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Objective: With the participation of private hospitals in the health system, improving hospital efficiency becomes more important. This study aimed to evaluate the technical efficiency of public and private hospitals in Beijing, China, and analyze the influencing factors of hospitals’ technical efficiency, and thus provide policy implications to improve the efficiency of public and private hospitals. Method: This study used a data set of 154–232 hospitals from “Beijing’s Health and Family Planning Statistical Yearbooks” in 2012–2017. The data envelopment analysis (DEA) model was employed to measure technical efficiency. The propensity score matching (PSM) method was used for matching “post-randomization” to directly compare the efficiency of public and private hospitals, and the Tobit regression was conducted to analyze the influencing factors of technical efficiency in public and private hospitals. Results: The technical efficiency, pure technical efficiency and scale efficiency of public hospitals were higher than those of private hospitals during 2012–2017. After matching propensity scores, although the scale efficiency of public hospitals remained higher than that of their private counterparts, the pure technical efficiency of public hospitals was lower than that of private hospitals. Panel Tobit regression indicated that many hospital characteristics such as service type, level, and governance body affected public hospitals’ efficiency, while only the geographical location had an impact on private hospitals’ efficiency. For public hospitals in Beijing, those with lower average outpatient and inpatient costs per capita had better performance in technical efficiency, and bed occupancy rate, annual visits per doctor, and the ratio of doctors to nurses also showed a positive sign with technical efficiency. For private hospitals, the average length of stay was negatively associated with technical efficiency, but the bed occupancy rate, annual visits per doctor, and average outpatient cost were positively associated with technical efficiency. Conclusions: To improve technical efficiency, public hospitals should focus on improving the management standards, including the rational structure of doctors and nurses as well as appropriate reduction of hospitalization expenses. Private hospitals should expand their scale with proper restructuring, mergers, and acquisitions, and pay special attention to shortening the average length of stay and increasing the bed occupancy rate.

Background Each year, 2.2 million intrapartum-related deaths (intrapartum stillbirths and first day neonatal deaths) occur worldwide with 99% of them taking place in low- and middle-income countries. Despite the accelerated increase in the proportion of deliveries taking place in health facilities in these settings, the stillborn and neonatal mortality rates have not reduced proportionately. Poor quality of care in health facilities is attributed to two-thirds of these deaths. Improving quality of care during the intrapartum period needs investments in evidence-based interventions. We aim to evaluate the quality improvement package—Scaling Up Safer Bundle Through Quality Improvement in Nepal (SUSTAIN)—on intrapartum care and intrapartum-related mortality in public hospitals of Nepal. Methods We will conduct a stepped wedge cluster randomized controlled trial in eight public hospitals with each having least 3000 deliveries a year. Each hospital will represent a cluster with an intervention transition period of 2 months in each. With a level of significance of 95%, the statistical power of 90% and an intra-cluster correlation of 0.00015, a study period of 19 months should detect at least a 15% change in intrapartum-related mortality. Quality improvement training, mentoring, systematic feedback, and a continuous improvement cycle will be instituted based on bottleneck analyses in each hospital. All concerned health workers will be trained on standard basic neonatal resuscitation and essential newborn care. Portable fetal heart monitors (Moyo®) and neonatal heart rate monitors (Neobeat®) will be introduced in the hospitals to identify fetal distress during labor and to improve neonatal resuscitation. Independent research teams will collect data in each hospital on intervention inputs, processes, and outcomes by reviewing records and carrying out observations and interviews. The dose-response effect will be evaluated through process evaluations. Discussion With the global momentum to improve quality of intrapartum care, better understanding of QI package within a health facility context is important. The proposed package is based on experiences from a similar previous scale-up trial carried out in Nepal. The proposed evaluation will provide evidence on QI package and technology for implementation and scale up in similar settings. Trial registration number ISRCTN16741720 . Registered on 2 March 2019.

Background Peripheral venous catheters are the most commonly used invasive devices in hospitals worldwide. Patients can experience multiple adverse events during the insertion, maintenance, and management of these devices. Health professionals aim to resolve the challenges of care variability in the use of peripheral venous catheter through adherence to clinical practice guidelines. The aim of this cluster-randomized controlled trial is to determine the efficacy of a multimodal intervention on incidence of adverse events associated with the use of peripheral venous catheters in adult hospital patients. Additional aims are to analyze the fidelity of nurses and the relationship between contextual factors on the use of best available and the outcomes of the intervention. Methods Five public hospitals in the Spanish National Health System, with diverse profiles, including one university hospital and four second-level hospitals, will be included. In total, 20 hospitalization wards will be randomized for this study by ward to one of two groups. Those in the first group receive an intervention that lasts 12 months implementing evidence-based practice in healthcare related to peripheral catheters through a multimodal strategy, which will contain updated and poster protocols insertion, maintenance and removal of peripheral venous catheters, technologies applied to e-learning, feedback on the results, user and family information related to peripheral catheter, and facilitation of the best evidence by face-to-face training session. Primary outcome measures: Incidence of adverse events associated with the use of peripheral venous catheters is measured by assessing hospital records. Secondary outcome measures: Nurses’ adherence to clinical practice guidelines, clinical outcomes, and the cost of implementing the multimodal intervention. Discussion Clinical implementation is a complex, multifaceted phenomenon which requires a deep understanding of decision-making, knowledge mobilization, and sense making in routine clinical practice. Likewise, the inclusion of strategies that promote fidelity to recommendations through multicomponent and multimodal intervention must be encouraged. The use of a transfer model could counterbalance one of the greatest challenges for organizations, the evaluation of the impact of the implementation of evidence in the professional context through quality indicators associated with prevention and control of infections. Trial registration Current Controlled Trials ISRCTN10438530 . Registered 20 March 2018.

