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BackgroundAs nurses are the principal care provider in the hospital setting, the completion or omission of nursing care is likely to have a sizable impact on the patient care experience. However, this relationship has not been explored empirically.AimTo describe the prevalence and patterns of missed nursing care and explore their relationship to the patient care experience.MethodsThis cross-sectional study used secondary nurse and patient survey data from 409 adult non-federal acute care US hospitals in four states. Descriptive statistics were calculated and linear regression models were conducted at the hospital level. Regression models included controls for hospital structural characteristics.ResultsIn an average hospital, nurses missed 2.7 of 12 required care activities per shift. Three-fourths (73.4%) of nurses reported missing at least one activity on their last shift. This percentage ranged from 25 to 100 across hospitals. Nurses most commonly reported not being able to comfort or talk with patients (47.6%) and plan care (38.5%). 6 out of 10 patients rated hospitals highly. This proportion ranged from 33% to 90% across hospitals. At hospitals where nurses missed more care (1 SD higher=0.74 items), 2.2% fewer patients rated the hospital highly (p<0.001); a coefficient equivalent to a one-quarter SD change.ConclusionsMissed nursing care is common in US hospitals and varies widely. Most patients rate their hospital care experience highly, but this also varies widely across hospitals. Patients have poorer care experiences in hospitals where more nurses miss required nursing care. Supporting nurses’ ability to complete required care may optimise the patient care experience. As hospitals face changing reimbursement landscapes, ensuring adequate nursing resources should be a top priority.

Background A widespread assumption across health systems suggests that greater clinicians’ involvement in governance and management roles would have wider benefits for the efficiency and effectiveness of healthcare organisations. However, despite growing interest around the topic, it is still poorly understood how managers with a clinical background might specifically affect healthcare performance outcomes. The purpose of this review is, therefore, to map out and critically appraise quantitatively-oriented studies investigating this phenomenon within the acute hospital sector. Methods The review has focused on scientific papers published in English in international journals and conference proceedings. The articles have been extracted through a Boolean search strategy from ISI Web of Science citation and search source. No time constraints were imposed. A manual search by keywords and citation tracking was also conducted concentrating on highly ranked public sector governance and management journals. Nineteen papers were identified as a match for the research criteria and, subsequently, were classified on the basis of six items. Finally, a thematic mapping has been carried out leading to identify three main research sub-streams on the basis of the types of performance outcomes investigated. Results and contribution The analysis of the extant literature has revealed that research focusing on clinicians’ involvement in leadership positions has explored its implications for the management of financial resources, the quality of care offered and the social performance of service providers. In general terms, the findings show a positive impact of clinical leadership on different types of outcome measures, with only a handful of studies highlighting a negative impact on financial and social performance. Therefore, this review lends support to the prevalent move across health systems towards increasing the presence of clinicians in leadership positions in healthcare organisations. Furthermore, we present an explanatory model summarising the reasons offered in the reviewed studies to justify the findings and provide suggestions for future research.

Background Performance measurement is vital for hospitals to become service-oriented, operate efficiently, attract customers, increase revenue, and improve both clinical and non-clinical outcomes, enabling them to succeed in the competitive healthcare sector. Key Performance Indicators (KPIs) play a crucial role in monitoring, assessing, and enhancing care quality and service delivery. However, identifying suitable KPIs for performance measurement can be challenging for hospitals due to a lack of comprehensive sources. Although many studies have explored KPIs, few have specifically addressed performance indicators within the hospital supply chain. Objectives This systematic review seeks to identify and categorize the current knowledge and evidence concerning KPIs for the hospital supply chain. Methods Seven bibliographic databases (PubMed, Scopus, Science Direct, Web of Science, Embase, ProQuest, and IEEE Xplore) were utilized in this research. The initial search identified 3661 articles; following a review of the titles, abstracts, and full texts, 32 articles were selected. Additionally, backward reference list checks were performed on the selected studies. Relevant studies were included based on the objectives, and data extraction was conducted using a form created in Word 2016. Results A total of 64 KPIs for the hospital supply chain were identified. The performance indicators were categorized into financial ( n  = 37), managerial ( n  = 15), and clinical ( n  = 12) categories. Conclusions This comprehensive review successfully identified 64 KPIs, highlighting their potential to advance clinical practice and enhance patient care in hospitals. Further research is essential to establish a standardized methodology for KPI development within the hospital supply chain.

