Health Care Management Review最新文献

{"title":"Burnout in modern-day health care: Where are we, and how can we markedly reduce it? A meta-narrative review from the EUREKA* project.","authors":"Mark Linzer, Emily C O'Brien, Erin Sullivan, Cheryl Rathert, Derick R Simmons, Dawn H Johnson, Warren T McKinney, Sanjoyita Mallick, Carolyn M Porta, Sara Poplau, Mike Wambua, Alli Bosquet, Heather Farley, Victor M Montori, Elizabeth Goelz","doi":"10.1097/HMR.0000000000000433","DOIUrl":"10.1097/HMR.0000000000000433","url":null,"abstract":"<p><strong>Background: </strong>Burnout is disrupting the health care workforce, threatening the livelihoods of health care workers and the probability of safe and effective patient care.</p><p><strong>Purposes: </strong>The aims of this study were to describe the evolution and gaps in burnout research and identify next steps to advance the field and reduce burnout.</p><p><strong>Methodology/approach: </strong>We formed a learning community of burnout scholars and Chief Wellness Officers, sought recent review articles for a meta-narrative synthesis of themes on health care worker burnout, and conducted focus groups with learning community members.</p><p><strong>Results: </strong>In 1,425 systematic burnout studies found in a Medline database search of systematic reviews published since 2018, 68 were retained for analysis. Many focused on individual interventions (e.g., mindfulness), paying inconsistent attention to (a) what comprises burnout, (b) prevalence and contributors, (c) theories underlying it, (d) presence in marginalized populations, and (e) innovative research methods. There was consensus that burnout poses a global crisis, but there was no agreement on how to address it. Focus group participants noted that although burnout research is now \"mainstream,\" health systems commit insufficient resources to addressing it. They proposed that emphasizing organizational finances and patient safety may make burnout a priority for health systems.</p><p><strong>Practice implications: </strong>Despite burnout's progressing unabated, many organizations do not employ known burnout indicators (worker dissatisfaction or turnover) as wellness metrics. Research into organizational contributors to burnout, rigorous evaluation of interventions, and organizational adoption of research findings into systemic action are urgently needed. A well-supported international research agenda is required to quickly move the field ahead and reduce or ultimately eliminate burnout.</p>","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":" ","pages":"57-66"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11902612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081753","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":"The complementary effects of formal and informal budgetary performance feedback on doctor-managers' responsibilities.","authors":"Manuela Paolini, Domenico Raucci, Federica Morandi, Fausto Di Vincenzo","doi":"10.1097/HMR.0000000000000429","DOIUrl":"10.1097/HMR.0000000000000429","url":null,"abstract":"<p><strong>Background: </strong>The reforms that have affected public health care organizations have changed the tasks and responsibilities of physicians heading operational units, who have become doctor-managers. This hybridization makes doctor-managers vulnerable to role ambiguities, with possible dysfunctional effects on their managerial behaviors and performance. The enhancement of different sources of budgetary performance feedback (BPF) and perceived organizational support (POS) can help them reconcile their managerial and clinical professional domains.</p><p><strong>Purpose: </strong>Rooted in psychology-based budgeting research, this study aimed to show the role of doctor-managers' perceptions of BPF by examining the complementary effects of formal and informal BPF on POS and their satisfaction with the budget-holder role.</p><p><strong>Methodology/approach: </strong>We collected self-reported data by administering questionnaires to a sample of doctor-managers from Italian public health care organizations. The hypotheses were tested using a linear regression model, clustered at the hospital level. Mediation analysis was used to test the mediating effects of POS.</p><p><strong>Results: </strong>Findings showed that formal and informal BPF perceptions positively influenced POS and satisfaction with the budget-holder role. Further, POS mediated the BPF-role satisfaction link.</p><p><strong>Conclusion: </strong>The study adds to the limited research on the individual-level benefits of perceived formal and informal BPF as complementary mechanisms for improving doctor-managers' attitudes toward the budget-holder role.</p><p><strong>Practice implications: </strong>Top management and controllers should develop budgeting practices that consider the psychological factors related to the complementary functioning of formal and informal BPFs. These factors may support doctor-managers in meeting their responsibilities as budget holders and mitigate role ambiguities.