Cohort Turnover and Productivity: The July Phenomenon in Teaching Hospitals

The impact of labor turnover on productivity has received a great deal of attention in the literature on organizations. We consider the impact of cohort turnover -- the simultaneous exit of a large number of experienced employees and a similarly sized entry of new workers -- on productivity in the context of teaching hospitals. In particular, we examine the impact of the annual July turnover of house staff (i.e., residents and fellows) in American teaching hospitals on levels of resource utilization (measured by risk-adjusted length of hospital stay) and quality (measured by risk-adjusted mortality rates). Using patient-level data from roughly 700 hospitals per year over the period from 1993 to 2001, we compare monthly trends in length of stay and mortality for teaching hospitals to those for non-teaching hospitals, which, by definition, do not experience systematic turnover in July. We find that the annual house-staff turnover results in increased resource utilization (i.e., higher risk-adjusted length of hospital stay) for both minor and major teaching hospitals and decreased quality (i.e., higher risk-adjusted mortality rates) for major teaching hospitals. Further, these effects with respect to mortality are not monotonically increasing in a hospital's reliance on residents for the provision of care. In fact, the most-intensive teaching hospitals manage to avoid significant effects on mortality following this turnover. We provide a preliminary examination of the roles of supervision and worker ability in explaining the ability of the most-intensive teaching hospitals to reduce turnover's negative effect on performance.

Effects of ownership, subsidization and teaching activities on hospital costs in Switzerland

This paper explores the cost structure of Swiss hospitals, focusing on differences due to teaching activities and those across different ownership and subsidization types. A stochastic total cost frontier with a Cobb-Douglas functional form has been estimated for a panel of 150 general hospitals over the six-year period from 1998 and 2003. Inpatient cases adjusted by DRG cost weights and ambulatory revenues are considered as two separate outputs. The adopted econometric specification allows for unobserved heterogeneity across hospitals. The results indicate that the time-invariant unobserved factors could account for considerable cost differences that could be only partly due to inefficiency. The results suggest that teaching activities are an important cost driving factor and hospitals that have a broader range of specialization are relatively more costly. The excess costs of university hospitals can be explained by more extensive teaching activities as well as the relatively high quality of medical units. However, even after controlling for such differences university hospitals have shown a relatively low cost-efficiency especially in the first two or three years of the sample period. The analysis does not provide any evidence of significant efficiency differences across ownership and subsidization categories.general hospitals, teaching hospitals, stochastic frontier, cost efficiency

DEVELOPMENT OF A MEDICAL STAFF RECRUITMENT SYSTEM FOR TEACHING HOSPITALS IN NIGERIA

Recruitment of staff into teaching hospitals in Nigeria, acts as the first step towards creating competitive strength and strategic advantage for such institutions. However, one of the major problems associated with these institutions in the South Western part of Nigeria is their mode of staff recruitment. In this research paper, we developed a suitable staff recruitment system for some health institutions in Nigeria, focusing specifically on some teaching hospitals. Three teaching hospitals in south west Nigeria, were visited and relevant information was collated through personal interviews and questionnaires administration to the staff of Human Resource Departments and other relevant health professionals of these teaching hospitals. The design and development of the system employs 3-tier web architecture. System design of the staff recruitment system consisted of design activities that produce system specifications satisfying the functional requirements that were developed in the system analysis process. A formal model of the staff recruitment system was built using Unified Modeling Language (UML). The UML, as a modeling system, which provides a set of conventions that were used to describe the software system in terms of objects, offers diagrams that provide different perspective views of the system parts. The Web-based Medical Recruitment System (WBMRS) was designed to be user friendly and it is easy to navigate

Finance versus costs for teaching hospitals in Spain

In this paper we analyse the observed systematic differences in costs for teaching hospitals (THhenceforth) in Spain. Concern has been voiced regarding the existence of a bias in the financing of TH’s has been raised once prospective budgets are in the arena for hospital finance, and claims for adjusting to take into account the ‘legitimate’ extra costs of teaching on hospital expenditure are well grounded. We focus on the estimation of the impact of teaching status on average cost. We used a version of a multiproduct hospital cost function taking into account some relevant factors from which to derive the observed differences. We assume that the relationship between the explanatory and the dependent variables follows a flexible form for each of the explanatory variables. We also model the underlying covariance structure of the data. We assumed two qualitatively different sources of variation: random effects and serial correlation. Random variation refers to both general level variation (through the random intercept) and the variation specifically related to teaching status. We postulate that the impact of the random effects is predominant over the impact of the serial correlation effects. The model is estimated by restricted maximum likelihood. Our results show that costs are 9% higher (15% in the case of median costs) in teaching than in non-teaching hospitals. That is, teaching status legitimately explains no more than half of the observed difference in actual costs. The impact on costs of the teaching factor depends on the number of residents, with an increase of 51.11% per resident for hospitals with fewer than 204 residents (third quartile of the number of residents) and 41.84% for hospitals with more than 204 residents. In addition, the estimated dispersion is higher among teaching hospitals. As a result, due to the considerable observed heterogeneity, results should be interpreted with caution. From a policy making point of view, we conclude that since a higher relative burden for medical training is under public hospital command, an explicit adjustment to the extra costs that the teaching factor imposes on hospital finance is needed, before hospital competition for inpatient services takes place.Cost functions, semi-parametric estimation, regression analysis, teaching hospitals, prospective payments

