Journal of Healthcare Management最新文献

{"title":"Strategic Healthcare Change: Balancing Change and Stability.","authors":"Jim Austin","doi":"10.1097/JHM-D-22-00228","DOIUrl":"https://doi.org/10.1097/JHM-D-22-00228","url":null,"abstract":"One day a few years ago, my boss at Baxter International asked for examples of organizations that undertook substantial or transformative change before the market or competitors’ challenges forced them to change. I could identify very few. Consistent with a natural human reticence to change before being forced, the track record of any significant efforts appeared to be dismal. One study found “just 26 percent of respondents say the transformations they’re most familiar with have been very or completely successful at both improving performance and equipping the organization to sustain improvements over time” (Jacquemont et al., 2015, p. 1). And yet, within the U.S. healthcare system, there are examples of successful transformative change, including:","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10501168","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":"Healthcare Workers' Perceptions of On-Site Childcare.","authors":"Amy Braddock,&nbsp;Elizabeth Malm-Buatsi,&nbsp;Sarah Hicks,&nbsp;Grant Harris,&nbsp;Patricia Alafaireet","doi":"10.1097/JHM-D-22-00007","DOIUrl":"https://doi.org/10.1097/JHM-D-22-00007","url":null,"abstract":"<p><strong>Goal: </strong>Measures taken by healthcare organizations to address COVID-19 highlighted the long-standing lack of childcare infrastructure required to support healthcare workers. This study, designed to provide evidence to support operations at an academic medical center, looked at the influence that in-house and emergency childcare could have on the retention, recruitment, and productivity of healthcare workers. This study also outlined the implications that childcare, or its lack, has for healthcare organizations during and after the COVID-19 pandemic.</p><p><strong>Methods: </strong>We conducted a 35-question electronic employee survey (under institutional review board approval) during pandemic-induced public school closures, which included both quantitative and qualitative (write-in) questions.</p><p><strong>Principal findings: </strong>The survey results showed that weekday on-site childcare was very or extremely important to more than half of survey respondents, the majority of whom were staff members (28%) or physicians (25%), followed by administrators (15%), researchers (12%), others (10%), nurses (5%), educators (2%), and residents (1%). Sixty percent of respondents reported that emergency on-site childcare was extremely important (34%) or very important (26%). Almost half (49%) reported that emergency childcare needs have disrupted their work in the past year, including canceling of clinics or surgical cases. Analysis of qualitative comments via a strategy based on coding and categorization showed that, when asked how childcare influences their work choices, employees responded that childcare availability has limited the hours or times they could work, that lack of childcare has prevented career growth, that they left a previous job or will leave their current job because of childcare needs, or that they stayed at a previous job or have remained in their current job longer because of the availability of childcare.</p><p><strong>Practical applications: </strong>Although data from this mixed-methods study support findings in the literature that there is a need for in-house and emergency childcare, the data suggest that current employees at this academic medical center do not currently expect it, likely because such childcare is not generally available at most academic institutions. With increased rates of burnout and healthcare workers leaving the field since COVID-19, offering in-house and emergency childcare provides hospital systems with new opportunities to retain and recruit physicians, nurses, and staff, as well as to improve their well-being and productivity.</p>","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10501173","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":"African Traditional Medicine: Its Potential, Limitations and Challenges","authors":"Sifuna Nixon","doi":"10.36959/569/475","DOIUrl":"https://doi.org/10.36959/569/475","url":null,"abstract":"","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75006385","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":"ABSTRACTS FROM THE FORUM ON ADVANCES IN HEALT HCARE MANAGEMENT RESEARCH.","authors":"","doi":"10.1097/JHM-D-22-00193","DOIUrl":"https://doi.org/10.1097/JHM-D-22-00193","url":null,"abstract":"<p><p>The following three abstracts are from presentations for the Forum on Advances in Healthcare Management Research that took place in March 2022 during the Congress on Healthcare Leadership of the American College of Healthcare Executives. An annual event, the Forum presents theoretical and empirical research with the potential for high impact on healthcare management.