A Hospital Performance Assessment Model Using the IPOCC Approach

BACKGROUND፡ Developing a practical model to assess hospital performance improves the quality of services and leads to patient satisfaction. This study aims to develop and present such a model using the IPOCC (Input, Process, Output, Control and Context) approach.METHODS: This study used a mixed-method research. The statistical population of the qualitative part included 27 experts who were purposefully selected and the sampling process was continued by the snowball method until the data saturation was reached. The quantitative part included 334 managers at differentlevels within a hospital, who were selected by a random sampling method based on Cochran's formula.RESULTS: The hospital evaluation model has 5 dimensions with 20 factors: input (human, financial, physical, information and equipment), process (treatment, para-clinical, prevention, management, and leadership processes), outcome (patient, staff and community outcomes and key performance index), control (internal control, external control), context (hospital culture,hospital status, the role of evaluators and community conditions). The value of chi-square was 4689.154, the degree of freedom was 2385, and the ratio of chi-square to the degree of freedom in the model was 1.966, which is an acceptable value. The values obtained from CFI, GFI, and IFI fit indices were acceptable. The SRMR index was 0.1130.CONCLUSIONS: Using a performance assessment model along with the IPOCC approach evaluates hospital processes and the output obtained from the proper implementation of these processes in all areas. The areas include the hospital provided services like the control and context, or the traditional perspectives like physical, human, financial, and equipment resources

A Comparison of Three Models of Hospital Performance Assessment Using IPOCC Approach

BACKGROUND: Hospital performance measurement is an essential component of providing feedback on the efficacy and effectiveness of service. The purpose of this study was to compare three models of performance assessment through the IPOCC approach.METHODS: This descriptive-analytical study was conducted in 2018 in Sari educational hospital. The data collection instrument was BSC, EFQM and accreditation questionnaire which was filled out through census. The validity of the BSC questionnaire and EFQM was based on expert opinion, and its reliability was found to be 0.97 and 0.92 using Cronbach's alpha coefficient. The accreditation questionnaire was developed using a checklist of the Ministry of Health. Using the expert panel, the components of the questionnaires were classified into dimensions of input, process, output, control, and context. Data analysis was done applying descriptive statistics and one way ANOVA.RESULTS: The highest distribution of components and acquired points through the IPOCC approach were found in the BSC in the process dimension (58.8%) and control dimension (3.62 ± 0.56), in the EFQM, in the result dimension (40.2%) and structure dimension (3.25 ± 0.44), and in the accreditation, in the process dimension (64.4%) and control dimension (3.45 ± 0.72), respectively. The results of one-way ANOVA showed that there was a significant difference between different quality models (P<0.001).CONCLUSION: The results of the present study showed that in evaluating the hospital through the IPOCC approach, the distribution of components was more in the dimensions of the process. Therefore, having a robust systematic approach was considered to be effective for hospitals.

文化的価値に基づくバランスト・スコアカードフレームワークの設計

Tohoku University青木雅明課

USING BALANCED SCORECARD TO HELP IMPROVING THE QUALITY OF CARE AND SERVICE FOR THE PRIVATE CLINICS IN TAIWAN

Aesthetic as opposed to National-Health-Insurance-Bureau (NHIB) affiliated clinics are largely unregulated by healthcare authorities in Taiwan. Their management is mainly focused on financial performance. Consequently, the quality of care and services cannot be easily assessed or measured. Two aims and fifteen specific hypotheses were established at the start of the study design: Aim one, Examine whether the implementation of Balanced Scorecard (BSC) improves organizational performance; Aim two, Examine whether the implementation of BSC improves patient care. With two clinics of similar characteristics in size, medical and service personnel and customers, one serving as the intervention or experimental group, the other one as the non-intervention or comparison group, after defining the organization’s mission, core values, vision, and strategies, breaking down the strategies into its component parts through the objectives and measures, and articulating goals for time, quality, performance and service, and translate them into measures, we selected the Balanced Scorecard (BSC) as the measuring management tool, designing an implementation model for the experimental group only, with key performance indicators (KPIs) in each of the following perspectives: financial, customer, internal processes and learning and growth. Data were collected for six months in both groups or clinics, subsequent analyses yielding convincing results in the intervention group with increased BSC scores in Financial and Customer perspectives compared to the non-intervention group, optimistic and confident scores in the Internal processes, with increased BSC scores in employee satisfaction and staff turnover, mixed results in others concerning the Learning and Growth perspective. Based upon these scores and results, both aims and twelve out of fifteen hypotheses were confirmed and accepted. Influences of instrumentation, attrition and contamination were cited as internal threats, whereas Hawthorne effect was mentioned as external threats to validity. The main strengths of this study are that this is the first BSC study designed for aesthetic clinics which could serve as the guidelines of establishing regulation parameters to the healthcare authorities. Meanwhile, due to the lack of time and allocated resources, the small sample size and short duration of data collection were the most evident limitations; hopefully we can expand the scope of the study in the near future

