West Kendall Baptist Hospital: meeting the demand of community-based healthcare in the new (and stormy) regulatory environment

2017 ◽  
Vol 13 (5) ◽  
pp. 592-632
Author(s):  
Miriam Weismann ◽  
Javier Hernandez Lichtl ◽  
Heather Pierce ◽  
Denise Harris ◽  
Lourdes Boue ◽  
...  
Keyword(s):  
Research Methodology ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Management Team ◽  
Regulatory Environment ◽  
Regulatory Change ◽  
Health Administration ◽  
The West ◽  
Content Type ◽  
Baptist Hospital

Synopsis The first three years of operation of the West Kendall Baptist Hospital (WKBH) in Miami, Florida provided a “poster child” for efficient and cost effective healthcare delivery to the West Kendall community that it served. The hospital leadership and management team exemplified a quality-oriented staff that moved as a cohesive and dedicated organization. WKBH exceeded every budget prediction and showed a profit in year 3, well before expected. Then came the winds of regulatory change. With the passage of the Affordable Care Act (ACA) and the attendant imposition of new reimbursement metrics, the picture at WKBH changed almost overnight. By the first quarter of 2016, WKBH started to lose money in excess of budget predictions despite its increased patient admissions, careful financial planning, expense reductions, quality service, and excellence in patient care delivery. A serious financial crisis was looming with little relief in sight. The hospital management team began to search for solutions. Research methodology The research methodology includes collecting quantitative data: original financial statements and financial data from WKBH, as well as qualitative data: interviews of hospital administrators and historical information. Relevant courses and levels Graduate capstone course in a finance course; masters in health administration; and/or the MBA program. Theoretical bases While it is clear that the ACA was designed with all good intentions, it has created substantial and perhaps, unanticipated financial burdens for caregivers. These issues are not only faced by WKBH. Most hospitals could relate to one or more of the four questions examined as part of this learning process. Graduate MBA students worked with the hospital to identify, define, focus, and resolve difficult quantitative and qualitative issues faced by the hospital as a result of major changes in the regulatory environment with the passage of the ACA. This case focuses upon the current reimbursement environment that has only recently emerged as a result of the implementation of the ACA.

That's how it should work: the perceptions of a senior management on the value of decentralisation in a service delivery organisation

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Mikael Ohrling ◽  
Sara Tolf ◽  
Karin Solberg-Carlsson ◽  
Mats Brommels
Keyword(s):  
Health Care ◽  
Scientific Literature ◽  
Care Delivery ◽  
A Priori ◽  
Healthcare Delivery ◽  
Management Team ◽  
Senior Management ◽  
Management Model ◽  
System Perspective ◽  
Content Type

PurposeDecentralisation in health care has been proposed as a way to make services more responsive to local needs and by that improve patient care. This study analyses how the senior management team conceptualised and implemented a decentralised management model within a large public health care delivery organisation.Design/methodology/approachData from in-depth interviews with a senior management team were used in a directed content analysis. Underlying assumptions and activities in the decentralisation process are presented in the logic model and scrutinised in an a priori logic analysis using relevant scientific literature.FindingsThe study found support in the scientific literature for the underlying assumptions that increased responsibility will empower managers as clinical directors know their local prerequisites best and are able to adapt to patient needs. Top management should function like an air traffic control tower, trust and loyalty improve managerial capacity, increased managerial skills release creativity and engagement and a system perspective will support collaboration and learning.Originality/valueTo the authors’ knowledge this is the first a priori logic analysis of a decentralised management model in a healthcare delivery organisation in primary and community care. It shows that the activities consist with underlying assumptions, supported by evidence, and timely planned give managers decision space and ability to use their delegated authority, not disregarding accountability and fostering necessary organisational and individual capacities to avoid suboptimisation.

Communication and psychological safety in veterans health administration work environments

2014 ◽  
Vol 28 (6) ◽  
pp. 754-776 ◽  
Author(s):  
Nancy J. Yanchus ◽  
Ryan Derickson ◽  
Scott C. Moore ◽  
Daniele Bologna ◽  
Katerine Osatuke
Keyword(s):  
Health Care Providers ◽  
Care Delivery ◽  
Clinical Care ◽  
Psychological Safety ◽  
Veterans Health Administration ◽  
Employee Perceptions ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Content Type

