Ana Zhelyazkova, Philipp M Fischer, Nina Thies, Julia S Schrader-Reichling, Thorsten Kohlmann, Kristina Adorjan, René Huith, Karl-Walter Jauch, Stephan M Prückner
{"title":"COVID-19 management at one of the largest hospitals in Germany: Concept, evaluation and adaptation.","authors":"Ana Zhelyazkova, Philipp M Fischer, Nina Thies, Julia S Schrader-Reichling, Thorsten Kohlmann, Kristina Adorjan, René Huith, Karl-Walter Jauch, Stephan M Prückner","doi":"10.1177/09514848221100752","DOIUrl":"https://doi.org/10.1177/09514848221100752","url":null,"abstract":"<p><strong>Context: </strong>The LMU University Hospital is among the largest healthcare facilities in Germany. The measures implemented prior to and during the first pandemic wave of COVID-19, were evaluated in preparation of a second pandemic wave. This paper presents the pandemic management concept, evaluation and adaptation of LMU University Hospital.</p><p><strong>Methods: </strong>Between July and September 2020 the disaster management team of LMU University Hospital conducted a mixed-method evaluation of the hospital's pandemic management. A workshop series based on the After Action Review working group format was organized to examine the management structure, decision-making processes, documentation, and crisis preparedness response for a second COVID-19 wave. Further, the satisfaction of employees with the hospital's COVID-19 management was examined through an anonymous survey.</p><p><strong>Results: </strong>The workshop series highlighted a need for structural and operational adaptation of the COVID-19 management at LMU University Hospital. The results of the employee survey (<i>N</i> = 2182) provided positive feedback for the measures taken during the first pandemic wave. Specific actions were derived concerning the availability of personal protective equipment and emergency childcare services. A key outcome of both evaluation activities was the identified need for further improvement in communication between stakeholders. All changes were adopted prior to the second pandemic wave.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":"36 1","pages":"63-74"},"PeriodicalIF":2.1,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9117989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10609542","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}
{"title":"Cost-effectiveness of future lockdown policies against the COVID-19 pandemic.","authors":"Afschin Gandjour","doi":"10.1177/09514848221080687","DOIUrl":"https://doi.org/10.1177/09514848221080687","url":null,"abstract":"<p><strong>Aim: </strong>While the European Union (EU) has approved several COVID-19 vaccines, new variants of concern may be able to escape immunity. The purpose of this study is to project the cost-effectiveness of future lockdown policies in conjunction with a variant-adapted vaccine booster. The exemplary scenario foresees a 25% decline in the vaccine protection against severe disease.</p><p><strong>Methods: </strong>A decision model was constructed using, for example, information on age-specific fatality rates, intensive care unit (ICU) costs and outcomes, and herd protection threshold. The costs and benefits of a future lockdown strategy were determined from a societal viewpoint under three future scenarios-a booster shot's efficacy of 0%, 50%, and 95%.</p><p><strong>Results: </strong>The cost-effectiveness ratio of a lockdown policy in conjunction with a booster dose with 95% efficacy is €44,214 per life year gained. A lockdown is cost-effective when the probability of approving a booster dose with 95% efficacy is at least 48% (76% when considering uncertainty in input factors).</p><p><strong>Conclusion: </strong>In this exemplary scenario, a future lockdown policy appears to be cost-effective if the probability of approving a variant-adapted vaccine booster with an efficacy of 95% is at least 48%.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":"36 1","pages":"51-62"},"PeriodicalIF":2.1,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8984600/pdf/10.1177_09514848221080687.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9164394","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}
{"title":"Competitive intelligence: A precursor to a learning health system.","authors":"H Fred Farley, Shelly Freyn","doi":"10.1177/09514848211065470","DOIUrl":"https://doi.org/10.1177/09514848211065470","url":null,"abstract":"<p><p>Unlike other developed countries, the US healthcare system is largely privatized and highly competitive. This dynamic stifles effective information sharing, while the need for prompt and accurate evidence-based decision making has become crucial. Crises, like the COVID-19 pandemic, elevate the importance of quality decision making and exacerbate issues associated with the lack of a cohesive system to share information. Competitive intelligence (CI) is a discipline that encourages gathering, analyzing, and sharing information throughout a firm in order to develop and sustain competitive advantage. CI could be considered a precursor in establishing a learning organization (LO). Although CI research has focused on its process and value, little is found in the literature on how to integrate CI into an organization; this is particularly true in healthcare. A conceptual model is proposed to build and integrate a CI function and culture within a healthcare organization to encourage effective information sharing and knowledge development. In turn, this can provide a mechanism to create a learning health system (LHS). Although the model was developed specifically for US healthcare, it offers application to healthcare in other countries as well as most any industry.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":"36 1","pages":"82-88"},"PeriodicalIF":2.1,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9134844","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}
