403 results on '"Stephen M. Shortell"'
Search Results
2. Validation of the Lean Healthcare Implementation Self-Assessment Instrument (LHISI) in the finnish healthcare context
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Elina Reponen, Ritva Jokela, Janet C. Blodgett, Thomas G. Rundall, Stephen M. Shortell, Mikko Nuutinen, Noora Skants, Markku Mäkijärvi, and Paulus Torkki
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Lean healthcare ,Lean management ,Lean implementation ,Self-assessment instrument ,Lean maturity assessment ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Lean management is growing in popularity in the healthcare sector worldwide, yet healthcare organizations are struggling with assessing the maturity of their Lean implementation and monitoring its change over time. Most existing methods for such assessments are time consuming, require site visits by external consultants, and lack frontline involvement. The original Lean Healthcare Implementation Self-Assessment Instrument (LHISI) was developed by the Center for Lean Engagement and Research (CLEAR), University of California, Berkeley as a Lean principles-based survey instrument that avoids the above problems. We validated the original LHISI in the context of Finnish healthcare. Methods The original HISI survey was sent over a secure organizational email system to the over 26,000 employees of the Hospital District of Helsinki and Uusimaa in March 2020. The data were randomly split with one part used to carry out an exploratory factor analysis (EFA), and the other for testing the resulting model using confirmatory factor analysis (CFA). Results A total of 6073 employees responded to the LHISI survey, for an overall response rate of 23%. The results indicated that the 43 items used in the original LHISI can be reduced to 25 items, and these items measure a five-dimensional model of the progress of Lean implementation: leadership, commitment, standard work, communication, and daily management system. In comparison with a single-factor model, the fit measures for the 5-factor model were better: smaller X2, larger comparative fit index (CFI), smaller root mean square error of approximation (RMSEA), and smaller standardized root mean square residual (SRMR). Conclusions The 25 item LHISI is valid and feasible to use in the context of Finnish healthcare. The LHISI allows the organization to self-monitor the progress of its Lean implementation and provides the leadership with actionable knowledge to guide the path towards Lean maturity across the organization. Our findings encourage further studies on the adoption and validation of the LHISI in healthcare organizations worldwide.
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- 2021
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3. Benchmarking outcomes on multiple contextual levels in lean healthcare: a systematic review, development of a conceptual framework, and a research agenda
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Elina Reponen, Thomas G. Rundall, Stephen M. Shortell, Janet C. Blodgett, Angelica Juarez, Ritva Jokela, Markku Mäkijärvi, and Paulus Torkki
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Lean management ,Lean healthcare ,Benchmarking ,Context ,Outcomes ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Reliable benchmarking in Lean healthcare requires widely relevant and applicable domains for outcome metrics and careful attention to contextual levels. These levels have been poorly defined and no framework to facilitate performance benchmarking exists. Methods We systematically searched the Pubmed, Scopus, and Web of Science databases to identify original articles reporting benchmarking on different contextual levels in Lean healthcare and critically appraised the articles. Scarcity and heterogeneity of articles prevented quantitative meta-analyses. We developed a new, widely applicable conceptual framework for benchmarking drawing on the principles of ten commonly used healthcare quality frameworks and four value statements, and suggest an agenda for future research on benchmarking in Lean healthcare. Results We identified 22 articles on benchmarking in Lean healthcare on 4 contextual levels: intra-organizational (6 articles), regional (4), national (10), and international (2). We further categorized the articles by the domains in the proposed conceptual framework: patients (6), employed and affiliated staff (2), costs (2), and service provision (16). After critical appraisal, only one fifth of the articles were categorized as high quality. Conclusions When making evidence-informed decisions based on current scarce literature on benchmarking in healthcare, leaders and managers should carefully consider the influence of context. The proposed conceptual framework may facilitate performance benchmarking and spreading best practices in Lean healthcare. Future research on benchmarking in Lean healthcare should include international benchmarking, defining essential factors influencing Lean initiatives on different levels of context; patient-centered benchmarking; and system-level benchmarking with a balanced set of outcomes and quality measures.
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- 2021
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4. Multi‐level analysis of the learning health system: Integrating contributions from research on organizations and implementation
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Michael I. Harrison and Stephen M. Shortell
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implementation science ,learning health system ,organizational learning ,Medicine (General) ,R5-920 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Introduction Organizations and systems that deliver health care may better adapt to rapid change in their environments by acting as learning organizations and learning health systems (LHSs). Despite widespread recognition that multilevel forces shape capacity for learning within care delivery organizations, there is no agreed‐on, comprehensive, multilevel framework to inform LHS research and practice. Methods We develop such a framework, which can enhance both research on LHSs and practical steps toward their development. We draw on existing frameworks and research within organization and implementation science and synthesize contributions from three influential frameworks: the Consolidated Framework for Implementation Research, the social‐ecological framework, and the organizational change framework. These frameworks come, respectively, from the fields of implementation science, public health, and organization science. Results Our proposed integrative framework includes both intraorganizational levels (individual, team, mid‐management, organization) and the operating and general environments in which delivery organizations operate. We stress the importance of examining interactions among influential factors both within and across system levels and focus on the effects of leadership, incentives, and culture. Additionally, we indicate that organizational learning depends substantially on internal and cross‐level alignment of these factors. We illustrate the contribution of our multilevel perspective by applying it to the analysis of three diverse implementation initiatives that aimed at specific care improvements and enduring system learning. Conclusions The framework and perspective developed here can help investigators and practitioners broadly scan and then investigate forces influencing improvement and learning and may point to otherwise unnoticed interactions among influential factors. The framework can also be used as a planning tool by managers and practitioners.
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- 2021
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5. Random or predictable?: Adoption patterns of chronic care management practices in physician organizations
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Isomi M. Miake-Lye, Emmeline Chuang, Hector P. Rodriguez, Gerald F. Kominski, Elizabeth M. Yano, and Stephen M. Shortell
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Chronic care ,Care management practices ,Adoption ,Physician organizations ,Medicine (General) ,R5-920 - Abstract
Abstract Background Theories, models, and frameworks used by implementation science, including Diffusion of Innovations, tend to focus on the adoption of one innovation, when often organizations may be facing multiple simultaneous adoption decisions. For instance, despite evidence that care management practices (CMPs) are helpful in managing chronic illness, there is still uneven adoption by physician organizations. This exploratory paper leverages this natural variation in uptake to describe inter-organizational patterns in adoption of CMPs and to better understand how adoption choices may be related to one another. Methods We assessed a cross section of national survey data from physician organizations reporting on the use of 20 CMPs (5 each for asthma, congestive heart failure, depression, and diabetes). Item response theory was used to explore patterns in adoption, first considering all 20 CMPs together and then by subsets according to disease focus or CMP type (e.g., registries, patient reminders). Mokken scale analysis explored whether adoption choices were linked by disease focus or CMP type and whether a consistent ordering of adoption choices was present. Results The Mokken scale for all 20 CMPs demonstrated medium scalability (H = 0.43), but no consistent ordering. Scales for subsets of CMPs sharing a disease focus had medium scalability (0.4 0.5). Scales for CMP type consistently ranked diabetes CMPs as most adoptable and depression CMPs as least adoptable. Within disease focus scales, patient reminders were ranked as the most adoptable CMP, while clinician feedback and patient education were ranked the least adoptable. Conclusions Patterns of adoption indicate that innovation characteristics may influence adoption. CMP dissemination efforts may be strengthened by encouraging traditionally non-adopting organizations to focus on more adoptable practices first and then describing a pathway for the adoption of subsequent CMPs. Clarifying why certain CMPs are “less adoptable” may also provide insights into how to overcome CMP adoption constraints.
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- 2017
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6. Quality-Based Payment for Medical Groups and Individual Physicians
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James C. Robinson, Stephen M. Shortell, Diane R. Rittenhouse, Sara Fernandes-Taylor, Robin R. Gillies, and Lawrence P. Casalino
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Public aspects of medicine ,RA1-1270 - Abstract
This paper measures the extent to which medical groups experience external pay-for-performance incentives based on quality and patient satisfaction and the extent to which these groups pay their primary care and specialist physicians using similar criteria. Over half (52%) of large medical groups received bonus payments from health insurance plans in the period 2006–2007 based on measures of quality and patient satisfaction. Medical groups facing external pay-for-performance incentives are more likely to pay their primary care physicians (odds ratio [OR] 4.5; p
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- 2009
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7. Responding to The Grand Challenges In Healthcare Via Organizational Innovation: Needed Advances in Management Research
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Stephen M. Shortell, Lawton Robert Burns, Jennifer L. Hefner, Stephen M. Shortell, Lawton Robert Burns, Jennifer L. Hefner and Stephen M. Shortell, Lawton Robert Burns, Jennifer L. Hefner, Stephen M. Shortell, Lawton Robert Burns, Jennifer L. Hefner
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- 2022
8. Managing Through a Pandemic: A Daily Management System for COVID-19 Response and Recovery
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Dorothy Y, Hung, Thomas G, Rundall, Justin, Lee, Negeen, Khandel, and Stephen M, Shortell
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Leadership and Management ,Strategy and Management ,Health Policy ,COVID-19 ,8.1 Organisation and delivery of services ,General Medicine ,Health Services ,Hospitals ,United States ,Leadership ,Good Health and Well Being ,Clinical Research ,Public Health and Health Services ,Health Policy & Services ,Humans ,Generic health relevance ,Delivery of Health Care ,Pandemics ,Health and social care services research - Abstract
GoalThis study explored the use of a Lean daily management system (DMS) for COVID-19 response and recovery in U.S. hospitals and health systems. Originally developed in manufacturing, Lean is an evidence-based approach to quality and process improvement in healthcare. Although Lean has been studied in individual hospital units and outpatient practices, it has not been examined as a whole system response to crisis events.MethodsWe conducted qualitative interviews with 46 executive leaders, clinical leaders, and frontline staff in four hospitals and health systems across the United States. We developed a semistructured interview guide to understand DMS implementation in these care delivery organizations. As interviews took place 6-8 months following the onset of the pandemic, a subset of our interview questions centered on DMS use to meet the demands of COVID-19. Based on a deductive approach to qualitative analysis, we identified clusters of themes that described how DMS facilitated rapid system response to the public health emergency.Principal findingsThere were many important ways in which U.S. hospitals and health systems leveraged their DMS to address COVID-19 challenges. These included the use of tiered huddles to facilitate rapid communication, the creation of standard work for redeployed staff, and structured problem-solving to prioritize new areas for improvement. We also discovered ways that the pandemic itself affected DMS implementation in all organizations. COVID-19 universally created greater DMS visibility by opening lines of communication among leadership, strengthening measurement and accountability, and empowering staff to develop solutions at the front lines. Many lessons learned using DMS for crisis management will carry forward into COVID-19 recovery efforts. Lessons include expanding telehealth, reactivating incident command systems as needed, and efficiently coordinating resources amid potential future shortages.Practical applicationsOverall, the Lean DMS functioned as a robust property that enabled quick organizational response to unpredictable events. Our findings on the use of DMS are consistent with organizational resilience that emphasizes collective sense-making and awareness of incident status, team decision-making, and frequent interaction and coordination. These features of resilience are supported by DMS practices such as tiered huddles for rapid information dissemination and alignment across organizational hierarchies. When used in conjunction with plan-do-study-act methodology, huddles provide teams with enhanced feedback that strengthens their ability to make changes as needed. Moreover, gaps between work-as-imagined (how work should be done) and work-as-done (how work is actually done) may be exacerbated in the initial chaos of emergency events but can be minimized through the development of standard work protocols. As a facilitator of resilience, the Lean DMS may be used in a variety of challenging situations to ensure high standards of care.
