Biomedical subjects

George H Pink

Publications and source records attributed to George H Pink.

12 recordsLinked to original sources

PubMed2006

Financial indicators for critical access hospitals.

CONTEXT: There is a growing recognition of the need to measure and report hospital financial performance. However, there exists little comparative financial indicator data specifically for critical access hospitals (CAHs). CAHs differ from other hospitals on a number of dimensions that might affect appropriate indicators of performance, including differences in Medicare reimbursement, limits on bed size and average length of stay, and relaxed staffing rules. PURPOSE: To develop comparative financial indicators specifically designed for CAHs using Medicare cost report data. METHODS: A technical advisory group of individuals with extensive experience in rural hospital finance and operations provided advice to a research team from the University of North Carolina at Chapel Hill. Twenty indicators deemed appropriate for assessment of CAH financial condition were chosen and formulas determined. Issues 1 and 2 of the CAH Financial Indicators Report were mailed to the chief executive officers of 853 CAHs in the summer of 2004 and 1,092 CAHs in the summer of 2005, respectively. Each report included indicator values specifically for their CAH, indicator medians for peer groups, and an evaluation form. FINDINGS: Chief executive officers found the indicators to be useful and the underlying formulas to be appropriate. The multiple years of data provide snapshots of the industry as a whole, rather than trend data for a constant set of hospitals. CONCLUSIONS: The CAH Financial Indicators Report is a useful first step toward comparative financial indicators for CAHs.

Benchmarking↗

PubMed2006

Pay-for-performance in publicly financed healthcare: some international experience and considerations for Canada.

Recent reports in the United States and Canada provide evidence that healthcare systems routinely fail to deliver safe and high-quality healthcare services. Governments and other healthcare payers have begun to experiment with pay-for-performance programs that offer healthcare providers and organizations financial incentives for quality. The purpose of this paper is (1) to provide an overview of the design of major pay-for-performance programs in the United States, the United Kingdom, and Australia, with specific focus on government-sponsored programs, and (2) to articulate some considerations for potential implementation of pay-for-performance in Canada.

Australia↗

PubMed2006

Financial benchmarks for Ontario hospitals.

Since the inception of the Hospital Reports in 1998, researchers have focused on three separate but related problems--how to measure performance; how to evaluate performance; and how to transfer knowledge about excellent performance to the field. This article describes a method to address the second problem--how to evaluate performance by benchmarking two indicators of financial performance and condition through three years of recent data for Ontario hospitals.

Benchmarking↗

PubMed2005

Acute care hospital strategic priorities: perceptions of challenges, control, competition and collaboration in Ontario's evolving healthcare system.

To explore the current and pending strategic agenda of Ontario hospitals (the largest consumers of the provincial healthcare budget), a survey of Ontario acute care hospital CEOs was conducted in January 2004. The survey, with an 82% response rate, identifies 29 strategic priorities under seven key strategic themes consistent across different hospital types. These themes include (1) human resources cultivation, (2) service integration and partnerships, (3) consumer engagement, (4) corporate governance and management, (5) organizational efficiency and redesign, (6) improved information use for decision-making, (7) patient care management. The extent to which an individual hospital's control over strategic resolutions is perceived may affect multilevel strategic priority-setting and action-planning. In addition to supporting ongoing development of meaningful performance measures and information critical to strategic decision-making, this study's findings may facilitate a better understanding of hospitals' key resource commitments, the extent of competition and collaboration for key resources, the perceived degree of individual control over strategic issue resolution and where systemic resolutions may be required.

Attitude of Health Personnel↗

PubMed2004

Nurse staffing models, nursing hours, and patient safety outcomes.

