Health Care Management Review最新文献

Background: Public reporting of home health care agencies' performance metrics, including patient satisfaction, care processes, and health outcomes, aims to inform customer decisions and encourage agencies to improve the quality of services. However, there is limited research that examines the heterogeneous performance of home health care agencies.

Purposes: The aim of this study was to analyze the performance of home health care agencies by identifying distinct subgroups of agencies with similar performance profiles and describing the relationships between agency characteristics and such subgroups.

Methodology/approach: We propose a two-stage analytical approach employing unsupervised machine learning methods. First, clustering analysis is applied to performance measures, allowing the partitioning of agencies into homogeneous subgroups based on similarities in performance. Then, association rule mining is used to uncover the relationships between cluster assignments and agency characteristics.

Results: The two-stage analytical approach identified four clusters with significantly different performance profiles and agency characteristics: cost-efficient agencies with high patient satisfaction (Cluster 1), high-cost agencies with high-quality care (Cluster 2), urban agencies with low patient satisfaction (Cluster 3), and small agencies with low-quality care (Cluster 4).

Conclusion: This study contributes to understanding agency performance in the U.S. home health care industry. By identifying distinct subgroups of agencies and understanding the factors influencing their performance, we can enhance home health care services' overall quality and effectiveness.

Practice implications: Our study uncovered diverse performance profiles and associated characteristics among home health care agencies, highlighting the need for tailored strategies and targeted interventions to improve the quality of care across clusters. Health care administrators and policymakers should consider cluster-specific recommendations.

Background: An important aspect of value-based health care is providing care in an integrated practice unit (IPU). In an IPU, the full cycle of care for a specific medical condition is delivered through collaboration among professionals with diverse functional backgrounds. Although the proposed functioning of an IPU in the literature on value-based health care is based on assumptions about leadership, the role of leadership in the context of IPUs is overlooked in empirical studies.

Purpose: Drawing on previous studies on shared leadership in other organizational contexts, this paper explores the role of formal leadership in the emergence of shared leadership in IPUs.

Methodology/approach: To this end, we carried out a qualitative study in four IPUs in the Netherlands with differing formal leadership structures.

Results/conclusion: We found that, in an IPU, leadership is mainly exhibited by those in formal leadership positions. It also appeared that having one versus multiple formal leaders can influence the opportunities for other IPU members to demonstrate leadership and the extent to which IPU members feel the need to exercise leadership in IPUs.

Practice implications: We encourage staff managers and IPU members to define clear roles for leaders and establish a structured strategy for sharing information and resources, such as communication channels and regular feedback loops.

Background: Quality management has been established in health care organizations as an important management function for internal quality measurement and external quality reporting. Digitalization processes have recently gained momentum with uncertain outcomes for health care organizations, quality, and the role of quality management.

Purpose: We conduct a systematic review to answer the questions of how the introduction of digital technologies affects quality management as a management function, how quality management is affecting digitalization, which quality management topics are addressed, and which competencies are needed during digitalization.

Methods: Four databases were searched from 2000 to January 2022. Both empirical and conceptual articles reporting on digital technologies and quality management as a management function, quality reporting, or risk management were included. The studies included were analyzed based on the PICOS and PRISMA approaches.

Results: A total of 20 out of 662 articles met the inclusion criteria. Results show that both quality management as a management function as well as the digitalization of quality managements' own work processes are barely visible in the existing research. Only parts of the core tasks of quality management are discussed in connection with digitalization. Core competencies relevant for digitalization processes and quality management are identified.

Practice implications: Quality managers require knowledge of digital technologies in order to develop and implement them to support their own work processes and the work processes of health care organizations in general. Currently, research is not guiding this process, which makes it important for quality managers to be able to access local knowledge. In addition, professional associations should develop skill catalogs for quality management education.

Background: Leadership instability in nursing homes marked by high administrator turnover threatens the well-being of vulnerable residents. Although numerous factors have been implicated, the role of ownership remains unexplored.

Purposes: Based upon the tenets from institutional theory and strategic management theory, the primary goal of this study was to examine the impact of ownership on administrator turnover.

Methodology/approach: Data were derived from different sources: LTCFocus.org , Nursing Home Five-Star Quality Rating System, and Area Health Resources Files (2021-2022). The dependent variable was administrator turnover categorized as follows: 0 = no administrators left, 1 = one administrator left, and 2 = two or more administrators left. The primary independent variable was ownership/chain affiliation categorized as four possible interactions of for-profit (FP) status and chain affiliation: not-for-profit (NFP) independent, FP independent, NFP chain, and FP chain. An ordinal logistic regression model was used, and predicted turnover probabilities were calculated across the four ownership categories.

