Browsing Theses and Dissertations, Electronic (ETDs) by Author "Aboumatar, Hanan"
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ItemCreating Performance Indicators for Public-Private Partnerships in Healthcare-Saudi Arabia(Johns Hopkins University, 2020-01-29) Albuthi, Abdullah; Burd, Irina; Engineer, Lilly; Hough, Douglas; Aljoudi, Abdullah; Aboumatar, HananIntroduction The Saudi government and Ministry of Health are under increasing pressure to find, evaluate, select, and adopt new solutions in order to improve the quality and access to healthcare facilities. One solution the government is exploring is public private partnerships (PPPs), the premise being that the private sector has more experience in effective and efficient operations and management of healthcare services. However, when adopting such solutions, the primary focus of decision-makers is the financial and managerial aspects during negotiating the contracts and partnerships with the private sector. This dissertation has made an effort to take the perspective of healthcare experts on prioritising proposed indicators in the two main domains of quality of care and access to care; for potential inclusion in contracts between the government and the private sector to manage the services utilising the PPP models. Study Aims The study began with a literature review about the Saudi healthcare system and the history of PPPs and management reforms in Saudi Arabia, aimed at understanding the historical relationship between the two sectors. The second manuscript focuses on the selection of performance indicators by experts, using the Delphi technique, to determine which should be included in the contracts between the government and the private sector for managing and operating the services in secondary care hospital settings in the Saudi healthcare system. Finally, the third paper assesses the feasibility of measuring the selected indicators if they were to be included in the contracts. However, the main objective of this study is to propose a methodology to decision makers suggesting ways to consider the healthcare professionals’ perspectives and inputs as part of contractual performance measurements with respect to important domains such as, quality of care and accessibility in initiatives such as PPPs. Methods The first manuscript’s methods included a review of literature between 1980 and 2017. The sources and type of the literature were from international and national journals in addition to local libraries to review both peer-reviewed papers, thesis and grey literature. For the second manuscript, the method used to reach an agreement among the experts to select the indicators for PPP project was Delphi technique with a questionnaire of list of indicators from valid sources, whereby the experts can rank them and score them using Likert-scale for scoring of each indicator. Finally, the third manuscript was a cross-sectional study of evaluating the feasibility to measure the recommended indicators from the second manuscript. This was achieved by sending a questionnaire with five questions to the quality directors in each hospital in the pilot. Thereafter, the discrepancy between the scores of the feasibility for each indicator was compared among the four hospitals by using Golden Standards method. Results The work from the first manuscript provided a general overview of the management reforms in the last three decades in the healthcare system in Saudi Arabia. Moreover, the study analysed the history of the relationship between the governmental and private sector in the healthcare industry during the same period. In the second and third manuscripts, the experts recommended 23 performance indicators including 17 Quality indicators (two for clinical care, 13 for patient safety, and two for patient-centred and coordinated care) and six Access indicators. Three of the 23 indicators were identified non-feasible to be measured and have high discrepancies among the pilot hospitals. It is proposed that these 20 recommended and feasible indicators can be included in contracts when the private sector is assuming control and offering services while utilising the PPP model. Conclusions In healthcare system, it is essential and significant to consider the perceptions and perspectives of healthcare professionals on monitoring and measurement of the performance, when private sector companies start operating and managing the services, historically offered by the government. Moreover, the experts appreciated the process followed in seeking their input using an evidence-based methodology such as the Delphi technique, which provides a good opportunity to achieve a general agreement among experts. ItemEvaluation of the CUSP Essential Team Behaviors Passport: A Tool for the Comprehensive Unit-based Safety Program (CUSP)(Johns Hopkins University, 2018-04-26) Kent, Paula S; Rosen, Michael; Engineer, Lilly; Morlock, Laura; Weaver, Sallie; Aboumatar, HananAbstract A recent report indicated that medical errors were the third leading cause of death in the United States after heart disease and cancer. Efforts toward reducing medical errors and improving patient safety efforts, especially those at the local level are important. The Comprehensive Unit-based Safety Program (CUSP) has been associated with reductions in medical errors, improvements in clinical outcomes such as decreased blood stream infection rates and human resource