JournalTOCs

Health Services Management Research
Journal Prestige (SJR): 0.273

Citation Impact (citeScore): 1
Number of Followers: 16

Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0951-4848 - ISSN (Online) 1758-1044
Published by Sage Publications

[1174 journals]

The implementation of a precision case management model in a Canadian
inpatient rehabilitation center: The 12-months post-implementation
findings of a quality improvement project
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  Authors: Michael Chislett, Karen Hurtubise, Jason McCarthy, Cathy Hoyles
  Abstract: Health Services Management Research, Ahead of Print.
  Despite recommendations, few have reported on quality improvement initiatives to implement length of rehabilitation stay benchmarks, while actively monitoring functional outcomes. This article describes the development, implementation, and evaluation of a precision case management model across all inpatient rehabilitation client groups in a Canadian facility. To develop the length of rehabilitation-stay (LoRS) benchmarks, patient data was retrospectively analyzed. A severity specific method was used to stratify median length of stay. A target reduction on 8.6 days in LoRS was established. Functional discharge targets were also set and monitored at specific intervals via the Functional Independence Measure (FIM®). The implementation used an incremental quality improvement phased approach. Following 12-months, a statistically significant reduction in mean LoRS of 13.2 days was achieved, along with a small increase in FIM® change across all rehabilitation client groups. A similar pattern was seen across the three main client groups, where a LoRS reduction greater than the target was achieved, along with important improvements in LoRS efficiency. This study demonstrates how the implementation of a precision case management model can assist a facility in markedly reducing LoRS across inpatient groups, without compromising functional change or community discharge rates and begin its transformation to a value-based organization.
  Citation: Health Services Management Research
  PubDate: 2022-06-20T11:18:48Z
  DOI: 10.1177/09514848221109832
Causing harm but doing good: Recognizing and overcoming the burden of
necessary evil enactment in healthcare service professions
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  Authors: Meena Andiappan
  Abstract: Health Services Management Research, Ahead of Print.
  Necessary evils – defined as acts that cause physical, psychological, or emotional harm to victims but are for the greater good of either the victim or society - are an everyday occurrence in the healthcare industry across the globe and across healthcare service professions. Healthcare professionals are tasked with behaviors that result in pain and suffering (e.g. nurses providing shots to patients; oncologists communicating cancer diagnoses) for the betterment of their patients and stakeholders. Although these behaviors are professionally mandated, they can also be cognitively and psychologically taxing for enactors. The current conceptual paper explores the undesired effects of performing necessary evils and proposes various actions through which healthcare organizations can reduce the negative repercussions of necessary evil enactment on healthcare service professionals.
  Citation: Health Services Management Research
  PubDate: 2022-06-20T08:35:22Z
  DOI: 10.1177/09514848221109833
Predictors of international Muslim medical tourists’ expectations on
halal-friendly healthcare services: A hospital-based study
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  Authors: Mohsen Naserirad, Mohamad Tavakol, Mahmoud Abbasi, Behrooz Jannat, Naficeh Sadeghi, Zahra Bahemmat
  Abstract: Health Services Management Research, Ahead of Print.
  BackgroundHalal-friendly healthcare services have emerged as an important sector of the overall healthcare service delivery system. This study aimed to examine levels and determinants of expectations on halal-friendly healthcare services from the Muslim medical tourists’ perspective.MethodsA cross-sectional survey was conducted in four cities, seventeen hospitals, across Iran, with a sample of 365 international Muslim medical tourists.ResultsMean expectation score of the respondents was 3.95 ± 1.43. Being in the 25–34 age group (aOR = 2.65; CI 95%: 2.14–3.16), being married (aOR = 2.09; CI 95%: 1.46–2.72), having completed secondary education (aOR = 2.14; CI 95%: 1.26–3.02), belonging to a high-income socioeconomic background (aOR = 1.69; CI 95%: 1.06–2.33), coming from Iraq (aOR = 3.08; CI 95%: 2.12–4.04), being Shia (aOR = 2.83; CI 95%: 2.00–3.67), receiving information by recommendation as a source for travel decision (aOR = 3.02; CI 95%: 1.82–4.22), traveling with family or relatives (aOR=2.16; CI 95%: 1.42–2.90), receiving medical service of cosmetic surgery (aOR = 1.57; CI 95%: 1.22–1.92) and cardiovascular therapy (aOR = 2.33; CI 95%: 1.23–3.43), and traveling one or two times in the past (aOR = 2.33; CI 95%: 1.00–3.66) significantly increased the expectations on halal-friendly healthcare services.ConclusionThis study will represent an important contribution to the literature concerned with the levels and drivers of expectations on halal-friendly healthcare services.