</p>","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":" ","pages":"140-149"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034338","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":"From the backroom to the boardroom: Health care chief information officers, stereotypes, and strategic leadership in the digital transformation era.","authors":"Michele L Heath, Geoffrey A Silvera, Tracy H Porter","doi":"10.1097/HMR.0000000000000436","DOIUrl":"10.1097/HMR.0000000000000436","url":null,"abstract":"<p><strong>Issue: </strong>The digital transformation of the U.S. health care system is underway, but the role of health care chief information officers (HCIOs) in that transformation has been unclear. As the landscape of health care technology continues to expand, there is an increasing need to understand the influence of HCIOs, who are in a unique position to impact key strategic decisions. We seek to demonstrate the strategic importance of HCIOs in meeting the needs of digital transformation, by managing the emergence and strategic implementation of health care technologies to benefit health care organization performance. We also propose that profession-based stereotypes inhibit HCIOs as they may be viewed as behind-the-scenes technicians rather than strategic leaders.</p><p><strong>Critical theoretical analysis: </strong>Upper echelons (UE) theory demonstrates how HCIOs' unique perspectives gained through education, experience, and the strategic decision-making process also can influence organizational performance. We build on UE to conceptualize the degree to which profession-based stereotypes moderate the decision-making of top management teams).</p><p><strong>Theoretical implications: </strong>We present two theoretical contributions. First, we introduce a profession-based stereotype moderated model of UE specific to HCIOs. Second, we offer an analysis of the role of HCIOs as strategic leaders in the digital transformation era.</p><p><strong>Practice implications: </strong>We call upon health care scholars and practitioners to examine HCIOs' influence and their roles in health care organization decision-making, top management team interactions, and organizational outcomes as the digital transformation in health care continues.</p>","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":" ","pages":"104-111"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048282","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":"Anonymity and employee engagement in creativity: A field experiment with nurses and patient care services staff.","authors":"Olivia S Jung, Paula McCree, Hiyam M Nadel","doi":"10.1097/HMR.0000000000000434","DOIUrl":"10.1097/HMR.0000000000000434","url":null,"abstract":"<p><strong>Background: </strong>Nurses and patient care services staff are promising sources of creative ideas for improving care delivery, but hierarchical barriers can hinder engagement in creativity.</p><p><strong>Purpose: </strong>We examined engagement in creativity among nurses and patient care services staff, particularly the support staff (e.g., medical assistants, unit coordinators) who sit low in the professional hierarchy. We tested whether the opportunity to give creative input anonymously increased engagement.</p><p><strong>Methodology/approach: </strong>An innovation contest at a hospital invited over 8,500 nurses, health professionals, and support staff to share improvement-oriented ideas. We conducted a field experiment, where a randomly assigned group of employees was told that idea submission would be anonymous, whereas another group was told that name and role would be attached to ideas. Engagement in creativity meant viewing the contest platform and submitting an idea.</p><p><strong>Results: </strong>Support staff were less likely to view the platform and submit an idea compared to other roles. With the promise of anonymity, support staff became more likely to view the platform, but not to submit ideas.</p><p><strong>Conclusion: </strong>Although innovation contests offer a structured process for soliciting creative ideas, simply implementing them may not result in widespread engagement, particularly among low-level employees. The promise of anonymity did increase interest in creativity among these employees, but it was not enough to motivate idea submission.</p><p><strong>Practice implications: </strong>Managers will need to pay attention to employee' hierarchy-driven beliefs about engaging in creativity when implementing mechanisms that solicit employees' creative input. The promise of anonymity may not be an effective motivator for creativity.</p>","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":"50 2","pages":"67-76"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460230","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":"Illuminating power dynamics that influenced a relational coordination program in a tertiary hospital: An institutional ethnography study.","authors":"Darren McLean, Martin Connor, Andrea P Marshall, Anne McMurray, Liz Jones","doi":"10.1097/HMR.0000000000000422","DOIUrl":"10.1097/HMR.0000000000000422","url":null,"abstract":"<p><strong>Background: </strong>Amidst the difficulty and contentiousness of improving hospitals, a relatively new approach is the Relational Model of Organizational Change (RMOC). However, this approach has its own challenges, including reports that its focus on communication and relationships is undervalued despite evidence supporting its use to facilitate practice improvements in hospitals. Research suggests power dynamics in hospitals influences how the RMOC is used, but the precise mechanisms through which this occurs have not been fully examined.</p><p><strong>Purpose: </strong>The purpose of this study was to examine how power dynamics shaped the implementation of a program using the RMOC in a hospital: the QPH RC Program.