Health Services Management Research最新文献

{"title":"Hospital-wide interventions to reduce emergency department overcrowding: Data-driven strategies and clinical governance at an Italian teaching hospital.","authors":"Roberta Bellini, Riccardo Boverio, Cristian Zanelli, Silvia Ingala, Valentina Lenti, Tatiana Maan, Massimo Corona","doi":"10.1177/09514848261490128","DOIUrl":"https://doi.org/10.1177/09514848261490128","url":null,"abstract":"<p><p>BackgroundEmergency Department (ED) overcrowding is a global systemic challenge driven by an imbalance between healthcare demand and resource availability. This study evaluates a multifaceted, organization-wide intervention at an Italian teaching hospital by focusing on throughput and output factors.MethodsA quasi-experimental, pre-post design analysed 100% of the available population data (N = 199354 visits) from 2019 to 2024. A \"Digital Twin\" simulation identified boarding as the primary bottleneck, consuming 47% of medical resources. Interventions included a \"Discharge Decalogue,\" digitalization of community care pathways (ADI/CAVS), and nursing protocols. Statistical significance for patient satisfaction (N = 1840) was assessed via t-tests (95% CI).ResultsDespite a 23.6% increase in total ED volume and a 37.8% surge in high-complexity presentations (Red Codes), interventions optimized outflow. The ALOS for complex discharges decreased for both CAVS (-24.6%) and ADI (-22.6%). Throughput protocols reduced chest pain response times by 27.7%. Satisfaction scores improved accordingly, particularly within the information domain (p < 0.001; 95/% CI [0.22, 0.38]). While overall waiting times fell by 17.8%, boarding times increased: this was driven by clinical complexity and a deliberate institutional policy to mitigate medical boarding within surgical units. This strategic prioritization was maintained to preserve elective surgical capacity.ConclusionsA systems-based approach prioritizing output optimization and hospital-territory integration demonstrates superior efficacy compared to traditional input-reduction strategies. This data-driven model provides a scalable framework to strengthen clinical governance and enhance patient experience within resource-constrained environments.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":" ","pages":"9514848261490128"},"PeriodicalIF":1.5,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Employee satisfaction and patient experience with home-visit nursing facilities: A facility-level analysis.","authors":"Hiromichi Takeda, Masahiro Hada","doi":"10.1177/09514848261490126","DOIUrl":"https://doi.org/10.1177/09514848261490126","url":null,"abstract":"<p><p>Employee satisfaction (ES) may influence patient experience, but facility-level evidence remains limited. This study examined the association between facility-level ES and Net Promoter Score (NPS)-based patient experience in home healthcare settings. This cross-sectional study included 87 home healthcare facilities. Questionnaire responses from 1,066 staff members underwent exploratory factor analysis, yielding four ES factors whose scores were aggregated to facility-level means: management integrity and governance, supervisor and workplace support, organizational pride and identification, and goal orientation and continuous improvement. Patient experience was assessed using NPS data from 6,615 survey responses. Multiple linear regression analyses examined facility-level NPS, promoter proportion, and detractor proportion. Detractor proportion was significantly associated with ES factors (<i>p</i> = 0.028); goal orientation and continuous improvement was negatively associated, whereas management integrity and governance was positively associated. Organizational factors related to goal orientation and continuous improvement were associated with lower detractor proportions. These findings suggest that specific dimensions of employee satisfaction may be more relevant to reducing negative patient evaluations than to increasing positive recommendations. However, the findings should be interpreted cautiously because only detractor proportion was significantly associated with employee satisfaction factors.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":" ","pages":"9514848261490126"},"PeriodicalIF":1.5,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chief operating officers: Exploring a new managerial role in healthcare.","authors":"Elin Boija, Björn Af Ugglas, Mikael Ohrling, Pamela Mazzocato","doi":"10.1177/09514848261486148","DOIUrl":"https://doi.org/10.1177/09514848261486148","url":null,"abstract":"<p><p>BackgroundThe rise of Chief Operating Officers (COO) in healthcare is filled with the expectation to improve demand and capacity management practices from a system perspective. Given the absence of empirical studies on the role of COOs in healthcare, this study explores the establishment and scope of COOs in Sweden, their responsibilities, decision-making authority, and the conditions influencing their role.MethodsAn interview study with Swedish healthcare COOs. Open-ended responses underwent qualitative content analysis; closed-ended items were summarized as counts and percentages. Two frameworks were combined: Healthcare Services Operations Management and the Decision Space Framework.ResultsThe study identifies key areas of responsibility for COOs, such as demand and capacity management, data-driven operations, and cross-organizational coordination. COOs operate at the intersection of centralized and decentralized management practices, requiring collaboration with CEOs and department managers. The study highlights the importance of organizational and individual capacities, including team competencies and a deep understanding of healthcare operations.ConclusionsCOOs have the potential to improve coordination of demand and capacity management and thereby support healthcare system efficiency. By clarifying decision spaces and ensuring demand and capacity management competencies and data infrastructure, the COO role can more reliably translate a system perspective into operational results.