Moving towards culturally competent health systems: organizational and market factors

Cultural competency has been proposed as an organizational strategy to address racial/ethnic disparities in the healthcare system; disparities are a long-standing policy challenge whose relevance is only increasing with the increasing population diversity of the US and across the world. Using an integrative conceptual framework based on the resource dependency and institutional theories, we examine the relationship between organizational and market factors and hospitals' degree of cultural competency. Our sample consists of 119 hospitals located in the state of California (US) and is constructed using the following datasets for the year 2006: Cultural Competency Assessment Tool of Hospitals (CCATH) Survey, California's Office of Statewide Health Planning & Development's Hospital Inpatient Discharges and Annual Hospital Financial Data, American Hospital Association's Annual Survey, and the Area Resource File. The dependent variable consists of the degree of hospital cultural competency, as assessed by the CCATH overall score. Organizational variables include ownership status, teaching hospital, payer mix, size, system membership, financial performance, and the proportion of inpatient racial/ethnic minorities. Market characteristics included hospital competition, the proportion of racial/ethnic minorities in the area, metropolitan area, and per capita income. Regression analyses were conducted to assess the relationship between the CCATH overall score and organizational and market variables. Our results show that hospitals which are not-for-profit, serve a more diverse inpatient population, and are located in more competitive and affluent markets exhibit a higher degree of cultural competency. Our results underscore the importance of both institutional and competitive market pressures in guiding hospital behavior. For instance, while not-for-profit may adopt innovative/progressive policies like cultural competency simply as a function of their organizational goals, linking cultural competency with organizational performance may be essential to attract more profit driven hospitals.     

公立医院非编制人员组织支持感、组织认同与工作投入的关系研究

目的:探讨中国人事制度背景下公立医院非编制人员的组织支持感、组织认同对工作投入的影响过程和影响机制,为医院管理者采取措施促进非编制人员的工作投入提供参考。方法:采用组织支持感问卷、组织认同量表和工作投入量表,对四川某市6所市属三级公立医院的650名非编制人员进行调查,采用SPSS19.0进行描述性分析、相关分析、回归分析,采用AMOS17.0建立3个变量的结构方程模型。结果:公立医院非编制人员的组织支持感总均分为(2.80±1.05)分,组织认同总均分为(3.73±1.03)分,工作投入总均分为(2.99±1.58)分;组织支持感、组织认同与工作投入呈两两显著正相关(P0.01);组织支持感对工作投入有直接效应,并能以组织认同为中介变量对其产生间接效应。结论:公立医院非编制人员组织支持感、工作投入程度处于较低水平,公立医院管理者可以通过提高非编制人员组织支持感及组织认同感促进工作投入。     

Implementation of Health Programs in Hospitals

Data from 480 short-term general nonfederal hospitals are analyzed by means of the Automatic Interaction Detector program in an attempt to discover manipulable factors influencing the innovation of programs contributing to comprehensiveness of health care. The data are divided into three sets of independent variables pertaining to contextual (locational) and organizational characteristics of hospitals and to personal characteristics of hospital administrators. The dependent variable is an overall implementation score for each hospital, assigned on the basis of a scale of rankings of a hypothetical service by a panel of experienced hospital personnel. The AID program eliminates variance in overall implementation attributable to the nonmanipulable contextual and organizational variables, permitting identification of residual variance arising from administrator characteristics.     

The Dutch heart health community intervention 'Hartslag Limburg': results of an effect study at organizational level

BACKGROUND: 'Hartslag Limburg', a cardiovascular diseases (CVD) prevention programme, integrates a community strategy and a high-risk strategy to reduce CVD risk behaviours. This article presents the results of the effect evaluation study of the community intervention at the organizational level. Organizational changes were an intermediate goal of the Hartslag Limburg community intervention, as these are assumed to be a prerequisite for changes at the individual level. METHODS: A baseline-post-test control group design was used. The baseline measurement was conducted in 1998 and the post-test measurement in 2001. At baseline, 700 organizations were selected in the Maastricht region, and 577 in a control region. All organizations that were potentially significant agents in health-promoting activities were included. Data on organizational involvement in health-promoting activities were gathered by means of structured questionnaires, and sent to organization representatives by mail. RESULTS: The overall post-test percentage of organizations involved in at least one activity relating to physical activity was higher in the Maastricht region than in the control region. Furthermore, the number of activities per organization involved in activities relating to healthy eating, smoking behaviour or physical activity was higher in the Maastricht region than in the control region at post-test. CONCLUSIONS: This study provided valuable information about organizational involvement in health-promoting activities, as well as important information to consider in future research in this area. Due to the limitations of the study, the importance of measuring change at different social levels in community-based programmes, and the scarcity of effect studies of community interventions at the organizational level, further research on this subject is warranted.     

