R. Mutasa, Sarah Baird, F. Takavarasha, A. Markus, J. Friedman, W. Zeng
Background: Ensuring value for health sector spending is a universal concern for policy makers in low-and middle-income countries (LMICs), where health care demands are rising and health sector financing is limited. Performance-based financing (PBF) is more frequently being implemented in LMICs to improve quality of care and ultimately health system outcomes. Through PBF, LMICs can potentially reduce variation in clinical practice, because PBF provider incentives are directly linked to achievement of predefined quality of care standards and adherence to quality protocols. Zimbabwe implemented PBF in 16 districts as a health system reform to improve the quality and coverage of health services from 2011. This paper first estimates the impact of PBF on quality of care, and then explores contextual factors mediating the effectiveness of PBF in improving quality of care LMICs were at various stages of piloting and scaling up performance-based incentive schemes (4). The underlying rationale is that performance-based financing (PBF) can extrinsically motivate health providers through incentives. By financially rewarding improvements in quality of health care, health providers will make greater efforts to achieve better results (3). As such, PBF is a core component of strategic purchasing of health services in a growing number of LMICs. Strategic purchasing helps link resources for health to the effective delivery of quality services (6). can or and that determine made to care by 27.7% (P<0.0001). Conclusions: Evaluations of complex health system reform interventions such as PBF need to go beyond exploring effects on priority health outcomes. As a strategic purchasing tool, PBF design should be informed by a country’s contextual factors. At the same time, evidence on contextual factors outside the control of policy makers and the health system—such as mean population wealth—must be better understood and documented.
{"title":"Exploratory study estimating the impact of performance-based financing (PBF) on quality of care and on the contextual factors mediating the effectiveness of PBF in improving quality of care in Zimbabwe","authors":"R. Mutasa, Sarah Baird, F. Takavarasha, A. Markus, J. Friedman, W. Zeng","doi":"10.21037/JHMHP-20-60","DOIUrl":"https://doi.org/10.21037/JHMHP-20-60","url":null,"abstract":"Background: Ensuring value for health sector spending is a universal concern for policy makers in low-and middle-income countries (LMICs), where health care demands are rising and health sector financing is limited. Performance-based financing (PBF) is more frequently being implemented in LMICs to improve quality of care and ultimately health system outcomes. Through PBF, LMICs can potentially reduce variation in clinical practice, because PBF provider incentives are directly linked to achievement of predefined quality of care standards and adherence to quality protocols. Zimbabwe implemented PBF in 16 districts as a health system reform to improve the quality and coverage of health services from 2011. This paper first estimates the impact of PBF on quality of care, and then explores contextual factors mediating the effectiveness of PBF in improving quality of care LMICs were at various stages of piloting and scaling up performance-based incentive schemes (4). The underlying rationale is that performance-based financing (PBF) can extrinsically motivate health providers through incentives. By financially rewarding improvements in quality of health care, health providers will make greater efforts to achieve better results (3). As such, PBF is a core component of strategic purchasing of health services in a growing number of LMICs. Strategic purchasing helps link resources for health to the effective delivery of quality services (6). can or and that determine made to care by 27.7% (P<0.0001). Conclusions: Evaluations of complex health system reform interventions such as PBF need to go beyond exploring effects on priority health outcomes. As a strategic purchasing tool, PBF design should be informed by a country’s contextual factors. At the same time, evidence on contextual factors outside the control of policy makers and the health system—such as mean population wealth—must be better understood and documented.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43000088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Across human history, civilizations have responded to disasters and outbreaks of disease with increasingly complex, systematic approaches as a means of organizing chaos and protecting human life. The SARS-CoV-2 coronavirus (COVID-19) pandemic provides a unique opportunity to learn from the practice of disaster management and crisis-driven changes to patient care processes in hospital and emergent care environments worldwide. COVID-19 acts as an accelerant for process change and the need for redesign in systems where classical, linear evaluation methods most often inform carefully implemented service improvements. Strikingly, many innovative approaches and valuable lessons come from all over the globe where technology and access to resources have been most limited. This article answers the question, what can we learn about how to respond to future disasters from the evolution of disaster management as performed by helping professionals and policymakers during the past hundred-plus years and best practices seen today? Macro practitioners have co-created unique approaches within several global communities to help cope with COVID-19 and other disasters despite limited resources and seemingly unlimited needs. Referencing existing case studies of patient care responses during COVID-19 in Italy, Nigeria, South Africa, South Korea, and the United States, the authors document innovative practices and use of diverse technologies in local patient care systems. The article concludes by suggesting best practices for designing more robust, adaptive, and crisis ready responses to patient care, as well as the use of developmental evaluation as an agile approach to evaluating and improving patient services. It also suggests roles that helping professionals can play in the translation of big data systems of disaster management from organizations such as the Center for Disease Control, World Health Organization, non-governmental organizations (NGOs), and selected think tanks, among others.
