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JAKOŚĆ ŚWIADCZEŃ MEDYCZNYCH W AKREDYTACJI SZPITALI

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EN
The article describes outcomes of the survey carried out on a group of Polish hospitals accredited by the National Centre for Quality Assessment in Health Care. The aim of the survey was to identify the groups of standards and individual standards that were difficult to implement, standards that weren’t implemented and the causes of problems with implementation. Hospitals have problems with implementation of standards in a field of information management, hospital infection monitoring, anesthesiology and assessment of patient condition. The standards that weren’t implement belong to groups called information management, anesthesiology and patient rights. The main reason of the problems was that the medical staff don’t accept changes in hospital operation appearing during the implementation of Hospital Accreditation Program.
EN
Purpose: The present study aimed to evaluate mental health and coping strategies among nursing staff in two public hospitals of Greece. Materials and methods: This cross-sectional study was conducted on 318 nurses working in two public hospitals in Attica, Greece from February 2017 to May 2017. Data were collected using the Patient Health Questionnaire-2 (PHQ-2), the Generalized Anxiety Disorder Questionnaire (GAD-2) and the Greek version of the Ways of Coping Questionnaire. The data were presented as mean and standard deviation and analyzed through student tâ“test, chi-square, and descript_ive statistics using SPSS Version 21.0. The significance level was accepted as P values <0.05. Results: Data analysis revealed that 44% of nurses were suffering from depression and 40.3% from anxiety, with the type of hospital (p≤ 0.001) and marital status (p = 0.031) affecting stress levels. Conclusions: Working in mental health hospital and married nurses were the main risk factors for manifestation of anxiety/depression symptoms among nursing staff. Individual nurse characteristics, such as working experience as well as working environment (general and mental health hospital) were found to be associated with the nurses’ coping strategies in their attempt to deal with their work.
EN
In individual cases of hospitals, we can see a far-reaching convergence of views, especially when this did not significantly affect the interests of groups or institutions. However, there were extremely fierce disputes over the proposals that undermined the monopolistic position of the Church and its income. During the Four-Year Sejm, anticlerical tendencies intensified. The Authorities of the Four-Year Sejm tried to solve the problem of hospital funds, repeatedly raised in the 18th century (and earlier), but – a.o., due to the resistance of some clergymen - they managed to gather only some information from hospital managers. The activities of the authorities with regard to the hospitals tentatively aimed at their medicalisation, whereas the Church, in its mainstream, adhered to inalterability of social care and opposed any interference or change.
EN
The purpose of this paper is to evaluate public hospitals profitability in Poland. The research was carried out on the basis of 67 financial statements and covers the period of time from 2009 to 2011. It has been hypothesized that the profitability of hospitals is systematically deteriorating due to cost pressure and the lack of a significant increase in revenues. In 2009, more than half of hospitals had a net profit and operating profit, while in 2011 only one-third. The average ROA, ROE and EBIT margin and ROS in each year were negative in the research sample. An exception was the average EBITDA margin. However, in hospitals which had an operating profit, ROS and EBIT margin was rather low and achieved approximately a value of 2%.
EN
The Customer Lifetime Value is crucial in every kind of economic activity as the customer is the good that brings profits to the companies. This is the main reason why entrepreneurs and managers should always think how to satisfy needs of its clients. One of markets, on which the customer value should be thoroughly analyzed is medicine. This article presents the theoretical basis of customer lifetime value management and tries to explain how it is being introduced on medical services market in Poland. As the health care in Poland seems to be on initial stage there is a lot of space for new, private medical centers to be set up. Majoroty of institution operates basing on concracts with National Health Fund (NFZ) and there are fully dependent from the amounts of money granted by the institution. It is renegotiated after certain period and there is always the risk of not winning it again. Unfortunately due to weaknesses of public health care system in Poland, many customers are disappointed with its quality and management form. In these conditions the private medicine services are improving. Unfortunately there is no possibility in choosing the form of health insurance (all are paying contribution to National Health Fund). In this case there is a hope for development of a competitive market, which would be certainly supported by private insurance. The artice is an introduction to deeper considerations regarding medicine in Poland and the effectiveness of managing medical centers (especially hospitals).
