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Showing papers in "Journal for Healthcare Quality in 2003"



Journal Article•DOI•

103 citations


Journal Article•DOI•
TL;DR: This book explains change in Institutionalized Practices in US Health Institutions and the Example of the Nursing Home Industry through the lens of Organization Theory, and discusses complexity and Health Care: Tools for Engagement.
Abstract: Figures and Tables vii Acknowledgments ix The Editors xi The Contributors xiii 1 Introduction: Events, Themes, and Progress 1 Stephen S. Farnsworth Mick and Patrick D. Shay 2 A Primer of Organization Theories in Health Care 25 Stephen S. Farnsworth Mick and Patrick D. Shay 3 Finding Strength in Numbers: Bringing Theoretical Pluralism into the Analysis of Health Care Organizations 53 Jacqueline S. Zinn and S. Diane Brannon 4 Explaining Change in Institutionalized Practices: A Review and Road Map for Research 79 Thomas D Aunno 5 Mechanisms for Culture Change in US Health Institutions and the Example of the Nursing Home Industry 99 Jane Banaszak-Holl and Rosalind E. Keith 6 Managing to Care: Design and Implementation of Patient-Centered Care Management Teams 125 Douglas R. Wholey, Xi Zhu, David Knoke, Pri Shah, and Katie M. White 7 Remember It Is a Workplace: Health Care Organizations as Sociological Artifacts 153 Timothy Hoff 8 Differentiated, Integrated, and Overlooked: Hospital-Based Clusters 179 Patrick D. Shay, Roice D. Luke, and Stephen S. Farnsworth Mick 9 Profound Change inMedical Technologies: Time to Reexamine the Technology-Structure Nexus in Health Care? 205 Mary L. Fennell, Steven B. Clauser, and Miriam Plavin-Masterman 10 Social Network Analysis and the Integration of Care: Theory and Method 229 Timothy R. Huerta and Roberto Dandi 11 Complexity and Health Care: Tools for Engagement 259 James W. Begun and Marcus Thygeson 12 Synthesis and Convergence: The Maturation of Organization Theory 283 Stephen S. Farnsworth Mick and Patrick D. Shay References 297 Name Index 355 Subject Index 369

84 citations


Journal Article•DOI•
TL;DR: Factors that place patients at risk for repeat hospitalizations after home healthcare admission and home health agencies that focus on these risk factors may improve the effectiveness and efficiency of their efforts to prevent rehospitalization.
Abstract: One indicator of quality home healthcare is the prevention of rehospitalization. This study explored factors that place patients at risk for repeat hospitalizations after home healthcare admission. One year of outcomes assessment information data from a large home health agency was used to identify 7,393 patients who had at least one episode of rehospitalization. Results revealed that after the data had been adjusted for age and gender, a number of demographic, clinical, and functional factors predicted repeat hospitalizations. Home health agencies that focus on these risk factors may improve the effectiveness and efficiency of their efforts to prevent rehospitalization.

64 citations



Book•DOI•
TL;DR: In this paper, Bennett and Lehman shed light on the limitations of drug testing and demonstrate how individual and organizational wellness efforts can more effectively reduce employee alcohol and drug abuse, including stress management, cardiovascular wellness, and team building.
Abstract: In Preventing Workplace Substance Abuse, editors Joel B Bennett and Wayne EK Lehman shed light on the limitations of drug testing and demonstrate how individual and organizational wellness efforts can more effectively reduce employee alcohol and drug abuse. In an era of widespread drug testing, employee substance abuse continues unabated and related safety, productivity, and medical costs persist. Why? Testing alone, say the editors, ignores alcohol use and fails to address underlying causes, including contextual workplace factors like stress, stigma, and coworker drinking. This groundbreaking volume offers a reasoned and well-researched approach that is broader and potentially more effective than coercion in inducing employees to change. Chapter authors describe science-based interventions linked to other areas of individual or organizational wellness, such as stress management, cardiovascular wellness, and team building, which appeal to a wider or more holistic sense of wellness. Those who design, implement, or advise on workplace prevention programs, as well as policy-makers and business owners will benefit from the research described and will find options that fit a range of organizational cultures, policy orientations, and employee motivation levels.

