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Volume 58, Number 5
September/October 2013

  • INTERVIEW
    Interview With Christina M. Freese-Decker, FACHE, President, Spectrum Health United and Kelsey Hospitals
    Stephen J. O'Connor
  • EQUITY OF CARE
    Increasing Diversity and Inclusion in Medical School to Improve the Health of All
    Darrell G. Kirch and Marc Nivet
  • • INTEGRATED HEALTH SYSTEMS
    Connecting Operations, Operating Economics, and Finance for Integrated Health Systems
    Daniel K. Zismer
  • ARTICLES
    Examining the Effect of EVS Spending on HCAHPS Scores: A Value Optimization Matrix for Expense Management
    Deirdre McCaughey, Samantha Stalley, and Eric Williams

    Practitioner Application: Christine C. Winn
    Do Senior Management Cultures Affect Performance? Evidence From Italian Public Healthcare Organizations
    Anna Prenestini and Federico Lega
    Practitioner Application: Joseph Webb
    Environmental and Organizational Influences on Magnet Hospital Recognition
    Thomas L. Powers and Tom J. Sanders

    Practitioner Application: Cole Edmonson
    A Longitudinal Study of Clinical Peer Review's Impact on Quality and Safety in U.S. Hospitals
    Marc T. Edwards
    Practitioner Application: Maire O. Simington

Executive Summary
Examining the Effect of EVS Spending on HCAHPS Scores: A Value Optimization Matrix for Expense Management Deirdre McCaughey, Samantha Stalley, and Eric Williams Using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, the Centers for Medicare & Medicaid Services' Value-Based Purchasing program has now linked patient care experience rating to hospital revenue reimbursement, thereby establishing a key relationship between revenue cycle management and the patient experience. However, little data exist on the effect of hospital resource spending on patient HCAHPS ratings. This article examines environmental services (EVS) expenses and HCAHPS ratings on hospital cleanliness and overall patient experience ratings to determine how these variables are related.

No linear relationship between EVS expense spending and HCAHPS ratings was found, but post hoc analysis identified a matrix that differentiated on hospital cleanliness ratings and overall EVS spending. A value score was calculated for each quadrant of the matrix, and it was determined that organizational value derives from management of expense spending rather than pursuit of high HCAHPS scores. A value optimization matrix is introduced, and its four quadrants are described.

With increased emphasis on subjective patient experience measures attached to financial consequences, leaders in the healthcare industry must understand the link between expense management and HCAHPS performance. This study has shown that effective operations are derived from the efficient use of resources and are supported by strong leadership, strategic management, and a culture of patient-centered achievement. The capacity of healthcare organizations to identify their unique costs-to-outcomes balance through the value optimization matrix will help provide them with a means to ensure that optimal value is extracted from all expense spending.

Executive Summary
Do Senior Management Cultures Affect Performance? Evidence From Italian Public Healthcare Organizations Anna Prenestini and Federico Lega

Healthcare organizations are often characterized by diffuse power, ambiguous goals, and a plurality of actors. In this complex and pluralistic context, senior healthcare managers are expected to provide strategic direction and lead their organizations toward their goals and performance targets. The present work explores the relationship between senior management team culture and performance by investigating Italian public healthcare organizations in the Tuscany region. Our assessment of senior management culture was accomplished through the use of an established framework and a corresponding tool, the competing values framework, which supports the idea that specific aspects of performance are related to a dominant management culture. Organizational performance was assessed using a wide range of measures collected by a multidimensional performance evaluation system, which was developed in Tuscany to measure the performance of its 12 local health authorities (LHAs) and four teaching hospitals (THs). Usable responses were received from 80 senior managers of 11 different healthcare organizations (two THs and nine LHAs).

Our findings show that Tuscan healthcare organizations are characterized by various dominant cultures: developmental, clan, rational, and hierarchical. These variations in dominant culture were associated with performance measures. The implications for management theory, professional practice, and public policy are discussed. .

Executive Summary
Environmental and Organizational Influences on Magnet Hospital Recognition Thomas L. Powers and Tom J. Sanders

This article reports on research studying the influence of environmental and organizational factors on the adoption of the magnet hospital concept. Although research has been reported on the adoption of innovations by healthcare organizations, research on factors influencing the adoption of administrative advances remains an important area to investigate. Logistic regression was used to determine both the significance and direction of the association of environmental and organizational factors with innovation adoption. In addition, the size and type of the hospitals in the sample was used as a control variable. It was found for environmental factors that environmental complexity and community resources were associated with innovation adoption and that competition and network externalities were not. For the organizational factors examined, it was found that organizational complexity and control of domain were associated with innovation adoption. Slack resources and external communications were not associated with adoption. The findings from this study contribute to healthcare management research by enhancing the understanding of the innovation adoption process. The results have important implications for both healthcare providers and policy makers.

Executive Summary
 A Longitudinal Study of Clinical Peer Review's Impact on Quality and Safety in U.S. Hospitals Marc T. Edwards

Clinical peer review is the dominant method of event analysis in U.S. hospitals. It is pivotal to medical staff efforts to improve quality and safety, yet the quality assurance process model that has prevailed for the past 30 years evokes fear and is fundamentally antithetical to a culture of safety. Two prior national studies characterized a quality improvement model that corrects this dysfunction but failed to demonstrate progress toward its adoption despite a high rate of program change between 2007 and 2009. This study's online survey of 470 organizations participating in either of the prior studies further assessed relationships between clinical peer review program factors, including the degree of conformance to the quality improvement model (the QI model score), and subjectively measured program impact variables. Among the 300 hospitals (64%) that responded, the median QI model score was only 60 on a 100-point scale. Scores increased somewhat for the 2007 cohort (mean pair-wise difference of 5.9 [2–10]), but not for the 2009 cohort. The QI model is expanded as the result of the finding that self-reporting of adverse events, near misses, and hazardous conditions—an essential practice in high-reliability organizations—is no longer rare in hospitals. Self-reporting and the quality of case review are additional multivariate predictors of the perceived ongoing impact of clinical peer review on quality and safety, medical staff perceptions of the program, and medical staff engagement in quality and safety initiatives. Hospital leaders and trustees who seek to improve patient outcomes should facilitate the adoption of this best practice model for clinical peer review.