Health Care Management Review最新文献

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.

Background: Domestic violence (DV) is a neglected topic in health care, resulting in delays in the identification of DV victims and suboptimal care.

Purpose: The attitudes of health care professionals (HCPs) toward stigmas associated with victims of DV can affect the care offered to the latter. The HCPs' attitude toward victims of DV is therefore an important but neglected topic in health care research. Therefore, the purpose of this study was to determine whether awareness training changes HCPs' attitudes toward victims of DV, especially with regard to their stigmatization.

Methodology: Problem-centered interviews were conducted with 12 health professionals (six women and six men, six with and six without previous awareness training) concerning their attitudes and approaches to DV and those affected by it.

Results: Our data analysis indicates a significant difference in HPC attitudes toward potential DV victims depending on whether or not HCPs have undergone awareness training.

Conclusion: Awareness training does not only improve theoretical knowledge about DV; it also changes staff attitudes toward DV victims, especially with regard to their stigmatization.

Practice implications: Our study shows that awareness training changes the HCPs' attitudes toward victims of DV. This change in attitude might reduce pressure on both the HCP and the victim, which in turn might help the victim to accept the care offered. Therefore, awareness training can help to reduce barriers to helping victims of DV.

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: Nurses and patient care services staff are promising sources of creative ideas for improving care delivery, but hierarchical barriers can hinder engagement in creativity.

Purpose: We examined engagement in creativity among nurses and patient care services staff, particularly the support staff (e.g., medical assistants, unit coordinators) who sit low in the professional hierarchy. We tested whether the opportunity to give creative input anonymously increased engagement.

Methodology/approach: An innovation contest at a hospital invited over 8,500 nurses, health professionals, and support staff to share improvement-oriented ideas. We conducted a field experiment, where a randomly assigned group of employees was told that idea submission would be anonymous, whereas another group was told that name and role would be attached to ideas. Engagement in creativity meant viewing the contest platform and submitting an idea.

Results: Support staff were less likely to view the platform and submit an idea compared to other roles. With the promise of anonymity, support staff became more likely to view the platform, but not to submit ideas.

Conclusion: Although innovation contests offer a structured process for soliciting creative ideas, simply implementing them may not result in widespread engagement, particularly among low-level employees. The promise of anonymity did increase interest in creativity among these employees, but it was not enough to motivate idea submission.

Practice implications: Managers will need to pay attention to employee' hierarchy-driven beliefs about engaging in creativity when implementing mechanisms that solicit employees' creative input. The promise of anonymity may not be an effective motivator for creativity.

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.

Background: Workplace violence (WPV) against nurses is a growing concern within the health care industry, contributing to increased stress, burnout, and higher staff turnover.

Purpose: The purpose of this study is to understand the experiences of nurses with WPV and examine the scope and impact of this violence based on nurse's recollections.

Methodology/approach: Using qualitative interpretive meta-synthesis and the job demands-resources framework, we examined patterns in nurses' experiences of WPV. Our analysis (N = 401) of nurses' accounts from diverse sources-patients, colleagues, and supervisors across various locations and health care settings-provides deep insights into WPV dynamics.

Results: Four main themes were identified: (a) it comes with the job-patient and family violence are normal, (b) a vulnerability in nurse safety, (c) sexual harassment, and (d) poor treatment within the organization.

Conclusion: WPV against nurses is a deeply ingrained issue that impacts their psychological health and job performance. A stark need for health care systems to address and mitigate WPV is evident.

Practice implications: There are clear signals that health care organizations need to implement comprehensive strategies to prevent WPV, foster a safe and supportive work environment, and equip nurses with job resources to manage the high stress of their roles.