Introduction This article outlines the original Medical Home model and PatientCentred Care approa... more Introduction This article outlines the original Medical Home model and PatientCentred Care approach to identify the disjoint between their concurrent application and the development of the Patient Centred Medical Home (PCMH) to answer the question-why is the whole (i.e. the PCMH model) not yet greater than the sum of its parts? We focus on the issue of evaluation and measurement, and more speci ically, how patient-centeredness must be incorporated when considering how to measure outcomes such as quality of care in the context of the PCMH. We conclude with a discussion of measurement issues to be addressed to adequately understand how patient-centeredness drives the healthcare system. Conclusion Focusing on the implementation of health information technology and patient-centred interventions within the PCMH has the potential to improve the Medical Home, but efforts must be made to develop and test appropriate measures of patient-centeredness and other key features of the PCMH. By kee...
care and patient outcomes. In this context, allowing physicians to compare their own performance ... more care and patient outcomes. In this context, allowing physicians to compare their own performance with anonymous peer performance may be more effective as it appears to trigger low performers' sense of competitiveness without making them less respected by team members.
Physician Perspectives about Telemedicine: Considering the Usability of Telemedicine in Response to Coronavirus Disease 2019
Journal of Pediatric Gastroenterology & Nutrition, 2021
Objective: Use of telemedicine in pediatric gastroenterology has increased dramatically in respon... more Objective: Use of telemedicine in pediatric gastroenterology has increased dramatically in response to the coronavirus disease 2019 (COVID-19) pandemic. The goal of this study was to systematically assess the usability of telemedicine in the field of pediatric gastroenterology. Methods: The previously validated Telehealth Usability Questionnaire was distributed to physician pediatric gastroenterologist members of North American Society for Pediatric Gastroenterology Hepatology and Nutrition. Physician demographic and practice characteristics were collected. Data were analyzed using descriptive, linear mixed-effect, and ordinary least squares regression methods. Results: One hundred sixty pediatric gastroenterologists completed the survey. The majority were from academic practice (77%) with experience ranging from trainee (11%) to over 20 years of clinical practice (34%). Most (82%) had no experience with telemedicine before the pandemic. The average usability score (scale 1–5) was 3...
Black men are more likely to die as a result of prostate cancer than white men, despite effective... more Black men are more likely to die as a result of prostate cancer than white men, despite effective treatments that improve survival for clinically significant prostate cancer. We undertook this study to identify gaps in prostate cancer care quality, racial disparities in care, and underlying reasons for poorer quality care. We identified all black men and random age-matched white men with Gleason scores ≥ 7 diagnosed between 2006 and 2013 at two urban hospitals to determine rates of treatment underuse. Underuse was defined as not receiving primary surgery, cryotherapy, or radiotherapy. We then interviewed treating physicians about the reasons for underuse. Of 359 black and 282 white men, only 25 (4%) experienced treatment underuse, and 23 (92%) of these were black. Most (78%) cases of underuse were due to system failures, where treatment was recommended but not received; 38% of these men continued receiving care at the hospitals. All men with treatment underuse due to system failures...
Getting to Zero: Goal Commitment to Reduce Blood Stream Infections
Medical Care Research and Review, 2015
While preventing health care–associated infections (HAIs) can save lives and reduce health care c... more While preventing health care–associated infections (HAIs) can save lives and reduce health care costs, efforts designed to eliminate HAIs have had mixed results. Variability in contextual factors such as work culture and management practices has been suggested as a potential explanation for inconsistent results across organizations and interventions. We examine goal-setting as a factor contributing to program outcomes in eight hospitals focused on preventing central line–associated bloodstream infections (CLABSIs). We conducted qualitative case studies to compare higher- and lower-performing hospitals, and explored differences in contextual factors that might contribute to performance variation. We present a goal commitment framework that characterizes factors associated with successful CLABSI program outcomes. Across 194 key informant interviews, internal and external moderators and characteristics of the goal itself differentiated actors’ goal commitment at higher- versus lower-pe...
