Journal of Healthcare Management最新文献

Goal: The primary goal of this systematic review is to assess the impact of healthcare information technology (HIT) applications on information sharing within and between healthcare organizations (HCOs) and their associated performance outcomes. This study is motivated by the significant growth in electronic health record adoption and other advanced technologies spurred by the Health Information Technology for Economic and Clinical Health Act of 2009. Despite this growth, there remains a gap in understanding where HIT adds value and how it affects various performance outcomes, particularly through information sharing in the healthcare sector.

Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA-P 2020) methodology, this review focuses on empirical studies that examine the use and adoption of HIT in healthcare settings. The inclusion criteria targeted studies evaluating the impact of information sharing within or among HCOs through the use of HIT. The 66 papers that met our criteria were analyzed using Porter's value chain framework, which examines both intraorganizational and interorganizational activities to understand where value is created.

Principal findings: The review reveals that HIT applications primarily enhance internal operations within HCOs, with 55% of the studies focusing on this aspect. In contrast, information sharing across multiple HCOs remains limited, with only 14% of the studies addressing this area. While quality improvement and cost reduction are the most frequently mentioned expected outcomes, surprisingly, productivity emerges as the most studied outcome variable, present in 33% of the articles. Most studies were conducted in the United States (67%), and physicians were the most frequently studied users of HIT, followed by nurses and other designated staff.

Practical applications: The findings highlight the need for broader connectivity across the healthcare ecosystem. While private networks like Epic Cosmos and CommonWell facilitate data exchange, they remain confined within specific electronic health record systems, creating silos. The Trusted Exchange Framework and Common Agreement offers a more comprehensive approach, promoting universal and scalable information sharing across all stakeholders. To realize this potential, healthcare leaders must actively pursue the Trusted Exchange Framework and Common Agreement integration, standardize performance metrics, and foster collaboration to enhance patient care and operational efficiency.

Goal: The COVID-19 pandemic exposed a lack of healthcare leadership preparedness for a widespread, persistent emergency. This study aimed to identify factors contributing to perceived leadership self-efficacy to better prepare leaders for future crises.

Methods: The researcher conducted an online composite survey (n = 96) of factors affecting perceived leadership self-efficacy from an American College of Healthcare Executives group using a quantitative correlational design with multiple regression analysis. Results were examined through the lens of Kolb's experiential learning theory to determine recommended leadership training.

Principal findings: The researcher found that the most significant factors contributing to perceived self-efficacy in leadership were years of experience and skill (β = .004). This was supported by a multiple regression model predicting leadership self-efficacy, F(6, 95) = 9.932, p < .001, and adjusted ΔR2 = .361. An overall moderate effect size supports the practical significance of these results. When given the opportunity to indicate what preparation would be most beneficial, healthcare leaders indicated a desire for more training in communication skills alongside tabletop drills to practice rapid assessment and response techniques.

Practical applications: As healthcare leaders continue to face unanticipated challenges, their self-perceived ability to handle crises competently is influenced by their years of experience and skill level. Of these two, skill level is practically addressable. Education and leadership development that incorporate evolving methods of training, such as tabletop drills, will improve critical skills, and thus, perceived self-efficacy during times of crisis.

Goal: A lack of healthcare worker well-being is a serious threat to patient care quality and safety, as well as to the overall operational performance of hospitals in the US healthcare delivery system. Extreme resilience depletion and compassion fatigue are known to negatively influence individual well-being and have contributed to the rise in turnover in the healthcare workforce. The primary aim of this research was to identify interventions that health system leaders can use to combat resilience depletion and exhaustion among healthcare workers.

Methods: Researchers deployed a randomized controlled trial methodology to study the association between the use of regular mindfulness practices, resilience, and compassion satisfaction. After completing an initial screening questionnaire and preassessments, participants were randomized into one of two groups: (1) an experimental group with mindfulness practices as the intervention and (2) a control group. The experimental group participated in structured mindfulness practices during their regular workday on three different days per week for a minimum of 10 minutes per day. At the end of the six-week study period, both groups completed postassessment questionnaires. Results from the pre- and postassessments were analyzed to determine the correlation between mindfulness practices, resilience, and compassion satisfaction.

Principal findings: Data analysis revealed that baseline resilience scores in the experimental group increased by 4 points, with a progressive 92% power. In addition, the experimental group demonstrated a statistically significant improvement in resilience (p mean difference pre-post = .147/.002) and compassion satisfaction (p mean difference pre-post = 3.99/.019).

Practical applications: Readily available, low-cost mindfulness practices may be introduced to hospital staff to build resilience and improve compassion satisfaction. In turn, this may help support hospital efforts to reduce turnover in the healthcare workforce.

Goal: The objective of this study was to better understand how healthcare systems' unit- and system-level leaders perceive and experience moral distress consultation services, including their utility, efficacy, and sustainability.

Methods: A multimethod design was conducted in tandem across two academic medical centers with longstanding and active moral distress consultation services. Moral distress data for healthcare providers participating in moral distress consultation were collected. The authors also conducted interviews about moral distress consultation with unit and organizational leaders using a semistructured interview format. They analyzed interview transcripts using both inductive and deductive coding strategies. Relevant themes and categories were then transferred onto a thematic map for final analysis.

Principal findings: Twenty moral distress consults (10 at each institution) were held during the five-month study period. The mean reported moral distress score for all preconsult participants (n = 52) was 6.9 (SD = 2.5), with scores ranging from 0 to 10. In the combined presurvey and postsurvey group (n = 22), the mean moral distress score was 5.9 (SD = 2.2) prior to the consult and 5.3 (SD = 2.7) after the consult. Participants indicated that moral distress causes were primarily team-level-focused prior to moral distress consultation and system-level-focused after consultation. As consult data were collected, eight unit- and system-level leaders were interviewed. Leaders described moral distress consultation as valuable and empowering to unit-based staff. They endorsed the service's ability to create safe spaces for open communication about morally distressing events. Leaders also suggested the need for more diverse professional representation (outside of nursing) among consultants and participants, as well as more transparent and consistent education plans related to the service, not only to increase leaders' knowledge and awareness of moral distress, but also to increase the visibility of the consult service, both within and outside the organization. Finally, leadership teams valued qualitative accounts of morally distressing events from staff.

Practical applications: Addressing moral distress requires intentional and systemic collaboration, including open communication between moral distress consultation leaders, participants, and unit- and system-level leadership teams. Transparent education plans, broad professional representation, and flexible success measures-including both quantitative and qualitative metrics-are necessary and should be considered for any current or developing moral distress consultation services.