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Topics
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- Ambulatory Care and Surgery (2)
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- (-) Organizational Change (32)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 32 Research Studies DisplayedSmith ME, Wells EE, Friese CR
Interpersonal and organizational dynamics are key drivers of failure to rescue.
This qualitative study of providers from hospitals with high and low rescue rates identified key factors that providers believe influence the successful rescue of surgical patients. These factors are: teamwork, action taking, psychological safety, recognition of complications, and communication. Providers surveyed agreed on two targets for improvement: delayed recognition of developing complications, and poor interprofessional communication and inability to express clinical concerns. The authors conclude that, to improve perioperative outcomes, hospitals and payers should shift their attention to improving early detection and increasing communication effectiveness when major complications occur.
AHRQ-funded; HS023621; HS024403.
Citation: Smith ME, Wells EE, Friese CR .
Interpersonal and organizational dynamics are key drivers of failure to rescue.
Health Aff 2018 Nov;37(11):1870-76. doi: 10.1377/hlthaff.2018.0704..
Keywords: Adverse Events, Communication, Hospitals, Mortality, Organizational Change, Patient Safety, Surgery
Brimhall KC, Mor Barak ME
The critical role of workplace inclusion in fostering innovation, job satisfaction, and quality of care in a diverse human service organization.
Using a sample of 213 participants within 21 departmental units in a diverse human service organization, the authors performed multilevel path analysis to examine the critical role of workplace inclusion in fostering innovation, job satisfaction, and quality of care in a diverse human service organization.
AHRQ-funded; HS024650.
Citation: Brimhall KC, Mor Barak ME .
The critical role of workplace inclusion in fostering innovation, job satisfaction, and quality of care in a diverse human service organization.
Hum Serv Organ Manag Leadersh Gov 2018 Nov/Dec;42(5):474-92..
Keywords: Quality of Care, Workforce, Organizational Change
Carpenter D, Hassell S, Mardon R
Ambulatory Surgery, Cost-Effectiveness, Health Care Costs, Evidence-based Practice, Organization and Administration
This paper describes the concept of using learning communities to support adoption of health care innovations. The authors assert that the learning community model of group learning can serve as an effective method to support dissemination and implementation of innovations, and to achieve desired outcomes in local settings.
AHRQ-funded; 290201100001C.
Citation: Carpenter D, Hassell S, Mardon R .
Ambulatory Surgery, Cost-Effectiveness, Health Care Costs, Evidence-based Practice, Organization and Administration
Jt Comm J Qual Patient Saf 2018 Oct;44(10):566-73. doi: 10.1016/j.jcjq.2018.03.010..
Keywords: Organizational Change, Patient-Centered Healthcare, Quality Improvement, Quality of Care
Wagner EH, LeRoy L, Schaefer J
AHRQ Author: Zhan C, Meyers D.
How do innovative primary care practices achieve the quadruple aim?
The Patient-Centered Medical Home (PCMH) defines excellent primary care but there is little empiric evidence that helps practices, payers, or policy makers understand how high-performing practices have improved outcomes. This paper reports findings from 38 high-performing practices. The authors describe how these practices execute 8 functions that collectively meet patient needs.
AHRQ-authored.
Citation: Wagner EH, LeRoy L, Schaefer J .
How do innovative primary care practices achieve the quadruple aim?
J Ambul Care Manage 2018 Oct/Dec;41(4):288-97. doi: 10.1097/jac.0000000000000249..
Keywords: Primary Care, Patient-Centered Healthcare, Practice Improvement, Organizational Change, Patient-Centered Outcomes Research
Harrison MI, Grantham S
AHRQ Author: Harrison MI
Learning from implementation setbacks: identifying and responding to contextual challenges.
The authors addressed organizational learning about implementation context during setbacks to primary care redesign in an ambulatory system. They found that redesigned teams were not implemented as widely or rapidly as anticipated and did not deliver hoped-for gains in operational metrics; however, team redesign was leading to improvements in chronic care and prevention and eased provider burden. Redesign and system leaders engaged in more thorough organizational learning. Their responses to challenges helped to strengthen the redesign's prospects, improved the delivery system's position in its labor market, and helped the system prepare to meet emerging requirements for value-based care and population health.
AHRQ-authored; AHRQ-funded; 2902010000341.
Citation: Harrison MI, Grantham S .
Learning from implementation setbacks: identifying and responding to contextual challenges.