Aligning for Accountable Care: Strategic Practices for Change in Accountable Care Organizations
Academy of Management Proceedings, 2015
Alignment of structures, processes, and behaviors among the many diverse components of accountabl... more Alignment of structures, processes, and behaviors among the many diverse components of accountable care organizations (ACOs) is crucial if these new entities are to achieve their lofty goals of reducing the total costs of care while improving the quality of care and the health of populations. Fundamental, transformational changes at the organizational and individual levels are required to produce such alignment. While a variety of integration models for alignment exist, we know little about the work entailed in accomplishing such change and building alignment. That is, we have models for what alignment is, but less knowledge of how alignment is produced and maintained. To address this gap, we conducted multi-year qualitative case studies of four commercial ACOs. Using a practice perspective, which emphasizes the role of continuous action in the production of social structure, we examined the strategic practices that these ACOs used to align the structures, processes, and behaviors of their organizations a...
Journal of the American Board of Family Medicine : JABFM
Inappropriate emergency department (ED) use among Medicaid enrollees is considered a problem beca... more Inappropriate emergency department (ED) use among Medicaid enrollees is considered a problem because of cost. We developed and evaluated a system change innovation designed to remove system barriers to primary care access for Medicaid patients. Patients who presented to the ED without an identified primary care provider were randomized to the intervention (n = 72) or comparison group (n = 68) for a 12-month study designed to connect these patients to primary care offices. Evaluation was mixed quantitative/qualitative. Significantly more intervention participants attended at least 1 primary care visit 3 months after the intervention (odds ratio [OR], 2.52; 95% confidence interval [CI], 1.06-6.02), though this difference was not significant by 12 months (OR, 1.74; 95% CI, 0.79-3.84). The intervention participants also did not have lower odds of returning to the ED for nonurgent reasons by the 12-month follow-up (OR, 1.27; 95% CI, 0.65-2.48). Patient-reported barriers to attending a pr...
Using High-Performance Work Practices to Prevent Blood Stream Infections: A Qualitative Study
Academy of Management Proceedings, 2014
Prior research suggests that high-performance work practices (HPWPs) can influence quality and sa... more Prior research suggests that high-performance work practices (HPWPs) can influence quality and safety outcomes in healthcare organizations. The cen¬tral line–associated bloodstream infection (CLABSI) is one of the most potentially harmful types of healthcare-associated infections (HAIs), and a major patient safety concern. Nationally, CLABSI rates have been reduced through the implementation of evidence-based interventions; thus far, however, hospitals still differ substantially in their success implementing these practices. Differences in non-clinical factors, such as leadership and management practices have been proposed as one potential explanation for this between-organization variability, but the influence of HPWPs on this important patient safety indicator is not clear. In this study we explored the role of high-performance work practices (HPWPs) within organizations as important factors impacting CLABSI-reduction outcomes among hospitals participating in statewide initiatives to improve quality of ...
Speaking Up is Hard to Do: What Can Management Do When Patient Safety is On the Line
Academy of Management Proceedings, 2013
Central line-associated blood stream infections (CLABSIs) are a leading cause of healthcare-assoc... more Central line-associated blood stream infections (CLABSIs) are a leading cause of healthcare-associated infections (HAIs), preventable deaths, and excess healthcare costs in U.S. hospitals. Hospitals that successfully implement evidence-based CLABSI- prevention practices have reduced, and at times eliminated, CLABSIs. Among these evidence-based practices is an intervention to empower nurses to speak up and stop the line when physicians violate infection control protocol during the central line insertion process. Employee reluctance to speak up in healthcare organizations is a well-recognized barrier to healthcare quality; to date, there is little known about how organizations can change employee behavior to speak up about errors or opportunities for improvement. In this paper we present evidence from a qualitative study of six organizations that have successfully empowered nurses to speak up in the context of CLABI-prevention efforts. Our results suggest that management efforts to motivate nurses, address ...
Perspectives in health information management / AHIMA, American Health Information Management Association, 2015
Electronic medical record (EMR) implementation efforts face many challenges, including individual... more Electronic medical record (EMR) implementation efforts face many challenges, including individual and organizational barriers and concerns about loss of productivity during the process. These issues may be particularly complex in large and diverse settings with multiple specialties providing inpatient and outpatient care. This case report provides an example of a successful EMR implementation that emphasizes the importance of flexibility and adaptability on the part of the implementation team. It also presents the top 10 lessons learned from this EMR implementation in a large midwestern academic medical center. Included are five overarching lessons related to leadership, initial approach, training, support, and optimization as well as five lessons related to the EMR system itself that are particularly important elements of a successful implementation.
