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Book part
Publication date: 7 February 2024

Nathan W. Carroll, Shu-Fang Shih, Saleema A. Karim and Shoou-Yih D. Lee

The COVID-19 pandemic created a broad array of challenges for hospitals. These challenges included restrictions on admissions and procedures, patient surges, rising costs of labor…

Abstract

The COVID-19 pandemic created a broad array of challenges for hospitals. These challenges included restrictions on admissions and procedures, patient surges, rising costs of labor and supplies, and a disparate impact on already disadvantaged populations. Many of these intersecting challenges put pressure on hospitals' finances. There was concern that financial pressure would be particularly acute for hospitals serving vulnerable populations, including safety-net (SN) hospitals and critical access hospitals (CAHs). Using data from hospitals in Washington State, we examined changes in operating margins for SN hospitals, CAHs, and other acute care hospitals in 2020 and 2021. We found that the operating margins for all three categories of hospitals fell from 2019 to 2020, with SNs and CAHs sustaining the largest declines. During 2021, operating margins improved for all three hospital categories but SN operating margins still remained negative. Both changes in revenue and changes in expenses contributed to observed changes in operating margins. Our study is one of the first to describe how the financial effects of COVID-19 differed for SNs, CAHs, and other acute care hospitals over the first two years of the pandemic. Our results highlight the continuing financial vulnerability of SNs and demonstrate how the factors that contribute to profitability can shift over time.

Details

Research and Theory to Foster Change in the Face of Grand Health Care Challenges
Type: Book
ISBN: 978-1-83797-655-3

Keywords

Article
Publication date: 18 July 2023

Linda H. Chen, Leslie Eldenburg and Theodore H. Goodman

The purpose of this study is to investigate how two types of drivers, namely, executive compensation and market competition, can affect hospital quality in the USA. Recently…

Abstract

Purpose

The purpose of this study is to investigate how two types of drivers, namely, executive compensation and market competition, can affect hospital quality in the USA. Recently, patients, insurers and regulators have increasingly focused on hospital quality. Understanding the interplay of incentives in this industry is important because in 2019, hospital treatment contributed $1.161bn to health-care costs in the USA. This study answers the call for more studies in the so-called “mixed” industry, where ownership differences can affect organizational objectives and operating constraints.

Design/methodology/approach

This study explores the roles of hospital executive compensation and industry competition as determinants of health-care quality. Specifically, the study probes the heterogeneity in the factors that influence quality across hospital types in the USA.

Findings

Using California hospital data from 2006 through 2020, the findings show that the effects of compensation and competition on hospital quality differ by ownership type. Executive compensation is positively associated with quality in for-profit hospitals but is not associated with that of nonprofit hospitals, suggesting for-profit hospitals are more likely to use higher levels of compensation to attract managers with higher ability, whereas the utility function for nonprofit managers may be multidimensional. Within the nonprofit hospital group, competition is more positively associated with quality for religious nonprofits relative to secular nonprofits, suggesting that competition provides more monitoring for religious hospitals.

Originality/value

Taken together, the findings provide evidence that the drivers of quality vary across hospitals in ways consistent with differences in constraints and objectives across ownership types. The findings are important for regulators seeking to incentivize higher quality. For example, Medicare in the USA has incorporated quality measures into its new hospital reimbursement scheme (value-based purchasing) to incentivize quality. This study proposes that regulators should consider differences across ownership types when evaluating the best ways to incentivize hospital quality.

Details

Review of Accounting and Finance, vol. 22 no. 4
Type: Research Article
ISSN: 1475-7702

Keywords

Abstract

Details

Occupational Therapy With Older People into the Twenty-First Century
Type: Book
ISBN: 978-1-83753-043-4

Article
Publication date: 7 December 2022

Sarah Lake, Trudy Rudge and Sandra West

This paper aims to explore how dispositions of nursing habitus carry shift handover into practice in acute care.

Abstract

Purpose

This paper aims to explore how dispositions of nursing habitus carry shift handover into practice in acute care.

Design/methodology/approach

Handover (the exchange of information by nurses between shifts) is more recently purported to be a procedure that transfers the responsibility of and accountability for care to maintain patient safety. Using Bourdieu's theory of practice as lens, this paper examines data from an ethnographic study of nurses' work in acute care to reveal what happens in and around nurses' practices of handover.

