Managerial features and outcome in neonatal intensive care units: results from a cluster analysis

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

Bibliometric Analysis of Development Trends and Research Hotspots in the Study of Data Mining in Nursing Based on CiteSpace

“… 62 Cluster analysis is more used in the analysis of clinical symptom clusters of diseases in nursing research to identify the characteristics of different clusters, so as to formulate different nursing interventions and achieve precision nursing. 63 , 64 Artificial neural network has more advantages in the application of clinical nursing management and nursing education. By constructing an accurate risk assessment model, it can optimize the loopholes in talent management and talent training, so as to improve the quality of management and education.…”

Discharge Age and Weight for Very Preterm Infants in Six Countries: 2012–2020

“…A systematic review of factors that increase length of stay in a neonatal unit found that organizational factors within a geographic region, such as level of care, may influence length of stay, but the study did not mention factors across geographic regions, such as healthcare financing systems [12]. Organizational factors such as management of neonatal intensive care units in Italy have also been found to be associated with outcomes [13]. However, in a large integrated health system in southern California, NICU patient days decreased from 2010 to 2018, although most of the change occurred among infants with higher birth weights and gestational ages [14].…”

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“…A pesar de las necesidades documentadas en estas unidades, como el trabajo colaborativo (Fanelli, Simone et al 2020), la gestión de alta carga laboral (Bray, Kate et al 2010) o la mejora de infraestructura en cuidados estructurales (Currie, Erin et al 2016), las profesionales enfermeras se establecen como nexo entre institución y pacientefamilia, especialmente en unidades como las unidades de cuidados críticos neonatales y pediátricos (Bloomer, Melissa et al 2015;Ribeiro, Catarina et al 2015). Estas profesionales deben de establecer una interacción entre ambos actores, demostrando habilidades, conocimientos, actitudes, empatía, identificando necesidades de aprendizaje, favoreciendo el bienestar y al mismo tiempo acompañar en los procesos que conlleven una pérdida o cambio de vida (Gramazio-Soares, Natalia et al 2016; Rossman, Beverly, Greene y Meier 2015).…”