Organizational innovation: the influence of individual, organizational, and contextual factors on hospital adoption of technological and administrative innovations.
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Analysis of Variance↗
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Payment mechanisms, nonprice incentives, and organizational innovation in health care.
Health care organizational structures support alternative combinations of payment and nonprice incentives for physicians, hospitals, and other providers. Changing perceptions among purchasers of the relative effectiveness of particular mechanisms lead to changes in the market shares held by particular organizational structures. This paper uses principal-agent and transactions cost economics to develop a conceptual matrix for understanding organizational innovation in the health care system. It contrasts the differing incentives in retrospective versus prospective payment mechanisms, arms-length review versus peer review mechanisms for controlling inappropriate utilization, and "free choice of physician" versus selective contracting mechanisms for structuring the basic insurer-provider relationship.
Delivery of Health Care↗
The impact of formalization, role conflict, role ambiguity, and communication quality on perceived organizational innovativeness in the Cancer Information Service.
Organizational members' levels of perceived innovativeness represent an insider's viewpoint of the organization's overall approach to innovation. This study tested a model of the impact of formalization, role ambiguity, role conflict, and communication quality on perceived organizational innovativeness in the Cancer Information Service. Data were gathered from self-report questionnaires completed by organizational members (n = 86) within the Cancer Information Service, a geographically dispersed federal government health information program that was implementing innovative intervention strategies related to disseminating health information to the public. Results indicated that although the predicted model provided a good overall fit to the data, there were some problematic paths. A revised model is offered to reconceptualize the relationships among role conflict, role ambiguity, and communication quality. These results are discussed in terms of their implications for managers and scholars who hope to understand the factors that contribute to perceptions of innovativeness in the new organizational forms emerging in the health service arena. These data suggest that formalization makes an important contribution to innovation in the highly uncertain world of new organizational forms.
Attitude of Health Personnel↗
Organizational innovation and the laboratory information system.
There is an urgent need for more innovation in health care and in clinical laboratories. Innovation can be divided into five separate categories: core products, components of the core products, production processes, uses of products, and the organization of production. Organizational innovation is an important as technological advances in increasing the quality and efficiency of clinical laboratories. The use of a laboratory information system (LIS) can stimulate organizational innovation such as the assignment of computer-oriented tasks to personnel within individual clinical laboratories. The authors refer to such LIS support personnel as "hidden personnel" and suggest that such a shift of responsibility empowers laboratory professionals and makes them stakeholders in automated information processing.
Clinical Laboratory Information Systems↗
[Qualitative analysis of organizational innovations in Spanish public hospitals].
OBJECTIVE: To determine the opinion of chief executive officers (CEOs) and physicians in public hospitals concerning new managerial trends. METHODS: We performed a qualitative study designed to determine the opinion of CEOs and physicians on the organizational innovations that affect more than one level of health management intervention. In-depth semi-structured interviews were conducted to identify behavior, experiences, opinions, knowledge and other personal and institutional aspects related to the study's aim. Focus groups (two study groups and one control group) were also used. Interaction between groups was used to obtain different types of information on the development of ideas, operational capacity, and the degree of consensus and disagreement on the subjects discussed. RESULTS: Comparison between the control and the study groups revealed that the new management trends added value in the following areas: economy of contracts, delegation, administrative decentralization, incentives, risk avoidance, process re-engineering, heath care continuity, competitiveness, leadership, information systems and client centeredness. CONCLUSIONS: Physicians are showing increased interest in organizational innovations while CEOs are ambivalent about their changing role and respective responsibilities. There is evidence of resistance to change. There is no single institutional model; institutional design depends on internal factors (cohesion and leadership) and external factors (environment, size and technology). The incipient development of innovations reveals the need for changes in the style and characteristics of management structure (composition, functions, responsibilities).
Attitude of Health Personnel↗
Internal consistency and reliability of a questionnaire assessing organizational innovation in two schools of dentistry.
