Enhanced Transitions of Care: Centralizing Discharge Phone Calls Improves Ability to Reach Patients and Reduces Hospital Readmissions.

Background: The discharge phone call (DPC) is an important initiative aimed at improving transitions of care and reducing readmissions. It is of added importance as financial penalties will be imposed on hospitals with "excessive" Medicare readmissions. This study examines the impact of DPCs on percentages of patients reached through the DPCs and hospital readmission rates based on the centralized or noncentralized mode of DPCs.

Hospital Characteristics are Associated With Readiness to Attain Stage 2 Meaningful Use of Electronic Health Records.

Purpose: To examine the difference between rural and urban hospitals as to their overall level of readiness for stage 2 meaningful use of electronic health records (EHRs) and to identify other key factors that affect their readiness for stage 2 meaningful use.

Methods: A conceptual framework based on the theory of organizational readiness for change was used in a cross-sectional multivariate analysis using 2,083 samples drawn from the HIMSS Analytics survey conducted with US hospitals in 2013.

Findings: Rural hospitals were less likely to be ready for stage 2 meaningful use compared to urban hospitals in the United States (OR = 0.

Organizational capacity for change in health care: Development and validation of a scale.

Background: We do not have a strong understanding of a health care organization's capacity for attempting and completing multiple and sometimes competing change initiatives. Capacity for change implementation is a critical success factor as the health care industry is faced with ongoing demands for change and transformation because of technological advances, market forces, and regulatory environment.

Purpose: The aim of this study was to develop and validate a tool to measure health care organizations' capacity to change by building upon previous conceptualizations of absorptive capacity and organizational readiness for change.

Studer Group® ' s evidence-based leadership initiatives.

Purpose: The purpose of this paper is to analyze the implementation of an organizational change initiative--Studer Group®'s Evidence-Based Leadership (EBL)--in two large, US health systems by comparing and contrasting the factors associated with successful implementation and sustainability of the EBL initiative.

Design/methodology/approach: This comparative case study assesses the responses to two pairs of open-ended questions during in-depth qualitative interviews of leaders and managers at both health systems. Qualitative content analysis was employed to identify major themes.

The influence of organization tenure on nurses' perceptions of multiple work process improvement initiatives.

Background: A nurse's optimism or skepticism toward an organization-mandated change initiative largely depends on their experience with similar change initiatives and their unit's and organization's track record with previous change efforts. Thus, depending on the context, organization tenure can work in favor or against any particular change initiative. However, few studies have examined the impact of organization tenure on perceptions toward change initiatives.

Physician Engagement: Strategic Considerations among Leaders at a Major Health System.

The authors utilize qualitative interviews with 38 health administrators at one large metropolitan, multihospital system to help identify perspectives regarding physician engagement. Here they focus on 1) lessons learned from past physician engagement efforts, 2) strategic considerations concerning the engagement of physicians, and 3) recommendations for future action. The authors conclude that current hospital leaders have learned from the failures of the past based on the identification of success factors critical to physician engagement.

Bedside shift reports: what does the evidence say?

Bedside shift reports are viewed as an opportunity to reduce errors and important to ensure communication between nurses and communication. Models of bedside report incorporating the patient into the triad have been shown to increase patient engagement and enhance caregiver support and education. Nurse shift reports and nurse handovers are 2 of the most critical processes in patient care that can support patient safety and reduce medical errors in the United States.

Success factors for strategic change initiatives: a qualitative study of healthcare administrators' perspectives.

Success factors related to the implementation of change initiatives are well documented and discussed in the management literature, but they are seldom studied in healthcare organizations engaged in multiple strategic change initiatives. The purpose of this study was to identify key success factors related to implementation of change initiatives based on rich qualitative data gathered from health leader interviews at two large health systems implementing multiple change initiatives. In-depth personal interviews with 61 healthcare leaders in the two large systems were conducted and inductive qualitative analysis was employed to identify success factors associated with 13 change initiatives.

Discharge phone calls: a technique to improve patient care during the transition from hospital to home.

The discharge process is a transitional period when the patient's care is shifted from the hospital to the home and can be stressful for patients. One technique used to improve the quality and continuity of care is the discharge phone call (DPC). A large, metropolitan hospital implemented the DPC program to improve quality of care and decrease readmission rates.

Multiproject interdependencies in health systems management: a longitudinal qualitative study.

Background: A health care organization often engages in the simultaneous implementation of multiple organization change initiatives. However, the degree to which these initiatives are implemented and can be enhanced based on their interdependencies is an open question. How organizations and the change initiatives they pursue might benefit from more careful examination of potential interdependencies among projects was explored in this article.

Health care administrators' perspectives on the role of absorptive capacity for strategic change initiatives: a qualitative study.

Background: The dimensions of absorptive capacity (ACAP) are defined, and the importance of ACAP is established in the management literature, but the concept has not been applied to health care organizations attempting to implement multiple strategic initiatives.

Purpose: The aim of this study was to test the utility of ACAP by analyzing health care administrators' experiences with multiple strategic initiatives within two health systems.

Methodology: Results are drawn from administrators' assessments of multiple initiatives within two health systems using in-depth personal interviews with a total of 61 health care administrators.

Use of a health information exchange system in the emergency care of children.

