Journal of Hospital Administration
ISSN / EISSN : 1927-6990 / 1927-7008
Published by: Sciedu Press (10.5430)
Total articles ≅ 538
Latest articles in this journal
Journal of Hospital Administration, Volume 11; https://doi.org/10.5430/jha.v11n1p17
Objective: The purpose of this study was to conduct a hospital workforce survey of nurses to determine what interprofessional collaborative practice components they have in place at their worksites. The findings could indicate what is needed to create, expand, and maintain an effective interprofessional collaborative practice environment. Methods: The study used a random sample of working perioperative nurses who were members of a national perioperative registered nurse association database and had interprofessional collaborative practice training either by continuing medical education or micro credentialing. These nurses were sent two surveys to assess their worksite presence of interprofessional components. These validated surveys assess an organization’s capacity to have an interprofessional collaboration by examining the workplace environment, environmental mechanism, and institutional support of interprofessional collaboration. Results: Interprofessional collaboration within the perioperative worksite setting exists in most of the structures in place. However, urban sites were more likely to lack supportive components that build, evaluate, and continuously create interprofessional teams. Conclusions: There was an uneven implementation of the interprofessional collaboration components. The components vary by site, with urban hospitals having few components resulting in a more asymmetrical interprofessional team. The study’s findings indicate a need for an assessment of worksite interprofessional collaboration to ensure all components are in place and for evaluation and improvement of interprofessional collaboration.
Journal of Hospital Administration, Volume 11; https://doi.org/10.5430/jha.v11n1p1
All hospitals engage in credentialing to evaluate the qualifications of practitioners who request clinical privileges. Credentialing always includes verifying an applicant’s education, training, licensure and board certification, and evaluating information provided by references who have worked with the applicant. Far fewer hospitals consider whether a practitioner’s volume of cases is sufficient to demonstrate proficiency in a specialty area. This is surprising, given the well-established relationship in the medical literature between volume and proficiency. The authors identified several reasons for hospitals’ reluctance to use volume-based credentialing. These include the fear of lawsuits by physicians and the practical difficulties of satisfying volume requirements in smaller hospitals with fewer patients. The authors conclude that legal challenges to volume-based credentialing are unlikely to be successful and that techniques exist to enable small hospitals to use volume-based credentialing to promote high quality and safe care.
Journal of Hospital Administration, Volume 11; https://doi.org/10.5430/jha.v11n1p8
Objective: Despite an abundance of evidence supporting screening adults for adverse childhood experiences (ACEs), the gap between this knowledge and screening persists. Evidence suggests that screening is warranted, feasible, and desired by patients. This feasibility study aimed to educate and train staff and providers on ACE screening and implement an ACE screening policy and protocol at an outpatient medical psychology practice. The two expected outcomes of this project, provider knowledge after ACE training and provider compliance with the ACE screening protocol, were measured to determine if a clinical practice change occurred. Methods: A quasi-experimental design with a pre-test/post-test was used to determine increases in provider knowledge following an ACEs training intervention. Additionally, post-intervention only data collection was used to determine compliance with ACE screening protocol, to determine practice change and feasibility of continued protocol use. Results: The project results indicated that the implementation of the ACE screening protocol was feasible. Thirty-three adult clients new to the practice completed the ACE screening. Of the 33 clients screened during the 12-week study, 26 clients had an ACE score of three or higher, and 14 (42%) received therapy referrals based on their ACE score after education and discussion by the intake therapist. Weekly chart checks revealed that 100% of clients screened received, at a minimum, the educational packet regarding the impact of ACEs on physical and mental health. The protocol encouraged providers to promote evidence-based interventions to mitigate the potential untoward outcomes associated with ACEs. Conclusions: These findings reflected a change in knowledge based on education and indicated that educational intervention was effective.
