Exploring the efficacy of healthcare quality practices, employee commitment, and employee control

This exploratory study examines healthcare quality program practices, employee commitment and control initiatives, and perceived results by surveying the directors of hospital quality programs. U.S. hospitals are renowned to be among the highest in quality, but recent studies assert that the majority of error-related deaths per year are preventable. In response, healthcare organizations have adopted quality management programs. Employee commitment and control theories propose that employee initiatives are critical to patient safety. However, little research has focused on the efficacy of employee commitment and control initiatives for quality programs at healthcare organizations. This study examines the responses from Quality and Risk Directors of 372 U.S. hospitals. The results of structural equation modeling (SEM) demonstrate that perceived quantitative and qualitative quality program results are more highly related to employee commitment and control initiatives than they are related to quality practices.     

The patient safety chain: Transformational leadership's effect on patient safety culture, initiatives, and outcomes

The purpose of this study is to investigate the existence of a patient safety chain for hospitals. Drawing on high reliability organization theory, multifactor leadership theory and total quality management literature, we develop and test a model for improving patient safety – a critical issue facing hospitals today. Specifically, we hypothesize that improving patient safety begins at the highest level of the organization with a transformational leadership style. This leads to a sequence of linkages whereby transformational leadership has an important relationship with creating a culture of safety, which in turn is associated with the adoption of patient safety initiatives, and ultimately with positive improvements in patient safety outcomes. Using data from a nationwide survey of over 200 hospitals, we use structural equation modeling to provide empirical support for the effectiveness of this patient safety chain model. The results have major implications for enhancing operations in hospital settings.     

Effects of healthcare quality and reimbursement rate in a hospital association

Tackling the mismatch between the supply of and demand for care service is an especially important issue among many healthcare providers and regulators. To entice patient demand distribution to become more equilibrated among different regions, some countries' governments have proposed to establish a hospital association with different levels of hospitals to implement patient mobility. However, the sustainable operation and management of the hospital association have not been formally analyzed. In this paper, we develop a Salop model to analyze the strategic behavior of patient welfare and hospital utility maximizations in a hospital association comprised of three hospitals in different income regions. For the former objective, we find that the higher quality provisions may harm patient welfare, and especially there are unique quality thresholds of the hospitals such that the higher quality provisions lead to higher patient welfare only when the quality provisions exceed the thresholds. For the latter objective, we capture the optimal equilibrium quality provisions of the overall hospital association. We consider both the case when the taxation rates are regulated (TRR) and exogenous to the hospitals and the case when taxation rates are adjusted (TRA) and constrained by hospital reimbursement rates. Under the TRA case, we find that a higher reimbursement rate of the local hospital causes a higher and lower quality threshold of the hospital in the local and neighboring regions, respectively; and we also show that with the utility maximization objective, the reimbursement rate's impact depends on regulator's altruism towards patient welfare. For a relatively low altruistic behavior, a TRA could improve the quality provision but lower the number of outflowing patients in the case of a high (and low) hospital's reimbursement rate in the local (and neighboring) region. When the regulator cares more about patient welfare, the findings in the quality provision and patient mobility are just contrary. Our analytical results lead to some important policy implications for facilitating the further deployment of hospital association delivery in the hospitals' quality provision associated with patient mobility.     

Understanding information exchange in healthcare operations: Evidence from hospitals and patients

Coordination – or the information exchange among physicians and hospital staff – is necessary for desirable patient outcomes in healthcare delivery. However, coordination is difficult because healthcare delivery processes are information intensive, complex and require interactions of hospitals with autonomous physicians working in multiple operational systems (i.e. multiple hospitals). We examine how three important variables distinctive of the healthcare operations context – use of IT for dissemination of test results (ITDR) (i.e. electronic health records systems) by physicians and hospital staff, social interaction ties among them, and physician employment – influence information exchange and patient perceptions of their care. Drawing from the literature on process inter-dependencies and coordination, vertical integration and social exchange, we develop and test research hypotheses linking ITDR, social interaction ties and physician employment to information exchange relationship, and information exchange relationship to provider–patient communication. Using a paired sample of primary survey data and secondary archival data from CMS HCAHPS for 173 hospitals in the USA, we find that increased information exchange relationship drives provider–patient communication, and increased social interaction ties drives information exchange relationship. Social interaction ties fully mediates the relationship between ITDR and information exchange relationship. Physician employment amplifies the link between ITDR and social interaction ties, but does not have an effect on the link between ITDR and information exchange. We do not find a direct relationship between ITDR, and information exchange relationship or provider–patient communication.     

