Operational efficiency vs clinical safety, care appropriateness, timeliness, and access to health care

Health care systems face resource scarcity that may jeopardise their financial sustainability as well as the quality of delivered health care. In view of that, the association between technical efficiency, access, and quality of services should be investigated, despite some past attempts that led to mixed, unclear, and perhaps biased results. We use a dataset composed of financial resources, hospital services, appropriateness and timeliness of care, patients’ clinical safety, access to health care services, demographics, and epidemiology variables to study the aforementioned link regarding the Portuguese public hospitals (operating between 2013 and 2016). Quality and access data are aggregated into three main composite indicators, through Grey Relational Analysis (GRA). Bias- and environmentally corrected efficiency scores are estimated via bootstrap-based directional Data Envelopment Analysis. A double bootstrap algorithm is employed, using GRA-based quality indicators as predictors of technical efficiency. Evidence suggests that (1) Portuguese public hospitals exhibit low performance in terms of quality, while the different indicators present considerable correlation among them and with hospital size and patients’ complexity characteristics; (2) patients’ clinical safety, appropriateness and timeliness, as well as access to health care services are consistent and significant predictors of technical efficiency; and (3) the association between efficiency, quality, and access depends on the interaction between appropriateness, timeliness, and access. Therefore, quality and access can be improved with no efficiency sacrifice and vice versa.info:eu-repo/semantics/publishedVersio

“High Spending, Poor Productivity Gains!” Assessing Public Health System (In)Efficiency and Hospital Performance In The State Of Kuwait: Would More Private Delivery Improve Healthcare?

The healthcare sector in the State of Kuwait has been nurtured for many decades by the government, where the majority of health services in the country are controlled by the Ministry of Health (MoH). Although healthcare services in public sector hospitals are at highly subsidized rates, causing private sector involvement in healthcare to be considerably low, the growing demands for private delivery of care burgeoned participation of private hospitals in Kuwait, and improving hospital efficiency and productivity is more critical and timelier than ever. This dissertation aims to analyze public health system efficiency and hospital performance in the State of Kuwait using data envelopment analysis (DEA) techniques; where we begin by evaluating the input-oriented technical efficiency (TE) of MoH hospitals in 2015-2019 and identifying potential areas for efficiency improvement by exploring influencing institutional and environmental factors. We further conduct an output-oriented comparative study of public-private productivity in view of ownership, hospital management, and other external variables to understand drivers of productive efficiency and potential factors of output maximization disparities in 2019/2020

The Influence of Public Service Motivation on Ethical Behaviour and Organizational Performance in Public Administration Sector: Evidence from the Hashemite Kingdom of Jordan

The Hashemite Kingdom of Jordan (HKJ) faces internal and external challenges and hazards that pose significant encounters for HKJ. Such challenges cast a heavy shadow on several public sectors, the most important of which is the public health sector. However, this dissertation aimed to investigate the influence of Public Service Motivation on Ethical behavior and Organizational Performance in Jordanian public hospitals. This dissertation had been divided into two folds that filled numerous flagrant gaps in the arena of PSM. In the first fold, we investigated the influence of PSM on Ethical Behavior using three-level models via SEM. In the second fold, we contribute to the methodological linking between PSM and Organizational Performance using econometrics techniques

A novel combination of Cased-Based Reasoning and Multi Criteria Decision Making approach to radiotherapy dose planning

In this thesis, a set of novel approaches has been developed by integration of Cased-Based Reasoning (CBR) and Multi-Criteria Decision Making (MCDM) techniques. Its purpose is to design a support system to assist oncologists with decision making about the dose planning for radiotherapy treatment with a focus on radiotherapy for prostate cancer. CBR, an artificial intelligence approach, is a general paradigm to reasoning from past experiences. It retrieves previous cases similar to a new case and exploits the successful past solutions to provide a suggested solution for the new case. The case pool used in this research is a dataset consisting of features and details related to successfully treated patients in Nottingham University Hospital. In a typical run of prostate cancer radiotherapy simple CBR, a new case is selected and thereafter based on the features available at our data set the most similar case to the new case is obtained and its solution is prescribed to the new case. However, there are a number of deficiencies associated with this approach. Firstly, in a real-life scenario, the medical team considers multiple factors rather than just the similarity between two cases and not always the most similar case provides with the most appropriate solution. Thus, in this thesis, the cases with high similarity to a new case have been evaluated with the application of the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS). This approach takes into account multiple criteria besides similarity to prescribe a final solution. Moreover, the obtained dose plans were optimised through a Goal Programming mathematical model to improve the results. By incorporating oncologists’ experiences about violating the conventionally available dose limits a system was devised to manage the trade-off between treatment risk for sensitive organs and necessary actions to effectively eradicate cancer cells. Additionally, the success rate of the treatment, the 2-years cancer free possibility, has a vital role in the efficiency of the prescribed solutions. To consider the success rate, as well as uncertainty involved in human judgment about the values of different features of radiotherapy Data Envelopment Analysis (DEA) based on grey numbers, was used to assess the efficiency of different treatment plans on an input and output based approach. In order to deal with limitations involved in DEA regarding the number of inputs and outputs, we presented an approach for Factor Analysis based on Principal Components to utilize the grey numbers. Finally, to improve the CBR base of the system, we applied Grey Relational Analysis and Gaussian distant based CBR along with features weight selection through Genetic Algorithm to better handle the non-linearity exists within the problem features and the high number of features. Finally, the efficiency of each system has been validated through leave-one-out strategy and the real dataset. The results demonstrated the efficiency of the proposed approaches and capability of the system to assist the medical planning team. Furthermore, the integrated approaches developed within this thesis can be also applied to solve other real-life problems in various domains other than healthcare such as supply chain management, manufacturing, business success prediction and performance evaluation

