RESUMO
BACKGROUND: Enthusiasm has grown about using patients' narratives-stories about care experiences in patients' own words-to advance organizations' learning about the care that they deliver and how to improve it, but studies confirming association have not been published. PURPOSE: We assessed whether primary care clinics that frequently share patients' narratives with their staff have higher patient experience survey scores. APPROACH: We conducted a 1-year study of 5,545 adult patients and 276 staff affiliated with nine clinics in one health system. We used multilevel models to analyze survey data from patients about their experiences and from staff about exposure to useful narratives. We examined staff confidence in own knowledge as a moderator because confidence can influence use of new information sources. RESULTS: Frequency of sharing useful narratives with staff was associated with patient experience scores for all measures, conditional on staff confidence in own knowledge ( p < .01). For operational measures (e.g., care coordination), increased sharing correlated with subsequently higher performance for more confident staff and lower performance or no difference for less confident staff, depending on measure. For relational measures (e.g., patient-provider communication), increased sharing correlated with higher scores for less confident staff and lower scores for more confident staff. CONCLUSION: Sharing narratives with staff frequently is associated with better patient experience survey scores, conditional on confidence in knowledge. PRACTICE IMPLICATIONS: Frequently sharing useful patient narratives should be encouraged as an organizational improvement strategy. However, organizations need to address how narrative feedback interacts with their staff's confidence to realize higher experience scores across domains.
Assuntos
Comunicação , Fonte de Informação , Adulto , Humanos , Avaliação de Resultados da Assistência ao PacienteRESUMO
BACKGROUND: Academic medical centers (AMCs) are well recognized for their innovations that enhance frontline care, but there is little study of their innovation management processes, which is key for advancing theory regarding the effectiveness of innovation efforts to improve care. PURPOSE: We aimed to identify organizational models used for frontline innovation by AMCs in the United States, core activities within models, and factors that influence innovation success. METHODS: We conducted a qualitative study of 12 AMCs using data from semistructured interviews with centers' innovation leaders. Inclusion required satisfying two of three criteria in 2021 (only met by 35 AMCs nationally): listed in the professional association of innovation leaders (Council of 33), Becker's review of most innovative hospitals, and/or top 20 U.S. News and World Report best hospitals honor roll. We analyzed the interview data using the constant comparative method. RESULTS: Innovative AMCs pursue innovation through innovation centers (using a centralized or multicenter model) or within clinical departments (department-level model). All three models emphasize seven activities, although performed differently: sourcing ideas, developing ideas, implementing innovations, fundraising, managing partnerships, measuring success, and managing mindset. Several factors influenced success: role performance, operational challenges, technology, public policy, customer clarity, stakeholder buy-in, diversity of input, and focus. The centralized model struggled less with standardization and coordination issues. CONCLUSION: AMCs have options for structuring their innovation efforts. However, there are consistent activities for successful innovation management and factors that they must manage. PRACTICE IMPLICATIONS: AMCs can select among innovation models to fit their circumstances but likely need to perform seven activities well for success.
Assuntos
Centros Médicos Acadêmicos , Hospitais , Humanos , Estados Unidos , Modelos Organizacionais , Pesquisa Qualitativa , Inovação OrganizacionalRESUMO
BACKGROUND: Patient-centered care (PCC) is a core component of quality care and its measurement is fundamental for research and improvement efforts. However, an inventory of surveys for measuring PCC in hospitals, a core care setting, is not available. OBJECTIVE: To identify surveys for assessing PCC in hospitals, assess PCC dimensions that they capture, report their psychometric properties, and evaluate applicability to individual and/or dyadic (eg, mother-infant pairs in pregnancy) patients. RESEARCH DESIGN: We conducted a systematic review of articles published before January 2019 available on PubMed, Web of Science, and EBSCO Host and references of extracted papers to identify surveys used to measure "patient-centered care" or "family-centered care." Surveys used in hospitals and capturing at least 3 dimensions of PCC, as articulated by the Picker Institute, were included and reviewed in full. Surveys' descriptions, subscales, PCC dimensions, psychometric properties, and applicability to individual and dyadic patients were assessed. RESULTS: Thirteen of 614 articles met inclusion criteria. Nine surveys were identified, which were designed to obtain assessments from patients/families (n=5), hospital staff (n=2), and both patients/families and hospital staff (n=2). No survey captured all 8 Picker dimensions of PCC [median=6 (range, 5-7)]. Psychometric properties were reported infrequently. All surveys applied to individual patients, none to dyadic patients. CONCLUSIONS: Multiple surveys for measuring PCC in hospitals are available. Opportunities exist to improve survey comprehensiveness regarding dimensions of PCC, reporting of psychometric properties, and development of measures to capture PCC for dyadic patients.
