Health Care Management Review最新文献

{"title":"Cognitive crafting and work engagement: A study among remote and frontline health care workers during the COVID-19 pandemic.","authors":"Indy Wijngaards,&nbsp;Florie R Pronk,&nbsp;Arnold B Bakker,&nbsp;Martijn J Burger","doi":"10.1097/HMR.0000000000000322","DOIUrl":"https://doi.org/10.1097/HMR.0000000000000322","url":null,"abstract":"<p><strong>Background: </strong>The outbreak of COVID-19 has led to a profound change in the organization of work in the health care sector. As frontline health care workers are essential in battling the pandemic and their work is appreciated in society, we argue that health care workers who are forced to work from home are likely to perceive their jobs as less meaningful, which in turn may negatively affect their engagement at work. Cognitive crafting, or the altering of the perceptions one has about their tasks and relationships with the aim to enhance the meaningfulness of work, may be a fruitful cognitive strategy to counter the problems remote health care workers face.</p><p><strong>Purpose: </strong>The primary purpose was to study the relationship between cognitive crafting, working from home (WFH), and work engagement.</p><p><strong>Methodology: </strong>We collected cross-sectional survey data between May 7 and June 2, 2020, from a single hospital in the Netherlands (n = 278). The central hypothesis was tested using multiple regression analysis.</p><p><strong>Results: </strong>The relationship between cognitive crafting and work engagement was moderated by WFH, such that the relationship is more positive for health care workers who work from home permanently since the start of the COVID-19 pandemic than for frontline workers and workers who work partially from home.</p><p><strong>Conclusion: </strong>Our findings are consistent with previous research on cognitive crafting. We conclude that cognitive crafting is an interesting cognitive strategy to stay engaged for health care workers who are mandated into WFH.</p><p><strong>Practice implications: </strong>We advise organizations to provide remote workers virtual group trainings that promote cognitive crafting and expose them to testimonies of people who are positively affected by their work. More generally, we recommend organizations to engage in effective top-down work design and foster a climate for cognitive as well as behavioral job crafting strategies.</p>","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":" ","pages":"227-235"},"PeriodicalIF":2.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9161752/pdf/hcmr-47-227.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39230015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A framework of the institutional policies and practice environments of nurse practitioner primary care models: A cross-case analysis","authors":"T. Hogan, Nicholas R. Maurer, L. Stevens, Jennifer L. Hefner","doi":"10.1097/HMR.0000000000000344","DOIUrl":"https://doi.org/10.1097/HMR.0000000000000344","url":null,"abstract":"Purpose The purpose of this article was to compare the implementation of distinct models of nurse practitioner (NP) integration into primary care offices. Design/Methodology A multiple case study design of three NP primary care practice models allowed for in-depth exploration of the management processes supporting the utilization of NPs. At each site, semistructured qualitative interviews, document review, and site tours/observations were conducted and subject to cross-case analysis guided by the NP Primary Care Organizational Framework (NP-PCOF)—developed for this study based on existing theory. Results Our case study sites represent three distinct NP primary care models. In the restricted practice model, NPs care for same-day/walk-in acute patients. NPs in the independent practice model have an independent panel of patients and interact collegially as independent coworkers. NPs in the comanagement model function on a team (a physician and two NPs), have a team office space, collectively care for a shared panel of patients, and can earn financial bonuses contingent upon meeting team quality metrics. Our cross-case analysis confirmed differences in physical space design, the relational structure of a workplace, and the capacity for innovation via NP compensation and performance metrics across different NP primary care models. Conclusion Our findings suggest that NP primary care models are supported by complex management systems and the NP-PCOF is a tool to help understand this complexity. Implications The NP-PCOF is a framework to understand the management systems that facilitate the utilization of NPs within primary care organizations.","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":"47 1","pages":"369 - 379"},"PeriodicalIF":2.5,"publicationDate":"2022-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45686628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician role differentiation: Patients, practice patterns, and performance","authors":"L. Comfort, E. Bambury, M. Atkinson","doi":"10.1097/HMR.0000000000000332","DOIUrl":"https://doi.org/10.1097/HMR.0000000000000332","url":null,"abstract":"Supplemental digital content is available in the text. Background Multispecialty clinical settings are increasingly prevalent because of the growing complexity in health care, revealing challenges with overlaps in expertise. We study hospitalists and inpatient specialists to gain insights on how physicians with shared expertise may differentiate themselves in practice. Purpose The aim of this study was to explore how hospitalists differentiate themselves from other inpatient physicians when treating patient cases in areas of shared expertise, focusing on differences in patient populations, practice patterns, and performance on cost and quality metrics. Methodology We use mixed-effects multilevel models