Dorothy Y. Hung, Justin Lee and Thomas G. Rundall
In this chapter, we identify three distinct transformational performance improvement (TPI) approaches commonly used to redesign work processes in health care organizations. We…
Abstract
In this chapter, we identify three distinct transformational performance improvement (TPI) approaches commonly used to redesign work processes in health care organizations. We describe the unique components or tools that each approach uses to improve the delivery of health services. We also summarize what is empirically known about the effectiveness of each TPI approach according to systematic reviews and recent studies published in the peer-reviewed literature. Based on examination of this research, we discuss what knowledge is still needed to strengthen the evidence for whole system transformation. This involves the use of conceptual frameworks to assess and guide implementation efforts, and facilitators and barriers to change as revealed in a recent evaluation of one major initiative, the Lean Enterprise Transformation (LET) at the Veterans Health Administration. The analysis suggests ways in which TPI facilitators can be developed and barriers reduced to improve the effectiveness and sustainability of quality initiatives. Finally, we discuss appropriate study designs to evaluate TPI interventions that may strengthen the evidence for their effectiveness in real world practice settings.
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John Øvretveit, Robin Gillies, Thomas G. Rundall, Stephen M. Shortell and Mats Brommels
The purpose of this paper is to discover the extent to which evidence‐based practices and computer systems for managing chronic illness are used within Swedish primary health care.
Abstract
Purpose
The purpose of this paper is to discover the extent to which evidence‐based practices and computer systems for managing chronic illness are used within Swedish primary health care.
Design/methodology/approach
The methodology was a replication of a similar national USA survey study and an interview study.
Findings
The findings show large variations and an under‐use of a number of evidence‐based care management practices and of IT for managing depression, heart disease, asthma, and diabetes in Sweden. Follow‐up interview studies with heads of primary care centres gathered their views about the factors which helped and hindered improving care and prevention for these patient groups.
Research limitations/implications
The study data identify actions which would significantly improve the quality of care for people suffering from chronic illnesses. Effective prevention and management of chronic illness in primary care can reduce unnecessary patient suffering and lower costs of care.
Originality/value
Evidence of effective methods for managing these illnesses has been reported, but it is not known how widely these methods or information technology are used in primary care outside the USA. The paper gives the first comprehensive nation‐wide data on the use of evidence‐based practices and computer systems for managing chronic illness in primary care in a European public health care system. It provides information allowing targeted actions which would improve quality of care which are low cost and high cost saving in the long term.
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Frances M Wu, Thomas G. Rundall, Stephen M. Shortell and Joan R Bloom
The purpose of this paper is to describe the current landscape of health information technology (HIT) in early accountable care organizations (ACOs), the different strategies ACOs…
Abstract
Purpose
The purpose of this paper is to describe the current landscape of health information technology (HIT) in early accountable care organizations (ACOs), the different strategies ACOs are using to develop HIT-based capabilities, and how ACOs are using these capabilities within their care management processes to advance health outcomes for their patient population.
Design/methodology/approach
Mixed methods study pairing data from a cross-sectional National Survey of ACOs with in-depth, semi-structured interviews with leaders from 11 ACOs (both completed in 2013).
Findings
Early ACOs vary widely in their electronic health record, data integration, and analytic capabilities. The most common HIT capability was drug-drug and drug-allergy interaction checks, with 53.2 percent of respondents reporting that the ACO possessed the capability to a high degree. Outpatient and inpatient data integration was the least common HIT capability (8.1 percent). In the interviews, ACO leaders commented on different HIT development strategies to gain a more comprehensive picture of patient needs and service utilization. ACOs realize the necessity for robust data analytics, and are exploring a variety of approaches to achieve it.
Research limitations/implications
Data are self-reported. The qualitative portion was based on interviews with 11 ACOs, limiting generalizability to the universe of ACOs but allowing for a range of responses.
Practical implications
ACOs are challenged with the development of sophisticated HIT infrastructure. They may benefit from targeted assistance and incentives to implement health information exchanges with other providers to promote more coordinated care management for their patient population.
Originality/value
Using new empirical data, this study increases understanding of the extent of ACOs’ current and developing HIT capabilities to support ongoing care management.
