BACKGROUND::

Nursing home administrators (NHAs) are in key positions to improve nursing home quality. NHAs require state-level licensure, which involves passing a national NHA licensure examination and fulfilling state-level licensure requirements that vary widely across states. With multiple pathways to NHA licensure, little is known about NHAs' preparation and training to meet the complex demands of this position.

PURPOSE:

: The aim of this study was to explore NHAs' self-assessed person-job fit based on NHAs' self-rated preparedness and the importance of the activities that supported their preparation.

METHOD

OLOGY/APPROACH:: A descriptive cross-sectional design was used to collect data from NHAs (N = 175) randomly recruited from nursing homes in five states, with a mailed self-administered questionnaire. Data analysis included descriptive statistics, correlations, and t tests/ANOVA.

FINDINGS:

: Thirty percent of respondents reported they were well prepared, overall, for their first NHA position. The findings suggest NHA preferences for more formalized ways to develop their entry-level competencies, with lower preference for On-the-job training, Previous job experience, and Self-study and higher preference for Administrator-in-training, Bachelor's degree programs, and Mentoring.

PRACTICE IMPLICATIONS:

: There is an urgent need for NHAs who are well prepared to effectively address our nation's mandates for nursing home quality improvement. With multiple pathways to NHA licensure, this exploratory study provides initial insights about NHAs' self-assessed preparation and training. The findings suggest that NHAs prefer more formalized ways to prepare for the NHA position. Research is needed to identify specific teaching/learning practices and on-the-job training that maximize the NHAs' preparation to meet their job demands.

BACKGROUND::

Organizational culture is an important but underinvestigated feature of the work environment that can impact provider behavior, including adherence to clinical practice guidelines. There is substantial evidence that physician assistance to smokers can produce significant reductions in tobacco use. However, this evidence has not been well translated into practice, as only a small proportion of smokers receive recommended treatment during medical visits.

PURPOSE:

: This study examines organizational culture as a contextual feature of primary care clinics and its impact on adherence to evidence-based guidelines for treating tobacco use.

METHODOLOGY:

: Cross-sectional survey data were collected from 500 primary care providers in 60 community clinics located in New York City. Relationships between provider adherence to "5A" clinical guidelines, as recommended by the U.S. Public Health Service, and both provider and organizational covariates were described. We used hierarchical linear modeling to examine the associations between clinic culture and provider treatment patterns.

FINDINGS:

: Providers in clinics with stronger "group/clan," "hierarchical," and "rational" culture types, as compared with a "developmental" culture, reported greater adherence to 5A guidelines (p < .05). System-level structures and care processes were positively associated (p < .01), whereas number of ongoing quality initiatives was negatively associated with 5A delivery (p < .05). Provider familiarity with guidelines (p < .01), confidence with cessation counseling (p < .05), and perceived effectiveness in helping smokers quit were associated with more frequent 5A intervention (p < .01).

PRACTICE IMPLICATIONS:

: Findings suggest that organizational culture can influence provider adherence to cessation treatment guidelines, even when controlling for other factors known to affect practice patterns. Specifically, cultures that emphasize human resources and performance standards are conducive to integrating 5A guidelines into routine practice. Understanding the role of organizational culture enables healthcare managers and practitioners to be strategic when implementing, and also sustaining, use of evidence-based guidelines.

BACKGROUND::

Although several previous studies have found "system affiliation" to be a significant and positive predictor of health information technology (IT) adoption, little is known about the association between corporate governance practices and adoption of IT within U.S. integrated delivery systems (IDSs).

PURPOSES:

: Rooted in agency theory and corporate governance research, this study examines the association between corporate governance practices (centralization of IT decision rights and strategic alignment between business and IT strategy) and IT adoption, standardization, and innovation within IDSs.

METHOD

OLOGY/APPROACH:: Cross-sectional, retrospective analyses using data from the 2011 Health Information and Management Systems Society Analytics Database on adoption within IDSs (N = 485) is used to analyze the correlation between two corporate governance constructs (centralization of IT decision rights and strategic alignment) and three IT constructs (adoption, standardization, and innovation) for clinical and supply chain IT. Multivariate fractional logit, probit, and negative binomial regressions are applied.

FINDINGS:

: Multivariate regressions controlling for IDS and market characteristics find that measures of IT adoption, IT standardization, and innovative IT adoption are significantly associated with centralization of IT decision rights and strategic alignment. Specifically, centralization of IT decision rights is associated with 22% higher adoption of Bar Coding for Materials Management and 30%-35% fewer IT vendors for Clinical Data Repositories and Materials Management Information Systems. A combination of centralization and clinical IT strategic alignment is associated with 50% higher Computerized Physician Order Entry adoption, and centralization along with supply chain IT strategic alignment is significantly negatively correlated with Radio Frequency Identification adoption

PRACTICE IMPLICATIONS:

: Although IT adoption and standardization are likely to benefit from corporate governance practices within IDSs, innovation is likely to be delayed. In addition, corporate governance is not one-size-fits-all, and contingencies are important considerations.

BACKGROUND::

Health care leaders have called for the development of communication and leadership skills to improve manager-employee relationships, employee job satisfaction, quality care, and work environments.

