A review of literature on risk prediction tools for hospital readmissions in older adults

Purpose The purpose of this paper is to identify and analyse the readmission risk prediction tools reported in the literature and their benefits when it comes to healthcare organisations and management.Design/methodology/approach Readmission risk prediction is a growing topic of interest with the aim of identifying patients in particular those suffering from chronic diseases such as congestive heart failure, chronic obstructive pulmonary disease and diabetes, who are at risk of readmission. Several models have been developed with different levels of predictive ability. A structured and extensive literature search of several databases was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis strategy, and this yielded a total of 48,984 records.Findings Forty-three articles were selected for full-text and extensive review after following the screening process and according to the eligibility criteria. About 34 unique readmission risk prediction models were identified, in which their predictive ability ranged from poor to good (c statistic 0.5–0.86). Readmission rates ranged between 3.1 and 74.1% depending on the risk category. This review shows that readmission risk prediction is a complex process and is still relatively new as a concept and poorly understood. It confirms that readmission prediction models hold significant accuracy at identifying patients at higher risk for such an event within specific context.Research limitations/implications Since most prediction models were developed for specific populations, conditions or hospital settings, the generalisability and transferability of the predictions across wider or other contexts may be difficult to achieve. Therefore, the value of prediction models remains limited to hospital management. Future research is indicated in this regard.Originality/value This review is the first to cover readmission risk prediction tools that have been published in the literature since 2011, thereby providing an assessment of the relevance of this crucial KPI to health organisations and managers.

Merger and post-merger integration at Oxford University Hospitals: mixed-methods evaluation and lessons learned

Purpose Hospital mergers are common in the United Kingdom and internationally. However, mergers rarely achieve their intended benefits and are often damaging. This study builds on existing literature by presenting a case study evaluating a merger of two hospitals in Oxford, United Kingdom with three distinct characteristics: merger between two university hospitals, merger between a generalist and specialist hospital and merger between two hospitals of differing size. In doing so, the study draws practical lessons for other healthcare organisations.Design/methodology/approach Mixed-methods single-case evaluation. Qualitative data from 19 individual interviews and three focus groups were analysed thematically, using constant comparison to synthesise and interpret findings. Qualitative data were triangulated with quantitative clinical and financial data. To maximise research value, the study was co-created with practitioners.Findings The merger was a relative success with mixed improvement in clinical performance and strong improvement in financial and organisational performance. The merged organisation received an improved inspection rating, became debt-free and achieved Foundation Trust status. The study draws six lessons relating to the contingencies that can make mergers a success: (1) Develop a strong clinical rationale, (2) Communicate the change strategy widely and early, (3) Increase engagement and collaboration at all levels, (4) Be transparent and realistic about the costs and benefits, (5) Be sensitive to the feelings of the other organisation and (6) Integrate different organizational cultures effectively.Originality/value This case study provides empirical evidence on the outcome of merger in a university hospital setting. Despite the relatively positive outcome, there is no strong evidence that the benefits could not have been achieved without merger. Given that mergers remain prevalent worldwide, the practical lessons might be useful for other healthcare organisations considering merger.

A practical framework for achieving value creation and capture in healthcare through process improvement

PurposeThe purpose of this study was to examine the concept of value in healthcare through a practical appraisal of the applicability of a conceptual framework, which is aimed at supporting the measurement and realisation of financial benefits from process improvement (PI) activities in a hospital setting.Design/methodology/approachA single case study of a hospital system in Melbourne, Victoria, Australia, was used to assess the applicability of the framework. The study sought to verify the framework's intention, that PI methods could be used to address known wastes that contribute to the cost of providing healthcare. The case study examines the current approach taken by the hospital to measure and realise financial benefits from PI activities and compares these to the components of the Strategy to Balance Cost and Quality in Health Care framework to assess its applicability in practice.FindingsThe case study revealed that the steps described in the framework were fundamentally in place albeit with some variation. Importantly, the case study identified an additional step that could be added into the framework to support hospitals to better define their portfolio of initiatives to deliver value. The case study also clarified three types of contributory elements that should be in place for the application of the framework to be successful.Practical implicationsThe Framework to Achieve Value in Healthcare is offered to hospitals as a model by which they can look to reduce expenditure through the removal of non-value adding activities. The modification to the conceptual framework has arisen from a single case study and would benefit from further testing by other hospitals in other policy settings (i.e. other countries).Originality/valueThis is the first paper to examine and enhance an existing framework to assist hospitals balance cost and quality through PI.

