Health Services Management Research

Using any number of open system strategic frameworks, the planning process follows a fairly consistent trajectory: formulation, implementation, and evaluation. Most agree that the formulation and evaluation phases are the most straightforward, yet successful implementation remains elusive. If done thoughtfully, taking advantage of a complementary framework suitable for aligning facility-level initiatives with system priorities presents a feasible opportunity for health systems interested in cascading enterprise-wide strategy successfully. This study provides lessons learned from: (a) consulting literature addressing barriers to implementing strategy effectively, and (b) analyzing insights from a participatory action research study designed to overcome impediments to aligning hospital-level initiatives with enterprise-wide goals and objectives. The analysis provides a baseline examination of hospital alignment efforts that underscores best practices and exposes gaps in both process and evaluation. Results suggest specific tools may function to effectively engage internal stakeholders in a cooperative process capable of yielding preferred strategic outcomes, particularly through the implementation and evaluation phases.

The National Health Service Staff Survey is an annual, England-wide survey of staff employed by National Health Service organisations. It is administered using online and paper questionnaires. Response rates have fallen over time, while the proportion of staff receiving the online version – which historically has a lower response rate – has increased. Three interventions to increase online response were tested using an experimental design: more reminders; change of signatory to the invitation to participate and concise messaging in the invitation. Thirteen thousand staff members in five National Health Service trusts received the online survey. Results were analysed using contingency tables and logistic regression to determine the effect of interventions independently and in combination. More reminders improved response by six percentage points (odds ratio 1.33, 95% CI 1.23–1.43) and concise messaging by two percentage points (odds ratio 1.08, 95% CI 1.00–1.17). Change of signatory had no statistically significant effect and neither did any combination of the interventions. Given that costs for the successful interventions were minimal, more reminders in combination with concise messaging are recommended as a strategy to improve online response to the survey.

The Healthy Cities Network (HCN) of the WHO seems to be an effective approach to introduce innovative ideas into the healthcare sector. It is a knowledge-based network and at the same time a learning network. Within literature, communication is carved out as an essential precondition for such organisational learning. Still, there exists no study that explicitly focusses on the communication processes of the HCN Germany. The aim of this study is to get first insights into such communication processes and the information flow within the HCN Germany and to analyse these with respect to the processes of inter-organisational learning. An online questionnaire was sent to all member institutions of the HCN Germany. The questionnaire analysed the communication between the member cities and also between the member cities and the other institutions of the HCN Germany. Furthermore, the efficiency and the outcome of the communication and information exchange is evaluated. The evaluation showed that the communication and the exchange of information within the network is rated rather good and that there is transfer as well as the sharing of knowledge. So far joint learning processes between the network members and also between the member cities and the other institutions of the HCN Germany are lacking. For the further development of the network and the development of the network as a learning organisation there should be also joint learning processes, which means the cooperation between the network members and the other network institutions should be deepened.

All over the world, health care systems are experiencing the challenges raised by the epidemiological transition from the prevalence of acute diseases to the preponderance of chronic illnesses. However, the traditional design for acute conditions of most of health care systems – which triggers a hospital-centric culture – is not consistent with the special health needs of people suffering from long-term conditions. In fact, the access of chronic patients to hospital services has been variously contested to be inappropriate and ineffective to meet their demand for care. Sticking to these considerations, this study investigates the factors that influence the occurrence of hospitalization and the length of hospital stays of a representative sample of Italian chronic patients. Secondary data were collected from the European Health Interview Survey. The sample consisted of 8,127 people. A probit model and a multiple regression analysis were performed to obtain some evidence on the regressors of Italian patients’ access to hospital care. Among others, gender, work condition, health services’ use and health status were found to have a role in influencing chronic patients’ behaviors. The study findings prompted the formulation of several avenues for future developments, which provide some food for thought to policy makers and inspire an agenda for further research.

In order to improve the quality and efficiency of hospitals, they can be viewed as a logistical system in which integration is a critical factor for performance. This paper describes the results of a scoping study that identifies the logistical parameters mentioned in international research on hospitals and indicates whether literature reflects system integration. When subsystems collaborate in order to accomplish the task of the entire organization, there is integration. A total number of 106 logistical parameters are identified in our study. In addition, the flow type – patients, materials and staff – and hospital subsystems were registered. The results presented in international literature show that logistics is highly fragmented in hospitals. Studies also show integration, although this takes place mainly within the subsystems of hospitals. A multi-agent perspective on hospitals is proposed, following the view that both integration and differentiation are essential for effective organizational performance. Given the widely recognised importance of controlling hospital costs and the potential of logistics to help in this process, it is important to gain more knowledge of hospitals as network organizations, as well as knowledge regarding the degree of integration and the logistical parameters that are required for better hospital performance.