Learn Health Syst 2018 Oct;2(4):e10068. doi: 10.1002/lrh2.10068..
Keywords: Organizational Change, Learning Health Systems, Health Systems, Primary Care: Models of Care, Primary Care, Ambulatory Care and Surgery, Implementation
McDonald KM, Rodriguez HP, Shortell SM
Organizational influences on time pressure stressors and potential patient consequences in primary care.
This study examines organizational determinants and patient consequences of time pressure, theorizing two types of time pressure and based on analysis of data from surveys of care team members and their patients. Measures of the two types - encounter-level and practice-level - were not correlated, nor predicted, which supported the hypothesis. Different organizational factors are associated with each type.
AHRQ-funded; HS024075.
Citation: McDonald KM, Rodriguez HP, Shortell SM .
Organizational influences on time pressure stressors and potential patient consequences in primary care.
Med Care 2018 Oct;56(10):822-30. doi: 10.1097/mlr.0000000000000974..
Keywords: Organizational Change, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care
Skinner D, Franz B, Howard J
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
The purpose of this study was to understand the perspectives of primary care innovators treating patient populations not traditionally considered to be within the purview of primary care. The authors indicated that their study findings suggested that the politics surrounding entrenched professional identities contributed to barriers faced by conference participants in their efforts to provide innovative care for these nontraditional populations. Specifically, obstacles surfaced in relation to sharing patients across disciplinary boundaries, which resulted in issues of possessiveness, a questioning of provider qualifications, and a lack of interprofessional trust.
AHRQ-funded; HS021287.
Citation: Skinner D, Franz B, Howard J .
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
J Healthc Manag 2018 Sep-Oct;63(5):323-36. doi: 10.1097/jhm-d-16-00030..
Keywords: Primary Care, Primary Care: Models of Care, Patient-Centered Healthcare, Cancer, Substance Abuse, Policy, Healthcare Delivery, Organizational Change, Quality of Care
Hung DY, Harrison MI , Truong Q
AHRQ Author: Harrison MI
Experiences of primary care physicians and staff following lean workflow redesign.
The researchers examined the work experiences of primary care physicians and staff after implementing Lean-based workflow redesigns. They found that both physicians and nonphysician staff reported higher levels of engagement and teamwork after implementing redesigns. However, the subjects also experienced higher levels of burnout and perceptions of the workplace as stressful.
AHRQ-authored; AHRQ-funded; 290201000022I.
Citation: Hung DY, Harrison MI , Truong Q .
Experiences of primary care physicians and staff following lean workflow redesign.
BMC Health Serv Res 2018 Apr 10;18(1):274. doi: 10.1186/s12913-018-3062-5.
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Keywords: Primary Care, Workflow, Burnout, Organizational Change, Provider: Physician, Teams
Martsolf GR, Ashwood S, Friedberg MW
Linking structural capabilities and workplace climate in community health centers.
This study examined the relationship between workplace climate and structural capabilities. Twenty-five community health centers (CHCs) were surveyed to determine workplace climate. CHC directors and adult primary care clinicians and staff were surveyed. Positive attributes included a manageable workload, staff relationships, a quality improvement orientation, and manager readiness. Lower electronic record functionality did not seem to improve workplace climates.
AHRQ-funded; HS020120.
Citation: Martsolf GR, Ashwood S, Friedberg MW .
Linking structural capabilities and workplace climate in community health centers.
Inquiry 2018 Jan-Dec;55:46958018794542. doi: 10.1177/0046958018794542..
Keywords: Community-Based Practice, Organizational Change, Quality Improvement, Quality of Care
Nembhard IM, Tucker AL
Applying organizational learning research to Accountable Care Organizations.
In this article, the authors discuss seven lessons from the organizational learning literature that can help Accountable Care Organizations (ACOs) overcome the inherent challenges of learning how to work together in radically new ways. The article concludes by outlining opportunities for future research on organizational learning in ACOs.
AHRQ-funded; HS018987.
Citation: Nembhard IM, Tucker AL .
Applying organizational learning research to Accountable Care Organizations.
Med Care Res Rev 2016 Dec;73(6):673-84. doi: 10.1177/1077558716640415..
Keywords: Quality of Care, Organizational Change, Health Insurance
Rodriguez HP, Chen X, Martinez AE
Availability of primary care team members can improve teamwork and readiness for change.
