Managed Health Care Organizations Research Articles

A case study of patient journey mapping to identify gaps in healthcare: Learning from experience with cancer diagnosis and treatment

Journey mapping methods have a number of practical uses. One of the most promising applications in the area of healthcare is to apply patient journey mapping to identify a patient’s pathway through their healthcare journey. Nowhere is this more important than in the area of cancer care. With lengthy wait times in many countries and the complexity of care paths that cancer patients travel, there is ample opportunity to identify both gaps in care as well as opportunities to improve care processes. In this article the authors discuss a case study of a patient journey involving multiple care organizations, several health professionals and care in both Canada and the United States. By applying patient journey mapping a simplified version of such complexity can be presented in a visual and succinct way, allowing health professionals and managers of healthcare organizations to identify where inefficiencies in care and patient safety issues occur. Furthermore, this mapping can form the basis for optimizing care processes and holds considerable promise for patient-centred healthcare. Implications of using patient journey mapping for improving cancer care and healthcare more generally are discussed.

Lean Management and Breakthrough Performance Improvement in Health Care.

Lean management in health care organizations attempts to empower staff to generate continuous improvement through incremental but regular improvements in work processes. However, because of the increasing pressure on health care organizations to substantially improve quality of care and patient outcomes while containing costs in the relatively short term, many health care leaders are looking for ways to achieve large breakthrough improvements in their organization's performance. The objective of this research is to understand whether and how Lean management can be used to achieve breakthrough improvements in performance. This study used grounded theory and content analysis of in-depth, semistructured interviews with 10 nationally recognized experts in the use of Lean management in health care organizations. The 10 participants constitute a purposive sample of experts with in-depth understanding of the strengths and limitations of Lean management in health care organizations. Two out of 10 participants defined breakthrough improvement as a major change in a performance metric; 2 participants defined it as a fundamental redesign in a process or service; the remaining 6 participants defined breakthrough improvement as having both these characteristics. The extent to which participants believed Lean was an effective means for achieving breakthrough improvement in performance was related to how they defined breakthrough improvement. The 2 participants who defined breakthrough improvement as a significant change in a performance metric believed Lean methods alone were sufficient. The 2 participants who defined breakthrough improvement to be a fundamental redesign tended not to view Lean alone as an effective approach. Rather, they, and the 6 participants who defined breakthrough improvement as having both change-in-metric and process redesign characteristics, viewed human-centered design thinking as the primary or important complementary approach to achieving breakthrough improvement. Participants identified resources, culture change, and leadership commitment beyond what would be required to achieve incremental improvement as the main facilitators and barriers to achieving breakthrough improvements. This research reveals some differences in experts' definitions of breakthrough improvement, and illuminates the value of human-centered design thinking, alone or as a complement to Lean management, in achieving breakthrough improvement in health care organizations. Most of our expert participants agreed that supplementing Lean management methods with the contributions of innovation design and investing significant resources, strengthening the organizational culture to support the necessary changes, and providing stronger leadership commitment to the effort are important facilitators for achieving breakthroughs in organizational performance.

Social participation needs of older adults living in a rural regional county municipality: toward reducing situations of isolation and vulnerability

BackgroundSocial participation is restricted for approximately half the older adult population but is critical in fostering community vitality, promoting health, and preventing disabilities. Although targeted through interventions by community organizations, healthcare professionals and municipalities, little is known about the needs of older adults to participate socially, especially in rural areas. This study thus aimed to identify and prioritize the social participation needs of older adults living in a rural regional county municipality.MethodsA participatory action research was conducted in a rural regional county municipality (RCM) in Quebec, Canada, with a convenience sample of 139 stakeholders, including older adults, caregivers, healthcare and community organization managers, healthcare and community organization workers, community partners and key informants.ResultsFacilitators and barriers to social participation are related to personal factors (e.g., health, interests, motivation), the social environment (e.g., availability of assistance or volunteers) and the physical environment (e.g., distance to resources, recreational facilities and social partners). Nine older adults’ needs emerged and were prioritized as follows: 1) having access to and being informed about transportation options, 2) being informed about available activities and services, 3) having access to activities, including volunteering opportunities, suited to their interests, schedule, cost, language and health condition, 4) being accompanied to activities, 5) having access to meeting places near home and adapted to their health condition, and 6–9 (no preferred order) being reached when isolated, being personally invited and welcomed to activities, having a social support network, and being valued and recognized. Differences emerged when prioritizing needs of older adults with disabilities (greater need for assistance, accessibility and adapted activities) and older adults living in a rural area (greater need for transportation).ConclusionsTo promote active participation in the community, the social participation needs of older women and men living in rural areas must be addressed, especially in regard to transportation, information, adapted activities, assistance and accessibility. The first part of this action research will be followed by community selection and implementation of initiatives designed to ultimately foster their social participation.