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals.Design Mixed method evaluation involving five substudies, before and after design.Setting NHS hospitals in the United Kingdom.Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals.Intervention The SPI1 was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change.Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals.Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening.

Vinmec Times City International Hospital is the first organization in Vietnam to receive certification from both the College of American Pathologists (CAP) Laboratory Accreditation Program (LAP) and Joint Commission International, marking a significant turning point in Vietnam's approach to health care quality control. This article shares our journey toward CAP accreditation, offering insights from a laboratory in a developing nation. The data sources include documentation of our laboratory's experiences during 2 years (2020-2022), illustrating the collaborative work and achievements in preparing for the first inspection of the CAP LAP, alongside prior discussions and commitments (2018-2020) to develop our plan. By working as a cohesive team of pathologists and staff, with a well-thought-out plan and strong support from the hospital's executive leadership and administrative team, Vinmec Times City International Hospital in Hanoi was able to take the initial steps toward achieving and maintaining an international standard in laboratory quality management.

Purpose The purpose of this paper is to assess the influence of patients’ expectations from healthcare service quality on their satisfaction with nursing in public and private hospitals of Pakistan. Design/methodology/approach Data (n=456) were collected from three public sector hospitals and three private sector hospitals of Lahore, the capital of Pakistan’s most populous province. Male and female patients who have experience of both sectors were surveyed using a self-administered questionnaire developed using the original SERVQUAL approach. Data were analyzed using the statistical techniques and the Laplace criterion. Findings This paper attempts to explain degree of influences of five service quality constructs (empathy, responsiveness, tangibility, reliability and assurance) on Pakistani patients’ expectations from the private and public sector hospitals and thus patient satisfaction. Further, this work can offer several intuitions into the effect of five constructs of service quality on patients’ expectations of healthcare service quality and patient satisfaction with the service providers/nursing. The results reveal that the patient satisfaction is most strongly related to empathy in public sector and to responsiveness in private sector. Research limitations/implications In light of the previous studies and the current research findings, the study anticipates no apparently significant improvement in healthcare sector of Pakistan in near future considering various factors discussed in the study. The study will also help the service providers and the policy makers in understanding the deteriorating situation of the Pakistani healthcare sector and will guide them in identifying the areas by improving which not only the healthcare service quality in the country can be improved but also the image of healthcare sector among the masses and competitiveness of the healthcare sector can be enhanced. Originality/value The value of the study rests in its critical analysis of the current status of the healthcare sector of Pakistan with a view to suggest the areas that need to be worked on by the service providers and policy makers. Also, the study tries to settle a controversy within Pakistani healthcare literature concerning the question that who is producing more satisfied patients: private hospitals or their public counterparts?

[...]the Italian national health system suggested a reorganization in order to optimize already existing resources and implement them to overcome the crisis caused by the pandemic. The entire OT team is equipped with full Personal Protection Equipment (PPE); numerically surgeons, nurses, anaesthetists are limited to the minimum required staff to perform surgery. [...]changes of personnel are limited until the end of the procedure in order to involve the least number of operators. According to the precautionary principle, every patient undergoing emergency surgery not already tested for COVID-19, must be considered as potentially infected, an issue that entails putting into practice of all precautions. [...]as suggested by Diaz et al. surgeons have witnessed one of the most dramatic changes in their practices with rapidly decreasing numbers of elective surgeries.5 In our opinion, the interruption of the elective non-oncological surgery procedures may cause stress due to the discomfort that the postponement will cause to the patient, as well as the rescheduling which the surgeon will