Researchers conducted a survey of adult primary care providers and staff in California safety net practices to assess primary care team structure (team size, team member availability, and access to interdisciplinary expertise), teamwork, and readiness for change. Greater team member availability was associated with greater readiness for change, but the relationship was stronger for staff than for primary care providers.
AHRQ-funded; HS020120.
Citation: Rodriguez HP, Chen X, Martinez AE .
Availability of primary care team members can improve teamwork and readiness for change.
Health Care Manage Rev 2016 Oct-Dec;41(4):286-95. doi: 10.1097/hmr.0000000000000082.
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Keywords: Primary Care, Teams, Patient-Centered Healthcare, Organizational Change, Practice Improvement
Friedberg MW, Rodriguez HP, Martsolf GR
Measuring workplace climate in community clinics and health centers.
The authors assessed the psychometric properties of a survey instrument combining items from several existing surveys of workplace climate and generated a shorter instrument for future use. They concluded that survey instruments designed to measure workplace climate have substantial overlap, and the set they identified might help target and tailor clinics' quality improvement efforts.
AHRQ-funded; HS020120.
Citation: Friedberg MW, Rodriguez HP, Martsolf GR .
Measuring workplace climate in community clinics and health centers.
Med Care 2016 Oct;54(10):944-9. doi: 10.1097/mlr.0000000000000585.
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Keywords: Community-Based Practice, Provider, Organizational Change, Quality Improvement, Quality of Care, Practice Improvement
Shao H, Brown L, Diana ML
Estimating the costs of supporting safety-net transformation into patient-centered medical homes in post-Katrina New Orleans.
The authors aimed to understand the characteristics of clinics that transformed into patient-centered medical homes and the incremental cost for transformation. The estimated incremental cost for clinics that underwent transformation was $37.61 per visit per 6 months, and overall it cost $24.86 per visit per 6 months in grant funds to support a clinic's transformation.
AHRQ-funded; HS022624.
Citation: Shao H, Brown L, Diana ML .
Estimating the costs of supporting safety-net transformation into patient-centered medical homes in post-Katrina New Orleans.
Medicine 2016 Sep;95(39):e4990. doi: 10.1097/md.0000000000004990.
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Keywords: Patient-Centered Healthcare, Healthcare Costs, Access to Care, Organizational Change
Hickner J, Smith SA, Yount N
Differing perceptions of safety culture across job roles in the ambulatory setting: analysis of the AHRQ Medical Office Survey on Patient Safety Culture.
This study examines differences in patient safety culture perceptions among providers, management and staff in a large national survey of safety culture in ambulatory practices in the USA. Its findings suggest that managers need to pay attention to the training needs of office staff, since this was an area with one of the greatest gaps in perceptions. In addition, both office managers and physicians need to encourage more open communication.
AHRQ-funded; 290200710024C.
Citation: Hickner J, Smith SA, Yount N .
Differing perceptions of safety culture across job roles in the ambulatory setting: analysis of the AHRQ Medical Office Survey on Patient Safety Culture.
BMJ Qual Saf 2016 Aug;25(8):588-94. doi: 10.1136/bmjqs-2014-003914.
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Keywords: Ambulatory Care and Surgery, Organizational Change, Patient Safety, Provider
Hung D, Chung S, Martinez M
Effect of organizational culture on patient access, care continuity, and experience of primary care.
The authors examined relationships between organizational culture and patient-centered outcomes in primary care. They found that, compared with a "Group-oriented" culture, a "Rational" culture type was associated with longer appointment wait times, and both "Hierarchical" and "Developmental" culture types were associated with less care continuity, but better patient experiences with care.
AHRQ-funded; HS019815; HS019167.
Citation: Hung D, Chung S, Martinez M .
Effect of organizational culture on patient access, care continuity, and experience of primary care.
J Ambul Care Manage 2016 Jul-Sep;39(3):242-52. doi: 10.1097/jac.0000000000000116.
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Keywords: Access to Care, Organizational Change, Patient-Centered Healthcare, Patient Experience, Primary Care
Poghosyan L, Liu J
Nurse practitioner autonomy and relationships with leadership affect teamwork in primary care practices: a cross-sectional survey.
The authors investigated whether nurse practitioner (NP) autonomy within primary care practices and the relationships they have with leadership affect teamwork between NPs and physicians. They concluded that NP autonomy and favorable relationships with leadership improve teamwork, and they recommended that policy and organizational change focus on promoting NP autonomy and improving the relationship between NPs and leadership to improve teamwork and consequently improve patient care and outcomes.
