Health Care Management Review最新文献

Background: The substitution hypothesis identifies absence constraints such as job and organizational demands as key precursors of presenteeism (attending work while ill). However, the relationship between absence constraints and presenteeism might be more complex than traditionally assumed (i.e., curvilinear). Moreover, it also remains unclear whether and how effective social support is in buffering these relationships.

Purpose: This study investigates whether the relationship between key absence constraints (i.e., attendance enforcement and work overload) and presenteeism follows a U-shaped curvilinear pattern and whether support mechanisms (i.e., colleague and manager support) moderate the absence constraints-presenteeism relationship.

Methodology: To answer these questions, we employed binary logistic regression analysis on survey data from a large and representative sample of nurses and midwives from Ireland ( N = 1,037).

Results: The relationship between absence constraints and presenteeism is dependent on the type of absence constraint, with attendance enforcement demonstrating a curvilinear relationship and work overload demonstrating a linear relationship. Contrary to expectations, social support had limited impact on this relationship and acted as a "constraint in disguise" in the case of manager support and had no impact in the case of colleague support.

Conclusion: Our study challenges the basic tenets of the substitution hypothesis of presenteeism, particularly the idea that eliminating absence constraints always reduces the likelihood of presenteeism among nurses and midwives.

Practice implications: Increasing support to reduce presenteeism is unlikely to be effective in controlling presenteeism among nurses and midwives. Hospitals would be better served by directly targeting the absence constraints of such presenteeism behavior.

Background: Hospitals are increasingly engaging in partnerships to address population health in response to national policies, such as value-based payment models. However, little is known about how institutional factors influence hospital partnerships for population health.

Purpose: Guided by institutional theory, we examine the association between institutional pressures (coercive, normative, and mimetic isomorphism) and hospital partnerships for population health.

Methodology: A pooled cross-sectional analysis used an unbalanced panel of 10,777 hospital-year observations representing respondents to a supplemental question of the American Hospital Association's annual survey (2015-2017). The analysis included descriptive and bivariate statistics, and regression models that adjusted for repeated observations to examine the relationship between key independent variables and partnerships over time.

Findings: In regression analyses, we found the most support for measures of coercive (e.g., regulatory factors) isomorphism, with nonprofit status, participation in accountable care organizations, and acceptance of bundled payments, all being consistently and significantly associated with partnerships across all organization types. Modest increases were observed from 2015 to 2017 for hospital partnerships with public health organizations (+2.8% points, p < .001), governmental organizations (+2.0% points, p = .009), schools (+4.1% points, p < .001), and businesses (+2.2% points, p = .007).

Practice implications: Our results suggest that institutional factors, particularly those related to regulatory policies and programs, may influence hospital partnerships to support population health. Findings from this study can assist hospital leaders in assessing the factors that can support or impede the creation of partnerships to support their population health efforts.

Background: In response to the complexity, challenges, and slow pace of innovation, health care organizations are adopting interdisciplinary team approaches. Systems engineering, which is oriented to creating new, scalable processes that perform with higher reliability and lower costs, holds promise for driving innovation in the face of challenges to team performance. A patient safety learning laboratory (lab) can be an essential aspect of fostering interdisciplinary team innovation across multiple projects and organizations by creating an ecosystem focused on deploying systems engineering methods to accomplish process redesign.

Purpose: We sought to identify the role and activities of a learning ecosystem that support interdisciplinary team innovation through evaluation of a patient safety learning lab.

Methods: Our study included three participating learning lab project teams. We applied a mixed-methods approach using a convergent design that combined data from qualitative interviews of team members conducted as teams neared the completion of their redesign projects, as well as evaluation questionnaires administered throughout the 4-year learning lab.

Results: Our results build on learning theories by showing that successful learning ecosystems continually create alignment between interdisciplinary teams' activities, organizational context, and innovation project objectives. The study identified four types of alignment, interpersonal/interprofessional, informational, structural, and processual, and supporting activities for alignment to occur.

Conclusion: Interdisciplinary learning ecosystems have the potential to foster health care improvement and innovation through alignment of team activities, project goals, and organizational contexts.

