The impacts of corporatisation of healthcare on medical practice and professionals in Maharashtra, India

A heterogeneous private sector dominates healthcare provision in many middle-income countries. In India the contemporary period has seen this sector undergo corporatisation processes characterised by emergence of large private hospitals and the takeover of medium-sized and charitable hospitals by corporate entities. Little is known about the operations of these private providers and the effects on healthcare professions as employment shifts from practitioner-owned small and medium hospitals to larger corporate settings. This article uses data from a mixed-methods study in two large cities in Maharashtra, India, to consider the implications of these contemporary changes for the medical profession. Data were collected from semi-structured interviews with 43 respondents who have detailed knowledge of healthcare in Maharashtra, and from a witness seminar on the topic of transformation in Maharashtra’s healthcare system. Transcripts from the interviews and witness seminar were analysed thematically through a combination of deductive and inductive approaches. Our findings point to a restructuring of medical practice in Maharashtra as training shifts towards private education and employment to those corporate hospitals. The latter is fuelled by substantial personal indebtedness, dwindling appeal of government employment, reduced opportunities to work in smaller private facilities, and the perceived benefits of work in larger providers. We describe a ‘re-professionalisation’ of medicine encompassing changes in employment relations, performance targets and constraints placed on professional autonomy within the private healthcare sector, that is accompanied by trends in cost inflation, medical malpractice, and distrust in doctor-patient relationships. The accompanying ‘re-stratification’ within this part of the profession affords prestige and influence to ‘star doctors’ while eroding the status and opportunity for young and early career doctors. The research raises important questions about the role that government and medical professionals’ bodies can, and should, play in contemporary transformation of private healthcare, and the implications of these trends for health systems more broadly

Understanding Nurses\u27 Knowledge Work

Hospitals are increasingly investing in technologies and electronic knowledge management systems to improve patient care outcomes. Yet, effective implementation of these initiatives has been difficult with questionable return on investment outcomes (Ontario Hospital Association [OHA], 2007, 2008). Paton (2009) argues that understanding how employees put their knowledge into action at work is essential to successful knowledge management for organizations. Thus, strategies that target nurses’ knowledge work may be more effective for hospitals; particularly in times of mounting fiscal deficits and demands for health services. This study examined the behaviors, influences, and outcomes of nurses’ knowledge work. The hypothesized model was based on Kelloway & Barling’s (2000) knowledge work theory; explaining the impact of empowering leadership on nurses’ accountability, role-breadth self-efficacy, and control over practice to influence their knowledge work behaviours and ultimately, patient care delivery outcomes. The model was tested on a random sample of 318 registered nurses in Ontario, and initially demonstrated poor fit with the observed data; with further refinement to improve the overall model fit [χ2(df) = 512.66 (199), p \u3c .001, SRMR = .064, CFI = .91, RMSEA = .071]. Final model results suggest that empowering leadership practices increase nurses’ knowledge work behaviors, which subsequently enhances their care coordination activities and patient care quality. Empowering leadership specifically increases nurses’ knowledge work by positively influencing their accountability and role-breadth self-efficacy, but not control over practice. This study is among the first to identify the behaviors by which nurses’ demonstrate their knowledge work, and the process by which empowering leadership influences such work behaviors to improve patient care quality

Safe Food Handling Knowledge, Attitude and Practice of Food Handlers in Hospital Kitchen

Hospital food hygiene plays an important role to patient's health. Studies proved that improper practices and lack of knowledge are contributing factors of foodborne diseases. This study was conducted to determine knowledge, attitude and practice of hospital safe food handling in Semarang, Central Java. A cross sectional study was conducted in two general hospitals' kitchen. Data were collected from 60 food handlers through validated questionnaire. Respondents were grouped into two categories: a. Teaching Hospital, and b.Non-teaching Hospital. Data were collected in February-April 2017. Most of food handlers (80%) were graduated from vocational senior high school (SMK). Respondent's age were 28-37 years (36.7%) in average. Most of respondent‟s work experience (85%) was less than 15 years. The result showed that more than 80% of food handlers have good knowledge in safe food handling procedures, good attitude (66%) and good practices (90%). There was no significant difference of knowledge, attitude and practices between two groups. Results strongly emphasize the need of food hygiene training of hospital food handlers. It also suggest that non food handlers such as nurse or kitchen supervisor should involved in the training. Some aspects of food handlers' safety behavior need to be emphasized

