Managerial practices that promote voice and taking charge among frontline workers

Process-improvement ideas often come from frontline workers who speak up by voicing concerns about problems and by taking charge to resolve them. We hypothesize that organization-wide process-improvement campaigns encourage both forms of speaking up, especially voicing concern. We also hypothesize that the effectiveness of such campaigns depends on the prior responsiveness of line managers. We test our hypotheses in the healthcare setting, in which problems are frequent. We use data on nearly 7,500 reported incidents extracted from an incident-reporting system that is similar to those used by many organizations to encourage employees to communicate about operational problems. We find that process-improvement campaigns prompt employees to speak up and that campaigns increase the frequency of voicing concern to a greater extent than they increase taking charge. We also find that campaigns are particularly effective in eliciting taking charge among employees whose managers have been relatively unresponsive to previous instances of speaking up. Our results therefore indicate that organization-wide campaigns can encourage voicing concerns and taking charge, two important forms of speaking up. These results can enable managers to solicit ideas from frontline workers that lead to performance improvement.

Operational Failures and Problem Solving: An Empirical Study of Incident Reporting

Operational failures occur in all industries with consequences that range from minor inconveniences to major catastrophes. Many organizations have implemented incident reporting systems to highlight actual and potential operational failures in order to encourage problem solving and prevent subsequent failures. Our study is among the first to develop and empirically test theory regarding which reported operational failures are likely to spur problem solving. We hypothesize that problem solving activities are especially likely to follow reported operational failures that provoke financial and legal liability risks. We also hypothesize that management commitment to problem solving, enacted through managers' communication and engagement practices, can encourage frontline workers to conduct problem solving. We test our hypotheses in the health care context, in which the use of incident reporting systems to highlight operational failures is widespread. Using data on nearly 7,500 reported incidents from a single hospital, we find support for our hypotheses. Our findings suggest that frontline workers' participation in problem solving is motivated by some inherent characteristics of the problems as well as by particular management practices.

The implications and impact of 3 approaches to health information exchange: community, enterprise, and vendor‐mediated health information exchange

IntroductionElectronic health information exchange (HIE) is considered essential to establishing a learning health system, reducing medical errors, and improving efficiency, but establishment of widespread, high functioning HIE has been challenging. Healthcare organizations now have considerable flexibility in selecting among several HIE strategies, most prominently community HIE, enterprise HIE (led by a healthcare organization), and electronic health record vendor‐mediated HIE. Each of these strategies is characterized by different conveners, capabilities, and motivations and may have different abilities to facilitate improved patient care.MethodsI reviewed the available scholarly literature to draw conceptual distinctions between these types of HIE, to assess the current evidence on each type of HIE, and to indicate important areas of future research.ResultsWhile community HIE seems to offer the most open approach to HIE allowing for high levels of connectivity, both enterprise HIE and vendor‐mediated HIE face lower barriers to formation and sustainability. Most existing evidence is focused on community HIE and points towards low overall use, challenges to usability, and ambiguous impact. To better guide organizational leaders and policymakers in the expansion of beneficial HIE and anticipate future trends, future research should work to better capture the prevalence of other forms of HIE, and to adopt common methods to allow comparisons of rate of use, usability, and impact on patient care across studies and types of HIE.ConclusionsHealthcare organizations’ choice of HIE strategy influences the set of partners the organization is connected to and may influence the benefit that efforts supported by HIE can offer to patients. Current research is not fully capturing the diversity of approaches to HIE and their potentially varying impact on providers and patients.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136725/1/lrh210021_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136725/2/lrh210021.pd

Photon Splitting in a Very Strong Magnetic Field

Photon splitting in a very strong magnetic field is analyzed for energy $\omega < 2m$. The amplitude obtained on the base of operator-diagram technique is used. It is shown that in a magnetic field much higher than critical one the splitting amplitude is independent on the field. Our calculation is in a good agreement with previous results of Adler and in a strong contradiction with recent paper of Mentzel et al.Comment: 5 pages,Revtex , 4 figure

Stable Scheduling Increases Productivity and Sales

Variable schedules are now the norm for part-time workers in a variety of industries including retail, where schedules typically change every day and every week, with three to seven days' notice of the next week's schedule. In recent years, these scheduling practices have come under increasing scrutiny in state attorney general offices, state and local legislatures, and the media. In retail, unstable schedules for employees have been considered an inevitable outcome of stores' need for profitability. Operations researchers have found that matching labor to incoming traffic is a key driver of retail store profitability (Perdikaki et al., 2012). At the same time, social scientists have studied the deleterious effects of variable schedules on employee wellbeing (Henly & Lambert, 2014). What has been lacking is evidence that schedules in service-sector jobs can be improved in ways that benefit both employers and employees

Health information exchange between hospital and skilled nursing facilities not associated with lower readmissions

ObjectiveTo assess whether an electronic health record (EHR) portal to enable health information exchange (HIE) between a hospital and three skilled nursing facilities (SNFs) reduced likelihood of patient readmission.Setting/DataSecondary data; all discharges from a large academic medical center to SNFs between July 2013 and March 2017, combined with portal usage records from SNFs with HIE access.DesignWe use differenceâ inâ differences to determine whether portal implementation reduced likelihood of readmission over time for patients discharged to HIEâ enabled SNFs, relative to those discharged to nonenabled facilities. Additional descriptive analyses of audit log data characterize portal use within enabled facilities.Data CollectionEncounterâ level clinical EHR data were merged with EHR audit log data that captured portal usage in the timeframe associated with a patient transition from hospital to SNF.Principal FindingsDeclines in likelihood of 30â day readmission were not significantly different for patients in HIEâ enabled vs control SNFs (diffâ inâ diff = 0.022; P = .431). We observe similar null effects with shorter readmission windows. The portal was used for 46 percent of discharges, with significant usage pattern variation within/across facilities.ConclusionsImplementation of a hospitalâ SNF EHR portal did not reduce readmissions from enabled SNFs. Emergent HIE use cases need to be better defined and leveraged for design and implementation that generates value in the context of postacute transitions.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153113/1/hesr13210.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153113/2/hesr13210-sup-0001-Authormatrix.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153113/3/hesr13210_am.pd