Practice implications: This study applies to interdisciplinary teams tackling multilevel system challenges in their health care organization and suggests that the work of such teams benefits from the four types of alignment. Alignment on all four dimensions may yield best results.

Background: The 1980s to 1990s saw many health systems in the United States enter and exit the insurance market in the form of provider-sponsored health plans (PSHPs). Reforms and value-based reimbursement methods have stimulated health care organizations to reconsider PSHP as a logical strategy.

Purpose: The aim of this study was to examine market and organizational factors associated with PSHP ownership and motivations for engaging in PSHP after health care reforms. The resource dependence theory was used as a theoretical lens.

Methodology/approach: A sequential quantitative to qualitative mixed-methods design was used. The quantitative analysis examined data for 5,849 U.S. hospitals. Results were synthesized with qualitative findings from 10 semistructured interviews representing eight health systems in five states.

Results: Organizational and environmental characteristics were significantly associated with PSHP ownership. Hospital and payer concentration, Medicare penetration, income, unemployment rate, government, and for-profit and metro area hospitals were associated with a lower likelihood of PSHP ownership. Salaried physician arrangements, clinically integrated network membership and adoption of other risk-bearing arrangements were associated with higher odds of PSHP ownership. Interviewees described PSHP as the culmination of the journey to value-based care and as a strategy to improve patient care, compete, and diversify revenue streams.

Conclusions: Both market and organizational factors are important considerations for hospitals contemplating PSHP ownership, and motivations for ownership cover a broad range of financial, competitive, strategic, and mission-based goals.

Practice implications: Hospitals considering PSHP ownership must carefully evaluate their competitive landscapes and organizational resources to ensure optimal conditions for this strategy. PSHP ownership has high start-up costs and requires a long-term organizational commitment.

Background: Community-academic health partnerships (CAHPs) have become increasingly common to bridge the knowledge-to-practice gap in health care. Because working in such partnerships can be excessively challenging, insights into the individual-level enablers of high performance will enable better management of CAHPs.

Purpose: Steered by the goal-setting theory, this study examined the relations between goal clarity, goal stress, goal importance, and their interactions on perceived project performance among individuals working in CAHPs' constituting projects.

Methodology: Using a convergent mixed-method research design, online survey data were collected from 268 participants working in a variety of CAHP projects in three German-speaking countries. We tested the hypotheses using structural equation modeling, after which thematic analysis was carried out on the 209 open-ended responses.

Results: CAHP project performance was positively associated with goal clarity and negatively associated with goal stress. A three-way interaction analysis showed that when goal importance was high, the relationship between goal clarity and project performance remained positive regardless of the level of goal stress. The qualitative data corroborate this finding.

Conclusion: In CAHP projects, high goal importance offsets the negative effect of goal stress on project performance, indicating that workers who perceive the project goals as important can manage the stress associated with demanding goals better.

Practice implications: To achieve high project performance in CAHPs, organizational and project leaders should (a) set clear project goals, (b) facilitate project workers in dealing with stress resulting from overly demanding goals, and (c) emphasize the importance of the project goals, especially when goal stress is high.

Background: Published literature on health care administration, management, and leadership and its impacts on health systems' programs to address health care inequities is limited, as is information about how organizations integrate health equity in their cultures, missions, and strategic plans.

Purpose: The aims of this study were to identify the key components necessary for health systems to implement systematic organizational change to promote health equity and to describe approaches organizations have implemented.

Methodology/approach: We conducted an environmental scan to identify central principles for implementing lasting change in health systems and experts working to advance health equity through organizational change. We interviewed 19 experts in health equity and hospital executives in 2020. Using iterative thematic analysis, we identified common themes.

Results: Consistent with the literature on organizational change, interviewees described a variety of systematic approaches to change, all of which involve the following core components: (a) committed and engaged leadership; (b) integrated organizational structure; (c) commitment to quality improvement and patient safety; (d) ongoing training and education; (e) effective data collection and analytics; and (f) stakeholder communication, engagement, and collaboration.

Conclusion and practice implications: There is no "one-size-fits-all" approach to advancing health equity. Decisions about which components require the most attention vary depending on an organization's internal and external environment. Understanding those environments and identifying which levers will be most effective are essential. As provider organizations strive to develop more strategic and systematic approaches to addressing disparities, long-term vision and commitment are necessary to achieve sustainable organizational change.

