Management

Creating value for participants in multi-stakeholder alliances: the shifting importance of leadership and collaborative decision-making over time

Creating value for participants in multi-stakeholder alliances: the shifting importance of leadership and collaborative decision-making over time
December 2015. Health Care Management Review.

D'Aunno, T., Alexander, J.A., & Jiang, L.
05/26/2016

BACKGROUND:

Multistakeholder alliances that bring together diverse organizations to work on health-related issues are playing an increasingly prominent role in the U.S. health care system. Prior research shows that collaborative decision-making and effective leadership are related to members' perceptions of value for their participation in alliances. Yet, we know little about how collaborative decision-making and leadership might matter over time in multistakeholder alliances.

PURPOSE:

The aim of this study was to advance understanding of the role of collaborative decision-making and leadership in individuals' assessments of the benefits and costs of their participation in multistakeholder alliances over time.

METHODS:

We draw on data collected from three rounds of surveys of alliance members (2007-2012) who participated in the Robert Wood Johnson Foundation's Aligning Forces for Quality program.

FINDINGS:

Results from regression analyses indicate that individuals' perceptions of value for their participation in alliances shift over time: Perceived value is higher with collaborative decision-making when alliances are first formed and higher with more effective leadership as time passes after alliance formation.

PRACTICE IMPLICATIONS:

Leaders of multistakeholder alliances may need to vary their behavior over time, shifting their emphasis from inclusive decision-making to task achievement.

Practice environments and job satisfaction and turnover intentions of nurse practitioners: Implications for primary care workforce capacity

Practice environments and job satisfaction and turnover intentions of nurse practitioners: Implications for primary care workforce capacity
November 2015. Health Care Management Review.

Poghosyan, L., Liu, J., Shang, J., & D'Aunno, T.
05/26/2016

BACKGROUND:

Health care professionals, organizations, and policy makers are calling for expansion of the nurse practitioner (NP) workforce in primary care to assure timely access and high-quality care. However, most efforts promoting NP practice have been focused on state level scope of practice regulations, with limited attention to the organizational structures.

PURPOSE:

We examined NP practice environments in primary care organizations and the extent to which they were associated with NP retention measures.

METHODOLOGY:

Data were collected through mail survey of NPs practicing in 163 primary care organizations in Massachusetts in 2012. NP practice environment was measured by the Nurse Practitioner Primary Care Organizational Climate Questionnaire, which has four subscales: Professional Visibility, NP-Administration Relations, NP-Physician Relations, and Independent Practice and Support. Two global items measured job satisfaction and NPs' intent to leave their job. We aggregated NP level data to organization level to attain measures of practice environments. Multilevel logistic regression models were used.

FINDINGS:

NPs rated the relationship between NPs and physicians favorably, contrary to the relationship between NPs and administrators. All subscales measuring NP practice environment had similar influence on the outcome variables. With every unit increase in each standardized subscale score, the odds of job satisfaction factors increased about 20% whereas the odds of intention of turnover decreased about 20%. NPs from organizations with higher mean scores on the NP-Administration subscale had higher satisfaction with their jobs (OR = 1.24, 95% CI [1.12, 1.39]) and had lower intent to leave (OR = 0.79, 95% CI [0.70, 0.90]).

PRACTICE IMPLICATIONS:

NPs were more likely to be satisfied with their jobs and less likely to report intent to leave if their organizations support NP practice, favorable relations with physicians and administration, and clear role visibility. Creating productive practice environments that can retain NPs is a potential strategy for increasing the primary care workforce capacity.

Hepatitis C Testing in Substance Use Disorder Treatment: The Role of Program Managers in Adoption of Testing Services

Hepatitis C Testing in Substance Use Disorder Treatment: The Role of Program Managers in Adoption of Testing Services
2016. Substance Abuse Treatment, Prevention, and Policy, 11:13.

Frimpong, J.A. & D'Aunno, T.
05/25/2016

BACKGROUND:

Health care organizations do not adopt best practices as often or quickly as they merit. This gap in the integration of best practices into routine practice remains a significant public health concern. The role of program managers in the adoption of best practices has seldom been investigated.

METHODS:

We investigated the association between characteristics of program managers and the adoption of hepatitis C virus (HCV) testing services in opioid treatment programs (OTPs). Data came from the 2005 (n = 187) and 2011 (n = 196) National Drug Abuse Treatment System Survey (NDATSS). We used multivariate regression models to examine correlates of the adoption of HCV testing. We included covariates describing program manager characteristics, such as their race/ethnicity, education, and their sources of information about developments in the field of substance use disorder treatment. We also controlled for characteristics of OTPs and the client populations they serve.

RESULTS:

Program managers were predominantly white and female. A large proportion of program managers had post-graduate education. Program managers expressed strong support for preventive services, but they reported making limited use of available sources of information about developments in the field of substance use disorder (SUD) treatment. The provision of any HCV testing (either on-site or off-site) in OTPs was positively associated with the extent to which a program manager was supportive of preventive services. Among OTPs offering any HCV testing to their clients, on-site HCV testing was more common among programs with an African American manager. It was also more common when program managers relied on a variety of information sources about developments in SUD treatment.

CONCLUSIONS:

Various characteristics of program managers are associated with the adoption of HCV testing in OTPs. Promoting diversity among program managers, and increasing managers' access to information about developments in SUD treatment, may help foster the adoption of best practices.