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Hospitais/normas , Preferência do Paciente/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente/estatística & dados numéricos , Assistência Centrada no Paciente/estatística & dados numéricos , Feminino , Humanos , Masculino , Corpo Clínico Hospitalar/organização & administração , Qualidade da Assistência à Saúde , Estados UnidosRESUMO
BACKGROUND: Slow progress in quality improvement (QI) has prompted calls to identify new QI ideas. Leaders guiding these efforts are advised to use evidence-based tactics, or specific approaches to address a goal, to promote clinician and staff engagement in the generation and implementation of QI ideas, but little evidence about effective tactics exists. OBJECTIVE: Examine the association between leader tactics and the creativity, implementation outcome, and evolution of QI ideas from clinicians and staff. DESIGN: Prospective panel analysis of 220 ideas generated by 12 leaders and teams (N = 72 members) from federally qualified community health practices in one center over 18 months. Measures were extracted from meeting minutes (note-taking by a member during meetings) and expert panel review. Multi-level models were used. MEASURES: Leader tactics, idea creativity, implementation outcome, evolution pathways, center, and idea-submitter characteristics. RESULTS: Leaders used one of four approaches: no tactic, meeting ground rules, team brainstorming, or reflection on team process. Implemented ideas evolved in three pathways: Plug and Play, Slow Burn, and Iterate and Generate. Compared with no leader tactic, meeting ground rules resulted in ideas not significantly different in creativity, implementation outcome, or evolution pathway. Brainstorming was associated with greater idea creativity, idea implementation, and ideas following a Plug and Play path (low member engagement and implementation over 2 months or less). Reflection on team process was associated with idea implementation (versus not), and ideas following an Iterate and Generate path (high member engagement and implementation over 3 months or more). CONCLUSIONS: Two tactics, brainstorming and reflection, are helpful depending on goals. Brainstorming may aide leaders seeking disruptive change via more creative, rapidly implemented ideas. Reflection on team process may aide leaders seeking high-engagement ideas that may be implemented slowly. Both tactics may help leaders cultivate dynamics that increase implementation of ideas that improve healthcare.
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Criatividade , Atenção à Saúde , Humanos , Estudos Prospectivos , Melhoria de QualidadeRESUMO
BACKGROUND: Investigating primary care provider (PCP)-team communication can provide insight into how colleagues work together to become high-functioning teams more able to address an increasingly complex set of tasks associated with chronic disease management. OBJECTIVE: To assess how PCP communication with their care team relates to patients' health. RESEARCH DESIGN: Longitudinal study of how 3 aspects of PCP-care team communication-participation, time spent listening, and uninterrupted speaking length-relate to disease management of patients with hypertension or diabetes, and the effect of these team communication behaviors on PCP-patient communication as a pathway by which this relationship might exist. We used multilevel regression models. SUBJECTS: Twenty-seven PCPs and 98 team members, and 18,067 patients with hypertension and 8354 patients with diabetes affiliated with a federally qualified health center with 12 practice sites. MEASURES: Primary data on communication collected using sociometric sensors worn by PCPs and team members, patient-PCP communication data collected with surveys, and patient health, PCP and patient characteristics extracted from electronic records. RESULTS: PCPs participated in 75% of care team conversations, spent 56% of conversation time listening, and had an average uninterrupted speaking length of 2.42 seconds. PCP participation, listening, and length of uninterrupted speaking time were associated with significantly higher odds that their patients had controlled hypertension and diabetes and improvements in disease control over time. PCP-patient communication mediates this relationship. CONCLUSIONS: PCP-team communication is associated with patient health management. How team members speak with one another may be as important as the content of their communication.