Background: Children may benefit greatly in terms of safety and care coordination from the information sharing promised by health information exchange (HIE). While information exchange capability is a required feature of the certified electronic health record, we known little regarding how this technology is used in general and for pediatric patients specifically.

Methods: Using data from an operational HIE effort in central Texas, we examined the factors associated with actual system usage.

Factors associated with health information exchange system usage in a safety-net ambulatory care clinic setting.

The Meaningful Use criteria promises to make health information exchange (HIE) much more widespread. However, the usage of the information systems made available by existing HIE efforts tends to be very low. This study sought to examine the factors associated with usage of an operational HIE system during ambulatory care visits to safety-net clinics.

Rural Healthy People 2010, 2020, and beyond: the need goes on.

Rural Healthy People 2010 represented the first effort to specifically include small and rural communities in the Healthy People movement to improve the health of Americans. Rural Healthy People 2010 set rural-specific health priority areas, documented what is known about health in rural areas, identified rural best practice programs/interventions, and promoted rural health services research and researchers. Over the last decade Rural Healthy People 2010 has provided policy makers, rural providers, and rural communities with a valuable resource for planning and policy making.

Patient-centered medical homes: will health care reform provide new options for rural communities and providers?

Many are calling for the expansion of the patient-centered medical home model into rural and underserved populations as a transformative strategy to address issues of access, efficiency, quality, and sustainability in the delivery of health care. Patient-centered medical homes have been touted as a promising cost-saving model for comprehensive management of persons with chronic diseases and disabilities, but it is unclear how rural practitioners in medically underserved areas will implement the patient-centered medical home. This article examines how the Patient Protection & Affordable Care Act of 2010 will enhance rural providers' ability to provide patient-centered care and services contemplated under the Act in a comprehensive, coordinated, cost-effective way despite leaner budgets and health workforce shortages.

Factors motivating and affecting health information exchange usage.

Objective: Health information exchange (HIE) is the process of electronically sharing patient-level information between providers. However, where implemented, reports indicate HIE system usage is low. The aim of this study was to determine the factors associated with different types of HIE usage.

Determinants of preventable readmissions in the United States: a systematic review.

Background: Hospital readmissions are a leading topic of healthcare policy and practice reform because they are common, costly, and potentially avoidable events. Hospitals face the prospect of reduced or eliminated reimbursement for an increasing number of preventable readmissions under nationwide cost savings and quality improvement efforts. To meet the current changes and future expectations, organizations are looking for potential strategies to reduce readmissions.

Medical homes: "where you stand on definitions depends on where you sit".

The medical home is a potentially transformative strategy to address issues of access, quality, and efficiency in the delivery of health care in the United States. While numerous organizations support a physician-driven definition, it is by no means the universally accepted definition. Several professional groups, payers, and researchers have offered differing, or nuanced, definitions of medical homes.

Health information exchange: persistent challenges and new strategies.

Recent federal policies and actions support the adoption of health information exchange (HIE) in order to improve healthcare by addressing fragmented personal health information. However, concerted efforts at facilitating HIE have existed for over two decades in this country. The lessons of these experiences include a recurrence of barriers and challenges beyond those associated with technology.

Studer unplugged: identifying underlying managerial concepts.

There is evidence that the application of Quint Studer's Hardwiring Excellence approach to organizational change is associated with significant accomplishments in hospitals. The authors' review finds the Studer approach to be closely aligned with management-related concepts of motivation and feedback, social networks, human capital, social capital, management by objectives, evidence based management, and organizational learning. The article is intended to familiarize more managers and management researchers with the content of the Studer approach, demonstrate its grounding in management concepts and principles, and stimulate additional discussion around the utility of such human resources-focused interventions in significant organizational change.

A critical review of the research literature on Six Sigma, Lean and StuderGroup's Hardwiring Excellence in the United States: the need to demonstrate and communicate the effectiveness of transformation strategies in healthcare.

Background: U.S. healthcare organizations are confronted with numerous and varied transformational strategies promising improvements along all dimensions of quality and performance.

An attempt to forecast hospital market share using admission data.

The purpose of this study was to develop a model to forecast market share before actual market share data become available to a hospital system. The typical data lag is about six to nine months, and market share information is often based on incomplete admissions data. Therefore, this exploratory analysis of admissions for all hospitals in a Texas hospital system was performed as an attempt to improve the accuracy and timeliness of market share data.

Evaluation and management documentation and coding technology adoption.

This study determines the relative effect of financial incentives, practice characteristics, and regulatory guidelines on the utilization of documentation and coding technology among physician practices employing HIM professionals. A total of 442 HIM professionals, 9.78 percent of the surveyed population, completed a Web-based survey regarding their practices and E/M documentation and coding methods used.

Organizational technologies for transforming care: measures and strategies for pursuit of IOM quality aims.

Progress on the Institute of Medicine's (IOM's) 6 aims to bridge the "quality chasm" requires both measurement and the concerting of multiple organizational technologies. The basic thesis of this article is that rapid progress on the IOM's multiple aims calls for transformative change within and among healthcare organizations. The promise of a number of types of transformative approaches is closely linked to their ability to simultaneously build upon several organizational technologies: clinical, social, information, and administrative technologies.