[Show abstract][Hide abstract] ABSTRACT: Background: The large number of uninsured individuals in the United States creates negative consequences for those who are uninsured and for those who are covered by health insurance plans. Young adults between the ages of 18 and 24 are the largest uninsured population subgroup. This subgroup warrants analysis. The major aim of this study is to determine why young adults between the ages of 18 and 24 are the largest uninsured population subgroup. Methods: The present study seeks to determine why young adults between the ages of 18 and 24 are the largest population subgroup that is not covered by private health insurance. Data on perceived health status, perceived need, perceived value, socioeconomic status, gender, and race was obtained from a national sample of 1,340 young adults from the 2005 Medical Expenditure Panel Survey and examined for possible explanatory variables, as well as data on the same variables from a national sample of 1,463 from the 2008 Medical Expenditure Panel Survey. Results: Results of the structural equation model analysis indicate that insurance coverage in the 2005 sample was largely a function of higher socioeconomic status and being a non-minority. Perceived health status, perceived need, perceived value, and gender were not significant predictors of private health insurance coverage in the 2005 sample. However, in the 2008 sample, these indicators changed. Socioeconomic status, minority status, perceived health, perceived need, and perceived value were significant predictors of private health insurance coverage. Conclusions: The results of this study show that coverage by a private health insurance plan in the 2005 sample was largely a matter of having a higher socioeconomic status and having a non-minority status.
BMC Health Services Research 05/2015; 15(1):195. DOI:10.1186/s12913-015-0848-6 · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Volunteer programs are expected to positively impact the organizations in which they exist. This article reviews the literature on volunteerism, including what volunteers do, how their contributions can be measured, and the financial- and quality-related outcomes of volunteer programs. The focus is on volunteerism in health care settings, particularly hospitals. The article summarizes the existing theoretical and empirical literature concerning the roles of volunteers, the economic value of volunteers, cost–benefit analysis of volunteer labor, and the impact of volunteers on quality and patient satisfaction. The review indicates that the use of volunteers offers significant cost savings to hospitals and may positively impact profit margins. Volunteers are also likely to enhance quality indicators such as patient satisfaction and safety. Implications of these findings for management and future research are discussed.
[Show abstract][Hide abstract] ABSTRACT: In large part due to current economic conditions and the political uncertainties of healthcare reform legislation, hospitals need to identify new sources of revenue. Two potentially untapped sources are inbound (international) and domestic (within the United States) medical tourists. This case study uses data from a large, urban healthcare system in the southeastern United States to quantify its potential market opportunities for medical tourism. The data were mined from electronic health records, and descriptive frequency analysis was used to provide a preliminary market assessment. This approach permits healthcare systems to move beyond anecdotal information and assess the relative market potential of their particular geographic area and the diagnostic services they offer for attracting inbound and domestic medical tourists. Implications for healthcare executives and guidance on how they can focus marketing efforts are discussed.
Journal of healthcare management / American College of Healthcare Executives 03/2014; 59(1):49-63. · 0.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study looks at employee information sharing among hospitals, a topic that is underresearched, underreported, and under the radar for most healthcare leaders. We initiated the research under the assumption that executives in healthcare are reluctant to share employment reference information about staff beyond the employee's name, dates of employment, and position held. We believed executives take this precaution because they fear being sued by the employee for defamation. However, not obtaining the necessary and critical information to hire a competent employee can open the potential employer up to a negligence lawsuit if it hires someone who jeopardizes the safety of patients or staff. Hence, the hiring organization faces a double-edged sword: On one side, it cannot get the critical information on a potential applicant from the previous employer due to a culture of "fear in sharing" information; on the other side, if it unwittingly hires a poor or dangerous applicant who threatens safety, it runs the risk of a negligence lawsuit for failure to ascertain information before the hire. Prior studies demonstrate that the likelihood of a successful defamation lawsuit is low and information sharing of factual incidents is unlikely to result in successful lawsuits. Why, then, are healthcare executives unwilling to provide comprehensive references when they should be aware that sustaining a culture of silence increases the potential for hiring a bad employee and seriously jeopardizes the security and safety of patients, other staff, and the public? This article's primary contribution to the literature is to offer the first nationwide study to empirically test the current levels of employee information sharing among hospitals. It is also the first study to focus exclusively on healthcare. Furthermore, this research considers factors that might influence executives in their willingness to share employee reference information. The study reveals that a culture of silence is pervasive among hospitals. Although many hospital executives are reluctant to share information, they tend to overestimate the likelihood of being sued (successfully or otherwise) by previous employees for defamation. In addition, this study shows that some hospital executives share negative information about former employees but may do so off the record.