Assuntos
Gerenciamento Clínico , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente/normas , Atenção Primária à Saúde/métodos , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/estatística & dados numéricos , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Recognition that coordination among healthcare providers is associated with better quality of care and lower costs has increased interest in interventions designed to improve care coordination. One intervention is to add care coordination to nurses' role in a formal way. Little is known about effects of this approach, which tends to be pursued by small organizations and those in lower-resource settings. We assessed effects of this approach on care experiences of high-risk patients (those most in need of care coordination) and clinician teamwork during the first 6 months of use. METHODS: We conducted a quasi-experimental study using a clustered, controlled pre-post design. Changes in staff and patient experiences at six community health center practice locations that introduced the added-role approach for high-risk patients were compared to changes in six locations without the program in the same health system. In the pre-period (6 months before intervention training) and post-period (about 6 months after intervention launch, following 3 months of training), we surveyed clinical staff (N = 171) and program-qualifying patients (3007 pre-period; 2101 post-period, including 113 who were enrolled during the program's first 6 months). Difference-in-differences models examined study outcomes: patient reports about care experiences and clinician-reported teamwork. We assessed frequency of patient office visits to validate access and implementation, and contextual factors (training, resources, and compatibility with other work) that might explain results. RESULTS: Patient care experiences across all high-risk patients did not improve significantly (p > 0.05). They improved somewhat for program enrollees, 5% above baseline reports (p = 0.07). Staff-perceived teamwork did not change significantly (p = 0.12). Office visits increased significantly for enrolled patients (p < 0.001), affirming program implementation (greater accessing of care). Contextual factors were not reported as problematic, except that 41% of nurses reported incompatibility between care coordination and other job demands. Over 75% of nurses reported adequate training and resources. CONCLUSIONS: There were some positive effects of adding care coordination to nurses' role within 6 months of implementation, suggesting value in this improvement strategy. Addressing compatibility between coordination and other job demands is important when implementing this approach to coordination.
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Centros Comunitários de Saúde/organização & administração , Relações Interprofissionais , Enfermeiros de Saúde Comunitária/psicologia , Cuidados de Enfermagem/organização & administração , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiros de Saúde Comunitária/estatística & dados numéricos , Pesquisa em Avaliação de Enfermagem , Adulto JovemRESUMO
In May 2019, scholars in management and organization of health care organizations and systems met. The opening plenary was a moderated discussion with five distinguished scholars who have exemplified pushing the frontier of organizational theory and practice throughout their careers: Ann Barry Flood of Dartmouth College, John Kimberly of the University of Pennsylvania, Anthony (Tony) Kovner of New York University, Stephen (Steve) Shortell of University of California at Berkeley, and Jacqueline (Jackie) Zinn of Temple University. The discussion was moderated by Ingrid Nembhard of the University of Pennsylvania. The goal of the plenary was to provide an opportunity to hear from senior members of the health care management community how they think about organizational behavior and theory, changes that they have observed, research gaps that they see, and lessons for research and practice that they have learned. This article is the transcript of that plenary discussion. It is shared to capture the intellectual history of the field and help surface the critical advancements still needed in organizational theory and practice in health care. The closing remarks of the panelists summarize recommendations for both practice and scholarship in health care organization management.
