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Zia Ud Din M, Yuan Yuan X, Ullah Khan N, Estay C. The impact of public leadership on collaborative administration and public health delivery. BMC Health Serv Res 2024; 24:129. [PMID: 38263150 PMCID: PMC10807078 DOI: 10.1186/s12913-023-10537-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/29/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND This research depicts the linkage of public leadership on public health delivery (PHD) and collaborative administration. The research is also focused to examine the effect of public leadership on public health delivery through the intervening variable of collaborative administration by using both social information processing theory and collaboration theory. METHODS This research is based on quantitative method. Data was collected from 464 public hospital administration in the context of Pakistan. This study evaluated data using SPSS, AMOS, and PROCESS Macro. RESULTS Public leadership has a positive profound effect on public health delivery and collaborative administration, and that collaborative administration significantly promotes public health delivery. The outcomes also exposed that public leadership has substantial influence on public health delivery through intervening collaborative administration. CONCLUSIONS Whilst public leadership demonstrated positive outcomes on public health delivery and collaborative administration, there is a need for more rigor studies on collaborative governance leadership, collaborative ethics and collaborative norms in the public health service.
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Affiliation(s)
- Muhammad Zia Ud Din
- School of Public Administration, Central South University, Yuelu District, Changsha, Hunan, 410017, China
| | - Xu Yuan Yuan
- School of Public Administration, Central South University, Yuelu District, Changsha, Hunan, 410017, China.
| | - Naqib Ullah Khan
- School of Public Administration, Central South University, Yuelu District, Changsha, Hunan, 410017, China.
| | - Christophe Estay
- FERRANDI Paris (France), Lirsa, Cnam, Hesam Université, Paris, France
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Usher MG, Tignanelli CJ, Hilliard B, Kaltenborn ZP, Lupei MI, Simon G, Shah S, Kirsch JD, Melton GB, Ingraham NE, Olson AP, Baum KD. Responding to COVID-19 Through Interhospital Resource Coordination: A Mixed-Methods Evaluation. J Patient Saf 2022; 18:287-294. [PMID: 34569998 PMCID: PMC8940726 DOI: 10.1097/pts.0000000000000916] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The COVID-19 pandemic stressed hospital operations, requiring rapid innovations to address rise in demand and specialized COVID-19 services while maintaining access to hospital-based care and facilitating expertise. We aimed to describe a novel hospital system approach to managing the COVID-19 pandemic, including multihospital coordination capability and transfer of COVID-19 patients to a single, dedicated hospital. METHODS We included patients who tested positive for SARS-CoV-2 by polymerase chain reaction admitted to a 12-hospital network including a dedicated COVID-19 hospital. Our primary outcome was adherence to local guidelines, including admission risk stratification, anticoagulation, and dexamethasone treatment assessed by differences-in-differences analysis after guideline dissemination. We evaluated outcomes and health care worker satisfaction. Finally, we assessed barriers to safe transfer including transfer across different electronic health record systems. RESULTS During the study, the system admitted a total of 1209 patients. Of these, 56.3% underwent transfer, supported by a physician-led System Operations Center. Patients who were transferred were older (P = 0.001) and had similar risk-adjusted mortality rates. Guideline adherence after dissemination was higher among patients who underwent transfer: admission risk stratification (P < 0.001), anticoagulation (P < 0.001), and dexamethasone administration (P = 0.003). Transfer across electronic health record systems was a perceived barrier to safety and reduced quality. Providers positively viewed our transfer approach. CONCLUSIONS With standardized communication, interhospital transfers can be a safe and effective method of cohorting COVID-19 patients, are well received by health care providers, and have the potential to improve care quality.
