Retaining Workers in Health Care

It's a critical issue that continues to find its way into health care industry headlines and remains a key concern for health care leaders: retention.  In a time when the health care industry is experiencing numerous changes and heightened demands, the health care workforce finds itself facing considerable pressures, and accounts of burnout across health care organizations abound.  A question many administrators ask today continues to be, how can I effectively retain members of the organization?

In the most recent issue of the peer-reviewed journal, Health Care Management Review, a longitudinal study by researchers from the University of Texas School of Public Health suggests that employee engagement is a key to achieving effectively retaining employees.  Led by Jessica M. Tullar, the team of researchers found that health care workers who had participated in an employee engagement program were less likely than non-participants to leave their hospital, even after controlling for numerous covarying factors.  This employee engagement program promoted employees' efforts to connect more deeply with their work and see their jobs as meaningful.

In the article, the authors also note that employee engagement is just one method to improve employee retention rates, identifying previous evidence that improved teamwork, efficiencies, and access to resources, as well as reduced job demands, have been shown to help retain employees.  Additionally, beyond the benefit of improved retention, the article also states that employee engagement efforts can help "improve performance...and employee communication with leadership, both important outcomes for managers" (p. 323).

For health care managers today, the issue of retention is critical for numerous reasons.  Employee turnover comes with many costs, from financial to operational, even profoundly affecting the organization's culture and morale.  Leaders in health care today would do well to reflect and consider: how are employees being engaged in my organization?  What can I do to help my fellow employees to connect more deeply and find significant meaning in their work?

Reference:

Tullar, J.M., et al. (2016). Improve employee engagement to retain your workforce. Health Care Management Review, 41 (4), 316-324.

What Influences Consumer Satisfaction In Health Care?

In the health care industry, one of the major indicators of quality in health care delivery focuses on consumer satisfaction. This is prevalent in many nations, not just the United States. Under recent health care reform, patient satisfaction has been identified as an important measure of value-based care, the management strategy that focuses on cost, quality, and outcomes. With that said, what factors impact consumer satisfaction? The answer to this question can greatly aid researchers and policy makers in their continued quest for health care reform.

  

In order to address this issue, the authors conducted a detailed analysis of independent variables that could possibly be associated with greater consumer satisfaction.  The variables that were measured related to treatment issues, financial issues, family-related issues, sources of health care information, physical location, and demographic-related factors.  The data were collected from the 2010 Health Tracking Household Survey, and results indicate that satisfaction with primary care physicians, health insurance, and general health status are the three most significant determinants of consumer satisfaction.

Satisfaction with primary care physicians (PCPs) was identified as the key determinant of consumer satisfaction. This raises important questions.  PCPs are generally a point of first contact for patients engaging in the health care delivery system; however, experts predict a severe shortage of PCPs, especially in the wake of expanded insurance coverage following the Affordable Care Act.  How will this shortage impact consumer satisfaction in the future?  What might be effective strategies to increase the supply of PCPs in the U.S. and ensure they can provide outstanding care that satisfies patients?  Would non-physician providers, such as physician assistants or nurse practitioners, be able to help fill the shortage in the supply of primary care providers, as is a current topic of intense debate? Are they equipped to function in such a role, or is that an inappropriate response to the issues and needs that must be addressed? 

Second, health insurance also served as a significant factor impacting overall consumer satisfaction, with the uninsured showing the lowest satisfaction rates.  The authors suggest this may be due in part to the tendencies of uninsured patients to forego or postpone needed care as well as their limited connection with PCPs given a lack of insurance coverage.  Additional significant determinants of consumer satisfaction identified by the authors included a patient's general health status, the promptness of their visit to a physician when ill, their family medical costs, family income, and family size, their efforts to seek out medical information from friends, and the patient's age.  The authors suggest several of these determinants point to the importance of managing expectations and helping address patients' unrealistic expectations.  Although there are several limitations, this study can serve as a basis for policy makers and researchers to understand the needs of the most important stakeholder in the health care system: the patient.

