Category 7 of the Baldrige criteria puts performance results into five areas: (1) product and process;(2) customer-focused;(3) workforce-focused;(4) leadership and governance;and (5) financial, market, and strategy (National Institute of Standards and Technology, n.d.). [...]it’s all about the results. According to Rosenkranz and colleagues, “The most critical value of diversity in healthcare is improving patient outcomes” (2021, p. 1058). To identify counterproductive tasks, healthcare leaders should again take a team-based approach—for example, information technology staff working alongside clinicians to identify ways to streamline the electronic health record entry.
{"title":"Systematic Outcomes Measurement Can Lead to Performance Excellence","authors":"Christine Pitocco","doi":"10.1097/JHM-D-22-00056","DOIUrl":"https://doi.org/10.1097/JHM-D-22-00056","url":null,"abstract":"Category 7 of the Baldrige criteria puts performance results into five areas: (1) product and process;(2) customer-focused;(3) workforce-focused;(4) leadership and governance;and (5) financial, market, and strategy (National Institute of Standards and Technology, n.d.). [...]it’s all about the results. According to Rosenkranz and colleagues, “The most critical value of diversity in healthcare is improving patient outcomes” (2021, p. 1058). To identify counterproductive tasks, healthcare leaders should again take a team-based approach—for example, information technology staff working alongside clinicians to identify ways to streamline the electronic health record entry.","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"67 1","pages":"145 - 148"},"PeriodicalIF":1.8,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49254170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Sonis, D. Pathman, S. Read, B. Gaynes, Courtney Canter, P. Curran, Cheryl B. Jones, Thomas Miller
SUMMARY Goal: Perceived organizational support (POS) may promote healthcare worker mental health, but organizational factors that foster POS during the COVID-19 pandemic are unknown. The goals of this study were to identify actions and policies regarding COVID-19 that healthcare organizations can implement to promote POS and to evaluate the impact of POS on physicians’ mental health, burnout, and intention to leave patient care. Methods: We conducted a cross-sectional national survey with an online panel of internal medicine physicians from the American College of Physicians in September and October of 2020. POS was measured with a 4-item scale, based on items from Eisenberger’s Perceived Organizational Support Scale that were adapted for the pandemic. Mental health outcomes and burnout were measured with short screening scales. Principal Findings: The response rate was 37.8% (N = 810). Three healthcare organization actions and policies were independently associated with higher levels of POS in a multiple linear regression model that included all actions and policies as well as potential confounding factors: opportunities to discuss ethical issues related to COVID-19 (β (regression coefficient) = 0.74, p = .001), adequate access to personal protective equipment (β = 1.00, p = .005), and leadership that listens to healthcare worker concerns regarding COVID-19 (β = 3.58, p < .001). Sanctioning workers who speak out on COVID-19 safety issues or refuse pandemic deployment was associated with lower POS (β = –2.06, p < .001). In multivariable logistic regression models, high POS was associated with approximately half the odds of screening positive for generalized anxiety, depression, post-traumatic stress disorder, burnout, and intention to leave patient care within 5 years. Applications to Practice: Our results suggest that healthcare organizations may be able to increase POS among physicians during the COVID-19 pandemic by guaranteeing adequate personal protective equipment, making sure that leaders listen to concerns about COVID-19, and offering opportunities to discuss ethical concerns related to caring for patients with COVID-19. Other policies and actions such as rapid COVID-19 tests may be implemented for the safety of staff and patients, but the policies and actions associated with POS in multivariable models in this study are likely to have the largest positive impact on POS. Warning or sanctioning workers who refuse pandemic deployment or speak up about worker and patient safety is associated with lower POS and should be avoided. We also found that high degrees of POS are associated with lower rates of adverse outcomes. So, by implementing the tangible support policies positively associated with POS and avoiding punitive ones, healthcare organizations may be able to reduce adverse mental health outcomes and attrition among their physicians.