Assuntos
Eficiência Organizacional , Administração de Instituições de Saúde , Pesquisa sobre Serviços de Saúde , Modelos Organizacionais , Mobilidade Ocupacional , Congressos como Assunto , Atenção à Saúde/organização & administração , Instalações de Saúde , Humanos , Estados UnidosRESUMO
BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are a common and costly quality problem, and their prevention is a national priority. A decade ago, researchers identified an evidence-based bundle of practices that reduce CLABSIs. Compliance with this bundle remains low in many hospitals. PURPOSE: The aim of this study was to assess whether differences in core aspects of work environments-workload, quality of relationships, and prioritization of quality-are associated with variation in maximal CLABSI bundle compliance, that is, compliance 95%-100% of the time in intensive care units (ICUs). METHODOLOGY/APPROACH: A cross-sectional study of hospital medical-surgical ICUs in the United States was done. Data on work environment and bundle compliance were obtained from the Prevention of Nosocomial Infections and Cost-Effectiveness Refined Survey completed in 2011 by infection prevention directors, and data on ICU and hospital characteristics were obtained from the National Healthcare Safety Network. Factor and multilevel regression analyses were conducted. FINDINGS: Reasonable workload and prioritization of quality were positively associated with maximal CLABSI bundle compliance. High-quality relationships, although a significant predictor when evaluated apart from workload and prioritization of quality, had no significant effect after accounting for these two factors. PRACTICE IMPLICATIONS: Aspects of the staff work environment are associated with maximal CLABSI bundle compliance in ICUs. Our results suggest that hospitals can foster improvement in ensuring maximal CLABSI bundle compliance-a crucial precursor to reducing CLABSI infection rates-by establishing reasonable workloads and prioritizing quality.
Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Unidades de Terapia Intensiva/estatística & dados numéricos , Pacotes de Assistência ao Paciente/métodos , Local de Trabalho/psicologia , Estudos Transversais , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Controle de Infecções/normas , Qualidade da Assistência à Saúde , Inquéritos e Questionários , Fatores de Tempo , Estados UnidosRESUMO
BACKGROUND: Teamwork in health care settings is widely recognized as an important factor in providing high-quality patient care. However, the behaviors that comprise effective teamwork, the organizational factors that support teamwork, and the relationship between teamwork and patient outcomes remain empirical questions in need of rigorous study. OBJECTIVE: To identify and review survey instruments used to assess dimensions of teamwork so as to facilitate high-quality research on this topic. RESEARCH DESIGN: We conducted a systematic review of articles published before September 2012 to identify survey instruments used to measure teamwork and to assess their conceptual content, psychometric validity, and relationships to outcomes of interest. We searched the ISI Web of Knowledge database, and identified relevant articles using the search terms team, teamwork, or collaboration in combination with survey, scale, measure, or questionnaire. RESULTS: We found 39 surveys that measured teamwork. Surveys assessed different dimensions of teamwork. The most commonly assessed dimensions were communication, coordination, and respect. Of the 39 surveys, 10 met all of the criteria for psychometric validity, and 14 showed significant relationships to nonself-report outcomes. CONCLUSIONS: Evidence of psychometric validity is lacking for many teamwork survey instruments. However, several psychometrically valid instruments are available. Researchers aiming to advance research on teamwork in health care should consider using or adapting one of these instruments before creating a new one. Because instruments vary considerably in the behavioral processes and emergent states of teamwork that they capture, researchers must carefully evaluate the conceptual consistency between instrument, research question, and context.
Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Psicometria , Qualidade da Assistência à Saúde/organização & administração , Inquéritos e Questionários , Comunicação , Comportamento Cooperativo , Processos Grupais , Humanos , Reprodutibilidade dos TestesRESUMO
Increasingly, there is recognition of the need for individuals with expertise in both management and public health to help health care organizations deliver high-quality and cost-effective care. The Yale School of Public Health and Yale School of Management began offering an accelerated Master of Business Administration (MBA) and Master of Public Health (MPH) joint degree program in the summer of 2014. This new program enables students to earn MBA and MPH degrees simultaneously from 2 fully accredited schools in 22 months. Students will graduate with the knowledge and skills needed to become innovative leaders of health care organizations. We discuss the rationale for the program, the developmental process, the curriculum, benefits of the program, and potential challenges.
