BACKGROUND:Nurse staffing directly affects patient outcomes and hospital performance, creating a cost-versus-care dilemma, especially in rural areas with nursing shortages. PURPOSE:To examine the impact of nurse staffing patterns on Pennsylvania's rural hospital performance using 2000-2023 data. DATA SOURCE/STUDY SETTING:Data from 2000 to 2023 on Pennsylvania rural hospitals were drawn from several sources, including the Pennsylvania Department of Health, the Pennsylvania Healthcare Cost Containment Council, and the American Hospital Directory. After excluding hospitals with incomplete or unavailable data, the final sample comprised 1,606 hospital-year observations. METHODOLOGY/APPROACH:This retrospective, longitudinal study analyzed acute care hospitals in Pennsylvania's rural counties using unbalanced panel data. We use robust econometric modeling to investigate how nurse staffing levels, skill mix, and flexibility influence financial sustainability, operational efficiency, and quality of care. RESULTS:Increased staffing and a higher skill mix increased costs per adjusted patient day but significantly reduced readmissions, mortality, and average length of stay (ALOS). Interestingly, staffing flexibility, while not impacting costs, increased ALOS, a finding consistent with previous research. Staffing decisions and patient outcomes are intertwined, demanding careful consideration in resource-constrained rural settings. CONCLUSIONS:Rural hospital performance is strongly linked to nurse staffing. While increasing staffing and skill mix may incur higher initial costs, they ultimately enhance patient outcomes and operational efficiency, contributing to long-term financial stability despite any short-term expenses. PRACTICE IMPLICATIONS:The insights from this study are vital for administrators and policymakers focused on enhancing healthcare in rural areas. Therefore, a shift is required: from cost-centric to value-based staffing, emphasizing RNs, a balanced skill mix, data-driven decisions, and policy support to address rural health care challenges.
BACKGROUND:Hospital mergers and acquisitions (M&As) reduce resource dependence on sources of input and purchasers of output, via market power, service diversification, and operational efficiency. While prior research has examined M&A effects on quality and pricing, less is known about their effects on supply chain cost performance-a core input to health care delivery and a frequently cited but not always realized driver of consolidation. PURPOSE:To determine the impact of hospital M&As on acquired hospital operating costs, in terms of magnitude and timing, and compare possible efficiencies in supply expenses relative to other expense categories. METHODOLOGY:We analyzed a longitudinal data set of U.S. acute care hospitals (2016-2021) using propensity score matching and panel regression. This approach isolated the effect of merger events on total operating expenses, salary expenses, supply expense categories (medical-surgical and pharmaceutical), and net income. FINDINGS:Acquired hospitals experienced significant reductions in total operating expenses in the postmerger period. These savings were largely attributable to streamlined payroll costs. We observed a modest reduction in medical-surgical supply costs 1 year post-acquisition, but no significant change in pharmaceutical supply costs. PRACTICE IMPLICATIONS:Supply chain cost savings from hospital acquisitions are easy to imagine but elusive to realize. Hospital leaders should first seek targets whose supply chain operations, strategies, and partners fit their own, and proactively communicate and integrate supply chain operations during post-acquisition planning to realize the anticipated operational synergies.
INTRODUCTION:Health care is increasingly organized in interorganizational networks, with patient participation gaining prominence to better tailor care to patient needs. However, these often occur independently, limiting understanding of how to organize interorganizational patient participation. Poorly implemented participation risks draining time and energy from vulnerable groups without creating meaningful change. METHODS:We conducted an in-depth case study of a multihospital network, using 23 semistructured interviews with patients, health care staff, and network administrators, 77 hours of observations, and 276 documents to explore how interorganizational patient participation functions. RESULTS:Our findings reveal the patient participation puzzle : the tension between the aspiration for patient participation at all interorganizational levels and its potential burden and unclear impact. Four interrelated themes emerged: aim, organizational structure, participant attributes, and impact. We distinguished participation within the network's operational level, closely tied to care delivery, and in network strategy, where patients' contributions are less clearly defined. CONCLUSION:Patient participation in network strategy often lacks clear aims, leaving patients' roles unclear and imposing undue burden. Key participant attributes like experiences and perspectives influence engagement but can also pose challenges. Participation's impact is not inherent; without clear aims, structures, and roles, it risks becoming symbolic and burdensome without meaningful impact. PRACTICE IMPLICATIONS:Organizing patient participation in health care networks is quite the puzzle. To avoid window dressing, network managers should acknowledge patient burden, set clear goals, act on patient input, and organize carefully to prevent tokenism. Accreditation bodies and policymakers should prioritize guidance and support over mandates to ensure meaningful impact.