{"title":"Effects of Healthcare Organization Actions and Policies Related to COVID-19 on Perceived Organizational Support Among U.S. Internists: A National Study","authors":"J. Sonis, D. Pathman, S. Read, B. Gaynes, Courtney Canter, P. Curran, Cheryl B. Jones, Thomas Miller","doi":"10.1097/JHM-D-21-00208","DOIUrl":"https://doi.org/10.1097/JHM-D-21-00208","url":null,"abstract":"SUMMARY Goal: Perceived organizational support (POS) may promote healthcare worker mental health, but organizational factors that foster POS during the COVID-19 pandemic are unknown. The goals of this study were to identify actions and policies regarding COVID-19 that healthcare organizations can implement to promote POS and to evaluate the impact of POS on physicians’ mental health, burnout, and intention to leave patient care. Methods: We conducted a cross-sectional national survey with an online panel of internal medicine physicians from the American College of Physicians in September and October of 2020. POS was measured with a 4-item scale, based on items from Eisenberger’s Perceived Organizational Support Scale that were adapted for the pandemic. Mental health outcomes and burnout were measured with short screening scales. Principal Findings: The response rate was 37.8% (N = 810). Three healthcare organization actions and policies were independently associated with higher levels of POS in a multiple linear regression model that included all actions and policies as well as potential confounding factors: opportunities to discuss ethical issues related to COVID-19 (β (regression coefficient) = 0.74, p = .001), adequate access to personal protective equipment (β = 1.00, p = .005), and leadership that listens to healthcare worker concerns regarding COVID-19 (β = 3.58, p < .001). Sanctioning workers who speak out on COVID-19 safety issues or refuse pandemic deployment was associated with lower POS (β = –2.06, p < .001). In multivariable logistic regression models, high POS was associated with approximately half the odds of screening positive for generalized anxiety, depression, post-traumatic stress disorder, burnout, and intention to leave patient care within 5 years. Applications to Practice: Our results suggest that healthcare organizations may be able to increase POS among physicians during the COVID-19 pandemic by guaranteeing adequate personal protective equipment, making sure that leaders listen to concerns about COVID-19, and offering opportunities to discuss ethical concerns related to caring for patients with COVID-19. Other policies and actions such as rapid COVID-19 tests may be implemented for the safety of staff and patients, but the policies and actions associated with POS in multivariable models in this study are likely to have the largest positive impact on POS. Warning or sanctioning workers who refuse pandemic deployment or speak up about worker and patient safety is associated with lower POS and should be avoided. We also found that high degrees of POS are associated with lower rates of adverse outcomes. So, by implementing the tangible support policies positively associated with POS and avoiding punitive ones, healthcare organizations may be able to reduce adverse mental health outcomes and attrition among their physicians.","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"67 1","pages":"192 - 205"},"PeriodicalIF":1.8,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44745092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Soumya Upadhyay, R. Weech-Maldonado, William Opoku-Agyeman
SUMMARY Goal: An organization’s cultural competency reflects its ongoing capacity to provide high-quality, equitable, safe, and patient-centered care. Cultural competency leadership and training (CCLT) influences organizational cultural competency, which could affect organizational performance. Policies regarding health disparities point to the need for hospitals to become culturally competent. This study aimed to explore if CCLT practices are associated with better financial performance. Methods: Using secondary data from three sources—the American Hospital Association Annual Survey, the Health Care Cost Information System, and the Area Health Resource File—a longitudinal panel study design reviewed 3,594 hospital-year observations for acute care hospitals across the United States from 2011 to 2012. CCLT, the independent variable, was measured as a summated scale of strategy, execution, implementation, and training in diversity practices. For financial performance, the operating and total margins of hospitals were measured as dependent variables. Two random-effects regression models with year- and state-fixed effects were used to examine the relationship, with hospital being the unit of analysis. Principal Findings: The descriptive statistics showed that hospitals had an average CCLT score of approximately 2 (the range was 0–4). Regression analysis indicated that an increase in the CCLT score was associated with a 0.3% and 0.4% increase in total and operating margins, respectively (p < .05). Also, with each 10 additional staffed beds, hospitals on average experienced a 0.1% increase in both total and operating margins. Overall, for-profit hospitals experienced a 2.4% higher total margin and a 4.9% higher operating margin, as compared to not-for-profit hospitals. On the contrary, government hospitals showed 1% and 5.8% lower total and operating margins, respectively. Applications to Practice: Results of our study support a business case for CCLT practices. Cultural competency makes good economic sense by helping to improve cost savings, increase market share, and enhance the efficiency of care. Therefore, healthcare leaders should consider investing in CCLT. With the growing emphasis on value-based purchasing related to patient outcomes and experience, hospitals that develop a high degree of cultural competency through CCLT can benefit from the changes in reimbursement. CCLT also affects financial performance through avoidance of costs related to employee absenteeism and turnover and improves team cohesiveness by reducing cultural conflicts. Other mechanisms by which CCLT assists in saving costs and affecting financial performance include avoidance of unnecessary readmissions and expensive hospitalizations through the proper screening of patients from diverse backgrounds. CCLT improves cultural competency and diversity management, thus creating a unique competitive advantage for hospitals.
