Health Services Management Research最新文献

Purpose: The aim of this study is to understand how healthcare practitioners experience organisational boundaries and silos in day-to-day operations. Based on a multi-dimensional scale of organisational boundaries, the study examines how organisational demarcation lines enable and constrain daily work tasks in the healthcare sector.Research design: The study is based on a quantitative and qualitative analysis of survey responses from 895 healthcare practitioners in Denmark.Results: The results indicate that tendencies toward organisational silos relate to systems and hierarchies (management-staff) rather than professions and departments. Moreover, the study identifies resource scarcity as an important undercurrent in the understanding of the respondents' perceptions of boundaries and silos.Conclusion: The study contributes to existing research by documenting the coordination and collaboration challenges linked to the multitude of demarcation lines in complex health organisations.

Over the past two decades, there has been a growing scholarly interest in the adoption of technology in healthcare. While numerous studies have delved into the effects of specific technologies on the performance of different organizational units and medical specialties, the findings have often been divergent. Unlike the established literature, our approach focuses on the organization's perspective to analyze how technology impacts process performance in hospital settings. More precisely, we compiled a tailored dataset from 56 healthcare organizations in Italy and conducted a comprehensive analysis of panel data from 2016 to 2019, utilizing Ordinary Least Squares (OLS) regression as our main analytical tool. The data shows a clear relationship between an organization's use of medical devices and its overall process performance. Our research highlights the importance of achieving substantial improvements in process performance by strategically integrating new technologies and devices. Policymakers are encouraged to consider introducing incentives to drive hospitals to invest in innovative technologies. Furthermore, monitoring expenditures on new devices could serve as a valuable metric for assessing the extent of technology adoption within clinical practices.

Background: A conspicuous consequence of gatekeeping arrangements in universal, tax-funded, single-payer health care systems is the long waiting times. Besides limiting equal access to care, long waiting times can have a negative impact on health outcomes. Long waiting times can create obstacles in a patient's care pathway. Organization for Economic Co-operation and Development (OECD) countries have implemented various strategies to tackle this issue, but there is little evidence for which approach is the most effective. This literature review examined waiting times for ambulatory care. Objective: The aim was to identify the main policies or combinations of policies universal, tax-funded, and single-payer healthcare systems have implemented to improve the governance of outpatient waiting times. Methods: Starting from 1040 potentially eligible articles, a total of 41 studies were identified via a 2-step selection process. Findings: Despite the relevance of the issue, the literature is limited. A set of 15 policies for the governance of ambulatory waiting time was identified and categorized by the type of intervention: generation of supply capacity, control of demand, and mixed interventions. Even if a primary intervention was always identifiable, rarely a policy was implemented solo. The most frequent primary strategies were: guidelines implementation and/or clinical pathways, including triage, guidelines for referral and maxim waiting times (14 studies), task shifting (9 studies), and telemedicine (6 studies). Most studies were observational, with no data on costs of intervention and impact on clinical outcomes.

This study addresses recent calls for more research on the potential intervening role exerted by certain individual variables in the relationship between performance feedback and performance. Specifically, this study selects medical managers' sense of managerial self-efficacy as a potential mediational variable in the feedback-performance relationship. A mediational model examining how the effect of performance feedback on medical managers' budgetary performance is influenced by their sense of managerial self-efficacy was established based on survey data from 60 medical managers working in a hospital. Data analysis was conducted using the partial least squares technique, and the results confirmed the hypothesised relationships. Specifically, performance feedback was positively associated with managerial self-efficacy, and managerial self-efficacy exerted a positive influence on medical managers' budgetary performance. Further, performance feedback was determined not to be directly associated with budgetary performance; however, a full mediating effect of managerial self-efficacy was found. These findings make several contributions to the literature and can help healthcare managers have a better understanding of the consequences and importance of the technical features of performance feedback reports.

Due to the growing population and advancing economy, medical waste accumulation has come to the attention of all facets of society. Although the issue of medical waste management planning has been addressed in developed nations, it still exists in several developing nations. This paper examines the effects of barriers under the Organization action, work handling, and Human Resource Practices section on the healthcare waste management (HCWM) sector in a developing country India. In this study, three hypotheses were constructed and tested using Structural equation modeling. The questionnaire was distributed among 200 health professionals to collect their responses. Ninety-seven responses were received, and 15 barriers were identified affecting the healthcare waste management sector. The results show that all three barriers (i.e., Organizational, Waste handling, and Human resources) hinder the Healthcare waste management sector. Organizational Barriers are the most significant among other barriers. So, the hospitals have to take appropriate actions to overcome these barriers. This paper helps to complete the research gap by providing the different characteristics of barriers. The development of a model for the analysis of barriers influencing HCWM is the Author's original contribution.