Engaging the Health Care Team through Operations Councils: Strategies to Improve Population Health from Within
Population Health Management in Health Care Organizations, 2014
Clinical front-line staff are best positioned within the organizations to identify patient safety... more Clinical front-line staff are best positioned within the organizations to identify patient safety problems and craft solutions. However, in traditional models, safety committees are led by senior executives who are not clinically responsible for patients. This top-down approach can result in missed opportunities to address patient-centered challenges and better manage the health of the defined populations served by these organizations. To foster teamwork, enhance empowerment, and improve the patient care environment, Operations Councils led by trained front-line staff were deployed in 15 clinical areas at the Ohio State University Wexner Medical Center (OSUWMC) as a performance improvement tool. Standardized training of Council facilitators was designed and implemented to guide the performance improvement process. Balanced scorecards were developed in each Council based on the risks and concerns of that particular clinical area. After initial implementation of the Operations Councils, patient safety events declined and team engagement improved by over 34% across the medical center; the highest changes were seen in areas where Operations Councils had been deployed. Additionally, outcome metrics including area-specific and system-wide mortality and readmissions improved after implementation. We suggest that this type of approach may be an appropriate strategy to consider in other health care organizations as such institutions are challenged to better manage the health of their defined patient populations.
Health care organizations, in response to federal programs, have sought to identify electronic me... more Health care organizations, in response to federal programs, have sought to identify electronic medical record (EMR) strategies that align well with their visions for success. Little exists in the literature discussing the transition from one EMR strategy to another. The analysis and planning process used by a major academic medical center in its journey to adopt a new strategy was described in this study. We use the transtheoretical model of change to frame the five phases through which the organization transitioned from a best-of-breed system to an enterprise system. We explore the five phases of change from the perspective of a maturing approach to new technology adoption. Data collection included archival retrieval and review as well as interviews with key stakeholders. Although there was always a focus on some enterprise capabilities such as computerized physician order entry, the emphasis on EMR selection tended to be driven by specialty requirements. Focusing on the patient across the continuum of care, as opposed to focusing on excessive requirements by clinical specialties, was essential in forming and deploying a vision for the new EMR. This research outlines a successful pathway used by an organization that had invested heavily in EMR technology and was faced with evaluating whether to continue that investment or start with a new platform. Rather than focusing on the technology alone, efforts to reframe the discussion to one that focused on the patient resulted in less resistance to change.
Leadership Development in Health Care: Results of Two Nationwide Studies
Two nationwide studies were conducted to study different aspects of health care leadership. In th... more Two nationwide studies were conducted to study different aspects of health care leadership. In the quantitative study, 844 respondents, or nearly one in five health care chief executives in the U.S., participated in a 72-item survey including a short version of the multifactor leadership questionnaire (MLQ). In the qualitative study, 160 informants were interviewed as experts or key informants associated with organizational case studies. Survey results highlight the importance of transformational leadership characteristics in contributing to executives' perceptions of leadership impact. In addition, respondents' reported plans to leave their current organizations in the near future underscored the need for health care institutions to appropriately plan for executive succession, as well as development of new leaders. Qualitative findings added insight to findings about leadership styles. In addition, informants predicted future needs for health care leadership competencies in the areas of ethics and values...
The role of computerized order sets in pediatric inpatient asthma treatment
Pediatric Allergy and Immunology, 2006
Condition‐specific order sets within computerized physician order entry (CPOE) systems are design... more Condition‐specific order sets within computerized physician order entry (CPOE) systems are designed to decrease unnecessary practice variation and to promote evidence‐based practice. This study quantitatively assessed the relationship between use of a computerized order set and processes of care in inpatient pediatric asthma treatment, and qualitatively assessed user attitudes toward order set use.The study population included 790 patients with a primary diagnosis of asthma admitted to Columbus Children's Hospital between November 1, 2001 and November 30, 2003. Rates of systemic corticosteroid (SCS) use, metered‐dose inhaler use, and pulse oximetry (PulseOx) were calculated for three patient groups: those admitted prior to order set implementation (‘pre‐set’); those admitted after implementation but without the order set used (‘no set’); and those admitted after implementation with the order set used (‘set’). Financial measures of length of stay, total charges, and pharmacy char...
