Category Archives: Health Management

Digital leadership in action in a hospital through a real time dashboard system implementation and experience

Jack Weiner, Mohan Tanniru, Jiban Khuntia, David Bobryk, Mehul Naik, Kenneth LePage
Journal of Hospital Administration, Volume 5, Issue 4, Pp. 34-43.

Background: Regulatory and competitive pressures and the need for cross-organizational data sharing are demanding that hospital leaders create a data-driven decision making culture to improve performance. Using an innovation assimilation strategy framework, this paper describes how a hospital used its implementation of a Real Time Dashboard System (rtDashboard) to improve performance, change its organizational culture and put it on a path towards digital leadership (DL).
Objective: Implement an rtDashboard system that can support a data-driven decision making culture for performance improvement while engaging business and information technology (IT) leaders in DL practice.
Results: The rtDashboard contributed significantly to monitoring hospital performance and influenced change in unit level decision making that was aligned with hospital goals. The rtDashboard implementation not only provided substantial performance improvement and quality benchmarking, but also changed the responsibility and accountability culture and helped the hospital put in practice DL principles to support future innovations.
Conclusions: DL through rtDashboard is a demonstration of how a hospital can seek and strive for excellence. As much as dashboards are pivotal to organizational performance monitoring at the senior leadership level, the process used to diffuse it to every operational unit in support of a data-driven decision making culture showcases how hospital executives and IT leaders can work together to continually align and re-align their strategies to reach organizational goals – the core of DL practice.

Information Systems Impact on Nurse Call Response–Role of Velocity and Uncertainty

Jiban Khuntia, Mohan Tanniru, Fabian Fregoli, Matthew Nawrocki
Pacific Asia Journal of the Association for Information Systems, Volume 8, Issue 1, Pp. 333-64

The nurse call system is the lifeline for a patient in a hospital room. Nurse call systems help patients initiate calls from their room in a hospital, and the response to these calls is a crucial factor in providing timely quality care and improving patient satisfaction. Two questions arise in relation to response time. Are there differences in the response to patient calls in different hospital units? Does an IT-enabled escalation of calls to ensure care quality improve the call response efficiency and effectiveness? In this study, we explore these two research questions. We argue that differences in call response time are influenced by two operational attributes of care units: velocity and uncertainty. These attributes will determine how nursing staff view both the need and urgency associated with calls and respond to them. Internet discussion forums at allnurses.com (secondary data analysis) are used to answer the first question. The analysis validates a 2 × 2 framework, which maps four different hospital units on velocity and uncertainty dimensions. A quantitative approach is then used to address the second question by analyzing the response time differences to patient calls by different hospital units when an IT-based escalation protocol is used. Data from 1,131 patient rooms provides evidence of response time differences in different units, each with a varying degree of velocity and uncertainty. We then discuss the implications of this research for future studies on patient satisfaction using a single metric such as nurse call response time.

Juggling digitization and technostress: The case of alert fatigues in the patient care system implementation

Jiban Khuntia, Mohan Tanniru, Jack Weiner
Health Policy and Technology, Volume 4, Issue 4, Pp. 364-377

Policy mandates and business benefits are propelling hospitals to implement several decision support systems that can help nurses to aid in clinical care decisions. These systems can plausibly reduce errors and provide care by offering real-time alerts about possible adverse reactions. But nurses often suffer “alert fatigue” caused by excessive numbers of warnings within the hospital while providing care. As a result, they may pay less attention to or even ignore some vital alerts, thus limiting these systems׳ effectiveness. In this study, we explore how implementation of an intelligent care system in a hospital with the objective of implementing several decision support systems inadvertently led to a set of alert fatigues. Our analysis of fatigue related technostress suggests a change in management strategy that involves synchronization of people, technology and policies, and is in support of patient care.

