Health Services Management Research最新文献_第9页

Responsible innovation in health and health system sustainability: Insights from health innovators' views and practices. 负责任的卫生创新和卫生系统可持续性:来自卫生创新者的观点和实践的见解。

IF 2.1

Health Services Management Research Pub Date : 2022-11-01 DOI: 10.1177/09514848211048606

Pascale Lehoux, Hudson P Silva, Robson Rocha de Oliveira, Renata P Sabio, Kathy Malas

{"title":"Responsible innovation in health and health system sustainability: Insights from health innovators' views and practices.","authors":"Pascale Lehoux, Hudson P Silva, Robson Rocha de Oliveira, Renata P Sabio, Kathy Malas","doi":"10.1177/09514848211048606","DOIUrl":"https://doi.org/10.1177/09514848211048606","url":null,"abstract":"Although healthcare managers make increasingly difficult decisions about health innovations, the way they may interact with innovators to foster health system sustainability remains underexplored. Drawing on the Responsible Innovation in Health (RIH) framework, this paper analyses interviews (n=37) with Canadian and Brazilian innovators to identify: how they operationalize inclusive design processes; what influences the responsiveness of their innovation to system-level challenges; and how they consider the level and intensity of care required by their innovation. Our qualitative findings indicate that innovators seek to: 1) engage stakeholders at an early ideation stage through context-specific methods combining both formal and informal strategies; 2) address specific system-level benefits but often struggle with the positioning of their solution within the health system; and 3) mitigate staff shortages in specialized care, increase general practitioners' capacity or patients and informal caregivers' autonomy. These findings provide empirical insights on how healthcare managers can promote and organize collaborative processes that harness innovation towards more sustainable health systems. By adopting a RIH-oriented managerial role, they can set in place more inclusive design processes, articulate key system-level challenges, and help innovators adjust the level and intensity of care required by their innovation.","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/49/60/10.1177_09514848211048606.PMC9574029.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10408202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

Managers do it their way: How managers act in a decentralised healthcare services provider organisation - a mixed methods study. 管理者按自己的方式做事:管理者如何在分散的医疗服务提供商组织中行动——一项混合方法研究。

IF 2.1

Health Services Management Research Pub Date : 2022-11-01 DOI: 10.1177/09514848211065467

Mikael Ohrling, Sara Tolf, Karin Solberg-Carlsson, Mats Brommels

{"title":"Managers do it their way: How managers act in a decentralised healthcare services provider organisation - a mixed methods study.","authors":"Mikael Ohrling, Sara Tolf, Karin Solberg-Carlsson, Mats Brommels","doi":"10.1177/09514848211065467","DOIUrl":"https://doi.org/10.1177/09514848211065467","url":null,"abstract":"Purpose: Decentralisation is considered a way to get managers more committed and more prone to respond to local needs. This study analyses how managers perceive a decentralised management model within a large public healthcare delivery organisation in Sweden. Design/methodology/approach: A programme theory evaluation was performed applying direct content analysis to in-depth interviews with healthcare managers. Balance score card data were used in a blinded comparative content analysis to explore relations between performance and how the delegated authority was perceived and used by the managers. Findings: Managers' perceptions of the decentralised management model supported its intentions to enable the front-line to make decisions to better meet customer needs and flexibly adapt to local conditions. The managers appreciated and used their delegated authority. Central policies and control on human resources and investments were accepted as those are to the benefit of the whole organisation. Leadership development and organisation-wide improvement programmes were of support. Units showing high organisational performance had proactive managers, although differences in manager perceptions across units were small. Originality: This, one of the first of its kind, study of a decentralisation in service delivery organisation shows a congruence between the rationale of a management model, the managers' perceptions of the authority and accountability as well as management practises. These observations stemming from a large public primary and community healthcare organisation has not, to our knowledge, been reported and provide research-informed guidance on decentralisation as one strategy for resolving challenges in healthcare service delivery organisations.","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10406966","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}

引用次数: 3

After all we're only human. 毕竟我们只是人。

IF 2.1

Health Services Management Research Pub Date : 2022-11-01 Epub Date: 2022-10-06 DOI: 10.1177/09514848221133242