</p><p><strong>Methodology: </strong>Institutional ethnography was applied to explicate textually mediated ruling relations (power dynamics) and examine how they exerted their influence on the QPH RC Program. This involved interviewing people and analyzing texts embedded in work processes that organized the implementation of the program.</p><p><strong>Results: </strong>The QPH RC Program was embedded in a cluster of ruling relations comprising an economic rationalist and scientific discourse and project management methodology. These ruling relations exerted their power via textually mediated social processes that influenced the focus and management of the program.</p><p><strong>Conclusion: </strong>The ruling relations functioned to align the QPH RC Program with the priorities of the hospital, suggesting that financial objectives were prioritized over objectives to improve communication or culture.</p><p><strong>Practice implications: </strong>Future research and practice change should include investigating and addressing the intersection of institutional contexts and the application of the RMOC to facilitate practice improvements in health care organizations, particularly hospitals.</p>","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":"50 1","pages":"23-31"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962481","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":"Workplace violence: Insights from nurses' lived experiences.","authors":"Gregory N Orewa, Ifeyimika O Ajaiyeoba, Nero Edevbie, Marla L White","doi":"10.1097/HMR.0000000000000424","DOIUrl":"10.1097/HMR.0000000000000424","url":null,"abstract":"<p><strong>Background: </strong>Workplace violence (WPV) against nurses is a growing concern within the health care industry, contributing to increased stress, burnout, and higher staff turnover.</p><p><strong>Purpose: </strong>The purpose of this study is to understand the experiences of nurses with WPV and examine the scope and impact of this violence based on nurse's recollections.</p><p><strong>Methodology/approach: </strong>Using qualitative interpretive meta-synthesis and the job demands-resources framework, we examined patterns in nurses' experiences of WPV. Our analysis (N = 401) of nurses' accounts from diverse sources-patients, colleagues, and supervisors across various locations and health care settings-provides deep insights into WPV dynamics.</p><p><strong>Results: </strong>Four main themes were identified: (a) it comes with the job-patient and family violence are normal, (b) a vulnerability in nurse safety, (c) sexual harassment, and (d) poor treatment within the organization.</p><p><strong>Conclusion: </strong>WPV against nurses is a deeply ingrained issue that impacts their psychological health and job performance. A stark need for health care systems to address and mitigate WPV is evident.</p><p><strong>Practice implications: </strong>There are clear signals that health care organizations need to implement comprehensive strategies to prevent WPV, foster a safe and supportive work environment, and equip nurses with job resources to manage the high stress of their roles.</p>","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":"50 1","pages":"44-54"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962485","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":"What makes proactive behaviors at work effective? Perspectives of health care executives.","authors":"Alden Yuanhong Lai, Jemima A Frimpong","doi":"10.1097/HMR.0000000000000421","DOIUrl":"10.1097/HMR.0000000000000421","url":null,"abstract":"<p><strong>Background: </strong>Proactive behaviors at work refer to behaviors that are self-starting, future focused, and change oriented. Proactive behaviors are generally thought of as positive and desired and can benefit both the employee (e.g., job promotion) and organization (e.g., innovation). These behaviors can, however, backfire (e.g., due to unintended consequences), reflecting the \"initiative paradox.\"</p><p><strong>Purpose: </strong>The aim of this study was to investigate, through the perspectives of health care executives, how employees can be more effective when engaging in proactive behaviors.</p><p><strong>Methodology: </strong>We used the episodic narrative interview method. Health care executives narrated instances of perceived effective and ineffective proactive behaviors among employees. We then performed an inductive qualitative analysis of these episodes to identify emerging themes and dimensions.</p><p><strong>Results: </strong>The effectiveness of proactive behaviors among health care employees is shaped by three dimensions: managerial expectation (in)congruence (e.g., knowledge of expectations, engagement with chain of command), organizational priority (in)congruence (e.g., degree of alignment between individual and organizational benefits), and boundaries of action and change (e.g., nonadherence to regulatory or financial conditions). Among the dimensions, managerial expectations may be the most challenging for employees to navigate.</p><p><strong>Conclusion: </strong>Engaging in proactive behaviors is not a straightforward process. Navigating multiple dimensions is necessary for health care employees to be effective.</p><p><strong>Practice implications: </strong>Employees should be equipped with knowledge on relevant expectations, priorities, and boundaries when engaging in proactive behaviors at work. Health care leaders and managers should aim to clarify and periodically reassess these dimensions to facilitate effective proactive behaviors and to generate benefits for employees and the organization.