江苏省基层医务人员工作压力研究

对905名基层医务人员进行问卷调查,了解基层医务人员工作压力情况及其影响因素,为建立适合基层卫生机构的良性人才发展机制提供依据。基层医务人员整体工作压力得分为56.54分;单因素方差分析显示,不同性别、年龄、婚姻状况、学历、职称、机构类型、工作量、工作年数、受患者尊重程度和社会地位的医务人员工作压力得分差异具有统计学意义;多元线性回归分析结果显示,社会地位、工作量、工作年数、受患者尊重程度、最高学历和性别对基层医务人员工作压力的影响具有统计学意义。需要着重关注乡镇卫生院医生的工作压力情况,重点应放在提升基层医务人员社会地位、及时关注中坚力量等方面,从而减轻其工作压力,提高工作积极性。     

Data envelopment analysis in the presence of measurement error: case study from the National Database of Nursing Quality Indicators® (NDNQI®)

Data envelopment analysis (DEA) is the most commonly used approach for evaluating healthcare efficiency [B. Hollingsworth, The measurement of efficiency and productivity of health care delivery. Health Economics 17(10) (2008), pp. 1107–1128], but a long-standing concern is that DEA assumes that data are measured without error. This is quite unlikely, and DEA and other efficiency analysis techniques may yield biased efficiency estimates if it is not realized [B.J. Gajewski, R. Lee, M. Bott, U. Piamjariyakul, and R.L. Taunton, On estimating the distribution of data envelopment analysis efficiency scores: an application to nursing homes’ care planning process. Journal of Applied Statistics 36(9) (2009), pp. 933–944; J. Ruggiero, Data envelopment analysis with stochastic data. Journal of the Operational Research Society 55 (2004), pp. 1008–1012]. We propose to address measurement error systematically using a Bayesian method (Bayesian DEA). We will apply Bayesian DEA to data from the National Database of Nursing Quality Indicators^® to estimate nursing units’ efficiency. Several external reliability studies inform the posterior distribution of the measurement error on the DEA variables. We will discuss the case of generalizing the approach to situations where an external reliability study is not feasible.     

弗洛伦斯·南丁格尔与克里米亚战争

弗洛伦斯·南丁格尔被誉为克里米亚战争（1854-1856）的女英雄和现代护理学的主要奠基人。战地记者无情揭露了克里米亚战争中英国军队存在的诸多弊端，促使英国政府派遣南丁格尔护士团前往克里米亚战争前线医院，而南丁格尔在护理教育、军队医疗和卫生改革等方面的贡献都要追溯到她在克里米亚战争中的经历。     

福建省城镇居民医疗保险运行对策

福建省自实行医疗保障制度改革以来,基本完成了从公费医疗、劳保医疗到社会保险的历史性转变,但仍存在医疗保险覆盖人群有限、医疗卫生体制改革不到位、政府投入不足等问题。进一步完善和发展福建省居民医疗保险制度,必须强化政府在医疗服务体系建设与发展中的作用,发展社区医疗服务,逐步扩大医疗保险覆盖范围,实施第三方对医疗费用和医疗质量的控制。     

Every Minute Counts: Using Process Improvement and Performance Feedback to Improve Patient Flow in an Emergency Department

Prolonged emergency department (ED) visits are associated with a number of adverse outcomes for patients as well as lower patient satisfaction scores and increased costs. Several factors that influence the length of ED visits are out of the control of hospital employees, but some opportunities exist to improve performance. For this study, the ED department of a 150-bed hospital in the southeastern United States wanted to improve door-to-discharge time. To do so, a subprocess of door-to-discharge time was targeted, door-to-order. After analyzing the process, the team created standard orders for the 10 most common presenting conditions in the ER with preapproval, allowing nurses to submit the orders without the provider first visiting the patient. Following the process change, daily feedback was added to increase utilization of the preapproved orders. Reductions in door-to-order times and door-to-discharge were observed and patient satisfaction remained stable. Implications for future research in this area are discussed.     

The U.S. Health System and Immigration: An Institutional Interpretation1

We examine the institutions that comprise the U.S. health system and their relationship to a surging immigrant population. The clash between the system and this human flow originates in the large number of immigrants who are unauthorized, poor, and uninsured and, hence, unable to access a system largely based on ability to pay. Basic concepts from sociological theory are brought to bear on the analysis of this clash and its consequences. Data from a recently completed study of health institutions in three areas of the United States are used as an empirical basis to illustrate various aspects of this complex relation. Implications of our results for theory and future health policy are discussed.     

Collecting feedback as a tool to reduce care paralysis: something for family group conferencing coordinators?

Family group conferencing (FGC) coordinators in public mental healthcare are confronted with clients who have little faith in professionals and organizations, who hold off decisions in their family life, who avoid care and who sometimes behave in a hostile manner. A lack of initiative to deal with their situation is not only reserved for clients – all bystanders, including professionals, can suffer from it. The multiplicity and severity of the client's problems lead to a situation wherein everyone involved waits for the initiative of the other. The independence of the FGC coordinator – a fellow citizen, who is free of organizational loyalties and comes to assist other citizens in establishing a plan – seems to work well with the client group of the public mental healthcare. However, the coordinator cannot always prevent deferral or failure of conferences. Drawing on empirical and theoretical findings, this paper considers the possibility of collecting feedback as a way to contribute positively to the alliance between FGC coordinators and those for whom a conference is deployed. We highlight findings from three case studies that centred on multiproblem families. The findings indicate the importance of feedback theory for FGC coordinators in enhancing trust and engagement.     

Chapter 2: The Business Case for the Integration of Employee Assistance,Work-Life and Wellness Services

SUMMARY

Employee assistance programs (EAP), work-life programs and wellness programs are three commonly provided kinds of interventions that have the goals of reducing healthcare costs, improving employee performance and fostering a healthier workplace culture. The integration of these kinds of programs is a recent trend that has the potential to offer additional synergistic benefits. New studies have linked comprehensive delivery services that support human capital needs with bottom-line financial success of the company. This evidence can be used to make the business case for offering EAP, work-life and wellness services in an integrated capacity. However, while promising, the scientific evidence thus far in this area has methodological limitations and there are critical aspects that require further study.     

Healthcare 4.0: trends,challenges and research directions

Abstract

This paper aims at examining the trends, challenges and theoretical gaps in the implementation of Healthcare 4.0 (H4.0) based on a scoping review of the literature. For that, we searched journal articles in four widely known databases and screened the retrieved articles to obtain a publications’ portfolio. Our findings indicate that, despite the recency of the subject, research in H4.0 has been conducted in an interdisciplinary way with a diversified set of applications and functionalities. In terms of its implementation, H4.0 has been more commonly found in hospitals’ information flows, especially the ones related to healthcare treatments. The identified implementation trends, however, neglect a more holistic approach for H4.0, which originated three main research directions for this topic. Although identified as a trending topic in the area of healthcare operations management, literature on H4.0 may be viewed as randomly conceived, lacking academic alignment and practical orientation based on a grounded theory, which we aim at providing with the present study.