Case Managers Caring for Patients in a Managed Health Care Organization in South Africa, Part 2.

Case Managers Caring for Patients in a Managed Health Care Organization in South Africa, Part 2.

Case Managers Caring for Patients in a Managed Health Care Organization in South Africa, Part 1.

Mbatha, Michelle M Cur (Master Curationis); Downing, Charlene PhD; Nkosi, Elizabeth M Cur (Master Curationis) Author Information

Conflict management as an organizational capacity: survey of hospital managers in healthcare organizations

PurposeThe purpose of this paper is twofold. The first objective is to outline the main theoretical framework on the conflict style phenomenon; the second purpose is to understand the conflict style in a sample of Medical Health Manager.Design/methodology/approachThe authors based this research on qualitative-quantitative analysis. This study starts with a survey questionnaire as a method to collect quantitative data. Therefore, the authors conducted a survey on the style of conflict management of hospital managers with subordinates. A modified version of the Rahim Organizational Conflict Inventory II (ROCI II) (Rahim, 1983) – Module B is used. This instrument is composed of 28 entries.FindingsThe results of this study offer a double perspective. From a theoretical point of view, the results highlight the main theoretical references related to conflict management. In particular, the main currents of study and the results of empirical evidence have been identified within organizational theory. The empirical part of this study, instead, offers a survey, carried out through the administration of the ROCI II – module B questionnaire.Originality/valueThis paper offers interesting food for thought on conflict management. In particular, it offers theoretical references on the subject and on the validation of the ROCI II - Form B model, in health organizations.

Organizational learning culture and business intelligence systems of health-care organizations in an emerging economy

PurposeThis paper aims to investigate the role of business intelligence systems (BIS) in the relationship between organizational learning culture and organizational performance in the health-care context.Design/methodology/approachA quantitative approach was applied to identify the hypothesized relationships. Data were obtained from a survey of 217 mid- and top-level managers of health-care organizations in Bangladesh. Structural equation modeling was used to analyze the data.FindingsThe findings attest to the effectiveness of the mediating role of BIS in the relationship between organizational learning culture and organizational performance within health-care organizations. The theoretical and practical implications of the findings are also discussed.Research limitations/implicationsThe study data were collected from a single country, which made generalization difficult. Further research should be carried out to replicate the present study with different organizational cultural variables and organizational outcomes, such as patient satisfaction.Practical implicationsThis study provides a clear direction for hospital managers to invest more resources in an effective learning culture, to be positively mediated by BIS and to eventually enhance their hospitals’ performance. In addition, this study also suggests that hospital managers should focus on building a knowledge-based learning culture, to effectively use the information provided by BIS.Originality/valueDespite the prior study on the applications of BIS and their value to an organization, little is known about the impact of organizational learning culture on BIS in health-care organizations. The findings give support to the argument that organizational learning culture plays an important role in BIS that, in turn, affects business performance.

Disappearing expertise in clinical automation: Barcode medication administration and nurse autonomy.

Using the case of barcode medication administration (BCMA), our objective is to describe the challenges nurses face when informatics tools are not designed to accommodate the full complexity of their work. Autonomy is associated with nurse satisfaction and quality of care. BCMA organizes patient information and verifies medication administration. However, it presents challenges to nurse autonomy. Qualitative fieldwork, including observations of everyday work and interviews, was conducted during the implementation of BCMA in a large academic medical center. Fieldnotes and interview transcripts were coded and analyzed to describe nurses' perspectives on medication safety. Nurses adopt orienting frames to structure work routines and require autonomy to ensure safe task completion. Nurses exerted agency by trusting their own judgment over system information when the system did not consider workload complexity. Our results indicate that the system's rigidity clashed with adaptive needs embodied by nurses' orienting frames. Despite the fact that the concept of nurse as knowledge worker is foundational to informatics, nurses may be perceived as doers, rather than knowledge workers. In practice, nurses not only make decisions, but also engage in highly complex task-related work that is not well supported by process-oriented information technology tools. Information technology developers and healthcare organization managers should engage and better understand nursing work in order to develop technological and social systems to support it.