Thomas Wilke, Hartmut Timmermann, Sabrina Mueller, Fraence Hardtstock, Victoria Unmuessig, Robert R Welte, Ulf Maywald
{"title":"Association between asthma control and healthcare costs: Results from a German linked data study.","authors":"Thomas Wilke, Hartmut Timmermann, Sabrina Mueller, Fraence Hardtstock, Victoria Unmuessig, Robert R Welte, Ulf Maywald","doi":"10.1177/09514848221100749","DOIUrl":"https://doi.org/10.1177/09514848221100749","url":null,"abstract":"<p><p><b>Background</b>: This study aimed to evaluate differences in healthcare resource utilization and cost among patients with controlled and uncontrolled asthma.<b>Methods</b>: Claims data from a German sickness fund was linked to patient survey data. Outpatient physicians enrolled patients and assessed asthma control using the ACT<sup>TM</sup> questionnaire. All-cause and asthma-specific healthcare resource use (HCRU)/costs were compared descriptively and based on multivariable models using a continuous ACT<sup>TM</sup> score.<b>Results</b>: Overall, 492 asthma patients were included (mean age: 53.8, 73.8% female). The mean/median ACT<sup>TM</sup> score was 19.9/20.7, with 183 patients (37.2%) classified as having uncontrolled asthma (mean ACT<sup>TM</sup> score<20) Patients with uncontrolled asthma had significantly more hospitalizations (<i>p</i> = .035) and medication prescriptions (<i>p</i> < .001), which resulted in higher total healthcare costs for asthma-related (€1785 vs. €1615; <i>p</i> = .004) and all-cause care (€4695 vs. €4117; <i>p</i> = .009). While controlling for baseline characteristics, multivariable models confirmed a negative association between asthma control and total all-cause healthcare costs (<i>p</i> = .008), total asthma-related costs (<i>p</i> = .008), and costs of medication prescriptions (<i>p</i> = .001). However, no significant association was found for all-cause (<i>p</i> = .062) and asthma-related hospitalization costs (<i>p</i> = .576).<b>Conclusion</b>: Considering continuous patient care, improving asthma control is not only desirable from a clinical perspective, but could also be an effective approach to reduce asthma-related HCRU and cost burden.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":"36 1","pages":"42-50"},"PeriodicalIF":2.1,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9135356","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}
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":"<p><p>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 (<i>n</i>=37) with Canadian and Brazilian innovators to identify: how they operationalize <i>inclusive</i> design processes; what influences the <i>responsiveness</i> of their innovation to system-level challenges; and how they consider the <i>level and intensity of care</i> 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.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":"35 4","pages":"196-205"},"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}
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":"<p><p><b>Purpose</b>: 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. <b>Design/methodology/approach</b>: 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. <b>Findings</b>: 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. <b>Originality</b>: 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.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":"35 4","pages":"215-228"},"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}
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":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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 <i>t</i>-test and multiple-groups path analytic modeling was used.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":"35 4","pages":"206-214"},"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}
{"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":"<p><p>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, <i>p</i><0.01). In addition, higher-volume hospitals had substantially shorter procedure time (17 min per 100 procedures, <i>p</i><0.01) and length of stay (0.88 incidence-rate ratio per 100 procedures <i>p</i><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.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":"35 4","pages":"229-239"},"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}
{"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":"<p><p>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.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":"35 3","pages":"189-193"},"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}
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":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":"35 3","pages":"134-145"},"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}