Journal Of Health And Human Services Administration[JOURNAL]
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200 papers
Do's and don'ts of public relations for government health care administration.
Lee M
J Health Hum Serv Adm · 2012 · PMID 23293804
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Introduction to the special edition on health communication's role in policy enactment and implementation.
Zahradnik A
J Health Hum Serv Adm · 2012 · PMID 23293803
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Risk of exposure to second hand smoke for adolescents in Las Vegas casinos: an evaluation of the Nevada Clean Indoor Air Act.
Cochran C, Henriques D, York N … +1 more , Lee K
J Health Hum Serv Adm · 2012 · PMID 23113419
Since the Surgeon General's groundbreaking report of 1964, "Smoking and Health," the medical and scientific communities have uncovered the devastating effects of tobacco smoke on health. In reaction to these findings, lo...
Since the Surgeon General's groundbreaking report of 1964, "Smoking and Health," the medical and scientific communities have uncovered the devastating effects of tobacco smoke on health. In reaction to these findings, local and state governments have enacted a variety of clean air acts to prevent unnecessary exposure to this known carcinogen. The Nevada Clean Indoor Air Act (NCIAA), a non-comprehensive smoke-free law, permits smoking in designated areas of casinos, bars, and taverns. With many Las Vegas casinos catering to all ages, this study was designed to evaluate the efficacy of NCIAA in protecting children from second hand smoke exposure. Using a device that measures ambient air particle matter concentrations, this study sampled the air quality in 15 casino gaming areas and corresponding non-smoking, children-friendly areas. The results indicate that current policy fails to preserve indoor air quality in these children-friendly areas. Furthermore, this research suggests the adoption of a more comprehensive, 100% smoke-free policy as the only effective remedy.
Management challenges at the intersection of public policy environments and strategic decision making in public hospitals.
Longest BB
J Health Hum Serv Adm · 2012 · PMID 23113418
Hospitals in the United States are heavily impacted by public policies that affect them. For example, Medicare and Medicaid programs account for more than half the revenue in most of the nation's almost 5,000 community h...
Hospitals in the United States are heavily impacted by public policies that affect them. For example, Medicare and Medicaid programs account for more than half the revenue in most of the nation's almost 5,000 community hospitals, including the almost 1,100 public hospitals controlled by state and local governments (American Hospital Association, 2012). The public hospitals are especially closely aligned with and controlled by governmental entities compared with hospitals with other kinds of sponsorship. This article addresses the management challenges at the intersection of the strategic management of public hospitals and their public policy environments. Public hospitals are complicated entities designed not only to provide health services but also in many cases to play key roles in health-related research and education and to play important general economic development roles in their communities. The multi-faceted strategic decision making in these organizations is as heavily affected by their public policy environments as by their business, demographic, technological or other external environments. Effectively managing the intersection of their public policy environments and their strategic management is indeed vital for contemporary public hospitals. This article is intended to clarify certain aspects of this intersection through a description and model of the strategic activity in public hospitals and the connection between this activity and their external environments. Specific attention is focused on the concept of public policy environments and their features. Attention is also given to how managers can assess public policy environments and incorporate the results into strategic activities.
Antenarratives to inform health care research: exploring workplace illness disclosure for people with multiple sclerosis (MS).
Vickers MH
J Health Hum Serv Adm · 2012 · PMID 23113417
I share Boje's (2001) concept of antenarratives as a useful means of presenting qualitative health care research, especially their capacity to share illness-related stories which may be fragmented, non-linear, sometimes...
I share Boje's (2001) concept of antenarratives as a useful means of presenting qualitative health care research, especially their capacity to share illness-related stories which may be fragmented, non-linear, sometimes incoherent, and often speculative. I do this to offer insights to health care professionals that might maximize the health care outcomes for those they serve. An Australian based qualitative research project explored the lived experience of what life is really like for a person with Multiple Sclerosis (MS). Rather than presenting a traditional, narrative based, coherent and saturated theme, I present antenarratives that vivify the lived experience of illness disclosure. Antenarratives have the capacity to share key elements of experience in ways that can edify health care practitioners concerned with offering support that consists of more than prescriptive solutions and certain advice.
Experience and education of home health administrators and nursing home administrators and the relationship to establishment ownership.
Decker FH, Decker SL
J Health Hum Serv Adm · 2012 · PMID 23113416
Administrators in long-term care may have an important influence on quality of care. Limited prior research has described the characteristics of nursing home administrators. Despite growing emphasis on home health care a...
