Journal of Healthcare Management最新文献

{"title":"John B. Chessare, MD, FACHE, President and CEO, GBMC HealthCare.","authors":"","doi":"10.1097/JHM-D-22-00219","DOIUrl":"https://doi.org/10.1097/JHM-D-22-00219","url":null,"abstract":"","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40673154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Creating Your Personal Board of Directors.","authors":"Eric W Ford","doi":"10.1097/JHM-D-22-00160","DOIUrl":"https://doi.org/10.1097/JHM-D-22-00160","url":null,"abstract":"","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33449957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Professional Behavior and Value Erosion: A Qualitative Study of Physicians and the Electronic Health Record.","authors":"Kelley M Skeff,&nbsp;Cati G Brown-Johnson,&nbsp;Steven M Asch,&nbsp;Dani L Zionts,&nbsp;Marcy Winget,&nbsp;Yaniv Kerem","doi":"10.1097/JHM-D-21-00070","DOIUrl":"https://doi.org/10.1097/JHM-D-21-00070","url":null,"abstract":"<p><strong>Goal: </strong>Occurrences of physician burnout have reached epidemic numbers, and the electronic health record (EHR) is a commonly cited cause of the distress. To enhance current understanding of the relationship between burnout and the EHR, we explored the connections between physicians' distress and the EHR.</p><p><strong>Methods: </strong>In this qualitative study, physicians and graduate medical trainees from two healthcare organizations in California were interviewed about EHR-related distressing events and the impact on their emotions and actions. We analyzed physician responses to identify themes regarding the negative impact of the EHR on physician experience and actions. EHR \"distressing events\" were categorized using the Accreditation Council for Graduate Medical Education (ACGME) Physician Professional Competencies.</p><p><strong>Principal findings: </strong>Every participating physician reported EHR-related distress affecting professional activities. Five main themes emerged from our analysis: system blocks to patient care; poor implementation, design, and functionality of the EHR; billing priorities conflicting with ideal workflow and best-practice care; lack of efficiency; and poor teamwork function. When mapped to the ACGME competencies, physician distress frequently stemmed from situations where physicians prioritized systems-based practice above other desired professional actions and behaviors. Physicians also reported a climate of silence in which physicians would not share problems due to fear of retribution or lack of confidence that the problems would be addressed.</p><p><strong>Practical applications: </strong>Physicians and administrators need to address the hierarchy of values that prioritizes system requirements such as those required by the EHR above physicians' other desired professional actions and behaviors. Balancing the importance of competing competencies may help to address rising burnout. We also recommend that administrators consider qualitative anonymous interviews as an effective method to uncover and understand physician distress in light of physicians' reported climate of silence.</p>","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fa/d1/jhcma-67-339.PMC9447433.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10370392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peggy D. Harris, FACHE, Regional Chief Diversity Officer, Atrium Health.","authors":"","doi":"10.1097/JHM-D-22-00159","DOIUrl":"https://doi.org/10.1097/JHM-D-22-00159","url":null,"abstract":"","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33449919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring Length of Stay of Acute Myocardial Infarction Patients: A Times Series Analysis Using Statistical Process Control.","authors":"Fatma Pakdil,&nbsp;Hannah Beazoglou","doi":"10.1097/JHM-D-21-00235","DOIUrl":"https://doi.org/10.1097/JHM-D-21-00235","url":null,"abstract":"<p><strong>Goal: </strong>Given that length of stay (LOS) of acute myocardial infarction (AMI) patients has a significant impact on the utilization of hospital resources and the health status of communities, this study focused on how best to monitor LOS of AMI patients admitted to U.S. hospitals by employing statistical process control (SPC).</p><p><strong>Methods: </strong>Data were abstracted from the Healthcare Cost and Utilization Project Nationwide Readmissions Database between 2010 and 2016. A total of 1,491 patients were examined in the study. Patients who were admitted to nonfederal government (public) hospitals in metropolitan areas of at least 1 million residents with the primary diagnosis of AMI were abstracted. They were excluded if they developed AMI secondary to an interventional procedure or surgery, died during their index hospitalization, and were admitted and discharged on the same day. Patients were also excluded if they were discharged to short-term hospitals, nursing facilities, intermediate care facilities, home healthcare, or against medical advice. Individual moving range (I-MR) charts were used to monitor LOS of individual AMI patients in each subgroup from 2010 to 2016.</p><p><strong>Principal findings: </strong>The results showed I-MR charts could be used to indicate statistically out-of-control signals on LOS. Specifically, I-MR charts showed that LOS decreased between 2010 and 2016. LOS appeared to be longer at teaching hospitals compared to nonteaching hospitals and varied by gender. Female patients appeared to stay longer than male patients in the hospitals.</p><p><strong>Practical applications: </strong>The application of SPC and control charts can facilitate improved decision-making in healthcare organizations. This study shows the value of integrating control charts in administrative and medical decision-making processes. It may also help healthcare providers and managers achieve higher quality and lower cost of care.</p>","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33449921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitigating Moral Distress in Leaders of Healthcare Organizations: A Scoping Review.","authors":"Attila J Hertelendy,&nbsp;Jennifer Gutberg,&nbsp;Cheryl Mitchell,&nbsp;Martina Gustavsson,&nbsp;Devin Rapp,&nbsp;Michael Mayo,&nbsp;Johan von Schreeb","doi":"10.1097/JHM-D-21-00263","DOIUrl":"https://doi.org/10.1097/JHM-D-21-00263","url":null,"abstract":"<p><strong>Goal: </strong>Moral distress literature is firmly rooted in the nursing and clinician experience, with a paucity of literature that considers the extent to which moral distress affects clinical and administrative healthcare leaders. Moreover, the little evidence that has been collected on this phenomenon has not been systematically mapped to identify key areas for both theoretical and practical elaboration. We conducted a scoping review to frame our understanding of this largely unexplored dynamic of moral distress and better situate our existing knowledge of moral distress and leadership.