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Abstracts From the Forum on Advances in Healthcare Management Research

doi: 10.1097/JHM-D-18-00197
ABSTRACT

The following three abstracts are from presentations given at the Forum on Advances in Healthcare Management Research that took place March 28, 2018, during the 2018 Congress on Healthcare Leadership of the American College of Healthcare Executives. An annual event, the Forum presents theoretical and empirical research with the potential for high impact on healthcare management.

TITLE. Doing Well by Doing Good: Evaluating the Influence of Patient Safety Performance on Hospital Financial Outcomes

AUTHORS. Brad Beauvais, PhD, FACHE, assistant professor of finance and quality management, Trinity University, San Antonio, Texas; Jason P. Richter, PhD, FACHE, medical support squadron commander and medical group administrator, Aviano Air Base, Italy; and Forest S. Kim, PhD, FACHE, program director and associate professor, University of the Incarnate Word, San Antonio, Texas

GOAL. Even as financial pressures on hospitals increase due to changing reimbursement structures and heightened focus on quality and value, the association between patient safety performance and financial outcomes remains unclear. The purpose of this study is to investigate if hospitals with higher patient safety performance are associated with higher levels of profitability than are those with lower safety performance.

METHODS. Using multinomial logistic regression, we analyzed data from the spring 2014 Leapfrog Hospital Safety Score Survey and the 2014 American Hospital Association Annual Survey to determine the association between Leapfrog Hospital Safety Score performance and three dimensions of organizational profitability: operating margin, net patient revenue, and operating income.

PRINCIPAL FINDINGS. Our findings suggest improved hospital safety scores are associated with a relative risk of being in the top versus bottom quartile of financial performance: 5.41 times greater (p < .001) for operating margin, 10.98 times greater (p < .001) for net patient revenue, and 4.03 times greater (p < .001) for operating income.

APPLICATIONS TO PRACTICE. Our findings suggest improved patient safety performance, as evaluated within the Leapfrog Hospital Safety Score, is associated with improved financial performance at the hospital level. Targeted focus on patient safety may allow hospitals to improve financial performance, maximize scarce resources, and generate additional capital to continue to positively evolve care.

CONTACT. For more information about the concepts in this abstract, contact Dr. Beauvais at bbeauvai@trinity.edu.

NOTE. Research previously published: Beauvais, B., Richter, J. P., & Kim, F. S. (2017, April 25). Doing well by doing good: Evaluating the influence of patient safety performance on hospital financial outcomes. Health Care Management Review (ahead of print). doi: 10.1097/JHM-D-18-00197

TITLE. Use of a Patient Communication Checklist Is Associated With Improved Satisfaction Scores

AUTHORS. Brian Carpenter, MD, SFHM, national director of telehospitalist services, Sound Physicians, Tacoma, Washington, and Adventist HealthCare Shady Grove Medical Center, Rockville, Maryland; Keri Barnett-Howell, clinical innovation and policy analyst, Sound Physicians; Laki Gajic, RN, director of innovation, Sound Physicians; and Caroline Ndiangui, RN, clinical performance nurse, Sound Physicians

GOAL. The magnitude and complexity of medical information can negatively affect patients’ healthcare literacy and satisfaction. We set out to help improve our patients’ experience and their understanding of their plan of care in the hospital by focusing on important questions for patients and their physicians to review and discuss daily. We created a checklist that was kept at the patient’s bedside to guide conversations during rounds. The checklist was designed to help patients understand their clinical conditions, promote clear communication, and empower them to become active collaborators in their care. We assessed if use of the checklist could be associated with improvement in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) doctor communication scores.

METHODS. We investigated data from inpatients at one hospital unit that piloted a communication checklist from October 2016 to March 2017. The hospitalist clinical performance nurses gave the checklists to new patients to prompt daily conversations with their hospitalists. Checklist topics covered the conditions that led to hospitalization, treatments, responses to treatment, anticipated outcomes, what a patient can do to help with treatment, discharge timing, and next sites of care. We compared quarterly hospitalist-specific HCAHPS survey scores for doctor communication six months before the project (April to September 2016) to scores after the pilot.

