No mission? No motivation. On hospitals' organizational form and charity care provision.
Ontology highlight
ABSTRACT:
SUBMITTER: Burani N
PROVIDER: S-EPMC9291797 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveTo test whether physicians' provision of charity care depends on their hourly wage.Data sourcesSecondary data from four rounds of the Community Tracking Study (CTS) Physician Survey (1996-2005). Data are nationally representative of nonfederal office- and hospital-based physicians spending at least 20 hours per week on patient care.Study designA two-part model with site-level fixed effects, time trend variables, and site-year interactions is used to model the relationship between physicians' hourly wage and both their decision to provide any charity care and the amount of charity care provided. Salaried and nonsalaried physicians are modeled separately.Data collection/extraction methodsData from each round of the CTS were merged into a single cross-sectional file with 38,087 physician-year observations.Principal findingsThe association between physician's hourly wage and the likelihood of providing charity care is positive for salaried physicians and negative for nonsalaried physicians. Among physicians providing any charity care, hourly wage is positively associated with the amount of charity care provided regardless of salaried status. Practice characteristics are also significant.ConclusionsThe financial considerations of salaried physicians differ significantly from those of nonsalaried physicians in the decision to provide charity care, but factor similarly into the amount of charity care provided.
| S-EPMC3026953 | biostudies-literature
Project description:Policymakers are using different ways to measure the community benefit provided by non-profit hospitals because different policy makers have different policy objectives. We compare 3 commonly used measures of community benefit; examine the correlation across the 3 measures; examine how the distribution of community benefits varies across non-profit hospitals; and compare the factors associated with the level of community benefit for each definition. The main dataset for this study is the Schedule H of IRS Form 990 data for 2017. We merged this data with the 2017 American Hospital Association (AHA), the 2017 CMS Hospital Cost Report, and the 2018 American Community Survey data. The final sample consists of 1904 non-profit hospitals. We define 3 measures of community benefit: (1) Total community benefits: combining all 17 possible measures in the 990 data; (2) Total community benefits less unreimbursed Medicaid care because it reflects a policy choice made by the state; and (3) only charity care. We also subdivided the community benefits into individual and service-based benefit. Gini Coefficients and descriptive analysis show the distribution of 3 types of community benefit measures. On average, hospitals spent 8.1% of their expenses on all community benefits; 4.3% on community benefits less unreimbursed Medicaid; and 1.7% on charity care. The provision of charity care showed more variation (Gini coefficient) than the other 2 measures. Different hospital and geographic characteristics were associated with each definition, suggesting that different types of hospitals place emphasis on different community benefits. When policy makers choose among different definitions of community benefit, they should consider what incentives they want to instill.
| S-EPMC8246580 | biostudies-literature
Project description:Strengthening health systems in developing countries such as Kenya is required to achieve the third United Nations' Sustainable Development Goal of health for all, at all ages. However, Kenya is experiencing a "brain drain" and a critical shortage of healthcare professionals. There is a need to identify the factors that motivate healthcare workers to work in the health sector in rural and marginalized areas. This cross-sectional study aims to investigate the factors associated with the level and types of motivation among healthcare professionals in public and mission hospitals in Meru county, Kenya. Data were collected from 24 public and mission hospitals using a self-administered structured questionnaire. A total of 553 healthcare professionals participated in this study; 78.48% from public hospitals and 21.52% from mission hospitals. Hospital ownership was statistically nonsignificant in healthcare professionals' overall motivation (p > 0.05). The results showed that sociodemographic and work-environment factors explained 29.95% of the variation in overall motivation scores among participants. Findings indicate there are more similarities than disparities among healthcare professionals' motivation factors, regardless of hospital ownership; therefore, motivation strategies should be developed and applied in both public and private not-for-profit hospitals to ensure an effective healthcare workforce and strengthen healthcare systems in Kenya.
| S-EPMC7761626 | biostudies-literature
Project description:For the last 20 years, health provider organizations have made efforts to align mission, values, and everyday practices to ensure high-quality, high-value, and ethical care. However, little attention has been paid to the organizational values and practices of community-based programs that organize and facilitate access to care for uninsured populations. This study aimed to identify and describe organizational values relevant to resource allocation and policy decisions that affect the services offered to members, using the case of community access programs: county-based programs that provide access to care for the uninsured working poor.Comparative and qualitative case study methodology was used, including document review, observations, and key informant interviews, at two geographically diverse programs.Nine values were identified as relevant to decision making: stewardship, quality care, access to care, service to others, community well-being, member independence, organizational excellence, decency, and fairness. The way these values were deployed in resource allocation decisions that affected services offered to the uninsured are illustrated in one example per site.This study addresses the previous dearth in the literature regarding an empirical description of organizational values employed in decision making of community organizations. To assess the transferability of the values identified, we compared our empirical results to prior empirical and conceptual work in the United States and internationally and found substantial alignment. Future studies can examine whether the identified organizational values are reflective of those at other health care organizations.