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- 2022
9. Electronic Health Records and Patient Activation - Their Interactive Role in Medication Adherence.
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Yunfeng Shi, Veronica Fuentes-Caceres, Megan McHugh, Jessica Greene, Nina Verevkina, Lawrence P. Casalino, and Stephen M. Shortell
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- 2015
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10. Adoption of Patient Engagement Strategies by Physician Practices in the United States
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Chris, Miller-Rosales, Valerie A, Lewis, Stephen M, Shortell, and Hector P, Rodriguez
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Medicaid ,Physicians ,Ownership ,Public Health, Environmental and Occupational Health ,Humans ,Patient Participation ,Medical Informatics ,United States - Abstract
Patient engagement strategies can equip patients with tools to navigate treatment decisions and improve patient-centered outcomes. Despite increased recognition about the importance of patient engagement, little is known about the extent of physician practice adoption of patient engagement strategies nationally.We analyzed data collected from the National Survey of Healthcare Organizations and Systems (NSHOS) on physician practice adoption of patient engagement strategies. Stratified-cluster sampling was used to select physician practices operating under different organizational structures. Multivariable linear regression models estimated the association of practice ownership, health information technology functionality, use of screening activities, patient responsiveness, chronic care management processes, and the adoption of patient engagement strategies, including shared decision-making, motivational interviewing, and shared medical appointments. All regression models controlled for participation in payment reforms, practice size, Medicaid revenue percentage, and geographic region.We found modest and varied adoption of patient engagement strategies by practices of different ownership types, with health system-owned practices having the lowest adoption of ownership types. Practice capabilities, including chronic care management processes, routine screening of medical and social risks, and patient care dissemination strategies were associated with greater practice-level adoption of patient engagement strategies.This national study is the first to characterize the adoption of patient engagement strategies by US physician practices. We found modest adoption of shared decision-making and motivational interviewing, and low adoption of shared medical appointments. Risk-based payment reform has the potential to motivate greater practice-level patient engagement, but the extent to which it occurs may depend on internal practice capabilities.
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- 2022
11. Telehealth Use, Care Continuity, and Quality: Diabetes and Hypertension Care in Community Health Centers Before and During the COVID-19 Pandemic
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Aaron A. Tierney, Denise D. Payán, Timothy T. Brown, Adrian Aguilera, Stephen M. Shortell, and Hector P. Rodriguez
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Glycated Hemoglobin ,hypertension ,diabetes ,telehealth ,Prevention ,Public Health, Environmental and Occupational Health ,care continuity ,COVID-19 ,Community Health Centers ,Continuity of Patient Care ,Cardiovascular ,Telemedicine ,Cohort Studies ,Good Health and Well Being ,Networking and Information Technology R&D (NITRD) ,Clinical Research ,Applied Economics ,Diabetes Mellitus ,Public Health and Health Services ,Health Policy & Services ,Humans ,Pandemics - Abstract
BackgroundCommunity health centers (CHCs) pivoted to using telehealth to deliver chronic care during the coronavirus COVID-19 pandemic. While care continuity can improve care quality and patients' experiences, it is unclear whether telehealth supported this relationship.ObjectiveWe examine the association of care continuity with diabetes and hypertension care quality in CHCs before and during COVID-19 and the mediating effect of telehealth.Research designThis was a cohort study.ParticipantsElectronic health record data from 166 CHCs with n=20,792 patients with diabetes and/or hypertension with ≥2 encounters/year during 2019 and 2020.MethodsMultivariable logistic regression models estimated the association of care continuity (Modified Modified Continuity Index; MMCI) with telehealth use and care processes. Generalized linear regression models estimated the association of MMCI and intermediate outcomes. Formal mediation analyses assessed whether telehealth mediated the association of MMCI with A1c testing during 2020.ResultsMMCI [2019: odds ratio (OR)=1.98, marginal effect=0.69, z=165.50, P
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- 2023
12. Using health information technology to manage a patient population in accountable care organizations
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Frances M Wu, Thomas G. Rundall, Stephen M. Shortell, and Joan R Bloom
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- 2016
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13. Comparing and improving chronic illness primary care in Sweden and the USA
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John Øvretveit, Patricia Ramsay, Stephen M. Shortell, and Mats Brommels
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- 2016
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14. Expert-Identified Practices for Achieving Measurable Performance Improvements With Lean Implementation
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Elina Reponen, Thomas G. Rundall, Stephen M. Shortell, Janet C. Blodgett, Ritva Jokela, Markku Mäkijärvi, and Paulus Torkki
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Health (social science) ,Leadership and Management ,Health Policy ,Care Planning - Abstract
Despite the rapid spread of Lean management in health care, few organizations have achieved measurable overall performance improvements with Lean. What differentiates these organizations from those that struggle with realizing the potential benefits of Lean management is unclear. In this qualitative study we explore measuring the impact of Lean and the recommended practices for achieving measurable performance improvements with Lean in health care organizations.Informed by preliminary quantitative results from analyses of high- and low-performing Lean hospitals, we conducted 17 semi-structured interviews with Lean health care experts on the Lean principles and practices associated with better performance. We conducted qualitative content analyses of the interview transcripts based on grounded theory and linking to core principles and practices of the Lean management system.The qualitative data revealed 3 categories of metrics for measuring the impact of Lean: currently used institutional measures, measures tailored to Lean initiatives, and population-level measures. Leadership engagement/commitment and clear organizational focus/prioritization/alignment had the highest weighted averages of success factors. The lack of these 2 factors had the highest weighted averages of biggest barriers for achieving measurable performance improvements with Lean implementation.Leadership engagement and organizational focus can facilitate achieving the organization's performance improvement goals, whereas their absence can considerably hinder performance improvement efforts. Many different approaches have been used to quantify the impact of Lean, but currently used institutional performance measures are preferred by the majority of Lean experts.
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- 2022
15. Physician Practices With Robust Capabilities Spend Less On Medicare Beneficiaries Than More Limited Practices
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Hector P. Rodriguez, Elizabeth L. Ciemins, Karl Rubio, and Stephen M. Shortell
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Health Policy - Published
- 2022
16. Examining the Relationship Between the Lean Management System and Quality Improvement Care Management Processes
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Elina Reponen, Stephen M. Shortell, Janet C. Blodgett, Thomas G. Rundall, and Aaron A. Tierney
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Information management ,care management processes ,Decision support system ,Health (social science) ,Quality management ,Leadership and Management ,media_common.quotation_subject ,8.1 Organisation and delivery of services ,Nursing ,Lean manufacturing ,Article ,Clinical Research ,quality of care ,Health care ,Medicine ,Operations management ,Quality (business) ,organization and administration ,Care Planning ,Management process ,hospital performance improvement ,media_common ,business.industry ,Health Policy ,Health Services ,Lean management ,Good Health and Well Being ,Public Health and Health Services ,Health Policy & Services ,Generic health relevance ,business ,Developed country ,Health and social care services research - Abstract
BACKGROUND AND OBJECTIVES: The United States has an under-performing healthcare system on both cost and quality criteria in comparison with other developed countries. One approach to improving system performance on both cost and quality is to use the Lean management system based on the Shingo principles originally developed by Toyota in Japan. Our objective is to examine the association between hospital use of the Lean management system and evidence-based or recommended quality improvement care management processes. METHODS: A cross sectional analysis of data from 223 hospitals that responded to both the 2017 National Survey of Healthcare Organizations and Systems (NSHOS) and the 2017 National Survey of Lean/Transformational Performance Improvement in Hospitals (NSL) was conducted. RESULTS: Controlling for hospital organizational and market characteristics, the number of years doing Lean was positively associated with use of electronic health record-based decision support, use of quality-focused information management, use of evidence-based guidelines, and support for care transitions at the p
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- 2021
17. Authors response to the commentaries on 'Integrating network theory into study of integrated healthcare'
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Lawton R. Burns, Ingrid M. Nembhard, and Stephen M. Shortell
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Health (social science) ,History and Philosophy of Science ,Delivery of Health Care, Integrated ,Humans ,Health Facilities - Published
- 2022
18. The Reliability of Graduate Medical Education Quality of Care Clinical Performance Measures
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Jung G. Kim, Hector P. Rodriguez, Eric S. Holmboe, Kathryn M. McDonald, Lindsay Mazotti, Diane R. Rittenhouse, Stephen M. Shortell, and Michael H. Kanter
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Education, Medical ,Reproducibility of Results ,Internship and Residency ,General Medicine ,Health Services ,United States ,Education ,Education, Medical, Graduate ,Clinical Research ,Medical ,Humans ,Family Practice ,Graduate ,Digestive Diseases ,Curriculum and Pedagogy ,Original Research - Abstract
Background Graduate medical education (GME) program leaders struggle to incorporate quality measures in the ambulatory care setting, leading to knowledge gaps on how to provide feedback to residents and programs. While nationally collected quality of care data are available, their reliability for individual resident learning and for GME program improvement is understudied. Objective To examine the reliability of the Healthcare Effectiveness Data and Information Set (HEDIS) clinical performance measures in family medicine and internal medicine GME programs and to determine whether HEDIS measures can inform residents and their programs with their quality of care. Methods From 2014 to 2017, we collected HEDIS measures from 566 residents in 8 family medicine and internal medicine programs under one sponsoring institution. Intraclass correlation was performed to establish patient sample sizes required for 0.70 and 0.80 reliability levels at the resident and program levels. Differences between the patient sample sizes required for reliable measurement and the actual patients cared for by residents were calculated. Results The highest reliability levels for residents (0.88) and programs (0.98) were found for the most frequently available HEDIS measure, colorectal cancer screening. At the GME program level, 87.5% of HEDIS measures had sufficient sample sizes for reliable measurement at alpha 0.7 and 75.0% at alpha 0.8. Most resident level measurements were found to be less reliable. Conclusions GME programs may reliably evaluate HEDIS performance pooled at the program level, but less so at the resident level due to patient volume.
