Health Care Management Review

BACKGROUND: The U.S. health care system has seen an increase in hospital-physician integration, with hospitals acquiring increasing numbers of physician practices. This shift has been linked to higher costs without significant improvements in quality. PURPOSE: This study sought to identify the characteristics of physicians who transitioned from independent practice to hospital integration. METHODOLOGY/APPROACH: We used physician variables, including quality scores, medical school rankings, years of experience, experience treating socially or medically complex patients, practice style, and location, as well as health care market and county-level variables to understand these determinants using a fixed-effects logistic regression model...

BACKGROUND: This study integrates patient-centered care (PCC) research and body work studies to understand how a focus on physical and sensorial aspects in the relationship between health care professionals (HPs) and patients contribute to the implementation of PCC. PURPOSE: To understand how HPs' body work practices contribute to the implementation of PCC, we investigate the meanings HPs ascribe to their and to patients' bodies. The goal is to grasp how these practices and meanings, rooted in unexplored sensorial perceptions, account for the emergence of a relationship of mutual acknowledgment between HPs and patients...

BACKGROUND: Quality improvement collaboratives (QICs) have facilitated cross-organizational knowledge exchange in health care. However, the local implementation of many quality improvement (QI) initiatives continues to fail, signaling a need to better understand the contributing factors. Organizational context, particularly the role of social networks in facilitating or hindering implementation within organizations, remains a potentially critical yet underexplored area to addressing this gap...

BACKGROUND: There is increasing recognition that beyond frontline workers' ability to speak up, their feeling heard is also vital, both for improving work processes and reducing burnout. However, little is known about the conditions under which frontline workers feel heard. PURPOSE: This inductive qualitative study identifies barriers and facilitators to feeling heard among nurses in hospitals. METHODOLOGY: We conducted in-depth semistructured interviews with registered nurses, nurse managers, and nurse practitioners across four hospitals (N = 24) in a U...

BACKGROUND: Although hospital leaders were already at a high risk for psychological and physical illnesses long before the pandemic, the COVID-19 pandemic exacerbated this situation. PURPOSE: Recognizing the crucial role of leaders in organizational crises and building on the conservation of resources theory, our study examines how hospital leaders cope with difficulties that endure over an extended period of time. By using the COVID-19 pandemic as an example for prolonged adversity in hospitals, we provide insight into the different responses to a given adversity and further expand knowledge about the role of time in crisis and for resilience...

BACKGROUND: Clinical care in modern intensive care units (ICUs) combines multidisciplinary expertise and a complex array of technologies. These technologies have clearly advanced the ability of clinicians to do more for patients, yet so much equipment also presents the possibility for cognitive overload. PURPOSE: The aim of this study was to investigate clinicians' experiences with and perceptions of technology in ICUs. METHODOLOGY/APPROACH: We analyzed qualitative data from 30 interviews with ICU clinicians and frontline managers within four ICUs...

BACKGROUND: Organizational citizenship behavior (OCB) may increase service quality. In contrast, counterproductive work behavior (CWB) may undermine patient safety. Efforts to increase OCB and reduce CWB rely on a good understanding of their antecedents, yet there is a lack of research in health care to inform such endeavors. PURPOSE: The aim of this study was to investigate the role of leadership, specifically leader-member exchange (LMX), in reducing CWB and increasing OCB in health care teams...

No abstract text is available yet for this article.

UNLABELLED: The alignment of physicians' interests with those of their hospital has garnered considerable interest in recent years, in part because of their central role in health care expenditure and patient outcomes. However, the systematic study of physician-hospital alignment is currently impeded by a lack of construct clarity. This is evidenced by research that conflates the actions intended to create alignment with alignment itself. It is also evidenced by a variety of different definitions, conceptualizations, and measures in the literature, most of which are confounded with constructs that are something other than alignment (e...

BACKGROUND: Our understanding of how highly reliable care delivery is brought about remains elusive, in part, because there is limited evidence regarding the organizational practices that enable safety organizing-the behaviors and processes underlying high reliability. PURPOSE: Because safety organizing relies on discretionary effort and lowering barriers to sharing expertise and discussing threats to safety and errors, we investigate three pay practices and their effects on information sharing and, in turn, safety organizing...