{"title":"Hospital Cultural Competency Leadership and Training is Associated with Better Financial Performance","authors":"Soumya Upadhyay, R. Weech-Maldonado, William Opoku-Agyeman","doi":"10.1097/JHM-D-20-00351","DOIUrl":"https://doi.org/10.1097/JHM-D-20-00351","url":null,"abstract":"SUMMARY Goal: An organization’s cultural competency reflects its ongoing capacity to provide high-quality, equitable, safe, and patient-centered care. Cultural competency leadership and training (CCLT) influences organizational cultural competency, which could affect organizational performance. Policies regarding health disparities point to the need for hospitals to become culturally competent. This study aimed to explore if CCLT practices are associated with better financial performance. Methods: Using secondary data from three sources—the American Hospital Association Annual Survey, the Health Care Cost Information System, and the Area Health Resource File—a longitudinal panel study design reviewed 3,594 hospital-year observations for acute care hospitals across the United States from 2011 to 2012. CCLT, the independent variable, was measured as a summated scale of strategy, execution, implementation, and training in diversity practices. For financial performance, the operating and total margins of hospitals were measured as dependent variables. Two random-effects regression models with year- and state-fixed effects were used to examine the relationship, with hospital being the unit of analysis. Principal Findings: The descriptive statistics showed that hospitals had an average CCLT score of approximately 2 (the range was 0–4). Regression analysis indicated that an increase in the CCLT score was associated with a 0.3% and 0.4% increase in total and operating margins, respectively (p < .05). Also, with each 10 additional staffed beds, hospitals on average experienced a 0.1% increase in both total and operating margins. Overall, for-profit hospitals experienced a 2.4% higher total margin and a 4.9% higher operating margin, as compared to not-for-profit hospitals. On the contrary, government hospitals showed 1% and 5.8% lower total and operating margins, respectively. Applications to Practice: Results of our study support a business case for CCLT practices. Cultural competency makes good economic sense by helping to improve cost savings, increase market share, and enhance the efficiency of care. Therefore, healthcare leaders should consider investing in CCLT. With the growing emphasis on value-based purchasing related to patient outcomes and experience, hospitals that develop a high degree of cultural competency through CCLT can benefit from the changes in reimbursement. CCLT also affects financial performance through avoidance of costs related to employee absenteeism and turnover and improves team cohesiveness by reducing cultural conflicts. Other mechanisms by which CCLT assists in saving costs and affecting financial performance include avoidance of unnecessary readmissions and expensive hospitalizations through the proper screening of patients from diverse backgrounds. CCLT improves cultural competency and diversity management, thus creating a unique competitive advantage for hospitals.","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"67 1","pages":"149 - 161"},"PeriodicalIF":1.8,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46319416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Mahoney, M. Winget, C. Brown-Johnson, Lindsay de Borba, D. Veruttipong, J. Luu, David Jones, Bryan D. Bohman, S. Vilendrer
SUMMARY Goal: Assessing barriers to vaccination among healthcare workers may be particularly important given their roles in their respective communities. We conducted a mixed methods study to explore healthcare worker perspectives on receiving COVID-19 vaccines at a large multisite academic medical center. Methods: A total of 5,917 employees completed the COVID-19 vaccine confidence survey (20% response rate). Most participants were vaccinated (93%). Compared to vaccinated participants, unvaccinated participants were younger (60% < 44 years), more likely to be from a non-Asian minority group (48%), and more likely to be nonclinical employees (57% vs. 46%). Among the unvaccinated respondents, 53% indicated they would be influenced by their healthcare provider, while 19% reported that nothing would influence them to get vaccinated. Key perceived barriers to vaccination from the qualitative analysis included the need for more long-term safety and efficacy data, a belief in the right to make an individual choice, mistrust, a desire for greater public health information, personal health concerns, circumstances such as prior COVID-19 infection, and access issues. Principal Findings: Strategies endorsed by some participants to address their concerns about safety and access included a communication campaign, personalized medicine approaches (e.g., individual appointments to discuss how the vaccine might interact with personal health conditions), and days off to recover. Mistrust and a belief in the right to make an individual choice may be harder barriers to overcome; further dialogue is needed. Applications to Practice: These findings reflect potential strategies for vaccine requirements that healthcare organizations can implement to enhance vaccine confidence. In addition, organizations can ask respected health professionals to serve as spokespeople, which may help shift the perspectives of unvaccinated healthcare workers.