What do you think: how can policy help improve the health care experience for patients, and how do you see health care organizations at work to address and improve patient satisfaction?

Article Citation

Deshpande, S. & Deshpande, S. (2014). "Factors Influencing Consumer Satisfaction with Health Care" The Health Care Manager, 33 (3), 261-266.

In Name Only? The Accountability of ACOs

In the health care industry, there has been little escaping news and opinion surrounding accountable care organizations, or ACOs, as an innovative health care delivery model.  An undeniably "hot topic" in health care that has been viewed with both optimism and skepticism, ACOs are intended to address the cost and quality components of the "iron triangle," working to keep health care providers accountable to providing high quality care while minimizing health care costs for the populations they serve.  But are these providers truly held accountable by the ACO model?  In the recently published fall issue of Health Care Management Review (volume 39, issue 4), authors Rachael Addicott (King's Fund) and Stephen Shortell (University of California, Berkeley) address this question, examining "the governance structures and accountability mechanisms that have been established by provider networks" engaged in ACO initiatives "to achieve the shared aims of improving quality and containing costs" (p. 271).  In other words, do the collaborating parties in ACOs hold each other accountable in their pursuit of improved coordination and integration?

To explore this question, the authors conducted in-depth case studies of four commercial ACOs from across the United States in the early stages of their development.  Their findings revealed common characteristics across the ACO sites (e.g., commercial at risk contracts, existing or proposed Medicare ACO contracts, and medical group-centered with collaborating hospitals and health plans) as well as key differences in terms of "their level of integration, corresponding governance structures, and mechanisms of accountability" (p. 273).  Ultimately, Addicott and Shortell found little evidence of formal shared accountability among ACO partners, little experience among partners with measures of collaboration, and little evidence that incentives were effectively applied to influence behaviors.

The authors conclude the article with numerous recommendations.  These include reinforcing ACO goals by establishing clear performance measures and incentives, aligning performance thresholds across different payer contracts, promoting access to transparent data, and engaging patients in the design, governance, and accountability mechanisms of ACOs (p. 277).   They also call for each ACO to tailor accountability structures to their participants and development, bringing to mind contingency theorists' arguments that, rather than finding a single best structure that should be applied like a cookie cutter across all ACOs, organizational structures should be identified that provide the best fit with an individual ACO's task and environmental contingencies.

What do you think?  What are your experiences with ACOs and their level of accountability?  Is the ACO model one that should be applied like a cookie cutter, or is it true that if you've seen one ACO, you've seen one ACO?  Please share your comments; we'd love to hear your perspective.

Article citation

Addicott, R., & Shortell, S.M. (2014). "How 'accountable' are accountable care organizations?" Health Care Management Review, 39 (4), 270-278.

Physician Engagement Around the World

In a recent survey by HealthLeaders Media, physician engagement was identified as the predominant challenge that hospitals and health systems face when working with physicians, ahead of other important factors such as governance, data management, revenue cycle, and employment agreements (Thomas, 2013).  A subsequent and related profile of health care organizations that successfully address physician engagement issues notes that, "High levels of physician engagement are vital to healthcare leaders who wish to avoid conflict within their organizations" (Commins, 2014).

But what is physician engagement?  And is it truly something that health care administrators today should be paying attention to or reflecting upon?  To answer these questions, Amer Kaissi (Trinity University) conducted a review of peer-reviewed studies and gray literature reports on physician engagement, identifying many ways the construct has been defined and measured across international settings.  In his article published in the most recent issue of International Journal of Health Services, Dr. Kaissi provides a history of the division between physician and management cultures in the United States, Canada, and the United Kingdom, he summarizes varied approaches to define the construct, and he lists the identified determinants, levels, measures, applications, and outcomes of physician engagement.  The article also identifies numerous conceptual models and frameworks of physician engagement, and it identifies best practices on enhancing physician engagement that have been discovered and described in national and international studies.

