Evaluation Indexes of Military Hospitals From the Experts' Perspective: A Qualitative Study.
20 May 2015-Disaster Medicine and Public Health Preparedness (Disaster Med Public Health Prep)-Vol. 9, Iss: 4, pp 409-414
TL;DR: The results of the present research can be used for the comprehensive evaluation of military hospitals, as a supplement to current evaluation methods such as accreditation.
Abstract: Given the importance of evaluation in an organization and considering the objectives and missions of military hospitals, we aimed to extract some indexes (in addition to common evaluation indexes) for use in evaluating military hospitals. This was an applied-type qualitative study. The participants were 15 health experts who were first chosen by a purposeful sampling, which was then continued by theoretical sampling. The data obtained were analyzed by using MAXQDA11 software and the content analysis method. After 290 obtained codes were analyzed, 17 indexes in 6 domains were extracted, including capacity development for crisis periods, equipment and facilities, training and research, passive defense, treatment, and services, from which 8 indexes were related to capacity development for crisis periods and equipment and facilities (4 indexes each), 3 indexes were related to services, and 6 indexes were related to training and research, passive defense, and treatment (2 indexes each). The results of the present research, as a supplement to current evaluation methods such as accreditation, can be used for the comprehensive evaluation of military hospitals.
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TL;DR: The Japan Medical Association (JMA) trains and coordinates medical teams, known as JMATs, to respond in the event of a disaster or other largescale medical emergency.
Abstract: The Japan Medical Association (JMA) trains and coordinates medical teams, known as Japan Medical Association Teams (JMATs), to respond in the event of a disaster or other largescale medical emergency. In response to the Great East Japan Earthquake, the JMA, which comprises 160,000 members, deployed JMATs to the 4 prefectures with the most devastating conditions: Iwate, Miyagi, Fukushima, and Ibaraki.
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Cites background from "Evaluation Indexes of Military Hosp..."
...The Japan Medical Association (JMA) trains and coordinates medical teams, known as Japan Medical Association Teams (JMATs), to respond in the event of a disaster or other largescale medical emergency.(1) In response to the Great East Japan Earthquake, the JMA, which comprises 160,000 members, deployed JMATs to the 4 prefectures with the most devastating conditions: Iwate, Miyagi, Fukushima, and Ibaraki....
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...In response to the Great East Japan Earthquake, the JMA, which comprises 160,000 members, deployed JMATs to the 4 prefectures with the most devastating conditions: Iwate, Miyagi, Fukushima, and Ibaraki.(1)...
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...EDITORLetters to the doi:10.1017/dmp.2015.109 International Medical Teams of the Japan Medical Association: A Framework for Foreign Medical Teams Takashi Nagata, MD,; Sumito Yoshida; Manabu Hasegawa, MD; Mayo Ojino; Shinichi Murata; Masami Ishii, MD, The Japan Medical Association (JMA) trainsand coordinates medical teams, known asJapan Medical Association Teams (JMATs), to respond in the event of a disaster or other largescale medical emergency.1 In response to the Great East Japan Earthquake, the JMA, which comprises 160,000 members, deployed JMATs to the 4 prefectures with the most devastating conditions: Iwate, Miyagi, Fukushima, and Ibaraki.1 After the Great East Japan Earthquake in 2011, the JMA, as the professional society of Japanese physicians, recognized the importance of incorporating foreign medical teams (FMTs) into its large-scale disaster response efforts.2 The JMA has developed international medical teams of the JMA, or iJMAT, as a new framework to accept FMTs to provide medical care in the event of major disasters, particularly the predicted Tokyo metropolitan or South Sea Thrust mega-earthquakes.3 The main aim of the iJMAT program is to secure the quality of care provided and certification of physicians’ qualifications to meet the needs of disaster-affected areas....
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TL;DR: This report describes how the Japan Medical Association’s disaster preparedness strategy and the World Medical Association Declaration of Montevideo on Disaster Preparedness and Medical Response helped improve the preparedness of the Japanese medical community.
Abstract: 1. Ishii M, Nagata T. The Japan Medical Association’s disaster preparedness: lessons from the Great East Japan Earthquake and Tsunami. Disaster Med Public Health Prep. 2013;7(5):507-512. 2. Ministry of Foreign Affairs, Government of Japan. Information relating to the recovery from the Great East Japan Earthquake: emergency assistance from other nations and regions in the world. http://www.mofa.go.jp/mofaj/ saigai/kaigai-iryo-shien.html. Accessed March 29, 2015. 3. Cabinet Office, Government of Japan. The estimated damage of the Tokyo Metropolitan mega-earthquake. 2013. http://www.bousai.go.jp/ jishin/syuto/taisaku_wg/index.html. Accessed March 29, 2015. 4. World Medical Association Declaration of Montevideo on Disaster Preparedness and Medical Response. World Med J. 2011; 57(6):227. 5. The Sphere Project. Humanitarian Charter and Minimum Standards in Humanitarian Response. http://www.spherehandbook.org/en/the-humanitarian-charter/. Accessed March 29, 2015.