USING BALANCED SCORECARD TO HELP IMPROVE THE QUALITY OF CARE AND SERVICE FOR THE PRIVATE CLINICS IN TAIWAN

Aesthetic as opposed to National-Health-Insurance-Bureau (NHIB) affiliated clinics are largely unregulated by healthcare authorities in Taiwan. Their management is mainly focused on financial performance. Consequently, the quality of care and services cannot be easily assessed or measured. Two aims and fifteen specific hypotheses were established at the start of the study design: Aim one, Examine whether the implementation of Balanced Scorecard (BSC) improves organizational performance; Aim two, Examine whether the implementation of BSC improves patient care. With two clinics of similar characteristics in size, medical and service personnel and customers, one serving as the intervention or experimental group, the other one as the non-intervention or comparison group, after defining the organization’s mission, core values, vision, and strategies, breaking down the strategies into its component parts through the objectives and measures, and articulating goals for time, quality, performance and service, and translate them into measures, we selected the Balanced Scorecard (BSC) as the measuring management tool, designing an implementation model for the experimental group only, with key performance indicators (KPIs) in each of the following perspectives: financial, customer, internal processes and learning and growth. Data were collected for six months in both groups or clinics, subsequent analyses yielding convincing results in the intervention group with increased BSC scores in Financial and Customer perspectives compared to the non-intervention group, optimistic and confident scores in the Internal processes, with increased BSC scores in employee satisfaction and staff turnover, mixed results in others concerning the Learning and Growth perspective. Based upon these scores and results, both aims and twelve out of fifteen hypotheses were confirmed and accepted. Influences of instrumentation, attrition and contamination were cited as internal threats, whereas Hawthorne effect was mentioned as external threats to validity. The main strengths of this study are that this is the first BSC study designed for aesthetic clinics which could serve as the guidelines of establishing regulation parameters to the healthcare authorities. Meanwhile, due to the lack of time and allocated resources, the small sample size and short duration of data collection were the most evident limitations; hopefully we can expand the scope of the study in the near future

Commonwealth Fund - 2006 Annual Report

Contains mission statement, president's message, program information, grants list, financial statements, project summaries, and list of board members and staff

Redesigning Systems to Improve Teamwork and Quality for Hospitalized Patients (RESET): Study Protocol Evaluating the Effect of Mentored Implementation to Redesign Clinical Microsystems

Background: A number of challenges impede our ability to consistently provide high quality care to patients hospitalized with medical conditions. Teams are large, team membership continually evolves, and physicians are often spread across multiple units and floors. Moreover, patients and family members are generally poorly informed and lack opportunities to partner in decision making. Prior studies have tested interventions to redesign aspects of the care delivery system for hospitalized medical patients, but the majority have evaluated the effect of a single intervention. We believe these interventions represent complementary and mutually reinforcing components of a redesigned clinical microsystem. Our specific objective for this study is to implement a set of evidence-based complementary interventions across a range of clinical microsystems, identify factors and strategies associated with successful implementation, and evaluate the impact on quality. Methods: The RESET project uses the Advanced and Integrated MicroSystems (AIMS) interventions. The AIMS interventions consist of 1) Unit-based Physician Teams, 2) Unit Nurse-Physician Co-leadership, 3) Enhanced Interprofessional Rounds, 4) Unit-level Performance Reports, and 5) Patient Engagement Activities. Four hospital sites were chosen to receive guidance and resources as they implement the AIMS interventions. Each study site has assembled a local leadership team, consisting of a physician and nurse, and receives mentorship from a physician and nurse with experience in leading similar interventions. Primary outcomes include teamwork climate, assessed using the Safety Attitudes Questionnaire, and adverse events using the Medicare Patient Safety Monitoring System (MPSMS). RESET uses a parallel group study design and two group pretest-posttest analyses for primary outcomes. We use a multi-method approach to collect and triangulate qualitative data collected during 3 visits to study sites. We will use cross-case comparisons to consider how site-specific contextual factors interact with the variation in the intensity and fidelity of implementation to affect teamwork and patient outcomes. Discussion: The RESET study provides mentorship and resources to assist hospitals as they implement complementary and mutually reinforcing components to redesign the clinical microsystems caring for medical patients. Our findings will be of interest and directly applicable to all hospitals providing care to patients with medical conditions. Trial Registration: NCT03745677. Retrospectively registered on November 19, 2018

The neglected contexts and outcomes of evidence-based management:A systematic scoping review in hospital settings