Federico Lega

引用次数: 0

A qualitative study on relationships and perceptions between managers and clinicians and its effect on value-based healthcare within the national health service in the UK. 对关系和管理者和临床医生之间的看法及其对英国国家卫生服务中基于价值的医疗保健的影响的定性研究。

IF 2.1

Health Services Management Research Pub Date : 2022-11-01 Epub Date: 2022-02-08 DOI: 10.1177/09514848211068624

Sze May Ng

{"title":"A qualitative study on relationships and perceptions between managers and clinicians and its effect on value-based healthcare within the national health service in the UK.","authors":"Sze May Ng","doi":"10.1177/09514848211068624","DOIUrl":"https://doi.org/10.1177/09514848211068624","url":null,"abstract":"One of the main drivers for change towards delivering value-based healthcare is to improve clinical and managerial culture and engagement within organisations. The relationships between clinicians and managers in an organisation are often considered to be either an enabler or disabler towards successful engagement to develop strategies towards better value healthcare. Successful engagement is dependent on effective and transformational leadership that can impact on organisational value in healthcare. The aim of this research was to explore the relationships, behaviours and perceptions between managers and clinicians towards value-based healthcare in the National Health Service in the United Kingdom. A qualitative research methodology of semi-structured in-depth interviewing on a sample consisting of hospital consultants, senior managers and board executives from a diverse group were conducted. A thematic analysis was used to analyse the data using a systematic approach. The study findings identified areas of potential barriers to engagement for clinicians and managers which were related to regulatory burden, financial challenges and workforce shortages. Key recommendations on what will be required to improve clinicians and managers engagement and the leadership approaches towards improving value-based healthcare are discussed.","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9574030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39762932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Examining supervisor undermining through the job-demands resources framework. 通过工作需求资源框架考察主管破坏行为。

IF 2.1

Health Services Management Research Pub Date : 2022-11-01 DOI: 10.1177/09514848211048608

Marilyn V Whitman, Russell A Matthews, Eric S Williams

{"title":"Examining supervisor undermining through the job-demands resources framework.","authors":"Marilyn V Whitman, Russell A Matthews, Eric S Williams","doi":"10.1177/09514848211048608","DOIUrl":"https://doi.org/10.1177/09514848211048608","url":null,"abstract":"Introduction: Supervisor undermining has recently gained increasing attention due to its negative effects on employee health and well-being. In the healthcare context, negative supervisor behaviors have been linked to unfavorable individual and organizational outcomes as well as medical errors and patient mortality. Our study, therefore, examines the influence that supervisor undermining behavior has on employee engagement and performance within a standard job stress framework.Methods: Our sample consisted of occupational therapists, a health professions group who is growing in demand and importance in the U.S. and has unique job demands. Using an observational, cross-sectional study design, a convenience sample of 521 occupational therapists completed an online survey. A series of independent t-test and multiple-groups path analytic modeling was used.Results: Participants who had a supervisor perceived as engaging in undermining behaviors reported lower levels of resources, higher levels of demands, less motivation, and more overload than those who did not perceive supervisor undermining. These participants were also less engaged and reported lower levels of performance.Conclusion: Our results shed further light on the importance of supervisory behaviors specifically in a healthcare setting and the need for organizations to create an environment that promotes positive and productive workplace behaviors.","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10406487","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}

引用次数: 1

The impact of management practices on relative patient mortality: Evidence from public hospitals. 管理实践对患者相对死亡率的影响:来自公立医院的证据。

IF 2.1

Health Services Management Research Pub Date : 2022-11-01 Epub Date: 2022-02-17 DOI: 10.1177/09514848211068627

