Christopher E. Johnson
University of Washington
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Journal of Applied Gerontology | 2010
Bita A. Kash; George Naufal; Leslie Cortés; Christopher E. Johnson
Because most turnover studies focus on certified nursing assistants (CNAs), licensed vocational nurses (LVNs), and administrators, little is known about registered nurses’ (RNs) higher turnover. This study builds on the current body of knowledge about turnover among RN supervisors in nursing homes. The article discusses a survey of RN nurse supervisors administered in more than 1,000 nursing homes that was merged with the 2003 Texas Medicaid cost report and the area resource file. Two 2-stage models are developed to predict RN turnover rates. RNs’ intent to leave predicts RN turnover through job satisfaction, perceived empowerment, and education level. High LVN and CNA turnover and high Medicare census are associated with higher turnover. Implications are that participation in management decisions and perceived wage competitiveness are an important determinant of RN retention in nursing homes. Future research should focus why RN supervisors with higher levels of education leave nursing homes.
Health Care Management Review | 2012
Robert Weech-Maldonado; Alex Laberge; Rohit Pradhan; Christopher E. Johnson; Zhou Yang; Kathryn Hyer
Background: The nursing home industry serves one of the most vulnerable populations, and its financial sustainability is a matter of public concern. However, limited empirical evidence exists on the impact of ownership and chain affiliation on nursing home financial performance. Purposes: The aim of this study was to examine the joint effects of ownership and chain affiliation on the financial performance of the nursing home industry for the study period 1999–2004 on a national sample of 11,236 nursing homes per year. Methodology/Approach: Data included the Medicare Cost Reports; the Online Survey, Certification, and Reporting file; and the Area Resource File. Dependent variables included operating and total margins. Independent variables included four ownership/chain affiliation combinations: for-profit chain, for-profit independent, not-for-profit chain, and not-for-profit independent. Random effects generalized least square regressions were performed. Findings: Results show that for-profit nursing homes delivered better financial performance than not-for-profit facilities did across both operating and total margins. However, the relationship between chain affiliation and financial performance was more nuanced. In the case of operating margin, chain-affiliated facilities delivered superior financial performance irrespective of ownership type; however, in the case of total margin, independents outperformed chain-affiliated facilities among for-profits. Practice Implications: Our findings show an interactive effect of ownership and chain affiliation on nursing home financial performance, suggesting the pursuit of different organizational strategies by different ownership/chain affiliation subgroups (for-profit chain, for-profit independent, not-for-profit chain, and not-for-profit independent), with implications for financial performance. For-profit independent nursing homes managed to be the top performing group in terms of overall financial despite the operating financial advantage of for-profit chain-affiliated nursing homes. Similarly, not-for-profit independent nursing homes and not-for-profit chain homes had comparable overall financial performance despite the operating financial advantage of chain homes.
Journal of Healthcare Management | 2014
Bita A. Kash; Aaron Spaulding; Christopher E. Johnson; Larry Gamm
EXECUTIVE SUMMARY Success factors related to the implementation of change initiatives are well documented and discussed in the management literature, but they are seldom studied in healthcare organizations engaged in multiple strategic change initiatives. The purpose of this study was to identify key success factors related to implementation of change initiatives based on rich qualitative data gathered from health leader interviews at two large health systems implementing multiple change initiatives. In‐depth personal interviews with 61 healthcare leaders in the two large systems were conducted and inductive qualitative analysis was employed to identify success factors associated with 13 change initiatives. Results from this analysis were compared to success factors identified in the literature, and generalizations were drawn that add significantly to the management literature, especially to that in the healthcare sector. Ten specific success factors were identified for the implementation of change initiatives. The top three success factors were (1) culture and values, (2) business processes, and (3) people and engagement. Two of the identified success factors are unique to the healthcare sector and not found in the literature on change models: service quality and client satisfaction (ranked fourth of 10) and access to information (ranked ninth). Results demonstrate the importance of human resource functions, alignment of culture and values with change, and business processes that facilitate effective communication and access to information to achieve many change initiatives. The responses also suggest opportunities for leaders of healthcare organizations to more formally recognize the degree to which various change initiatives are dependent on one another.