AHRQ-funded; HS020999.
Citation: Poghosyan L, Liu J .
Nurse practitioner autonomy and relationships with leadership affect teamwork in primary care practices: a cross-sectional survey.
J Gen Intern Med 2016 Jul;31(7):771-7. doi: 10.1007/s11606-016-3652-z.
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Keywords: Nursing, Organizational Change, Primary Care, Teams
Rangachari P
Role of social knowledge networking technology in facilitating meaningful use of electronic health record medication reconciliation.
In this paper, Rangachari 1) conducted a narrative review of the literature on "technology use," to understand how technologies-in-practice may be transformed from limited use to meaningful use; 2) conducted a narrative review of the literature on "organizational change implementation," to understand how changes in technology use could be successfully implemented and sustained in a healthcare organizational context; and 3) applied lessons learned from the narrative literature reviews to identify strategies for the meaningful use and successful implementation of EHR Medication Reconciliation technology.
AHRQ-funded; HS024335.
Citation: Rangachari P .
Role of social knowledge networking technology in facilitating meaningful use of electronic health record medication reconciliation.
J Hosp Adm 2016 Jun;5(3):98-106. doi: 10.5430/jha.v5n3p98.
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Keywords: Health Systems, Medication, Hospitals, Organizational Change, Electronic Health Records (EHRs)
Gray CP, Harrison MI, Hung D
AHRQ Author: Harrison MI
Medical assistants as flow managers in primary care: challenges and recommendations.
Drawing on an empirical study of a large, multispecialty delivery system engaged in reconfiguration of primary care, the authors found that using medical assistants (Mas) as flow managers required overcoming several challenges. These included entrenched social and occupational hierarchies between physicians and MAs, a lack of adequate training and mentorship, and difficulty attracting and retaining talented MAs.
AHRQ-authored; AHRQ-funded; 2902010000221.
Citation: Gray CP, Harrison MI, Hung D .
Medical assistants as flow managers in primary care: challenges and recommendations.
J Healthc Manag 2016 May-Jun;61(3):181-91.
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Keywords: Primary Care, Organizational Change, Practice Improvement, Quality Improvement, Quality of Care, Workflow, Provider
Harrison MI, Paez K, Carman KL
AHRQ Author: Harrison MI
Effects of organizational context on Lean implementation in five hospital systems.
In order to help reduce gaps in knowledge of effects of intraorganizational context, the authors researched Lean implementation initiatives in five organizations and examined 12 of their Lean rapid improvement projects. They identified intraorganizational characteristics including CEO commitment to Lean and active support for it, prior organizational capacity for quality improvement-based performance improvement, and alignment of the Lean initiative with the organizational mission.
AHRQ-authored.
Citation: Harrison MI, Paez K, Carman KL .
Effects of organizational context on Lean implementation in five hospital systems.
Health Care Manage Rev 2016 Apr-Jun;41(2):127-44. doi: 10.1097/hmr.0000000000000049..
Keywords: Organizational Change, Hospitals, Quality Improvement, Quality of Care, Healthcare Delivery, Implementation
Howard J, Etz RS, Crocker JB
Maximizing the patient-centered medical home (PCMH) by choosing words wisely.
The authors described new terminology that some innovative primary care practices are using to support the transformational culture of the PCMH. Using data from the AHRQ-funded Working Conference for PCMH Innovation 2013, they found that language innovations were used by 5 of the 10 convened practices and that participants felt that the language used was important for reinforcing substantive changes. They concluded that new terminology must represent values to which practices genuinely aspire.
AHRQ-funded; HS021287.
Citation: Howard J, Etz RS, Crocker JB .
Maximizing the patient-centered medical home (PCMH) by choosing words wisely.
J Am Board Fam Med 2016 Mar-Apr;29(2):248-53. doi: 10.3122/jabfm.2016.02.150199.
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Keywords: Cultural Competence, Patient-Centered Healthcare, Primary Care, Organizational Change
Davis KK, Harris KG, Mahishi V
Perceptions of culture of safety in hemodialysis centers.
Staff members, physicians, nurse practitioners, and physician assistants from a sample of hemodialysis facilities completed a 10-item assessment with modified questions from the Hospital Survey on Patient Safety Culture, with an emphasis on safety culture related to vascular access infections. Overall, scores were high, indicating a positive patient safety culture.
