Health Care Management Review最新文献

Background: This paper examines the campaign contributions made by hospitals and their employees to state legislators in the years following the Affordable Care Act, during the period in which hospitals sought Medicaid expansion in all 50 states.

Purpose: The purpose of this research was to identify the institutional characteristics in which campaign contributions are an effective management tool for obtaining favorable policy.

Methods: In this study, we combined archival data from the Kaiser Commission on Medicaid and the Uninsured, the National Institute on Money in State Politics, the National Conference of State Legislatures, and the U.S. Census Bureau from 2010 to 2015. The analysis uses a two-stage residual inclusion Cox proportional hazards model to estimate the conditional effects of hospitals' state-level campaign contributions on the hazard of Medicaid expansion.

Results: In this analysis, it has been demonstrated that campaign contributions increased the likelihood of Medicaid expansion in states with large legislative districts but decreased the likelihood of Medicaid expansion in states in which a single political party controls the executive and legislative branches. This research concludes that the effectiveness of campaign contributions is contingent on characteristics of local legislative institutions.

Practice implications: Our findings encourage health care administrators to assess the institutional environment before engaging in political activities. Dollars contributed to campaigns in states with large legislative districts are likely to be effective, whereas dollars spent in states with unified governments are likely the least effective. In these latter contexts, health care administrators are encouraged to seek alternative methods of policy influence.

Background: Illegitimate tasks are work assignments perceived as unreasonable or unnecessary. Such tasks fall outside the boundaries of duties considered appropriate for a given professional role. Illegitimate tasks are a widespread issue in the health care sector. Literature has largely emphasized the negative outcomes of illegitimate tasks. However, we suggest that the consequences of illegitimate tasks might not always be uniformly negative but could be paradoxical, depending upon the appraisal mechanisms.

Purposes: Using the lens of the transactional model of stress and coping, we suggest that when individuals appraise illegitimate tasks as challenges, it is associated with positive outcomes like employee resilience. However, if they appraise illegitimate tasks as hindrances, it is associated with negative outcomes like the intention to quit.

Method: The study was conducted using a time-lagged survey of 207 nurses in the health care sector in India, where illegitimate tasks are highly prominent.

Results: Illegitimate tasks were positively associated with challenge and hindrance appraisals. The appraisal mechanisms mediated the relationship between illegitimate tasks and employee outcomes (employee resilience and intention to quit). Individuals with higher calling orientation were less likely to perceive illegitimate tasks as hindrances.

Practice implications: Organizations should ensure that illegitimate tasks are appraised as challenges rather than hindrances through workload and stress management techniques.

Issue: Digital workplace transformation (DWT) in health care promises improved efficiency and care delivery; however, it also generates new leadership challenges. Leaders must navigate ethical dilemmas, workforce strain, and fragmented coordination across stakeholder groups. Existing leadership models often fall short in addressing these multidimensional pressures, particularly with respect to clinician well-being, responsible innovation, and the legitimacy of technological change.

Critical theoretical analysis: This article synthesizes transformational, responsible, and digital leadership theories to propose a Responsible Digital Transformational Leadership (RDTL) framework for health care DWT. RDTL framework is grounded in leadership literature and aligned with emerging health care realities, such as the strategic role of health care leaders and the need for team-based leadership configurations. RDTL is underpinned by five testable, interrelated principles: ethical stewardship, inclusive engagement, navigating complexity with agility, empowering digital confidence, and visionary digital stewardship.

Insight/advance: The RDTL model advances leadership theory by integrating ethical responsibility, technological competence, and human-centered change in a unified framework. It offers testable propositions linking leadership behaviors to key outcomes such as staff well-being, patient care quality, and the ethical legitimacy of digital transformation initiatives. Unlike leader-centric models, RDTL also foregrounds team-based dynamics and stakeholder inclusivity as essential drivers of responsible innovation.

