JournalTOCs

Health Care Management Review
Journal Prestige (SJR): 1.244

Citation Impact (citeScore): 2
Number of Followers: 16

Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0361-6274 - ISSN (Online) 1550-5030
Published by LWW Wolters Kluwer

[302 journals]

Publishing in HCMR: What are we looking for in a manuscript'
- Authors: Hearld; Larry R.; Rathert, Cheryl
  Abstract: No abstract available
  PubDate: Thu, 01 Apr 2021 00:00:00 GMT-
Associations between hospital structures, processes and patient
experiences of preparation for discharge in breast cancer centers: A
multilevel analysis
- Authors: Nowak; Marina; Swora, Michael; Karbach, Ute; Pfaff, Holger; Ansmann, Lena
  Abstract: Background Discharge management is a central task in hospital management. Mitchell's quality health outcomes model offers a contextual framework to derive expectations about the relationship between indicators of hospital structures and processes with patient experiences of preparation for discharge.Purpose The aim is to analyze the association between hospital structures and processes with patient experiences of preparation for discharge in breast cancer centers.Methodology The data were collected between February 1 and July 31, 2014–2016, with annual cross-sectional postal surveys on patient experiences of preparation for discharge in breast cancer center hospitals in Germany. These data were combined with secondary data on hospital structures, obtained from structured quality reports 2014 and the accreditation institution certifying breast cancer centers, constituting a hierarchical data structure. A total of 10,750 newly diagnosed breast cancer patients from 67 hospitals were analyzed. Following listwise deletion, 9,762 patients could be included in linear hierarchical regression analyses.Results Patients felt better prepared for discharge in hospitals that communicate the discharge date timely to patients, with good coordinative processes, and which cooperate with two other breast cancer center hospitals. Hospital structures, size, teaching status, and ownership were not associated with the patient experiences of preparation for discharge.Conclusion The results suggest that timely and informative communication, well-organized care processes, and the network structure of centers allow for an improvement of preparation for discharge. Current and future approaches for the improvement of hospital discharge should consider the identified hospital resources.Practice Implications Hospital management should increase the focus on structured communication and coordination processes to improve the discharge process. Cooperating networks should be expanded to increase expertise and resources. Results can be generalized to other care domains with caution. Patients' characteristics should further be assessed in order to use resources efficiently.
  PubDate: Thu, 01 Apr 2021 00:00:00 GMT-
What makes health services usable': Insights from a qualitative study
of caregivers of children with disabilities
- Authors: Hilligoss; Brian; Tanenbaum, Sandra J.; Paul, Marika H.; Ferrari, Renée M.; Song, Paula H.
  Abstract: Background The concept of usability from the field of user-centered design addresses the extent to which a system is easy to use, including under extreme conditions. Apart from applications to technologies, however, little attention has been given to understanding what shapes usability of health services more generally. Health service usability may impact the extent to which patients avail themselves of and benefit from those services.Purpose The aim of the study was to develop the concept of usability as it applies to health services, particularly for a high-need, complex patient population.Approach We conducted interviews and focus groups with 66 caregivers of children with disabilities and analyzed data through inductive coding and constant comparison.Results We find that before health services can be rendered usable for patients with complex health conditions, work is often required to develop trusting relationships with individual providers and to manage time demands and attendant challenges of physical access. In addition, our findings show that actions crucial to receiving benefits from one service often entail difficult tradeoffs either with other services or with other important features in the patient’s life-world. Finally, we propose the concept of configuration to capture the complex interdependent arrangement of connections to multiple health services, often for multiple household members, and other life-world factors (e.g., employment, transportation, living conditions). These configurations are dynamic, fragile, and vulnerable to shocks—events that destabilize them, often negatively impacting the relative usability of services and of the entire configuration. Collectively, these findings illustrate health service usability as a relational, situated, emergent property rather than an inherent feature of the service itself.Practice Implications System-centered design perspectives produce services that are usable for the mythical “ideal” user. To be truly “patient centered,” designs must “decenter” the health service and recognize it as one component of the patient’s life-world configuration.
  PubDate: Thu, 01 Apr 2021 00:00:00 GMT-
Optimizing patient partnership in primary care improvement: A qualitative
study
- Authors: Alidina; Shehnaz; Martelli, Peter F.; J. Singer, Sara; Aveling, Emma-Louise
  Abstract: Background The need to expand and better engage patients in primary care improvement persists.Purpose Recognizing a continuum of forms of engagement, this study focused on identifying lessons for optimizing patient partnerships, wherein engagement is characterized by shared decision-making and practice improvement codesign.Methodology Twenty-three semistructured interviews with providers and patients involved in improvement efforts in seven U.S. primary care practices in the Academic Innovations Collaborative (AIC). The AIC aimed to implement primary care improvement, emphasizing patient engagement in the process. Data were analyzed thematically.Results Sites varied in their achievement of patient partnerships, encountering material, technical, and sociocultural obstacles. Time was a challenge for all sites, as was engaging a diversity of patients. Technical training on improvement processes and shared learning “on the job” were important. External, organizational, and individual-level resources helped overcome sociocultural challenges: The AIC drove provider buy-in, a team-based improvement approach helped shift relationships from providers and recipients toward teammates, and individual qualities and behaviors that flattened hierarchies and strengthened interpersonal relationships further enhanced “teamness.” A key factor influencing progress toward transformative partnerships was a strong shared learning journey, characterized by frequent interactions, proximity to improvement decision-making, and learning together from the “lived experience” of practice improvement. Teams came to value not only patients’ knowledge but also changes wrought by working collaboratively over time.Conclusion Establishing practice improvement partnerships remains challenging, but partnering with patients on improvement journeys offers distinctive gains for high-quality patient-centered care.Practice Implications Engaging diverse patient partners requires significant disruption to organizational norms and routines, and the trend toward team-based primary care offers a fertile context for patient partnerships. Material, technical, and sociocultural resources should be evaluated not only for whether they overcome specific challenges but also for how they enhance the shared learning journey.
  PubDate: Thu, 01 Apr 2021 00:00:00 GMT-
The impact of interpersonal support, supervisory support, and employee
engagement on employee turnover intentions: Differences between
financially distressed and highly financially distressed hospitals
- Authors: Boakye; Kwabena G.; Apenteng, Bettye A.; Hanna, Mark D.; Kimsey, Linda; Mase, William A.; Opoku, Samuel T.; Owens, Charles; Peden, Angela
  Abstract: Background Critical access hospitals (CAHs) are small hospitals in rural communities in the United States. Because of changes in rural population demographics, legacy financial obligations, and/or structural issues in the U.S. health care system, many of these institutions are financially distressed. Indeed, many have closed due to their inability to maintain financial viability, resulting in a health care and economic crisis for their communities. Employee recruitment, retention, and turnover are critical to the performance of these hospitals. There is limited empirical study of the factors that influence turnover in such institutions.Purpose The primary purpose of the study was to study relationships between interpersonal support, supervisory support, employee engagement, and employee turnover intentions in CAHs. A secondary purpose was to study how financial distress affects these relationships.Methodology Based on a survey of CAH employees (n = 218), the article utilizes mediated moderation analysis of a structural equation model.Results Interpersonal support and supervisory support are positively associated with employee engagement, whereas employee engagement mediates the relationships between both interpersonal support and supervisory support and employee turnover intentions. Statistically significant differences are found between these relationships in financially distressed and highly financially distressed institutions.Conclusions Our results are consistent with the social exchange theory upon which our hypotheses and model are built and demonstrate the value of using the degree of organizational financial distress as a contextual variable when studying motivational factors influencing employee turnover intentions.Practical Implications In addition to advancing management theory as applied in the CAH context, our study presents the practical insight that employee perceptions of their employer’s financial condition should be considered when organizations develop employee retention strategies. Specifically, employee engagement strategies appear to be of greater value in the case of highly financially distressed organizations, whereas supervisory support seems more effective in financially distressed organizations.
  PubDate: Thu, 01 Apr 2021 00:00:00 GMT-
Assessing the relationship of the human resource, finance, and information
technology functions on reported performance in hospitals using the Lean
management system
- Authors: Shortell; Stephen M.; Rundall, Thomas G.; Blodgett, Janet C.
  Abstract: Background Given pressures to control costs and improve quality of care, one of the most prevalent transformational performance improvement approaches in health care is Lean management. However, the roles of support functions such as human resource (HR), finance, and information technology (IT) in Lean management and the relationships of these support functions with performance are unknown.Purpose The aim of this study was to examine the relationships between the HR, finance, and IT functions, overall Lean implementation, and self-reported performance improvement in hospitals that have implemented Lean.Methodology/Approach Data from a national survey of Lean in U.S. hospitals (N = 1,222; 847 reported using Lean) were analyzed using multivariable regression and bootstrapped mediation analysis. The extent to which HR, finance, and IT functions support Lean management was measured using indices including six, three, and six items respectively. Lean implementation was measured by the number of units doing Lean (up to 29) and by a four-level self-reported maturity scale. Performance improvement was measured using an index of self-reported achievements (ranging from 0 to 16).Results There were significant positive associations between Lean HR, finance, and IT functions and self-reported performance impact (controlling for organizational and market variables). Tests of mediation indicated that the associations of HR, finance, and IT functions with self-reported performance were significantly mediated by the number of Lean units (mediated proportion ranging from 40% to 73%), and HR function was also mediated by self-reported maturity (61% mediated). There were no moderating effects.Conclusion HR, finance, and IT functions are positively associated with self-reported Lean impact on performance and primarily explained by the overall degree of Lean implementation.Practice Implications Efforts to align HR, finance, and IT functions with overall Lean implementation can help to ensure that frontline caregivers and managers have the data and skills required to meet transformational improvement goals.
  PubDate: Thu, 01 Apr 2021 00:00:00 GMT-
It’s how we communicate! Exploring face-to-face versus electronic
communication networks in multidisciplinary teams
- Authors: Mascia; Daniele; Rinninella, Emanuele; Pennacchio, Nicola Walter; Cerrito, Lucia; Gasbarrini, Antonio
  Abstract: Background Previous research suggests that multidisciplinary team communication networks enhance knowledge exchange, learning, and quality of care in health organizations. However, little is known about team members’ reliance on face-to-face versus electronic-based communication networks for information and knowledge exchange.Purpose The aim of the study was to describe patterns of face-to-face versus electronic-based communication networks in a multidisciplinary team and to explore the relationships between team communication networks and performance, measured as promptness of treatment implementation.Methodology We collected data on work-based communication among members of a multidisciplinary tumor board (MDT) in a large Italian research hospital. A social network survey was administered in 2016 to all board members to gather network data on face-to-face interaction and the use of electronically based communication channels (e-mail, text messages, and WhatsApp) for sharing clinical knowledge. Twenty physicians (71%) completed the survey. Archival data were accessed to obtain detailed information about 222 clinical cases discussed over a 1-year period during weekly MDT meetings. Minutes of board meetings were used to link all discussed cases to team members. We used the multiple regression quadratic assignment procedure (MR-QAP) to study associations between team member characteristics and communication networks. Negative binomial regression was employed to test relationships between team communication networks and performance.Results MDT members relied on different communication channels for knowledge sharing. The geographical proximity of team members positively predicted the frequency of face-to-face interaction. Physicians’ seniority was related to the use of WhatsApp as a communication channel; greater interaction of this type was observed between team members of different seniority. Performance was related positively to face-to-face communication networks but negatively to communication via WhatsApp.Practice Implications Although team communication networks are important for knowledge exchange, health administrators must pay attention to the increasing propensity of team members to rely on electronic-based communication. The use of these easy-to-use tools can hinder the quality of group discussion and debate.
  PubDate: Thu, 01 Apr 2021 00:00:00 GMT-
Are community health centers’ chief executive officers’ compensation
related to clinical performance'
- Authors: Davlyatov; Ganisher; Borkowski, Nancy; Qu, Haiyan; Burke, Darrell; Bronstein, Janet; Brickman, Andrew
  Abstract: Background Most research of chief executive officer (CEO) compensation in the health care industry has been limited to hospitals. This study expands our knowledge of CEO compensation into the nonhospital areas of the industry, specifically community health centers (CHCs). CHCs are safety-net providers that are an integral part of the U.S. health delivery system for medically underserved populations. Since the passage of the Patient Protection and Affordable Care Act, the federal government has created financial incentives for CHCs to improve care through access and quality performance criteria. To promote quality improvement, CEOs need to set their organization’s priorities. One method used to achieve this goal is to tie the CEO’s compensation to the organization’s quality performance. However, there is a gap in our knowledge if CHCs’ CEOs compensation is associated with quality performance outcomes.Purpose The primary aim of this study was to examine the relationship between clinical performance and CEO compensation in CHCs.Methods/Approach Agency, social comparison, and managerial power theories guided this research, which examines the relationship of clinical performance and CEO compensation. Secondary data on Uniform Data System’s CHC clinical performance combined with CEO compensation from Internal Revenue Service Form 990 were analyzed using generalized estimating equations with state and year fixed effects on a national sample of section 330 grant-funded CHCs (N = 984) for the period 2011–2016.Results We found no evidence that clinical performance was associated with CHCs’ CEO compensation. Except for race, all other CEO characteristics were positively associated with CEO compensation and in line with previous research. We found that non-White CEOs were compensated more than White CEOs. In addition, further subanalyses revealed that an increase in the highest paid employees’ compensation was associated with an increase in CEO compensation.Practice Implications The findings of this study can assist Health Resources and Services Administration improve its assessment policies in funding allocation to CHCs, as well as help board members make informed decisions regarding tying CEO compensation to predetermined performance metrics.