</p>","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":" ","pages":"13-22"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510444","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":"Guest editorial: Leading with soft skills.","authors":"Kimberly Enard, Marcea Walter, Larry Hearld, Cheryl Rathert","doi":"10.1097/HMR.0000000000000425","DOIUrl":"10.1097/HMR.0000000000000425","url":null,"abstract":"","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":"50 1","pages":"1-2"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962465","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":"Improving joy at work and reducing burnout in health care workers in Victoria, Australia using the Institute for Healthcare Improvement joy in work framework: A mixed-methods study.","authors":"Joanne E Jordan, Kerryn Garner, Kate Bones, Lisa McKenzie, Mark Linzer, Cheryl Rathert, Elizabeth Goelz, Jesse McCall, Eleanor Sawyer, Briana Baass, Fiona Herco","doi":"10.1097/HMR.0000000000000420","DOIUrl":"10.1097/HMR.0000000000000420","url":null,"abstract":"<p><strong>Background: </strong>Burnout in health care workers (HCWs) has serious ramifications for individual well-being, patients, organizations, and health systems. Global evidence demonstrates the COVID-19 pandemic has amplified the risk of burnout. Scalable interventions to address burnout are critical to protect HCW well-being.</p><p><strong>Purpose: </strong>Underpinned by the Conservation of Resources theory, this study examines the impacts of a statewide improvement initiative (the Initiative), using the Institute for Healthcare Improvement Joy in Work (JiW) Framework, to reduce burnout and increase joy at work across participating health care organizations in Victoria, Australia.</p><p><strong>Methodology/approach: </strong>An impact evaluation was undertaken utilizing a mixed-methods design. Quantitative outcomes included burnout and joy at work measured using an adapted Mini Z tool. In-depth interviews with implementation teams sought insights into the effectiveness of interventions.</p><p><strong>Results: </strong>Overall, 20 teams from 17 organizations across diverse health care settings and geographical locations participated. At a statewide level, outcomes in burnout and joy at work were inconclusive due to limited data. However, five out of eight teams reporting sufficient data achieved measurable improvements in one or more outcomes. Qualitative data revealed the Initiative increased workplace resources and supports such as providing \"permission\" for HCWs to prioritize well-being at work, improved communications between management and HCWs, and increased HCWs' teamwork and camaraderie, resulting in safer and more positive workplaces.</p><p><strong>Conclusion and practice implications: </strong>The JiW Framework, implemented across diverse settings, provided organizations with a structured process to develop multifaceted improvements that resulted in enhanced resources that appeared to improve HCW well-being. Compared to individual well-being support, this approach offers organization-level change and scalability potential.</p>","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":" ","pages":"3-12"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510443","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 information technology to advance care in accountable care organizations: Implications for Medicare patients.","authors":"Kaushik Ghosh, Mona Al-Amin, Kate Jiayi Li, David Muhlestein","doi":"10.1097/HMR.0000000000000423","DOIUrl":"10.1097/HMR.0000000000000423","url":null,"abstract":"<p><strong>Background: </strong>Prior research has explored the link between health information technology (HIT) and performance of accountable care organizations (ACOs). However, the challenges of HIT use in ACOs for the management of chronic diseases among Medicare beneficiaries remain less examined.</p><p><strong>Purpose: </strong>Given the high costs of implementing HIT and the occurrence of multiple chronic conditions (MCC) among elderly individuals, it is important to understand the extent to which HIT capabilities enable chronic disease management among the Medicare population.</p><p><strong>Methodology/approach: </strong>Regression analysis was conducted using data from multiple sources for the year 2017, including Leavitt Partners data, the ACO Public Use File published by the Shared Savings Program of the Centers for Medicare & Medicaid Services (CMS), and the CMS hospital referral region data. The sample consisted of 470 ACOs.</p><p><strong>Results: </strong>Findings revealed that health information exchange (HIE)- and HIT-enabled patient engagement reduced unplanned admissions for Medicare patients with MCC. When primary care services were utilized, HIE- and HIT-enabled patient engagement and medication reconciliation further decreased unplanned admissions.</p><p><strong>Conclusion: </strong>This study provides empirical support for HIT's role in reinforcing the applicability of the chronic care model to improve health outcomes.</p><p><strong>Practice implications: </strong>From the managerial perspective, adopting HIT functions that support care management may be important for ACOs to improve patient outcomes.</p>","PeriodicalId":47778,"journal":{"name":"Health Care Management Review","volume":"50 1","pages":"32-43"},"PeriodicalIF":2.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962478","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}