Hospitals, Volume 2, Issue 3 (September 2025) – 9 articles

The challenge for healthcare policy makers, managers and practitioners is finding ways to effectively collaborate with patients and community to plan, deliver and evaluate services. The study examined how managers engage the community with the strategic redesign of health services. The study focused on four large scale redevelopment projects, valued at A$2.8B, occurring within a health district in New South Wales, Australia. The study employed a multiple qualitative methods design comprising semi-structured interviews and focus groups. Participants were professionals (n = 24) involved in the strategic planning of health facility redevelopment. Thematic analysis was used to identify, analyse and report findings. Three issues emerged as significant factors influencing engagement, including the following: establishing a new mindset to service planning and delivery; future proofing service delivery; and management of stakeholder expectations. The unique contribution of the research is the identification of three interwoven strategies with 30 actions proposed to assess, understand and respond to external factors: 1. Foster an environment that allows for flexible and adaptable thinking and discussion; 2. Develop systems, structures and processes that facilitate engagement; 3. Encourage systems thinking for effective continuous service provision and redevelopment. Large scale redevelopment projects provide a platform for the strategic redesign of health services. When doing so, engaging the community with strategic planning, implementation and evaluation of healthcare services can lead to improved care outcomes. Full article

Understanding the utilization patterns of nuclear medicine (NM) services is essential for optimizing resource allocation and service provision. This study aimed to address the regional evidence gap by reporting the demand for NM services by sex and age at a public hospital in Jamaica. This was a non-experimental, retrospective study of NM scans that were completed at the University Hospital of the West Indies from 1 June 2022 to 31 May 2024. While all scans were reported in the descriptive totals, for patients with multiple scans during the study period, only the data from the first visit was used in the inferential statistical analysis. This was performed with the IBM SPSS (version 29.0) software and involved the use of chi-square goodness of fit and multinomial logistic regression. A total of 1135 NM scans for 1098 patients were completed (37 patients had more than one scan); 596 (54.3%) were female and 502 (45.7%) were male, with the ages ranging from 3 days to 94 years old. Among the female patients, there was a greater demand in the ≥60 years age group for cardiac amyloid scans (χ² = 6.40, p < 0.05), while females 18–59 years had a greater demand for thyroid scans (χ² = 7.714, p < 0.05) and bone scans (χ² = 3.904, p < 0.05). On the other hand, significantly more males in the ≥60 age group presented for cardiac amyloid (χ² = 4.167; p < 0.05) and bone scans (χ² = 145.79, p < 0.01). Males were significantly less likely to undergo a thyroid scan than females (p < 0.01, OR = 0.072, 95% CI: 0.021, 0.243) while individuals aged 18–59 years were more likely to undergo this scan than patients aged 60 or older (p = 0.02, OR = 3.565, 95% CI: 1.258, 10.104). Males were more likely to do a cardiac amyloid scan (p < 0.05, OR = 2.237, 95% CI: 1.023, 4.891) but less likely to undergo a cardiac rest/stress test than females (p = 0.02, OR = 0.307, 95% CI: 0.114, 0.828). Prolonged life expectancy and an aging population have the potential to impact NM utilization, thus requiring planning for infrastructure, equipment, work force, and supplies. Cancer-related and cardiovascular indications are a top priority at this facility; hence, age- and sex-specific analysis are useful in establishing models for policy makers with regard to the allocation of economic and human resources for the sustainability of this specialized service. Full article

Objective: This study aimed to develop a performance evaluation index system for a district-level public hospital in Chongqing, China, based on Diagnosis-Related Groups (DRGs), to provide a benchmark for performance assessment in similar hospitals. The system was constructed using a literature analysis, the Delphi method, and the Analytic Hierarchy Process (AHP) to identify and weight relevant indicators. Results: The evaluation system consists of three primary indicators and eighteen secondary indicators. Key secondary indicators include the Case Mix Index (CMI), cost consumption index, low-risk group mortality rate, the proportion of patients with three- or four-level surgeries at discharge, and the proportion of medical service revenue to medical income. In 2020, significant improvements were observed in several indicators, such as a decrease in the low-risk group mortality rate to 0% and increases in the proportion of patients with three- or four-level surgeries and CMI by nearly 10% and 13%, respectively. Conclusions: This study successfully developed a comprehensive and scientifically sound performance evaluation index system for a district-level public hospital in Chongqing. The system has proven effective in objectively assessing inpatient medical care performance and providing valuable guidance for improving healthcare services in similar settings. Full article