BACKGROUND:Artificial intelligence (AI) enabled systems hold significant promise for transforming health care delivery. These technologies are frequently developed and commercialized by firms focused on creating innovative products or services and positioning them as essential solutions for clinical and organizational needs. However, despite their transformative potential, the integration of artificial intelligence into routine clinical practice has been met with notable resistance from physicians. PURPOSE:The purpose of this systematic review was to examine the factors contributing to physicians' resistance to AI-enabled technologies in clinical practice. Rogers' Diffusion of Innovations (DOI) theory was employed as the guiding theoretical framework to analyze how perceived innovation attributes shape physician resistance. METHODOLOGY/APPROACH:We conducted a PRISMA-guided systematic literature review across five databases, examining sixteen empirical studies from the United States published in English. CONCLUSION:We identified resistance factors for AI among physicians in clinical practice using a deductive approach guided by Rogers' Diffusion of Innovations (DOI) framework, focusing on perceived relative advantage, compatibility, and complexity of AI-enabled technologies. PRACTICE IMPLICATIONS:These findings show that physician adoption of AI tools depends on whether innovations demonstrably improve clinical quality, efficiency, and workload compared with existing practices. Adoption is strengthened when hospital leaders make benefits visible through data, pilots, physician champions, and collaborative testing environments that build trust and reduce uncertainty about the technology's value.
Background: Considering the future of work and an aging workforce, emerging technologies such as artificial intelligence (AI) and robots are promising fields to promote wellbeing, companionship, and care, together with operational efficiency in workplaces. Purpose: Using Design theory, this review examines how AI-pet robots can be adopted to interact with aging workers in innovation districts and health care innovative environments, considering the Human-robot attachment and Ethorobotics approaches. Methodology/Approach: A scoping review was guided by the Population, Concept, Context (PCC) framework, as suggested by the Joanna Briggs Institute (JBI), to explain the scope and eligibility criteria, followed by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Academic peer-reviewed transdisciplinary studies that were published on or before 2024 were sourced from the Scopus and Web of Science databases. The review included empirical and non-empirical studies, published in the English language, and excluded non-peer-reviewed publications. Results: A total of 31 studies were reviewed. The key findings revealed that AI-pet robots enhance emotional wellbeing through human-robot attachment. By adopting a human-centric perspective, organizations can implement advanced technologies that promote not only productivity but also companionship and support for aging workers. These findings provide a strategic health care management pathway for innovative solutions that integrate AI-driven pet robotics into workspaces, specifically in innovation districts. Practice Implications: The study emphasizes the transformative potential of AI-pet robots, in addressing the challenges of an aging workforce within innovation districts. While most of the reviewed studies are situated in general innovation environments and health care, the findings have strong applicability to innovation districts. The results reveal that human-robot attachment, supported by AI and the Ethorobotics approach enhances emotional wellbeing and operational efficiency in workplaces. These insights are particularly relevant to innovation districts, where human-centered technologies can be trialed and embedded to support inclusive workforce transitions.