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Susan Moffatt-Bruce, Ann Scheck McAlearney, Alison Aldrich, Tina Latimer and Edmund Funai
Clinical front-line staff are best positioned within the organizations to identify patient safety problems and craft solutions. However, in traditional models, safety committees…
Abstract
Purpose
Clinical front-line staff are best positioned within the organizations to identify patient safety problems and craft solutions. However, in traditional models, safety committees are led by senior executives who are not clinically responsible for patients. This top-down approach can result in missed opportunities to address patient-centered challenges and better manage the health of the defined populations served by these organizations.
Design/methodology/approach
To foster teamwork, enhance empowerment, and improve the patient care environment, Operations Councils led by trained front-line staff were deployed in 15 clinical areas at the Ohio State University Wexner Medical Center (OSUWMC) as a performance improvement tool.
Findings
Standardized training of Council facilitators was designed and implemented to guide the performance improvement process. Balanced scorecards were developed in each Council based on the risks and concerns of that particular clinical area. After initial implementation of the Operations Councils, patient safety events declined and team engagement improved by over 34% across the medical center; the highest changes were seen in areas where Operations Councils had been deployed. Additionally, outcome metrics including area-specific and system-wide mortality and readmissions improved after implementation.
Originality/value
We suggest that this type of approach may be an appropriate strategy to consider in other health care organizations as such institutions are challenged to better manage the health of their defined patient populations.
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Despite the growth and adoption of human resource (HR) analytics, it remains unknown whether HR analytics can impact organizational performance. As such, this study aims to…
Abstract
Purpose
Despite the growth and adoption of human resource (HR) analytics, it remains unknown whether HR analytics can impact organizational performance. As such, this study aims to address this important issue by understanding why, how and when HR analytics leads to increased organizational performance and uncover the mechanisms through which this increased performance occurs.
Design/methodology/approach
Using data collected from 155 Irish organizations, structural equation modeling was performed to test the chain mediation model linking HR technology, HR analytics, evidence-based management (EBM) and organizational performance.
Findings
The study's findings support the proposed chain model, suggesting that access to HR technology enables HR analytics which facilitates EBM, which in turn enhances organizational performance.
Originality/value
This research contributes significantly to the HR analytics and EBM literature. First, the study extends our understanding of why and how HR analytics leads to higher organizational performance. Second, the authors identify that access to HR technology enables and is an antecedent of HR analytics. Finally, empirical evidence is offered to support EBM and its impact on organizational performance.
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Ashley Y. Metcalf, Yong Wang and Marco Habermann
Hospitals throughout the USA are facing increasing patient demand and employee shortages. This capacity issue has led to understaffing in some hospital areas. The purpose of this…
Abstract
Purpose
Hospitals throughout the USA are facing increasing patient demand and employee shortages. This capacity issue has led to understaffing in some hospital areas. The purpose of this paper is to examine the understaffing in hospital-unit respiratory care and the impact to error rates, specifically missed treatments rates. The moderating effects of teamwork and standardized, integrated information systems are also considered.
Design/methodology/approach
Survey methodology is used for data collection of respiratory care managers within hospital units. Regression is used to test the hypotheses in this study.
Findings
The regression results show that higher rates of understaffing are associated with more missed treatments. In addition, both teamwork and integrated information systems are associated with lower missed treatments. Finally, the moderating effect of teamwork is also highly significant within the model while integrated information systems are not a significant moderator.
Practical implications
Managers working within understaffed hospital units can try to reduce missed treatment rates by both integrated information systems and teamwork among employees. Additional benefits can be gained from teamwork due to the indirect effects (moderating effects) as well. This indicates teamwork training can be useful for quality initiatives.
Originality/value
Understaffing is associated with higher missed treatments in hospital units. Standardized, integrated information systems within a hospital are associated with less missed treatments. Furthermore, employee teamwork within a hospital unit is associated with a direct effect on missed treatment rates as well as an indirect effect by weakening the negative impact of understaffing.
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Robert G. Hamlin and Taran Patel
This paper aims to report the results of a replication study of perceived managerial and leadership effectiveness within a Romanian public sector hospital, and to discuss the…
Abstract
Purpose
This paper aims to report the results of a replication study of perceived managerial and leadership effectiveness within a Romanian public sector hospital, and to discuss the extent to which they are similar to and different from findings from equivalent studies carried out in two British NHS Trust hospitals.