EN
This paper aims to provide an efficiency evaluation of selected hospital bed care providers during years 2010 -2012 with respect to selected factors: The size of the hospital establishment according to number of beds, number of hospitalized patients, the average length of stay per a patient in care, total staff cost calculated per bed, total revenues calculated per bed, and total costs calculated per bed. For this purpose, hospitals providing primarily acute bed care were chosen. From the legal point of view, they are allowance organizations of a particular region. The evaluation concerns both allocative efficiency and technical efficiency. The allocative efficiency is treated from the proper algorithm point of view and it compares total costs calculated per bed with total revenues calculated per bed. A method denominated Data Envelopment Analysis was applied for the calculation of the technical efficiency of units. To be more specific, it was input-oriented model with constant returns to scale (CCR). The input parameters involve the number of beds, the average length of stay and costs per day of stay. Output parameters were as follows: Bed occupancy in days and the number of hospitalized patients. The data published by the Institute of Health Information and Statistic of the Czech Republic and by ÚFIS system (the Data Base of Ministry of Finance of the Czech Republic) were used as the source of data. The evaluation implies that only three hospitals were economically-effective: Silesian Hospital in Opava, Hospital Jihlava, and TGM Hospital Hodonín. The most significant factor influencing the efficiency was determined - the average length of stay.
EN
Objectives: The paper aims to describe the current model of supervision over public hospitals in Poland. Research Design & Methods: The paper is based on a scoping review and content analysis of applicable legislation, their resumes, and pertinent data sourced from the Internet, including articles, reports, and dedicated websites. The sourced data was identified with the aid of the Google search engine. All assembled source materials were subsequently filtered out in terms of their suitability for the subject matter under scrutiny, and assessed in line with the key assumptions of the agency theory, whereby an agent is entrusted by the principal with the task of managing an organisation. Findings: Polish hospitals operate either as the so-called autonomous public healthcare units, or as commercial companies. Both forms are publicly owned and invested with identical scope of statutory tasks, whereas their supervision remains subject to different statutory regulations. However, the organisational models presently in place do not actually provide for an effective securing of the key supervisory objectives. Implications / Recommendations: A general structural overhaul is therefore postulated, with a view to introducing more effective, in-house-developed supervisory solutions, especially with regard to autonomous public hospitals. Article classification: research article
EN
Objectives: Hospitals are the entry point for newly implemented innovative health technologies. Hospital-based health technology assessment (HB-HTA) has been developed to facilitate the use of new health technologies in hospitals. The purpose of this study was to evaluate opportunities to implement HB-HTA in selected hospitals located in the Kraków municipality in Poland. Research Design & Method: We used shortened version of a questionnaire from a project called “Implementation of the Hospital-Based HTA (HB-HTA) – Hospital Assessment of Innovative Medical Technologies”. The participants were hospital managers working in three hospitals located in Kraków: the Ujastek Medical Centre Limited Liability Company (LLC), the Brothers Hospitallers of Saint John of God Hospital LLC, and the University Hospital in Kraków. The survey was conducted and made available online. Findings: Each of the participating hospitals had implemented new medical technologies. Applications for the implementation of innovative medical technology had been considered by the hospital directors; however, departmental heads were required to act as the lead applicants. Two out of these three hospitals had developed both an application template for the implementation of innovative technologies and a formalized path for their examination. The main source of financing new technologies is the hospitals’ funds. Before implementing the technology, hospitals had consulted the following agencies: the National Health Fund, the Ministry of Health, medical technology manufacturers or producer organisations, medical voivodeship consultants, and other hospitals. The financial consequences of the medical technologies implementation were analyzed. Implications / Recommendations: The hospitals define innovative medical technologies in a correct way. There are no separate HTA units in any of the hospitals. The surveyed hospitals have the capability to implement HB-HTA. Contribution / Value Added: The implementation of HB-HTA processes in the analysed hospitals may require the hospital managers to broaden knowledge about this area. The implementation of HB-HTA procedures in hospitals may have positive economic effects on the entire health care system.
EN
The article concerns the legal grounds for the activity of five (not including the lazaret) hospitals in Toruń in the mid-17th century. The rules of 1665 how to manage this type of institution, preserved in the form of copies from the beginning of the 18th century, constitute the source base of the article and the edited appendix to it. The document is an amendment to the rules of 1570, which was necessary due to the war and the change in the economic situation in the city. It discusses the hierarchical system of hospital management such as the authority of provisors (Provisores), the hospital supervisors (Vorstehern), their director (Director des Vorsteher Amts) and lower rank personnel, as well as the manner of managing the property of the institution which included e.g. proceeds from confiscations, the lease of the hospital’s estates, fines, money collections, special rents and charges for the stay in hospital. The authors also addressed a very important category of proceeds such as foundations, bequests and legacies, which referred to the ideology of Christian mercy. The authors also touched upon the question of the rules of the execution of back rents from eases, which must have been a significant problem for hospital supervisors (Vorstehern) in the face of the social-economic situation in the second half of the 17th century. Thus, the problem was thoroughly discussed in the article. The conclusions from the analysis of the rules confirm Weber’s thesis about the beginnings of the spirit of capitalism. Hospitals in Protestant towns were to work in an economic way. Apart from looking after the sick and the poor, they were to generate profits, or at least to be financially self-sufficient.