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Affiliation(s)
- Michael G. Usher
- From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine
| | - Christopher J. Tignanelli
- Department of Surgery, University of Minnesota Medical School
- Institute for Health Informatics, University of Minnesota
| | - Brian Hilliard
- From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine
| | - Zachary P. Kaltenborn
- From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine
| | | | - Gyorgy Simon
- Institute for Health Informatics, University of Minnesota
| | - Surbhi Shah
- Division of Hematology and Oncology, Department of Medicine
| | - Jonathan D. Kirsch
- From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine
| | - Genevieve B. Melton
- Department of Surgery, University of Minnesota Medical School
- Institute for Health Informatics, University of Minnesota
| | - Nicholas E. Ingraham
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Andrew P.J. Olson
- From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine
| | - Karyn D. Baum
- From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine
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Le Guillou A, Chrusciel J, Sanchez S. The impact of hospital support function centralization on patient outcomes: A before-after study. PUBLIC HEALTH IN PRACTICE 2021; 2:100174. [PMID: 36101612 PMCID: PMC9461299 DOI: 10.1016/j.puhip.2021.100174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 11/02/2022] Open
Abstract
Objectives Study design Methods Results Conclusions Integrated health systems including multiple hospitals are increasingly frequent and can lead to economies of scale. We found a decrease in readmissions and average length of stay associated with the centralization of support functions. Additional studies are needed to evaluate the effect of health systems integration on patient outcomes.
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Lasater KB, Richards MR, Dandapani NB, Burns LR, McHugh MD. Magnet hospital recognition in hospital systems over time. Health Care Manage Rev 2020; 44:19-29. [PMID: 28614165 PMCID: PMC5729072 DOI: 10.1097/hmr.0000000000000167] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Magnet hospitals are recognized for nursing excellence and high-value patient outcomes, yet little is known about which and when hospitals pursue Magnet recognition. Concurrently, hospital systems are becoming a more prominent feature of the U.S. health care landscape. PURPOSE The aim of the study was to examine Magnet adoption among hospital systems over time. APPROACH Using American Hospital Association surveys (1998-2012), we characterized the proportion of Magnet hospitals belonging to systems. We used hospital level fixed-effects regressions to capture changes in a given system hospital's Magnet status over time in relation to a variety of conditions, including prior Magnet adoption by system affiliates and nonaffiliates in local and geographically distant markets and whether these relationships varied by degree of system centralization. RESULTS The proportion of Magnet hospitals belonging to a system is increasing. Prior Magnet adoption by a hospital within the local market was associated with an increased likelihood of a given system hospital becoming Magnet, but the effect was larger if there was prior adoption by affiliates (7.4% higher likelihood) versus nonaffiliates (2.7% higher likelihood). Prior adoption by affiliates and nonaffiliates in geographically distant markets had a lesser effect. Hospitals belonging to centralized systems were more reactive to Magnet adoption of nonaffiliate hospitals as compared with those in decentralized systems. CONCLUSIONS Hospital systems take an organizational perspective toward Magnet adoption, whereby more system affiliates achieve Magnet recognition over time. PRACTICE IMPLICATIONS The findings are relevant to health care and nursing administrators and policymakers interested in the diffusion of an empirically supported organizational innovation associated with quality outcomes, particularly in a time of increasing hospital consolidation and system expansion. We identify factors associated with Magnet adoption across system hospitals and demonstrate the importance of considering diffusion of organizational innovations in relation to system centralization. We suggest that decentralized system hospitals may be missing potential benefits of such organizational innovations.