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- 2022
19. Lean Management and Breakthrough Performance Improvement in Health Care
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Stephen M. Shortell, Christie Ahn, Thomas G Rundall, Janet C. Blodgett, and Elina Reponen
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Health (social science) ,Process management ,Quality management ,Leadership and Management ,Organizational culture ,Context (language use) ,Organizational performance ,Lean manufacturing ,Grounded theory ,Culture change ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Humans ,030212 general & internal medicine ,Care Planning ,business.industry ,030503 health policy & services ,Health Policy ,Organizational Culture ,Quality Improvement ,Leadership ,Health Facilities ,0305 other medical science ,business ,Psychology ,Delivery of Health Care - Abstract
Background and objectives Lean management in health care organizations attempts to empower staff to generate continuous improvement through incremental but regular improvements in work processes. However, because of the increasing pressure on health care organizations to substantially improve quality of care and patient outcomes while containing costs in the relatively short term, many health care leaders are looking for ways to achieve large breakthrough improvements in their organization's performance. The objective of this research is to understand whether and how Lean management can be used to achieve breakthrough improvements in performance. Methods This study used grounded theory and content analysis of in-depth, semistructured interviews with 10 nationally recognized experts in the use of Lean management in health care organizations. The 10 participants constitute a purposive sample of experts with in-depth understanding of the strengths and limitations of Lean management in health care organizations. Results Two out of 10 participants defined breakthrough improvement as a major change in a performance metric; 2 participants defined it as a fundamental redesign in a process or service; the remaining 6 participants defined breakthrough improvement as having both these characteristics. The extent to which participants believed Lean was an effective means for achieving breakthrough improvement in performance was related to how they defined breakthrough improvement. The 2 participants who defined breakthrough improvement as a significant change in a performance metric believed Lean methods alone were sufficient. The 2 participants who defined breakthrough improvement to be a fundamental redesign tended not to view Lean alone as an effective approach. Rather, they, and the 6 participants who defined breakthrough improvement as having both change-in-metric and process redesign characteristics, viewed human-centered design thinking as the primary or important complementary approach to achieving breakthrough improvement. Participants identified resources, culture change, and leadership commitment beyond what would be required to achieve incremental improvement as the main facilitators and barriers to achieving breakthrough improvements. Conclusion This research reveals some differences in experts' definitions of breakthrough improvement, and illuminates the value of human-centered design thinking, alone or as a complement to Lean management, in achieving breakthrough improvement in health care organizations. Most of our expert participants agreed that supplementing Lean management methods with the contributions of innovation design and investing significant resources, strengthening the organizational culture to support the necessary changes, and providing stronger leadership commitment to the effort are important facilitators for achieving breakthroughs in organizational performance.
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- 2020
20. Integrated health systems.
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Stephen M. Shortell and Rodney K. McCurdy
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- 2009
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21. Organizational integration, practice capabilities, and outcomes in clinically complex medicare beneficiaries
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Mariétou H. Ouayogodé, Elliott S. Fisher, Wendy Yang, Stephen M. Shortell, Ellen Meara, Carrie H. Colla, Alexander J Mainor, and Valerie A. Lewis
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Gerontology ,Aging ,Policy and Administration ,Beneficiary ,integration ,Efficiency ,Efficiency, Organizational ,Medicare ,Outcome and Process Assessment ,Organizational ,7.3 Management and decision making ,Financial management ,Health Information Systems ,03 medical and health sciences ,0302 clinical medicine ,Clinical Protocols ,Theme Issue: Comparative Health System Performance ,Clinical Research ,Physicians ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,Quality of Health Care ,Response rate (survey) ,Data collection ,business.industry ,030503 health policy & services ,Health Policy ,Medicare beneficiary ,Financial integration ,Fee-for-Service Plans ,Continuity of Patient Care ,Health Services ,United States ,health care organizations and systems ,Health Care ,Outcome and Process Assessment, Health Care ,Cross-Sectional Studies ,Good Health and Well Being ,Cohort ,Public Health and Health Services ,Health Policy & Services ,Group Practice ,Health Services Research ,Management of diseases and conditions ,0305 other medical science ,business - Abstract
ObjectiveTo assess the association between clinical integration and financial integration, quality-focused care delivery processes, and beneficiary utilization and outcomes.Data sourcesMultiphysician practices in the 2017-2018 National Survey of Healthcare Organizations and Systems (response rate 47%) and 2017 Medicare claims data.Study designCross-sectional study of Medicare beneficiaries attributed to physician practices, focusing on two domains of integration: clinical (coordination of patient services, use of protocols, individual clinician measures, access to information) and financial (financial management and planning across operating units). We examined the association between integration domains, the adoption of quality-focused care delivery processes, beneficiary utilization and health-related outcomes, and price-adjusted spending using linear regression adjusting for practice and beneficiary characteristics, weighting to account for sampling and nonresponse.Data collection/extraction methods1604580 fee-for-service Medicare beneficiaries aged 66 or older attributed to 2113 practices. Of these, 414209 beneficiaries were considered clinically complex (frailty or 2+chronic conditions).Principal findingsFinancial integration and clinical integration were weakly correlated (correlation coefficient=0.19). Clinical integration was associated with significantly greater adoption of quality-focused care delivery processes, while financial integration was associated with lower adoption of these processes. Integration was not generally associated with reduced utilization or better beneficiary-level health-related outcomes, but both clinical integration and financial integration were associated with lower spending in both the complex and noncomplex cohorts: (clinical complex cohort: -$2518, [95% CI: -3324, -1712]; clinical noncomplex cohort: -$255 [95% CI: -413, -97]; financial complex cohort: -$997 [95% CI: -$1320, -$679]; and financial noncomplex cohort: -$143 [95% CI: -210, -$76]).ConclusionsHigher levels of financial integration were not associated with improved care delivery or with better health-related beneficiary outcomes. Nonfinancial forms of integration deserve greater attention, as practices scoring high in clinical integration are more likely to adopt quality-focused care delivery processes and have greater associated reductions in spending in complex patients.
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- 2020
22. Financial Integration’s Impact On Care Delivery And Payment Reforms: A Survey Of Hospitals And Physician Practices
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Meredith B. Rosenthal, Stephen M. Shortell, Taressa Fraze, A. James O'Malley, Marisha E. Palm, Andrew Wood, Steven Woloshin, Elliott S. Fisher, Hector P. Rodriguez, Ellen Meara, Nilay Shah, Valerie A. Lewis, and Carrie H. Colla
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medicine.medical_specialty ,Quality management ,business.industry ,Health Policy ,media_common.quotation_subject ,Integrated systems ,Financial integration ,Payment ,Consolidation (business) ,Family medicine ,Health care ,medicine ,Business ,Health policy ,media_common ,Healthcare system - Abstract
Health systems continue to grow in size. Financial integration-the ownership of hospitals or physician practices-often has anticompetitive effects that contribute to the higher prices for health care seen in the US. To determine whether the potential harms of financial integration are counterbalanced by improvements in quality, we surveyed nationally representative samples of hospitals (n = 739) and physician practices (n = 2,189), stratified according to whether they were independent or were owned by complex systems, simple systems, or medical groups. The surveys included nine scales measuring the level of adoption of diverse, quality-focused care delivery and payment reforms. Scores varied widely across hospitals and practices, but little of this variation was explained by ownership status. Quality scores favored financially integrated systems for four of nine hospital measures and one of nine practice measures, but in no case favored complex systems. Greater financial integration was generally not associated with better quality.