34 citations


Journal Article•DOI•
TL;DR: It is demonstrated that THA, in addition to being an effective treatment for hip arthritis, also is a desirable option from the perspective of patient satisfaction with the process of care.
Abstract: As total hip arthroplasty (THA) becomes an increasingly desirable treatment option for hip arthritis, it is important for providers to assess patients' satisfaction with the complex process surrounding this procedure. This study looked at 336 THA patients' satisfaction with 16 specific services before and during hospitalization. Provider characteristics considered reflected attributes of reliability, responsiveness, communication, and interpersonal care. Among patient characteristics considered, the most marked finding was that older individuals and those who did not live alone tended to be more satisfied. This study demonstrated that THA, in addition to being an effective treatment for hip arthritis, also is a desirable option from the perspective of patient satisfaction with the process of care.

33 citations


Journal Article•DOI•
TL;DR: This volume reviews social, organizational, and financial aspects of delivery with an emphasis on the needs and responsibilities of pharmacists in the U.S.

26 citations


Journal Article•DOI•
TL;DR: The Hawaii Medical Service Association's Physician Quality and Service Recognition program offers an innovative and effective approach for improving delivery of high-quality and cost-effective care to patients enrolled in preferred provider organizations.
Abstract: This case report describes a qualitative and preliminary quantitative assessment of a quality-based physician compensation program. The Hawaii Medical Service Association's Physician Quality and Service Recognition program offers an innovative and effective approach for improving delivery of high-quality and cost-effective care to patients enrolled in preferred provider organizations. Support for the program is demonstrated through increasing numbers of voluntarily participating physicians. Preliminary assessment of population outcomes reveals sustained improvements in many clinical areas and mixed findings in others. This study contributes to the body of knowledge available to payers and policy makers considering alternative payment methods to reward improved performance.

26 citations


Journal Article•DOI•
TL;DR: This article provides healthcare administrators and managers with a framework and model for developing a balanced scorecard and demonstrates the remarkable success of this process, which brings focus to leadership decisions about the allocation of resources.
Abstract: This article provides healthcare administrators and managers with a framework and model for developing a balanced scorecard and demonstrates the remarkable success of this process, which brings focus to leadership decisions about the allocation of resources. This scorecard was developed as a top management tool designed to structure multiple priorities of a large, complex, integrated healthcare system and to establish benchmarks to measure success in achieving targets for performance in identified areas. Significant benefits and positive results were derived from the implementation of the balanced scorecard, based upon benchmarks considered to be critical success factors. The network's chief executive officer and top leadership team set and articulated the network's primary operating principles: quality and efficiency in the provision of comprehensive healthcare and support services. Under the weighted benchmarks of the balanced scorecard, the facilities in the network were mandated to adhere to one non-negotiable tenet: providing care that is second to none. The balanced scorecard approach to leadership continuously ensures that this is the primary goal and focal point for all activity within the network. To that end, systems are always in place to ensure that the network is fully successful on all performance measures relating to quality.

20 citations


Journal Article•DOI•
TL;DR: A case study and other examples that show how to lose weight by making systemic changes in lifestyles are offered, providing a 7-step approach to system thinking in a personal context.
Abstract: People can create positive environments so that their chances of relapse to poor habits are reduced and their likelihood of success is increased. Continuous quality improvement (CQI) suggests that this can be accomplished by making systemwide changes and deemphasizing personal effort. This article provides a 7-step approach to system thinking in a personal context. It offers a case study and other examples that show how to lose weight by making systemic changes in lifestyles. Learning about system thinking in a personal context also may help healthcare professionals understand the application of CQI within organizations.

Journal Article•DOI•
TL;DR: It is found that it is possible to improve the quality of information related to pain assessment through the development of explicit documentation tools.
Abstract: As a result of standards published by the Joint Commission on Accreditation of Healthcare Organizations, there is new emphasis in the area of pain management. This pilot study was conducted to assess the visibility of pain management through documentation; the effect of implementing new tools (forms) was measured to determine whether they improve documentation of pain management assessment and intensity. A retrospective chart review was conducted to determine presence of this documentation. This study found that it is possible to improve the quality of information related to pain assessment through the development of explicit documentation tools.