The use of computer-based learning tools for teaching and clinical purposes: Interactive computing strategy for Iraq

Medical universities and teaching hospitals in Iraq are facing a lack of professional staff due to the ongoing violence that forces them to flee the country. The professionals are now distributed outside the country which reduces the chances for the staff and students to be physically in one place to continue the teaching and limits the efficiency of the consultations in hospitals. A survey was done among students and professional staff in Iraq to find the problems in the learning and clinical systems and how Information and Communication Technology could improve it. The survey has shown that 86% of the participants use the Internet as a learning resource and 25% for clinical purposes while less than 11% of them uses it for collaboration between different institutions. A web-based collaborative tool is proposed to improve the teaching and clinical system. The tool helps the users to collaborate remotely to increase the quality of the learning system as well as it can be used for remote medical consultation in hospitals

An investigation of biases in Patient Safety Indicator score distribution among hospital cohorts

Denman Research Forum- 2nd Place, Health Professions-ClinicalThe Centers for Medicare and Medicaid Services (CMS) have implemented a hospital reimbursement system that incentivizes payment proportional to the quality of care delivered and performance on certain metrics. One such metric is the Agency for Healthcare Research and Quality’s Patient Safety Indicator 90 (PSI-90). It is composed of eight individual indicators designed to flag adverse patient events that are potentially preventable, such as post-operative wound dehiscence and accidental lacerations. CMS publicly reports four of these individual PSI scores (6, 12, 14 and 15) in addition to the composite PSI-90. Previous studies question the PSIs’ validity beyond screening purposes and furthermore question the underlying administrative data’s ability to accurately and reliably flag such events. This study looks to analyze biases in PSI score distribution for hospitals depending on teaching status, differences in patient demographics and lastly, interactions between teaching status and patient demographic factors and their ability to account for differences in PSI rates. Significant differences were found between teaching and non-teaching hospitals for PSIs 6, 12, 15 and 90 (p<0.01). Inpatient volume and patient severity (p<0.01) were found to be significantly different between teaching status cohorts. Lastly, significant differences in PSI scores were found between patient severity quartiles for PSI 6, 15 and 90 (p<0.05) and between socio-economic quartiles for PSI 6, 12, 15 and 90 (p<0.05); but interaction between patient severity and teaching status was only significant for PSI 90 (p<0.05) and between socioeconomic and teaching statuses for PSI 6 (p<0.05). These results indicate current PSI score distributions may be biased against teaching hospitals for 4 out of 5 PSI measures. Further studies will involve assessing the adequacy of risk-adjustment methodology for PSI metrics. Until then, use of PSI metrics to determine federal reimbursement can lead to bias against teaching hospitals.A three-year embargo was granted for this item.Academic Major: Health Information Management and System

Estimation of the Romanian hospitals efficiency in relation to hospital market competition

The study examines a sample of 20 teaching and research Romanian hospitals, located in Bucharest, during the period 2001 – 2005, in terms of their efficiency and influence on their neighbouring health care units, expressed as an idiosyncratic form of market competition. Perspectives in case price competition will become a differentiation factor among hospitals, as health care migrates from the public to the for-profit sector will be addressed to, as well as the analysis of a possible switch, in the teaching and research hospitals’ (TRH) policy, from focusing on technical efficiency to trying to compensate their low operating margins by offering more unverifiable quality, which will be appreciated by the patients suiting a different, now emerging, customer profile.efficiency estimates, hospital market, Lewin Group model.

Medical College of Virginia Hospitals 125 Years of health care 1861 - 1986

The Medical College of Virginia (MCV) grew in size and reputation in the latter half of the twentieth century, amid a time of technological advancements in the medical field and the rise of teaching hospitals. Starting with the opening of the College Infirmary in 1861, this book follows the history of MCV’s hospitals. Also discussed is MCV’s role during the Civil War, contributions to the college, and William T. Sanger’s influence on the school’s growth. The book includes photos of the buildings and a timeline of the hospitals.https://scholarscompass.vcu.edu/vcu_books/1015/thumbnail.jp

Efficiency of Hospitals in the Czech Republic

The paper estimates cost efficiency of 99 general hospitals in the Czech Republic during 2001-2008 using Stochastic Frontier Analysis. We estimate a baseline model and also a model accounting for various inefficiency determinants. Group-specific inefficiency is present even having taken care of a number of characteristics. We found that inefficiency increases with teaching status, more than 20,000 treated patients a year, not-for-profit status and a larger share of the elderly in the municipality. Inefficiency decreases with less than 10,000 patients treated a year, larger population, and more hospitals in the region.Efficiency, hospitals, stochastic frontier analysis