On-site Bundled Rapid HIV/HCV Testing in Substance Use Disorder Treatment Programs: Study Protocol for a Hybrid Design Randomized Controlled Trial

On-site Bundled Rapid HIV/HCV Testing in Substance Use Disorder Treatment Programs: Study Protocol for a Hybrid Design Randomized Controlled Trial
2016, March 3. Trials, published online.

Frimpong, J.A., D'Aunno, T., Perlman, D.C., Strauss, S.M., Mallow, A., Hernandez, D., Schackman, B.R., Feaster, D.J., & Metsch, L.R.
05/25/2016

Background

More than 1.2 million people in the United States are living with human immunodeficiency virus (HIV), and 3.2 million are living with hepatitis C virus (HCV). An estimated 25 % of persons living with HIV also have HCV. It is therefore of great public health importance to ensure the prompt diagnosis of both HIV and HCV in populations that have the highest prevalence of both infections, including individuals with substance use disorders (SUD).

Methods/design

In this theory-driven, efficacy-effectiveness-implementation hybrid study, we will develop and test an on-site bundled rapid HIV/HCV testing intervention for SUD treatment programs. Its aim is to increase the receipt of HIV and HCV test results among SUD treatment patients. Using a rigorous process involving patients, providers, and program managers, we will incorporate rapid HCV testing into evidence-based HIV testing and linkage to care interventions. We will then test, in a randomized controlled trial, the extent to which this bundled rapid HIV/HCV testing approach increases receipt of HIV and HCV test results. Lastly, we will conduct formative research to understand the barriers to, and facilitators of, the adoption, implementation, and sustainability of the bundled rapid testing strategy in SUD treatment programs.

Discussion

Novel approaches that effectively integrate on-site rapid HIV and rapid HCV testing are needed to address both the HIV and HCV epidemics. If feasible and efficacious, bundled rapid HIV/HCV testing may offer a scalable, potentially cost-effective approach to testing high-risk populations, such as patients of SUD treatment programs. It may ultimately lead to improved linkage to care and progress through the HIV and HCV care and treatment cascades.

Supplying Health to the World

Supplying Health to the World
The Medicine Maker, 0315, Article #302.

Privett, N.
04/07/2015

New and improved drugs are released every year to tackle global health needs – and many pharma companies have initiatives to supply those drugs to the developing world. Unfortunately, efforts are wasted without proper supply chain management. Here, we prioritize the top ten challenges.

Assessment of a government-subsidized supermarket in a high-need area on household food availability and children's dietary intakes.

Assessment of a government-subsidized supermarket in a high-need area on household food availability and children's dietary intakes.
Public Health Nutrition. 18(15): 2881-2890.

Elbel B, Moran A, Dixon LB, Kiszko K, Cantor J, Abrams C, Mijanovich T.
01/07/2015

Objective: To assess the impact of a new government-subsidized supermarket in a
high-need area on household food availability and dietary habits in children.
Design: A difference-in-difference study design was utilized.
Setting: Two neighbourhoods in the Bronx, New York City. Outcomes were
collected in Morrisania, the target community where the new supermarket was
opened, and Highbridge, the comparison community.
Subjects: Parents/caregivers of a child aged 3–10 years residing in Morrisania
or Highbridge. Participants were recruited via street intercept at baseline (presupermarket
opening) and at two follow-up periods (five weeks and one year
post-supermarket opening).
Results: Analysis is based on 2172 street-intercept surveys and 363 dietary recalls
from a sample of predominantly low-income minorities. While there were small,
inconsistent changes over the time periods, there were no appreciable differences
in availability of healthful or unhealthful foods at home, or in children’s dietary
intake as a result of the supermarket.
Conclusions: The introduction of a government-subsidized supermarket into an
underserved neighbourhood in the Bronx did not result in significant changes in
household food availability or children’s dietary intake. Given the lack of healthful
food options in underserved neighbourhoods and need for programmes that
promote access, further research is needed to determine whether healthy food
retail expansion, alone or with other strategies, can improve food choices of
children and their families.

The Top Ten Global Health Supply Chain Issues: Perspectives from the Field

The Top Ten Global Health Supply Chain Issues: Perspectives from the Field
Operations Research for Health Care. 3(4) 226-230.

Privett, N. and D. Gonsalves
12/01/2014

In the battle for global health, supply chains are often found wanting. Yet most of what is known about in-country pharmaceutical supply chains resides in the experiences of individual stakeholders, with limited amounts of this knowledge captured in technical reports and papers. This short communication taps into the collective experience and wisdom of global health supply chain professionals through interviews and surveys to identify and prioritize the top 10 global health pharmaceutical supply chain challenges: (1) lack of coordination, (2) inventory management, (3) absent demand information, (4) human resource dependency, (5) order management, (6) shortage avoidance, (7) expiration, (8) warehouse management, (9) temperature control, and (10) shipment visibility. As such, this work contributes to the foundational knowledge of global health pharmaceutical supply chains. These challenges must be addressed by researchers, policy makers, and practitioners alike if global pharmaceutical supply chains are to be developed and improved in emerging regions of the world.

A Cascade of Failures: Why Government Fails, and How to Stop It

A Cascade of Failures: Why Government Fails, and How to Stop It
Brookings Institute, Center for Effective Public Management, Washington D.C., July 2014.

Light, Paul C.
07/14/2014

In this research paper, Paul C. Light writes that the “first step in preventing future failures is to find a reasonable set of past failures that might yield lessons for repair.” To meet this goal, Light asks four key questions about past federal government failures: (1) where did government fail, (2) why did government fail, (3) who caused the failures, and (4) what can be done to fix the underlying problems?

Pages

Subscribe to Management