Health Services Management Research最新文献

Equity, diversity, and inclusion (EDI) is increasingly identified as a priority in healthcare organizations and an essential component of high-quality care. However, research on advancing EDI in healthcare workplaces is limited. This study sought to elucidate how to advance inclusive excellence in a clinical department of a comprehensive cancer centre. A mixed-methods quality improvement project was undertaken whereby staff completed an online survey, and a sub-group were interviewed. Quantitative data were summarized using descriptive statistics and univariate regression analyses and qualitative data were analyzed using thematic analysis. 103 of 219 staff/learners completed the survey and 17 staff were interviewed. Over 90% of survey participants agreed EDI should be a priority and 29% had experienced discrimination, which was associated with considering leaving the organization. Facilitators to EDI were: enthusiasm/awareness of EDI, openness to new ideas, gender diversity, and safe environments for self-expression. Barriers to EDI were lack of: EDI knowledge, cohesion/collaboration, psychological safety, diversity along various dimensions, EDI-related communication, and burnout. To advance departmental EDI, initiatives should leverage facilitators and overcome barriers to meet department needs aligning with organizational goals. These findings will inform the development of a story huddle learning series to strengthen EDI-related knowledge and skills.

Care coordination has been the subject of several laws on coordinated care pathways and healthcare system modernization to make care paths more fluid, simplify, and consolidate support systems for coordinating complex pathways. However, patients and professionals continue to experience deteriorating systems and slow changes. In this context, our research studies the effective modalities of multi-professional coordination of patient care pathways in France. To this end, we conducted 51 interviews with professionals, structures, patients, and caregivers. To analyze the data, we drew on the literature to distinguish between organizational, functional, and personalized coordination regarding intra- and inter-organizational dimensions. The results of our study provide a better understanding of the contributions and limitations of the new coordination systems, as well as the challenges still to be met.

Healthcare organizations increasingly use performance management systems to ensure flexibility, service quality, and cost efficiency. In this context, the balanced scorecard (BSC) represents one of the most popular performance management tools for achieving these objectives. A crucial element that makes it widely employed is that it allows measures and perspectives to be linked through clearly defined cause-and-effect relationships. Nevertheless, despite its centrality in implementing BSC, a discussion regarding the effective interpretation of cause-and-effect relationships has sparked. In particular, the previous literature emphasizes the dichotomy between non-statistical causality, i.e., based on logical or finality relationships, and causality tested statistically. This study aims to investigate the nature of causal relationships between indicators and perspectives of BSC through a systematic literature review of studies conducted in the health and social care contexts. Findings reveal that both perspectives of causality can be identified; however, numerous directions for future research are possible for both. Overall, there is a need for more attention to theoretical perspectives supporting causal analysis. Furthermore, although the development of quantitative methodologies to support empirical analyses is remarkable, there is room for further improvement. Finally, the research focuses mainly on the organizational level, overlooking the role of BSC causality at other levels.

Over the last two decades, processes of digital transformation have been progressively implemented in the sphere of public services, including the health sector, albeit at difference paces depending on organizations' levels of digital maturity. Although the nominal advantages of digitalizing health services are well identified in the conception phase, once implemented, the perceptions of different stakeholders tend to differentiate, even generating certain tensions. Based on qualitative grounded theory research approach among 15 different stakeholders from nine different hospitals of a regional health system located in the northern part of France, this study shows that different stakeholders perceived different advantages, such as improving the integration between the different stakeholders' practices, improving care practices, offering more services, and reducing costs and increasing efficiency. However, a paradox also emerged in the contraposition between the need for higher perceived quality, which requires more investments, and the search for efficiency through the digital transformation of health services, which aims at reducing costs. We conclude by discussing the theoretical contributions and implications for practice.

IntroductionHealthcare systems have a responsibility to improve organizational health literacy (OHL) to increase health equity. This study explored two organizational cultural factors, leadership support and staff buy-in, for organizations planning OHL change.MethodsTen community-based health organizations participated in an OHL program. The study design was mixed methods. The qualitative inquiry was interviews with senior leaders to explore awareness of OHL and: impetus to transform, leadership commitment, staff engagement, alignment to organizational goals, and integration of health literacy change with current practices. The quantitative assessment was the Organizational Readiness for Implementing Change (ORIC) questionnaire to assess staff's perceptions about OHL change readiness.ResultsSenior leaders articulated the effects of low health literacy in their patient and client population. Support for OHL change was seen at both leadership and staff levels. Impetus for change was primarily a response to a community need or for quality improvement. Most of the non-clinical organizations had higher ORIC scores than the clinical organizations, indicating a perceived higher level of readiness for OHL change.ConclusionLeadership commitment and staff buy-in are important factors of readiness for OHL change. A novel finding is that community-based health organizations are able and willing to engage in OHL change.