  Citation: Health Services Management Research
  PubDate: 2022-06-17T03:04:46Z
  DOI: 10.1177/09514848221109831
COVID-19 management at one of the largest hospitals in Germany: Concept,
evaluation and adaptation
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  Authors: Ana Zhelyazkova, Philipp M Fischer, Nina Thies, Julia S Schrader-Reichling, Thorsten Kohlmann, Kristina Adorjan, René Huith, Karl-Walter Jauch, Stephan M Prückner
  Abstract: Health Services Management Research, Ahead of Print.
  ContextThe LMU University Hospital is among the largest healthcare facilities in Germany. The measures implemented prior to and during the first pandemic wave of COVID-19, were evaluated in preparation of a second pandemic wave. This paper presents the pandemic management concept, evaluation and adaptation of LMU University Hospital.MethodsBetween July and September 2020 the disaster management team of LMU University Hospital conducted a mixed-method evaluation of the hospital’s pandemic management. A workshop series based on the After Action Review working group format was organized to examine the management structure, decision-making processes, documentation, and crisis preparedness response for a second COVID-19 wave. Further, the satisfaction of employees with the hospital’s COVID-19 management was examined through an anonymous survey.ResultsThe workshop series highlighted a need for structural and operational adaptation of the COVID-19 management at LMU University Hospital. The results of the employee survey (N = 2182) provided positive feedback for the measures taken during the first pandemic wave. Specific actions were derived concerning the availability of personal protective equipment and emergency childcare services. A key outcome of both evaluation activities was the identified need for further improvement in communication between stakeholders. All changes were adopted prior to the second pandemic wave.
  Citation: Health Services Management Research
  PubDate: 2022-05-18T08:39:48Z
  DOI: 10.1177/09514848221100752
Who counts when health counts' A case-study of multi-stakeholder
initiative to promote value-creation in Swedish healthcare
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  Authors: Leonard Tragl, Carl Savage, Magna Andreen-Sachs, Mats Brommels
  Abstract: Health Services Management Research, Ahead of Print.
  A European initiative to design a “medical information framework” conceptualised how multiple stakeholders join in collaborative networks to create innovations. It conveyed the ways in which value is created and captured by stakeholders. We applied those insights to analyse a multi-stakeholder initiative to promote improvement of Swedish healthcare. Our longitudinal case study covered totally fifty stakeholders involved in a national project, aiming at designing a system to support value-based evaluation and reimbursement. During the project the focus changed from reimbursement to benchmarking. Sophisticated case-mix adjusting algorithms were designed to make outcome comparisons valid and incorporated in a software platform enabling detailed analysis of eight patient groups across seven regional health authorities. Those were deliverables demonstrating value created. However, the project was unable to transfer the system into routine use in the regions, a failed value-capture. The initial success was promoted by collaborative processes in diagnosis-specific working groups of well-informed and engaged professionals. The change of focus away from reimbursement decreased the involvement among health authorities, leaving no centrally placed persons to push for implementation. It highlights the importance of health professionals as the key stakeholder, who has both the know-how instrumental to creating an innovation, and the local involvement guaranteeing its implementation.
  Citation: Health Services Management Research
  PubDate: 2022-05-16T07:27:04Z
  DOI: 10.1177/09514848221100751
Association between asthma control and healthcare costs: Results from a
German linked data study
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  Authors: Thomas Wilke, Hartmut Timmermann, Sabrina Mueller, Fraence Hardtstock, Victoria Unmuessig, Robert R Welte, Ulf Maywald
  Abstract: Health Services Management Research, Ahead of Print.