Journal of healthcare management / American College of Healthcare Executives 07/2013; 58(3):225-37; discussion 238-9. · 0.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The well-anticipated and well-documented demographic shift attributed to ageing of the baby boomer generation will place significant demands upon the health-care industry in the future. Significant resources such as the nurse workforce, will be needed to provide health-care services to this cohort. There is a looming shortage of professional and paraprofessional nurses. This paper evaluates strategies that can be utilized to decrease the rate of the nursing shortage, while retaining the current supply of nurses. Recommendations for solving the nursing shortage problem include enhancing the work environment through fostering open communication, improving technology, nurse empowerment, building long-lasting and fulfilling partnerships, and efficient workplace organization.
Health Services Management Research 02/2012; 25(1):41-7. DOI:10.1258/hsmr.2011.011015
[Show abstract][Hide abstract] ABSTRACT: This chapter summarizes the major determinants of health insurance coverage rates among young adults. Socioeconomic status, demographics, actual and perceived health status, perceived value, and perceived need are all examined in order to determine what the literature reveals regarding each variable and how each variable impacts a young adult's decision to purchase health insurance. Results indicate that socioeconomic status, demographics, perceived value, and perceived need were the most significant determinates of health insurance status of young adults. A conceptual framework is also examined and used to illustrate theoretical implications. Managerial implications for marketing health plans to young adults are also addressed. Finally, policy implications concerning the new Patient Protection and Affordable Care Act are addressed.
Advances in Health Care Management 01/2011; 11:185-213. DOI:10.1108/S1474-8231(2011)0000011011
[Show abstract][Hide abstract] ABSTRACT: The purpose of this research was to explore the effect work environment has on the intent to leave the profession for rural hospital bedside registered nurses (RNs). Subscales of autonomy, control over the practice setting, nurse-physician relationship and organizational support were incorporated into the analysis to determine which aspects of work environment directly affect the intent to leave the profession. An explanatory cross-sectional survey was distributed to 259 direct care bedside RNs employed at a rural system-affiliated hospital in Central Florida between February 2007 and June 2007. Anonymity was assured. A questionnaire containing demographic questions, the Nursing Work Index-Revised and Blau's intent to leave scale was distributed to all direct care nurses. A 32.8% response rate was achieved for a total of 85 complete and usable surveys. Data analysis shows that the work environment in general is negatively related to intent to leave. In addition, each of the four subscales was also negatively related to the intent to leave the profession. The results of this study support several recommendations for practice and education, including the promotion of professional practice environments, fostering inter-departmental relationships, and increasing the managerial training of RN managers.
Health Services Management Research 11/2010; 23(4):185-92. DOI:10.1258/hsmr.2010.010008
[Show abstract][Hide abstract] ABSTRACT: Retail clinics in health care have been characterized as a “low-cost disruptive innovation” (Christensen, Anthony, & Roth, 2004). This article examines the retail clinic innovation, how it has grown and evolved over time, and the human resource implications of this phenomenon. The article provides a comprehensive literature review of both academic research and practitioner perspectives. Data regarding how retail clinics have impacted consumer access to health services, cost of health services, clinical outcomes, and customer satisfaction are examined. Even though retail clinics use lower cost staffing patterns than do traditional providers, data indicate positive outcomes and high levels of customer satisfaction with retail clinics. The evolution of retail clinics through multiple models and staffing patterns are discussed. The article concludes with implications for theory, health administration practice, public policy, and future research.