BackgroundWithin many advanced healthcare systems, patient advocacy associations are gaining a more relevant role in healthcare policy decisions. These associations provide help, representation, and voice to patients and citizens. However, although their role is important, a paucity of research exists analyzing their foundation dynamics, including their organizational decision, from a managerial perspective. To fill this knowledge gap, we formulated two research questions to investigate the motivations underlying the foundation of patient advocacy associations and the institutional pressures influencing the changes that have occurred in these associations throughout their evolution.MethodsUsing a semi-structured questionnaire developed as part of a larger research project, we collected data about 31 patient advocacy associations operating within the Italian National Health Service. We employed qualitative analysis to examine the associations' birth and evolution as well as the motivations and influences driving change within the sampled organizations.ResultsQuestionnaire responses provided information about the patient advocacy associations' histories and highlighted their close links with the Italian National Health Service. Our results indicated the motivations for the associations' establishment could be grouped into five categories: support at the system level, patient protection and support, actions to increase awareness, actions for improving patients' health and quality of life, and dissemination of knowledge. We also identified the frequency and nature of the changes within the associations and explored the institutional pressures that influenced these organizational changes.ConclusionsThe results can be interpreted considering the organizational theories that focus on organizations' establishment decisions and how external pressures impact organizations' dynamics and evolution.

BackgroundTraditional hospital management responses during the coronavirus disease 2019 (COVID-19) pandemic proved ineffective, particularly considering the pre-existing challenges in healthcare systems. The study examines hospital management challenges during the COVID-19 pandemic, transforming their lived experiences into a conceptual approach to prevent repetition and benefit health planners and policymakers in future crises and normal times.MethodsThis qualitative study utilized the grounded theory methodology, conducting in-depth interviews with 12 hospital administrators from seven major referral hospitals in Shiraz, Bushehr, and Tehran, focusing on COVID-19 patients' complex conditions. The participants had a mean age of 46.6 ± 8.8 years. Data analysis was conducted using the grounded theory (Straussian approach).ResultsA total of 98 subthemes and 25 themes were identified during the data analysis process. Using axial and selective coding, we found that in the presence of contextual and causal conditions, the lack of hospital resilience was recognized as the core theme in the final model. Intervening conditions, strategies to overcome the challenges of hospital management, and the outcomes were identified.ConclusionsIranian hospital administrators dealing with COVID-19 recognize the lack of hospital resilience as their main management obstacle. Non-resilient hospitals' response to crises with new management strategies can fail due to insufficient documentation and information sharing, leading to persistent problems. Prioritizing evidence-based strategies and sharing successful approaches from other healthcare systems can improve resilience. Nationwide guidelines will ensure equitable patient treatment and reduce lawsuits against physicians for resource-efficient use. Hospital resilience implementation in real-world settings is widely sought for evidence.

The COVID-19 outbreak resulted in an unprecedented surge in telehealth utilization. However, the effects of policy enactment on utilization remain understudied in the literature. Our research examines the impact of policy mandates relating to federal incentive programs on telehealth utilization across states during the pandemic by considering technology infrastructure, such as broadband penetration and equipment possession. This study also considers the impact of political orientation and control factors, including income attributes, on telehealth utilization. Considering telehealth utilization in the Medicare program as a test case, this study employed the partial least square and structural equation model to analyze data from the Centers for Medicare & Medicaid Services, the American Community Survey, and the Microsoft Airband Project to draw inferences. Our study finds that telehealth legislation, broadband penetration, political orientation, and control factors have a direct significant impact on telehealth utilization, whereas incentive programs and equipment possession have an indirect impact through broadband penetration.

BackgroundWhile health systems are primarily designed for acute health issues, managing life-long conditions often results in chronic care discontinuity. This refers to situations where a chronic patient's planned care fails to actualise.Research DesignThis study descriptively explores the reasons behind chronic care discontinuity in outpatient care.Data CollectionData was collected via interviews and a focus group with healthcare professionals, and a patient survey specifically targeting chronic abdominal patients.AnalysisUsing grounded theorising the Discontinuity of Chronic Care (DoCC) framework was developed, to identify and categorise reasons behind chronic care discontinuity.ResultsThe framework reveals that reasons for discontinuity can be largely divided into healthcare system related factors-including caregiver, technological, and process challenges-and patient-related factors such as situational and internal psychological challenges.ConclusionsThe DoCC-framework provides a valuable tool for analysing various patient processes, offering healthcare managers insights to improve the management of chronic patient journeys. Additionally, it guides healthcare professionals to better focus their development efforts on challenges they have the capacity to address.