{"title":"Organizational learning—COVID-19 experience: innovative global practices for improving patient care in crisis response","authors":"James A. Muskopf, N. Sudan, E. Verdooner, M. Nair","doi":"10.21037/JHMHP-21-19","DOIUrl":"https://doi.org/10.21037/JHMHP-21-19","url":null,"abstract":": Across human history, civilizations have responded to disasters and outbreaks of disease with increasingly complex, systematic approaches as a means of organizing chaos and protecting human life. The SARS-CoV-2 coronavirus (COVID-19) pandemic provides a unique opportunity to learn from the practice of disaster management and crisis-driven changes to patient care processes in hospital and emergent care environments worldwide. COVID-19 acts as an accelerant for process change and the need for redesign in systems where classical, linear evaluation methods most often inform carefully implemented service improvements. Strikingly, many innovative approaches and valuable lessons come from all over the globe where technology and access to resources have been most limited. This article answers the question, what can we learn about how to respond to future disasters from the evolution of disaster management as performed by helping professionals and policymakers during the past hundred-plus years and best practices seen today? Macro practitioners have co-created unique approaches within several global communities to help cope with COVID-19 and other disasters despite limited resources and seemingly unlimited needs. Referencing existing case studies of patient care responses during COVID-19 in Italy, Nigeria, South Africa, South Korea, and the United States, the authors document innovative practices and use of diverse technologies in local patient care systems. The article concludes by suggesting best practices for designing more robust, adaptive, and crisis ready responses to patient care, as well as the use of developmental evaluation as an agile approach to evaluating and improving patient services. It also suggests roles that helping professionals can play in the translation of big data systems of disaster management from organizations such as the Center for Disease Control, World Health Organization, non-governmental organizations (NGOs), and selected think tanks, among others.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42626187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Breast cancer is the most common cancer among women with a 5-year survival rate of up to 99% when detected early. This survival rate presents challenges to healthcare systems and providers in terms of ensuring patients receive adequate and timely support during the lengthy and often difficult journey of treatment and survivorship. The primary aim of this quality improvement project piloted the use of the Fitbit Alta HR fitness trackers in a large academic medical center in the south, where 19 breast cancer patients wore and synchronized a Fitbit Alta HR for 28 days. Participants were patients diagnosed with breast cancer (stages 0, I, II, III) who were actively receiving, or who had recently received, breast cancer treatment and care, and who had not previously used any type of health tracking device. The purpose was to understand how self-reported data could enhance patient-centered breast cancer care. Patients provided information on their physical activity and distress status, that enabled certified exercise physiologists to promote healthy lifestyle choices, identify potential treatment complications, and improve the patient’s overall quality of life. Although the sample size was small, a positive correlation between minutes asleep and number of awakenings (r=0.6852), and a negative correlation between distress levels and minutes fairly active (r=−0.3346), stood out as potential indications of the impact of distress on breast cancer patients. This project illuminated the potential value of understanding the ability to, and effectiveness of, capturing relevant patient reported outcomes as a valuable contribution to patient-centered healthcare delivery for patients undergoing treatment for breast cancer. Important findings suggest that building in the daily distress indicators to wearable devices may provide increased utility and expanded insight when such devices are used for patient reported monitoring and outcomes.