Background: Collectively, an individual's ability and willingness to adjust to uncertain and complex changes in the workplace and an environment that supports employee problem-solving may facilitate individual-level adaptation to changes in the workplace and help mitigate the negative impact of work-related stressors on health care professionals' work-related behavior and mental health outcomes.

Purpose: This study uses an interactionist perspective to assess how resources such as perceived adaptivity and organizational support for innovation serve as contextual boundary conditions of role overload in mitigating emotional exhaustion among health care workers.

Methodology: A cross-sectional survey design was used to collect data from rural health care workers (n = 310). A moderated moderation analysis was performed to address the aims of the study.

Results: The results indicate that role overload has a significant positive effect on emotional exhaustion. Furthermore, a statistically significant three-way interaction effect of perceived adaptivity, organizational support for innovation, and role overload on emotional exhaustion was observed. Organizational support for innovation was found to mitigate the negative impact of role overload on emotional exhaustion for employees with high perceived adaptivity, but not for those with low perceived adaptivity levels.

Conclusions: The findings from this study suggest that in high-stress work environments, integrating and appropriately matching personal and organizational resources could serve as a buffer against the effects of work stressors on emotional exhaustion.

Practical implications: Effective strategies to enhance employee emotional well-being may require the joint consideration of individual and organizational factors.

Background: As large numbers of coronavirus disease 2019 (COVID-19) patients were admitted to intensive care units (ICUs) in 2020 and 2021, the United States faced a shortage of critical care providers. Intensivists are physicians specializing in providing care in the ICU. Although studies have explored the clinical and financial benefits associated with the use of intensivists, little is known about the organizational and market factors associated with a hospital administrator's strategic decision to use intensivists.

Purpose: The aim of this study was to use the resource dependence theory to better understand the organizational and market factors associated with a hospital administrator's decision to use intensivists.

Methodology: The sample consisted of the national acute care hospitals (N = 4,986) for the period 2007-2017. The dependent variable was the number of full-time equivalent intensivists staffed in hospitals. The independent variables were organizational and market-level factors. A negative binomial regression model with state and year fixed effects, clustered at the hospital level, was used to examine the relationship between the use of intensivists and organizational and market factors.

Results: The results from the analyses show that administrators of larger, not-for-profit hospitals that operate in competitive urban markets with relatively high levels of munificence are more likely to utilize intensivists.

Practice implications: When significant strains are placed on ICUs like what was experienced during the COVID-19 pandemic, it is imperative that hospital administrators understand how to best staff their ICUs. With a better understanding of the organizational and market factors associated with the use of intensivists, practitioners and policymakers alike can better understand how to strategically utilize intensivists in the ICU, especially in the face of a continuing pandemic.

Issue: In broad terms, current thinking and literature on the spread of innovations in health care presents it as the study of two unconnected processes-diffusion across adopting organizations and implementation within adopting organizations. Evidence from the health care environment and beyond, however, shows the significance and systemic nature of postadoption challenges in sustainably implementing innovations at scale. There is often only partial diffusion of innovative practices, initial adoption that is followed by abandonment, incomplete or tokenistic implementation, and localized innovation modifications that do not provide feedback to inform global innovation designs.

Critical theoretical analysis: Such important barriers to realizing the benefits of innovation question the validity of treating diffusion and implementation as unconnected spheres of activity. We argue that theorizing the spread of innovations should be refocused toward what we call embedding innovation-the question of how innovations are successfully implemented at scale. This involves making the experience of implementation a central concern for the system-level spread of innovations rather than a localized concern of adopting organizations.

Insight/advance: To contribute to this shift in theoretical focus, we outline three mechanisms that connect the experience of implementing innovations locally to their diffusion globally within a health care system: learning, adapting, and institutionalizing. These mechanisms support the distribution of the embedding work for innovation across time and space.

Practical implications: Applying this focus enables us to identify the self-limiting tensions within existing top-down and bottom-up approaches to spreading innovation. Furthermore, we outline new approaches to spreading innovation, which better exploit these embedding mechanisms.