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Andersen‐Hollekim T, Hole T, Solbjør M. Exploring Healthcare Paradoxes in Hospital Haemodialysis-A Qualitative Study. Health Expect 2024; 27:e70000. [PMID: 39212122 PMCID: PMC11362838 DOI: 10.1111/hex.70000] [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: 02/04/2024] [Revised: 07/02/2024] [Accepted: 07/04/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION The complex logics of healthcare systems inherit paradoxes that can lead to interpersonal conflicts impacting both patients and professionals. In this study, we aimed to identify and explore tensions and conflicts arising from paradoxes within hospital haemodialysis. METHODS We conducted a secondary supplementary analysis to previously collected qualitative data, including individual interviews with 11 patients and 10 nephrologists and focus groups involving a total of 13 haemodialysis nurses. Data were collected in Norway through three primary studies focused on exploring experiences of patient participation. For the current study, we employed thematic analysis. RESULTS Patient-professional conflicts emerged in three fundamental areas: (1) the hospital haemodialysis treatment, in which patients' views of treatment diverged from those of professionals, (2) patient-professional responsibility that became a negotiation point, with differing views on responsibilities, and (3) time, in which professional time took precedence over patients' time, indirectly impacting patients due to resource allocation. These conflicts stemmed from paradoxes driven by unevenly validated principles, conflict of interest, and conceptual ambiguity. CONCLUSION Altering healthcare logics by bringing in new perspectives or clarifying conceptual ambiguity could mitigate patient-professional conflicts. However, changing existing healthcare logics may give rise to new paradoxes and conflicts, which health services at various levels must address. PATIENT OR PUBLIC CONTRIBUTION This secondary analysis utilized previously collected data from a project that did not involve patient or public contribution.
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Affiliation(s)
- Tone Andersen‐Hollekim
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Torstein Hole
- Medical Department, Ålesund Hospital, Møre og Romsdal Hospital Trust, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Marit Solbjør
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
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Gifford R, van Raak A, Govers M, Westra D. Back to the Future: What Healthcare Organizations Need to Thrive in the Face of Persistent Environmental Uncertainty. Adv Health Care Manag 2024; 22:3-27. [PMID: 38262008 DOI: 10.1108/s1474-823120240000022001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
While uncertainty has always been a feature of the healthcare environment, its pace and scope are rapidly increasing, fueled by myriad factors such as technological advancements, the threat and frequency of disruptive events, global economic developments, and increasing complexity. Contemporary healthcare organizations thus persistently face what is known as "deep uncertainty," which obscures their ability to predict outcomes of strategic action and decision-making, presenting them with novel challenges and threatening their survival. Persistent, deep uncertainty challenges us to revisit and reconsider how we think about uncertainty and the strategic actions needed by organizations to thrive under these circumstances. Simply put, how can healthcare organizations thrive in the face of deeply uncertain environments? We argue that healthcare organizations need to employ both adaptive and creative strategic approaches in order to effectively meet patients' needs and capture value in the long-term future. The chapter concludes by offering two ways organizations can build the dynamic capabilities needed to employ such approaches.
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Through the looking glass: Confronting health care management's biggest challenges in the wake of a crisis. Health Care Manage Rev 2023; 48:185-196. [PMID: 36792956 PMCID: PMC9970016 DOI: 10.1097/hmr.0000000000000365] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND The challenges brought on by the pandemic triggered a renewed scholarly focus on managing during crises. Now, 3 years on, having covered the initial crisis response, it is important to reevaluate what the crisis has taught us about health care management more generally. In particular, it is useful to consider the persistent challenges that continue to face health care organizations in the wake of a crisis. PURPOSE The present article aims to identify the biggest challenges that currently face health care managers in order to formulate a postcrisis research agenda. METHODOLOGY/APPROACH We employ an exploratory qualitative study, utilizing in-depth interviews with hospital executives and management to explore the persistent challenges facing managers in practice. RESULTS Our qualitative inquiry reveals three key challenges that extend beyond the crisis and are salient for health care managers and organizations in the years to come. Specifically, we identify the centrality of human resource constraints (amidst increasing demand), the necessity of collaboration (amidst competition), and a need to reconsider the approach to leadership (utility of humility). CONCLUSION We conclude by drawing upon relevant theories such as paradox theory to formulate a research agenda for health care management scholars that can support the creation of novel solutions and approaches to persistent challenges in practice. PRACTICE IMPLICATIONS We identify several implications for organizations and health systems, including the need to eliminate competition and the importance of building human resource management capacities within organizations. In highlighting areas for future research, we provide organizations and managers with useful and actionable insights to address their most persistent challenges in practice.