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- 2020
23. Factors Associated With Family Medicine and Internal Medicine First-Year Residents’ Ambulatory Care Training Time
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Jung G. Kim, Hector P. Rodriguez, Stephen M. Shortell, Eric S. Holmboe, Bruce Fuller, and Diane R. Rittenhouse
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Adult ,medicine.medical_specialty ,Time Factors ,020205 medical informatics ,education ,Training time ,Graduate medical education ,MEDLINE ,Context (language use) ,02 engineering and technology ,Environment ,Medicare ,Accreditation ,Education ,03 medical and health sciences ,0302 clinical medicine ,Ambulatory care ,Internal medicine ,Ambulatory Care ,Internal Medicine ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Humans ,030212 general & internal medicine ,Receipt ,Medicaid ,Internship and Residency ,General Medicine ,United States ,Cross-Sectional Studies ,Education, Medical, Graduate ,Family medicine ,Family Practice - Abstract
PURPOSE Despite the importance of training in ambulatory care settings for residents to acquire important competencies, little is known about the organizational and environmental factors influencing the relative amount of time primary care residents train in ambulatory care during residency. The authors examined factors associated with postgraduate year 1 (PGY-1) residents' ambulatory care training time in Accreditation Council for Graduate Medical Education (ACGME)-accredited primary care programs. METHOD U.S.-accredited family medicine (FM) and internal medicine (IM) programs' 2016-2017 National Graduate Medical Education (GME) Census data from 895 programs within 550 sponsoring institutions (representing 13,077 PGY-1s) were linked to the 2016 Centers for Medicare and Medicaid Services Cost Reports and 2015-2016 Area Health Resource File. Multilevel regression models examined the association of GME program characteristics, sponsoring institution characteristics, geography, and environmental factors with PGY-1 residents' percentage of time spent in ambulatory care. RESULTS PGY-1 mean (standard deviation, SD) percent time spent in ambulatory care was 25.4% (SD, 0.4) for both FM and IM programs. In adjusted analyses (% increase [standard error, SE]), larger faculty size (0.03% [SE, 0.01], P < .001), sponsoring institution's receipt of Teaching Health Center (THC) funding (6.6% (SE, 2.7), P < .01), and accreditation warnings (4.8% [SE, 2.5], P < .05) were associated with a greater proportion of PGY-1 time spent in ambulatory care. Programs caring for higher proportions of Medicare beneficiaries spent relatively less time in ambulatory care (< 0.5% [SE, 0.2], P < .01). CONCLUSIONS Ambulatory care time for PGY-1s varies among ACGME-accredited primary care residency programs due to the complex context and factors primary care GME programs operate under. Larger ACGME-accredited FM and IM programs and those receiving federal THC GME funding had relatively more PGY-1 time spent in ambulatory care settings. These findings inform policies to increase resident exposure in ambulatory care, potentially improving learning, competency achievement, and primary care access.
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- 2020
24. Moving organizational theory in health care forward: A discussion with suggestions for critical advancements
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Ann Barry Flood, Anthony R. Kovner, John R. Kimberly, Ingrid M. Nembhard, Stephen M. Shortell, and Jacqueline S. Zinn
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Leadership and Management ,Strategy and Management ,Efficiency, Organizational ,Intellectual history ,Health care management ,03 medical and health sciences ,Frontier ,0302 clinical medicine ,Health care ,Humans ,030212 general & internal medicine ,Sociology ,Organizational theory ,business.industry ,030503 health policy & services ,Health Policy ,Congresses as Topic ,United States ,Management ,Career Mobility ,Scholarship ,Organizational behavior ,Models, Organizational ,Health Facilities ,Health Services Research ,Health Facility Administration ,0305 other medical science ,business ,Delivery of Health Care - Abstract
In May 2019, scholars in management and organization of health care organizations and systems met. The opening plenary was a moderated discussion with five distinguished scholars who have exemplified pushing the frontier of organizational theory and practice throughout their careers: Ann Barry Flood of Dartmouth College, John Kimberly of the University of Pennsylvania, Anthony (Tony) Kovner of New York University, Stephen (Steve) Shortell of University of California at Berkeley, and Jacqueline (Jackie) Zinn of Temple University. The discussion was moderated by Ingrid Nembhard of the University of Pennsylvania. The goal of the plenary was to provide an opportunity to hear from senior members of the health care management community how they think about organizational behavior and theory, changes that they have observed, research gaps that they see, and lessons for research and practice that they have learned. This article is the transcript of that plenary discussion. It is shared to capture the intellectual history of the field and help surface the critical advancements still needed in organizational theory and practice in health care. The closing remarks of the panelists summarize recommendations for both practice and scholarship in health care organization management.
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- 2020
25. The Impact Of Decision Aids On Adults Considering Hip Or Knee Surgery
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Ming D Leung, Yue Wang, Hector P. Rodriguez, Vanessa B Hurley, Stephen M. Shortell, and Stephen Kearing
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medicine.medical_specialty ,business.industry ,030503 health policy & services ,Health Policy ,medicine.medical_treatment ,Knee replacement ,Context (language use) ,medicine.disease ,Hip replacement (animal) ,Odds ,03 medical and health sciences ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,Health care ,medicine ,Decision aids ,Physical therapy ,030212 general & internal medicine ,0305 other medical science ,business ,Medicaid - Abstract
Trials of decision aids developed for use in shared decision making find that patients engaged in that process tend to choose more conservative treatment for preference-sensitive conditions. Shared decision making is a collaborative process in which clinicians and patients discuss trade-offs and benefits of specific treatment options in light of patients' values and preferences. Decision aids are paper, video, or web-based tools intended to help patients match personal preferences with available treatment options. We analyzed data for 2012-15 about patients within the ten High Value Healthcare Collaborative member systems who were exposed to condition-specific decision aids in the context of consultations for hip and knee osteoarthritis, with the intention that the aids be used to support shared decision making. Compared to matched patients not exposed to the decision aids, those exposed had two-and-a-half times the odds of undergoing hip replacement surgery and nearly twice the odds of undergoing knee replacement surgery within six months of the consultation. These findings suggest that health care systems adopting decision aids developed for use in shared decision making, and used in conjunction with hip and knee osteoarthritis consultations, should not expect reduced surgical utilization.
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- 2020
26. Comparing health care system and physician practice influences on social risk screening
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Stephen M. Shortell, Amanda L. Brewster, Jennifer Frehn, and Hector P. Rodriguez
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medicine.medical_specialty ,Leadership and Management ,Health information technology ,Strategy and Management ,Policy and Administration ,Organizational culture ,Article ,social risk screening ,Clinical Research ,Physicians ,Health care ,Behavioral and Social Science ,medicine ,Humans ,Mass Screening ,multilevel modeling ,Social risk ,business.industry ,Health Policy ,Prevention ,Business and Management ,Health Services ,System characteristics ,Interpersonal violence ,Food insecurity ,Good Health and Well Being ,Family medicine ,organizational behavior ,Public Health and Health Services ,Health Policy & Services ,Group Practice ,Patient Participation ,business ,Psychology ,Medical Informatics ,social needs ,Healthcare system - Abstract
BACKGROUND: Health care systems can support dissemination of innovations, such as social risk screening in physician practices, but to date, no studies have examined the association of health system characteristics and practice-level adoption of social risk screening. PURPOSE: The aim of the study was to examine the association of multilevel organizational capabilities and adoption of social risk screening among system-owned physician practices. METHODOLOGY: Secondary analyses of the 2018 National Survey of Healthcare Organizations and Systems were conducted. Multilevel linear regression models examined physician practice and system characteristics associated with practice adoption of screening for five social risks (food insecurity, housing instability, utility needs, interpersonal violence, and transportation needs), accounting for clustering of practices within systems using random effects. RESULTS: System-owned practices screened for an average of 1.7 of the five social risks assessed. The intraclass correlation indicated 16% of practice variation in social risk screening was attributable to differences between their health systems owners, with 84% attributable to differences between individual practices. Practices owned by systems with multiple hospitals screened for an additional 0.44 social risks (p = .046) relative to practices of systems without hospitals. Practice characteristics associated with social risk screening included health information technology capacity (β = 0.20, p = .005), innovation culture (β = 0.26, p < .001), and patient engagement strategies (β = 0.57, p < .001). CONCLUSIONS: Health care system capabilities account for less variation in physician practice adoption of social risk screening compared to practice-level capabilities. PRACTICE IMPLICATIONS: Efforts to expand social risk screening among system-owned physician practices should focus on supporting practice capabilities, including enhancing health information technology, promoting an innovative organizational culture, and advancing patient engagement strategies.
- Published
- 2022
27. Care Continuity, Telehealth Use, and Quality of Diabetes and Hypertension Care in Community Health Centers Before and During the COVID-19 Pandemic: Repeated Cross-sectional Study
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Aaron Alexander Tierney, Denise D Payán, Timothy Brown, Adrian Aguilera, Stephen M Shortell, and Hector P Rodriguez
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General Medicine - Abstract
Background Community health centers (CHCs) pivoted to remote chronic care services during the COVID-19 pandemic. While care continuity is associated with improved care quality and patients’ experiences, telehealth’s impact on these relationships is unclear. Objective We aimed to examine the association among care continuity, telehealth use, and quality of diabetes or hypertension care in CHCs before and during the COVID-19 pandemic. Methods We collected electronic health record data from a cohort of 20,792 patients with diabetes or hypertension with ≥2 visits per year from March to December 2019 and 2020 among 166 California CHCs in the OCHIN Accelerating Data Value Across a National Community Health Center Network Collaborative. Logistic regression models estimated the association between care continuity (modified, modified continuity index [MMCI]) and telehealth adoption and blood pressure or hemoglobin A1c (HbA1c) testing. Generalized linear regression models for 2019 and 2020 estimated the association between MMCI and blood pressure or HbA1c, exploring telehealth as a mediator. Results Patients experienced reduced care continuity (2019: MMCI=0.71, SD 0.28; 2020: MMCI=0.63, SD 0.36; P Conclusions Care continuity facilitates telehealth use and enables resilient performance on process measures. Elucidating how care continuity influences telehealth adoption may provide insights about implementing patient-centered innovations.