TOWARD ORGANIZATIONAL EVIDENCE-BASED MANAGEMENT IN HEALTHCARE ORGANIZATIONS

Purpose – To date, relatively little evidence has been published as to what represents an effective evidence-based management in healthcare organizations. Existing studies are rarely conceived or developed with respect to organizational factors determining whether such studies succeed or fail. One of the challenges in linking organizational factors to evidence-based management is to identify the focus at which characteristics of healthcare organizations and management of knowledge resources are most obvious. This paper sets out to sense this issue. Design/methodology/approach – The paper suggests a conceptual framework through reviewing the existing literature on organizational factors and evidence-based management in the healthcare sector. A new conceptual approach as to how organizational factors and managerial-decision process can be more effectively linked through the organizational-level of healthcare organizations. Findings – Recommendations are provided with regard to how future healthcare organizations can approach the evidence-based management from a logically wide organizational-level and context perspective. Originality/value – The present paper represents an attempt to link organizational factors and evidence-based management in a more meaningful way. A conceptual model has been provided as a way to frame and imagine the organizational circle of producing management evidence. Keywords – Context; Organizational characteristics; Organizational culture, Evidence-based management, Healthcare organizations

Human resource management in healthcare organizations

The article deals with changes in the human resources potential in the Russian health care system, which are the result of the reform of the medical sphere carried out in recent years. The COVID-19 pandemic, which began in early 2020, exposed significant shortcomings of the Russian healthcare reform, showing serious problems in the shortage of specialists, hospital beds, protective equipment, ventilators, tests, and medicines. The reduction of hospital beds and the number of infectious diseases doctors in order to increase the average salary in healthcare has led to the inability of the Russian healthcare system to cope with the spread of coronavirus infection without involving residents, professors, teachers and students of medical organizations. At the present stage of development, the issues of combating the spread of coronavirus infection, mobilization and professional training of medical workers are of particular relevance. Nevertheless, despite the results of the health care reform, which led to a massive reduction of medical organizations in our country, the number of doctors per 10,000 people in 2018 was 47.9 employees, over the past 20 years, has not changed much in the direction of reduction. In our view, we should not talk about a global reduction in human resources in healthcare. The existing personnel problems in healthcare are the low qualification of medical personnel and the General shortage of specialists in the labor market.

How Medical Studies in Poland Prepare Future Healthcare Managers for Crises and Disasters: Results of a Pilot Study.

In the event of a crisis, rapid and effective assistance for victims is essential, and in many cases, medical assistance is required. To manage the situation efficiently, it is necessary to have a proactive management system in place that ensures professional assistance to victims and the safety of medical personnel. We evaluated the perceptions of students and graduates in public health studies at the Medical University of Lublin, Poland, concerning their preparation and management skills for crises such as the COVID-19 pandemic. This pilot study was conducted in March 2020; we employed an online survey with an anonymous questionnaire that was addressed to students and graduates with an educational focus in healthcare organization and management. The study involved 55 people, including 14 men and 41 women. Among the respondents, 41.8% currently worked in a healthcare facility and only 21.7% of them had participated in training related to preparation for emergencies and disasters in their current workplace. The respondents rated their workplaces’ preparedness for the COVID-19 pandemic at four points. A significant number of respondents stated that if they had to manage a public health emergency, they would not be able to manage the situation correctly and not be able to predict its development. Managers of healthcare organizations should have the knowledge and skills to manage crises. It would be advisable for them to have been formally educated in public health or healthcare administration. In every healthcare facility, it is essential that training and practice of performing medical procedures in full personal protective equipment (PPE) be provided. Healthcare facilities must implement regular training combined with practical live scenario exercises to prepare for future crises.

