Consequences of Organizational Change in U.S. Hospitals

Organizational change has become commonplace among U.S. hospitals. Empirical investigations of the consequences of organizational change, however, are relatively scarce, and findings of existing studies are inconsistent. In this article, the authors review the rationale and performance implications of hospital organizational change in three areas: (1) the development of new multi-institutional arrangements, (2) change in traditional ownership and management configurations, and (3) diversification in organizational products/services and consolidation of organizational scale. Empirical research on hospital change published between 1980 and 1999 in the health services research, social science, and business literatures is reviewed to highlight the potential pitfalls that hospitals may encounter in their effort to remain viable. The article also summarizes the strengths and weaknesses of current hospital change research and provides specific suggestions for future research in this area.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68386/2/10.1177_107755879905600301.pd

Uncovering middle managers' role in healthcare innovation implementation

<p>Abstract</p> <p>Background</p> <p>Middle managers have received little attention in extant health services research, yet they may have a key role in healthcare innovation implementation. The gap between evidence of effective care and practice may be attributed in part to poor healthcare innovation implementation. Investigating middle managers' role in healthcare innovation implementation may reveal an opportunity for improvement. In this paper, we present a theory of middle managers' role in healthcare innovation implementation to fill the gap in the literature and to stimulate research that empirically examines middle managers' influence on innovation implementation in healthcare organizations.</p> <p>Discussion</p> <p>Extant healthcare innovation implementation research has primarily focused on the roles of physicians and top managers. Largely overlooked is the role of middle managers. We suggest that middle managers influence healthcare innovation implementation by diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation.</p> <p>Summary</p> <p>Teamwork designs have become popular in healthcare organizations. Because middle managers oversee these team initiatives, their potential to influence innovation implementation has grown. Future research should investigate middle managers' role in healthcare innovation implementation. Findings may aid top managers in leveraging middle managers' influence to improve the effectiveness of healthcare innovation implementation.</p

Development of the Two‐Stage Rapid Estimate of Adult Literacy in Dentistry

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86828/1/j.1600-0528.2011.00619.x.pd

Providing Hospice Care to Children and Young Adults: A Descriptive Study of End-of-Life Organizations

Over the past two decades, end-of-life organizations have served an increasing number of children and young adults and expanded services important to terminally ill youth, and yet we know little about these organizations. The purpose of this study was to describe the characteristics of end-of-life care organizations that admitted children and young adults to hospice care. Using data from the 2007 National Hospice and Palliative Care Organization (NHPCO) Survey, we conducted a descriptive analysis of operational, mission, market, and financial characteristics, and explored a sub-analysis by age group. Our analysis revealed that these organizations had similar profit status, ownership, and payer mix when compared to the hospice industry. However, they differed in agency type, referrals, organizational size, geographic location, team member caseload, and revenues. We also found important differences in organizations that provided hospice care by age groups (infants, toddler, school-age children, and adolescents/young adults) in geographic location, region, agency type, accreditation, and team member caseload. These findings have managerial and policy implications

Analysis of Hospital Community Benefit Expenditures’ Alignment With Community Health Needs: Evidence From a National Investigation of Tax-Exempt Hospitals

Objectives. We investigated whether federally tax-exempt hospitals consider community health needs when deciding how much and what types of community benefits to provide. Methods. Using 2009 data from hospital tax filings to the Internal Revenue Service and the 2010 County Health Rankings, we employed both univariate and multivariate analyses to examine the relationship between community health needs and the types and levels of hospitals’ community benefit expenditures. The study sample included 1522 private, tax-exempt hospitals throughout the United States. Results. We found some patterns between community health needs and hospitals’ expenditures on community benefits. Hospitals located in communities with greater health needs spent more as a percentage of their operating budgets on benefits directly related to patient care. By contrast, spending on community health improvement initiatives was unrelated to community health needs. Conclusions. Important opportunities exist for tax-exempt hospitals to improve the alignment between their community benefit activities and the health needs of the community they serve. The Affordable Care Act requirement that hospitals conduct periodic community health needs assessments may be a first step in this direction

