Andrew N. Garman

Staff burnout and patient satisfaction: Evidence of relationships at the care unit level.

Research on burnout has thus far focused primarily on the individual; however, in work environments in which teamwork is emphasized, it seems plausible that a meaningful group-level burnout construct could emerge. This theory was tested by examining burnout in psychosocial rehabilitation teams and its effects on patient satisfaction. Three hundred thirty-three staff from 31 behavioral health teams completed the Maslach Burnout Inventory; 405 of the clients they served completed the Consumer Satisfaction Scale. Multilevel analyses (hierarchical linear modeling) confirmed the existence of a meaningful team-level burnout construct. Team-level analyses revealed significant relationships between team burnout and patient satisfaction.

Leadership competencies: an introduction.

O ur goal with this column is to provide a useful, practical introduction to competency modeling, a practice that is already a mainstay in many health professions and that is likely to find expanded use within health administration in the coming years. The competency model recently made available by the Healthcare Leadership Alliance (HLA) will serve to frame subsequent installments of this column. The Alliance was formed as a partnership between six of the major healthcare leadership professional associations in administration, nursing, and medicine, including the American College of Healthcare Executives (ACHE), Healthcare Financial Management Association (HFMA), Health Information Management Systems Society (HIMSS), American Organization of Nurse Executives (AONE), American College of Physician Executives (ACPE), and Medical Group Management Association and American College of Medical Practice Executives (ACMPE). In this column, we will illustrate several of the ways competency models can be used efficiently and effectively by individual leaders, leadership teams, and organizations to support their organizational strategy. In this first installment, our focus is on clarifying what competencies are, what they can be used for, and what is currently happening within the profession related to competencies. We offer a practical definition of competencies, a task that calls for providing some historical context as well.

Patient satisfaction as a predictor of return-to-provider behavior: analysis and assessment of financial implications.

Although customer loyalty is frequently cited as a benefit of patient satisfaction, an empirical link between the two has not, to our knowledge, ever been statistically established in a hospital setting. The goal of the present study was to evaluate the relationship between self-reported patient satisfaction measures and subsequent return to the provider for care at a large academic medical center. Data from all adult medical patients responding to a patient satisfaction survey distributed by a large midwestern academic medical center during fiscal year 1997 (n = 1485) were analyzed. Response patterns were examined as they related to whether patients returned to the provider during the subsequent 2-year period. Analyses suggested that return-to-provider was associated with only a minority of the satisfaction items (approx. 11%). All items showing a significant relationship measured perceptions of how well physicians and nurses attended to, and provided information to, patients and their families. Although the size of these relationships was generally small, the estimated financial implications are substantial. Other implications of these findings for planning effective service improvement initiatives as well as improving patient survey design are discussed.

High-performance work systems in health care management, Part 1: Development of an evidence-informed model

Background: Although management practices are recognized as important factors in improving health care quality and efficiency, most research thus far has focused on individual practices, ignoring or underspecifying the contexts within which these practices are operating. Research from other industries, which has increasingly focused on systems rather than individual practices, has yielded results that may benefit health services management. Purpose: Our goal was to develop a conceptual model on the basis of prior research from health care as well as other industries that could be used to inform important contextual considerations within health care. Methodology/Approach: Using theoretical frameworks from A. Donabedian (1966), P. M. Wright, T. M. Gardner, and L. M. Moynihan (2003), and B. Schneider, D. B. Smith, and H. W. Goldstein (2000) and review methods adapted from R. Pawson (2006b), we reviewed relevant research from peer-reviewed and other industry-relevant sources to inform our model. The model we developed was then reviewed with a panel of practitioners, including experts in quality and human resource management, to assess the applicability of the model to health care settings. Findings: The resulting conceptual model identified four practice bundles, comprising 14 management practices as well as nine factors influencing adoption and perceived sustainability of these practices. The mechanisms by which these practices influence care outcomes are illustrated using the example of hospital-acquired infections. In addition, limitations of the current evidence base are discussed, and an agenda for future research in health care settings is outlined. Practice Implications: Results may help practitioners better conceptualize management practices as part of a broader system of work practices. This may, in turn, help practitioners to prioritize management improvement efforts more systematically.BACKGROUND : A capable workforce is central to the delivery of high-quality care. Research from other industries suggests that the methodical use of evidence-based management practices (also known as high-performance work practices [HPWPs]), such as systematic personnel selection and incentive compensation, serves to attract and retain well-qualified health care staff and that HPWPs may represent an important and underutilized strategy for improving quality of care and patient safety. PURPOSE : The aims of this study were to improve our understanding about the use of HPWPs in health care organizations and to learn about their contribution to quality of care and patient safety improvements. METHODOLOGY/APPROACH : Guided by a model of HPWPs developed through an extensive literature review and synthesis, we conducted a series of interviews with key informants from five U.S. health care organizations that had been identified based on their exemplary use of HPWPs. We sought to explore the applicability of our model and learn whether and how HPWPs were related to quality and safety. All interviews were recorded, transcribed, and subjected to qualitative analysis. FINDINGS : In each of the five organizations, we found emphasis on all four HPWP subsystems in our conceptual model-engagement, staff acquisition/development, frontline empowerment, and leadership alignment/development. Although some HPWPs were common, there were also practices that were distinctive to a single organization. Our informants reported links between HPWPs and employee outcomes (e.g., turnover and higher satisfaction/engagement) and indicated that HPWPs made important contributions to system- and organization-level outcomes (e.g., improved recruitment, improved ability to address safety concerns, and lower turnover). PRACTICE IMPLICATIONS : These case studies suggest that the systematic use of HPWPs may improve performance in health care organizations and provide examples of how HPWPs can impact quality and safety in health care. Further research is needed to specify which HPWPs and systems are of greatest potential for health care management.

