Cost accountancy and cost control in hospitals

It is a fact that there now exists a sound framework of accounting theory to ascertain the working results and the investment status of hospitals. Yet, there is no system of accounting in practice to conduct its activities with utmost efficiency. No attempts have hitherto been made for the continuous improvement in the servics rendered by hospitals. Personal investments in hospitals have made the interaction of business to some extent.Planning, decision making and control assume increasing importance as hospitals grow in size and complexity. Moreover, wise and effective utilisation of resources should be ensured. The importance of cost cannot be overlooked in this context. Cost is the most effective factor in the determination of the prices of hospital services rendered. The important managerial functions have to rely heavily on accurate and timely cost information. More people can be provided with services if no services cost more than what is a must to provide the necessary level of care. The price paid for high cost technology for a few is no technology at all for the many. Hence no pains must be spared in ascertaining, presenting, controlling and reducing costs. An effective system of Cost Accountancy and Cost Control is imperative for the survival of hospitals in the intensely competitive conditions of today. The valuable objective of "better patient care" can be attained only if the management can make use of the various tools and techniques to ascertain, control and reduce each item of cost in hospitals. Constant efforts must be made by the management to continuously improve their services and bring down costs and prices of all hospital services. Cost Accountancy has made its impresssive impact on almost all the spheres of human activities. It is high time a comprehensive Cost Accountancy and Cost Control system be implemented in hospitals. The problem under study thus is the designing of a sound and full-fledged Cost Accountancy and Cost Control system that suits the requirements of hospitals. It is for the first time in India during the evolution of Cost Accountancy that a comprehensive cost system is tried in hospitals.

Subcontract and supply enquiries in the tender process of contractors

In the tender process, contractors often rely on subcontract and supply enquiries to calculate their bid prices. However, this integral part of the bidding process is not empirically articulated in the literature. Over 30 published materials on the tendering process of contractors that talk about enquiries were reviewed and found to be based mainly on experiential knowledge rather than systematic evidence. The empirical research here helps to describe the process of enquiries precisely, improve it in practice, and have some basis to support it in theory. Using a live participant observation case study approach, the whole tender process was shadowed in the offices of two of the top 20 UK civil engineering construction firms. This helped to investigate 15 research questions on how contractors enquire and obtain prices from subcontractors and suppliers. Forty-three subcontract enquiries and 18 supply enquiries were made across two different projects with average value of 7m. An average of 15 subcontract packages and seven supply packages was involved. Thus, two or three subcontractors or suppliers were invited to bid in each package. All enquiries were formulated by the estimator, with occasional involvement of three other personnel. Most subcontract prices were received in an average of 14 working days; and supply prices took five days. The findings show 10 main activities involved in processing enquiries and their durations, as well as wasteful practices associated with enquiries. Contractors should limit their enquiry invitations to a maximum of three per package, and optimize the waiting time for quotations in order to improve cost efficiency.

Across the dividing range - bridging the divides: Pharmacy opportunities across the hospital/community and inter-professional divides in rural and remote Australia

Rural and remote areas of Australia offer many opportunities for innovation in healthcare services. Some true healthcare 'network' models based around rural pharmacy can be established and evaluated. The lines between community and hospital pharmacy are often blurred and communication between health professionals enhanced. The blurring divide between hospital and community pharmacy in rural and remote areas has provided significant advances in practice. Projects have been set up to investigate the feasibility of community pharmacists integrating care for patients. These projects take advantage of the dual roles and the enhanced interaction between pharmacists and other health professionals in the bush. Opportunities for provision of clinical services beyond the traditional supply role have been taken in a number of remote communities

ENERGETIC BIOCIDAL MATERIALS AND SPORE NEUTRALIZATION

The objective of this dissertation is to explore a more accurate and versatile approach to investigating the neutralization of spores suffered from ultrafast heating and biocide based stresses, and further to explore and understand novel methods to supply ultrafast heating and biocides through nanostructured energetic materials A surface heating method was developed to apply accurate (± 25 ˚C), high heating rate thermal energy (200 - 800 ˚C, ~103 - ~105 ˚C/s). Uniform attachment of bacterial spores was achieved electrophoretically onto fine wires in liquids, which could be quantitatively detached into suspension for spore enumeration. The spore inactivation increased with temperature and heating rate, and fit a sigmoid response. The neutralization mechanisms of peak temperature and heating rate were correlated to the DNA damage at ~104 ˚C/s, and to the coat rupture by ultrafast vapor pressurization inside spores at ~105 ˚C/s. Humidity was found to have a synergistic effect of rapid heating and chlorine gas to neutralization efficiency. The primary neutralization mechanism of Cl2 and rapid heat is proposed to be chlorine reacting with the spore surface. The stress-kill correlation above provides guidance to explore new biocidal thermites, and to probe mechanisms. Results show that nano-Al/K2S2O8 released more gas at a lower temperature and generated a higher maximum pressure than the other nano-Al/oxysalts. Given that this thermite formulation generates the similar amount of SO2 as O2, it can be considered as a potential candidate for use in energetic biocidal applications. The reaction mechanisms of persulfate and other oxysalts containing thermites can be divided into two groups, with the reactive thermites (e.g. Al/K2S2O8) that generate ~10× higher of pressure and ~10× shorter of burn time ignited via a solid-gas Al/O2 reaction, while the less reactive thermites (e.g. Al/K2SO4) following a condensed phase Al/O reaction mechanism. These different ignition mechanisms were further re-evaluated by investigating the roles of free and bound oxygen. A constant critical reaction rate for ignition was found which is independent to ignition temperature, heating rate and free vs. bound oxygen.

