Jennifer L. Hefner

What Is the Return on Investment for Implementation of a Crew Resource Management Program at an Academic Medical Center

Crew Resource Management (CRM) training has been used successfully within hospital units to improve quality and safety. This article presents a description of a health system-wide implementation of CRM focusing on the return on investment (ROI). The costs included training, programmatic fixed costs, time away from work, and leadership time. Cost savings were calculated based on the reduction in avoidable adverse events and cost estimates from the literature. Between July 2010 and July 2013, roughly 3000 health system employees across 12 areas were trained, costing

Hospital Website Rankings in the United States: Expanding Benchmarks and Standards for Effective Consumer Engagement

3.6 million. The total number of adverse events avoided was 735—a 25.7% reduction in observed relative to expected events. Savings ranged from a conservative estimate of

Primary Care Access Barriers as Reported by Nonurgent Emergency Department Users Implications for the US Primary Care Infrastructure

12.6 million to as much as

Evidence-based management of ambulatory electronic health record system implementation: An assessment of conceptual support and qualitative evidence

28.0 million. Therefore, the overall ROI for CRM training was in the range of

Ventilator-dependent children and the health services system. Unmet needs and coordination of care.

9.1 to

Connecting Emergency Department Patients to Primary Care

24.4 million. CRM presents a financially viable way to systematically organize for quality improvement.

Cultural Transformation After Implementation of Crew Resource Management: Is It Really Possible?

Background Passage of the Patient Protection and Affordable Care Act (ACA) increased the roles hospitals and health systems play in care delivery and led to a wave of consolidation of medical groups and hospitals. As such, the traditional patient interaction with an independent medical provider is becoming far less common, replaced by frequent interactions with integrated medical groups and health systems. It is thus increasingly important for these organizations to have an effective social media presence. Moreover, in the age of the informed consumer, patients desire a readily accessible, electronic interface to initiate contact, making a well-designed website and social media strategy critical features of the modern health care organization. Objective The purpose of this study was to assess the Web presence of hospitals and their health systems on five dimensions: accessibility, content, marketing, technology, and usability. In addition, an overall ranking was calculated to identify the top 100 hospital and health system websites. Methods A total of 2407 unique Web domains covering 2785 hospital facilities or their parent organizations were identified and matched against the 2009 American Hospital Association (AHA) Annual Survey. This is a four-fold improvement in prior research and represents what the authors believe to be a census assessment of the online presence of US hospitals and their health systems. Each of the five dimensions was investigated with an automated content analysis using a suite of tools. Scores on the dimensions are reported on a range from 0 to 10, with a higher score on any given dimension representing better comparative performance. Rankings on each dimension and an average ranking are provided for the top 100 hospitals. Results The mean score on the usability dimension, meant to rate overall website quality, was 5.16 (SD 1.43), with the highest score of 8 shared by only 5 hospitals. Mean scores on other dimensions were between 4.43 (SD 2.19) and 6.49 (SD 0.96). Based on these scores, rank order calculations for the top 100 websites are presented. Additionally, a link to raw data, including AHA ID, is provided to enable researchers and practitioners the ability to further explore relationships to other dynamics in health care. Conclusions This census assessment of US hospitals and their health systems provides a clear indication of the state of the sector. While stakeholder engagement is core to most discussions of the role that hospitals must play in relation to communities, management of an online presence has not been recognized as a core competency fundamental to care delivery. Yet, social media management and network engagement are skills that exist at the confluence of marketing and technical prowess. This paper presents performance guidelines evaluated against best-demonstrated practice or independent standards to facilitate improvement of the sector’s use of websites and social media.

Meaningful Engagement of ACOs With Communities: The New Population Health Management.