Performance management in context: formative cross-functional performance monitoring for improvement and the mediating role of relational coordination in hospitals

Recent research suggests that to fully realise its potential, performance management should be bespoke to the social context in which it operates. Here, we analyse factors supporting the use of performance data for improvement. The study purposively examines a developmentally oriented performance management system with cross-functional goals. We suggest that these system characteristics are significant in interdependent work contexts, such as health care. We propose and test that (a) relational coordination helps employees work effectively to resolve issues identified through formative and cross-functional performance monitoring and (b) that this contributes to better outcomes for both employees and patients. Based on survey data from management and employee representatives across Irish acute hospitals, the study found that perceptions of relational coordination mediated the link between formative cross-functional performance monitoring and employee outcomes and partially mediated the link between formative cross-functional performance monitoring and patient care. Our findings signal potential for a more contextually driven and interdependent approach to the alignment of management and human resource management practices. While relational coordination is important in health care, we also note potential to identify other social drivers supporting productive responses to performance monitoring in different contexts.     

Comparative study on the relationship between just-in-time production practices and operational performance in manufacturing plants

This study analyzes the differences in approaching JIT production across countries in order to identify alternative paths to high manufacturing performance. We applied ANOVA and regression techniques to the database of High Performance Manufacturing Project to examine the similarities and differences across countries in JIT implementation and the effect of JIT production practices on operational performance. The results indicated that JIT production practices were implemented in different ways across the countries. We found that the relationship between JIT production practices and plant performance is contingent on the national context and infrastructure practices in quality and workforce management. JIT delivery by suppliers, JIT layout, and setup time reduction were found to be the most effective approaches to improve cost, delivery, and flexibility. This study highlights the important role of shop-floor communication and information sharing, which should be focused for maximizing the benefits of JIT implementation.     

A healthy bottom line and quality patient care: can they coexist?

In summary, it is the writer's opinion that a healthy bottom line and quality patient care can coexist. With today's economic pressures and with more and tighter controls and regulations being imposed by the government and regulatory agencies, providers (especially hospitals) need to be cost efficient and cost effective. Will the cost-containment measures necessary to maintain a healthy bottom line reduce the quality of patient care? They needn't. In point, such measures might actually increase the quality of care by avoiding wasteful clinical practices. Quality patient care comprises three basic elements: value, service, and compassion. To omit any one of these ingredients is to remove the quality from patient care. Should this happen, no cost-containment measure will be enough to sustain a hospital. Financial accountability is essential; quality care is imperative. Blended together thoroughly, they are the recipe to survival--for the hospital and for the patient.     

The Link Between Participation in Management Decision-Making and Quality of Patient Care as Perceived by Chinese Doctors

Abstract

This study examined whether and how participation by doctors in management decision-making was associated with patient care. A questionnaire survey was conducted in three hospitals operating in China. Staff members of the selected hospitals were invited to participate in the survey, measuring perceived quality of patient care, employee participation in management decisions, psychological empowerment and affective commitment. This study focuses on the results of the 160 doctors employed by the hospitals who completed the questionnaire. The study found that psychological empowerment and affective commitment mediated the relationship between participation in management decisions and the quality of patient care as perceived by the doctors. Implications are drawn for public management practice in Chinese health care settings.     

Improving operational performance by influencing shopfloor behavior via performance management practices

It is generally believed that companies applying performance management practices outperform those that do not measure and manage their performance. Studies examining the link between performance management and performance improvement implicitly assume that performance management affects behavior of individuals in an organization, which then facilitates the achievement of organizational goals. This study takes a step towards understanding this implicit assumption. We investigate how performance management practices relate to improvement in performance by influencing behavior of individuals. We focus on operational performance management, i.e. the definition and use of performance measures on the shopfloor in production and distribution. We use a survey among 102 companies to identify the relations between performance management practices, shopfloor behavior and improvement in performance. We identified three independent clusters of operator behavior that positively correlate with performance improvement: “Understanding”, “Motivation” and “Focus on Improvement”. We show that 17 out of the 20 performance management practices found in literature have a significant and positive relation with one or more clusters of operator behavior. We furthermore found that there is a positive correlation between the number of performance management practices applied and performance improvement, suggesting that it is not only which practices are applied but also how many. Recommendations emerging from this study enable managers to identify which behavioral changes are desired to improve performance and to select those performance management practices that positively influence the desired behavior.     