Administrators in long-term care may have an important influence on quality of care. Limited prior research has described the characteristics of nursing home administrators. Despite growing emphasis on home health care as an alternative to nursing homes, almost no research has described the characteristics of administrators of home health agencies. Using the 2004 National Nursing Home Survey and the 2007 National Home and Hospice Care Survey, we describe the career experience of administrators, and examine the relationship between experience and education of administrators both within and across the nursing home and home health sectors. We also explore the characteristics of nursing homes and home health agencies, including establishment ownership (e.g., nonchain not-for-profit), that are associated with being able to attract administrators with the most experience. We find that home health administrators have, on average, less experience than nursing home administrators. Among home health agencies, administrators with the least experience also tend to have less education. In nursing homes, administrators with less experience tend to have more education. Results from multivariate analysis suggest that chain for-profits may be the least able to attract experienced administrators. More research on the effects of different levels of experience and education among administrators is needed.
Symposium conclusion: Future research on the dimensions of collaboration.
Clay JA
J Health Hum Serv Adm · 2012 · PMID 22838062
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Commentary: Human service delivery and interorganizational relationships.
Leslie R
J Health Hum Serv Adm · 2012 · PMID 22838061
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Human service delivery in a multi-tier system: the subtleties of collaboration among partners.
Mayhew F
J Health Hum Serv Adm · 2012 · PMID 22838060
This article examines the nature of interorganizational relationships that are formed within a multi-tier human service delivery system. Taking into account the hierarchical structure of a statewide initiative to support...
This article examines the nature of interorganizational relationships that are formed within a multi-tier human service delivery system. Taking into account the hierarchical structure of a statewide initiative to support early childhood education, the study investigates the differences in the relationships between organizations at the service and administrative levels of the system. Forty-nine administrative level and 146 service delivery level relationships are evaluated. Findings indicate that organizations involved in direct service delivery form more collaborative relationships. Thus, when government provides funding for human services, policymakers must seek to balance public accountability with the advantages believed to be inherent in devolved service delivery. Furthermore, practitioners who appreciate the importance and nuances of interorganizational relationships will be in a position to better manage their organizations in an environment of increased collaborative activity and joint delivery of services. Going forward, human service systems will continue to involve organizations from the public, nonprofit, and private sector. A better understanding of how these organizations work together is crucial to the effective delivery of these essential services.
Commentary: A Head Start program's response to state-funded pre-K.
Sakran JA
J Health Hum Serv Adm · 2012 · PMID 22838059
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From threat to opportunity: a Head Start program's response to state-funded pre-K.
Wrobel S
J Health Hum Serv Adm · 2012 · PMID 22838058
Early childhood education and childcare have traditionally been dominated by nonprofit and other grant-funded agencies. However, public education agencies are increasingly involved with early childhood education through...
Early childhood education and childcare have traditionally been dominated by nonprofit and other grant-funded agencies. However, public education agencies are increasingly involved with early childhood education through state funded pre-K program initiatives. As public pre-school programming has steadily expanded, programs such as Head Start have to compete for enrollment. As funds for these programs are tied directly to enrollment, the sustainability of these programs is uncertain. Not all such agencies view state funded pre-K as a threat however. Some have seized this as an opportunity to improve service delivery through interagency collaboration. This case study examines the partnership between an urban school district and its local Head Start program. Responding, in part, to the potential threat from state-funded Pre-K, Head Start partnered with the school district to provide enhanced services to Head Start eligible children in the district's early childhood education programs. Through an examination of secondary data and staff surveys, the collaboration is first evaluated in terms of the use of best practices. The success of the collaboration is measured through teacher and administrator perceptions. From these results, specific recommendations for early education and childcare providers are offered.
Commentary: Interorganizational relationships in program delivery.
Word AK
J Health Hum Serv Adm · 2012 · PMID 22838057
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Inter-organizational relationships of health partnerships: characteristics of the Fulton County SPARC Program.
Sullivan BA
J Health Hum Serv Adm · 2012 · PMID 22838056
Local governments have long used partnerships and collaborations with the nonprofit and private sectors to improve services, support innovation, and save cost. Nowhere is this more evident than in the public health and h...
Local governments have long used partnerships and collaborations with the nonprofit and private sectors to improve services, support innovation, and save cost. Nowhere is this more evident than in the public health and human services sectors. This case study follows up on an earlier report on the attributes of a collaborative public/private-nonprofit health partnership; Fulton County, Georgia's Sickness Prevention Achieved Through Regional Collaboration program, (SPARC). Fulton County has been able to sustain its SPARC partnership despite the demise of similar efforts within the region. This study examines the characteristics of the Fulton County SPARC partnership that may have contributed to its endurance. A series of interviews and surveys were administered to Fulton County SPARC partners in 2009 and 2011 to capture operational characteristics of the partnership and the degree to which partners interacted among themselves. Results indicate that despite changes thought to strengthen the partnership, the developmental stages of partnerships and collaborations are shown to be non-linear; therefore, movement from one stage to the other is not guaranteed thus warranting leaders' regular attention to both individual and organizational commitment to collaboration dynamics.
