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Cleaning Up
To cut costs and maximize profits, hospitals in the United States and many other countries are outsourcing such tasks as cleaning and food preparation to private contractors. InCleaning Up, the first book to examine this transformation in the healthcare industry, Dan Zuberi looks at the consequences of outsourcing from two perspectives: its impact on patient safety and its role in increasing socioeconomic inequality. Drawing on years of field research in Vancouver, Canada as well as data from hospitals in the U.S. and Europe, he argues that outsourcing has been disastrous for the cleanliness of hospitals-leading to an increased risk of hospital-acquired infections, a leading cause of severe illness and death-as well as for the effective delivery of other hospital services and the workers themselves.
Zuberi's interviews with the low-wage workers who keep hospitals running uncover claims of exposure to near-constant risk of injury and illness. Many report serious concerns about the quality of the work due to understaffing, high turnover, poor training and experience, inadequate cleaning supplies, and on-the-job injuries. Zuberi also presents policy recommendations for improving patient safety by reducing the risk of hospital-acquired infection and ameliorating the work conditions and quality of life of hospital support workers. He makes the case that hospital outsourcing exemplifies the trend towards \"low-road\" service-sector jobs that threatens to undermine society's social health, as well as the physical health and well-being of patients in health care settings globally.
eBook
Architecture and the modern hospital : Nosokomeion to Hygeia
\"More than any other building type in the twentieth century, the hospital was connected to transformations in the health of populations and expectations of lifespan. From the scale of public health to the level of the individual, the architecture of the modern hospital has reshaped knowledge about health and disease and perceptions of bodily integrity and security. However, the rich and genuinely global architectural history of these hospitals is poorly understood and largely forgotten. This book explores the rapid evolution of hospital design in the twentieth century, analysing the ways in which architects and other specialists re-imagined the modern hospital. It examines how the vast expansion of medical institutions over the course of the century was enabled by new approaches to architectural design and it highlights the emerging political conviction that physical health would become the cornerstone of human welfare\"-- Provided by publisher.
Book
Impact of scribes on emergency medicine doctors’ productivity and patient throughput: multicentre randomised trial
To evaluate the changes in productivity when scribes were used by emergency physicians in emergency departments in Australia and assess the effect of scribes on throughput.
Randomised, multicentre clinical trial.
Five emergency departments in Victoria used Australian trained scribes during their respective trial periods. Sites were broadly representative of Australian emergency departments: public (urban, tertiary, regional referral, paediatric) and private, not for profit.
88 physicians who were permanent, salaried employees working more than one shift a week and were either emergency consultants or senior registrars in their final year of training; 12 scribes trained at one site and rotated to each study site.
Physicians worked their routine shifts and were randomly allocated a scribe for the duration of their shift. Each site required a minimum of 100 scribed and non-scribed shifts, from November 2015 to January 2018.
Physicians' productivity (total patients, primary patients); patient throughput (door-to-doctor time, length of stay); physicians' productivity in emergency department regions. Self reported harms of scribes were analysed, and a cost-benefit analysis was done.
Data were collected from 589 scribed shifts (5098 patients) and 3296 non-scribed shifts (23 838 patients). Scribes increased physicians' productivity from 1.13 (95% confidence interval 1.11 to 1.17) to 1.31 (1.25 to 1.38) patients per hour per doctor, representing a 15.9% gain. Primary consultations increased from 0.83 (0.81 to 0.85) to 1.04 (0.98 to 1.11) patients per hour per doctor, representing a 25.6% gain. No change was seen in door-to-doctor time. Median length of stay reduced from 192 (interquartile range 108-311) minutes to 173 (96-208) minutes, representing a 19 minute reduction (P<0.001). The greatest gains were achieved by placing scribes with senior doctors at triage, the least by using them in sub-acute/fast track regions. No significant harm involving scribes was reported. The cost-benefit analysis based on productivity and throughput gains showed a favourable financial position with use of scribes.
Scribes improved emergency physicians' productivity, particularly during primary consultations, and decreased patients' length of stay. Further work should evaluate the role of the scribe in countries with health systems similar to Australia's.
ACTRN12615000607572 (pilot site); ACTRN12616000618459.
Journal Article
American Catholic Hospitals
InAmerican Catholic Hospitals, Barbra Mann Wall chronicles changes in Catholic hospitals during the twentieth century, many of which are emblematic of trends in the American healthcare system.
Wall explores the Church's struggle to safeguard its religious values. As hospital leaders reacted to increased political, economic, and societal secularization, they extended their religious principles in the areas of universal health care and adherence to the Ethical and Religious Values in Catholic Hospitals, leading to tensions between the Church, government, and society. The book also examines the power of women--as administrators, Catholic sisters wielded significant authority--as well as the gender disparity in these institutions which came to be run, for the most part, by men. Wall also situates these critical transformations within the context of the changing Church policy during the 1960s. She undertakes unprecedented analyses of the gendered politics of post-Second Vatican Council Catholic hospitals, as well as the effect of social movements on the practice of medicine.
eBook
A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest
In a randomized trial involving 8014 patients with out-of-hospital cardiac arrest, the use of epinephrine resulted in a significantly higher rate of 30-day survival than placebo but not a higher rate of survival with a favorable neurologic outcome.
Journal Article
Conflicted health care : professionalism and caring in an urban hospital
\"This book takes an intimate look at how health care practitioners struggle to live up to their professional and caring ideals on twelve-hour shifts on the hospital floor\"--Provided by publisher.
Book
Technical Efficiency of Public and Private Hospitals in Beijing, China: A Comparative Study
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.
Journal Article