{"title":"Gearing Up for a Vaccine Requirement: A Mixed Methods Study of COVID-19 Vaccine Confidence Among Workers at an Academic Medical Center","authors":"M. Mahoney, M. Winget, C. Brown-Johnson, Lindsay de Borba, D. Veruttipong, J. Luu, David Jones, Bryan D. Bohman, S. Vilendrer","doi":"10.1097/JHM-D-21-00226","DOIUrl":"https://doi.org/10.1097/JHM-D-21-00226","url":null,"abstract":"SUMMARY Goal: Assessing barriers to vaccination among healthcare workers may be particularly important given their roles in their respective communities. We conducted a mixed methods study to explore healthcare worker perspectives on receiving COVID-19 vaccines at a large multisite academic medical center. Methods: A total of 5,917 employees completed the COVID-19 vaccine confidence survey (20% response rate). Most participants were vaccinated (93%). Compared to vaccinated participants, unvaccinated participants were younger (60% < 44 years), more likely to be from a non-Asian minority group (48%), and more likely to be nonclinical employees (57% vs. 46%). Among the unvaccinated respondents, 53% indicated they would be influenced by their healthcare provider, while 19% reported that nothing would influence them to get vaccinated. Key perceived barriers to vaccination from the qualitative analysis included the need for more long-term safety and efficacy data, a belief in the right to make an individual choice, mistrust, a desire for greater public health information, personal health concerns, circumstances such as prior COVID-19 infection, and access issues. Principal Findings: Strategies endorsed by some participants to address their concerns about safety and access included a communication campaign, personalized medicine approaches (e.g., individual appointments to discuss how the vaccine might interact with personal health conditions), and days off to recover. Mistrust and a belief in the right to make an individual choice may be harder barriers to overcome; further dialogue is needed. Applications to Practice: These findings reflect potential strategies for vaccine requirements that healthcare organizations can implement to enhance vaccine confidence. In addition, organizations can ask respected health professionals to serve as spokespeople, which may help shift the perspectives of unvaccinated healthcare workers.","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"67 1","pages":"206 - 220"},"PeriodicalIF":1.8,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46866638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Quest towards Abstract Background : Access to health care services without being plunged into financial hardship is a life blood of the Universal Health Coverage. Kenya’s health sector is heavily dependent on out of pocket health expenditure. This model of health financing is inequitable and leads to underutilization of the much needed health care services. Majority of Kenyans travel for longer distances to access health care services. The geographic access barrier is linked to delayed care, missed appointments, delayed medication and undue loss of life. This study examines the correlates of financial and geographic health care access barriers in the UHC implementing Counties in Kenya. Methodology : The study used a cross-sectional data collected from 249 respondents using exit interviews at the health facilities drawn from the Kenya Master Health Facility List (KMHL). A multivariate log it regression model was used to analyze the predictors of probability of failure to access health care services owing to prohibitive health care and transport costs. Results: High out-of-pocket monthly expenditure on medicine; wider proximity, higher transportation cost and a longer traveling time to a health facility increases the probability of not seeking medical treatment owing to prohibitive health care and transportation costs. These factors thus, acts as key barriers to health care access. Conclusion : Financial and geographic access barriers negatively impact on health care access. To hasten the realization of the Universal Health Coverage, prepayment models such as use of taxes and insurance should be pursued.