PURPOSES:

: The aim of the study reported here was to pilot how a 2-day coaching workshop ("Coaching for Impressive CARE") conducted as a leadership development strategy influenced frontline care managers' coaching practices in residential long-term care (LTC) settings. We had four objectives: (a) to identify managers' perceptions of their role as a coach of employee performance in LTC facilities, (b) to understand managers' intentions to coach employee performance, (c) to examine opportunities and factors that contributed to or challenged implementation of workshop coaching skills in daily leadership/management practice, and (d) to examine managers' reports of using coaching practices and employee responses after the workshop.

METHODS::

We used an exploratory/descriptive design involving pre-/post-workshop surveys, e-mail reminders, and focus groups to examine participation of 21 LTC managers in a 2-day coaching workshop and their use of coaching practices in the workplace.

FINDINGS:

: Focus group findings provided examples of how participants used their coaching skills in practice (e.g., communicating empathy) and how staff responded. Factors contributing to and challenging implementation of these coaching skills in the workplace were identified. Attitudes and intentions to be a coach increased significantly, and some coaching skills were used more frequently after the workshop, specifically planning for performance change with employees.

PRACTICE IMPLICATIONS:

: The coaching workshop was feasible to implement, well received by participants, influenced their willingness to become coaches, and had some noted impact on their use of coaching behaviors in the workplace. Coaching skills by managers to improve staff performance with residents in LTC facilities can be learned.

BACKGROUND::

Despite continued scrutiny over executive earnings in the health care industry, the evidence for executive pay determinants is uncertain and inconclusive. Theoretical motivations for executive compensation practices have been debated, and questions remain about the explanatory power of previously applied theoretical models.

PURPOSES:

: Our systematic review considered evidence of executive compensation determinants among health care organizations and sought to identify factors affecting executive pay that are commonly supported by previous studies. We also aimed to survey the theoretical perspectives employed in health care executive compensation studies to address how organization theory may explain executive remuneration practices at health care organizations.

METHOD

OLOGY/APPROACH:: Twenty-one eligible studies were identified after a search of the MEDLINE/PubMed and CINAHL electronic reference databases and the reference lists of relevant studies. Eligible studies included those examining health care organizations and providing empirical, regression-based outcomes regarding the determinants of executive compensation. Each eligible study was coded to identify pertinent information, including study settings, executive compensation measures, executive compensation determinants and their measures (e.g., financial performance measured as profit margin), outcomes (direction and level of statistical significance of regression model coefficients), and theoretical applications.

FINDINGS:

: Studies are mixed in their findings regarding the statistical significance of various determinants of executive compensation. Many studies indicate that, in addition to firm financial performance, other factors may influence health care executive compensation, including organizational size and human capital attributes. Agency theory was the predominant framework applied, yet the findings suggest a complementary theoretical perspective may better explain health care executive compensation.

PRACTICE IMPLICATIONS:

: To address critics who assert health care executive compensation levels are not consistent with organizational performance, health care organization CEOs, board members, and consultants would benefit to carefully consider and effectively communicate the numerous factors influencing executive compensation beyond firm financial performance.

BACKGROUND::

Retention of nursing staff remains an important issue for health care managers. Turnover research has focused primarily on motivational and social factors as keys to retention, whereas the role of the physical work conditions has received considerably less attention. However, work design theory suggests that physical work conditions may be an important factor in fostering retention among nursing staff.

PURPOSE:

: The aim of this study was to integrate work design theory with turnover process models to explore the influence of perceptions of physical work conditions on the development of turnover intentions among nursing staff.

METHODS::

Drawing on two samples of registered nurses working in cancer units in metropolitan hospitals in the southeastern United States, this study explores the impact of perceptions of physical work conditions on turnover intentions using ordinary least squares regression. Hypotheses are tested in Study 1 and replicated in Study 2. A measure of perceptions of physical work conditions is also developed and validated using exploratory (Study 1) and confirmatory (Study 2) factor analyses.

FINDINGS:

: Perceptions of physical work conditions explain variance in turnover intentions above than that explained by motivational and social factors. Specifically, employee perceptions of noisy work conditions are found to significantly increase turnover intentions, whereas perceptions that work conditions facilitate tasks were found to significantly reduce turnover intentions. Perceptions of temperature and health hazard did not show significant effects.

PRACTICE IMPLICATIONS:

: Results suggest that health care managers and scholars should re-examine the role of physical work conditions in the turnover process. Investments in upgrades that facilitate tasks may foster retention better than investments that simply improve employee comfort. Negative perceptions of work conditions may have no impact if they are considered a normal "part of the job," although negative perceptions of conditions that are viewed as under the organization's control may be important in creating a desire to leave.

BACKGROUND::

Human resource (HR) practices, such as training and communication, have been linked to positive employee job commitment and lower turnover intent for direct care workers (DCWs). Not many studies have looked at the combined interaction of HR practices and organizational structure.

PURPOSE:

: The aim of this study is to examine the relationship between organizational structure (centralization, formalization, and span of control) and HR practices (training, horizontal communication, and vertical communication) on DCW's job satisfaction and turnover intent.