Results: The primary hypothesis was supported and compared to NFP independent, FP chain, FP independent, and NFP chain nursing homes that exhibited approximately 2.3, 1.7, and 1.4 times higher odds of administrator turnover. Predicted probabilities confirmed these trends: FP chain nursing homes had the lowest retention, with a 42% probability of no turnover, 32% for one administrator leaving, and 26% for two or more leaving. In contrast, NFP independent facilities had the highest retention rates, with a 62% chance of no turnover, 25% for one leaving, and 13% for two or more. Differences between groups were statistically significant ( p < .001).

Conclusion: FP chain ownership was associated with the highest administrator turnover rates, whereas NFP facilities experienced the lowest. FP independent and NFP chain homes had intermediate probabilities of administrator turnover.

Practice implications: Tailoring management strategies to the specific ownership structure may reduce administrator turnover and ensure consistent resident care.

Issue: Many hospitals in the United States are facing significant postpandemic operational challenges largely as a result of increasing demand for health care services. Operational issues increase the risk of service failures. Improving the patient experience after service failures may lead to better outcomes for both patients and hospitals.

Critical theoretical analysis: Drawing support from service failure recovery and quality management paradigms, we suggest that hospitals could periodically obtain deidentified patient feedback data drawn from multiple sources-including social media-to build a comprehensive patient experience dashboard that can be used to improve health care quality.

Insight/advance: We offer an overarching conceptual framework to support organizational learning and make hospitals more adaptive to patient feedback. Staff members and leaders could examine patient feedback data to identify service failures and take appropriate action to prevent their recurrence in hospitals. A patient experience dashboard can be developed to document and visualize remedial actions taken by hospitals against each past service failure and shared with all stakeholders.

Practice implications: Reorienting health care as a service where hospitals immediately listen to patients and promptly address their questions and concerns may help to strengthen the continuity of health care services offered by hospitals as well as improve their financial position, quality of care, and the overall patient experience.

Background: Burnout is disrupting the health care workforce, threatening the livelihoods of health care workers and the probability of safe and effective patient care.

Purposes: The aims of this study were to describe the evolution and gaps in burnout research and identify next steps to advance the field and reduce burnout.

Methodology/approach: We formed a learning community of burnout scholars and Chief Wellness Officers, sought recent review articles for a meta-narrative synthesis of themes on health care worker burnout, and conducted focus groups with learning community members.

Results: In 1,425 systematic burnout studies found in a Medline database search of systematic reviews published since 2018, 68 were retained for analysis. Many focused on individual interventions (e.g., mindfulness), paying inconsistent attention to (a) what comprises burnout, (b) prevalence and contributors, (c) theories underlying it, (d) presence in marginalized populations, and (e) innovative research methods. There was consensus that burnout poses a global crisis, but there was no agreement on how to address it. Focus group participants noted that although burnout research is now "mainstream," health systems commit insufficient resources to addressing it. They proposed that emphasizing organizational finances and patient safety may make burnout a priority for health systems.

Practice implications: Despite burnout's progressing unabated, many organizations do not employ known burnout indicators (worker dissatisfaction or turnover) as wellness metrics. Research into organizational contributors to burnout, rigorous evaluation of interventions, and organizational adoption of research findings into systemic action are urgently needed. A well-supported international research agenda is required to quickly move the field ahead and reduce or ultimately eliminate burnout.

Background: The reforms that have affected public health care organizations have changed the tasks and responsibilities of physicians heading operational units, who have become doctor-managers. This hybridization makes doctor-managers vulnerable to role ambiguities, with possible dysfunctional effects on their managerial behaviors and performance. The enhancement of different sources of budgetary performance feedback (BPF) and perceived organizational support (POS) can help them reconcile their managerial and clinical professional domains.

Purpose: Rooted in psychology-based budgeting research, this study aimed to show the role of doctor-managers' perceptions of BPF by examining the complementary effects of formal and informal BPF on POS and their satisfaction with the budget-holder role.

Methodology/approach: We collected self-reported data by administering questionnaires to a sample of doctor-managers from Italian public health care organizations. The hypotheses were tested using a linear regression model, clustered at the hospital level. Mediation analysis was used to test the mediating effects of POS.