The objective was to explore variation by insurance status in patient-reported barriers to accessing primary care. The authors fielded a brief, anonymous, voluntary survey of nonurgent emergency department (ED) visits at a large academic medical center and conducted descriptive analysis and thematic coding of 349 open-ended survey responses. The privately insured predominantly reported primary care infrastructure barriers—wait time in clinic and for an appointment, constraints related to conventional business hours, and difficulty finding a primary care provider (because of geography or lack of new patient openings). Half of those insured by Medicaid and/or Medicare also reported these infrastructure barriers. In contrast, the uninsured predominantly reported insurance, income, and transportation barriers. Given that insured nonurgent ED users frequently report infrastructure barriers, these should be the focus of patient-level interventions to reduce nonurgent ED use and of health system-level policies to enhance the capacity of the US primary care infrastructure.

Fundamental issues in implementing an ambulatory care electronic health record.

OBJECTIVES While electronic health record (EHR) systems have potential to drive improvements in healthcare, a majority of EHR implementations fall short of expectations. Shortcomings in implementations are often due to organizational issues around the implementation process rather than technological problems. Evidence from both the information technology and healthcare management literature can be applied to improve the likelihood of implementation success, but the translation of this evidence into practice has not been widespread. Our objective was to comprehensively study and synthesize best practices for managing ambulatory EHR system implementation in healthcare organizations, highlighting applicable management theories and successful strategies. METHODS We held 45 interviews with key informants in six U.S. healthcare organizations purposively selected based on reported success with ambulatory EHR implementation. We also conducted six focus groups comprised of 37 physicians. Interview and focus group transcripts were analyzed using both deductive and inductive methods to answer research questions and explore emergent themes. RESULTS We suggest that successful management of ambulatory EHR implementation can be guided by the Plan-Do-Study-Act (PDSA) quality improvement (QI) model. While participants did not acknowledge nor emphasize use of this model, we found evidence that successful implementation practices could be framed using the PDSA model. Additionally, successful sites had three strategies in common: 1) use of evidence from published health information technology (HIT) literature emphasizing implementation facilitators; 2) focusing on workflow; and 3) incorporating critical management factors that facilitate implementation. CONCLUSIONS Organizations seeking to improve ambulatory EHR implementation processes can use frameworks such as the PDSA QI model to guide efforts and provide a means to formally accommodate new evidence over time. Implementing formal management strategies and incorporating new evidence through the PDSA model is a key element of evidence-based management and a crucial way for organizations to position themselves to proactively address implementation and use challenges before they are exacerbated.

Improving Operating Room Efficiency: First Case On-Time Start Project.

RATIONALE Children dependent on mechanical ventilation are a vulnerable population by virtue of their chronic disability and are therefore at increased risk for health disparities and access barriers. The present study is the first, to our knowledge, to conduct a large-scale survey of caregivers of ventilator-dependent children to develop a comprehensive socio-demographic profile. OBJECTIVES To describe the demographic and health status profile of ventilator-dependent children, to identify the types of unmet needs families caring for a child on a ventilator face, and to determine the correlates of access to care coordination. METHODS A survey was administered to 122 parents whose children attended a pediatric home ventilator clinic at a large tertiary Midwestern medical center (84% of the clinic population). MEASUREMENTS AND MAIN RESULTS Half of the patient population had severe functional limitations, and 70% had one or more comorbidities. One quarter of caregivers reported current financial struggles, and 16% screened positive for a probable depressive disorder. More than half of families reported unmet needs for care, most frequently therapeutic services and skilled nursing care. Of those reporting an unmet need for skilled nursing care, lack of adequate staffing was the main barrier (71.1%). Financial struggles and a probable caregiver depressive disorder were significantly associated with an unmet need for care coordination. CONCLUSIONS This is the first large-scale quantitative study to investigate the themes of unmet need and care coordination within this vulnerable population. The results suggest these families face barriers accessing therapeutic and skilled nursing services, and caregiver mental health and financial struggles may be important points of intervention for service providers through the inclusion of multidisciplinary care teams and the strengthening of social services referral networks.