Field Of Healthcare Management Research Articles

Perils of Professionalization: Chronicling a Crisis and Renewing the Potential of Healthcare Management.

This paper critically examines efforts to "professionalize" the field of healthcare management and its corresponding costs. Drawing upon the scholarly critiques of professionalization in medicine and the broader field of management, this paper seeks to explore the symbolic role professionalization might play in the psyche of its constituents, and specifically its function as a defense against uncertainty and anxiety. This psychodynamic heuristic is then deployed to put forth the hypothesis that an ongoing crisis of professional identity continues to both propel and impede professionalization efforts in healthcare management, giving rise to a litany of standardization pressures that ultimately limit the field's potential. To mitigate these pressures, the call is made for rekindling healthcare management's moral, political, and existential aspects. Specifically, this entails engaging with the deeper themes that flow through the field: the experience of illness and what it means to suffer, the experience of life and what it means to have hope, and the experience of death and dying. It also entails squarely confronting questions of power, poverty and disease, and the pursuit of justice.

Capturing Innovation in Surgeries: An Evaluation from a Management Perspective

Surgery is considered as an integral part of any health system, comprising 30% of global burden of disease along with serious access problems and catastrophic payments across the world. More than 230 million major surgeries are done every year. Surgical innovations typically represent the greatest part of innovations in terms of their contributions to ensuring safer and high-quality care and thus saving lives in the field of healthcare management. Such innovations also contribute significantly to the knowledge society. Correctly identifying innovations in surgery and enabling them to be known and adapted by other surgeons is a critical concern for all stakeholders in healthcare. There exists no information on surgical innovations from a managerial perspective in Turkey. This study aims to explore how surgeons identify surgical innovations based on their real experiences of past surgeries using a semi-structured questionnaire distributed to surgeons in a major hospital chain in &#Istanbul, Turkey. The results shed light on recognising and evaluating surgical innovations provided by the practicing surgeons via a management perspective.

Between Policy and Politics: When Bioethics Ventures into Public Debate

Between Policy and Politics: When Bioethics Ventures into Public Debate Jean–Christophe Bélisle Pipon, Marie–Ève Lemoine, Maude Laliberté, and Bryn Williams–Jones Preamble Dissemination of and discussion about research results are increasingly recognized as a necessary part of research, to the point that knowledge [End Page 3] transfer (KT) is viewed by many researchers and institutions as an ethical obligation and is increasingly expected (and even required) by research funders. KT is especially important for population health researchers, whose research has a direct impact on the lives of individuals and communities. However, it is not easy to transfer knowledge to the general public, especially when the subject is sensitive or highly political. The advice of academic experts may be ignored or contested by policy makers, for example, due to differences in values and priorities, or because it does not fit political objectives. In this context, we—a group of bioethics students, with the support of a professor—produced a YouTube video explaining the current state of knowledge and the potential consequences of a bill that would massively reorganise healthcare administration in the province of Québec, Canada. Our goal was to stimulate debate about the bill and its impact on the healthcare system. This paper recounts, in narrative form, a fictional dialogue1 between the students and two professors regarding the development, dissemination and ensuing critique of the video, and their reflections on how junior and established bioethics scholars can and should engage in innovative KT on topics of public importance, that have significant political ramifications for a variety of stakeholders. Dialogue Three bioethics students are having lunch in their department; two of their professors walk by and stop for a chat. Professor A: Hi guys! I’m glad to find the three of you here, I wanted to congratulate you on that Bill 10 KT project! You did a great job summarizing the issues and presenting it in a simple and entertaining fashion. I was impressed! Student 1: I’m glad that you liked it. There was very little we could do in a short space of time. But at least we hope to have raised awareness in the general public. Professor B: A KT project on Bill 10? What form did it take? Did you do a presentation or something? Professor A: Actually, these three, with the help of a few more students in the Faculty, developed and released a very cool YouTube video that explained to lay–people how Bill 10 was contrary to most evidence in the field of healthcare management, and how it would likely have a major impact on healthcare costs and service delivery. Their video received 10,000 views in a little over two weeks, which is quite impressive in a small market such as the province of Quebec. Professor B: Oh, okay, no offense intended, but on what grounds do you students justify expressing these views? You’re not experts in the field of healthcare management, nor in the field of KT. Student 2: You’re right. We fully acknowledge that we’re not healthcare management experts, but we gathered our information from a panel presentation given by four eminent researchers in the field, and also searched the literature. As for KT, we think it should be part of bioethics activities and also of all graduate studies actually, and we like to believe that KT can be learned along the way—and it was quite a learning experience! With all humility, our goal was simply to share with the public what we learned in the academic context, and so help raise awareness of what is clearly an important issue for all citizens in our province. Student 3: Experts do research and write papers and reports. They very seldom bother engaging with lay–people to help inform them about their findings. We felt like somebody had to do something, and as socially engaged bioethics students, we wanted to put our values into practice. Professor A: I fully agree! I regularly tell my students—and my colleagues!—that its critical that we move academic findings and knowledge into the public space and so support more informed public debate. I even go so...