{"title":"Financial and Geographic Barriers to Health Care Access in Kenya: The Quest towards Universal Health Coverage","authors":"Obiero Brian Odhiambo, K. Purity","doi":"10.36959/569/474","DOIUrl":"https://doi.org/10.36959/569/474","url":null,"abstract":"The Quest towards Abstract Background : Access to health care services without being plunged into financial hardship is a life blood of the Universal Health Coverage. Kenya’s health sector is heavily dependent on out of pocket health expenditure. This model of health financing is inequitable and leads to underutilization of the much needed health care services. Majority of Kenyans travel for longer distances to access health care services. The geographic access barrier is linked to delayed care, missed appointments, delayed medication and undue loss of life. This study examines the correlates of financial and geographic health care access barriers in the UHC implementing Counties in Kenya. Methodology : The study used a cross-sectional data collected from 249 respondents using exit interviews at the health facilities drawn from the Kenya Master Health Facility List (KMHL). A multivariate log it regression model was used to analyze the predictors of probability of failure to access health care services owing to prohibitive health care and transport costs. Results: High out-of-pocket monthly expenditure on medicine; wider proximity, higher transportation cost and a longer traveling time to a health facility increases the probability of not seeking medical treatment owing to prohibitive health care and transportation costs. These factors thus, acts as key barriers to health care access. Conclusion : Financial and geographic access barriers negatively impact on health care access. To hasten the realization of the Universal Health Coverage, prepayment models such as use of taxes and insurance should be pursued.","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"45 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77168481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Scanlon, M. Sciegaj, Laura J. Wolf, Jocelyn M. Vanderbrink, Bobbie L Johannes, Bethany Shaw, Kassidy Shumaker, Diane C Farley, Erin Kitt-Lewis, L. Davis
SUMMARY Goal: In January 2019, the first cohort of rural hospitals began to operate under the Pennsylvania Rural Health Model for all-payer prospective global budget reimbursement as part of a demonstration funded by the Center for Medicare and Medicaid Innovation. Using information from primary source documents and interviews with key stakeholders, we sought to identify challenges and lessons learned throughout the design, development, and early implementation stages of the model. Methods: We relied on two qualitative research approaches: (1) review of primary source documents such as peer-reviewed publications and news accounts related to the model and (2) semistructured interviews with key staff and stakeholders, including current and former members of the Pennsylvania Department of Health, first-year applicant hospitals, technical assistance providers, and members of state and federal organizations and agencies familiar with the Pennsylvania and Maryland payment reform efforts for rural health and rural hospitals (N = 20). Principal Findings: We identified four primary attributes that innovative projects such as the model need: (1) a champion at the state and hospital level, significant cooperation across state agencies and between federal and state agencies, and support from nongovernment stakeholders; (2) ongoing engagement and education of all stakeholders, particularly related to rural health disparities, the challenges faced by rural hospitals (especially resource limitations), and the differences between rural and urban health and health service delivery; (3) realistic time lines, noting that stakeholder relationships with hospital leadership develop over many months; and (4) multistakeholder collaboration, because participating hospitals must have ongoing engagement with community members (i.e., consumers of healthcare), nonacute community partners, and other rural hospitals to foster a “rural health movement.” Applications to Practice: A successful Pennsylvania model holds promise for other states seeking to address the needs of rural populations and the hospitals that are vital to those communities. The lessons in this article can assist others in making the transition from volume to value in rural healthcare.