Results: Findings showed that formal and informal BPF perceptions positively influenced POS and satisfaction with the budget-holder role. Further, POS mediated the BPF-role satisfaction link.

Conclusion: The study adds to the limited research on the individual-level benefits of perceived formal and informal BPF as complementary mechanisms for improving doctor-managers' attitudes toward the budget-holder role.

Practice implications: Top management and controllers should develop budgeting practices that consider the psychological factors related to the complementary functioning of formal and informal BPFs. These factors may support doctor-managers in meeting their responsibilities as budget holders and mitigate role ambiguities.

Issue: The digital transformation of the U.S. health care system is underway, but the role of health care chief information officers (HCIOs) in that transformation has been unclear. As the landscape of health care technology continues to expand, there is an increasing need to understand the influence of HCIOs, who are in a unique position to impact key strategic decisions. We seek to demonstrate the strategic importance of HCIOs in meeting the needs of digital transformation, by managing the emergence and strategic implementation of health care technologies to benefit health care organization performance. We also propose that profession-based stereotypes inhibit HCIOs as they may be viewed as behind-the-scenes technicians rather than strategic leaders.

Critical theoretical analysis: Upper echelons (UE) theory demonstrates how HCIOs' unique perspectives gained through education, experience, and the strategic decision-making process also can influence organizational performance. We build on UE to conceptualize the degree to which profession-based stereotypes moderate the decision-making of top management teams).

Theoretical implications: We present two theoretical contributions. First, we introduce a profession-based stereotype moderated model of UE specific to HCIOs. Second, we offer an analysis of the role of HCIOs as strategic leaders in the digital transformation era.

Practice implications: We call upon health care scholars and practitioners to examine HCIOs' influence and their roles in health care organization decision-making, top management team interactions, and organizational outcomes as the digital transformation in health care continues.

Background: In delivering health care, hospitals contribute to climate change, which adversely impacts human health. Given this paradox, there are mounting efforts to encourage environmental sustainability in hospitals.

Purpose: With growing attention on the environmental impact of hospitals and the adverse health effects of climate change, the purpose of this study is to examine factors that influence the likelihood of hospital commitment to environmental sustainability.

Methodology: Using data on U.S. hospitals in 2022, the study estimates logit models to predict the likelihood of signing The White House Health Sector Climate Pledge.

Results: Health system size is positively associated with the likelihood of hospital commitment to environmental sustainability and when interacting with nonprofit control this association strengthens. The delivery of uncompensated care increases the likelihood of commitment, but commitment declines at high levels of uncompensated care. Contrary to expectations, hospitals operating in communities that experience the most harmful health impacts from climate change are less likely to commit to sustainability.

Conclusion: A hospital's priorities and structure facilitate attention toward environmental sustainability, but external factors that draw attention to the need for environmental sustainability do not stimulate, and instead stifle, sustainability commitment.

Practice implications: Hospital leaders, advocacy groups, and policymakers should not assume the experience of adverse climate-related health outcomes leads hospitals to make commitments to environmental sustainability, but rather focus should be on actively building coalitions, starting with nonprofit, larger system-affiliated hospitals, already predisposed to prosocial behavior, in order to rally broader commitment toward environmental sustainability in the health care sector.

Background: Amidst the difficulty and contentiousness of improving hospitals, a relatively new approach is the Relational Model of Organizational Change (RMOC). However, this approach has its own challenges, including reports that its focus on communication and relationships is undervalued despite evidence supporting its use to facilitate practice improvements in hospitals. Research suggests power dynamics in hospitals influences how the RMOC is used, but the precise mechanisms through which this occurs have not been fully examined.

Purpose: The purpose of this study was to examine how power dynamics shaped the implementation of a program using the RMOC in a hospital: the QPH RC Program.

Methodology: Institutional ethnography was applied to explicate textually mediated ruling relations (power dynamics) and examine how they exerted their influence on the QPH RC Program. This involved interviewing people and analyzing texts embedded in work processes that organized the implementation of the program.

Results: The QPH RC Program was embedded in a cluster of ruling relations comprising an economic rationalist and scientific discourse and project management methodology. These ruling relations exerted their power via textually mediated social processes that influenced the focus and management of the program.

Conclusion: The ruling relations functioned to align the QPH RC Program with the priorities of the hospital, suggesting that financial objectives were prioritized over objectives to improve communication or culture.

Practice implications: Future research and practice change should include investigating and addressing the intersection of institutional contexts and the application of the RMOC to facilitate practice improvements in health care organizations, particularly hospitals.