The assessment of successfulness of management decision-making in medical organizations

The decision-making management in health care organizations is one of the basic components of their efficiency. However, there is imbalance between requirements of everyday practice and scientific rationale of process under consideration, in particular lacking of appropriate criteria-diagnostic apparatus causing certain difficulties in decision-making. The purpose of the study was to design automated multi-criteria method of evaluating success of decision-making management in health care organizations. The survey of 62 experts, health care managers, was carried out. 23 criteria for evaluating success of decision-making management in health care organizations have been defined as well as their gradation and significance, integral model options, i.e. the multi-criteria evaluation method has been designed. The automation of method on "1C: Enterprise" software greatly facilitates assessment of not one but a number of health care organizations enabling their ranking. The machine processing results in integral evaluation and informative criteria determining it thus making possible search of case causes and ways of correction. The obtained results can be applied in daily procedures and training of executives of health care organizations.

Background characteristics and exposure to violence predict well-being at work among psychiatric outpatient nurses

AimsTo investigate the well-being at work and analyze relevant predictors of it among nurses working in psychiatric outpatient settings including following specific objectives 1) describe the current state of well-being at work among psychiatric nurses; and 2) examine how background characteristics and exposure to violence predict well-being at work. DesignA cross-sectional survey design. MethodsTwo-staged sampling was used to select participants from psychiatric outpatient units. Data were collected with printed Nordic Questionnaire for Monitoring the Age Diverse Workforce (QPSNordic-ADW) and Violence Incidence Assessment (VIA-Q) questionnaire from January 2019 to June 2019. Descriptive statistics were performed to summarize the collected data and binary logistic regression was used to identify predictors related to the well-being at work. ResultsThe respondents (n = 181) generally evaluated well-being at work quite positively but were more critical towards interaction with their immediate superior, organizational culture, interaction between work and private life, and organizational commitment. Working experience in psychiatric nursing and experiences of harassment were identified as strong predictors of well-being at work. ConclusionThe management of healthcare organizations should discuss nursing ethics and morale more, as well as pay attention to the ethical environment to prevent moral distress among nurses. Several weaknesses seem to exist especially in the management of psychiatric outpatient units which influence nurses' well-being at work. Identification of these can help organizations to develop management and implement interventions to increase nurses' well-being at work. Conversations about the managerial culture and collegial climate should also arise at the organizational and unit levels.

Total Quality Management: Perspective of Saudi Healthcare Organizations

Total Quality Management is essential in the healthcare sector. Delivering good healthcare services is one of the main issues among healthcare organizations. Healthcare customers are satisfied with healthcare providers when their services meet the level of their expectations. Satisfying healthcare customers (both public and private) can be attained through Total Quality Management. This paper highlights the importance of using Total Quality Management in healthcare organizations in the Kingdom of Saudi Arabia (KSA). A review of the implementation of TQM among Saudi healthcare organizations highlighted the challenges faced in the sector. The sustained efforts in improving the service quality in Saudi healthcare have led to remarkable results. However, there are more challenges regarding the quality of services. This paper is helpful for strategic planners, policy makers, and management in the KSA healthcare sector and in other jurisdictions.

Assessing the Readiness Level of Healthcare for Implementing Agility Using Fuzzy Logic Approach

An agile strategy in healthcare would authorize organizations to provide efficient, customized and standard service on time at an optimized cost. To implement agility, the management of the healthcare organization needs to know the mechanisms and how to make the whole organization ready for change process. Thus, the current study assesses the readiness level of healthcare utilizing fuzzy logic approach to implement agility. The conceptual readiness model is framed with five enablers, twenty criteria and fifty-six attributes. The proposed model is applied in to a case hospital to assess the readiness level. The Fuzzy readiness for the implementation of agility index (FRAI) and fuzzy performance importance index (FPII) are computed to determine the readiness level of the case hospital and its weaker attributes in the implementation of agility. FRAI is computed as average ready with (3.00, 4.78, 6.56), and FPII identifies 15 weaker attributes from 56 attributes. It constructs the conceptual model which analyses the current readiness of healthcare and weaker attributes are denoted and required corrective actions should be carried by the management of healthcare organization to improve the readiness. The continuation of assessment readiness model over a period of time would help to improve the readiness level of healthcare for agile implementation.

