Domains and core competencies for effective evidence-based practice in diversity leadership.
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Competency-Based Education↗
Biomedical subjects
J L Dreachslin
Publications and source records attributed to J L Dreachslin.
Workforce diversity: implications for the effectiveness of health care delivery teams.
This paper examines the implications of racial diversity for the self-perceived communication effectiveness of nursing care teams. An RN leads the nursing care team (NCT) and delivers care in collaboration with two or more nonlicensed caregivers. Overlap is intentionally designed into the roles of NCT members and the range of duties the team performs is generally expanded to include functions previously performed by personnel from centralized departments. NCTs are highly reliant on mutual respect and effective communication among team members. Team conflict and miscommunication can be exacerbated by the strong correlation between role on the nursing care team (NCT) and race. Verbatim transcripts of fourteen focus groups from two study hospitals were used to develop a grounded theory of the role that race plays in the self-perceived communication effectiveness of nursing care teams. Two themes that emerged from the focus group discussions constitute the overarching framework within which racially diverse team members evaluate team communication effectiveness: different perspectives and alternative realities. Three additional themes, social isolation, selective perception and stereotypes, that serve as reinforcing factors were also identified, i.e., these factors deepen the conflict and dissatisfaction with team communication that occurs as a natural consequence of the overarching framework of different perspectives and alternative realities. Leadership emerged as a powerful mitigating factor in the model of how race influences the self-perceived communication effectiveness of nursing care teams. Leaders who can transcend racial identity as evidenced by the ability to validate alternative realities and appreciate different perspectives appear to moderate the potential negative effects of racial diversity on team communication processes and strengthen the positive aspects of diversity.
Communication Barriers↗
Diversity leadership.
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Cultural Diversity↗
Key indicators of nursing care team performance: insights from the front line.
Self-directed nursing care teams (NCTs), comprised of a registered nurse (RN) team leader and two or more non-licensed caregivers, are a key feature of patient-focused care reengineering. In well-functioning teams: (1) role overlap routinely occurs; (2) team members express satisfaction with interpersonal communication; and (3) team members express the belief that their shared purpose--and that of the health care organization--is the patient. Focus groups of team members in two case study hospitals expressed generalized dissatisfaction with performance on all three key imperatives of well-functioning teams, but also generally agreed that team delivery of bedside nursing care can work if properly managed. Based on study findings, recommendations for process improvement are made.
Attitude of Health Personnel↗
Conducting effective focus groups in the context of diversity: theoretical underpinnings and practical implications.
Demographic trends reveal that the socially and culturally relevant diversity of patients, caregivers, and managers in health care organizations will continue to increase. In addition, social attitudes are moving from a goal of assimilation or homogenization to one of differentiation and maintenance of subgroup identity. These shifts in demographics and social attitudes require the associated development of theory and practice guidelines for focus groups conducted in the context of diversity. Diversity has a profound impact on factors ranging from study design to the selection and training of facilitators and the analysis of results. Racial identity development theory, models of communication style differences, ethnographic studies of cultural archetypes or ethnic markers, and the author's experiences in facilitating focus groups that explore the sensitive topic of race/ethnicity provide insights for researchers and practitioners who want to ensure that focus groups conducted in the context of diversity produce valid results.
Cultural Diversity↗
Data comparability issues in international research and quality assurance.
Impediments to and progress toward valid and reliable international quality comparisons at the diagnosis or case type level are identified and discussed. The need for uniformity in each of the following is established: (1) international clinical data set, (2) definitions of clinical data elements and (3) data collection practices. The need to establish a clinically adequate international data base is discussed and action steps are identified.
Data Collection↗
The EC's need for a common currency in health care quality assurance.