Findings

Exploring handover as a practice enables identification of nurses' responsibilities of work as professional, clinician and employee. These responsibilities are not practised separately, rather, as braided identities they are embodied into nurses' practices of work. Nurses' clinician and employee identities address the clinical and organisationally relevant material contained in handover, but it is in the ways that nurses embody their responses that their professional identity becomes evident.

Research limitations/implications

Viewing handover as a procedure suggests that nurses are rule followers and/or sole players and conceptualises nurses as individualised professionals only. This received knowledge as doxa misrecognises the centrality of connectedness between nurses in their work in the acute care setting.

Originality/value

Recognising nurses' braided workplace identities as being professional, clinician and employee upends the doxa of nurses work as tasks and roles in the delivery of healthcare in the acute care setting.

Details

Journal of Organizational Ethnography, vol. 12 no. 1
Type: Research Article
ISSN: 2046-6749

Keywords

Article
Publication date: 31 July 2023

Mélanie Lefèvre, Jens Detollenaere, Renate Zeevaert and Carine Van de Voorde

Many countries have developed hospital-at-home (HAH) models to bring hospital services closer to home. Although some countries already have a long tradition of HAH for adults…

Abstract

Purpose

Many countries have developed hospital-at-home (HAH) models to bring hospital services closer to home. Although some countries already have a long tradition of HAH for adults, paediatric HAH has been developed more recently. Specificities of paediatric care make it difficult to directly extend an adult HAH model to the paediatric population. The objective of this study is to compare the organisation of paediatric HAH in four countries: France, Australia (states of Victoria and New South Wales), the Netherlands and Belgium. Ultimately, lessons can be drawn for further development in the countries analysed and/or for implementation in other countries.

Design/methodology/approach

Legal documents and other grey literature were analysed to describe the legal context for the provision of paediatric HAH in the selected countries. In addition, semi-structured in-depth interviews were conducted with key informants from paediatric HAH organisations in these countries, addressing the following topics: historical background, legal framework, functioning of HAH models, workforce, number of services, profile of children, type of care activities, funding, coordination with other providers and quality of care. Results were reviewed by a content expert from the respective country.

Findings

Organisational differences were highlighted in terms of coordinating actor (hospital or home nursing care services), decision-making process, range of clinical conditions treated, territorial organisation, qualifications and expertise of the team members, medical expertise, financing, responsibilities, etc.

Originality/value

There is no single preferred model for the provision of HAH care for children. There is a large variety in almost all aspects of organisation. There are, however, also some common characteristics across the different models. Notably, paediatric expertise of nurses within the HAH team was considered indispensable in all programmes.

Details

Journal of Integrated Care, vol. 31 no. 3
Type: Research Article
ISSN: 1476-9018

Keywords

Book part
Publication date: 7 February 2024

Maike Tietschert, Sophie Higgins, Alex Haynes, Raffaella Sadun and Sara J. Singer

Designing and developing safe systems has been a persistent challenge in health care, and in surgical settings in particular. In efforts to promote safety, safety culture, i.e.…

Abstract

Designing and developing safe systems has been a persistent challenge in health care, and in surgical settings in particular. In efforts to promote safety, safety culture, i.e., shared values regarding safety management, is considered a key driver of high-quality, safe healthcare delivery. However, changing organizational culture so that it emphasizes and promotes safety is often an elusive goal. The Safe Surgery Checklist is an innovative tool for improving safety culture and surgical care safety, but evidence about Safe Surgery Checklist effectiveness is mixed. We examined the relationship between changes in management practices and changes in perceived safety culture during implementation of safe surgery checklists. Using a pre-posttest design and survey methods, we evaluated Safe Surgery Checklist implementation in a national sample of 42 general acute care hospitals in a leading hospital network. We measured perceived management practices among managers (n = 99) using the World Management Survey. We measured perceived preoperative safety and safety culture among clinical operating room personnel (N = 2,380 (2016); N = 1,433 (2017)) using the Safe Surgical Practice Survey. We collected data in two consecutive years. Multivariable linear regression analysis demonstrated a significant relationship between changes in management practices and overall safety culture and perceived teamwork following Safe Surgery Checklist implementation.