Assuntos
Comércio/educação , Educação de Pós-Graduação/organização & administração , Educação Profissional em Saúde Pública/organização & administração , Educação Baseada em Competências/organização & administração , Connecticut , Humanos , Liderança , Desenvolvimento de Programas , Faculdades de Saúde Pública/organização & administraçãoRESUMO
BACKGROUND: Despite the potential for electronic health records (EHRs) to improve patient safety and quality of care, the intended benefits of EHRs are not always realized because of implementation-related challenges. Enlisting clinician super users to provide frontline support to employees has been recommended to foster EHR implementation success. In some instances, their enlistment has been associated with implementation success; in other cases, it has not. Little is known about why some super users are more effective than others. The purpose of this study was to identify super users' mechanisms of influence and examine their effects on EHR implementation outcomes. METHODS: We conducted a longitudinal (October 2012 - June 2013), comparative case study of super users' behaviors on two medical units of a large, academic hospital implementing a new EHR system. We assessed super users' behaviors by observing 29 clinicians and conducting 24 in-depth interviews. The implementation outcome, clinicians' information systems (IS) proficiency, was assessed using longitudinal survey data collected from 43 clinicians before and after the EHR start-date. We used multivariable linear regression to estimate the relationship between clinicians' IS proficiency and the clinical unit in which they worked. RESULTS: Super users on both units employed behaviors that supported and hindered implementation. Four super user behaviors differed between the two units: proactivity, depth of explanation, framing, and information-sharing. The unit in which super users were more proactive, provided more comprehensive explanations for their actions, used positive framing, and shared information more freely experienced significantly greater improvement in clinicians' IS proficiency (p =0.03). Use of the four behaviors varied as a function of super users' role engagement, which was influenced by how the two units' managers selected super users and shaped the implementation climate. CONCLUSIONS: Super users' behaviors in implementing EHRs vary substantively and can have important influence on implementation success.
Assuntos
Atitude do Pessoal de Saúde , Registros Eletrônicos de Saúde , Relações Interprofissionais , Competência Profissional , Adulto , Registros Eletrônicos de Saúde/estatística & dados numéricos , Hospitais Universitários , Humanos , Estudos LongitudinaisRESUMO
BACKGROUND: Research suggests that staff voice-discretionary communication of ideas, suggestions, concerns, or opinions about work-related issues with the intent to improve organizational or unit functioning-is associated with quality improvement, which most agree is needed in health care. Nevertheless, health professionals often do not voice. Little research has explored their reluctance to speak up and, relatedly, the conditions under which they voice. PURPOSE: We examine the drivers of voice for health professionals in hospitals. Specifically, we investigate the factors that influence their voice, why these factors are influential, and the purposes for which staff use their voice. METHODOLOGY: We conducted a qualitative study using data from 99 in-depth interviews with diverse staff at 12 randomly sampled hospitals in the United States. Data were collected from December 2007 to December 2008, the first year of a 4-year study of improvement. By national standards, all of the hospitals had significant room for improvement in their care of patients experiencing heart attack, suggesting that there were potentially issues and suggestions for staff to voice. FINDINGS: Factors related to individuals (e.g., tenure), work (e.g., work configuration), organizational context (e.g., culture), data (e.g., benchmarking), and the external environment (e.g., attention) influenced health professionals' voice. These factors shaped their sense of safety, efficacy, opportunity, and/or legitimacy, all of which affected their belief about the risk and benefit of voice and willingness to voice. They voiced for three purposes: to learn for themselves, inform others, and protect patients. PRACTICE IMPLICATIONS: These findings indicate that hospitals and their leaders must attend to multiple factors (e.g., work configuration, culture, etc.) if they wish to increase staff voice in service of quality improvement. The presence of many influential factors suggests that there are several levers that leaders can use to elicit voice, noting that voice can be used in multiple ways to facilitate improvement.