2 citations
TL;DR: This report describes how the Japan Medical Association’s disaster preparedness strategy and the World Medical Association Declaration of Montevideo on Disaster Preparedness and Medical Response improved the preparedness of medical professionals around the world.
Abstract: 1. Ishii M, Nagata T. The Japan Medical Association’s disaster preparedness: lessons from the Great East Japan Earthquake and Tsunami. Disaster Med Public Health Prep. 2013;7(5):507-512. 2. Ministry of Foreign Affairs, Government of Japan. Information relating to the recovery from the Great East Japan Earthquake: emergency assistance from other nations and regions in the world. http://www.mofa.go.jp/mofaj/ saigai/kaigai-iryo-shien.html. Accessed March 29, 2015. 3. Cabinet Office, Government of Japan. The estimated damage of the Tokyo Metropolitan mega-earthquake. 2013. http://www.bousai.go.jp/ jishin/syuto/taisaku_wg/index.html. Accessed March 29, 2015. 4. World Medical Association Declaration of Montevideo on Disaster Preparedness and Medical Response. World Med J. 2011; 57(6):227. 5. The Sphere Project. Humanitarian Charter and Minimum Standards in Humanitarian Response. http://www.spherehandbook.org/en/the-humanitarian-charter/. Accessed March 29, 2015.
1 citations
Cites methods from "Evaluation Indexes of Military Hosp..."
...We recently read an article entitled “Evaluation Indexes of Military Hospitals From the Experts’ Perspective: A Qualitative Study” in your prestigious journal owing to our interest in qualitative studies.(1) Although this article is an innovative one in terms of its topic, it seems that some issues should be further taken into consideration....
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References
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TL;DR: Despite criticism of patient-satisfaction measures, patient-experience surveys that are designed and administered appropriately provide robust measures of the quality of health care and offer insight into a dimension that is otherwise difficult to measure objectively.
Abstract: Despite criticism of patient-satisfaction measures, patient-experience surveys that are designed and administered appropriately provide robust measures of the quality of health care and offer insight into a dimension that's otherwise difficult to measure objectively.
701 citations
"Evaluation Indexes of Military Hosp..." refers background in this paper
...Therefore, governments do not release the results to the public.(11) The third-party evaluation model includes ISO standards, peer reviews, and accreditation....
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TL;DR: A multi-level framework that captures the predominant factors that impact implementation outcomes is identified, a systematic review of available measures assessing constructs subsumed within these primary factors are conducted, and the criterion validity of these measures in the search articles is determined.
Abstract: Two of the current methodological barriers to implementation science efforts are the lack of agreement regarding constructs hypothesized to affect implementation success and identifiable measures of these constructs. In order to address these gaps, the main goals of this paper were to identify a multi-level framework that captures the predominant factors that impact implementation outcomes, conduct a systematic review of available measures assessing constructs subsumed within these primary factors, and determine the criterion validity of these measures in the search articles. We conducted a systematic literature review to identify articles reporting the use or development of measures designed to assess constructs that predict the implementation of evidence-based health innovations. Articles published through 12 August 2012 were identified through MEDLINE, CINAHL, PsycINFO and the journal Implementation Science. We then utilized a modified five-factor framework in order to code whether each measure contained items that assess constructs representing structural, organizational, provider, patient, and innovation level factors. Further, we coded the criterion validity of each measure within the search articles obtained. Our review identified 62 measures. Results indicate that organization, provider, and innovation-level constructs have the greatest number of measures available for use, whereas structural and patient-level constructs have the least. Additionally, relatively few measures demonstrated criterion validity, or reliable association with an implementation outcome (e.g., fidelity). In light of these findings, our discussion centers on strategies that researchers can utilize in order to identify, adapt, and improve extant measures for use in their own implementation research. In total, our literature review and resulting measures compendium increases the capacity of researchers to conceptualize and measure implementation-related constructs in their ongoing and future research.
633 citations
"Evaluation Indexes of Military Hosp..." refers methods in this paper
...There are different methods for assessment of organizations.(32) There are also several methods for assessment of health-therapeutic organizations....
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TL;DR: A systematic review conducted by Sanjay Basu and colleagues reevaluates the evidence relating to comparative performance of public versus private sector healthcare delivery in low- and middle-income countries.
Abstract: Introduction: Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. Methods and Findings: Peer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of ‘‘private sector’’ included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. ‘‘Competitive dynamics’’ for funding appeared between the two sectors, such that public funds and personnel were redirected to private sector development, followed by reductions in public sector service budgets and staff. Conclusions: Studies evaluated in this systematic review do not support the claim that the private sector is usually more efficient, accountable, or medically effective than the public sector; however, the public sector appears frequently to lack timeliness and hospitality towards patients. Please see later in the article for the Editors’ Summary.
