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Volume 52, Number 6
November/December 2007

  • INTERVIEW
    Interview with LTC Jessie L. Tucker III, Ph.D., FACHE, Deputy Commissioner for Administration (COO), Womack Army Medical Center, Kyle L. Grazier
  • DIVERSITY
    Applying Six Sigma and DMAIC to Diversity Initiatives, Janice L. Dreachslin and Peggy D. Lee
  • ARTICLES
    Exploring the Relationship of Hospital and Market Characteristics and Organ Donation in U.S. Hospitals, Susan D. Roggenkamp, Alicia Aldridge, Bonnie Guy, and Courtney A. Rocheleau
    Nurse Residency Program Implementation: The Utah Experience, Mollie R. Poynton, Connie Madden, Roxanne Bowers, and Maureen Keefe Hospital Adoption of Information Technologies and Improved Patient Safety: A Study of 98 Hospitals in Florida, Nir Menachemi, Charles Saunders, Askar Chukmaitov, Michael C. Matthews, and Robert G. Brooks
    Financial Preconditions for Successful Community Initiatives for the Uninsured, Paula H. Song and Dean G. Smith

Executive Summary

Exploring the Relationship of Hospital and Market Characteristics and Organ Donation in U.S. Hospitals, Susan D. Roggenkamp, Alicia Aldridge, Bonnie Guy, and Courtney A. Rocheleau  

Unmet demand for organ transplantation is, in part, a result of low rates of organ donation. While the transplant community works diligently to improve rates of organ donation, patients on waiting lists for transplantation continue to die. This article reviews factors that are associated with rates of organ donation at U.S. hospitals. We analyzed two years of data on the numbers of actual and potential donors at U.S. hospitals to discern whether hospital or market attributes are directly related to a hospital’s rate of securing organ donations. We found that certain hospital characteristics are related to higher donation rates. Further research and a deeper understanding of organizational and environmental influences on the complex nature of securing organ donations are needed to help alleviate transplantation waiting lists.

Executive Summary

Nurse Residency Program Implementation: The Utah Experience, Mollie R. Poynton, Connie Madden, Roxanne Bowers, and Maureen Keefe

Recently, nurse residency programs have been shown to improve satisfaction and enhance the retention of new graduate nurses, offering one solution for hospital executives, administrators, and managers searching for innovative ways to address nursing staff shortages. This article identifies crucial lessons that will assist leaders in designing and implementing a nurse residency program in their own institutions. The lessons are drawn from the experience of the successful University of Utah program. Four important practical components of such programs are described: an adaptive curriculum, promotion of autonomy, mentoring, and meeting the needs of participants with associate degrees. Although the lessons are based on the perspective of one nurse residency program, they hold import for the design of nurse residency programs in diverse settings.

Executive Summary

Hospital Adoption of Information Technologies and Improved Patient Safety:
A Study of 98 Hospitals in Florida, Nir Menachemi, Charles Saunders, Askar Chukmaitov, Michael C. Matthews, and Robert G. Brooks

Most of the studies linking the use of information technology (IT) to improved patient safety have been conducted in academic medical centers or have focused on a single institution or IT application. Our study explored the relationship between overall IT adoption and patient safety performance across hospitals in Florida. Primary data on hospital IT adoption were combined with secondary hospital discharge data. Regression analyses were used to examine the relationship between measures of IT adoption and the Patient Safety Indicators (PSIs) of the Agency for Healthcare Research and Quality.

We found that eight PSIs were related to at least one measure of IT adoption. Compared with administrative IT adoption, clinical IT adoption was related to more patient safety outcome measures. Hospitals with the most sophisticated and mature IT infrastructures performed significantly better on the largest number of PSIs. Adoption of IT is associated with desirable performance on many important measures of hospital patient safety. Hospital leaders and other decision makers who are examining IT systems should consider the impact of IT on patient safety.

Executive Summary

Financial Preconditions for Successful Community Initiatives for the Uninsured, Paula H. Song and Dean G. Smith

Community-based initiatives are increasingly being implemented as a strategy to address the health needs of the community, with a growing body of evidence on successes of various initiatives. This study addresses financial status indicators (preconditions) that might predict where community-based initiatives might have a better chance for success.

We evaluated five community-based initiatives funded by the Communities in Charge (CIC) program sponsored by the Robert Wood Johnson Foundation. These initiatives focus on increasing access by easing financial barriers to care for the uninsured. At each site, we collected information on financial status indicators and interviewed key personnel from health services delivery and financing organizations.

With full acknowledgment of the caveats associated with generalizations based on a small number of observations, we suggest four financial preconditions associated with successful initiation of CIC programs: (1) uncompensated care levels that negatively affect profitability, (2) reasonable financial stability of providers, (3) stable health insurance market, and (4) the potential to create new sources of funding. In general, sites that demonstrate successful program initiation are financially stressed enough by uncompensated care to gain the attention of local healthcare providers. However, they are not so strained and so concerned about revenue sources that they cannot afford to participate in the initiative. In addition to political and managerial indicators, we suggest that planning for community-based initiatives should include financial indicators of current health services delivery and financing organizations and consideration of whether they meet preconditions for success.