Hepatology | 2016
Hannah Jones; Laura Hargrove; Lindsey Kennedy; Fanyin Meng; Allyson Graf-Eaton; Jennifer Owens; Gianfranco Alpini; Christopher E. Johnson; Francesca Bernuzzi; Jennifer Demieville; Sharon DeMorrow; Pietro Invernizzi; Heather Francis
Hepatic fibrosis is marked by activation of hepatic stellate cells (HSCs). Cholestatic injury precedes liver fibrosis, and cholangiocytes interact with HSCs promoting fibrosis. Mast cells (MCs) infiltrate following liver injury and release histamine, increasing biliary proliferation. We evaluated if inhibition of MC‐derived histamine decreases biliary proliferation and fibrosis. Wild‐type and multidrug resistance 2 knockout mice (9‐11 weeks) were treated with cromolyn sodium for 1 week to block MC‐derived histamine. Biliary mass and proliferation were evaluated by immunohistochemistry for cytokeratin 19 and Ki‐67. Bile flow, bicarbonate excretion, and total bile acids were measured in all mice. Fibrosis was evaluated by sirius red/fast green staining and by quantitative polymerase chain reaction for alpha‐smooth muscle actin, fibronectin, collagen type 1a, and transforming growth factor‐beta 1. HSC activation was evaluated by quantitative polymerase chain reaction in total liver and immunofluorescent staining in tissues for synaptophysin 9. Histamine serum secretion was measured by enzymatic immunoassay. Mouse liver and human liver samples from control or primary sclerosing cholangitis patients were evaluated for MC markers by quantitative polymerase chain reaction and immunohistochemistry. In vitro, cultured MCs were transfected with histidine decarboxylase short hairpin RNA to decrease histamine secretion and subsequently cocultured with cholangiocytes or HSCs prior to measuring fibrosis markers, proliferation, and transforming growth factor‐beta 1 secretion. Treatment with cromolyn sodium decreased biliary proliferation, fibrosis, histamine secretion, and bile flow in multidrug resistance 2 knockout mice. Primary sclerosing cholangitis mice and patients have increased MCs. Knockdown of MC histidine decarboxylase decreased cholangiocyte and HSC proliferation/activation. Conclusion: MCs are recruited to proliferating cholangiocytes and promote fibrosis. Inhibition of MC‐derived histamine decreases fibrosis, and regulation of MC mediators may be therapeutic for primary sclerosing cholangitis. (Hepatology 2016;64:1202‐1216)
Journal of Perinatal & Neonatal Nursing | 2005
Christopher E. Johnson; Eileen Handberg; Aram Dobalian; Neslihan Gurol; Vivian Pearson
This study reviews the development and implementation of the Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs). The genesis of the use of administrative data as a tool to combat safety problems is presented, and how indicators were constructed using various administrative codes. Examples of how the PSIs are being used to identify potential safety problems within the general population are presented, with a special emphasis on how these are being used within the perinatal and neonatal arena to understand current issues within that subpopulation. Results from studies within the general population and targeted at perinatal and neonatal patients are presented. Finally, suggestions are discussed for clinicians to use the AHRQ PSIs as one of their early warning tools for potential safety-related problems.
Health Care Management Review | 2010
Bita A. Kash; George Naufal; Rada K. Dagher; Christopher E. Johnson
BACKGROUND Although the importance of nurse leadership stability and participation in decision making in nursing homes is well established, scarce literature exists on determinants of intent to leave among directors of nursing (DONs) in nursing homes. PURPOSE : The purpose of this study was to examine factors associated with DON intent to leave in nursing homes. METHODOLOGY We examined potential factors associated with DON intent to leave at three levels: individual DON characteristics, facility, and county-level market factors. A survey of nurse supervisors in Texas nursing homes, the 2003 Texas Nursing Facility Medicaid Cost Report, and the Area Resource File were merged. We only included respondents who identified themselves as DONs in this study (572 observations). We examined bivariate differences in individual DON characteristics on the basis of facility ownership (for-profit versus not-for-profit homes) and geographic location (urban versus rural location). We constructed three alternative logit models to explore the relationships between DON intent to leave and DON, facility, and market characteristics. FINDINGS DONs working in for-profit homes were more inclined to leave, less satisfied with their job, and had lower levels of perceived empowerment in terms of autonomy. Educational level and intention to leave were significantly higher for DONs working in urban areas. Job satisfaction was significantly and inversely associated with intent to leave in all three models. Higher perceived salary competitiveness and level of empowerment were associated with reduced odds of intending to leave. Higher educational levels were associated with higher odds of intentions to leave. PRACTICE IMPLICATIONS Nursing homes should focus on improving DON job satisfaction, empowerment in decision making, and salary competitiveness when designing retention strategies for DONs.
