Dashboard Metrics Evaluation

Healthcare institutions’ care outcomes continuously assess their data to promote patient safety and ensure quality and safe patient outcomes. Health dashboards help institutions evaluate their data and also asses their performance against nationally and locally set standards.

Dashboard Metrics Evaluation

This essay focuses on the diabetes dashboards for Mercy Medical Center. The institution is Villa Health Affiliated due to its outstanding performance in various fields over the years. The essay will also evaluate the data based on set policies and existing benchmarks, the consequences of not meeting these benchmarks, and ethical interventions to improve the underperforming benchmarks.

Hospital Dashboard Metrics Evaluation

The hospital serves all populations, from reproductive health patients, emergency and critical care, and theatre, to outpatient care services. The institution serves over 20000 individuals. The population is spread across all ages, with the highest being individuals between ages 21-44 (14732) and the lowest being adults above 65 (2371). Whites (28537) are the largest population served by the institution, and interracial form the minority group (1016). Among the 36192 individuals served by the institution, 17957 are male, and 18235 are female.

The dashboard at the healthcare facility is evaluated quarterly, and the performance is assessed based on the performance of previous years or quarters. The data accommodates age and race in burden and changes through the various quarters. In the last of 2020, the data on racial distribution was as follows: 63% whites, 6% Asians, 13% American Indians, 17 African Americans, and 11 other ethnicities. 73 did not respond. Among them, 38% were males, and 62% were females. The results of interest are HbA1c and Diabetic foot examinations.

In the last quarter, the diabetic foot exam was 62, while the HbA1c tests were 64, a drop from 78 in the previous quarter (Villa Health, n.d.). The information provided is missing vital information, such as the total number of diabetic patients and the newly diagnosed patients, for more accurate calculations and informing change/action.

Benchmarks Set Forth by Local, State, & Federal Laws

Comparing the performance of various originations at the local, state, or national level is vital for continuous improvement in healthcare institutions. The IHI and the Agency for Healthcare Research and Quality (AHRQ)rds are the most proactive organizations in setting quality standards.

The AHRQ sets the standards for organizations by assessing the best-performing organizations and using their data as the standard for all other organizations. This step makes the benchmarks realistic and achievable at all care levels. The AHRQ relies on systems and big data organizations such as DARTNet, SAFTINet, and the National Committee on Quality assurance to collect and analyze healthcare data.

The AHRQ releases the national health disparities and quality report that showcases changes and any new standards for the various metrics. The NHDQR report (2021) is the basis for evaluating these metrics. According to the NHDQR (2021), “more than 79.5% of diabetic patients should take the HgbA1c test twice annually, more than 84% of patients should take annual diabetic foot tests, and more than 75.2% of patients should take annual eye exams” (AHRQ, n.d.). Every institution should yearn to achieve these set benchmarks.

Consequences of not Meeting the Prescribed Benchmarks

Diabetes management and follow-up are integral for all patients. Diabetes is the most expensive healthcare condition. The various benchmarks are set to ensure effective diabetes monitoring; without them being met, diabetes patients are not receiving adequate follow-up and monitoring.

Failure to monitor patients leads to increased complications and missed opportunities and their early detection. These have the effect of increasing morbidity and mortality. The failure also increases the burden of diabetes complications and increases healthcare costs due to these complications.

Other consequences are a bad reputation due to poor patient outcomes and other sanctions, such as decreased ACA funding and lawsuits (Chali et al., 2018). Thus, monitoring these exams and test is vital, and healthcare institutions should ensure they are appropriately met. Institutions should also avail all necessary data for quality healthcare decision-making and quality care outcomes.

Evaluation of a Benchmark Underperformance

The interest benchmark is the HbA1c test. These tests have been declining. From some of the available data, these tests have declined over the last quarter. In addition, the nationally set benchmarks require a biannual HbA1c test for these patients, unlike the one-eye and foot exams. Thus, HbA1c tests should be at least double the number of diabetic foot and eye exams.

On the contrary, the diabetic foot exams were 62, and the HBA1c tests were 64 (Vila Health, n.d.). The results show that there are problems in the facility’s execution or access to the HbA1c tests. HbA1c tests are vital because they show a patient’s response to treatment and the effectiveness of therapy changes and are thus crucial to disease prognosis (Imai et al., 2021). Their absence can lead to poor diabetes management. An ethical intervention is thus necessary.