The objective of this study was to test the internal consistency and test-retest reliability of a questionnaire designed to assess the status of and factors associated with organizational innovation in schools of dentistry. The questionnaire included thirty-three questions that assessed the following six domains: innovation/environment, innovation/leadership, innovation/personal, feedback/environment, feedback/personal, and feedback/interpersonal. A seventh domain, evidence-based learning, assessed the reaction of dental faculty to a scenario where the scientific evidence found a current treatment to be ineffective in improving the health status of patients. The questionnaire was mailed three times to a systematic sample of fifty-six dental faculty working at a research-intensive dental school (RES) and all thirty-nine dental faculty working at a dental school where the emphasis is on clinical education (CL). The two U.S. dental schools had similar numbers of students; however, they differed significantly in their research portfolios. The response rate was 70.5 percent. The seven domains had alpha coefficients ranging between 0.60 and 0.89. The test-retest reliability for the seven domains ranged between 0.65 and 0.92. Dental faculty of the RES school had significantly higher average scores than faculty of the CL school on innovation/leadership, innovation/environment, feedback/environment, and feedback/personal domains. Regression analyses found no differences between the two schools in innovation/environment scores. The innovation/environment scores were significantly associated with innovation/leadership, feedback/environment, feedback/interpersonal, and age. The evidence-based learning domain was negatively associated with the innovation/environment domain, indicating that faculty who were willing to abandon teaching of a treatment found to be ineffective felt that their school environment was not highly innovative. In conclusion, this preliminary study found that the questionnaire reliably assessed six domains representing innovation and feedback. This preliminary study also found that an innovative environment in two schools of dentistry is associated with presence of leaders who promote change and innovation, an environment that encourages feedback, and faculty members who value interpersonal feedback.
Age Factors↗
The 1989 Healthcare Forum/3M organizational innovator awards.
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Awards and Prizes↗
The 1988 Healthcare Forum/3M Organizational Innovator Awards.
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Awards and Prizes↗
Patient-physician communication as organizational innovation in the managed care setting.
Despite changes in the healthcare system, the relationship between patients and physicians remains fundamental to high-quality care. Managed care rules and restrictions, such as constraints on choice of providers, review processes, and decreasing length of visits, are creating potential conflicts between patients and their physicians. To strengthen the patient-physician relationship, some managed care organizations are implementing communication skills training for physicians. This article provides case studies describing how 2 large managed care organizations successfully incorporated communication skills training into their environments. An organizational perspective is used to delineate the 3 stages--adoption, implementation, and institutionalization--that managed care organizations generally traverse in incorporating communication skills programs and making them an integral part of their organizational culture. Specific suggestions are provided for physician leaders and administrators who are considering similar programs in their settings.
Clinical Competence↗
Organizational innovations that nourish staff leadership.
Health care is experiencing a paradigm shift that has the potential to redefine traditional roles, systems, and practices. At Albert Einstein Medical Center in Philadelphia, Pennsylvania, the nursing organization has capitalized on this potential and has been energized by the array of opportunities for innovation and experimentation. The results of these efforts suggest that many of these changes not only are positive approaches to patient care but also promote staff leadership and an entrepreneurial spirit at the front line.
Decision Making, Organizational↗
An organizational innovation: the Yale Primary Care Residency Program's experience with a firm system.
BACKGROUND: Integrated inpatient-outpatient firms developed in residencies with single institutions may not be applicable to residency programs with multiple inpatient and outpatient training sites. Our objective was to develop a firm in a multisite residency program that improved education and patient care. DESCRIPTION: One ward team was restructured into a firm that included two interns, three residents, and four private practice internists whose patients were admitted to the firm. Educational impact, length of stay, hospital charges, and in-hospital mortality were evaluated. EVALUATION: The firm experience increased outpatient training, fostered mentoring relationships, and increased attending availability. Mean length of stay (5.7 vs. 6.5 days, p = .2) and mean hospital charges ($10,888 vs. $12,316, p = .8) for firm and nonfirm patients, respectively, were not different. In-hospital mortality was lower for firm patients (9 of 348, 3%, vs. 87 of 1,565, 6%; p = .02). CONCLUSIONS: Firm structures with educational and patient care advantages can be instituted in multisite residencies.
Adolescent↗
[Elective Caesarean section team--an organizational innovation].
INTRODUCTION: The increasing rate of delivery by caesarean section demands more effective use of resources in obstetrical departments and anaesthesiological departments. At the Danish State Hospital, Rigshospitalet, in 2002, we decided to optimise the cooperation between the various professionals involved, by softening the professional boundaries, and by performing most planned caesarean sections on the same day, carried out by the same team, the "elective caesarean section team" (EST). In 2003 a similar structure was established at Hvidovre Hospital. This paper describes the process of establishing EST, the organisational implications, and the results of an evaluation of EST by the users. MATERIALS AND METHODS: The case records of all caesarean sections performed by the EST-team at Rigshospitalet and Hvidovre Hospital in 2004, were examined. All users in a two-month period evaluated the EST by questionnaires at planned discharge. RESULTS: Most users (60.5%) were discharged after two days. The user evaluation showed a high level of satisfaction. CONCLUSION: The introduction of EST has increased the efficiency within the organisation for carrying out planned caesarean sections. It has generated a high level of satisfaction among users, and a high educational value for the staff.
Anesthesia Department, Hospital↗
[Independent medical processing enterprises as innovative organizational model for market of medical services].