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Gabay G, Netzer D, Elhayany A. Shared trust of resident physicians in top‐management and professional burnout: A cross‐sectional study towards capacity for patient‐focussed care, peer support and job expectations. Int J Health Plann Manage 2022; 37:2395-2409. [DOI: 10.1002/hpm.3479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 01/27/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
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Côté-Boileau É, Breton M, Rouleau L, Denis JL. Appropriating integrated performance management tools in healthcare: a sociomaterial work story. J Health Organ Manag 2021; ahead-of-print. [PMID: 34873898 DOI: 10.1108/jhom-01-2021-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to explore the appropriation of control rooms based on value-based integrated performance management tools implemented in all publicly funded health organizations in Quebec (Canada) as a form of legitimate sociomaterial work. DESIGN/METHODOLOGY/APPROACH Multi-site organizational ethnographic case studies in two Integrated health and social services centers, with narrative process analysis of triangulated qualitative data collected through non-participant observation (163 h), individual semi-structured interviews (N = 34), and document review (N = 143). FINDINGS Three types of legitimate sociomaterial work are accomplished when actors appropriate control rooms: 1) reformulating performance management work; 2) disrupting accountability work and; 3) effecting value-based integrated performance management. Each actor (tools, institutions and people) follows recurrent institutional work-paths: tools consistently engage in disruptive work; institutions consistently engage in maintaining work, and people consistently engage in creation work. The study reveals the potential of performance management tools as "effective integrators" of the technological, managerial, policy and delivery levels of data-driven health system performance and improvement. PRACTICAL IMPLICATIONS This paper draws on theoretically informed empirical insights to develop actionable knowledge around how to better design, implement and adapt tool-driven health system change: 1) Packaging the three agents of data-driven system change in health care: tools, institutions, people; 2) Redefining the search for performance in health care in the context of value creation, and; 3) Strengthening clinical and managerial relevance in health performance management practice. ORIGINALITY/VALUE The authors aim to stimulate new and original scholarship around the under-theorized concept of sociomaterial work, challenging theoretical, ontological and practical conceptions of work in healthcare organizations and beyond.
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Affiliation(s)
- Élizabeth Côté-Boileau
- Health Sciences Research, Faculty of Medicine and Health Sciences, University of Sherbrooke, Fonds de recherche du Québec - Santé, Montreal, Canada
| | - Mylaine Breton
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Charles-Le Moyne Hospital Research Center, University of Sherbrooke, Longueuil, Canada
| | - Linda Rouleau
- Department of Management, HEC Montreal, Montreal, Canada
| | - Jean-Louis Denis
- Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal Hospital Research Center, University of Montreal, Montreal, Canada
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Boumans J, van Boekel LC, Verbiest ME, Baan CA, Luijkx KG. Exploring how residential care facilities can enhance the autonomy of people with dementia and improve informal care. DEMENTIA 2021; 21:136-152. [PMID: 34215163 PMCID: PMC8739616 DOI: 10.1177/14713012211030501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Residential care facilities (RCFs) strive to enhance autonomy for people with dementia and to enhance informal care provision, although this is difficult. This study explored how RCF staff can enhance autonomy and improve informal care by looking at the influence of interactions (contact and approachability between residents, staff members and informal caregivers) and the physical environment, including the use of technologies. RESEARCH DESIGN AND METHODS A realist evaluation multiple-case study was conducted using document analyses, eight semi-structured interviews with staff members and relatives and 56 hours of observations of residents across two RCFs aiming to provide person-centred care. Realist logic of analysis was performed, involving Context-Mechanism-Outcome configurations. FINDINGS The behaviour, attitudes and interactions of staff members with residents and informal caregivers appeared to contribute to the autonomy of people with dementia and enhance informal care provision. The physical environment of the RCFs and the use of technologies were less relevant to enhancing autonomy and informal care provision, although they can support staff members in providing person-centred care in daily practice. DISCUSSION AND IMPLICATIONS The findings add to those of other studies regarding the importance of interaction between residents, staff members and informal caregivers. The findings provide insight for other RCFs on how successfully to enhance autonomy for their residents and to improve informal care provision, as well as, more broadly, how to implement person-centred care.
