Background: Thai government recently launched the policy and formulated the strategy for health care system development in Thailand to embrace the principles and practices of good governance for high quality of care. The aim is to solve and decrease the problems of quality and effectiveness in health care delivery. Therefore, many hospitals place the policy into implementation; especially General Hospitals which are the center of network between primary hospitals and tertiary hospitals. There are 2 level of General Hospitals which are S level and M1 level. To meet the aim of the good governance in administration in General Hospitals service quality, the policy should be concretely formulated for the implementation and widely distributed to all organization’s members, especially nursing organization. To develop and improve the quality of care is the directed obligation and responsibility of nursing organization that nursing organization develops the competency of nursing staff in order to be competent in clinical services. Head Nurse is the nursing administrator who is closest and provides the direct training to nursing staff to improve the competency in patient care. Thus, Head Nurse can majorly and dynamically drive the policy into practice in order to promote and sustain the principles of Good Governance in health care.
Method: The objectives of this descriptive research were to study the good governance of head nurses in general hospitals and compare administration based on good governance principles classified by educational level, time from patient ward management as a head nurse, department assignment, nursing administration training programs and general hospital service provision. The sample was composed of 365 head nurses in general hospitals who were selected by using the multi-stage sampling technique. The data collection instrumentation included a questionnaire based on the management of the good governance concepts developed by Weiss (2000), Office of the Public Sector Development Commission (2009), King Prajadhipok's Institute (2006), Office of the Civil Service Commission (2003). The questionnaire was validated by a panel of five qualified experts who checked for content validity (0.85).Reliability was tested by finding Cronbach’s alpha coefficient, which yielded a reliability value of.96. Data were statistically analyzed by frequency distribution, percentage, mean, standard deviation, t-test statistics and one-way ANOVA.
Result:
- Overall administration the good governance principles of head nurses in general hospitals was found to be good (mean = 4.30). When individual aspects were considered, the responsibility was found to earn the highest mean score (mean = 4.45), followed by legal principles (mean = 4.44), participation (mean = 4.37), morality and ethics (mean = 4.35) and transparency (mean = 4.25). Effectiveness had the lowest mean score (mean = 4.00).
- Head nurses at general hospitals with doctorate and master’s degrees had higher scores for administrative behaviors in compliance with good governance principles than head nurses with bachelor’s degree education levels. Head nurses at general hospitals with administrative time of 5 – 15 years were found to have better administration in line with good governance than head nurses with administrative time at 1 – 5 years with statistical significance at .05. Head nurses who received administrative training programs and worked in different settings with service provision characteristics of Level S and M1 general hospitals administrated based on good governance with no difference.
Conclusion: The administration based on the principle of Good Governance focuses on the role of head nurses in managing the limited resources to maximize the benefits and cost-effectiveness of resource usage. To a abide by the principle of Good Governance, the administrator should maintain the decentralization of organization's administrative structure to promote the nurses involving in decision making, finding the solutions for problem solving or even initiating the practice guidelines to prevent the further issues. Once the nurses have the opportunities to get involved in the organization's administration, they will feel assured, trusted the organization and feel the sense of rectitude and finally result in organizational engagement and commitment and they certainly will provide the high quality care for all patients.
Keywords: Good governance, Head nurses, General hospital
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