Health Services Management Research最新文献

The objective of this study was to evaluate the mobbing perception levels of health workers, who were mobbed and to determine whether the socio-demographic characteristics of the employees made a significant difference in the perception of mobbing. Within the scope of the study, the mobbing perception levels of 516 healthcare personnel were evaluated by using relational screening model. In order to collect data, socio-demographic data form and Leymann Psychological Terrorist Scale developed by Heinz Leymann were used. As a result of the study, 70.0% of the participants who were exposed to mobbing reported that they were exposed to mobbing behaviors by their managers. The Leymann Psychological Terrorism Scale was found to be 1.49. Mobbing behaviors that affect self-disclosure and communication possibilities is the most common bullying behavior that the participants were exposed (x̄: 1.73). As a result, the data suggested that company policies rather than demographic characteristics of individuals are effective in the exposure to mobbing behaviors. It is thought that the cultural structures of the societies and the individuals' knowledge about which behaviors can be evaluated as mobbing have an effect on the mobbing perception levels of the individuals. Accepting mobbing behaviors as a normal situation in hierarchical structure or interpersonal relationships is one of the important problems in prevention. For this reason, one of the most important steps in the prevention of mobbing is to ensure that both managers and employees are informed about mobbing.

Objective: This study sought to understand the relationship of hospital performance with high-level electronic medical record (EMR) adoption, hospitalists staffing levels, and their potential interaction.

Materials and methods: We evaluated 2,699 non-federal, general acute hospitals using 2016 data merged from four data sources. We performed ordinal logistic regression of hospitals' total performance score (TPS) on their EMR capability and hospitalists staffing level while controlling for other market- and individual-level characteristics.

Results: Hospitalists staffing level is shown to be positively correlated with TPS. High-level EMR adoption is associated with both short-term and long-term improvement on TPS. Large, urban, non-federal government hospitals, and academic medical centers tend to have lower TPS compared to their respective counterparts. Hospitals belonging to medium- or large-sized healthcare systems have lower TPS. Higher registered nurse (RN) staffing level is associated with higher TPS, while higher percentage of Medicare or Medicaid share of inpatient days is associated with lower TPS.

Discussion: Although the main effects of hospitalists staffing level and EMR capability are significant, their interaction is not, suggesting that hospitalists and EMR act through separate mechanisms to help hospitals achieve better performance. When hospitals are not able to invest on both simultaneously, given financial constraints, they can still reap the full benefits from each.

Conclusion: Hospitalists staffing level and EMR capability are both positively correlated with hospitals' TPS, and they act independently to bolster hospital performance.

Objective: The measurement of patient safety climate within hospitals, and specifically in operating rooms is a basic tool for the development of the patient's safety policy. There are no validated Spanish versions of instruments to measure safety climate. The objective of this research was to validate the Spanish version of the Hospital Survey on Patient Safety (HSOPS®), with the addition of a module for surgical units, to evaluate the patient safety climate in operating rooms.

Methods: Survey validation study. The Hospital Survey on Patient Safety (HSOPS®) was applied to health workers from 6 acute general hospitals, from Medellín (Colombia), with surgical procedures greater than 300 per month, 18 items were added considered specific for Operating Rooms. For construct validation, an exploratory factor analysis (EFA) was used, utilizing principal components as the extraction method. Reliability was evaluated with Cronbach's α.

Results: A 10 dimensions model was obtained with EFA, most of the dimensions of the original questionnaire were conserved, although the factorial structure was not reproduced. Two new dimensions emerged from the added items. The Cronbach's α ranged between 0.66 and 0.87. Conclusions: We found the HSOPS questionnaire is valid and reliable for measuring patient safety climate in Spanish speaking Latin American countries. Two additional dimensions are proposed for Operating Rooms.

Over the last decade, second victim phenomenon (SVP) has been identified as a serious issue for healthcare workers (HCWs). Results from a 2018 survey of Canadian HCWs demonstrated that the majority of those who responded had experienced SVP and indicated that there was a lack of support in the workplace. The overall objectives of this paper are to a) heighten the awareness about SVP and its impact on HCWs and 2) to recommend an organizational/systems approach to support HCWs as second victims. This will be accomplished by first defining SVP and its relationship to patient safety. We will apply a health geography framework which incorporates the concepts of location, place, human interaction, movement and region to demonstrate the variability across care settings and the need for a systems approach to support HCWs. A human geography approaches to SVP would allow policymakers, leadership teams and managers within a health care setting to uniquely tailor their support systems to their individual contexts, which in turn will create a workplace culture of safety that builds on the organization's unique qualities.

