviews with Trust staff and policy experts along with observation of performance review meetings in the chosen Trust. Ethical approval for the study was obtained from a local NHS research ethics committee.

Significant unintended consequences of the ambulance performance targets based on response times have been systematically documented, which are likely to put the target under spotlight, especially that of the eight‐minute response. The current policy focus to reform the eight‐minute target by making it more stringent has the potential of jeopardising the reform agenda based on developing clinical skills of the paramedics and introducing clinical management in the service.

The paper makes an objective assessment of the sustainability of the current policy framework and identifies future lines of enquiry for further research.

This paper makes an original contribution in identifying and documenting the disjuncture between stated and unintended consequences of ambulance performance measurement, which will be of value to academics, practitioners and policy makers.

The purpose of this paper is to describe the design and construction of a privilege mapping system (clinical and organizational competences) of the medical staff of the Niguarda Hospital in Milan, Italy. The second aim is to measure and assess the impact of implementing an evaluation process of clinical competences at the same hospital.

The paper retraces the development and implementation of the evaluation of the privilege system, highlighting the subjects involved, the phases and outputs. Moreover, a questionnaire was distributed to 50 heads of unit involved in the planning, building and implementation of competences mapping. Five areas were investigated: competences evaluation for professional development; the impact on work organization and professional roles; professional collaboration; its impact according to context (hospital or unit) and time scale (short or long term); and ability to evaluate clinical outcome.

Results reveal success factors for the development and implementation of a privilege mapping system. Furthermore, the survey revealed that clinical leaders are aware of the importance of competences evaluation. In particular, they consider it as a management tool useful for professional development, for identifying excellence and planning operational activities.

Literature and practical evidence recognize the need to assess the clinical and organizational competences in order to assign tasks and responsibilities. However, there are no studies that describe the construction of systems of evaluation of privileges, as it has never been investigated as professionals perceive these tools.

Clinical governance (CG) is crucial for healthcare quality of care improvement and safeguarding high standards of care. Little is known about CG in sub-Saharan Africa. The authors assessed health workers' perceptions of CG and hospital performance in Ghana's psychiatric hospitals.

A cross-sectional survey was conducted among 230 health workers across two psychiatric hospitals in Ghana. Data were collected with a structured questionnaire and analyzed with Statistical Package for Social Sciences (SPSS), version 23.0.

The majority (59.5%) of the respondents were females. The authors found that less than five in ten respondents felt that the hospitals have adopted measures to promote quality assurance (43.2%) and research and development (43.7%). However, a little above half of the respondents felt that the hospitals have adopted measures to promote education and training (57.7%); clinical audit (52.7%); risk management (50.7%) and clinical effectiveness (68.6%). The authors also found a statistically significant association between CG and hospital performance (p < 0.05).

There was a positive relationship between CG and hospital performance. Therefore, investing in CG may help to increase hospital performance.

This is the maiden study to investigate CG and hospital performance in Ghana's psychiatric hospitals and one of the few studies in Africa. This study makes a modest contribution to the global discourse on the subject matter.

This paper attempts to define quality (particularly in terms of evidence‐based health care) and considers the incentives available to bring about improvements in quality. It examines the contribution that economics, as a discipline, can make to the debate on clinical governance. It considers the nature and importance of clinical governance, measuring quality, objectives and behaviour in questions raised concerning objectives and individual and team behaviour.

The performance of NHS UK hospitals is under continuous scrutiny as they are constantly under pressure to perform well. A recent document published by an independent body has recommended a host of clinical indicators to assess non‐financial performance of hospitals. This study aims to critically analyse the performance of a single UK hospital against several of these recommended indicators.

Data presented to the Hospital Trust Board for 12 months were used for this study. Previous years' data were used wherever available.

Based on data analysis, this hospital's performance is extremely difficult to calculate. The indicators use complex ratios and due to lack of standardisation, the hospital performance could be interpreted as better, worse or indifferent.

This study analyses most of the recommended indicators. Literature review did not reveal a similar analysis of another hospital against these indicators which precludes comparison.

This study highlights the difficulty in comparing the performance of hospitals due to the inherent lack of consistency. Therefore it is apparent that any reward‐rebuke system linked to performance should interpret the data with caution. It is therefore suggested that easy to control single value activities and standardised routine activities could be used to measure hospital performance. Alternatively, the hospital could compare with its own statistics from previous years.

Literature acknowledges the difficulties in measuring clinical performance. This paper elucidates these difficulties applied to the NHS and suggests alternatives.

The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) program is known to improve team and clinical performance, but the relationship to psychological stress has not been clarified. The purpose of this paper is to evaluate team performance, clinical performance and psychological stress simultaneously in a simulation-based training combined with or without the TeamSTEPPS program.

This randomized, controlled, prospective pilot study was performed to reveal TeamSTEPPS impact on psychological stress. The course included an emergency care training course, the TeamSTEPPS program, and a scenario simulation. Ten medical student teams were randomly allocated two groups: a TeamSTEPPS group and a non-TeamSTEPPS group. Team performance, clinical performance and psychological stress were evaluated simultaneously in the course; i.e., questionnaire evaluation and an observational evaluation for team performance; an assessor’s evaluation and a simulator’s evaluation for clinical performance. Autonomic nervous activity, represented by salivary amylase levels and heart rate variability, were measured as psychological stress indicators.

Team performance and clinical performance were significantly better in the TeamSTEPPS group, while psychological stress did not differ between the groups.

This is the first study to examine the relationship between TeamSTEPPS and psychological stress. Although only preliminary conclusions can be drawn from this small-scale study, results suggest that the TeamSTEPPS program improved team and clinical performance without increasing psychological stress.