Smoking, depression, and suicide risk in the nursing staff of a Third-Level Hospital

Objective: To determine the association between smoking, depression and suicide risk in the Nursing Staff of a University Hospital. Materials and method: this was a non-experimental, correlational cross-range study with observational analysis carried out between May 2012 and May 2013. We studied 232 nurses of the “Dr. José Eleuterio gonzález” University Hospital. two self-administered scales were applied, one for depression and one for suicide risk. Another hetero-applied scale of nicotine dependency was also used, and the subjects’ socio-demographic records were reviewed. Results: A total of 527,232 nurses were studied. A smoking prevalence of 22.8% (53 subjects), an operational depression prevalence of 15.1% (35 subjects), and a suicide risk of 5.1% (12 subjects) were found. Gender and age, speciically being male and young (mean age 29.2 years) were found to increase the risk of smoking. We also found that those nurses who had a partner and had a higher level of education smoked less compared to those who did not have a partner or had a lower degree of education. there were hospital departments where there was a higher prevalence of smoking, such as Internal Medicine and Shock trauma. No association between smoking and the presence of depression was found. Regarding depression, we found that those nurses who worked in the Department of Pensioners were more likely to develop operational depression than those working in any other department. We also found that the risk of presenting operational depression decreases as age increases. About suicide risk, a statistically signiicant association between smoking and suicide risk was found. We also found an association between operational depression and suicide risk.Conclusions: It is recommended to consider nicotine dependence as a fundamental part of psychopathology assessment because of its strong association with suicide risk. this study emphasizes the complexity of the issue of the comorbidity of smoking and psychopathology and the need to continue research lines.

The impact of Portuguese demographic changes on the demand and supply of blood in the region of Algarve

Dissertação de Mastrado, Gestão de Unidades de Saúde, Faculdade de Economia, Universidade do Algarve, 2016

Nutritional screening and prevalence of hospital malnutrition risk. University Hospital of the UANL, Monterrey

Introduction: Hospital malnutrition risk has prevalence values of 20%-50%, and it is a major health problem in the health institutions worldwide. Objective: To assess the accomplishment of nutritional screening and the prevalence of hospital malnutrition risk in a University Hospital. Materials and methods: A retrospective analysis was carried out with nutritional screening, using primary data from six clinical areas obtained in the period between July 2012 and December 2013. According to previous results in Mexican health institutions and considering a mean malnutrition risk prevalence of 50%, it was calculated that a sample size of 3200 subjects was required for the assessment of valid risk values. Patients with values ≥3 on the Nutritional Risk Screening (NRS, 2002) were classiied as carriers of nutritional risk. Results: A total of 5611 patients (38% of all patients admitted) were studied. The rate of screening declined from 55% in 2012 to 31% in 2013. During the whole period, 3034 patients were classiied with risk of malnutrition (54% prevalence). Conclusions: The prevalence of hospital malnutrition risk was high. The accomplishment of the nutritional screening was deicient, and declined between 2012 and 2013. The lack of nutritional screening does not meet the vital care requirements of hospitalized patients and prevents the timely treatment of those at malnutrition risk.

Identifying aggregate demand and supply shocks in a small open economy

The standard Blanchard-Quah (BQ) decomposition forces aggregate demand and supply shocks to be orthogonal. However, this assumption is problematic for a nation with an inflation target. The very notion of inflation targeting means that monetary policy reacts to changes in aggregate supply. This paper employs a modification of the BQ procedure that allows for correlated shifts in aggregate supply and demand. It is found that shocks to Australian aggregate demand and supply are highly correlated. The estimated shifts in the aggregate demand and supply curves are then used to measure the effects of inflation targeting on the Australian inflation rate and level of GDP.

Demand for, and Supply of, the Services of Primary Producer Representative Bodies in Queensland

In Queensland, at least 93 bodies exist to represent the interests of, and provide other services for, their farmer members, and their industries. The bodies vary greatly in focus, roles and activities, priorities, resources, size, and affiliations with other bodies. Results from a survey of 68 producer representative bodies (PRBs), and other data and information are used to examine the demand for, and supply of, farmer representational and other services in Queensland. The main results were: 1. member demand for services varies considerably between PRBs and is influenced by numerous factors; 2. members and non-members of one PRB vary significantly in the importance attached to some services; 3. the types of activities undertaken by PRBs varies between those for emerging and established industries; and 4. PRBs with paid staff/officers undertake more activities than others. The paper concludes that PRBs must continue to evolve and adapt their operations and structures to take account of changes in member and industry needs, external environments, cost pressures, resource availability, and sources of funding/assistance.