Journal Article•DOI•
TL;DR: The analysis indicated that the use of the flowsheet was associated with improved provider compliance in the completion of foot examinations only and providers involved in the study believed that the process of theflowsheet plus feedback contributed to their greater awareness of diabetes management guidelines.
Abstract: The purpose of this study was to develop and test two interventions designed to improve provider compliance with diabetes management guidelines: the use of a diabetes management flowsheet inserted into patient charts and the use of a diabetes management flowsheet plus quarterly provider feedback about compliance levels. Diabetic patient charts from six family practice clinics were randomly selected and audited at baseline and at 12 months. The analysis indicated that the use of the flowsheet was associated with improved provider compliance in the completion of foot examinations only. Providers involved in the study believed that the process of the flowsheet plus feedback contributed to their greater awareness of diabetes management guidelines.

Journal Article•DOI•
TL;DR: This three-part series will give readers an understanding of the concepts of inferential statistics as well as the specific tools for calculating confidence intervals for samples of data.
Abstract: Healthcare quality improvement professionals need to understand and use inferential statistics to interpret sample data from their organizations. In quality improvement and healthcare research studies all the data from a population often are not available, so investigators take samples and make inferences about the population by using inferential statistics. This three-part series will give readers an understanding of the concepts of inferential statistics as well as the specific tools for calculating confidence intervals for samples of data. This article, Part 1, presents basic information about data including a classification system that describes the four major types of variables: continuous quantitative variable, discrete quantitative variable, ordinal categorical variable (including the binomial variable), and nominal categorical variable. A histogram is a graph that displays the frequency distribution for a continuous variable. The article also demonstrates how to calculate the mean, median, standard deviation, and variance for a continuous variable.

Journal Article•DOI•
TL;DR: The development of a case management unit proved the most effective intervention as compliance rates for post-hospitalization after-care visits improved and hospital readmittance rates declined.
Abstract: This article documents the quality improvement process implemented by HIP Health Plan of New York (HIP) for the behavioral health continuity-of-care measure, Follow-Up After Hospitalization for Mental Illness. This Health Plan Employer Data and Information Set (HEDIS) measure identifies the percentage of members who receive psychiatric follow-up care after their hospital discharge. Studies indicate that post-hospitalization psychiatric follow-up care is an effective method for reducing hospital readmissions. HIP's mental health services department pursued a number of improvement initiatives with this HEDIS measure. The development of a case management unit proved the most effective intervention as compliance rates for post-hospitalization after-care visits improved and hospital readmittance rates declined. These findings provide valuable resource information for behavioral health providers throughout the United States.

Journal Article•DOI•
TL;DR: Co-bedding may promote maternal bonding and has no negative clinical or developmental outcomes, and parents should be offered the option to co-bed multiple-gestation infants in the NICU.
Abstract: This study was part of a large departmental performance improvement initiative to implement and evaluate developmental and family-centered care as "best practice" in the neonatal intensive care unit (NICU). The goal was to evaluate the safety, effect on infant clinical and developmental outcomes, and maternal satisfaction of co-bedding of multiple-gestation infants compared to traditionally bedded infants/mothers. A secondary purpose was to evaluate co-bedding and American Academy of Pediatrics-recommended "back to sleep" behaviors in the same infants/mothers after discharge. A retrospective, comparative, descriptive design was used. Chart reviews and mailed written surveys were used to collect study data. Findings showed no significant differences in demographic variables or clinical and developmental outcomes between the total traditionally bedded and co-bedded groups. All mothers reported positive experiences with the NICU. Co-bedding may promote maternal bonding and has no negative clinical or developmental outcomes. Once policies and education are in place, parents should be offered the option to co-bed multiple-gestation infants in the NICU. There is a performance improvement opportunity regarding the education provided to parents of multiple-gestation infants before discharge on the "back to sleep" recommendations.

Journal Article•DOI•
TL;DR: Federal regulations to protect research subjects, levels of IRB review, and strategies to simplify the IRB approval process are explored and implications for QI studies are discussed.
Abstract: Healthcare quality improvement (QI) studies are systematic analyses of processes and outcomes. As such, they meet one of the federal regulatory criteria defining research. They also meet the second criterion in many instances, generalizability of findings, even if it was not the study's original intent. Therefore, to err on the side of patients' rights, any studies involving human subjects or human data must be approved by federally mandated institutional review boards (IRBs) or their designees. This article explores federal regulations to protect research subjects, levels of IRB review, and strategies to simplify the IRB approval process and discusses implications for QI studies.


