Performance of Public Hospitals Across the River Jordan
Given the lack of performance measurement system and the absence of regular and organized reports in public hospitals in the West Bank and Jordan, the focus of the thesis is on measuring performance with the aim of identifying areas for potential improvement. The analysis, although it does include J...
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| Format: | Dissertation |
| Language: | English |
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ProQuest Dissertations & Theses
01-01-2018
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| Online Access: | Get full text |
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| Summary: | Given the lack of performance measurement system and the absence of regular and organized reports in public hospitals in the West Bank and Jordan, the focus of the thesis is on measuring performance with the aim of identifying areas for potential improvement. The analysis, although it does include Jordan, mainly addresses the transitional context in the West Bank. Throughout the research studies, we have argued that it would be misleading to judge hospital performance in the West Bank without considering the historical and ongoing associations with Jordan, the implications of international donors, or the need to identify and measure vital organizational signs. To understand the many dimensions of hospital performance, we have developed a framework of analysis that utilized domain theory and Donabedian's (1980) approach to health care assessment. The produced structure supports the three-key decisionmakers in the provision of public hospital services: (1) health professionals; (2) managers; and (3) policymakers and donors, linking them with three organizational constructs: (1) structure; (2) processes; (3) and outcomes. These decision makers will be the users of the information generated by the research, while the three constructs refer to the areas in which the performance measures are rooted. The existing relevant literature is descriptive and does not contemplate the use of analytical techniques. The thesis extends the aim of previous work by four research studies while filling this gap in the Palestinian literature. This work is the first to quantify, analyze and discuss performance measures of public hospitals in this region. The work addresses two major performance dimensions: the productive efficiency and the effectiveness of medical interview. Throughout the embedded studies, two methods are employed: (1) the Data Envelopment Analysis (DEA) with the extensions of the Malmquist index and Tobit regression; and (2) multivariate statistical techniques like Canonical correlation and cluster analysis. For the first dimension, we analyzed the operational data of two sets of nationally representative hospitals (from the West Bank and Jordan) during the period 2010 - 2015, and for the second dimension, we conducted a survey of doctors from private and public hospitals in the West Bank with 369 valid responses. Due to historical, social, and cultural associations, it is important to start by introducing Jordan’s role in health care provision in the West Bank. Therefore, we compare and evaluate the relative performance of public hospitals during 2010 - 15 in both countries. The obtained results show that the improvements in productive efficiency during the study period were driven by new technologies in West Bank and by managerial innovation in Jordan. Then, we perform a longitudinal analysis of the efficiency of Palestinian public hospitals in to identify potential savings in health care expenditures given the actual context of decrease of international donations, the deteriorating economy of the country and the increasing health needs. Despite the improvement of 4% in the technical efficiency, hospitals showed regress in productivity over the period 2010-15. However, this regress was attributed to technological regress. The main predictors that explain hospital efficiency are bed occupancy rate, outpatient-inpatient ratio, size of the hospital, availability of primary centers within the governorate, the percentage of the available public to beds, and location. Following, we conducted a deeper investigation concerning the technical efficiency and scale efficiency of the Jordanian public hospitals since they set the benchmark for productive efficiency in this region. Finally, in our fourth research work related to the second dimension of performance, we describe Palestinian doctors' views on Patient-Centered Care (PCC) and explore contextual drivers associated with their perceived views. Results show that only 45% of the participants knew about PCC. Doctors with positive views are older, married, specialists, previously familiar with PCC, and working in private hospitals. Results also highlighted performance gaps between public and private hospitals and suggested room for improving the doctors’ interpersonal skills. The final value given by the research studies will only be fully acquired when the relevant decision makers understand the identified failures and response to overcome them. |
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| ISBN: | 9798383467596 |