There is a growing interest in applying the Service Design (SD) approach to innovate and transform healthcare systems. However, comprehensive studies are scarce. This study systematically reviews the literature on SD initiatives towards healthcare system transformation. The research questions are: How has the SD approach been applied to the healthcare sector? To what extent are the SD initiatives contributing to transform the health systems? What are the main challenges faced by SD initiatives to transform the health system? Which are the main stakeholders involved in the process, and how could they change according to the type of initiative? The search was conducted in March 2021 in eight databases and returned 990 articles evaluated through a research protocol, resulting in 47 studies included in this review. These studies were explored through thematic analysis and considering two conceptual models: the SD approach (Patrício et al., 2020) and the ecosystem perspective (Beirão et al., 2017). The findings show that SD initiatives have been implemented at all levels of the ecosystem, but only 49% (47/23 studies) present a transformative character. The SD initiatives challenges were organized into four themes: (1) Planning SD initiatives as a lever in transforming health systems; (2) Using SD tools creatively; (3) Considering the use of new technologies to transform health systems positively, and (4) Facing the challenges of applying the Experience-Based Design and Experience Based in Co-Design approaches in project development. This study is relevant for helping managers and researchers in their efforts to design truly transformative services with a focus on improving health systems and social wellbeing.

Self-care of patients with chronic noncommunicable diseases is an essential component of contemporary healthcare. The purpose of this paper is to present a novel self-care process model and place it in the broader context of professional care. The extended Event-driven Process Chain approach to process modelling was used, focusing on a detailed overview of sequences of events, connections and activities and other elements/building blocks. A self-care process model was designed. The model is divided into two parts. The first part represents the self-care process when patients are able to manage their symptoms and be independent. The second part includes the process when patients are unable to perform self-care and/or need professional support. By identifying the essential elements of this process and incorporating them into the patients' care process, we can ensure that professional support for self-care creates a dynamic balance in the patients' ecosystems. Patients with chronic noncommunicable diseases need to make timely decisions about individual aspects of their health and seek professional help. In this way, an optimal level of health and well-being of patients can be achieved. Focusing on the patients' self-care process could also reduce treatment costs and improve the quality of life of patients. The novel designed model of the process of self-care, with all its essential elements, can be supported by digital technology, especially in the decision-making process and needs to become an important part of healthcare and long-term care systems.

This research focuses on market power in the private healthcare sector. This topic has been poorly explored by the extant literature and the reasons mainly rely on the peculiarities of the sector and the specific market. In fact, health providers' market power is influenced by multiple factors and by the fact that prices are often regulated by national or regional public authorities. To fill this gap, the article explores the relationship between performance characteristics and health providers' market power, measured through the Lerner index. The research is based on the analysis of panel data for 437 Italian private healthcare providers over the period 2012-2020. To explore the determinants of health providers' market power, this research employs System-generalized method of moments (SYS-GMM) estimation models. The results highlight a significant and non-linear relationship between market power and process performance, as well as with gender diversity. Intangible assets are another input variable that has a significant and positive relationship with market power. The study contributes to the identification of the performance characteristics driving health providers' market power.

Previous studies of healthcare organizations' workforces and their performance have focused on burnout and its impact on care. The aim of this research is to expand on this and examine the association of positive organizational states, engagement and recommendation of employer as a place to work, in comparison to burnout on Hospital performance. Methods: This was a panel study of the respondents to the 2012-2019 yearly Staff Surveys of the English National Health Service (NHS) hospital Trusts with hospital performance measured by the adjusted inpatient Summary Hospital-level Mortality Indicator (SHMI). Results: In univariable regression, all three organizational states significantly and negatively correlated with SHMI, with recommendation and engagement showing a nonlinear effect. In multivariable analysis, all three states remained significant predictors of SHMI. Engagement and recommendation showed mutual correlation, with engagement being a more prevalent state than recommendation. Conclusion: Our study indicates that organizations could benefit from monitoring multiple workforce variables to preserve or enhance workforce well-being, while optimizing organizational performance. The surprising finding that higher burnout was associated with improved short-term performance requires further investigation, as does the finding of less frequent staff recommendation of work compared to staff engagement with their work.

Objectives: Typologies are frequently utilised in analyses of the quality, funding, and efficiency of aged care systems. This review aims to provide a comprehensive resource identifying and critiquing existing aged care typologies. Methods: Systematic search of MEDLINE, Econlit, Google Scholar, greylit.org and Open Grey databases from inception to July 2020, including typologies of national, regional or provider aged care systems. Article screening, data extraction, and quality appraisal were conducted in duplicate. Results: 14 aged care typologies were identified; five applied to residential care, two to home care and seven to mixed settings; eight examined national systems and seven regional or provider systems. Five typologies classifying national financing or home care services, provider financing of staff and services and quality of residential care were considered high quality. The schematic provided summarises the focus area and aids in typology selection. Discussion: The aged care typologies identified cover a wide range of areas and contexts of aged care provision. This schematic, summary and critique will aid researchers, providers, and aged care policy makers to examine their own setting, compare it to other approaches to aged care provision and assist in identifying alternatives and important considerations, when undertaking aged care reform.