Journal Article•DOI•
TL;DR: Most physical therapy students suggested that spiritual and religious considerations should be part of PT practice, noting their potential effect upon motivation, functional status, and outcomes.
Abstract: Integrating patients' spiritual values into healthcare is important to quality of care according to patients and to accrediting agencies. Little is known, however, about how or whether physical therapists, as members of the healthcare team, are knowledgeable about these values or incorporate them into practice. Therefore, we explored the perspectives of 34 physical therapy (PT) students via an online discussion. Most suggested that spiritual and religious considerations should be part of PT practice, noting their potential effect upon motivation, functional status, and outcomes. Further dialog about and assessment of PT education and practice related to spiritual issues seem warranted.

Journal Article•DOI•
TL;DR: This three-part series will give readers an understanding of the concepts of inferential statistics as well as the specific tools for calculating confidence intervals for samples of data.
Abstract: Healthcare quality improvement professionals need to understand and use inferential statistics to interpret sample data from their organizations. In quality improvement and healthcare research studies all the data from a population often are not available, so investigators take samples and make inferences about the population by using inferential statistics. This three-part series will give readers an understanding of the concepts of inferential statistics as well as the specific tools for calculating confidence intervals for samples of data. This article, Part 3, describes standard error and margin of error for a continuous variable and how they are calculated from the sample size and standard deviation of a sample. The article then demonstrates how the standard error and margin of error are used to calculate the confidence interval for estimating a population mean based on a sample mean.

Journal Article•DOI•
TL;DR: The data showed a trend indicating that physicians regarded the value of direct physician-to-physician communication more highly than they personally practiced such direct communication when requesting a consult.
Abstract: We undertook the current survey-based study to assess clinicians' views on the determinants of effective inpatient consultation and the existing process of inpatient consultation at the Cleveland Clinic Hospital. A 25-question survey developed for this study using Likert scale responses was completed by 181 (of 404 eligible addressees, a 45% response rate) members of the Cleveland Clinic staff in the divisions of medicine, surgery, and pediatrics. Ratings of the overall value of inpatient consultation reflected moderate satisfaction (mean 6.9 of possible 10). Types of consults that were most valued were those requesting a procedure and those seeking assistance in establishing a diagnosis and in interpreting data. Features deemed most important in making a consult excellent were legibility of the consultant's note, timeliness of the response (i.e., within 24 hours), and direct communication of the consult question. The data showed a trend indicating that physicians regarded the value of direct physician-to-physician communication more highly than they personally practiced such direct communication when requesting a consult. Study findings indicate the opportunity to improve the process of inpatient consultation by implementing measures that enhance direct physician-to-physician communication about the consult, ensure timeliness, facilitate identification of the appropriate consultants, and allow easier auditing. We propose a novel process for requesting inpatient consultations that extends currently available hospital information systems but offers a process improvement that warrants development.


Journal Article•DOI•
TL;DR: BlueCross BlueShield of Tennessee's (BCBST) success in blending evidence with experience has provided a winning solution for members, providers, and the health plan.
Abstract: This article describes BlueCross BlueShield of Tennessee's (BCBST) success in blending evidence with experience. This process has provided a winning solution for members, providers, and the health plan. Provider input has proved to be an invaluable tool in assessing both new and established technologies. BCBST uses a variety of methods, from formal panels to a modified Delphi approach, to obtain provider input into the creation of clinical decision tools. Provider experience fills the gap in the assessment of technologies that are widely used but do not have sufficient evidence to support them. This approach has significant implications for health plan delivery. It also meets the Institute of Medicine's concern that every healthcare organization, purchaser, regulator and educational institution encourage the delivery of services based upon the best available scientific knowledge.

