BACKGROUND::

Decision makers in hospitals are regularly faced with choices about the adoption of new technologies. Wrong decisions lead to a waste of resources and can have serious effects on the patients' and hospital's well-being.

PURPOSE:

: The goal of this research was to contribute to the understanding of decision making in hospitals. This study produced insights regarding relevant decision criteria and explored their specific relevance.

METHOD

OLOGY/APPROACH:: An initial empirical survey was used to collect the relevant criteria for technological decision making in hospitals. In total, 220 experts in the field of health technology assessment from 34 countries participated in the survey. As a second step, the abovementioned criteria were used to form the basis of an analytic hierarchy process model. A group of 115 physicians, medical technical assistants, and other staff, all of whom worked in the field of radiooncology, prioritized the criteria. An analysis of variance was performed to explore differences among groups in terms of institutional and personal categorization variables.

FINDINGS:

: The first part of the research revealed seven key criteria for technological decision making in hospitals. The analytic hierarchy process model revealed that organizational impact was the most important criterion, followed by budget impact. The analysis of variance indicated that there were differences in the perceptions of the importance of the identified criteria. PRACTICAL

IMPLICATIONS:

: This exploration of the criteria for technological decision making in hospitals will help decision makers consider all of the relevant aspects, leading to more structured and rational decisions. For the optimal resource allocation, all of the relevant stakeholder perspectives and local issues must be considered appropriately.

BACKGROUND::

Patients' agents rather than patients themselves often choose hospitals and rehabilitation centers and evaluate inpatient stays. Thus, online reviews of a hospital may reflect a service experience the patient is not responsible for in two ways. First, a patient may evaluate a hospital that a physician as agent has selected, although he still received the service and is qualified to evaluate it. Second, relatives who may not be directly involved in the inpatient stay may write online reviews, which reflect their own experiences and evaluations.

PURPOSE:

: The study analyzes patient satisfaction data in online hospitals reviews and patients' underlying motives for electronic word-of-mouth according to the type of hospital admission and the perspective of the reviewer.

METHODOLOGY:

: The study uses a sample of 822 reviews from an online platform for hospital reviews and primary data generated by an online survey distributed to the writers of these reviews.

FINDINGS:

: Patients who choose a hospital themselves write more positive online reviews than those with an other-directed choice. Relatives' online reviews more often deal with negative hospital experiences and are more likely to reflect a desire for retaliation.

PRACTICE IMPLICATIONS:

: The study results imply that medical care centers (hospitals and rehabilitation facilities) should pay more attention to agency by focusing on the needs and perceptions of relatives who often act as the critical voice of patients in electronic word-of-mouth behavior.

BACKGROUND::

Nonprofit hospitals (NFPs) are expected to provide community benefits to justify the tax benefits they receive, but recent budgetary constraints have called into question the degree to which the tax benefits are justified. The empirical literature comparing community benefits provided by NFPs and their for-profit counterparts is mixed. However, NFPs are not a homogenous group and can include religious hospitals, community-owned hospitals, or academic medical centers.

PURPOSE:

: This longitudinal study examines how religious hospitals compare with other NFPs and for-profit hospitals with respect to providing community benefits and how the provision of community benefits by hospitals has changed over time.

METHODOLOGY:

: Using a pooled cross-sectional design, we examine two summated scores based on questions from the American Hospital Association annual survey that focus on community orientation among hospitals. We analyze two regressions with year, facility, and market controls to determine how religious hospitals compare with the other groups over time.

FINDINGS:

: Overall, 11% of U.S. hospitals are religious. Religious hospitals were more likely to engage in each individual community benefit activity examined. In addition, the mean values of community benefits provided by religious hospitals, as measured on two summated scores, were significantly higher than those provided by other hospital types in bivariate and regression analyses. Overall, community benefits provided by all hospitals increased over time and then leveled off during the start of the recent economic downturn.

PRACTICE IMPLICATIONS:

: As the debate continues regarding federal tax exemption status, policymakers should consider religious hospitals separately from NFPs. Managers at religious hospitals should consider how their increased levels of community benefits are related to their missions and set benchmarks that recognize and communicate those achievements.

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.