Behavioral health influences patient health outcomes and healthcare utilization rates. Hospitals are promising settings for appropriate identification, treatment, and referral of behavioral health issues and may affect hospital admission rates and healthcare costs. Implementation frameworks are designed to aid successful adoption and scaling of health innovations. One type - process models - present staged frameworks for rolling out an innovation into routine practice. Process models are appealing for their pragmatism but are criticized for oversimplifying the complexity of implementation. This review investigates the empirical evidence for process models' utility in hospitals, chosen for their uniquely complex structures, by determining whether their use impacts implementation outcomes. Using systematic search and selection criteria across six databases, ten peer-reviewed studies were identified. Each applied a process model for implementing behavioral health innovations within hospital systems. Studies were coded by type of stage framework and reported implementation outcomes. Studies reported mostly favorable or mixed outcomes. No one framework prevailed in use nor evidence. Due to the paucity of published literature and reported data, there is limited evidence that process model application propels implementation outcomes in hospital settings. Furthering the science requires creating and utilizing systematic guidelines to employ process models, measure and report implementation stage transition, and measure and report implementation outcomes. Management and practitioners can include such data collection in standard process evaluations of hospital implementation and scale-up activities, or adopt complexity-informed approaches that lack the simplicity of process models but may be more realistic for complex settings.

The role and tasks performed by hospital volunteers (HV), their relationship with other stakeholders and the management of volunteers, are controversial topics, not widely explored in literature. Through an exploratory study, which incorporated the collection and analysis of qualitative data, involving 46 interviews with volunteers, staff and hospital administration from three hospitals in Portugal, we analyze hospital volunteers, as well as the tasks they perform, how these tasks are assigned, and how they relate to other stakeholders. As a result, we conclude that the job definition of HV is generic, open to different interpretations and that the assigned functions of HV are not known from all stakeholders. This problem can have negative repercussions in the relationship between volunteers and health professionals, potentially fostering conflict. Nevertheless, most respondents are satisfied with the current format of volunteer management.

Nurses' turnover is a major global problem with significant service and cost implications. Although sizeable research inquiries have been made into the antecedents, the dynamics, and the consequences of nurses' turnover, there is still a lack of fine-grained understanding of the psychological states that reflect the cumulative impact of different antecedents and immediately precede nurses' intentions to quit either from their unit/organization and/or their profession. This paper introduces and develops a meaning-based view of nurses' turnover. This perspective distinguishes between meaning in work (based on the nurses' relationship with their work) and meaning at work (based on the nurses' relationship with their work environment) and explain the implications of high/low meaning in and at work on nurses' turnover. This meaning-based view of nurses' turnover offers nurses, administrators and policy makers a deeper and a more nuanced understanding of turnover and promises more tailored remedies for the turnover problem.

Background: The hybrid role (clinical and managerial leadership tasks) of physicians in medical leadership positions (MLPs) is a driver of the attractiveness of these positions. The increasing feminization of the medical profession makes gender-related preferences for hybrid roles relevant.

Purpose: The current study uses the (EPL) career aspirations framework to analyze the (gender-related) effects that efficacy beliefs, motivations, and preferences for clinical leadership and managerial leadership have on the willingness of chief physicians to apply for an MLP.Methodology: A survey of senior physicians in German university hospitals yielded a sample size of N = 496. The resulting data were analyzed using a structural equation modeling approach.

Findings: The results confirm the low preference for MLPs among senior physicians, which is mainly affected by preferences for managerial leadership tasks. Female senior physicians perceive the position of an MLP to be less attractive than their male counterparts do, and female physicians' willingness to apply for an MLP is concurrently driven by their preferences for clinical leadership and managerial leadership tasks.Practical implications: Mentoring programs could boost female senior physicians' preparedness for MLPs. Further, flexibility in fulfilling managerial leadership tasks could be promoted to make MLPs more attractive to women.

Background: Value-Based Health Care (VBHC) is an evolving model of healthcare delivery aimed at achieving better patient outcomes at lower costs to the healthcare provider. The practise of VBHC requires efficient information systems with good reporting capability and subsequent outcome measuring. Information systems within the National Health Service (NHS) are often multiple and not necessarily integrated to one another. We therefore developed a systematic approach to collecting, validating and analysing data from multiple sources and information systems, with the aim of designing and endorsing an automatic system to capture health outcomes data in heart failure to support future VBHC models.

Methods: A retrospective cohort of heart failure patients with reduced ejection fraction undergoing Implantable Cardioverter Defibrillator (ICD) or Cardiac Resynchronization Therapy (CRT) procedures within a limited geographical area in South London were evaluated. A purpose built database was created to integrate, transform and validate health care data from multiple information systems.

Results: Validation analysis shows that our implemented methodology has produced a robust dataset. Our limited cohort of 134 patients does not allow for any complex statistical analysis however has identified some important themes related to outcomes and costs.

Conclusion: We have created a validated database specific to our Trust that can be upscaled locally with ease and transferred to other health diseases. Due to variations in local procedure from one Trust to another, this methodology now requires implementation across multiple sites to understand differences in transformation of data and outcome measuring.