Healthcare Delivery Management Research Articles

Shared Governance among Nurses: A Descriptive Study from Jordan

Background: Shared governance of employees is crucial in building trust within healthcare organizations. Control over practice, ownership of actions, feeling of independence and involvement in work decisions significantly increase employees’ intent to stay, whereas exclusion from the decision-making process leads to a higher rate of turnover. Improving decision-making and enhancing collaboration among nursing staff and nurse leaders pave the way for greater autonomy and management of healthcare delivery. Purpose: The study aims to examine shared governance perceptions among Jordanian registered nurses in different clinical areas. Methods: A descriptive, cross-sectional design was used using the RN-focused index of professional nursing governance survey. A convenient sample consisting of 261 nurses was recruited from three hospitals in Jordan between 2017 and 2018. Results: The total shared governance score ranged between 86 and 344 with a mean of 175.6. There were slight differences in the total shared governance scores among the hospitals under study. However, when the sub-scales were compared across the three hospitals, some differences emerged, specifically in nurses’ total perceived personnel and total perceived goal and conflict. The median age of the sample members was 28 years and about a half of them (54%) were males. Conclusion: Our results demonstrated that there is a room to increase the level of nurses’ control and influence in decision-making, particularly in those departments that scored lower on the index of professional nursing governance. Implications for Nursing: The study results have implications in nursing administration, policy development and decision-making when choosing/adopting a model of organizational SG to cultivate excellence in the workplace. Keywords: Shared governance, Registered nurses, Work environment.

Factors influencing health managers’ acceptance of eHealth services in Saudi Arabia

Introduction: The World Health Organization (WHO) refers to the term of Electronic Health (eHealth) as “the use of Information and Communication Technology (ICT) for health”. In the Kingdom of Saudi Arabia (KSA) where difficult geographical terrain makes the delivery of healthcare services challenging, eHealth offers innovative solutions for improving the access and management of healthcare delivery. Health managers are professionals with responsibility for services, resources and partnership in healthcare including eHealth. They are drawn from a range of backgrounds, many are clinicians employed in health management roles. For the purpose of gaining a deeper and broader understanding of the questions under investigation, this doctoral study has been planned to be carried out in three sequential phases in which findings from each phase informs the next one. A systematic review (SR) of the status of eHealth in Saudi Arabia from the perspectives of multiple professionals was the first phase. It was conducted in 2017. Findings showed that despite the growth of eHealth services in KSA, research publications related to the end-users’ acceptance/intention to use services remains scarce. Thirty-nine influencing factors to the acceptance and use of eHealth services were identified and similarities and differences between these outcomes and what had been found from other studies such as were highlighted.

English

English

The Cleveland Clinic Way

The global healthcare market continues to rapidly evolve, so it is important for all healthcare practitioners to be equally adept in their management of healthcare delivery as in their practice of medicine. A recent book by Toby Cosgrove MD, the CEO and president of the Cleveland Clinic, offers exquisite insight into transforming the institution’s healthcare delivery and outcomes to meet the 21st century expectations of patients and payors. The book, The Cleveland Clinic Way: Lessons in Excellence from One of the World’s Leading Healthcare Organizations (MgGraw-Hill, 2014), describes the journey of modernizing a large academic institution. This project encompassed all practice areas from personnel organization to global expansion, from outcomes reporting to centers of excellence, and from cost-effective medicine to patient satisfaction. Dr Cosgrove offers a unique perspective on the business of medicine and offers valuable pearls of wisdom in the execution of value-based medicine. The contents of the book are logically developed to explore the opportunities for care efficiency and efficacy in large group practices. The principles of optimizing care delivery through economies of scale may be helpful to smaller practices negotiating with hospitals, surgical centers and suppliers. Electronic medical records (EMRs) are becoming universal and offer additional opportunities to improve care collaboration. As Dr Cosgrove discusses collaborative care may be more efficient in managing patients, especially those that require subspecialty. This principle is immediately applicable to those who provide such specialized services as hip preservation surgery, since patients will often receive work-up and long-term follow-up by primary care physician-based teams. Cost-control pressures are ubiquitous but inexpensive care does not necessarily yield optimal societal or patient outcomes. Dr Cosgrove argues that EMRs’ utility may be leveraged to not only improve the efficiency of patient care management but also offer substantial value for improving outcomes. EMRs can predict potential medical hazards to patients, allow for rapid querying of patient data and the ability to enhance transparency in patient, surgeon and practice outcomes. His arguments are supported by detailed case studies that demonstrate using EMRs for transparency in outcomes; outcomes reporting can be a surgeon’s best asset rather than a medical and financial liability. Under his leadership at the Cleveland Clinic, this strategy has reduced costs and increase revenue while increasing patient satisfaction and clinical outcomes. The Cleveland Clinic Way ultimately makes a case for patient-centric care that is derived as much from careful attention to operations and business practices as it is from medical knowledge and skill. The innovations in healthcare delivery outlined in his book are supported by detailed case studies from a wide breadth of literature. His perspectives are easily digested and universally applicable to any practicing physician or surgeon.

