To be or not to be compliant? Hospitals' initial strategic responses to the federal price transparency rule.

Objective: To understand US hospitals' initial strategic responses to the federal price transparency rule that took effect January 2021.

Data Sources And Study Setting: Primary interview data collected from 12 not-for-profit hospital organizations in six US metropolitan markets. All but one organization were multihospital systems; the 12 organizations represent a total of 81 hospitals.

Closing the Gender Gap in Healthcare Leadership: Can Administrative Fellowships Play a Role?

Goal: Although women make up most of the healthcare workforce, they are underrepresented in higher levels of leadership positions. Leadership development programs for early careerists, such as administrative fellowships, have been suggested as one strategy for accelerating gender equity in leadership roles. However, the potential impact of these programs has not yet been the subject of systematic evaluation.

Amblyopia Risk Factors in Premature Children in the First 3 Years of Life.

Purpose: To determine the incidence of amblyopia risk factors during the first 3 years of life in premature children.

Methods: This prospective cohort included 145 premature children (gestational age of less than 37 weeks) who were evaluated for amblyopia risk factors every 6 months until age 3 years. The incidence rate, cumulative incidence, and prevalence of any amblyopia risk factor were assessed in retinopathy of prematurity (ROP) and non-ROP screened groups.

Toward a high-performance management system in health care, Part 5: How high-performance work practices facilitate speaking up in health care organizations.

Background: Employees' reluctance to speak up about problems and/or make suggestions for improvement is a noted barrier to quality and patient safety improvement in health care organizations. High-performance work practices (HPWPs) offer a framework for considering how management practices can encourage speaking up in these organizations.

Purposes: We aimed to explore how implementation of HPWPs in U.

The effect of enucleation on orbital growth in patients with retinoblastoma.

Purpose: To measure orbital volume using serial magnetic resonance imaging (MRI) scans to determine the effect of enucleation on orbital growth over time.

Methods: The medical records of patients who underwent unilateral enucleation for retinoblastoma with a minimum of 2 MRIs were retrospectively reviewed. Orbital asymmetry was calculated using MRI measurements.

Encouraging employees to speak up to prevent infections: Opportunities to leverage quality improvement and care management processes.

Background: Central line-associated bloodstream infections (CLABSIs) are associated with increased morbidity, mortality, and cost for U.S. hospitals, but many infections are preventable.

Toward a high-performance management system in health care, part 4: Using high-performance work practices to prevent central line-associated blood stream infections-a comparative case study.

Background: Central line-associated bloodstream infections (CLABSIs) are among the most harmful health care-associated infections and a major patient safety concern. Nationally, CLABSI rates have been reduced through the implementation of evidence-based interventions; thus far, however, hospitals still differ substantially in their success implementing these practices. Prior research on high-performance work practices (HPWPs) suggests that these practices may explain some of the differences health systems experience in the success of their quality improvement efforts; however, these relationships have not yet been systematically investigated.

Preventing central line-associated bloodstream infections: a qualitative study of management practices.

Objective: To identify factors that may explain hospital-level differences in outcomes of programs to prevent central line-associated bloodstream infections.

Design: Extensive qualitative case study comparing higher- and lower-performing hospitals on the basis of reduction in the rate of central line-associated bloodstream infections. In-depth interviews were transcribed verbatim and analyzed to determine whether emergent themes differentiated higher- from lower-performing hospitals.

Implementing high-performance work practices in healthcare organizations: qualitative and conceptual evidence.

Studies across industries suggest that the systematic use of high-performance work practices (HPWPs) may be an effective but underused strategy to improve quality of care in healthcare organizations. Optimal use of HPWPs depends on how they are implemented, yet we know little about their implementation in healthcare. We conducted 67 key informant interviews in five healthcare organizations, each considered to have exemplary work practices in place and to deliver high-quality care, as part of an extensive study of HPWP use in healthcare.

Facilitating ambulatory electronic health record system implementation: evidence from a qualitative study.

Background: Ambulatory care practices have increasing interest in leveraging the capabilities of electronic health record (EHR) systems, but little information is available documenting how organizations have successfully implemented these systems. Objective. To characterize elements of successful electronic health record (EHR) system implementation and to synthesize the key informants' perspectives about successful implementation practices.

Using high-performance work practices in health care organizations: a perspective for nursing.

Studies suggest that the use of high-performance work practices (HPWPs) may help improve quality in health care. We interviewed 67 administrators and clinicians across 5 health care organizations and found that the use of HPWPs was valued and salient for nurses. Communication appeared particularly important to facilitate HPWP use.

The role of leadership in eliminating health care-associated infections: a qualitative study of eight hospitals.

Purpose: Despite hospitals' efforts to reduce health care-associated infections (HAIs), success rates vary. We studied how leadership practices might impact these efforts.

Design/methodology/approach: We conducted eight case studies at hospitals pursuing central line-associated blood stream infection (CLABSI)-prevention initiatives.