：癌症是女性中最常见的癌症，早期发现的5年生存率高达99%。在确保患者在漫长且往往困难的治疗和存活过程中获得足够和及时的支持方面，这种存活率给医疗系统和提供者带来了挑战。该质量改进项目的主要目的是在南部一家大型学术医疗中心试用Fitbit Alta HR健身追踪器，19名癌症乳腺癌患者佩戴Fitbit AltaHR并同步28天。参与者是被诊断为癌症（0、I、II、III期）的患者，他们正在积极接受或最近接受过癌症治疗和护理，并且以前没有使用过任何类型的健康跟踪设备。目的是了解自我报告的数据如何加强以患者为中心的癌症护理。患者提供了有关其身体活动和痛苦状态的信息，这使经过认证的运动生理学家能够促进健康的生活方式选择，识别潜在的治疗并发症，并提高患者的整体生活质量。尽管样本量很小，但睡眠分钟数与苏醒次数之间的正相关（r=0.6852），以及痛苦水平与相当活跃的分钟数之间的负相关（r=-0.3346），都是痛苦对癌症患者影响的潜在指标。该项目阐明了了解获取相关患者报告结果的能力和有效性的潜在价值，作为对接受癌症治疗的患者以患者为中心的医疗保健的宝贵贡献。重要的研究结果表明，当可穿戴设备用于患者报告的监测和结果时，在可穿戴设备上内置日常遇险指示器可以提供更高的实用性和更深入的洞察力。
{"title":"Wearable technology to track activity and distress in breast cancer patients: case series","authors":"Warren Smedley, Sue S. Feldman, Carson Ralphs","doi":"10.21037/JHMHP-20-99","DOIUrl":"https://doi.org/10.21037/JHMHP-20-99","url":null,"abstract":": Breast cancer is the most common cancer among women with a 5-year survival rate of up to 99% when detected early. This survival rate presents challenges to healthcare systems and providers in terms of ensuring patients receive adequate and timely support during the lengthy and often difficult journey of treatment and survivorship. The primary aim of this quality improvement project piloted the use of the Fitbit Alta HR fitness trackers in a large academic medical center in the south, where 19 breast cancer patients wore and synchronized a Fitbit Alta HR for 28 days. Participants were patients diagnosed with breast cancer (stages 0, I, II, III) who were actively receiving, or who had recently received, breast cancer treatment and care, and who had not previously used any type of health tracking device. The purpose was to understand how self-reported data could enhance patient-centered breast cancer care. Patients provided information on their physical activity and distress status, that enabled certified exercise physiologists to promote healthy lifestyle choices, identify potential treatment complications, and improve the patient’s overall quality of life. Although the sample size was small, a positive correlation between minutes asleep and number of awakenings (r=0.6852), and a negative correlation between distress levels and minutes fairly active (r=−0.3346), stood out as potential indications of the impact of distress on breast cancer patients. This project illuminated the potential value of understanding the ability to, and effectiveness of, capturing relevant patient reported outcomes as a valuable contribution to patient-centered healthcare delivery for patients undergoing treatment for breast cancer. Important findings suggest that building in the daily distress indicators to wearable devices may provide increased utility and expanded insight when such devices are used for patient reported monitoring and outcomes.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47214579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Taryn E. Leroy, Raminta V. Theriault, Nathan J. Sinz, Gabriel S. Perrone, Christopher J. Fang, D. Mattingly, Eric L. Smith
Background: The coronavirus disease (COVID-19) pandemic has created significant change globally in healthcare systems. With the recommendation to stop elective surgery, healthcare systems incurred significant financial losses. As the initial surge begins to decline, hospitals and surgery centers are devising plans to resume elective cases. Therefore, the aim of this study is to describe an approach to resuming elective surgery for total joint replacement at our single-specialty, orthopaedic-only institution. Methods: With our multidisciplinary team, our hospital created an approach to resume elective surgery for total joint replacement under the COVID-19 pandemic conditions and state regulations. We describe our steps and processes to remain a COVID-19 negative institution. Results: Through our approach, our orthopaedic-only specialty institution was able to return to elective total joint arthroplasty procedures at significant volume during the pandemic, and, to date, has remained COVID-19 negative through these efforts. Conclusions: This manuscript aims to summarize an approach to the resumption of elective surgery focusing on four main areas of care: (I) preoperative screening and care, (II) operative care, (III) immediate post-operative care, and (IV) inpatient concerns. Our example may serve as a basic model which can be used as a template and customized to meet the specific needs and restrictions of other institutions as they work through returning to baseline.