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Affiliation(s)
- Jogé Boumans
- Tranzo, Tilburg School of Social and Behavioral Sciences, 7899Tilburg University, Tilburg, Noord-Brabant, the Netherlands
| | - Leonieke C van Boekel
- Tranzo, Tilburg School of Social and Behavioral Sciences, 7899Tilburg University, Tilburg, Noord-Brabant, the Netherlands
| | - Marjolein Ea Verbiest
- Tranzo, Tilburg School of Social and Behavioral Sciences, 7899Tilburg University, Tilburg, Noord-Brabant, the Netherlands
| | - Caroline A Baan
- Tranzo, Tilburg School of Social and Behavioral Sciences, 7899Tilburg University, Tilburg, Noord-Brabant, the Netherlands; Ministry of Health, Welfare and Sports, The Hague, the Netherlands
| | - Katrien G Luijkx
- Tranzo, Tilburg School of Social and Behavioral Sciences, 7899Tilburg University, Tilburg, Noord-Brabant, the Netherlands
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Engle RL, Mohr DC, Holmes SK, Seibert MN, Afable M, Leyson J, Meterko M. Evidence-based practice and patient-centered care: Doing both well. Health Care Manage Rev 2021; 46:174-184. [PMID: 31233424 PMCID: PMC8162222 DOI: 10.1097/hmr.0000000000000254] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Health care organizations increasingly strive to deliver care that is both evidence based and patient centered. Although often complementary, fundamental contradictions may exist between these goals, and the organizational culture and infrastructure necessary to be successful in one domain may inherently diminish performance in the other. PURPOSE We assessed the relationship between evidence-based practice (EBP) and patient-centered care (PCC) by seeking to identify specific behavioral and process mechanisms, along with organizational characteristics that distinguish medical centers that are able to provide inpatient care that is both evidence based and patient centered from those where performance is either mixed or low in both domains. METHODOLOGY/APPROACH We analyzed interview data from 142 employees at 12 Veterans Affairs Medical Centers selected based on EBP and PCC performance (high, low, or mixed) using a priori constructs consistent with organizational literature, as well as emergent themes. RESULTS We confirmed that tensions may arise when attempting to deliver both EBP and PCC and found unique characteristics of organizations that do both well. High-performing sites exhibited organizational cultures of empowerment where both EBP and PCC expectations were emphasized; provided formal and informal institutional supports and structures with regard to PCC and EBP; and fostered multidisciplinary, multidirectional approaches to care and communication that facilitated delivery of both EBP and PCC. CONCLUSIONS AND PRACTICE IMPLICATIONS Organizations that excel in providing both EBP and PCC exhibit unique characteristics and processes. Recognizing that some characteristics such as culture are difficult to change, these findings nonetheless highlight areas that could be enhanced by medical centers striving to deliver care that is both evidence based and patient centered.