Journal of the American Medical Informatics Association, 2005
To describe strategies that organizations select to support physicians' use of handheld computers... more To describe strategies that organizations select to support physicians' use of handheld computers (HHCs) in clinical practice and to explore issues about facilitating HHC use. Design: A multidisciplinary team used focus groups and interviews with clinical, administrative, and information technology (IT) staff to gather data from 161 informants at seven sites. Transcripts were coded using a combination of deductive and inductive approaches to both answer research questions and identify patterns and themes that emerged in the data. Measurements: Answers to questions about strategies for HHC support and themes about (1) how to facilitate physician adoption and use and (2) organizational concerns. Results: Three main organizational strategies for HHC support were characterized among sites: (1) active support for broad-based use, (2) active support for niche use, and (3) basic support for individual physician users. Three high-level themes emerged around how to best facilitate physician adoption and use of HHCs: (1) improving usability and usefulness, (2) promoting HHCs and device use, and (3) providing training and support. However, four major themes also emerged related to organizations' concerns about HHC use: (1) security-related concerns, (2) economic concerns, (3) technical concerns, and (4) strategic concerns. An organizational approach to HHC support that involves individualized attention to existing and potential physician users rather than one-size-fits-all, organization-wide implementation efforts was an important facilitator promoting physician use of HHCs. Health care organizations interested in supporting HHC use must consider issues related to security, economics, and IT strategy that may not be prominent concerns for physician users.
International Journal of Medical Informatics, 2008
The purpose of this study is four-fold. First, the hospitals' current level of computerized physi... more The purpose of this study is four-fold. First, the hospitals' current level of computerized physician order entry (CPOE) adoption is reported; second, internal and external influence factors' roles in determining CPOE adoption rates are described; third, the future diffusion rate of CPOE systems in US hospitals is empirically predicted; finally, the current technology's state-of-the-art is assessed. Data source: Secondary data from 3 years of the Leapfrog Group's annual survey (2002)(2003)(2004) of US tertiarycare hospitals. Study design: This study estimates CPOE market penetration rates applying technology diffusion theory and Bass modeling techniques for three future CPOE adoption scenarios-‗Optimistic,' ‗Best estimate', and ‗Conservative' are empirically derived. Principal findings: Two of the CPOE adoption scenarios have diffusion S-curve that indicates a technology will achieve significant market penetration. Under current conditions, CPOE adoption in urban hospitals will not reach 80% penetration until 2029. The promise of improved quality of care through medication error reductions and significant cost controls prompted the Institute of Medicine to call for universal CPOE adoption by 1999. However, the CPOE products available as of 2006 represent only a ‗second generation technology', characterized by many limitations. Without increased external and internal pressures, such CPOE systems are unlikely to achieve full diffusion in US hospitals in a timely manner. Alternatively, developing a new generation of CPOE technology that is more ‗user-friendly' and easily integrated into hospitals' legacy systems may be a more expedient approach to achieving widespread adoption.
An Exploratory Study of How Trust in Health Care Institutions Varies across African American, Hispanic and white Populations
Communication and Medicine, 2011
Background: Minority and non-minority patients in the United States have different levels of trus... more Background: Minority and non-minority patients in the United States have different levels of trust in health care; however, few studies have examined how determinants of trust and distrust in health care vary across diverse groups. Objective: To explore how trust in health care institutions varies across diverse populations. Methods: We conducted 17 focus groups with 117 participants in Chicago: 9 with African American, 5 with Hispanic, and 3 with white participants. Discussions were audiotaped, transcribed verbatim and coded using grounded theory analysis to identify dominant themes. Results: We found a core set of factors that contribute to trust and distrust across racial/ethnic groups. In addition, there were unique factors that contributed to distrust among African Americans and Hispanics. Both of these groups discussed expectations of discrimination in the health care setting and African Americans discussed expectations of being experimented on as determinants of distrust. Bas...
