The impact of management practices on relative patient mortality: Evidence from public hospitals.

IF 1.6 Q3 HEALTH POLICY & SERVICES Health Services Management Research Pub Date : 2022-11-01 Epub Date: 2022-02-17 DOI:10.1177/09514848211068627
Reza Salehnejad, Manhal Ali, Nathan C Proudlove
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Abstract

A small, but growing, body of empirical evidence shows that the material and persistent variation in many aspects of the performance of healthcare organisations can be related to variation in their management practices. This study uses public data on hospital patient mortality outcomes, the Summary Hospital-level Mortality Indicator (SHMI) to extend this programme of research. We assemble a five-year dataset combining SHMI with potential confounding variables for all English NHS non-specialist acute hospital trusts. The large number of providers working within a common system provides a powerful environment for such investigations. We find considerable variation in SHMI between trusts and a high degree of persistence of high- or low performance. This variation is associated with a composite metric for management practices based on the NHS National Staff Survey. We then use a machine learning technique to suggest potential clusters of individual management practices related to patient mortality performance and test some of these using traditional multivariate regression. The results support the hypothesis that such clusters do matter for patient mortality, and so we conclude that any systematic effort at improving patient mortality should consider adopting an optimal cluster of management practices.

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管理实践对患者相对死亡率的影响:来自公立医院的证据。
一个小的,但不断增长的经验证据表明,在许多方面的医疗保健组织的性能的实质性和持久的变化可能与他们的管理实践的变化有关。本研究使用医院病人死亡率结果的公开数据,即医院一级死亡率综合指标(SHMI),以扩展这一研究方案。我们收集了一个五年的数据集,将SHMI与所有英国NHS非专科急性医院信托的潜在混杂变量相结合。在一个共同系统内工作的大量提供者为此类调查提供了强大的环境。我们发现,信任与高绩效或低绩效的高度持续性之间的SHMI存在相当大的差异。这种变化与基于NHS全国员工调查的管理实践的综合度量有关。然后,我们使用机器学习技术来建议与患者死亡率表现相关的个人管理实践的潜在集群,并使用传统的多变量回归测试其中的一些。结果支持这样一个假设,即这样的集群确实对患者死亡率有影响,因此我们得出结论,任何提高患者死亡率的系统努力都应该考虑采用最佳的管理实践集群。
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来源期刊
Health Services Management Research
Health Services Management Research HEALTH POLICY & SERVICES-
CiteScore
4.00
自引率
4.80%
发文量
33
期刊介绍: Health Services Management Research (HSMR) is an authoritative international peer-reviewed journal which publishes theoretically and empirically rigorous research on questions of enduring interest to health-care organizations and systems throughout the world. Examining the real issues confronting health services management, it provides an independent view and cutting edge evidence-based research to guide policy-making and management decision-making. HSMR aims to be a forum serving an international community of academics and researchers on the one hand and healthcare managers, executives, policymakers and clinicians and all health professionals on the other. HSMR wants to make a substantial contribution to both research and managerial practice, with particular emphasis placed on publishing studies which offer actionable findings and on promoting knowledge mobilisation toward theoretical advances.
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