Hospital layouts play a critical role in supporting efficient care processes, which are continually evolving. While care processes adapt over time, the spatial needs of care professionals are expected to remain relatively stable. This study proposes an evaluation framework combining cognitive mapping and space syntax analysis (SSA) to assess how hospital layouts align with these spatial needs. The framework is applied to a real-world emergency department (ED) with two distinct layout configurations. Cognitive mapping captures spatial needs from the perspective of care professionals, while SSA evaluates how the layout supports or constrains these needs. Drawing on the open building approach, we interpret layout adaptability through a layered system of primary (rigid), secondary (adaptable), and tertiary (care process) levels. Our results show that the choices in primary and secondary system designs can limit the functionality of the tertiary system. This approach supports informed decision-making by addressing multiple spatial needs simultaneously, offering insights into the coherence between spatial configuration and care delivery, and enabling quantitative comparison across different layout designs. Full article

Background: The emergency department (ED) often represents the entry point to care for patients that require urgent medical attention or have no alternative for medical treatment. This has implications on scope of practice and how quality of care is measured. A diverse array of methodologies has been developed to evaluate the quality of clinical care and broadly includes quality improvement (QI), quality assurance (QA), observational research (OR) and clinical quality registries (CQRs). Considering the overlap between QI, QA, OR and CQRs, we conceptualized a modular framework for TECOR to effectively and efficiently streamline clinical quality evaluations. Streamlining is both appropriate and justified as it reduces redundancy, enhances clarity and optimizes resource utilization, thereby allowing clinicians to focus on delivering high-quality patient care without being overwhelmed by excessive data and procedural complexities. The objective of this study is to describe the process for designing a modular framework for ED CQRs using TECOR as a case study. Methods: We performed a scoping audit of all quality projects performed in our ED over a 1-year period (1 January 2021 to 31 December 2021) as well as data mapping and categorical formulation of key themes from the TECOR dataset with clinical data sources. Both these processes then informed the design of TECOR. Results: For the audit of quality projects, we identified 29 projects. The quality evaluation methodologies for these projects included 12 QI projects, 5 CQRs and 12 OR projects. Data mapping identified that clinical information was fragmented across 11 distinct data sources. Through thematic analysis during data mapping, we identified three extraction techniques: self-extractable, manual entry and on request. Conclusions: The modular framework for TECOR aims to enable an efficient streamlined approach that caters to all aspects of clinical quality evaluation to enable higher throughput of clinician-led quality evaluations and improvements. TECOR is also an essential component in the development of a learning health system to drive evidence-based practice and the subject of future research. Full article

This study applies stochastic discrete event modeling to demonstrate that reducing wait times for specialized outpatient clinics in the Costa Rican public healthcare system is possible. The classification process identified four medical specialties with the longest wait times. It includes the creation of a separate queuing theory model for each specialty. The birth and death model allowed for estimating the number of arrivals and consultations in the simulation. Validation was performed by comparing the model’s input and output data with real-world statistical reports. An analysis of medical specialists revealed that approximately 22% of patients referred to secondary care did not require specialized medical consultation. Through simulation and the use of stochastic input data, patient waiting times decreased. In an optimistic scenario, waiting times decreased steadily across all specialties over 24 months. Ophthalmology and orthopedics reduced their waiting times to less than 300 days. Otorhinolaryngology decreased from 370 to 250 days, and urology showed the most significant improvement, decreasing from 350 to 100 days in the first year and remaining stable. This evidence transforms the traditional paradigm of increasing capacity as the only solution to the waiting list problem and positions improving the referral process as an alternative. To achieve these results, the study highlights the importance of implementing improved triage protocols in primary care, integrating decision-support tools for general practitioners using machine learning, for example, to reduce unnecessary referrals. Training programs and feedback mechanisms could also align referral practices with specialty criteria. While these strategies were not implemented in this study, the simulation results provide a solid basis for their design and future evaluation. Full article