{"title":"The Pennsylvania Rural Health Model: Hospitals’ Early Experiences With Global Payment for Rural Communities","authors":"D. Scanlon, M. Sciegaj, Laura J. Wolf, Jocelyn M. Vanderbrink, Bobbie L Johannes, Bethany Shaw, Kassidy Shumaker, Diane C Farley, Erin Kitt-Lewis, L. Davis","doi":"10.1097/JHM-D-20-00347","DOIUrl":"https://doi.org/10.1097/JHM-D-20-00347","url":null,"abstract":"SUMMARY Goal: In January 2019, the first cohort of rural hospitals began to operate under the Pennsylvania Rural Health Model for all-payer prospective global budget reimbursement as part of a demonstration funded by the Center for Medicare and Medicaid Innovation. Using information from primary source documents and interviews with key stakeholders, we sought to identify challenges and lessons learned throughout the design, development, and early implementation stages of the model. Methods: We relied on two qualitative research approaches: (1) review of primary source documents such as peer-reviewed publications and news accounts related to the model and (2) semistructured interviews with key staff and stakeholders, including current and former members of the Pennsylvania Department of Health, first-year applicant hospitals, technical assistance providers, and members of state and federal organizations and agencies familiar with the Pennsylvania and Maryland payment reform efforts for rural health and rural hospitals (N = 20). Principal Findings: We identified four primary attributes that innovative projects such as the model need: (1) a champion at the state and hospital level, significant cooperation across state agencies and between federal and state agencies, and support from nongovernment stakeholders; (2) ongoing engagement and education of all stakeholders, particularly related to rural health disparities, the challenges faced by rural hospitals (especially resource limitations), and the differences between rural and urban health and health service delivery; (3) realistic time lines, noting that stakeholder relationships with hospital leadership develop over many months; and (4) multistakeholder collaboration, because participating hospitals must have ongoing engagement with community members (i.e., consumers of healthcare), nonacute community partners, and other rural hospitals to foster a “rural health movement.” Applications to Practice: A successful Pennsylvania model holds promise for other states seeking to address the needs of rural populations and the hospitals that are vital to those communities. The lessons in this article can assist others in making the transition from volume to value in rural healthcare.","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"67 1","pages":"162 - 172"},"PeriodicalIF":1.8,"publicationDate":"2022-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48943302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY Goal: The goal of this study was to describe the prevalence and pattern of population health partnerships by hospitals and examine whether these partnerships were associated with different types of payment model programs. Methods: We conducted a cross-sectional analysis of 3,012 U.S. hospitals using data from the American Hospital Association’s Annual Survey, the Area Health Resources File, and the County Health Rankings & Roadmaps data. We ran a multivariable Poisson regression model to examine the relationship between value-based payment designs and the number of population health partnerships. Binary logistic regression models were used to assess whether participation in value-based payment design programs was associated with specific types of population health partnerships. Principal Findings: We found that two thirds or more of hospitals used more informal collaborative partnerships with local or state government, faith-based organizations, and local businesses; formal alliances were most common with health insurance companies and other healthcare providers. Accountable care organizations and bundled payment program participation were associated with greater numbers of population health partnerships, whereas hospital ownership of a health plan was not associated with significantly greater numbers of population health partnerships. Applications to Practice: Hospitals were engaged in an intermediate number of partnerships (mean = 3.5, out of 8.0 possible), with opportunities for more partnerships with specific types of organizations (faith-based organizations, health insurance companies). Our findings also suggest that certain types of payment models, particularly those that are less capital intensive and entail less extensive organizational transformation on the part of hospitals, may support hospital engagement in population health partnerships. Hospital leaders need to monitor these partnerships continually to determine if they can capitalize on opportunities to play a more prominent role in population health management in local communities.
{"title":"Participation in Value-Based Payment Programs and U.S. Acute Care Hospital Population Health Partnerships","authors":"Larry R. Hearld, Aizhan Karabukayeva","doi":"10.1097/JHM-D-20-00338","DOIUrl":"https://doi.org/10.1097/JHM-D-20-00338","url":null,"abstract":"SUMMARY Goal: The goal of this study was to describe the prevalence and pattern of population health partnerships by hospitals and examine whether these partnerships were associated with different types of payment model programs. Methods: We conducted a cross-sectional analysis of 3,012 U.S. hospitals using data from the American Hospital Association’s Annual Survey, the Area Health Resources File, and the County Health Rankings & Roadmaps data. We ran a multivariable Poisson regression model to examine the relationship between value-based payment designs and the number of population health partnerships. Binary logistic regression models were used to assess whether participation in value-based payment design programs was associated with specific types of population health