A critical review of the research literature on Six Sigma, Lean and StuderGroup's Hardwiring Excellence in the United States: the need to demonstrate and communicate the effectiveness of transformation strategies in healthcare

<p>Abstract</p> <p>Background</p> <p>U.S. healthcare organizations are confronted with numerous and varied transformational strategies promising improvements along all dimensions of quality and performance. This article examines the peer-reviewed literature from the U.S. for evidence of effectiveness among three current popular transformational strategies: Six Sigma, Lean/Toyota Production System, and Studer's Hardwiring Excellence.</p> <p>Methods</p> <p>The English language health, healthcare management, and organizational science literature (up to December 2007) indexed in Medline, Web of Science, ABI/Inform, Cochrane Library, CINAHL, and ERIC was reviewed for studies on the aforementioned transformation strategies in healthcare settings. Articles were included if they: appeared in a peer-reviewed journal; described a specific intervention; were not classified as a pilot study; provided quantitative data; and were not review articles. Nine references on Six Sigma, nine on Lean/Toyota Production System, and one on StuderGroup meet the study's eligibility criteria.</p> <p>Results</p> <p>The reviewed studies universally concluded the implementations of these transformation strategies were successful in improving a variety of healthcare related processes and outcomes. Additionally, the existing literature reflects a wide application of these transformation strategies in terms of both settings and problems. However, despite these positive features, the vast majority had methodological limitations that might undermine the validity of the results. Common features included: weak study designs, inappropriate analyses, and failures to rule out alternative hypotheses. Furthermore, frequently absent was any attention to changes in organizational culture or substantial evidence of lasting effects from these efforts.</p> <p>Conclusion</p> <p>Despite the current popularity of these strategies, few studies meet the inclusion criteria for this review. Furthermore, each could have been improved substantially in order to ensure the validity of the conclusions, demonstrate sustainability, investigate changes in organizational culture, or even how one strategy interfaced with other concurrent and subsequent transformation efforts. While informative results can be gleaned from less rigorous studies, improved design and analysis can more effectively guide healthcare leaders who are motivated to transform their organizations and convince others of the need to employ such strategies. Demanding more exacting evaluation of projects consultants, or partnerships with health management researchers in academic settings, can support such efforts.</p

Determinants of preventable readmissions in the United States: a systematic review

<p>Abstract</p> <p>Background</p> <p>Hospital readmissions are a leading topic of healthcare policy and practice reform because they are common, costly, and potentially avoidable events. Hospitals face the prospect of reduced or eliminated reimbursement for an increasing number of preventable readmissions under nationwide cost savings and quality improvement efforts. To meet the current changes and future expectations, organizations are looking for potential strategies to reduce readmissions. We undertook a systematic review of the literature to determine what factors are associated with preventable readmissions.</p> <p>Methods</p> <p>We conducted a review of the English language medicine, health, and health services research literature (2000 to 2009) for research studies dealing with unplanned, avoidable, preventable, or early readmissions. Each of these modifying terms was included in keyword searches of readmissions or rehospitalizations in Medline, ISI, CINAHL, The Cochrane Library, ProQuest Health Management, and PAIS International. Results were limited to US adult populations.</p> <p>Results</p> <p>The review included 37 studies with significant variation in index conditions, readmitting conditions, timeframe, and terminology. Studies of cardiovascular-related readmissions were most common, followed by all cause readmissions, other surgical procedures, and other specific-conditions. Patient-level indicators of general ill health or complexity were the commonly identified risk factors. While more than one study demonstrated preventable readmissions vary by hospital, identification of many specific organizational level characteristics was lacking.</p> <p>Conclusions</p> <p>The current literature on preventable readmissions in the US contains evidence from a variety of patient populations, geographical locations, healthcare settings, study designs, clinical and theoretical perspectives, and conditions. However, definitional variations, clear gaps, and methodological challenges limit translation of this literature into guidance for the operation and management of healthcare organizations. We recommend that those organizations that propose to reward reductions in preventable readmissions invest in additional research across multiple hospitals in order to fill this serious gap in knowledge of great potential value to payers, providers, and patients.</p

Use of a health information exchange system in the emergency care of children

<p>Abstract</p> <p>Background</p> <p>Children may benefit greatly in terms of safety and care coordination from the information sharing promised by health information exchange (HIE). While information exchange capability is a required feature of the certified electronic health record, we known little regarding how this technology is used in general and for pediatric patients specifically.</p> <p>Methods</p> <p>Using data from an operational HIE effort in central Texas, we examined the factors associated with actual system usage. The clinical and demographic characteristics of pediatric ED encounters (n = 179,445) were linked to the HIE system user logs. Based on the patterns of HIE system screens accessed by users, we classified each encounter as: no system usage, basic system usage, or novel system usage. Using crossed random effects logistic regression, we modeled the factors associated with basic and novel system usage.</p> <p>Results</p> <p>Users accessed the system for 8.7% of encounters. Increasing patient comorbidity was associated with a 5% higher odds of basic usage and 15% higher odds for novel usage. The odds of basic system usage were lower in the face of time constraints and for patients who had not been to that location in the previous 12 months.</p> <p>Conclusions</p> <p>HIE systems may be a source to fulfill users' information needs about complex patients. However, time constraints may be a barrier to usage. In addition, results suggest HIE is more likely to be useful to pediatric patients visiting ED repeatedly. This study helps fill an existing gap in the study of technological applications in the care of children and improves knowledge about how HIE systems are utilized.</p