Identifying Bands in the Knowledge Exchange Spectrum in an Online Health Infomediary

Dobin Yim, Jiban Khuntia, Young Argyris
International Journal of Healthcare Information Systems and Informatics (IJHISI), Volume 10, Issue 3, Pp. 63-84

Online health infomediaries have the objective of knowledge exchange between participants. Visitor contribution is an important factor for the success of the infomediaries. Providers engaged with infomediaries need visitor identification for reputational incentives. However, identification or classification of visitors in online health infomediaries is sparse in literature. This study proposes two dimensions of participation, the intention and intensity levels of visitors, to conceptualize four user categories: community supporters, experiencer providers, knowledge questors, and expertise contributors. The authors validate these categories using a unique large data set collected from a health infomediary for cosmetic surgery, and consisting of 162,598 observed activities of 44,350 visitors, at different participation levels in the year 2012-13. They use cluster analysis to describe similarities and differences among the four user categories. Practice implications are discussed.

Extending Care Outside of the Hospital Walls: A Case of Value Creation through Synchronous Video Communication for Knowledge Exchange in Community Health Network

Jiban Khuntia, Mohan Tanniru, John Zervos
International Journal of E-Business Research (IJEBR), Volume 11 Issue 2, Pp. 1-17

In healthcare settings knowledge exchange among important stakeholders such as doctors, family and patients, and other care providers is a critical imperative. However, such a community modelled approach is missing, limited in scope or its business value not well understood. In this study, the authors illustrate the value potential and subsequent development of a business model for knowledge exchange within the healthcare delivery model outside a hospital setting. Specifically, they illustrate how Synchronous Video Consultation with social media features, in a staged approach, can support knowledge exchange among a network of community health care professionals who address global health disparities and sustain this exchange through resource generation. The authors discuss the contributions and implications of the proposed framework towards value creation in a collaborative setting in general and suggest opportunities for future research.

Media Reinforcement for Psychological Empowerment in Chronic Disease Management

Kaushik Ghosh, Jiban Khuntia, Sudhir Chawla, Xiaodong Deng
Communications of the Association for Information Systems, Volume 34, Article 22

Although information technology (IT) is often argued to have the potential to enable greater patient participation in healthcare delivery, how IT empow ers patients to take charge of their own health is a less explored area. This study explores how IT-enabled communication plays a significant role in shaping the patients’ psychological empow erment for managing a chronic disease—diabetes. Psychological empow erment reflects a patient’s cognitive
response and motivation to manage the disease. Two dimensions of psychological …

Information Technology and Voluntary Quality Disclosure by Hospitals

Corey Angst, Ritu Agarwal, Guodong Gordon Gao, Jiban Khuntia, Jeffrey S McCullough
Decision Support Systems, Volume 57, Issue 1, Pp. 367-375

Information asymmetry between consumers and health care providers is a well-known phenomenon in health care systems. Disclosure of health care quality information is one important mechanism through which hospitals can signal performance to potential patients and competitors, yet little is known about the organizational factors that contribute to voluntary disclosure. In this study we develop an empirical model to investigate the factors associated with choosing to participate in a voluntary quality disclosure initiative, specifically isolating the importance of information technology (IT) in facilitating disclosure. We extend the scope of prior work on the quality disclosure choice by augmenting it with an important decision variable: the operational costs of collecting and reporting quality data. We suggest that IT can facilitate disclosure by reducing these costs, thereby extending the literature on the value of IT. Empirical findings using data from a major voluntary quality disclosure program in California hospitals support our assertion related to the role of IT. Our results further highlight other hospital characteristics contributing to disclosure. We discuss implications of these findings for research and practice.

Patient perceptions of electronic medical records: physician satisfaction, portability, security and quality of care

Christopher Sibona, Steven Walczak, Jon Brickey, and Madhavan Parthasarathy
International Journal of Healthcare Technology and Management, Vol. 12, Number 1, Pages 62-84

Physicians are adopting electronic medical records in much greater numbers today and are escalating the rate of adoption. The American Recovery and Reinvestment Act of 2009 provides incentives for physicians to adopt this technology. The objectives of this paper are to determine whether patient satisfaction is affected by computer use in the exam room and whether patients who have experienced computers in the exam room perceive differences in the utility of electronic medical records. Physicians received higher overall satisfaction scores when a computer was used to retrieve patient information. Physicians received similar satisfaction scores when a computer was used to enter patient information. Patients who have experienced electronic medical records perceive benefits such as increased portability of the record but do not believe that physicians who use electronic medical records produce better health outcomes. Patients who have experienced electronic medical records do not desire more control over their record than those who have traditional medical records.