EN
This study examines the introduction of management changes in a hospital based on the Lewin's model. It focuses on the attitudes of a hospital's mid-level managers to a new management-budgeting system. The conclusions are based on empirical research. The article analyzes the change implementation process related to the budgeting system in a hospital with particular consideration of the attitudes and the level of involvement of employees in the performance of new tasks. The analysis showed that the top management of hospitals and the mid-level management do not see the effects of changes related to budgeting in similar ways. This may cause significant hindrances to the process of employees adopting attitudes and behaviors required by the top management. The diversity of opinions in this area may result from: not specifying in detail the targets of budgeting by the top management or not informing the medium-level management of them, a lack of set measures for evaluation of the performance of budget tasks, aiming at achievement of the assumed targets by means of methods not accepted by the employees.
EN
The health care system in Germany is undergoing a phase of transformation. The resulting challenges and fields of action for the hospitals were described as one outcome of a scenario analysis conducted by the author. These include, for example, setting up new organisation structures, professionalising management competence or also developing a comprehensive quality management system. In the following analysis, the hospitals are to be described and compared to one another in terms of their initial conditions regarding these fields of action. The question at the focus is which different prerequisites and options the clinics have subject to their organisational structure.
EN
In the last 20 years many OECD countries have adopted some form of diagnosis-related group (DRG) prospective payment system to reimburse hospitals. In Poland, hospitals are also paid fixed prices, imposed by Narodowy Fundusz Zdrowia (NFZ) according to DRG, for patients treated. The aim of this paper is to calculate, analyze and compare the costs of patient conditions within the same DRG (F72 – inguinal hernia), collate these costs and the reimbursement from NFZ with the purpose of determining the net profit and then check if it matches bigger research samples. In order to realize the aim of the paper, a comparative and a content analysis of medicals documents and financial data were adopted, and Student’s t-test was performed. The Shapiro-Wilk test was applied to confirm the correctness of the research sample. The results revealed that the reimbursement for costs related to inguinal hernia treatment covers the costs of 90% of patient conditions from the research sample.
PL
W niniejszym artykule opisano wyniki badania dotyczącego nadzoru sprawowanego przez powiaty nad podległymi im podmiotami leczniczymi (szpitalami). Działania, jakie w tym zakresie podejmują powiaty, można uznać za niewystarczające. Mimo deklaracji dotyczących rozbudowanych struktur administracyjnych odpowiedzialnych za nadzór nie mają one wiedzy nie tylko na temat procesów zarządczych stosowanych w podległych im podmiotach, ale i stanu ich finansów. To, co powiaty nazywają nadzorem, polega w dużym stopniu na kontroli – wyrywkowej i formalnej. Luka informacyjna między nadzorującym a nadzorowanym jest na tyle duża, że istotnie wpływa na możliwość sprawowania przez powiaty nadzoru nad podległymi im podmiotami.
EN
This article describes the results of a survey on the supervision by the counties on the subordinated therapeutic entities (hospitals). Action taken by counties in this area can be considered as insufficient. Despite the declarations of complex administrative structures responsible for the supervision, counties do not have the knowledge not only about the management processes used in the subordinate entities, but also the state of their finances. What counties call a supervision is to a large extent a control – sampling and formal. Information gap between the supervisor and the supervised is so large, that significantly affect the ability of supervision by the counties on the subordinated entities.
EN
Healthcare sector is considered as the knowledge-based sector and because of this innovation and creativity should be regarded as prerequisite for the survival and growth of the organizations which perform their activities within the sector. In this context development of pro-innovative culture within hospitals becomes crucial. In search for tools allowing to create the culture employees appraisal becomes an interesting tool to be further investigated. Due to the fact the main aim of the paper is to investigate the relationships between the employee appraisal system and innovation in the context of the organizational culture in the hospitals. Study was carried in eight public hospitals located in two voivodships in Poland. Not only qualitative but also quantitative data was analyzed in order to identify usefulness of employees appraisal as the tool of pro-innovative culture creation.
