Health Care Management Review最新文献

Background: Shortage of nurses and instability in the nursing workforce due to turnover have become a global concern.

Purpose: The aim of this study was to investigate whether symptoms of psychological distress mediated the impact of age, gender, workplace bullying, job satisfaction, and hardiness on turnover intention when controlling for living with children, marital status, percentage of full-time equivalent, and number of night shifts last year and whether the same variables (except full-time equivalent and number of night shifts last year) could predict real turnover.

Methods: In all, 1,246 nurses took part in a survey in 2008/2009 (T1) assessing symptoms of insomnia, sleepiness, anxiety, depression, fatigue, alcohol consumption, age, gender, workplace bullying, job satisfaction, and hardiness. Three years (T2) later they completed a survey assessing turnover intention, living with children, marital status, percentage of full-time equivalent, and number of night shift last year. A total of 99 nurses had left the nursing profession during this period.

Results: Workplace bulling was positively related to turnover intention, whereas job satisfaction and hardiness were negatively related to turnover intention. The impact of all three predictors was partly mediated by symptoms of insomnia and anxiety. Age was negatively whereas male gender was positively associated with turnover intention. These effects were partly mediated by harmful alcohol use. Nurses who were living with a partner at T2 and nurses with high scores on fatigue at T1 were more prone to leave the nursing profession during the study period compared to their counterparts.

Conclusion: Symptoms like insomnia, anxiety, and alcohol consumption may mediate the impact of working conditions and personality traits associated with turnover intention in nurses.

Practice implications: Interventions aiming at counteracting bullying, improving job satisfaction, and alleviating fatigue may reduce turnover intention/turnover.

Background: Local multihospital systems (LMSs) commonly struggle to effectively coordinate across system members. Although a recent taxonomy of LMSs found the majority of systems to display lower levels of differentiation, integration, and coordination, some categories of LMS forms exhibited higher levels of integration and coordination.

Purpose: This study examines organizational and environmental factors associated with LMS forms displaying higher levels of integration and coordination.

Methodology/approach: Applying a multitheoretical framework and drawing from sources including the American Hospital Association Annual Survey, Intellimed databases, and primary data collected from LMS communications, descriptive and multinomial logistic regression analyses were conducted to examine the association between LMS forms and varied organizational and environmental characteristics among LMSs in Florida, Maryland, Nevada, Texas, Virginia, and Washington.

Results: The results of analysis of variance, Games-Howell, and Fisher's exact tests identified significant relationships between each of the five LMS categories and varying market, competitive, organizational, and operational factors. A multinomial logistic regression analysis also distinguished the three most common LMS forms according to organizational and environmental factors.

Conclusion: Recognizing the varied degrees of integration and coordination across LMSs today, the results point to several factors that may explain such variation, including market size and resources, local competitors and their forms, organizational size and ownership, patient complexity, and regulatory restrictions.

Practice implications: With the continued promotion and development of innovative health care reform models and with the progressing expansion of care into outpatient sites and diverse settings, LMSs will continue to face greater pressure to integrate and coordinate services throughout the continuum of care across system components and service locations. Navigating the challenges of effective coordination requires administrators and policymakers to be cognizant of the organizational and environmental factors that may hinder or fuel coordination efforts across system components in local markets.

Background: The Veterans Health Administration piloted a nationwide Lean Enterprise Transformation program to optimize delivery of services to patients for high value care.

Purpose: Barriers and facilitators to Lean implementation were evaluated.

Methods: Guided by the Lean Enterprise Transformation evaluation model, 268 interviews were conducted, with stakeholders across 10 Veterans Health Administration medical centers. Interview transcripts were analyzed using thematic analysis techniques.

Results: Supporting the utility of the model, facilitators and barriers to Lean implementation were found in each of the Lean Enterprise Transformation evaluation model domains: (a) impetus to transform, (b) leadership commitment to quality, (c) improvement initiatives, (d) alignment across the organization, (e) integration across internal boundaries, (f) communication, (g) capability development, (h) informed decision making, (i) patient engagement, and (j) organization culture. In addition, three emergent themes were identified: staff engagement, sufficient staffing, and use of Lean experts (senseis).

