Journal of Healthcare Management最新文献

Goal: Chaplaincy departments may be an important resource for directly improving patient experience, and they may indirectly provide staff support resources to address workplace well-being. However, there is little empirical evidence to support whether or not having a chaplaincy department is associated with positive benefits for acute care hospitals.

Methods: This study used survey data from the American Hospital Association Annual Survey, the Area Health Resource File, and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data by the Centers for Medicare & Medicaid Services (CMS) to examine urban adult acute care hospitals between 2015 and 2019 and determine whether having a chaplaincy department impacted HCAHPS patient experience scores.

Principal findings: Hospitals with chaplaincy departments reported higher HCAHPS global ratings and higher ratings of patients likely to recommend the hospital.

Practical applications: The study demonstrates that chaplaincy services may be an underutilized tool to improve patient experience scores. The scores are critical for hospital reimbursement, improved patient outcomes, and patient loyalty. In October 2022, CMS began allowing hospitals to start coding for chaplaincy service encounters. As a result, we may now see even more evidence demonstrating the positive relationship between chaplaincy services and other important hospital metrics.

Goal: Healthcare organizations have always faced challenges, yet the past decade has been particularly difficult due to workforce shortages, the COVID-19 pandemic, and economic demands, all of which can impact quality of care. While some healthcare organizations have demonstrated the ability to adapt to such stressors-which has been termed "organizational resilience"-others have not. Most of the research on resilience in healthcare has been on individual clinicians; less is known about how extra-individual groups such as teams, units, and systems develop resilience. Understanding what organizational resilience is, how to measure it, and how healthcare organizations can develop it is essential to responding effectively to future acute and chronic stressors in the healthcare industry. The purpose of this scoping review is to synthesize how organizational resilience is defined and measured in the current healthcare literature and to inform future interventions to improve organizational resilience.

Methods: We searched PubMed and Scopus databases for articles mentioning organizational resilience in healthcare. Eligible sources were those published in English through December 2023 in any format, and that described or measured organizational resilience in healthcare. Titles and abstracts were screened, and information was extracted from eligible articles.

Principal findings: We screened 243 articles and included 97 in our review. Across these studies, organizational resilience was described as a healthcare system's ability to continue functioning and meet its objectives when exposed to stressful stimuli. Reactive and proactive strategies, as well as reflection, were identified as key components of organizational resilience. Four measures of organizational resilience were developed for use in healthcare, but only two have been validated.

Practical applications: Future studies should focus on validating and comparing existing measures of organizational resilience and using them to investigate how organizational resilience may impact quality of care and clinician well-being, allowing the field to move beyond the focus on individual clinician resilience.

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: Efficient patient flow is critical at Tampa General Hospital (TGH), a large academic tertiary care center and safety net hospital with more than 50,000 discharges and 30,000 surgical procedures per year. TGH collaborated with GE HealthCare Command Center to build a command center (called CareComm) with real-time artificial intelligence (AI) applications, known as tiles, to dynamically streamline patient care operations and throughput. To facilitate patient flow for our neuroscience service line, we partnered with the GE HealthCare Command Center team to configure a Downgrade Readiness Tile (DRT) to expedite patient transfers out of the neuroscience intensive care unit (NSICU) and reduce their length of stay (LOS).

Methods: As part of an integrated NSICU performance improvement project, our LOS reduction workgroup identified the admission/discharge and transfer process as key metrics. Based on a 90%-plus average capacity, early identification of patients eligible for a downgrade to lower acuity units is critical to maintain flow from the operating rooms and emergency department. Our group identified clinical factors consistent with downgrade readiness as well as barriers preventing transition to the next phase of care. Configuration of an AI-powered model was identified as a mechanism to drive earlier downgrade and reduce LOS in the NSICU. A multidisciplinary ICU LOS reduction steering committee met to determine the criteria, design, and implementation of the AI-powered DRT. As opposed to identifying traditional clinical factors associated with stability for transfer, our working group asked, "What are clinical barriers preventing downgrade?" We identified more than 76 clinical elements from the electronic medical records that are programmed and displayed in real-time with a desired accuracy of over 95%. If no criteria are present, and no bed is requested or assigned, the DRT will report potential readiness for transfer. If three or more criteria are present, the DRT will suggest that the patient is not eligible for transfer.

Principal findings: The DRT was implemented in January 2022 and is used during multidisciplinary rounds (MDRs) and displayed on monitors positioned throughout the NSICU. During MDRs, the bedside nurses present each patient's key information in a standardized manner, after which the DRT is used to recommend or oppose patient transfer. Six months postimplementation period of the DRT and MDRs, the NSICU has seen a 7% or roughly eight-hour reduction in the ICU length of stay (4.15-3.88 days) with a more than three-hour earlier placement of a transfer order. Unplanned returns to the ICU (or bouncebacks) have remained low with no change in the preimplementation rate of 3% within 24 hours. As a result of this success, DRTs are being implemented in the medical ICUs.

Practical applications: This work is uniquely innovative as it shows AI can