BACKGROUND:Effective expatriate management has become crucial in the health care sector, driven by the growing number of globally mobile professionals. The Saudi Ministry of Health data shows that 53% of the health care workforce in Saudi Arabia is comprised of expatriates, with expatriate health care workers constituting up to 90% of the workforce in some Gulf Cooperation Council (GCC) countries. In addition, technological advancements such as telemedicine, artificial intelligence, and electronic health records are transforming health care delivery, presenting both opportunities and challenges for expatriate health care workers. Despite these trends, there is a lack of research in examining expatriate outcomes for health systems. PURPOSE:The purpose of this paper is to examine the advantages and challenges of employing expatriates in Saudi Arabia's health care industry. METHODOLOGY/APPROACH:This study employs a mixed-methods approach. Qualitative data were collected from the top management team (TMT) overseeing health care expatriates (N=32), and thematic analysis was used to analyze the data. The findings of this study were triangulated with the secondary data collected from the Ministry of Health and the Saudi Health Council. FINDINGS:The findings reveal five primary advantages-international clinical experience, health care professionalism, ethical patient care, adaptability to local environments, and workforce diversity-and four main challenges: high expatriate labor costs, Saudization policies, operational risks related to knowledge transfer, and language barriers in patient communication. CONCLUSION:There are more advantages of employing expatriates than challenges, leading to a novel framework. Findings were triangulated with secondary quantitative data, which confirmed the same. This study fills a gap in the expatriate workforce literature by providing empirical insights from the underexplored context of the Middle East, particularly Saudi Arabia. It extends Caligiuri's performance dimension theory by integrating performance outcomes and contextual challenges specific to health care expatriates in Saudi Arabia. The study also offers actionable recommendations to overcome operational challenges, such as expatriates' reluctance to share knowledge and challenges associated with the Saudization policy, with the ongoing need for skilled expatriates. It also contributes to the human resource management and health care/aged care management literature. PRACTICAL IMPLICATIONS:The study recommends fostering public-private collaborations and partnerships between health care institutions and global universities to address skill gaps and ensure workforce sustainability in Saudi Arabia's health care sector.
BACKGROUND:As global populations age, health care systems face mounting pressure to provide accessible, efficient, and patient-centered care. Digital health technologies offer promising solutions for supporting older adults' independence and chronic disease management; however, adoption remains inconsistent due to barriers related to perceived usefulness (PU), perceived ease of use (PEOU), and attitudes toward technology (ATT). PURPOSE:This systematic review and meta-analysis synthesized existing evidence on digital health technology acceptance among older adults, identifying key determinants of behavioral intention (BI) and examining moderating effects of culture, age, and technology type. METHODS:A comprehensive search across PubMed, Scopus, and EBSCOhost identified 59 eligible studies. Of these, 19 studies with quantitative data were included in a meta-analysis using random-effects modeling. Correlation coefficients were converted to standardized path coefficients (β) for comparability. Subgroup and meta-regression analyses assessed heterogeneity and moderator effects across cultural regions, age groups, and technology categories. RESULTS:Perceived usefulness emerged as the strongest predictor of adoption (PU → BI: β = 0.72, 95% CI: .70-.73), followed by attitude (ATT → BI: β = 0.53, 95% CI: .50-.56). Perceived ease of use exerted an indirect influence through usefulness (PEOU → PU: β = 0.60), highlighting the interdependence between usability and perceived benefits. Substantial heterogeneity (I2 = 57.5%-99.7%) reflected genuine contextual diversity. Moderation analyses revealed stronger relationships in Western cultures and among younger-old adults (60-70 years). Technology-specific differences showed that digital health platforms benefited most from usefulness-driven adoption, while assistive technologies depended heavily on usability. CONCLUSIONS:Acceptance of digital health technologies among older adults is shaped by perceived usefulness, ease of use, and contextual moderators such as culture, age, and technology type. The findings underscore that technology adoption in aging populations is not universal but deeply context-dependent. PRACTICAL IMPLICATIONS:Health care administrators and designers should prioritize interventions that enhance perceived usefulness and usability through evidence-based, context-specific strategies such as outcome-driven feedback systems, intuitive interfaces, and culturally tailored digital literacy programs. Policy efforts should support iterative evaluation frameworks that adapt to diverse user needs to ensure equitable and sustainable technology adoption in health and aged care.
