Online Program
Session Type: Paper Session
Program Session: 1875 | Submission: 20753 | Sponsor(s): (HCM)
Scheduled: Tuesday, Aug 13 2019 11:30AM - 1:00PM at Sheraton Boston Hotel in Beacon G
 
Role of Contextual Factors for Teams, Professionals, and Patients
Contextual Factors
Research

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Chair: Eva Maria Wild, U. of Hamburg
HCM: Role of Organizational and Market Factors in Nursing Home Hospitalizations: A Longitudinal Analysis
Author: Neeraj Dayama, U. of Arkansas Medical Sciences
Author: Rohit Pradhan, U. of Arkansas Medical Sciences
Author: Holly Felix, U. of Arkansas Medical Sciences
OBJECTIVES: To examine the association of organizational and market characteristics with nursing home hospitalizations. DESIGN: Cross-sectional time series. SETTING: All federally certified U.S nursing homes (except Hawaii and Alaska) in the period 2000-2014. MEASUREMENT: Analytical datafile was constructed by (county-year level) merger of nursing home data downloaded from LTCfocus.org data with Area Resource Files. Nursing home hospitalizations were regressed on facility characteristics and market (county-level) characteristics using panel data ordinary least squares regression with facility and year level fixed-effects. RESULTS: Nursing homes had an average of 0.94 (SD= 0.59) hospitalization per resident-year. Higher hospitalizations were seen in for-profit (1.56%), chain affiliated (0.65%), % Medicare (0.97%); whereas RN skill mix (-2.41%) and % Medicaid (-0.09%) were associated with lower hospitalizations, after adjusting for occupancy rate, case-mix, and hospital-based facility type. CONCLUSION: The study provides mixed evidence on nursing home organizational and market factors linked to hospitalizations; however, the question of policy importance for future study in view of the introduction of Skilled Nursing Facility Value-Based Purchasing program in 2019. Key words: nursing homes, hospitalizations, Medicare, market characteristics, long-term care
Paper is No Longer Available Online: Please contact the author(s).
HCM: The Role of Resources in Reducing Citizenship Fatigue among Healthcare Workers
Author: Matthew B. Perrigino, Elon U.
Author: Sofia Montalbo, Elon U.
Author: Robert Dickey, Elon U.
Author: Benjamin B. Dunford, Purdue
Author: Matt Troup, Conway Regional Health System
Author: Wayne Boss, U. of Colorado
Citizenship fatigue is a phenomenon where employees feel tired and worn out from engaging in extra-role behaviors. Previous research applies resource-based theories to argue that citizenship fatigue is caused by resource depletion. We integrate resource-based perspectives from the broaden-and-build theory of positive emotions and the positive organizational behavior literature to argue that the acquisition and possession of resources can help reduce experiences of citizenship fatigue. Among a sample of 272 healthcare employees from a hospital located in the Southeastern United States, we find that personal resources (e.g., optimism and self-esteem) are associated with lower levels of citizenship fatigue. We also find that the absence of organizational resources (higher levels of understaffing) leads to increases in citizenship fatigue. Although we found that the negative relationship between personal resources and citizenship fatigue was attenuated (i.e., weakened) when understaffing was low, we also found that average levels of citizenship fatigue were lower among these employees. We discuss the implications of our findings in terms of both future research and practical implications. In terms of practice, we highlight the importance of both personal and organizational resources as key mechanisms to limit experiences of citizenship fatigue.
Paper is No Longer Available Online: Please contact the author(s).
HCM: Examining the Influence of Proximal Density to Nurse Education Resources on Quality of Care Outcomes
Author: Courtney Nichole Haun, Auburn U.
A positive relationship has been demonstrated between nurse staffing and care quality. However, the extent of this relationship has been sparcely studied in long-term care facilities. The objective of this examination is to determine the influence of proximal density to nurse education resources (nursing schools) on care quality in nursing homes throughout the United States. Building from a previous study (Haun, Mahafza, Cook, & Silvera, 2018) that demonstrates a negative relationship as the resource dependence theory would advocate (Pfeffer & Salancik, 1978), this paper expands to include nursing homes throughout the entire nation. Thus, the study tests the hypothesis that there is a negative relationship between proximal density to nurse education resources (nursing schools) and care quality. Proximal density data is developed utilizing geographic information systems (GIS) software and analyzed via an ordered logistic regression utilizing nursing home data from CMS’s Nursing Home Compare (n=15,760) and nursing school data from the American Association of College of Nursing (n=811). This examination finds that proximal density to nurse education resources has a positive influence on nursing home quality outcomes, with the exception of one rating variable, health inspection. Additional analysis is offered to examine if the nature of this relationship is sensitive to health care facilities in locations of high or low resource densities. The results of this sensitivity analysis confirm principal findings. This examination builds on a previous study to better understand the relationship between nurse education resources and care quality by considering the role of proximal density to nurse education resources.
Paper is No Longer Available Online: Please contact the author(s).
HCM: Managing Constraints in Interdisciplinary Teams: Tactics for Continued Learning and Progress
Author: Mariam Krikorian Atkinson, Harvard U.
Author: Sophie Higgins, Harvard T.H. Chan School of Public Health
Author: Sara Singer, Stanford U.
Interdisciplinary teamwork has been recognized as a major driver of innovation across many industries, with teamwork influencing and influenced by contextual factors. External constraints, including all kinds of challenges from outside a team, can negatively influence teamwork and impede team progress. This paper used an ethnographic study of four interdisciplinary teams working to redesign and implement complex healthcare delivery processes to develop theory about external constraints and the tactics interdisciplinary teams use to overcome them. The study identified external constraints as occurring on vertical and horizontal dimensions: hierarchical constraints that came from management and heterarchical constraints that emerged from distributions of power and preferences among professionals in an organization. Teams facing these constraints deployed tactics to overcome them, including indirect tactics to influence the external environment via the team’s internal workings and direct tactics to directly influence the external environments. Three of the four teams were ultimately successful in progressing through their projects; one team halted project work as hierarchical constraints dominated team activities, and misalignment in the tactics to utilize led to discord among team members and ultimate dissolution. The constraint management process (CMP), presented herein, illustrates the vital need for interdisciplinary teams to understand external constraints, particularly the influence of both vertical and horizontal stakeholders, and the strategies they can utilize in response. KEYWORDS: constraint management, hierarchy, heterarchy, interdisciplinary teams
Paper is No Longer Available Online: Please contact the author(s).
  
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