The business value and cost-effectiveness of genomic medicine.

Genomic medicine offers the promise of more effective diagnosis and treatment of human diseases. Genome sequencing early in the course of disease may enable more timely and informed intervention, with reduced healthcare costs and improved long-term outcomes. However, genomic medicine strains current models for demonstrating value, challenging efforts to achieve fair payment for services delivered, both for laboratory diagnostics and for use of molecular information in clinical management. Current models of healthcare reform stipulate that care must be delivered at equal or lower cost, with better patient and population outcomes. To achieve demonstrated value, genomic medicine must overcome many uncertainties: the clinical relevance of genomic variation; potential variation in technical performance and/or computational analysis; management of massive information sets; and must have available clinical interventions that can be informed by genomic analysis, so as to attain more favorable cost management of healthcare delivery and demonstrate improvements in cost-effectiveness.

Clinicians as managers

Healthcare has become a complex business and far from a simple exercise, which requires expertise in healthcare management to operate efficiently, especially when resources are limited. Due to increased reliance on economic efficiency, quality of care, consumer involvement, accountability, and scientific methods of service delivery, it is impossible for clinicians to keep themselves away from management issues. The role of a consultant is evolving with responsibilities as a clinician, teacher, manager and leader. Most doctors are reluctant to participate in management due to lack of time, poor involvement in management by the managers, lack of understanding of management culture, and lack of opportunities to get training in management in spite of a strong inner desire to be involved which leaves them frustrated at times. Most clinicians are content and rewarded by their clinical work. There are few who accept challenge but want to retain credibility with fellow clinicians by retaining an active clinician’s role as well which makes it further difficult for them to fulfil two roles. On the other side, it is difficult in our current healthcare structure to make a clinician’s role meaningful with realistic involvement in management of healthcare delivery. Ross states that ‘‘Power without responsibility is dangerous, but responsibility without power is frustrating’’. In spite of lot of government initiatives, doctors are not sure what role is expected from them, whether it should be, ‘‘doctors as managers’’, ‘‘doctors in management’’, or ‘‘doctors and management’’. Due to current competitive environment to get higher specialist training schemes and substantive consultant posts, most doctors do different types of courses ranging from a day course to masters in healthcare management but experiencing difficulties in finding structure which facilitate their involvement in management particularly as non-consultant hospital doctors. At present in Republic of Ireland, we are going through a process of selection or recruitment of clinical directors in different specialities and regions without clarifying role, responsibilities and powers of this new post. It is also mentioned that if all colleagues unanimously select a consultant as a clinical director, then there will be no interview which in my opinion undermines the formal training, experience and management capabilities of the person. In my opinion it is important to facilitate a participative relationship between clinician’s and managers which starts from a very early stage as a non-consultant hospital doctor and increases as he/she progresses in his/her clinical career which include management training in their organisational context which will result in new generation of clinicians as managers.

