The Social Determinants of Health and the Role of the Health Care System: A Case Study of the Significance of Good Governance in Public Hospitals in South Africa

Increasingly international and national policies are being directed at actions for the social determinants of health and for an integrated approach to health care provision, not only in terms of institutional cooperation but also stakeholder involvement. A key component of both these policies is the development of good governance principles in all health care agencies and organizations. A neglected dimension in these debates has been the role of the public hospital which remains a vital and expensive dimension of service provision. In a case study of a public hospital in South Africa, this paper charts the readiness of its management principles and activities to provide quality health care linked to population health and to contribute to the non-medical determinant of health. Using Taylor’s principles of good governance, we conclude that there is a mixture of good and not so good governance activity. The paper concludes by examining the external constraints on the public hospital and by providing suggestions for future activities.

Healthcare waste management in selected government and private hospitals in Southeast Nigeria

Objective:To assess healthcare workers' involvement in healthcare waste management in public and private hospitals.Methods:Validated questionnaires(n = 660) were administered to randomly selected healthcare workers from selected private hospitals between April and July 2013.Results:Among the healthcare workers that participated in the study,187(28.33%) were medical doctors,44(6.67%) were pharmacists,77(11.67%) were medical laboratory scientist,35(5.30%) were waste handlers and 317(48.03%) were nurses.Generally,the number of workers that have heard about healthcare waste disposal system was above average 424(69.5%).More health-workers in the government(81.5%) than in private(57.3%) hospitals were aware of healthcare waste disposal system and more in government hospitals attended training on it.The level of waste generated by the two hospitals differed significantly(P=0.0086) with the generation level higher in government than private hospitals.The materials for healthcare waste disposal were significantly more available(P=0.001) in government than private hospitals.There was no significant difference(P = 0.285) in syringes and needles disposal practices in the two hospitals and they were exposed to equal risks(P =0.8510).Fifty-six(18.5%) and 140(45.5%) of the study participants in private and government hospitals respectively were aware of the existence of healthcare waste management committee with 134(44.4%) and 19(6.2%) workers confirming that it did not exist in their institutions.The existence of the committee was very low in the private hospitals.Conclusions:The availability of material for waste segregation at point of generation,compliance of healthcare workers to healthcare waste management guidelines and the existence of infection control committee in both hospitals is generally low and unsatisfactory.

Surgical Site Infection Prevention Practices and Associated Factors among Nurses Working in Government Hospitals of Harari Regional State and Dire Dawa City Administration, Eastern Ethiopia

Background:Surgical site infections are the most frequent type of preventable hospital acquired infections with a serious and undesirable outcome of surgery associated with increase morbidity,mortality rate,hospital stay,readmission and excess cost.Surgical site infection prevention is one of the most important challenge in delivering optimal nursing care.Studies suggest that the nurses’practices of surgical site infection prevention is not well addressed.Moreover,there is clearly paucity of information,in Africa including the study area.Objective:The aim of this study was to assess surgical site infection prevention practices and associated factors among nurses working in government hospitals of Harari Regional State and Dire Dawa City Administration,Eastern Ethiopia from March 01 to 28,2019.Method and Materials:An institutional based cross-sectional study design was employed for a total of 515 nurses.Simple random sampling method was used to select study participants.Data were collected using pretested structured self-administered questionnaire supplemented by observation.Data were checked,coded,entered and cleaned using Epi-data version 3.1 and exported to SPSS version 20 for analysis.Bivariate and multivariate analysis were undertaken and P values less than 0.05 at 95%confidence interval were considered as statistically significant.Result:The overall self-reported level of SSI prevention practice was found to be 40.8%(95%CI:36.9%,45.4%).Nurses with BSc and above[Adjusted odds ratio(AOR)=2.52,95%CI(1.14,5.54)],trained on infection prevention[AOR=2.22,95%CI(1.29,3.82)],good knowledge[AOR=2.21,95%CI(1.32,3.71)],good attitude[AOR=5.11,95%CI(3.05,8.57)],got supply of personal protective equipment[AOR=2.57,95%CI(1.46,4.49)],had management support[AOR=3.41,95%CI(1.90,6.12)],experience of 5 to 10 years[AOR=5.38,95%CI(2.82,10.27)]and≥11 years[AOR=3.48,95%CI(1.47,8.25)],were found to be statistically and positively associated with nurses SSI prevention practice.Conclusion:In this study,the level of surgical site infection prevention practice was poor.Being BSc and above,being knowledgeable and good attitude,got personal protective equipment,had management support,serving for≥5 years and trained on infection prevention were found to be significantly associated with surgical site infection prevention practice.Updating knowledge and practice of nurses through in-service education and training on latest evidence-based practice,regularly supplying of personal protective equipment,developing hospital policy and procedures for surgical site infection prevention practice is recommended.