Commentary: County government influence on health care safety-nets.
Mirvis D
J Health Hum Serv Adm · 2012 · PMID 22838055
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Testing a model of county government influence on health care safety-nets.
Knepper H
J Health Hum Serv Adm · 2012 · PMID 22838054
In the United States, health care is not equitably distributed. As indicated in the literature, age, income, and other socio-economic indicators contribute to substantial differences in the variety and scope of health se...
In the United States, health care is not equitably distributed. As indicated in the literature, age, income, and other socio-economic indicators contribute to substantial differences in the variety and scope of health services. The 2010 Affordable Care Act illustrates the United States' effort to bring balance and equity to the health care system. In the meantime, county governments are struggling with rising health care costs on their budgets (Eaton, 2009; Phaup, 2009; Clark, 2003), particularly health care for low-income residents (Benton, Byers, Cigler, Klase, Menzel, Salant, Streib, Svara, & Waugh, 2008). However, as learned in this study, county governments across the country continue to address the health care needs of uninsured and underinsured citizens through participation in health care safety nets. This research identifies possible county government influences on health care safety-nets. This study analyzed 123 responses from county government administrators and elected officials along with secondary data from the U.S. Census Bureau and the International City/County Manager Association using a variety of statistical techniques, culminating in structural equation modeling. These analyses provided reasonable explanation for the variation among the variables leading to network performance improvement in meeting the health care needs of uninsured and underinsured people as well as the significant influence of county government involvement.
Symposium introduction: Assessing multiple dimensions of collaboration.
Norris-Tirrell D
J Health Hum Serv Adm · 2012 · PMID 22838053
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Organizational change for services integration in public human service organizations: experiences in seven counties.
Packard T, Patti R, Daly D … +1 more , Tucker-Tatlow J
J Health Hum Serv Adm · 2012 · PMID 22530287
This is a study of organizational change strategies employed in seven county human service agencies to improve the coordination of services through the structural integration of previously free standing organizations or...
This is a study of organizational change strategies employed in seven county human service agencies to improve the coordination of services through the structural integration of previously free standing organizations or the development of voluntary interagency collaborative service delivery systems. The central question involves the identification of organizational change tactics which contributed to the success of the organizational change initiatives. The literature on organizational change is reviewed, with particular attention to a framework developed by Fernandez and Rainey based on their extensive review and synthesis of the research on successful change strategies in the public and business sectors. Qualitative and quantitative data were gathered from over 250 individuals and from agency documents. Findings are compared with the success factors identified by Fernandez and Rainey, and refinements to their propositions are suggested. More precise methods for measuring successful and unsuccessful change initiatives are suggested. Implications for practice and research are presented.
Benefits and costs of a free community-based primary care clinic.
Fertig AR, Corso PS, Balasubramaniam D
J Health Hum Serv Adm · 2012 · PMID 22530286
This study estimates the benefits and costs of a free clinic providing primary care services. Using matched data from a free clinic and its corresponding regional hospital on a sample of newly enrolled clinic patients, p...
This study estimates the benefits and costs of a free clinic providing primary care services. Using matched data from a free clinic and its corresponding regional hospital on a sample of newly enrolled clinic patients, patients' non-urgent emergency department (ED) and inpatient hospital costs in the year prior to clinic enrollment were compared to those in the year following enrollment to obtain financial benefits. We compare these to annual estimates of the costs associated with the delivery of primary care to these patients. For our sample (n = 207), the annual non-urgent ED and inpatient costs at the hospital fell by $170 per patient after clinic enrollment. However, the cost associated with delivering primary care in the first year after clinic enrollment cost $505 per patient. The presence of a free primary care clinic reduces hospital costs associated with non-urgent ED use and inpatient care. These reductions in costs need to be sustained for at least 3 years to offset the costs associated with the initially high diagnostic and treatment costs involved in the delivery of primary care to an uninsured population.
Is there an association between local health department organizational and administrative factors and childhood immunization coverage rates?
Ransom J, Schaff K, Kan L
J Health Hum Serv Adm · 2012 · PMID 22530285
BACKGROUND: Vaccines are valuable, cost-effective tools for preventing disease and improving community health. Despite the importance and ubiquity of vaccinations, childhood immunization coverage rates vary widely by geo...
