Assessing the Effectiveness of a Performance Evaluation System in the Public Health Care Sector: Some Novel Evidence from the Tuscany Region Experience

Since 80's the introduction of New Public Management principles has promoted the use of performance measurement to drive a more efficient, effective and accountable public sector. The adoption of a sophisticated and comprehensive multidimensional performance measurement system, which looks beyond traditional financial measures, based on organization strategies, such as the balanced scorecard, has thus been suggested. This revolution in the public management came together with the devolution processes that involved most European public health systems. Set within this context, in the last decade, each of the twenty Italian regions developed its own management tools. Among others, the Tuscan performance evaluation system (PES) has been valued as a particularly innovative and comprehensive system. This paper reports the novel experience of the Tuscan PES; in particular, it measures PES effectiveness and discusses the critical factors that could have led to the PES success. Five are the critical success factors identified by researchers: the visual reporting system, the linkage between PES and CEO's reward system, the public disclosure of data, the high level of employees and managers involvement into the entire process and the strong political commitment. All those factors run together to achieve better results; however, the process of development of the system plays a pivotal role. Scholars suggest the use of a constructive approach in order to gain effective changes in human organization. According to this stream of literature, this paper contributes by the novel experience of the Tuscan PES in addressing as a further fruitful application of the constructivist approach in healthcare

Quality improvement cycles that reduced waiting times at Tshwane District Hospital Emergency Department

BACKGROUND: Tshwane District Hospital is a level-one hospital, delivering services in the centre of Pretoria since February 2006. It is unique in location, being only 100m away from the tertiary hospital, Pretoria Academic Hospital. In South Africa, public sector emergency units are under enormous pressure with large patient numbers, understaffing and poor resources. TDH Emergency Department (ED) is a typical example. An average of 3900 patients per month visited this ED in 2006. Recurrent complaints and dissatisfaction shown by the patients, about prolonged waiting times before consulting the medical practitioners in the ED was one of the initial challenges faced by the newly established hospital. It was decided to undertake a quality improvement study to analyse and improve the situation, using waiting time as a measure of improvement. METHODS: A quality improvement team was chosen. A total of 150 waiting times of stable and unstable patients were evaluated. There were 50 waiting times for each month; May, September and December 2006. Waiting time was defined as the time from arrival of the patient in the unit until the start of the consultation by the medical practitioner. Surveys were done in May and September to analyse the problems causing prolonged waiting times. The plan of action included instituting a functional triage system, improving the process of up- and down-referrals to and from the tertiary hospital, easy access to stock, reorganisation of doctors’ duty roster, re-organisation of the academic programme, announcement to patients of waiting time, nurses carrying out minor procedures, improvements in the registration, enhancing laboratory delays and availability of protocols. RESULSTS: The median waiting times for stable patients were; May 2006: 545 minutes, September 2006: 230 minutes and in December 2006: 89 minutes. There was a significant difference among these waiting times for May, September and December 2006 (p < 0.000; Kruskal-Wallis test).The median waiting times for unstable patients were; May 2006: zero minutes, September 2006: zero minutes and in December 2006: 0.5 minutes. There was no difference among the waiting times of unstable patients for May, September and December 2006 (p=0.906; Kruskal-Wallis test). CONCLUSION: This quality improvement exercise identified and rectified problems causing prolonged waiting time for stable patients in the Emergency Department. This was done without compromising the time taken to see unstable patients. Similar strategies might be used in other hospitals to reduce the waiting time

Alimentação hospitalar: proposições para a qualificação do Serviço de Alimentação e Nutrição, avaliadas pela comunidade científica Hospital food: proposals for qualification of the Food and Nutrition Service, evaluated by the scientific community

OBJETIVO: validar proposições para qualificar a alimentação hospitalar pela comunidade científica brasileira. MATERIAIS E MÉTODOS: aplicou-se um questionário eletrônico a profissionais da área de nutrição clínica, cadastrados na Plataforma Lattes, base de dados brasileira de currículos de pesquisadores e instituições, das áreas de Ciência e Tecnologia. O questionário era acompanhado por uma escala Likert, com espaços para argumentações. Os temas abrangiam a participação do paciente, a qualidade nutricional e sensorial das dietas hospitalares e o planejamento e metas do Serviço de Alimentação e Nutrição Hospitalar (SANH). Também foram solicitadas as cinco prioridades para um SANH. Foi considerada aprovada a proposição com concordância total ou parcial maior ou igual a 70%. RESULTADOS: todas as proposições obtiveram concordância total igual ou maior que 70%. Houve adesão mínima de 70% na proposição que considera que a intervenção nutricional deve ser realizada em comum acordo com o paciente, e máxima de 93% sobre a necessidade de controles estatísticos de dietas prescritas pelo SANH. As prioridades mais citadas referem-se à infraestrutura e à capacitação de recursos humanos (40%), a qualidade da alimentação hospitalar (27%) e ao estado nutricional do paciente.<br>The scope of this paper is to validate proposals used to qualify hospital food by the Brazilian scientific community. An electronic questionnaire was applied to clinical nutrition professionals registered on the Lattes Platform (Brazilian database of institutions and researchers' curricula in the areas of Science and Technology). The questionnaire incorporated a Likert scale and had spaces for comments. The themes dealt with patient participation, the nutritional and sensory quality of hospital diets, and planning and goals of the Hospital Food and Nutrition Service (HFNS). The questionnaire also asked for the top five priorities for a HFNS. Proposals with total or partial adherence equal to or greater than 70% were considered to be approved. All proposals had total adherence equal to or greater than 70%. The proposal that had minimal adherence (70%) was the one that proposed that nutritional intervention must be arranged by mutual agreement with the patient. The proposal that had maximal adherence (93%) was the one advocating that there must be statistical control on diets prescribed by the HFNS. The most cited priorities referred to infrastructure and training of human resources (40%), the quality of hospital food (27%) and the nutritional status of the patient