Purpose – The purpose of this paper is to explore employee perceptions of communication in psychologically safe and unsafe clinical care environments. Design/methodology/approach – Clinical providers at the USA Veterans Health Administration were interviewed as part of planning organizational interventions. They discussed strengths, weaknesses, and desired changes in their workplaces. A subset of respondents also discussed workplace psychological safety (i.e. employee perceptions of being able to speak up or report errors without retaliation or ostracism – Edmondson, 1999). Two trained coders analysed the interview data using a grounded theory-based method. They excerpted passages that discussed job-related communication and summarized specific themes. Subsequent analyses compared frequencies of themes across workgroups defined as having psychologically safe vs unsafe climate based upon an independently administered employee survey. Findings – Perceptions of work-related communication differed across clinical provider groups with high vs low psychological safety. The differences in frequencies of communication-related themes across the compared groups matched the expected pattern of problem-laden communication characterizing psychologically unsafe workplaces. Originality/value – Previous research implied the existence of a connection between communication and psychological safety whereas this study offers substantive evidence of it. The paper summarized the differences in perceptions of communication in high vs low psychological safety environments drawing from qualitative data that reflected clinical providers’ direct experience on the job. The paper also illustrated the conclusions with multiple specific examples. The findings are informative to health care providers seeking to improve communication within care delivery teams.

Governance and coordination in health care: organic processes and structural capacity

2019 ◽  
Vol 33 (7/8) ◽  
pp. 757-763
Author(s):  
Peter Nugus ◽  
Jean-Louis Denis ◽  
Denis Chênevert
Keyword(s):  
Health Care ◽  
Organizational Behavior ◽  
Health Care Delivery ◽  
Research Policy ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Human Action ◽  
Future Research ◽  
Content Type ◽  
Local Agency

Purpose The purpose of this paper is to articulate cutting-edge conceptions of the relationship between local processes in the here-and-now, and the broader influences on those processes, that are both organic and overtly designed, and to discern the implications of this relationship for future research, policy and practice. Design/methodology/approach A focused and structured approach was taken to give effect to this purpose by reviewing the chosen articles in this collection, which from the 2018 Organizational Behavior in Health Care conference papers. Findings Research in coordination within and across health care boundaries increasingly recognizes: the multilevel influences on human action and interaction in health care delivery; the challenge of balancing individual or local agency with overt interventions; the everchanging the local circumstances of healthcare delivery; and the need to foster reflexivity, that is, self-improvement capacity, in healthcare organizations. Research limitations/implications Interventions to improve care coordination must be grounded in the reality of changing local circumstances and incentives for action from the broader environment. Originality/value This paper articulates the implied tension in health care delivery between individual and local agency, and imposed structures that may contradict, but are at the same time necessary, to foster such agency.

Do You Get What You Measure? Research Opportunities Based on the Veterans Health Administration Experience

2014 ◽  
Vol 28 (2) ◽  
pp. 385-413 ◽  
Author(s):  
Nicole Thibodeau ◽  
John Harry Evans ◽  
Nandu J. Nagarajan
Keyword(s):  
Healthcare Delivery ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Performance Incentives ◽  
Healthcare Network ◽  
Similar Patient ◽  
Private And Public ◽  
The U.S

SYNOPSIS Starting in 1995, the Veterans Health Administration (VHA) transformed a bureaucratic healthcare system into a performance-driven, patient-focused integrated healthcare network. The VHA's experience may offer lessons for private and public sector providers as the U.S. explores alternative healthcare delivery systems and payment methods. Similar patient-focused integrated systems are one of the hallmarks of the latest U.S. attempt to improve the quality and efficiency of healthcare delivery. The use of performance incentives to promote cooperation and innovation is also central to both the VHA and the U.S. reform. This study reviews the VHA's experience with an eye to identifying issues and potential research avenues for accounting researchers interested in the role of accounting information for control, coordination, and organizational change.

Understanding decoupling in response to corporate governance reform pressures

2015 ◽  
Vol 23 (4) ◽  
pp. 369-382 ◽  
Author(s):  
Mario Krenn
Keyword(s):  
Corporate Governance ◽  
Design Methodology ◽  
Good Governance ◽  
Regulatory Change ◽  
Compliance Monitoring ◽  
Governance Reform ◽  
Firm Level ◽  
Content Type ◽  
Good Corporate Governance ◽  
Actual Use

Purpose – The purpose of this article is to explain under what circumstances firm-level adoption of codes of good corporate governance will more likely be superficial rather than substantive in nature. The article contains lessons for any agency or country that attempts to implement deep and lasting changes in corporate governance via codes of good corporate governance. Design/methodology/approach – The article reviews the literature on compliance with codes of good corporate governance and develops a conceptual model to explain why some firms that have formally adopted a code of good governance decouple this policy from its actual use. Findings – Decoupling in response to the issuance of codes of good corporate governance will be more attractive to firms and also more sustainable under the following conditions: firms’ compliance costs are relatively high firms’ costs of outright and visible non-compliance are relatively high and outsiders’ compliance monitoring costs are relatively high. Originality/value – The article contributes to the debate on compliance and convergence and provides policymakers with a conceptual framework for assessing the likelihood of successful regulatory change in corporate governance.