Assuntos
Angioplastia Coronária com Balão , Comportamento Cooperativo , Administração Hospitalar , Comunicação Interdisciplinar , Infarto do Miocárdio/terapia , Melhoria de Qualidade/organização & administração , Tomada de Decisões Gerenciais , Eficiência Organizacional , Medicina Baseada em Evidências/organização & administração , Pesquisa sobre Serviços de Saúde/organização & administração , Humanos , Equipe de Assistência ao Paciente/organização & administração , Estudos de Tempo e Movimento , Estados UnidosRESUMO
BACKGROUND: Aspects of the patient care experience, despite being central to quality care, are often problematic. In particular, patients frequently report problems with timeliness of care. As yet, research offers little insight on setting characteristics that contribute to patients' experience of timely care. PURPOSE: The aims of this study were to assess the relationship between organizational climate and patients' reports of timely care in primary care clinics and to broadly examine the link between staff's work environment and patient care experiences. We test hypotheses about the relationship between voice climate--staff feeling safe to speak up about issues--and reported timeliness of care, consistency in reported voice climate across professions, and how climate differences for various professions relate to timely care. METHODOLOGY: We conducted a cross-sectional study of employees (n = 1,121) and patients (n = 8,164) affiliated with 37 clinics participating in a statewide reporting initiative. Employees were surveyed about clinics' voice climate, and patients were surveyed about the timeliness of care. Hypotheses were tested using analysis of variance and generalized estimating equations. FINDINGS: Clinical and administrative staff (e.g., nurses and office assistants) reported clinics' climates to be significantly less supportive of voice than did clinical leaders (e.g., physicians). The greater the difference in reported support for voice between professional groups, the less patients reported experiencing timely care in three respects: obtaining an appointment, seeing the doctor within 15 minutes of appointment time, and receiving test results. In clinics where staff reported climates supportive of voice, patients indicated receiving more timely care. Clinical leaders' reports of voice climate had no relationship to reported timeliness of care. PRACTICAL IMPLICATIONS: Our findings suggest the importance of clinics developing a strong climate for voice, particularly for clinical and administrative staff, to support better service quality for patients.
Assuntos
Cultura Organizacional , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde/organização & administração , Adolescente , Adulto , Idoso , Comunicação , Estudos Transversais , Feminino , Pessoal de Saúde/organização & administração , Pessoal de Saúde/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Qualidade da Assistência à Saúde/normas , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: Patient experience narratives (narratives) are an increasingly important element of both measurement approaches and improvement efforts in healthcare. Prior studies show that narratives are considered by both clinicians and staff to be an appealing, meaningful, and credible form of evidence on performance. They also suggest that making concrete use of narratives within organizational settings to improve care can be complex and challenging. Our qualitative study was designed to explore how middle managers working in a health system's outpatient clinics value and use written narratives in their day-to-day work. METHODS: We conducted qualitative interviews with 20 middle managers working in 8 outpatient clinics. Interviews were fully transcribed, loaded into MAX-QDA software, and coded using thematic analysis techniques. Code reports were extracted and reanalyzed for subthemes related to the objectives of this paper. RESULTS: Middle managers across sites described valuing narratives as a tool to: enable better patient experience assessment by augmenting data from patient experience scores; deepen understanding of and relationships with patients; provide insight about operational issues; identify areas for needed improvement and potential solutions; and facilitate strategic work. They reported using narratives for a range of activities related to their roles as supervisors, such as focusing attention on positive practices and needed improvements, promoting deeper group learning, motivating change, reinforcing sense of purpose for staff, recognizing staff strengths and training needs, and inspiring transformational thinking. Finally, interviewees reported numerous specific quality improvement projects (both short- and longer-term) that were informed by narratives-for example, by identifying an issue to be addressed or by suggesting a workable solution. Together, these interviews suggest a collective "narrative about narratives" woven by these organizational actors-a story which illustrates how narratives are highly relevant for how middle managers derive meaning from their work, put organizational values such as responsive service provision into practice, and enact their roles as supervisors. CONCLUSIONS: Our results add to the nascent literature a detailed description of how narratives can be used both as a tool for middle managers in their leadership and supervisory roles, and as a blueprint for improvement work within outpatient settings. They also illuminate why patient experience scores may improve when narrative data are collected and used. Finally, our results suggest that for middle managers, perhaps "nothing is more powerful than words" because narratives function as both an insight provider and a compelling tool that adds direction and meaning to workplace endeavors.