{"title":"Reopening of elective total joint replacement surgery in a high-volume single-specialty hospital within a COVID-19 epicenter","authors":"Taryn E. Leroy, Raminta V. Theriault, Nathan J. Sinz, Gabriel S. Perrone, Christopher J. Fang, D. Mattingly, Eric L. Smith","doi":"10.21037/JHMHP-20-149","DOIUrl":"https://doi.org/10.21037/JHMHP-20-149","url":null,"abstract":"Background: The coronavirus disease (COVID-19) pandemic has created significant change globally in healthcare systems. With the recommendation to stop elective surgery, healthcare systems incurred significant financial losses. As the initial surge begins to decline, hospitals and surgery centers are devising plans to resume elective cases. Therefore, the aim of this study is to describe an approach to resuming elective surgery for total joint replacement at our single-specialty, orthopaedic-only institution. Methods: With our multidisciplinary team, our hospital created an approach to resume elective surgery for total joint replacement under the COVID-19 pandemic conditions and state regulations. We describe our steps and processes to remain a COVID-19 negative institution. Results: Through our approach, our orthopaedic-only specialty institution was able to return to elective total joint arthroplasty procedures at significant volume during the pandemic, and, to date, has remained COVID-19 negative through these efforts. Conclusions: This manuscript aims to summarize an approach to the resumption of elective surgery focusing on four main areas of care: (I) preoperative screening and care, (II) operative care, (III) immediate post-operative care, and (IV) inpatient concerns. Our example may serve as a basic model which can be used as a template and customized to meet the specific needs and restrictions of other institutions as they work through returning to baseline.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43919093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: The coronavirus disease 2019 (COVID-19) infection was declared a pandemic by the World Health Organization (WHO) on 11 March 2020. As of 16 January 2021, the WHO reported a total of 92,506,811 cases globally, with 2,001,773 deaths. The total number of confirmed COVID-19 infections in Singapore reported by the Ministry of Health (MOH) as of 16 January 2021 is 59,054 cases with 270 active cases. As there is currently no cure for COVID-19 infection, the best management strategy remains prevention of transmission through public infection control measures and the recently introduced vaccination programs. Globally, healthcare institutions across multiple disciplines are actively taking measures to reduce their ambulatory outpatient load for low-risk conditions to avoid unnecessary clinic visits and hence reduce the risk of exposure and transmission. In this paper, we describe the challenges faced and the reorganisation of care in the outpatient Obstetrics and Gynaecology (O&G) service in the largest tertiary hospital and referral centre for O&G in Singapore during the COVID-19 outbreak. We also present the challenges we anticipated upon resumption of our services in the post-outbreak period, and discuss the novel strategies we implemented to cope with the increased number of cases expected. These strategies are aimed to improve the standard of patient care, whilst adhering to public infection control guidelines to ensure the safety of our patients and healthcare workers.