- Published
- 2023
28. Pathways for primary care practice adoption of patient engagement strategies
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Chris Miller‐Rosales, Isomi M. Miake‐Lye, Amanda L. Brewster, Stephen M. Shortell, and Hector P. Rodriguez
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Primary Health Care ,Health Policy ,Physicians ,Surveys and Questionnaires ,Humans ,Patient Participation - Abstract
To identify potential orderings of primary care practice adoption of patient engagement strategies overall and separately for interpersonally and technologically oriented strategies.We analyzed physician practice survey data (n = 71) on the adoption of 12 patient engagement strategies.Mokken scale analysis was used to assess latent traits among the patient engagement strategies.Three groupings of patient engagement strategies were analyzed: (1) all 12 patient engagement strategies, (2) six interpersonally oriented strategies, and (3) six technologically oriented strategies.We did not find scalability among all 12 patient engagement strategies, however, separately analyzing the subgroups of six interpersonally and six technologically oriented strategies demonstrated scalability (Loevinger's H coefficient of scalability [range]: interpersonal strategies, H = 0.54 [0.49-0.60], technological strategies, H = 0.42 [0.31, 0.54]). Ordered patterns emerged in the adoption of strategies for both interpersonal and technological types.Common pathways of practice adoption of patient engagement strategies were identified. Implementing interpersonally intensive patient engagement strategies may require different physician practice capabilities than technological strategies. Rather than simultaneously adopting multiple patient engagement strategies, gradual and purposeful practice adoption may improve the impact of these strategies and support sustainability.
- Published
- 2021
29. Validation of the Lean Healthcare Implementation Self-Assessment Instrument (LHISI) in the finnish healthcare context
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Janet C. Blodgett, Stephen M. Shortell, Paulus Torkki, Noora Skants, Elina Reponen, Ritva Jokela, Thomas G. Rundall, Mikko Nuutinen, Markku Mäkijärvi, HUS Perioperative, Intensive Care and Pain Medicine, Anestesiologian yksikkö, Clinicum, Medicum, Department of Anatomy, Helsinki University Hospital Area, Department of Neurosciences, HUS Helsinki and Uusimaa Hospital District, and Department of Public Health
- Subjects
Self-assessment ,Self-Assessment ,Psychometrics ,Context (language use) ,Nursing ,Lean manufacturing ,Structural equation modeling ,Health administration ,03 medical and health sciences ,Library and Information Studies ,Surveys and Questionnaires ,Lean healthcare ,Humans ,Medicine ,0501 psychology and cognitive sciences ,Operations management ,Finland ,COMPLEXITY ,business.industry ,Research ,030503 health policy & services ,Health Policy ,05 social sciences ,Reproducibility of Results ,Self-assessment instrument ,Statistical ,THINKING ,3142 Public health care science, environmental and occupational health ,Lean maturity assessment ,Confirmatory factor analysis ,Exploratory factor analysis ,Lean management ,3141 Health care science ,050106 general psychology & cognitive sciences ,Lean implementation ,PRINCIPLES ,Management system ,Public Health and Health Services ,Health Policy & Services ,Public aspects of medicine ,RA1-1270 ,Factor Analysis, Statistical ,0305 other medical science ,business ,Delivery of Health Care ,Factor Analysis - Abstract
Lean management is growing in popularity in the healthcare sector worldwide, yet healthcare organizations are struggling with assessing the maturity of their Lean implementation and monitoring its change over time. Most existing methods for such assessments are time consuming, require site visits by external consultants, and lack frontline involvement. The original Lean Healthcare Implementation Self-Assessment Instrument (LHISI) was developed by the Center for Lean Engagement and Research (CLEAR), University of California, Berkeley as a Lean principles-based survey instrument that avoids the above problems. We validated the original LHISI in the context of Finnish healthcare. Background Lean management is growing in popularity in the healthcare sector worldwide, yet healthcare organizations are struggling with assessing the maturity of their Lean implementation and monitoring its change over time. Most existing methods for such assessments are time consuming, require site visits by external consultants, and lack frontline involvement. The original Lean Healthcare Implementation Self-Assessment Instrument (LHISI) was developed by the Center for Lean Engagement and Research (CLEAR), University of California, Berkeley as a Lean principles-based survey instrument that avoids the above problems. We validated the original LHISI in the context of Finnish healthcare. Methods The original HISI survey was sent over a secure organizational email system to the over 26,000 employees of the Hospital District of Helsinki and Uusimaa in March 2020. The data were randomly split with one part used to carry out an exploratory factor analysis (EFA), and the other for testing the resulting model using confirmatory factor analysis (CFA). Results A total of 6073 employees responded to the LHISI survey, for an overall response rate of 23%. The results indicated that the 43 items used in the original LHISI can be reduced to 25 items, and these items measure a five-dimensional model of the progress of Lean implementation: leadership, commitment, standard work, communication, and daily management system. In comparison with a single-factor model, the fit measures for the 5-factor model were better: smaller X-2, larger comparative fit index (CFI), smaller root mean square error of approximation (RMSEA), and smaller standardized root mean square residual (SRMR). Conclusions The 25 item LHISI is valid and feasible to use in the context of Finnish healthcare. The LHISI allows the organization to self-monitor the progress of its Lean implementation and provides the leadership with actionable knowledge to guide the path towards Lean maturity across the organization. Our findings encourage further studies on the adoption and validation of the LHISI in healthcare organizations worldwide.
- Published
- 2021
30. Research Paper: Adoption of Order Entry with Decision Support for Chronic Care by Physician Organizations.
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Jodi S. Simon, Thomas G. Rundall, and Stephen M. Shortell
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- 2007
- Full Text
- View/download PDF
31. EHR Use and Diabetes Care: Does primary care team unity moderate improvements in care quality?
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Ilana Graetz, Mary E. Reed, Thomas G. Rundall, Stephen M. Shortell, and John Hsu
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- 2012
32. Adoption of Patient-Reported Outcomes by Health Systems and Physician Practices in the USA
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Hector P. Rodriguez, Martin J. Kyalwazi, Valerie A. Lewis, Karl Rubio, and Stephen M. Shortell
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Surveys and Questionnaires ,Patient-Centered Care ,Physicians ,Internal Medicine ,Humans ,Pain ,Patient Reported Outcome Measures ,United States - Abstract
Patient-reported outcome measures (PROs) can help clinicians adjust treatments and deliver patient-centered care, but organizational adoption of PROs remains low.This study examines the extent of PRO adoption among health systems and physician practices nationally and examines the organizational capabilities associated with more extensive PRO adoption.Two nationally representative surveys were analyzed in parallel to assess health system and physician practice capabilities associated with adoption of PROs of disability, pain, and depression.A total of 323 US health system and 2,190 physician practice respondents METHODS: Multivariable regression models separately estimated the association of health system and physician practice capabilities associated with system-level and practice-level adoption of PROs.Health system and physician practice adoption of PROs for depression, pain, and disability.Pain (50.6%) and depression (43.8%) PROs were more commonly adopted by all hospitals and medical groups within health systems compared to disability PROs (26.5%). In adjusted analyses, systems with more advanced health IT functions were more likely to use disability (p0.05) and depression (p0.01) PROs than systems with less advanced health IT. Practice-level advanced health IT was positively associated with use of depression PRO (p0.05), but not disability or pain PRO use. Practices with more chronic care management processes, broader medical and social risk screening, and more processes to support patient responsiveness were more likely to adopt each of the three PROs. Compared to independent physician practices, system-owned practices and community health centers were less likely to adopt PROs.Chronic care management programs, routine screening, and patient-centered care initiatives can enable PRO adoption at the practice level. Developing these practice-level capabilities may improve PRO adoption more than solely expanding health IT functions.
- Published
- 2021
33. The cross-national applicability of lean implementation measures and hospital performance measures: a case study of Finland and the USA
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Elina Reponen, Thomas G. Rundall, Markku Mäkijärvi, Paulus Torkki, Ritva Jokela, Stephen M. Shortell, and Janet C. Blodgett
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Organizational performance ,Lean manufacturing ,03 medical and health sciences ,0302 clinical medicine ,Empirical research ,Health care ,Humans ,Operations management ,Relevance (information retrieval) ,030212 general & internal medicine ,Finland ,business.industry ,030503 health policy & services ,Health Policy ,Process Assessment, Health Care ,Public Health, Environmental and Occupational Health ,General Medicine ,Benchmarking ,Hospitals ,3. Good health ,Conceptual framework ,Patient Satisfaction ,Customer satisfaction ,Business ,0305 other medical science - Abstract
Background Health-care organizations around the world are striving to achieve transformational performance improvement, often through adopting process improvement methodologies such as lean management. Indeed, lean management has been implemented in hospitals in many countries. But despite a shared methodology and the potential benefit of benchmarking lean implementation and its effects on hospital performance, cross-national lean benchmarking is rare. Health-care organizations in different countries operate in very different contexts, including different health-care system models, and these differences may be perceived as limiting the ability of improvers to benchmark lean implementation and related organizational performance. However, no empirical research is available on the international relevance and applicability of lean implementation and hospital performance measures. To begin understanding the opportunities and limitations related to cross-national benchmarking of lean in hospitals, we conducted a cross-national case study of the relevance and applicability of measures of lean implementation in hospitals and hospital performance. Methods We report an exploratory case study of the relevance of lean implementation measures and the applicability of hospital performance measures using quantitative comparisons of data from Hospital District of Helsinki and Uusimaa (HUS) Helsinki University Hospital in Finland and a sample of 75 large academic hospitals in the USA. Results The relevance of lean-related measures was high across the two countries: almost 90% of the items developed for a US survey were relevant and available from HUS. A majority of the US-based measures for financial performance (66.7%), service provision/utilization (100.0%) and service provision/care processes (60.0%) were available from HUS. Differences in patient satisfaction measures prevented comparisons between HUS and the USA. Of 18 clinical outcome measures, only four (22%) were not comparable. Clinical outcome measures were less affected by the differences in health-care system models than measures related to service provision and financial performance. Conclusions Lean implementation measures are highly relevant in health-care organizations operating in the USA and Finland, as is the applicability of a variety of performance improvement measures. Cross-national benchmarking in lean healthcare is feasible, but a careful assessment of contextual factors, including the health-care system model, and their impact on the applicability and relevance of chosen benchmarking measures is necessary. The differences between the US and Finnish health-care system models is most clearly reflected in financial performance measures and care process measures.
