Assessing the Impact of Electronic Health Record Systems Implementation on Hospital Patient Perceptions of Care

The delivery of health care services has been impacted by advances in Knowledge Management Information Systems (KMIS) and Information Technology (IT). The literature reveals that Electronic Health Records Systems (EHRs) are a comprehensive KMIS. There is a wide recognition in the body of knowledge that demonstrates the potential of EHRs to transform all aspects of health care services and, in consequence, the performance of Health Care Delivery Organizations (HCDO). Authors of published research also agree that there is a need for more empirical contributions that demonstrate the impact of EHRs upon HCDO. It is argued that in most cases, studies have been deployed with very limited data or in a specific health care setting. Small gains in performance and mixed results have made difficult to conclusively demonstrate a significant effect of EHRs on the quality of health care services. This study contributes to the knowledge base by empirically assessing the link between a hospital\u27s level of implementation of EHRs and patients\u27 perceptions of the quality of health care services through the analysis of 2,036 hospitals. Findings reveal that the level of implementation of EHRs has a positive impact, both on the percentage of patients who are willing to recommend the hospital to family and friends, and on the percentage of patients who give high ratings based on their last stay in the hospital

The Hospital Consumer Assessment of Healthcare Providers and Systems and Central-Line-Associated Bloodstream Infections

Central-line-associated bloodstream infections (CLABSIs) are common healthcare-associated infections (HAIs) contributing to extended hospital stays, morbidity, mortality, and healthcare costs. In 2011, the Centers for Medicare and Medicaid Services implemented the Hospital Value-Based Purchasing initiative, which links acute care hospitals\u27 payments to quality performance. A gap in the literature existed regarding the relationship between hospital characteristics, patient experience, and CLABSI rates. This quantitative study aimed to explore the relationship between patient experience scores reported by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and CLABSI standardized infection ratio (SIR) in nonprofit acute care hospitals in the United States. Three domains of HCHAPS were selected for the study as a proxy for patient safety. Donabedian\u27s structure-process-outcome framework guided the study. The study data was gathered from the American Hospital Directory and Hospital Compare website. Random sampling was completed. A sample size of 77 nonprofit acute hospitals with a complete dataset was included in the study. A standard multiple linear regression analysis showed that nurse communication and room cleanliness statistically correlated with CLABSI rates (p \u3c .001). No significant correlation was found for staff responsiveness (p \u3c .864). The research findings emphasize quality care through reducing microbial contamination and effective communication. Future research on the correlation between nurse-to-patient ratio, patient experience, and outcome is recommended. The study promotes positive social change by providing empirical information to improve quality, clinical processes, patient experience, and outcome measures

A Systematic Review of Structured Communication Among Interprofessional Teams

A leading cause of errors in health care settings is failure of interprofessional teams to communicate effectively. Ineffective communication has been associated with delays in treatment, omission of care, readmissions, and adverse and sentinel events. These incidents cost billions of dollars per year and with current reimbursement processes, health care organizations are now incurring the cost of such errors. The purpose of this project was to promote effective communication between nurses and physicians to reduce errors by standardizing the interaction among team members during interdisciplinary rounds and patient handoffs to increase the nurse communication HCAHPS scores, the physician communication HCAHPs scores, and the patient satisfaction HCAHPS scores in an acute care hospital. The theory of planned behavior, which focuses on motivation, perceived attitudes, and behavioral control and Donabedian’s model of structure-process-outcome support this project related to effective team communication to reduce the risk of poor patient outcomes. The project approach was a systematic review of the literature to determine best practices regarding communication during interdisciplinary rounds by linking quantitative data with a review of the qualitative studies reviewed, and in applying research findings to this identified clinical practice issue, consistent communication processes can be developed that will promote positive social change for patients, families, nurses, and physicians

Recent Developments in Smart Healthcare

Medicine is undergoing a sector-wide transformation thanks to the advances in computing and networking technologies. Healthcare is changing from reactive and hospital-centered to preventive and personalized, from disease focused to well-being centered. In essence, the healthcare systems, as well as fundamental medicine research, are becoming smarter. We anticipate significant improvements in areas ranging from molecular genomics and proteomics to decision support for healthcare professionals through big data analytics, to support behavior changes through technology-enabled self-management, and social and motivational support. Furthermore, with smart technologies, healthcare delivery could also be made more efficient, higher quality, and lower cost. In this special issue, we received a total 45 submissions and accepted 19 outstanding papers that roughly span across several interesting topics on smart healthcare, including public health, health information technology (Health IT), and smart medicine