Background: Intermediate Care (IMC) provides intensive rehabilitation to prevent long-term disability among partially dependent individuals. Demand for IMC in Thailand is rising, yet governance frameworks remain underdeveloped. The Seamless Health and Social Services Provision for Elderly Persons (S-TOP) project, a Japan International Cooperation Agency (JICA) pilot, aimed to strengthen IMC governance by improving service delivery for older adults. Purpose: To explore and compare the governance models of IMC in two pilot sites in Thailand from the viewpoints of health and social service providers. Methodology/Approach: We explored IMC governance within JICA pilot sites through a qualitative comparative case design. We gathered data from 13 in-depth interviews, site visits, and document reviews. Using thematic analysis, we compared different governance patterns from the provider’s perspective to understand how local contexts shape implementation, transdisciplinary teamwork, and overall governance. Findings: Two distinct governance models emerged, both perceived by stakeholders as having achieved integration of health and social care. The lead organization model enabled direct service creation and flexible resource allocation, while the shared governance model leveraged strong health care networks and community altruism to coordinate care within the national framework. Despite differing in seniority structures, with one based on position and the other on age, both models enhanced service accessibility and promoted health equity through tailored, community-based systems. Conclusions: Community-based IMC governance succeeds when aligned with local structural and cultural contexts. The integration of health and social care requires adaptable mechanisms, whether through local government leadership or collaborative health care networks, while respecting culturally embedded decision-making norms. Practice Implications: The lead organization model suits decentralized settings with strong local government. The shared governance model suits centralized settings with robust health care networks and cultural assets like age-based seniority and altruism. Health administrators should cultivate transdisciplinary teams that integrate professional expertise with community knowledge and respect local decision-making norms.
BACKGROUND:Dental, vision, and hearing impairments are among the most prevalent long-term conditions affecting older adults, contributing to late-life disability and reducing quality of life. Early detection and prevention may reduce avoidable emergency hospitalizations and health system costs while enhancing well-being. Despite this, integrated service delivery across these sensory and oral health domains remains limited, especially in community care settings. AIM:This systematic review aimed to synthesize evidence on integrated workforce models involving dental, vision, and hearing professionals within community care settings for older adults. METHODS:A mixed-method systematic review was conducted using a comprehensive three-step search strategy across MEDLINE, CINAHL, Web of Science, Embase, and Scopus spanning January 2010 to December 2024, and updated in October 2025. In all, 798 articles were identified, with 14 meeting inclusion criteria for convergent integrated synthesis. Included studies involved adults aged 60+ or with samples containing at least 50% older adults, examining community-based models where dental, vision, or hearing personnel collaborated with at least one other health or welfare provider. Critical appraisal and data synthesis followed the Joanna Briggs Institute methodology. RESULTS:Of the 14 studies (5 qualitative, 6 mixed methods, 3 quantitative), 9 focused on dental, 3 on vision, and 2 on hearing workforce models. Studies were primarily from the United States (n=8), Australia (n=2), the Netherlands (n=2), Germany (n=1), and Norway (n=1). Two workforce model types emerged inductively: profession-led models (n=10), characterized by leadership and care coordination, and led by a dental, vision or hearing expert, and collaborative-led models (n=4), featuring shared leadership and an extended skill mix. Profession-led models emphasized clinical interventions; collaborative-led models prioritized health promotion and prevention. Reported outcomes primarily related to service delivery, workforce processes, and patient experiences, including patient satisfaction. Evidence of clinical effectiveness outcomes was limited, and studies varied substantially in design, context and outcome measures. CONCLUSION:Integrated workforce models in dental, vision, and hearing for older adults in community care show promise in improving care delivery processes and patient-reported outcomes. However, the current evidence base is limited and heterogenous, with few robust evaluations of clinical effectiveness. As such, these models need to undergo further rigorous research to assess their effectiveness, scalability, and context-specific implementation.
Health and aged care systems are increasingly confronted by ageing-related challenges that exceed the boundaries of any single discipline, profession, sector, or policy domain. This commentary proposes a transdisciplinary framework for health and aged care management as a shift from parallel domain-specific reforms to the deliberate design of structurally interconnected systems. We argue that workforce design, models of care, technology, governance, financing, and place-based environments must be understood as mutually constitutive elements of healthy ageing systems rather than discrete areas of improvement. The papers included in this special issue illustrate this systems-oriented framework across diverse contexts, including Saudi Arabia, Thailand, India, Finland, Malaysia, the Asia-Pacific region, and community care settings in high-income countries. Collectively, they demonstrate that reforms are more effective when governance arrangements align workforce capability, digital infrastructure, financing mechanisms, referral pathways, community legitimacy, and accountability structures. Conversely, siloed reform can exacerbate inequities, particularly in low- middle-income countries where fragmented systems divert scarce resources and shift hidden costs to families and communities. We argue that future research in health and aged care management should move beyond evaluating standalone innovations towards examining the “connective tissue” of reform: how integration is designed, governed, financed, implemented, measured, scaled, and sustained across systems. Transdisciplinary integration should therefore be understood not as a rhetorical aspiration, but as a practical governance discipline for ageing societies.