| S-EPMC5540336 | biostudies-other
Project description:BACKGROUND:Numerous published articles show that clinicians do not follow clinical practice guidelines (CPGs). However, a few studies explore what clinicians consider evidence and how they use different forms of evidence in their care decisions. Many of these existing studies occurred before the advent of smartphones and advanced Web-based information retrieval technologies. It is important to understand how these new technologies influence the ways clinicians use evidence in their clinical practice. Mindlines are a concept that explores how clinicians draw on different sources of information (including context, experience, medical training, and evidence) to develop collectively reinforced, internalized tacit guidelines. OBJECTIVE:The aim of this paper was to explore how evidence is integrated into mindline development and the everyday use of mindlines and evidence in care. METHODS:We draw on ethnographic data collected by shadowing internal medicine teams at 2 teaching hospitals. Fieldnotes were tagged by evidence category, teaching and care, and role of the person referencing evidence. Counts of these tags were integrated with fieldnote vignettes and memos. The findings were verified with an advisory council and through member checks. RESULTS:CPGs represent just one of several sources of evidence used when making care decisions. Some forms of evidence were predominately invoked from mindlines, whereas other forms were read to supplement mindlines. The majority of scientific evidence was accessed on the Web, often through smartphones. How evidence was used varied by role. As team members gained experience, they increasingly incorporated evidence into their mindlines. Evidence was often blended together to arrive at shared understandings and approaches to patient care that included ways to filter evidence. CONCLUSIONS:This paper outlines one way through which the ethos of evidence-based medicine has been incorporated into the daily work of care. Here, multiple Web-based forms of evidence were mixed with other information. This is different from the way that is often articulated by health administrators and policy makers whereby clinical practice guideline adherence is equated with practicing evidence-based medicine.
| S-EPMC6458541 | biostudies-literature
Project description:ObjectiveThe main objective of the study was to assess level of motivation, how nurses perceived work motivation and its effects on organizational performance among nurses working in Hawassa public and private hospitals.ResultsIt was found that majority (64.1%) of the nurses perceived motivation as motivators. Getting prospective encouragement, recognition and financial incentives were the main descriptions the nurses gave to motivation. Increased work performance, job satisfaction, good team spirit, patient satisfaction and job attachment were the reported effects of nurses' motivation.
| S-EPMC6454626 | biostudies-literature
Project description:BackgroundCybersecurity incidents are a growing threat to the health care industry in general and hospitals in particular. The health care industry has lagged behind other industries in protecting its main stakeholder (ie, patients), and now hospitals must invest considerable capital and effort in protecting their systems. However, this is easier said than done because hospitals are extraordinarily technology-saturated, complex organizations with high end point complexity, internal politics, and regulatory pressures.ObjectiveThe purpose of this study was to develop a systematic and organizational perspective for studying (1) the dynamics of cybersecurity capability development at hospitals and (2) how these internal organizational dynamics interact to form a system of hospital cybersecurity in the United States.MethodsWe conducted interviews with hospital chief information officers, chief information security officers, and health care cybersecurity experts; analyzed the interview data; and developed a system dynamics model that unravels the mechanisms by which hospitals build cybersecurity capabilities. We then use simulation analysis to examine how changes to variables within the model affect the likelihood of cyberattacks across both individual hospitals and a system of hospitals.ResultsWe discuss several key mechanisms that hospitals use to reduce the likelihood of cybercriminal activity. The variable that most influences the risk of cyberattack in a hospital is end point complexity, followed by internal stakeholder alignment. Although resource availability is important in fueling efforts to close cybersecurity capability gaps, low levels of resources could be compensated for by setting a high target level of cybersecurity.ConclusionsTo enhance cybersecurity capabilities at hospitals, the main focus of chief information officers and chief information security officers should be on reducing end point complexity and improving internal stakeholder alignment. These strategies can solve cybersecurity problems more effectively than blindly pursuing more resources. On a macro level, the cyber vulnerability of a country's hospital infrastructure is affected by the vulnerabilities of all individual hospitals. In this large system, reducing variation in resource availability makes the whole system less vulnerable-a few hospitals with low resources for cybersecurity threaten the entire infrastructure of health care. In other words, hospitals need to move forward together to make the industry less attractive to cybercriminals. Moreover, although compliance is essential, it does not equal security. Hospitals should set their target level of cybersecurity beyond the requirements of current regulations and policies. As of today, policies mostly address data privacy, not data security. Thus, policy makers need to introduce policies that not only raise the target level of cybersecurity capabilities but also reduce the variability in resource availability across the entire health care system.
