الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 183 |  |  |
| | | from | 183 | | |
Abstract
CG is the system that manage the organization based on a structured framework through practicing the defined legal aspects and conducting the code of conduct and ethics that led by a board of directors who guide the corporate managers and monitor their commitment to their responsibilities, utilizing the fundamental principles of justice, fairness and faithfulness, emphasizing the culture of integrity as well as combat corruption. Additionally, it serves as the foundation for a positive/healthy work environment that is based on a regulated transparency and disclosure that support the stakeholders to be informed by their organizational activities and the business’s financial performance. CG is critical for shaping a business and ensuring its competitiveness against global corporations; its principles could safeguard shareholders, stakeholders, and investors from business scandals and enforce their critical role in contributing to the organization’s long-term profitability and performance.
The HC sector is particularly susceptible to corruption as a result of; asymmetric information system between their stakeholders, patients’ vulnerability, services complexity, and huge sums of money flowing through the health system. It disproportionately affects vulnerable communities, who lack the knowledge, resources, and contacts necessary to obtain care or services. Hence, it is necessary to identify issues, prioritize actions, risk management, and sequence mitigation methods. Integrating or mainstreaming openness, accountability, and stakeholder involvement into the health sector is a cutting-edge approach in fighting against corruption and cultivate the concept of integrity. Mitigating strategies should focus firstly on creating efficient healthcare and secondary on a value add framework. These strategies improve the capability to prevent wasting materials, information, money, energy, effort, and time in achieving the desired outcome; they also improve transparency, accountability, enhance efficiency and sustain the organizational development and responsibility.
Aim of the study
The purpose of this study was to assess the compliance of the healthcare organizations to corporate governance’s practices and its relation to efficiency in the operating theaters (OTs). The subsequent objectives are to:
1. a. Assess principles of corporate governance.
1. b. Measure efficiency in OTs.
2. Assess the relationship between corporate governance and efficiency in OTs.
3. Develop a proposed value-add strategy in OTs.
Study design:
Quantitative descriptive correlational research design was followed to conduct the current study.
Setting
Eleven hospitals were chosen for the study’s preliminary phase and given the go-ahead to take part. Of the initial eleven hospitals, only ten continued the trial, and one hospital decided to discontinue participation altogether. These hospitals were chosen based on the fulfillment of specific adopted selection criteria; five of the hospitals under study were for-profit, private healthcare facilities situated in Alexandria, Egypt, and the remaining five were governmental hospitals connected to the M.O.H.P. and situated in Al-Behira, Egypt. One of the eleven hospitals decides to withdraw from the participation of the study.
Subjects:
The subjects of the study were classified into two main groups:
At the time of data collection, all management personnel, leaders, and healthcare professionals who were employed in the inpatient units of hospitals or in their general operating rooms (ORs) were included in group I (N=467). The following two subcategories are represented by group I:
a. Hospital administration (managers/board members n= 114) who were occupying senior/different managerial levels and available to participate in the study as the following: board of directors (20), general hospital directors (10), and managers of non-clinical/administrative departments; financial affairs, human resources, storage and procurement, legal affairs (74); nursing directors and first line-nurse managers in the OTs (10).
b. Healthcare professionals (n=353) who were employed by these facilities and were presented in the studied operation rooms. They are divided into the 193 nurses, 108 surgeons, and 52 anesthetists who work in the chosen OTs.
group II: It consists of a sample size of 62 patients who were observed in accordance with the selection of two operating rooms (ORs) scheduled lists that underwent only to planned general procedures in the examined operating rooms during morning shifts. Unscheduled or impromptu surgeries were not included in this study.
Tools: Three data gathering tools were employed in this study:
Tool 1: Corporate Governance Practices Assessment (CGPA):
It was measured by two parts:
The first part: is baseline data sheet of the staff: It was developed to evaluate the staff’s demographic and professional characteristics including; age, current job title, years of experience since graduation, and years of experience with the present employer.
The second part: CGPA Structured Interview: The researcher developed this tool after reviewing relevant recent literature (Shi et al., 2017; Sitnikov et al., 2014; McKnight & Weir, 2009; Eunjung, 2000). As it relates to hospitals’ compliance with the determinants/practices/standards of CG in the studied hospitals, it is used to capture the perspectives of HC providers working in the ORs (nurses, anesthetists, surgeons) and managers/leaders (board of directors, medical and non-medical managers, and nursing managers). It was used to evaluate how administrators, leaders, and healthcare professionals felt about how well hospitals comply with CG principles and procedures, through 129 questions covered eight main determinants or practices and were classified into the following categories: governance framework (35 items) distributed into four sub-determinants, including the code of corporate governance (3 items), legal and ethical considerations (18 items), governance structure (5 items), and clinical governance (9 items); responsibility, sustainability, and accountability (8 items); shareholders’ rights (5 items); shareholders’ rights were also covered (39 items). The responses were yes = (2) or no = (1). The overall score, ranging from 129 to 258 and the corresponding compliance levels, are:
- ≤ 60% (less than 155 points) = unacceptable level of compliance with CG determinants/practices.