Participatory simulation in hospital work system design

When ergonomic considerations are integrated into the design of work systems, both overall system performance and employee well-being improve. A central part of integrating ergonomics in work system design is to benefit from emplo y-ees’ knowledge of existing work systems. Participatory simulation (PS) is a method to access employee knowledge; namely employees are involved in the simulation and design of their own future work systems through the exploration of models representing work system designs. However, only a few studies have investigated PS and the elements of the method. Yet understanding the elements is essential when analyzing and planning PS in research and practice.This PhD study investigates PS and the method elements in the context of the Danish hospital sector, where PS is applied in the renewal and design of public hospitals and the work systems within the hospitals. The investigation was guided by three research questions focusing on: 1) the influence of simulation media on ergonomic evaluation in PS, 2) the creation of ergonomic knowledge in PS, and 3) the transfer and integration of the ergonomic knowledge into work system design.The investigation was based on three PS cases in the Danish hospital sector. The cases were analyzed from an ergonomics system perspective combined with theories on knowledge creation, transfer, and integration. The results are presented in six scientific papers from which three core findings are extracted: 1) simulation media attributes influence the type of ergonomic conditions that can be evaluated in PS, 2) sequences and overlaps of knowledge creation activities are sources of ergonomic knowledge creation in PS, and 3) intermediaries are means of knowledge transfer, and interpretation and transformation are means of knowledge integration

Hypertensive patients' perceptions of their physicians' knowledge about them: a cross-sectional study in Japan

<p>Abstract</p> <p>Background</p> <p>In order to evaluate the difference in quality of primary care provided by physicians between the types of medical institutions in Japan, we examined whether the physicians' comprehensive knowledge of their patients is perceived differently by the patients seen at clinics and hospitals.</p> <p>Methods</p> <p>Patients with prescriptions for hypertensive drugs were approached sequentially at 13 pharmacies, and were administered a questionnaire on their perception of their physician's knowledge about them. Data were obtained for 687 patients (362 from clinics and 325 from hospitals). A physician's knowledge of his or her patients was assessed according to six aspects: their medical history, their current medications, history of allergy, what worries patients most about their health, patients' values and beliefs on their health, and patients' roles and responsibilities at work, home, or school. Responses were scored from 1 through 6 (1: knows very well; 6: doesn't know at all).</p> <p>Results</p> <p>Patients treated in clinics were seen more frequently, for a longer period, and had fewer complications than the patients who were treated in hospitals. Among the six aspects of physicians' knowledge assessed, 79.3% of the patients reported that their physicians knew their complete list of medications "very well or well," while 28.3% reported the same about their roles and responsibilities at work, home, or school. Physicians in clinics were considered to know their patients' worries about their health (p = 0.004) and the roles and responsibilities of the patients at work, home, or school (p = 0.028) well. Multiple regression analysis showed that the type of medical institutions remained as a significant variable only for the aspect of patients' worries about their health. The factor that consistently affected the patients' perception of physicians' knowledge about them was the patients' age.</p> <p>Conclusions</p> <p>Hypertensive patients' perceptions of their physicians' knowledge about them did not differ significantly between clinics and hospitals in Japan for most of the aspects. In order to differentiate the roles of physicians in hospitals and clinics better and ensure the quality of primary care, the establishment of a standardized educational system to train primary care physicians better is recommended.</p

Evolution of the Governmental Accounting Reform implementation in Greek Public Hospitals: Testing the institutional framework

Purpose – In an attempt to promote efficiency, effectiveness and economy in health service production, the Greek government imposed in 2003 an accrual basis financial and cost accounting system in all public hospitals of the National Health System (NHS). The purpose of this study is not to investigate thoroughly the accounting reform implementation and adoption in specific organizations, but rather to obtain an overall idea of the reform adoption process in Greek public hospitals by identifying major areas of non-compliance with the mandatory legislative accounting framework and various organisational contingencies that influence the level of reform adoption within a broad institutional framework. Design/methodology/approach – Our analysis is based on the results of an empirical survey that took place during 2009. For the purposes of this survey, a compliance index is constructed and applied on a sample of 94 Greek public hospitals using a structured questionnaire and semi-structured interviews with six public hospital Financial and Accounting executives. Findings – The empirical evidence reveals that the level of accrual basis financial and especially cost accounting adoption in Greek public hospitals is realized only to a limited extent. In particular, results show that the relationship between the institutional isomorphic pressures and accounting reform implementation process is restricted by organizational capability factors (i.e., the quality of existing Information Technology systems, the education level of finance and accounting staff, the extent of reform related training, and the professional support of consultants). Research limitations/implications – Although this study takes into consideration the work of previous researchers in the health care area, it acknowledges that empirical research on the subject in the Greek environment is limited. Therefore this study should be viewed as an initial step to address this limitation. Originality/value – This study draws on the information systems change, management accounting innovation, and public sector reform literatures to contribute to the current knowledge in public sector accounting by examining a number of factors that are expected to influence the implementation and adoption process of accrual and cost accounting practises in the Greek public healthcare sector within a broad institutional framework. Contribution - This study contributes to the international literature of New Public Management (NPM) initiatives in public health sector by providing, to our knowledge, the first large cross-sectional assessment of accrual accounting reform adoption and implementation in Greek public hospitals. Additionally, the empirical evidence of this study can enhance researchers’ and managers’ understanding of major implementation processes and challenges and thus help them refine models of effective implementation process and improve systems and processes on similar future projects.Accrual Accounting, Public Sector Accounting, Compliance Index, Public Hospitals, Isomorphism.

Semantic Integration of Cervical Cancer Data Repositories to Facilitate Multicenter Association Studies: The ASSIST Approach

The current work addresses the unifi cation of Electronic Health Records related to cervical cancer into a single medical knowledge source, in the context of the EU-funded ASSIST research project. The project aims to facilitate the research for cervical precancer and cancer through a system that virtually unifi es multiple patient record repositories, physically located in different medical centers/hospitals, thus, increasing fl exibility by allowing the formation of study groups “on demand” and by recycling patient records in new studies. To this end, ASSIST uses semantic technologies to translate all medical entities (such as patient examination results, history, habits, genetic profi le) and represent them in a common form, encoded in the ASSIST Cervical Cancer Ontology. The current paper presents the knowledge elicitation approach followed, towards the defi nition and representation of the disease’s medical concepts and rules that constitute the basis for the ASSIST Cervical Cancer Ontology. The proposed approach constitutes a paradigm for semantic integration of heterogeneous clinical data that may be applicable to other biomedical application domains

Prevalence and causes of prescribing errors: the prescribing outcomes for trainee doctors engaged in clinical training (PROTECT) study

Objectives Study objectives were to investigate the prevalence and causes of prescribing errors amongst foundation doctors (i.e. junior doctors in their first (F1) or second (F2) year of post-graduate training), describe their knowledge and experience of prescribing errors, and explore their self-efficacy (i.e. confidence) in prescribing. Method A three-part mixed-methods design was used, comprising: prospective observational study; semi-structured interviews and cross-sectional survey. All doctors prescribing in eight purposively selected hospitals in Scotland participated. All foundation doctors throughout Scotland participated in the survey. The number of prescribing errors per patient, doctor, ward and hospital, perceived causes of errors and a measure of doctors' self-efficacy were established. Results 4710 patient charts and 44,726 prescribed medicines were reviewed. There were 3364 errors, affecting 1700 (36.1%) charts (overall error rate: 7.5%; F1:7.4%; F2:8.6%; consultants:6.3%). Higher error rates were associated with : teaching hospitals (p&#60;0.001), surgical (p = &#60;0.001) or mixed wards (0.008) rather thanmedical ward, higher patient turnover wards (p&#60;0.001), a greater number of prescribed medicines (p&#60;0.001) and the months December and June (p&#60;0.001). One hundred errors were discussed in 40 interviews. Error causation was multi-factorial; work environment and team factors were particularly noted. Of 548 completed questionnaires (national response rate of 35.4%), 508 (92.7% of respondents) reported errors, most of which (328 (64.6%) did not reach the patient. Pressure from other staff, workload and interruptions were cited as the main causes of errors. Foundation year 2 doctors reported greater confidence than year 1 doctors in deciding the most appropriate medication regimen. Conclusions Prescribing errors are frequent and of complex causation. Foundation doctors made more errors than other doctors, but undertook the majority of prescribing, making them a key target for intervention. Contributing causes included work environment, team, task, individual and patient factors. Further work is needed to develop and assess interventions that address these.</p

Physician Attitudes and Perceptions of Complementary and Alternative Medicine (CAM): A Multicentre Italian Study

Purpose: Complementary and Alternative Medicine (CAM) interventions are widely used by patients with chronic disorders, including cancer, and may interact with cancer treatment. Physicians are often unaware of this, probably due to poor patient-physician communication on CAM. The purpose of this study was to evaluate physicians' knowledge, attitudes and practice patterns regarding CAM in a survey conducted in Italy. Methods: A questionnaire was administered to 438 physicians (11 Italian hospitals) who predominantly treat patients with chronic disease, to collect personal and professional data and information on attitudes toward CAM and its possible role in Conventional Medicine (CM). Results: Of the 438 participants, most were specialists in oncology (18%), internal medicine (17%), surgery (15%), and radiotherapy (11%). Most worked at university (44%) or research hospitals (31%). Forty-two percent of participants believed that CAM could have an integrative role within CM. Oncologists were the physicians who were best informed on CAM (58%). Physicians working at research institutes or university hospitals had a greater knowledge of CAM than those employed at general hospitals (p &lt; 0.0001), and those who were also involved in research activity had a greater knowledge of CAM than those who were not (p &lt; 0.003). Length of work experience was significantly related to CAM knowledge. Moreover, 55% of participants suggest CAM interventions to their patients and 44% discuss CAM with them. The best-known interventions were acupuncture, Aloe vera and high-dose vitamin C. Conclusion: CAM use by patients with chronic disease and/or cancer has become a topical issue for the scientific community and for physicians. Knowing the reasons that prompt these patients to use CAM and guiding them in their decisions would improve treatment and outcomes and also benefit healthcare systems. Our findings contribute to a greater understanding of CAM knowledge, attitudes, and practice among Italian physicians. Further research is needed to identify the more effective CAM treatments and to work toward an integrated healthcare model