outcomes such as decreased nurse turnover. While the factors associated with CUSP team strength and patient safety climate improvement are not well understood, CUSP relies on the wisdom of frontline staff to proactively identify and assess both safety defects and potential patient safety risks. The CUSP program has been in place at Johns Hopkins for more than 10 years. In an effort to encourage patient safety behaviors, the CUSP Essential Team Behaviors Passport (CUSP Passport) was implemented in 2015. The CUSP Passport engages team members in activities that demonstrate essential team behaviors such as collaboration, communication and recognition, analysis and process, education and innovation, and utilization of resources. It was designed to encourage each team to share these activities as evidence of their team behaviors and safety activities. The purpose of this dissertation is to evaluate several components of the CUSP Passport to assess whether we can measure patient safety improvements as a function of the CUSP Passport and whether CUSP teams are able to influence their patient safety and teamwork safety culture scores as a result of completing the CUSP Passport activities. This study analyzed retrospective data from CUSP teams at Johns Hopkins Hospital and Johns Hopkins Community Physicians (81 teams, JHH = 63 and JHCP = 18). For Aim 1, associations between stronger safety climate and teamwork domain scores in the SCA (2015) and the number of completed CUSP Passport challenges were compared. We found significant associations between teamwork domain scores and the number of CUSP Passport challenges completed. We found that with each unit increase of time 1 SCA teamwork domain score, the total number of CUSP Passport tasks completed had a 3% increase. For Aim 2, associations between teams with completed CUSP Passport challenges and the change in safety climate and teamwork domain scores for the time 1 SCA (2015) and time 2 SCA (2017) were compared. No significant associations were noted between teamwork or safety domain scores and the number of CUSP Passport challenges completed and changes in the safety climate and teamwork domain scores. These findings support the conclusion that the CUSP teams with stronger 2015 teamwork domain scores in this sample completed more CUSP Passport challenges than those who do not have strong teamwork domain scores. This underscores the value of conducting this research and the importance of filling in the gaps in the literature for evaluation of CUSP programs and identifying programs that will help CUSP teams improve their completion of safety improvement efforts. ItemHEALTHCARE PROFESSIONALS’ FEAR OF CONTRACTING COVID-19, BURNOUT, AND PERCEPTION OF THE QUALITY OF CARE IN GHANA: A MIXED METHODS STUDY(Johns Hopkins University, 2023-04-18) Arhinful, Benedicta; Aboumatar, Hanan; Engineer, Lilly; Austin, Matt; Hsu, Yea-Jen; Ansong, Daniel; Engineer, Cyrus; Yuan, ChristinaSARS-CoV-2, a coronavirus, was discovered in China in December 2019 and has since infected millions globally. Globally, over 600 million infections and 6.8 million fatalities attributable to COVID-19 have been confirmed as of February 2023. While Ghana, a country in sub-Saharan West Africa, has recorded 171,152 cases and 1,462 deaths as of February 2023. Africa accounts for only approximately 2 percent of all SARS-CoV-2 infections worldwide as of January 01, 2023. Ghana recorded its first two cases of SARS-CoV-2, also known as the novel coronavirus disease 2019 (COVID-19), on March 12, 2020. The pandemic spread quickly across Ghana, resulting in significant morbidity and mortality. Like any developing country, Ghana's health system is strained by a high patient-to-doctor and patient-to-nurse ratio and a chronic shortage of medicines and supplies. Thus, the potential of Ghana's health system to be overwhelmed with an increasing number of cases during a COVID-19 pandemic is very high. This study used a mixed methods approach to evaluate the impact of the pandemic on healthcare professionals' fear of contracting COVID-19, burnout, preparedness, and the perceived quality of care provided. Data were obtained from a quantitative survey of 323 healthcare professionals and an interview with 26 healthcare professionals. The data was obtained through a cross-sectional online survey of healthcare professionals in Ghana. Regression models assessed the association between preparedness, fear of contracting COVID-19 infection, and burnout. Logistic models were used to determine the association between burnout, perceived quality of health services, and provider-patient interaction. A mediation analysis was used to determine the relationship between preparedness and burnout mediated by fear of COVID-19. Research findings revealed preparedness was associated with a decreased fear of contracting COVID-19. Results additionally showed fear of contracting COVID-19 partially mediates the relationship between preparedness and burnout. Also, the fear of contracting COVID-19 had a positive relationship with burnout. Burnout also impacted patient-provider communication, but healthcare professionals' burnout did not affect time spent with patients. Interviews revealed most healthcare professionals had some training/protocols on COVID-19 during the pandemic. Some healthcare workers feared contracting COVID-19 due to a lack of personal protective equipment, inadequate training, and protocols.