Journal of Strategy and Management | 2014
Bita A. Kash; Aaron Spaulding; Larry Gamm; Christopher E. Johnson
Purpose – The purpose of this paper is to examine how two large health systems formulate and implement strategy with a specific focus on differences and similarities in the nature of strategic initiatives across systems. The aim is to gain a better understanding of the role of resource dependency theory (RDT) and resource based view (RBV) in healthcare strategic management.Design/methodology/approach – A comparative case study design is used to describe, categorize and compare strategic change initiatives within a children’s health and a multi-hospital system located in two competitive metropolitan markets. A total of 61 in-person semi-structured interviews with healthcare administrators were conducted during 2009. Summary statistics and qualitative content analysis were employed to examine strategic initiatives.Findings – The two health systems have as their top initiatives very similar pursuits, thus indicating that both utilize an externally oriented RDTmethod of strategy formulation. The relevance of the RBV becomes apparent during resource deployment for strategy implementation. The process of healthcarestrategic decision-making incorporates RDT and RBV as separate and compatible activities that are sequential.Research limitations/implications – Results from this comparative case study are based on only two health systems. Further, the RBV perspective only takes managerial resources and time into consideration.Practical implications – Given that external resources are likely to become more constrained, it is important that hospitals leverage relevant internal resources, in the identification of competitive advantages and effective execution of strategic initiatives.Originality/value – The author propose a refined healthcare strategic management framework that takes both RDT and RBV into consideration by systematically linking strategy formulation with deployment of resources.
Health Care Management Review | 2004
Christopher E. Johnson; Deborah K. Hedgecock; Oakley Ml; Aram Dobalian; Salmon; Kathryn Hyer; Larry Polivka
The objective of this study is to examine the litigation experience of twenty-eight nursing homes in Hillsborough County, Florida. Primary data were collected from Hillsborough County Circuit Courts Clerks Recording Computer System about lawsuit activity from 1996 to 2000 and linked to the Centers for Medicare and Medicaid Services Online Survey, Certification, and Reporting system. We found that registered nurse levels, size, and being part of a chain or system impacted litigation in Hillsborough County.
Health Care Management Review | 2017
Aaron Spaulding; Bita A. Kash; Christopher E. Johnson; Larry Gamm
Background: We do not have a strong understanding of a health care organization’s capacity for attempting and completing multiple and sometimes competing change initiatives. Capacity for change implementation is a critical success factor as the health care industry is faced with ongoing demands for change and transformation because of technological advances, market forces, and regulatory environment. Purpose: The aim of this study was to develop and validate a tool to measure health care organizations’ capacity to change by building upon previous conceptualizations of absorptive capacity and organizational readiness for change. Methodology/Approach: A multistep process was used to develop the organizational capacity for change survey. The survey was sent to two populations requesting answers to questions about the organization’s leadership, culture, and technologies in use throughout the organization. Exploratory and confirmatory factor analyses were conducted to validate the survey as a measurement tool for organizational capacity for change in the health care setting. Findings: The resulting organizational capacity for change measurement tool proves to be a valid and reliable method of evaluating a hospital’s capacity for change through the measurement of the population’s perceptions related to leadership, culture, and organizational technologies. Practical Implications: The organizational capacity for change measurement tool can help health care managers and leaders evaluate the capacity of employees, departments, and teams for change before large-scale implementation.
Journal of Rural Health | 2015
Christopher E. Johnson; Ruth Bush; Jeffrey S. Harman; Jane N. Bolin; Gina Evans Hudnall; Ann M. Nguyen
PURPOSE Rural-dwelling Department of Veterans Affairs (VA) enrollees are at high risk for a wide variety of mental health-related disorders. The objective of this study is to examine the variation in the types of mental and nonmental health services received by rural VA enrollees who have a mental health-related diagnosis. METHODS The Andersen and Aday behavioral model of health services use and the Agency for Healthcare Research and Quality Medical Expenditure Panel Survey (MEPS) data were used to examine how VA enrollees with mental health-related diagnoses accessed places of care from 1999 to 2009. Population survey weights were applied to the MEPS data, and logit regression was conducted to model how predisposing, enabling, and need factors influence rural veteran health services use (measured by visits to different places of care). Analyses were performed on the subpopulations: rural VA, rural non-VA, urban VA, and urban non-VA enrollees. FINDINGS For all types of care, both rural and urban VA enrollees received care from inpatient, outpatient, office-based, and emergency room settings at higher odds than urban non-VA enrollees. Rural VA enrollees also received all types of care from inpatient, office-based, and emergency room settings at higher odds than urban VA enrollees. Rural VA enrollees had higher odds of a mental health visit of any kind compared to urban VA and non-VA enrollees. CONCLUSIONS Based on these variations, the VA may want to develop strategies to increase screening efforts in inpatient settings and emergency rooms to further capture rural VA enrollees who have undiagnosed mental health conditions.