Practice implications: RDTL provides health care leaders with a values-driven roadmap for guiding digital transformation while safeguarding employee well-being and ethical standards. It emphasizes participatory decision-making, psychological safety, and long-term stewardship as essential components of trustworthy and sustainable change.

Background: Primary care teams are essential to high-quality patient-centered care but face persistent challenges. In other industries, team creativity is well-studied and is gaining traction in health care, particularly in primary care, where it may foster innovation and improvement.

Purposes: The aim of this study was to adapt and refine the concept of team creativity for primary care, using management literature to develop a context-specific framework.

Methodology/approach: A three-stage empirical design was used. First, team creativity dimensions were identified through a review and thematic analysis of management literature. Second, a panel of 15 primary care experts adapted these dimensions for primary care. Third, a survey of 648 primary care team members in a large health system was followed by exploratory factor analysis to identify core dimensions.

Results: Five dimensions of primary care team creativity emerged: team orientation to creativity, team creative processes, job-required creativity, team creative outputs, and leveraging team creativity.

Conclusion: Team creativity can be conceptualized and measured in primary care.

Practice implications: Primary care teams can apply these five dimensions to generate creative ideas in daily work. Managers can support this by allocating resources, implementing supportive practices, and recognizing creative contributions.

Background: According to organizational mindfulness (OM) theory, teams must constantly anticipate and recover from unforeseen events by avoiding oversimplified explanations, being attuned to operational details, maintaining commitment to resilience, engaging in preoccupation with failure, and prioritizing expertise in problem solving. Despite its merits, the assimilation of OM theory into health care systems remains challenging, as fundamental practices and procedures within these systems often conflict with the core principles of OM, leading to an implementation gap.

Purpose: We begin by emphasizing why health care professionals, particularly nurses, are not yet ready for and even resistant to OM. Although OM is intensely patient focused and enables nurses to practice in alignment with the ideals of nursing, they may be reluctant to embrace it due to the burden it places on them without adequate resources.

Methodology: We argue that readiness for change (RFC) theory offers valuable insights into addressing this challenge by identifying and mitigating barriers to change. We combine research on OM with the RFC model to conceptualize how to systematically integrate OM into health care settings.

Findings: Conceptually integrating RFC and OM frameworks can aid in narrowing the OM theory-implementation gap. To advance the field further, OM scholars should focus on better operationalizing OM principles, designing interventions to implement OM, and assessing their effectiveness with longitudinal designs and identify contextual boundary conditions for OM effective implementation. Moreover, we describe how leaders can support OM and RFC while managing resource constraints and supporting overwhelmed health care workers.

Practice implications: We distill our analysis into the 6-Step Road Map, suggesting evidence-based strategies for health care policymakers, administrators, and managers aiming to implement OM.

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: Community orientation, developed and fostered through partnerships between hospitals and community organizations, is a key approach for health care organizations to build deeper community ties. Such efforts are instrumental in building trust within the community, and one way for hospitals to do so is to develop a strong organizational equity orientation as a strategic priority.

Purpose: The aim of the study was to explore the association between hospitals' organizational equity and community orientation using Moulton's publicness theory framework, which focuses on cultural-cognitive, regulative, and normative public value.

Methodology/approach: Using data from 2021 to 2022 American Hospital Association annual surveys and the 2018 Social Capital Project, a Poisson model with random effects was conducted to assess the association between hospitals' internal equity orientation and community orientation.

Results: Hospitals with higher organizational equity orientation were associated with an increased degree of community orientation (incident rate ratio [IRR] = 1.04, p < .001). Not-for-profit and public hospital ownership (IRR = 1.66 and 1.53, p < .001, respectively), teaching status ( IRR = 1.08, p < .001), The Joint Commission accreditation ( IRR = 1.07, p < .001), and higher social capital (IRR = 1.10, p < .05) were also associated with higher degree of community orientation.

Conclusions: As hospitals explore opportunities to reduce disparities and improve equity, they should focus on measuring and assessing organizational equity orientation at various levels, which can, in turn, offer an advantage in deepening community relationships.