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":" ","pages":"9514848261486148"},"PeriodicalIF":1.5,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of warmth and competence as stereotypical leadership perceptions on occupational well-being and behavioral loyalty of hospital employees: An empirical analysis.","authors":"Marcella S Mueller, Chris Malone, Jörg Lindenmeier, Zeynep Erden, Florian Liberatore","doi":"10.1177/09514848251360072","DOIUrl":"10.1177/09514848251360072","url":null,"abstract":"<p><p><b>Background:</b> The shortage of healthcare professionals and demanding working conditions have prompted healthcare organizations to implement effective retention strategies. Leadership practices largely shape the organizational climate and influence occupational well-being and related retention. Research has identified warmth and competence as the two fundamental dimensions by which leaders are evaluated.<b>Purpose:</b> This study explores how perceptions of leadership-related warmth and competence translate into hospital employees' loyalty, both directly and indirectly, through occupational well-being, that is, through the mechanisms of positive and negative work-related affect.<b>Research Design:</b> A cross-sectional survey design was used.<b>Study Sample:</b> The study sample consisted of N = 1907 employees from a U.S. hospital.<b>Data Collection and Analysis:</b> Data were collected via a structured survey instrument assessing leadership perceptions, affective well-being at work, and employee loyalty. Structural equation modeling was used to assess the hypothesized relationships and mediating mechanisms.<b>Results:</b> Both leadership-related warmth and competence perceptions directly influence employee loyalty. We identified different mechanisms underlying the indirect effects of occupational well-being on loyalty. Only leadership-related warmth perceptions had a positive indirect effect on loyalty through both positive and negative work-related affect. Leadership-related competence perceptions increased both positive and negative work-related affect.<b>Conclusions:</b> An empathic leadership style that leads to favorable leadership-related warmth perceptions is an effective approach for promoting occupational well-being and loyalty among hospital employees. Leaders should foster leadership-related competence perceptions in periods with more favorable working conditions while avoiding them in stressful working conditions.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":" ","pages":"116-128"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thank you!","authors":"","doi":"10.1177/09514848261466768","DOIUrl":"10.1177/09514848261466768","url":null,"abstract":"","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":" ","pages":"115"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptance of a patient portal: Analysis of an Italian regional public system.","authors":"Alberto Zanutto, Diego Ponte, Diego Giuliani, Maria Michela Dickson","doi":"10.1177/09514848251358321","DOIUrl":"10.1177/09514848251358321","url":null,"abstract":"<p><p>BackgroundPatient portals allow patients to access their health information and interact with their healthcare system. While their use is still limited, this article explores the behavioral intention to use a patient portal implemented by a public regional authority in Italy. The authors also investigate the role of sociodemographic moderators - age, gender, education, and occupation - on the intention to use the portal.MethodsWhile most of the literature on patient portals is focused on small sets of respondents or is verticalized on specific diseases, this paper describes the results of a survey sent to 34,256 users registered on the patient portal. Of these, 15,102 users answered the questionnaire. The survey explored the acceptance of the patient portal through the extended unified theory of acceptance and use of technology model (UTAUT2). Descriptive and SEM analyses were also conducted.ResultsThe model has good explanatory power for the behavioral intention to use a patient portal. One construct of the UTAUT2 model showed insignificant effects on the intention to use. The results indicate that the impact of the constructs affecting the intention to use the patient portal is significantly moderated by individuals' sociodemographic characteristics.ConclusionsThe analysis results confirm a good acceptance of patient portals provided by public authorities. This supports the idea that public institutions can also develop innovative tools. The results confirm the desirability of these tools among citizens. The results have important policy implications for public health investments.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":" ","pages":"129-140"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bibliometric analysis and trends related to dental tourism: Qualitative, social, economic and ethical implications.","authors":"Valerio Brescia, Francesco Cavarra, Maura Campra, Paolo Boffano, Vincenzo Rocchetti","doi":"10.1177/09514848251314111","DOIUrl":"10.1177/09514848251314111","url":null,"abstract":"<p><p>This article delves into the multifaceted realm of dental tourism, scrutinizing patient incentives, economic ramifications, and ethical aspects. An in-depth 2023 analysis discerns research gaps, underscoring the necessity for a more exhaustive investigation to enrich the understanding of the global oral healthcare landscape. Utilizing bibliometric analysis method, the study examines the worldwide trajectory of scientific publications on dental tourism. Employing Scopus, it dissects document types, annual production, authorship, and international collaborations. The results spotlight microvariables derived from Saxena, Deheriya, Datla's macrovariables, unveiling influencers on dental tourism, ranging from social and economic to cultural factors. The study advocates for defined bilateral agreements to ensure quality care and stresses ethical considerations, emphasizing shared standards and legal implications. Economic ramifications, both positive and negative, are discussed, with an expanding global focus on dental tourism evident. In conclusion, the study accentuates micro variables, signaling avenues for future research.