Journal of Hospital Administration, Volume 10; https://doi.org/10.5430/jha.v10n6p12
There is a growing demand to increase the representation and empowerment of female leaders, and companies must implement effective policies to rise to the challenge. This article presents a potent new set of DEI (diversity, equity, and inclusion) protocols for healthcare administration to meet this challenge. The paper evaluates DEI practices and provides suggestions on advancing metrics such as recruitment, engagement and retention of women employees. We conducted a literature review and interviewed field experts to investigate best practices for shaping an inclusive healthcare leadership team. We identified four recurring themes, which are the key takeaways for successfully implementing any DEI initiative: 1. Garner support from the CEO and Board of Directors to establish the importance of the initiative throughout the company. 2. Engage employees directly; lead participants in designing diversity initiatives and encourage them to contribute their own ideas, rather than just going through the motions. 3. Involve the entire workforce, not just the top managers. As a definition of inclusion, everyone’s perspective is essential for building a widespread work culture that exemplifies DEI principles. 4. Design DEI protocols that encompass life both in and out of the office, such as assisting women leaders with childcare needs. We then examine the most common DEI strategies: diversity training, employee resource groups, mentorship programs, and leadership development. Though these methods have their merits and shortcomings, expert input can mitigate the pitfalls. Lastly, we validate research-based interventions. According to the literature, healthcare has not adequately taken advantage of sponsorship opportunities, so we designed an executive-emerging leader sponsorship program. This protocol is supplemented with other interventions, such as interactive diversity training and ERG (employee resource group) playbooks, to foster the workspace crucial to the flourishing of program participants. Overall, we conducted secondary research on the best DEI protocols available, and augmented our findings with interviews we conducted. Therefore the findings we share are based on limited knowledge and do not represent the entire solution to diversity, equity and inclusion in healthcare leadership. Based on the best practices we are aware of, we present a multi-pronged approach to help healthcare administration shape a more equitable future for people of all backgrounds.
Journal of Hospital Administration, Volume 10; https://doi.org/10.5430/jha.v10n6p27
Wellness and engagement in busy and complex healthcare systems are challenging. Much has been written about how individual healthcare workers can prevent their own burnout and improve wellness as well as the role of institutional and organizational goals to promote engagement and wellness. However, while there is clearly not one explanation or one solution for this problem, there is also not one standard approach to assessing these important issues, though surveys are most commonly used to assess the characteristics of the workplace. We suggest a framework of strategies for effective use of surveys to improve employee wellness and engagement based on practical experience that involve operational next steps organizations and programs can take after surveys as well as contextualizing the information they provide. These steps include adapting and leveraging quality improvement (QI) tools customarily used for patient safety for the purpose of wellness and engagement.
Journal of Hospital Administration, Volume 10; https://doi.org/10.5430/jha.v10n6p34
Risks associated with drugs and treatments are a key concern in clinical investigations of therapeutics. There is a keen attention to side effects and adverse events included in critical safety documentation presented in regulatory submissions for new drugs. Likewise, Companion Diagnostic (CDx) technology is subject to rigorous regulated research and testing because of the risk associated with a false test result that could affect clinical decisions and treatment. The rigor of testing imposed by the regulatory path to clearance or approval is intended to ensure an assay is reliable when performance criteria are defined by a fixed set of these variables so that there is the least risk of false test results. The clinical validation of these assays is especially important when the test result is used to manage therapeutic decisions for patients. The same patients that expect a clinician to use reliable diagnostics to recommend treatment may also be recruited to participate in CDx clinical investigations. This educational review of CDx product development, regulations, and clinical investigations involving human subjects is important to: (1) Clinicians who rely on the test results to manage patient care; (2) Patients who trust these test results are informing the clinician, and (3) Hospital administrators who oversee human subjects safety and data intergrity for clinical investigations in the personalized medicine space.