- > 60%: ≤ 80% (from 155- 206 points) = partially acceptable level of compliance with CG determinants/practices.
- > 80% (more than 206 points = acceptable level of compliance with CG determinants/practices.
Tool 2: GEMBA Walk Tool:
The researcher used this tool after reviewing research in the field (Taggart et al., 2019; Soliman, 2018; Lot et al., 2018) to observe the actual patient journeys scheduled for general surgery and underwent from the time they were referred to OTs until they returned to inpatient units after the surgical procedure and also to identify the value add and non-value add activities. As it was viewed as an initial stage in the development and structuring of this observational tool which is the result of the process shadowing of patients by GEMBA walk. A defined technique was followed for GEMBA walk observation to see the reality of the situation and actual pere-operative processes including:
Define a clear purpose for GEMBA walk which is to:
-- Observe healthcare providers, ask about their tasks related journey of patients underwent surgeries
- Observe the actual patient journeys scheduled for general surgery and underwent from the time they were referred to OTs until they returned to inpatient units
- To identify the unnecessary andinefficiency activities of the processes
• Decide the process is needed to be observed;
- Pere-operative processes related to scheduled general surgeries including; pre-operative, intra-operative, and post-operative processes and sub-processes.
• Select the location by defining a specified OR,
• Prepare the required tools to complete the observation as related documents, patients’ data, equipment for data collection ” check list , stop watch ”, records,
• Analyze the observed processes and sub-processes,
• Through the observational process the researcher must respect the culture of the studied hospitals and its OTs, following the rules, norms, and etiquette of the environment.
There are two parts constitute the tool:
• The first part included a blank sheet to record the actually observed processes and sub-processes carried out in caring for patients undergoing general surgeries.
• The second part: Itis
- A direct observational technique to document all processes and practices related to the surgical procedures in the patient’s journey to operating theaters and documenting it.
- The level of saturation of the pere-operative processes and activities achieved and repeated simultaneously at the thirty observed patients who underwent general scheduled surgeries
- It concluded thirty three tasks essential and fundamental for the patients underwent surgical procedures.
- Tracking of patient’s journey for surgery checking the defining standards concerning the following;
Define each action done by clear statement as ”assuring patient’s identification by full name and file number, confirming that the patient signed an informed consent, obtaining the medical and surgical history of patient”,
Determining the assigned personnel to accomplish the task,
Report the frequency of each action,
Estimating the time that actually consumed to perform tasks and eliminating any wasted motion and waiting times from this observation.
The responses on GEMBA walk observational checklist were measured by using compiled (2) or not-compiled (1). The total score ranging from 33 to 66.
Tool 3: Operating Theaters’ Efficiency Practices Observational Checklist
It includes three parts:
A. Patients’General Information Checklist:It was developeded by the researcher, It was utilized to make sure that each patient undergoing surgery was appropriately evaluated before a decision to do surgery was made that reflect the healthcare providers’ compliance with safe surgery standards as well as reflect hospitals’ compliance to CG practices. It included seven items, it used to gather the baseline information about the observed patients who underwent general surgeries including; length of stay pre-operatively, payment method (paid services or free services). In addition, items assessed medical history pre-operatively, surgical history pre-operatively, patients’ current complaint, as well as, documentation ofpatients’ final diagnosis, and assessment for patients’ fitness for anesthesia. In addition to,patient identification data that includes; patients’ file number, age. The items to this checklist were scored using yes = (2) or no = (1). The overall score, ranged from 7 to 14.
B. An observational Safe Surgery Checklist:This checklist was developed based on the current related literature (Willassen et al., 2018; Jain et al., 2018; Haynes et al., 2015; Pancieri et al., 2013; Mahajan, 2011) and the direct observational technique of the GEMBA walk as well as a review of relevant related literatures; the the Egyptian Ministry of Health and Population’s (M.O.H.P) Guideline for Safe Surgery (2010), W.H.O Standards for Safe Surgery (2008), the National Safety Requirements (NSR) (2018), and general authority for accreditation and regulations, GAHAR, (2018) throughout of 96 items covering the four main phases to assess thehealthcare providers’ adherence to safe surgical procedures. These practices classified into preoperative practices and measured by 35 items, patient handoff practices and measured by 13 items, the induction of anesthesia & intraoperative which was measured by 35 items, and recovery practices and patient’s discharge from OR that was measured by 13 items. The responses on safe surgery checklist were measured by using compiled (2) or not-compiled (1) or not applicable (0). The total score ranging from 96 to 192 taking into consideration that not applicable response should be substracted from the total. The total/overall score classified into;
- ≤ 60% (less than 115 points) = unacceptable level of compliance with safe surgery standard.
- > 60%: ≤ 80% (from 115- 153 points) = partially acceptable level of compliance with safe surgery standard.
- > 80% (more than 153 points) = acceptable level of compliance with safe surgery standard.
C. OR Efficiency Assessment sheet: It was developed by the researcher based on the most recent relevant literature (Elshazly, 2016; Lyons, 2014; Zakaria, 2013) to measure eight metrics/indicators that characterize operating theatre efficiency. According on their identifier of measurement, the ORs’ indicators were categorized as follows: