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Shu S, Zhu J, Shi W, Chuang YC, Liu C, Lu H. Identifying key mental health and improvement factors in hospital administrators working from home using a DEMATEL-based network analysis model. Front Public Health 2024; 12:1287911. [PMID: 38566796 PMCID: PMC10985262 DOI: 10.3389/fpubh.2024.1287911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose To identify the key mental health and improvement factors in hospital administrators working from home during COVID-19 normalization prevention and control. Methods The survey was conducted from May to June 2023, and the practical experiences of 33 hospital administrators were collected using purposive sampling. The study examined a set of mental health factor systems. The relationship structure between the factors was constructed using the Decision-making Trial and Evaluation Laboratory (DEMATEL) method. Finally, the structure was transformed using the influence weight of each factor via the DEMATEL-based Analytic Network Process. Results Regarding influence weight, the key mental health factors of hospital administrators are mainly "lack of coordination," "time management issues," and "work-life imbalances." The influential network relation map shows that improvements can be made by addressing "improper guidelines," "laziness due to being at home," and "job insecurity" because they are the main sources of influence. The reliability level of the results for the network structure and weight was 98.79% (i.e., the gap was 1.12% < 5%). Conclusion The network analysis model based on DEMATEL proposed in this study can evaluate the mental health factors of hospital administrators during the pandemic period from a multidimensional and multidirectional perspective and may help improve mental health problems and provide suggestions for hospital administrators.
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Affiliation(s)
- Sheng Shu
- Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Jie Zhu
- Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Wenqing Shi
- Business College, Taizhou University, Taizhou, Zhejiang, China
| | - Yen-Ching Chuang
- Business College, Taizhou University, Taizhou, Zhejiang, China
- Institute of Public Health and Emergency Management, Taizhou University, Taizhou, Zhejiang, China
- Key Laboratory of Evidence-Based Radiology of Taizhou, Linhai, Zhejiang, China
| | - Chao Liu
- The Second Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
- Institute for Hospital Management, Tsinghua University, Shenzhen International Graduate School (SIGS), Shenzhen, Guangdong, China
| | - Hongsheng Lu
- Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
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Pierre-Wright MJ, Mathey L, Risser HJ. Can Telehealth Provide Timely and Equitable Quality Medical Forensic Services? Perspectives of Illinois Hospital Administrators. J Forensic Nurs 2023; 19:223-230. [PMID: 37318268 DOI: 10.1097/jfn.0000000000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Research has shown the viability of telehealth consultations to provide medical forensic services, particularly in areas with a dearth of medical examiners. This study examined Illinois hospital administrators' willingness to utilize telehealth to meet new requirements under Illinois Public Act 100-0775, which intends to increase timely access to quality forensic examiners. Consequently, as of March 2021, roughly half of Illinois hospitals unable to meet these requirements have opted not to treat some or all patients presenting for medical forensic services of sexual assault. METHODS We surveyed and conducted in-depth interviews (between October 2020 and April 2021) with 65 hospital administrators responsible for implementing Illinois Public Act 100-0775. Descriptive statistical analysis was used to analyze survey results. RESULTS Our study found limited staffing resources and difficulties educating and training new forensic medical examiners were the major barriers to providing acute medical forensic services. The overwhelming majority of respondents (95%) saw opportunities to use telehealth across all aspects of the medical forsenic evaluation. Barriers to implementing telehealth included perceived patient discomfort with telehealth technology and current legislative restrictions. DISCUSSION Legislative efforts to mandate timely access to qualified medical forensic examiners can unintentionally exacerbate disparities in access to care. Illinois hospital administrators are receptive to utilizing telehealth to improve access to forensic examiners, particularly in lower-resourced hospitals. CONCLUSION One method for responding to staffing shortages and improving equitable access to forensic sexual assault services may include implementing networks of qualified forensic examiners that support on-site clinicians in lower-resourced areas via telehealth.
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Affiliation(s)
| | - Lisa Mathey
- Ann and Robert H. Lurie Children's Hospital of Chicago
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Begley P. Making a "Happy Hospital": Emotional Investment and Professional Identity Amongst Anglo-American Hospital Administrators. J Hist Med Allied Sci 2023; 78:352-364. [PMID: 37210468 PMCID: PMC10518051 DOI: 10.1093/jhmas/jrad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This article examines the place of emotion in modern hospital administration and the relationship between professional identities and emotional landscapes in the healthcare field. The focus is a broad emotional and philosophical investment that many administrators made in their work. In the United States and then in Britain, amidst rapid change in the practice and provision of health services, a new sense of professional identity emerged. This was often underpinned by a kind of emotional investment, one which had to be constructed and cultivated. Here formal training and education, collective identities, and a shared understanding of the kind of personal qualities required were important. The extent to which developments in Britain were influenced by best practice in the US is also striking. This process might best be understood as the further drawing out of established beliefs and ways of working rather than an abstract transfer of ideas and practices across the Atlantic, but there was a distinct Anglo-American dimension to the development of hospital administration.
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Ampomah IG, Malau-Aduli BS, Seidu AA, Malau-Aduli AEO, Emeto TI. Perceptions and Experiences of Orthodox Health Practitioners and Hospital Administrators towards Integrating Traditional Medicine into the Ghanaian Health System. Int J Environ Res Public Health 2021; 18:11200. [PMID: 34769719 PMCID: PMC8582872 DOI: 10.3390/ijerph182111200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/13/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022]
Abstract
The government of Ghana has been piloting traditional medicine (TM) integration in 17 health facilities across the country. However, the nature of current practice of integrated healthcare has not been thoroughly explored. This paper sought to explore the experiences and recommendations of orthodox health practitioners and hospital administrators in the Ashanti region regarding the practice of integrated healthcare in Ghana. The study adopted a qualitative, phenomenological approach involving 22 interviews. Purposive sampling technique was used in selecting study participants. Framework analysis was used to draw on the experiences of participants relating to TM integration. Participants were knowledgeable about the existence of integrated health facilities and stated that TM integration has created options in health services. However, participants deemed the integrated system ineffective and attributed the inefficiency to poor processing and certification of TM products, opposition of medical doctors to TM usage, absence of a protocol to guide the integration process, and inadequate publicity. Professional training of TM practitioners and inclusion of TM in medical school curriculum could improve collaboration between the health practitioners. Future research should focus on assessing the opinions and involvements of TM practitioners regarding the integration of traditional therapies into national health systems.
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Affiliation(s)
- Irene G. Ampomah
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia; (I.G.A.); (A.-A.S.); (A.E.O.M.-A.)
- Department of Population and Health, University of Cape Coast, Cape Coast P.O. Box UC 182, Ghana
| | - Bunmi S. Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville 4811, Australia;
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia; (I.G.A.); (A.-A.S.); (A.E.O.M.-A.)
- Department of Population and Health, University of Cape Coast, Cape Coast P.O. Box UC 182, Ghana
| | - Aduli E. O. Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia; (I.G.A.); (A.-A.S.); (A.E.O.M.-A.)
| | - Theophilus I. Emeto
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia; (I.G.A.); (A.-A.S.); (A.E.O.M.-A.)
- World Health Organization Collaborating Centre for Vector-Borne and Neglected Tropical Diseases, James Cook University, Townsville 4811, Australia
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Gualandi R, Masella C, Viglione D, Tartaglini D. Challenges and potential improvements in hospital patient flow: the contribution of frontline, top and middle management professionals. J Health Organ Manag 2021; ahead-of-print. [PMID: 32978906 DOI: 10.1108/jhom-11-2019-0316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE This study aims to describe and understand the contributions of frontline, middle and top management healthcare professionals in detecting areas of potential improvement in hospital patient flow and proposing solutions. DESIGN/METHODOLOGY/APPROACH This is a qualitative interview study. Semistructured interviews were conducted with 22 professionals in the orthopedic department of a 250-bed academic teaching hospital. Data were analyzed through a thematic framework analytical approach by using an a priori framework. The Consolidated Criteria for Reporting Qualitative (COREQ) checklist for qualitative studies was followed. FINDINGS When dealing with a hospital-wide process, the involvement of all professionals, including nonhealth professionals, can reveal priority areas for improvement and for services integration. The improvements identified by the professionals largely focus on covering major gaps detected in the technical and administrative quality. RESEARCH LIMITATIONS/IMPLICATIONS This study focused on the professional viewpoint and the connections between services and further studies should explore the role of patient involvement. The study design could limit the generalizability of findings. PRACTICAL IMPLICATIONS Improving high-quality, efficient hospital patient flow cannot be accomplished without learning the perspective of the healthcare professionals on the process of service delivery. ORIGINALITY/VALUE Few qualitative studies explore professionals' perspectives on patient needs in hospital flow management. This study provides insights into what produces value for the patient within a complex process by analyzing the contribution of professionals from their particular role in the organization.
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Martinez-Hollingsworth A, Kim L, Richardson TG, Angulo M, Liu R, Friedman T, Choi K. Supporting "Bleeders" and "Billers": How Safety-Net Administrators Mitigate Provider Burnout During the COVID-19 Pandemic and Beyond. J Ambul Care Manage 2021; 44:172-183. [PMID: 34016846 PMCID: PMC8174579 DOI: 10.1097/jac.0000000000000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Organizational factors impacting burnout have been underexplored among providers in low-income, minority-serving, safety-net settings. Our team interviewed 14 health care administrators, serving as key decision makers in Federally Qualified Health Center primary care clinics. Using a semistructured interview guide, we explored burnout mitigation strategies and elements of organizational culture and practice. Transcribed interviews were coded and analyzed using the Braun and Clark (2006) Thematic Analysis method. Mission-Driven Ethos to Mitigate Provider Burnout emerged as the primary theme with 2 categories: (1) Promoting the Mission: "Bleeders" and (2) Competing Priorities: "Billers." These categories represent various properties and reflect administrators' use of organizational mission statement as a driver of staff recruitment, training, retention, and stratification. Data collection occurred before and during the COVID-19 global pandemic, as such additional themes associated with administrative behaviors during a prolonged, clinical crisis provide insight into possible strategies that may mitigate burnout in this setting.
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Affiliation(s)
- Adrienne Martinez-Hollingsworth
- National Clinician Scholars Program, University of California at Los Angeles (Drs Martinez-Hollingsworth and Choi); Cedars Sinai, Los Angeles, California (Dr Kim); Graduate School of Education and Psychology, Howard Hughes Center, Pepperdine University, Los Angeles, California (Ms Richardson); Medical Education Department, AltaMed Institute for Health Equity, Los Angeles, California (Drs Angulo and Liu); Department of Internal Medicine and Division of Endocrinology, Metabolism and Molecular Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, California (Dr Friedman); and Department of Research & Evaluation, Kaiser Permanente Southern California Pasadena, California, and School of Nursing, University of California at Los Angeles (Dr Choi)
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Jia Z, Wen X, Lin X, Lin Y, Li X, Li G, Yuan Z. Working Hours, Job Burnout, and Subjective Well-Being of Hospital Administrators: An Empirical Study Based on China's Tertiary Public Hospitals. Int J Environ Res Public Health 2021; 18:ijerph18094539. [PMID: 33922884 PMCID: PMC8123124 DOI: 10.3390/ijerph18094539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 12/18/2022]
Abstract
(1) Purpose: To analyze the role of job burnout in connection with working hours and subjective well-being (SWB) among hospital administrators in China’s tertiary public hospitals. (2) Methods: A multi-stage, stratified, cluster random sampling method was used to select 443 hospital administrators in six tertiary public hospitals for study. The data were collected and analyzed using the working hours measuring scale, Maslach burnout, and the subjective well-being schedule. Pearson correlation, structural equation model, and bootstrap tests were conducted to examine the association between job burnout, working hours, and SWB. (3) Results: Among the 443 respondents, 330 worked more than 8 h per day on average (76.2%), 81 had the longest continuous working time more than 16 h (18.7%), and 362 worked overtime on weekends (82.2%). The prevalence of job burnout in hospital administrators was 62.8%, among which, 59.8% have mild burnout and 3.00% have severe burnout. In the dimension of emotional exhaustion, depersonalization, and reduced personal achievement, the proportion of people in high burnout was 21.0% (91/433), 15.0% (65/433), and 45.3% (196/433), respectively. Job burnout has a mediating effect between working hours and SWB, which accounted for 95.5% of the total effect. (4) Conclusion: Plagued by long working hours and severe job burnout, the hospital administrators in China’s tertiary public hospitals may have low SWB. Working hours have a negative direct impact on job burnout and SWB, and an indirect impact on SWB through job burnout as a mediator. Targeted strategies should be taken to adjust working hours to promote the physical and mental health of hospital administrators.
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Affiliation(s)
- Zhihui Jia
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China; (Z.J.); (X.L.); (Y.L.)
| | - Xiaotong Wen
- School of Health Sciences, Global Health Institute, Wuhan University, 115 Donghu Road, Wuhan 430071, China; (X.W.); (X.L.)
| | - Xiaohui Lin
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China; (Z.J.); (X.L.); (Y.L.)
| | - Yixiang Lin
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China; (Z.J.); (X.L.); (Y.L.)
| | - Xuyang Li
- School of Health Sciences, Global Health Institute, Wuhan University, 115 Donghu Road, Wuhan 430071, China; (X.W.); (X.L.)
| | - Guoqing Li
- The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
- Correspondence: (G.L.); (Z.Y.); Tel.: +86-150-7080-3840 (G.L.); +86-135-7693-5811 (Z.Y.)
| | - Zhaokang Yuan
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, China; (Z.J.); (X.L.); (Y.L.)
- Correspondence: (G.L.); (Z.Y.); Tel.: +86-150-7080-3840 (G.L.); +86-135-7693-5811 (Z.Y.)
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Affiliation(s)
- Skip Morelock
- Skip Morelock is an associate clinical professor of nursing at Collin College in McKinney, Tex
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Abstract
OBJECTIVES Clinicians are facing increasing demands on their time, exacerbated by fiscal constraints and increasing patient complexity. Volunteers are an essential part of the many healthcare systems, and are one resource to support improved patient experience and a mechanism through which to address unmet needs. Hospitals rely on volunteers for a variety of tasks and services, but there are varying perceptions about volunteers' place within the healthcare team. This study aimed to understand the role of volunteers in stroke rehabilitation, as well as the barriers to volunteer engagement. DESIGN A qualitative case study was conducted to understand the engagement of volunteers in stroke rehabilitation services within a complex rehabilitation and continuing care hospital in Ontario, Canada. PARTICIPANTS 28 clinicians, 10 hospital administrators and 22 volunteers participated in concurrent focus groups and interviews. Organisational documents pertaining to volunteer management were retrieved and analysed. RESULTS While there was support for volunteer engagement, with a wide range of potential activities for volunteers, several barriers to volunteer engagement were identified. These barriers relate to paid workforce/unionisation, patient safety and confidentiality, volunteer attendance and lack of collaboration between clinical and volunteer resource departments. CONCLUSIONS An interprofessional approach, specifically emphasising and addressing issues related to key role clarity, may mediate these barriers. Clarity regarding the role of volunteers in hospital settings could support workforce planning and administration.
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Affiliation(s)
- Michelle L A Nelson
- Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Thombs
- Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Juliana Yi
- Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
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Abstract
OBJECTIVES This study investigates perceived barriers towards the implementation of multiprofessional team briefings (MPTB) in operating theatres, as well as ways to overcome these perceived barriers. Previous research shows that MPTB can enhance teamwork and communication, but are underused in operating theatres. By adopting a multilevel systems perspective, this study examines perceived barriers and solutions for MPTB implementation. DESIGN Participants completed open-ended survey questions. Responses were coded via qualitative content analysis. The analysis focused on themes in the responses and the systems level at which each barrier and solution operates. SETTING Four tertiary hospitals in Australia. PARTICIPANTS 103 operating theatre staff, including nurses, surgeons, anaesthetists, technicians and administrators. RESULTS Participants identified barriers and solutions at the organisational (15.81% of barriers; 74.10% of solutions), work group (61.39% of barriers; 25.09% of solutions) and individual level (22.33% of barriers; 0% of solutions). Of all the perceived barriers to MPTB occurrence, a key one is getting everyone into the room at the same time . Matching of perceived barriers and solutions shows that higher systems-level solutions can address lower level barriers, thereby showing the relevance of implementing such wider reaching solutions to MPTB occurrence (including work practices at occupational level and above) as well as addressing more local issues. CONCLUSIONS Successful MPTB implementation requires changes at various systems levels. Practitioners can strategically prepare and plan for systems-based strategies to overcome barriers to MPTB implementation. Future research can build on this study's findings by directly examining higher systems-level barriers and solutions via detailed case analyses.
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Affiliation(s)
- Laura Fruhen
- School of Psychological Science, The University of Western Australia, Crawley, Western Australia, Australia
| | | | - Sharon K Parker
- Future of Work Institute, Curtin University, Perth, Western Australia, Australia
| | - Yee Leung
- Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Adrian F S Flemming
- Faculty of Health and Medical Sciences, Surgery, The University of Western Australia, Crawley, Western Australia, Australia
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Liu Y, Hebert LE, Hasselbacher LA, Stulberg DB. "Am I Going to Be in Trouble for What I'm Doing?": Providing Contraceptive Care in Religious Health Care Systems. Perspect Sex Reprod Health 2019; 51:193-199. [PMID: 31802624 DOI: 10.1363/psrh.12125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 06/18/2019] [Accepted: 09/04/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Catholic systems control a growing share of health care in the United States. Because patients seeking contraceptives in Catholic facilities face doctrinal restrictions that may affect access to and quality of care, it is important to understand whether and how providers work within and around institutional policies regarding contraception. METHODS In 2016-2018, in-depth interviews were conducted in Illinois with 28 key informants-including providers (obstetrician-gynecologists, other physicians, nurse-midwives) and nonclinical professionals (ethicists, administrators, chaplains)-who had experience in secular, Protestant or Catholic health care systems. Interviews addressed multiple aspects of reproductive care and hospital and system policy. A thematic content approach was used to identify themes related to participants' experiences with and perspectives on contraceptive care. RESULTS While respondents working in secular and Protestant systems reported few limitations on contraceptive care, those working in Catholic systems reported multiple barriers. Providers who had worked in Catholic systems described variable institutional policies and enforcement practices, ranging from verbal admonishments to lease agreements prohibiting contraceptive provision in secular clinics on church-owned land. Despite these restrictions, patients' needs motivated many providers to utilize work-arounds; some providers reported having been pressured or directly instructed to document false diagnoses in patients' medical records. Interviewees described how these obstacles burdened patients, especially those with social and financial constraints, and resulted in delayed or lower quality care. CONCLUSIONS Providers working in Catholic hospitals are limited in their ability to serve women of reproductive age. Work-arounds intended to circumvent restrictions may inadvertently stigmatize contraception and negatively affect patient care.
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Affiliation(s)
- Yuan Liu
- Icahn School of Medicine, Mount Sinai Hospital, New York
| | - Luciana E Hebert
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle
| | - Lee A Hasselbacher
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health, The University of Chicago, Chicago
| | - Debra B Stulberg
- Department of Family Medicine, The University of Chicago, Chicago
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White AA, McIlraith T, Chivu AM, Cyrus R, Cockerham C, Vora H, Vulgamore P. Collaboration, Not Calculation: A Qualitative Study of How Hospital Executives Value Hospital Medicine Groups. J Hosp Med 2019; 14:662-667. [PMID: 31339842 DOI: 10.12788/jhm.3249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hospital medicine groups (HMGs) typically receive financial support from hospitals. Determining a fair amount of financial support requires negotiation between HMG and hospital leaders. As the hospital medicine care model evolves, hospital leaders may regularly challenge HMGs to demonstrate the financial value of activities that do not directly generate revenue. OBJECTIVE To describe current attitudes and beliefs of hospital executives regarding the value of contributions made by HMGs. DESIGN Thematic content analysis of key informant interviews. PARTICIPANTS Twenty-four healthcare institutional leaders, including hospital presidents, chief medical officers, chief executive officers, and chief financial officers. Participants comprised a diverse sample from all regions in the United States, including rural, suburban, and urban locations, and academic and nonacademic institutions. RESULTS Executives highly valued hospitalist groups that demonstrate alignment with hospital priorities, and often used this concept to summarize the HMG's success across several value domains. Most executives evaluated only a few key HMG metrics, but almost no executives reported calculating the HMG return on investment by summing pertinent quantitative contributions. Respondents described an evolving concept of hospitalist value and believed that HMGs generate substantial value that is difficult to measure financially. CONCLUSIONS Hospital executives appear to make financial support decisions based on a small number of basic financial or care quality metrics combined with a subjective assessment of the HMG's broader alignment with hospital priorities. HMG leaders should focus on building relationships that facilitate dialog about alignment with hospital needs.
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Affiliation(s)
- Andrew A White
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | | | - Anton M Chivu
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Rachel Cyrus
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Hardik Vora
- Hospital Medicine Division, Riverside Regional Medical Center, Newport News, Virginia
| | - Patrick Vulgamore
- Temple Center for Population Health, Temple University Health System, Philadelphia, Pennsylvania
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Dew R, Wilkes S. Evaluation of the referral management systems (RMS) used by GP practices in Northumberland: a qualitative study. BMJ Open 2019; 9:e028436. [PMID: 31289080 PMCID: PMC6629383 DOI: 10.1136/bmjopen-2018-028436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Exploring the views of stakeholders to the referral management systems (RMS) used by GP practices in Northumberland, UK to evaluate its perceived effectiveness. DESIGN This was an in-depth qualitative semi-structured interview study. PARTICIPANTS AND SETTING 32 participants (GPs, hospital consultants, referral support, hospital managers, Clinical Commissioning Group manager) in the North East of England, UK. METHOD Interviews using a grounded theory approach and thematic analysis. RESULTS The main benefit of RMS mentioned by participants was that it allowed for unnecessary referrals to be vetted by consultants, and helps ensure patients are sent to the correct clinic. Generally, the consultants in our study felt that RMS did not significantly help them reject referrals. Some GPs experienced that RMS undermined GP autonomy and did not help when they had exhausted their abilities to manage a patient in primary care, and it was suggested that in some cases RMS may delay rather than prevent a referral. The main perceived disadvantage of RMS was the additional workload for GPs and consultants, and RMS was felt to be a barrier to commutation between GPs and consultants. Frustration with the system design and lack of knowledge of its cost-effectiveness were articulated. CONCLUSION Although RMS was reported to reduce some unnecessary referrals, the effect of referral delay and rejection is unknown. Although there were some positive attributes described, RMS was mostly received negatively by the stakeholders.
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Affiliation(s)
- Rosie Dew
- School of Medicine, University of Sunderland, Sunderland, UK
| | - Scott Wilkes
- School of Medicine, University of Sunderland, Sunderland, UK
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Abstract
PURPOSE The purpose of this paper is to give a comprehensive and updated analysis of the available academic literature (2000-2016) on management and reforms in the Nordic hospital landscape. DESIGN/METHODOLOGY/APPROACH A systematic literature review was conducted by searching articles in Scopus database, as well as applicable journals. FINDINGS The vast majority of the Nordic articles are relatively coherent on the following: first, the reforms have created a change in the manager role or rather there are new expectations about the content of the manager role. Second, the reforms entail tension between profession and administration. Doctors who are managers identify themselves primarily as doctors, implicating that the medical logic has not competed out by an administrative logic. Third, the reforms have brought new opportunities for nurses. Still, nurse managers perceive tension between the profession and administration. Fourth, new public management (NPM) is often the framework or background for understanding change in hospitals or manager roles in the articles. Fifth, the majority of the articles are focusing on management as a general key concept. RESEARCH LIMITATIONS/IMPLICATIONS The search was limited to the period 2000-2016 and have only included articles published in English. There are several limitations around these choices: first, research published in a language other than English (i.e. Norwegian, Swedish, Finnish or Danish) are excluded. Second, it may take years before consequences of hospital reforms have impact on management and manager roles. Some of the articles are published relatively shortly after the implementation of the reform. Third, many factors in a reform have impact on management or manager roles, thus it is challenging to give simple explanations. PRACTICAL IMPLICATIONS The authors would welcome a more pluralistic approach, and contributions that are not quite so busy describing and criticizing the NPMization of hospitals and management. In particular, the authors look forward to more research on how other reform trends, such as NPG, affect management in hospitals. ORIGINALITY/VALUE This review summarizes the literature on how academic literature (2000-2016) - in a Nordic reform context - has dealt with management in hospitals. The study reflects upon the academic literature per se. There are tendencies to explore reforms and management with some conceptual equivalence.
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Affiliation(s)
- Ralf Kirchhoff
- Department of Health Sciences Ålesund, Norwegian University of Science and Technology , Trondheim, Norway
| | - Erlend Vik
- Faculty of Business Administration and Social Science, Hogskolen i Molde, Molde, Norway
| | - Turid Aarseth
- Faculty of Business Administration and Social Science, Hogskolen i Molde, Molde, Norway
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Al Knawy BA, Al-Kadri HMF, Elbarbary M, Arabi Y, Balkhy HH, Clark A. Perceptions of postoutbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study. BMJ Open 2019; 9:e017476. [PMID: 31061009 PMCID: PMC6502063 DOI: 10.1136/bmjopen-2017-017476] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES This study examines perceptions of the operational and organisational management of a major outbreak of Middle East Respiratory Syndrome (MERS) caused by a novel coronavirus (MERS-CoV) in the Kingdom of Saudi Arabia (KSA). Perspectives were sought from key decision-makers and clinical staff about the factors perceived to promote and inhibit effective and rapid control of the outbreak. SETTING A large teaching tertiary healthcare centre in KSA; the outbreak lasted 6 weeks from June 2015. PARTICIPANTS Data were collected via individual and focus group interviews with 28 key informant participants (9 management decision-makers and 19 frontline healthcare workers). DESIGN We used qualitative methods of process evaluation to examine perceptions of the outbreak and the factors contributing to, or detracting from successful management. Data were analysed using qualitative thematic content analysis. RESULTS Five themes and 15 subthemes were found. The themes were related to: (1) the high stress of the outbreak, (2) factors perceived to contribute to outbreak occurrence, (3) factors perceived to contribute to success of outbreak control, (4) factors inhibiting outbreak control and (5) long-term institutional gains in response to the outbreak management. CONCLUSION Management of the MERS-CoV outbreak at King Abdulaziz Medical City-Riyadh was widely recognised by staff as a serious outbreak of local and national significance. While the outbreak was controlled successfully in 6 weeks, progress in management was inhibited by a lack of institutional readiness to implement infection control (IC) measures and reduce patient flow, low staff morale and high anxiety. Effective management was promoted by greater involvement of all staff in sharing learning and knowledge of the outbreak, developing trust and teamwork and harnessing collective leadership. Future major IC crises could be improved via measures to strengthen these areas, better coordination of media management and proactive staff counselling and support.
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Affiliation(s)
| | - Hanan M F Al-Kadri
- College of Medicine, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mahmoud Elbarbary
- College of Public Health, King Abdulla International Research Center and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yaseen Arabi
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hanan H Balkhy
- Department of Pediatrics, King Abdullah International Medical Research Centre and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Alex Clark
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Eshete MT, Baeumler PI, Siebeck M, Tesfaye M, Wonde D, Haileamlak A, Michael GG, Ayele Y, Irnich D. The views of patients, healthcare professionals and hospital officials on barriers to and facilitators of quality pain management in Ethiopian hospitals: A qualitative study. PLoS One 2019; 14:e0213644. [PMID: 30870467 PMCID: PMC6417681 DOI: 10.1371/journal.pone.0213644] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 02/26/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Postoperative pain remains a challenge in the developed world, but the consequences of inadequately treated postoperative pain are particularly severe in low- and middle-income countries. Since 2011, reports have drawn attention to the poor quality of postoperative pain management in Ethiopia; however, our multicenter qualitative study was the first to attempt to understand the factors that are barriers to and facilitators of quality pain managment in the country. To this aim, the study explored the perspectives of patients, healthcare professionals, and hospital officials. We expected that the results of this study would inform strategies to improve the provision of quality pain management in Ethiopia and perhaps even in other low- and middle-income countries. METHODS This study used a qualitative, descriptive approach in which nine healthcare professionals, nine patients, and six hospital officials (i.e. executives in a managerial or leadership position in administration, nursing, or education) participated in face-to-face, semi-structured interviews. Thematic data analysis was conducted, and patterns were explained with the help of a theoretical framework. FINDINGS The barriers identified ranged from healthcare professionals' lack of empathy to a positive social appraisal of patients' ability to cope with pain. They also included a lack of emphasis on pain and its management during early medical education, together with the absence of available resources. Enhancing the ability of healthcare professionals to create favorable rapport with patients and increasing the cultural competence of professionals are essential ingredients of future pain education interventions. CONCLUSIONS Barriers to and facilitators of postoperative pain management do not exist independently but are reciprocally linked. This finding calls for holistic and inclusive interventions targeting healthcare professionals, patients, and hospital officials. The current situation is unlikely to improve if only healthcare professionals are educated about pain physiology, pharmacology, and management. Patients should also be educated, and the hospital environment should be modified to provide high-quality postoperative pain management.
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Affiliation(s)
- Million Tesfaye Eshete
- Department of Anesthesiology, Institute of Health, Faculty of Medicine, Jimma University, Jimma, Ethiopia
- Centre for International Health, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Petra I. Baeumler
- Multidisciplinary Pain Center, Department of Anaesthesiology, University Hospital Ludwig Maximilians University Munich, Munich, Germany
| | - Matthias Siebeck
- Centre for International Health, Ludwig-Maximilians-Universität Munich, Munich, Germany
- Department of General, Visceral, Vascular and Transplantation Surgery, Hospital of the University of Munich (LMU), Munich, Germany
| | - Markos Tesfaye
- Department of Psychiatry, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Dereje Wonde
- Department of Sociology, College of Social Sciences and Humanity, Jimma, University, Ethiopia
| | - Abraham Haileamlak
- Department of Pediatrics and Child Health, Institute of Health, Faculty of Medicine, Jimma University, Jimma, Ethiopia
| | - Girma G. Michael
- Department of Anesthesiology, Institute of Health, Faculty of Medicine, Jimma University, Jimma, Ethiopia
| | - Yemane Ayele
- Department of Anesthesiology, Institute of Health, Faculty of Medicine, Jimma University, Jimma, Ethiopia
| | - Dominik Irnich
- Multidisciplinary Pain Center, Department of Anaesthesiology, University Hospital Ludwig Maximilians University Munich, Munich, Germany
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17
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Anderson JR, Chung TDY, Clark L, Weis JA, Danielsen AJ, Khosla S, Gores GJ, Badley AD. Translation to Practice: Accelerating the Cycle of Innovation to Impact. Mayo Clin Proc 2019; 94:490-499. [PMID: 30738605 PMCID: PMC6853057 DOI: 10.1016/j.mayocp.2018.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 06/04/2018] [Accepted: 08/14/2018] [Indexed: 10/27/2022]
Abstract
The Office of Translation to Practice (OTP) is housed in the Center for Clinical and Translational Sciences at Mayo Clinic. Established in 2015, the office was tasked with developing and managing novel tools, mechanisms, and processes to facilitate and accelerate the translation of products, such as drugs, biological agents, and medical devices, into practice. Since its inception, the OTP is credited with creating valuable services through several strategic alliances and active scientific and project management involvement. The OTP continues to move forward to assist Mayo Clinic physicians and scientists to interact effectively with internal and external collaborators to advance translational projects that will benefit patients. Best practices, innovations, and nascent successes of the OTP are presented and discussed herein.
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Affiliation(s)
- Jeff R Anderson
- Office of Translation to Practice, Mayo Clinic, Rochester, MN; Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN
| | - Thomas D Y Chung
- Translational Programs Outreach, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA
| | | | | | | | - Sundeep Khosla
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN
| | | | - Andrew D Badley
- Office of Translation to Practice, Mayo Clinic, Rochester, MN; Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN; Research Administration; Department of Medicine, Mayo Clinic, Rochester, MN.
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Guidry-Grimes L, Warren M, Lipman HI, Kent K, Krishnamurthy KB, Davis AM, May T, Jiro MC, Jankowski J. Clarifying a Clinical Ethics Service's Value, the Visible and the Hidden. J Clin Ethics 2019; 30:251-261. [PMID: 31573970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Our aim in this article is to define the difficulties that clinical ethics services encounter when they are asked to demonstrate the value a clinical ethics service (CES) could and should have for an institution and those it serves. The topic emerged out of numerous related presentations at the Un-Conference hosted by the Cleveland Clinic in August 2018 that identified challenges of articulating the value of clinical ethics work for hospital administrators. After a review these talks, it was apparent that the field of clinical ethics may be at a crisis of sorts due to increased pressure to provide explicit measures to healthcare institutions to concretely demonstrate that CESs make a valuable difference in healthcare delivery. In this article we grapple with how to satisfy the need for demonstrable value in a field in which metrics alone may not capture the scope of clinical ethics practice. We suggest that capturing the value of a CES has been difficult because the benefits of ethics consultation may be overt or attributable to the CES, but are often hidden due to the systems-level and process-oriented nature of clinical ethics work. Part of the difficulty in demonstrating the value of CESs is capturing and conveying all of the ways the integration of a CES throughout an institution positively affects patients, families, visitors, healthcare professionals, administrators, and the institution itself. Our aim is to (1) elucidate the multifaceted value added by a CES, including value that tends to be hidden and (2) suggest how to demonstrate value to others in a way that is not simplistic or reductionistic.
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Affiliation(s)
- Laura Guidry-Grimes
- Assistant Professor of Medical Humanities and Bioethics at the University of Arkansas for Medical Sciences in Little Rock, Arkansas, and Affiliate Faculty at the Center for Health Literacy in Little Rock, Arkansas USA.
| | - Marika Warren
- Network Ethicist at Nova Scotia Health Ethics Network and an Assistant Professor in the Dalhousie University Department of Bioethics in Dalhousie, Nova Scotia, Canada
| | - Hannah I Lipman
- Director of Bioethics at Hackensack University Medical Center and Associate Professor of Medicine at Hackensack Meridian School of Medicine at Seton Hall in Hackensack, New Jersey USA. Hannah.Lipman@Hackensack Meridian.org
| | - Kelly Kent
- Cleveland Fellow in Advanced Bioethics at the Cleveland Clinic in Cleveland, Ohio USA.
| | - Kaarkuzhali Babu Krishnamurthy
- Assistant Professor in Neurology at Harvard Medical School in Boston, Massachusetts, and Chair of the Ethics Committee at St. Elizabeth's Medical Center in Brighton, Massachusetts USA.
| | - Arlene M Davis
- Director of the Clinical Ethics Service at UNC Hospitals, and Associate Professor of Social Medicine at the UNC School of Medicine in Chapel Hill, North Carolina USA.
| | - Thomas May
- Floyd and Judy Rogers Endowed Professor at the Elson S. Floyd College of Medicine, Washington State University, in Spokane, Washington USA.
| | - Marycon Chin Jiro
- Bioethics Research Associate in the Northern California Regional Ethics Program, Kaiser Permanente.
| | - Jane Jankowski
- Associate Staff Bioethicist at the Center for Bioethics at the Cleveland Clinic in Cleveland, Ohio USA.
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Skogøy BE, Sørgaard K, Maybery D, Ruud T, Stavnes K, Kufås E, Peck GC, Thorsen E, Lindstrøm JC, Ogden T. Hospitals implementing changes in law to protect children of ill parents: a cross-sectional study. BMC Health Serv Res 2018; 18:609. [PMID: 30081882 PMCID: PMC6080385 DOI: 10.1186/s12913-018-3393-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Norway is one of the first countries to require all health professionals to play a part in prevention for children of parents with all kinds of illnesses (mental illness, drug addiction, or severe physical illness or injury) in order to mitigate their increased risk of psychosocial problems. Hospitals are required to have child responsible personnel (CRP) to promote and coordinate support given by health professionals to patients who are parents and to their children. METHODS This study examined the extent to which the new law had been implemented as intended in Norwegian hospitals, using Fixsen's Active Implementation Framework. A stratified random sample of managers and child responsible personnel (n = 167) from five Hospitals filled in an adapted version of the Implementation Components Questionnaire (ICQ) about the implementation of policy changes. Additional information was collected from 21 hospital coordinators (H-CRP) from 16 other hospitals. RESULTS Significant differences were found between the five hospitals, with lowest score from the smallest hopitals. Additional analysis, comparing the 21 hospitals, as reported by the H-CRP, suggests a clear pattern of smaller hospitals having less innovative resources to implement the policy changes. Leadership, resources and system intervention (strategies to work with other systems) were key predictors of a more successful implementation process. CONCLUSIONS Legal changes are helpful, but quality improvements are needed to secure equal chances of protection and support for children of ill parents. TRIAL REGISTRATION The study is approved by the Regional Committee on Medical and Health Research Etics South-East (reg.no. 2012/1176 ) and by the Privacy Ombudsmann.
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Affiliation(s)
- Bjørg Eva Skogøy
- Nordland Hospital Trust, Kløveråsveien 1, 8092 Bodø, Norway
- The Faculty of Health Sciences, UiT, The Arctic University of Norway, Box 6050, 9037 Tromsø, Norway
| | - Knut Sørgaard
- Nordland Hospital Trust, Kløveråsveien 1, 8092 Bodø, Norway
- The Faculty of Health Sciences, UiT, The Arctic University of Norway, Box 6050, 9037 Tromsø, Norway
| | - Darryl Maybery
- Monash University Department of Rural Health, Box 973, Moe, VIC 3825 Australia
| | - Torleif Ruud
- Department for Research and Development, Mental Health Services, Akershus University Hospital, Box 1000, 1478 Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Box 1171, Blindern, 0318 Oslo, Norway
| | - Kristin Stavnes
- Nordland Hospital Trust, Kløveråsveien 1, 8092 Bodø, Norway
- Institute of Clinical Medicine, University of Oslo, Box 1171, Blindern, 0318 Oslo, Norway
| | - Elin Kufås
- Vestre Viken Hospital Trust, Box 800, 3004 Drammen, Norway
| | | | - Eivind Thorsen
- BarnsBeste (Children’s Best Interests) - National Competence Network for Children as Next of Kin, Sørlandet Hospital Trust, Box 416, 4604 Kristiansand, Norway
| | - Jonas Christoffer Lindstrøm
- Department for Research and Development, Mental Health Services, Akershus University Hospital, Box 1000, 1478 Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Box 1171, Blindern, 0318 Oslo, Norway
- Health and Services Research Unit, Akershus University Hospital, Box 1000, 1478 Lørenskog, Norway
| | - Terje Ogden
- Norwegian Center for Child Behavioral Development, Unirand, Box 7053, Majorstuen, 0368 Oslo, Norway
- Institute of Psychology, University of Oslo, Box 1171, Blindern, 0318 Oslo, Norway
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20
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Desai SV, Asch DA, Bellini LM, Chaiyachati KH, Liu M, Sternberg AL, Tonascia J, Yeager AM, Asch JM, Katz JT, Basner M, Bates DW, Bilimoria KY, Dinges DF, Even-Shoshan O, Shade DM, Silber JH, Small DS, Volpp KG, Shea JA. Education Outcomes in a Duty-Hour Flexibility Trial in Internal Medicine. N Engl J Med 2018; 378:1494-1508. [PMID: 29557719 PMCID: PMC6101652 DOI: 10.1056/nejmoa1800965] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Concern persists that inflexible duty-hour rules in medical residency programs may adversely affect the training of physicians. METHODS We randomly assigned 63 internal medicine residency programs in the United States to be governed by standard duty-hour policies of the 2011 Accreditation Council for Graduate Medical Education (ACGME) or by more flexible policies that did not specify limits on shift length or mandatory time off between shifts. Measures of educational experience included observations of the activities of interns (first-year residents), surveys of trainees (both interns and residents) and faculty, and intern examination scores. RESULTS There were no significant between-group differences in the mean percentages of time that interns spent in direct patient care and education nor in trainees' perceptions of an appropriate balance between clinical demands and education (primary outcome for trainee satisfaction with education; response rate, 91%) or in the assessments by program directors and faculty of whether trainees' workload exceeded their capacity (primary outcome for faculty satisfaction with education; response rate, 90%). Another survey of interns (response rate, 49%) revealed that those in flexible programs were more likely to report dissatisfaction with multiple aspects of training, including educational quality (odds ratio, 1.67; 95% confidence interval [CI], 1.02 to 2.73) and overall well-being (odds ratio, 2.47; 95% CI, 1.67 to 3.65). In contrast, directors of flexible programs were less likely to report dissatisfaction with multiple educational processes, including time for bedside teaching (response rate, 98%; odds ratio, 0.13; 95% CI, 0.03 to 0.49). Average scores (percent correct answers) on in-training examinations were 68.9% in flexible programs and 69.4% in standard programs; the difference did not meet the noninferiority margin of 2 percentage points (difference, -0.43; 95% CI, -2.38 to 1.52; P=0.06 for noninferiority). od Institute and the ACGME; iCOMPARE ClinicalTrials.gov number, NCT02274818 .). CONCLUSIONS There was no significant difference in the proportion of time that medical interns spent on direct patient care and education between programs with standard duty-hour policies and programs with more flexible policies. Interns in flexible programs were less satisfied with their educational experience than were their peers in standard programs, but program directors were more satisfied. (Funded by the National Heart, Lung, and Blo
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Affiliation(s)
- Sanjay V Desai
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - David A Asch
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - Lisa M Bellini
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - Krisda H Chaiyachati
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - Manqing Liu
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - Alice L Sternberg
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - James Tonascia
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - Alyssa M Yeager
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - Jeremy M Asch
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - Joel T Katz
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - Mathias Basner
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - David W Bates
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - Karl Y Bilimoria
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - David F Dinges
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - Orit Even-Shoshan
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - David M Shade
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - Jeffrey H Silber
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - Dylan S Small
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - Kevin G Volpp
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
| | - Judy A Shea
- From the Departments of Medicine (S.V.D.), Epidemiology (A.L.S., J.T., D.M.S.), and Biostatistics (J.T.), Johns Hopkins University, Baltimore; the Departments of Medicine (D.A.A., L.M.B., K.H.C., M.L., A.M.Y., J.M.A., J.A.S.), Psychiatry (M.B., D.F.D.), and Medical Ethics and Policy (K.G.V.) and the Department of Statistics, the Wharton School (D.S.S.), University of Pennsylvania, the Corporal Michael J. Crescenz Veterans Affairs Medical Center (D.A.A., K.H.C., K.G.V.), and the Department of Pediatrics, Children's Hospital of Philadelphia (O.E.-S., J.H.S.) - all in Philadelphia; the Department of Medicine, Brigham and Women's Hospital, Boston (J.T.K., D.W.B.); and the Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago (K.Y.B.)
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Saluvan M, Ozonoff A. Functionality of hospital information systems: results from a survey of quality directors at Turkish hospitals. BMC Med Inform Decis Mak 2018; 18:6. [PMID: 29329532 PMCID: PMC5767047 DOI: 10.1186/s12911-018-0581-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 01/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to determine availability of core Hospital Information Systems (HIS) functions implemented in Turkish hospitals and the perceived importance of these functions on quality and patient safety. METHODS We surveyed quality directors (QDs) at civilian hospitals in the nation of Turkey. Data were collected via web survey using an instrument with 50 items describing core functionality of HIS. We calculated mean availability of each function, mean and median values of perceived impact on quality, and we investigated the relationship between availability and perceived importance. RESULTS We received responses from 31% of eligible institutions, representing all major geographic regions of Turkey. Mean availability of 50 HIS functions was 65.6%, ranging from 19.6% to 97.4%. Mean importance score was 7.87 (on a 9-point scale) ranging from 7.13 to 8.41. Functions related to result management (89.3%) and decision support systems (52.2%) had the highest and lowest reported availability respectively. Availability and perceived importance were moderately correlated (r = 0.52). CONCLUSION QDs report high importance of the HIS functions surveyed as they relate to quality and patient safety. Availability and perceived importance of HIS functions are generally correlated, with some interesting exceptions. These findings may inform future investments and guide policy changes within the Turkish healthcare system. Financial incentives, regulations around certified HIS, revisions to accreditation manuals, and training interventions are all policies which will help integrate HIS functions to support quality and patient safety in Turkish hospitals.
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Affiliation(s)
- Mehmet Saluvan
- Center for Applied Pediatric Quality Analytics, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Al Ozonoff
- Center for Applied Pediatric Quality Analytics, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
- Department of Pediatrics, Harvard Medical School, Boston, MA USA
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Esdar M, Liebe JD, Babitsch B, Hübner U. Determinants of Clinical Information Logistics: Tracing Socio-Organisational Factors and Country Differences from the Perspective of Clinical Directors. Stud Health Technol Inform 2018; 253:143-147. [PMID: 30147060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The establishment of successful clinical information logistics (CIL) within the care processes is one of the main objectives of strategic health IT management in hospitals. While technical realisations in terms of useful, usable and interoperable IT solutions are essential precursors of CIL, there is limited empirical research on what socio-organisational factors underlie an innovation-friendly culture and how they can affect successful information provision. We applied factor analysis on survey data from 403 clinical directors from Germany, Austria and Switzerland and used the dimensions identified to explain the level of CIL with ordered logistic regression analysis. The intensity of collaboration and exchange with the IT department as well as the degree of executive IT leadership showed to be strongly associated with better CIL while personal views and attitudes of clinical directors were not. Analysing country differences revealed the degree of the exchange with the IT department to be significantly lower in German hospitals. This points at a potential strategic lever for German hospital executives to focus on.
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Affiliation(s)
- Moritz Esdar
- Health Informatics Research Group, Osnabrück University AS, Germany
| | - Jan-David Liebe
- Health Informatics Research Group, Osnabrück University AS, Germany
| | - Birgit Babitsch
- Human Sciences, New Public Health, University Osnabrück, Germany
| | - Ursula Hübner
- Health Informatics Research Group, Osnabrück University AS, Germany
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Yager J, Kay J. Much of What We Have Needed to Know as Academic Managers We Learned Leading Teenage Jazz Groups. Acad Psychiatry 2017; 41:753-756. [PMID: 29030740 DOI: 10.1007/s40596-017-0834-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 09/27/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Joel Yager
- University of Colorado School of Medicine, Aurora, CO, USA.
| | - Jerald Kay
- Boonshaft School of Medicine, Wright State University School of Medicine, Dayton, OH, USA
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Janati A, Hasanpoor E, Hajebrahimi S, Sadeghi-Bazargani H. Health Care Managers' Perspectives on the Sources of Evidence in Evidence-Based Hospital Management: A Qualitative Study in Iran. Ethiop J Health Sci 2017; 27:659-668. [PMID: 29487475 PMCID: PMC5811945 DOI: 10.4314/ejhs.v27i6.11] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 05/10/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Evidence-based management (EBMgt) has been developed as a management framework for improving the quality of management decisions. To use that, we need to identify the source of evidence in decision-making. Therefore, the purpose of this study was to identify the sources of evidence in managing hospitals. METHODS Qualitative methods were used to explore the sources of evidence and to identify hospital managers' attitudes towards evidence-based management. A series of semi-structured interviews (n=48), with a purposive sample of 48 participants, were conducted in 2016. Also, four focus group discussions (FGDs) were conducted with health managers and specialists in the field of management. A questionnaire was used for collection of demographic characteristics and managers' perspectives. RESULTS Six main themes emerged from the interviews including: scientific and research evidence, facts and information of hospital, political-social development plans, managers' professional expertise and ethical-moral evidence. Also, the results showed that the majority of participants believed to use the evidence-based hospital management (95.83%). CONCLUSIONS Our study suggested that a full evidence-based hospital manager someone who is using all the sources of evidence for making hospital decisions. Using hexagon of evidence sources, managers can identify the best available evidence for hospital decisions and to make the best decision in the process of evidence-based decision making.
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Affiliation(s)
- Ali Janati
- Iranian Center of Excellence in Health Management (ICEHM), School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Edris Hasanpoor
- Iranian Center of Excellence in Health Management (ICEHM), School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Abstract
Purpose The purpose of this paper is twofold: first, to develop and test theory on how commitment human resource (HR) practices affect hospital professionals' job satisfaction that motivates them to generate desirable patient care and subsequently improve doctor-patient relationships (DPR) and second, to examine how commitment HR practices influence hospital managers and clinicians in different ways. Design/methodology/approach Using a cross-sectional survey, the authors collected data from 508 clinicians and hospital managers from 33 tertiary public hospitals in China. Structural equation model was employed to test the relationships of the variables in the study. Findings Commitment HR practices positively affect the job satisfaction of the healthcare professionals surveyed and a positive relationship is perceived between job satisfaction and DPR. Overall, the model shows a reversal on the strongest path linking job satisfaction and DPR whereby managers' main association operates through extrinsic job satisfaction while for clinicians it occurs through intrinsic satisfaction only. Practical implications DPR might be improved by applying commitment HR practices to increase healthcare professional's intrinsic and extrinsic satisfaction. In addition, while recognizing the importance of compensation and benefits to address the underpayment issue of Chinese healthcare professionals, empowerment and autonomy in work, and the use of subjects' expertise and skills may serve as stronger motivators for clinicians rather than hard economic incentives in achieving DPR improvements. Originality/value This study contributes to the small but growing body of research on human resource management (HRM) in the healthcare sector with new evidence supporting the link between commitment HR practice and work attitudes, as well as work attitudes and patient care from the perspective of clinicians and hospital managers. This study represents an initial attempt to examine the associations among commitment HR practices, job satisfaction and DPR in the Chinese healthcare sector. The findings provide evidence to support the value of commitment HR practices in Chinese hospital context, and demonstrate the importance of effective HRM in improving both hospital managers and clinicians' work attitudes.
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Affiliation(s)
- Shaozhuang Ma
- Instituto Universitario de Lisboa (ISCTE-IUL) , Business Research Unit (UNIDE-IUL), Lisbon, Portugal
| | - Xuehu Xu
- Third Affiliated Hospital of Guangzhou Medical University , Guangzhou, China
| | - Virginia Trigo
- Instituto Universitario de Lisboa (ISCTE-IUL) , Business Research Unit (UNIDE-IUL), Lisbon, Portugal
| | - Nelson J C Ramalho
- Instituto Universitario de Lisboa (ISCTE-IUL) , Business Research Unit (UNIDE-IUL), Lisbon, Portugal
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Tersigni AR. An MPJP Contemplates Charism, Calling and the Future. Health Prog 2017; 98:25-29. [PMID: 30039954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The story of Catholic health care spans generations, continuing to serve as an unbroken link to the healing ministry of Jesus. Through the Spirit’s creative provision, the unique charisms that strengthened and sustained the sisters and brothers who went before us continue today in the hearts and minds of lay and religious alike.
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Burmahl B. Who's up next? Hospitals work to develop the next generation of facilities managers. Health Facil Manage 2017; 30:20-25. [PMID: 29493200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Fontana JM. Good Formation Is All About Transformation. Health Prog 2017; 98:60-61. [PMID: 30040338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
They’re all over the place today — Star Wars characters, superheroes, pirates, Minnie Mouse, witches, Minions from “Despicable Me” and, of course, nurses dressed as they usually are in your health care institutions, in white fishnet and 6-inch heels!
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Gatmaitan A. Outsider's question helps spur a health system COO's quest for safer patient care. Mod Healthc 2017; 47:25. [PMID: 30428171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sometimes it takes an outsider to point out an uncomfortable truth. I encountered that bit of wisdom early in my career, running my first hospital in central Indiana in the mid-1990s.
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Abstract
Objective to analyze managers and professionals' perceptions on the changes in hospital management deriving from accreditation. Method descriptive study with qualitative approach. The participants were five hospital quality managers and 91 other professionals from a wide range of professional categories, hierarchical levels and activity areas at four hospitals in the South of Brazil certified at different levels in the Brazilian accreditation system. They answered the question "Tell me about the management of this hospital before and after the Accreditation". The data were recorded, fully transcribed and transported to the software ATLAS.ti, version 7.1 for access and management. Then, thematic content analysis was applied within the reference framework of Avedis Donabedian's Evaluation in Health. Results one large family was apprehended, called "Management Changes Resulting from the Accreditation: perspectives of managers and professionals" and five codes, related to the management changes in the operational, structural, financial and cost; top hospital management and quality management domains. Conclusion the management changes in the hospital organizations resulting from the Accreditation were broad, multifaceted and in line with the improvements of the service quality.
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Affiliation(s)
- João Lucas Campos de Oliveira
- Doctoral student, Universidade Estadual de Maringá, Maringá, PR, Brazil.
Assistant Professor, Colegiado de Enfermagem, Universidade Estadual do Oeste do Paraná,
Cascavel, PR, Brazil
| | - Carmen Silvia Gabriel
- PhD, Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de
São Paulo, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto,
SP, Brazil
| | - Hosanna Pattrig Fertonani
- PhD, Adjunct Professor, Departamento de Enfermagem, Universidade
Estadual de Maringá, Maringá, PR, Brazil
| | - Laura Misue Matsuda
- PhD, Associate Professor, Departamento de Enfermagem, Universidade
Estadual de Maringá, Maringá, PR, Brazil
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Wood E. Conference takes OR business leaders to the next level. OR Manager 2017; 33:1-9. [PMID: 30028103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Blesch G. Hospital execs assure investors they can weather ACA repeal. Mod Healthc 2017; 47:9. [PMID: 30620794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Largest healthcare executive search firms: Ranked by total number of U.S. placements made for senior-level healthcare executives* in 2015. Mod Healthc 2016; Suppl:12. [PMID: 30716250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Stempniak M. Three questions with: Richard Afable, M.D. Hosp Health Netw 2016; 90:16-17. [PMID: 30005532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Ramos Hegwer L. From HFMA's CFO Forum: Finding Value in Healthcare Innovation Centers. Healthc Financ Manage 2016; 70:25. [PMID: 29897208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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MILLENNIALS Who they are, what they want, & why you need them. Hosp Health Netw 2016; 90:22-4, 26-7. [PMID: 30005534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Morrissey J. THE ClO-CMIO PARTNERSHIP Execs now work together to get more value out of IT. Health Data Manag 2016; 24:42-44. [PMID: 29799689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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O'Connor M. Three questions for Kevin Vermeer. Hosp Health Netw 2016; 90:17-21. [PMID: 30005506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Cotroneo BE. Strong Networks Have High Net Worth for Women Leaders. J Med Pract Manage 2016; 32:57-59. [PMID: 30452848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Women executives in healthcare have unique challenges to building strong professional networks. As in corporate settings, women in healthcare delivery systems often represent a large constituent group within the organization, but are only a small percentage of the organization's leadership pool. Male leaders often are identified as viable candidates for advancement through professional networks and invitations to participate in collegial networking opportunities. With this advancement may come higher earning power, autonomy, and author- ity. Since women continue to be underrepresented at the top of most corporate structures, it is imperative they be provided better opportunities to network, and be included in invitations extended to their male counterparts for company- sponsored networking activities.
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Stempniak M. Three questions for: Christopher Dawes. Hosp Health Netw 2016; 90:16. [PMID: 30005491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Castellucci M. As IT's importance grows, CIO role grows with technology's reach. Mod Healthc 2016; 46:8-9. [PMID: 30475480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
As technology becomes more integral to all aspects of running hospitals, CEOs and board members are handing CIOs more authority. And they want data and results in return.
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Meckstroth DJ, Dore AK, Kerr BJ. Key Variables to Consider in Service Alteration. Healthc Financ Manage 2016; 70:84-89. [PMID: 29894125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Schade S. Ten Questions With ….Sue Schade. Biomed Instrum Technol 2016; 50:227. [PMID: 27413824 DOI: 10.2345/0899-8205-50.4.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Abstract
Not-for-profit hospitals are complex organizations and, therefore, may face unique challenges in responding to financial incentives for quality. In this research, we explore the types of behavioural changes made by not-for-profit Michigan hospitals in response to a pay-for-performance system for quality. We also identify factors that motivate or facilitate changes in effort. We apply a conceptual framework based on agency theory to motivate our research questions. Using data derived from structured interviews and surveys administered to 86 hospitals participating in a pay-for-performance system, we compare hospitals reporting and not reporting behavioural changes. Separate analyses are performed for hospitals reporting structure-related changes and hospitals reporting process-related changes. Our findings confirm that hospitals respond to incentive payments; however, our findings also reveal that hospital responses are not universal. Rather, involvement by boards of trustees, willingness to exert leverage with physicians, and financial and competitive motivations are all associated with hospitals' behavioural responses to incentives. Results of this research will help inform payers and hospital managers considering the use of incentives about the nature of hospitals' responses.
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Affiliation(s)
- Kristin L Reiter
- Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, USA.
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46
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Jacobs R, Martin S, Goddard M, Gravelle H, Smith P. Exploring the determinants of NHS performance ratings: lessons for performance assessment systems. J Health Serv Res Policy 2016; 11:211-7. [PMID: 17018194 DOI: 10.1258/135581906778476517] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives: A basic tenet of effective performance management is that decision makers should be held responsible only for aspects of performance over which they have control. We examine the degree to which variations in the performance of health care organizations are explained by a range of factors that are subject to differing degrees of managerial control. Methods: We use multiple regression methods and data on 304 National Health Service (NHS) Primary Care Trusts (PCTs) in England for 2002/03 to analyse the relationship between their performance, as measured by 'star ratings' and nine key performance targets, and a large number of explanatory variables. We classify the explanatory variables into five groups along a spectrum from 'no managerial control' to 'total managerial control'. We also analyse the relationship between PCTs that are service purchasers and their main providers to assess the degree to which their performance is linked. Results: For all of the key performance targets, most of the variation in performance is unexplained, although variables in groups 1, 2 and 3 (less managerial control) explain the largest proportion of variation. We find some evidence that socioeconomic and geographic factors have an impact on performance. We also find a positive relationship between the performances of purchaser and provider organizations. Conclusions: The star ratings did not allow for the different environmental circumstances within which PCTs operate and which affect their performance. Policy-makers should exercise caution in using such performance indicators to regulate health care organizations.
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Affiliation(s)
- Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
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47
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Zhu X, Baloh J, Ward MM, Stewart GL. Deliberation Makes a Difference: Preparation Strategies for TeamSTEPPS Implementation in Small and Rural Hospitals. Med Care Res Rev 2016; 73:283-307. [PMID: 26429835 PMCID: PMC4833673 DOI: 10.1177/1077558715607349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 08/31/2015] [Indexed: 11/15/2022]
Abstract
Small and rural hospitals face special challenges to implement and sustain organization-wide quality improvement (QI) initiatives due to limited resources and infrastructures. We studied the implementation of TeamSTEPPS, a national QI initiative, in 14 critical access hospitals. Drawing on QI and organization development theories, we propose five strategic preparation steps for TeamSTEPPS: assess needs, reflect on the context, set goals, develop a shared understanding, and select change agents. We explore how hospitals' practices correspond to suggested best practices by analyzing qualitative data collected through quarterly interviews with key informants. We find that the level of deliberation was a key factor that differentiated hospitals' practices. Hospitals that were more deliberate in preparing for the five strategic steps were more likely to experience engagement, perceive efficacy, foresee and manage barriers, and achieve progress during implementation. We discuss potential steps that hospitals may take to better prepare for TeamSTEPPS implementation.
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Affiliation(s)
- Xi Zhu
- University of Iowa, Iowa City, IA, USA
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48
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Largest healthcare executive search firms. Mod Healthc 2016; 46:34. [PMID: 27494017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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49
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Schwartz SK. Building strong physician-manager teams. Med Econ 2016; 93:51-53. [PMID: 27363114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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50
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Royse D. From 'horror show' to community resource: Evans aids revival of Roseland Hospital. Mod Healthc 2016; 46:20. [PMID: 27382888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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