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Biomedical subjects

P Leatt

Publications and source records attributed to P Leatt.

At least 19 recordsLinked to original sources
PubMed2000

The behavioural outcomes of quality improvement teams: the role of team success and team identification.

This study investigates the relationship between hospital quality improvement (QI) team success and changes in empowerment, 'organizational commitment, organizational citizenship behaviour' (OCB) and job behaviour related to QI. Data were collected from administrative staff, healthcare professionals and support staff from four community hospitals. The study involved a field investigation with two data collection points. Structured questionnaires and interviews with hospital management were used to collect data on the study variables. High scores were observed for organizational commitment, OCB and job behaviour related to QI when individuals identified with teams that were successful. Low scores were observed when individuals identified with teams that were unsuccessful. Empowerment was positively related to job behaviour associated with QI. It is concluded that participation on QI teams can lead to organizational learning, resulting in the inculcation of positive 'extra-role' and 'in-role' job behaviour.

Health Services Research↗
PubMed1999

Measurement of staff empowerment within health service organizations.

A measure of empowerment was developed and its psychometric properties evaluated. Employees (n = 52) of two hospitals participated in semistructured interviews and a pilot test of the research instrument. A second study was undertaken with professional, support, and administrative staff (n = 405) of four community hospitals. Psychometric evaluation included factor analysis, reliability estimation, and validity assessment. Subjects responded to questionnaires measuring empowerment, leadership behavior, organizational citizenship behavior and job behaviors related to quality improvement. Factor analysis indicated three dimensions of empowerment: behavioral, verbal, and outcome empowerment. Coefficient alphas ranged from .83 to .87. The three dimensions were positively related to leadership behavior that encouraged self-leadership and negatively related to directive leadership. The three dimensions discriminated between the empowerment level of managers compared to that of nonmanagement staff. Empowerment predicted organizational citizenship behavior and job behaviors related to quality improvement.

Adult↗
PubMed1997

Governing integrated health delivery systems: meeting accountability requirements.

Many Canadian provincial governments are exploring methods to increase the integration of health services in an effort to improve the care provided, while maintaining or reducing the costs. Integrated health delivery systems are being implemented in the United States, Britain and other European countries. Such systems aim to provide a full continuum of care to a defined target population under a financing system of capitation. This article explores the issues associated with the governance accountabilities of an IDS. A review of potential governance models is completed, and the factors that influence the choice of a governance model for an integrated delivery system are presented. In 1987. Ewell identified governing boards as the weakest link in the integrated health care systems of the United States. It is suggested that early attention to governance in the development of IDS models in Canada may improve the effectiveness of these systems.

Canada↗
PubMed1997

A framework for assessing the performance of integrated health delivery systems.

Competing demands for resources within the health care system require health care providers to ensure the most effective and efficient use of resources. The evidence from the United States, the United Kingdom and other jurisdictions suggests that integrated health delivery systems (IDS) may be a cost-effective way to meet the health care needs of a population. This article introduces a framework for use in monitoring and evaluating the performance of an integrated delivery system. The establishment of a consistently used evaluation framework for integrated delivery systems will provide the government, governing bodies and other evaluators with an effective assessment tool that will enable greater understanding of the impact of the IDS on the health care system. It will also provide information to enable ongoing performance improvements within the system.

Canada↗
PubMed1997

Downsizing, reengineering, and restructuring: long-term implications for healthcare organizations.

This article provides a framework for analyzing how downsizing and reengineering have affected healthcare organizations. These approaches are reviewed, and key tools that have been used, such as across-the-board cuts, reorganizing, and redesigning, are described. Examples are drawn from healthcare as well as other business sectors. The consequences of cost reduction strategies for an organizations's performance in terms of costs, quality of services, and satisfaction of consumers and employees are explored. The case is made that an organization's context--that is, its culture, level of trust, and leadership--is an important factor that influences the effect of cost-cutting strategies. Characteristics of organizations where downsizing has a better chance of succeeding also are described.

Contract Services↗
PubMed1996

Integrated delivery systems: has their time come in Canada?

In the 1990s every Canadian province is struggling to reduce health care expenditures without jeopardizing access to health care or quality of care. The authors propose a new model for health care delivery: the Canadian Integrated Delivery System (CIDS). A CIDS is a network of health care organizations; it would provide, or arrange to provide, a coordinated continuum of services to a defined population and would be held clinically and fiscally accountable for the outcomes in and health status of that population. A CIDS would serve 100,000 to 2 million people; the care it would provide would be funded on a capitation basis. For providers, there would be explicit financial incentives to minimize costs. At the same time, service quality and consumer choice of primary care practitioner would be maintained. Primary care physicians and specialists would work with other health care service providers to offer a full spectrum of care. CIDS providers would form strategic alliances with community agencies, hospitals, the private sector and other health care services not managed by the CIDS, as needed. For physicians, affiliation with a CIDS that provided strong clinical leadership could be beneficial to their income stability and autonomy. Pilot projects of this model in several communities would determine whether this concept is feasible in the Canadian health care context.