Rethinking how to measure organizational culture in the hospital setting. The Hospital Culture Scale

Like all organizations, health care delivery systems must be concerned with understanding the implicit beliefs, values, and assumptions extant within the organization that ubiquitously motivate and shape the behavior of participating members. The Hospital Culture Scale (HCS) was designed as a way to assess the unique culture of hospital organizations. The HCS demonstrated high discriminant validity and reliability when applied to all members (patients, nurses, and physicians) of this particular organization. Data provided from different hospital organizations indicated that the HCS could differentiate between a variety of hospitals. Physicians, nurses, and patients were also compared. Although there was agreement between nurses and patients on how scale items are used, there were disagreements when these organizational members were compared to physicians. Differences between hospital members on the overall perception of hospital culture were found. The implications and utility of the HCS are discussed.     

2018年上海健康自我管理小组健康促进生活方式情况及影响因素分析

目的 了解参加"健康自我管理小组"的市民健康促进生活方式及其影响因素,以便采取相应的措施进一步提高健康自管小组的效果.方法 在上海全市16个区开展问卷调查.每个区调查6个健康自我管理小组,被抽取的小组内所有组员均作为调查对象.结果 共调查107个健康自我管理小组,调查人数1582人.健康促进生活方式总评分为(157.68±25.59);6个维度评分分别为:自我实现(26.76±5.24)、人际关系(28.67±4.71)、体育运动(22.90±4.98)、健康职责(27.42±5.18)、营养(28.69±4.46)、压力处理(23.85±4.42);性别、年龄、健康状况、参加小组时间、朋友支持和社区支持是健康促进生活方式的影响因素.结论 应加强社区行动,推进健康自我管理活动多元化、规范化发展,增强公众个人健康主体责任意识,提升居民健康意识、健康素养与自我管理能力.     

An analysis of relationships among transformational leadership,job satisfaction,organizational commitment and organizational trust in two Turkish hospitals

The purpose of this study was to investigate the relationships among employee organizational commitment, organizational trust, job satisfaction and employees' perceptions of their immediate supervisors' transformational leadership behaviors in Turkey. First, this study examined the relationships among organizational commitment, organizational trust, job satisfaction and transformational leadership in two Turkish public hospitals. Second, this investigation examined how job satisfaction, organizational trust and transformational leadership affect organizational commitment. Moreover, it was aimed to investigate how organizational commitment, job satisfaction and transformational leadership affect organizational trust. A quantitative, cross‐sectional method, self‐administered questionnaire was used for this study. Eight hundred four employees from two public hospitals in Turkey were recruited for collecting data. The overall response rate was 38.14%. The measurement instruments of survey were the Job Satisfaction Survey (developed by P. Spector), the Organizational Commitment Questionnaire (developed by J. Meyer and N. Allen), the Organizational Trust Inventory‐short form (developed by L. Cummings and P. Bromiley) and the Transformational Leadership Inventory (TLI) (developed by P. M. Podsakoff). Five‐point Likert scales were used in these measurement instruments. Correlation test (the Pearson's rank test) was used to examine relationships between variables. Also, multiple regression analysis was used to determine the regressors for organizational commitment and organizational trust. There were significant relationships among overall job satisfaction, overall transformational leadership and organizational trust. Regression analyses showed that organizational trust and two job satisfaction dimensions (contingent rewards and communication) were significant predictors for organizational commitment. It was found that one transformational leadership dimension (articulating a vision), two job satisfaction dimensions (pay and supervision) and two organizational commitment dimensions (affective commitment and normative commitment) were significant regressors for organizational trust. There is a lack of research in the health organizations regarding organizational commitment, organizational trust, job satisfaction and transformational leadership. The investigator of the proposed study intends to add to the literature and intends to prove that the proposed study would be important for healthcare organizations. A number of specific measures should be undertaken to reduce factors that negatively affect organizational commitment, organizational trust and job satisfaction of hospital personnel and to improve transformational leadership behaviors of hospital administrators. Copyright © 2012 John Wiley & Sons, Ltd.     