Ignorance Isn’t Bliss: Complaint Experience and Organizational Learning in the California Nursing Home Industry, 1997–2004

Vinit M. Desai
British Journal of Management,  Dec. 2010, Vol. 21 Issue 4, pp. 829-842.

Organizational learning theory suggests that complaints about products and services can promote organizational learning and change. However, evidence suggests that potentially valuable forms of experience may be ignored or discounted in organizations, and additional research is needed to determine why this happens. This study contributes to those efforts by examining how multiple forms of complaint experience interactively influence organizational outcomes. An empirical test on a longitudinal panel of Californian nursing homes finds that complaints about other issues may distract attention away from complaints about a focal issue, but only when complaints are provided anonymously. These findings forward organizational learning theories by suggesting that multiple types of experience may detract from rather than supplement each other in some cases. Additional implications and opportunities for further research are also discussed.

Keys for successful implementation of total quality management in hospitals

Carman, James M.; Shortell, Stephen M.; Foster, Richard W.; Hughes, Edward F.X.; Boerstler, Heidi; O’ Brien, James L.; and O’Connor, Edward J.
Health Care Management Review Vol. 35, Issue 4, pp 283-293

This article reports the findings of an analysis of the implementation of continuous quality improvement (CQI) or total quality management (TQM) programs in 10 hospitals. This analysis is the result of a 2-year study designed to identify and assess the ingredients that lead to the successful implementation of CQI programs in acute care hospitals.

Andragogy-the missing gap in osteoporosis patient education

Miller, P. M.
Journal of Clinical Densitometry, Vol. 13 Issue 1, March 2010,  pp. 127.

Over 50 articles were reviewed for the paper that covered the general topic of patient compliance in all chronic conditions, issues and current practices of patient education, in-depth reviews of osteoporosis compliance, and the socio-economic outcome of osteoporosis compliance issues.  Research with strong efforts to affect patient outcomes has been conducted and published in the literature.  The literature suggested minimal positive outcomes from those efforts which included physicians, nurses, pharmacists, and others as the educational conduit for treatment success.  Other literature reviews conclude that up to 50% of osteoporosis patients did not take their medications as directed.  Inundating healthcare providers with educational materials and responsibility for educating patients has produced few significant improvements.  The purpose of the abstract was to draw attention to the concept of treating the patient of chronic diseases as adult learners.

Separately Together

O’Connor, Edward J. and Fiol, C. Marlena
Healthcare Executive,  Vol. 25 Issue 1, pp. 72-75

The article discusses the ways to treat intractable physician-administrator conflicts in the U.S. It mentions that intractable physician-administrator conflicts poses a major problem to attaining the improved quality and financial outcomes needed in healthcare environment. It presents steps in helping disentangle physicians and administrators which includes identifying common ground such as shared commitments to quality care and transparency.

Managing clinical knowledge among hospital nurses.

Ghosh, Biswadip, and Scott, Judy E.
International Journal of Technology Management Vol. 47 Issue 1-3,  pp. 57-74

Knowledge Management (KM) tools and processes, while established in many industries, are relatively new to healthcare. Healthcare organisations resemble virtual organisations that build flexible and dynamic care networks of multiple medical providers and professionals to address a patient’s needs. This research studies the major factors impacting clinical KM strategy and processes in the floor nursing function in a large metropolitan area hospital. Empirical data has been collected and analysed to understand what infrastructure enablers and process capabilities are important contributors to KM effectiveness in floor nursing. The results indicate that technology can play a pivotal role in KM initiatives among nurses, provided it supports the processes involved with knowledge acquisition and application in solving new problems. The findings have implications for the selection, deployment and management of Information Technology (IT) to enable clinical KM.