PRINCIPAL FINDINGS. One hundred eighty-four patients completed the HCAHPS survey (including the doctor communication domain) before the pilot; 221 completed the survey after the pilot. We found a 22% increase in mean HCAHPS scores in the doctor communication domain after provision of the checklist (81% post checklist versus 59% pre checklist; p < 0.01). We found a 26% increase in mean HCAHPS scores in the subdomain of clear communication by the doctor after use of the checklist (82% post checklist versus 56% pre checklist; p < 0.01). Higher HCAHPS scores in the subdomain of clear communication by doctors was positively correlated with the subdomain of clear communication by nurses (r = 0.672).

APPLICATIONS TO PRACTICE. Our findings indicate that providing patients with a standardized and structured communication checklist empowers them to ask their physicians vital questions and increases HCAHPS satisfaction scores for both doctor and nursing communication. These results are important for designing tools to drive improvements in key areas of communication and help patients better understand their conditions, treatments, and expected outcomes—and in this way improve their satisfaction with care.

CONTACT. For more information about the concepts in this abstract, contact Dr. Carpenter at bcarpenter@soundphysicians.com.

TITLE. Transforming the Healthcare Workforce: Evaluation of Disease-Specific and Behavioral Health Training on Allied Health Professionals in a Collaborative Health System/Primary Care Network

AUTHORS. Beth-Anne Christopher, RN, CNL, assistant professor, Rush University College of Nursing, and project director, Better Care Teams Building Healthy Urban Communities, Rush University Medical Center, Chicago, Illinois; Lola A. Coke, PhD, ACNS-BC, FAHA, FPCNA, FAAN, associate professor and clinical nurse specialist, Rush University College of Nursing, Chicago, Illinois; and Angela Freeman, project manager, Building Healthy Urban Communities

GOAL. Allied health professionals are encouraged to update their knowledge and maintain clinical competence; however, uncertainties remain about the development, implementation, and evaluation of continuing education models for nonlicensed professionals. The Building Healthy Urban Communities initiative presents a framework to improve patient outcomes with continuing education as a key component for both nonlicensed and licensed professionals. The primary aim of this study was to better understand and measure program participants’ perceptions of the effectiveness of motivational interviewing, which includes goal-setting exercises, de-escalation techniques, and 13 disease-specific and behavioral health-training modules.

METHODS. The authors reviewed, collated, and analyzed the effect of formal motivational interviewing, behavioral health, and disease-specific training for care coordinators and care managers in the Medical Home Network (MHN). One hundred and fifty-one allied health professionals, representative of nine Federally Qualified Health Centers and three hospital systems within the MHN, participated in cohort 1 of these trainings. Evaluation was integral to the curriculum design. First, using pre–post testing methodology, participants assessed interpersonal competencies and proficiency in 13 behavioral health or disease-specific topic areas. Second, formative evaluation to demonstrate improved communication and application of disease-specific knowledge was measured using high-fidelity simulation. Clinical scenarios were developed and videotaped to demonstrate effective and ineffective communication methods so that learners could review, debrief, identify, and discuss strengths and areas for improvement.

PRINCIPAL FINDINGS. This curriculum model presents a systematic approach for improving allied health professional education and performance as part of an overall strategy for community health improvement.

APPLICATIONS TO PRACTICE. With the shift to population-based healthcare, continuing education models must adapt to the needs of the allied health workforce. Standardized on-the-job training for nonlicensed health professionals can strengthen a broad range of clinical competencies and skills and produce lasting changes in job performance. Our research provides a template for healthcare administrators and providers interested in reducing health disparities through interprofessional continuing education for the allied health workforce. This research can inform curriculum design by advancing more sophisticated, effective continuing education models and encouraging further innovation in the field.

CONTACT. For more information about the concepts in this abstract, contact Ms. Christopher at Beth-Anne_Christopher@rush.edu.

© 2018 Foundation of the American College of Healthcare Executives