Journal Of Health And Human Services Administration[JOURNAL]
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200 papers
MAKING FEDERALISM WORK? THE POLITICS OF INTERGOVERNMENTAL COLLABORATION AND THE PPACA.
Rocco P
J Health Hum Serv Adm · 2015 · PMID 27149761
The Patient Protection and Affordable Care Act (PPACA) is a complex piece of legislation that requires a high level of collaboration between actors at multiple levels of government, federal and state, to successfully imp...
The Patient Protection and Affordable Care Act (PPACA) is a complex piece of legislation that requires a high level of collaboration between actors at multiple levels of government, federal and state, to successfully implement its provisions. However, the polarized political environment in which the law was passed has created roadblocks for implementation, with Republican governors claiming that they will not negotiate with federal agencies over many of the law's key details. Though the decisions of governors and of state legislatures are critical for policy implementation, much of the effort will require administrators at multiple levels of government, and often with different preferences, to collaborate with one another to set policy priorities and oversee the operation of key features of the law. This paper reports on the results of a recent in-depth survey of state-level administrators that examines the extent of state-federal collaboration to implement health reform. Using qualitative and quantitative indicators, I find that state administrators' engagement in collaborative activity is generally robust. Even so, state administrators' perceptions of their relationship with federal agents appear to vary by the partisan compositions of their respective states, suggesting that political conflict over the reform may pose some dilemmas for future implementation efforts.
HEALTHCARE POLICY LEGISLATION AND ADMINISTRATION: PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010.
Martin EJ
J Health Hum Serv Adm · 2015 · PMID 27149760
Abstract loading — click title to view on PubMed.
NATIONAL INCIDENCE OF MEDICAL TRANSFER: PATIENT CHARACTERISTICS AND REGIONAL VARIATION.
Reimer AP, Schiltz N, Koroukian SM … +1 more , Madigan EA
J Health Hum Serv Adm · 2016 · PMID 27079058
The aim of this descriptive study was to establish and describe the national incidence, cost, and outcomes of patients that undergo medical transfer. Using discharge data from the Nationwide Inpatient Sample 2011, Health...
The aim of this descriptive study was to establish and describe the national incidence, cost, and outcomes of patients that undergo medical transfer. Using discharge data from the Nationwide Inpatient Sample 2011, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, the dataset was analyzed using weighted frequency distribution. Approximately 1.6 million patients are transferred yearly. Transferred patients experience a mean length of stay of 9.3 days (std dv 13.5) versus 4.3 days for patients not transferred (std dv 6.0), and cost more than twice as much (mean $19,234) versus those not transferred (mean $9,469). Additionally, patients who undergo inter-facility transfer cost an additional $15.8 billion annually. Interhospital patient transfers require closer scrutiny regarding appropriateness and future policy implications.
TALK NERDY TO ME: THE ROLE OF INTELLECTUAL STIMULATION IN THE SUPERVISOR-EMPLOYEE RELATIONSHIP.
Smothers J, Doleh R, Celuch K … +2 more , Peluchette J, Valadares K
J Health Hum Serv Adm · 2016 · PMID 27079057
This study investigates (1) if communication with one's supervisor is related to empowerment through establishing perceptions of leader integrity, and (2) the extent to which the relationship between leader integrity and...
This study investigates (1) if communication with one's supervisor is related to empowerment through establishing perceptions of leader integrity, and (2) the extent to which the relationship between leader integrity and empowerment is moderated by intellectual stimulation. Due to the dynamic nature of today's organizational environment, understanding the nuances among these variables is vital to effective performance at the individual and organizational level. Hierarchical multiple regression tests were performed with a sample of 259 nurses in two regional healthcare facilities in the Midwestern United States. The results support a moderated-mediation relationship such that open communication with one's supervisor is positively related to empowerment through perceptions of leader integrity, but the relationship between leader integrity and empowerment varies across levels of intellectual stimulation. Specifically, while supervisor integrity mediates the relationship between patient safety communication and empowerment, this mediated relationship is only significant for followers who experience high intellectual stimulation, and is not significant for followers who report low intellectual stimulation. Thus, open communication and leader integrity will only empower followers if the leader is intellectually stimulating. This research clarifies how leaders in health care environments should communicate with their followers to empower them to think and act by their own initiative. Specifically, followers who communicate openly with their supervisor will feel more empowered, but only if they experience high intellectual stimulation which can improve their job performance and patient safety overall.