and mediation models to analyze medical records and disaggregated billing data for admissions to a large urban pediatric hospital from January 1, 2009, to August 31, 2015. Results In areas of shared physician expertise, patients with more ambiguous diagnoses and multiple chronic conditions are more likely to be assigned to a hospitalist. Controlling for differences in patient populations, hospitalists order laboratory tests and medications at lower rates than specialists. Hospitalists’ laboratory testing rate had a significant mediating role in their lower total charges and lower odds of their patients experiencing any nonsurgical adverse events compared to specialists, though hospitalists did not differ from specialists in 30- and 90-day readmission rates. Practice Implications Physicians with shared expertise, such as hospitalists and inpatient specialists, differentiate their roles through assignment to ambiguous diagnoses and multisystem conditions, and practice patterns such as laboratory and medication orders. Such differentiation can improve care coordination and establish professional identity when roles overlap.","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":"47 1","pages":"279 - 288"},"PeriodicalIF":2.5,"publicationDate":"2022-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61706411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fostering organizational resilience: The relevance of organization theory in a postpandemic world.","authors":"J. Zinn","doi":"10.1097/HMR.0000000000000331","DOIUrl":"https://doi.org/10.1097/HMR.0000000000000331","url":null,"abstract":"ASSOCIATE EDITORS NOTE\u0000This article is an adapted version of Dr. Jacqueline Zinn's Keith G. Provan Distinguished Scholar Award plenary to the Health Care Management Division of the Academy of Management in 2020. We are excited to share it with you because it is noteworthy among scholarly career award plenaries. Specifically, the article does two big things exceptionally well: (a) provides a compelling and informative retrospective on a truly exceptional scholarly career renowned for work that consistently and deeply engages with practice, practitioners, and emerging, urgent problems in a conceptually and empirically rigorous manner and (b) inventively connects her research to the health care, managerial, and organizational challenges posed by the pandemic (and pandemics from prior eras) to provide a forward looking research agenda on organizational resilience and well-being that offers ready-made conceptual development and empirical work for the next generation.","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":"1 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48974080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resident physicians’ advice seeking and error making: A social networks approach","authors":"Tal Katz-Navon, E. Naveh","doi":"10.1097/HMR.0000000000000333","DOIUrl":"https://doi.org/10.1097/HMR.0000000000000333","url":null,"abstract":"Background Resident physicians are especially at risk of being involved in medical errors because they bear tremendous responsibility for patient care yet are still in the process of learning and mastering their profession. To increase knowledge and gain information, they create a professional-instrumental network, that is, the deliberate initiation of advice ties with senior physicians. Purpose We aim to explore whether and how residents’ networking with senior physicians is associated with their error rates. Specifically, we aim to identify whether the centralities of residents (advice seekers) and senior physicians (advice givers) in the social network are associated with residents’ error rates. Methodology We surveyed 142 resident physicians working in 22 wards in two general hospitals about whom and how frequently they consult using a sociometric technique. Information about errors made in a 3-month period was collected independently. Results Residents made less errors when they sought advice from few senior physicians but consulted more frequently with focal senior physicians (those whom many other advice seekers frequently consult). However, when residents sought advice from many senior physicians, their frequency of consultation with focal senior physicians was not associated with their number of errors. These effects were more pronounced for residents at the beginning of their residency period. Conclusions Results of this study provide evidence of a specific association between resident physicians’ consultation patterns and their error rates. Practice Implications Results inform ward managers about ways to leverage opportunities and remove constraints for residents to ask for advice and for focal physicians to provide it.","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":"47 1","pages":"E41 - E49"},"PeriodicalIF":2.5,"publicationDate":"2022-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41608943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Being “low on the totem pole”: What makes work worthwhile for medical assistants in an era of primary care transformation","authors":"A. Lai, Bram P. I. Fleuren, J. Larkin, Lynda Gruenewald-Schmitz, C. Yuan","doi":"10.1097/HMR.0000000000000342","DOIUrl":"https://doi.org/10.1097/HMR.0000000000000342","url":null,"abstract":"Background Primary care is undergoing a transformation to become increasingly team-based and multidisciplinary. The medical assistant (MA) is considered a core occupation in the primary care workforce, yet existing studies suggest problematic rates and costs of MA turnover. Purpose We investigated what MAs perceive their occupation to be like and what they value in it to understand how to promote sustainable employability, a concept that is concerned with an employee’s ability to function and remain in their job in the long term. Approach We used a case of a