Search results

The purpose of the study was to explore in literature what different leadership styles and behaviors of head nurses have a positive influence on the outcomes of patient safety or quality of care.

We reviewed the literature from January 2000 until September 2011. We searched Pubmed, Embase, Cinahl, Psychlit, and Econlit.

We found 10 studies addressing the relationship between head nurse leadership and safety and quality. A wide array of styles and practices were associated with different patient outcomes. Transformational leadership was the most used concept in the studies. A trend can be observed over these studies suggesting that a trustful relationship between the head nurse and subordinates is an important driving force for the achievement of positive patient outcomes. Furthermore, the effects of these trustful relationships seem to be amplified by supporting mechanisms, often objective conditions like clinical pathways and, especially, staffing level.

This study offers an up-to-date review of the limited number of studies on the relationship between nurse leadership and patient outcomes. Although mostly transformational leadership was found to be responsible for positive associations with outcomes, also contingent reward had positive influence on outcomes. We formulated some comments on the predominance of the transformational leadership concept and suggested the application of complexity theory and political leadership for the current context of care. We formulated some implications for practice and further research, mainly the need for more systematic empirical and cross cultural studies and the urgent need for the development of a validated set of nurse-sensitive patient outcome indicators.

Early writings about teamwork in healthcare emphasized that healthcare providers needed to evolve from a team of experts into an expert team. This is no longer enough. As patients, accreditation bodies, and regulators increasingly demand that care is coordinated, safe, of high quality, and efficient, it is clear that healthcare organizations increasingly must function and learn not only as expert teams but also as expert multiteam systems (MTSs).

In this chapter, we offer a portrait of the robust, and albeit complex, multiteam structures that many healthcare systems are developing in order to adapt to rapid changes in regulatory and financial pressures while simultaneously improving patient safety, quality, and performance.

The notion of continuous improvement rooted in continuous learning has been embraced as a battle cry from the boardroom to the bedside, and the MTS concept offers a meaningful lens through which we can begin to understand, study, and improve these complex organizational systems dedicated to tackling some of the most important goals of our time.

As the new Patient Protection and Affordable Care Act (ACA) achieves full implementation in 2014–2015, public perceptions regarding improvement in access and quality of care due to the ACA provide a fertile area for sociological research. The aim of this chapter is to determine if race is independently associated with perceptions of quality of care and access to care after ACA implementation. And, secondarily, we examined if such a relationship remained stable after considering SES (education and income) alone and SES with other relevant individual characteristics.

Data come from a telephone survey of a representative sample of Georgia residents aged 18 years or older. For each domain of the dependent variables (quality of care and access to care), three models were fitted with a nested design. The first model included only race. The second model included only race and SES. Model 3 included race, SES, and the following individual characteristics: (1) self-rated health status; (2) sense of coherence (SOC; a construct used to explain why some people are more disposed than others to illness after stressful situations); (3) travel time to doctor’s office; (4) importance of short wait times as doctor’s office; (5) political affiliation; and (6) geographic location (rural/non-rural).

Race was significantly associated with both the quality of care and the access to care. Non-White respondents were more likely to perceive improvements to both as a result of the ACA. Likewise, respondents with either higher education or income were also more likely to perceive improvements in quality and access as a result of the ACA. However, these associations were partly explained by respondents’ self-reported political affiliations.

Results of this study show that public perceptions toward the ACA and its impact on quality and access to care seem to differ based on an individuals’ race, income level and political affiliation. This may be a reflection of the media blitzkrieg that surrounds the ACA rather than a direct consequence of the policy itself. A concerted effort to develop communication strategies and outreach efforts by race and SES that can better educate the general population on the ACA may alleviate some of the reservations that are inherent to any major policy implementation, especially in terms of healthcare quality and access.

Nursing facility inspections routinely produce statistics revealing sharp disparities in care at both the facility and the state level. But whether high rates of deficiencies are more indicative of stringent enforcement of standards, leading to improved care, or ongoing poor quality care remains unclear. Until this question is answered, families of nursing facility residents, responsible public officials and interested professionals, are all unable to make sound decisions about long-term care quality. We employ cross-sectional, panel data to compare states on multiple indices of both care quality and enforcement stringency. We use the multi-method-multi-trait approach to distinguish these concepts. We find that low rates of deficiencies are positively associated with independent measures of high quality care. But, a prominent nursing facility enforcement index likely registers poor quality care more than stringency of enforcement since it is associated positively with independent indices of poor quality care and negatively with independent measures of enforcement. Attentive publics can have reasonable confidence that low rates of deficiencies indicate high quality care. High rates tend to reflect glaring deterioration in care quality. They are less signals of stringent enforcement than of obviously poor care which prompts more visible enforcement activities. Sadly, there is little evidence suggesting that these enforcement measures improve state-level care quality and thus reduce cross-state disparities in the quality of nursing facility long-term care. However, at least some of the factors responsible for sharp disparities in nursing facility care lie within the capacity of states to rectify even in the short term.