Argues that the economic integration of the EC's 12 member nations into a single community and the elimination of barriers to free trade will not result in a single health-care system. However, the closer relationships among the member nations and the members' individual desires for competitive advantage in the new marketplace will, inevitably, lead to an interest in comparing health-care systems along cost and quality dimensions. Without a common currency for quality assurance, such comparisons will be time consuming, costly and of questionable validity. Consensus must be achieved on the following: the essential elements in a database for health care quality assurance; common classification systems for key elements in the QA database; standardized conventions for coding practices to ensure data validity and reliability. Suggests an assessment of current practices in health data collection in the member nations; a pilot project to assess the feasibility of developing a common currency for quality assurance, and an EC-wide symposium to discuss data comparability issues as next steps.
Data Collection↗
Management information and self-governing NHS hospital trusts.
The proposal for self-governing hospital trusts within the NHS, announced in the White Paper Working for Patients on 31 January 1989 and enacted through passage of the National Health Service and Community Care Act 1990 last July, introduces free market incentives to NHS hospitals. Hospitals applying for self-governing status must first demonstrate that they have an information system appropriate to support decision making in the new context. An overall information systems flow and an approach to information systems development are recommended based upon the Freeman Hospital model. The Freeman Hospital is a national pilot site selected by the NHS Management Executive for development of information systems for NHS hospitals.
Budgets↗
A comparison of the resource intensity of inpatients in urban and rural nonteaching hospitals.
PL 98-21 mandated a prospective payment system based on diagnosis related groups (DRGs) for all Medicare inpatients. The predetermined payment for each DRG is intended to reflect the resources used to treat patients within the DRG. Eventually, the system will allow for one payment level for each DRG in rural hospitals and a higher payment level for the same DRG in urban hospitals. This represents an equitable approach, provided there is not a predominance of high severity cases in rural hospitals and that higher costs in urban hospitals are reflective of higher priced exogenous factors beyond the control of the hospital. Equitability also requires that DRGs capture the resource intensity of treatment for a given classification of patients, equally for urban and rural patients. This work compares the pediatric population of urban hospitals without a pediatric residency program with that of rural hospitals in terms of major diagnostic category, DRG, disease severity, length of stay, and charges. It also compares the capacity of DRGs to explain the variation in resource consumption in urban and rural hospitals. A sample of 116,721 discharges from 130 urban hospitals and a sample of 54,073 discharges from 97 rural hospitals are used in this work. The results indicate that there is no difference in the patient populations of these two hospital groups. The results also indicate that DRGs explain only 50 percent of the variance in the resource variables, but this obtains equally for both populations.
Child↗
Should children's hospitals have special consideration in reimbursement policy?
Children's hospitals were excluded indefinitely from the prospective payment system until a methodology for their reimbursement could be developed. Special consideration in reimbursement policy could be made for children's hospitals if their patients were generally more resource intensive than the pediatric patients of other hospitals. The resource intensity of patients in children's hospitals was compared with pediatric patients in other hospital groups. The results indicate that the patient population of children's hospitals is similar to the pediatric patient population of university hospitals and considerably different from the pediatric patient populations of the urban and rural hospitals.
Adolescent↗
A reconsideration of economies of scale in the health care field.
The Health Care Financing Administration has demonstrated an interest in the economies of scale phenomenon as it might apply to reimbursement methodologies. This paper provides a critical evaluation of the economies of scale research methodology and a critical review of both the analytical (LRAC estimates) and the implied economies of scale (spreading fixed costs) literature. Given that estimates of Minimum Optimum Scale are based on individual coefficients generated by a regression model, this work illustrates the danger inherent in this approach and examines the volatility of the coefficient values and their dependence upon model specification. The ambiguity present in the literature addressing the LRAC estimates is thereby explained. An evaluation of the implied economies of scale literature reveals that average fixed costs decrease with increasing levels of output. This should not be a surprise to anyone. The notion of economies of scale is implied in this literature but never addressed. It is suggested in this work that the means to better standardize the output of the hospital industry, the sine qua non of economies of scale research, is now available in various methodologies of patient grouping.
Centers for Medicare and Medicaid Services, U.S.↗
Capital financing in prospective payment.
