Health Care Management Review最新文献

Background: Evidence on effective interventions to reduce missed care is limited. While various strategies exist, proactive huddle intervention remains underexplored.

Objectives: This study aimed to develop, implement, and evaluate proactive huddles as an effective process to reduce missed care in nursing wards. A secondary objective was to investigate the moderating effect of personal nurse accountability on the relationship between proactive huddles and missed care.

Methodology: A randomized controlled study was conducted in a medium-sized hospital, involving 180 nurses across six internal and four surgical wards.

Methods: Participants were randomly assigned to a 3-month intervention ( n = 85) and control ( n = 95) groups between March 2022 and May 2023. The intervention consisted of daily huddles, incorporating four key elements: status of tasks, potential delays, tasks that might not be completed, and assistance needed. The MISSCARE Survey (measured on three different occasions) and the 3D Accountability Questionnaire were assessed at baseline and immediately after the 3-month intervention.

Results: A total of 602 huddles, each lasting about 5 minutes, were included. Gaps were identified in 69% of huddles, with 57% resolved. The intervention group showed reduced missed nursing care compared to the control, with effectiveness moderated by personal accountability-benefiting nurses with lower accountability more.

Conclusions: Huddles require minimal resource investment to reduce missed nursing care, especially for nurses with lower personal accountability. Making huddles a standard practice can improve nursing care quality.

Practice implications: Nursing managers are encouraged to support consistently implementing huddles in hospital settings.

Background: Health care crises underscore the critical need to maintain a robust safety climate to prevent medical errors and improve patient outcomes. Leadership behaviors, particularly initiating structure and consideration, are vital in shaping safety climate. However, inconsistent findings have raised questions regarding the effectiveness of these behaviors in crisis contexts.

Purpose: This study examines how the initiating structure and consideration behaviors of clinical leaders influence safety climate during crises and explores the moderating role of leaders' affectivity in these relationships.

Methodology/approach: Empirical data were collected from 108 dyads of clinical leaders and their direct reports across 21 public hospitals in Thailand at three intervals over one year. The study employed growth modeling using random coefficient models to analyze the impact of leadership behaviors on safety climate, accounting for the nonindependence of observations over time and variations in leader affectivity.

Findings: The results show that the positive impact of consideration behaviors on safety climate diminishes during crises, whereas initiating structure plays a crucial role in enhancing safety climate by providing clarity and stability. Additionally, leaders' positive affectivity enhances the impact of consideration behaviors on safety climate, although this effect weakens as the crisis intensifies.

Practice implications: These findings highlight the need for clinical leaders to balance initiating structure with consideration to enhance safety climate during crises, while leveraging positive affectivity to integrate new information to stabilize safety practices and develop effective contingency responses to immediate needs.

Background: The Pennsylvania Rural Health Model (PARHM) was launched in 2019 to increase access to high-quality care, improve hospitals' financial stability, and better serve their communities by transitioning to value-based care.

Purpose: We examine the impact of participating in PARHM on hospitals' financial performance using agency theory as the theoretical foundation.

Methods: We analyzed retrospective data from 65 eligible acute care hospitals in rural Pennsylvania, spanning 2015-2022. Complete data sets were available for 61 hospitals from 2015 to 2020 and 57 hospitals from 2021 to 2022, totaling 480 hospital-year observations. We employed both traditional two-way fixed effects difference-in-differences and Callaway and Sant'Anna's difference-in-differences approach with multiple intervention periods for our analysis.

Results: Our findings indicate that PARHM was associated with improved financial outcomes for the participating hospitals, although these improvements were not statistically significant across the board. Statistical significance was observed only when comparing early participants (who joined in 2019) with late participants.

Conclusions: While PARHM has been associated with some financial improvements in the participating hospitals, overall enhancements cannot be conclusively determined due to confounding factors such as pandemic-related aid. Further research is necessary to evaluate the long-term sustainability and effectiveness of PARHM as more data become available.

Practice implications: Advocacy and additional state and federal policymaking are required to address the persistent equity issues in rural health care, increase funding for robust and adaptable health care infrastructure, and expand on current models and policies that have worked well for rural providers.

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: Community health centers (CHCs) receive federal grant money to reduce health care disparities. To be eligible, at least 51% of their board members must be descriptively representative patients (i.e., truly represent the population served by the clinic). However, research paints an unclear picture of how these patients influence board effectiveness.

Purpose: The aim of this study was to investigate the impact of descriptively representative patients on board conversations contributing to the board's effectiveness.

Methodology/approach: Two studies were conducted. Study 1 involved 23 semistructured interviews, observations of six board meetings, and five discussions with subject matter experts to examine the impact of descriptively representative patients on conversations that contribute to board effectiveness. Study 2 was a two-wave survey administered to 177 CHC chief executive or operating officers to investigate the impact of descriptively representative patients on the relationship between volubility (i.e., the amount of talking within a group) and board effectiveness.

Results: Study 1 revealed that although representative patients provided valuable insights, there was skepticism about their ability to contribute effectively, leading some to circumvent the requirement for such members. Additionally, we found that descriptively representative patients influence two key mechanisms-participative decision making and pointless discussion-through which conversations influence board effectiveness. In Study 2, we discovered that increased descriptive patient representation can mitigate the negative impact of volubility on pointless discussion and, in turn, enhance board effectiveness.

Conclusion: Descriptive patient representatives are valuable members of CHC boards, and the information they provide can keep conversations more focused.

Practice implications: CHC boards should not underestimate the value of truly representative patients. The Health Resources and Services Administration, which provides grants to CHCs, should be aware of efforts to circumvent the requirement for descriptive patient representation on CHC boards.

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.