partnerships. Principal Findings: We found that two thirds or more of hospitals used more informal collaborative partnerships with local or state government, faith-based organizations, and local businesses; formal alliances were most common with health insurance companies and other healthcare providers. Accountable care organizations and bundled payment program participation were associated with greater numbers of population health partnerships, whereas hospital ownership of a health plan was not associated with significantly greater numbers of population health partnerships. Applications to Practice: Hospitals were engaged in an intermediate number of partnerships (mean = 3.5, out of 8.0 possible), with opportunities for more partnerships with specific types of organizations (faith-based organizations, health insurance companies). Our findings also suggest that certain types of payment models, particularly those that are less capital intensive and entail less extensive organizational transformation on the part of hospitals, may support hospital engagement in population health partnerships. Hospital leaders need to monitor these partnerships continually to determine if they can capitalize on opportunities to play a more prominent role in population health management in local communities.","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"67 1","pages":"103 - 119"},"PeriodicalIF":1.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45001738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY Goal: Little is known about how physicians conceptualize leadership, what factors influence that conceptualization, and how their conceptualization may impact willingness to lead. We sought to explore how physicians conceptualize leadership. Methods: We conducted an exploratory study of data from a convenience sample of physicians across the United States using an anonymous, 54-item, online survey. We devised a novel leadership resonance score (LRS) to distinguish between leadership and management based on published definitions and prior pilot work. The activities fit on a spectrum from purely leadership actions to purely management actions, and we assigned a numeric value to each activity, allowing for quantification of a respondent’s conceptualization of leadership as either more managing or more leading. Principal Findings: There were 206 respondents (57% male; median age of 43 years [interquartile ranges, IQR: 32, 72]) who completed the survey. Respondents viewed leadership abilities to be highly important for physicians, with a median importance score of 80 (range 0–100, IQR: 50, 100). LRS indicated most physicians conflate leadership and management. Compared to other physicians, respondents assessed their own preparedness for leadership highly (median preparedness score: 70, IQR: 2, 100). Respondents’ assessment of their preparedness for leadership was associated with age (Spearman’s rho = 0.24, p < .001). LRS was not associated with preparedness for leadership (Spearman’s rho = 0.12, p = .08). “Aversion to politics” was the most common barrier to interest in leadership (45%, 93/206), with “loss of personal time” being second (30%, 62/206). Applications to Practice: Our data demonstrate physicians misunderstand the differences between leadership and management. We surmise that if an accurate conceptualization of leadership by physicians is associated with increased willingness to lead, then educational activities designed to improve physicians’ understanding of leadership could be beneficial in increasing physicians’ willingness to take on leadership positions. An increased willingness by physicians to take on leadership roles would ultimately have a positive impact not only on individual patient care, but also on the healthcare system as a whole.
{"title":"Physician Understanding of and Beliefs About Leadership","authors":"R. T. Collins, N. Purington, S. Roth","doi":"10.1097/JHM-D-21-00036","DOIUrl":"https://doi.org/10.1097/JHM-D-21-00036","url":null,"abstract":"SUMMARY Goal: Little is known about how physicians conceptualize leadership, what factors influence that conceptualization, and how their conceptualization may impact willingness to lead. We sought to explore how physicians conceptualize leadership. Methods: We conducted an exploratory study of data from a convenience sample of physicians across the United States using an anonymous, 54-item, online survey. We devised a novel leadership resonance score (LRS) to distinguish between leadership and management based on published definitions and prior pilot work. The activities fit on a spectrum from purely leadership actions to purely management actions, and we assigned a numeric value to each activity, allowing for quantification of a respondent’s conceptualization of leadership as either more managing or more leading. Principal Findings: There were 206 respondents (57% male; median age of 43 years [interquartile ranges, IQR: 32, 72]) who completed the survey. Respondents viewed leadership abilities to be highly important for physicians, with a median importance score of 80 (range 0–100, IQR: 50, 100). LRS indicated most physicians conflate leadership and management. Compared to other physicians, respondents assessed their own preparedness for leadership highly (median preparedness score: 70, IQR: 2, 100). Respondents’ assessment of their preparedness for leadership was associated with age (Spearman’s rho = 0.24, p < .001). LRS was not associated with preparedness for leadership (Spearman’s rho = 0.12, p = .08). “Aversion to politics” was the most common barrier to interest in leadership (45%, 93/206), with “loss of personal time” being second (30%, 62/206). Applications to Practice: Our data demonstrate physicians misunderstand the differences between leadership and management. We surmise that if an accurate conceptualization of leadership by physicians is associated with increased willingness to lead, then educational activities designed to improve physicians’ understanding of leadership could be beneficial in increasing physicians’ willingness to take on leadership positions. An increased willingness by physicians to take on leadership roles would ultimately have a positive impact not only on individual patient care, but also on the healthcare system as a whole.","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"67 1","pages":"120 - 136"},"PeriodicalIF":1.