Department of Economics and Management, University of Parma, Via J. F. Kennedy, 6, Parma (PR), Italy.
Neonatal Intensive Care Unit, ASST of Lecco, Lecco, Italy.
BMC Health Serv Res. 2020 Oct 16;20(1):957. doi: 10.1186/s12913-020-05796-0.
Healthcare organisations differ in performance even if they are located in the same country or region. Suitable managerial practices and organisational processes can lead to better health outcomes. As a result, hospitals are constantly looking for managerial arrangements that can improve outcomes and keep costs down. This study aims to identify different managerial models in neonatal intensive care units (NICUs) and their impact on a large number of outcomes.
The research was conducted in Italy, within the SONAR project. SONAR's aim was to identify the characteristics of NICUs, monitor outcomes and promote best practices. This study includes 51 of the 63 NICUs that took part in the SONAR project. Questionnaires on the activities and managerial features were administered to doctors and nurses working in NICUs. A total of 643 questionnaires were analysed from doctors and a total of 1601 from nurses. A cluster analysis was performed to identify managerial models of NICUs.
Three managerial models emerged from cluster analysis: traditional, collaborative and individualistic. In the "traditional" model the doctor is above the nurse in the hierarchy, and the nurse therefore has exclusively operational autonomy. The "collaborative" model has as key elements professional specialisation and functional coordination. The "individualistic" model considers only individual professional skills and does not concern the organisational conditions necessary to generate organisational effectiveness. The results also showed that there is an association between managerial model and neonatal outcomes. The collaborative model shows best results in almost all outcomes considered, and the traditional model has the worst. The individualistic model is in the middle, although its values are very close to those of traditional model.
Health management needs to assess NICU strategically in order to develop models to improve outcomes. This study provides insights for management useful for designing managerial characteristics of NICUs in order to achieve better results. NICUs characterised by a collaborative model in fact show better neonatal outcomes.
即使在同一国家或地区，医疗机构的表现也存在差异。适当的管理实践和组织流程可以带来更好的健康结果。因此，医院一直在寻找可以改善结果并降低成本的管理安排。本研究旨在确定新生儿重症监护病房（NICU）中的不同管理模式及其对大量结果的影响。
该研究在意大利的 SONAR 项目中进行。SONAR 的目的是确定 NICU 的特征，监测结果并推广最佳实践。本研究包括参与 SONAR 项目的 63 个 NICU 中的 51 个。向在 NICU 工作的医生和护士发放了关于活动和管理特征的问卷。对医生进行了 643 份问卷分析，对护士进行了 1601 份问卷分析。通过聚类分析确定了 NICU 的管理模式。
聚类分析得出了三种管理模式：传统模式、协作模式和个人主义模式。在“传统”模式中，医生在等级制度中高于护士，护士因此仅具有操作自主权。“协作”模式的关键要素是专业分工和职能协调。“个人主义”模式仅考虑个人专业技能，不关注产生组织效力的组织条件。结果还表明，管理模式与新生儿结局之间存在关联。协作模式在几乎所有考虑的结果中都表现出最佳结果，而传统模式则最差。个人主义模式居中，尽管其值与传统模式非常接近。
医疗保健管理需要战略性地评估 NICU，以制定改善结果的模型。本研究为管理提供了见解，有助于设计 NICU 的管理特征，以实现更好的结果。协作模式的 NICU 实际上表现出更好的新生儿结局。