scholarly journals Leaning Into Whole Health: Sustaining System Transformation While Supporting Patients and Employees During COVID-19

2021 ◽  
Vol 10 ◽  
pp. 216495612110210
Author(s):  
Eileen M Dryden ◽  
Rendelle E Bolton ◽  
Barbara G Bokhour ◽  
Juliet Wu ◽  
Kelly Dvorin ◽  
...  
Keyword(s):  
Healthcare System ◽  
Technology Use ◽  
Care Delivery ◽  
Quality Care ◽  
Qualitative Interviews ◽  
Veterans Health ◽  
Health Administration ◽  
System Transformation ◽  
Virtual Technology ◽  
Exogenous Shock

Background The US Veterans Health Administration (VA) is transforming its healthcare system to create a Whole Health System (WHS) of care. Akin to such reorganization efforts as creating patient-centered medical homes and primary care behavioral health integration, the WHS goes beyond by transforming the entire system to one that takes a proactive approach to support patient and employee health and wellness. The SARS-CoV-2 pandemic disrupted the VA’s healthcare system and added stress for staff and patients, creating an exogenous shock for this transformation towards a WHS. Objective We examined the relationship between VA’s WHS transformation and the pandemic to understand if transformation was sustained during crisis and contributed to VA’s response. Methods Qualitative interviews were conducted as part of a multi-year study of WHS transformation. A single multi-person interview was conducted with 61 WHS leaders at 18 VA Medical Centers, examining WH transformation and use during the pandemic. Data were analyzed using rapid directed content analysis. Results While the pandemic initially slowed transformation efforts, sites intentionally embraced a WH approach to support patients and employees during this crisis. Efforts included conducting patient wellness calls, and, for patients and employees, promoting complementary and integrative health therapies, self-care, and WH concepts to combat stress and support wellbeing. A surge in virtual technology use facilitated innovative delivery of complementary and integrative therapies and promoted continued use of WH activities. Conclusion The pandemic called attention to the need for healthcare systems to address the wellbeing of both patients and providers to sustain high quality care delivery. At a time of crisis, VA sites sustained WH transformation efforts, recognizing WH as one strategy to support patients and employees. This response indicates cultural transformation is taking hold, with WH serving as a promising approach for promoting wellbeing among patients and employees alike.

Examining the pull, the push, and their simultaneous effects on managerial turnover

2020 ◽  
Vol 58 (12) ◽  
pp. 2639-2654 ◽  
Author(s):  
Yoonhee Choi ◽  
Namgyoo K. Park
Keyword(s):  
Top Management Team ◽  
The United States ◽  
Management Team ◽  
Top Management ◽  
Content Type ◽  
Economic Mechanism ◽  
Positive Effects ◽  
Psychological Mechanisms ◽  
Managerial Turnover ◽  
Psychological Mechanism

PurposeThis paper aims to examine the economic and psychological mechanisms in turnover at the managerial level. The paper investigates how (1) the ease of moving posed by alternative jobs (i.e. the economic mechanism) and (2) the desire to move due to low job satisfaction (i.e. the psychological mechanism) simultaneously influence top management team (TMT) turnover and these managers' subsequent job position and pay.Design/methodology/approachUsing 25 years of panel data on more than 2,000 top managers in the United States, the paper utilizes fixed-effects logistic regressions and the ordinary least squares model to test the hypotheses.FindingsThe authors find that CEO awards (an economic mechanism) and low compensation (a psychological mechanism) independently have positive effects on turnover. Turnover due to the economic mechanism leads to a higher position and pay, whereas turnover due to the psychological mechanism does not guarantee the same outcome. Further, when examining how pay dissatisfaction influences turnover simultaneously with CEO awards, the authors find that managers with the highest pay leave their firm, and not those with the lowest pay.Originality/valueThe paper employs the pull-and-push theory in the employee turnover literature and applies it to the top management team literature. By doing so, this paper contributes original insights to how economic and psychological mechanisms simultaneously affect managerial turnover and its subsequent outcomes.

scholarly journals Veterans Health Administration’s Whole Health System of Care: Supporting the Health, Well-Being, and Resiliency of Employees

2021 ◽  
Vol 10 ◽  
pp. 216495612110226
Author(s):  
Kavitha P Reddy ◽  
Tamara M Schult ◽  
Alison M Whitehead ◽  
Barbara G Bokhour
Keyword(s):  
Health System ◽  
Care Delivery ◽  
Health Planning ◽  
Well Being ◽  
Employee Health ◽  
Veterans Health ◽  
Health Administration ◽  
Patient Centered ◽  
Foundational Work ◽  
Health And Well Being