Journal Article•DOI•
TL;DR: A manual written for health care professionals who care for patients from diverse religious and cultural backgrounds and is designed to help providers best meet needs of their ethnically diverse patients while satisfying stringent new regulatory standards for culturally sensitive care.
Abstract: A manual written for health care professionals who care for patients from diverse religious and cultural backgrounds. First developed by doctors and nurses at Children's Hospital in Boston, it contains detailed, practical information for working with dozens of religious and cultural groups and is designed to help providers best meet needs of their ethnically diverse patients while satisfying stringent new regulatory standards for culturally sensitive care.

Journal Article•DOI•
TL;DR: The recommendations within the VHA report are intended as a starting point for dialogue to provide guidance for the responsible ethical conduct of QI projects.
Abstract: The distinction between QI, research, and clinical care projects has never been clear. However, QI projects may raise ethical concerns, and organizations need to ensure that patients involved in QI projects are adequately protected. The recommendations within the VHA report are intended as a starting point for dialogue to provide guidance for the responsible ethical conduct of QI projects. Discussion and oversight will need to occur at several levels within organizations to ensure ethical care is being provided.

Journal Article•DOI•
TL;DR: The goals of an improvement initiative were to ensure that allergy immunotherapy practices complied with published guidelines and to improve staff's patient assessments, dosage calculations, and documentation skills.
Abstract: Allergy immunotherapy commonly is administered in primary care practices by nurses and medical assistants, who often have little education or experience in this procedure. An assessment of an organization's 18 primary care offices revealed a number of deficiencies in clinical practices and documentation. The goals of an improvement initiative were to ensure that allergy immunotherapy practices complied with published guidelines and to improve staff's patient assessments, dosage calculations, and documentation skills. A policy was developed to guide practice, practice standards were implemented, staff education was provided, documentation methods and standards were established, and ongoing monitoring was set in place. After 2 years, allergy immunotherapy practices are standardized throughout the organization and improvements have been noted.

Journal Article•DOI•
TL;DR: The structure and type of information that board members need to know to better guide the hospital leadership through the decision-making process and to fulfill their obligations to the institution they serve is focused on.
Abstract: Hospital leaders face challenges from many different arenas--business, finance, and patient care. One resource often overlooked as a strategic asset is the hospital board of directors. Too often hospital boards erroneously assume or are forced into the roles of either micro-management or crisis management. Board education, which focuses on pertinent healthcare market information and strategic decision making, can help board members' understanding of their roles. As part of its overall plan, hospital leadership should ensure that its board members understand the market environment and its effect upon the hospital's strategic directions, options, and priorities. This article focuses on the structure and type of information that board members need to know to better guide the hospital leadership through the decision-making process and to fulfill their obligations to the institution they serve.

Journal Article•DOI•
TL;DR: This three-part series will give readers an understanding of the concepts of inferential statistics as well as the specific tools for calculating confidence intervals for samples of data.
Abstract: Healthcare quality improvement professionals need to understand and use inferential statistics to interpret sample data from their organizations. In quality improvement and healthcare research studies all the data from a population often are not available, so investigators take samples and make inferences about the population by using inferential statistics. This three-part series will give readers an understanding of the concepts of inferential statistics as well as the specific tools for calculating confidence intervals for samples of data. This article, Part 2, describes probability, populations, and samples. The uses of descriptive and inferential statistics are outlined. The article also discusses the properties and probability of normal distributions, including the standard normal distribution.


Journal Article•DOI•
TL;DR: Immunization rates for end stage renal disease (ESRD) patients were well below the 80% target set by Healthy People 2000 and Centers for Medicare and Medicaid Services and the authors sought to increase documentation of immunization status, and influenza immunization rates of patients.
Abstract: Immunization rates for end stage renal disease (ESRD) patients were well below the 80% target set by Healthy People 2000 and Centers for Medicare and Medicaid Services. The authors sought to increase documentation of immunization status, and influenza immunization rates of these patients. A survey was distributed to dialysis facilities to determine immunization practices. Facilities were provided with an immunization toolbox and spreadsheets to document the immunization status of patients. A total of 102 facilities (53%) provided data for three collection periods (1999, 2000, and 2001). Immunization rates for each influenza season increased significantly from 62.1% and 61.4% in 1998-1999 to 80.3% and 80.0% in 2000-2001 (Pennsylvania and Delaware respectively).