Research on China＆#39;s Public Hospital Governance： From Perspective of Implementation Issues

INTRODUCTIONHart once proposed in his book ＂corporate governance＂： Some theory and implications that governance issue would emerge if there is any interest conflict between principal and agent with no support of a complete contract in a principal-agent relation. Governance theory developed from the governance issue believes that an effective institutional arrangement could avoid or decrease the occurrence of these issues and force the agent to maxilnize his principal＇s interest.

Qualitative analysis of direction of public hospital reforms in China

Reforms in public hospitals are among the most important improvements in China＇s health care system over the last two decades. However, the reforms that should be implemented in public hospitals are unclear. Thus, a feasible direction of reforms in Chinese public hospitals is suggested and reliable policy suggestions are provided for the government to reform public hospitals. The data used in this study were mainly derived from a qualitative study. Focus group discussions and in-depth interviews were conducted in Shanghai, Guangdong, and Gansu between May and December 2014. Government funding accounted for approximately eight percent of the total annual revenue of public hospitals in China, and the insufficient government subsidy considerably affects the operation mechanism of public hospitals. However, solely increasing this subsidy cannot address the inappropriate incentives of public hospitals in China. The most crucial step in setting the direction of reforms in public hospitals in China is transforming inappropriate incentives by implementing a new evaluation index system for directors and physicians in public hospitals.

公立医院行风建设指数定量评价体系构建研究

目的:从医院管理视角引入指数定量评价体系,用形象、具体且高度凝练的指标和评价要点来描述公立医院的行风建设工作。方法:立足当前公立医院行风建设管理中重点督查的关键领域,围绕落实主体责任、完善制度建设等5个维度,设计定量与定性相结合的行风建设指数评价模式。结果:构建了适用于公立医院临床科室的数字化行风建设指数评价机制,划定评价周期并实行动态管理,实现对行风建设发展问题的精准定位和对行风监督工作具体实施情况的有效全面评估。结论:本研究客观评价医德医风水平和医院行风建设管理现状,有助于综合理解和客观评估复杂的管理行为,为未来数字医院的横向管理与纵向规划提供了有效的战略改进支撑,有助于推动现代化医院行风治理的标准化、精细化和信息化发展。

基于灾害脆弱性分析的医院舆情治理体系建设探索

在全媒体时代,网络舆情事件给医疗行业带来困扰,医院网络舆情管理面临严峻考验。阐述了医院网络舆情治理存在的主要问题,介绍了北京大学人民医院基于灾害脆弱性分析的医院网络舆情治理策略与方法,即从舆情风险识别、舆情管理体系建设、提高科室管理水平等方面完善医院网络舆情管理模式,以期减少和避免网络舆情事件的负面影响,构建和谐的医患关系,改善医疗服务。

公立医院政府采购组织与管理现状调研

目的:调研公立医院政府采购现状与组织管理政策,以提高政府采购规范化管理水平。方法:采用电子问卷调查方式收集到全国216所公立医院(涉及28个省市自治区)的政府采购组织与管理现状信息进行调研,分析公立医院政府采购管理的组织结构管理体系、工作模式、监督评价、预算立项、招标采购、合同签订、验收流程、付款管理等现状。结果:调查问卷共回收216份(216所医院)有效问卷,其中综合医院、专科医院和中医医院分别为165、37和13所,分别占76.39%、17.13%和6.02%;医院级别中三级医院202所(占93.52%)。被调查公立医院政府采购管理机构中采购管理委员会、采购管理办公室、采购中心和业务及行政后勤部门4层组织机构分别为112、103、110和112个,分别占51.85%、47.69%、50.93%和51.85%;所有医院政府采购公开招标限额标准均符合国家法规要求;各医院付款必须条件的资金审批情况均符合要求;医院风险防控管理效果中非常好、良好、一般和不到位4种情况分别为48、125、34和9所,分别占22.22%、57.87%、15.74%、4.17%。结论:公立医院政府采购的组织框架与管理体系日趋规范,不同医院政府采购工作模式与流程存在一定差异,监管评价相对薄弱值得关注和加强管理。