{"title":"Challenges, reorganisation and recovery of obstetrics and gynecology outpatient services during and after the COVID-19 pandemic in a tertiary hospital","authors":"M. J. Seet, Krystal Koh, M. Mathur","doi":"10.21037/JHMHP-20-150","DOIUrl":"https://doi.org/10.21037/JHMHP-20-150","url":null,"abstract":": The coronavirus disease 2019 (COVID-19) infection was declared a pandemic by the World Health Organization (WHO) on 11 March 2020. As of 16 January 2021, the WHO reported a total of 92,506,811 cases globally, with 2,001,773 deaths. The total number of confirmed COVID-19 infections in Singapore reported by the Ministry of Health (MOH) as of 16 January 2021 is 59,054 cases with 270 active cases. As there is currently no cure for COVID-19 infection, the best management strategy remains prevention of transmission through public infection control measures and the recently introduced vaccination programs. Globally, healthcare institutions across multiple disciplines are actively taking measures to reduce their ambulatory outpatient load for low-risk conditions to avoid unnecessary clinic visits and hence reduce the risk of exposure and transmission. In this paper, we describe the challenges faced and the reorganisation of care in the outpatient Obstetrics and Gynaecology (O&G) service in the largest tertiary hospital and referral centre for O&G in Singapore during the COVID-19 outbreak. We also present the challenges we anticipated upon resumption of our services in the post-outbreak period, and discuss the novel strategies we implemented to cope with the increased number of cases expected. These strategies are aimed to improve the standard of patient care, whilst adhering to public infection control guidelines to ensure the safety of our patients and healthcare workers.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47111246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: In the later months of 2019, coronavirus disease of 2019 (COVID-19) began to spread across the globe. The pandemic quickly became a challenge for healthcare facilities to respond to and hospitals were expected to lose billions. Subsequently, many hospitals implemented mandatory furloughs, layoffs or pay cuts amongst their clinical staffs. Previous research has demonstrated it is important for organizational members to pull together and act as a team during a crisis situation. A team approach offers a number of organizational benefits however; most of the literature on teamwork is focused at the micro level (e.g., unit level) and does not address the importance of an organizational level team. We propose the importance of creating an organizational level team (e.g., one, which spans throughout the organization) as being key to successfully mitigating organizational crises. We offer an applied social identity approach as a theoretical lens to understand this phenomenon. We offer insight into one hospital, which dealt with the COVID-19 pandemic based on an organizational wide team. We explain the steps the Cleveland Clinic took in preparation for and during the pandemic. These steps allowed the Clinic to avoid many of the negative consequences other hospitals suffered, such layoffs, furloughs, and potential long-term organizational workforce problems. 5
{"title":"A One-Team approach to crisis management: a hospital success story during the COVID-19 pandemic","authors":"T. Porter, Cheryl Rathert, S. Ayad, N. Messina","doi":"10.21037/JHMHP-21-9","DOIUrl":"https://doi.org/10.21037/JHMHP-21-9","url":null,"abstract":": In the later months of 2019, coronavirus disease of 2019 (COVID-19) began to spread across the globe. The pandemic quickly became a challenge for healthcare facilities to respond to and hospitals were expected to lose billions. Subsequently, many hospitals implemented mandatory furloughs, layoffs or pay cuts amongst their clinical staffs. Previous research has demonstrated it is important for organizational members to pull together and act as a team during a crisis situation. A team approach offers a number of organizational benefits however; most of the literature on teamwork is focused at the micro level (e.g., unit level) and does not address the importance of an organizational level team. We propose the importance of creating an organizational level team (e.g., one, which spans throughout the organization) as being key to successfully mitigating organizational crises. We offer an applied social identity approach as a theoretical lens to understand this phenomenon. We offer insight into one hospital, which dealt with the COVID-19 pandemic based on an organizational wide team. We explain the steps the Cleveland Clinic took in preparation for and during the pandemic. These steps allowed the Clinic to avoid many of the negative consequences other hospitals suffered, such layoffs, furloughs, and potential long-term organizational workforce problems. 5","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46464588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: The COVID-19 pandemic placed intense pressure on individual hospitals and hospital systems. While no hospital could have predicted the exact needs required to respond to the crisis, there may be certain organizational characteristics or hospital system types that were better prepared to respond effectively. In this article, we propose a conceptual model for effectiveness of health system organizational response to COVID-19, using the theoretical foundation of organizational slack which is defined as the “excess” accumulated resources that do not contribute to that organization’s immediate production function. We first define and describe the contributors of organizational slack, such as accumulated social capital or financial health. We then describe the benefits of organizational slack such as the ability to be more innovative or having more operational flexibility. Next, we discuss the application of organizational slack during the pandemic to adapt operations, redeploy staff and/or supplies and to manage any technological pivots (e.g., the rapid escalation of telehealth). Finally, we address the ways that hospital system structures may moderate the relationship between the benefits and applications of organizational slack. The COVID-19 pandemic placed unique pressures on hospitals as the crisis was sustained and will most likely transform future operations and care delivery. Through the lens of organizational slack, we can better understand the optimal ways to respond to future crises.