BACKGROUND: Toxic work environments and bullying are rampant in health care organizations. The Joint Commission asserted that bullying is a threat to patient safety, and furthermore, it implied that bullying affects clinician psychological safety. However, after decades of trying to reduce bullying, it persists. PURPOSE: The purpose of this study was to determine if system justification (SJ) theory can help explain the persistence of bullying in health care organizations...

BACKGROUND AND PURPOSE: Distributed leadership has been suggested for describing patterns of influence in collaborative settings where public services are performed across professions and organizations. This study explores how leadership in health quality improvement collaboratives (QICs) is characterized by aligned distributed leadership practices, and how these practices relate with experienced progress and achievements in the quality improvement (QI) work. METHODS: The analysis relied on a qualitative, multicase study of two nationwide Danish QICs...

ISSUE: When frontline employees' voice is not heard and their ideas are not implemented, patient care is negatively impacted, and frontline employees are more likely to experience burnout and less likely to engage in subsequent change efforts. CRITICAL THEORETICAL ANALYSIS: Theory about what happens to voiced ideas during the critical stage after employees voice and before performance outcomes are measured is nascent. We draw on research from organizational behavior, human resource management, and health care management to develop a multilevel model encompassing practices and processes at the individual, team, managerial, and organizational levels that, together, provide a nuanced picture of how voiced ideas reach implementation...

BACKGROUND: Hospitals are often tasked with improving patient care while simultaneously increasing operational efficiency. Although efficiency may be gained by maintaining higher patient volume per nurse (higher workload), high-quality patient care requires low levels of nurse turnover, which might be adversely affected by an increase in workload. PURPOSE: Drawing upon job demands-resources theory, we hypothesized that hospital-level workload will predict nurse turnover and that nurse turnover will predict patient mortality, and that registered nurse hiring rates and human resource management practices will moderate (buffer) the positive relationship between nurse workload and nurse turnover, whereas quality care structures will moderate (buffer) the positive relationship between nurse turnover and patient mortality...

BACKGROUND: Whereas organizational literature has provided much insight into the conceptual and theoretical underpinnings of organizational leadership and management during emergencies, measures to operationalize related effective practices during crises remain sparse. PURPOSE: To address this need, we developed the Healthcare Emergency Response Optimization survey, which set out to examine the leadership and management practices in health care organizations that support resilience and performance during crisis...

BACKGROUND: Enthusiasm has grown about using patients' narratives-stories about care experiences in patients' own words-to advance organizations' learning about the care that they deliver and how to improve it, but studies confirming association have not been published. PURPOSE: We assessed whether primary care clinics that frequently share patients' narratives with their staff have higher patient experience survey scores. APPROACH: We conducted a 1-year study of 5,545 adult patients and 276 staff affiliated with nine clinics in one health system...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Enthusiasm has grown about using patients' narratives-stories about care experiences in patients' own words-to advance organizations' learning about the care that they deliver and how to improve it, but studies confirming association have not been published. PURPOSE: We assessed whether primary care clinics that frequently share patients' narratives with their staff have higher patient experience survey scores. APPROACH: We conducted a 1-year study of 5,545 adult patients and 276 staff affiliated with nine clinics in one health system...

BACKGROUND: Hospitals are often tasked with improving patient care while simultaneously increasing operational efficiency. Although efficiency may be gained by maintaining higher patient volume per nurse (higher workload), high-quality patient care requires low levels of nurse turnover, which might be adversely affected by an increase in workload. PURPOSE: Drawing upon job demands-resources theory, we hypothesized that hospital-level workload will predict nurse turnover and that nurse turnover will predict patient mortality, and that registered nurse hiring rates and human resource management practices will moderate (buffer) the positive relationship between nurse workload and nurse turnover, whereas quality care structures will moderate (buffer) the positive relationship between nurse turnover and patient mortality...