The Veterans Health Administration (VHA) is implementing a Whole Health System (WHS) of care that empowers and equips Veterans to take charge of their health and well-being and live their lives to the fullest, and increasingly leaders recognize the need and value in implementing a similar approach to support the health and well-being of employees. The purpose of this paper is to do the following: 1) provide an overview of the WHS of care in VHA and applicability in addressing employee resiliency; 2) provide a brief history of employee well-being efforts in VHA to date; 3) share new priorities from VHA leadership as they relate to Employee Whole Health strategy and implementation; and 4) provide a summary of the impacts of WHS of care delivery on employees. The WHS of care utilizes all therapeutic, evidence-based approaches to support self-care goals and personal health planning. Extending these approaches to employees builds upon 10 years of foundational work supporting employee health and well-being in VHA. In 2017, one facility in each of the 18 Veterans Integrated Service Networks (VISNs) in VHA was selected to participate in piloting the WHS of care with subsequent evaluation by VA’s Center for Evaluating Patient-Centered Care (EPCC). Early outcomes, from an employee perspective, suggest involvement in the delivery of the WHS of care and personal use of the whole health approach have a meaningful impact on the well-being of employees and how they experience the workplace. During the COVID-19 pandemic, VHA has continued to support employees through virtual resources to support well-being and resiliency. VHA's shift to this patient-centered model is supporting not only Veteran care but also employee health and well-being at a time when increased support is needed.

scholarly journals Big Data Analytics in Healthcare

2015 ◽  
Vol 2015 ◽  
pp. 1-16 ◽  
Author(s):  
Ashwin Belle ◽  
Raghuram Thiagarajan ◽  
S. M. Reza Soroushmehr ◽  
Fatemeh Navidi ◽  
Daniel A. Beard ◽  
...  
Keyword(s):  
Big Data ◽  
Data Analytics ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Big Data Analytics ◽  
Healthcare Systems ◽  
Medical Data ◽  
Unstructured Data ◽  
Process Of Care ◽  
Multimodal Data

The rapidly expanding field of big data analytics has started to play a pivotal role in the evolution of healthcare practices and research. It has provided tools to accumulate, manage, analyze, and assimilate large volumes of disparate, structured, and unstructured data produced by current healthcare systems. Big data analytics has been recently applied towards aiding the process of care delivery and disease exploration. However, the adoption rate and research development in this space is still hindered by some fundamental problems inherent within the big data paradigm. In this paper, we discuss some of these major challenges with a focus on three upcoming and promising areas of medical research: image, signal, and genomics based analytics. Recent research which targets utilization of large volumes of medical data while combining multimodal data from disparate sources is discussed. Potential areas of research within this field which have the ability to provide meaningful impact on healthcare delivery are also examined.

A journey towards integrated person-centred care: a case study of a mental health perspective in the voluntary sector

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Louise Kermode
Keyword(s):  
Mental Health ◽  
Best Practice ◽  
Care Delivery ◽  
Voluntary Sector ◽  
Assessment Tools ◽  
Valuable Insight ◽  
Physical And Mental Health ◽  
Content Type ◽  
Health And Social Care

PurposePerson-centred care is a fundamental component of any service. This case study aims to explore the delivery of person-centred care in the voluntary sector, discussing how integrating support can be achieved to benefit individuals. It identifies challenges, best practice and learning that can be applied across sectors and promotes further enquiry.Design/methodology/approachThis case study is the result of a service audit at a mental health charity. The findings are a blend of reflections, observations and examples from service delivery, synthesised with national policy to provide evidence of best practice and processes that enable person-centred care.FindingsA focus on need not diagnosis, creating accessible and inclusive services, employing dual trained practitioners, having a varied skill mix along with holistic self-assessment tools are all enablers for integrated person-centred support. Multi-agency assessment frameworks, collaboration across services, cross-agency supervision and a shared vision for integration and person-centred care support services to coordinate more effectively. Barriers to integrated person-centred support include complex physical and mental health needs and harmful risk and safeguarding. The diversity of the voluntary sector, a lack of resources along with complex and competitive funding also hinder integration.Originality/valueThis case study provides a valuable insight into the voluntary sector and shares its findings to enhance best practice. It aims to promote interest and invites further research into health and social care delivery by the voluntary sector. As this delivery continues to increase, it is vital to examine the interface between the voluntary and statutory sector. Through better understanding and further research across all sectors, the author can identify how they can achieve person-centred outcomes and deliver the national policies.

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