{"title":"The application of organizational slack to hospital system responsiveness during the COVID-19 pandemic","authors":"John P. McHugh, Dori A. Cross","doi":"10.21037/JHMHP-21-13","DOIUrl":"https://doi.org/10.21037/JHMHP-21-13","url":null,"abstract":": The COVID-19 pandemic placed intense pressure on individual hospitals and hospital systems. While no hospital could have predicted the exact needs required to respond to the crisis, there may be certain organizational characteristics or hospital system types that were better prepared to respond effectively. In this article, we propose a conceptual model for effectiveness of health system organizational response to COVID-19, using the theoretical foundation of organizational slack which is defined as the “excess” accumulated resources that do not contribute to that organization’s immediate production function. We first define and describe the contributors of organizational slack, such as accumulated social capital or financial health. We then describe the benefits of organizational slack such as the ability to be more innovative or having more operational flexibility. Next, we discuss the application of organizational slack during the pandemic to adapt operations, redeploy staff and/or supplies and to manage any technological pivots (e.g., the rapid escalation of telehealth). Finally, we address the ways that hospital system structures may moderate the relationship between the benefits and applications of organizational slack. The COVID-19 pandemic placed unique pressures on hospitals as the crisis was sustained and will most likely transform future operations and care delivery. Through the lens of organizational slack, we can better understand the optimal ways to respond to future crises.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45783661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Planned organizational change has a long history in formal organizations of all types. A model of planned organizational change from the existing literature can be used to identify a set of principles which can be offered for use during the current COVID-19 crisis, but this traditional model may not be fully adequate during this especially challenging period. A relatively new model from the field of complexity theory for organizations, Complex Adaptive Systems (CAS), offers promise for addressing the unique crisis conditions facing hospitals in the COVID-19 era. These conditions require constant assessment; ongoing high levels of communication; and iterative cycles of experimentation, reflection and learning, which can be better addressed in a CAS framework. Healthcare providers are experiencing periods of relative calm and interspersed crisis, which need to be proactively recognized and managed through sustained, “big picture” changes using timely combinations of traditional methods, complexity approaches, with the flexibility and ethical considerations of crisis management strategies built in. Successful crisis management requires leadership skills of those involved in decision-making at the local level, with a preference for the use of inclusive and adaptive leadership styles. Innovative strategies, teamwork, and crisis management models that have recently emerged may enable deeper systemic change in the long term. Any hospital or program in a healthcare system should be able to use this material to address a significant organizational change need.
{"title":"Rethinking organizational change in the COVID-19 era","authors":"A. Choflet, T. Packard, Keren B. Stashower","doi":"10.21037/JHMHP-21-11","DOIUrl":"https://doi.org/10.21037/JHMHP-21-11","url":null,"abstract":"Planned organizational change has a long history in formal organizations of all types. A model of planned organizational change from the existing literature can be used to identify a set of principles which can be offered for use during the current COVID-19 crisis, but this traditional model may not be fully adequate during this especially challenging period. A relatively new model from the field of complexity theory for organizations, Complex Adaptive Systems (CAS), offers promise for addressing the unique crisis conditions facing hospitals in the COVID-19 era. These conditions require constant assessment; ongoing high levels of communication; and iterative cycles of experimentation, reflection and learning, which can be better addressed in a CAS framework. Healthcare providers are experiencing periods of relative calm and interspersed crisis, which need to be proactively recognized and managed through sustained, “big picture” changes using timely combinations of traditional methods, complexity approaches, with the flexibility and ethical considerations of crisis management strategies built in. Successful crisis management requires leadership skills of those involved in decision-making at the local level, with a preference for the use of inclusive and adaptive leadership styles. Innovative strategies, teamwork, and crisis management models that have recently emerged may enable deeper systemic change in the long term. Any hospital or program in a healthcare system should be able to use this material to address a significant organizational change need.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45125439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-01Epub Date: 2021-03-25DOI: 10.21037/jhmhp-20-103
Janeane N Anderson, Rebecca A Krukowski, Andrew J Paladino, J Carolyn Graff, Lee Schwartzberg, Andrea N Curry, Gregory A Vidal, Tameka N Jones, Teresa M Waters, Ilana Graetz
Background: Women with hormone receptor-positive, early-stage breast cancer who adhere to adjuvant endocrine therapy (AET) reduce the risk of cancer recurrence and mortality. AET, however, is associated with adverse symptoms that often result in poor adherence. We applied participatory action research (PAR) principles to conduct focus groups and interviews to refine and enhance a web-enabled app intervention that facilitates patient-provider communication about AET-related symptoms and other barriers to adherence.