  Background: This study aimed to evaluate differences in healthcare resource utilization and cost among patients with controlled and uncontrolled asthma.Methods: Claims data from a German sickness fund was linked to patient survey data. Outpatient physicians enrolled patients and assessed asthma control using the ACTTM questionnaire. All-cause and asthma-specific healthcare resource use (HCRU)/costs were compared descriptively and based on multivariable models using a continuous ACTTM score.Results: Overall, 492 asthma patients were included (mean age: 53.8, 73.8% female). The mean/median ACTTM score was 19.9/20.7, with 183 patients (37.2%) classified as having uncontrolled asthma (mean ACTTM score
  Citation: Health Services Management Research
  PubDate: 2022-05-13T06:24:17Z
  DOI: 10.1177/09514848221100749
Allied health clinical supervision: An opportunity lost
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  Authors: Nicky Baker, Jill Garner, Liz Kapur, Belinda Lange
  Abstract: Health Services Management Research, Ahead of Print.
  This study investigated clinical supervision with Allied Health professionals in a public health setting. Staff perceptions and experiences were explored through focus group discussions. Key themes identified that supervisees “tip-toe into complexity” by engaging in reflective practice for incremental personal and professional development. In contrast, supervisors identified that reflexivity was required for the opportunity to “develop at a deeper level”. Offering a choice of supervisor and providing supervisor training enhanced supervision experiences. Challenges to effective supervision were identified. Competing priorities, inconsistent modes of delivery, major organisational change and the role of clinical supervision in line with professional development confounded the experiences. Health managers could improve the processes and outcomes by implementing consistency with approach, timing, documentation, language, and structure of Clinical Supervision.
  Citation: Health Services Management Research
  PubDate: 2022-05-11T05:25:53Z
  DOI: 10.1177/09514848221100747
Toward a universalistic behavioural model of perceived managerial and
leadership effectiveness for the health services sector
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  Authors: Robert G Hamlin, Carlos E Ruiz, Jenni Jones, Taran Patel
  Abstract: Health Services Management Research, Ahead of Print.
  Much management and leadership development provision for healthcare professionals has been the subject of considerable criticism, and there have been numerous calls for training programmes explicitly focused on the specific managerial (manager/leader) behaviours healthcare managers, physician leaders and nurse managers need to exhibit to be perceived effective. The aim of our multiple cross-case/cross-nation comparative study has been to: i) identify similarities and differences between the findings of published qualitative critical incident studies of effective and ineffective managerial behaviour observed within British, Egyptian, Mexican and Romanian public hospitals, respectively, and ii) if possible, deduce from the identified commonalities a healthcare-related behavioural model of perceived managerial and leadership effectiveness. Adopting a philosophical stance informed by pragmatism, epistemological instrumentalism and abduction, we used realist qualitative analytic methods to code and classify into a maximum number of discrete behavioural categories empirical source data obtained from five previous studies. We found high degrees of empirical generalization which resulted in the identification of five positive (effective) and four negative (ineffective) behavioural dimensions (BDs) derived, respectively, from 14 positive and 9 negative deduced behavioural categories (BCs). These BDs and underpinning BCs are expressed in the form of an emergent two-factor universalistic behavioural model of perceived managerial and leadership effectiveness. We suggest the model could be used to critically evaluate the relevance and appropriateness of existing training provision for physician leaders, nurse managers and other healthcare managers/leaders in public hospitals or to design new explicit training programmes informed and shaped by healthcare-specific management research, as called for in the literature.
  Citation: Health Services Management Research
  PubDate: 2022-04-29T09:41:17Z
  DOI: 10.1177/09514848211065462
Cost-effectiveness of future lockdown policies against the COVID-19
pandemic
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  Authors: Afschin Gandjour
  Abstract: Health Services Management Research, Ahead of Print.