- Published
- 2021
34. How Do Accountable Care Organizations Deliver Preventive Care Services? A Mixed-Methods Study
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Laura B. Beidler, Stephen M. Shortell, Taressa Fraze, Adam D M Briggs, Andrew L. Glick, and Elliott S. Fisher
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Quality management ,media_common.quotation_subject ,Clinical Sciences ,health care reform ,Medicare ,01 natural sciences ,Preventive care ,03 medical and health sciences ,0302 clinical medicine ,prevention ,Nursing ,General & Internal Medicine ,Surveys and Questionnaires ,Preventive Health Services ,Secondary Prevention ,Internal Medicine ,Health insurance ,Humans ,Medicine ,Quality (business) ,030212 general & internal medicine ,0101 mathematics ,Qualitative Research ,Original Research ,preventive care ,media_common ,Accountable Care Organizations ,business.industry ,Patient Protection and Affordable Care Act ,010102 general mathematics ,United States ,3. Good health ,Incentive ,Accountable care ,Survey data collection ,Health care reform ,business - Abstract
Background The Affordable Care Act and the introduction of accountable care organizations (ACOs) have increased the incentives for patients and providers to engage in preventive care, for example, through quality metrics linked to disease prevention. However, little is known about how ACOs deliver preventive care services. Objective To understand how Medicare ACOs provide preventive care services to their attributed patients. Design Mixed-methods study using survey data reporting Medicare ACO capabilities in patient care management and interviews with high-performing ACOs. Participants ACO executives completed survey data on 283 Medicare ACOs. These data were supplemented with 39 interviews conducted across 18 Medicare ACOs with executive-level leaders and associated clinical and managerial staff. Main Measures Survey measures included ACO performance, organizational characteristics, collaboration experience, and capabilities in care management and quality improvement. Telephone interviews followed a semi-structured interview guide and explored the mechanisms used, and motivations of, ACOs to deliver preventive care services. Key Results Medicare ACOs that reported being comprehensively engaged in the planning and management of patient care - including conducting reminders for preventive care services - had more beneficiaries and had a history of collaboration experience, but were not more likely to receive shared savings or achieve high-quality scores compared to other surveyed ACOs. Interviews revealed that offering annual wellness visits and having a system-wide approach to closing preventive care gaps are key mechanisms used by high-performing ACOs to address patients’ preventive care needs. Few programs or initiatives were identified that specifically target clinically complex patients. Aside from meeting patient needs, motivations for ACOs included increasing patient attribution and meeting performance targets. Conclusions ACOs are increasingly motivated to deliver preventive care services. Understanding the mechanisms and motivations used by high-performing ACOs may help both providers and payers to increase the use of preventive care.
- Published
- 2019
35. Assessing the relationship of the human resource, finance, and information technology functions on reported performance in hospitals using the Lean management system
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Stephen M. Shortell, Thomas G. Rundall, and Janet C. Blodgett
- Subjects
Mediation (statistics) ,Leadership and Management ,Strategy and Management ,Control (management) ,Lean manufacturing ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Humans ,030212 general & internal medicine ,Finance ,business.industry ,030503 health policy & services ,Health Policy ,Information technology ,Quality Improvement ,Maturity (finance) ,Hospitals ,Transformational leadership ,Scale (social sciences) ,Workforce ,Information Technology ,0305 other medical science ,business ,Psychology ,Total Quality Management - Abstract
BACKGROUND Given pressures to control costs and improve quality of care, one of the most prevalent transformational performance improvement approaches in health care is Lean management. However, the roles of support functions such as human resource (HR), finance, and information technology (IT) in Lean management and the relationships of these support functions with performance are unknown. PURPOSE The aim of this study was to examine the relationships between the HR, finance, and IT functions, overall Lean implementation, and self-reported performance improvement in hospitals that have implemented Lean. METHODOLOGY/APPROACH Data from a national survey of Lean in U.S. hospitals (N = 1,222; 847 reported using Lean) were analyzed using multivariable regression and bootstrapped mediation analysis. The extent to which HR, finance, and IT functions support Lean management was measured using indices including six, three, and six items respectively. Lean implementation was measured by the number of units doing Lean (up to 29) and by a four-level self-reported maturity scale. Performance improvement was measured using an index of self-reported achievements (ranging from 0 to 16). RESULTS There were significant positive associations between Lean HR, finance, and IT functions and self-reported performance impact (controlling for organizational and market variables). Tests of mediation indicated that the associations of HR, finance, and IT functions with self-reported performance were significantly mediated by the number of Lean units (mediated proportion ranging from 40% to 73%), and HR function was also mediated by self-reported maturity (61% mediated). There were no moderating effects. CONCLUSION HR, finance, and IT functions are positively associated with self-reported Lean impact on performance and primarily explained by the overall degree of Lean implementation. PRACTICE IMPLICATIONS Efforts to align HR, finance, and IT functions with overall Lean implementation can help to ensure that frontline caregivers and managers have the data and skills required to meet transformational improvement goals.
- Published
- 2019
36. The influence of leadership facilitation on relational coordination among primary care team members of accountable care organizations
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Thomas P. Huber, Stephen M. Shortell, and Hector P. Rodriguez
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Adult ,Male ,team participation ,Leadership and Management ,Strategy and Management ,media_common.quotation_subject ,Primary care.team ,Policy and Administration ,education ,leadership facilitation ,Article ,03 medical and health sciences ,0302 clinical medicine ,Clinical Research ,relational coordination ,Integrated ,Surveys and Questionnaires ,Organizational change ,Humans ,030212 general & internal medicine ,Association (psychology) ,media_common ,Patient Care Team ,Teamwork ,Accountable Care Organizations ,Primary Health Care ,Delivery of Health Care, Integrated ,030503 health policy & services ,Health Policy ,Business and Management ,primary care practice teams ,solidarity culture ,Middle Aged ,Organizational Innovation ,Solidarity ,Integrated care ,Leadership ,accountable care organization ,Accountable care ,Public Health and Health Services ,Health Policy & Services ,Facilitation ,Female ,0305 other medical science ,Psychology ,Delivery of Health Care ,Social psychology - Abstract
BACKGROUND Teamwork is a central aspect of integrated care delivery and increasingly critical to primary care practices of accountable care organizations. Although the importance of leadership facilitation in implementing organizational change is well documented, less is known about the extent to which strong leadership facilitation can positively influence relational coordination among primary care team members. PURPOSE The aim of this study was to examine the association of leadership facilitation of change and relational coordination among primary care teams of accountable care organization-affiliated practices and explore the role of team participation and solidarity culture as mediators of the relationship between leadership facilitation and relational coordination among team members. METHODOLOGY/APPROACH Survey responses of primary care clinicians and staff (n = 764) were analyzed. Multilevel linear regression estimated the relationships among leadership facilitation, team participation, group solidarity, and relational coordination controlling for age, time, occupation, gender, team tenure, and team size. Models included practice site random effects to account for the clustering of respondents within practices. RESULTS Leadership facilitation (β = 0.19, p < .001) and team participation (β = 0.18, p < .001) were positively associated with relational coordination, but solidarity culture was not associated. The association of leadership facilitation and relational coordination was only partially mediated (9%) by team participation. CONCLUSIONS Leadership facilitation of change is positively associated with relational coordination of primary care team members. The relationship is only partially explained by better team participation, indicating that leadership facilitation has a strong direct effect on relational coordination. Greater solidarity was not associated with better relational coordination and may not contribute to better team task coordination. PRACTICE IMPLICATIONS Leadership facilitation of change may have a positive and direct impact on high relational coordination among primary care team members.
- Published
- 2019
37. Landscape of Health Systems in the United States
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Eugene C. Rich, Rachel Machta, Michael F. Furukawa, Stephen M. Shortell, Valerie A. Lewis, Ellen Meara, Dennis P. Scanlon, A. James O'Malley, David Jones, and Kirsten Barrett
- Subjects
hospital-physician affiliations ,medicine.medical_specialty ,Resource (biology) ,Knowledge management ,media_common.quotation_subject ,hospital–physician affiliations ,Vertical integration ,Article ,vertical integration ,Clinical Research ,Integrated ,Acute care ,delivery system organization ,Agency (sociology) ,Health care ,medicine ,Humans ,Quality (business) ,media_common ,Delivery of Health Care, Integrated ,business.industry ,Health Policy ,Ownership ,Business and Management ,Health Services ,Hospitals ,United States ,Compendium ,Organizational Affiliation ,Good Health and Well Being ,Public Health and Health Services ,Health Policy & Services ,Key (cryptography) ,Generic health relevance ,Business ,Delivery of Health Care ,health systems - Abstract
Despite the prevalence of vertical integration, data and research focused on identifying and describing health systems are sparse. Until recently, we lacked an enumeration of health systems and an understanding of how systems vary by key structural attributes. To fill this gap, the Agency for Healthcare Research and Quality developed the Compendium of U.S. Health Systems, a data resource to support research on comparative health system performance. In this article, we describe the methods used to create the Compendium and present a picture of vertical integration in the United States. We identified 626 health systems in 2016, which accounted for 70% of nonfederal general acute care hospitals. These systems varied by key structural attributes, including size, ownership, and geographic presence. The Compendium can be used to study the characteristics of the U.S. health care system and address policy issues related to provider organizations.