How high-performance work systems drive health care value: an examination of leading process improvement strategies.

Background: As hospitals focus on increasing health care value, process improvement strategies have proliferated, seemingly faster than the evidence base supporting them. Yet, most process improvement strategies are associated with work practices for which solid evidence does exist. Evaluating improvement strategies in the context of evidence-based work practices can provide guidance about which strategies would work best for a given health care organization.

The role of cognitive and learning theories in supporting successful EHR system implementation training: a qualitative study.

Given persistent barriers to effective electronic health record (EHR) system implementation and use, the authors investigated implementation training practices in six organizations reputed to have ambulatory care EHR system implementation "best practices." Using the lenses of social cognitive and adult learning theories, they explored themes related to EHR implementation training using qualitative data collected through 43 key informant interviews and 6 physician focus groups conducted between February 2009 and December 2010. The authors found consistent evidence that training practices across the six organizations known for exemplary implementations were congruent with the tenets of these theoretical frameworks and highlight seven best practices for training.

High-performance work systems in health care, part 3: the role of the business case.

Background: Growing evidence suggests the systematic use of high-performance work practices (HPWPs), or evidence-based management practices, holds promise to improve organizational performance, including improved quality and efficiency, in health care organizations. However, little is understood about the investment required for HPWP implementation, nor the business case for HPWP investment.

Purpose: The aim of this study is to enhance our understanding about organizations' perspectives of the business case for HPWP investment, including reasons for and approaches to evaluating that investment.

Exploring the business case for ambulatory electronic health record system adoption.

Widespread implementation and use of electronic health record (EHR) systems has been recognized by healthcare leaders as a cornerstone strategy for systematically reducing medical errors and improving clinical quality. However, EHR adoption requires a significant capital investment for healthcare providers, and cost is often cited as a barrier. Despite the capital requirements, a true business case for EHR system adoption and implementation has not been made.

Using extended cognitive behavioral treatment and medication to treat dependent smokers.

Objectives: We evaluated smoking-cessation efficacy of an extended course of sustained-release bupropion (bupropion SR) and cognitive-behavioral treatment (CBT).

Methods: Participants who smoked at least 10 cigarettes per day and who smoked within 30 minutes of arising (n = 406) completed a 12-week smoking-cessation treatment including group counseling, nicotine-replacement therapy, and bupropion SR. Participants were then randomly assigned to 1 of 5 conditions: (1) no further treatment, (2) active bupropion SR for 40 weeks, (3) placebo for 40 weeks, (4) active bupropion SR and 11 sessions of CBT for 40 weeks (A-CBT), or (5) placebo and 11 sessions of CBT for 40 weeks.

High-performance work systems in health care management, part 2: qualitative evidence from five case studies.

Background: : A capable workforce is central to the delivery of high-quality care. Research from other industries suggests that the methodical use of evidence-based management practices (also known as high-performance work practices [HPWPs]), such as systematic personnel selection and incentive compensation, serves to attract and retain well-qualified health care staff and that HPWPs may represent an important and underutilized strategy for improving quality of care and patient safety.

Purpose: : The aims of this study were to improve our understanding about the use of HPWPs in health care organizations and to learn about their contribution to quality of care and patient safety improvements.

Perceived efficiency impacts following electronic health record implementation: an exploratory study of an urban community health center network.

Purpose: Faced with an increasingly complex patient population and growing demand for services, community health centers (CHCs) are recognizing that electronic health records (EHRs) may help their efforts to improve efficiency in care delivery. Yet little is known about the benefits, challenges, and specific impacts of EHR implementation in the often resource-constrained CHC environment, especially from users' perspectives. The objective of this study was to explore EHR users' perspectives about the EHR implementation process and impact in a CHC network.

Moving from good to great in ambulatory electronic health record implementation.

Despite a good general understanding of the need to ensure provider adoption and use of electronic health record (EHR) systems, many implementations fall short of expectations, and little is known about effective approaches in the ambulatory care area. We aimed to comprehensively study and synthesize best practices for ambulatory EHR system implementation in healthcare organizations, emphasizing strategies that maximize physician adoption and use. Following an extensive literature review, we held 47 key informant interviews with representatives of six U.

Extended treatment of older cigarette smokers.

Aims: Tobacco dependence treatments achieve abstinence rates of 25-30% at 1 year. Low rates may reflect failure to conceptualize tobacco dependence as a chronic disorder. The aims of the present study were to determine the efficacy of extended cognitive behavioral and pharmacological interventions in smokers > or = 50 years of age, and to determine if gender differences in efficacy existed.

The adolescent incest victim and the judicial system.

The effect on the adolescent incest victim of contact with the judicial system is reviewed, and the victim's sense of insignificance, hopelessness, and guilt is noted. A conceptual framework is offered to aid clinicians in their work with incest victims, and suggestions are made for case management.