The neglected contexts and outcomes of evidence-based management: a systematic scoping review in hospital settings

PurposeThe coronavirus disease 2019 (COVID-19) pandemic highlighted the necessity of practicing Evidence-based Management (EBMgt) as an approach to decision-making in hospital settings. The literature, however, provides limited insight into the process of EBMgt and its contextual nuances. Such insight is critical for better leveraging EBMgt in practice. Therefore, the authors' aim was to integrate the literature on the process of EBMgt in hospital settings, identify the gaps in knowledge and delineate areas for future research.Design/methodology/approachThe authors conducted a systematic scoping review using an innovative methodology that involved two systematic searches. First using EBMgt terminology and second using terminology associated with the EBMgt concept, which the authors derived from the first search.FindingsThe authors identified 218 relevant articles, which using content analysis, they mapped onto the grounded model of the EBMgt process; a novel model of the EBMgt process developed by Sahakian and colleagues. The authors found that the English language literature provides limited insight into the role of managers' perceptions and motives in EBMgt, the practice of EBMgt in Global South countries, and the outcomes of EBMgt. Overall, this study’s findings indicated that aspects of the decision-maker, context and outcomes have been neglected in EBMgt.Originality/valueThe authors contributed to the EBMgt literature by identifying these gaps and proposing future research areas and to the systematic review literature by developing a novel scoping review method.

Towards quality primary health care: the dilemma of Community-Based Health Planning and Services (CHPS) in health service provision in Ghana

PurposeOver the past two decades, Community-Based Health Planning and Services (CHPS) has been a pragmatic strategy towards universal Primary Health Care (PHC) in Ghana. However, the ability and capacity of these facilities to deliver quality primary health care remain an illusion as they are still crumbling in myriad challenges. These challenges are translated to the poor-quality services provision and low community utilization of CHPS facilities. The study presents a comparative analysis of three communities in the Kassena-Nankana East Municipality, Ghana.Design/methodology/approachUsing a mixed-method research design, the study gathered and analysed data from 110 households, three community health officers (CHOs) and three community leaders using semi-structured questionnaires and interview guides.FindingsThe findings indicated that the facilities do not have the requisite inputs such as drugs and supplies, logistics, appropriate health personnel, good infrastructure, funding support necessary to deliver quality and appropriate healthcare services that meet the health needs of the communities. For the CHPS to realize their full potentials as PHC facilities, it is required that the needed inputs such as logistics, drugs and appropriate staff are in place to facilitate the activities of CHOs.Research limitations/implicationsDue to the limited number of participants and selection of the study communities, the results may generalization. Also, the researchers acknowledged the inability to interview the district level health officials and the Kassena-Nankana Municipal Assembly during the field visits. This could have provided in-depth knowledge on the findings of this research as well as the validation of the results from the communities' perspective. Several attempts were made to contact and interview district-level authorities which proven futile due to the unavailability of targeted respondents. This resulted in limiting the studies at the community level. However, this limitation does not disprove the findings of this study.Practical implicationsThe article implications for planning primary health care strategies include a keen assessment of community health needs and institutional management of primary health care facilities, equip PHC facilities with adequate resources such as drugs and appropriate staffing to provide the health needs of the communities.Originality/valueThe paper fulfils the gap in the literature by providing empirical data on how the challenges of primary health care facilities affected the provision of high quality service and how this can affect community’s use of the facilities.

Process facilitators shifting between the support and expert roles in a complex work environment intervention in the Swedish healthcare sector

PurposeProcess facilitation as part of a complex intervention for changing or improving practices within workplaces is becoming a common work method. The aim of this study was to investigate what characterizes the process-facilitating role in a complex intervention.Design/methodology/approachThe present study focuses on a complex work environment intervention targeting eight organizational units (workplaces) in the Swedish healthcare sector. The study applies a mixed-method approach and has been carried out in two steps. First, a qualitative process evaluation was performed. Secondly, an evaluation was conducted to see to what extent these identified conditions and mechanisms affected the quantitative intervention effect in term of sickness absence.FindingsThe analysis shows that the facilitating role consisted of three overlapping and partially iterative phases. These phases involved different activities for the facilitating role. Depending on how the facilitating role and the intervention were designed, various supporting conditions were found to significantly affect the outcome of the intervention measured as the total sickness absence.Research limitations/implicationsIt is concluded that the facilitation is not static or fixed during the change process. Instead, the facilitation role develops and emerges through the process of support during the different implementation phases.Practical implicationsThe facilitative role of performing support is based on a combination of support role activities and expert role activities. The support role focuses on support activities, while the expert role includes capacity building through knowledge- and legitimacy-oriented activities.Originality/valueThis study contributes to earlier research by developing a methodological approach for carrying out process facilitation in complex interventions.

A literature review of leadership training and a novel conceptual model of leader-member exchange theory for new dentists

PurposeThe purpose of the paper is to describe the current state of leadership and leader–member exchange (LMX) theory in dentistry and develop a novel conceptual model of LMX to guide future research and highlight the importance of enhancing leadership training for new dentists.Design/methodology/approachA literature review exploring leadership in dentistry and LMX in dentistry was completed. The findings were analyzed with framework analysis to develop a novel conceptual model of LMX specific to dentistry.FindingsLMX theory was applied to leadership in dentistry, including a focus on new dentists, senior dentists, other dental team members and the patient. A new conceptual model of the New Dentist LMX Quartet, which is unique and specific to new dentist teams, was developed.Research limitations/implicationsThe study identifies the need for research in LMX in dentistry, contributes a new conceptual model for LMX theory and identifies future research.Practical implicationsPractitioners, policymakers and educators can utilize this information to explore concepts in leadership and improve training and dental practice.Originality/valueNo other studies specifically exploring LMX in dentistry for new dentists exist. The current literature review and conceptual paper begins the conversation on developing understanding of leadership in dentistry through further research.

