Mary K. Zimmerman

Quality and Quantity: Reconstructing Feminist Methodology.

Many feminist sociologists have rejected quantitative in favor of qualitative methods, a position which might seem justified by feminist critiques of positivism. This paper examines both quantitative and qualitative methods in light of two major themes in radical feminist epistemology, the critique of objectivity and the politics of the research process, and finds both classes of methods vulnerable. We argue that underlying the argument against quantitative methods is a rejection of abstraction and a dichotomization of methodologies, both of which are inconsistent with feminist insights. We call for a reconstruction of methodology that transforms both quantitative and qualitative techniques in ways informed by feminist epistemology and builds research agendas that integrate both approaches.

Career advancement and gender equity in healthcare management

Purpose – The purpose of this paper is to analyze the conditions for career advancement in healthcare management and examine factors that may be impeding gender equity.Design/methodology/approach – The authors assess gender differences in the odds of being promoted to senior management by: analyzing the relative impact of individual, organizational and family level variables in accounting for gender inequity; examining gender differences in experiences of perceived gender discrimination and sexual harassment, as well as attitudes regarding gender equity in senior management; and by exploring gender differences in aspirations for senior management. ANOVA, χ2 and logistic regression were used to analyze data from 685 respondents to the 2006 Gender and Careers in Healthcare Management Survey.Findings – Women were significantly less likely to be promoted to senior management, even after controlling for individual, organizational and family level characteristics. One third of women healthcare managers in our s...

Responding to Symptoms of Alzheimer’s Disease: Husbands, Wives, and the Gendered Dynamics of Recognition and Disclosure:

In this article, we analyze the process of redefining marital relations within the context of couples dealing with Alzheimer’s disease and related disorders (ADRDs), drawing on intensive interviews with 13 caregiver husbands and 15 caregiver wives. Men were slower to recognize the symptoms of ADRDs, with social others usually bringing the problems to their attention. They often attributed symptoms to a less-problematic cause and engaged in extended normalization of their wife’s condition. Women were quicker to recognize symptoms and often noticed subtle changes in their husbands but failed to take action quickly. They were reluctant to disclose their concerns to their impaired husbands, which might have protected the husband’s masculine identity and served to maintain the wife’s own sense of self in relation to him. We suggest that husbands were able to normalize because the wife’s symptoms did not change marital authority dynamics, but authority relations were reversed by the illness for caregiver wives.

Decision Making in Long-Term Care

Abstract This article reports findings from a qualitative study of approaches to long-term care decision making used by older adults (N = 52) who continued to reside long-term in the community following nursing facility pre-admission screening. Older adults used different approaches to decision-making (autonomous, collaborative, and delegated) while seeking the most appropriate care setting. Factors such as mental capacity, the role of family caregivers, and self-advocacy skills influenced the choice of decision-making approach. Findings also illustrate how older adults moved through multiple pathways in order to reach their eventual long-term residence. These findings are discussed in terms of their implications for clinical practice and research.

Reforming Gendered Health Care: An Assessment of Change

Health policy in the United States has changed dramatically over the past three decades, with the main concern shifting from expanded health care coverage to containment of health care costs. The current focus on providing cost-effective health services, reflected in the growth of managed care initiatives, has elevated concern about the quality of health care. The authors contend that quality of health care has always been the key focus in the womens health movement, which evolved in the late 1960s as the first significant challenge to modern medicine. In this article, they apply the analytic lens of gender to develop a fresh perspective on U.S. health care organizations and policies, examining the six broad demands of the feminist consumer model of health care, all of which hinge on the issue of quality care for women, to determine whether womens health needs are now being better addressed. The authors conclude that, despite some notable gains in the roles of women as consumers and providers of health care, many of the new health reforms have replicated and solidified the historical inequities in the health care system.

Review criteria for stroke rehabilitation outcomes

OBJECTIVES To develop review criteria from the Agency for Health Care Policy and Research Stroke Rehabilitation Guidelines, to review chart records from three sites of care, and to evaluate the interrater and intrarater reliability for the chart review. DESIGN A descriptive cross-sectional study using a convenience sample. SETTING Charts for abstraction were obtained from three sites of care home health care, nursing facilities, and inpatient rehabilitation centers. PARTICIPANTS Charts were included in the study from the three sites of care if the following conditions were met: (1) the clients first admission to a rehabilitation setting; (2) the clients care was Medicare reimbursed; (3) the client lived in the community prior to the stroke; and (4) the client was receiving skilled rehabilitation services. MEASURES Review criteria, developed directly from the AHCPR Stroke Rehabilitation guidelines, consisted of 11 global quality criteria representative of comprehensive multidisciplinary rehabilitative care. There were approximately 150 variables, comprised of specific criteria to measure each of the 11 global quality criteria plus comprehensive demographic and client-specific information. RESULTS Results of this study suggest that differences exist in documentation of care across the three sites of care. There was difficulty in obtaining adequate numbers of home health charts. Intrarater reliability, using Cohens Kappa, was .78 and interrater reliability was .64. CONCLUSIONS Based on chart documentation, there is variability in the process of stroke rehabilitation care across nursing facilities, inpatient rehabilitation facilities, and home health. This variability can be reliably assessed by chart review. This study provides the impetus for future research specifically evaluating the associations between documentation of the processes of care and patient outcomes.