Background Hospitals constitute an essential part of health systems. Although fragmented data indicate that hospitals in many European countries face financial problems, no structured, comparative data are available. The objective of this study was to identify, synthetize, and map the existing evidence on hospital financial performance (FP) across European countries. Methods A scoping literature review was conducted, following standardized methodological guidelines and a previously published protocol. Four scientific databases (PubMed, Web of Science Core Collection, Scopus, and ProQuest Central) were searched to identify studies published since 2010. The inclusion criteria were as follows: (1) the focus is on hospital settings in a European country; (2) FP is measured at the hospital level using a defined ratio; and (3) it is a full text publication in English. Results After screening 3422 records, a total of 62 full text publications focusing on 13 European countries were included (53 empirical studies and nine policy/discussion papers or technical reports). The empirical studies focused on four main categories: (1) measuring and/or comparing hospital FP ( n  = 20/53); (2) identifying associations between FP and other hospital (mostly organizational) characteristics ( n  = 38/53); (3) analysing the impact of an event on hospital FP ( n  = 11/53); and (4) other, e.g. developing a comprehensive hospital performance matrix with FP as one of the dimensions ( n  = 6/53). The vast majority of empirical studies are quantitative, use secondary data sources, and apply single profitability indicators to measure FP. The results of the identified studies are often mixed and highly specific to context, data, and methods. Conclusions Research evidence on hospital FP in Europe is available for a limited number of countries. The existing empirical studies focus mostly on analysing the relationships between hospital FP and other organizational characteristics (e.g., ownership and management style). Our review highlights two major research gaps: (1) a lack of evidence on associations between hospital FP and quality of care metrics; and (2) a need for more theoretical/conceptual work on composite FP metrics that are relevant for hospital care providers.

Introduction The risk of dose errors is high in paediatric inpatient settings. Computerized provider order entry (CPOE) systems with clinical decision support (CDS) may assist in reducing the risk of dosing errors. Although a frequent type of medication error, the prevalence of dose errors is not well described. Dosing error rates in hospitals with or without CPOE have not been compared. Objective Our aim was to conduct a systematic review assessing the prevalence and impact of dose errors in paediatric wards with and without CPOE and/or CDS. Methods We systematically searched five databases to identify studies published between January 2000 and December 2017 that assessed dose error rates by medication chart audit or direct observation. Results We identified 39 studies, nine of which involved paediatric wards using CPOE with or without CDS. Studies of paediatric wards using paper medication charts reported approximately 8–25% of patients experiencing a dose error, and approximately 2–6% of medication orders and approximately 3–8% of dose administrations contained a dose error, with estimates varying by ward type. The nine studies of paediatric wards using CPOE reported approximately 22% of patients experiencing a dose error, and approximately 1–6% of medication orders and approximately 3–8% of dose administrations contained a dose error. Few studies provided data for individual wards. The severity and prevalence of harm associated with dose errors was rarely assessed and showed inconsistent results. Conclusions Dose errors occur in approximately 1 in 20 medication orders. Hospitals using CPOE with or without CDS had a lower rate of dose errors compared with those using paper charts. However, few pre/post studies have been conducted and none reported a significant reduction in dose error rates associated with the introduction of CPOE. Future research employing controlled designs is needed to determine the true impact of CPOE on dosing errors among children, and any associated patient harm.

ObjectiveTo explore the causes of failure to activate the rapid response system (RRS). The organisation has a recognised incidence of staff failing to act when confronted with a deteriorating patient and leading to adverse outcomes.DesignA multi-method study using the following: a point prevalence survey to determine the incidence of abnormal simple bedside observations and activation of the rapid response team by clinical staff; a prospective audit of all patients experiencing a cardiac arrest, unplanned intensive care unit admission or death over an 8-week period; structured interviews of staff to explore cognitive and sociocultural barriers to activating the RRS.SettingSouthern Health is a comprehensive healthcare network with 570 adult in-patient beds across four metropolitan teaching hospitals in the south-eastern sector of Melbourne.MeasurementsFrequency of physiological instability and outcomes within the in-patient hospital population. Qualitative data from staff interviews were thematically coded.ResultsThe incidence of physiological instability in the acute adult population was 4.04%. Nearly half of these patients (42%) did not receive an appropriate clinical response from the staff, despite most (69.2%) recognising their patient met physiological criteria for activating the RRS, and being ‘quite’, or ‘very’ concerned about their patient (75.8%). Structured interviews with 91 staff members identified predominantly sociocultural reasons for failure to activate the RRS.ConclusionsDespite an organisational commitment to the RRS, clinical staff act on local cultural rules within the clinical environment that are usually not explicit. Better understanding of these informal rules may lead to more appropriate activation of the RRS.