Autumn’s approach brings a new school year here where I teach at the University of Alabama at Birmingham. Like the leaves, the old course syllabus is turning yellow with age and could do with some sprucing up. In refreshing any syllabus, one of the main tasks is updating the reading lists—which means I have to do a literature review.
Literature reviews are popular because both professional and academic readers appreciate the value of having a topic effectively synthesized. The good news is that authors, too, recognize the popularity of literature reviews and submit quite a few for publication in the Journal of Healthcare Management. The bad news is that many of these manuscripts suffer from obvious flaws and are rejected. Later in this editorial, I highlight three common mistakes in literature reviews that authors can easily rectify. First, here is a preview of this issue of JHM.
The interview subject is Richard D. Cordova, FACHE, president emeritus of Children’s Hospital Los Angeles. We discuss hospital governance and the dynamics of working with a board to achieve organizational goals. Mr. Cordova presents many useful insights, drawing from his experience as both a CEO and a board member.
Paul B. Hofmann, FACHE, continues our yearlong series on Caring for the Caregivers by characterizing burnout as a largely untreated epidemic in healthcare. Dr. Hofmann suggests a genuinely effective stress reduction program for organizations.
Our Sustaining Relevance series continues with a column by Joel A. Port, FACHE, senior vice president at Delaware Valley ACO, an accountable care organization based in Radnor, Pennsylvania. He and his colleagues recount how two health systems came together to form the ACO and achieved positive results.
The first empirical research article looks at length of stay in neonatal intensive care units (NICUs). Authors Geoffrey Williams, Henrietta Bada, Lorie Chesnut, Emily Ferrell, and Glen P. Mays find that keeping very low birthweight babies in the NICU longer significantly reduces their need for an apnea/cardio monitor—a better care outcome. Their methods section provides a good example of how to use instrumental variables to establish causal relationships.
Next, Paulchris Okpala takes a qualitative approach to tackling the avoidable costs of unnecessary diagnostic procedures and specialty referrals. To that end, he recommends the implementation of a patient-centered strategy.
Daniel Skinner, Berkeley Franz, Jenna Howard, Kelly Kelleher, and Benjamin F. Crabtree also use qualitative methods to explore interprofessional boundaries in the treatment of cancer and substance abuse. They find that professional territorial behaviors can lead to suboptimal care integration. Many programs fail to account for professional entrenchment, which often is a contributing factor when integration efforts fail to advance access to care, care coordination, and cost control.
Complementing our Caring for the Caregivers column, researchers Sean T. Gregory, Terri Menser, and Brian T. Gregory share an intervention that moves care delivery from a physician/nurse and certified medical assistant dyad to a more team-based approach for managing a panel of patients. They identify a positive impact on the intervention group’s well-being. Such innovations are valuable, given the cost of replacing burned-out staff.
This issue of JHM also includes three online exclusives. In the first, Deephak Swaminath, FACHE, et al. seek ways to improve clinical documentation among physicians at an academic medical center. Documentation specialists in this study interacted with physicians after completing their documentation and while they were in the process. Results indicate that in-service interaction can be effective in improving clinical documentation practices.
The second online article looks at how ACOs perform with readmissions as compared to other organizations. The researchers—Ryan Duggal; Yongkang Zhang, and Mark L. Diana—find mixed results in heart failure, pneumonia, and acute myocardial infarction readmission rates. They conclude that the ACO program has not yet fully realized the anticipated benefits in the delivery of care.
The final online article looks at how health systems can increase patient trust. Employing focus groups for their study, Amanda M. B. Doty; Rhea E. Powell, Brendan G. Carr, Deborah B. Nelson, and Kristin L. Rising identify privacy, supportive patient–provider relationships, and respect as the prime considerations for trust. Furthermore, they suggest that system-level guidelines to support these principles must be in place to improve community health.
LITERATURE REVIEW ERRORS AND HOW TO FIX THEM
Earlier, I mentioned that I often find three mistakes in literature reviews that authors can easily rectify.
- Search algorithm shortfalls. When a literature review hits my desk, I first look for the search algorithm, which can be illustrated in a figure that shows the databases used and how many articles each database yielded, deduplication across sources, articles removed for each evaluation criterion, and the final number of articles analyzed. I immediately reject any manuscript that lacks these details.
- Questionable keyword queries. Next, I look for a good set of keywords used to query the databases. In health services research, a reference to MeSH (medical subject headings) compiled by the U.S. National Library of Medicine is needed (https://meshb.nlm.nih.gov/search), as is a systematic means of identifying other terms that might be used in natural-language search engines. Also, how the Boolean operators combined terms in the searches should be described so that the methods can be replicated.
- Incomplete evaluations. Finally, for articles selected for inclusion in the analysis, both the citations used by them and the citations made to them must be added back into the top of the evaluation algorithm. This iterative process of pulling in new articles until no new references are identified is often omitted but is absolutely necessary.
Literature reviews are among the most useful and regularly cited type of research. Tools such as online databases and citation management software can simplify the tasks in such research. Nevertheless, a rigorous review still requires a great deal of work to be acceptable for publication. Following these suggestions will help. Good luck!