Assessing Panamanian hospitals' performance with alternative frontier methods

In the last decades, there has been a growing interest in measuring the efficiency of hospitals using different methodological approaches, mainly represented by data envelopment analysis (DEA) and stochastic frontier analysis (SFA). In this study, we estimate efficiency measures of performance for a sample of Panamanian public hospitals over an 11-year period (2005–2015) using both traditional methods (DEA and SFA) and compare them with efficiencies estimated with an alternative approach, the so-called StoNED (stochastic semi-nonparametric envelopment of data), which combines the virtues of those methods in a unified framework. One of the most interesting features of the public health system in Panama is that it is segmented, as hospitals are operating under two parallel management schemes (the Ministry of Health and the Social Security Fund), thus in our empirical analysis we will also focus on exploring the differences between hospitals operating under each regime. Our results show that there are certain divergences in the efficiency scores estimated with different methodologies, but for all of them it is possible to detect that Panamanian hospitals experienced a clear decrease in their efficiency levels throughout the period evaluated, being this much higher in the hospitals belonging to the Social Security Fund.     

Statement on report of Joint Commission on Mental Illness and Health.

An "endorsement of Action for Mental Health [see 35: 6705], the final report of the Joint Commission on Mental Illness and Health." The report cites the very substantial cost of adequate care for mental patients, hidden costs of mental illness, gross inadequacy of present measures, and presents a pattern of increased federal financial support to deal with the problem. It recommends the demise of the large custodial "mental hospital" and calls for "invention and trial of novel approaches." Reservations about the report are also made explicit: the report emphasized improved treatment of mental illness at the expense of other facets of the problem area; it says little about promoting more effective personal development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hospital learning from extreme weather events: using causal loop diagrams

Extreme weather events (EWEs) represent an important opportunity for hospital facilities managers to learn lessons to improve future hospital resilience. However, little is known about the process by which this occurs and how effectively this happens. These questions are addressed by an exploration of how individual hospital stakeholders learn about the performance of their facilities and share these lessons in the adaptation of future hospital disaster management plans. More specifically, the evidence of behavioural and social/collective learning is investigated amongst hospital stakeholders during EWEs. The data gathered from a case study of a major hospital network of four hospitals were qualitatively analysed within a constructionist ontology and interpretivist epistemology using causal loop diagrams (CLDs). This revealed how lessons were learned in the hospital network from collective stakeholder EWEs’ experiences. The findings highlight the need to develop appropriate processes and structures to capture, share and use facilities-related knowledge and embed new lessons learnt into future hospital disaster planning processes. Using Nonaka and Takeuchi's model of organizational knowledge creation, this paper presents new theoretical and practical insights for hospital facilities managers to build hospital resilience by better capturing the facilities-related lessons learnt in responding to an EWE.     

远程医疗背景下社区医院和患者行为选择的演化分析

采用演化博弈理论方法,在远程医疗合作背景下,建立了社区医院和患者策略选择的演化博弈模型,分析了社区医院远程医疗合作策略和患者选择就医医院策略博弈的演化路径、演化均衡及其影响因素,并用Matlab软件对博弈演化过程进行数值仿真。研究发现,决策参数(政府对社区医院的资金支持、患者享有的医保报销比例等)取值的改变会对演化结果产生影响,并且给出了相应决策参数的确定方法。最后,根据分析结果为远程医疗的推广提出了合理性建议。     

基于Web Service的中小型医院电子病历系统设计

针对中小型医院的数据特性,提出基于Web Service的电子病历系统设计方法,设计中小型医院电子病历系统。根据Web Service的特点和优势,本文探讨基于Web Service的电子病历系统的体系结构、数据模型和安全性设计,并在此基础上提出下一步研究方向。方便患者就诊,减少大量检查手续,为患者提供方便。     

Critical Incident Stress Management (CISM) in complex systems: Cultural adaptation and safety impacts in healthcare

In complex systems, such as hospitals or air traffic control operations, critical incidents (CIs) are unavoidable. These incidents can not only become critical for victims but also for professionals working at the “sharp end” who may have to deal with critical incident stress (CIS) reactions that may be severe and impede emotional, physical, cognitive and social functioning. These CIS reactions may occur not only under exceptional conditions but also during every-day work and become an important safety issue. In contrast to air traffic management (ATM) operations in Europe, which have readily adopted critical incident stress management (CISM), most hospitals have not yet implemented comprehensive peer support programs. This survey was conducted in 2010 at the only European general hospital setting which implemented CISM program since 2004. The aim of the article is to describe possible contribution of CISM in hospital settings framed from the perspective of organizational safety and individual health for healthcare professionals. Findings affirm that daily work related incidents also can become critical for healthcare professionals. Program efficiency appears to be influenced by the professional culture, as well as organizational structure and policies. Overall, findings demonstrate that the adaptation of the CISM program in general hospitals takes time but, once established, it may serve as a mechanism for changing professional culture, thereby permitting the framing of even small incidents or near misses as an opportunity to provide valuable feedback to the system.     

An algorithm for shift scheduling which considers circadian principles

The principles of circadian rhythms in human beings have been applied to devise a methodology for scheduling shift work in a hospital unit which is operating under several important constraints. Considered here are time off between shifts, number of consecutive work days, number of distinct shifts in any two calendar weeks, number of shifts per week and special staffing for informational and training meetings. It is shown how the method of Czeisler et al. (1982) can be adapted for the more constrained work environment. A set of evaluation scales for circadian theory violations is devised and applied to an example from Togus VA Hospital. Results include the actual schedules together with evaluations on three different aspects of circadian theory: length of cycle on a single shift, rotation involving night shifts and rotation not involving night shifts. Improvements of each of these evaluations with respect to previously published results are obtained.     

精神康复医院住院楼设计特性初探

本文以心理学为理论基础,通过对国内先进精神康复医院的调研,总结精神康复医院住院楼的功能特征,并提出一系列切实可用的精神康复医院设计依据。     

Functional recovery of a resilient hospital type

Four adaptation options for ‘Nightingale’-type hospital ward buildings devised with practising clinicians are presented and evaluated. The adaptations recover functionality in an archaic ward configuration by delivering care to current UK National Health Service (NHS) models whilst preserving resilience to summer overheating. The investigation builds on recent work that demonstrates the significant resilience to heatwaves enjoyed by such traditionally constructed communal dormitories, the dominant UK hospital type between the late 1850s and 1939. Nightingale wards are potentially well-ventilated naturally, with good dilution of airborne pathogens. Although condemned as outdated by health ministers in recent years, many remain in use. As financial retrenchment suggests economical, creative refurbishment of hospitals will be required rather than new-build and replacement, the authors argue for health estates’ strategies that place value on resilience in a changing climate. Proposed adaptation options are investigated to assess resulting internal airflows and patient exposure to airborne pathogens. Options are costed and payback periods calculated to the standard public sector methodology. The proposed adaptations save time and cost over new-build equivalents. Selection of the most appropriate option is dependent on the characteristics of the patient cohort and care required.