Introduction This article outlines the original Medical Home model and PatientCentred Care approa... more Introduction This article outlines the original Medical Home model and PatientCentred Care approach to identify the disjoint between their concurrent application and the development of the Patient Centred Medical Home (PCMH) to answer the question-why is the whole (i.e. the PCMH model) not yet greater than the sum of its parts? We focus on the issue of evaluation and measurement, and more speci ically, how patient-centeredness must be incorporated when considering how to measure outcomes such as quality of care in the context of the PCMH. We conclude with a discussion of measurement issues to be addressed to adequately understand how patient-centeredness drives the healthcare system. Conclusion Focusing on the implementation of health information technology and patient-centred interventions within the PCMH has the potential to improve the Medical Home, but efforts must be made to develop and test appropriate measures of patient-centeredness and other key features of the PCMH. By kee...
care and patient outcomes. In this context, allowing physicians to compare their own performance ... more care and patient outcomes. In this context, allowing physicians to compare their own performance with anonymous peer performance may be more effective as it appears to trigger low performers' sense of competitiveness without making them less respected by team members.
Physician Perspectives about Telemedicine: Considering the Usability of Telemedicine in Response to Coronavirus Disease 2019
Journal of Pediatric Gastroenterology & Nutrition, 2021
Objective: Use of telemedicine in pediatric gastroenterology has increased dramatically in respon... more Objective: Use of telemedicine in pediatric gastroenterology has increased dramatically in response to the coronavirus disease 2019 (COVID-19) pandemic. The goal of this study was to systematically assess the usability of telemedicine in the field of pediatric gastroenterology. Methods: The previously validated Telehealth Usability Questionnaire was distributed to physician pediatric gastroenterologist members of North American Society for Pediatric Gastroenterology Hepatology and Nutrition. Physician demographic and practice characteristics were collected. Data were analyzed using descriptive, linear mixed-effect, and ordinary least squares regression methods. Results: One hundred sixty pediatric gastroenterologists completed the survey. The majority were from academic practice (77%) with experience ranging from trainee (11%) to over 20 years of clinical practice (34%). Most (82%) had no experience with telemedicine before the pandemic. The average usability score (scale 1–5) was 3...
Black men are more likely to die as a result of prostate cancer than white men, despite effective... more Black men are more likely to die as a result of prostate cancer than white men, despite effective treatments that improve survival for clinically significant prostate cancer. We undertook this study to identify gaps in prostate cancer care quality, racial disparities in care, and underlying reasons for poorer quality care. We identified all black men and random age-matched white men with Gleason scores ≥ 7 diagnosed between 2006 and 2013 at two urban hospitals to determine rates of treatment underuse. Underuse was defined as not receiving primary surgery, cryotherapy, or radiotherapy. We then interviewed treating physicians about the reasons for underuse. Of 359 black and 282 white men, only 25 (4%) experienced treatment underuse, and 23 (92%) of these were black. Most (78%) cases of underuse were due to system failures, where treatment was recommended but not received; 38% of these men continued receiving care at the hospitals. All men with treatment underuse due to system failures...
Getting to Zero: Goal Commitment to Reduce Blood Stream Infections
Medical Care Research and Review, 2015
While preventing health care–associated infections (HAIs) can save lives and reduce health care c... more While preventing health care–associated infections (HAIs) can save lives and reduce health care costs, efforts designed to eliminate HAIs have had mixed results. Variability in contextual factors such as work culture and management practices has been suggested as a potential explanation for inconsistent results across organizations and interventions. We examine goal-setting as a factor contributing to program outcomes in eight hospitals focused on preventing central line–associated bloodstream infections (CLABSIs). We conducted qualitative case studies to compare higher- and lower-performing hospitals, and explored differences in contextual factors that might contribute to performance variation. We present a goal commitment framework that characterizes factors associated with successful CLABSI program outcomes. Across 194 key informant interviews, internal and external moderators and characteristics of the goal itself differentiated actors’ goal commitment at higher- versus lower-pe...