How Health Management Leaders Evaluate the Interpersonal Skills of U.S. Business and Health Management-Trained Professionals

Abstract A national survey was conducted to determine the current state of senior executive perceptions of recent entrant managers within corporate headquarters, hospital systems, and freestanding hospitals. The survey was constructed based on leadership interpersonal competencies and competency-based career development programs. A total of 676 respondents returned a survey, representing 31 percent of the mailing sample. The goal of the research was to determine the perceptions that senior executives have about the interpersonal skills of recent entrants to the field of health care management and identify best practices for organizational training of such entrants. The research in this study focuses on MBA versus MHA preparation and how senior executives view entry managers from each discipline. While there is no statistically significant difference in how senior executives evaluate REMs with an MBA or MHA, there were interpersonal competencies that REMs from all educational backgrounds needed to develop. Senior executives reported that the MBA graduates needed to enhance their ability to accept constructive criticism, take direction, control their emotions, read other’s emotions, enhance their ability to work with others, handle situations with diplomacy, and build rapport with the management team. Senior executives reported that MHA graduates need to enhance their ability to exercise authority, confront others about mistakes, and improve their understanding of organizational politics. Senior executives also observed the need to require additional training of recent entrant managers in areas of management skills on understanding organizational politics, using a variety of techniques to influence others, handling difficult people or situations using diplomacy, confronting others about their mistakes, and exercising authority.

Inernational research in health care management: its need in the 21st century, methodological challenges, ethical issues, pitfalls, and practicalities.

This commentary argues in favor of international research in the 21st century. Advances in technology, science, communication, transport, and infrastructure have transformed the world into a global village. Industries have increasingly adopted globalization strategies. Likewise, the health sector is more internationalized whereby comparisons between diverse health systems, international best practices, international benchmarking, cross-border health care, and cross-cultural issues have become important subjects in the health care literature. The focus has now turned to international, collaborative, cross-national, and cross-cultural research, which is by far more demanding than domestic studies. In this commentary, we explore the methodological challenges, ethical issues, pitfalls, and practicalities within international research and offer possible solutions to address them. The commentary synthesizes contributions from four scholars in the field of health care management, who came together during the annual meeting of the Academy of Management to discuss with members of the Health Care Management Division the challenges of international research. International research is worth pursuing; however, it calls for scholarly attention to key methodological and ethical issues for its success. This commentary addresses salient issues pertaining to international research in one comprehensive account.

The interpersonal skills of recent U.S. entrants to the field of healthcare management

A national survey was conducted to determine the current state of senior executive perceptions of recent entrant managers within corporate headquarters, hospital systems, and freestanding hospitals. The survey was constructed based on leadership interpersonal competencies and competency-based career development programs. A total of 676 respondents returned a survey, representing 31% of the mailing sample. The goal of the research was to determine the perceptions that senior executives have about the interpersonal skills of recent entrants to the field of health care management and identify best practices for organizational training of such entrants. Findings reveal that senior executives view the recent entrant manager favorably regardless of age, gender, education, and non-clinical/clinical background. Senior executives also observed the need to require additional training of recent entrant managers in areas of management skills on understanding organizational politics, using a variety of techniques to influence others, handling difficult people or situations using diplomacy, confronting others about their mistakes, and exercising authority.

