Hospital Board and Management Practices Are Strongly Related to Hospital Performance on Clinical Quality Metrics

Thomas C Tsai; Ashish K. Jha; Atul A. Gawande; Robert S. Huckman; Nicholas  Bloom; Raffaella  Sadun

Article | Health Affairs | August 2015

Hospital Board and Management Practices Are Strongly Related to Hospital Performance on Clinical Quality Metrics

by Thomas C Tsai, Ashish K. Jha, Atul A. Gawande, Robert S. Huckman, Nicholas Bloom and Raffaella Sadun

Abstract

National policies to improve health care quality have largely focused on clinical provider outcomes and, more recently, payment reform. Yet the association between hospital leadership and quality, although crucial to driving quality improvement, has not been explored in depth. We collected data from surveys of nationally representative groups of hospitals in the United States and England to examine the relationships among hospital boards, management practices of front-line managers, and the quality of care delivered. First, we found that hospitals with more effective management practices provided higher-quality care. Second, higher-rated hospital boards had superior performance by hospital management staff. Finally, we identified two signatures of high-performing hospital boards and management practice. Hospitals with boards that paid greater attention to clinical quality had management that better monitored quality performance. Similarly, we found that hospitals with boards that used clinical quality metrics more effectively had higher performance by hospital management staff on target setting and operations. These findings help increase understanding of the dynamics among boards, front-line management, and quality of care and could provide new targets for improving care delivery.

Keywords: Quality; Governing and Advisory Boards; Management Practices and Processes; Service Delivery; Health Care and Treatment; Health Industry;

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Tsai, Thomas C., Ashish K. Jha, Atul A. Gawande, Robert S. Huckman, Nicholas Bloom, and Raffaella Sadun. "Hospital Board and Management Practices Are Strongly Related to Hospital Performance on Clinical Quality Metrics." Health Affairs 34, no. 8 (August 2015): 1304–1311.

Article | Annals of Emergency Medicine

The Inpatient Discharge Lounge as a Potential Mechanism to Mitigate Emergency Department Boarding and Crowding

Brian Franklin, Sharif Vakili, Robert S. Huckman, Sarah Hosein, Nicholas Falk, Katherine Cheng, Maria Murray, Sheila Harris, Charles A. Morris and Eric Goralnick

Delayed access to inpatient beds for admitted patients contributes significantly to emergency department (ED) boarding and crowding, which have been associated with deleterious patient safety effects. To expedite inpatient bed availability, some hospitals have implemented discharge lounges, allowing discharged patients to depart their inpatient rooms while awaiting completion of the discharge process or transportation. This conceptual article synthesizes the evidence related to discharge lounge implementation practices and outcomes. Using a conceptual synthesis approach, we reviewed the medical and gray literature related to discharge lounges by querying PubMed, Google Scholar, and Google and undertaking backward reference searching. We screened for articles either providing detailed accounts of discharge lounge implementations or offering conceptual analysis on the subject. Most of the evidence we identified was in the gray literature, with only three peer-reviewed articles focusing on discharge lounge implementations. Articles generally encompassed single-site descriptive case studies or expert opinions. Significant heterogeneity exists in discharge lounge objectives, features, and apparent influence on patient flow. Although common barriers to discharge lounge performance have been documented, including underuse and care team objections, limited generalizable solutions are offered. Overall, discharge lounges are widely endorsed as a mechanism to accelerate access to inpatient beds, yet the limited available evidence indicates wide variation in design and performance. Further rigorous investigation is required to identify the circumstances under which discharge lounges should be deployed as well as how discharge lounges should be designed to maximize their effect on hospitalwide patient flow, ED boarding and crowding, and other targeted outcomes.

Keywords: health care delivery; emergency room; operations improvement; operations management; Health Care and Treatment; Service Delivery; Operations; Management; Performance Improvement; Service Operations;

Citation:

Franklin, Brian, Sharif Vakili, Robert S. Huckman, Sarah Hosein, Nicholas Falk, Katherine Cheng, Maria Murray, Sheila Harris, Charles A. Morris, and Eric Goralnick. "The Inpatient Discharge Lounge as a Potential Mechanism to Mitigate Emergency Department Boarding and Crowding." Annals of Emergency Medicine 75, no. 6 (June 2020): 704–714. View Details

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This Viewpoint discusses the shifting landscape of health care financing, regulation, and delivery as a result of the coronavirus pandemic, and discusses regulatory and other changes that need to be in place if telehealth and physician practice and hospital mergers become the “new normal” once the pandemic is controlled.

Internal communication has been a central theme in organizational economics, as employee collaboration provides insight into the structure of firms. Use of electronic communications data can be transformational for organizational economics, as these data provide a standardized way to measure organizational communication patterns and to determine the connection between these patterns and firm performance. We discuss the value of data that capture patterns of employee interactions, the benefits and risks associated with the use of electronic communication data (email and meetings) as empirical proxies for these collaboration patterns, and the research possibilities for studies across larger sets of firms.

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Hospital Board and Management Practices Are Strongly Related to Hospital Performance on Clinical Quality Metrics

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