Ethical Intervention for the Underperforming Benchmark

The underperforming benchmark may result from unfavorable policies, patients’ and nurses’ negligence, reluctance, and lack of knowledge. The benchmark’s underperformance could significantly affect patients, nurses, and healthcare leaders. Patient and staff education are ethical interventions that will increase these parties’ perceived benefits and risks and thus improve their self-efficacy in promoting better performance.

Ghisi et al. (2021) note that patient education in diabetes is a practical, ethical intervention that often requires extensive staff education for implementation and success. The various interventions include multimedia, such as fliers and brochures, staff workshops, and diabetes self-management education (DSME) (Ghisi et al., 2021).

Patient and staff education will improve effort from either side, hence superimposed positive effects. Lambrinou et al. (2019) note that diabetes patient education should include the significance and frequency of HbA1c tests and will also highlight the consequences of not undertaking the various tests and interventions.

Conclusion

Healthcare dashboards are vital tools in organizational evaluation and quality improvement. Institutions use their internal data and evaluate I against these standards to determine gaps and needs and intervene accordingly. The healthcare dashboard in this assessment reveals a gap in HbA1c tests, and their attention is necessary for the institution’s success. Patient and staff education through various avenues will improve the benchmark performance and the overall organization’s performance. It will also alleviate the consequences for the various stakeholders.

References

  • Agency for Healthcare Research and Quality. (n.d.). National Healthcare Quality and Disparities Report 2021. The National Diabetes Quality Measures. https://nhqrnet.ahrq.gov/inhprdr/national/benchmark/table/diseases_and_conditions/diabetes
  • Agency for Healthcare Research and Quality. (n.d.). Practice Facilitation Handbook, Module 7. Measuring and Benchmarking Clinical Performance. AHRQ. Agency for Healthcare Research and Quality. https://www.ahrq.gov/ncepcr/tools/pf-handbook/mod7.html
  • Chali, S. W., Salih, M. H., & Abate, A. T. (2018). Self-care practice and associated factors among Diabetes Mellitus patients on follow up in Benishangul Gumuz Regional State Public Hospitals, Western Ethiopia: a cross-sectional study. BMC Research Notes, 11(1), 1-8. https://doi.org/10.1186/s13104-018-3939-8
  • Ghisi, G. L. D. M., Seixas, M. B., Pereira, D. S., Cisneros, L. L., Ezequiel, D. G. A., Aultman, C., Sandison, N., Oh, p., & da Silva, L. P. (2021). Patient education program for Brazilians living with diabetes and prediabetes: findings from a development study. BMC Public Health, 21(1), 1-16. https://doi.org/10.1186/s12889-021-11300-y
  • Imai, C., Li, L., Hardie, R. A., & Georgiou, A. (2021). Adherence to guideline-recommended HbA1c testing frequency and better outcomes in patients with type 2 diabetes: a 5-year retrospective cohort study in Australian general practice. BMJ Quality & Safety, 30(9), 706-714. http://dx.doi.org/10.1136/bmjqs-2020-012026
  • Lambrinou, E., Hansen, T. B., & Beulens, J. W. (2019). Lifestyle factors, self-management and patient empowerment in diabetes care. European Journal Of Preventive Cardiology, 26(2_suppl), 55-63. https://doi.org/10.1177/2047487319885455

Dashboard Metrics Evaluation Assignment Instructions:

Write a 3-5 page report for a senior leader that communicates your evaluation of current organizational or interprofessional team performance, with respect to prescribed benchmarks set forth by government laws and policies at the local, state, and federal levels.

Introduction

In the era of health care reform, many of the laws and policies set forth by government at the local, state, and federal levels have specific performance benchmarks related to care delivery outcomes that organizations must achieve. It is critical for organizational success that the interprofessional care team is able to understand reports and dashboards that display the metrics related to performance and compliance benchmarks.

Maintaining standards and promoting quality in modern health care are crucial, not only for the care of patients, but also for the continuing success and financial viability of health care organizations. In the era of health care reform, health care leaders must understand what quality care entails and how quality in health care connects to the standards set forth by relevant federal, state, and local laws and policies. Understanding relevant benchmarks that result from these laws and policies and how they relate to quality care and regulatory standards is also vitally important.

