Journal of Healthcare Management最新文献

Goal: This retrospective study aims to understand the factors that are associated with healthcare workers' perceptions of senior leaders who maintain high standards of honesty and integrity.

Methods: We analyzed responses from 180,663 Veterans Health Administration employees who completed the 2023 Veterans Affairs All Employee Survey. Ordinal logistic regression was used to examine the association between perceptions of senior leader honesty and integrity and various factors related to manager effectiveness, work group dynamics, personal work experiences, and employee demographics. Dominance analysis was performed to identify the relative importance of variables in explaining the overall variance in perceptions of senior leader honesty and integrity.

Principal findings: Factors that contributed most to healthcare workers' perceptions of senior leader honesty and integrity were satisfaction with the job performance of the manager above their direct supervisor (12.7% of variance), manager communication of organizational goals (12.4%), different work units collaborating well (10.5%), ability to disclose suspected violations without fear of reprisal (6.7%), satisfaction with recognition (5.9%), and satisfaction with involvement in decisions (5.81%). Demographic factors such as tenure, gender, minority status, age, and supervisory role were also associated with perceptions of senior leader integrity; however, these factors explained little of the overall variance.

Practical applications: The findings highlight the critical role of midlevel leaders and organizational communication in shaping employee perceptions of senior leader honesty and integrity. Healthcare organizations should focus on selecting and training effective midlevel leaders to cultivate trust at higher levels. Developing a culture of frequent appreciation and recognition can improve trust in senior leaders and other important outcomes noted in the literature. Creating an environment where employees feel safe to report violations without fear of reprisal is essential for fostering trust in senior leadership. Healthcare leaders should consider these factors when designing strategies to enhance perceptions of senior leader honesty and integrity within their organizations.

Goal: The purpose of this study was to enhance access to medication assistance programs (MAPs), which are crucial for providing free medications to patients who cannot afford them. These programs are particularly beneficial for the management of chronic conditions such as diabetes, heart failure, and cancer, for which medication adherence is vital for positive patient outcomes, and cost is a common barrier.

Methods: This quality improvement project aimed at optimizing the MAP enrollment process. Interventions included the development of frequently asked questions documents, standardized templates for documentation, establishment of MAP technician office spaces, and standardization of patient referrals. A Mann-Whitney U test and a chi-square test were used to summarize the data in this study.

Principal findings: The project resulted in a 56% increase in new patient enrollments (p  < .01) and a 33% increase in medications provided, with a significant reduction in the average time from patient referral to application approval.

Practical applications: The project improved patient access to MAPs, optimized pharmacy technician resources, and significantly reduced processing times, an important factor in preventing treatment delays and improving patient care. Future plans include expanding the new enrollment process to annual reenrollments, formally establishing the MAP technician within departments, and considering additional pharmacy technician support in response to increasing demand for MAPs.

Goal: This study examines the impact of supportive processes, work-life balance, and leadership on employees' job satisfaction, intention to stay, and job engagement at US health centers.

Methods: This study utilizes secondary data from the Health Center Workforce Well-Being Survey conducted by the Health Resources and Services Administration from late November 2022 to mid-February 2023. We conducted cross-sectional moderated mediation analyses using Model 60 from the Hayes PROCESS macro to examine the effects of supportive health center processes, work-life balance, and leadership on employee job satisfaction and, subsequently, employees' intentions to stay and job engagement.

Principal findings: The mediation analyses demonstrated that job satisfaction mediates the relationship between supportive processes and both intention to stay and job engagement. Moreover, work-life balance and leadership moderate the relationship between supportive processes and job satisfaction with different patterns. Leadership also plays a dual moderating role, reducing dependence on job satisfaction for employee intention to stay while amplifying its effect on job engagement.

Practical applications: Our findings highlight the need for targeted workforce strategies in health center settings. Healthcare leaders should first enhance employees' job satisfaction by investing in workplace supportive processes, work-life balance initiatives, and leadership development tailored to their organizational context. After job satisfaction is strengthened, its influence on employees' intention to stay and job engagement remains contingent on leadership. The decision about how much to invest in leadership initiatives should be guided by the organization's current job satisfaction levels.

Goal: Provider buy-in to leadership priorities, patient experience measurement, and quality improvement (QI) is necessary for sustained improvements in care. However, little is documented about provider perceptions of patient experience measurement and QI in primary care. We examined provider perceptions of the work environment, patient care issues, measurement of and improvement in care quality, as well as their knowledge and perceived usefulness of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group (CG-CAHPS) Survey measures for QI.

Methods: We surveyed and interviewed providers about their use of CG-CAHPS for QI. Of the 143 providers at a large urban Federally Qualified Health Center (FQHC), 74 (52% response) completed a web-based survey; 19 were also interviewed. We asked questions about the clinic environment, use of the CG-CAHPS survey, patient interactions, burnout, job satisfaction, and compensation. We replicated measures from six relevant surveys.

Principal findings: Providers reported working in supportive environments that encouraged QI efforts, having leadership and colleagues who facilitated improvements that enabled them to do their job better (M = 3.8 on a 5-point scale), and serious efforts to solve problems (M = 3.7). Providers also reported significant barriers to patient care (e.g., time pressure and patient complexity). Interviews highlighted providers' difficulty in managing visit duration and ensuring effective patient-provider communication. Participants expressed mixed views on the usefulness of CG-CAHPS scores for QI (M = 2.5), suggesting a need for leadership to discuss and engage with CG-CAHPS performance more regularly. QI in primary care is often guided by patient experience outcomes. The time pressures faced by FQHC providers to care for patients with complex needs heighten the need for targeted interventions that enhance provider support. Providers also identified several areas that needed improvement, some of which are measured by CAHPS items: tools to communicate laboratory or other test results to patients, tools to elicit information on patient concerns, improved access to interpreter services, training for other care team staff, and more discussion of best practices.

Practical applications: To improve the patient experience, primary care organizations should foster environments that support QI and invest more in QI that better incorporates patient feedback and experience measures in ways that are relevant to providers and actionable by organizations to improve care experiences. Addressing these issues has the potential to improve both patient care outcomes and provider satisfaction. This is both practical and important given that CAHPS measures or other standardized patient experience measures, although not mandated, are increasingly in use.