Methods: We conducted four focus groups with women with early-stage breast cancer on AET (N=28), stratified by race (Black and White) and length of time on AET (<6 months and >6 months), to determine preferences and refine the app-based intervention. A fifth mixed-race focus group was convened (N=6) to refine THRIVE app content using high-fidelity mock-ups and to develop new, tailored feedback messages. We also conducted interviews with oncology nurses (N=5) who participated in the THRIVE randomized controlled trial.
Results: Participants reported preferences for weekly reminder messages to use the THRIVE app, a free-text option to write in AET-related symptoms, and app aesthetics. Other requested app features included: a body map for identifying pain, sleep and dental problems on the symptom list, a dashboard, tailored feedback messages, and information about social support resources. Participants also developed new intervention messages, decided which messages to keep, and edited language for appropriateness and sensitivity. They also discussed the type of electronic pill monitor and incentive plan to be used in the intervention. Nurses reported THRIVE alerts integrated seamlessly into their clinical workflow and increased patient-provider communication, facilitating quicker response to patients' reported symptoms. Nurses reported no negative feedback or usability concerns with the app.
Conclusions: THRIVE app content reflects researchers' partnership with a racially diverse sample of breast cancer survivors and healthcare providers and adherence to participatory design by incorporating patient-requested app features, app aesthetics, and message content. The app has the potential to improve AET adherence and quality of life among breast cancer survivors and reduce disparities in mortality rates for Black women by facilitating communication with healthcare providers.
{"title":"THRIVE intervention development: using participatory action research principles to guide a mHealth app-based intervention to improve oncology care.","authors":"Janeane N Anderson, Rebecca A Krukowski, Andrew J Paladino, J Carolyn Graff, Lee Schwartzberg, Andrea N Curry, Gregory A Vidal, Tameka N Jones, Teresa M Waters, Ilana Graetz","doi":"10.21037/jhmhp-20-103","DOIUrl":"https://doi.org/10.21037/jhmhp-20-103","url":null,"abstract":"<p><strong>Background: </strong>Women with hormone receptor-positive, early-stage breast cancer who adhere to adjuvant endocrine therapy (AET) reduce the risk of cancer recurrence and mortality. AET, however, is associated with adverse symptoms that often result in poor adherence. We applied participatory action research (PAR) principles to conduct focus groups and interviews to refine and enhance a web-enabled app intervention that facilitates patient-provider communication about AET-related symptoms and other barriers to adherence.</p><p><strong>Methods: </strong>We conducted four focus groups with women with early-stage breast cancer on AET (N=28), stratified by race (Black and White) and length of time on AET (<6 months and >6 months), to determine preferences and refine the app-based intervention. A fifth mixed-race focus group was convened (N=6) to refine THRIVE app content using high-fidelity mock-ups and to develop new, tailored feedback messages. We also conducted interviews with oncology nurses (N=5) who participated in the THRIVE randomized controlled trial.</p><p><strong>Results: </strong>Participants reported preferences for weekly reminder messages to use the THRIVE app, a free-text option to write in AET-related symptoms, and app aesthetics. Other requested app features included: a body map for identifying pain, sleep and dental problems on the symptom list, a dashboard, tailored feedback messages, and information about social support resources. Participants also developed new intervention messages, decided which messages to keep, and edited language for appropriateness and sensitivity. They also discussed the type of electronic pill monitor and incentive plan to be used in the intervention. Nurses reported THRIVE alerts integrated seamlessly into their clinical workflow and increased patient-provider communication, facilitating quicker response to patients' reported symptoms. Nurses reported no negative feedback or usability concerns with the app.</p><p><strong>Conclusions: </strong>THRIVE app content reflects researchers' partnership with a racially diverse sample of breast cancer survivors and healthcare providers and adherence to participatory design by incorporating patient-requested app features, app aesthetics, and message content. The app has the potential to improve AET adherence and quality of life among breast cancer survivors and reduce disparities in mortality rates for Black women by facilitating communication with healthcare providers.