Journal of Health Management

This article highlights a study undertaken in the workplace that observed the features of a National Health Service (NHS) general manager's job that determined ‘reflective space’ at work. The study was initiated following the suggestion that the workplace might conspire to limit reflective practice amongst NHS general managers who would ordinarily espouse the value of such an approach. Assessing this inference would, arguably, illuminate the relative productivity of meetings and workplace events and assist in future application amongst NHS employees. The study did not attempt to question whether NHS general managers were armed with the competencies of reflection but whether they were able to apply it having developed the skills and what might constrain them. In doing so there would then be opportunities to challenge convention through the application of a reflective tool.

The study involved the classification of work events where reflection was notably high or low. An analysis of data indicated five major characteristics of the reflective practitioner's workplace that can inhibit or facilitate reflective practice. This has enabled the development of a reflective tool to assist NHS general managers. The tool might therefore be added to the personal management development ‘toolkit’ that each general manager might wish to access.

Stress has become the most important factor influencing individual efficacy and satisfaction in modern day occupational settings. In this context, the nursing profession is increasingly characterised by occupational stress. This study was conducted with the aim of investigating the effect of role stress in a sample of 120 nursing professionals of government and private hospitals. They were administered Organisational Role Stress Scale by Pareek (1981) in order to assess the level of stress experienced by them. The obtained results revealed that male nurses experienced significantly higher stress level as compared to females. Second, male nurses from private hospitals showed significantly higher level of stress levels than the government nurses on eight out of the ten dimensions of Organisational Role Stress Scale.

The main objective of the present study is to highlight the extent of reproductive health problems, the factors responsible for increasing RTI cases and to suggest appropriate strategies. Five types of obstetric problems and seven types of gynaecological problems were listed in both National Family Health Survey-2 (NFHS-2) and Reproductive and Child Health (RCH) surveys. Fewer than half the women reported at least one obstetric morbidity and more than one-tenth reported at least one gynaecological morbidity. More women in urban areas had reported obstetric morbidity whereas more women from rural areas reported gynaecological morbidity. Educated women, women who work in other activities and Scheduled Caste and Scheduled Tribe women reported that they are suffering from obstetric problems. Women who do not have toilet facilities at home and women who live in semipucca houses reported gynaecological problems. There is a relationship between age at first delivery or ‘child-birth’ and the reproductive morbidity of women. Reproductive morbidity due to abortion is high among rural women.

Data reveals that fewer than half the women who reported gynaecological problems did not seek treatment. Of the women who reported at least one symptom of gynaecological problems nearly half were in the 25–34 age group and only 50–60 per cent of them sought treatment. Education played a major role in women's health-seeking behaviour. Among those who sought treatment majority had gone to private health facilities. There is need to expand informed choices among women. Women must be empowered to take charge of their pregnancy-related needs. It is important to raise community awareness regarding early marriage and pregnancy. Misconceptions about nutrition and health care during pregnancy must be confronted at the community level and among pregnant women, and the families in which they reside.

Public health challenges such as AIDS, tuberculosis, plague, and leprosy have implicitly assumed stigmatisation of patients. This article is about stigmatised illnesses, a disease where patients face medical and social challenges. Today, diseases such as leprosy, TB are curable if detected early. However, the social problem of stigma still persists. Why is it that despite the availability of treatment, persons with diseases continue to be ostracised by the community? What is the role of the health-workers? Should they be effective distributor of medicines and methods of cure or should they also empower the community to examine and reflect upon this medical cum sociological phenomenon and help the community to devise methods of providing cure as well as providing care? What are the best practices the community can follow to deal with leprosy and its social ramifications? Importantly, what are the implications for participatory communication and for effective interventions in the future? This article discusses several core themes that suggest some answers to these questions.

As majority of HIV infection occurs among the productive age groups, the impact on the affected families is devastating especially among low socio-economic category. The treatment facilities available to infected being very meagre in India, the present article evaluates the option of providing care in the existing public sector, by drawing a case study on one of the leading medical college from Kerala, India. This study is more appropriate and relevant, with the recent central and state governments proposal to provide universal ART to the HIV infected individuals.

The changeover to single sex accommodation in psychiatric hospitals was intended to strengthen patients' dignity, safety and privacy (DoH 2000). Previous research on patients' attitudes to single sex accommodation suggests that female patients in particular are in favour, although the views of staff are less well known. Our aim was to examine both patient and staff perspectives on single-sex accommodation. We surveyed patients in acute psychiatric wards using a patient questionnaire that covered satisfaction of care and preference for single or mixed sex accommodation. In addition we undertook brief in-depth interviews using a semi-structured questionnaire with patients and staff in order to gain a better understanding of this issue. The results revealed that safety is a major concern in determining patient satisfaction with services. Female patients were much more likely to prefer segregated accommodation than men (χ² = 26.56, df = two, p < 0.0000). Patients suggest that diagnosis, severity of illness, and age are equally important in determining hospital accommodation and a safe, therapeutic environment. Male staff are concerned with potential allegations of sexual harassment, while women staff view single-sex accommodation as a threat to creating a more natural environment for patients. We conclude that while the majority of women patients favour single sex accommodation. The results of this study indicate that the views of patient and staff are more complex. Patient concerns of safety on psychiatric wards may not be wholly resolved by the introduction of single-sex accommodation. Clear policy guidelines and training must also be provided for staff members.