The Hospital Consumer Assessment of Healthcare Providers and Systems and Central-Line-Associated Bloodstream Infections

Central-line-associated bloodstream infections (CLABSIs) are common healthcare-associated infections (HAIs) contributing to extended hospital stays, morbidity, mortality, and healthcare costs. In 2011, the Centers for Medicare and Medicaid Services implemented the Hospital Value-Based Purchasing initiative, which links acute care hospitals\u27 payments to quality performance. A gap in the literature existed regarding the relationship between hospital characteristics, patient experience, and CLABSI rates. This quantitative study aimed to explore the relationship between patient experience scores reported by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and CLABSI standardized infection ratio (SIR) in nonprofit acute care hospitals in the United States. Three domains of HCHAPS were selected for the study as a proxy for patient safety. Donabedian\u27s structure-process-outcome framework guided the study. The study data was gathered from the American Hospital Directory and Hospital Compare website. Random sampling was completed. A sample size of 77 nonprofit acute hospitals with a complete dataset was included in the study. A standard multiple linear regression analysis showed that nurse communication and room cleanliness statistically correlated with CLABSI rates (p \u3c .001). No significant correlation was found for staff responsiveness (p \u3c .864). The research findings emphasize quality care through reducing microbial contamination and effective communication. Future research on the correlation between nurse-to-patient ratio, patient experience, and outcome is recommended. The study promotes positive social change by providing empirical information to improve quality, clinical processes, patient experience, and outcome measures

Relationship Between Nurse-to-Patient Ratios, Patient Satisfaction Scores, and Hospital Profitability

In 2019, hospital profitability margins were at their lowest levels since the great recession due to a declining volume of patients. Hospital executives who fail to improve profitability are at risk of sustainability. Grounded in the service-profit chain theory, the purpose of this quantitative correlational study was to examine whether nurse-to-patient ratios and patient satisfaction scores significantly predict hospital profitability. Data were collected from 74 hospitals in Southern California from the Centers for Medicare & Medicaid Services government database and publicly available financial statements. Results from multiple regression analysis were not statistically significant. A key recommendation is for hospital executives to invest in software to monitor the number of nurses on staff, the number of hospital beds filled, and the patient satisfaction scores they are receiving. The implications for positive social change include the opportunity for hospital executives to understand nurse-to-patient ratios and patient satisfaction in hospitals to improve the health of the individuals in local communities

The Impact of Adaptive Leadership Capacity on Complex Organizational Health Systems Outcomes

Nonlinear and chaotic environmental changes characterize health services organizations as complex adaptive systems in which leaders must exercise non-traditional leadership practices to succeed. Health services leaders who have learned and implemented traditional linear management approaches are ill prepared to lead in complex environments. This study tested complexity and adaptive leadership theories of agility and resilience in complex health systems. The purpose of this quantitative cross-sectional internet-based survey study was to quantify relationships between independent variables of agility and resilience and secondary dependent variables of financial, patient satisfaction, quality and human capital outcomes. The impact of turbulence was also examined. Included sample data were collected from 533 employed healthcare leaders using probability-based systematic proportional random sampling methods and were analyzed through correlation, regression, one-way analysis of variance, t tests, and Hayes PROCESS statistical analytics. Agility correlated with and predicted patient satisfaction outcomes. Resilience independently correlated with and predicted financial performance and patient satisfaction outcomes and augmented the correlation and predictability of agility. Agility and resilience cumulatively predicted financial performance outcomes. Turbulence was related to agility, resilience, financial performance, and patient care quality outcomes and mediated relationships with financial and patient care quality outcomes. Health services leaders may apply these findings to promote social change through the implementation of the agile and resilient leadership approaches necessary to achieve organizational performance outcomes that benefit vulnerable populations

The Impact of Adaptive Leadership Capacity on Complex Organizational Health Systems Outcomes