Journal of Hospital Administration, Volume 10; https://doi.org/10.5430/jha.v10n6p1
Objective: Although the differences in the quality levels between the public and private sectors have been identified in literature not much is known about the level of quality differences that exist when full time government employee doctors offer the same clinical services in their own privately managed facilities. The objective of this study was to compare service user perceived quality of care provided by full-time government employee doctors in the public system and in their own privately managed facilities in Nigeria. Methods: A cross-sectional multistage sampling design was used to elicit service user views on process, structure and outcome elements of quality identified in the Donabedian’s care quality model. The software for population surveys in EPI Info 7 was used to calculate the required sample. A total of 407 questionnaires were administered and completed after a pre-test. Results: Respondents reported better health outcomes in private practice than in the public system and a majority would recommend visiting a dual physician’s private practice than the public system where they work full-time. Process aspects of quality, including better rapport with doctors, greater perceived confidentiality, shorter wait times, and absence of bureaucratic impediments were said to be better in privately managed facilities of government doctors. However, respondents said that the public sector was superior in respect of the structure element of quality as reflected in better infrastructure, equipment, and availability of drugs. Conclusions: Despite the relatively lower cost of care in government hospitals the outcome and process elements are still crucial in determining which sector patients prefer. These two elements seem to have influenced patronage for private practices of dual practitioners.
Journal of Hospital Administration, Volume 10; https://doi.org/10.5430/jha.v10n5p31
Objective: This study aims to analyze COVID-19 hospitalization and death rate in the Asian population of a predominantly Asian-serving multi-hospital system (ASMHS).Methods: The COVID-19 patient information was collected electronically from March 1 to November 12, 2020, including demographics, insurance, mortality, ICU admissions, and length of stay (LOS). Demographic characteristics were compared with the county-level and national data. A comparison of hospital LOS between Asians and non-Asians was conducted.Results: The prevalence ratio of deaths in Asians at ASMHS was 1.29, which was 53% higher than the county and 77% higher than the nation. The ICU admission for ASMHS Asian patients was 11.8% compared to 5.6% for non-Asian. Overall Asians and Asians aged > 65 had significantly longer LOS than non-Asians (p < .001).Conclusions: High prevalence ratio of deaths was noted in ASMHS’s Asian patients which may be related to older age, higher ICU rate, and longer LOS.
Journal of Hospital Administration, Volume 10; https://doi.org/10.5430/jha.v10n5p24
Background: While the volume of Emergency Department (ED) visits has declined during the 2019 novel coronavirus disease or COVID-19, the opposite has been observed with mental-health related visits. The need to screen and manage potential COVID-19 symptoms in parallel with psychiatric complaints have imposed new challenges in the ED at an academic public hospital.Objective: The objective is to share operational modifications in addressing the challenges related to the influx of ED mentalhealth related complaints at the departmental, hospital-wide, and city-wide level within an academic, public hospital.Methods: At the departmental level, a triage algorithm for screening patients with concerning symptoms was developed. A dedicated Respiratory Decision Unit with psychiatrically safe rooms that adhered to infection prevention protocol was also created. All staff were trained to utilize personal protective equipment through lectures, asynchronous learning, and multidisciplinary simulations. The ED team worked with hospital leadership to increase inpatient medical psychiatric bed capacity and to develop testing protocols for patients being admitted to allow for cohorting of symptomatic patients. At the city level, leadership within the three main organizations that provide mental health services to the city met regularly to address operational issues.Conclusions: The COVID-19 pandemic has imposed new challenges in terms of increased psychosocial needs while limiting transmission risks. Based on the experiences shared, a multitier approach is necessary. At all levels, the goals were to screen appropriately, decrease transmission risk, and maintain throughput. The purpose of this descriptive manuscript is to encourage dialogue and to raise awareness about the unique needs of the mental health system.
Journal of Hospital Administration, Volume 10; https://doi.org/10.5430/jha.v10n5p11
During the Covid Pandemic, a lot of structural and process changes had to be made in a quick time in almost all the hospitals to accommodate the patients and admit them with the least exposure to the Hospital Staff and the bystanders of the patients. AIIMS Hospital in New Delhi India is a premier tertiary care teaching hospital, which is spread out in different areas. Two Hospital centers of AIIMS were designated as COVID Hospitals. Since there was no previous experience of intrahospital transfers of this magnitude, the hospital had to face lots of difficulties in such transfers and this translated into increased turnaround time. This paper concentrates on the mechanisms in which the Department of Hospital Administration found out the various issues plaguing this process. Later by Change Management, an Intervention was brought in, which helped in the framing of a standard operating procedure that helped in the easy transfer of the patients which was hassle-free and which continued to the second wave of the COVID pandemic.