A critical review of recent US market level health care strategy literature

Does Nursing Home Ownership Change Affect Family Ratings on Experience with Care?

Person-centeredness may suffer in nursing homes (NHs) with recent ownership changes. This study identifies associations between ownership change and reported care experiences, important measures of person-centered care for long-term residents in Maryland NHs. Care experience measures and ownership change data were collected from Maryland Health Care Commission reports, which reported data on 220 Maryland NHs from 2011 and 2012. Facility and market covariates were obtained from 2011 NH Compare and Area Health Resource Files. Linear regression was used to examine whether ownership change in 2011 was associated with lower care experience ratings reported during April to June 2012. Dependent variables were overall care rating (scale 1-10), percentage of respondents answering that they would recommend the NH, and assessments of five care and resident life domains (scale 1-4). Care experiences reported in 2012 were high; however, after controlling for covariates, ownership change was associated with significant decreases in 6 out of 7 measures, including a 0.39-point decrease in overall care rating (p = .001). NH managers and policy makers should consider strategies to improve patient-centeredness after ownership change.

Readying health services for climate change: a policy framework for regional development

Climate change presents the biggest threat to human health in the 21st century. However, many public health leaders feel ill equipped to face the challenges of climate change and have been unable to make climate change a priority in service development. I explore how to achieve a regionally responsive whole-of-systems approach to climate change in the key operational areas of a health service: service governance and culture, service delivery, workforce development, asset management, and financing. The relative neglect of implementation science means that policymakers need to be proactive about sourcing and developing models and processes to make health services ready for climate change. Health research funding agencies should urgently prioritize applied, regionally responsive health services research for a future of climate change.

Medical home infrastructure: effect of the environment and practice characteristics on adoption in Virginia

This study examined whether environmental factors and practice characteristics influence the existence of patient-centered medical home elements in family practices in Virginia. The study used multiple secondary data sets to measure the external environment and a survey of family practices to enumerate and describe medical home elements and practice environment. Results show a positive association between organizational slack, organizational relationships, and stakeholder expectations on the existence of medical home elements. A negative association was found between competition and medical home elements. Medicare and managed care penetration were not associated with medical home elements. The ability or willingness, or both, of family practices to innovate along the patient-centered medical home model is constrained by important institutional and resource dependencies, and policy makers should take these constraints into account if there is to be widespread adoption of a medical home approach to fee-for-service practices.

Using rural and remote settings in the undergraduate medical curriculum: AMEE Guide No. 47

The goal of global equity in health care requires that the training of health-care professionals be better tuned to meet the needs of the communities they serve. In fact medical education is being driven into isolated communities by factors including workforce undersupply, education pedagogy, medical practice and research needs. Rural and remote medical education (RRME) happens in rural hospitals and rural general practices, singly or in combination, generally for periods of 4 to 40 weeks. An effective RRME programme matches the context of the local health service and community. Its implementation reflects the local capacity for providing learning opportunities, facilitates collaboration of all participants and capitalises on local creativity in teaching. Implementation barriers stem from change management, professional culture and resource allocation. Blending learning approaches as much as technology and local culture allow is central to achieving student learning outcomes and professional development of local medical teachers. RRME harnesses the rich learning environment of communities such that students rapidly achieve competence and confidence in a primary care/generalist setting. Longer programmes with an integrated (generalist) approach based in the immersion learning paradigm appear successful in returning graduates to rural practice and a career track with a quality lifestyle.

Environmental scanning as a moderator of strategy–performance relationships: an empirical analysis of physical therapy facilities

To date, strategic management research in health care is largely confined to the acute care sector of the industry. This research examines the linkages among environmental scanning, competitive strategy and performance in physical therapy facilities. Nontrivial differences between acute and subacute care firms suggest the role of environmental scanning may change in non-acute care settings. Consistent with previous research, these results indicate that the frequency of internal and external scanning is related to the strategic orientation of physical therapy facilities. Contrary to the expectations, broader scope of scanning is positively related to an increasing market-focused and increasing efficiency strategic orientation. A key objective of the research is to test the impact of strategy/scanning alignment on facility performance. These findings support predictions on the moderating role of scanning activities in the strategy–performance relationship. However, a para-doxical pattern of results has possible implications for clinician managers in subacute care settings as well as the interpretation of scanning activities.

Strategy as simple rules: understanding success in a rural clinic

Drawing on chaos and complexity theories, we apply the concept of "strategy as simple rules" to analyze the success of one rural health clinic. We document how such rules may emerge as success is viewed retrospectively. We describe four simple rules that emerged in this setting and explicate how our case analysis may assist other rural providers.