Aligning for Accountable Care: Strategic Practices for Change in Accountable Care Organizations
Academy of Management Proceedings, 2015
Alignment of structures, processes, and behaviors among the many diverse components of accountabl... more Alignment of structures, processes, and behaviors among the many diverse components of accountable care organizations (ACOs) is crucial if these new entities are to achieve their lofty goals of reducing the total costs of care while improving the quality of care and the health of populations. Fundamental, transformational changes at the organizational and individual levels are required to produce such alignment. While a variety of integration models for alignment exist, we know little about the work entailed in accomplishing such change and building alignment. That is, we have models for what alignment is, but less knowledge of how alignment is produced and maintained. To address this gap, we conducted multi-year qualitative case studies of four commercial ACOs. Using a practice perspective, which emphasizes the role of continuous action in the production of social structure, we examined the strategic practices that these ACOs used to align the structures, processes, and behaviors of their organizations a...
Journal of the American Board of Family Medicine : JABFM
Inappropriate emergency department (ED) use among Medicaid enrollees is considered a problem beca... more Inappropriate emergency department (ED) use among Medicaid enrollees is considered a problem because of cost. We developed and evaluated a system change innovation designed to remove system barriers to primary care access for Medicaid patients. Patients who presented to the ED without an identified primary care provider were randomized to the intervention (n = 72) or comparison group (n = 68) for a 12-month study designed to connect these patients to primary care offices. Evaluation was mixed quantitative/qualitative. Significantly more intervention participants attended at least 1 primary care visit 3 months after the intervention (odds ratio [OR], 2.52; 95% confidence interval [CI], 1.06-6.02), though this difference was not significant by 12 months (OR, 1.74; 95% CI, 0.79-3.84). The intervention participants also did not have lower odds of returning to the ED for nonurgent reasons by the 12-month follow-up (OR, 1.27; 95% CI, 0.65-2.48). Patient-reported barriers to attending a pr...
Using High-Performance Work Practices to Prevent Blood Stream Infections: A Qualitative Study
Academy of Management Proceedings, 2014
Prior research suggests that high-performance work practices (HPWPs) can influence quality and sa... more Prior research suggests that high-performance work practices (HPWPs) can influence quality and safety outcomes in healthcare organizations. The cen¬tral line–associated bloodstream infection (CLABSI) is one of the most potentially harmful types of healthcare-associated infections (HAIs), and a major patient safety concern. Nationally, CLABSI rates have been reduced through the implementation of evidence-based interventions; thus far, however, hospitals still differ substantially in their success implementing these practices. Differences in non-clinical factors, such as leadership and management practices have been proposed as one potential explanation for this between-organization variability, but the influence of HPWPs on this important patient safety indicator is not clear. In this study we explored the role of high-performance work practices (HPWPs) within organizations as important factors impacting CLABSI-reduction outcomes among hospitals participating in statewide initiatives to improve quality of ...
Speaking Up is Hard to Do: What Can Management Do When Patient Safety is On the Line
Academy of Management Proceedings, 2013
Central line-associated blood stream infections (CLABSIs) are a leading cause of healthcare-assoc... more Central line-associated blood stream infections (CLABSIs) are a leading cause of healthcare-associated infections (HAIs), preventable deaths, and excess healthcare costs in U.S. hospitals. Hospitals that successfully implement evidence-based CLABSI- prevention practices have reduced, and at times eliminated, CLABSIs. Among these evidence-based practices is an intervention to empower nurses to speak up and stop the line when physicians violate infection control protocol during the central line insertion process. Employee reluctance to speak up in healthcare organizations is a well-recognized barrier to healthcare quality; to date, there is little known about how organizations can change employee behavior to speak up about errors or opportunities for improvement. In this paper we present evidence from a qualitative study of six organizations that have successfully empowered nurses to speak up in the context of CLABI-prevention efforts. Our results suggest that management efforts to motivate nurses, address ...
Perspectives in health information management / AHIMA, American Health Information Management Association, 2015
Electronic medical record (EMR) implementation efforts face many challenges, including individual... more Electronic medical record (EMR) implementation efforts face many challenges, including individual and organizational barriers and concerns about loss of productivity during the process. These issues may be particularly complex in large and diverse settings with multiple specialties providing inpatient and outpatient care. This case report provides an example of a successful EMR implementation that emphasizes the importance of flexibility and adaptability on the part of the implementation team. It also presents the top 10 lessons learned from this EMR implementation in a large midwestern academic medical center. Included are five overarching lessons related to leadership, initial approach, training, support, and optimization as well as five lessons related to the EMR system itself that are particularly important elements of a successful implementation.