To evaluate the prevalence of vitamin D deficiency among a group of Saudi children with type 1 diabetes mellitus (T1DM) in Armed Forces Hospital and Riyadh Care Hospital in Riyadh, Kingdom of Saudi Arabia. Methods: The study was carried out in Riyadh Armed Forces Hospital and Riyadh Care Hospital in Riyadh, Kingdom of Saudi Arabia, from January to June 2017. This study included a total of 100 Saudi (50 males and 50 females) participants with T1DM, aged 2-12 years old. Hemoglobin A1c (HbA1c) levels, serum calcium phosphorous and 25(OH) vitamin D were analyzed. Results: Seventy percent of the children with T1DM examined showed a reduced level of vitamin D. Vitamin D deficiency was more common in female children compared than male. Serum 25(OH) vitamin D was significantly inversely associated with body mass index as well as HbA1c. Conclusion: There is a concern that growing children with low vitamin D may be at higher risk for T1DM. It is necessary to further examine the mechanisms underlying vitamin D deficiency in T1DM children.

China's 3 year, CN¥850 billion (US$125 billion) reform plan, launched in 2009, marked the first phase towards achieving comprehensive universal health coverage by 2020. The government's undertaking of systemic reform and its affirmation of its role in financing health care together with priorities for prevention, primary care, and redistribution of finance and human resources to poor regions are positive developments. Accomplishing nearly universal insurance coverage in such a short time is commendable. However, transformation of money and insurance coverage into cost-effective services is difficult when delivery of health care is hindered by waste, inefficiencies, poor quality of services, and scarcity and maldistribution of the qualified workforce. China must reform its incentive structures for providers, improve governance of public hospitals, and institute a stronger regulatory system, but these changes have been slowed by opposition from stakeholders and lack of implementation capacity. The pace of reform should be moderated to allow service providers to develop absorptive capacity. Independent, outcome-based monitoring and evaluation by a third-party are essential for mid-course correction of the plans and to make officials and providers accountable.

Abstract Objective To assess the effectiveness of moving patients who are waiting in hospital for a long term care bed to an off-site transitional care facility. Design Randomised controlled trial. Setting Three public hospitals in Southern Adelaide. Participants 320 elderly patients (mean age 83 years) in acute hospital beds (212 randomised to intervention, 108 to control). Interventions A transitional care facility where all patients received a single assessment from a specialist elder care team and appropriate ongoing therapy. Main outcome measures Length of stay in hospital, rates of readmission, deaths, and patient's functional level (modified Barthel index), quality of life (assessment of quality of life), and care needs (residential care scale) at four months. Results From admission, those in the intervention group stayed a median of 32.5 days (95% confidence interval 29 to 36 days) in hospital. In the control group the median length of stay was 43.5 days (41 to 51 days) (95% confidence interval for difference 6 to 16 days). Patients in the intervention group took a median of 21 days (6 to 27 days) longer to be admitted to permanent care than those in the control group. In both groups few patients went home (14 (7%) in the intervention group v 9 (9%) in the control group). There were no significant differences in death rates (28% v 27%) or rates of transfer back to hospital (28% v 25%). Conclusions For frail elderly patients who are awaiting a residential care bed transfer out of hospital to an off-site transitional care unit with focus on aged care “unblocks beds” without adverse effects.

Background Extant literature suggested that positive organizational climate leads to higher levels of organizational commitment, which is an important concept in terms of employee attitudes, likewise, the concept of perceived organizational performance, which can be assumed as a mirror of the actual performance. For healthcare settings, these are important matters to consider due to the fact that the service is delivered thoroughly by healthcare workers to the patients. Therefore, attitudes and perceptions of the employees can influence how they deliver the service. The aim of this study was to evaluate healthcare employees’ perceptions of organizational climate and test the hypothesized impact of organizational climate on organizational commitment and perceived organizational performance. Methods The study adopted a quantitative approach, by collecting data from the healthcare workers currently employed in public hospitals in North Cyprus, utilizing a self-administered questionnaire. Collected data was analyzed with the help of Statistical Package for Social Sciences, and ANOVA and Linear Regression analyses were used to test the hypothesis. Results Results revealed that organizational climate is highly correlated with organizational commitment and perceived organizational performance. Simple linear regression outcomes indicated that organizational climate is significant in predicting organizational commitment and perceived organizational performance. Conclusions There was a positive and linear relationship between organizational climate with organizational commitment and perceived organizational performance. Results from the regression analysis suggested that organizational climate has an impact on predicting organizational commitment and perceived organizational performance of the employees in public hospitals of North Cyprus. Organizational climate was found to be statistically significant in determining the organizational commitment of the employees. The results of the study provided some critical issues regarding the relationship of three concepts in the study. According to the findings, if the organizational climate scores of the employees are high, organizational commitment scores of the employees are high at the same time. In other words, if the employees in public hospitals of North Cyprus perceive the organizational climate in a positive way, they will have higher levels of organizational commitment. Findings suggested that organizational climate is an important factor in healthcare settings in terms of employee commitment and how employees perceive organizational performance, which would lead to significant results about the provision of service in healthcare organizations.