| S-EPMC5996174 | biostudies-literature
Project description:OBJECTIVE: To illustrate the use of decision-analytic modeling to assist decision making in organizational innovations. STUDY SETTING/DATA SOURCES: Regarding an organizational innovation (shared care in hearing aid provision) available evidence from different sources was synthesized. STUDY DESIGN: A probabilistic Markov model was constructed. DATA COLLECTION/EXTRACTION: We modeled the long-term cost-effectiveness of different organizational formats of shared care as opposed to the current organization. We assessed the expected value of perfect information (EVPI) for several groups of parameters in the model. PRINCIPAL FINDINGS: The current organization had the highest probability of being cost-effective. Additional research is worthwhile, especially on access to care and safety (sensitivity to detect pathology). CONCLUSIONS: Decision-analytic modeling in an early stage of organizational innovation is a valuable tool to facilitate evidence-based decision making.
| S-EPMC2653881 | biostudies-other
Project description:BackgroundThe number of elderly people living in the community who are limited in daily activities is increasing worldwide. This generates prolonged care, which usually falls on one family member, the family caregiver. Caregivers are prone to develop psychosocial and physical symptoms. As a result, the World Health Organization (WHO) issued a clear directive to assess and support these caregivers. The main goals of this study were to assess primary care physicians' (PCP) awareness to caregivers' health risks and the extent that they recommended preventive measures to maintain the health of the caregivers. As no suitable instrument existed, a secondary goal was to develop a scale to measure physicians' awareness to caregivers' health and preventive treatment and test it's psychometric properties.MethodsData were collected from a convenience sample of 201 PCP interviewed with structured questionnaires.ResultsThe participants' mean age was 48.5 ± 11.2 years and 53.5% were female. Only 48.5% were Israel medical graduates and 72% were board-certified family physicians. Nearly 34% had been primary caregivers of family members. Most physicians (83.6%) were aware of the primary caregiver's high-risk for morbidity and mortality, and recommended preventive care. On a multivariate regression, PCP's higher level of risk awareness, their country of medical school and board certification were significant for explaining recommendations for preventive care. However, being a primary caregiver for a sick family member neither contributed significantly to the physicians' awareness to caregiving risks nor to their preventive care.ConclusionAlthough a high percentage of physicians were aware and concerned about caregivers' health, their preventive care activities were relatively passive. PCPs should take a more active and preventive role for maintaining caregivers' health.
| S-EPMC8593856 | biostudies-literature
Project description:This study aimed to investigate factors associated with dental prosthesis procedures by oral health teams (OHTs) in the Brazilian primary health care in 2013-2014, who participated in the National Program for Improving Access and Quality of Primary Health Care (PMAQ-AB). This is an analytical cross-sectional study using a questionnaire with dichotomous questions applied in 18,114 OHTs. The dependent variable studied was making any type of prosthesis (removable or fixed). Independent variables involved issues related to human resources and health service management. Data were submitted to simple and multiple binary logistic regression with odds ratio calculation, 95% confidence intervals, and p-values. Most OHTs (57%) do not perform any dental prosthesis. The teams that are more likely to perform dental prostheses have human resources-related characteristics, such as professionals admitted through public examinations (OR 1.25, 95% CI 1.14-1.36) and those involved in permanent education (OR 1.13, 95% CI 1.02-1.26). Moreover, OHTs with a more organized work process and that receive more significant support from municipal management are more likely to perform dental prostheses (p < 0.05). The oral health teams which tended to provide the most dental prostheses to benefit patients were; hired as civil servants, had a municipal career plan, involved all members of the oral health team, and trained undergraduate dental students from outreach programs. Better organizational support and improved work incentives may be needed to get the majority of oral health teams to start providing dental prostheses to their patients.
| S-EPMC7084312 | biostudies-literature