Valuing the Benefit for Cancer Patients of Receiving Blood Transfusions at Home

In the field of health care management, contingent valuation surveys (CV) are used in cost benefit analyses (CBA) to elicit patients’ monetary valuation of program benefits. We considered the empirical situation of blood transfusions (BT) in cancer patients. Before planning such a CBA, we had to make sure that the CV approach could be used in a particularly critical clinical situation to estimate the marginal benefit of changing from hospital BT to home BT. The fact that the CV approach is feasible and acceptable to severely ill patients was not taken for granted a priori.We measured patient’s willingness-to-pay (WTP) for home BT in a sample of 139 patients who received transfusions either at home or in the hospital. After considering patient’s participation to the survey and protest responses, we identified possible determinants of WTP values derived from previous knowledge, then we compared their expected influences to predicted influences resulting from econometric analysis to assess the validity of our results. Participation was high (90%) and few patients gave protest responses. Most patients (65%) had received home care, including 43% BT. The median WTP for home BT was 26.5 € per patient.Good consistency was observed between the expected and predicted influences of possible determinants of WTP. The anchoring bias hypothesis was confirmed. The WTP for home BT increased with previous experience of home care, age, living far from the hospital and low quality of life. Our CV approach is thus a first contribution to the debate on the appropriateness of generalizing access to home BT. However, our results would be worth confirming with a formal cost-benefit analysis.

Assessing hospitals' readiness for clinical governance quality initiatives through organisational climate

The purpose of this paper is to consider organisational climate as the vehicle to get an understanding, map and enhance the appropriate organisational culture for good clinical governance (CG). Based on this assertion, the purpose of this research is fourfold: to investigate CG attributes embedded in Greek hospitals' climate; to test the validity and reliability of the Clinical Governance Climate Questionnaire (CGCQ) and highlight the dimensions of CG climate in the Greek context; to illuminate the "red flag" aspects of hospital's climate and areas shaping the perceptions of the quality of the provided services; and to explore the influence of hospital's legal status on CG climate and service quality. Empirical research using the CGCQ was conducted in three Greek NHS hospitals. A total of 214 usable questionnaires completed by the hospitals' personnel were gathered. The validity and reliability tests proved that the study's five-dimension structure of CGCQ is capable of conceptualising the basic elements of CG climate in the Greek context. Hospital's climate was found to be not supportive to successful CG implementation, and areas that demand attention were illuminated. Hospital's legal status seems to mediate CG climate and service quality. CGCQ proved to be a useful tool for managers and policymakers to trace "problematic" areas of hospital's climate and develop strategies for successful CG initiatives. The paper contributes to the field of health care management, since it demonstrates that CG climate can be used as a "gauge" of the prevailing CG culture. CGCQ is revealed as a valid, reliable and flexible tool.

Models as instruments for optimizing hospital processes: a systematic review

The purpose of this article is to find decision-making models for the design and control of processes regarding patient flows, considering various problem types, and to find out how usable these models are for managerial decision making. A systematic review of the literature was carried out. Relevant literature from three databases was selected based on inclusion and exclusion criteria and the results were analyzed. A total of 68 articles were selected. Of these, 31 contained computer simulation models, ten contained descriptive models, and 27 contained analytical models. The review showed that descriptive models are only applied to process design problems, and that analytical and computer simulation models are applied to all types of problems to approximately the same extent. Only a few models have been validated in practice, and it seems that most models are not used for their intended purpose: to support management in decision making. The comparability of the relevant databases appears to be limited and there is an insufficient number of suitable keywords and MeSH headings, which makes searching systematically within the broad field of health care management relatively hard to accomplish. The findings give managers insight into the characteristics of various types of decision-support models and into the kinds of situations in which they are used. This is the first time literature on various kinds of models for supporting managerial decision making in hospitals has been systematically collected and assessed.

Comments on “Health economic evaluation in lumbar spinal fusion. A systematic literature review anno 2005”