EN
The main aims of the study were to explore the frequency of missed nursing care (MNC) among Czech hospital nurses, and to find the relationship between nurse’s job satisfaction and MNC.Material and MethodsThe sample consisted of 513 nurses from 9 hospitals in the Czech Republic. Data were collected in January–August 2019 using the standardized MISSCARE Survey questionnaire, complemented with items assessing nurse’s job satisfaction and demographic data.ResultsThe most frequently missed nursing activities were patient ambulation and emotional support to the patient and/or family. The surveyed nurses were most satisfied with being a nurse and least satisfied with the level of teamwork on their unit. The strongest correlation was found between satisfaction with the current position and satisfaction with being a nurse; there was a negative correlation between satisfaction with the current position and the overall level of MNC. There was a significant trend between the rating of satisfaction with the current position and MNC.ConclusionsNurse’s job satisfaction is associated with the level of nursing care provided; more missed care means more dissatisfaction among nurses. Med Pr. 2021;72(3):231–7
EN
Background The lack of nursing staff is a current problem not only in Poland, but also in the world. The decision of nurses to leave the workplace, apart from the financial aspect, often results from unfavourable working conditions related to the work environment. Material and Methods The study was multicentre, cross-sectional. The study was conducted among a group of 1509 nurses employed in surgical and internal medicine wards in 21 hospitals in Poland. The key variables of the study were: the intention of the nurses to leave their jobs, the nurses’ working environment, the level of satisfaction, the level of occupational burnout and the number of patients cared for on the last shift, the number of nurses on the last shift. The Practice Environment Scale of the Nursing Work Index (PES-NWI) and the Maslach Burnout Inventory (MBI) questionnaire were used in the research. Results Almost half of the surveyed nurses (48.84%) declared their willingness to leave their current workplace. The statistical analysis showed that nurses declaring their willingness to quit their job in the hospital where they were employed were significantly younger (42.88 vs. 45.04, p = 0.000), had shorter total length of service overall (19.96 vs. 23.20), and also in the hospital where they were employed (15.86 vs. 18.50, p = 0.000). The increase in the number of patients by one was significantly associated with a 1% increase in the risk of leaving work (OR = 1.01, 95% CI 1.00–1.02). An increase in emotional exhaustion significantly increased the risk of leaving work by 2% (OR = 1.02, 95% CI 0.99–1.03). Conclusions Younger age of nurses, greater workload resulting from more patients and occupational burnout – emotional exhaustion is correlated with the risk of leaving work in the hospital. A lower risk of leaving the job is associated with a higher level of job satisfaction in the hospital, salary and promotion opportunities.
PL
Niniejszy artykuł przedstawia role medical managers i nastawienie do nich prezentowane przez brytyjskich i polskich lekarzy oraz ewolucję tego nastawienia w ostatnich dekadach. Artykuł powstał na podstawie analizy literatury, dokumentów systemowych, statystyk dotyczących ochrony zdrowia oraz wywiadów półustrukturyzowanych.W wyniku badania stwierdzono, że w przeszłości lekarze niechętnie podejmowali role zarządcze w brytyjskim systemie ochrony zdrowia, natomiast w polskim – byli nimi zainteresowani. Zmiany w obu krajach (większa orientacja rynkowa, polityka prowadzona w Wielkiej Brytanii) zmieniły omawiane nastawienie lekarzy. Obecnie w Wielkiej Brytanii lekarze wykazują chęć podejmowania ról zarządczych, a w Polsce w publicznych szpitalach lekarze są mniej zainteresowani takimi stanowiskami, w związku z pojawianiem się większych korzyści finansowych za wykonywanie zadań klinicznych. W szpitalach prywatnych natomiast lekarze lepiej rozumieją potrzebę współpracy z menedżerami i z innymi grupami zawodowymi.
EN
This paper surveys the attitudes to managerial roles shown by Polish and British doctors and their evolution over the past decades. The paper is based on a review and analysis of literature, policy documents, healthcare statistic sand semi-structured interviews. Results of this research show that in the past doctors were reluctant to assume managerial roles in the UK system, whereas they were actually keen to do so in the Polish one. Changes in both countries (more market orientation in both countries, UK state policy) changed the doctors’ attitude to management. In the UK, doctors are at the moment more interested in taking on managerial responsibilities, while in Poland they are less interested in doing so in public hospitals due to the financial incentives attached to clinical work. In private hospitals, however, doctors understand the need for collaboration with general managers and other professional groups.
