Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
106
result(s) for
"Stock, Gregory"
Sort by:
The effects of physicians on operational and financial performance in United States hospitals: staffing, human capital and knowledge spillovers
PurposeThe authors examine how physician staffing, human capital and knowledge spillovers are related to multiple dimensions of hospital operational and financial performance at the organizational level.Design/methodology/approachThe authors use a data set assembled from multiple sources for more than 1,300 US hospitals and employ hierarchical linear regression to test this study’s hypotheses. The authors use multiple quality, efficiency and financial measures of performance for these hospitals.FindingsThe authors find that higher levels of staffing, skills and knowledge spillovers associated with physicians were positively associated with multiple dimensions of hospital performance. The authors find linear and nonlinear relationships between experience and performance, with the relationships primarily negative, and nonlinear relationships between spillovers and quality performance.Practical implicationsHospital managers should consider increasing physician staffing levels if possible. In addition, the overall Final MIPS Score from the Centers for Medicare and Medicaid Services might be included as a factor in determining which physicians practice in a hospital. Finally, if possible, encouraging physicians to practice at multiple hospitals will likely be beneficial to hospital performance.Originality/valueThis study’s findings are original in that they explore how physician-specific staffing and human capital, which have received comparatively little attention in the literature, are related to several different dimensions of hospital-level operational and financial performance. To the best of the authors’ knowledge, this paper is also the first to examine the relationship between the construct of physician knowledge spillovers and hospital-level operational and financial performance.
Journal Article
Leadership, safety climate, and continuous quality improvement
Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals.
We present a research model that shows how transformational leadership, safety climate, and continuous quality improvement (CQI) initiatives are related to objective quality and patient safety outcome measures.
The proposed framework is tested using structural equation modeling, based on data collected for 204 hospitals, and supplemented with objective outcome data from the Centers for Medicare and Medicaid Services.
The results provide empirical evidence that a safety climate, which is connected to the chief executive officer's transformational leadership style, is related to CQI initiatives, which are linked to improved process quality. A unique finding of this study is that, although CQI initiatives are positively associated with improved process quality, they are also associated with higher hospital-acquired condition rates, a measure of patient safety. Likewise, safety climate is directly related to improved patient safety outcomes.
The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.
Journal Article
Evaluation of direct-to-consumer low-volume lab tests in healthy adults
Clinical laboratory tests are now being prescribed and made directly available to consumers through retail outlets in the USA. Concerns with these test have been raised regarding the uncertainty of testing methods used in these venues and a lack of open, scientific validation of the technical accuracy and clinical equivalency of results obtained through these services.
We conducted a cohort study of 60 healthy adults to compare the uncertainty and accuracy in 22 common clinical lab tests between one company offering blood tests obtained from finger prick (Theranos) and 2 major clinical testing services that require standard venipuncture draws (Quest and LabCorp). Samples were collected in Phoenix, Arizona, at an ambulatory clinic and at retail outlets with point-of-care services.
Theranos flagged tests outside their normal range 1.6× more often than other testing services (P < 0.0001). Of the 22 lab measurements evaluated, 15 (68%) showed significant interservice variability (P < 0.002). We found nonequivalent lipid panel test results between Theranos and other clinical services. Variability in testing services, sample collection times, and subjects markedly influenced lab results.
While laboratory practice standards exist to control this variability, the disparities between testing services we observed could potentially alter clinical interpretation and health care utilization. Greater transparency and evaluation of testing technologies would increase their utility in personalized health management.
This work was supported by the Icahn Institute for Genomics and Multiscale Biology, a gift from the Harris Family Charitable Foundation (to J.T. Dudley), and grants from the NIH (R01 DK098242 and U54 CA189201, to J.T. Dudley, and R01 AG046170 and U01 AI111598, to E.E. Schadt).
Journal Article
Improving service operations: linking safety culture to hospital performance
Purpose
The purpose of this paper is to examine the relationship between patient safety culture and hospital performance using objective performance measures and secondary data on patient safety culture.
Design/methodology/approach
Patient safety culture is measured using data from the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture. Hospital performance is measured using objective patient safety and operational performance metrics collected by the Centers for Medicare and Medicaid Services (CMS). Control variables were obtained from the CMS Provider of Service database. The merged data included 154 US hospitals, with an average of 848 respondents per hospital providing culture data. Hierarchical linear regression analysis is used to test the proposed relationships.
Findings
The findings indicate that patient safety culture is positively associated with patient safety, process quality and patient satisfaction.
Practical implications
Hospital managers should focus on building a stronger patient safety culture due to its positive relationship with hospital performance.
