Health Services Management Research最新文献

Emergency Department (ED) overcrowding is a global challenge, and although tailored local interventions are recommended, their effectiveness remains unclear. This retrospective study evaluated the impact of patient flow governance interventions on ED overcrowding at a large academic hospital. A three-phase (input-throughput-output) model was adopted to analyze factors affecting both static and dynamic indicators of ED overcrowding. Two 6-month periods (2019 vs 2023) were compared, accounting for organizational changes implemented between 2019 and 2022. Over 80% of ED visits involved lower-acuity conditions, and more than 40% of patients were aged over 65 years. ED stays longer than 24 h increased by 637%, whereas medical ward admissions decreased by 31.2% and the daily average number of off-unit admissions declined by 94.3%. The ED discharge rate rose by 3.3%, accompanied by a 200% increase in transfers of frail patients to community facilities. The overall self-discharge rate fell by 3.4%, even though the proportion of patients leaving before being seen increased by 15%. Organizational strategies focusing on throughput and output were associated with fewer hospital admissions and a substantial reduction in off-unit admissions, but these gains came at the cost of increased ED overcrowding and workload.

The significance of investigating innovation in academic medical centers has been underscored, as they are recognized as leaders in frontline innovation and accelerators of healthcare advancement. The factors that contribute to innovation success, particularly those associated with benefits, can be identified by examining innovation attributes in relation to innovation process stages. This study aimed to understanding the innovation process by identifying the key factors that characterize innovation and their outcomes in academic medical centers. The central research questions were: what are the main attributes of innovation in an academic medical center? and which innovation attributes influence the outcomes of innovation in an academic medical center? Clinical directors from one academic medical center in Italy, Careggi University Hospital, responded to a questionnaire. Exploratory factor and regression analyses were performed to analyze the data. The findings highlighted the crucial role of middle managers in promoting and developing significant high-quality innovations. Our study deepens the innovation attribute framework and enables a better understanding of the relationship between attributes and benefits in the healthcare context. From a practical perspective, our study equips academic medical center administrators with a tool to evaluate innovation attributes and their relationship with outcomes, enabling better leverage of the potential benefits.

The implementation of Value-Based Healthcare (VBHC) has spread across international healthcare systems, aiming to improve decision-making by combining information about patient outcomes and costs of care. Time-Driven Activity-Based Costing (TDABC) is introduced as a pragmatic yet accurate method to calculate costs of care pathways. It is often applied to demonstrate value-improving opportunities, such as interventions aimed at service delivery redesign. It is imperative for healthcare managers to know whether these interventions yield the expected outcome of improving patient value, for which TDABC is also suitable. However, its application becomes more complex and labour intensive if the intervention extends beyond activity-level changes in existing care pathways, to the implementation of entirely new care pathways. The complexity arises from the potential influence of such interventions on the costs of related care pathways. To fully comprehend the impact of such interventions on organizational costs, it is important to include these factors in the cost calculation. Given the substantial effort required for this analysis, this may explain the limited number of prior TDABC studies with similar objectives. This methodological development paper addresses this gap by offering a pragmatic enrichment of the TDABC methodology. This enrichment is twofold. First, it provides guidance on calculating a change in costs without the need for a total cost calculation. Second, to secure granularity, a more detailed level of cost-allocation is proposed. The aim is to encourage further application of TDABC to conduct financial evaluations of promising interventions in the domain of VBHC and service delivery redesign.

Background: Throughout the United States and Europe, the home health care industry is rapidly consolidating, with merger and acquisition (M&A) activity on the rise.Purpose: The consolidation of the industry raises questions about the impact that diminished competition may have on the quality of care being delivered.Research Design: This study utilizes a weighted, staggered difference-in-differences analysis.Study Sample: This study examines the impact of home health agency acquisition on quality of care among a sample of 10,184 home health agencies across the United States.Analysis: Utilizing publicly available data from the Outcome and Assessment Information Set (OASIS) and the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) from 2018 to 2022, this study investigates changes in clinical outcomes, organizational process measures, and patient experience.Results: The findings suggest there is a modest 1.07 percentage point improvement in process measures post-acquisition, but no significant changes in outcome or patient experience measures among the 169 agencies that were acquired during the study period.Conclusion: These findings suggest that, while integration has the potential to modestly improve home health process efficiency, there is very little benefit to patients.

The Primary Health Care (PHC) approach is essential to ensuring that individuals and communities receive quality health services without financial hardship, thereby advancing Universal Health Coverage (UHC). PHC-oriented models of care promote people-centered services that are accessible, comprehensive, and responsive to the needs of individuals and communities. However, practical tools and approaches are needed to guide the shift from traditional disease-based models to integrated, people-centered systems tailored to diverse and evolving population needs. To facilitate this transition, the WHO Regional Office for the Eastern Mediterranean (EMRO) developed a Community Health Needs and Assets Assessment (CHNAA) guide to assist member states in integrating community voices into local health planning and decision-making, and aligning services with identified community priorities to advance PHC-oriented care. This perspective paper, grounded in a review of literature, policy guidance, and regional implementation experiences, outlines the rationale behind the guide, its core principles, and its potential to support health system reforms toward more resilient and equitable care in the Eastern Mediterranean Region (EMR).