</p><p><strong>Methods: </strong>Using moral distress theory as our conceptual framework, we evaluated recent literature on moral distress and leadership to understand how prior studies have conceptualized the effects of moral distress. Our search yielded 1,640 total abstracts. Further screening with the PRISMA process resulted in 72 included articles.</p><p><strong>Principal findings: </strong>Our scoping review found that leaders-not just their employees- personally experience moral distress. In addition, we identified an important role for leaders and organizations in addressing the theoretical conceptualization and practical effects of moral distress.</p><p><strong>Practical applications: </strong>Although moral distress is unlikely to ever be eliminated, the literature in this review points to a singular need for organizational responses that are intended to intervene at the level of the organization itself, not just at the individual level. Best practices require creating stronger organizational cultures that are designed to mitigate moral distress. This can be achieved through transparency and alignment of personal, professional, and organizational values.</p>","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33449923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Professional Fulfillment and Burnout Among CEOs and Other Healthcare Administrative Leaders in the United States.","authors":"Tait Shanafelt,&nbsp;Mickey Trockel,&nbsp;Hanhan Wang,&nbsp;Thom Mayer,&nbsp;Leslie Athey","doi":"10.1097/JHM-D-22-00012","DOIUrl":"https://doi.org/10.1097/JHM-D-22-00012","url":null,"abstract":"<p><strong>Goal: </strong>The objective of this study was to evaluate the prevalence of burnout and professional fulfillment among healthcare administrative leaders and examine the association between burnout and professional fulfillment and personal and professional characteristics.</p><p><strong>Methods: </strong>Between June 7 and June 30, 2021, we performed a national survey of CEOs and other senior operational leaders to evaluate their personal work experience. Burnout and professional fulfillment-as well as a sleep-related impairment and self-valuation-were assessed using standardized instruments.</p><p><strong>Principle findings: </strong>Of the 5,994 members of the American College of Healthcare Executives who were sent an invitation to participate, 1,269 (21.2%), including 279 CEOs, submitted usable responses. The mean overall burnout score was 2.71 (range: 0-10), and 33% of participants had burnout scores that fell in the high range (unfavorable). Mean professional fulfillment score was 7.29 (range: 0-10), with 56.6% scoring in the high range (favorable). Burnout and professional fulfillment scores varied by role. On multivariable analysis, sleep-related impairment (OR for each 1-point increase = 1.29, 95% CI [1.19-1.41]; p < .001) and self-valuation (OR for each 1-point increase = 0.63, 95% CI [0.57-0.68]; p < .001) were independently associated with burnout after adjusting for all other variables.</p><p><strong>Applications to practice: </strong>Results of this study suggest that healthcare leaders had lower burnout and professional fulfillment scores than clinicians. Nonetheless, one third of healthcare leaders had burnout scores that fell in the high range. At the individual level, improved sleep health and self-valuation appear to reduce risk of burnout and promote professional fulfillment.</p>","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3f/57/jhcma-67-317.PMC9447437.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10370387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Measured Quality and Future Financial Performance Among Hospitals Performing Cardiac Surgery.","authors":"Samuel J Enumah,&nbsp;Thoralf M Sundt,&nbsp;David C Chang","doi":"10.1097/JHM-D-21-00262","DOIUrl":"https://doi.org/10.1097/JHM-D-21-00262","url":null,"abstract":"<p><strong>Goal: </strong>For decades, hospitals performing cardiac surgery have carried the cost of implementing quality improvement activities and reporting quality outcomes. However, the financial return of such investments is unclear, which weakens the incentive for hospitals to invest in quality improvement activities. This study explored the relationship between a hospital's measured quality and its financial performance.</p><p><strong>Methods: </strong>Using data from the American Hospital Association and Hospital Compare from 2014 to 2018, we performed an observational study of hospitals performing cardiac surgery. We used mixed-effects regression models with fixed-year effects and random intercepts to explore associations between measured quality and hospital financial performance. Our dependent variables were margins (profit divided by revenue) and financial distress; our independent variables included Patient Safety Indicator 90 (PSI-90) and hospital characteristics.</p><p><strong>Principal findings: </strong>Our sample included 4,927 hospital-years from 1,209 unique hospitals. Hospitals in the worst-performing PSI-90 score quartile experienced a lower operating margin (-1.26%, 95% CI [-2.10 to -0.41], p = .004), a lower total margin (-0.92%, 95% CI [-1.66 to -0.17], p = .016), and an increased odds of financial distress in the next year (OR: 2.12, 95% CI [1.36-3.30], p = .001) when compared with the best-performing hospitals.</p><p><strong>Practical applications: </strong>Our exploration into financial distress provides managers with a better understanding of the relationship between a hospital's measured quality and its financial position. In reflecting on our findings, hospital leaders may consider viewing patient safety as a modifiable factor that can improve their organization's overall financial health. Our findings suggest that excellent safety performance may be both financially and clinically beneficial to hospitals.</p>","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10007573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caring for Those Who Care for Us: Three Steps to Address the Workforce Crisis.","authors":"Richard J Pollack","doi":"10.1097/JHM-D-22-00155","DOIUrl":"https://doi.org/10.1097/JHM-D-22-00155","url":null,"abstract":"ired. Anxious. Exhausted. Burned out. These are words","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33449920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"You Can't Manage What You Don't Measure.","authors":"Eric W Ford","doi":"10.1097/JHM-D-22-00114","DOIUrl":"https://doi.org/10.1097/JHM-D-22-00114","url":null,"abstract":"","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40595800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}