large, integrated health system in the United States that practices team-based care and has an MA career development program. We conducted semistructured interviews with 16 MAs in this system and performed an inductive analysis of themes. Results Our analysis revealed four themes on what MAs value at work: (a) using clinical competence, (b) being a multiskilled resource for clinic operations, (c) building meaningful relationships with patients and coworkers, and (d) being recognized for occupational contributions. MAs perceived scope-of-practice regulations as limiting their use of clinical competence. They also perceived task similarity with nurses in the primary care setting and expressed a relative lack of performance recognition. Conclusion Some of the practice changes that enable primary care transformation may hinder MAs’ ability to attain their work values. Extant views on sustainable employability assume a high bar for intrinsic values but are limited when applied to low-wage health care workers in team-based environments. Practice Implications Efforts to effectively employ and retain MAs should consider proactive communications on scope-of-practice regulations, work redesign to emphasize clinical competence, and the establishment of greater recognition and respect among MAs and nurses.","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":"47 1","pages":"340 - 349"},"PeriodicalIF":2.5,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48498754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health care professionals' motivation, their behaviors, and the quality of hospital care: A mixed-methods systematic review.","authors":"Gepke L Veenstra, Kirsten F A A Dabekaussen, Eric Molleman, Erik Heineman, Gera A Welker","doi":"10.1097/HMR.0000000000000284","DOIUrl":"10.1097/HMR.0000000000000284","url":null,"abstract":"<p><strong>Background: </strong>Health care professionals' work motivation is assumed to be crucial for the quality of hospital care, but it is unclear which type of motivation ought to be stimulated to improve quality. Motivation and similar concepts are aligned along a motivational continuum that ranges from (intrinsic) autonomous motivation to (extrinsic) controlled motivation to provide a framework for this mixed-methods systematic review.</p><p><strong>Purpose: </strong>This mixed-methods systematic review aims to link various types of health care professionals' motivation directly and through their work-related behaviors to quality of care.</p><p><strong>Methods: </strong>Six databases were searched from January 1990 to August 2016. Qualitative and quantitative studies were included if they reported on work motivation in relationship to work behavior and/or quality, and study participants were health care professionals working in hospitals in high-income countries. Study bias was evaluated using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. The review protocol was registered in the PROSPERO database (CRD42016043284).</p><p><strong>Results: </strong>A total of 84 out of 6,525 unique records met the inclusion criteria. Results show that health care professionals' autonomous motivation improves their quality perceptions and work-related behaviors. Controlled motivation inhibits voicing behavior, but when balanced with autonomous motivation, it stimulates core task and proactive behavior. Proactivity is associated with increased quality of care perceptions.</p><p><strong>Practice implications: </strong>To improve quality of care, policy makers and managers need to support health care professionals' autonomous motivation and recognize and facilitate proactivity as an essential part of health care professionals' jobs. Incentive-based quality improvements need to be complemented with aspects that stimulate autonomous motivation.</p>","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":"47 2","pages":"155-167"},"PeriodicalIF":1.7,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5b/03/hcm-47-155.PMC8876425.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37817622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing the value to users of machine learning-based clinical decision support tools: A framework for iterative, collaborative development and implementation.","authors":"Sara J Singer,&nbsp;Katherine C Kellogg,&nbsp;Ari B Galper,&nbsp;Deborah Viola","doi":"10.1097/HMR.0000000000000324","DOIUrl":"https://doi.org/10.1097/HMR.0000000000000324","url":null,"abstract":"<p><strong>Background: </strong>Health care organizations are integrating a variety of machine learning (ML)-based clinical decision support (CDS) tools into their operations, but practitioners lack clear guidance regarding how to implement these tools so that they assist end users in their work.</p><p><strong>Purpose: </strong>We designed this study to identify how health care organizations can facilitate collaborative development of ML-based CDS tools to enhance their value for health care delivery in real-world settings.</p><p><strong>Methodology/approach: </strong>We utilized qualitative methods, including 37 interviews in a large, multispecialty health system that developed and implemented two operational ML-based CDS tools in two of its hospital sites. We performed thematic analyses to inform presentation of an explanatory framework and recommendations.</p><p><strong>Results: </strong>We found that ML-based CDS tool development and implementation into clinical workflows proceeded in four phases: iterative solution coidentification, iterative coengagement, iterative coapplication, and iterative corefinement. Each phase is characterized by a collaborative back-and-forth process between the technology's developers and users, through which both users' activities and the technology itself are transformed.