</p>","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":"10374699","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":"Healthcare Workplace Violence: Hurting Those Who Try to Help.","authors":"Chris Van Gorder","doi":"10.1097/JHM-D-22-00206","DOIUrl":"https://doi.org/10.1097/JHM-D-22-00206","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":"40673155","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":"Closing the Gender Gap in Healthcare Leadership: Can Administrative Fellowships Play a Role?","authors":"Julie Robbins,&nbsp;Brooke Z Graham,&nbsp;Andrew N Garman,&nbsp;Randa Smith Hall,&nbsp;Jeffrey Simms","doi":"10.1097/JHM-D-21-00314","DOIUrl":"https://doi.org/10.1097/JHM-D-21-00314","url":null,"abstract":"<p><strong>Goal: </strong>Although women make up most of the healthcare workforce, they are underrepresented in higher levels of leadership positions. Leadership development programs for early careerists, such as administrative fellowships, have been suggested as one strategy for accelerating gender equity in leadership roles. However, the potential impact of these programs has not yet been the subject of systematic evaluation. In this study, we examined the (1) benefits of administrative fellowship programs on career attainment and (2) differences in attainment by gender.</p><p><strong>Methods: </strong>We completed this study using a data set involving alumni from a consortium of 11 graduate healthcare management programs whose students frequently pursue administrative fellowships. Our data included individual-level demographic and career attainment data for graduating classes from 5, 10, and 20 years prior to the reference year. Using multiple regression analysis, we tested the relationship of three independent variables-graduation year, gender, and completion of a fellowship-on career attainment. This analysis enabled us to determine differences in overall career attainment by gender, evaluate the role of fellowships in career attainment, and consider the differential impact of fellowships on attainment by gender.</p><p><strong>Principal findings: </strong>Our findings suggest that fellowship programs accelerate leadership career paths for individual leaders, but that the effect is stronger for males than their female counterparts.</p><p><strong>Practical applications: </strong>These findings not only support the value of administrative fellowships for early careerist leadership development but also suggest that closing the gender disparity gap in leadership may require additional and focused career-supportive strategies. We provide recommendations for healthcare organizations in developing their administrative fellowship programs to help minimize the gender disparity in healthcare leadership positions. Furthermore, we discuss research implications and future areas of research in administrative fellowships.</p>","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":"40673157","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":"Hospital-Wide Intervention in Billing and Coding to Capture Complexity of Care at an Academic Referral Center.","authors":"Danielle DeCicco,&nbsp;Troy M Krupica,&nbsp;Ronald Pellegrino,&nbsp;Ziad O Dimachkie","doi":"10.1097/JHM-D-21-00213","DOIUrl":"https://doi.org/10.1097/JHM-D-21-00213","url":null,"abstract":"<p><strong>Goal: </strong>Downcoding at nonprofit healthcare institutions can account for significant revenue losses that, in turn, can affect the amount and quality of care they provide. Using the inpatient medical note to assess the complexity of care, we wanted to quantify the visit coding distribution at the largest tertiary care center in West Virginia and to improve the documentation and coding if found to be below national benchmarks.</p><p><strong>Methods: </strong>We measured the number of encounters and associated documentation of level 1, 2, and 3 visits among hospitalists. We compared our data to national benchmark data. We then implemented a multifaceted, multidisciplinary intervention to improve documentation and coding.</p><p><strong>Principal findings: </strong>We found a significant average increase of level 3 admission history and physical visits of 76% ( p &lt; .0001) and 112% ( p &lt; .001) for subsequent encounters compared with baseline preintervention visit types. With team-based coding interventions in place, documentation accurately now reflects the complexity of care delivered. Based on Medicare reimbursement rates, this new accuracy has led to an increase in revenue of $233, 988.79 per 10,000 encounters.</p><p><strong>Applications to practice: </strong>Provider knowledge of medical billing and coding guidelines is essential. In particular, large academic institutions typically operate on small margins, so even simple adjustments and quality improvement efforts in billing and coding can help immensely by accurately representing the amount and quality of medical services. An institution can markedly improve revenues by coding notes to reflect the true complexity of care that is delivered.</p>","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":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6b/d3/jhcma-67-416.PMC9640277.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10016790","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":"Managing Through a Pandemic: A Daily Management System for COVID-19 Response and Recovery.","authors":"Dorothy Y Hung,&nbsp;Thomas G Rundall,&nbsp;Justin Lee,&nbsp;Negeen Khandel,&nbsp;Stephen M Shortell","doi":"10.1097/JHM-D-21-00319","DOIUrl":"https://doi.org/10.1097/JHM-D-21-00319","url":null,"abstract":"<p><strong>Goal: </strong>This study explored the use of a Lean daily management system (DMS) for COVID-19 response and recovery in U.S. hospitals and health systems. Originally developed in manufacturing, Lean is an evidence-based approach to quality and process improvement in healthcare. Although Lean has been studied in individual hospital units and outpatient practices, it has not been examined as a whole system response to crisis events.