深圳市某医院护士健康促进生活方式现状及影响因素研究

目的探讨深圳市某医院护士健康促进生活方式现状及其相关影响因素。方法采用健康促进生活方式量表和一般资料调查表,对深圳市某医院667名护士进行问卷调查。结果调查对象健康促进生活方式量表总分为128.5±19.5分,条目平均得分为2.5±0.4分,其中人际关系得分最高,为24.2±4.2分,其次为自我实现,为24.1±4.4分,运动锻炼得分最低,为17.1±4.1分。低年龄组、文化程度为高中或中专、职称低的调查对象,其量表得分较低(P<0.05);睡眠状况较好者其量表得分较高,健康促进生活方式较好(P<0.05);不同科室、不同婚姻状况的调查对象,其量表得分的差异无统计学意义(P>0.05)。结论相关管理人员应加强对年龄小、文化程度低、工龄短、职称低、睡眠差护士的健康教育,促使其采取健康的生活方式,以增进其健康生活理念和身心健康,从而提升临床护理质量。     

Hospital governing boards: a study of their effectiveness in relation to organizational performance

This article describes the development and evolution of governing boards and summarizes critical findings from a research study on hospital governing boards. The purpose of the research was to examine factors that measure performance of governing boards and the relationship of governing board effectiveness to the organizational performance of hospitals. Board leaders from 64 nonprofit hospitals across the country were surveyed using the BSAQ tool, which measures board effectiveness in six areas of competency. Board competency scores of this group were compared with those of a previous group, which consisted of more than 300 nonprofit boards, and demonstrated significantly higher scores. A factor analysis conducted to compare the six competency factors between study groups revealed a strong single factor in this study. The factors that measure governing board performance were found to be consolidated into one single factor of collaborative board functioning consistent with emerging governance theory. This may support the concept of the importance of governing boards as collaborative, socially dynamic networks of leaders. The hospital performance was assessed using data from the nationally recognized program, Solucient's 100 Top Hospitals. The results demonstrate that higher performing boards did have better hospital performance in several dimensions, most notably in profitability and lower expenses. Lower expenses were related to higher scores for the BSAQ total score. Hospital profitability was positively correlated with all seven BSAQ scores. A more favorable Solucient ranking was related to hospitals that had a lower BSAQ political score. This was also found in a multiple regression model that predicted a favorable ranking when the BSAQ political score was lower. This may mean that these boards do what needs to be done to maintain excellent performance and do not let politics get in the way of their work. Although governance and its effect on hospital performance is a complex concept to study, this investigation yields findings of interest to leaders in the healthcare field.     

Autonomy and performance in the public sector: the experience of English NHS hospitals

Since 2004, English NHS hospitals have been given the opportunity to acquire a more autonomous status known as a Foundation Trust (FT), whereby regulations and restrictions over financial, management, and organizational matters were reduced in order to create incentives to deliver higher-quality services in the most efficient way. Using difference-in-difference models, we test whether achieving greater autonomy (FT status) improved hospital performance, as proxied by measures of financial management, quality of care, and staff satisfaction. Results provide little evidence that the FT policy per se has made any difference to the performance of hospitals in most of these domains. Our findings have implications for health policy and inform the trend towards granting greater autonomy to public-sector organizations.     

Organisationskultur als Wettbewerbsfaktor im Krankenhaus?

Focusing on organizational culture as a “soft” factor, the authors pursue the question of how the hospital can increase its competitiveness. They attempt to determine which characteristics are present in an organizational culture that enhances the organizational members’ willingness to change and thereby increases the ability to innovate as a competitive factor. The distinction between an open and a closed organizational culture (Gebert/ Boerner 1999) serves as the basis for developing the hypothesis that a relatively open organizational culture promotes the organizational members’ willingness to change and an organization’s innovativeness and can be interpreted as a response to competitive pressure. This hypothesis is empirically tested on organizations outside the realm of hospitals. The authors then seek to find the extent to which a relatively open organizational culture is salient to innovativeness and competitiveness in hospitals as well and try to ascertain the current degree of openness in hospitals. The results of the investigation are used to draw conclusions for hospital management.     

