1,721,013 research outputs found
Waiting times in emergency departments: A resource allocation or an efficiency issue?
Full text linkBackground: In recent years, the flow of patients to the Emergency Departments (ED) of Western countries has steadily increased, thus generating overcrowding and extended waiting times. Scholars have identified four main causes for this phenomenon, related to: continuity of primary care services; availability of specific clinical pathways for chronic patients; ED's personnel endowment; organization of the ED. This study aims at providing a logical diagnostic framework to support managers in investigating specific solutions to be applied to their EDs to cope with high ED waiting times. The framework is based on the ED waiting times and ED admission rate matrix. It was applied to the Tuscan EDs as illustrative example. Methods: To provide the factors to be analyzed once the EDs are positioned into the matrix, a list of issues has been identified. The matrix was applied to Tuscan EDs. Data were collected from the Tuscan performance evaluation system, integrated with specific data on Tuscan EDs' personnel. The Tuscan EDs matrix, the descriptive statistics for each quadrant and the Spearman's rank correlation analysis among waiting times, admission rates and a set of performance indicators were conducted to help managers to read the phenomena that they need to investigate. Results: The combined reading of the correlations and waiting times-admission rates matrix shows that there are no optimal rules for all the EDs in managing admission rates and waiting times, but solutions have to be found considering mixed and personalized strategies. Conclusions: The waiting times-admission rates matrix provides a tool able to support managers in detecting the problems related to the management of ED services. In particular, using this matrix, healthcare managers could be facilitated in the identification of possible solutions for their specific situation
Enhancing Learning Systems in Using Patient Experience Data: An Exploratory Mixed-Method Study in Two Italian Regions
Full text linkIn the quest for healthcare systems enhancement, the improvement of patient experience plays a central role. The challenge lies in converting patient-reported experience data into actionable knowledge for quality improvement. This study aims to investigate the use of patient-reported data as knowledge base for actions and to identify and map actions derived from the use of patient-experience data within two Italian regional healthcare systems. Patient Experience Data are systematically collected in both systems, providing real-time updates accessible by professionals and managers through web-based reporting systems and including a collaborative network among practitioners. A sequential exploratory mixed-method study was carried out in several qualitative and quantitative phases. In the first phase, a qualitative method was conducted to discuss the actionability of patient-reported data and to design a tool for collecting the improvement actions based on these data. In the second phase, a quali-quantitative survey was performed to explore the professionals' use of patient-reported information and the types of actions implemented. Finally, a workshop was held to discuss, interpret and validate the results. The initial workshop identified key dimensions for improvement initiatives. After design and distribution of survey, a total of 189 responses was collected, respectively 96 from Region A and 93 from Region B. Both regions ensured widespread use of patient-reported data (89%). The establishment of a collaborative network seemed to reduce the learning curve in using patient-reported data and fostered a culture of using patient feedback effectively. The results reveal a difference between the two regions, with a more extensive patient-reported data use in Region A, attributed to its systematic joining the PREMs Observatory, prior experiences with patient-feedback collection and use, and patient-experience indicators integrated into the performance evaluation system. Regarding practices of data use, four themes emerged, namely, internal actions addressed to hospital staff (35.9%), external actions addressed to users (18.6%), comfort and hospitality aspects (34.7%) and review of processes and procedures (10.8%). The study highlights the importance of effectively using patient-reported data to achieve organisational goals, by combining different managerial strategies. It demonstrates how professionals use such data for improvement actions and underscores the significance of various forms of knowledge dissemination and sharing. It advocates for fostering a culture of continuous learning and improvement within and across healthcare organisations
How do health authorities inform about general practitioner selection? Analysis of Italian Websites
Full text linkTricky choices between short or long-term financial sustainability: cost allocation for medical malpractice claims in Italy
Full text linkFinancial sustainability is a recurring challenge for public organizations and is closely linked to resource allocation. Medical malpractice claims can significantly impact public healthcare costs, prompting several countries, including Italy, to adopt different strategies for managing these risks. These strategies range from insurance-based systems to self-insurance models. While the former offers greater long-term security, it tends to be more expensive in the short term. Conversely, self-insurance, if properly implemented, can provide both adequate protection and cost savings. However, it also carries the risk of incentivizing opportunistic behavior aimed at achieving short-term
financial gains. This study explores the propensity of Italian healthcare organizations to choose between these approaches and the relationship between their choice and short-term financial viability. A quantitative analysis of the relationship between premiums, provisions, and financial indicators, such as ROA and ROS provides empirical evidence of potential opportunistic behavior. Additionally, semi-structured interviews are conducted to validate the interpretations from the statistical analyses. Our findings reveal that many regional administrations have insufficient coverage for risk exposure, which may temporarily improve financial performance but increase the risk of long-term financial instability
Unintended consequences of expenditure targets on resource allocation in health systems
No full textIn recent decades, several countries have reformed their health care systems leading to the devolution of power to a lower governance level and, subsequently, to re-centralisation. Due to the ambiguous results of these policies and the start of the financial crisis of 2008, a wide number of national governments implemented cutback initiatives aimed at controlling health expenditure. The literature shows that the introduction of such initiatives may have produced unintended consequences on health systems’ performance. In order to better understand the power relations and the resulting decision-making processes between national governments and local authorities, it is important to focus on the effects of such expenditure control mechanisms on the inputs of the health systems, i.e. the production factors. This research aims at investigating the effects of a cutback initiative intended to control personnel costs in a federal Beveridge health system through the analysis of resource allocation at the devolved level. The paper is based on a quantitative analysis of data resulting from the financial statements published by the 21 Italian regional health systems from 2012 to 2017. The results show that, although the Italian regional health systems managed to reduce personnel costs – i.e. hitting the target – the control of the total cost dynamic was not fully addressed. Overall, the initiative implemented by the national government had the effect of limiting the decision-making autonomy of regional authorities, pushing them toward shifting resource allocation from personnel to the purchase of services
PSU14 Assessing Unwarranted Variation in Minimally-Invasive Surgery for Pelvic Organ Prolapse in Tuscany, Italy: A Case Study
No full textAssessing inter-organizational performance through customer value: a literature review
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