Health Care Management Review最新文献

Background: Bringing together professionals with different knowledge and skills comes with the opportunity to spur the innovativeness of primary care teams. Nevertheless, empirical evidence shows that it is not self-evident that these innovations are also realized. The social categorization theory suggests that a better understanding of whether these potential team innovations are realized can be obtained by looking at the social cohesion of such teams.

Purpose: The aim of this study was to study the relationship between functional diversity and team innovation in primary care teams by examining the mediating role of social cohesion.

Methodology: Survey responses and administrative data of 887 primary care professionals and 75 supervisors in 100 primary care teams were analyzed. Structural equation modeling was used to examine a curvilinear mediated relationship among functional diversity and team innovation through social cohesion.

Results: The findings show a positive relationship between social cohesion and team innovation as expected. Contrary to the expectations, the relationship between functional diversity and social cohesion is insignificant, and the results show an inverted U-shaped relationship between functional diversity and team innovation instead.

Conclusions: This study reveals an unexpected inverted U-shaped relationship between functional diversity and team innovation. This relationship is not mediated by social cohesion; however, social cohesion is still a significant predictor of team innovation.

Practice implications: Policymakers should be aware of the relevance as well as the complexity of creating social cohesion in functionally diverse primary care teams. As long as it remains unknown how social cohesion is stimulated in functionally diverse teams, it seems best for the team innovation to prevent bringing together too many, but also too few, different functions.

Background: Collaboration between clinical and community-based social service organizations is increasingly seen as vital for preventing and managing chronic diseases but has been challenging to establish and sustain.

Purpose: The aim of this study was to identify organizational barriers and facilitators for clinic-community collaboration.

Methodology/approach: We employed multiple methods to study a national sample of nonprofit community-based organizations that each collaborated with local clinical organizations for diabetes prevention in the United States. We used qualitative data collected longitudinally through 65 semistructured interviews from 2016 to 2017 at seven of these organizations and their clinical collaborators to understand their relationships. We employed survey data ( N = 247 with 73% response rate) to measure and explore relationships among qualitatively identified themes and collaboration performance.

Results: We documented three levels of organizational challenges to community-clinic collaboration. Interorganizational challenges pertain to facing only weakly aligned interests across organizations. Interpersonal challenges pertain to misperceptions and miscommunications that occur as frontline employees from differing organizations seek to work together. Task-related challenges pertain to the inadequacy of current processes to effectively link services across clinical and community settings. We found that bridging leadership , provisional teamwork, and learning processes helped to overcome these challenges by enabling iterative progress. Follow-up national survey results indicated that these facilitators were significantly associated with collaboration performance.

Conclusions: Because community-clinic collaboration presents substantial interorganizational, interpersonal, and task-related challenges, financial incentives alone are likely insufficient for success.

Practice implications: Resources that help develop capacity to work across community and clinical settings may be vital and warrant dedicated funding.

Background: The challenges brought on by the pandemic triggered a renewed scholarly focus on managing during crises. Now, 3 years on, having covered the initial crisis response, it is important to reevaluate what the crisis has taught us about health care management more generally. In particular, it is useful to consider the persistent challenges that continue to face health care organizations in the wake of a crisis.

Purpose: The present article aims to identify the biggest challenges that currently face health care managers in order to formulate a postcrisis research agenda.

Methodology/approach: We employ an exploratory qualitative study, utilizing in-depth interviews with hospital executives and management to explore the persistent challenges facing managers in practice.

Results: Our qualitative inquiry reveals three key challenges that extend beyond the crisis and are salient for health care managers and organizations in the years to come. Specifically, we identify the centrality of human resource constraints (amidst increasing demand), the necessity of collaboration (amidst competition), and a need to reconsider the approach to leadership (utility of humility).

Conclusion: We conclude by drawing upon relevant theories such as paradox theory to formulate a research agenda for health care management scholars that can support the creation of novel solutions and approaches to persistent challenges in practice.

Practice implications: We identify several implications for organizations and health systems, including the need to eliminate competition and the importance of building human resource management capacities within organizations. In highlighting areas for future research, we provide organizations and managers with useful and actionable insights to address their most persistent challenges in practice.

Background: Although trust and psychological safety (PS) are critical for improving patient safety and medical error reporting, little is known about how they work together and how health care systems promote PS.

Purpose: This study examined how leadership for self-worth, inclusion, and trust may work together to foster PS and how this influences medical error reporting.

Approach: Data were collected in 2019 from 373 employees (24% response rate) in 85 hospital departments (54% response rate) in a nonprofit health care system in the eastern United States. Constructs were operationalized at the department level.

Results: Negative binomial path model results found several direct effects. Leadership for self-worth was positively associated with inclusion, inclusion was positively associated with trust and PS, trust was positively associated with reported medical errors, and PS was negatively associated with reported medical errors. Indirect effects uncovered leadership for self-worth was positively associated with PS by enhancing inclusion. In addition, leadership for self-worth increased inclusion, which increased trust and ultimately encouraged PS. Leadership for self-worth was associated with fewer reported medical errors through increasing inclusion, trust, and PS.

Practical implications: Trust encourages the formal reporting of medical errors whereas PS encourages learning from mistakes and improving care to reduce future errors (and consequently the number of reported errors). Leaders who understand employees' unique needs, express confidence in employees' abilities, and encourage employees to share their ideas, create inclusive and trusting work environments that encourage PS and ultimately help reduce reported medical errors.

Introduction: Patient-Centered Medical Home (PCMH) recognition is designed to promote whole-person team-based and integrated care.

Purpose: Our goal was to assess changes in staffing infrastructure that promoted team-based and integrated care delivery before and after PCMH recognition in Health Resources & Services Administration (HRSA)-funded health centers (HCs).