In the era of prospective payment, arranging financing for hospital capital projects is expected to become even more complicated than under cost-based reimbursement systems. This article outlines the information needed for a bond issue in the prospective payment environment, defines the roles and duties of several external persons and organizations involved with planning a major capital financing, and provides an overview of the entire process. This article assumes for illustrative purposes that a tax-exempt bond issue is going to be used to finance a facility expansion. This method was chosen since over 70% of all major capital financing for hospitals use the tax-exempt bond as the principal vehicle for attracting the necessary debt to finance a major construction project. The tax-exempt bond issue also requires the most detail in documentation and legal provisions.
Capital Financing↗
Competitive forces in hospital care: the physician's, administrator's roles.
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Economic Competition↗
Three case-type classifications: suitability for use in reimbursing hospitals.
This study compared three case-type classifications--the cross-classification of the Commission on Professional and Hospital Activities, Diagnosis-Related Groups (DRGs) and Staging--with respect to per cent of variance in total patient charges accounted for. The purpose was to assess the relative usefulness of the classifications for application in hospital reimbursement schemes. The sample consisted of 50 hospitals. A nested analysis of variance was performed with case type nested within hospital. Per cent of variance accounted for was calculated for each of three data sets: the full data set, a truncated version of that set and a logarithmically transformed version. Results support the contention that none of the currently available classifications accounts for enough variance to permit straightforward use of case-type standard costs in a reimbursement mechanism. New developments in case-type classification may result in a classification that is more suitable for this use.
Analysis of Variance↗
Communication patterns and group composition: implications for patient-centered care team effectiveness.
To assess how diversity affects team communication and to identify strategies to improve communication and patient care, focus groups of care production team members were held in two case study hospitals that have implemented the patient-centered care model. Results indicate that care production team members generally support patient-centered care as a model that can work effectively in practice, even in an urban environment in which diversity concerns can affect team cohesiveness and communication. Successful implementation of the model, however, requires that hospitals consistently employ management strategies and reward structures that reinforce the value of teamwork and emphasize training and staff development. Key steps that healthcare executives can undertake to improve the performance of care production teams are detailed in this article and center around the following themes: team involvement in process improvement; a heightened emphasis on training (i.e., team and diversity training for all team members, task focused training for nonlicensed care givers; and leadership training for RNs); and the implementation of team-based reward and incentive structures.
Adult↗
Diversity leadership and organizational transformation: performance indicators for health services organizations.
Health services organizations can follow a five-part process to reposition themselves through diversity leadership. The first part of the process, discovery, refers to the emerging awareness of racial and ethnic diversity as a significant strategic issue; the second part, assessment, refers to systematic review of the organization's racial and ethnic diversity climate; the third part, exploration, denotes systematic training initiatives to improve the health services organization's ability to effectively manage diversity; the fourth part, transformation, refers to fundamental changes in organizational practices that result in a culture in which racial and ethnic diversity is valued; and the final part, revitalization, refers to renewal and expansion of racial and ethnic diversity initiatives to reward change agents and to include additional identity groups among the health services organization's diversity initiatives. This article presents a series of behaviorally based performance indicators for each of the five parts of the diversity leadership process. Healthcare executives are encouraged to assess their organization's strategic positioning against best demonstrated practices, as represented by the performance indicators. A method for analyzing organizational performance against the diversity leadership indicators is outlined as are suggestions for future research.
Benchmarking↗
Race, ethnicity, and careers in healthcare management.
This article discusses the result of a study we conducted to investigate the factors that facilitate or impede healthcare management career opportunities and satisfaction from the perspective of racially and ethnically diverse healthcare managers. These healthcare managers were invited to participate in focus groups wherein they engaged in a structured discussion of six questions germane to race, ethnicity, and healthcare management careers. Nineteen themes were identified in the study analysis, eight of which emerged in all focus groups irrespective of race and ethnicity. In this article, we discuss the implications of the results for research and organization change and development and we recommend plans of action in four areas identified from the 19 themes: (1) industry leadership, (2) health administration education, (3) health management research, and (4) best practices.
Attitude of Health Personnel↗