Health Services Management Research

Priority setting and resource allocation are key management functions; however, there may be different understandings as to what makes for a high-performing organization in this area. To interpret how decision makers actually approach this question, our research looks at what might contribute to one’s reputation as such. Two sets of qualitative data are used. Senior healthcare leaders were asked to nominate organizations which they considered high performers in priority setting and resource allocation and to justify their choices. This open-ended question was analyzed to identify themes. Rigorous process was most often cited. Six case studies were subsequently conducted; respondents were asked to comment upon why they thought their organization might be named by others as a high performer. These replies were analyzed qualitatively to identify prominent storylines: three distinctive narratives are summarized here. These help us to understand how organization leaders in particular contexts bring together stakeholders to pursue locally appropriate strategies for achieving contextually defined high performance.

Data envelopment analysis is a methodology particularly well-suited to measuring the efficiency of hospitals because it is able to accommodate multiple heterogeneous inputs and outputs in order to model the complex relationships that exist within them. This research uses data envelopment analysis to develop a model of Canadian hospital production efficiency in collaboration with the Canadian Institute for Health Information. The model is intended to illustrate the utility of data envelopment analysis as a hospital performance measurement tool for Canadian Institute for Health Information and to augment their current hospital performance indicators. The model measures the overall production efficiency of acute care hospitals using labour and capital inputs together with outputs measuring inpatient and outpatient activity. The model also includes non-discretionary variables adjusting for case-mix variations among the hospitals. The model is extensively validated and identifies a set of highly referenced, efficient hospitals ideal for the establishment of best practices.

How and if public hospital leaders in a national health system use an annual Serious and Sentinel Events (SSE) report, an aim of which is to stimulate improvements in health care quality and patient safety, is an important question that is under-researched. This exploratory qualitative study in New Zealand using semi-structured interviews was undertaken in response. Interviewees included 29 representatives in patient safety leadership roles from 20 hospital districts, each of whom were recommended by their Chief Executives. Four themes describing factors contributing to the use of the SSE report were identified: response to the report itself; perceived use of and value of the report as a quality improvement tool; collaboration amongst hospitals around the findings; and, the priority given to improving quality within respondents' healthcare organisations. This article provides examples of these themes and how they relate to the use of the SSE report as a quality improvement tool. The article concludes that an annual SSE report has the potential to be a very useful tool for health care leaders in addressing SSEs. However, it also suggests that the report is underutilised and consequently some of this potential is lost. This may be explained by hospital capacity to absorb information from, and respond to, the SSE report.