BACKGROUND: Vaccines are valuable, cost-effective tools for preventing disease and improving community health. Despite the importance and ubiquity of vaccinations, childhood immunization coverage rates vary widely by geography, race, and ethnicity. These differences have been documented for nearly two decades, but their sources are poorly understood. Between 2005 and 2008, immunization staff of the National Association of County & City Health Officials (NACCHO) visited 17 local health department (LHD) immunization programs in 10 states to assess their immunization service delivery (ISD) practices and their impact on community childhood immunization coverage rates. PURPOSE: To qualitatively characterize LHD immunization programs and specific organizational factors underlying ISD performance challenges and successes related to community childhood immunization coverage rates. METHODS: Case studies were conducted in a convenience sample of 17 geographically and demographically diverse LHDs, predicated on each LHD's childhood immunization coverage rates per data from the National Immunization Survey and/or Kindergarten Retrospective Survey. NACCHO staff selected LHDs with high (> or = 80% up to date [UTD]), moderate (> or = 75% UTD but < 80% UTD), and low (< 75% UTD) coverage rates. All immunization staff members interviewed (n = 112) were included in focus group interviews at each LHD per a standard semi-structured interview script developed by NACCHO staff. Supporting documents from each LHD immunization program were also collected for inclusion in the analysis. Content and thematic analyses of interview transcripts and supporting documents were conducted. RESULTS: Two thematic dimensions and six key factors emerged from the data. The dimensions of the themes were success and challenge elements. The organizational factors that were associated with success and/or challenges with regard to improving childhood immunization coverage rates included 1) leadership: organizational leadership and management related to aligning ISD with other child-focused services within the LHD; 2) resources: organizational efforts focused on aligning federal and state ISD financing with local ISD needs; 3) politics: political advocacy and partnering with local community stakeholders, including local political entities and boards of health to better organize ISD; 4) community engagement/coalitions and partnerships: partnerships, coalitions, and community engagement to support local immunization-related decision-making and prioritization; 5) credibility: agency credibility and its ability to influence community attitudes and perspectives on the health department's value in terms of child health; and 6) cultural competency of LHD staff: LHD staff members' perceptions and understandings of its community's cultural, economic, and demographic attributes shaped their responses to and understandings of the community and how they interacted with it in terms of service delivery. DISCUSSION: Public health researchers are in a nascent stage of understanding how health department organizational factors may contribute to specific community health outcomes, such as childhood immunization coverage rates. An implicit challenge to LHD immunization programs is to implement strategies that lead to equitable and high vaccination coverage among children, despite shrinking resources and community demographic differences. Community-specific attributes (e.g., poverty, lack of health insurance, or geographic isolation) affect childhood immunization coverage rates, but internal LHD aspects such as leadership and organizational culture also likely have a significant impact.
Reducing health disparities: medical advice received for minorities with diabetes.
Vaccaro JA, Huffman FG
J Health Hum Serv Adm · 2012 · PMID 22530284
OBJECTIVE: to examine the relationships among reported medical advice, diabetes education, health insurance and health behavior of individuals with diabetes by race/ethnicity and gender. METHOD: Secondary analysis of dat...
OBJECTIVE: to examine the relationships among reported medical advice, diabetes education, health insurance and health behavior of individuals with diabetes by race/ethnicity and gender. METHOD: Secondary analysis of data (N = 654) for adults ages > or = 21 years with diabetes acquired through the National Health and Nutrition Examination Survey (NHANES) for the years 2007-2008 comparing Black, non-Hispanics (BNH) and Mexican-Americans (MA) with White, non-Hispanics (WNH). The NHANES survey design is a stratified, multistage probability sample of the civilian noninstitutionalized U.S. population. Sample weights were applied in accordance with NHANES specifications using the complex sample module of IBM SPSS version 18. RESULTS: The findings revealed statistical significant differences in reported medical advice given. BNH [OR = 1.83 (1.16, 2.88), p = 0.013] were more likely than WNH to report being told to reduce fat or calories. Similarly, BNH [OR = 2.84 (1.45, 5.59), p = 0.005] were more likely than WNH to report that they were told to increase their physical activity. Mexican-Americans were less likely to self-monitor their blood glucose than WNH [OR = 2.70 (1.66, 4.38), p < 0.001]. There were differences by race/ethnicity for reporting receiving recent diabetes education. Black, non-Hispanics were twice as likely to report receiving diabetes education than WNH [OR = 2.29 (1.36, 3.85), p = 0.004]. Having recent diabetes education increased the likelihood of performing several diabetes self-management behaviors independent of race. CONCLUSIONS: There were significant differences in reported medical advice received for diabetes care by race/ethnicity. The results suggest ethnic variations in patient-provider communication and may be a consequence of their health beliefs, patient-provider communication as well as length of visit and access to healthcare. These findings clearly demonstrate the need for government sponsored programs, with a patient-centered approach, augmenting usual medical care for diabetes. Moreover, the results suggest that public policy is needed to require the provision of diabetes education at least every two years by public health insurance programs and recommend this provision for all private insurance companies.
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