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Affiliation(s)
- Karen B Lasater
- Karen B. Lasater, PhD, RN, is Postdoctoral Fellow, Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia. E-mail: . Michael R. Richards, MD, PhD, MPH, is Assistant Professor, Department of Health Policy, Vanderbilt University, Nashville, Tennessee. Nikila B. Dandapani, BA, is Research Assistant, Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia. Lawton R. Burns, PhD, MBA, is Professor and Director, Wharton Center for Health Management and Economics, University of Pennsylvania, Philadelphia. Matthew D. McHugh, PhD, JD, RN, MPH, CRNP, FAAN, is Associate Professor and Associate Director, Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia
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Abstract
BACKGROUND The Affordable Care Act introduced a major systematic change aimed to promote coordination across the care continuum. Yet, it remains unknown the extent to which hospital system structures have changed following the Affordable Care Act. The structure of hospital systems has important implications for the cost, quality, and accessibility of health services. OBJECTIVES To assess trends in the structures of hospital systems. RESEARCH DESIGN We aggregated data from the American Hospital Association (AHA) Annual Survey to the system level. Using a panel of hospital systems from 2008 to 2015, we assessed trends in the number of hospital systems, their size, ownership characteristics, geospatial arrangements, and integration with outpatient services. RESULTS In the period 2008-2015, there was an increasing percentage of hospitals that were system affiliated as well as growth in the number of hospital systems. A greater percentage of hospital systems that were organized as moderately centralized systems transitioned to centralized systems than to decentralized systems (19.8% vs. 4.7%; P<0.001). In terms of geospatial arrangement, a greater percentage of hub-and-spoke systems moved to a regional design than to national systems (20.0% vs. 8.2%; P<0.05). An increasing trend over time toward greater integration with outpatient services was found in a measure of total system level integration with outpatient services. CONCLUSIONS Our findings suggest that hospital systems may be moving toward more regional designs. In addition, the trend of increasing integration offered across hospital systems overall, and as portion of total integration, suggests that systems may be increasing their services along the continuum of care.
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Abstract
Policy Points: Policymakers seek to transform the US health care system along two dimensions simultaneously: alternative payment models and new models of provider organization. This transformation is supposed to transfer risk to providers and make them more accountable for health care costs and quality. The transformation in payment and provider organization is neither happening quickly nor shifting risk to providers. The impact on health care cost and quality is also weak or nonexistent. In the longer run, decision makers should be prepared to accept the limits on transformation and carefully consider whether to advocate solutions not yet supported by evidence. CONTEXT There is a widespread belief that the US health care system needs to move "from volume to value." This transformation to value (eg, quality divided by cost) is conceptualized as a two-fold movement: (1) from fee-for-service to alternative payment models; and (2) from solo practice and freestanding hospitals to medical homes, accountable care organizations, large hospital systems, and organized clinics like Kaiser Permanente. METHODS We evaluate whether this transformation is happening quickly, shifting risk to providers, lowering costs, and improving quality. We draw on recent evidence on provider payment and organization and their effects on cost and quality. FINDINGS Data suggest a low prevalence of provider risk payment models and slow movement toward new payment and organizational models. Evidence suggests the impact of both on cost and quality is weak. CONCLUSIONS We need to be patient in expecting system improvements from ongoing changes in provider payment and organization. We also may need to look for improvements in other areas of the economy or to accept and accommodate prospects of modest improvements over time.
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Cohen GR, Jones DJ, Heeringa J, Barrett K, Furukawa MF, Miller D, Mutti A, Reschovsky JD, Machta R, Shortell SM, Fraze T, Rich E. Leveraging Diverse Data Sources to Identify and Describe U.S. Health Care Delivery Systems. EGEMS (WASHINGTON, DC) 2017; 5:9. [PMID: 29881758 PMCID: PMC5983023 DOI: 10.5334/egems.200] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 11/17/2017] [Indexed: 11/20/2022]
Abstract
Health care delivery systems are a growing presence in the U.S., yet research is hindered by the lack of universally agreed-upon criteria to denote formal systems. A clearer understanding of how to leverage real-world data sources to empirically identify systems is a necessary first step to such policy-relevant research. We draw from our experience in the Agency for Healthcare Research and Quality's Comparative Health System Performance (CHSP) initiative to assess available data sources to identify and describe systems, including system members (for example, hospitals and physicians) and relationships among the members (for example, hospital ownership of physician groups). We highlight five national data sources that either explicitly track system membership or detail system relationships: (1) American Hospital Association annual survey of hospitals; (2) Healthcare Relational Services Databases; (3) SK&A Healthcare Databases; (4) Provider Enrollment, Chain, and Ownership System; and (5) Internal Revenue Service 990 forms. Each data source has strengths and limitations for identifying and describing systems due to their varied content, linkages across data sources, and data collection methods. In addition, although no single national data source provides a complete picture of U.S. systems and their members, the CHSP initiative will create an early model of how such data can be combined to compensate for their individual limitations. Identifying systems in a way that can be repeated over time and linked to a host of other data sources will support analysis of how different types of organizations deliver health care and, ultimately, comparison of their performance.