BACKGROUND DATA: Limited research has been conducted examining the effect of nurse staffing models on costs and patient outcomes. OBJECTIVE: The objective of this study was to evaluate the effect of different nurse staffing models on costs and the patient outcomes of patient falls, medication errors, wound infections, and urinary tract infections. METHODS: A descriptive correlational study was conducted in all of the 19 teaching hospitals in Ontario, Canada. The sample comprised hospitals and adult medical, surgical, and obstetric inpatients within those hospitals. RESULTS: The lower the proportion of professional nursing staff employed on a unit, the higher the number of medication errors and wound infections. The less experienced the nurse, the higher the number of wound infections. Nurse staffing models that included a lower proportion of professional nursing staff in the mix used more nursing hours in this study. CONCLUSIONS: The results of this study suggest that a higher proportion of professional nurses in the staff mix (RNs/RPNs) on medical and surgical units in Ontario teaching hospitals are associated with lower rates of medication errors and wound infections. Higher patient complexity was associated with greater patient use of nursing care resources.

Adult↗

PubMed2004

Comparative performance data for critical access hospitals.

CONTEXT: Among small rural hospitals, there is a growing recognition of the need to measure and report on the use of resources and the safety and quality of the services provided. Dashboards, clinical value compasses, and balanced scorecards are approaches to performance measurement that have been adopted by many health care organizations. However, there exists very little comparative performance data specific for critical access hospitals. PURPOSE: To identify how comparative performance data for critical access hospitals (CPD-CAH) might facilitate performance and quality improvement, to assess the potential benefits and drawbacks of such data, and to identify some of the critical issues in the development and implementation of CPD-CAH. METHODS: Assessment of discussions by participants at a rural hospital performance improvement summit and authors' analyses. FINDINGS: CPD-CAH potentially could improve quality of care and patient outcomes, provide comparative data and benchmarks, inform policy development, facilitate collaboration, and enhance community relations. However, CPD-CAH could also impose an unaffordable cost, produce poor information, require complex coordination, induce a negative public reaction, and result in perverse hospital behavior. Development and implementation of CPD-CAH would require including stakeholders' assessment of its desirability and feasibility, setting objectives, establishing guiding principles, developing a method, collecting and analyzing data, and disseminating results. CONCLUSIONS: CPD-CAH could significantly advance CAH performance and quality improvement. However, development and implementation would be a complicated exercise requiring academic expertise and practitioner consultation. The potential value of CPD-CAH should be carefully weighed against its potential cost.

Benchmarking↗

PubMed2004

Canadian-trained nurses in North Carolina.

Little is known about nurses who leave Canada to work in the US. The main purpose of this study is to gain some insight into the emigration component of nursing supply and demand by comparing characteristics of nurses who left Canada to nurses who stayed. Specifically, Canadian-trained RNs who work in the state of North Carolina are compared to RNs who work in Canada. Results show that there are 40% more Canadian-trained RNs in North Carolina than there are in Prince Edward Island. A higher percentage of Canadian-trained RNs in North Carolina are male, under 40 years of age, have baccalaureate training and graduated less than 10 years ago. Canadian-trained nurses in both countries have very low rates of unemployment. The loss of Canadian-trained RNs to the US is a significant problem, and there is an urgent need to obtain a better understanding of why nurses leave the country.

Adult↗

PubMed2003

The use of 'arms-length' organizations for health system change in Ontario, Canada: some observations by insiders.

During the past decade, there has been substantial health system reform in the United States, United Kingdom, New Zealand, and many other countries. For the most part, Canada has not pursued 'big bang' health system change but rather a variety of strategies to achieve incremental change. In this paper, we present the ways in which three arms-length organizations have been used by government to effect incremental system change in Ontario during the past several years. We observe that, (1) the influence of politics and political interference can be reduced through an arms-length organization; (2) an arms-length organization with the power to make decisions entails more political risk for government and encounters more scrutiny and criticism by providers and the media than an organization with the power to recommend only; (3) an arms-length organization with a limited lifespan faces more delaying tactics by adversely affected parties than an organization without a limited lifespan; (4) an arms-length organization with perceived influence may attract causes that are not related to its mandate; (5) the importance and difficulty of communicating complex information about system change to a wide variety of audiences cannot be overstated; (6) system change informed by the use of expert opinion encounters less provider resistance and may result in better decisions; and (7) the reputation of the Chair and the perceived competence and experience of the CEO are critical success factors in the success of an arms-length organization.