The authors have presented an interesting review dealing with a hot topic: cost-effectiveness in spine surgery. In the field of healthcare management, full health economic evaluations including cost-effectiveness analyses (CEA) and cost-utility analyses (CUA) are increasingly requested by those responsible for fund allocation. In both CEA and CUA, the cost difference between two treatment alternatives is illustrated in the numerator, and the difference in treatment effects in the denominator. The result is given as a ratio reflecting the extra cost per extra effect unit gained by using one treatment instead of another, the incremental cost effectiveness ratio (ICER). Thus, CEA and CUA relate to our ambition to select the best available treatment for the money available, and could therefore serve as a bridge of understanding among clinicians, managers, healthcare policy-makers and politicians. Two reviewers, one health economist and one clinician were reported to be involved in the study, which should be accepted as a minimum. The used methodology is accurate, making use of a merged instrument for assessing the quality of the included studies [2, 8, 9]. Few relevant health economic studies dealing with CEA in the field of lumbar spinal fusion were found, which accurately reflects the current state of affairs. One British study, which should be analysed according to the method used in the current paper, was recently published [6]. All but two studies reported ICER from the perspective of the healthcare sector (in this case, hospitals). The authors therefore chose to exclude results from a societal perspective. However, it should be noted that the healthcare perspective is mainly of concern to local healthcare administrators, while most other parties are interested in the societal perspective, where the economic implications of being off work are also considered. Since this is far more costly than the actual healthcare costs [3], future studies would benefit from including also the societal perspective. One problem with CEA and CUA is the use of different methods in collecting information on costs, as well as different outcome instruments and measuring techniques and also somewhat different study populations. This is one reason why it has so far been difficult to use results from CEA/CUAs to decide on priorities among specific treatment options in the surgical field. The situation is somewhat different in the pharmaceutical field where reported cost-effectiveness is frequently used to support or reject reimbursement of drugs [4]. Consequently, the authors stress the importance of raising the awareness of health economic evaluations and agreeing on methodological issues. The Panel on cost-effectiveness in the US has dealt with this challenge for approximately 10 years [7], and the Spine Society of Europe (SSE) also recently addressed it, when a Health Economic task force including clinicians, economists, epidemiologists and statisticians, was established in 2004. Besides discussing theoretical issues on methodology and how to analyse and present data, this group will be able to give practical advice on protocols and outcome instruments. Recently they also decided to arrange instructional courses in health economics. In conclusion, the authors are to be congratulated for helping to put health economic analyses in the field of spine surgery on the agenda, and hopefully, future clinical studies will more often include a health economic evaluation related to clinical outcome. If a CUA is feasible it would be advantageous to include that, using a preference-based outcome instrument, like the EQ5D or SF-6D [1, 5]. These instruments are used to measure patient perceived changes in quality of life after a given treatment (utility), and if these differences are correlated with time, they can be expressed in terms of gains or losses in quality-adjusted life years (QALYs). Reporting costs per QALY will make it possible to discuss priorities among different treatment options—not only within the same diagnostic entity, but even among different diagnostic entities. This will increase interest in these analyses within the profession as well as among fund holders. However, the ethical concerns inherent in health economic evaluations should not be taken lightly, and must be discussed and analysed continuously by the profession.

Organisational performance evaluation: application to Belgian hospitals

In many Western countries, the hospital environment has completely changed in the last 20 years. Today's hospitals cope with economical, technological and social pressures. One of the major changes is the generalisation of the Prospective Payment System or more controlled retrospective payment systems. This evolution yields new efficiency criteria that constrain many areas in healthcare management and forces hospital managers to revise completely the system of care production. In this volatile context, one new challenge for hospital managers is to find the most appropriate organisational design to face these more controlled payment systems. The above-mentioned challenge relies upon the link between the two following elements: performance evaluation and organisational design. This paper only analyses performance and is thus the first part of a larger research that grapples with this and more complicated issues. The first section of this paper is devoted to the elaboration of a performance model that would allow hospital evaluation and benchmarking. The problem that we face in developing such a model is that the criteria used to measure performance are conflicting. This forces us to perform a necessary arbitration between those performance criteria and raises a question related to which trade-offs are necessary. In the second section, we present a study conducted on 61 Belgian hospitals where we intend to highlight the existing link between some organisational parameters and hospital performance. In a first phase we use the DEA (Data Envelopment Analysis) approach to calculate performance scores for hospitals. A second phase analyses which factors can explain the variation of these performance scores. To perform this phase, we are greatly limited by the organisational factors data contained in our database. Observed variations in performance could be explained only by the following structural data private or public status and teaching or non-teaching character. We conclude with future research likely to define more accurately the relationship between organisational design and performance in the very specific field of healthcare management.

Finding Information on Health Care Management: The Health Planning and Administration Database

To work in the field of health care management, one must have thorough knowledge of management principles, as well as a solid understanding of the health care system. To students and practitioners in this field, finding information for papers, research, or problem‐solving might appear to be a difficult task. The Health Planning and Administration database (HEALTH) offers a quick and efficient solution to this problem.

The impact of diagnosis related groups and prospective pricing systems on health care management.

Prospective pricing systems for medical care based on diagnosis related groups will probably become the norm for the entire medical care industry. Such an approach will have an impact on health care managers' roles, and it is up to them to achieve an optimistic outcome from implementation of the system.