Toward a Theory of Local Legitimacy by MNEs in Developing Nations: Newmont Mining and Health Sustainable Development in Peru

Blair Gifford and Andrew Kestler
Journal of International Management Vol. 14, Issue 4, p. 340-352

This paper describes a current initiative by Newmont Mining Corporation (Newmont) to develop sustainable community benefit in communities around its mining operations in Peru in response to heightened criticism of Newmont by non-government organizations and the media. Using anthropologically oriented methods, a community health assessment project in an area of projected mining is described in detail in this paper. This case adds to London and Hart’s social embeddedness strategy for multi-national enterprises (MNEs) working in developing nations by introducing a locally-based community interaction model, which we describe as a local legitimacy strategy, in an effort to bring about sustainable development in the communities that surround a MNE’s production activities. The components of our local legitimacy strategy include co-analysis of community needs by MNEs and community partners, and planning and investment in developments to enhance the social fabric and the physical infrastructure needs of communities. The developing world is getting better at publicizing and monitoring the work of MNEs. We argue that it will be increasingly necessary for MNEs, like Newmont, to add local sustainable benefit into their strategic mix to gain the social license and legitimacy that is needed to operate in poorer communities.

Primary Care Provider Turnover and Quality of Care in Managed Care Organizations

Mary E. Plomondon, David J. Magid, John F. Steiner, Samantha Whinney, Blair D. Gifford, Sarah C. Shih, Gary K. Grunwald and John S. Rumsfeld
American Journal of Managed Care Vol. 13, Issue 8, p. 465-472

Objectives: To examine the association between primary care provider turnover in managed care organizations and measures of member satisfaction and preventive care.

Study Design: Retrospective cohort study of a national sample of 615 managed care organizations that reported HEDIS® data to the National Committee for Quality Assurance from 1999 through 2001.

Methods: Multivariable hierarchical regression modeling was used to evaluate the association between health plan primary care provider turnover rate and member satisfaction and preventive care measures, including childhood immunization, well-child visits, cholesterol, diabetes management, and breast and cervical cancer screening, adjusting for patient and organizational characteristics, time, and repeated measures.

Results: The median primary care provider turnover rate was 7.1% (range, 0%-53.3%). After adjustment for plan characteristics, health plans with higher primary care provider turnover rates had significantly lower measures of member satisfaction, including overall rating of healthcare (P < .01). A 10% higher primary care provider turnover rate was associated with 0.9% fewer members rating high overall satisfaction with healthcare. Health plans with higher provider turnover rates also had lower rates of preventive care, including childhood immunization (P = .045), well-child visits (P = .002), cholesterol screening after cardiac event (P = .042), and cervical cancer screening (P = .024). For example, a 10% higher primary care provider turnover was associated with a 2.7% lower rate of child-members receiving well-child visits in the first 15 months of life.

Conclusions: Primary care provider turnover is associated with several measures of care quality, including aspects of member satisfaction and preventive care. Future studies should evaluate whether interventions to reduce primary care provider turnover can improve quality of care and patient outcomes.

Handling Emotional Reactions to Change

O’Connor, Edward J. and Fiol, C. Marlena
Physician Executive Vol. 32 Issue 6, p. 78-80

The article presents the authors’ views on handling individual emotional reactions to change. Individual emotional reactions to change go through several phases including naive confidence, denial, depression and informed hopefulness. It is important to understand and manage the transitions of people through these phases. After diagnosing a particular phase of emotional transition, specific actions can be taken toward the next phase of emotional transition.

Reclaiming Physician Power: Your Role as a Physician Executive

O’Connor, Edward J. and Fiol, C. Marlena
Physician Executive Vol. 32 Issue 6, p. 46-50

The article discusses various issues related to physician morale. According to a survey, physicians have tried to regain their autonomy in several ways. Physician attitudes and behaviors affect the cost, and quality of health services in many ways. Several clinical quality improvement initiatives launched by accreditation bodies, and government agencies are designed to address the identified quality problem.