Background: With the global increase in the elderly demographics, significant challenges are presented for urban environments. The escalation of urbanization and migration trends engenders a heightened demand for cities that are conducive to the needs of older adults. India, with 10.5% of its population aged 60 years and above (National Statistical Office, 2023), faces an urgent imperative to develop age-friendly urban environments. Cities like Bengaluru exemplify both opportunities and challenges in achieving this. As a result, Bengaluru's elderly population is growing, but the city lacks infrastructure to meet their needs. This study assesses the city's age-friendliness in several important areas, matching WHO standards with the Indian setting to offer workable urban solutions. Methodology/Approach: A cross-sectional study was conducted across 27 geographic locations comprising 214 discrete public amenities in Bengaluru, using the WHO's "Checklist of Essential Features of AFCC." Data were analyzed across eight domains. Locations were scored across all these domains and categorized based on cumulative scores as not age-friendly, moderately age-friendly, and age-friendly. Results: Among the 27 locations assessed, it was noted that 19 (70.4%) of public areas were clean, 23 (85.2%) of them lacked wheelchair-accessible pavements, and 26 (96.3%) had no safe pedestrian crossings. Well-connected transportation was available in 17 (63%) locations, but only 1 (3.7%) had specialized transport for disabled individuals. Among 25 locations deemed suitable, 20 (80%) were suitable, with only 3 (12%) suitable for the disabled. Overall, 2 (7.4%) locations were completely age-friendly, 2 (7.4%) locations were moderately age-friendly, while the remaining majority, 23 (85.2%) locations, were not age-friendly. Conclusion: This study showcases the varying landscape of urban amenities for the aging population. The results depict deficiencies in accessibility, health care services, and housing. The conceptual framework proposed through this study encompasses key elements promulgated in the UN Healthy Aging Agenda: 2020-2030.Practice Implications: This study provides actionable insights for policymakers and urban planners to improve age-friendly urban spaces. By combining inclusive transportation, technology-driven healthcare solutions, and accessible public areas, the proposed framework addresses the social and infrastructural gap. Aligning the city planning with the global frameworks for Age-friendly Cities and Communities (AFCC) standards will ensure that older people live independently, fairly, and with dignity.
Background: Health care service providers face increasing challenges in delivering high-quality care due to an aging population, workforce shortages, and limited financial budgets. Mobile Integrated Healthcare (MIH) offers an alternative value-based solution for elderly patients with manageable acute conditions at home. Finland is piloting this model, but its value, task redesign, and cost-efficiency require thorough evaluation before formal integration. Purpose: This study explores the value of MIH for patients and the health care system through the lens of value creation, delivery, and capture. Methods: Qualitative data were collected via semistructured interviews with 21 frontline health care professionals (HCPs) involved in Finland’s MIH service. Results: MIH provides human-centered acute care for the elderly, enabling convenient access to emergency services at home and reducing unnecessary hospital visits. Value is cocreated through integrated networks of emergency and social services, leveraging paramedics’ and geriatric nurses’ expertise while standardizing care pathways. Effective implementation requires coordination and task-shifting across emergency departments, MIH teams, and social care providers. Conclusions: MIH enhances care quality, supports elderly independence, and contributes to the sustainability of the health care system by reducing emergency interventions and hospitalizations. Practical Implications: Health managers should prioritize skill development for health care professionals (HCPs), integration across governance, service, HCPs, and patient levels, and the establishment of coordinated information systems. This study offers policymakers a valuable example of how MIH can be organized within a collective, publicly funded health care system to promote equity, accessibility, and sustainability for value-based health care.