SUN-626 Survival of Patients with Gastroenteropancreatic Neuroendocrine Tumors and Diabetes Mellitus in a Seer-Medicare Cohort

Background: The incidence and prevalence of gastroenteropancreatic neuroendocrine tumors (GEP-NET) is increasing globally and has been associated with diabetes mellitus (DM). In this study we aimed to compare tumor characteristics, disease-specific survival (DSS) and overall survival (OS) of GEP-NET patients (pts) with and without DM. Methods: Using the Surveillance, Epidemiology, and End Results registry (SEER) linked to Medicare claims, we identified pts diagnosed with GEP-NET between January 1995 and December 2010, aged ≥65 years at the time of GEP-NET diagnosis. We included patients who were in exclusive Medicare coverage without healthcare management organizations and had Medicare Parts A and B coverage for ≥1year after GEP-NET diagnosis or until death. Within the pts with GEP-NET diagnosis, we identified those without a diagnosis of DM prior to the GEP-NET diagnosis. We compared baseline sociodemographics, co-morbidities, and GEP-NET location, stage, grade and treatment between pts with and without DM using χ 2 analysis. Kaplan Meier (KM) curves were used to compare OS and DSS up to 10 years between the DM and non-DM groups. We used Cox proportional hazards analysis to compare the DSS between the groups, adjusting for confounding variables. Results: We identified a cohort of 1,969 well-characterized GEP-NET patients with accurate tumor stage, grade, comorbidities, and treatment data. 478 (25.7%) had DM and 1,383 (74.3%) did not have DM. There were no statistically significant differences in gender or age at the time of GEP-NET diagnosis in the DM (mean age 74.7±SD 6.6 yrs) and non-DM (74.9±7.4 yrs) groups. Significant differences in race were found in the DM (80.6% white, 13.6% black, 1.3% hispanic) and non-DM (86.8% white, 8.2% black, 1.8% Hispanic) groups (p=0.002). Patients with DM had more gastric (14.7%), duodenal (10.9%) and pancreatic (21.0%), and less jejunal/ ileal (12.8%) NETs compared with the non-DM group (9.7%, 6.4%, 16.9%, 18.2%, respectively, p<0.0001). Patients with DM had earlier stage disease than those without DM (p=0.0012), but no difference in tumor grade or treatment was found. KM curves revealed no differences in OS and DSS in the GEP-NET patients with and without DM across all stages. Multivariate adjusted Cox proportional-hazards model found no significant difference in DSS between those with and without DM (HR=0.97, 95%CI: 0.76–1.24). Compared with pts with pancreatic NETs, pts with colon (HR=1.39, 95%CI: 1.04–1.86) had worse survival, while those with jejunal/ileal (HR = 0.59, 95%CI: 0.42–0.83) NETs had a better survival. Discussion: This is the first study to investigate the effect of DM on survival of pts GEP-NETs. We found a high prevalence of pre-existing DM in pts with GEP-NETs, but no difference in OS or DSS in pts with and without DM. Interestingly, pts with DM had more foregut GEP-NETs which may suggest mechanistic links between DM and GEP-NETs at these sites.

Why, what and how do European healthcare managers use performance data? Results of a survey and workshop among members of the European Hospital and Healthcare Federation.

Objective of this study was to better understand the use of performance data for evidence-based decision-making by managers in hospitals and other healthcare organisations in Europe in 2019. In order to explore why, what and how performance data is collected, reported and used, we conducted a cross-sectional study based on a self-reported online questionnaire and a follow-up interactive workshop. Our study population were participants of a pan-European professional Exchange Programme and their hosts (n = 125), mostly mid-level hospital managers. We found that a substantial amount of performance data is collected and reported, but could be utilised better for decision-making purposes. Motivation to collect and report performance data is equally internal and external, for improvement as well as for accountability purposes. Benchmarking between organisations is recognised as being important but is still underused. A plethora of different data sources are used, but more should be done on conceptualising, collecting, reporting and using patient-reported data. Managers working for privately owned organisations reported greater use of performance data than those working for public ones. Strategic levels of management use performance data more for justifying their decisions, while managers on operational and clinical levels use it more for day-to-day decision-making. Our study showed that, despite the substantial and increasing use of performance data for evidence-based management, there is room and need to further explore and expand its role in strategic decision-making and supporting a shift in healthcare from organisational accountability towards the model of learning organisations.

