A reasonable benchmarking frontier using DEA : an incentive scheme to improve efficiency in public hospitals

There exists research relating management concepts with productivity measurement methods that offers useful solutions for improving management control in the public sector. Within this sphere, we connect agency theory with efficiency analysis and describe how to define an incentives scheme that can be applied in the public sector to monitor the efficiency and productivity of managers. To fulfill the main objective of this research, we propose an iterative process for determining what we define as a ‘reasonable frontier’, a concept that provides the foundation required to establish the incentive scheme for the managers. Our ‘reasonable frontier’ has the following properties: i) it detects the presence of outliers, ii) it proposes a procedure to establish the influence introduced by extreme observations, and iii) it sorts out the problem of data masking. The proposed method is applied to a sample of hospitals taken from the public network of the Spanish health service. The results obtained confirm the applicability of the proposal made. Summing up, we define and apply a useful method, combining aspects of agency theory and efficiency analysis, which is of interest to those public authorities trying to design effective incentive schemes which influence the decision making of the public managers

Accessing Antecedents and Outcomes of RFID Implementation in Health Care

This research first conceptualizes, develops, and validates four constructs for studying RFID in health care, including Drivers (Internal and External), Implementation Level (Clinical Focus and Administrative Focus), Barriers (Cost Issues, Lack of Understanding, Technical Issues, and Privacy and Security Concerns), and Benefits (Patient Care, Productivity, Security and Safety, Asset Management, and Communication). Data for the study were collected from 88 health care organizations and the measurement scales were validated using structural equation modeling. Second, a framework is developed to discuss the causal relationships among the above mentioned constructs. It is found that Internal Drivers are positively related to Implementation Level, which in turn is positively related to Benefits and Performance. In addition, Barriers are found to be positively related to Implementation Level, which is in contrast to the originally proposed negative relationship. The research also compares perception differences regarding RFID implementation among the non-implementers, future implementers, and current implementers of RFID. It is found that both future implementers and current implementers consider RFID barriers to be lower and benefits to be higher compared to the non-implementers. This paper ends with our research implications, limitations and future research

A reasonable benchmarking frontier using DEA : an incentive scheme to improve efficiency in public hospitals

There exists research relating management concepts with productivity measurement methods that offers useful solutions for improving management control in the public sector. Within this sphere, we connect agency theory with efficiency analysis and describe how to define an incentives scheme that can be applied in the public sector to monitor the efficiency and productivity of managers. To fulfill the main objective of this research, we propose an iterative process for determining what we define as a ‘reasonable frontier’, a concept that provides the foundation required to establish the incentive scheme for the managers. Our ‘reasonable frontier’ has the following properties: i) it detects the presence of outliers, ii) it proposes a procedure to establish the influence introduced by extreme observations, and iii) it sorts out the problem of data masking. The proposed method is applied to a sample of hospitals taken from the public network of the Spanish health service. The results obtained confirm the applicability of the proposal made. Summing up, we define and apply a useful method, combining aspects of agency theory and efficiency analysis, which is of interest to those public authorities trying to design effective incentive schemes which influence the decision making of the public managers.

Using Intervention Mapping to Develop an Efficacious Multicomponent Systems-Based Intervention to Increase Human Papillomavirus (HPV) Vaccination in a Large Urban Pediatric Clinic Network

Background: The CDC recommends HPV vaccine for all adolescents to prevent cervical, anal, oropharyngeal, vaginal, vulvar, and penile cancers, and genital warts. HPV vaccine rates currently fall short of national vaccination goals. Despite evidence-based strategies with demonstrated efficacy to increase HPV vaccination rates, adoption and implementation of these strategies within clinics is lacking. The Adolescent Vaccination Program (AVP) is a multicomponent systems-based intervention designed to implement five evidence-based strategies within primary care pediatric practices. The AVP has demonstrated efficacy in increasing HPV vaccine initiation and completion among adolescents 10-17 years of age. The purpose of this paper is to describe the application of Intervention Mapping (IM) toward the development, implementation, and formative evaluation of the clinic-based AVP prototype. Methods: Intervention Mapping (IM) guided the development of the Adolescent Vaccination Program (AVP). Deliverables comprised: a logic model of the problem (IM Step 1); matrices of behavior change objectives (IM Step 2); a program planning document comprising scope, sequence, theory-based methods, and practical strategies (IM Step 3); functional AVP component prototypes (IM Step 4); and plans for implementation (IM Step 5) and evaluation (IM Step 6). Results: The AVP consists of six evidence-based strategies implemented in a successful sequenced roll-out that (1) established immunization champions in each clinic, (2) disseminated provider assessment and feedback reports with data-informed vaccination goals, (3) provided continued medical and nursing education (with ethics credit) on HPV, HPV vaccination, message bundling, and responding to parent hesitancy, (4) electronic health record cues to providers on patient eligibility, and (5) patient reminders for HPV vaccine initiation and completion. Conclusions: IM provided a logical and systematic approach to developing and evaluating a multicomponent systems-based intervention to increase HPV vaccination rates among adolescents in pediatric clinics