Advances in Health Care Management 08/2010; 9:137-162. DOI:10.1108/S1474-8231(2010)0000009010
[Show abstract][Hide abstract] ABSTRACT: As health care organizations expand and move into global markets, they face many leadership challenges, including the difficulty of leading individuals who are geographically dispersed. This article provides global managers with guidelines for leading and motivating individuals or teams from a distance while overcoming the typical challenges that "virtual leaders" and "virtual teams" face: employee isolation, confusion, language barriers, cultural differences, and technological breakdowns. Fortunately, technological advances in communications have provided various methods to accommodate geographically dispersed or "global virtual teams." Health care leaders now have the ability to lead global teams from afar by becoming "virtual leaders" with a responsibility to lead a "virtual team." Three models of globalization presented and discussed are outsourcing of health care services, medical tourism, and telerobotics. These models require global managers to lead virtually, and a positive relationship between the virtual leader and the virtual team member is vital in the success of global health care organizations.
The health care manager 04/2009; 28(2):117-23. DOI:10.1097/HCM.0b013e3181a2cb63
[Show abstract][Hide abstract] ABSTRACT: This exploratory survey examines the relationship between selected dimensions of spirituality and self-perceived effective leadership practices of health-care managers. Kouzes and Posner's Leadership Practices Inventory and Beazley's Spiritual Assessment Scale were administered to a sample of health-care managers. Significant statistical relationships were found between and among the dimensions of both subscales. Analysis of variance revealed a statistically significant difference in three effective leadership practices by 'more spiritual than non-spiritual' managers. The confirmatory factor analysis of our theory-based model revealed a moderately positive correlation between spirituality and leadership (r = 0.50). The paper concludes with a conceptual theory postulating a rationale for the relationship between spirituality and effective leadership.
Health Services Management Research 12/2008; 21(4):236-47. DOI:10.1258/hsmr.2008.008004
[Show abstract][Hide abstract] ABSTRACT: Violence in the health care workplace is occurring in a covert fashion; it is occurring at the patient bedside. However, data on workplace violence tend to be underreported and relatively scarce. This article identifies and examines the phenomenon of unreported and underreported workplace violence against nursing staff that is virtually hidden. Health care executives need to be attuned to this type of violence because it may significantly affect their ability to recruit and retain nursing staff. This article provides a synthesis of literature and data from health services administration and nursing and human resources, as well as the experience of the first author. Workplace violence in health care is a critical issue that must be addressed from legal, financial, ethical, and human resources management perspectives. It is a problem for staff providing direct care services to patients with Alzheimer disease. This article suggests strategies and offers a framework for meeting the challenges of managing hidden workplace violence. In addition to the more discrete consequences of violence including physical injury, physical disability, trauma, or even death, the complementary organizational effects call for thoughtful managerial planning and critical thinking. Guidelines for preventing and addressing workplace violence in health care organizations are also published by the Occupational Safety and Health Administration.
The health care manager 10/2008; 27(4):357-63. DOI:10.1097/HCM.0b013e31818c810b
[Show abstract][Hide abstract] ABSTRACT: Volunteers have been present in health care settings for centuries. However, there is little empirical evidence regarding the impact that volunteers make on hospital performance. Since the 1990s, hospitals in the United States have had a great deal of pressure to produce high-quality care at minimum expense. These pressures have enhanced the benefits of using volunteers in a hospital setting.
This study utilized multiple regression analysis to explore the impact of the use of volunteers and the level of professionalism of volunteer programs on cost effectiveness and patient satisfaction in hospitals.
Hospitals throughout the state of Florida were invited to participate in the study by completing a brief questionnaire about their volunteer programs. Performance indicators of volunteer cost savings and patient satisfaction scores for 50 Florida hospitals were analyzed using data sets from the American Hospital Association and Agency for Health Care Administration along with data obtained from a questionnaire.