Canada↗
PubMed1996

Prediction of the financial performance of Ontario hospitals: a test of environmental determinist and adaptationist perspectives.

While other industries for many years have been concerned with the problem of financial distress, it is only recently that this issue has become a matter of interest to hospital managers, policy makers, and the general public. However, the determinants of hospital financial performance are neither well studied nor understood. The objectives of this study were to identify factors that affect the financial performance of Ontario hospitals and to construct a model that could be used to predict financial performance in the future. A number of organization and environmental factors that could influence financial performance were postulated and then tested for their statistical impact and predictive ability. Cross-sectional data over the 3-year-period 1986-1988 for 223 Ontario public hospitals were used. The first 2 years of data served as a derivation sample for hypothesis testing and development of a predictive model. The third year of data was used as a holdout sample for cross validation. Information on the variables investigated came from secondary sources, in particular Statistics Canada's Annual Hospital Returns. Univariate analyses revealed distressed hospitals were more likely to earn more revenues from non-government sources, to be non-teaching institutions and have longer chronic lengths of stay, and to be found in areas with higher per capita incomes, number of females in the population, physician supply, and area wage rates. A five variable prediction model was developed which accounted for 25% of the variance in financial performance in the derivation sample and on cross validation dropped to 21%. The model identified greater hospital size, older plants, higher technological complexity, more intensive care services, and location in areas with more females to be significant predictors of financial distress. Overall, environmental factors (community and structural characteristics) were more important in influencing financial performance. The implication for hospital managers is to underscore that an important dimension of successful leadership requires they remain outwardly focused and involved in managing the external environment. For policy makers the need is to develop funding formulae which encourage efficiency and are also responsive to differences in community and structural characteristics across hospitals.

Cross-Sectional Studies↗
PubMed1995

Technology acquisition in Canadian hospitals: how are we doing?

We surveyed attitudes of decision makers involved in making decisions about technology acquisition in hospitals, receiving replies from 989 (72%) anglophone respondents and 201 (68%) from francophone respondents. Respondents split on whether to try unverified procedures, strongly agreed that medical technology should be evaluated, and expressed a desire for technology assessment data. The quality of health care, need, and compatibility with the institution's role and mission were seen as the most important factors affecting acquisitions. Our study suggests that half the battle has been won; decision makers appear convinced that technologies must be evaluated. Organizational mechanisms, however, may still be required to ensure implementation.

Adult↗
PubMed1995

The role of the educator in state, provincial, and federal health policy.

Many faculty members of programs in health administration participate in the policy-setting process. It is critical at the present time of health care reform that faculty members play an active role in influencing health policy. Educators may become involved in this activity in a number of ways. First, there may be opportunities as researchers to conduct short-term or long-term projects which promote a policy agenda. Faculty members can bring a range of analytical skills and knowledge and may bring in multi-disciplinary perspectives on substantive policy issues. Second, educators need to re-examine curriculum content of university programs in health administration to assure appropriate policy content and to seek out opportunities for graduates in policy analysis positions. Third, through community services, educators may take on advocacy roles for the promotion of particular perspectives or the support of special interest groups. It is clear that there are going to be growing opportunities for faculty members to work with practitioners to substantially influence health policy.

Faculty↗
PubMed1994

Physicians in health care management: 9. Strategic alliances and relationships between organizations.

Health care organizations must increasingly develop strategic alliances with other groups and organizations. A variety of interorganizational relationships are possible: shared services, joint programs, umbrella organizations, health agency networks and mergers. As governments try to control health care costs, physicians will play an important role in developing and implementing these alliances. They will be expected to advocate on behalf of patients and communities to ensure that these new organizational arrangements facilitate coordinated care.

Canada↗
PubMed1994

Physicians in health care management: 1. Physicians as managers: roles and future challenges.

Physicians are increasingly expected to assume responsibility for the management of human and financial resources in health care, particularly in hospitals. Juggling their new management responsibilities with clinical care, teaching and research can lead to conflicting roles. However, their presence in management is crucial to shaping the future health care system. They bring to management positions important skills and values such as observation, problem-solving, analysis and ethical judgement. To improve their management skills physicians can benefit from management education programs such as those offered by the Physician-Manager Institute and several Canadian universities. To manage in the future environment they must increase their knowledge and skills in policy and political processes, financial strategies and management, human resources management, systems and program quality improvement and organizational design.

Canada↗
PubMed1994

Technology acquisition in Canadian hospitals: how is it done, and where is the information coming from?