</p>","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":"5 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4c/48/nihms-1724796.PMC8302021.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39221448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: In 2014-15, 63.4% of Australian adults were overweight or obese, with 25% categorized as obese. Internationally, people with obesity are reported to experience inadequate quality of care, increased length of stay, more adverse events and higher costs of care. There are unique challenges associated with ensuring this cohort is provided with safe care which promotes their personal dignity. The aim of this study was to describe the experience of clinical leaders and managers of care provision to people with obesity, during inpatient admissions to an Australian public health service. Methods: A purposive, convenience sampling method was utilised, resulting in the recruitment of 17 participants. Data was collected via semi-structured interviews in the workplace, which were all digitally recorded for verbatim transcription. All data was subjected to thematic analysis, with identified codes reorganised into overall themes. Results: Five overarching themes were identified, four of which are discussed in this publication. The main themes and subthemes were (I) resource allocation (incorporating inequality, economic resources, human resources and physical resources); (II) service context (incorporating understanding ‘bariatric’, physical/ built environment, staff knowledge and skills, and organisational culture; (III) care transitions (incorporating transitions in care, communication and organisational processes; and recommendations for best care for people with obesity. Conclusions: The experience and perceptions of participants reflect the issues they prioritised in their respective roles, and confirm that providing care for people with obesity has significant policy and practice implications. These issues cannot be considered in isolation, with significant overlap and interdependence was evident. Participants also described the positive outcomes and progress which could be achieved when organisations take direct action to improve the care they provide to people with obesity.
{"title":"Perceptions of clinical leaders and managers of inpatients with obesity in an Australian public health service","authors":"Alison Qvist, F. Pazsa, D. Hitch","doi":"10.21037/JHMHP-20-98","DOIUrl":"https://doi.org/10.21037/JHMHP-20-98","url":null,"abstract":"Background: In 2014-15, 63.4% of Australian adults were overweight or obese, with 25% categorized as obese. Internationally, people with obesity are reported to experience inadequate quality of care, increased length of stay, more adverse events and higher costs of care. There are unique challenges associated with ensuring this cohort is provided with safe care which promotes their personal dignity. The aim of this study was to describe the experience of clinical leaders and managers of care provision to people with obesity, during inpatient admissions to an Australian public health service. Methods: A purposive, convenience sampling method was utilised, resulting in the recruitment of 17 participants. Data was collected via semi-structured interviews in the workplace, which were all digitally recorded for verbatim transcription. All data was subjected to thematic analysis, with identified codes reorganised into overall themes. Results: Five overarching themes were identified, four of which are discussed in this publication. The main themes and subthemes were (I) resource allocation (incorporating inequality, economic resources, human resources and physical resources); (II) service context (incorporating understanding ‘bariatric’, physical/ built environment, staff knowledge and skills, and organisational culture; (III) care transitions (incorporating transitions in care, communication and organisational processes; and recommendations for best care for people with obesity. Conclusions: The experience and perceptions of participants reflect the issues they prioritised in their respective roles, and confirm that providing care for people with obesity has significant policy and practice implications. These issues cannot be considered in isolation, with significant overlap and interdependence was evident. Participants also described the positive outcomes and progress which could be achieved when organisations take direct action to improve the care they provide to people with obesity.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45855683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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