PANACEA OR PLACEBO? AN EVALUATION OF THE VALUE OF EMOTIONAL INTELLIGENCE IN HEALTHCARE WORKERS.
Vandewaa EA, Turnipseed DL, Cain G
J Health Hum Serv Adm · 2016 · PMID 27079056
The purpose of this study was to empirically investigate the relationship between emotional intelligence and desirable nursing behaviors, measured as organizational citizenship beehavior (OCB). We used Mayer and Salovey'...
The purpose of this study was to empirically investigate the relationship between emotional intelligence and desirable nursing behaviors, measured as organizational citizenship beehavior (OCB). We used Mayer and Salovey's (1997) four-dimensional model of emotional intelligence and Organ's (1988) OCB construct to test the EI-OCB relationships. Using a sample of 137 clinical nurses, and analyzing the data with hierarchical multiple regressions, we obtained results indicating that the EI dimension perceiving emotion was linked to conscientiousness, and facilitating thinking wvas linked to civic virtue. Managing emotion was linked to conscientiousness, civic virtue, altruism and courtesy. There were no relationships between facilitating thinking and the OCB dimensions. Results suggest that EI may increase conscientiousness in performing nursing duties, and in the levels of involvement and participation in hospital affairs. Higher levels of emotional intelligence may also increase altruistic activities and discretionary coordinating efforts. However, there is no reason to expect that a poor work climate, and grieving, complaining behaviors will respond positively to increasing EI. Managers should realize that efforts to improve EI may not provide global results.
PERCEIVED RACIAL DISCRIMINATION AMONG HOME HEALTH AIDES: EVIDENCE FROM A NATIONAL SURVEY.
Lee D, Muslin I, McInerney M
J Health Hum Serv Adm · 2016 · PMID 27079055
Home health aides are one of our essential human resources in the U.S. long-term care industry but understanding whether home health aides experience racial discrimination in the workplace and, if so, which personal/orga...
Home health aides are one of our essential human resources in the U.S. long-term care industry but understanding whether home health aides experience racial discrimination in the workplace and, if so, which personal/organizational factors are associated at the national level has been unnoticed. Using a nationally representative sample (n=3377), we attempt to investigate the association between racial discrimination and personal and organizational factors. The study found the 13.5% prevalence rate of racial discrimination. The study findings from multiple regression analysis reveal that black home care aides are more likely than white aides to experience racial discrimination in the workplace, suggesting that racial disparity may be an additional barrier to our home health care industry. National chain affiliation and low income were also found to be associated with perceived racial discrimination.
FEE-SCHEDULE INCREASES IN CANADA: IMPLICATION FOR SERVICE VOLUMES AMONG FAMILY AND SPECIALIST PHYSICIANS.
Ariste R
J Health Hum Serv Adm · 2015 · PMID 26897992
Physician spending has substantially increased over the last few years in Canada to reach $27.4 billion in 2010. Total clinical payment to physicians has grown at an average annual rate of 7.6% from 2004 to 2010. The key...
Physician spending has substantially increased over the last few years in Canada to reach $27.4 billion in 2010. Total clinical payment to physicians has grown at an average annual rate of 7.6% from 2004 to 2010. The key policy question is whether or not this additional money has bought more physician services. So, the purpose of this study is to understand if we are paying more for the same amount of medical services in Canada or we are getting more bangs for our buck. At the same time, the paper attempts to find out whether or not there is a productivity difference between family physician services and surgical procedures. Using the Baumol theory and data from the National Physician Database for the period 2004-2010, the paper breaks down growth in physician remuneration into growth in unit cost and number of services, both from the physician and the payer perspectives. After removing general inflation and population growth from the 7.6% growth in total clinical payment, we found that real payment per service and volume of services per capita grew at an average annual rate of 3.2% and 1.4% respectively, suggesting that payment per service was the main cost driver of physician remuneration at the national level. Taking the payer perspective, it was found that, for the fee-for-service (FFS) scheme, volume of services per physician decreased at an average annual rate of -0.6%, which is a crude indicator that labour productivity of physicians on FFS has fallen during the period. However, the situation differs for the surgical procedures. Results also vary by province. Overall, our finding is consistent with the Baumol theory, which hypothesizes higher productivity growth in technology-driven sectors.