Background: With the rapid agiing of populations globally, the demand for long-term care (LTC) services for older people is growing exponentially. However, policy responses across the region have varied significantly. Purpose: This scoping review aims to map and describe available policies that address LTC within the Asia-Pacific Aged Care Hub (APACH) countries, specifically examining governance, implementation, and strategic challenges in this area. Methodology/Approach: This scoping review followed the framework as outlined by Arksey and O’Malley (2005). A comprehensive literature search was conducted on five electronic databases, including PubMed, Scopus, CINAHL, and Web of Science. Grey literature was identified through Google Scholar, government and public health websites. A two-stage screening process was undertaken by two reviewers independently, which was followed by data extraction and synthesis. Findings: We identified 310 articles, of which 85 were included for full review. The studies revealed that there are health policies in place in all the APACH countries. The two prevalent LTC models are residential care and community-based care. The policy documents have a common focus on LTC for older adults with emphasis on infrastructure, governance and funding, and capacity building. Effective operationalization of the existing policies has been challenged by current structural and capacity issues. Although the aged care policies have included monitoring and evaluation frameworks, comprehensive assessments of policy impact remain limited. Conclusions: Though there are policies for LTC, the review highlights significant gaps in the implementation of these policies across the APACH countries. There is a pressing need for robust regulatory frameworks and interagency collaboration to provide sustainable LTC approaches. Practical Implications: Although APACH countries have adopted several approaches to LTC, it is critical to strengthen policies and initiatives regarding regulatory frameworks, health and social care integration, quality standards, and cultural adaptability to improve LTC administration and management.
ISSUE:Health care organizations face pressure to advance environmental sustainability. Core challenges include pursuing distant-future goals (e.g., climate neutrality by 2050), leading sustainability initiatives beyond formal authority, and making mitigation decisions whose benefits accrue in the future and outside the organization. CRITICAL THEORETICAL ANALYSIS:Dominant management theories tend to treat the future as a strategic context or planning horizon rather than as an object of sustained organizational work. Long-term orientation is often assumed rather than explained. Leadership is conceptualized as hierarchical or professionally anchored, leaving distributed and extra-professional leadership weakly theorized. Moreover, prevailing theories assume alignment between decision-makers and beneficiaries, privileging value creation and capture while inadequately addressing harm reduction and externalized and future-oriented environmental benefits and costs. INSIGHT/ADVANCE:We suggest a shift from treating the future as a given condition to be anticipated or adapted to, toward actively pursuing distant futures as ongoing organizational work. We conceptualize sustainability leadership as distributed across fragmented authority structures and reframe environmental sustainability as a governance challenge of managing asymmetric costs and benefits alongside clinical priorities. Reframing of sustainability leadership provides opportunities for healthcare management research to advance environmentally sustainable health care through managerial work. PRACTICE IMPLICATIONS:We highlight the need for health care managers to actively sustain future-oriented goals over time, lead sustainability initiatives without relying solely on formal authority, and develop decision and performance frameworks capable of integrating temporally and spatially uneven payoffs.
BACKGROUND:Polypharmacy and the use of potentially inappropriate medications (PIMs) are major concerns in managing older adults with multiple chronic conditions, as they can increase the risk of adverse drug reactions. However, data on deprescribing interventions for older persons in lower- to middle-income countries (LMIC) remains limited. PURPOSE:To develop and evaluate the feasibility of the Physician-Pharmacist Partnership Intervention to Deprescribe Medications (P3iD) among ambulatory older persons. METHODOLOGY/APPROACH:The P3iD, a health workforce model intervention for deprescribing medications among older adults, was developed based on findings from previous literature and a qualitative study. This intervention consists of five steps: (1) potentially inappropriate medication (PIM) identification, (2) decisions on prioritization of cessation, (3) medication withdrawal, (4) monitoring and support, and (5) documentation. A feasibility study was conducted in March 2022 at a tertiary primary care clinic at a teaching hospital, which offers general outpatient services, including preventive care, routine health check-ups, and chronic disease management. Participants aged 65 years or older with multiple chronic diseases, prescribed five or more medications with at least one PIM (according to Beer's Criteria 2019), were recruited. Physician partners were drawn from their treating physicians, who comprised family medicine trainees. The intervention was conducted by a pharmacist in collaboration with the patient's doctor. RESULTS:Twenty participants and 14 doctors were recruited. Participants consumed a total of 167 medications, from which 36 (22%) PIMs were identified. Deprescribing was performed on 14/20 (70%) older patients. The number of PIMs accepted for deprescribing was 19/36 (52.7%). CONCLUSION AND PRACTICE IMPLICATIONS:Recruiting older adult participants and conducting the P3iD in a tertiary primary care clinic was feasible. Incorporating deprescribing into routine practice through periodic medication reviews provides a structured, safer, and more effective approach to managing polypharmacy and improving patient outcomes, subsequently optimizing health management and strengthening health care systems.