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Whose experience is it anyway? Toward a constructive engagement of tensions in patient-centered health care. JOURNAL OF SERVICE MANAGEMENT 2020. [DOI: 10.1108/josm-04-2020-0095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeHealthcare delivery faces increasing pressure to move from a provider-centered approach to become more consumer-driven and patient-centered. However, many of the actions taken by clinicians, patients and organizations fail to achieve that aim. This paper aims to take a paradox-based perspective to explore five specific tensions that emerge from this shift and provides implications for patient experience research and practice.Design/methodology/approachThis paper uses a conceptual approach that synthesizes literature in health services and administration, organizational behavior, services marketing and management and service operations to illuminate five patient experience tensions and explore mitigation strategies.FindingsThe paper makes three key contributions. First, it identifies five tensions that result from the shift to more patient-centered care: patient focus vs employee focus, provider incentives vs provider motivations, care customization vs standardization, patient workload vs organizational workload and service recovery vs organizational risk. Second, it highlights multiple theories that provide insight into the existence of the tensions and how they may be navigated. Third, specific organizational practices that engage the tensions and associated examples of leading organizations are identified. Relevant measures for research and practice are also suggested.Originality/valueThe authors develop a novel analysis of five persistent tensions facing healthcare organizations as a result of a shift to a more consumer-driven, patient-centered approach to care. The authors detail each tension, discuss an existing theory from organizational behavior or services marketing that helps make sense of the tension, suggest potential solutions for managing or resolving the tension and provide representative case illustrations and useful measures.
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Chu J, Wang N, Choi YS, Roby DH. The Effect of Patient-Centered Communication and Racial Concordant Care on Care Satisfaction Among U.S. Immigrants. Med Care Res Rev 2019; 78:404-412. [DOI: 10.1177/1077558719890988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Immigrants living in the United States experience disparities in satisfaction with medical care. Practicing patient-centered communication and providing racially (or race-concordant) concordant care are suggested as effective approaches to improve care satisfaction. Using the Medical Expenditure Panel Survey, we found that immigrant patients with medical providers who practiced patient-centered communication were more likely to be satisfied with the care they received regardless of patient–provider racial concordance, and that simply having racially concordant medical providers did not significantly affect the satisfaction level for immigrant patients. The findings suggest that providing patient-centered communication may mitigate racial and cultural differences between providers and patients, and is key to reducing disparities and improving immigrant patients’ satisfaction level with medical care.
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Affiliation(s)
- Jun Chu
- University of Maryland, College Park, MD, USA
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Casu G, Gremigni P, Sommaruga M. The Patient-Professional Interaction Questionnaire (PPIQ) to assess patient centered care from the patient's perspective. PATIENT EDUCATION AND COUNSELING 2019; 102:126-133. [PMID: 30098906 DOI: 10.1016/j.pec.2018.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate how patients evaluate the provision of patient-centered care (PCC) by healthcare professionals and psychometrically test a questionnaire to assess it. A tool previously developed for self-assessment of professionals' provision of PCC was adapted into a patient-rated form, named Patient-Professional Interaction Questionnaire (PPIQ). METHODS A sample of 1139 patients from six hospitals completed the 16-item PPIQ and the questionnaire structure, reliability, susceptibility to social desirability, and associations with other variables were tested. RESULTS The PPIQ confirmed the original four-factor structure (effective communication, interest in the patient's agenda, empathy, and patient involvement in care) and showed acceptable reliability and measurement invariance across both in-/out-patients and first/non-first encounter with the evaluated professional. Associations with patients' social desirability were negligible and effective communication was rated the highest among the PPIQ dimensions. PPIQ scores varied according to patients' educational level and type of professional evaluated, while associations between first/non-first encounter and PPIQ scores varied according to in-/out-patient. CONCLUSION The PPIQ is a psychometrically sound patient-rated measure of the provision of PCC by healthcare professionals. PRACTICE IMPLICATIONS The PPIQ has potential value in promoting quality patient-professional interactions in the hospital setting, as patients' reported experience is an important dimension of the clinician's performance.
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Affiliation(s)
- Giulia Casu
- Department of Psychology, University of Bologna, Italy.
| | | | - Marinella Sommaruga
- Clinical Psychology and Social Support Unit, Istituti Clinici Scientifici Maugeri - IRCCS, Milan, Italy.
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