Health Care Management Review最新文献

Background: The unprecedented use of travel and temporary nurses in recent years requires further investigation of the impact on patient care.

Purpose: We conducted a systematic review of empirical research investigating the relationship between travel nurses and patient care to identify if consistent significant associations exist and how structural and process variables may influence such associations.

Methods: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of six databases resulted in the identification of 21 relevant articles.

Results: The existing research of travel nurse use differs widely in terms of the definition of travel nurse, study design, and included controls. The literature has failed to establish a consistent relationship between travel nurses and patient outcomes. Adverse associations between travel nursing and patient care may reflect staffing levels or work environments rather than the specific care by the travel nurses themselves.

Practice implications: Underlying structural and process variables, such as staffing levels and the practice work environment, may be confounding associations between travel nurse usage and quality patient care. Administrators and managers are urged to assess staffing and the work environment when employing travel nurses.

Background: Communication is an essential organizational process for responding to adversity. Managers are often advised to communicate frequently and redundantly during crises. Nonetheless, systematic investigation of how information receivers perceive organizational communication amid crises has remained lacking.

Purpose: The aim of this study was to characterize features of effective internal crisis communication by examining how information-sharing processes unfolded during the initial stage of the COVID-19 pandemic.

Methodology: Between June and August 2020, we conducted 55 semistructured interviews with emergency department workers practicing in a variety of roles. We analyzed interview transcripts following constructivist constant comparative methods.

Results: Our findings revealed that at the onset of COVID-19 pandemic response, emergency department workers struggled with immense fear and anxiety amid high uncertainty and equivocality. Frequent and redundant communication, however, resulted in information delivery and uptake problems, worsening anxiety, and interpersonal tension. These problems were ameliorated by the emergence of contextual experts who centralized and democratized communication. Centralization standardized information received across roles, work schedules, and settings while decoupling internal communication from turbulence in the environment. Democratization made information accessible in a way that all could understand. It also ensured information senders' receptiveness to feedback from information receivers. Centralization and democratization together worked to reduce sensed uncertainty and equivocality, which reduced anxiety and interpersonal tension.

Conclusion: Establishing frequent and redundant communication strategies does not necessarily address the anxiety and interpersonal tension produced by uncertainty and equivocality in crises.

Practice implications: Centralization and democratization of crisis communication can reduce anxiety, improve coordination, and promote a safer workplace and patient care environment.

Background: Increasingly, hospitals are expected to provide patient-centered care that attends to patients' health needs, including spiritual care needs. Chaplaincy services help to meet patients' spiritual care needs, which have been shown to have a positive impact on health outcomes. Variation in the provision of chaplaincy services suggests hospitals do not uniformly conform to the expectation of making chaplaincy services available.

Purpose: The aim of this study was to examine the availability and factors that influence hospitals' provision of chaplaincy services.

Methodology: Data were combined from the American Hospital Association annual surveys with the Area Health Resource File at the county level from 2010 to 2019. Observations on general, acute-care community hospitals were analyzed (45,384 hospital-year observations) using logistic regression that clustered standard errors at the hospital level.

Results: Hospitals with Joint Commission accreditation, more staffed beds, nonprofit and government ownership, teaching status, one or more intensive care units, a higher percentage of Medicare inpatient days, church affiliation, and system membership were more likely to provide chaplaincy services than their counterparts. Certification as a trauma hospital and market competition showed no influence on the provision of chaplaincy services.

Conclusion: The lack of chaplaincy services in many hospitals may be due to limited resources, workforce shortage, or a lack of consensus on scope and nature of chaplaincy services.

Practice implications: Chaplaincy services are an underutilized resource that influences patient experience, clinician burnout and turnover, and the goal of ensuring care is patient-centered. Administrators should consider stronger partnerships where services are provided; researchers and policymakers should consider how the lack of these services in some hospitals may reinforce existing health disparities.

Background: Given that emotional exhaustion and nurse engagement have significant implications for nurse well-being and organizational performance, determining how to increase nurse engagement while reducing nurse exhaustion is of value.

Purpose: Resource loss and gain cycles, as theorized in conservation of resources theory, are examined using the experience of emotional exhaustion to evaluate loss cycles and work engagement to evaluate gain cycles. Furthermore, we integrate conservation of resources theory with regulatory focus theory to examine how the ways in which individuals approach work goals serves as a facilitator to the acceleration and deceleration of both of these cycles.

Methodology/approach: Using data from nurses working in a hospital in the Midwest United States at six time points spanning over 2 years, we demonstrate the accumulation effects of the cycles over time using latent change score modeling.