601 citations
"Evaluation Indexes of Military Hosp..." refers background in this paper
...Furthermore, because this model is implemented by local governments, it cannot be generalized globally and its results do not include employees and patients.(9,10) In the surveys of patients’ experiences model, the focus is on health training, patient well-being, continuous serving, settling the complaints, and patient satisfaction....
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TL;DR: The health care accreditation industry appears to be purposefully moving towards constructing the evidence to ground the understanding of accreditation, with consistent findings in two categories: promote change and professional development.
Abstract: Purpose. The purpose of this study was to identify and analyze research into accreditation and accreditation processes. Data sources. A multi-method, systematic review of the accreditation literature was conducted from March to May 2007. The search identified articles researching accreditation. Discussion or commentary pieces were excluded. Study selection. From the initial identification of over 3000 abstracts, 66 studies that met the search criteria by empirically examining accreditation were selected. Data extraction and results of data synthesis. The 66 studies were retrieved and analyzed. The results, examining the impact or effectiveness of accreditation, were classified into 10 categories: professions’ attitudes to accreditation, promote change, organizational impact, financial impact, quality measures, program assessment, consumer views or patient satisfaction, public disclosure, professional development and surveyor issues. Results. The analysis reveals a complex picture. In two categories consistent findings were recorded: promote change and professional development. Inconsistent findings were identified in five categories: professions’ attitudes to accreditation, organizational impact, financial impact, quality measures and program assessment. The remaining three categories—consumer views or patient satisfaction, public disclosure and surveyor issues—did not have sufficient studies to draw any conclusion. The search identified a number of national health care accreditation organizations engaged in research activities. Conclusion. The health care accreditation industry appears to be purposefully moving towards constructing the evidence to ground our understanding of accreditation.
449 citations
"Evaluation Indexes of Military Hosp..." refers background in this paper
...On the other hand, the effect of accreditation on quality is not concrete, and it cannot be definitely said that hospitals where accreditation has been implemented offer services with higher quality.(17) Furthermore, participants in this study also confirmed implementation of accreditation in such hospitals but they did not accept it as a perfect model for evaluating military hospitals....
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TL;DR: This project evaluated a major change effort in inner London, funded by a charitable donation of approximately $21 million, which spanned four large health care organizations, and sought to "modernize" these services with a view to making health care more efficient, effective, and patient centered.
Abstract: Context: Large-scale, whole-systems interventions in health care require imaginative approaches to evaluation that go beyond assessing progress against predefined goals and milestones. This project evaluated a major change effort in inner London, funded by a charitable donation of approximately $21 million, which spanned four large health care organizations, covered three services (stroke, kidney, and sexual health), and sought to “modernize” these services with a view to making health care more efficient, effective, and patient centered.
Methods: This organizational case study draws on the principles of realist evaluation, a largely qualitative approach that is centrally concerned with testing and refining program theories by exploring the complex and dynamic interaction among context, mechanism, and outcome. This approach used multiple data sources and methods in a pragmatic and reflexive manner to build a picture of the case and follow its fortunes over the three-year study period. The methods included ethnographic observation, semistructured interviews, and scrutiny of documents and other contemporaneous materials. As well as providing ongoing formative feedback to the change teams in specific areas of activity, we undertook a more abstract, interpretive analysis, which explored the context-mechanism-outcome relationship using the guiding question “what works, for whom, under what circumstances?”
Findings: In this example of large-scale service transformation, numerous projects and subprojects emerged, fed into one another, and evolved over time. Six broad mechanisms appeared to be driving the efforts of change agents: integrating services across providers, finding and using evidence, involving service users in the modernization effort, supporting self-care, developing the workforce, and extending the range of services. Within each of these mechanisms, different teams chose widely differing approaches and met with differing success. The realist analysis of the fortunes of different subprojects identified aspects of context and mechanism that accounted for observed outcomes (both intended and unintended).
Conclusions: This study was one of the first applications of realist evaluation to a large-scale change effort in health care. Even when an ambitious change program shifts from its original goals and meets unforeseen challenges (indeed, precisely because the program morphs and adapts over time), realist evaluation can draw useful lessons about how particular preconditions make particular outcomes more likely, even though it cannot produce predictive guidance or a simple recipe for success. Noting recent calls by others for the greater use of realist evaluation in health care, this article considers some of the challenges and limitations of this method in the light of this experience and suggests that its use will require some fundamental changes in the worldview of some health services researchers.
334 citations
"Evaluation Indexes of Military Hosp..." refers background in this paper
...No fixed approach exists for evaluating organizations and institutes, and a specific approach should be selected that takes into account an organization’s goals and even different conditions.(5) However, integral approaches are more efficient and useful for evaluation....
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