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Narração , Pesquisa Qualitativa , Melhoria de Qualidade , Humanos , Melhoria de Qualidade/organização & administração , Satisfação do Paciente , Entrevistas como Assunto , Instituições de Assistência Ambulatorial/organização & administração , Feminino , MasculinoAssuntos
Corticosteroides/uso terapêutico , Assistência Ambulatorial/estatística & dados numéricos , Broncodilatadores/uso terapêutico , Fidelidade a Diretrizes/organização & administração , Hospitais de Veteranos/organização & administração , Readmissão do Paciente/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração Artificial/estatística & dados numéricos , Administração por Inalação , Idoso , Progressão da Doença , Retroalimentação , Feminino , Humanos , Modelos Logísticos , Masculino , Medicaid , Medicare , Pessoa de Meia-Idade , Política Organizacional , Guias de Prática Clínica como Assunto , Autocuidado , Estados Unidos , United States Department of Veterans AffairsRESUMO
OBJECTIVE: To summarize the predictors and outcomes of empathy by health care personnel, methods used to study their empathy, and the effectiveness of interventions targeting their empathy, in order to advance understanding of the role of empathy in health care and facilitate additional research aimed at increasing positive patient care experiences and outcomes. DATA SOURCE: We searched MEDLINE, MEDLINE In-Process, PsycInfo, and Business Source Complete to identify empirical studies of empathy involving health care personnel in English-language publications up until April 20, 2021, covering the first five decades of research on empathy in health care (1971-2021). STUDY DESIGN: We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. DATA COLLECTION/EXTRACTION METHODS: Title and abstract screening for study eligibility was followed by full-text screening of relevant citations to extract study information (e.g., study design, sample size, empathy measure used, empathy assessor, intervention type if applicable, other variables evaluated, results, and significance). We classified study predictors and outcomes into categories, calculated descriptive statistics, and produced tables to summarize findings. PRINCIPAL FINDINGS: Of the 2270 articles screened, 455 reporting on 470 analyses satisfied the inclusion criteria. We found that most studies have been survey-based, cross-sectional examinations; greater empathy is associated with better clinical outcomes and patient care experiences; and empathy predictors are many and fall into five categories (provider demographics, provider characteristics, provider behavior during interactions, target characteristics, and organizational context). Of the 128 intervention studies, 103 (80%) found a positive and significant effect. With four exceptions, interventions were educational programs focused on individual clinicians or trainees. No organizational-level interventions (e.g., empathy-specific processes or roles) were identified. CONCLUSIONS: Empirical research provides evidence of the importance of empathy to health care outcomes and identifies multiple changeable predictors of empathy. Training can improve individuals' empathy; organizational-level interventions for systematic improvement are lacking.
Assuntos
Empatia , Pessoal de Saúde , Humanos , Estudos Transversais , Atenção à SaúdeRESUMO
BACKGROUND: The lack of quality-oriented organizational climates is partly responsible for deficiencies in patient-centered care and poor quality more broadly. To improve their quality-oriented climates, several organizations have joined quality improvement collaboratives. The effectiveness of this approach is unknown. OBJECTIVE: To evaluate the impact of collaborative membership on organizational climate for quality and service quality. SUBJECTS: Twenty-one clinics, 4 of which participated in a collaborative sponsored by the Institute for Clinical Systems Improvement. RESEARCH DESIGN: Pre-post design. Preassessments occurred 2 months before the collaborative began in January 2009. Postassessments of service quality and climate occurred about 6 months and 1 year, respectively, after the collaborative ended in January 2010. We surveyed clinic employees (eg, physicians, nurses, receptionists, etc.) about the organizational climate and patients about service quality. MEASURES: Prioritization of quality care, high-quality staff relationships, and open communication as indicators of quality-oriented climate and timeliness of care, staff helpfulness, doctor-patient communication, rating of doctor, and willingness to recommend doctor's office as indicators of service quality. RESULTS: There was no significant effect of collaborative membership on quality-oriented climate and mixed effects on service quality. Doctors' ratings improved significantly more in intervention clinics than in control clinics, staff helpfulness improved less, and timeliness of care declined more. Ratings of doctor-patient communication and willingness to recommend doctor were not significantly different between intervention and comparison clinics. CONCLUSION: Membership in the collaborative provided no significant advantage for improving quality-oriented climate and had equivocal effects on service quality.