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Affiliation(s)
| | | | | | | | | | - Dan Miller
- Agency for Healthcare Research and Quality, US
| | | | | | | | | | - Taressa Fraze
- The Dartmouth Institute for Health Policy and Clinical Practice, US
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Shay PD, Mick SSF. Clustered and distinct: a taxonomy of local multihospital systems. Health Care Manag Sci 2016; 20:303-315. [PMID: 26780776 DOI: 10.1007/s10729-016-9353-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
Abstract
Despite their prevalence and power in markets throughout the United States, local multihospital systems (LMSs)-also referred to as hospital-based "clusters"-remain an understudied organizational form, with studies instead primarily focusing either upon individual hospitals or viewing hospital systems collectively without distinguishing the local "sub-systems" that comprise larger regional or national hospital chains. To better understand these organizational forms, we develop a taxonomy specifically devoted to LMSs, applying taxonomic analysis methods to a sample of LMSs in six U.S. states while accounting for LMSs' geographic arrangements and non-hospital-based service locations. Our analysis identifies five distinct LMS categories, with forms clearly distinguished according to their varying degrees of differentiation and integration. The study's results accentuate the importance of accounting for hospital systems' activities and arrangements in local markets-including their non-hospital-based sites-and highlight differences in systems' achievement of integration and coordination across services and locations, providing considerations in light of U.S. health system reform as well as international patterns of regional system formation.
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Affiliation(s)
- Patrick D Shay
- Department of Health Care Administration, Trinity University, One Trinity Place, #58, San Antonio, TX, 78212, USA.
| | - Stephen S Farnsworth Mick
- Department of Health Administration, School of Allied Health Professions, Virginia Commonwealth University, P.O. Box 980203, Richmond, VA, 23298, USA
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Burns LR, McCullough JS, Wholey DR, Kruse G, Kralovec P, Muller R. Is the system really the solution? Operating costs in hospital systems. Med Care Res Rev 2015; 72:247-72. [PMID: 25904540 DOI: 10.1177/1077558715583789] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 03/12/2015] [Indexed: 11/16/2022]
Abstract
Hospital system formation has recently accelerated. Executives emphasize scale economies that lower operating costs, a claim unsupported in academic research. Do systems achieve lower costs than freestanding facilities, and, if so, which system types? We test hypotheses about the relationship of cost with membership in systems, larger systems, and centralized and local hub-and-spoke systems. We also test whether these relationships have changed over time. Examining 4,000 U.S. hospitals during 1998 to 2010, we find no evidence that system members exhibit lower costs. However, members of smaller systems are lower cost than larger systems, and hospitals in centralized systems are lower cost than everyone else. There is no evidence that the system's spatial configuration is associated with cost, although national system hospitals exhibit higher costs. Finally, these results hold over time. We conclude that while systems in general may not be the solution to lower costs, some types of systems are.
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Affiliation(s)
| | | | | | | | | | - Ralph Muller
- University of Pennsylvania, Philadelphia, PA, USA
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Burns LR, Goldsmith JC, Sen A. Horizontal and vertical integration of physicians: a tale of two tails. Adv Health Care Manag 2013; 15:39-117. [PMID: 24749213 DOI: 10.1108/s1474-8231(2013)0000015009] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE 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. DESIGN/METHODOLOGY APPROACH: 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. FINDINGS 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. RESEARCH LIMITATIONS 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. RESEARCH IMPLICATIONS Our review suggests that scale and scope economies in physician practice are limited. This may explain why most physicians have retained their small practices. PRACTICAL IMPLICATIONS 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. ORIGINALITY/VALUE 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.
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