Short Assessment of Health Literacy for Portuguese-speaking Adults

OBJETIVO: Desarrollar y validar un instrumento breve para evaluación de alfabetismo en salud en el idioma portugués. MÉTODOS: El instrumento desarrollado consiste de 50 itens que evalúan la capacidad del individuo de pronunciar y comprender términos médicos comunes. Las propiedades psicométricas se evaluaron en una muestra de 226 ancianos brasileños. La validez del constructo se estableció por la correlación con el número de años de escolaridad, relato de alfabetismo funcional y desempeño cognitivo global. La validez discriminatoria fue establecida por la exactitud del instrumento en la detección de alfabetismo en salud inadecuado, definido como la incapacidad de comprender correctamente prescripciones médicas estandarizadas. RESULTADOS: Las correlaciones con los criterios de constructo presentaron magnitud moderada a alta (coeficientes de Spearman = 0,63 a 0,76). El instrumento presentó también consistencia interna satisfactoria (Cronbach = 0,93) y buena confiabilidad examen-reexamen (coeficiente de correlación intra-clase = 0,95). El área bajo la curva característica de operación del receptor para detección de alfabetismo inadecuado fue 0,82. Una versión con 18 itens fue derivada y presentó propiedades psicométricas similares. CONCLUSIONES: El instrumento desarrollado presentó buena validez y consistencia en una muestra de ancianos brasileños y puede ser utilizado en ambientes clínicos o de investigación con la finalidad de detectar alfabetismo en salud inadecuado.OBJECTIVE: To develop and validate a short health literacy assessment tool for Portuguese-speaking adults. METHODS: The Short Assessment of Health Literacy for Portuguese-speaking Adults is an assessment tool which consists of 50 items that assess an individual's ability to correctly pronounce and understand common medical terms. We evaluated the instrument's psychometric properties in a convenience sample of 226 Brazilian older adults. Construct validity was assessed by correlating the tool scores with years of schooling, self-reported literacy, and global cognitive functioning. Discrimination validity was assessed by testing the tool's accuracy in detecting inadequate health literacy, defined as failure to fully understand standard medical prescriptions. RESULTS: Moderate to high correlations were found in the assessment of construct validity (Spearman's coefficients ranging from 0.63 to 0.76). The instrument showed adequate internal consistency (Cronbach's alpha=0.93) and adequate test-retest reliability (intraclass correlation coefficient=0.95). The area under the receiver operating characteristic curve for detection of inadequate health literacy was 0.82. A version consisting of 18 items was tested and showed similar psychometric properties. CONCLUSIONS: The instrument developed showed good validity and reliability in a sample of Brazilian older adults. It can be used in research and clinical settings for screening inadequate health literacy.OBJETIVO: Desenvolver e validar um instrumento breve para avaliação de alfabetismo em saúde na língua portuguesa. MÉTODOS: O instrumento desenvolvido consiste de 50 itens que avaliam a capacidade do indivíduo de pronunciar e compreender termos médicos comuns. As propriedades psicométricas foram avaliadas em uma amostra de 226 idosos brasileiros. A validade de construto foi estabelecida pela correlação com o número de anos de escolaridade, relato de alfabetismo funcional e desempenho cognitivo global. A validade discriminativa foi estabelecida pela acurácia do instrumento na detecção de alfabetismo em saúde inadequado, definido como a incapacidade de compreender corretamente prescrições médicas padronizadas. RESULTADOS: As correlações com os critérios de construto apresentaram magnitude moderada a alta (coeficientes de Spearman = 0,63 a 0,76). O instrumento apresentou ainda consistência interna satisfatória (Cronbach = 0,93) e boa confiabilidade teste-reteste (coeficiente de correlação intraclasse = 0,95). A área sob a curva característica de operação do receptor para detecção de alfabetismo inadequado foi 0,82. Uma versão com 18 itens foi derivada e apresentou propriedades psicométricas similares. CONCLUSÕES: O instrumento desenvolvido apresentou boa validade e consistência em uma amostra de idosos brasileiros e pode ser utilizado em ambientes clínicos ou de pesquisa com a finalidade de detectar alfabetismo em saúde inadequado

Short Assessment of Health Literacy-Spanish and English: A Comparable Test of Health Literacy for Spanish and English Speakers: Short Assessment of Health Literacy

The intent of the study was to develop and validate a comparable health literacy test for Spanish-speaking and English-speaking populations

Impacts of Geographic Distance on Peritoneal Dialysis Utilization: Refining Models of Treatment Selection

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/136011/1/hesr12489.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/136011/2/hesr12489-sup-0001-AuthorMatrix.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/136011/3/hesr12489_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/136011/4/hesr12489-sup-0002-Appendix.pd

Use of Qualitative Methods in Published Health Services and Management Research: A 10-Year Review

Over the past 10 years, the field of health services and management research has seen renewed interest in the use of qualitative research methods. This article examines the volume and characteristics of qualitative research articles published in nine major health services and management journals between 1998 and 2008. Qualitative research articles comprise 9% of research articles published in these journals. Although the publication rate of qualitative research articles has not kept pace with that of quantitative research articles, citation analysis suggests that qualitative research articles contribute comparably to the field’s knowledge base. A wide range of policy and management topics has been examined using qualitative methods. Case study designs, interviews, and documentary sources were the most frequently used methods. Half of qualitative research articles provided little or no detail about key aspects the study’s methods. Implications are discussed and recommendations are offered for promoting the publication of qualitative research

Improving the Effectiveness of Health Care Innovation Implementation: Middle Managers as Change Agents

The rate of successful health care innovation implementation is dismal. Middle managers have a potentially important yet poorly understood role in health care innovation implementation. This study used self-administered surveys and interviews of middle managers in health centers that implemented an innovation to reduce health disparities to address the questions: Does middle managers’ commitment to health care innovation implementation influence implementation effectiveness? If so, in what ways does their commitment influence implementation effectiveness? Although quantitative survey data analysis results suggest a weak relationship, qualitative interview data analysis results indicate that middle managers’ commitment influences implementation effectiveness when middle managers are proactive. Scholars should account for middle managers’ influence in implementation research, and health care executives may promote implementation effectiveness by hiring proactive middle managers and creating climates in which proactivity is rewarded, supported, and expected