- Published
- 2019
38. Multi-level analysis of the learning health system: Integrating contributions from research on organizations and implementation
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Stephen M. Shortell and Michael I. Harrison
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Medicine (General) ,medicine.medical_specialty ,Knowledge management ,Computer science ,Health Informatics ,R5-920 ,Health Information Management ,learning health system ,organizational learning ,Commentaries ,Health care ,Behavioral and Social Science ,medicine ,implementation science ,Point (typography) ,business.industry ,Public health ,Perspective (graphical) ,Public Health, Environmental and Occupational Health ,Learning organization ,Incentive ,Organizational learning ,Commentary ,Implementation research ,Generic health relevance ,Public aspects of medicine ,RA1-1270 ,business - Abstract
Author(s): Harrison, Michael I; Shortell, Stephen M | Abstract: IntroductionOrganizations and systems that deliver health care may better adapt to rapid change in their environments by acting as learning organizations and learning health systems (LHSs). Despite widespread recognition that multilevel forces shape capacity for learning within care delivery organizations, there is no agreed-on, comprehensive, multilevel framework to inform LHS research and practice.MethodsWe develop such a framework, which can enhance both research on LHSs and practical steps toward their development. We draw on existing frameworks and research within organization and implementation science and synthesize contributions from three influential frameworks: the Consolidated Framework for Implementation Research, the social-ecological framework, and the organizational change framework. These frameworks come, respectively, from the fields of implementation science, public health, and organization science.ResultsOur proposed integrative framework includes both intraorganizational levels (individual, team, mid-management, organization) and the operating and general environments in which delivery organizations operate. We stress the importance of examining interactions among influential factors both within and across system levels and focus on the effects of leadership, incentives, and culture. Additionally, we indicate that organizational learning depends substantially on internal and cross-level alignment of these factors. We illustrate the contribution of our multilevel perspective by applying it to the analysis of three diverse implementation initiatives that aimed at specific care improvements and enduring system learning.ConclusionsThe framework and perspective developed here can help investigators and practitioners broadly scan and then investigate forces influencing improvement and learning and may point to otherwise unnoticed interactions among influential factors. The framework can also be used as a planning tool by managers and practitioners.
- Published
- 2021
39. Hospital‐based health systems 20 years later: A taxonomy for policy research and analysis
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Stephen M. Shortell, A. James O'Malley, Daniel J. Gottlieb, and Pablo Martínez Camblor
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Data collection ,business.industry ,Delivery of Health Care, Integrated ,030503 health policy & services ,Health Policy ,Varimax rotation ,media_common.quotation_subject ,Ownership ,Hospitals and Health Systems ,Public policy ,Hospitals, General ,United States ,03 medical and health sciences ,0302 clinical medicine ,Taxonomy (general) ,Health care ,Survey data collection ,Humans ,Operations management ,030212 general & internal medicine ,Social determinants of health ,0305 other medical science ,business ,Autonomy ,media_common - Abstract
Objective Building on the original taxonomy of hospital-based health systems from 20 years ago, we develop a new taxonomy to inform emerging public policy and practice developments. Data sources The 2016 American Hospital Association's (AHA) Annual Survey; the 2016 IQVIA Healthcare Organizations and Systems (HCOS) database; and the 2017-2018 National Survey of Healthcare Organizations and Systems (NSHOS). Study design Cluster analysis of the 2016 AHA Annual Survey data to derive measures of differentiation, centralization, and integration to create categories or types of hospital-based health systems. Data collection Principal components factor analysis with varimax rotation generating the factors used in the cluster algorithms. Principal findings Among the four cluster types, 54% (N = 202) of systems are decentralized (-0.35) and relatively less differentiated (-0.37); 23% of systems (N = 85) are highly differentiated (1.28) but relatively decentralized (-0.29); 15% (N = 57) are highly centralized (2.04) and highly differentiated (0.65); and approximately 9 percent (N = 33) are least differentiated (-1.35) and most decentralized (-0.64). Despite differences in calculation, the Highly Centralized, Highly Differentiated System Cluster and the Undifferentiated, Decentralized System Cluster were similar to those identified 20 years ago. The other two system clusters contained similarities as well as differences from those 20 years ago. Overall, 82 percent of the systems remain relatively decentralized suggesting they operate largely as holding companies allowing autonomy to individual hospitals operating within the system. Conclusions The new taxonomy of hospital-based health systems bears similarities as well as differences from 20 years ago. Important applications of the taxonomy for addressing current challenges facing the healthcare system, such as the transition to value-based payment models, continued consolidation, and the growing importance of the social determinants of health, are highlighted.
- Published
- 2021
40. Reflections on the Five Laws of Integrating Medical and Social Services-21 Years Later
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Stephen M. Shortell
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Social Work ,Accountable Care Organizations ,business.industry ,Delivery of Health Care, Integrated ,Health Policy ,Public Health, Environmental and Occupational Health ,Social Welfare ,Health Care Costs ,Public relations ,Health Planning ,Political science ,Humans ,Milbank Quarterly Classics ,Comprehensive Health Care ,business - Published
- 2020
41. Integrating network theory into the study of integrated healthcare
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Lawton R. Burns, Ingrid M. Nembhard, and Stephen M. Shortell
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Health (social science) ,History and Philosophy of Science - Published
- 2022
42. Responding to The Grand Challenges In Healthcare Via Organizational Innovation : Needed Advances in Management Research
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Stephen M. Shortell, Lawton Robert Burns, Jennifer L. Hefner, Stephen M. Shortell, Lawton Robert Burns, and Jennifer L. Hefner
- Subjects
- Health services administration, Organizational change
- Abstract
This book contains two Open Access chapters. The 21st volume of Advances in Health Care Management presents informed commentaries solicited from leaders across the field of health care management. Each chapter tackles a specific health care challenge, describing the state of the research on the challenge, identifying appropriate organizational innovations to respond to the challenge, and setting out a future research agenda. Expert authors consider what is known, what is not known, and what is needed to fill the gaps and advance knowledge. Responding to The Grand Challenges in Healthcare Via Organizational Innovation explores in detail varied scenarios and suggestions for dealing with unexpected crises, improving diversity, equity and inclusion in health care, building strategic alliances for inter-sector collaboration, as well as analyzing organizational governance and physician financial risk models.
- Published
- 2023
43. Lean Management and Hospital Performance: Adoption vs. Implementation
- Author
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Elina Reponen, Thomas G. Rundall, Rachel Mosher Henke, Stephen M. Shortell, and Janet C. Blodgett
- Subjects
Multivariate analysis ,Sociotechnical system ,Leadership and Management ,media_common.quotation_subject ,Medicare ,Lean manufacturing ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Health care ,Patient experience ,Humans ,Quality (business) ,Operations management ,030212 general & internal medicine ,media_common ,Aged ,Inpatients ,business.industry ,030503 health policy & services ,Hospitals ,United States ,3. Good health ,Transformational leadership ,Patient Satisfaction ,Business ,0305 other medical science ,Medicaid - Abstract
The Lean management system is being adopted and implemented by an increasing number of US hospitals. Yet few studies have considered the impact of Lean on hospitalwide performance.A multivariate analysis was performed of the 2017 National Survey of Lean/Transformational Performance Improvement in Hospitals and 2018 publicly available data from the Agency for Healthcare Research and Quality and the Center for MedicareMedicaid Services on 10 quality/appropriateness of care, cost, and patient experience measures.Hospital adoption of Lean was associated with higher Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experience scores (b = 3.35, p0.0001) on a scale of 100-300 but none of the other 9 performance measures. The degree of Lean implementation measured by the number of units throughout the hospital using Lean was associated with lower adjusted inpatient expense per admission (b = -38.67; p0.001), lower 30-day unplanned readmission rate (b = -0.01, p0.007), a score above the national average on appropriate use of imaging-a measure of low-value care (odds ratio = 1.04, p0.042), and higher HCAHPS patient experience scores (b = 0.12, p0.012). The degree of Lean implementation was not associated with any of the other 6 performance measures.Lean is an organizationwide sociotechnical performance improvement system. As such, the actual degree of implementation throughout the organization as opposed to mere adoption is, based on the present findings, more likely to be associated with positive hospital performance on at least some measures.
- Published
- 2020
44. Financial Integration's Impact On Care Delivery And Payment Reforms: A Survey Of Hospitals And Physician Practices
- Author
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Elliott S, Fisher, Stephen M, Shortell, A James, O'Malley, Taressa K, Fraze, Andrew, Wood, Marisha, Palm, Carrie H, Colla, Meredith B, Rosenthal, Hector P, Rodriguez, Valerie A, Lewis, Steven, Woloshin, Nilay, Shah, and Ellen, Meara
- Subjects
Physicians ,Ownership ,Humans ,Delivery of Health Care ,Hospitals ,United States ,Article ,Quality of Health Care - Abstract
Health care systems continue to grow in size. Financial integration—the ownership of hospitals or physician practices—often has anticompetitive effects that contribute to the higher prices for health care seen in the US. To determine whether the potential harms of financial integration are counterbalanced by improvements in quality, we surveyed nationally representative samples of hospitals (n = 739) and physician practices (n = 2,189), stratified according to whether they were independent or were owned by complex systems, simple systems, or medical groups. The surveys included nine scales measuring the level of adoption of diverse, quality-focused care delivery and payment reforms. Scores varied widely across hospitals and practices, but little of this variation was explained by ownership status. Quality scores favored financially integrated systems for four of nine hospital and one of nine practice measures, but in no case favored complex systems. Greater financial integration was generally not associated with better quality.
- Published
- 2020
45. Assessing the Short-Term Association Between Rural Hospitals' Participation in Accountable Care Organizations and Changes in Utilization and Financial Performance
- Author
-
L. Comfort, Stephen M. Shortell, and Brent D. Fulton
- Subjects
medicine.medical_specialty ,education.field_of_study ,Accountable Care Organizations ,030503 health policy & services ,Rural health ,Hospitals, Rural ,Population ,Operating margin ,Public Health, Environmental and Occupational Health ,Regression analysis ,Sample (statistics) ,Medicare ,United States ,03 medical and health sciences ,0302 clinical medicine ,Turnover ,Family medicine ,Propensity score matching ,medicine ,Humans ,030212 general & internal medicine ,Business ,0305 other medical science ,education ,Association (psychology) - Abstract
Purpose Although much research has been done on accountable care organizations (ACOs), little is known about their impact on rural hospitals. We examine the association between rural hospitals' participation in an ACO and their performance on utilization and financial measures. Methods This quasi-experimental study estimates the relationship between voluntary ACO participation and hospital metrics using propensity score-matched, longitudinal regression models with year and hospital fixed effects. Regression models controlled for secular trends and time-varying hospital and county characteristics. Hospital measures were from the American Hospital Association, RAND Hospital Data, and Leavitt Partners. The initial population comprises 643 rural hospitals that participated in an ACO for at least one year during the 2011 to 2018 study period and 1,541 rural hospitals that did not participate in an ACO. From this population we created a sample of propensity score-matched hospitals consisting of 525 ACO-participating and 525 comparable non-ACO hospitals. Results Rural hospitals' participation in an ACO is not associated with changes in hospital utilization or financial measures, nor is there an association between these performance metrics and whether another within-county hospital participated in an ACO. A secondary analysis limited to Critical Access Hospitals provides some evidence that inpatient utilization increases in the second year of ACO participation, though the increases are not significant in year 3 and beyond. Conclusion We find no evidence that rural hospitals experience substantive changes in outpatient visits, inpatient utilization, or operating margin in the years immediately after joining an ACO.