PurposeThe objective is to test contingency theory among "community homes" in a region in Northern Italy. Community homes constitute an emerging key setting in the Italian primary healthcare system and are emblematic of the most recent organizational solutions in primary care across countries.MethodsA case study was carried out through semi-structured interviews administered in community homes to key professionals. Results were validated in two communities of practices.FindingsSeveral elements of organizational and managerial variability were detected across the sample of community homes involved in the study, although they were all responding to the same regulations and normative pressures.Original valueThe study provides preliminary evidence on the role of contingency theory in the primary healthcare sector, shedding light on its characteristics and providing food for thought on the extent to which organizational variability should be supported, rather than hindered.

IntroductionHybrid managers have the potential to respond to the need for more integrated, responsive and accountable healthcare. Scholars have studied the antecedents of hybridization, but the role of gender has been neglected. Therefore, we study whether and how gender impacts on the way in which medical professionals exercise their managerial role.MethodsWe adopted a qualitative approach in order to gain an in-depth understanding of the specificities of women hybrids. Data was collected through semi-structured interviews, focusing on hybrids in Italy in the field of neurology.ResultsWe found that women hybrids show specific abilities and motivations, but they also encounter a specific lack of opportunities. Women hybrid managers appear well positioned to foster the evolution of professionalism, but healthcare organizations should implement policies and practices to effectively support them.ConclusionWhile existing research has treated hybrid managers as a homogenous group, we underline the specificities of women hybrids. They can support the evolution of healthcare organizations towards logics of service integration, user centricity, and staff engagement. Therefore, our findings have important theoretical and practical implications for health policy and management.

Background: Addressing high rates of drug and alcohol mortality requires a sustained commitment to supporting a resilient and skilled substance use workforce. Employee well-being in wider health and social care has been the subject of much empirical research, however there is a dearth of evidence specific to professionals working in substance use services.Methods: Data were derived from a cross-sectional survey of publicly-funded drug and alcohol services operating in Scotland during autumn 2021. Nested semi-log regression models estimated the associations between workplace characteristics and workforce composition, and the main outcome measure: non-Covid sickness absence. Qualitative data were analysed using thematic analysis.Results: 88 services, representing 43% of Scotland's drug and alcohol services, were included in the study. Factors significantly and positively associated with non-Covid sickness absence in multivariable analysis included average caseload per whole-time equivalent and number of whole-time equivalent clinical roles. Descriptive statistics show that vacancy rates and caseloads are comparatively higher in statutory services, and are also higher for clinical than non-clinical positions.Conclusion: This study revealed that and burnout leading to sickness absence are serious issues for frontline staff in drug and alcohol services, and these worsened during the Covid-19 pandemic. This research provides a foundation for validating the current findings via future large-scale longitudinal studies, and improving the well-being of people delivering health and social care services in substance use settings.

ObjectiveIn the United States healthcare system, employee retention is impacted by a range of factors including work environment, culture, remuneration, and managerial relationships. Leaders who understand these dynamics are crucial for enhancing retention and improving patient outcomes. This study aimed to identify key job satisfaction indicators-such as onboarding, comfort, productivity, job expectations, and perceived challenge-across various employment stages within a multi-hospital system in the Midwestern United States.Theoretical FrameworkGuided by Job Embeddedness Theory, this study examined how employees' links to the organization, sense of fit, and potential sacrifices associated with leaving influenced retention patterns.MethodsA quantitative descriptive-comparative design was used. MANOVA and one-way ANOVAs were conducted to evaluate differences among new employees at 30, 60, and 90+ days of employment based on five retention-related variables.ResultsStatistically significant differences emerged across all five indicators. Employees at 30 days were more likely to report that their job met expectations, felt productive, and were satisfied with onboarding. However, job satisfaction and comfort declined substantially by 60 and 90+ days, suggesting potential gaps in ongoing support. These patterns provide empirical support for Job Embeddedness Theory by demonstrating how employees' sense of fit and organizational links initially strengthen retention intentions but weaken without sustained reinforcement, highlighting the importance of continuous integration strategies.ConclusionWhile early onboarding experiences were positive, findings highlight a marked decline in satisfaction over time. Recommendations include enhancing long-term engagement strategies, aligning job expectations with role realities, fostering leadership engagement, and offering continuous professional development tailored to employee tenure. Healthcare leaders who prioritize sustained employee support, clear communication, and adaptive retention strategies may improve workforce stability, organizational performance, and ultimately, patient care outcomes.