Hospital marketing orientation and managed care processes: are they coordinated?

The hospital marketing function has been widely adopted as a way to learn about markets, attract sufficient resources, develop appropriate services, and communicate the availability of such goods to those who may be able to purchase such services. The structure, tasks, and effectiveness of the marketing function have been the subject of increased inquiry by researchers and practitioners alike. A specific understanding of hospital marketing in a growing managed care environment and the relationship between marketing and managed care processes in hospitals is a growing concern. Using Kotler and Clarke's framework for assessing marketing orientation, we examined the marketing orientation of hospitals in a single state at two points in time--1993 and 1999. Study findings show that the overall marketing orientation score decreased from 1993 to 1999 for the respondent hospitals. The five elements of the Kotler and Clarke definition of marketing orientation remained relatively stable, with slightly lower scores related to customer philosophy. In addition, we evaluated the degree to which selected managed care activities are carried out as part of its marketing function. A significant (p < .05) decrease in managed care processes coordinated with the formal marketing function was evident from 1993 to 1999. With increasing numbers of managed care plan enrollees, hospitals are likely focusing on organizational buyers as important customers. In order to appeal to organizational buyers, hospital executives may be focusing more on clinical quality and cost efficiency in the production of services, which will improve a hospital's position with organizational buyers.     

Institutionalization of quality improvement programs in Korean hospitals.

OBJECTIVE: To investigate the institutionalization of quality improvement (QI) programs in Korean hospitals, in which organizational efforts to improve the quality of care have been made only recently. DESIGN: A cross-sectional study based upon an initial telephone contact and follow-up mail survey. STUDY PARTICIPANTS: All hospitals with 400 beds or more, 100 as of 1997, were contacted in the initial telephone survey. The survey questionnaire was then sent to all of 28 hospitals found to have a QI department; 26 hospitals returned the completed questionnaire. RESULTS: Hospitals that had larger bed capacities, that provided tertiary levels of care or that were in urban areas were found to have a higher tendency to establish QI departments. These QI departments most frequently cited improvement of patient satisfaction as one of their overall missions. They also reported that their most important responsibilities were monitoring performance and preparing for the two national Korean hospital assessment programs. Participating in these hospital assessment programs helped them to initiate and develop their QI activities. The main difficulties they had in performing their QI programs stemmed from lack of knowledge and resources. These survey findings indicate that hospital assessment programs significantly aided Korean hospitals to institutionalize their QI programs. At the same time, the survey data indicate that the hospital assessment programs may emphasize short-term benefits from QI activities at the expense of long-term QI institutionalization. CONCLUSION: QI programs have not as yet been fully institutionalized in Korean hospitals. More support for QI structure and organizational preparation at both the national and organizational levels will be needed.     

The role of organizational infrastructure in implementation of hospitals' quality improvement

Quality improvement (QI) is an organized approach to planning and implementing continuous improvement in performance. Although QI holds promise for improving quality of care and patient safety, hospitals that adopt QI often struggle with its implementation. This article examines the role of organizational infrastructure in implementation of quality improvement practices and structures in hospitals. The authors focus specifically on four elements of hospital support and infrastructure for QI-integrated data systems, financial support for QI, clinical integration, and information system capability. These macrolevel factors provide consistent, ongoing support for the QI efforts of clinical teams engaging in direct patient care, thus promoting institutionalization of QI. Results from the multivariate analysis of 1997 survey data on 2350 hospitals provide strong support for the hypotheses. Results signal that organizations intent upon improving quality must attend to the context in which QI efforts are practiced, and that such efforts are unlikely to be effective unless appropriate support systems are in place to ensure full implementation.     

Strategic planning in rural health care organizations.

Is strategic planning associated with higher levels of performance in health care organizations? Is strategic planning effective? This article examines strategic planning's impact on rural hospital and rural nursing facility performance, organizational characteristics, and strategy. The findings suggest that strategic planning in rural hospitals is strongly associated with higher profits, operating margins and planning effectiveness, and associated to a lesser extent with lower costs and higher revenues per patient day. However, strategic planning does not appear to be associated with higher performance in nursing facilities. The implications for strategic planning in rural health care organizations are discussed.     