Assuntos
Cultura Organizacional , Qualidade da Assistência à Saúde/organização & administração , Adolescente , Adulto , Idoso , Atitude do Pessoal de Saúde , Comportamento Cooperativo , Atenção à Saúde/normas , Feminino , Serviços de Saúde/normas , Administração de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Assistência Centrada no Paciente/normas , Médicos/normas , Adulto JovemRESUMO
BACKGROUND: Quality improvement collaboratives are an increasingly common strategy for implementing evidence-based practices in health care. However, research shows that many participating organizations do not achieve the level of performance improvement desired. PURPOSE: This study examined the use of interorganizational learning activities (inter-OLAs) as an explanation for mixed performance improvement among collaborative participants. We tested the hypotheses that inter-OLA use is positively associated with participants' performance improvement and that this relationship is moderated by the use of intraorganizational learning activities (intra-OLAs) and quality-focused human resource (Q-HR) practices. METHODOLOGY: We conducted a survey of organizational teams participating in 4 Institute for Healthcare Improvement Breakthrough Series collaboratives. Survey responses from 52 teams, regarding the use of inter-OLAs, intra-OLAs and Q-HR practices, were linked to performance improvement data obtained from the Institute for Healthcare Improvement and demographic data obtained from secondary sources. FINDINGS: The more collaborative teams used inter-OLAs, the more their organizations' performance improved. Contrary to our hypothesis, the use of intra-OLAs did not moderate this relationship; teams' use of intra-OLAs added to, but did not multiply, the effect of inter-OLA use. In contrast, an organization's use of Q-HR practices multiplied the performance benefit of inter-OLA use. PRACTICE IMPLICATIONS: Our findings suggest that organizations that participate in collaboratives are more likely to improve their performance if they use the inter-OLAs offered by the collaborative. Our results also suggest that complementing high use of inter-OLAs with intra-OLA use and Q-HR practices enhances performance improvement. For collaborative sponsors, our findings imply that including activities that facilitate interorganizational and intraorganizational learning are worthwhile.
Assuntos
Pessoal Administrativo/psicologia , Equipes de Administração Institucional , Relações Interinstitucionais , Gestão do Conhecimento , Melhoria de Qualidade/normas , Adulto , Comportamento Cooperativo , Prática Clínica Baseada em Evidências , Mão de Obra em Saúde , Humanos , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Organizational culture is an important driver of organizational performance. However, little is known about the cultures of medical groups, which play an important role in health care. PURPOSE: We sought to characterize the cultures of medical groups and identify factors that influence these cultures. METHODOLOGY: We conducted a qualitative study of the organizational cultures of 8 U.S. multispecialty medical groups, using data collected during site visits and in-depth interviews with clinical and administrative staff (N = 69). Groups were randomly selected from those that participated in the second National Study of Physician Organizations using stratified sampling along three dimensions (i.e., ownership type, use of care management practices, and outcome performance). We analyzed the data to assess the presence of seven culture types-group, hierarchical, rational, developmental, quality oriented, patient centered, and physician centered-using the constant comparative method. FINDINGS: We found that a multiplicity and diversity of cultures exist within and across multispecialty medical groups, with a dominance of patient-centered, physician-centered, rational, or quality-oriented cultures and less emphasis on group, developmental, and hierarchical cultures. Culture types that may seem antithetical, for example, patient-centered and physician-centered cultures, often coexisted within the same group. Across culture types, we found that six factors influenced medical group culture: financial, people, leadership, structural, processes, and environmental. PRACTICE IMPLICATIONS: As medical groups adapt to changes under health care reform, their success likely depends on their having cultures that facilitate collaboration with other organizations (e.g., hospitals) that possess different cultures and adaptation to changes in payment and regulation. Our study suggests that some groups may not have the developmental and group cultures needed to adapt. Our study identifies six categories of levers they can use to alter their culture as desired.