Cardiac Care Facilities↗

PubMed2003

Nurse staffing models as predictors of patient outcomes.

BACKGROUND: Little research has been conducted that examined the intended effects of nursing care on clinical outcomes. OBJECTIVE: The objective of this study was to evaluate the impact of different nurse staffing models on the patient outcomes of functional status, pain control, and patient satisfaction with nursing care. RESEARCH DESIGN: A repeated-measures study was conducted in all 19 teaching hospitals in Ontario, Canada. SUBJECTS: The sample comprised hospitals and adult medical-surgical and obstetric inpatients within those hospitals. MEASURES: The patient's functional health outcomes were assessed with the Functional Independence Measure (FIM) and the Medical Outcome Study SF-36. Pain was assessed with the Brief Pain Inventory and patient perceptions of nursing care were measured with the nursing care quality subscale of the Patient Judgment of Hospital Quality Questionnaire. RESULTS: The proportion of regulated nursing staff on the unit was associated with better FIM scores and better social function scores at hospital discharge. In addition, a mix of staff that included RNs and unregulated workers was associated with better pain outcomes at discharge than a mix that involved RNs/RPNs and unregulated workers. Finally, patients were more satisfied with their obstetric nursing care on units where there was a higher proportion of regulated staff. CONCLUSIONS: The results of this study suggest that a higher proportion of RNs/RPNs on inpatient units in Ontario teaching hospitals is associated with better clinical outcomes at the time of hospital discharge.

Adult↗

PubMed2003

A province-wide study of the association between hospital resource allocation and length of stay.

The relationship between hospital resource allocation and clinical efficiency is poorly understood. Within the single-payer healthcare system in Ontario, Canada, the association between hospital spending patterns and length of stay was studied using data from 1117090 patient discharges in 1997/8 at 162 of 171 acute care hospitals. A weighted regression model was created using an overall hospital length of stay index (actual length of stay divided by predicted length of stay) as the dependent variable. Control variables included: hospital size, teaching activity, occupancy rate, rural location and geographic region. Four independent spending variables were defined as a percentage of total hospital spending: nursing, ambulatory care, administration and support, and diagnostics and therapeutics. The reduced regression model had an r-squared of 0.45. Across all spending variables, hospitals spending relatively too little or too much had significantly longer length of stay. Hospitals' overall pattern of resource allocation was also significantly associated with length of stay. Thus, measurable clinical effects can be seen with resource allocation decisions made by hospital management, supporting the need for rigorous decision-making processes. Future research should focus on exploring the nature of this relationship and the potential interdependencies among hospital services that cause this effect.

Acute Disease↗

PubMed2003

Use of the balanced scorecard in health care.

Since Kaplan and Norton published their article proposing a balanced scorecard, the concept has been widely adopted by industry and health care provider organizations. This article reviews the use of the balanced scorecard in health care and concludes that the balanced scorecard: (1) is relevant to health care, but modification to reflect industry and organizational realities is necessary; (2) is used by a wide range of health care organizations; (3) has been extended to applications beyond that of strategic management; (4) has been modified to include perspectives, such as quality of care, outcomes, and access; (5) increases the need for valid, comprehensive, and timely information; and (6) has been used by two large-scale efforts across many health care organizations in a health care sector, which differ, namely in the units of analysis, purposes, audiences, methods, data, and results.

Benchmarking↗

PubMed2002

Nurse staffing and work status in medical, surgical and obstetrical units in Ontario teaching hospitals.

This article reports on the staff mix and work status of nurses in the adult medical, surgical and obstetrical units in Ontario's teaching hospitals. While staff nurses have extensive career experience, most have been on their unit a much shorter period of time. More than one-third of the nursing staff in the study were employed on a part-time or casual basis, with few indicating an interest in moving into full-time positions. The need for enhanced retention strategies on these units is identified, as well as the development of a better understanding of motivating factors for nurses' regarding full-time, part-time or casual work options.

Adult↗