Nonlinear and chaotic environmental changes characterize health services organizations as complex adaptive systems in which leaders must exercise non-traditional leadership practices to succeed. Health services leaders who have learned and implemented traditional linear management approaches are ill prepared to lead in complex environments. This study tested complexity and adaptive leadership theories of agility and resilience in complex health systems. The purpose of this quantitative cross-sectional internet-based survey study was to quantify relationships between independent variables of agility and resilience and secondary dependent variables of financial, patient satisfaction, quality and human capital outcomes. The impact of turbulence was also examined. Included sample data were collected from 533 employed healthcare leaders using probability-based systematic proportional random sampling methods and were analyzed through correlation, regression, one-way analysis of variance, t tests, and Hayes PROCESS statistical analytics. Agility correlated with and predicted patient satisfaction outcomes. Resilience independently correlated with and predicted financial performance and patient satisfaction outcomes and augmented the correlation and predictability of agility. Agility and resilience cumulatively predicted financial performance outcomes. Turbulence was related to agility, resilience, financial performance, and patient care quality outcomes and mediated relationships with financial and patient care quality outcomes. Health services leaders may apply these findings to promote social change through the implementation of the agile and resilient leadership approaches necessary to achieve organizational performance outcomes that benefit vulnerable populations

Workplace Bullying, Nurse Practice Environment, Patient Outcomes: A Descriptive Study

Better nursing practice environments are associated with improved patient safety, yet little is known about the nurse’s experiences of bullying or flourishing within the practice environment. This study described nurses’ experiences of workplace bullying and flourishing and identified associations with patient outcomes. The study used an exploratory cross-sectional survey design following Donabedian’s Quality Framework of structure-process-outcome and informed through critical feminist theory. The study took place at a large medical facility in the northeastern United States. A multi-instrument survey included four sections. The demographic section and the Practice Environment Scale of the Nurse Work Index (PES-NWI) were used to measure structure variables. The process variables were measured using the Negative Acts Questionnaire Revised for the United States (NAQR-US) to measure workplace bullying, and an investigator designed instrument was used to measure the workplace flourishing based on Chinn’s PEACE and Power model. Online survey results from 138 bedside nurses were correlated with outcome variables patient satisfaction from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, and unit based patient safety rates. Patient falls, 30-day readmissions, medication errors, pressure injuries, overall patient satisfaction, and whether patients would recommend the hospital were averaged by patient unit and assigned to each nurse based on unit association. Following descriptive analysis, multiple regression models were conducted for each patient outcome. The respondents were 76% female, 52 % had a bachelor’s degree or higher and the average time as an RN was 15 years. Nurse perception of the practice environment was inversely associated with patient falls (r=-0.21, pr=-0.26, p r=-0.26, p. Workplace flourishing had a moderate and significant positive association with the better practice environments (r=0.44, p This study contributes to a better understanding of the nurses practice environment by the associations found with bullying and flourishing. Implicit in the PES-NWI description of strong nursing practice environments is nursing control and autonomy of practice. More work is needed to explore the concept of flourishing and what keeps nurses working in adverse environments. As the practice environment is linked to patient safety, an understanding of nurse’s work that includes the practice environments, work satisfaction, the absence of bullying and intentional work flourishing will contribute to better patient outcomes. Further research is needed to understand the complex nature of the nurses’ work environment and the impact on nurses and patients

Relationships Between Nursing Resources, Uncompensated Care, Hospital Profitability, and Quality of Care

The value-based purchase requirement of the Patient Protection and Affordable Care Act puts pressure on hospital leaders to control cost while improving quality of care. The resource dependency theory was the theoretical framework for this correlational study. Archival data from the Centers for Medicare and Medicaid Services collected from 166 acute care urban hospitals for the Fiscal Year 2016. Multiple linear regression analysis was used to determine the relationship between nursing salaries per patient day, cost of uncompensated care as a percentage of net patient revenue, percentage of net income from patient services, and overall patient satisfaction for quality of care received. The multiple regression analysis results indicated the model as a whole to significantly predict overall patient satisfaction for quality of care for the Fiscal Year 2016, F (3,162) = 13.788, p = .000, and R2 = .203. In the final model, all 3 independent variables significantly predicted overall patient satisfaction for quality of care. Nursing salaries per patient day and percentage of net income from patient services were significant positive predictors of overall patient satisfaction for quality of care. Nursing salaries per patient day (� = .366, t = 5.120, p = .000) accounted for a higher contribution to the model than percentage of net income from patient services (� = .169, t = 2.374, p = .019). The cost of uncompensated care as a percentage of net patient revenue displayed a significant negative relationship with overall patient satisfaction for quality of care (� = .176, t = 2.458, p = .015). The implications of this study for positive social change include the potential to enhance the quality of care for patients while maintaining local hospitals\u27 financial viability