Design of financial incentives and payment schemes in healthcare systems: A review

In this paper, we review the existing studies on the design of financial incentives and payment mechanisms for healthcare service providers, which have been published in the literature of operations research & management science. We classify these studies in two ways: first, by the care provider focused on: physicians or hospitals; and next, by categorizing payment/incentive schemes as retrospective or prospective models under each care provider group. The problem setting, including the geographic background and research methodology, are briefly discussed for each paper, as are the findings with regard to accessibility, quality, efficiency, and the facilitation of integration and collaboration, if reported. We also provide a detailed discussion of potential research problems that would offer promising avenues for future study.     

Management,supervision, and healthcare: A field experiment

We used a randomized management consulting intervention with 80 public-sector healthcare facilities in Nigeria to study the role of information, training, and supervision on the adoption of improved organizational practices. Facilities that received detailed improvement plans and 9 months of implementation support—including regular visits to monitor progress and set intermediate goals related to the plans—showed large, significant short-term effects on the adoption of practices that were under the responsibility of facility staff. Facilities that received general improvement advice but no implementation support showed no change in practices. Implementation support appears crucial for improvements, especially in contexts without market incentives for the adoption of effective managerial practices.     

Children's hospitals: specialty hospitals that treat children specially

Any reader who has children will agree that they make special patients, whether at home or in the hospital. These patients have unique requirements for love and compassionate care, and children's hospitals deliver on their promises. The well-run children's hospitals researched for this article have converted their material management operational challenges to opportunities. They have built thoughtful material management strategic plans, reorganized their support services to provide customer service to end users, and they have centered their materiel management efforts around service and quality improvement.     

The impact of buyer-supplier relationship quality and information management on industrial vending machine benefits in the healthcare industry

Despite the calls for a deeper understanding of SCM in the healthcare industry, theoretical research focused on healthcare buyer-supplier collaboration, specifically inventory management issues, remains nascent and fragmented. Although slow to change, healthcare organizations have begun to consider alternative inventory management systems to improve inventory control and patient care. Industrial vending machines (IVM) can help healthcare organizations address inventory management issues. Grounded in transaction cost economics and contingency theory, this research develops and empirically tests a model that highlights the critical role of information management in the link between buyer-supplier relationship quality and performance outcomes within the context of IVM implementation and use in the healthcare industry. Based on survey data from healthcare managers, results indicate that both information management and relationship quality are tied to a series of benefits in the context of collaborative buyer-supplier IVM agreements.     

Ten years after: Interference of hospital slack in process performance benefits of quality practices

We investigate the long-term relationship between an organization's quality management practices and process-level performance. Further, we examine whether availability of organizational slack over the study interval interferes with the relationship between quality practices and process performance. Organizational slack consists of the available and accessible resources in an organization; we focus here on unabsorbed slack in the form of financial resources. We investigate the quality practices of U.S. general acute care hospitals, measured by their depth of implementation of practices characterizing a total quality management system, and use them to predict process performance related to four medical conditions. Analysis reveals differing effects that are dependent on hospital slack conditions. In hospitals with high slack, quality practices significantly predict three of four studied process performance measures. In contrast, in hospitals with low slack, quality practices predict only one of the four process performance measures, while other factors outweigh the effects of quality practices. This study lends support to management taking a long-term perspective related to implementation of quality management systems, and highlights the relevance of slack conditions in garnering the benefits of such systems.     