Details

Research and Theory to Foster Change in the Face of Grand Health Care Challenges
Type: Book
ISBN: 978-1-83797-655-3

Keywords

Article
Publication date: 4 November 2022

Atsushi Katsuda, Yoshiyuki Naito and Toshihiko Ishihara

In Japan, health-care systems have long been supported by physicians' long working hours. To solve this problem, there is an urgent need to improve the working environment for…

Abstract

Purpose

In Japan, health-care systems have long been supported by physicians' long working hours. To solve this problem, there is an urgent need to improve the working environment for physicians while practicing patient-centered medicine and controlling health-care costs. This paper aims to examine the effect of task shifting to nurses and discuss its usefulness from the perspective of health-care value co-creation.

Design/methodology/approach

This paper analyzes task shifting to nurses in acute care hospitals in Japan as a solution for the shortage of anesthesiologists. The authors discuss how the value was created from the perspective of the health-care ecosystem, with conceptual consideration of the value co-creation mechanism through patient-centered practices.

Findings

The study showed that task shifting initiatives in Japan can improve the motivation of nurses through human resource development while maintaining high quality. The study also suggested that task shifting from physicians to nurses may contribute to improving net income and maintaining the health-care system.

Practical implications

The findings are highly reproducible and can be immediately applied to initiatives at other medical institutions in Japan. Furthermore, it is suggested that these findings might provide some perspective on the realignment of fragmented healthcare in the USA.

Originality/value

It was confirmed in practical terms that micro-level initiatives have an impact on the macro level as well. In addition, the academic presentation of the concept has contributed to the deepening of value research.

Details

The TQM Journal, vol. 36 no. 3
Type: Research Article
ISSN: 1754-2731

Keywords

Article
Publication date: 25 May 2023

Miguel Vega and Joao Vieira da Cunha

The purpose of this study is to examine the management perceptions towards calculative practices behind the reconstruction of a mandatory hospital accreditation (HA) system that…

Abstract

Purpose

The purpose of this study is to examine the management perceptions towards calculative practices behind the reconstruction of a mandatory hospital accreditation (HA) system that transforms multiple facets of health-care quality into a single performance index.

Design/methodology/approach

This study contributes to the sociology of quantification mobilising the concept of commensuration as a social process to reflect on contemporary changes in managing HA systems. Data are collected adopting a case study of a Spanish public hospital drawing on semi-structured interviews, observation and documentary review.

Findings

Findings emphasise a shift from standards’ compliance to a more comprehensive view encouraging continuous quality improvement. Accreditation acts as a tin opener to facilitate external inspection removing contextual differences amongst hospitals and reducing organisational practices into controllable objects. It also reveals underlying ethical concerns as the system was built as a care quality measure that promptly developed into an attainment goal.

Practical implications

The valuable role of HA to enhance quality standards and the limitations resulting from its commensuration practices will be of interest to policymakers, organisational managers and researchers.

Originality/value

Despite a growing emphasis on audit and valuation practices in health care, accounting studies examining the capacity of public hospitals to manage quality improvement are scarce. This study inspires further research on accreditation to overcome commensuration flaws regarding external transparency, evaluation ambiguity and extra incentives.

Details

Journal of Accounting & Organizational Change, vol. 19 no. 4
Type: Research Article
ISSN: 1832-5912

Keywords

Content available
Book part
Publication date: 7 February 2024

Abstract

Details

Research and Theory to Foster Change in the Face of Grand Health Care Challenges
Type: Book
ISBN: 978-1-83797-655-3

Book part
Publication date: 5 April 2024

Zhichao Wang and Valentin Zelenyuk

Estimation of (in)efficiency became a popular practice that witnessed applications in virtually any sector of the economy over the last few decades. Many different models were…

Abstract

Estimation of (in)efficiency became a popular practice that witnessed applications in virtually any sector of the economy over the last few decades. Many different models were deployed for such endeavors, with Stochastic Frontier Analysis (SFA) models dominating the econometric literature. Among the most popular variants of SFA are Aigner, Lovell, and Schmidt (1977), which launched the literature, and Kumbhakar, Ghosh, and McGuckin (1991), which pioneered the branch taking account of the (in)efficiency term via the so-called environmental variables or determinants of inefficiency. Focusing on these two prominent approaches in SFA, the goal of this chapter is to try to understand the production inefficiency of public hospitals in Queensland. While doing so, a recognized yet often overlooked phenomenon emerges where possible dramatic differences (and consequently very different policy implications) can be derived from different models, even within one paradigm of SFA models. This emphasizes the importance of exploring many alternative models, and scrutinizing their assumptions, before drawing policy implications, especially when such implications may substantially affect people’s lives, as is the case in the hospital sector.

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