Advances in Health Care Management最新文献

Purpose: Personnel costs typically account for 60% or more of total operating expenses in health systems, and as such become a necessary focus in most if not all substantive health reform adaptations. This study sought to assess whether strategic alignment of the human resource (HR) and learning functions was associated with greater adaptive capacity in U.S. health systems.

Design/methodology/approach: Data were gathered using a survey that was distributed electronically to chief human resource officers from two U.S.-based associations. The survey included questions about organizational structure, strategic human resource management, strategic learning, and organizational response to health reform.

Findings: Significant correlations were found between strategic alignment of HR and HR's involvement in responses related to cost control (r = 0.46, p < 0.01); quality improvement (r = 0.45, p < 0.01), and patient access (r = 0.39, p < 0.01). However, no significant relationships were found between strategic alignment of organizational learning and HR involvement with these responses.

Value/originality: Results suggest that HR structure may affect an organization's capacity for adaptive response. Top-management teams in health systems should consider positioning HR as part of the core leadership team, with a reporting relationship that allows HR to maximally participate in formulating and implementing organizational adaptation.

Purpose: We discuss the impact of complexity science on the design and management of health care organizations over the past decade. We provide an overview of complexity science issues and their impact on thinking about health care systems, particularly with the rising importance of information systems. We also present a complexity science perspective on current issues in today's health care organizations and suggest ways that this perspective might help in approaching these issues.

Approach: We review selected research, focusing on work in which we participated, to identify specific examples of applications of complexity science. We then take a look at information systems in health care organizations from a complexity viewpoint.

Findings: Complexity science is a fundamentally different way of understanding nature and has influenced the thinking of scholars and practitioners as they have attempted to understand health care organizations. Many scholars study health care organizations as complex adaptive systems and through this perspective develop new management strategies. Most important, perhaps, is the understanding that attention to relationships and interdependencies is critical for developing effective management strategies.

Research and practice implications: Increased understanding of complexity science can enhance the ability of researchers and practitioners to develop new ways of understanding and improving health care organizations.

Originality/value: This analysis opens new vistas for scholars and practitioners attempting to understand health care organizations as complex adaptive systems. The analysis holds value for those already familiar with this approach as well as those who may not be as familiar.

Purpose: The purpose of the study was to explore in literature what different leadership styles and behaviors of head nurses have a positive influence on the outcomes of patient safety or quality of care.

Design/methodology/approach: We reviewed the literature from January 2000 until September 2011. We searched Pubmed, Embase, Cinahl, Psychlit, and Econlit.

Findings: We found 10 studies addressing the relationship between head nurse leadership and safety and quality. A wide array of styles and practices were associated with different patient outcomes. Transformational leadership was the most used concept in the studies. A trend can be observed over these studies suggesting that a trustful relationship between the head nurse and subordinates is an important driving force for the achievement of positive patient outcomes. Furthermore, the effects of these trustful relationships seem to be amplified by supporting mechanisms, often objective conditions like clinical pathways and, especially, staffing level.

Value/originality: This study offers an up-to-date review of the limited number of studies on the relationship between nurse leadership and patient outcomes. Although mostly transformational leadership was found to be responsible for positive associations with outcomes, also contingent reward had positive influence on outcomes. We formulated some comments on the predominance of the transformational leadership concept and suggested the application of complexity theory and political leadership for the current context of care. We formulated some implications for practice and further research, mainly the need for more systematic empirical and cross cultural studies and the urgent need for the development of a validated set of nurse-sensitive patient outcome indicators.

Purpose: This chapter proposes a paradigm shift in considering the collective identification of employed physicians and how it influences physician engagement.

Design/methodology/approach: There are many challenges for organizations employing physicians, particularly in terms of engagement in organizational initiatives. Prior research suggests this conflict stems from how physicians think of themselves as professionals versus employees (as forms of collective identification). Unfortunately, research is limited in addressing these dynamics.

Findings: This conceptual chapter considers the complex network of relationships that physicians perceive between the collectives to which they belong. A primary collective identification (i.e., the profession) is proposed to influence subsequent collective identification (i.e., the organization), and that these meanings and relationships along with contextual factors drive engagement.

Originality/value: Health care organizations increasingly rely on engagement from their physicians to improve upon coordinated care. This proposed conceptualization offers new insight into the dynamics surrounding how and why employed physicians become engaged.