Residential Outcomes for Nursing Facility Applicants Who Have Been Diverted: Where Are They 5 Years Later?

PURPOSE The purpose of this longitudinal study was to determine the length of community tenure for adults aged 60 and older after application for nursing facility (NF) admission and to examine the proportion of older adults who lost community tenure due to either (a) death while a community resident or (b) permanent NF admission. DESIGN AND METHODS In this 5-year prospective study, we tracked older adults who had applied for NF admission and were diverted (residing in the community 30 days later). Four waves of NF applicants (N = 2,882) were identified, and those diverted (n = 599) were tracked for 60 months at 3-month intervals. RESULTS Sixty months after diversion, 18.0% of older adults (n = 108) were residing in the community, 39.2% died as community residents (n = 235), and 42.7% (n = 256) became permanent NF residents. In all, 414 diverted older adults (69.1%) died during the 5 years following NF application, with the majority of deaths occurring while older adults were community residents. IMPLICATIONS This longitudinal study documents the capacity of NF applicants aged 60 and older to remain in the community long term, which was previously unknown. Policymakers now have data indicating that for many NF applicants, diversion does not simply delay NF admission; rather, diversion helps older adults avoid permanent NF placement until death.

Feminism and Profit in American Hospitals The Corporate Construction of Women's Health Centers

This article provides a critical analysis of the evolution and impact of hospital-sponsored womens health centers. Using original data gathered from interviews, participant observation, and content analysis of documents and brochures, the authors describe the development of four models of hospital-sponsored womens health centers and illustrate three specific mechanisms of the co-optation process. They show how many elements of feminist health care were used for the purpose of marketing and revenue production rather than for empowering women and transforming the delivery of care. Following Stratigakis notion of negative countereffect, the authors show how the key feminist concepts of women-centered care and empowerment ended up contradicting their original meaning and purpose. Rather than being the subject of care, women became the object of treatment and revenue production.

Silent Bias: Challenges, Obstacles, and Strategies for Leadership Development in Academic Medicine-Lessons From Oral Histories of Women Professors at the University of Kansas.

Purpose Despite dramatic increases in female learners and junior faculty, a significant gap remains in female leadership in academic medicine. To assess challenges and obstacles encountered, strategies for academic success, and lessons learned for leadership development, the authors conducted an in-depth study of women full professors. Method The authors used a qualitative oral history approach, interviewing 87% of the cohort of female full professors at one Midwestern medical school in 2013 using a pretested, open-ended, semistructured interview guide. Interviews were videotaped and the audio recordings transcribed. Content was sorted into categories and key themes identified within each category. Results Participants described significant challenges: being treated with “silent bias,” “being ignored,” and being seen as an “other.” Coping strategies included downplaying, keeping a distance, employing humor, and using symbols (e.g., white coat) to carefully present themselves. Explanations for success included intelligence, meritocracy, being even-tempered, and carefully constructing femininity. The participants recommended individual skills and actions to prepare for leadership development. Virtually all women could describe an individual mentor (sponsor), usually male, who provided essential assistance for their career success. At the same time, they stressed the importance of institutional support for diversity, especially with child care. Conclusions Attaining “full professor” status is the pinnacle of academic success. Women who successfully navigated this academic ladder describe significant external and internal challenges that require multiple strategies to overcome. Leadership development entails a combination of individual support through mentors and sponsors, self-education and reflection, and organizational structural support to promote diversity.

The Role of Governments in Health Care: Implications for Women's Health and Access to Care

The role of government quickly devolved into one of the hot button issues of the 2009–2010 health care reform debate. The intensity surrounding this issue has led us to consider how governments figure into health care delivery in advanced economy countries and to explore what effects greater government intervention might have on women’s health and health care access in the United States. Conflicting viewpoints over the benefits of a public plan reveal sharply differing understandings about health systems abroad. Even feminist policy scholars have long been conflicted about whether government is an adversary or a friend (Dahlerup, 1994). What are the main government roles in health care? How do differences in these roles affect access to care and health? How do women fare in these types of health systems? We begin with a brief discussion of health system organization and how governments figure into systems abroad. We then identify three distinctive features of women’s lives that shape their health care needs, looking to see how women fare in these regards across system types. Finally, we explore U.S. health care organization and reform proposals, discussing which promise to best serve women’s health needs.