  PubDate: Thu, 01 Apr 2021 00:00:00 GMT-
The role of organizational learning and resilience for change in building
quality improvement capacity in primary care
- Authors: Schuttner; Linnaea; Coleman, Katie; Ralston, James; Parchman, Michael
  Abstract: Background The extent that organizational learning and resilience for the change process, that is, adaptive reserve (AR), is a component of building practice capacity for continuous quality improvement (QI) is unknown.Purpose The aim of the study was to examine the association of AR and development of QI capacity.Methodology One hundred forty-two primary care practices were evaluated at baseline and 12 months in a randomized trial to improve care quality. Practice AR was measured by staff survey along with a validated QI capacity assessment (QICA). We assessed the association of baseline QICA with baseline AR and both baseline and change in AR with change in QICA from 0 to 12 months. Effect modification by presence of QI infrastructure in parent organizations and trial arm was examined.Results Mean QICA increased from 6.5 to 8.1 (p < .001), and mean AR increased from 71.8 to 73.9 points (p < .001). At baseline, there was a significant association between AR and QICA scores: The QICA averaged 0.34 points higher (95% CI [0.04, 0.64], p = .03) per 10-point difference in AR. There was a significant association between baseline AR and 12-month QICA—which averaged 0.30 points higher (95% CI [0.02, 0.57], p = .04) per 10 points in baseline AR. There was no association between changes in AR and the QICA from 0 to 12 months and no effect modification by trial arm or external QI infrastructure.Conclusions Baseline AR was positively associated with both baseline and follow-up QI capacity, but there was no association between change in AR and change in the QICA, suggesting AR may be a precondition to growth in QI capacity.Practice Implications Findings suggest that developing AR may be a valuable step prior to undertaking QI-oriented growth, with implications for sequencing of development strategies, including added gain in QI capacity development from building AR prior to engaging in transformation efforts.
  PubDate: Thu, 01 Apr 2021 00:00:00 GMT-
Multilevel analysis exploring the relative importance of workplace
resources in explaining nurses’ workload perceptions: Are we setting the
right focus'
- Authors: Oppel; Eva-Maria; Mohr, David C.
  Abstract: Background Nurses’ workload has become increasingly recognized as an important determinant of nurse turnover and shortage and has been also associated with poorer quality of care. Despite strong evidence that heavy workloads have negative consequences, we still lack a comprehensive understanding of the workplace characteristics that contribute most to improving nurses’ workload, the relative importance of each in doing so, or indeed the workplace characteristics and other factors that drive nurses’ perceptions of their workload.Purpose The aim of this study was to examine workplace resources as antecedents of nurses’ perceptions of their workload and to investigate their relative importance in explaining workload perceptions. We considered workplace resources related to staffing, professional relationships, and technology.Methodology The study sample comprised nurse-reported and administrative data from U.S. Veterans Health Administration hospitals between 2014 and 2017. Our multilevel analyses are based on data from 20,330 nurses working in 273 work groups at 123 hospitals. We developed and empirically tested a theoretical model using multilevel mixed-effects linear regression. The relative importance of workplace resources was assessed by dominance analysis.Results Staffing levels, relational climate, and information technology were significantly associated with nurses’ workload perceptions. Dominance analysis indicated that relational resources are the most important measure in explaining nurses’ workload perceptions.Practice Implications This is the first study to examine the relative importance of workplace resources in explaining nurses’ perceptions of their workload. Our results suggest that much might be gained by investing in interventions to boost relational resources. In turn, these findings could lead to more targeted, effective, and resource efficient interventions to improve nurses’ workload.
  PubDate: Thu, 01 Apr 2021 00:00:00 GMT-