Methodology/approach: We identified changes in staffing 2 years before and 3 years after PCMH recognition using 2010-2019 Uniform Data System data among three cohorts of HCs that received PCMH recognition in 2013 ( n = 346), 2014 ( n = 207), and 2015 ( n = 115). Our outcomes were team-based ratio (full-time equivalent medical and nonmedical providers and staff to one primary care physician) and a multidisciplinary staff ratio (allied medical and nonmedical staff to 1,000 patients). We used mixed-effects Poisson regression models.

Results: The earlier cohorts served fewer complex patients and were larger before PCMH recognition. Three years following recognition, the 2013 and 2014 cohorts had significantly larger team-based ratios, and all three cohorts had significantly larger multidisciplinary staff ratios. Cohorts varied, however, in the type of staff that drove this change. Both ratios increased in the longer term.

Conclusion: Our study suggests that growth in team-based and multidisciplinary staff ratios in each cohort may have been due to a combination of HCs' perceptions of need for specific services, HRSA funding, and technical assistance opportunities.

Policy implications: Further research is needed to understand barriers such as costs of employing a multidisciplinary staff, particularly those that cannot directly bill for services as well as whether such changes lead to practice transformation and improved quality of care.

Background: Skilled nursing facilities' (SNFs) ability to provide optimal post-acute care depends on effective receipt of information from hospitals ("information continuity"). Little is known about how SNFs perceive information continuity and how it may relate to upstream information sharing processes, organizational context, and downstream outcomes.

Purpose: First, this study aims to identify how SNF perceptions of information continuity may be shaped by hospital information sharing practices, including measures of completeness, timeliness, and usability, as well as characteristics of the transitional care environment (i.e., integrated care relationships and/or consistency of information sharing practices across different hospital partners). Second, we analyze which of these characteristics are associated with quality of transitional care (measured by 30-day readmissions).

Approach: A cross-sectional analysis of nationally representative SNF survey ( N = 212) linked to Medicare claims was performed.

Results: SNF perceptions of information continuity are strongly and positively associated with hospital information sharing practices. Adjusting for actual information sharing practices, SNFs that experienced discordance across hospitals reported lower perceptions of continuity (β = -0.73, p = .022); evidence of stronger relationships with a given hospital partner appears to help facilitate resources and communication that helps to close this gap. Perceptions of information continuity, more so than the upstream information sharing processes reported, exhibited a more reliable and significant association with rates of readmissions as an indicator of transitional care quality.

Conclusion: SNF perceptions of information continuity are strongly associated with patient outcomes and are reflective of both hospital information sharing practices as well as characteristics of the transitional care environment that can mitigate or amplify the cognitive and administration challenge of their work.

Practice implications: Improving transitional care quality requires that hospitals improve information sharing behaviors but also invest in capacity for learning and process improvement in the SNF environment.

Background: The introduction of electronic health records (EHRs) has contributed considerably to EHR work outside work (WOW) hours for physicians. Prior research has identified the pressures associated with stress resulting from EHR WOW, yet developing a nuanced understanding of how physicians appraise and respond to this stress, and the resulting impacts, remains absent from the literature.

Purpose: Grounded in the technostress model, this study takes a qualitative approach to explore both the pressures and opportunities associated with EHR WOW.

Methods: Thematic analysis of data from semistructured interviews was utilized to examine the pressures and opportunities associated with EHR WOW among primary care pediatricians (n = 15) affiliated with a large Midwestern pediatric health system.

Results: The physicians in this study regularly spent time working in the EHR outside work hours. They felt the EHR contributed to their documentation burden, which ultimately increased their EHR WOW, and reported a sense of burden from ubiquitous EHR availability. Conversely, they appreciated the flexibility the EHR provided in terms of work-life balance. Suggestions for improvement under the direct purview of practice management included enhanced EHR usability, improvements in workflow during work hours to free up time to document, and more training on both EHR documentation strategies and ongoing software upgrades.

Conclusion: Physicians perceive that the EHR exerts certain pressures while affording new opportunities and conveniences. This study provides evidence of both the pressures and opportunities of EHR WOW and their effect on physician well-being.

Practice implications: Specific opportunities are identified for health administrators to enable physicians to better manage EHR WOW.

Background: Academic medical centers (AMCs) are well recognized for their innovations that enhance frontline care, but there is little study of their innovation management processes, which is key for advancing theory regarding the effectiveness of innovation efforts to improve care.

Purpose: We aimed to identify organizational models used for frontline innovation by AMCs in the United States, core activities within models, and factors that influence innovation success.

Methods: We conducted a qualitative study of 12 AMCs using data from semistructured interviews with centers' innovation leaders. Inclusion required satisfying two of three criteria in 2021 (only met by 35 AMCs nationally): listed in the professional association of innovation leaders (Council of 33), Becker's review of most innovative hospitals, and/or top 20 U.S. News and World Report best hospitals honor roll. We analyzed the interview data using the constant comparative method.

Results: Innovative AMCs pursue innovation through innovation centers (using a centralized or multicenter model) or within clinical departments (department-level model). All three models emphasize seven activities, although performed differently: sourcing ideas, developing ideas, implementing innovations, fundraising, managing partnerships, measuring success, and managing mindset. Several factors influenced success: role performance, operational challenges, technology, public policy, customer clarity, stakeholder buy-in, diversity of input, and focus. The centralized model struggled less with standardization and coordination issues.

Conclusion: AMCs have options for structuring their innovation efforts. However, there are consistent activities for successful innovation management and factors that they must manage.

Practice implications: AMCs can select among innovation models to fit their circumstances but likely need to perform seven activities well for success.