Emerald | Leadership in Health Services | Table of Contents

Leveraging the Patient-Centered Medical Home (PCMH) model as a health care logistics support strategy

literatinetwork@emeraldinsight.com (Jerry D. VanVactor) — Fri, 26 Apr 2013 00:00:00 +0100

Abstract

Purpose – The purpose of this work is to add to professional practice and academia information related specifically to health care supply chain management and to demonstrate how an existing health care management model can be applied to supply chain operations. Design/methodology/approach – Employing a review of practice-oriented literature related to the patient-centered medical home model this work examines and expounds on the implications and applicability toward more effective supply chain management. Findings – This paper presents a discourse in evaluating health care supply chain management processes to place more emphasis on interactive customer relationships, collaborative communications, and more effective support to health care operations. Practical implications – An effective health care supply chain operation involves key tenets of ensuring that the right products are provided to the right customer in a timely manner. While this discussion is directed specifically toward health care, the principles are applicable across a wide array of industries. Social implications – Health care logistics involves a symbiotic relationship among multi-disciplined, multifaceted stakeholders working closely together and leveraging one another, patients, and technology to produce a desired outcome related to cost effective processes and business practices. Originality/value – While existent literature provides information related to the effective management of logistics (outside of health care organizations) little information is directly concerned with operations within a health care environment. In an applied sense, this article provides practitioners with concepts related to cost reduction and effective supply chain management.

Error proofing healthcare: an analysis of low cost, easy to implement and effective solutions

literatinetwork@emeraldinsight.com (Jamison V. Kovach, Lee Revere, Ken Black) — Fri, 26 Apr 2013 00:00:00 +0100

Abstract

Purpose – This study aims to provide healthcare managers with a meaningful synthesis of state of the art knowledge on error proofing strategies. The purpose is to provide a foundation for understanding medical error prevention, to support the strategic deployment of error proofing strategies, and facilitate the development and implementation of new error proofing strategies. Design/methodology/approach – A diverse panel of 40 healthcare professionals evaluated the 150 error proofing strategies presented in the AHRQ research monograph using classification systems developed by earlier researchers. Error proofing strategies were ranked based on effectiveness, cost, and ease of implementation as well as based on their aim/purpose, i.e. elimination, replacement, facilitation, detection, or mitigation of errors. Findings – The findings of this study include prioritized lists of error proofing strategies from the AHRQ manual based on the preferred characteristics (i.e. effectiveness, cost, ease of implementation) and underlying principles (i.e. elimination, replacement, facilitation, detections mitigation of errors) associated with each strategy. Research limitations/implications – The results of this study should be considered in light of certain limitations. The sample size of 40 panelists from hospitals, medical practices, and other healthcare related companies in the Gulf Coast region of the USA prevents a stronger generalization of the findings to other groups or settings. Future studies that replicate this approach, but employ larger samples, are appropriate. Through the use of public forums and expanded sampling, it may be possible to further validate research findings in this paper and to expand and build on the results obtained in this study. Practical implications – Using the error-proofing strategies identified provides a starting point for researchers seeking to better understand the impact of error proofing on healthcare services, the quality of those services and the potential financial ramifications. Further, the results presented enhance the strategic deployment of error proofing strategies by bringing to light some of the important factors that healthcare managers should consider when implementing error proofing solutions. Most notably, healthcare managers are encouraged to implement effective solutions, rather than those that are merely inexpensive and/or easy to implement, which is more often the case. Originality/value – This study provides a much-needed forum for sharing error-proofing strategies, their effectiveness, and their implementation.

The influence of professional identity on the process of nurses' training: an empirical study

literatinetwork@emeraldinsight.com (Mário Franco, Paulo Tavares) — Fri, 26 Apr 2013 00:00:00 +0100

Abstract

Purpose – This paper aims to analyze the relationship between professional identity and the training of nurses in the context of change. Specifically, this study aims to focus on two research questions: first, how do nurses experience their professional identity? Second, will professional training have an effect on nurses' developing identity? Design/methodology/approach – Data were obtained from 173 nurses in a Portuguese hospital. Respondents had to evaluate the degree of importance they gave to several variables about professional identity and training. For data analysis and reliability, the variables were classified using factor analysis. Subsequently, the retained factors and variables underwent multiple regression analysis. Findings – Results indicate that nurses consider they have their own identity, which differentiates them from other health professionals, although they feel their work still lacks socio-professional recognition, which hinders their autonomous intervention within the multi-disciplinary team. Research limitations/implications – The sample for the study was self-selected from one hospital, which may limit the generalization of some of the findings and points to the need to resort to larger samples. This study allowed the formation of some measures that can contribute to the value and benefits of nurses' professional training in the Portuguese health system. Originality/value – Research on professional identity has been relatively scarce. Taking into account the relevance of the research topic for the nursing profession, the study's findings show that identity is of some consequence in nurses' professional training.

Registered nurses' views on nursing competence at residential facilities

literatinetwork@emeraldinsight.com (Carina Furåker, Nilsson Agneta) — Fri, 26 Apr 2013 00:00:00 +0100

Abstract

Purpose – The aim of this paper is to describe registered nurses' (RNs') ways of working and their views on what competence they require, make use of and wish to develop when caring for older people at residential facilities. Design/methodology/approach – The participants comprised 23 RNs, trained after 1993 and working at seven residential facilities. The data collection consists of group interviews during spring 2009. The group interviews were subjected to content analysis. Findings – Three main categories and six sub-categories were identified. The findings show that the majority of RNs work in a consultative way although they are responsible for basic care as well as advanced nursing care. They must rely on the staff's competence. They compare the residential facilities to a “mini-hospital” and they are often frustrated by the staff's incompetence. Attitudes to research findings and to the use of evidence-based knowledge were limited. Research limitations/implications – RNs require extensive theoretical, technical and medical knowledge as well as knowledge related to persons with dementia conditions and psychiatric disorders and how to lead, teach and supervise. Practical implications – Social and professional isolation influences competence development and working situation and the differences in leadership influence the quality of nursing care. RNs do not critically reflect on what knowledge they require and make use of and how to search for scientific knowledge and this will have a negative influence on the attitude to the competence. Originality/value – There is a need of extensive and varied knowledge in evidence-based nursing as well as in leadership and teaching to be able to work independently.

Healthcare leadership: learning from evaluation

literatinetwork@emeraldinsight.com (John Edmonstone) — Fri, 26 Apr 2013 00:00:00 +0100

Abstract

Purpose – The purpose of this paper is to review eight major evaluations of leadership and management development programmes in parts of the UK National Health Service and also to identify learning from these as a basis for an evaluation framework which focuses on impact within healthcare organisations. Design/methodology/approach – Eight evaluations conducted over a 13-year period are reviewed in terms of the staff groups covered, numbers involved, duration, programme elements, evaluation approach adopted and key learning points. General conclusions are derived from this review. Findings – Although each evaluation relates to a unique context or setting, there are clear common messages running across all those studied which are of wider interest and concern. Practical implications – The framework developed from the review may be useful to those commissioning, designing, delivering and evaluating leadership programmes. Originality/value – The paper seeks to identify common learning across programmes involving some 1,653 people, ranging in duration from seven to 18 months and covering first-line clinical management to executive director positions.

Making Wicked Problems Governable – the Case of Managed Networks in Health Care