Reza Salehnejad, Manhal Ali, Nathan C Proudlove

{"title":"The impact of management practices on relative patient mortality: Evidence from public hospitals.","authors":"Reza Salehnejad, Manhal Ali, Nathan C Proudlove","doi":"10.1177/09514848211068627","DOIUrl":"https://doi.org/10.1177/09514848211068627","url":null,"abstract":"A small, but growing, body of empirical evidence shows that the material and persistent variation in many aspects of the performance of healthcare organisations can be related to variation in their management practices. This study uses public data on hospital patient mortality outcomes, the Summary Hospital-level Mortality Indicator (SHMI) to extend this programme of research. We assemble a five-year dataset combining SHMI with potential confounding variables for all English NHS non-specialist acute hospital trusts. The large number of providers working within a common system provides a powerful environment for such investigations. We find considerable variation in SHMI between trusts and a high degree of persistence of high- or low performance. This variation is associated with a composite metric for management practices based on the NHS National Staff Survey. We then use a machine learning technique to suggest potential clusters of individual management practices related to patient mortality performance and test some of these using traditional multivariate regression. The results support the hypothesis that such clusters do matter for patient mortality, and so we conclude that any systematic effort at improving patient mortality should consider adopting an optimal cluster of management practices.","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9574893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39807457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Volume creates value: The volume-outcome relationship in Scandinavian obesity surgery. 数量创造价值：斯堪的纳维亚肥胖症手术中的手术量与手术结果之间的关系。

IF 1.6

Health Services Management Research Pub Date : 2022-11-01 Epub Date: 2022-02-06 DOI: 10.1177/09514848211048598

Anna Svarts, Thorell Anders, Mats Engwall

{"title":"Volume creates value: The volume-outcome relationship in Scandinavian obesity surgery.","authors":"Anna Svarts, Thorell Anders, Mats Engwall","doi":"10.1177/09514848211048598","DOIUrl":"10.1177/09514848211048598","url":null,"abstract":"This study establishes the relationship between surgical volume and cost and quality outcomes, using patient-level clinical data from a national quality registry for bariatric surgery in Sweden. Data include patient characteristics with comorbidities, surgical and follow-up data for patients that underwent gastric bypass or gastric sleeve operations between 2007 and 2016 (52,703 patients in 51 hospitals). The relationships between surgical volume (annual number of bariatric procedures) and several patient-level outcomes were assessed using multilevel, mixed-effect regression models, controlling for patient characteristics and comorbidities. We found that hospitals with higher volumes had lower risk of intraoperative complications as well as complications within 30 days post-surgery (odds ratios per 100 procedures are 0.78 and 0.87, respectively, p<0.01). In addition, higher-volume hospitals had substantially shorter procedure time (17 min per 100 procedures, p<0.01) and length of stay (0.88 incidence-rate ratio per 100 procedures p<0.01). Our results support the claim that increased surgical volume significantly improves quality. Further, the results strongly suggest that increased volume leads to lower cost per surgery, by reducing cost drivers such as procedure time and length of stay.","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9574905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10408723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The new strategic agenda for value transformation. 价值转型的新战略议程。

IF 2.1

Health Services Management Research Pub Date : 2022-08-01 Epub Date: 2021-04-26 DOI: 10.1177/09514848211011739

Paul B van der Nat

{"title":"The new strategic agenda for value transformation.","authors":"Paul B van der Nat","doi":"10.1177/09514848211011739","DOIUrl":"https://doi.org/10.1177/09514848211011739","url":null,"abstract":"The model for value-based healthcare introduced in 2006 by Porter and Teisberg is still relevant, but it is incomplete. Porter and Teisberg put a strong focus on measuring outcomes, but how to use these measurements to actually improve quality of care has not been described. In addition, value-based healthcare as originally introduced neglects that a true shift from volume to patient value requires a change in culture and way of working of healthcare professionals. The original strategic agenda for value transformation (in short: 'value agenda') consists of six elements: organize into Integrated Practice Units (1), measure outcomes and costs for every patient (2), move to bundled payments for care cycles (3), integrate care delivery systems (4), expand geographic reach (5), and build an enabling information technology platform (6). For value-based healthcare to become a reality, the strategic agenda needs to be extended with four elements. First, healthcare providers need to set up a systematic approach for value-based quality improvement. Second, value needs to be integrated in patient communication. Third, we should invest in a culture of value delivery. And fourth, we should build learning platforms for healthcare professionals based on patient outcome data. Best practices on value-based healthcare implementation are working on these four elements in addition to the original value agenda. In conclusion, a new strategic agenda for value transformation is proposed that combines the vision of the founders of value-based healthcare with implementation experience in order to support healthcare providers in their shift to become value-based.","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/09514848211011739","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38909311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 21