Conclusions: Effective implementation required staff engagement, strategic planning, proper scoping and pacing, deliberate coaching, and accountability structures. Visible, stable leadership drove Lean when leaders articulated a clear impetus to change, aligned goals within the facility, and supported middle management. Reliable data and metrics provided support for and evidence of successful change. Strategic early planning with continual reassessment translated into focused and sustained Lean implementation.

Practice implications: Prominent best practices identified include (a) reward participants by broadcasting Lean successes; (b) provide time and resources for participation in Lean activities; (c) avoid overscoping projects; (d) select metrics that closely align with improvement processes; and (e) invest in coaches, informal champions, process improvement staff, and senior leadership to promote staff engagement and minimize turnover.

Background: Hospices provide end-of-life care to patients who have complex health care needs and whose symptoms are difficult to control. Understanding why some hospices offer inpatient hospice care to patients could bring more evidence for policy makers and researchers to focus on the role of inpatient care in hospice.

Purpose: The purpose of this study was to examine market and organizational factors that are associated with the provision of hospice inpatient care.

Methodology: This study used a retrospective, longitudinal design (2009-2013). The study sample was drawn from three data resources: the Area Health Resources Files, the Provider of Services files, and Hospice Cost Reports from Centers for Medicare & Medicaid Services. The sample size was 2,391 hospices or 10,999 hospice observations over 5 years. A generalized linear mixed-effects model was used to examine the association between market and organizational factors and hospice inpatient services offering.

Results: On average, 94.59% of hospices offer inpatient services to patients. Proportion of adults who were over 65 years old (OR = 1.12) and Medicare-managed care penetration (OR = 1.02) were positively associated with the provision of hospice inpatient services. The number of hospitals with hospice program was negatively related to hospice inpatient services offering (OR = .95). Other factors such as nursing skill mix, volunteer dependence, and census region were also associated with inpatient services offering.

Practice implications: The age demand of hospice care and Medicare-managed care penetration are related to hospice inpatient services offering. Hospices located in the market with more competition from hospitals that offer hospice program are less likely to offer inpatient care.

Background: As the second largest expense category after labor, supply expense has received more strategic attention in recent years. Collaborative buyer-supplier relationships play a significant role in strategic supply chain management. In the health sector, however, buyer-supplier relationships are generally perceived as adversarial and distrusting.

Purpose: The aim of this study was to investigate the major buyer-supplier relationship barriers, with an emphasis on the role of the physician as a surrogate buyer in the hospital's procurement process.

Methodology: Semistructured interviews were conducted with informants from six health systems and five medical device manufacturers in the United States. Additional data were gathered through a focus group consisting of 10 senior-level physicians. A structured qualitative analysis identified important themes in buyer-supplier relationship factors.

Results: From the data, four major themes emerged regarding the barriers to collaborative buyer-supplier relationships: lack of information sharing, opportunistic pricing behavior, changing regulations, and physician-supplier alliances. Further investigation regarding the role of the physician in purchasing reveals triadic implications.

Conclusions: The medical device market continues to exhibit strained buyer-supplier relationships. The physician's professional role in supply selection can undermine the hospital's strategic supply management efforts.

Practice implications: Both buyers and suppliers need to exhibit more information transparency in order to develop collaborative relationships with at least a small number of strategic partners. Supply chain executives at hospitals need to play a more active role in facilitating the link between the hospital's physicians and suppliers. Alternatively, hospitals can provide physicians with substitute services to curb supplier influences on physician preferences.

Background: Hospice performance is an overlooked area in the health care field due to the difficulty of measuring quality of care and the infrequent quality inspection. Based on the daily reimbursement mechanism for different levels of hospice care, inpatient services provision could influence both hospice-level length of stay (LOS) and financial performance.

Purpose: The objective of this study was to explore the relationship between hospice inpatient services provision and hospice utilization and financial performance.