The Weak Charge of the Proton and New Physics

We address the physics implications of a precision determination of the weak charge of the proton, QWP, from a parity violating elastic electron proton scattering experiment to be performed at the Jefferson Laboratory. We present the Standard Model (SM) expression for QWP including one-loop radiative corrections, and discuss in detail the theoretical uncertainties and missing higher order QCD corrections. Owing to a fortuitous cancellation, the value of QWP is suppressed in the SM, making it a unique place to look for physics beyond the SM. Examples include extra neutral gauge bosons, supersymmetry, and leptoquarks. We argue that a QWP measurement will provide an important complement to both high energy collider experiments and other low energy electroweak measurements. The anticipated experimental precision requires the knowledge of the order alpha_s corrections to the pure electroweak box contributions. We compute these contributions for QWP, as well as for the weak charges of heavy elements as determined from atomic parity violation.Comment: 22 pages of LaTeX, 5 figure

Identifying and addressing barriers to implementing core electronic health record use metrics for ambulatory care: Virtual consensus conference proceedings

Precise, reliable, valid metrics that are cost-effective and require reasonable implementation time and effort are needed to drive electronic health record (EHR) improvements and decrease EHR burden. Differences exist between research and vendor definitions of metrics. PROCESS:  We convened three stakeholder groups (health system informatics leaders, EHR vendor representatives, and researchers) in a virtual workshop series to achieve consensus on barriers, solutions, and next steps to implementing the core EHR use metrics in ambulatory care. CONCLUSION:  Actionable solutions identified to address core categories of EHR metric implementation challenges include: (1) maintaining broad stakeholder engagement, (2) reaching agreement on standardized measure definitions across vendors, (3) integrating clinician perspectives, and (4) addressing cognitive and EHR burden. Building upon the momentum of this workshop\u27s outputs offers promise for overcoming barriers to implementing EHR use metrics

Electronic health information exchange in underserved settings: examining initiatives in small physician practices & community health centers

BackgroundHealth information exchange (HIE) is an important tool for improving efficiency and quality and is required for providers to meet Meaningful Use certification from the United States Centers for Medicare and Medicaid Services. However widespread adoption and use of HIE has been difficult to achieve, especially in settings such as smaller-sized physician practices and federally qualified health centers (FQHCs). We assess electronic data exchange activities and identify barriers and benefits to HIE participation in two underserved settings.MethodsWe conducted key-informant interviews with stakeholders at physician practices and health centers. Interviews were recorded, transcribed, and then coded in two waves: first using an open-coding approach and second using selective coding to identify themes that emerged across interviews, including barriers and facilitators to HIE adoption and use.ResultsWe interviewed 24 providers, administrators and office staff from 16 locations in two states. They identified barriers to HIE use at three levels-regional (e.g., lack of area-level exchanges; partner organizations), inter-organizational (e.g., strong relationships with exchange partners; achieving a critical mass of users), and intra-organizational (e.g., type of electronic medical record used; integration into organization's workflow). A major perceived benefit of HIE use was the improved care-coordination clinicians could provide to patients as a direct result of the HIE information. Utilization and perceived benefit of the exchange systems differed based on several practice- and clinic-level factors.ConclusionsThe adoption and use of HIE in underserved settings appears to be impeded by regional, inter-organizational, and intra-organizational factors and facilitated by perceived benefits largely at the intra-organizational level. Stakeholders should consider factors both internal and external to their organization, focusing efforts in changing modifiable factors and tailoring HIE efforts based on all three categories of factors. Collective action between organizations may be needed to address inter-organizational and regional barriers. In the interest of facilitating HIE adoption and use, the impact of interventions at various levels on improving the use of electronic health data exchange should be tested

NETIMIS: Dynamic Simulation of Health Economics Outcomes Using Big Data

Many healthcare organizations are now making good use of electronic health record (EHR) systems to record clinical information about their patients and the details of their healthcare. Electronic data in EHRs is generated by people engaged in complex processes within complex environments, and their human input, albeit shaped by computer systems, is compromised by many human factors. These data are potentially valuable to health economists and outcomes researchers but are sufficiently large and complex enough to be considered part of the new frontier of ‘big data’. This paper describes emerging methods that draw together data mining, process modelling, activity-based costing and dynamic simulation models. Our research infrastructure includes safe links to Leeds hospital’s EHRs with 3 million secondary and tertiary care patients. We created a multidisciplinary team of health economists, clinical specialists, and data and computer scientists, and developed a dynamic simulation tool called NETIMIS (Network Tools for Intervention Modelling with Intelligent Simulation; http://www.netimis.com) suitable for visualization of both human-designed and data-mined processes which can then be used for ‘what-if’ analysis by stakeholders interested in costing, designing and evaluating healthcare interventions. We present two examples of model development to illustrate how dynamic simulation can be informed by big data from an EHR. We found the tool provided a focal point for multidisciplinary team work to help them iteratively and collaboratively ‘deep dive’ into big data