Health care is a dynamic, complex, and heavily regulated industry. For this reason, you will be expected to constantly scan the external environment for emerging laws, new regulations, and changing industry standards. You may discover that as new policies are enacted into law, ambiguity in interpretation of various facets of the law may occur. Sometimes, new laws conflict with preexisting laws and regulations, or unexpected implementation issues arise, which may warrant further clarification from lawmakers. Adding partisan politics and social media to the mix can further complicate understanding of the process and buy-in from stakeholders.

Health care is a dynamic, complex, and heavily regulated industry. For this reason, you will be expected to constantly scan the external environment for emerging laws, new regulations, and changing industry standards. You may discover that as new policies are enacted into law, ambiguity in interpretation of various facets of the law may occur. Sometimes, new laws conflict with preexisting laws and regulations, or unexpected implementation issues arise, which may warrant further clarification from lawmakers. Adding partisan politics and social media to the mix can further complicate understanding of the process and buy-in from stakeholders.

Instructions

Choose one of the following two options for a performance dashboard to use as the basis for your evaluation:

Option 1: Dashboard Metrics Evaluation Simulation

Use the data presented in your Assessment 1 Dashboard and Health Care Benchmark Evaluation activity as the basis for your evaluation.

Note: The writing you do as part of the simulation could serve as a starting point to build upon for this assessment.

Option 2: Actual Dashboard

Use an actual dashboard from a professional practice setting for your evaluation. If you decide to use actual dashboard metrics, be sure to add a brief description of the organization and setting that includes:

  • The size of the facility that the dashboard is reporting on.
  • The specific type of care delivery.
  • The population diversity and ethnicity demographics.
  • The socioeconomic level of the population served by the organization.

Note: Ensure your data are Health Insurance Portability and Accountability Act (HIPAA) compliant. Do not use any easily identifiable organization or patient information.

To complete this assessment:

  1. Review the performance dashboard metrics in your Assessment 1 Dashboard and Health Care Benchmark Evaluation activity, as well as relevant local, state, and federal laws and policies. Consider the metrics that are falling short of the prescribed benchmarks. Note: The writing you do as part of the simulation could serve as a starting point to build upon for this assessment.
  2. Write a report for a senior leader that communicates your evaluation of current organizational or interprofessional team performance, with respect to prescribed benchmarks set forth by government laws and policies at the local, state, and federal levels. In addition, advocate for ethical and sustainable action to address benchmark underperformance and explain the potential for improving the overall quality of care and performance, as reflected on the performance dashboard.
  3. Make sure your report meets the Report Requirements listed below. Structure it so that it will be easy for a colleague or supervisor to locate the information they need, and be sure to cite the relevant health care policies or laws when evaluating metric performance against established benchmarks.

Report Requirements

The report requirements outlined below correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, be sure to note the requirements for document format and length and for supporting evidence.

  • Evaluate dashboard metrics associated with benchmarks set forth by local, state, or federal health care laws or policies.
    • Which metrics are not meeting the benchmark for the organization?
    • What are the local, state, or federal health care policies or laws that establish these benchmarks?
    • What conclusions can you draw from your evaluation?
    • Are there any unknowns, missing information, unanswered questions, or areas of uncertainty where additional information could improve your evaluation?
  • Analyze the consequence(s) of not meeting prescribed benchmarks and the impact this has on health care organizations or teams.
    • Consider the following examples:
      • Organizational mission and vision.
      • Resources.
        • Staffing.
        • Financial: Operational and capital funding.
        • Logistical considerations: Physical space.
        • Support services (any ancillary department that gives support to a specific care unit in the organization, such as pharmacy, cleaning services, dietary, et cetera).
      • Cultural diversity in the community.
      • Staff skills.
      • Procedures and processes.
    • Address the following:
      • What are the challenges that may potentially contribute to benchmark underperformance?
      • What assumptions underlie your conclusions?
  • Evaluate a benchmark underperformance in a heath care organization or interprofessional team that has the potential for greatly improving overall quality or performance.
    • Focus on the benchmark you chose to target for improvement. Which metric is underperforming its benchmark by the greatest degree?
    • State the benchmark underperformance that is the most widespread throughout the organization or interprofessional team.
    • State the benchmark that affects the greatest number of patients.
    • Include how this underperformance will affect the community that the organization serves.
    • Include the greatest opportunity to improve the overall quality of care or performance of the organization or interpersonal team and, ultimately, to improve patient outcomes, as you think about the issue and the current poor benchmark outcomes.
  • Advocate for ethical and sustainable action(s), directed toward an appropriate group of stakeholders, needed to address a benchmark underperformance.
    • Who would be an appropriate group of stakeholders to act on improving your identified benchmark metric?
    • Why should the stakeholder group take action?
    • What are some ethical actions the stakeholder group could take that support improved benchmark performance?
  • Organize content so ideas flow logically with smooth transitions.
    • Proofread your report, before you submit it, to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your evaluation and analysis.
  • Support main points, assertions, arguments, conclusions, or recommendations with relevant and credible evidence.
    • Be sure to apply correct APA formatting to source citations and references.