  Aim: While the European Union (EU) has approved several COVID-19 vaccines, new variants of concern may be able to escape immunity. The purpose of this study is to project the cost-effectiveness of future lockdown policies in conjunction with a variant-adapted vaccine booster. The exemplary scenario foresees a 25% decline in the vaccine protection against severe disease. Methods: A decision model was constructed using, for example, information on age-specific fatality rates, intensive care unit (ICU) costs and outcomes, and herd protection threshold. The costs and benefits of a future lockdown strategy were determined from a societal viewpoint under three future scenarios—a booster shot’s efficacy of 0%, 50%, and 95%. Results: The cost-effectiveness ratio of a lockdown policy in conjunction with a booster dose with 95% efficacy is €44,214 per life year gained. A lockdown is cost-effective when the probability of approving a booster dose with 95% efficacy is at least 48% (76% when considering uncertainty in input factors). Conclusion: In this exemplary scenario, a future lockdown policy appears to be cost-effective if the probability of approving a variant-adapted vaccine booster with an efficacy of 95% is at least 48%.
  Citation: Health Services Management Research
  PubDate: 2022-04-05T01:08:56Z
  DOI: 10.1177/09514848221080687
Why are there so many hospital beds in Germany'
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  Authors: Matthias Brunn, Torsten Kratz, Michael Padget, Marie-Caroline Clément, Marc Smyrl
  Abstract: Health Services Management Research, Ahead of Print.
  The place of hospitals in health systems is undergoing rapid change worldwide due to the high cost of hospital care and the changing health needs of the population. The Covid-19 pandemic has recently drawn public attention towards hospital capacity and has added new urgency to discussions on the future role of hospitals. In this context, recent experience in Germany provides valuable information for health systems seeking to manage hospital capacity. Despite reform efforts to reduce hospital capacity, Germany has the highest rates of intensive care beds among high-income countries and the highest overall hospital capacity in Europe. The capacity of the German hospital system can be explained in large part by the high number of elderly in-patients. This, in turn, is driven by (1) a fragmented ambulatory care system; (2) physicians admitting and maintaining elderly patients in hospital at a high rate; (3) a hospital market adding incentives to admit patients; and (4) a political commitment to egalitarian access and universal care. Additionally, recent policies to reduce hospital capacity have had limited impact because hospitals have not responded to financial incentives in the expected manner. Countries looking to learn from Germany’s hospital capacity must therefore consider systemic features, political commitments, and unintended policy consequences.
  Citation: Health Services Management Research
  PubDate: 2022-03-25T05:53:49Z
  DOI: 10.1177/09514848221080691
Effect of surgeon experience on technical efficiency
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  Authors: Yoshinori Nakata, Yuichi Watanabe, Hiroshi Otake
  Abstract: Health Services Management Research, Ahead of Print.
  Surgeon experience certainly improves their technical efficiency although it also causes physiological changes with aging. The authors hypothesized that surgeons’ technical efficiency improves with increasing experience up to a point where it then decreases, which is a concave relationship. The authors collected data from all the surgical procedures performed at University Hospital from April through September in 2013–19. The dependent variable was defined as surgeons’ technical efficiency scores that were calculated using output-oriented Charnes–Cooper–Rhodes model of data envelopment analysis. Inputs were defined as (1) the number of assistants and (2) the duration of surgical operation. The output was defined as the surgical fee for each surgery. Surgeon experience was defined as the number of years since medical school graduation. Five control variables were selected: surgical volume, gender, academic rank, surgical specialty, and the year of surgery. Multiple regression analysis using pooled and random-effects Tobit models was performed for our panel data. Totally 20,375 surgical procedures performed by 264 surgeons in 42 months were analyzed. The coefficients of experience and the square of experience were not significantly different from zero. The other coefficients were also insignificant. Surgeons’ technical efficiency does not have a concave relationship with experience.
  Citation: Health Services Management Research
  PubDate: 2022-03-25T03:44:28Z
  DOI: 10.1177/09514848221080688
Do policies affect management' Evidence from a survey of clinicians of
the Italian National Health Service
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  Authors: Giovanni Fattore, Dino Numerato, Domenico Salvatore
  Abstract: Health Services Management Research, Ahead of Print.
  Since the early 1990s, New Public Management ideas have deeply influenced reforms and their implementation in the Italian NHS. We compare doctors’ perceptions about management systems in two Italian regions which differ in the dominant values of the regional political environment. In total 220 doctors, orthopaedists and cardiologists, working in public hospitals in Lombardy and Emilia-Romagna, were surveyed. Doctors in Emilia-Romagna perceived their organization to be more managerially driven in comparison to their colleagues in Lombardy. Doctors from Lombardy perceived their professional freedom to be higher, regardless of their specialization. The divergence of professionals’ perception between these two Italian regions, which operate within the same Beveridge model, shows that dominant values of regional politics may have tangible effects on hospital management.