Practice implications: With increasing emphasis from Centers for Medicare & Medicaid Services on health equity and community partnerships, hospitals prioritizing organizational equity in multiple ways may stand to benefit. By demonstrating a commitment to equity within the organizations, hospitals will be more likely to gain trust from community partners.

Background: Chief executive officer (CEO) turnover is especially frequent in hospitals and represents a critical organizational event, yet its predictors and effects remain poorly understood.

Purpose: We conducted a systematic review of the empirical literature on the predictors and effects of hospital CEO turnover worldwide to synthesize and assess the multiple findings scattered across studies.

Methodology: In this systematic review, 30 empirical studies published between 1987 and 2024 were identified from three databases: Business Source Complete, MEDLINE, and APA PsycInfo. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: We found that the methodological quality of the studies was highly variable. Furthermore, we identified 46 unique predictors of hospital CEO turnover, including organizational, environmental, and personal characteristics, as well as characteristics related to prior performance. The findings regarding the effects of CEO turnover suggest that it can result in a temporary decline in financial performance and an elevated risk of organizational failure for hospitals.

Practice implications: Our results underscore that, in hospitals with a higher likelihood of CEO turnover, early and systematic succession planning is crucial to increase leadership stability, reduce recruitment costs, and ensure organizational resilience.

Background: Sharing health care assets promises to enhance asset utilization, increase efficiency, and reduce costs, but this tactic also might risk adverse patient outcomes. Identifying potential mitigation strategies thus represents a pressing research need.

Purposes: This study investigates the effects of sharing a health care asset on patients' perceptions, as well as how providing explanatory information might mitigate the negative effects of such sharing on patient outcomes.

Methodology/approach: Building on signaling theory and data gathered from a scenario-based experiment (n = 303 German participants), the authors perform regression analyses, in which trust in the physician and perceived risk represent mediators of the relationship between sharing a health care asset and patients' intentions to return. They also explore if physicians' explanatory information provision functions as a moderator.

Findings: Trust in the physician and perceived risk serially mediate the effect of sharing a health care asset on patients' intentions to return. Explanatory information provision can mitigate the negative effects of asset sharing on patients' trust in the physician.

Practice implications: Explanatory information provision is crucial for implementing shared asset use strategies in the health care sector, because it offers the potential to mitigate the negative effects of such uses on patient outcomes. Health care providers pursuing shared asset strategies should provide patients with clear information about the shared asset, to prevent adverse effects.

Background: Exploring the "wicked" problem of improving care for patients with complex care needs could benefit a large swath of health system stakeholders given the breadth and depth of this issue. Patients with complex health and social needs often require customized care that deviates from expected care trajectories. At Canadian Stroke Distinction sites, clinicians provide care for a high proportion of patients with complex needs while adhering to best practice recommendations.

Methods: We conducted an interpretive description study, which explored the perspectives of 16 stroke rehabilitation clinicians, four organizational key informants, and two health system key informants. We collected data via 45- to 60-minute virtual interviews and engaged in a hybrid inductive-deductive approach to analysis.

Results: We constructed three main themes: (a) recognizing complexity is routine work for clinicians, (b) clinicians use workarounds to manage complexity, and (c) clinicians perceived and worked to bridge a difference between organizational processes and the realities of patient care. When comparing clinician and key informant perspectives, we noted differences regarding their perceptions of the prevalence and nature of patient complexity. We developed the concept of "work-as-expected" as an intermediary to bridge the gap between the "work-as-imagined" and "work-as-done" framework.

Conclusion: We describe the strategies used by expert clinicians to continually manage care for a high proportion of patients with complex care needs. Although expert clinicians have developed effective workarounds, they experience significant moral distress when these strategies are unable to compensate for health system limitations.

Practice implications: A better understanding of how clinicians manage the needs of patients with complex care needs could support policymakers and organizational leaders to consider macro- and meso-level strategies to support the adaptive practices of clinicians.