The relationship between healthcare service provision models and patient experience

PurposeUser experience is key for measuring and improving the quality of services, especially in high personal and relation-intensive sectors, such as healthcare. However, evidence on whether and how the organizational model of healthcare service delivery can affect the patient experience is at an early stage. This study investigates the relationship between healthcare service provision models and patient experience by focusing on the nursing care delivery.Design/methodology/approach65 nurses' coordinators were involved to map the nursing models adopted in the healthcare organizations of in an Italian region, Tuscany. This dataset was merged with patient experience measures reported by 9,393 individuals discharged by the same organizations and collected through a Patient-Reported Experience Measures Observatory. The authors run a series of logistic regression models to test the relationships among variables.FindingsPatients appreciate those characteristics of care delivery related to a specific professional nurse. Having someone who is in charge of the patient, both the reference nurse and the supervisor, makes a real difference. Purely organizational features, for instance those referring to the team working, do not significantly predict an excellent experience with healthcare services.Research limitations/implicationsDifferent features referring to different nursing models make the difference in producing an excellent user experience with the service.Practical implicationsThese findings can support managers and practitioners in taking decisions on the service delivery models to adopt. Instead of applying monolithic pure models, mixing features of different models into a hybrid one seems more effective in meeting users' expectations.Originality/valueThis is one of the first studies on the relationship between provision models of high-contact and relational-intensive services (the healthcare services) and users' experience. This research contributes to the literature on healthcare service management suggesting to acknowledge the importance of hybridization of features from different, purely theoretical service delivery models, in order to fit with providers' practice and users' expectations.Highlights This is one of the first studies on the relationship between provision models of nursing care and patient experience.Healthcare services' users appreciate service delivery characteristics identified with “be cared by,” or in other words with having a reference nurse.Nursing models' features that relate to the organizations and that providers tend to judge as professionalizing and evolutive, such as team working, appear not key in relation to patient experience.Pure models of service delivery are theoretically useful, but hybrid models can better meet users' expectations.

The compatibility of multiple leadership styles in responding to a complex crisis: leading a health service COVID-19 response

PurposeThe health service response to COVID-19 provided a unique opportunity to build our understanding of the leadership styles in use in managing a crisis event. Existing literature emphasises command and control leadership; however, there has been less emphasis on relational approaches and the behaviours necessary to ensure the agility of the response and minimise the risk of relational disturbances. The purpose of this paper is to understand leadership styles in use, as part of a health service response to COVID-19.Design/methodology/approachThis paper draws on data from semi-structured interviews with 27 executives and senior leaders from a tertiary health service in Australia. The data were analysed using thematic analysis. Notes and examples were coded according to deductively derived criteria around leadership styles and competencies from the literature, while remaining open to emergent themes.FindingsHealth system leaders described examples of both command and control and relational leadership behaviours. This dually provided the discipline (command and control) and agility (relational) required of the crisis response. While some leaders experienced discomfort in enacting these dual behaviours, this discomfort related to discordance with leadership preferences rather than conflict between the styles. Both leadership approaches were considered necessary to effectively manage the health system response.Originality/valueCrisis management literature has typically focused on defining and measuring the effectiveness of behaviours reflective of a command and control leadership response. Very few studies have considered the relational aspects of crisis management, nor the dual approaches of command and control, and relational leadership.

Strategic leadership and management factors driving sustainability in health-care organizations in Thailand

Purpose This empirical study aims to identify the essential strategic leadership and management factors underlying sustainability in healthcare. It also examines which factors drive sustainability performance outcomes (SPO) in health-care organizations, an analysis lacking to date. It provides a strategic leadership and management perspective toward sustainable healthcare, responding to the United Nations Sustainable Development Goals.Design/methodology/approachThe investigation adopted Sustainable Leadership as its research framework. Using a cross-sectional survey, 543 employees working in health-care and pharmaceutical companies in Thailand voluntarily provided responses. Factor analyses and structural equation modeling were employed.Findings The results revealed an emergent research model and identified 20 unidimensional strategic leadership and management factors toward sustainability in healthcare. The findings indicate significant positive effects on SPO in health-care organizations. Significant factors include human resource management/development, ethics, quality, environment and social responsibility, and stakeholder considerations.Research limitations/implicationsThe study was conducted in one country. Future studies should examine these relationships in diverse contexts. In practice, health-care firms should foster significant strategic leadership and management practices to improve performance outcomes for sustainability in healthcare.Originality/value This paper is the first empirical, multidisciplinary study with a focus on strategic leadership, health-care management and organizational sustainability. It identifies a proxy for measuring the effects of essential strategic leadership and managerial factors for sustainability in pharmaceutical health-care companies. It advances our currently limited knowledge and provides managerial implications for improving performance outcomes toward sustainable healthcare.