In Russia, current stage of health care development is characterized by occurrence of various problems. Most of them are related to cooperation between participators of market of medical services. Different options are proposed to resolve cooperation problems embedded into medical services market with emphasis on development of ultimately different medical processing enterprise with brand-new organizational and functional structure. Its functioning is based on process management logistics. The company broad professional experience allows to implement above-mentioned managerial structure and make it function as well as claims positive perspectives of described option.
Health Care Reform↗
Organizational innovation in a professionally dominated system: responses of physicians to a new program in medical education.
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Attitude of Health Personnel↗
Kaiser on innovation--Part five. Organizational structure and innovation.
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Hospital Administration↗
A revisionist view of the integrated academic health center.
Like many academic health centers that had expanded aggressively during the 1990s, the nation's first vertically integrated academic health center, the University of Pennsylvania Health System, was profoundly challenged by the dramatic and unanticipated financial impacts of the Balanced Budget Act of 1997. The author explains why-although Penn's Health System had lost $300 million over two years and its debts threatened to cause serious financial and educational damage to the rest of the University-Penn chose to manage its way out of the financial crisis (instead of selling or spinning off its four hospitals, clinical practices, and possibly even its medical school). A strategy of comprehensive integration has not only stabilized Penn's Health System financially, but strengthened its position of leadership in medical education, research, and health care delivery. The author argues that a strategy of greater horizontal integration offers important strategic advantages to academic health centers. In an era when major social and scientific problems demand broadly multidisciplinary and highly-integrated approaches, such horizontally integrated institutions will be better able to educate citizens and train physicians, develop new approaches to health care policy, and answer pressing biomedical research questions. Institutional cultural integration is also crucial to create new, innovative organizational structures that bridge traditional disciplinary, school, and clinical boundaries.
Academic Medical Centers↗
The effects of organization on medical utilization: an analysis of service line organization.
OBJECTIVES: To determine whether clinical service lines in primary care and mental health reduces inpatient and urgent care utilization. METHODS: All VHA medical centers were surveyed to determine whether service lines had been established in primary care or mental health care prior to the beginning of fiscal year 1997 (FY97). Facility-level data on medical utilization from Veterans Health Affairs (VHA) administrative databases were used for descriptive and multivariate regression analyses of utilization and of changes in measures between FY97 and FY98. Nine primary care-related and 5 mental health-related variables were analyzed. PRINCIPAL FINDINGS: Primary care and mental health service lines had been established in approximately half of all facilities. Service lines varied in duration and extent of restructuring. Mere presence of a service line had no positive and several negative effects on measured outcome variables. More detailed analyses showed that some types of service lines have statistically significant and mostly negative effects on both mental health and primary care-related measures. Newly implemented service lines had significantly less improvement in measures over time than facilities with no service line. CONCLUSIONS: Health care organizations are implementing innovative organizational structures in hopes of improving quality of care and reducing resource utilization. We found that service lines in primary care and mental health may lead to an initial period of disruption, with little evidence of a beneficial effect on performance for longer duration service lines.
Efficiency, Organizational↗
Challenges faced by the HIV health services planning council in Oakland, California, 1991-1994.
This study reports the findings of a case study of the health services planning council established in the Oakland, California, eligible metropolitan area (the Oakland EMA) under Title I of the Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (the CARE Act). We gathered primary data through observation of planning council meetings, examination of documentary evidence, and in-depth interviews with key participants. An important finding of this study was the inconsistency observed between the rational, linear planning model embedded in the CARE Act legislation and the politicized, emergent, and, at times, chaotic planning process actually observed in the Oakland EMA. The primary reasons for this inconsistency included confusion among council members about the planning council's responsibilities and authority, as well as its relationship with the local health department; limitations on administrative support at the local level; reluctance of program administrators at the federal level to provide advice concerning development of the council; allegations of conflict of interest among members of the council; pre-existing societal tensions and divisions; concerns about the representativeness of the council's membership; competition among providers of services for funding; conflicting demands for services by persons affected by HIV disease; disagreements between the council and providers of services over policies and procedures for administering the services contracts; and concerns about the council's involvement in the selection of specific agencies for funding, its lapses in compliance with rules of order, and its failure to accurately record minutes of all of its meetings. Despite the challenges faced by the Oakland planning council, it was able to meet its Title I obligations, which resulted in significant increases in the availability of medical and social services for persons affected by HIV disease. However, dealing with the confusion and conflicts described above consumed a considerable amount of the planning council's time and energy and eventually required a complete reorganization of the council to assure its stability and the legitimacy of the Title I program at the local level. Medical Subject Headings (MeSH): health planning councils; health planning organizations; health care coalitions; organization and administration; organizational innovation; models, organizational.
California↗