Regularity of contact with general practitioners and diabetes-related hospitalisation through a period of policy change: A retrospective cohort study. 政策改变期间与全科医生接触和糖尿病相关住院的规律性:一项回顾性队列研究

IF 2.1

Health Services Management Research Pub Date : 2022-08-01 Epub Date: 2021-06-19 DOI: 10.1177/09514848211020866

David Youens, David B Preen, Mark Harris, Cameron Wright, Rachael Moorin

{"title":"Regularity of contact with general practitioners and diabetes-related hospitalisation through a period of policy change: A retrospective cohort study.","authors":"David Youens, David B Preen, Mark Harris, Cameron Wright, Rachael Moorin","doi":"10.1177/09514848211020866","DOIUrl":"https://doi.org/10.1177/09514848211020866","url":null,"abstract":"Background: This study evaluated changes in regularity of general practitioner (GP) contact (the pattern of visits over time) and the impact of regularity on diabetes-related hospitalisation following introduction of care co-ordination incentives.Methods: Linked primary care, hospital and death records covered West Australian adults from 1991-2004. Different eras were evaluated based on incentive program changes and model fit, to assess changes in regularity. Changes in regularity, derived from the variance in the number of days between GP contacts, were evaluated using ordered logistic regression. The impact of regularity on hospitalisation rates and costs were evaluated.Results: Two eras prior to program introduction (1991/92-1994/9 and 1995/96-1998/99), and one after (1999/2000-2002/03) were assessed. Among 153,455 at risk of diabetes-related hospitalisation GP contact became slightly less regular in the second era, though there was no change from the second to third era. The most regular decile had 5.5% fewer hospitalisations (95% CI -0.9% to -9.9%) and lower per-patient costs (difference AU$115, CI -$63 to -$167) than the least regular. Associations were similar in each era.Conclusions: Ongoing relationships between GPs and patients are important to maintaining health. Historical data provide the opportunity to assess the impact of care co-ordination incentives on relationships.","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/09514848211020866","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39248707","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}

引用次数: 2

Member engagement in multi-sector health care alliances. 成员参与多部门卫生保健联盟。

IF 2.1

Health Services Management Research Pub Date : 2022-08-01 Epub Date: 2021-07-07 DOI: 10.1177/09514848211028708

Larry R Hearld, Jeffrey Alexander, Yunfeng Shi, Laura J Wolf

{"title":"Member engagement in multi-sector health care alliances.","authors":"Larry R Hearld, Jeffrey Alexander, Yunfeng Shi, Laura J Wolf","doi":"10.1177/09514848211028708","DOIUrl":"https://doi.org/10.1177/09514848211028708","url":null,"abstract":"Many communities are developing innovative forms of collaborative organizations such as multi-sector health care alliances (MHCAs) to address problems of misaligned incentives among providers, payers, and community stakeholders and improve health and health care. Member engagement is essential to the success of these organizations due to their dependence on volunteer members to develop and implement strategy and provide material and in-kind support for alliance efforts, yet relatively little research has examined how alliances can foster engagement. This study examined behavioral indicators of member engagement (e.g., recruitment and retention of organizational and individual members) and how they are related to two foundational dimensions of alliance functioning - alliance leadership and community centrality. Using three rounds of an internet-based survey of alliance members from 14 alliances, the study found that organizational recruitment and retention increased over time, from 26.6% to 41.5% and 56.0% to 65.2%, respectively. Recruitment of individuals increased over the study period (38.3% to 47.2%, while retention of individual members declined over the study period (61.0% to 53.2%). Alliance leadership was associated with lower levels of recruitment (both organizational and individual members) but higher levels of organizational retention (both organizational and individual members). Collectively, our findings suggest that behavioral aspects of alliances are more effective at retaining members than relatively stable characteristics such as size and positioning in the community. Contrasting relationships between recruitment and retention, however, suggest that different forms of leadership may be required to simultaneously attract new members while retaining existing ones.","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/09514848211028708","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39161016","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}

引用次数: 0