PERSPECTIVES ON MULTIDISCIPLINARY TEAM PROCESSES AMONG HEALTHCARE EXECUTIVES: PROCESSES THAT FACILITATE TEAM EFFECTIVENESS.
Landry A, Erwin C
J Health Hum Serv Adm · 2015 · PMID 26897991
BACKGROUND: Multidisciplinary teams (MDTs) are used in healthcare organizations to address both clinical and managerial functions. Despite their prevalence, little is known about how team processes work to facilitate eff...
BACKGROUND: Multidisciplinary teams (MDTs) are used in healthcare organizations to address both clinical and managerial functions. Despite their prevalence, little is known about how team processes work to facilitate effectiveness among MDT leadership teams. PURPOSE: This study explores perceptions of MDT participation experienced by organizational leaders in healthcare organizations in the United States. METHODOLOGY/APPROACH: A survey of American College of Healthcare Executives members was conducted to assess involvement and perceptions of MDTs among health care management professionals. Descriptive statistics, independent T-Tests and Chi-square analyses were used to examine participation in MDTs, perception of MDT processes, and the association of participation and perceived processes with employee and organizational characteristics. FINDINGS: The survey yielded a sample comprised of 492 healthcare executive or executive-track employees. An overwhelming majority indicated participation in MDTs. The study identified team processes that could use improvement including communication, cooperation, and conflict resolution. PRACTICE IMPLICATIONS: The study provides evidence that can help guide the development of training programs that focus on providing managerial leaders with strategies aimed at improving communication, coordination, and conflict resolution that will improve the effectiveness of MDT functioning in healthcare organizations.
FAMILY DEVELOPMENT CREDENTIAL TRAINING IMPACT ON SELF-EFFICACY BELIEFS OF HUMAN SERVICE WORKERS.
Smith DB, Day NE
J Health Hum Serv Adm · 2015 · PMID 26897990
The Family Development Credential (FDC) Training offers an innovative interagency training for human service workers within a community. We use a mixed-methods approach to evaluate the impact of FDC on work-related self-...
The Family Development Credential (FDC) Training offers an innovative interagency training for human service workers within a community. We use a mixed-methods approach to evaluate the impact of FDC on work-related self-efficacy beliefs. Quantitative data found FDC participants increased their levels of positive self-efficacy beliefs and had no change in negative self-efficacy beliefs; a comparison group saw no change in positive self-efficacy beliefs but increased their levels of negative self-efficacy beliefs. Qualitative data indicated training increased work-related self-efficacy beliefs. Overall, findings suggest that FDC training improved self-efficacy in human service workers and that no training allowed negative self-efficacy beliefs to grow.
LOWER SATISFACTION AMONG HOSPITALS THAT DISPROPORTIONATELY TREAT BLACK PATIENTS.
Tajeu GS, Kazley AS, Menachemi N
J Health Hum Serv Adm · 2015 · PMID 26897989
Abstract loading — click title to view on PubMed.
Using Focus Groups to Modify the Workplace Affective Commitment Multidimensional Questionnaire (WACMQ) for use in Health Care.
Perreira T, Berta W
J Health Hum Serv Adm · 2016 · PMID 29389100
BACKGROUND: The Workplace Affective Commitment Multidimensional Questionnaire (W ACMQ) measures affective commitment towards eight work-related targets. While this questionnaire was developed in the business sector, we b...
BACKGROUND: The Workplace Affective Commitment Multidimensional Questionnaire (W ACMQ) measures affective commitment towards eight work-related targets. While this questionnaire was developed in the business sector, we believe that the multi-target conceptualization of affective commitment has applicability to complex health care contexts where providers of care, in the production and delivery of care, likely develop commitment toward a multiplicity of targets. Affective commitment is a strong predictor of extra-role workplace behavior; indispensable behaviors which enable health systems to function. OBJECTIVE: The aim of this psychometric exercise is to content validate the WACMQ questions for use in health care. METHODS: Two focus groups were conducted, consisting of nurses working in acute care and emergency hospitals in Ontario. Linguistic validation and cognitive debriefing were used. RESULTS: A total of 14 modifications to the wording of items on the original WACMQ questionnaire were made. CONCLUSIONS: This modified version of the WACMQ reflects the need for researchers in health care settings to acknowledge the complex context of health care and the attendant complexities of worker attitudes. Health care workers can experience affective commitment toward leadership (clinical or administrative), co-workers (nurses or interprofessional), patients, their profession, organization, work or tasks. Further, in some health care settings, features like union membership may have important implications when examining affective commitment or behaviors. Psychometric properties of the modified WACMQ will be established in an upcoming study that will examine the relationships between extra-role behaviors, commitment, perceived organizational support and justice within acute care and emergency departments of hospitals operating in Ontario.