This study analyzes the comparative performance of ten hospitals in the Kadutu Health Zone in the Democratic Republic of Congo using the EGIPSS model. This study was carried out at the height of the COVID-19 pandemic in August and September 2021, in a changing global context where health systems were called upon to improve their resilience capacity while maintaining high levels of performance. This is a descriptive observational study using documentary review, interviews with 85 key informants, and participatory observation at ten hospitals selected based on several criteria, including the organization of a complete complementary package of activities assigned to a hospital in the DR Congo. This study mainly reveals three facts, namely that (i) university hospitals show the best performance, (ii) adaptive capacity considerably influences the other dimensions of the EGIPSS model and the overall performance of the hospital, and (iii) to adapt, hospitals need resources and good management and governance. Adapting hospitals in the Kadutu Health Zone to the changing context requires a holistic approach that combines clinical work with research, investments in infrastructure (often dilapidated and not modern), training, technology, and governance. It also involves learning from practices implemented in more efficient hospitals. Full article

The majority of Australians who die each year do so in an acute hospital setting and are cared for during the end of their life by a multidisciplinary team comprising nurses, medical staff, and allied health staff. Despite the range of professional disciplines that services this patient group, the experiences of the staff providing this end-of-life care is not well understood. This study sought to explore the experiences of multidisciplinary staff providing this care at an acute hospital in Sydney, Australia and to identify the barriers that affect the end-of-life care provided. Data were collected through an online survey from a multidisciplinary sample group. A combination of statistical analysis and thematic analysis was used to analyse the data with four key themes emerging. These themes included the implications for staff working in end-of-life care, communication gaps in the acute hospital setting, recognition of the dying process, and improvement of end-of-life care through further education. This study highlighted the challenges experienced by healthcare staff in the end-of-life context, with recommendations provided for increased education and training. The need for staff to receive training with a focus on end-of-life skill development, professional confidence, and preparedness for end-of-life conversations was highlighted. Full article

Healthcare is a dynamic and ever-changing phenomenon and is subject to multiple challenges, particularly concerning sustainability and cost issues. The literature identifies bed space and problems related to the lack of hospital beds as being directly or indirectly related to both admission and discharge processes, with delays in in-patient discharges being identified as a variable of significance when it comes to a health system’s overall performance. In this respect, the aim of this research was to explore factors related to delayed discharges in an acute hospital setting in Malta, a small European member state, through the perspectives of health professionals. This study followed a qualitative approach. Semi-structured interviews (n = 8) and focus groups (n = 2) were conducted with a diverse group of experienced health professionals. Informed consent was obtained from all participants, and all data were treated with strict confidentiality throughout the study. The sample was limited to professionals working in adult, non-specialized healthcare settings. Manual thematic analysis was carried out. Codes were grouped to derive seven main themes, which were identified after carrying out the thematic analysis process on the transcripts of the interviews/focus groups. The derived themes are the following: (a) a faulty system, which is open to abuse and inefficiency, (b) procedural delays directly impacting delayed discharges, (c) long-term care/social cases as a major cause of delayed discharges, (d) the impact of external factors on delayed discharges, (e) stakeholder suggestions to management to counteract delayed discharges, (f) the impact of COVID-19 on delayed discharges, and (g) inter-professional relationships. Factors related to delayed discharges and the effects of delayed discharges on the hospital emerged from the main findings, together with specific potential interventions to minimise delays in discharge. Health professional interactions and the effects of inter-professional relationship setbacks on delayed discharges were explored, and the impact of the COVID-19 pandemic on hospital dynamics and additional delays were also addressed. This information is intended to provide hospital administrators with data-driven internal organisational evidence to guide them through changes and to inform future decisions regarding hospital performance and efficiency from a discharge delay perspective. Full article