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic highlighted the necessity of practicing Evidence-based Management (EBMgt) as an approach to decision-making in hospital settings. The literature, however, provides limited insight into the process of EBMgt and its contextual nuances. Such insight is critical for better leveraging EBMgt in practice. Therefore, the authors' aim was to integrate the literature on the process of EBMgt in hospital settings, identify the gaps in knowledge and delineate areas for future research. DESIGN/METHODOLOGY/APPROACH: The authors conducted a systematic scoping review using an innovative methodology that involved two systematic searches. First using EBMgt terminology and second using terminology associated with the EBMgt concept, which the authors derived from the first search. FINDINGS: The authors identified 218 relevant articles, which using content analysis, they mapped onto the grounded model of the EBMgt process; a novel model of the EBMgt process developed by Sahakian and colleagues. The authors found that the English language literature provides limited insight into the role of managers' perceptions and motives in EBMgt, the practice of EBMgt in Global South countries, and the outcomes of EBMgt. Overall, this study’s findings indicated that aspects of the decision-maker, context and outcomes have been neglected in EBMgt. ORIGINALITY/VALUE: The authors contributed to the EBMgt literature by identifying these gaps and proposing future research areas and to the systematic review literature by developing a novel scoping review method

Evaluation of a Complex Health Intervention in Zambia: The case of the Better Health Outcome through Mentorship and Assessment (BHOMA) Applying system wide approaches to measuring health system strengthening: Essential Markers and Impact Pathway

Introduction: In many low income countries the delivery of quality health services is hampered by health system-wide barriers which are often interlinked, however empirical evidence on how to assess the level and scope of these barriers is scarce. It has been recognised that taking a more comprehensive approach to assessing these barriers is more likely to provide lessons on what works and why. WHO has been advocating the use of systems wide approaches such as systems thinking to guide intervention design and evaluation. This thesis reports system-wide assessment of a complex health system intervention in Zambia known as Better Health Outcome through Mentorship and Assessment (BHOMA) that aimed to improve service quality at the health facility and influence service demand from the community. Methodology: This study is nested within a cluster randomised trial of the BHOMA intervention that aims to strengthen the health system in three rural districts covering 42 health facilities in Zambia. The main trial has a stepped wedge design where the intervention is being rolled-out to all the 42 health facilities over a period of 4 years. A baseline health facility survey was done in 2011. This was followed by a 12 months post-intervention evaluation survey. At the time of the follow up survey 24 health facilities had received the intervention while 18 had not. Data collection used both quantitative and qualitative methods. The study was guided by a systems thinking theoretical framework which was inspired by the WHO building blocks for health system strengthening. Results: The baseline survey validated tools and indicators for assessing health system building blocks. Research paper 2 applied an innovative measure of health worker motivation which was initially applied in Kenya. The results showed that this simple tool was reliable with cronbach’s alpha of 0.73 for the 21 item measures of health workers’ motivation. Baseline assessment of health worker motivation showed variation in motivation score based on gender and access to training. Research paper 3 tested and applied a new tool for measuring health systems governance at health facility level. The new tool for measuring governance was reliable with the 16 item one side cronbach’s alpha ranging between 0.69-0.74.The tool was simple to use and found to be applicable in the Zambian health care setting. A balanced scorecard approach was applied to measure the baseline health system characteristics for the target districts. Differences in performance were noted by district and residence in most domains with finance and service delivery domains performing poorly in all study districts. Regression modelling showed that children’s clinical observation scores were negatively correlated with drug availability (coeff 20.40, p = 0.02) while Adult clinical observation scores were positively association with adult service satisfaction score (coeff 0.82, p = 0.04) Baseline qualitative results are presented in paper 5. The results showed close linkages between health system building blocks. Challenges noted in service delivery were linked to human resources, medical supplies, information flow, governance and finance building blocks either directly or indirectly. The 12 months post intervention survey applied both quantitative and qualitative methods. Research paper 6 presents 12 months post intervention quantitative results applying the balanced scorecard approach as at baseline. Comparison was made between the control and intervention health facilities. The results showed significant mean differences between intervention (I) and control (C) sites in the following domains: Training domain (Mean I:C;87.5.vs 61.1, mean difference 23.3,p=0.031),adult clinical observation domain (mean I:C;73.3 vs.58.0, mean difference 10.9,p=0.02 ). The 12 months post intervention qualitative evaluation applied systems thinking approach and the conceptual framework developed before the intervention. The findings are presented in research paper 7. The overall results showed that the community had accepted the intervention with increasing demand for services reported in all sites where the BHOMA intervention was implemented. The indications were that in the short term there was increased demand for services but the health workers’ capacity was not severely affected. However, from a systems thinking perspective, it was clear that several unintended consequences also occurred during the implementation of the BHOMA. Conclusion: In evaluation of complex interventions such as the BHOMA attention should be paid to context. Using system wide approaches and triangulating data collection methods seems to be important to successful evaluation of such complex intervention