Dashboard Metrics Evaluation Paper Sample 2

Healthcare institutions endeavor to improve care quality and safety and reduce costs through periodic evaluation and intervention. A major organizational assessment method is through dashboards. Comparing the dashboard metrics helps healthcare institutions note the underperforming areas and provokes the development of interventions to improve them.

Dashboards can be internally or externally prepared. Internal dashboards help organizations evaluate their performance over time, while external dashboards help them compare their performance against other institutions and national standards. Internal dashboards are the best in determining an institution’s progress over time, and they can also be compared against set benchmarks to show the institution’s performance relative to other organizations.

Mercy Medical Center is the hospital of interest. It is Villa Health-Affiliated and a renowned hospital for its quality care, as reflected in its various achievements such as outstanding patient experiences, high safe surgery ratings, and best emergency services (Vila Health, n.d.). Mercy Medical Center’s diabetes dashboard metrics are the focus of this assessment. It will also evaluate its performance, relevant local, state, and federal policy challenges in meeting the benchmarks, and develop an ethical intervention to address the poorly performing benchmarks.

Mercy Medical Center Dashboard Metrics Evaluation

The services offered by a healthcare institution may differ depending on the population characteristics. Mercy Medical Center is a large institution serving over 20,000 individuals. The hospital serves 2371 over 65 years, 6099 aged 45-64, 14732 aged 21-44, and 12 126 under 20 years (Vila Health, n.d.). The ethnic and racial distribution from the largest to the smallest group is as follows: whites 28537, Asians 3822, Hispanic Latino 2890, African Americans 1601, interracial 1016, American Indian 4333, and other ethnicities 11611. The region’s total population is 36192, and the gender distribution is 17957 males and 18235 females. Race, age, and gender are important factors in diabetes management.

Mercy Medical Center’s public diabetes dashboard is evaluated quarterly, and the institution evaluates its performance for each quarter. The data is presented based on gender, age, and race and includes the number and percentage changes relative to the total number of diabetic patients. 2019’s last quarter statistics were as follows: 355 whites (63%), 34 Asians (6%),73 American Indians (13%), 17 African Americans (3%), 11 other races (2%), and 73 did not respond (Vila Health, n.d.). Of these, 214 patients were males (38%), while 347 (62%) were female, and two did not respond to the gender question.

Among them, 118 were below 20 years, 51 were between 21 and 44, 214 were between 45 and 64, and 180 patients were 65 years and above (Vila Health, n.d.). The government requires individuals to attend an annual diabetic foot, eye, and HbA1c examination. The rates of HbA1c have been dropping gradually, and the number of diabetic foot exams has been relatively low. These rates are relatively low and cause concern, judging from the number of new patients for the last quarter.

There are several areas of missing information. The total number of patients available makes it difficult to calculate the percentage of patients attending diabetic foot, eye, and HbA1c examinations. In addition, other diabetes interventions vital to diabetes monitoring, such as diabetes complications and their categories that help show the actual impact of the benchmarks, are missing.

Benchmarks Set Forth by Local, State, & Federal Laws

Benchmarking is an important way of evaluating performance. Comparing the organization’s performance against the national and state-set standards will help gauge the organization’s success in meeting healthcare needs. These standards help maintain high-quality care and spearhead quality improvement processes in healthcare institutions. Institutions can borrow ideas from other organizations succeeding in various benchmarks to improve care delivery, quality, and patient safety associated with the benchmark of choice.