</p><p><strong>Methods: </strong>We conducted qualitative interviews with 46 executive leaders, clinical leaders, and frontline staff in four hospitals and health systems across the United States. We developed a semistructured interview guide to understand DMS implementation in these care delivery organizations. As interviews took place 6-8 months following the onset of the pandemic, a subset of our interview questions centered on DMS use to meet the demands of COVID-19. Based on a deductive approach to qualitative analysis, we identified clusters of themes that described how DMS facilitated rapid system response to the public health emergency.</p><p><strong>Principal findings: </strong>There were many important ways in which U.S. hospitals and health systems leveraged their DMS to address COVID-19 challenges. These included the use of tiered huddles to facilitate rapid communication, the creation of standard work for redeployed staff, and structured problem-solving to prioritize new areas for improvement. We also discovered ways that the pandemic itself affected DMS implementation in all organizations. COVID-19 universally created greater DMS visibility by opening lines of communication among leadership, strengthening measurement and accountability, and empowering staff to develop solutions at the front lines. Many lessons learned using DMS for crisis management will carry forward into COVID-19 recovery efforts. Lessons include expanding telehealth, reactivating incident command systems as needed, and efficiently coordinating resources amid potential future shortages.</p><p><strong>Practical applications: </strong>Overall, the Lean DMS functioned as a robust property that enabled quick organizational response to unpredictable events. Our findings on the use of DMS are consistent with organizational resilience that emphasizes collective sense-making and awareness of incident status, team decision-making, and frequent interaction and coordination. These features of resilience are supported by DMS practices such as tiered huddles for rapid information dissemination and alignment across organizational hierarchies. When used in conjunction with plan-do-study-act methodology, huddles provide teams with enhanced feedback that strengthens their ability to make changes as needed. Moreover, gaps between work-as-imagined (how work should be done) and work-as-done (how work is actually done) may be exacerbated in the initial chaos of emergency events but can be minimized through the development of standard work protocol","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9640242/pdf/jhcma-67-446.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10007597","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":"Implementation of a Virtual Asynchronous Scribe Program to Reduce Physician Burnout.","authors":"Jennifer Stephens,&nbsp;Autumn M Kieber-Emmons,&nbsp;Melanie Johnson,&nbsp;Grant M Greenberg","doi":"10.1097/JHM-D-21-00329","DOIUrl":"https://doi.org/10.1097/JHM-D-21-00329","url":null,"abstract":"<p><strong>Goal: </strong>Administrative burden is one of many potential root causes of physician burnout. Scribe documentation assistance can reduce this burden. However, traditional in-person scribe services are challenged by consistent staffing because the model requires the physical presence of a scribe and limits the team to a single individual. In addition, in-person scribes cannot provide the flexible support required for virtual care encounters, which can now pivot geographically and temporally. To respond to these challenges, our health network implemented an asynchronous virtual scribe model and evaluated the program's impact on clinician perceptions of burnout across multiple outpatient specialties.</p><p><strong>Methods: </strong>Using a mixed-methods, pre-/postdesign, this evaluation measured the impact of an asynchronous virtual scribe program on physician burnout. Physicians were given the Professional Fulfillment Index tool (to self-assess their mental state) and free-text comment surveys before virtual scribe initiation and again at 3-, 6-, and 12-month intervals after program implementation. Descriptive statistics of survey results and qualitative review of free-text entries were analyzed for themes of facilitation and barriers to virtual scribe use.</p><p><strong>Principal findings: </strong>Of 50 physician participants in this study, 42 (84%) completed the preintervention survey and 15 (36%) completed all 4 surveys; 25 participants (50%) discontinued scribe use after 12 months. Burnout levels-as defined by dread, exhaustion, lack of enthusiasm, decrease in empathy, and decrease in colleague connection-all trended toward improvement during this study. Importantly, quality, time savings, burnout, and productivity moved in positive directions as well.</p><p><strong>Practical application: </strong>The cost burden to physicians and the COVID-19 pandemic inhibited the continued use of asynchronous virtual medical scribes. Nevertheless, those who continued in the program have reported positive outcomes, which indicates that the service can be a viable and effective tool to reduce physician burnout.</p>","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":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a8/6c/jhcma-67-425.PMC9640286.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10007595","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":"From Teams to Transactions: Stepping Back From Feed-Forward Practices.","authors":"Eric W Ford","doi":"10.1097/JHM-D-22-00214","DOIUrl":"https://doi.org/10.1097/JHM-D-22-00214","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":"40475264","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}