Health information exchange: persistent challenges and new strategies

Recent federal policies and actions support the adoption of health information exchange (HIE) in order to improve healthcare by addressing fragmented personal health information. However, concerted efforts at facilitating HIE have existed for over two decades in this country. The lessons of these experiences include a recurrence of barriers and challenges beyond those associated with technology. Without new strategies, the current support and methods of facilitating HIE may not address these barriers

Leadership, Culture, and Organizational Technologies as Absorptive Capacity for Innovation and Transformation in the Healthcare Sector: A Framework for Research

Organizational transformation, in brief, is the profound reshaping of the organization\u27s and its people\u27s performance. The same transformational initiative might prove effective in one health system yet not another. Variations in success also exist across facilities, departments, or other units within a healthcare organization. Such variations remain relatively unexplored in the literature. We propose that some of these variations might be due to levels of absorptive capacity (ACAP), the ability to discover and exploit innovation, across and within healthcare organizations. The purpose of this article is to provide a research framework and recommend a measurement model for the study of ACAP for transformations in the healthcare setting. To develop a framework for ACAP for transformation, we reviewed 118 peer-reviewed journal articles, 36 books or book sections and two websites related to transformation and ACAP. We also reviewed literature covering related topics, including ACAP measurement models, organizational learning, organizational change, innovation, complex adaptive systems, strategy execution, organizational technologies, leadership, and culture. This comprehensive review of literature covered fields of sociology, organizational theory, management science, and systems theory. The approach sought a parsimonious framework sufficient to capture the significant complexities of ACAP for transformation in healthcare. Our proposed framework of measuring ACAP in healthcare organizations encompasses three dimensions: leadership (L), culture (C), and organizational technologies (OT) that are relevant to transformative change. By applying this LCOT framework in measuring ACAP levels associated with transformation issues, barriers, and outcomes, we propose that constraints can be identified and addressed, and successful implementation of transformational initiatives can be realized. Capturing and tracking the level of ACAP will help healthcare leaders with improving transformation implementation and success, making informed decisions about timing and selection of initiatives, and decisions about continuation or contraction of specific transformations within specific departments, teams or their healthcare system. © Common Ground, Bita Kash, Aaron Spaulding, Larry Gamm, Christopher Johnson, All Rights Reserved

Leadership, culture, and organizational technologies as absorptive capacity for innovation and transformation in the healthcare sector: A framework for research

Organizational transformation, in brief, is the profound reshaping of the organization\u27s and its people\u27s performance. The same transformational initiative might prove effective in one health system yet not another. Variations in success also exist across facilities, departments, or other units within a healthcare organization. Such variations remain relatively unexplored in the literature. We propose that some of these variations might be due to levels of absorptive capacity (ACAP), the ability to discover and exploit innovation, across and within healthcare organizations. The purpose of this article is to provide a research framework and recommend a measurement model for the study of ACAP for transformations in the healthcare setting. To develop a framework for ACAP for transformation, we reviewed 118 peer-reviewed journal articles, 36 books or book sections and two websites related to transformation and ACAP. We also reviewed literature covering related topics, including ACAP measurement models, organizational learning, organizational change, innovation, complex adaptive systems, strategy execution, organizational technologies, leadership, and culture. This comprehensive review of literature covered fields of sociology, organizational theory, management science, and systems theory. The approach sought a parsimonious framework sufficient to capture the significant complexities of ACAP for transformation in healthcare. Our proposed framework of measuring ACAP in healthcare organizations encompasses three dimensions: leadership (L), culture (C), and organizational technologies (OT) that are relevant to transformative change. By applying this LCOT framework in measuring ACAP levels associated with transformation issues, barriers, and outcomes, we propose that constraints can be identified and addressed, and successful implementation of transformational initiatives can be realized. Capturing and tracking the level of ACAP will help healthcare leaders with improving transformation implementation and success, making informed decisions about timing and selection of initiatives, and decisions about continuation or contraction of specific transformations within specific departments, teams or their healthcare system. © Common Ground, Bita Kash, Aaron Spaulding, Larry Gamm, Christopher Johnson, All Rights Reserved

Healthcare strategic management and the resource based view

Purpose – The purpose of this paper is to examine how two large health systems formulate and implement strategy with a specific focus on differences and similarities in the nature of strategic initiatives across systems. The aim is to gain a better understanding of the role of resource dependency theory (RDT) and resource based view (RBV) in healthcare strategic management. Design/methodology/approach – A comparative case study design is used to describe, categorize and compare strategic change initiatives within a children\u27s health and a multi-hospital system located in two competitive metropolitan markets. A total of 61 in-person semi-structured interviews with healthcare administrators were conducted during 2009. Summary statistics and qualitative content analysis were employed to examine strategic initiatives. Findings – The two health systems have as their top initiatives very similar pursuits, thus indicating that both utilize an externally oriented RDT method of strategy formulation. The relevance of the RBV becomes apparent during resource deployment for strategy implementation. The process of healthcare strategic decision-making incorporates RDT and RBV as separate and compatible activities that are sequential. Research limitations/implications – Results from this comparative case study are based on only two health systems. Further, the RBV perspective only takes managerial resources and time into consideration. Practical implications – Given that external resources are likely to become more constrained, it is important that hospitals leverage relevant internal resources, in the identification of competitive advantages and effective execution of strategic initiatives. Originality/value – The author propose a refined healthcare strategic management framework that takes both RDT and RBV into consideration by systematically linking strategy formulation with deployment of resources