Purpose – The numbers of health care transparency initiatives are increasing. Despite the growing availability of quality data, there seems to be a shortage of evidence about the effects and effectiveness of such initiatives. The aim of this systematic review is to document the effects of transparency, defined as the public release of quality performance data, on hospital care outcomes.

Design/methodology/approach – Through a review of the literature, we chose 46 keywords to use in our searches and focused on empirical studies published in English between 2010 and 2015. The use of combinations of these keywords in searches of four databases (PubMed, Scopus, Web of Science, and the Cochrane Library) generated 13,849 publications. The removal of duplicates and exclusion of studies that were not empirical or not relevant to transparency and quality resulted in 39 studies to be reviewed.

Findings – Our review of the literature confirmed the growth of health care transparency efforts, led by the United States, and found mixed results regarding the effects of transparency on hospital care outcomes. For example, mortality, the most frequently researched performance measure (n = 15), exhibited this mixed pattern by having studies showing a reduction (n = 4), increase (n = 1), mixed findings (n = 4), and no significant relationship (n = 6) as a result of public release. We also found a limited number of articles related to unintended consequences of public reporting. When compared with earlier systematic reviews, there seems to be a trend in the reduction of unintended consequences. Therefore, we recommend exploration of this potential trend in future studies empirically.

Practical Implications – The research findings summarized in this systematic review can be used to understand the results of existing transparency efforts and to develop future transparency initiatives that may better enhance hospital quality performance.

Originality/value – This is the latest and most comprehensive systematic review summarizing the effects of transparency of quality metrics on hospital care outcomes.

Federal and state governments collaborate on state Medicaid nursing facility long-term care (SMNF-LTC) programs. These programs are increasingly expensive as the baby-boomers retire. Yet serious resident outcome problems continue in spite of the Centers for Medicare and Medicaid Services’ (CMS) extensive process-focused regulatory efforts. This study identifies a promising and simpler auxiliary path for improving resident outcomes.

Drawing on a longitudinal (1997–2005), 48-state data set and panel-corrected, time-series regression, we compare the effects on resident outcomes of CMS process-focused surveys and four minimally regulated program structural features on which the states vary considerably.

We find that each of these four structural features exerts a greater effect on resident outcomes than process quality.

We suggest augmenting current process-focused regulation with a less arduous approach of more extensive regulation of these program features.

To date SMNF-LTC program regulation has focused largely on member facility processes. While regulating processes is appropriate, we show that regulating program structural features directly, an arguably easier task, might well produce considerable improvement in the quality of resident outcomes.

Long-term care (LTC) homes are highly regulated settings that provide care to people living with complex health conditions who are often at the end of their lives. Mental health and quality of life are important concepts in LTC given the inherent poor health and diminished autonomy of residents living in this setting. The COVID-19 pandemic had the potential to further compound these issues through lockdowns limiting movement within and outside of LTC homes, increased fear of severe COVID-19 infections, staff shortages, and impaired communication through personal protective equipment. However, the evidence describing the effect of the pandemic on mental health and quality of life is mixed, with some studies describing increased rates of mental health concerns and others presenting modest increases or decreases. Creative strategies to mitigate negative mental health consequences of lockdown included technology supported and window or outdoor visits, increased access to volunteers, and supports for families. However, the evidence in this area continues to evolve as subsequent waves of the pandemic progress. Future research may present new evidence about other strategies that became important in different stages of the pandemic.

This chapter provides an introduction to the volume and reviews some issues related to access, quality and satisfaction with care as three critical concepts in health services and health care delivery. In addition to this review of some of the material on access, quality and satisfaction with care, this chapter also serves as an introduction to the volume. As such, the chapter explains the organization of the volume and briefly comments on each of the chapters included in the volume.

Researchers recommend a reorganization of the medical profession into larger groups with a multispecialty mix. We analyze whether there is evidence for the superiority of these models and if this organizational transformation is underway.

We summarize the evidence on scale and scope economies in physician group practice, and then review the trends in physician group size and specialty mix to conduct survivorship tests of the most efficient models.

The distribution of physician groups exhibits two interesting tails. In the lower tail, a large percentage of physicians continue to practice in small, physician-owned practices. In the upper tail, there is a small but rapidly growing percentage of large groups that have been organized primarily by non-physician owners.

While our analysis includes no original data, it does collate all known surveys of physician practice characteristics and group practice formation to provide a consistent picture of physician organization.

Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices.

Larger, multispecialty groups have been primarily organized by non-physician owners in vertically integrated arrangements. There is little evidence supporting the efficiencies of such models and some concern they may pose anticompetitive threats.

This is the first comprehensive review of the scale and scope economies of physician practice in nearly two decades. The research results do not appear to have changed much; nor has much changed in physician practice organization.