Ultimately, Kaissi ties physician engagement to notions of both active involvement and commitment exhibited by physicians towards the health care organizations they work with as well as processes and conditions created by such organizations to foster and support relationships with physicians.  Building from past studies and the varied best practices previously identified, Kaissi develops an integrative framework that health care organizations may apply to enhance physician engagement.  He proposes that three strategies must be part of organizations' effective physician engagement efforts: 1) "developing clear and efficient communication channels" with physicians; 2) "building trust, understanding, and respect" with physicians; and, 3) "identifying and developing physician leaders that can help engage the rest of the physicians in the organization" (p. 584).  Specific tactics are provided for each of these three strategies, such as developing communication plans, emphasizing information sharing, being involved in physician orientation programs, inviting physicians to "have a seat at the table," establishing clear expectations and responsibilities, and providing ample support and recognition for physician leaders (pp. 584-585).  Kaissi concludes by identifying opportunities for future research and calling for the prioritization of improved relations between physicians and health care organization managers, explaining that "enhancing physician engagement...will have far-reaching and positive effects on the clinical, service, and financial outcomes of any health care organization" (p. 589).

What are your thoughts?  How does your organization address physician engagement, and in what ways have you found physician engagement efforts to be either successful or challenging?  We'd love to hear from you in the comments section!

Articles Citation

Kaissi, A. (2014). "Enhancing physician engagement: An international perspective." International Journal of Health Services, 44 (3), 567-592.

Works Cited
Commins, J. (2014, February 13). "Addressing physician engagement." HealthLeaders Magazine, 17 (1).  Retrieved from: http://www.healthleadersmedia.com/content/MAG-300794/Addressing-Physician-Engagement

Thomas, J.R. (2013). "Physician Alignment in the New Shared Risk Environment."  HealthLeaders Media Intelligence Report: September 2013.  Retrieved from: http://content.hcpro.com/pdf/content/295631.pdf

Executive Compensation in Health Care

It's a topic that has repeatedly received attention from the press, the public, and politicians: executive compensation in health care.  Just in the past month, Modern Healthcare published results of its annual executive compensation survey, noting the criticism some hospital and healthcare system executives face for falling under the top 1 percent of wage earners in this country (Landen, 2014).  In the face of such criticism, hospitals and health care systems have continually worked to justify the levels of compensation determined for their leaders, prompting health care management scholars to examine what factors ultimately determine an executive's compensation in health care organizations.

A recent article published in the July-September issue of Health Care Management Review addresses this "hot-button" issue, examining the empirical evidence to date for health care executive pay determinants.  The study's authors, Patrick D. Shay (Trinity University) and Kenneth R. White (University of Virginia), conducted a systematic review of the health care management literature, finding 21 studies spanning 1991 to 2012 that have provided empirical results through regression-based analysis of what factors are directly related to health care executive compensation.  The results of their review reveal that studies have produced inconsistent and, at times, conflicting findings regarding what factors are most closely associated with CEO pay in health care.  No single determinant was consistently identified across each of the studies as a significant determinant of health care executive compensation.  However, of the factors that were more commonly highlighted as key determinants, the most frequently identified and predominant determinant of healthcare executive pay was organizational size.  Firm financial performance was also a statistically significant determinant in seven studies, but in eight other studies financial performance either produced mixed or insignificant results as a determinant.  Other factors identified in some of the studies as significant determinants included job difficulty, market characteristics, organizational ownership, hospital type, and human capital attributes.  Executive demographics, board attributes, and nonfinancial performance measures were identified as the determinants that, for the most part, yielded either mixed or insignificant relationships to executive pay.