Results: We found that prevention focus was associated with the accelerated accumulation effects of emotional exhaustion and that promotion focus was associated with the accelerated accumulation effects of work engagement. Furthermore, prevention focus attenuated the acceleration of engagement, but promotion did not influence the acceleration of exhaustion.

Conclusion: Our findings suggest that individual factors such as regulatory focus are key to helping nurses to better control their resource gain and loss cycles.

Practice implications: We provide implications for nurse managers and health care administrators to help encourage promotion focus and suppress prevention focus in the workplace.

Background: Performance-based budgeting (PBB) is a variation of pay for performance that has been used in government hospitals but could be applicable to any integrated system. It works by increasing or decreasing funding based on preestablished performance thresholds, which incentivizes organizations to improve performance. In late 2006, the U.S. Army implemented a PBB program that tied hospital-level funding decisions to performance on key cost and quality-related metrics.

Purpose: The aim of this study was to estimate the impact of PBB on quality improvement in U.S. Army health care facilities.

Approach: This study used a retrospective difference-in-differences analysis of data from two Defense Health Agency data repositories. The merged data set encompassed administrative, demographic, and performance information about 428 military health care facilities. Facility-level performance data on quality indicators were compared between 187 Army PBB facilities and a comparison group of 241 non-PBB Navy and Air Force facilities before and after program implementation.

Results: The Army's PBB programs had a positive impact on quality performance. Relative to comparison facilities, facilities that participated in PBB programs increased performance for over half of the indicators under investigation. Furthermore, performance was either sustained or continued to improve over 5 years for five of the six performance indicators examined long term.

Conclusion: Study findings indicate that PBB may be an effective policy mechanism for improving facility-level performance on quality indicators.

Practice implications: This study adds to the extant literature on pay for performance by examining the specific case of PBB. It demonstrates that quality performance can be influenced internally through centralized budgeting processes. Though specific to military hospitals, the findings might have applicability to other public and private sector hospitals who wish to incentivize performance internally in their organizational subunits through centralized budgeting processes.

Background: A large volume of literature identifies positive, rejuvenating benefits associated with giving compassion to others. However, the relationship between giving compassion and feelings of exhaustion remains underexplored. Understanding when giving compassion can potentially lead to feelings of emotional exhaustion is particularly important for nurses who are called upon to provide high levels of compassion to suffering patients in their daily work. We suggest that by engaging in transformational leadership behaviors, frontline supervisors can help nurses realize the positive benefits associated with giving compassion.

Purpose: The aim of this study was to examine the impact of nurses' perceptions of transformational leadership offered by their supervisors on the relationship between the levels of compassionate behaviors nurses report engaging in with patients and feelings of emotional exhaustion and job satisfaction.

Methodology/approach: A time-lagged field survey was conducted across two waves of 112 full-time employed inpatient nurses within the United States.

Results: Providing high levels of compassionate behavior to patients was associated with reduced (increased) perceptions of emotional exhaustion and increased (decreased) job satisfaction when supervisors engaged in higher (lower) levels of transformational leadership.

Discussion: Transformational leadership serves as an important resource to help caregivers such that nurses feel invigorated and satisfied, as opposed to drained or fatigued, when engaging in high levels of compassionate behaviors toward suffering patients.

Practice implications: For nurses to fully reap the established positive benefits associated with providing compassion to patients, frontline supervisors should be encouraged to engage in behaviors reflective of transformational leadership.

Background: Health care organizations are constantly creating new work to achieve evolving goals such as digitalization, equity, value, or well-being. However, scholars have paid less attention to how such work becomes "work" in the first place, despite implications for the design, quality, and experience of work and, consequently, employee and organizational outcomes.

Purpose: The aim of this study was to investigate how new work becomes enacted in health care organizations.

Methodology: A longitudinal, qualitative case study on the enactment of entrance screening-a new operation in response to COVID-19-in a multihospital academic medical center was performed.

Results: Entrance screening comprised four tasks, whose design was initially influenced by institutional guidelines (e.g., Centers for Disease Control and Prevention recommendations) and clinical experts. Organizational-level influences (e.g., resource availability) then became more prominent, necessitating multiple feedback-response loops to calibrate the performance of entrance screening. Finally, entrance screening was integrated into existing operations of the organization to ensure operational sustainability. The treatment of entrance screening as an operation changed over time-initially seen as infection control work, it eventually bifurcated into patient care and clerical work.