Methodology/approach: A longitudinal secondary data set (2009-2013) was merged from three sources: (a) Hospice Cost Reports from the Centers for Medicare & Medicaid Services, (b) the Provider of Services files, and (c) the Area Health Resources Files. The dependent variable in this study was hospice average LOS and financial performance measured by total operating margin (TOM) and return on assets. The independent variable was hospice inpatient services' offering. Mixed-effects regression models were used in the multivariate regression analyses.

Results: When comparing to hospices not providing inpatient services, offering inpatient services by staff was negatively related to average LOS (b = -0.063, p < .05) and TOM (b = -0.022, p < .05). The combination method with providing inpatient services by staff and under arrangement was negatively associated with return on assets (b = -0.073, p < .05).

Conclusion: Hospice inpatient services provision was associated with average LOS and financial performance.

Practice implications: Offering the inpatient services to patients by staff decreased average LOS and TOM. Hospice agencies may seek strategies to maintain their financial sustainability through outsourcing.

Background: In the United States, a long-standing debate has existed over advantages/disadvantages of general versus specialty hospitals. A recent stream of research has investigated whether general hospitals accrue performance benefits from a focus strategy; a strategy of specializing in certain clinical conditions while remaining a multiproduct firm. In contrast, a substantial and long-standing body of research on hospitals has been concerned with the absolute volume of cases in a service area as an indication of experience based largely on the idea that absolute volume confers learning opportunities.

Purpose: We investigated whether hospital focus and experience in a service area have complementary effects or are largely substitutive for hospital performance.

Methodology/approach: Key data sources were patient discharge records and hospital discharge profiles from California's Office of Statewide Health Policy and Development for years 2010-2014. We specified hospital focus as the proportion of total cardiology-related discharges and hospital experience as the cumulative volume of cardiology-related discharges for each hospital. Performance was specified using quality (inpatient mortality and 30-day readmission) and efficiency (length of stay and cost) patient-level performance metrics. We analyzed the data using logistic and log-linear ordinary least squares regression models.

Results: Study results generally supported our hypotheses that focus and experience are related to better quality and efficiency performance and that the effects are largely substitutive for hospitals.

Conclusion: Our study extends the literature by finding that hospitals exhibit distinct and stable patterns regarding their positioning on focus and experience and that these patterns have important implications for hospitals' performance in terms of quality and efficiency.

Practice implications: Many general hospitals in the United States may be stretched too thin across service areas for which they lack necessary patient volumes for clinical proficiency. A viable alternative is to select a limited set of service areas on which to focus.

Background: Interprofessional health care teams are increasingly employed to solve complex problems through innovative solutions. However, there is evidence that such teams are not always successful. The impact of profession and professional divides is likely to be particularly important in health care teams as team membership and contribution typically derive from member's unique professional expertise. Yet, there remains a dearth of research exploring the role of professional faultlines in multidisciplinary teams. In an effort to address this research gap, we explore the role of professional faultlines in interprofessional team innovation.

Purpose: Drawing on faultline theory and learning from the sociology of the professions, this study develops and investigates a model of team innovation predicted by professional faultlines. More specifically, we propose that professional faultlines increase interprofessional differentiation within teams and, through this mediator, increase innovation, contingent on interprofessional inclusive leadership.

Methodology: We investigate our model and hypothesis using a cross-sectional correlational design. Survey data of 70 interprofessional health care teams is used to investigate our model.

Results: Support is found for our moderated mediation model. We find evidence that professional faultlines increase interprofessional differentiation, which, in turn, increases team innovation contingent on inclusive leadership.

Conclusion: Our study finding allows us to contribute to the evolving discussion on health care teams and team faultlines, particularly professional faultlines, and their role in team innovation.

Practice implications: A number of strategies to increase innovation in interprofessional teams are indicated by our findings. In particular, the role of inclusive leadership is highlighted as a useful approach, particularly when profession aligns with biodemographic attributes, such as gender.