The adoption,character and impact of strategic human resource management: a case study of two large metropolitan Vietnamese public hospitals

In this paper the researchers set out to explore the adoption, character and impact of strategic human resource management (SHRM) in two large metropolitan Vietnamese public hospitals using a multi-level qualitative research design. Data are analyzed from 21 interviews and 5 focus groups with key players from the hospitals and government authorities. Findings show that the State controls many of the core day-to-day HR functions of public hospitals, curtailing local autonomy and management innovation. This is compacted by inadequate government funding, poor training of medical staff, and inadequate management and business skills of hospital managers. Inhibiting greater experimentation with SHRM is the fear of developing management initiatives out of sync with the State. Consequently, many managers and clinicians held negative views of the HR department and their relevance for the day-to-day management of healthcare services. Respondents reported that they perceived these factors had a negative impact on the well-being of medical staff and the quality of patient care. The paper concludes with a discussion on the necessity for continued State reforms that can enable greater autonomy of the hospitals' HRM functions and greater investment in local HR capabilities to materialize the link between SHRM, employee well-being and quality of patient care.     

The link between the management of employees and patient mortality in acute hospitals

The relationship between human resource management practices and organizational performance (including quality of care in health-care organizations) is an important topic in the organizational sciences but little research has been conducted examining this relationship in hospital settings. Human resource (HR) directors from sixty-one acute hospitals in England (Hospital Trusts) completed questionnaires or interviews exploring HR practices and procedures. The interviews probed for information about the extensiveness and sophistication of appraisal for employees, the extent and sophistication of training for employees and the percentage of staff working in teams. Data on patient mortality were also gathered. The findings revealed strong associations between HR practices and patient mortality generally. The extent and sophistication of appraisal in the hospitals was particularly strongly related, but there were links too with the sophistication of training for staff, and also with the percentages of staff working in teams.     

The impact of service design and process management on clinical quality: An exploration of synergetic effects

While service design and process management have received research attention in the past, there is limited empirical work examining both factors in the hospital setting. Through operationalizing focus as a service design approach and quality improvement (QI) initiatives as process management efforts, we hypothesize that focus and QI initiatives affect clinical quality both individually and collectively. Utilizing heart attack procedures as the study context, we examine a set of hypotheses based on a panel dataset consisted of 201 hospitals from 2005 to 2011 in the state of Florida. After accounting for potential lag effects and endogeneity biases, we find empirical support to the proposed hypotheses.     

Leveraging multi-tier healthcare facility network simulations for capacity planning in a pandemic

The COVID-19 pandemic has placed severe demands on healthcare facilities across the world, and in several countries, makeshift COVID-19 centres have been operationalised to handle patient overflow. In developing countries such as India, the public healthcare system (PHS) is organised as a hierarchical network with patient flows from lower-tier primary health centres (PHC) to mid-tier community health centres (CHC) and downstream to district hospitals (DH). In this study, we demonstrate how a network-based modelling and simulation approach utilising generic modelling principles can (a) quantify the extent to which the existing facilities in the PHS can effectively cope with the forecasted COVID-19 caseload; and (b) inform decisions on capacity at makeshift COVID-19 Care Centres (CCC) to handle patient overflows. We apply the approach to an empirical study of a local PHS comprising ten PHCs, three CHCs, one DH and one makeshift CCC. Our work demonstrates how the generic modelling approach finds extensive use in the development of simulations of multi-tier facility networks that may contain multiple instances of generic simulation models of facilities at each network tier. Further, our work demonstrates how multi-tier healthcare facility network simulations can be leveraged for capacity planning in health crises.     

Relating focus to quality and cost in a healthcare setting

Focus in healthcare has been heralded as the next frontier in improving its efficiency and efficacy (Herzlinger 2004). Focus takes several different forms, ranging from standalone specialty centers to a hospital that places a strategic emphasis on a clinical area. We adopt this latter perspective and define focus as a disproportionate emphasis on a particular clinical area in a hospital. We use secondary data from hospitals providing cardiology care in New York State to examine the relationship between focus and performance. We develop two measures of focus. Proportional focus is defined to be the proportion of cases treated in a particular clinical specialty. Expertise focus is defined to be specific evidence that a hospital has taken action to build expertise in treating diseases in that specialty. We operationalize hospital performance along cost and quality dimensions, and we use hierarchical regression to examine the impact of focus on performance. Our results indicate that proportional focus, but not expertise focus, is associated with better cost performance. Quality performance, on the other hand, was associated only with the interaction between proportional focus and expertise focus, which means that only hospitals exhibiting higher levels of both proportional and expertise focus achieve better quality performance. These findings support the notion that not only is focus important in healthcare, but also that researchers and practitioners need to recognize that relationships are contingent on the performance and focus measures used and thus, findings may not be generalizable from one metric to another.