Challenges and Opportunities of Health Care Supply Chain Management in the United States

This article explores current supply chain management challenges and initiatives and identifies problems that affect supply chain management success in the U.S. health-care industry. In addition, it investigates the impact of health care supply chain management (SCM) initiatives on the overall organizational effectiveness. The attitudinal results, as well as the performance results presented in this study support the claim of health care proponents that the SCM allows organizations to reduce cost, improve quality, and reduce cycle time, and leads to high performance.     

Does hospital ownership influence hospital referral region health rankings in the United States

Extensive evidence demonstrates that a hospital's organizational ownership structure impacts its overall performance, but little is known concerning the influence of hospital structure on the health of its community. This paper explores the association between US hospital referral region (HRR) health rankings and hospital ownership and performance. Data from the 2016 Commonwealth Fund Scorecard on Local Health System Performance, the American Hospital Association dataset, and the Hospital Value‐Based Purchasing dataset are utilized to conduct a cross‐sectional analysis of 36 quality measures across 306 HRRs. Multivariate regression analysis was used to estimate the association among hospital ownership, system performance measures—access and affordability, prevention and treatment, avoidable hospital use and cost, and healthy lives—and performance as measured by value‐based purchasing total performance scores. We found that indicators of access and affordability, as well as prevention and treatment, were significantly associated across all 3 hospitals' organizational structures. Hospital referral regions with a greater number of not‐for‐profit hospitals demonstrated greater indications of access and affordability, as well as better prevention and treatment rankings than for‐profit and government hospitals. Hospital referral regions with a greater number of government, nonfederal hospitals had worse scores for healthy lives. Furthermore, the greater the total performance scores score, the better the HRR score on prevention and treatment rankings. The greater the per capita income, the better the score across all 4 dimensions. As such, this inquiry supports the assertion that performance of a local health system is dependent on its community's resources of health care delivery entities and their structure.     

Distinguishing community benefits: tax exemption versus organizational legitimacy

US policymakers continue to call into question the tax-exempt status of hospitals. As nonprofit tax-exempt entities, hospitals are required by the Internal Revenue Service (IRS) to report the type and cost of community benefits they provide. Institutional theory indicates that organizations derive organizational legitimacy from conforming to the expectations of their environment. Expectations from the state and federal regulators (the IRS, state and local taxing authorities in particular) and the community require hospitals to provide community benefits to achieve legitimacy. This article examines community benefit through an institutional theory framework, which includes regulative (laws and regulation), normative (certification and accreditation), and cultural-cognitive (relationship with the community including the provision of community benefits) pillars. Considering a review of the results of a 2006 IRS study of tax-exempt hospitals, the authors propose a model of hospital community benefit behaviors that distinguishes community benefits between cost-quantifiable activities appropriate for justifying tax exemption and unquantifiable activities that only contribute to hospitals' legitimacy.     

Knowledge sharing networks related to hospital quality measurement and reporting

BACKGROUND: With the growing momentum toward hospital quality reporting by public payers, hospitals face increasing pressures to improve their medical record documentation and administrative data coding performance. The literature on "professional complex systems" has put forth various strategies for improving the performance of professional organizations. In doing so, it has emphasized the importance of creating effective structures for knowledge sharing and organizational learning. This study integrates knowledge networks and professional organizations literatures to develop hypotheses related to knowledge sharing network effectiveness in professional organizations. PURPOSE: Correspondingly, this study explores the relationship between the organizational knowledge sharing structure related to quality and hospital coding performance related to quality. Simultaneously, this study seeks to identify other organizational characteristics associated with coding for quality measurement. The purpose is to identify strategies not only for improving hospital coding performance but also for the organization to adapt to the changing environment. METHODS: An exploratory and comparative research design is used. The sample is composed of four hospitals, two showing "good-coding" performance for quality measurement and two showing "poor-coding" performance. Interviews and surveys are conducted with administrators and staff in the quality, medical staff, and coding subgroups in each facility. Survey data are subjected to social network analysis to examine knowledge sharing structures. FINDINGS AND IMPLICATIONS: This study finds that good-coding performance is systematically associated with a knowledge sharing network structure rich in brokerage and hierarchy (with leaders connecting different professional subgroups to each other and to the external environment) rather than in density (where everyone is directly connected to everyone else). From a health care management perspective, this study suggests that to improve hospital coding performance, senior administrators must undertake proactive and unceasing efforts to coordinate knowledge exchange across physician and coding subgroups and connect these subgroups with the changing external environment.