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42236548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY Goal: We examined whether higher skilled nursing facility (SNF) lagged profitability is associated with a lower 30-day all-cause all-payer risk-adjusted hospital readmission rate. Our aim was to provide insight into whether SNFs with limited financial resources are able to respond to incentives to lower their readmission rates to hospitals. Methods: We used data from 2012–2016 to estimate a fixed effects (FE) model with a time trend. Our data included financial data from the Centers for Medicare & Medicaid Services Healthcare Cost Report Information System SNF cost reports, facility characteristics including the all-cause all-payer risk-adjusted unplanned 30-day readmission rate from the LTCFocus (Long-Term Care Focus) project at Brown University, and county-level market variables from the Area Health Resource File. We also examined the relationship for a shorter time frame (2012–2015) after stratifying the sample by system membership or ownership. Principal Findings: SNFs with an increase in the lagged operating margin showed a statistically significant, small decrease (<.01 percentage point) in the risk-adjusted readmission rate. The results were robust for different time periods and model specifications. Fixed effects model estimates for SNFs in the highest quartile of percentage of Medicaid patients (≥73.9%) had a lagged operating margin coefficient that is almost four times as large as the coefficient of the FE model with all SNFs. Application to Practice: SNFs have an important role in achieving the national priority of reducing hospital readmissions. The study findings suggest that managers of SNFs should not see low profitability as an obstacle to reducing readmission rates, which is good news given the low average profitability of SNFs. Further, reductions in profitability due to penalties incurred from the recently implemented Medicare Skilled Nursing Facility Value-Based Purchasing Program may not limit SNFs’ ability to lower hospital readmission rates, at least initially. However, policymakers may need to determine whether additional resources to high Medicaid SNFs can lower readmission rates for these SNFs.
{"title":"Is Skilled Nursing Facility Financial Status Related to Readmission Rate Improvement?","authors":"J. Clement, Kristin M MacDonald","doi":"10.1097/JHM-D-20-00320","DOIUrl":"https://doi.org/10.1097/JHM-D-20-00320","url":null,"abstract":"SUMMARY Goal: We examined whether higher skilled nursing facility (SNF) lagged profitability is associated with a lower 30-day all-cause all-payer risk-adjusted hospital readmission rate. Our aim was to provide insight into whether SNFs with limited financial resources are able to respond to incentives to lower their readmission rates to hospitals. Methods: We used data from 2012–2016 to estimate a fixed effects (FE) model with a time trend. Our data included financial data from the Centers for Medicare & Medicaid Services Healthcare Cost Report Information System SNF cost reports, facility characteristics including the all-cause all-payer risk-adjusted unplanned 30-day readmission rate from the LTCFocus (Long-Term Care Focus) project at Brown University, and county-level market variables from the Area Health Resource File. We also examined the relationship for a shorter time frame (2012–2015) after stratifying the sample by system membership or ownership. Principal Findings: SNFs with an increase in the lagged operating margin showed a statistically significant, small decrease (<.01 percentage point) in the risk-adjusted readmission rate. The results were robust for different time periods and model specifications. Fixed effects model estimates for SNFs in the highest quartile of percentage of Medicaid patients (≥73.9%) had a lagged operating margin coefficient that is almost four times as large as the coefficient of the FE model with all SNFs. Application to Practice: SNFs have an important role in achieving the national priority of reducing hospital readmissions. The study findings suggest that managers of SNFs should not see low profitability as an obstacle to reducing readmission rates, which is good news given the low average profitability of SNFs. Further, reductions in profitability due to penalties incurred from the recently implemented Medicare Skilled Nursing Facility Value-Based Purchasing Program may not limit SNFs’ ability to lower hospital readmission rates, at least initially. However, policymakers may need to determine whether additional resources to high Medicaid SNFs can lower readmission rates for these SNFs.","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"67 1","pages":"89 - 102"},"PeriodicalIF":1.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44005075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Moonesar Immanuel Azaad, Stephens Melodena, Mazrouei Kulaithem Saif Al, Henriksson Dorcus Kiwanuka, Gordeev Vladimir Sergeevich
{"title":"Telemedicine in the Midst of the COVID-19 Crisis: A Case Study in Government and Healthcare Agility","authors":"Moonesar Immanuel Azaad, Stephens Melodena, Mazrouei Kulaithem Saif Al, Henriksson Dorcus Kiwanuka, Gordeev Vladimir Sergeevich","doi":"10.36959/569/472","DOIUrl":"https://doi.org/10.36959/569/472","url":null,"abstract":"","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"15 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2022-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80474489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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