Because of overcrowding and cost-control efforts, emergency departments are under pressure to refer patients with nonacute conditions to other settings. However, no validated systematic methods exist for safely performing such referrals. To determine the effects on health status and access to care of systematically referring patients with nonacute conditions to next-day primary care. Randomized, controlled trial. An emergency department in a public hospital. 156 adults who used the emergency department on weekdays from 7:00 a.m. to 3:00 p.m. and met criteria for deferred care. The criteria applied to three symptom complexes that account for 33% of U.S. emergency department visits by adults. Next-day care at the study site's primary care center or usual same-day care. Self-reported health status and use of health services during 1-week follow-up. Patients assigned to next-day care did not demonstrate clinically important disadvantages in health status or physician visits compared with usual care patients. In each group, more than 95% of patients were evaluated at least once by a physician, 4% sought health services after their initial evaluation, and no patients were hospitalized or died. At follow-up, both groups reported improved health status and fewer days in bed or with disability, although the deferred care group reported less improvement on all three measures. The 95% CIs were sufficiently narrow to exclude a clinically significant difference in self-reported health status. However, the possibility of 1 additional day in bed or with disability in the deferred care group could not be excluded. Clinically detailed standardized screening criteria can safely identify patients at public hospital emergency departments for referral to next-day care. However, larger studies are needed to assess the possibility of adverse effects.

Achieving universal health care coverage—a key target of the United Nations Sustainable Development Goal number 3—requires accessibility to health care services for all. Currently, in sub-Saharan Africa, at least one-sixth of the population lives more than 2 h away from a public hospital, and one in eight people is no less than 1 h away from the nearest health center. We combine high-resolution data on the location of different typologies of public health care facilities [J. Maina et al., Sci. Data 6, 134 (2019)] with population distribution maps and terrain-specific accessibility algorithms to develop a multiobjective geographic information system framework for assessing the optimal allocation of new health care facilities and assessing hospitals expansion requirements. The proposed methodology ensures universal accessibility to public health care services within prespecified travel times while guaranteeing sufficient available hospital beds. Our analysis suggests that to meet commonly accepted universal health care accessibility targets, sub-Saharan African countries will need to build ∼6,200 new facilities by 2030. We also estimate that about 2.5 million new hospital beds need to be allocated between new facilities and ∼1,100 existing structures that require expansion or densification. Optimized location, type, and capacity of each facility can be explored in an interactive dashboard. Our methodology and the results of our analysis can inform local policy makers in their assessment and prioritization of health care infrastructure. This is particularly relevant to tackle health care accessibility inequality, which is not only prominent within and between countries of sub-Saharan Africa but also, relative to the level of service provided by health care facilities.

Respectful provision of care is an integral component of quality maternity care service. The objective of the present study was to assess the status of respectful maternity care and its associated factors in public and private hospitals in Bangladesh. A cross-sectional study was conducted at a tertiary care public hospital and a tertiary care private hospital in Chittagong, Bangladesh from October 2023 to September 2024. Face-to-face interviews using a structured questionnaire was conducted to collect data from postnatal women. Respectful maternity care was measured using a validated 15-item tool with four domains (friendly, abuse-free, timely, and discrimination-free care). Logistic regression analysis was used to identify factors associated with respectful maternity care. A number of 264 postnatal women from the public hospital and 334 from the private hospital were included in the study. Overall, 55.5% of them received respectful maternity care, with significant differences between public (33.7%) and private (72.8%) hospitals (p-value <0.001). Women in private hospitals reported higher standards across all domains, with the largest disparity in discrimination-free care (98% in private vs. 56% in public hospitals, p < 0.001). Logistic regression showed that women in private hospitals (adjusted odds ratio, aOR 18.10; 95% confidence interval, CI 8.43-42.0), those with facility-level referrals (aOR 2.88; 95% CI 1.59-5.31), and cesarean deliveries (aOR 2.45; 95% CI 1.26-5.07) were significantly more likely to receive respectful maternity care. Respectful maternity care was significantly more likely among women delivering in private hospitals, through facility-level referrals, and by cesarean section, indicating gaps in public hospital practices that require attention to ensure respectful care for all mothers.