Relational Benefits, Customer Satisfaction, And Customer Loyalty In Chain Store Restaurants

[[abstract]]This study aims to investigate the structural relationships among relational benefits, customer satisfaction, and customer loyalty in the chain store restaurants. Based on a theoretical background literature review, three types of customer relational benefits were determined: psychological, social, and special treatment benefits. Theoretical relationships among relational benefits, customer satisfaction, and customer loyalty were derived from the review of literature, and a theoretical model was proposed. The proposed model was then tested employing data collected from 267 customers of chain store restaurants. The results of subsequent analysis of the data indicated that relational benefits influence customer loyalty, and customer satisfaction with employees influence customer loyalty. In addition, the impact of which is partially mediated by satisfaction with employees. The managerial implications of these findings are discussed in the latter part of this article.[[notice]]補正完畢[[incitationindex]]EI[[booktype]]電子

Manager’s and citizen’s perspective of positive and negative risks for small probabilities

So far „risk‟ has been mostly defined as the expected value of a loss, mathematically PL, being P the probability of an adverse event and L the loss incurred as a consequence of the event. The so called risk matrix is based on this definition. Also for favorable events one usually refers to the expected gain PG, being G the gain incurred as a consequence of the positive event. These “measures” are generally violated in practice. The case of insurances (on the side of losses, negative risk) and the case of lotteries (on the side of gains, positive risk) are the most obvious. In these cases a single person is available to pay a higher price than that stated by the mathematical expected value, according to (more or less theoretically justified) measures. The higher the risk, the higher the unfair accepted price. The definition of risk as expected value is justified in a long term “manager‟s” perspective, in which it is conceivable to distribute the effects of an adverse event on a large number of subjects or a large number of recurrences. In other words, this definition is mostly justified on frequentist terms. Moreover, according to this definition, in two extreme situations (high-probability/low-consequence and low-probability/high-consequence), the estimated risk is low. This logic is against the principles of sustainability and continuous improvement, which should impose instead both a continuous search for lower probabilities of adverse events (higher and higher reliability) and a continuous search for lower impact of adverse events (in accordance with the fail-safe principle). In this work a different definition of risk is proposed, which stems from the idea of safeguard: (1Risk)=(1P)(1L). According to this definition, the risk levels can be considered low only when both the probability of the adverse event and the loss are small. Such perspective, in which the calculation of safeguard is privileged to the calculation of risk, would possibly avoid exposing the Society to catastrophic consequences, sometimes due to wrong or oversimplified use of probabilistic models. Therefore, it can be seen as the citizen‟s perspective to the definition of risk

The impact of competitive environment on the service marketing mix strategy of health organisations in developing countries : Jordanian private sector hospital senior managers perspective

The environment of Jordanian private hospitals has never been so complex and challenging as at present. There are huge influences on these hospitals in the current climate. Managers in these hospitals are finding themselves, more than ever before, confronted by increasing pressures and demands which they must seek to understand and respond to in their service marketing mix strategy in order to achieve effective strategic marketing in terms of their choice of service marketing mix strategy components (namely health service, pricing, distribution, promotion, physical evidence, process, and personal strategies). This research, therefore, investigates the influence competitive environment factors have on the service marketing mix strategy components made by Jordanian private hospital managers, and on the reality of the Jordanian private hospital marketing. The literature review reveals that there is an extensive body of research that addresses service marketing mix strategy in general but there is less emphasis on the health sector. Moreover, evidence of the impact of a competitive environment on service marketing mix strategy and hospital performance measurements' criteria in the hospital industry is limited. In order to explore this issue, a triangulation method was used to collect primary data through a questionnaire, which was administered in the private sector hospitals in the six Jordanian governorates and, via in-depth semi structured interviews with hospital managers and experts in the health services in Jordan. All Jordanian general private sector hospitals were targeted in this research rather than a representative sample of these hospitals. A purposive sampling strategy was used to choose the participants in this research. In total, - 143 senior managers (general manager, administrative manager, medical manager, public relation manager, marketing manager, and out patients clinic manager) participated in this study. The results confirm significant differences in the influence of competitive environment factors on service marketing mix strategy components. They also reveal that the components of the marketing mix strategy have varied significant and insignificant influence on the hospital performance, which demonstrates that the hospital performance phenomenon is complicated and multi-dimensional in nature. Furthermore, the results exhibit that hospital managers might benefit more by placing more emphasis on an integrated service marketing mix strategy and recognising the competitive environment influences on their hospitals. The results also highlight several implications for future research in health services marketing and fills in several gaps in the existing literature on health services marketing. This research contributes to the academic and practical knowledge as being one of the first attempts to investigate empirically the impact of the competitive environment on service marketing mix strategy. As such, the influences of service marketing mix strategy on hospitals' performance criteria, identifying the main concerns and problems which face the management and marketing in Jordanian private sector hospitals, are explored in addition to recognising the vital roles of marketing in improving the hospital performance. This research integrates, refines and extends the empirical work conducted in the field of health services marketing in developing countries. It raises many implications for managers in these hospitals, such as considering the importance of influences by competitive environment on marketing mix strategy and the vital role this strategy plays in the performance of Jordanian private sector hospitals. This research provides useful guidelines for further and future research possibilities such as exploring the influence of the competitive environment factors influence on hospital performance criteria.EThOS - Electronic Theses Online ServiceGBUnited Kingdo