</p><p><strong>Conclusion: </strong>Health care organizations that anticipate iterative collaboration to be an integral aspect of their ML-based CDS tools' development and implementation process may have more success in deploying ML-based CDS tools that assist end users in their work than organizations that expect a traditional technology innovation process.</p><p><strong>Practice implications: </strong>Managers developing and implementing ML-based CDS tools should frame the work as a collaborative learning opportunity for both users and the technology itself and should solicit constructive feedback from users on potential changes to the technology, in addition to potential changes to user workflows, in an ongoing, iterative manner.</p>","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":"47 2","pages":"E21-E31"},"PeriodicalIF":2.5,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39412008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practices to support relational coordination in care transitions: Observations from the VA rural Transitions Nurse Program.","authors":"Heather M Gilmartin,&nbsp;Catherine Battaglia,&nbsp;Theodore Warsavage,&nbsp;Brigid Connelly,&nbsp;Robert E Burke","doi":"10.1097/HMR.0000000000000300","DOIUrl":"https://doi.org/10.1097/HMR.0000000000000300","url":null,"abstract":"<p><strong>Background: </strong>Ensuring safe transitions of care around hospital discharge requires effective relationships and communication between health care teams. Relational coordination (RC) is a process of communicating and relating for the purpose of task integration that predicts desirable outcomes for patients and providers. RC can be measured using a validated survey.</p><p><strong>Purpose: </strong>The aim of the study was to demonstrate the application of RC practices within the rural Transitions Nurse Program (TNP), a nationwide transitions of care intervention for Veterans, and assess relationships and mechanisms for developing RC in teams.</p><p><strong>Methodology/approach: </strong>TNP implemented practices expected to support RC. These included creation of a transition nurse role, preimplementation site visits, process mapping to understand workflow, creation of standardized communication templates and protocols, and inclusion of teamwork and shared accountability in job descriptions and annual reviews. We used the RC Survey to measure RC for TNP health care teams. Associations between the months each site participated in TNP, number of Veterans enrolled, and adherence to the TNP intervention were assessed as possible mechanisms for developing high RC using Spearman (rs) correlations.</p><p><strong>Results: </strong>The RC Survey was completed by 44 providers from 11 Veterans Health Administration medical centers. RC scores were high across sites (mean = 4.19; 1-5 Likert scale) and were positively correlated with months participating in TNP (rs = .66) and number of enrollees (rs = .63), but not with adherence to the TNP intervention (rs = .12).</p><p><strong>Practice implications: </strong>The impact of practices to support RC can be assessed using the RC Survey. Our findings suggest scale-up time is a likely mechanism to the development of high-quality relationships and communication within teams.</p>","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":"47 2","pages":"109-114"},"PeriodicalIF":2.5,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38602955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disruptive behavior in a high-power distance culture and a three-dimensional framework for curbing it.","authors":"Sandy Lim,&nbsp;E-Yang Goh,&nbsp;Eugene Tay,&nbsp;Yew Kwan Tong,&nbsp;Deborah Chung,&nbsp;Kamala Devi,&nbsp;Chay Hoon Tan,&nbsp;Inthrani Raja Indran","doi":"10.1097/HMR.0000000000000315","DOIUrl":"https://doi.org/10.1097/HMR.0000000000000315","url":null,"abstract":"<p><strong>Background: </strong>Disruptive behavior can harm high-quality care and is prevalent in many Western public health systems despite increasing spotlight on it. Comparatively less knowledge about it is available in Asia, a region commonly associated with high-power distance, which may limit its effectiveness in addressing disruptive behavior.</p><p><strong>Purpose: </strong>The aim of this study was to develop a comprehensive framework for tackling disruptive behavior among health care professionals in a public health system.</p><p><strong>Methodology: </strong>A nationwide cross-sectional study relying on the Nurse-Physician Relationship Survey was conducted in Singapore. Four hundred eighty-six public health care professionals responded.</p><p><strong>Results: </strong>Two hundred ninety-eight doctors (95.5%) and 163 nurses (93.7%) had witnessed a form of disruptive behavior. Doctors observed disruptive behavior committed by other doctors and nurses much more frequently than did nurses. Doctors made stronger associations between disruptive behavior and negative employee outcomes and between disruptive behavior and negative patient outcomes. Qualitative analyses of participants' open-ended answers produced a multipronged three-dimensional approach for tackling disruptive behavior: (a) deterrent measures, (b) development of knowledge and skills, and (c) demonstration of organizational commitment through proper norms, empathizing with staff, and structural reforms.</p><p><strong>Practice implications: </strong>Disruptive behavior is a multifaceted problem requiring a multipronged approach. Our three-dimensional framework is a comprehensive approach for giving health care professionals the capability, opportunity, and motivation to address disruptive behavior effectively.</p>","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":"47 2","pages":"133-143"},"PeriodicalIF":2.5,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a5/91/hcm-47-133.PMC8876433.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39010406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}