Purpose: This chapter seeks to increase our understanding of health care employees' perceptions of effective and ineffective leadership behavior within their organization.

Design/methodology/approach: Interviews were conducted with 59 employees working in a diversity of positions within the case study hospital. Interviewees were asked to cite behaviors of both an effective and an ineffective leader in their organization. They were also asked to clarify whether their example described the behavior of a formal or informal leader. Grounded theory data analysis techniques were used and findings were interpreting using existing leadership behavior theories.

Findings: (1) There was a consistent link between effective leadership and relationally oriented behaviors. (2) Employees identified both formal and informal leadership within their hospital. (3) There were both similarities and differences with respect to the types of behaviors attributed to informal versus formal leaders. (4) Informants cited a number of leadership behaviors not yet accounted for in the leadership behavior literature (e.g., 'hands on', 'professional', 'knows organization'). (5) Ineffective leadership behavior is not simply the opposite of effective leadership.

Research implications: Findings support the following ideas: (1) there may be a relationship between the type of job held by employees in health care organizations and their perceptions of leader behavior, and (2) leadership behavior theories are not yet comprehensive enough to account for the varieties of leadership behavior in a health care organization. This study is limited by the fact that it focused on only those leadership theories that considered leader behavior.

Practical implications: There are two practical implications for health care organizations. (1) leaders should recognize that the type of behavior an employee prefers from a leader may vary by follower job group (e.g., nurses may prefer relational behavior more than managerial staff do), and (2) organizations could improve leader development programs and evaluation tools by identifying ineffective leadership behaviors that they want to see reduced within their workplace.

Social implications: Health care organizations could use these findings to identify informal leaders in their organization and invest in training and development for them in hopes that these individuals will have positive direct or indirect impacts on patient, staff, and organizational outcomes through their informal leadership role.

Value/originality: This study contributes to research and practice on leadership behavior in health care organizations by explicitly considering effective and ineffective leader behavior preferences across multiple job types in a health care organization. Such a study has not previously been done despite t

Purpose: Despite hospitals' efforts to reduce health care-associated infections (HAIs), success rates vary. We studied how leadership practices might impact these efforts.

Design/methodology/approach: We conducted eight case studies at hospitals pursuing central line-associated blood stream infection (CLABSI)-prevention initiatives. At each hospital, we interviewed senior leaders, clinical leaders, and line clinicians (n = 194) using a semistructured interview protocol. All interviews were transcribed and iteratively analyzed.

Findings: We found that the presence of local clinical champions was perceived across organizations and interviewees as a key factor contributing to HAI-prevention efforts, with champions playing important roles as coordinators, cheerleaders, and advocates for the initiatives. Top-level support was also critical, with elements such as visibility, commitment, and clear expectations valued across interviewees. VALUE/ORGINALITY: Results suggest that leadership plays an important role in the successful implementation of HAI-prevention interventions. Improving our understanding of nonclinical differences across health systems may contribute to efforts to eliminate HAIs.

Purpose: The hospital-physician relationship (HPR) has been the focus of many scholars given the potential impact of this relationship on hospitals' ability to achieve socially and organizationally desirable health care outcomes. Hospitals are dominated by professionals and share many commonalities with professional service firms (PSFs). In this chapter, we explore an alternative HPR based on the governance models prevalent in PSFs. DESIGN/METHODOLOGY APPROACH: We summarize the issues presented by current HPRs and discuss the governance models dominant in PSFs.

Findings: We identify the non-equity partnership model as a governance archetype for hospitals; this model accounts for both the professional dominance in health care decisions and the increasing demand for higher accountability and efficiency.

Research limitations: There should be careful consideration of existing regulations such as the Stark law and the antikickback statue before the proposed governance model and the compensation structure for physician partners is adopted.

Research implications: While our governance archetype is based on a review of the literature on HPRs and PSFs, further research is needed to test our model.

Practical implications: Given the dominance of not-for-profit (NFP) ownership in the hospital industry, we believe the non-equity partnership model can help align physician incentives with those of the hospital, and strengthen HPRs to meet the demands of the changing health care environment.

Originality/value: This is the first chapter to explore an alternative hospital-physician integration strategy by examining the governance models in PSFs, which similar to hospitals have a high reliance on a predominantly professional staff.