Correlates and Consequences of Nursing Staff Job Insecurity.
Burke RJ, Singh P
J Health Hum Serv Adm · 2016 · PMID 29389099
The health care system, and hospitals, underwent considerable restructuring and downsizing in the early to mid-1900s in several countries as governments cut costs to reduce their budget deficits. Studies of the effects o...
The health care system, and hospitals, underwent considerable restructuring and downsizing in the early to mid-1900s in several countries as governments cut costs to reduce their budget deficits. Studies of the effects of these efforts on nursing staff and hospital functioning in various countries generally reported negative impacts with threats to job security emerging as an important outcome of these changes. Health care restructuring and hospital downsizing is again being implemented as governments struggle to reduce deficits at a time of worldwide economic recession in 2008/2010. This study examines correlates and consequences of job insecurity among Canadian nursing staff, with a focus on nurses’ well-being. Data were collected from 290 nursing staff working in hospitals in Ontario, Canada. Feelings of job insecurity in the sample as a whole were relatively low. Personal demographics and work situation characteristics were generally uncorrelated with feelings of job insecurity. Consistent with previous findings, perceived job insecurity was once again associated with less favorable work and well-being outcomes. Some suggestions for more successful approaches to addressing levels of subjective job insecurity are offered.
Effect of Physician IT Use on Practice Performance.
Lee D, Sikula A, Lee T … +2 more , Dodds AA, Na Y
J Health Hum Serv Adm · 2016 · PMID 29389095
The role of information technology (IT) remains important within the medical community. However, little is known about the extent to which practicing physicians improve practice performance by having and utilizing IT at...
The role of information technology (IT) remains important within the medical community. However, little is known about the extent to which practicing physicians improve practice performance by having and utilizing IT at the national level. The present study, analyzing a national physician survey (n = 4,720), seeks to explore associations of IT availability and utilization with practice performance at the national level. The multivariate regression analysis results suggest that patient information IT functionality upholds physician advantages in annual income but prescription drug IT functionality was reversely linked to annual income. We also found a negative association of patient information IT functionality with patient visit volume. Our study results revealed mixed findings. Not all IT functionalities would offer benefits to practicing physicians. Our data suggest that patient information IT functionality can moderate cost concerns related to IT investment among providers.
Policy Making to Build Relationships: A Grounded Theory Analysis of Interviews and Documents Relating to H1N1, Ebola, and the U.S. Public Health Preparedness Network.
Myers N
J Health Hum Serv Adm · 2016 · PMID 29389094
In the last five years, the American public health emergency preparedness and response system has been tested by two significant threats, H1N1 and Ebola. While neither proved as dangerous as initially feared, these virus...
In the last five years, the American public health emergency preparedness and response system has been tested by two significant threats, H1N1 and Ebola. While neither proved as dangerous as initially feared, these viruses highlighted on-going issues with collaborations in the field of public health and health care. Strengths were identified within the network, but also challenges that must be resolved before the U.S. faces a major pandemic. Employing interview data from public health emergency response practitioners and documentary evidence from the H1N1 and Ebola responses, this qualitative analysis uses the grounded theory approach to identify key areas for collaborative improvement. The grounded theory developed calls for a stronger policy framework at the federal level to facilitate more collaboration between U.S. agencies and facilitate more collaboration at the state and local level.
EMPOWERING PATIENTS TO BECOME BETTER PARTNERS.
Gittner LS
J Health Hum Serv Adm · 2015 · PMID 26442365
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IMPACT OF A SERIOUS GAME FOR HEALTH ON CHRONIC DISEASE SELF-MANAGEMENT: PRELIMINARY EFFICACY AMONG COMMUNITY DWELLING ADULTS WITH HYPERTENSION.
Hickman RL, Clochesy JM, Pinto MD … +2 more , Burant C, Pignatiello G
J Health Hum Serv Adm · 2015 · PMID 26442364
Most Americans will acquire a chronic disease during their lifetime. One of the most prevalent chronic diseases that affect Americans is hypertension (HTN). Despite the known comorbidities and increased mortality rate as...