Originality/value
This is the first study to test these relationships using several objective performance measures and a comprehensive patient safety culture data set that includes a substantial number of respondents per hospital. The study contributes to the literature by explicitly mapping high-reliability organization (HRO) theory to patient safety culture, thereby illustrating how HRO theory can be applied to safety culture in the hospital operations context.
Journal Article
Hospital operations and length of stay performance
Purpose - As hospital costs continue to rise, increasing attention is being paid to the way these organizations are and should be managed. This attention typically comes in the form of focus on costs of services, quality (often measured through mortality rates) and length of stay. Hospital management has a broad array of choices at their disposal to address these challenges. As service operations, hospitals present a significant opportunity to apply the many tools and techniques from the field of operations strategy to this important industry. The objective of this paper is to use the operations strategy framework to assess the relationship between a set of operational elements and hospital performance in terms of average length of stay (ALOS), so that hospital managers improve the effectiveness and efficiency of patient care of their hospitals.Design methodology approach - Using the structural and infrastructural operations strategy framework, this study examines the relationship between several strategic variables and hospital performance. To analyze these relationships the paper employs data from the population of hospitals in New York State. The performance measure is the ALOS for patients, adjusted for the mix and severity of cases in each hospital.Findings - The paper finds that a direct relationship exists between the dependent variable and location, capacity, and teaching status, and failed to find a direct relationship for capital expenditures, salary, and staffing levels. However, the paper did find significant interaction effects between capital expenses and both salary and staffing levels.Practical implications - There appear to be trade-offs between capital expenditures and workforce decisions that have significant implications in light of current and expected hospital staffing shortages. The findings indicate that reductions in staff may not be perfectly replaced by corresponding increases in capital expenditures.Originality value - This paper further expands the body of research that addresses the important challenges hospitals face from an operations management perspective.
Journal Article
A Cross-sectional Study of Hospital Performance on ICU Utilization Practices for Patients with Chronic Obstructive Pulmonary Disease
Purpose
Intensive care unit (ICU) resources are a costly but effective commodity used in the management of critically ill patients with chronic obstructive pulmonary disease (COPD). ICU admission decisions are determined by patient diagnosis and severity of illness, but also may be affected by hospital differences in quality and performance. We investigate the variability in ICU utilization for patients with COPD and its association with hospital characteristics.
Methods
Using a 3M administrative dataset spanning 2008–2013, we conducted a retrospective cohort study of adult patients discharged with COPD at hospitals in three state to determine variability in ICU utilization. Quality metrics were calculated for each hospital using observed-to-expected (O/E) ratios for overall mortality and length of stay. Logistic and multilevel multivariate regression models were constructed, estimating the association between hospital quality metrics on ICU utilization, after adjustment for available clinical factors and hospital characteristics.
Results
In 434 hospitals with 570,517 COPD patient visits, overall ICU admission rate was 33.1% [range 0–89%; median (IQR) 24% (8, 54)]. The addition of patient, hospital, and quality characteristics decreased the overall variability attributable to individual hospital differences seen within our cohort from 40.9 to 33%. Odds of ICU utilization were increased for larger hospitals and those seeing lower pulmonary case volume. Hospitals with better overall O/E ratios for length of stay or mortality had lower ICU utilization.
Conclusions
Hospital characteristics, including quality metrics, are associated with variability in ICU utilization for COPD patients, with higher ICU utilization seen for lower performing hospitals.
Journal Article
External technology integration in product and process development
This paper empirically examines the process of acquiring technology from a source, external to the firm, and incorporating it into a new product or operational process under development. We refer to this key activity in product and process innovation as external technology integration. This paper develops a conceptual model of external technology integration based on organizational information processing theory and a wide range of technology management literature. Field interviews were conducted to evaluate the validity of the model across diverse settings. Our results indicate general support for the conceptual model. We close with a discussion of the implications of this study for both theory and practice.
Journal Article
Leadership, safety climate, and continuous quality improvement
Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals.
We present a research model that shows how transformational leadership, safety climate, and continuous quality improvement (CQI) initiatives are related to objective quality and patient safety outcome measures.
The proposed framework is tested using structural equation modeling, based on data collected for 204 hospitals, and supplemented with objective outcome data from the Centers for Medicare and Medicaid Services.
The results provide empirical evidence that a safety climate, which is connected to the chief executive officer's transformational leadership style, is related to CQI initiatives, which are linked to improved process quality. A unique finding of this study is that, although CQI initiatives are positively associated with improved process quality, they are also associated with higher hospital-acquired condition rates, a measure of patient safety. Likewise, safety climate is directly related to improved patient safety outcomes.
The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.
Journal Article