The Impact of Market Conditions on RN Staffing in Hospitals: Using Resource Dependence Theory and Information Uncertainty Perspective

The perceived impact of physician shortages on human resource strategies in German hospitals - a resource dependency perspective

PURPOSE

Like other European countries, Germany is facing regional physician shortages, which have several consequences on patient care. This study analyzes how hospitals perceive physician shortages and which strategies they adopt to address them. As a theoretical framework, the resource dependency theory is chosen.

DESIGN/METHODOLOGY/APPROACH

The authors conducted 20 semi-structured expert interviews with human resource officers, human resource directors, and executive directors from hospitals in the northwest of Germany. Hospitals of different ownership types, of varying sizes and from rural and urban locations were included in the sample. The interviews were analyzed by using qualitative content analysis.

FINDINGS

The interviewees reported that human resource departments in hospitals expand their recruiting activities and no longer rely on one single recruiting instrument. In addition, they try to adapt their retaining measures to physicians' needs and offer a broad range of employment benefits (e.g. childcare) to increase attractiveness. The study also reveals that interviewees from small and rural hospitals report more difficulties with attracting new staff and therefore focus on recruiting physicians from abroad.

PRACTICAL IMPLICATIONS

Since the staffing situation in German hospitals will not change in the short term, the study provides suggestions for hospital managers and health policy decision-makers in dealing with physician shortages.

ORIGINALITY/VALUE

This study uses the resource dependency theory to explain hospitals' strategies for dealing with healthcare staff shortages for the first time.

Does Geographic Location Affect the Quality of Care? The Difference in Readmission Rates Between the Border and Non-Border Hospitals in Texas

Purpose

Materials and Methods

Results

Conclusion

The organizational and environmental characteristics associated with hospitals' use of intensivists

BACKGROUND

As large numbers of coronavirus disease 2019 (COVID-19) patients were admitted to intensive care units (ICUs) in 2020 and 2021, the United States faced a shortage of critical care providers. Intensivists are physicians specializing in providing care in the ICU. Although studies have explored the clinical and financial benefits associated with the use of intensivists, little is known about the organizational and market factors associated with a hospital administrator's strategic decision to use intensivists.

PURPOSE

The aim of this study was to use the resource dependence theory to better understand the organizational and market factors associated with a hospital administrator's decision to use intensivists.

METHODOLOGY

The sample consisted of the national acute care hospitals (N = 4,986) for the period 2007-2017. The dependent variable was the number of full-time equivalent intensivists staffed in hospitals. The independent variables were organizational and market-level factors. A negative binomial regression model with state and year fixed effects, clustered at the hospital level, was used to examine the relationship between the use of intensivists and organizational and market factors.

RESULTS

The results from the analyses show that administrators of larger, not-for-profit hospitals that operate in competitive urban markets with relatively high levels of munificence are more likely to utilize intensivists.

PRACTICE IMPLICATIONS

When significant strains are placed on ICUs like what was experienced during the COVID-19 pandemic, it is imperative that hospital administrators understand how to best staff their ICUs. With a better understanding of the organizational and market factors associated with the use of intensivists, practitioners and policymakers alike can better understand how to strategically utilize intensivists in the ICU, especially in the face of a continuing pandemic.

Is Rural Kansas Prepared? An Assessment of Resources Related to the COVID-19 Pandemic

Introduction

This cross-sectional study investigated rural Kansas healthcare resources relevant to COVID-19 at the county level in the context of population characteristics.

Methods

The federal Area Health Resource File was used to assess system capacity and critical care-related resources and COVID-19-related risk factors at the county level. Data were described with summary statistics, cross-tabulations, and bivariate tests to discern differences across county rurality categories (2013 Rural-Urban Continuum Codes).

Results

Kansas has 105 counties. Metropolitan counties had an average of 1.5 physicians (M.D. or D.O., any specialty) per 1,000 people, while rural counties had 0.8. A total of 63.5% of rural counties had no anesthesia providers and 100.0% of rural counties had no pulmonary disease physicians. While 96 counties have at least one hospital, nearly 90% rural counties had no intensive care unit (ICU) services. The percent of the population estimated to be over 65 was higher among rural counties (24.2%) than metropolitan counties (19.3%). On average, rural counties had nearly twice as many deaths per 1,000 people by cardiovascular disease and more chronic obstructive pulmonary disease deaths than metropolitan and nonmetropolitan/urban adjacent counties.

Conclusions

Kansas faced limited ICU capabilities and physician workforce shortages in rural counties, both in primary care and specialties such as anesthesia and pulmonology. In addition, nonmetropolitan/urban adjacent and rural population age structures and mortality rates potentially demonstrated an increased risk to overwhelm local healthcare systems. This may have serious implications for rural health, particularly in the context of the COVID-19 pandemic.