METHODOLOGY:

: Data were collected from 58 long-term care facilities in five states. We used latent class analysis to group facility characteristics into three sets of combinations: "organic," "mechanistic," and "minimalist." We used multivariate regression to test the relationship of each of these groups on DCW's job satisfaction and turnover intent.

FINDINGS:

: After controlling for state, organizational, and individual covariates, the organic group, which represents decentralized and less formalized structures and high levels of job training and communication, was positively related to job satisfaction and negatively related to intent to leave. On the other hand, the minimalist group, which is characterized by low levels of job-related training and communication, showed no significant differences from the mechanistic group (referent) on job satisfaction and intent to leave.

PRACTICE IMPLICATIONS:

: These findings imply that managers in long-term care facilities may want to consider adopting organic, decentralized structures and HR practices to retain DCWs.

BACKGROUND::

Why organizational cliques are associated with better performance in service delivery networks has yet to be explained. Certain properties of cliques may account for improved performance including the composition of clique members and the quality of their relationships.

PURPOSE:

: The aim of this study is to offer insight into how organizations working through cliques improve network performance by exploring the complementarity of services provided by clique members and testing two hypotheses about trust and perceived benefits among clique members.

METHODOLOGY:

: Survey and archival data were collected from a regional network of 36 nonprofit children's mental health agencies that belong to a coalition. First, clique analyses and network visualization were used to identify cohesive subgroups. Second, the complementarity of services provided by the groups was explored by calculating scores for each group to reflect the level of differentiation in services and client population as reported in archival data. Third, ANOVA density models were used to test whether clique relationships are characterized by higher perceived trust and benefits compared with nonclique member relationships.

FINDINGS:

: Three groups were identified. These groups provide complementary services to similar client populations. Trust within all three cliques was higher than nonclique member relationships. Members of all three cliques perceived greater efficiency, and two of the three cliques also perceived greater access to care and service quality.

PRACTICE IMPLICATIONS:

: Results support selecting clique partners based on service mix. To gain organizational benefits and improve network performance, partners should offer distinct services relative to one another but to similar clients.

BACKGROUND::

Catholic hospitals play a critical role in the provision of health care in the United States; yet, empirical evidence of patient outcomes in these institutions is practically absent in the literature.

PURPOSE:

: The purpose of this study was to determine whether patient perceptions of care are more favorable in Catholic hospitals as compared with non-Catholic hospitals in a national sample of hospitals.

METHODOLOGY:

: This cross-sectional secondary analysis used linked data from the 2008 American Hospital Association Annual Survey, the 2008 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, the 2008 Medicare Case Mix Index file, and the 2010 Religious Congregations and Membership Study. The study included over 3,400 hospitals nationwide, including 494 Catholic hospitals. Propensity score matching and ordinary least-squares regression models were used to examine the relationship between Catholic affiliation and various HCAHPS measures.

FINDINGS:

: Our findings revealed that patients treated in Catholic hospitals appear to rate their hospital experience similar to patients treated in non-Catholic hospitals. Catholic hospitals maintain a very slight advantage above their non-Catholic peers on five HCAHPS measures related to nurse communication, receipt of discharge information, quietness of the room at night, overall rating, and recommendation of the hospital; yet, these differences were minimal.

PRACTICE IMPLICATIONS:

: If the survival of Catholic health care services is contingent upon how its provision of care is distinct, administrators of Catholic hospitals must show differences more clearly. Given the great importance of Catholic hospitals to the health of millions of patients in the United States, this study provides Catholic hospitals with a set of targeted areas on which to focus improvement efforts, especially in light of current pay-for-performance initiatives.

BACKGROUND::

Patient navigation is a widely implemented intervention to facilitate access to care and reduce disparities in cancer care, but the activities of navigators are not well characterized.

PURPOSE:

: The aim of this study is to describe what patient navigators actually do and explore patterns of activity that clarify the roles they perform in facilitating cancer care.

METHOD

OLOGY/APPROACH:: We conducted field observations of nine patient navigation programs operating in diverse health settings of the national patient navigation research program, including 34 patient navigators, each observed an average of four times. Trained observers used a structured observation protocol to code as they recorded navigator actions and write qualitative field notes capturing all activities in 15-minute intervals during observations ranging from 2 to 7 hours; yielding a total of 133 observations. Rates of coded activity were analyzed using numerical cluster analysis of identified patterns, informed by qualitative analysis of field notes.

FINDINGS:

: Six distinct patterns of navigator activity were identified, which differed most relative to how much time navigators spent directly interacting with patients and how much time they spent dealing with medical records and documentation tasks. Navigator actions reveal a complex set of roles in which navigators both provide the direct help to patients denoted by their title and also carry out a variety of actions that function to keep the health system operating smoothly.

PRACTICE IMPLICATIONS:

: Working to navigate patients through complex health services entails working to repair the persistent challenges of health services that can render them inhospitable to patients. The organizations that deploy navigators might learn from navigators' efforts and explore alternative approaches, structures, or systems of care in addressing both the barriers patients face and the complex solutions navigators create in helping patients.