The Agency for Healthcare Research and Quality is responsible for preparing national quality standards for various healthcare conditions. AHRQ relies on data sources such as the National Committee on Quality Assurance, DART Net, and SAFTINet, large data organizations with high efficiency, specialization, and reliability (AHRQ, 2021). The agency liaises with other bodies responsible for specific conditions, such as the American Heart Association (stroke and heart disease) and the American Diabetes Association (diabetes), to collect and analyze data vital in preparing these benchmark dashboards.

AHRQ prepares annual reports that contain specific dashboards for managing various healthcare conditions and certain conducts within the hospital. The National Healthcare Quality and Disparities Report is a comprehensive document prepared each year to reflect the data collected and analyzed and the inferences made by the AHRQ. The national diabetes quality measures by the NHQDR feature the national benchmarks for diabetes on dilated eye and foot exams and HbA1c tests.

Dashboard Metrics Evaluation Paper

Image Source: AHRQ

AHRQ (n.d.) notes that these benchmarks are results from top-performing institutions, and other institutions can gauge their performance using them. NHDQR (2019) report states that more than 79.5% of diabetic patients should take the HgbA1c test twice annually, more than 84% of patients should take annual diabetic foot tests, and more than 75.2% of patients should take annual eye exams (AHRQ, n.d.). These percentages are set from the results of the best-performing healthcare institutions. These tests are integral to detecting patient complications early and intervening before injury results in the patient.

Challenge Posed by Meeting Prescribed Benchmarks

Meeting the prescribed benchmarks would pose a challenge to healthcare staffing. Diabetes patients place a significant burden on the healthcare workers’ workload. Winter et al. (2020) note that a global healthcare staff shortage affects most hospitals. Meeting the benchmark will increase the number of patients attending the hospital, further aggravating the shortage of healthcare staff due to the increased demand.

Available staff in hospitals with staff shortages focus more on completing the assigned tasks than ensuring quality care. It is thus easy for them to overlook some items, such as annual checkups, despite their potential to influence diabetes patient outcomes. Understaffing increases error incidences, interferes with work productivity, and promotes high employee fatigue and burnout, high employee turnover, and poor patient outcomes (Winter et al., 2020). The few staff can also overlook the comprehensive and keen patient assessment.

Pankhurst & Edmonds (2018) state that staff shortage leads to decreased staff efficiency and reliance; hence, it is easy to overlook details such as changes in HbA1c test variations, wounds and minor injuries, and slight changes in visual acuity when attempting to complete the many tasks.

Patient education is a vital aspect of diabetes management. With inadequate staff, there is limited time to emphasize the importance of these follow-ups, leading to low patient turnout. Understaffing would thus affect the quality of care and increase patient safety issues. Healthcare staff shortages are a global pandemic, and very few hospitals have nurses and physicians close to the recommended health worker-to-patient ratio (Winter et al., 2020). The problem affects government and private institutions. A major assumption is that Mercy Medical Center is also affected by the global healthcare staff shortage.

HbA1c tests are integral in determining the effectiveness of interventions in managing blood glucose levels within acceptable limits. Imai et al. (2021) state that tests help with interventions such as changes in patient therapy, patient education, and family involvement in cases of self-care deficit. HbA1c tests help detect complications and impaired glucose regulation early; thus, healthcare providers intervene early to prevent complications.

Imai et al. (2021) also note that patients with strict adherence to HbA1c tests have better outcomes and effectiveness in glycemic control. Failure to monitor HbA1c leads to complications such as persistent high blood glucose, peripheral neuropathies, and stroke. It thus decreases care quality and interferes with patient safety, hence poor population health. HbA1c tests and results monitoring are thus integral.

Ethical Intervention for the Underperforming Benchmark

The stakeholder group to take action is the healthcare leaders. The leaders prepare policies and can easily organize and provide resources for any intervention in the healthcare institution. Diabetes management requires the input of various professionals, including nurses, doctors, ophthalmologists, and laboratory technicians, and these professionals interact with the patients to varying degrees.

The chosen intervention, staff education, is an integral step in ensuring that patients understand the importance of HbA1c tests and other metrics in diabetes management. The main goal is to increase the patient’s knowledge and promote healthy behavior. Researchers note that staff training increases their confidence, the immediacy of action, quality healthcare decisions, and patient safety and promotes better staff work experiences (Torani et al., 219).