Higher Sustainability and Lower Opportunistic Behaviour in Healthcare: A New Framework for Performing Hospital-Based Health Technology Assessment. Sustainability

Innovative health technology deployment represents the primary challenge within the sustainability of public health systems. On one hand, new technologies may potentially improve access to care and the quality of services. On the other hand, their rapid evolution and broad implications on existing procedures increase the risk to adopt technologies that are not value for money. As a consequence, Health Technology Assessment (HTA) is a critical process at each level of the National Health System. Focusing on the organisational level, this paper explores the current practices of Hospital-Based HTA (HB-HTA) in terms of management, control and behaviours of various actors involved. Among several tasks, decision-makers are appointed at managing the conflict of interest around health technology development, that could pave the way for corruption or other misleading behaviours. Accordingly, the purpose of the study is proposing a new strategic framework, named Health Technology Balanced Assessment (HTBA), to foster hospital-based health technology management aimed to align strategy and actions. The conceptual model is developed on three perspectives (clinical, economic and organisational) to make the actors involved in the assessment (clinicians, health professionals, hospital managers and patients) aware of the impact of new technology on the value chain. Besides supporting the decision-making process, such a tool represents support for the internal control system as a whole. By promoting structured evaluation, it increases transparency and accountability of public health organisations. Moreover, in the long run, the framework proposed will be useful to reach selected United Nations Sustainable Development Goals (UN SDGs) to enhance the quality of healthcare in the future

Evidence-based management in hospital settings:Unraveling the process and the role of the person and the context

Evidence-based Management in Hospital Settings: Unraveling the Process and the Role of the Person and the Context Lay Summary Tina Sahakian The use of digital healthcare technologies, such as electronic medical records and health information systems, is increasing in hospital settings and is leading to the collection of large amounts of data about patients, employees, and hospital operations. This data, if used by managers as the basis for decisions, can help improve decision-making, and consequently enhance the quality of healthcare services. One approach to encourage managers to use this and other sources of data is evidence-based management (EBMgt). EBMgt involves gathering data from different sources, assessing the reliability and relevance of this data, and using it to make decisions. However, our current knowledge about the EBMgt approach is limited because:(1) there is little research on how managers can apply the EBMgt decision process, (2) there is little research on how factors related to the decision maker, like their competencies, and factors related to the context, like organizational politics, impact EBMgt, (3) there is confusion about what data managers should rely on. The aim of my dissertation is to develop an in-depth data-driven understanding of EBMgt in hospital settings, by unraveling how the EBMgt process can be applied, what evidence is used in this process, and how the decision-maker and the context impact this process. To fulfill this aim, I conducted three studies. In Study 1, I focused on identifying the competencies needed by managers to be able to practice EBMgt in hospital settings. I conducted interviews with managers in hospitals across Lebanon and identified 13 knowledge, skills, abilities, and other characteristics that are necessary to practice EBMgt in hospital settings. These included research knowledge, resourcefulness, relationship building, and open mindedness. In Study 2, I focused on better understanding the EBMgt decision-making process, what evidence is used in the process, and what contextual factors impact the process. I conducted interviews with managers in hospitals across Lebanon and developed the Grounded Model of the EBMgt Process. The model showed that the EBMgt decision-making process involves a series of steps starting from identifying a problem to implementing a solution. The model also showed that different sources of evidence are used in this process, including evidence in the form of experience, scientific research, data from the organization, and feedback from stakeholders. Finally, the model showed that different contextual factors impact the EBMgt process. These factors can relate to the individual, for example, managers’ competencies impact the evidence they gather. These factors can relate to the organization, for example organizational resource constraints impact the solutions managers apply. These factors can also relate to the nation, for example national capacity to gather and disseminate data impact the evidence available to managers. In Study 3, I focused on identifying the gaps in our knowledge of EBMgt in hospital settings, which can be filled with future research. I searched the literature for articles about EBMgt in hospital settings using a systematic approach. I found that there are gaps in our knowledge of how managers reasons for using evidence impact the EBMgt process, how EBMgt can be conducted in developing countries, and how applying EBMgt impacts organizational outcomes. These gaps are important areas for future research. Overall, my dissertation contributes to the literature on EBMgt in hospital settings by determining the competencies needed to practice EBMgt, providing an in-depth understanding about the process of EBMgt and the factors that influence this process, and identifying gaps in our knowledge of EBMgt in hospital settings, which future research can fill

We are bitter, but we are better off: Case study of the implementation of an electronic health record system into a mental health hospital in England

In contrast to the acute hospital sector, there have been relatively few implementations of integrated electronic health record (EHR) systems into specialist mental health settings. The National Programme for Information Technology (NPfIT) in England was the most expensive IT-based transformation of public services ever undertaken, which aimed amongst other things, to implement integrated EHR systems into mental health hospitals. This paper describes the arrival, the process of implementation, stakeholders' experiences and the local consequences of the implementation of an EHR system into a mental health hospital