新时代公立医院全面从严治团工作路径研究

目的:调研公立医院团组织自身建设情况,探索新时代公立医院全面从严治团的工作路径。方法:采用问卷调查法,对北京市19所公立医院的1 435名团员和青年进行问卷调查。结果:团组织“第一议题”学习机制已基本落实到位,多数医院已成立青年理论学习小组并开展学习,但77.36%的团员和青年每周自主开展的理论学习时长<2小时;团委班子职数设置和书记、副书记配备基本规范,团支部设置大多数与党支部、科室设置有对应关系,团员和青年对团组织评价高,但只有15.79%的医院设置了除团委书记外的专职团干部;团组织能够对团员和青年经常开展纪法教育和提醒,但38.73%的团干部或团员没有接受过《中国共产主义青年团纪律处分条例(试行)》培训,团干部接受过培训的比例高于普通团员(P<0.001)。结论:要创新思想引领的形式和载体,增强团员和青年政治理论学习的积极性;配齐配强配优专职团务人员,增强团干部能力素质和工作本领;健全完善纪律教育机制,增强团员和青年遵纪守法的意识和能力。

大数据时代智慧医院规范化数据治理方案的制定与实施

目的:探索大数据时代综合医院的数据治理,促进智慧医院信息化医疗数据合理利用,推动智慧医院高质量发展。方法:通过分析综合医院信息化发展中数据治理的难点,建立统一明确的标准化数据架构,制定统一的指标体系,推行精细化的数据质量管理规范,并通过实际建设成效进行验证。结果:通过基于标准的数据治理,提高了医疗数据及其资源的管理水平,提升了临床研究效率,推动了医疗流程的优化。结论:大数据时代下智慧医院基于统一标准的数据治理,可复制推广,有助于数据要素发挥新质生产力乘数效应的经济效益和社会价值。

基于医院评审标准的重点专业质量控制指标数据治理的思考

目的根据国家对三级医院评审的要求,对重点专业质量控制指标数据进行治理,以促进数据安全和医疗服务能力的提升。方法成立数据质量治理小组,汇总统计口径模糊的指标,按名称和类型进行分类整理。通过引进专业质控系统,制订病历结构化模板,将19个质控指标嵌入模板。在HIS系统中设置“专业质控指标数据集”入口,可直接获取质控指标数据集。结果19个重点专业质量控制指标(合计298个指标,1286项数据)中纯手工提取43项,信息化手段获取1243项,信息化手段占96.66%,手工提取数据占3.34%;手工提取下降89.97%。结论电子病历结构化有助于实现数据的精细化管理,促进医院高质量发展。

公立医院高质量发展下政府采购精细化管理探究

本文首先介绍了公立医院高质量发展下政府采购精细化管理的重要性,指出在新医改政策驱动下,公立医院政府采购管理存在的问题。并详细叙述了公立医院高质量发展下政府采购精细化管理的做法与实践策略,提出政府采购精细化管理的对策和建议,旨在探究公立医院实现高质量发展所需的政府采购精细化管理措施,以提高医疗服务的质量和效率,为公立医院的高质量发展提供有益参考和借鉴。

浅谈医院医疗卫生健康数据治理与应用

在医疗卫生信息化建设发展进程中,医疗卫生健康数据量持续增长,正确的利用这些医疗卫生健康数据,能够为医疗健康体系带来巨大的潜在价值。在大数据时代背景下,数据的应用与治理要建立在数据量大、覆盖面广的前提下,医院通过对医疗卫生数据的开放与共享,推动社会应用创新,使其成为互联网医疗模式的基础支撑。本文基于医疗卫生数据广泛应用背景,针对医院对医疗卫生健康数据采集、传输、储存与应用等方面的治理措施进行了探讨。

公立医院医疗腐败问题治理路径与防控策略研究

公立医院医疗腐败治理对于推进公立医院改革,加速公立医院高质量发展进程,实现健康中国目标具有重要意义。文章从定量分析案件的角度出发,结合中国裁判文书网医疗腐败案件数据和工作具体实践分析当前公立医院腐败问题现状,深入剖析医疗腐败治理存在的困境,如医疗腐败隐蔽性较强,查处极为困难;利益冲突导致“经济人”代理活动频发道德风险;公立医院内部监督制约机制不够有力等。在此基础上,提出创新公立医院反腐败手段,加强反腐深度;优化绩效薪酬分配体系,强化自我约束;健全公立医院内部制约监督机制,扎实推进惩防体系建设等建议。