- Published
- 2020
46. Adoption of Lean management and hospital performance: Results from a national survey
- Author
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Stephen M. Shortell, Rachel Mosher Henke, Thomas G. Rundall, Janet C. Blodgett, and David Foster
- Subjects
Leadership and Management ,Strategy and Management ,Beneficiary ,Sample (statistics) ,Medicare ,Lean manufacturing ,Unit (housing) ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Surveys and Questionnaires ,Humans ,Operations management ,030212 general & internal medicine ,Aged ,030503 health policy & services ,Health Policy ,Hospitals ,United States ,Transformational leadership ,Patient Satisfaction ,Market data ,Business ,0305 other medical science ,Medicaid ,American Hospital Association - Abstract
BACKGROUND Despite being adopted by a large number of hospitals, the relationship between Lean management and hospital performance is mixed and not well understood. PURPOSE We examined the relationships between Lean and hospital financial performance, patient outcomes, and patient satisfaction in a large national sample of hospitals, controlling for relevant organizational and market factors. METHODOLOGY/APPROACH A mixed effects linear regression analysis was performed to assess the relationships between adoption of Lean and 10 measures of hospital performance using data from 1,152 hospitals that responded to the 2017 National Survey of Lean/Transformational Performance Improvement in Hospitals. Hospital performance, organizational, and market data over the period 2011-2015 come from the 2015 American Hospital Association Annual Hospital Survey and the respective annual Centers for Medicare & Medicaid Services (CMS) Medicare Cost Report, CMS Hospital Compare, CMS MEDPAR, and the CMS Hospital Service Area File. RESULTS Lean adoption was significantly associated at alpha < .05, with lower Medicare spending per beneficiary (b = -.005, p = .027). None of the other nine associations were statistically significant, although eight of them were in the predicted direction. CONCLUSION Lean adoption is not associated with most measures of hospital performance. It is likely Lean implementation varies greatly across hospitals. Future research should examine the relationships among the various dimensions of Lean implementation and performance. PRACTICE IMPLICATIONS If Lean management is to contribute to hospital performance improvement, leaders must be highly cognizant of what "adoption of Lean" actually means in their hospital. Although limited, single-unit Lean initiatives in an emergency room or other patient care unit may improve performance on some unit-specific measures, improvement on hospital-wide measures of performance requires a broad, sustained commitment to the implementation of Lean practices and tools.
- Published
- 2020
47. Patient Activation as a Pathway to Shared Decision-making for Adults with Diabetes or Cardiovascular Disease
- Author
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Bing Ying Poon, Hector P. Rodriguez, and Stephen M. Shortell
- Subjects
Patient Activation ,Adult ,Male ,Patient physician communication ,medicine.medical_specialty ,Decision Making ,Clinical Sciences ,Disease ,patient-centered care ,Medicare ,01 natural sciences ,03 medical and health sciences ,0302 clinical medicine ,patient-physician communication ,Clinical Research ,Diabetes mellitus ,patient activation ,General & Internal Medicine ,Internal Medicine ,medicine ,Diabetes Mellitus ,Humans ,Physician patient relationship ,030212 general & internal medicine ,0101 mathematics ,Intensive care medicine ,Routine care ,Aged ,business.industry ,Prevention ,010102 general mathematics ,shared decision-making ,Patient-centered care ,Middle Aged ,medicine.disease ,patient-physician relationship ,United States ,Shared ,Good Health and Well Being ,Cardiovascular Diseases ,Female ,Patient Participation ,business - Abstract
BackgroundShared decision-making (SDM) is widely recognized as a core strategy to improve patient-centered care. However, the implementation of SDM in routine care settings has been slow and its impact mixed.ObjectiveWe examine the temporal association of patient activation and patients' experience with the SDM process to assess the dominant directionality of this relationship.DesignPatient activation, or a patients' knowledge, skills, and confidence in self-management, was assessed using the 13-item Patient Activation Measure (PAM). Patient-reported assessment of the SDM process was assessed using the 3-item CollaboRATE measure. Patients at 16 adult primary care practices were surveyed in 2015 and 2016 on PAM (α = 0.92), CollaboRATE (α = 0.90), and demographics. The relationship between PAM and CollaboRATE was estimated using a cross-lagged panel model with clustered robust standard errors and practice fixed effects, controlling for patient characteristics.Participants1222 adult patients with diabetes and/or cardiovascular disease with survey responses at baseline (51% response rate) and a 1-year follow-up (73% response rate).ResultsPAM (mean 3.27 vs 3.28 on a range of 1 to 4; p = 0.082) and CollaboRATE (mean 3.62 vs 3.63 on a range of 1 to 5; p = 0.14) did not change significantly over time. In adjusted analyses, the path from baseline PAM to follow-up CollaboRATE (β = 0.35; p
- Published
- 2020
48. Assessing Patient Activation and Engagement Activities at Primary Care Clinics Within Accountable Care Organizations
- Author
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Glyn Elwyn, Elliott S. Fisher, Susan L. Ivey, Hector P. Rodriguez, Patricia P. Ramsay, and Stephen M. Shortell
- Subjects
Patient Activation ,Nursing ,business.industry ,Accountable care ,Medicine ,Primary care ,business - Published
- 2020
49. The CMS State Innovation Models Initiative and Improved Health Information Technology and Care Management Capabilities of Physician Practices
- Author
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Taressa Fraze, Hector P. Rodriguez, Salma Bibi, Diane R. Rittenhouse, Stephen M. Shortell, and Zosha K. Kandel
- Subjects
Health information technology ,media_common.quotation_subject ,MEDLINE ,Medicare ,Centers for Medicare and Medicaid Services, U.S ,Article ,03 medical and health sciences ,0302 clinical medicine ,State (polity) ,Physicians ,Health care ,Humans ,030212 general & internal medicine ,health care economics and organizations ,media_common ,Aged ,Payment reform ,business.industry ,030503 health policy & services ,Health Policy ,Public relations ,Payment ,United States ,Delivery system ,0305 other medical science ,business ,Medicaid ,Medical Informatics - Abstract
The Centers for Medicare and Medicaid Services’ (CMS) State Innovation Models (SIMs) initiative funded 17 states to implement health care payment and delivery system reforms to improve health system performance. Whether SIM improved health information technology (HIT) and care management capabilities of physician practices, however, remains unclear. National surveys of physician practices ( N = 2,722) from 2012 to 2013 and 2017 to 2018 were linked. Multivariable regression estimated differential adoption of 10 HIT functions and chronic care management processes (CMPs) based on SIM award status (SIM Round 1, SIM Round 2, or non-SIM). HIT and CMP capabilities improved equally for practices in SIM Round 1 (5.3 vs. 6.8 capabilities, p < .001), SIM Round 2 (4.7 vs. 7.0 capabilities, p < .001), and non-SIM (4.2 vs. 6.3 capabilities, p < .001) states. The CMS SIM Initiative did not accelerate the adoption of ten foundational physician practice capabilities beyond national trends.
- Published
- 2020
50. Use of Lean and Related Transformational Performance Improvement Systems in Hospitals in the United States: Results From a National Survey
- Author
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Peter D. Kralovec, Thomas G. Rundall, Stephen M. Shortell, and Janet C. Blodgett
- Subjects
Inservice Training ,Leadership and Management ,media_common.quotation_subject ,Lean manufacturing ,03 medical and health sciences ,0302 clinical medicine ,Hospital Administration ,Residence Characteristics ,Health care ,Humans ,Quality (business) ,Operations management ,030212 general & internal medicine ,media_common ,Response rate (survey) ,business.industry ,030503 health policy & services ,Ownership ,Six Sigma ,Quality Improvement ,United States ,Leadership ,Transformational leadership ,Hospital Bed Capacity ,Health Care Surveys ,Management system ,Survey data collection ,0305 other medical science ,business ,Total Quality Management - Abstract
Background The health care system in the United States is costly with high variance in quality. There is growing interest in transformational performance improvement initiatives, such as the Lean management system, to eliminate waste and inefficiency and improve quality of care for patients. Methods A national survey of all 4,500 short-term acute general medical/surgical and pediatric hospitals in the United States was fielded between May and September 2017 by the Survey Data Center of the American Hospital Association. Results Responses were received from 1,222 hospitals (27.3% response rate). Sixty-nine percent (69.3%) reported use Lean or related Lean plus Six Sigma or Robust Process Improvement approaches. Not-for-profit hospitals, hospitals located in metro/urban areas, those belonging to a system/network, and those with 100–399 beds were most likely to be engaged in these activities and for an average of 5.2 years. However, only 12.6% (n = 102) of hospitals reported being at a mature hospitalwide stage of implementation. The degree of maturity, leadership commitment, daily management system use, and training were each positively associated with reported positive performance outcomes. Conclusion A majority of hospitals have adopted Lean-based transformational performance improvement approaches but with wide variance in the degree of implementation. It takes time for Lean to gain traction. The length of time doing Lean is positively associated with implementation progress and reported positive performance impacts. The extent to which Lean has an organizationwide performance impact awaits further research that links the variables in this study with objective cost and quality measures.
- Published
- 2018
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