Engaging the Health Care Team through Operations Councils: Strategies to Improve Population Health from Within
Population Health Management in Health Care Organizations, 2014
Clinical front-line staff are best positioned within the organizations to identify patient safety... more Clinical front-line staff are best positioned within the organizations to identify patient safety problems and craft solutions. However, in traditional models, safety committees are led by senior executives who are not clinically responsible for patients. This top-down approach can result in missed opportunities to address patient-centered challenges and better manage the health of the defined populations served by these organizations. To foster teamwork, enhance empowerment, and improve the patient care environment, Operations Councils led by trained front-line staff were deployed in 15 clinical areas at the Ohio State University Wexner Medical Center (OSUWMC) as a performance improvement tool. Standardized training of Council facilitators was designed and implemented to guide the performance improvement process. Balanced scorecards were developed in each Council based on the risks and concerns of that particular clinical area. After initial implementation of the Operations Councils, patient safety events declined and team engagement improved by over 34% across the medical center; the highest changes were seen in areas where Operations Councils had been deployed. Additionally, outcome metrics including area-specific and system-wide mortality and readmissions improved after implementation. We suggest that this type of approach may be an appropriate strategy to consider in other health care organizations as such institutions are challenged to better manage the health of their defined patient populations.
Health care organizations, in response to federal programs, have sought to identify electronic me... more Health care organizations, in response to federal programs, have sought to identify electronic medical record (EMR) strategies that align well with their visions for success. Little exists in the literature discussing the transition from one EMR strategy to another. The analysis and planning process used by a major academic medical center in its journey to adopt a new strategy was described in this study. We use the transtheoretical model of change to frame the five phases through which the organization transitioned from a best-of-breed system to an enterprise system. We explore the five phases of change from the perspective of a maturing approach to new technology adoption. Data collection included archival retrieval and review as well as interviews with key stakeholders. Although there was always a focus on some enterprise capabilities such as computerized physician order entry, the emphasis on EMR selection tended to be driven by specialty requirements. Focusing on the patient across the continuum of care, as opposed to focusing on excessive requirements by clinical specialties, was essential in forming and deploying a vision for the new EMR. This research outlines a successful pathway used by an organization that had invested heavily in EMR technology and was faced with evaluating whether to continue that investment or start with a new platform. Rather than focusing on the technology alone, efforts to reframe the discussion to one that focused on the patient resulted in less resistance to change.
Leadership Development in Health Care: Results of Two Nationwide Studies
Two nationwide studies were conducted to study different aspects of health care leadership. In th... more Two nationwide studies were conducted to study different aspects of health care leadership. In the quantitative study, 844 respondents, or nearly one in five health care chief executives in the U.S., participated in a 72-item survey including a short version of the multifactor leadership questionnaire (MLQ). In the qualitative study, 160 informants were interviewed as experts or key informants associated with organizational case studies. Survey results highlight the importance of transformational leadership characteristics in contributing to executives' perceptions of leadership impact. In addition, respondents' reported plans to leave their current organizations in the near future underscored the need for health care institutions to appropriately plan for executive succession, as well as development of new leaders. Qualitative findings added insight to findings about leadership styles. In addition, informants predicted future needs for health care leadership competencies in the areas of ethics and values...
The role of computerized order sets in pediatric inpatient asthma treatment
Pediatric Allergy and Immunology, 2006
Condition‐specific order sets within computerized physician order entry (CPOE) systems are design... more Condition‐specific order sets within computerized physician order entry (CPOE) systems are designed to decrease unnecessary practice variation and to promote evidence‐based practice. This study quantitatively assessed the relationship between use of a computerized order set and processes of care in inpatient pediatric asthma treatment, and qualitatively assessed user attitudes toward order set use.The study population included 790 patients with a primary diagnosis of asthma admitted to Columbus Children's Hospital between November 1, 2001 and November 30, 2003. Rates of systemic corticosteroid (SCS) use, metered‐dose inhaler use, and pulse oximetry (PulseOx) were calculated for three patient groups: those admitted prior to order set implementation (‘pre‐set’); those admitted after implementation but without the order set used (‘no set’); and those admitted after implementation with the order set used (‘set’). Financial measures of length of stay, total charges, and pharmacy char...