Ethics in healthcare are integral. Respecting autonomy and fidelity are the basis for developing the intervention. The main goal is to increase the patients’ knowledge to make the right decisions (Lambrinou et al., 2019). Patients also participate in healthcare decisions when they understand their implications.

The education will also remind the nurses of the importance of carrying out the tests and encourage them to meet the requirements when managing these patients. The education will increase their faithfulness when assessing and educating these patients to ensure adherence to the diabetes management requirements. Comprehensive education will also help improve other standards, such as vaccination requirements not included in this dashboard.

Most initiatives and emphasis on healthcare interventions are initiated by healthcare providers, thus sensitizing the nurses to the benchmarks and reminding them of the importance of teaching patients. Reminding nurses will help manage the underperforming benchmark and prevent further complications while ensuring the interventions do not stretch the existing healthcare resources. Other interventions that can supplement the intervention include preparing learning material such as handouts and online resources, and referring patients to them will further increase their information and create the need and urgency to adhere to the recommendations of HbA1c tests (Ghisi et al., 2021).

Conclusion

Dashboard evaluation helps in healthcare performance and quality improvement. These healthcare dashboards help determine progress and show the hospital’s performance to other institutions and the nationally set standards. Mercy Medical Center’s diabetes dashboard metrics show the need for interventions to improve HbA1c tests. The tests are poorly done compared to the nationally set standards.

The lack of statistics on the total number of patients makes it difficult to calculate actual percentages. Moreover, eye exams and diabetic foot exams are also performing poorly, and there is room for improvement. The intervention to improve the underperforming dashboard metric is based on various ethical principles, including autonomy, respect for persons, and fidelity. Staff training will help improve the underperforming benchmark and overall diabetes management.

References

  • Agency for Healthcare Research and Quality. (n.d.). National Healthcare Quality and Disparities Report 2021. The National Diabetes Quality Measures. Accessed 30th June 2022 from https://nhqrnet.ahrq.gov/inhprdr/national/benchmark/table/diseases_and_conditions/diabetes
  • Agency for Healthcare Research and Quality. (n.d.). Practice Facilitation Handbook, Module 7. Measuring and Benchmarking Clinical Performance. AHRQ. Agency for Healthcare Research and Quality. Accessed 30th June 2022 from https://www.ahrq.gov/ncepcr/tools/pf-handbook/mod7.html
  • Ghisi, G. L. D. M., Seixas, M. B., Pereira, D. S., Cisneros, L. L., Ezequiel, D. G. A., Aultman, C., Sandison, N., Oh, p., & da Silva, L. P. (2021). Patient education program for Brazilians living with diabetes and prediabetes: findings from a development study. BMC Public Health, 21(1), 1-16. https://doi.org/10.1186/s12889-021-11300-y
  • Imai, C., Li, L., Hardie, R. A., & Georgiou, A. (2021). Adherence to guideline-recommended HbA1c testing frequency and better outcomes in patients with type 2 diabetes: a 5-year retrospective cohort study in Australian general practice. BMJ Quality & Safety, 30(9), 706-714. http://dx.doi.org/10.1136/bmjqs-2020-012026
  • Lambrinou, E., Hansen, T. B., & Beulens, J. W. (2019). Lifestyle factors, self-management and patient empowerment in diabetes care. European Journal Of Preventive Cardiology, 26(2_suppl), 55-63. https://doi.org/10.1177/2047487319885455
  • Pankhurst, C. J. W., & Edmonds, M. E. (2018). Barriers to foot care in patients with diabetes as identified by healthcare professionals. Diabetic Medicine, 35(8), 1072–1077. https://doi.org/10.1111/dme.13653
  • Torani, S., Majd, P. M., Maroufi, S. S., Dowlati, M., & Sheikhi, R. A. (2019). The importance of education on disasters and emergencies: A review article. Journal of Education And Health Promotion, 8. https://doi.org/10.4103/jehp.jehp_262_18
  • Vila Health. (n.d.). Dashboard and Health Care Benchmark Evaluation. Capella University. Accessed from https://media.capella.edu/coursemedia/nhs6004element17010/wrapper.asp#
  • Winter, V., Schreyögg, J., & Thiel, A. (2020). Hospital staff shortages: environmental and organizational determinants and implications for patient satisfaction. Health Policy, 124(4), 380-388. https://doi.org/10.1016/j.healthpol.2020.01.001

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