  Citation: Health Services Management Research
  PubDate: 2022-02-23T04:27:24Z
  DOI: 10.1177/09514848211073521
The impact of management practices on relative patient mortality: Evidence
from public hospitals
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  Authors: Reza Salehnejad, Manhal Ali, Nathan C Proudlove
  Abstract: Health Services Management Research, Ahead of Print.
  A small, but growing, body of empirical evidence shows that the material and persistent variation in many aspects of the performance of healthcare organisations can be related to variation in their management practices. This study uses public data on hospital patient mortality outcomes, the Summary Hospital-level Mortality Indicator (SHMI) to extend this programme of research. We assemble a five-year dataset combining SHMI with potential confounding variables for all English NHS non-specialist acute hospital trusts. The large number of providers working within a common system provides a powerful environment for such investigations. We find considerable variation in SHMI between trusts and a high degree of persistence of high- or low performance. This variation is associated with a composite metric for management practices based on the NHS National Staff Survey. We then use a machine learning technique to suggest potential clusters of individual management practices related to patient mortality performance and test some of these using traditional multivariate regression. The results support the hypothesis that such clusters do matter for patient mortality, and so we conclude that any systematic effort at improving patient mortality should consider adopting an optimal cluster of management practices.
  Citation: Health Services Management Research
  PubDate: 2022-02-17T04:13:57Z
  DOI: 10.1177/09514848211068627
A qualitative study on relationships and perceptions between managers and
clinicians and its effect on value-based healthcare within the national
health service in the UK
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  Authors: Sze May Ng
  Abstract: Health Services Management Research, Ahead of Print.
  One of the main drivers for change towards delivering value-based healthcare is to improve clinical and managerial culture and engagement within organisations. The relationships between clinicians and managers in an organisation are often considered to be either an enabler or disabler towards successful engagement to develop strategies towards better value healthcare. Successful engagement is dependent on effective and transformational leadership that can impact on organisational value in healthcare. The aim of this research was to explore the relationships, behaviours and perceptions between managers and clinicians towards value-based healthcare in the National Health Service in the United Kingdom. A qualitative research methodology of semi-structured in-depth interviewing on a sample consisting of hospital consultants, senior managers and board executives from a diverse group were conducted. A thematic analysis was used to analyse the data using a systematic approach. The study findings identified areas of potential barriers to engagement for clinicians and managers which were related to regulatory burden, financial challenges and workforce shortages. Key recommendations on what will be required to improve clinicians and managers engagement and the leadership approaches towards improving value-based healthcare are discussed.
  Citation: Health Services Management Research
  PubDate: 2022-02-09T07:40:47Z
  DOI: 10.1177/09514848211068624
Reducing hospital admissions and transfers to long-term inpatient care: A
systematic literature review
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  Authors: Stephan Herberg, Frank Teuteberg
  Abstract: Health Services Management Research, Ahead of Print.
  Individuals in need of long-term care and their relatives prefer to receive and give care in their domestic environment for as long as possible. Residential long-term care is to be avoided for as long as possible. To achieve this goal, the care setting must be optimally oriented to the needs of the person in need of care. Moreover, relatives who provide care must be professionally supported. The Regional Care Competence Center (ReKo), launched on October 1, 2019, is a quasi-experimental study (two groups and pre-post design), funded by the Innovation Fund. As part of the ReKo project, people in need of care and their relatives are assisted by a case management (CM) system. An independent CM, supported by an IT network that includes the most important service providers, is to establish a comprehensive CM for people in need of care. Based on a literature review, this paper aimed to take a conceptual approach to the ReKo project by drawing on previous research and comparing the findings with the ReKo approach. The review considered CM projects that defined avoidance of hospitalization and/or delay in the transition of care recipients to long-term inpatient care as endpoints. Using PubMed and Google Scholar, the study screened 270 articles, abstracted and quality-assessed data, and included eight randomized clinical trials, two other studies, and seven reviews in the analysis. The review results and ReKo approaches are presented along the dimensions of clinical and medical benefits, community and public health benefits, economic benefits, and political and legislative benefits. CM organizations will continue to be established internationally in aging societies. The questions of improving quality of care, avoiding service costs, and the costs of establishing a CM must be raised, even if clear evidence is difficult to provide.