Journal of the American Medical Informatics Association, 2005
To describe strategies that organizations select to support physicians' use of handheld computers... more To describe strategies that organizations select to support physicians' use of handheld computers (HHCs) in clinical practice and to explore issues about facilitating HHC use. Design: A multidisciplinary team used focus groups and interviews with clinical, administrative, and information technology (IT) staff to gather data from 161 informants at seven sites. Transcripts were coded using a combination of deductive and inductive approaches to both answer research questions and identify patterns and themes that emerged in the data. Measurements: Answers to questions about strategies for HHC support and themes about (1) how to facilitate physician adoption and use and (2) organizational concerns. Results: Three main organizational strategies for HHC support were characterized among sites: (1) active support for broad-based use, (2) active support for niche use, and (3) basic support for individual physician users. Three high-level themes emerged around how to best facilitate physician adoption and use of HHCs: (1) improving usability and usefulness, (2) promoting HHCs and device use, and (3) providing training and support. However, four major themes also emerged related to organizations' concerns about HHC use: (1) security-related concerns, (2) economic concerns, (3) technical concerns, and (4) strategic concerns. An organizational approach to HHC support that involves individualized attention to existing and potential physician users rather than one-size-fits-all, organization-wide implementation efforts was an important facilitator promoting physician use of HHCs. Health care organizations interested in supporting HHC use must consider issues related to security, economics, and IT strategy that may not be prominent concerns for physician users.
International Journal of Medical Informatics, 2008
The purpose of this study is four-fold. First, the hospitals' current level of computerized physi... more The purpose of this study is four-fold. First, the hospitals' current level of computerized physician order entry (CPOE) adoption is reported; second, internal and external influence factors' roles in determining CPOE adoption rates are described; third, the future diffusion rate of CPOE systems in US hospitals is empirically predicted; finally, the current technology's state-of-the-art is assessed. Data source: Secondary data from 3 years of the Leapfrog Group's annual survey (2002)(2003)(2004) of US tertiarycare hospitals. Study design: This study estimates CPOE market penetration rates applying technology diffusion theory and Bass modeling techniques for three future CPOE adoption scenarios-‗Optimistic,' ‗Best estimate', and ‗Conservative' are empirically derived. Principal findings: Two of the CPOE adoption scenarios have diffusion S-curve that indicates a technology will achieve significant market penetration. Under current conditions, CPOE adoption in urban hospitals will not reach 80% penetration until 2029. The promise of improved quality of care through medication error reductions and significant cost controls prompted the Institute of Medicine to call for universal CPOE adoption by 1999. However, the CPOE products available as of 2006 represent only a ‗second generation technology', characterized by many limitations. Without increased external and internal pressures, such CPOE systems are unlikely to achieve full diffusion in US hospitals in a timely manner. Alternatively, developing a new generation of CPOE technology that is more ‗user-friendly' and easily integrated into hospitals' legacy systems may be a more expedient approach to achieving widespread adoption.
An Exploratory Study of How Trust in Health Care Institutions Varies across African American, Hispanic and white Populations
Communication and Medicine, 2011
Background: Minority and non-minority patients in the United States have different levels of trus... more Background: Minority and non-minority patients in the United States have different levels of trust in health care; however, few studies have examined how determinants of trust and distrust in health care vary across diverse groups. Objective: To explore how trust in health care institutions varies across diverse populations. Methods: We conducted 17 focus groups with 117 participants in Chicago: 9 with African American, 5 with Hispanic, and 3 with white participants. Discussions were audiotaped, transcribed verbatim and coded using grounded theory analysis to identify dominant themes. Results: We found a core set of factors that contribute to trust and distrust across racial/ethnic groups. In addition, there were unique factors that contributed to distrust among African Americans and Hispanics. Both of these groups discussed expectations of discrimination in the health care setting and African Americans discussed expectations of being experimented on as determinants of distrust. Bas...
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Papers by A. McAlearney