药品集采中政府与公立医院间的博弈研究

目的:探究公立医疗机构完成集采任务的动力,分析影响集采工作效果的因素,为政府实施监管及相关决策提供参考。方法:分析14家三级公立医院前五批国家组织集采药品采购情况,基于博弈论的角度,通过构建政府与医院的博弈模型,求出其纳什均衡解。结果:在医院落实集采政策方面,存在政府监管力度不强、公立医院药品报量逐批下降、参与积极性不高等问题。结论:建议优化政府监管机制,加大日常监管力度,完善激励与约束制度,提高医疗机构纯收益等。

医疗大数据信息平台创新医院管理应用的探索与实践

随着医疗信息化的持续推进,与人们生命健康密切相关的医疗数据呈现出爆炸式增长的特点。①医院互联互通、智慧医院建设为医疗大数据的应用奠定了良好的基础;②海量数据的增长对数据处理能力的要求越来越高,如何利用数据挖掘、数据治理、深度学习、大数据可视化等技术,实现医疗数据在采集、存储、治理和服务等多个环节的有效组织和管理成为当前迫切的需求。本文针对现存医院管理问题,构建医疗大数据信息平台,探索其在医院管理方面的创新应用,并提出医疗大数据信息平台未来发展建议,旨在提高医疗管理数字化程度,推动大数据技术在医疗领域的应用和发展。

院所融合协同治理有效性研究——以浙江省肿瘤医院和中国科学院杭州医学研究所为例

目的调查浙江省肿瘤医院与中国科学院杭州医学研究所院所融合协同治理的有效性现状,分析影响融合的具体原因,并提出建议。方法根据浙江省肿瘤医院与中国科学院杭州医学研究所院所融合协同治理的具体运行情况,设计协同治理的问卷调查表,研究对象为浙江省肿瘤医院、中国科学院杭州医学研究所职工,共计305人参与问卷调查。结果“影响院所融合成效的首要因素”与“当前院所融合存在的主要问题”存在相关性,性别、职称、学历与“院所融合成效的首要因素”存在相关性,年龄、职务、工作年限、来院工作年限与“院所融合存在的主要问题”存在相关性;职务与“院所融合对医院和医学所产生的实际效果和作用”“对目前院所融合推进程度的评价”“中科院杭州医学所在院所融合过程中发挥的作用”“了解院所融合相关体制机制”等存在相关性。结论“是否为中层干部”对院所融合中的诸多方面产生影响,得出信息获取存在不通畅现象、部分职工激励措施有待加强、融合治理体制机制有待健全等结论。为提升院所融合协调治理的有效性,提出强化信息流通、加强职工激励、健全体制体系等对策。

医院数据资源生产要素化路径研究

近年来数字经济蓬勃发展,国家密切出台政策文件推动数据要素市场的培育和发展。在医疗领域,数据的核心作用逐步呈现和强化,医院数据资源作为生产要素将为医疗行业发展和社会数字经济注入新的动能和活力。本研究通过调研分析影响医院数据资源生产要素化的各项因素和痛点,探索构建了医院数据资源生产要素化路径,以期为相关医疗机构的实践探索提供参考,推动医院数据潜在影响力和社会价值的释放,推动医疗机构的数字化转型。

长三角一体化背景下沪蚌公立医院跨区域合作探索与实践

在长三角卫生健康一体化建设的背景下,同济大学附属第十人民医院与蚌埠市卫生健康委员会开展院地跨区域合作,整体帮扶蚌埠市3家市属公立综合性医院发展。详细阐述了在选派管理团队、确定合作目标任务、输出管理理念、推动合作医院高质量发展等方面的主要做法及所取得的初步成效。研究发现,大型公立医院优质医疗资源下沉,有组织、有计划地“组团式”帮扶地市级城市公立医院,有助于实现医疗资源均衡化。

等级医院评审监测指标数据治理组织建设探索

随着2019年以来“公立医院绩效考核”“新版等级医院评审标准”系列政策文件的发布,使得数据量化方式已经成为综合医院评价的重要手段。但目前除了少部分管理相对完善和信息系统基础较好的医院外,仍有众多医院存在关键系统缺失、大量指标数据靠手工、数据不准确且无法溯源等问题。数据不仅直接影响医院的评审评价结果,也给医院相关部门带来巨大工作负担。文章结合广州艾力彼(GAHA)在医院管理和医院信息化方面多年来的管理经验,以及笔者近两年来在国内多家公立医院信息建设和数据治理咨询辅导的实践案例进行总结,分析当前三级医院评审评价指标数据管理的现状,从指标数据的整体流程、组织建设、制度体系、系统配套等方面提出具体建议,对未来医院数据治理和应用相关工作提出展望。