BACKGROUND AND OBJECTIVES: Each primary care practice should be viewed as a complex adaptive micro-system with its own unique characteristics. To improve safety, under constraints of limited resources and numerous competing demands, practices need to identify those vulnerabilities that pose the greatest risks and focus efforts on these. The Objective was to develop and test a novel methodology that forms self-empowered learning teams that can prioritise safety problems based on the combination of error frequency and severity of consequences, and then devise feasible interventions.

METHODS: A survey instrument was designed and used to elicit, in qualitative terms, staff perceptions of frequency, p, and severity, s, of various types/causes of primary care errors. The qualitative responses were quantified using an algorithm that allowed for risk aversion. Relative hazard rate, h = pxs, was used as the basis for prioritising safety problems in two primary care test practices.

RESULTS: Each site identified its own set of priorities with very little overlap. Within each site there was high concordance between priorities identified by physicians, nursing and administrative staff but each site appeared to be unique. Priorities also remained stable with variation in the degree of risk aversiveness assumed in the Hazard calculation.

INTERPRETATION AND CONCLUSIONS: The method aided formation of central ‘attractors’ in the form of self-empowered effective learning teams with a common vision to help their complex micro-systems to adapt and thrive. This pro-active type of methodology helps in creating a sustainable safety culture, and has been adapted for other health-care settings and physician training.

A structured teaching programme was designed for second year student nurses who were on a 1-week placement at the ENT hospital of Mauritius. As part of the programme, this article discusses how a teaching session on tracheostomy suctioning and humidification was implemented. The teaching session incorporated both the pedagogical and andragogical techniques in order to make the learning experience meaningful for the students. The learning outcomes were evaluated in terms of, knowledge, skill and attitude and were found to have been mostly met. However, more practice was required on the part of the students in order to become more proficient. Formal training and assessing in clinical practice can contribute significantly towards improving the quality of care and satisfying the needs of patients.

The functioning of a pharmacy at a private sector multi-specialty hospital was studied with the objective of improving its services. It was found that average number of drugs per prescription was 3.78. This was higher than the normal 1.8 to 2. Though the dispensing time was 6.51 mins, only 0.57 mins was utilised for providing the drug information. Al-though, the pharmacy used inventory management tools such as ABC and FSN analysis, other tools such as VEN analysis, EOQ and safety stock were not used. There is a need for improving the services through utilisation of modern management tools. The pharmacy was located outside the hospital, which was inconvenient to the patients. The pharmacists had to substitute the drug in 54 per cent of the new cases and in 46 per cent of the old cases. In case the prescribed brand was not available the pharmacist invariably consulted the doctor before the substitution with another drug. However, the patients were very unhappy about it. Patients also resented being dispensed the whole strip, which they saw as a waste of money. The study indicates that the quality of services can be improved consider-ably through good managerial practices.

Today new ways of managing are changing hospital-maintenance services. Maintenance and Engineering in health institutions have become activities that must be managed and not just generate a cost supported by the organisation. So the actual model is being trans-formed to an integral system included in the structure of hospital-strategies using the ‘Balanced Scorecard’.

The article presents a framework for e-health governance complete solutions through a relational model that emphasise e-health strategies to develop and implement. It simplifies the task of developing, deploying, and managing complex, integrated, and standards-compliant e-health governance solutions. It also provides commonly used health services such as access to citizen and health records, access control and authentication services, public key infrastructure, and support for digital systems.

Hospital administrations in the developing–world face great challenges to meet the demand for more physicians in hospitals. A computer-based physician requirement planning model is a user-friendly approach in response to such demands. This article presents a new method-ology based on a Graphic User Interface (GUI) using Java. Information on work days/hours, activity-wise standard times and annual workload information, bed capacity and occupancy figures are inputted in a visual display screen and the model generates activity-wise and overall physician requirements. Current availability is entered and prevailing productivity levels are estimated. An institutional summary presents overall and specialty-wise current availability and requirement of physicians. Computerisation empowers policy makers/planners to respond promptly to requests by hospitals for manpower assessment and decide objectively on additional posts. It enables health administration to visualize human resource implications of changing utilisation scenarios and variation in model parameters.