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":" ","pages":"150-161"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How are digital platforms affecting the accessibility of healthcare services?","authors":"Gaurav Talwar, Sabyasachi Sinha","doi":"10.1177/09514848251358328","DOIUrl":"10.1177/09514848251358328","url":null,"abstract":"<p><p>The healthcare industry has traditionally lagged in adopting technology, contributing to rising costs, limited accessibility, and ongoing challenges in affordability. This study explores how digital platforms can transform healthcare by reducing the friction in transactions and facilitate increase in the depth and width of accessibility of healthcare services. Using a qualitative research approach, we applied Gioia's method to identify emerging patterns and aggregate dimensions leading to formulation of a robust theoretical framework. We used dynamic capability and an ecosystem lens to investigate our research inquiry. Our research indicates that digital platforms enhance healthcare accessibility by ensuring last-mile delivery, reducing friction, ensuring symmetrical information dissemination, personalizing information, and facilitating remote diagnosis. Platform players' ability to reconfigure capabilities at speed and scale and offer services never imagined have begun to show green shoots in healthcare. While these platforms offer significant opportunities, strategic implementation and adaptation are essential. Policymakers, practitioners, and providers must collaborate to ensure effective use and integration. Our conceptual framework bridges theoretical concepts with practical applications, offering new insights for future research.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":" ","pages":"162-173"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical success factors for public private partnership (PPP) in hospital services.","authors":"Akram Baniasadi, Aida Asghari, Mahdi Mahdavi, Ebrahim Jaafaripooyan","doi":"10.1177/09514848251407116","DOIUrl":"10.1177/09514848251407116","url":null,"abstract":"<p><p>BackgroundGiven the importance of health services delivery, especially under a public-private partnership agreement, attention to the related success factors is overly essential. This study thus intends to explore critical success factors and analyze the agreement of public and private partners on these factors in hospital services.MethodA mixed-method study was conducted; first in a qualitative phase the critical success factors, via 25 face-to-face, semi-structured interviews with the purposely recruited hospital managers, heads of diagnostic services, and managers of private companies were identified. Interviews were then transcribed and analyzed using conventional content analysis, assisted by \"MAXQDA-12\". In the quantitative phase, the consensus upon these factors were sought using a questionnaire survey and analyzed according to the RAF analysis.ResultsA number of 52 factors categorized under nine main categories represented the key, agreed-upon success factors for implementing PPP. The highest agreement was on the 'Legal aspects of partnership' and the lowest upon the 'Partnership execution'.ConclusionsWeak agreement among the partners could evidently jeopardize the success of any PPP initiative and there is a need for more interaction and negotiation to have a win-win partnership.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":" ","pages":"141-149"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Door-to-door strategies - A study of healthcare strategies for managing patients, from home to the emergency department during the pandemic.","authors":"Susanna Forsberg, Amir Khorram-Manesh, Krzysztof Goniewicz, Kevin Kupietz, Lesley Gray, Phatthranit Phattharapornjaroen, Carl Magnusson, Katarzyna Naylor, Attila J Hertelendy, Ingela Wennman, Eric Carlström","doi":"10.1177/09514848261469984","DOIUrl":"https://doi.org/10.1177/09514848261469984","url":null,"abstract":"<p><p>BackgroundThis study aimed investigate and document organizational strategies in prehospital care when dealing with the challenge of assessing patients with suspected COVID-19 when transporting and triaging patients for hospital admission.MethodsData about door-to-door management, i.e., from their homes to the entrance door of an emergency department, of suspected COVID-19 patients, were collected from 50 participants, recruited from staff from Temporary Triage and Treatment areas (TTTs) located outside the hospital emergency departments and ambulance services in Sweden, Poland, and the United States. The data were, analyzed and subjected to a thematic analysis based on the CSCATT framework, i.e. (Command and Control, Safety, Communication, Assessment, Triage, Treatment, and Transport).ResultsThe results revealed a successful collaboration within the healthcare organizations. Team roles were, according to the respondents, distributed efficiently, and staff participated actively in the workflow. Challenges included a shortage of training, and preparedness, inadequate facilities, insufficient facility preparedness, and, at times, a fear of working with COVID-19 patients. Excessive guidelines, frequently changing protocols, and the constant release of new information were other challenges.ConclusionThe conclusion emphasizes the importance of proactive measures, such as robust contingency plans, education, and information dissemination. Future strategies should focus on developing robust, scalable models that can be rapidly deployed. This includes investing in diagnostic tools, enhancing the production capabilities for essential medical supplies, and ensuring a streamlined supply chain. Future healthcare strategies can be more resilient, responsive, and equipped to manage public health emergencies effectively.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":" ","pages":"9514848261469984"},"PeriodicalIF":1.5,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}