&lt;p&gt;Risk Management in Executive Levels of Healthcare Organizations: Insights from a Scoping Review (2018)&lt;/p&gt;

BackgroundThis study attempted to present a framework and appropriate techniques for implementing risk management (RM) in executive levels of healthcare organizations (HCOs) and grasping new future research opportunities in this field.MethodsA scoping review was conducted of all English language studies, from January 2000 to October 2018 in the main bibliographic databases. Review selection and characterization were performed by two independent reviewers using pretested forms.ResultsFollowing a keyword search and an assessment of fit for this review, 37 studies were analyzed. Based on the findings and considering the ISO31000 model, a comprehensive yet simple framework of risk management is developed for the executive levels of HCOs. It includes five main phases: establishing the context, risk assessment, risk treatment, monitoring and review, and communication and consultation. A set of tools and techniques were also suggested for use at each phase. Also, the status of risk management in the executive levels of HCOs was determined based on the proposed framework.ConclusionThe framework can be used as a training tool to guide in effective risk assessment as well as a tool to assess non-clinical risks of healthcare organizations. Managers of healthcare organizations who seek to ensure high quality should use a range of risk management methods and tools in their organizations, based on their need, and not assume that each tool is comprehensive.

ТЕХНОЛОГИИ УПРАВЛЕНИЯ: ОТ ТЕОРИИ К ПРАКТИКЕ ПРИМЕНЕНИЯ В УЧРЕЖДЕНИЯХ ЗДРАВООХРАНЕНИЯ

Significance. Development and implementation of new medical and information technologies in healthcare, development of quality management system and digitalization are prioritized by the Decree of the President of the Russian Federation as of June 6, 2019 No.254 «On Strategy on healthcare development in the Russian Federation for the period until 2025». They are also mentioned in the list of key activities of the Ministry of Health of the Russian Federation in 2019-2024. Modern evidence-based management approaches are necessary to work in the mentioned fields, while the system development requires improvements including improvements in the management process based on best Russian and international practices in modern management in healthcare. Purpose. To assess the possibility of using modern management technologies to increase flexibility and efficiency of the medical organization. Material and methods. Analysis of domestic and foreign literature, normative legal documents for the period from 2015 to 2020 was carried out by means of theoretical analysis and synthesis using databases of the Russian Science Citation Index, Google Scholar, «Garant» reference system, open Internet sources and keywords search in Yandex search system. Results. Based on the analysis and guided by the functional principle, the authors have proposed a three-group classification of modern management technologies in healthcare allowing to structure the management process in a health care organization depending on the objectives. The groups include: 1) technologies that ensure development and implementation of organizational solutions; 2) technologies that ensure treatment and diagnostic process, quality and safety of health care; and 3) technologies for human resource management. Each group of technologies is represented by a set of organizational solutions, the characteristics of which are presented in this study. Conclusion. Application of flexible technologies is determined by the need to cope with changes in the business environment and to adapt the management system to new conditions. Due to objective restrictions related to the normative nature of the facility functioning and existing personnel limitations preventing development of the necessary managerial competencies of the staff, managers of health care organizations may not be able to properly attend to these issues. At the same time, the accumulated successful experience in implementing individual project management tools, the Agile method and other modern management technologies in the international practice suggest their possible replication to improve management processes in health care organizations in Russia. Scope of application. The study results can be used by healthcare managers, heads of health care organizations in developing and implementing managerial decisions, selecting modern tools and management technologies in order to achieve flexibility and efficiency of the institution's performance, as well as by regional authorities in public health in determining priorities for organizational development of health care organizations. Keywords: modern tools and methods of management in healthcare; project management; flexible management technologies.

Features of Quality Management in Healthcare of the Republic of Kazakhstan

The main factor that determined the relevance of the author’s research is the need to continue and develop the processes of modernization in the healthcare economy, provided for in the framework of the state program of health development of the Republic of Kazakhstan “Densaulyk”, as well as the “ Strategy-2050. The article shows the significant changes affecting the increase in the provision of medical organizations with high-tech medical and diagnostic equipment, as well as the solution of issues related to their informatization through the introduction of medical information and analytical systems aimed at automating the main processes of medical activity. The authors prove that in order to achieve the highest efficiency and effectiveness of the functioning of medical organizations, it seems appropriate to introduce process-oriented quality management systems in healthcare, which are a synthesis of professional management and modern information technologies. The objectives of the study in the study of the main aspects of quality management in healthcare organizations and the analysis of the quality management system are defined. On the basis of the study, the authors draw the appropriate conclusions.