AHRQ-funded; 2902010000251.
Citation: Davis KK, Harris KG, Mahishi V .
Perceptions of culture of safety in hemodialysis centers.
Nephrol Nurs J 2016 Mar-Apr;43(2):119-26, 82; quiz 27.
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Keywords: Surveys on Patient Safety Culture, Patient Safety, Dialysis, Kidney Disease and Health, Organizational Change, Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Provider
Urick BY, Kaskie BP, Carnahan RM
Improving antipsychotic prescribing practices in nursing facilities: the role of surveyor methods and surveying agencies in upholding the Nursing Home Reform Act.
The objectives of this study were to explore surveyor observations of skilled nursing facilities/nursing facilities care practices subsequent to participation the Partnership guidance program and to use a social ecological framework to estimate how these observations were influenced by individual, organizational, and contextual factors. It found substantial variation in surveyor observations of changes to clinical care in response to the Partnership guidance initiative.
AHRQ-funded; HS019355.
Citation: Urick BY, Kaskie BP, Carnahan RM .
Improving antipsychotic prescribing practices in nursing facilities: the role of surveyor methods and surveying agencies in upholding the Nursing Home Reform Act.
Res Social Adm Pharm 2016 Jan-Feb;12(1):91-103. doi: 10.1016/j.sapharm.2015.04.006.
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Keywords: Elderly, Nursing Homes, Long-Term Care, Policy, Medication, Organizational Change
Nembhard IM, Morrow CT, Bradley EH
Implementing role-changing versus time-changing innovations in health care: differences in helpfulness of staff improvement teams, management, and network for learning.
This paper examined the hypothesis that the degree to which access to groups that can alter organizational learning depends on innovation type. Team representativeness and network membership were positively associated with implementing role-changing practices; while senior management engagement was positively associated with implementing time-changing practices. The authors concluded that these findings advance implementation science by explaining mixed results across past studies, that the nature of change for workers alters potential facilitators' effects on implementation.
AHRQ-funded; HS018987.
Citation: Nembhard IM, Morrow CT, Bradley EH .
Implementing role-changing versus time-changing innovations in health care: differences in helpfulness of staff improvement teams, management, and network for learning.
Med Care Res Rev 2015 Dec;72(6):707-35. doi: 10.1177/1077558715592315.
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Keywords: Healthcare Delivery, Quality Improvement, Organizational Change, Teams, Quality of Care, Learning Health Systems, Implementation
Cutting EM, Overby CL, Banchero M
Using workflow modeling to identify areas to improve genetic test processes in the University of Maryland Translational Pharmacogenomics Project.
The researchers used information gained from focus groups in order to illustrate the current process of delivering genetic test results to clinicians. They proposed a business process model and notation (BPMN) representation of this process for a Translational Pharmacogenomics Project being implemented at the University of Maryland Medical Center. They found that the current process could be improved to reduce input errors, better inform and notify clinicians about the implications of certain genetic tests, and make results more easily understood. They demonstrated theiruse of BPMN to improve this important clinical process for CYP2C19 genetic testing.
AHRQ-funded; HS023390.
Citation: Cutting EM, Overby CL, Banchero M .
Using workflow modeling to identify areas to improve genetic test processes in the University of Maryland Translational Pharmacogenomics Project.
AMIA Annu Symp Proc 2015 Nov 5;2015:466-74.
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Keywords: Genetics, Diagnostic Safety and Quality, Medication, Workflow, Quality Improvement, Quality of Care, Organizational Change
Collins CE, Pringle PL, Santry HP
Innovation or rebranding, acute care surgery diffusion will continue.
The researchers conducted a qualitative study comprising face-to-face interviews with senior surgeons responsible for acute care surgery (ACS) at 18 teaching hospitals chosen to ensure diversity of opinions and practice environment. Their analysis suggests that the implementation of ACS, whether a true health care delivery innovation or an innovative rebranding, fits into the Rogers’ diffusion of innovation theory.
AHRQ-funded; HS022694.
Citation: Collins CE, Pringle PL, Santry HP .
Innovation or rebranding, acute care surgery diffusion will continue.
J Surg Res 2015 Aug;197(2):354-62. doi: 10.1016/j.jss.2015.03.046..
Keywords: Surgery, Critical Care, Organizational Change, Provider: Physician