Patient satisfaction with nursing care: a multilevel analysis.

Although prior research has suggested that satisfaction with nursing care is affected by multilevel factors (e.g., patient characteristics, episode-of-care, the institution providing care), these studies typically focused only on a single level of analysis. The present study examines three levels of influence simultaneously to assess the relative effect each has on satisfaction. Results suggest that satisfaction is determined primarily by the patient and the episode of care; organization-level factors explained almost no additional variance.

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

Background: A capable workforce is central to the delivery of high-quality care. Research from other industries suggests that the methodical use of evidence-based management practices (also known as high-performance work practices [HPWPs]), such as systematic personnel selection and incentive compensation, serves to attract and retain well-qualified health care staff and that HPWPs may represent an important and underutilized strategy for improving quality of care and patient safety. Purpose: The aims of this study were to improve our understanding about the use of HPWPs in health care organizations and to learn about their contribution to quality of care and patient safety improvements. Methodology/Approach: Guided by a model of HPWPs developed through an extensive literature review and synthesis, we conducted a series of interviews with key informants from five U.S. health care organizations that had been identified based on their exemplary use of HPWPs. We sought to explore the applicability of our model and learn whether and how HPWPs were related to quality and safety. All interviews were recorded, transcribed, and subjected to qualitative analysis. Findings: In each of the five organizations, we found emphasis on all four HPWP subsystems in our conceptual model-engagement, staff acquisition/development, frontline empowerment, and leadership alignment/development. Although some HPWPs were common, there were also practices that were distinctive to a single organization. Our informants reported links between HPWPs and employee outcomes (e.g., turnover and higher satisfaction/engagement) and indicated that HPWPs made important contributions to system- and organization-level outcomes (e.g., improved recruitment, improved ability to address safety concerns, and lower turnover). Practice Implications: These case studies suggest that the systematic use of HPWPs may improve performance in health care organizations and provide examples of how HPWPs can impact quality and safety in health care. Further research is needed to specify which HPWPs and systems are of greatest potential for health care management.

Impact of medical travel on imports and exports of medical services

OBJECTIVES Medical travel is travel outside of an individuals home region or country in pursuit of medical care that is more accessible, of higher quality and/or of lower cost. This paper estimates the inflows of foreign residents seeking medical care in the U.S. and outflows of U.S. residents seeking care abroad. METHODS Using data from the U.S. Bureau of Economic Analysis, U.S. International Trade Administration and a survey of domestic health care providers, we estimate the lower and upper bounds for the number of medical travelers into and out of the U.S. and the value of these services. RESULTS We estimate that between 43,000 and 103,000 foreigners came into the U.S. for medical care, and between 50,000 and 121,000 U.S. residents traveled abroad for care in 2007. Despite a net loss in the number of medical travelers flowing out of the U.S. for care, the trade surplus for medical travel could be as high as

Development and validation of a 360-degree-feedback instrument for healthcare administrators.

1 billion. CONCLUSIONS While a slight net outflow of patients leaving the U.S. for medical care may exist, the resulting impact on exports is still positive for the U.S., due to a higher average spending per patient coming to the U.S. New mechanisms are needed to track the balance of mobility and trade for medical care on a regular basis.

Transformational and Transactional Leadership Skills for Mental Health Teams

EXECUTIVE SUMMARY Multisource or 360‐degree feedback has become a widely used component of leadership development in many organizations, and a growing body of research supports its use for this purpose. Unfortunately, most commercially available multisource surveys were developed in private‐sector corporate settings, making their transferability to healthcare settings less than straightforward. This article describes a research project undertaken to develop a job‐relevant, commercial‐quality multisource feedback survey for use in health administration settings. Using critical incident methodology and enlisting the help of subject matter expert groups (i.e., executive search consultants, human resources executives, leadership development consultants, and administrative fellowship supervisors), a competency framework was developed containing 26 competencies arranged according to seven clusters. A third survey was then conducted with incumbent leaders to populate the competency framework with behavioral descriptors. The end result was a survey consisting of 128 total items that, when matrixed across four relationship types, create surveys ranging from 36 to 95 items in length. Two pilot studies were then conducted to assess reliability as well as validity against other measures of leadership ability. Results from these studies suggest that the instrument can provide reliable and valid assessments of leadership effectiveness for development purposes.

The use of patient satisfaction surveys and alternative coding procedures to predict malpractice risk.

Many treatments for persons with severe mentalillness are provided by mental health teams. Teammembers work better when led by effective leaders.Research conducted by organizational psychologists, and validated on mental health teams, haveidentified a variety of skills that are useful for theseleaders. Bass (1990, 1997) identified two sets ofespecially important skills related to transformational and transactional leadership. Leaders usingtransformational skills help team members to view theirwork from more elevated perspectives and developinnovative ways to deal with work-related problems.Skills related to transformational leadership promoteinspiration, intellectual stimulation, individualconsideration, participative decision making, andelective delegation. Mental health and rehabilitationteams must not only develop creative and innovativeprograms, they must maintain them over time as a seriesof leader-team member transactions. Transactionalleadership skills include goal-setting, feedback, and reinforcement strategies which help teammembers maintain effective programs.