Health Services Management Research最新文献

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.

Background: The rapid expansion of the hospital sector in Indonesia, fueled by the National Health Insurance Program (JKN), emphasizes the need for improved service quality. Understanding patient perceptions of hospital service quality is crucial for enhancing satisfaction and optimizing healthcare delivery.Purpose: This study aims to evaluate hospital service quality from the patient's perspective, focusing on empathy, safety, tangibility, perceived quality, and patient expectations. It also investigates the moderating role of patient expectations on the relationship between perceived service quality and satisfaction.Research Design: A quantitative approach using structural equation modeling (SEM) was employed, with confirmatory factor analysis (CFA) to assess construct validity.Study Sample: 355 hospital patients from Jakarta, Indonesia, were surveyed using a 7-point Likert scale.Results: Empathy significantly enhanced perceived service quality, while safety and tangibility had negligible effects. Perceived quality was a key driver of patient satisfaction. Additionally, patient expectations moderated the relationship between perceived service quality and satisfaction, with low expectations leading to greater satisfaction at moderate service levels.Conclusions: The study underscores empathy's critical role in improving perceived quality and satisfaction. It highlights the importance of managing patient expectations and fostering empathy in healthcare settings to boost patient satisfaction.

Background: The shortage of healthcare professionals and demanding working conditions have prompted healthcare organizations to implement effective retention strategies. Leadership practices largely shape the organizational climate and influence occupational well-being and related retention. Research has identified warmth and competence as the two fundamental dimensions by which leaders are evaluated.Purpose: This study explores how perceptions of leadership-related warmth and competence translate into hospital employees' loyalty, both directly and indirectly, through occupational well-being, that is, through the mechanisms of positive and negative work-related affect.Research Design: A cross-sectional survey design was used.Study Sample: The study sample consisted of N = 1907 employees from a U.S. hospital.Data Collection and Analysis: Data were collected via a structured survey instrument assessing leadership perceptions, affective well-being at work, and employee loyalty. Structural equation modeling was used to assess the hypothesized relationships and mediating mechanisms.Results: Both leadership-related warmth and competence perceptions directly influence employee loyalty. We identified different mechanisms underlying the indirect effects of occupational well-being on loyalty. Only leadership-related warmth perceptions had a positive indirect effect on loyalty through both positive and negative work-related affect. Leadership-related competence perceptions increased both positive and negative work-related affect.Conclusions: An empathic leadership style that leads to favorable leadership-related warmth perceptions is an effective approach for promoting occupational well-being and loyalty among hospital employees. Leaders should foster leadership-related competence perceptions in periods with more favorable working conditions while avoiding them in stressful working conditions.

BackgroundPatient portals allow patients to access their health information and interact with their healthcare system. While their use is still limited, this article explores the behavioral intention to use a patient portal implemented by a public regional authority in Italy. The authors also investigate the role of sociodemographic moderators - age, gender, education, and occupation - on the intention to use the portal.MethodsWhile most of the literature on patient portals is focused on small sets of respondents or is verticalized on specific diseases, this paper describes the results of a survey sent to 34,256 users registered on the patient portal. Of these, 15,102 users answered the questionnaire. The survey explored the acceptance of the patient portal through the extended unified theory of acceptance and use of technology model (UTAUT2). Descriptive and SEM analyses were also conducted.ResultsThe model has good explanatory power for the behavioral intention to use a patient portal. One construct of the UTAUT2 model showed insignificant effects on the intention to use. The results indicate that the impact of the constructs affecting the intention to use the patient portal is significantly moderated by individuals' sociodemographic characteristics.ConclusionsThe analysis results confirm a good acceptance of patient portals provided by public authorities. This supports the idea that public institutions can also develop innovative tools. The results confirm the desirability of these tools among citizens. The results have important policy implications for public health investments.

This study explores the factors influencing healthcare professionals' willingness to adopt knowledge-generation-driven Blockchain technology (KGDBT) in government healthcare facilities, using the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) framework. It introduces transparency as an independent variable and examines the mediating role of knowledge generation in the relationship between transparency and healthcare professionals' intention to adopt KGDBT. Data were collected from 322 healthcare professionals in government hospitals and analyzed using SPSS version 26 and SmartPLS version 3.9 for Partial Least Squares Structural Equation Modeling (PLS-SEM). The results strongly support the theoretical framework, demonstrating that performance expectancy, effort expectancy, social influence, facilitating conditions, and transparency significantly influence healthcare professionals' adoption of Blockchain technology. Additionally, the study identifies knowledge generation as a critical mediating factor between transparency and behavioral intention to adopt KGDBT. This research addresses the challenges of implementing Blockchain technology in healthcare by proposing a knowledge management-oriented approach to enhance its effectiveness. It highlights the critical role of transparency in promoting technology adoption and fills a gap in the literature on Blockchain and knowledge management, particularly within the Iraqi healthcare context. This study offers new insights, contributing to a comprehensive understanding of the role of knowledge generation in Blockchain adoption.

The healthcare industry has traditionally lagged in adopting technology, contributing to rising costs, limited accessibility, and ongoing challenges in affordability. This study explores how digital platforms can transform healthcare by reducing the friction in transactions and facilitate increase in the depth and width of accessibility of healthcare services. Using a qualitative research approach, we applied Gioia's method to identify emerging patterns and aggregate dimensions leading to formulation of a robust theoretical framework. We used dynamic capability and an ecosystem lens to investigate our research inquiry. Our research indicates that digital platforms enhance healthcare accessibility by ensuring last-mile delivery, reducing friction, ensuring symmetrical information dissemination, personalizing information, and facilitating remote diagnosis. Platform players' ability to reconfigure capabilities at speed and scale and offer services never imagined have begun to show green shoots in healthcare. While these platforms offer significant opportunities, strategic implementation and adaptation are essential. Policymakers, practitioners, and providers must collaborate to ensure effective use and integration. Our conceptual framework bridges theoretical concepts with practical applications, offering new insights for future research.

BackgroundThe recent pandemic, along with heavy workloads and staff shortages, has placed significant pressure on healthcare workers. Maintaining adequate work ability is vital for ensuring favorable working conditions, mitigating stress and safeguarding worker performance and patient safety.PurposeThis study analyses the key factors influencing work ability in healthcare, exploring individual and organizational determinants, challenges faced by vulnerable groups such as women and older workers or membership of a specific department. In addition, the influence of family composition and work-life balance is examined.Research Design and Study SampleTo achieve these objectives, 443 healthcare workers of the Azienda Ospedaliero-Universitaria di Modena were interviewed through a survey between 1 August and 30 September 2022.ResultsThe results show that positive workplace factors - such as supervisor support, teamwork, decision-making autonomy, process involvement, and skill-task alignment - are associated with higher work ability. Female and older employees experience lower work ability, with notable differences in the emergency and medical departments. The emergency department (ED), in particular, stands out as the most demanding, characterized by high work intensification, low support, poor work ability, and a strained work-life balance. Finally, among employees with reduced work ability, 47% report poor work-life balance, and 50% care for at least one dependent adult.ConclusionsThese findings highlight the urgent need for tailored interventions, such as improved leadership training, work-life balance policies, and targeted support for vulnerable groups, to enhance well-being and resilience in healthcare workplaces.