Conclusion: The enactment of new work is constrained by the fit between resources and its intended output. Furthermore, the schema of work influences how and when organizational actors calibrate this fit.

Practice implications: Health care leaders and managers should continuously update their schemas of work so that they can develop more sufficient and accurate representations of the employee capabilities that are required for the performance of new work.

Background: Interprofessional collaboration between nurses and physicians has become an essential part of patient care, which, when lacking, can lead to well-known challenges. One possible explanation for ineffective nurse-physician collaboration is a lack of respect.

Purpose: This review aims to enhance our understanding of the role of respect in work between nurses and physicians by synthesizing evidence about the conceptualization of respect, its mechanisms and outcomes, and its origins.

Methods: We performed a PRISMA-guided systematic literature review across five databases and reviewed 28 empirical studies about respect between nurses and physicians in acute care settings.

Findings: Research about respect between nurses and physicians varied in its conceptualization of respect in terms of its nature (as an attitude or behavior), its target (respect for individuals or groups), and its object (respect for task-relevant capabilities or human rights). The greatest convergence was on respect's object; the majority of studies focused on respect for task-relevant capabilities. The work reviewed offered insights into respect's potential mechanisms (attention and civility), outcomes (e.g., collaboration, patient outcomes, and provider outcomes such as job satisfaction), and origins (e.g., professional status and competence)-the latter suggesting how respect might be generated, developed, and maintained.

Practice implications: Our review highlights a need to appreciate how respect for task-relevant capabilities relates to respect for human rights and what fosters each to avoid rewarding only one while hoping for both, allowing leaders to cultivate more effective nurse-physician collaborations and better patient and provider outcomes.

Background: The limited published evidence relating to the experiences and outcomes of a unit dispersement model is generally more negative than positive from an allied health perspective.

Purpose: The perceptions of allied health managers and leaders after the transition to a unit dispersement structure were explored in this study. The objectives were to review the impacts of this type of structure and the factors for health care organizations to consider before incorporating allied health professions into a clinical matrix structure.

Methodology: A qualitative study was conducted in a large regional multisite public hospital and health service located in Australia. Semistructured interviews and focus groups were conducted with 30 allied health frontline managers and leaders.

Results: Four negative impacts on the work experience of allied health professionals in a dispersement structure were identified through data analysis as: a negative impact on service delivery to patients, a detrimental effect on professional identity, reduced ability of allied health managers and leaders to do their role effectively, and a negative impact on morale, culture, and emotional well-being. Several key factors for public hospitals to consider before embarking on an organizational structure that includes allied health professionals were identified.

Conclusion: The impacts of the unit dispersement structure on allied health professionals working within the organization under study were generally negative and did not deliver on the desired objectives. The findings reinforce the unique requirements pertaining to allied health professionals for optimal functioning.

Practice implications: The learnings have implications for administrators in health care organizations embarking on organizational change that incorporates allied health professions in certain settings. The findings recommend that health care organizations consider several important factors before they introduce any structural change that would affect the delivery of allied health services.

Background: The Palliative Care: Promoting Access and Improvement of the Cancer Experience (PC-PAICE) initiative is a team-based, palliative care (PC) quality improvement (QI) project working to promote high-quality PC in India. As a PC QI initiative, PC-PAICE implementation relied upon building interdisciplinary teams, providing the ideal context for understanding facilitators of team cohesion that compelled clinical, organizational, and administrative team members to work together. There is an opportunity to leverage the intersection between QI implementation and organizational theory to inform and improve implementation science.

Purpose: As a subaim of a larger implementation evaluation, we aimed to identify facilitators of team cohesion within QI implementation context.

Methodology: A quota sampling approach captured the perspectives of 44 stakeholders across three strata (organizational leaders, clinical leaders, and clinical team members) from all seven sites through a semistructured interview guide informed by the Consolidated Framework for Implementation Research (CFIR). We used a combination of inductive and deductive approaches informed by organizational theory to identify facilitators.

Result: We identified three facilitators of PC team cohesion: (a) balancing formalization and flexibility around team roles, (b) establishing widespread awareness of the QI project, and (c) prioritizing a nonhierarchical organizational culture.

Practice implications: Leveraging CFIR to analyze PC-PAICE stakeholder interviews created a data set conducive to understanding complex multisite implementation. Layering role and team theory to our implementation analysis helped us identify facilitators of team cohesion across levels within the team (bounded team), beyond the team (teaming), and surrounding the team (culture). These insights demonstrate the value of team and role theories in implementation evaluation efforts.