Most Americans will acquire a chronic disease during their lifetime. One of the most prevalent chronic diseases that affect Americans is hypertension (HTN). Despite the known comorbidities and increased mortality rate associated with uncontrolled HTN, most community dwelling adults with HTN do not have sufficient blood pressure control Therefore, the aim of this article is to report the preliminary efficacy of a serious game for health to enhance blood pressure control among community dwelling adults with HTN. A nonprobability sample of 116 community dwelling adults with HTN participated in this nonblinded, randomized controlled trial. Participants were randomly assigned to: (1) an intervention arm that consisted of four exposures to a serious game for health known as eSMART-HD; or (2) an attentional control arm that compromised of four exposures to screen-based HTN education. The primary outcome measure for this trial was blood pressure reduction over a four month observational period. In this study, baseline characteristics and blood pressure measurements were similar between participants in each study arm. There was no significant between-group difference in blood pressure reduction over time. However, there were significant within-group reductions in systolic and diastolic blood pressures across time among favoring participants exposed to eSMART-HD. This study establishes the preliminary efficacy of eSMART-HD that can be easily administered to community dwelling adults and facilitate clinically significant reductions in systolic and diastolic blood pressures. Future studies should assess the influential components of this promising serious game for health (eSMART-HD) combined with medication management in larger and more diverse samples of community dwelling adults with HTN.
ENHANCING COMMUNICATION BETWEEN PATIENTS AND HEALTHCARE PROVIDERS: SBAR3.
Clochesy JM, Dolansky MA, Hickman RL … +1 more , Gittner LS
J Health Hum Serv Adm · 2015 · PMID 26442363
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BE HEARD: HEALTHCARE PERSPECTIVES FROM MEDICALLY AND SOCIALLY DISENFRANCHISED COMMUNITIES.
Gittner LS, Clochesy JM, Gutierrez JO … +1 more , Robinson JL
J Health Hum Serv Adm · 2015 · PMID 26442362
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WAIT, WON'T! WANT: BARRIERS TO HEALTH CARE AS PERCEIVED BY MEDICALLY AND SOCIALLY DISENFRANCHISED COMMUNITIES.
Clochesy JM, Gittner LS, Hickman RL … +2 more , Floersch JE, Carten CL
J Health Hum Serv Adm · 2015 · PMID 26442361
OBJECTIVES: We explored barriers to healthcare as perceived by members of medically and socially disenfranchised communities. METHODS: We conducted focus groups with 28 women and 32 men from Northeast Ohio who identified...
OBJECTIVES: We explored barriers to healthcare as perceived by members of medically and socially disenfranchised communities. METHODS: We conducted focus groups with 28 women and 32 men from Northeast Ohio who identified themselves as African-American, Hispanic/Latino, lesbian/gay/bisexual/transgendered, and/or Russian immigrant. RESULTS: Participants described their experiences of waiting, things they won't tolerate, when they won't participate, and what they want from providers. They described behaviors, actions and relationship characteristics that they want from their providers and characteristics that they prefer in health systems. CONCLUSIONS: The themes of Wait, Won't, and Want have healthcare practice and policy implications. Patient-provider interactions are known to be significant determinants of healthcare outcomes and these exploratory findings suggest that they might also affect patient self-management strategies. Future efforts should focus on developing and testing patient-centered strategies that address the themes identified to increase engagement to increase self-management of health.
CREATING A SERIOUS GAME FOR HEALTH.
Clochesy JM, Buchner M, Hickman RL … +2 more , Pinto MD, Znamenak K
J Health Hum Serv Adm · 2015 · PMID 26442360
The prevalence of chronic illnesses continues to increase as does the cost of such care. Teaching self-management skills is more effective than solely providing information and teaching technical skills at improving heal...
The prevalence of chronic illnesses continues to increase as does the cost of such care. Teaching self-management skills is more effective than solely providing information and teaching technical skills at improving health outcomes. Serious games for health provide an opportunity to support learning and health-related behavior change using messages and experiences in an engaging and entertaining format. We developed eSMART-HD with the intention of improving interactions between patients with chronic disorders and their health care providers. This paper describes the factors that we considered when creating eSMART-HD, a serious game for health.
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