A 1990 nation-wide survey on technology acquisition in Canadian hospitals, based on 509 Anglophone and 55 Francophone hospital questionnaires and 193 hospital equipment request forms, revealed that 53% of capital funds were used to replace existing equipment, with the remainder spent on new purchases. However, very little regional planning was taking place. Most of the institutional acquisition decisions were made by committees, 17% of which were classified as medical staff, 25.1% as administrative, 32.4% as board committees and 22.5% as mixed. Although administration was heavily represented, medical staff were frequently present and nursing was just as likely to have at least minimal representation. However, technical experts usually played a minimal role. This omission, combined with the limited information asked for on equipment request forms and the limited availability and use of technology assessment information, suggests that acquisition decisions in many Canadian hospitals are likely to be based on inadequate information.

Canada↗
PubMed1994

Decentralization of decision-making in Canada's health system: the Sunnybrook experience.

Though there is a significant literature which notes that physicians are fast becoming organizational members, there has been little research evidence to suggest that the adoption of new management models have actually facilitated their involvement. This study sought to examine whether a conscious effort at decentralizing decisions at the clinical unit level would actually result in increased involvement of physicians and other clinicians in decision-making at that level. Two major surveys examining individual roles and responsibilities and unit relationships with other units were conducted, at two points in time, in a large Canadian tertiary care centre. Results suggest that physicians had experienced an increase in administrative discretion. There was an overall increase of many groups in influencing clinical unit decisions with a perceived decrease in senior management influence in budget administration at the unit level. Lessons learned in conducting this type of research are described.

Analysis of Variance↗
PubMed1993

Ethical issues faced by clinician/managers in resource-allocation decisions.

This article explores the ethical issues faced by clinicians with management responsibilities (clinician/managers) when making decisions related to resource allocation and utilization at a Canadian teaching hospital. Using a focus group method, 28 individuals participated in four homogeneous groups that included nurse managers, managers from other professional groups, and physician managers. Ethical issues that recurred throughout the discussions included fairness, concern with preventing harm, consumer/patient choice, balancing needs of different groups of patients, conflict between financial incentives and patient needs, and professional autonomy. The particular issue of conflict is analyzed from two perspectives--a theory of professional-bureaucratic roles and of obligation--that illustrate how both management and philosophical issues are related. The findings suggest that decentralizing resource allocation and utilization decisions does raise ethical issues for clinician/managers and that a better understanding of these issues can be obtained using an interdisciplinary perspective.

Canada↗
PubMed1992

Hospital-physician integration: case studies of community hospitals.

Hospitals are attempting more meaningfully to involve physicians in management as one approach to increasing the efficiency and effectiveness of their operations. The purpose of this research was to explore the relationship between the structure of the medical staff organization, the extent to which physicians are integrated into hospital decision making and the hospital's financial performance. A measure of hospital-physician integration was developed based on Alexander et al's (1986) dimensions of hospital-physician integration which were based on Scott's (1982) organizational models, ie, autonomous, heteronomous and conjoint. A multiple case study design, which comprised eight community non-teaching hospitals over 200 beds located in the Province of Ontario, Canada, was used to examine the relationship between variables. Study results suggest that there is variation among community hospitals on both contextual and organization factors. Hospitals with high levels of hospital-physician integration were located in highly populated areas, had formulated and implemented a strategic plan, had highly structured medical staff organizations, and had no budgetary deficit. In contrast, hospitals with moderate or low levels of integration were more likely to be located in lowly populated areas, had little planning activity, had a moderately structured medical staff organization, and had deficit budgeting. Suggested areas for future research include examining the role of the Board of Trustees in determining physicians' organizational roles and identifying differences in commitments, characteristics, and motivations of physicians working in rural versus urban hospitals and their impact on integrative strategies.

Attitude of Health Personnel↗
PubMed1992

Regulatory intensity, hospital size and the formalization of medical staff organization in hospitals.

Using a theory of organizational response to regulation, this study examined the effects of regulatory intensity and hospital size on the formalization of medical staff organization in Canadian hospitals. The general hypothesis was that, in provinces with greater regulatory intensity, hospitals would exhibit greater formalization of medical staff, and greater involvement of physicians in hospital governance and management; larger hospitals would have greater formalization of medical staff than smaller hospitals. Data from 574 hospitals indicated that both hospital size and provincial regulatory intensity were important factors predictive of the overall formalization of medical staff organization. Depending upon the provincial location, hospitals have developed different patterns of formalizing their medical staff structures.

Canada↗
PubMed1992

Different systems, different costs? An examination of the comparability of workload measurement systems.

This study examines the equivalence of the hours of care estimates of four patient classification/workload measurement systems. Although the hours of care estimates of the systems were similar, differences between the estimates could be as great as 4.53 hours per day for the same patient. The researchers developed relational statements that made hours of care estimates equivalent for all systems studied. System differences can have a profound impact on nursing unit and department budgets, if not adjusted.

Costs and Cost Analysis↗