Whose Side Are You On? Interdependence and its Consequences in Management of Healthcare Delivery

Healthcare employees who are committed to the organization and go the extra mile are especially needed today. An empirical study of visiting nurse agency employees showed that a sense of being "in the same boat" with management, or perceiving outcome interdependence, contributed to positive behaviors. Supervisors were generally more inclined than were their subordinates to perceive this interdependence, to be committed, and to exhibit good citizenship behavior. Unexpectedly, physical therapists who worked as hourly part-time contractors reported even stronger feelings of being in the same boat with management and being more committed than the supervisors. Such a sense of partnership could have been a result of the therapists' long-term relationship with the agency over an indefinite time. They might have also felt that they worked voluntarily and autonomously, rather than under close supervision. These findings point to various management actions that can engender a feeling of interdependence, pride in the organization, and fairness of treatment. One step is to involve employees in joint goal setting, organized around "our problems," not just the person's own concerns. Authentic downward communication and the sharing of operating results can convey to employees the major issues that challenge the organization. Such information makes it possible for employees to provide vital input, if not actually take on more decisions themselves. Executives can expect less commitment and less inclination from employees to go above and beyond what is expected if they fail to acknowledge good performance and if they accentuate differences between the most-senior leaders and lower-level employees.

PRACTITIONER APPLICATION: Whose Side Are You On? Interdependence and its Consequences in Management of Healthcare Delivery

PRACTITIONER APPLICATION: Whose Side Are You On? Interdependence and its Consequences in Management of Healthcare Delivery

ANESTHESIOLOGY: 21st Century Opportunities

ANESTHESIOLOGY: 21st Century Opportunities

A multisite collaborative for the development of interdisciplinary education in continuous improvement for health professions students

In 1994, The Institute for Healthcare Improvement, in Boston, Massachusetts, formed the Interdisciplinary Professional Education Collaborative (the Collaborative). The mission of the Collaborative is to create an interdisciplinary teaching and learning environment in which future health professionals learn to work together to improve health care delivery. Apart from emphasizing interdisciplinary collaboration, the Collaborative focuses on teaching the methods of continuous improvement (CI), a system of management first developed for manufacturing industries that is increasingly being used in the management of health care delivery. The Collaborative consists of four local interdisciplinary teams (LITs): the Cleveland LIT, the "George" LIT (a collaboration between George Washington University in Washington, D.C., and George Mason University in Fairfax, Virginia), the South Carolina LIT, and the Pennsylvania LIT; and a coordinating committee. This paper describes each LIT's approach to achieving the Collaborative's commitment to give health professions students the opportunity to work in interdisciplinary teams to learn about and practice CI methods, training the Collaborative believes will enable them to be effective providers in a variety of health care systems. The paper describes the overall goals of the Collaborative, presents reports from the four LITs, and discusses common lessons learned.

Health planning and the law: an update on the statute.

This column, the first in a series, addresses the legal background and program issues involved in comprehensive health planning, a concept that has become a permanent factor in the management of health care delivery. An examination of the 1974 Health Planning Act, its 1979 Amendments, and its evolution from voluntary planning to government control provides insights concerning the path of future regulation.Planning for health care services originated in hospital and community initiatives that sought to guide the distribution of charitable and governmental funds to the neediest hospitals. Purely voluntary in nature, the success of these efforts depended almost entirely on the cooperation and acquiescence of the affected institutions, motivated primarily by their own desire to reduce competition among themselves in fund raising efforts. However, because the desirability of more services was usually assumed, little effort was made to measure the need for the services being proposed.

The Impact of Consumerism on Health Care Change: Alternatives for the Future?

The quest for consumer participation in the management of health care delivery may have experienced its first signs of success, but the implications of that success are as yet unclear. The establishment of consumer majorities on the newly developed health systems agency (HSA) boards was seen as an important milestone in the development of the consumer movement in America over the last ten years. The initial wave of optimism over the Great Society programs that in part gave birth to the consumer movement has long since vanished, but some of the organizational results of those attempts at innovation have become routinely established, as the requirements for consumer participation specified in wave after wave of health related amendments clearly indicates. But what are the results of this participation, and what can we reasonably expect in the future?