EN
The article is focused on the study of socio-political and socio-economic background of the origin and development of higher medical education in the western regions of Ukraine in 40–90-ies of the twentieth century. This background has contributed to the formation of a network of the higher medical educational institutions in the given region in the context of Ukraine’s state policy in the health care area. The study has used such methods as theoretical analysis and generalization of archival and printed sources, historical, pedagogical and educational-and-methodological literature; comparative, problem-chronological, historical and genetic analyses which contributes to the study and analysis of the preconditions of the higher medical education formation in the western region in the studied period. The investigation and analysis of historical and archival documents has shown that the western lands were part of Poland, Romania, Czechoslovakia and Hungary for decades, which significantly affected the socio-economic, cultural and national development of the region. The study of historical sources shows that the agricultural sector played a leading role in the economy as industry developed slowly. The population lived in poverty, lacking funds for necessary things. Medical institutions functioned mainly in urban areas, and doctors’ service was paid. This made impossible to provide necessary medical care to the general population. The region experienced high mortality of adults and children. Also, dangerous diseases were spread. After the liberation of these lands from invaders in the 40-ies of the XX century to eliminate dangerous disease, prophylactic medical institutions were organized for improving the population health. For the proper provision of highly qualified personnel, it was needed to form a network of higher medical education institutions that could train specialists, especially involving local youth.
PL
Polityka rachunkowości jest definiowana jako zbiór zasad, rozwiązań, reguł i procedur dobranych przez zarząd podmiotu odpowiednio do odwzorowania jego rzeczywistej pozycji finansowej, dochodowej i dokonań. Może ona być również wykorzystana do świadomego kształtowania dopuszczalnych przez prawo bilansowe rozwiązań w zakresie rachunkowości, pomagających w osiągnięciu określonych celów. Celem artykułu jest analiza stopnia wykorzystania wybranych instrumentów polityki rachunkowości w polskich szpitalach. Główną uwagę zwrócono przy tym na instrumenty materialnej polityki rachunkowości. Wpierwszej części opracowania zastosowano metodę studiów literaturowych. Przedstawiono w niej istotę polityki rachunkowości oraz odniesiono się do dyskusji nad tożsamością i rozbieżnościami określeń „polityka rachunkowości” i „polityka bilansowa”. W drugiej części artykułu przedstawiono wyniki badania empirycznego przeprowadzonego w wybranych polskich szpitalach w latach 2012–2013. W badaniu uczestniczyła kadra menedżerska szpitali, która odpowiadała na pytania dotyczące stopnia wykorzystania wybranych instrumentów materialnej polityki rachunkowości w kształtowaniu zawartości informacyjnej sprawozdań finansowych na potrzeby realizacji celów podmiotu. Z materiału badawczego wynika, że polskie szpitale nie stosują lub stosują w ograniczonym zakresie narzędzia polityki rachunkowości wspierające proces zarządzania. W większości przebadanych przypadków menedżerowie szpitali nie są zainteresowani polityką rachunkowości w ogóle i nie interesuje ich jej wpływ na zawartość sprawozdań finansowych szpitala.
EN
Accounting policy is defined as a set of rules and methods for estimating conventional values, and procedures regarding the presentation of financial statements. It can also be used for determining the value of assets and financial results in financial statements to help in achieving specific goals of the entity. The aim of the article is to analyze the degree of use of selected instruments of accounting policy in Polish hospitals. The main attention was paid to the instruments of material accounting policies. The first part of the paper uses the method of literature studies. It describes the essence of accounting policy and tries to provide an explanation of existing differences between the terms "balance sheet policy" and "accounting policy" because there are at least a few perspectives on their meaning and their relations with each other. The second part of paper presents the results of an empirical study conducted in 2012-2013 in selected Polish hospitals. The study involved managers of hospitals that responded to questions regarding the use of selected instruments of material accounting policies in shaping the information content of financial statements for the purpose of achieving the objectives of the entity. The research showed that Polish hospitals do not apply (or apply to a limited extent) the instruments of accounting policy to support the management process. In most of cases, the managers are not interested in accounting policy in general, and they are not interested in its impact on the content of the financial statements of the hospital.
EN
The aim of the article is to present the scope of determinants influencing hospitals’ functioning in contemporary Europe with emphasize put on the health sector human recourses issue. Multiplicity of the functions realized by the hospitals units relates to the plurality of determinants which influence their present situation as well as long-term transformation processes. The determinants can be categorized into three main groups: these related to the demand side of the hospital services, their supply and determinants being the results of the social and economic changes. Regardless of the differences existing between health systems in specific countries – all European countries are facing similar problems of increasing health care costs, strong need of efficiency improvement and deficits of medical staff. In case of the hospital sector the key issue is number of beds reduction and transformation of the hospitals’ organizational form
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