Results indicate that the use of volunteers offers significant cost savings to hospitals and enhances patient satisfaction scores.
Larger volunteer programs appear to enhance patient satisfaction while containing costs. Future research opportunities related to the impact of volunteers and volunteer professionalism on other hospital performance measures are suggested.
Health care management review 08/2008; 34(2):119-28. DOI:10.1097/HMR.0b013e31819e919a · 1.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Among 10,384 rural Colorado female patients who received MDC 14 (obstetric services) from 2000 to 2003, 6,615 (63.7%) were admitted to their local rural hospitals; 1,654 (15.9%) were admitted to other rural hospitals; and 2,115 (20.4%) traveled to urban hospitals for inpatient services. This study is to examine how network participation, service scopes, and market competition influences rural women's choice of hospital for their obstetric care. A conditional logistic regression analysis was used. The network participation (p < 0.01), the number of services offered (p < 0.05), and the hospital market competition had a positive and significant relationship with patients' choice to receive obstetric care. That is, rural patients prefer to receive care from a hospital that participates in a network, that provides more number of services, and that has a greater market share (i.e., a lower level of market competition) in their locality. Rural hospitals could actively increase their competitiveness and market share by increasing the number of health care services provided and seeking to network with other hospitals.
Journal of Medical Systems 08/2008; 32(4):343-53. DOI:10.1007/s10916-008-9139-7 · 2.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective This study examines the impact of certificate of need (CON) regulation on hospital costs.Design A modified structure—conduct—performance paradigm was applied to a national sample of US hospitals in order to investigate the impact of CON regulation on hospital costs.Methods Secondary data for 1957 US acute care hospitals in 301 standard metropolitan statistical areas (SMSAs) from the American Hospital Association's Annual Survey of Hospitals in 1991 were used. The dependent variable was hospital costs per adjusted admission in 1991. Predictor variables were the existence of a CON law in each hospital's state and the dollar limit (if any) required for CON approval. Control variables were environmental, market, and institutional characteristics. Associations between predictor and dependent variables were investigated using multiple regression analyses.Results The results indicate that CON laws had a positive, statistically significant relationship to hospital costs per adjusted admission. Conclusion These findings suggest not only that CON do not really contain hospital costs, but may actually increase them by reducing competition. Implications for public policy are discussed.
Health Education Journal 09/2007; 66(3):229-244. DOI:10.1177/0017896907080127 · 0.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present study uses canonical analysis to examine the contingency model of organizations in the nursing home field. Data on environmental pressures and managerial practices relevant to the decision-making process are analyzed. Results support the theory that managerial practices are contingent on environmental pressures. The implications of these results for health-care decision makers and for future assessments of managerial-environmental relationships are discussed.
[Show abstract][Hide abstract] ABSTRACT: More and more Native American tribes are assuming control of their own public health care delivery systems by contracting the functions of the Indian Health Service (IHS) through the provisions of P.L. (public law) 93-638, the Indian Self-Determination and Education Assistance Act. In doing this, some Native American tribes are making decisions to create or plan their own departments of public health. In Arizona, the Gila River Indian Community has already established its own department of public health and the Navajo Nation is in the planning stages of establishing its own department of public health.
This paper proposes three public health organizational delivery models to meet the public health needs of small, medium, and large Native American tribes. Information for these models was derived from interviews with officials associated with the Arizona Department of Health Services and leaders of Native American tribes. These models progress in size and complexity as we move from small to medium to large tribes.
(a) service delivery should focus on both preventative and curative services; (b) services should be developed with input from the underserved population; (c) members of underserved populations should be trained to provide service to their communities; (d) one model of health service delivery will not be appropriate for all underserved populations; and (e) different models are required to respond to differing cultures, populations, and geographic locations.
Public Health 05/2007; 121(4):296-307. DOI:10.1016/j.puhe.2006.11.005 · 1.43 Impact Factor