Design/methodology/approach
Concrete examples (critical incidents) of effective and ineffective managerial behaviour were collected using Flanagan's critical incident technique (CIT). The critical incidents were content analyzed to identify a smaller number of behavioural statements (BSs). These were then compared and contrasted against two British BS data sets using realist qualitative analytic methods, and deductively coded and sorted into extant behavioural categories.
Findings
A total of 57 BSs were identified of which 30 were examples of effective and 27 of least effective/ineffective managerial behaviour. The multi‐case/cross‐nation comparative analysis revealed high degrees of commonality and relative generalization between the Romanian and British findings.
Research limitations/implications
Data saturation may not have been achieved during the CIT collection phase of the study. The relevance and transferability of the findings to other public sector hospitals in Romania have yet to be demonstrated empirically. The results have potential as “best evidence” to inform and shape “evidence‐based HRD” initiatives designed to train and develop effective managers and leaders within the health services sector of Romania and the United Kingdom.
Originality/value
The study is a rare example of indigenous managerial behaviour research in a non‐Anglo country. The results lend strong empirical support for universalistic explanations of the nature of perceived managerial and leadership effectiveness.
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The purpose of this article is to present an alternative theory to why publicly‐traded physician practice management companies in the US were popular and successful for a limited…
Abstract
Purpose
The purpose of this article is to present an alternative theory to why publicly‐traded physician practice management companies in the US were popular and successful for a limited number of years and then essentially self‐destructed.
Design/methodology/approach
The short history of publicly‐traded practice management companies suggests that they had limited value and utility in the US healthcare industry. It is the premise of the paper that the sudden appearance these for‐profit companies upset the natural order within the healthcare industry and created a disequilibria which ultimately resulted in their demise. While Gaia theory is most commonly applied to the natural sciences, it has been applied to a number of interdisciplinary issues.
Findings
Physicians gravitated to these for‐profit companies either out of fear of encroaching managed care or out a desire to sell their practice to the highest bidder. Physician practice management companies, on the other hand, saw a way to entice stockholders to invest in a growth industry. The paper suggests that the physician practice management companies added little new value to the health care industry and applies Gaia theory as a possible explanation for this phenomena. Gaia theory was first postulated in 1979 to address the evolution of the material environment and corresponding organisms as a tightly coupled system which attempt to manipulate the environment for the purpose of creating biologically favorable conditions.
Originality/value
The paper is one of the first to suggest that the laws of nature, as understood from the perspective of Gaia theory, may have applicability to the US health care industry.
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June Marques Fernandes, Luciana Paula Reis and Raphael Mansk
This study aims to validate a model to assess the level of lean maturity of Brazilian hospitals based on the adaptation of the SAE J4000/2021 standard.
Abstract
Purpose
This study aims to validate a model to assess the level of lean maturity of Brazilian hospitals based on the adaptation of the SAE J4000/2021 standard.
Design/methodology/approach
The methodology was divided: (1) adaptation of the standard to the health context, (2) application of the questionnaire through a survey, and (3) comparison of the results of the level of maturity in the standard and by the clustering technique, using Minitab.
Findings
The research presents two contributions: (1) validation of a model to assess the level of lean maturity based on the SAE J4000/2021; (2) insights into the level of maturity of Brazilian hospitals. It was observed that only 10% of the sample was classified at maturity level 3 and 75% at level 2. Private and large hospitals showed greater maturity compared to the others.
Research limitations/implications
This includes the limited number of hospitals that participated in the survey, given the difficulty of adherence to due constraints of time and staffing from hospitals, during the COVID-19 pandemic.
Practical implications
This article presents a lean maturity assessment proposal, adapting a consolidated standard in the automobile industry to the health context. Insights on the lean maturity of Brazilian hospitals can contribute to the development of policies to encourage the implementation of the lean philosophy directed to each specific environment.
Social implications
This study serves as a guide for public agents interested in monitoring the quality of hospital indicators through the SAE J4000/2021 standard. From this lean maturity analysis, hospital managers can understand their opportunities for improvement in both human and organizational aspects. This favors the improvement of service delivery to society that depends on health services.
Originality/value
Due to the lack of research that validates lean maturity level assessment models in Brazilian hospitals, this study can be considered a pioneer in this Brazilian research by validating the SAE J4000/2021 standard in its updated version in the health context.