  Citation: Health Services Management Research
  PubDate: 2022-02-07T10:42:42Z
  DOI: 10.1177/09514848211068620
Volume creates value: The volume–outcome relationship in
Scandinavian obesity surgery
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  Authors: Anna Svarts, Thorell Anders, Mats Engwall
  Abstract: Health Services Management Research, Ahead of Print.
  This study establishes the relationship between surgical volume and cost and quality outcomes, using patient-level clinical data from a national quality registry for bariatric surgery in Sweden. Data include patient characteristics with comorbidities, surgical and follow-up data for patients that underwent gastric bypass or gastric sleeve operations between 2007 and 2016 (52,703 patients in 51 hospitals). The relationships between surgical volume (annual number of bariatric procedures) and several patient-level outcomes were assessed using multilevel, mixed-effect regression models, controlling for patient characteristics and comorbidities. We found that hospitals with higher volumes had lower risk of intraoperative complications as well as complications within 30 days post-surgery (odds ratios per 100 procedures are 0.78 and 0.87, respectively, p
  Citation: Health Services Management Research
  PubDate: 2022-02-07T04:53:44Z
  DOI: 10.1177/09514848211048598
Competitive intelligence: A precursor to a learning health system
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  Authors: H Fred Farley, Shelly Freyn
  Abstract: Health Services Management Research, Ahead of Print.
  Unlike other developed countries, the US healthcare system is largely privatized and highly competitive. This dynamic stifles effective information sharing, while the need for prompt and accurate evidence-based decision making has become crucial. Crises, like the COVID-19 pandemic, elevate the importance of quality decision making and exacerbate issues associated with the lack of a cohesive system to share information. Competitive intelligence (CI) is a discipline that encourages gathering, analyzing, and sharing information throughout a firm in order to develop and sustain competitive advantage. CI could be considered a precursor in establishing a learning organization (LO). Although CI research has focused on its process and value, little is found in the literature on how to integrate CI into an organization; this is particularly true in healthcare. A conceptual model is proposed to build and integrate a CI function and culture within a healthcare organization to encourage effective information sharing and knowledge development. In turn, this can provide a mechanism to create a learning health system (LHS). Although the model was developed specifically for US healthcare, it offers application to healthcare in other countries as well as most any industry.
  Citation: Health Services Management Research
  PubDate: 2022-02-05T04:12:13Z
  DOI: 10.1177/09514848211065470
Analysis of the effect of patients’ health status on efficiency:
Application of data envelopment analysis in healthcare
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  Authors: Tamás Koltai, Rita V. Dénes, Zoltán Dénes
  Abstract: Health Services Management Research, Ahead of Print.
  The effective and efficient operation of public healthcare systems is more and more important as a consequence of the increasing amount of money spent on their operation. For this reason, accurate and science-based efficiency information is needed for managers and healthcare policy makers. The evaluation of the efficiency in this sector is particularly difficult because several measures and indicators are used. Data envelopment analysis (DEA) can provide aggregate and overall measures of efficiency. The purpose of this paper is the examination of the efficiency of in-patient rehabilitation units curing musculoskeletal disorders in Hungary. The research presented focuses on rehabilitation units which attend to patients recovering from stroke or other acquired brain injuries. Output-oriented, slack-based DEA models are applied for the evaluation of in-patient rehabilitation units using data of a national survey. The novelty of the method presented is the consideration of the change in patients' functional status when efficiency is evaluated using DEA.
  Citation: Health Services Management Research
  PubDate: 2022-01-21T09:04:08Z
  DOI: 10.1177/09514848211065464
No health organization or system will ever be better than its people...
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  Authors: Federico Lega
  First page: 57
  Abstract: Health Services Management Research, Ahead of Print.
  
  Citation: Health Services Management Research
  PubDate: 2022-04-13T01:26:22Z
  DOI: 10.1177/09514848221096184