Shay and White point to the inconsistent methods and findings across the review's studies as evidence that "the question of what factors determine health care executive compensation remains unsettled according to the extant empirical literature" (p. 264).  They acknowledge that the professional literature on health care executive compensation has identified organizational performance as a "relatively small consideration for boards when compensating executives" (p. 266; Bjork, 2012), perhaps in contrast to public expectations or assumptions.  In an age in which the public increasingly expects executive pay to be tied to firm performance, and as the industry increasingly embraces a "pay for performance" mentality, the study authors suggest health care organizations would benefit to more clearly incorporate performance measures - including financial as well as nonfinancial measures - as a contributing determinant of executive compensation.  They also call for "critical consideration as to what factors comprise the truly necessary and concrete determinants of pay," particularly in the event of declining organizational performance, as well as how to effectively communicate the varied determinants of pay to stakeholders and community members.  Shay and White note that, given the consistent public interest as well as continued media attention (e.g., Bartlett, 2014; Evans, 2014; Rosenthal, 2014), this subject is not likely to fade away soon, and further empirically-based studies are needed to shed light on the determinants of health care executive compensation.

What do you think about this subject?  Do you have any related questions or perspectives to share?  We'd love to hear your thoughts in the comments section.

Article Citation
Shay, P.D., & White, K.R. (2014). "Executive compensation in health care: A systematic review." Health Care Management Review, 39 (3), 255-267.

Works Cited
Bartlett, J. (2014, August 18). "Partners HealthCare, Lahey, Tufts executives see double-digit pay raises." Boston Business Journal.  Retrieved from: http://www.bizjournals.com/boston/blog/health-care/2014/08/partners-healthcare-executives-see-double-digit.html?page=all

Bjork, D.A. (2012). Healthcare executive compensation: A guide for leaders and trustees. Chicago, IL: Health Administration Press.

Evans, M. (2014, April 26). "Bonuses still tied to better financials: Use of CEO pay incentives for quality is uneven across for-profit hospital systems." Modern Healthcare.  Retrieved from: http://www.modernhealthcare.com/article/20140426/MAGAZINE/304269985

Landen, R. (2014, August 9). "Hospital executives see slower growth in compensation." Modern Healthcare. Retrieved from: http://www.modernhealthcare.com/article/20140809/MAGAZINE/308099980

Rosenthal, E. (2014, May 17). "Medicine's top earners are not the M.D.s." The New York Times. Retrieved from: http://www.nytimes.com/2014/05/18/sunday-review/doctors-salaries-are-not-the-big-cost.html?_r=0

Out of the Tower

The Murchison Tower at Trinity University

Here at Trinity University, the tower carries multiple meanings.  Those who have visited or passed by our campus have no doubt seen the iconic Murchison Tower that has become a San Antonio landmark and now serves as the University's official logo.  More generally, the term "ivory tower" has long been associated with academia, becoming a perjorative expression relating to intellectuals and institutions that foster academic elitism and engage in scholarly research without practical application.

This blog, "The Trinity Healthcare Digest," has been created with the intent of bringing the latest research in healthcare management "out of the tower" and into the hands of practicing health care administrators who can engage in study findings, relate the findings to their own experiences, foster a dialogue about how to advance the discipline of health care administration, and ultimately improve the health services patients receive.  In an industry as complex and dynamic as health care, we recognize that it is a considerable challenge to keep up with all of the changes that are taking place as we continually gain new understanding about health care and the provision of health services.  Textbooks on the subject of health care administration that were written just a few years ago are already falling behind current knowledge in some regards, and staying informed and up-to-date on the state of health care administration requires constant and vigilant effort.  At the same time, we recognize that too often health services research falls short in dissemination and application.  For many health care administrators, accessing relevant studies from a range of scholarly journals that speak to the issues and problems they face daily is a difficult, laborious, or frustrating exercise.  We also appreciate the difficulty administrators face in finding the time to read and reflect upon the latest studies.

Therefore, we are starting this blog as a means to highlight high-quality, recently published healthcare management and health services research in a form that will be easily digested by practicing health care administrators.  Each week, we aim to provide a citation and summary of a recent study  from a peer-reviewed journal relating to healthcare management or health services organization.  We encourage you to share your own thoughts and comments on these research briefings, and please also let us know what research topics, subjects, or questions you'd like to read about.  Finally, please share the link for our blog with others in the health care administration profession...let's bring the latest knowledge about health care administration "out of the tower" and bring others into the conversation as we work to make health care work better.