BACKGROUND:Promoting manager well-being is important for organizations. Failure to do so can harm employees directly through contagion effects on employee well-being and indirectly by hindering managers' leadership efforts. This comes with the risk of reducing employee motivation and job satisfaction, potentially harming organizational performance. Despite its importance, manager well-being remains underexplored in research. PURPOSE:This study aims to enhance the understanding of demands and resources in the psychosocial work environment of frontline hospital managers and how these factors are associated with their well-being. METHODOLOGY/APPROACH:Using a sample of 514 frontline managers working in Danish hospitals, we analyzed relationships between psychosocial work environment factors and manager well-being through descriptive statistics and OLS regressions. Qualitative insights from an open-ended question were further used to illustrate the investigated dynamics. RESULTS:We observed substantial variation in the managers' well-being levels, with average levels lower than those in the Danish general population. Frontline hospital managers face substantial demands in their daily work, but they also report having access to important resources. For the associations between factors in the psychosocial work environment and manager well-being, we found particularly strong associations between frontline hospital manager well-being and the organizational climate, possibilities for performing work tasks, and emotional as well as quantitative demands. PRACTICE IMPLICATIONS:This study contributes to knowledge on well-being among frontline managers and highlights critical factors for public organizations to address in their efforts to support well-being among their managers.
BACKGROUND:Despite the growing demand for patient-centered care (PCC), there is a limited understanding of how hospitals configure and coordinate patient-facing technologies, such as Patient Engagement Systems (PES), telehealth, and Remote Patient Monitoring (RPM), on a national scale. PURPOSE:This study seeks to identify existing technology configurations in U.S. hospitals and analyze the association between these configurations and various hospital performance measures. METHODOLOGY/APPROACH:Using cluster analysis on data from over 3,300 U.S. hospitals, we developed a taxonomy of three distinct technology configurations: Patient-Centric Pioneers, Selective Tech Adopters, and Traditional Care Providers. The differences in structural characteristics and performance measures among these groups are statistically analyzed. RESULTS:Hospitals in the Patient-Centric Pioneers group, which fully implement and effectively integrate PES, telehealth, and RPM, consistently outperform the others in terms of efficiency, clinical quality, and patient satisfaction. Selective Tech Adopters displayed the highest manpower productivity. However, they did not achieve better patient satisfaction than Traditional Care Providers with limited technologies. PRACTICE IMPLICATIONS:Our research presents a comprehensive, robust empirical taxonomy of PCC technology configuration and technology complementarity literature, highlighting a strong correlation between a holistic technology strategy and improved hospital-level performance. These findings encourage hospital administrators and policymakers to support the strategic and integrated implementation of PES, telehealth, and RPM, even after the COVID-19 pandemic has passed.
BACKGROUND:Health information technology (HIT) investments are on the rise, yet research on the impact of HIT sourcing strategies on hospital performance is limited. PURPOSES:This study defines a two-dimensional framework for assessing a hospital's IT sourcing strategy using vendor turnover and concentration of applications among vendors. We study the impact of these dimensions on hospital performance metrics, including costs and quality outcomes. METHODOLOGY/APPROACH:We analyze HIT sourcing patterns using a data setof over 2,500 U.S. hospitals from the Healthcare Information and Management Systems Society database, the Centers for Medicare and Medicaid Services Hospital Compare Data, and the American Hospital Association Annual Survey Database. We apply ordinary least squares and two-stage least squares analysis to evaluate the effects of vendor turnover and application concentration on hospital ratings, readmission rates, IT operating expenses, and total operating costs. FINDINGS:Greater application concentration among fewer vendors and reductions in the number of vendors are associated with lower readmission rates and lower operating costs. In contrast, adding vendors is associated with higher operating expenses. The findings suggest that vendor consolidation can improve efficiency and selected quality outcomes, whereas frequent vendor expansion may increase financial and operational burdens. PRACTICE IMPLICATIONS:Managers should adopt strategic approaches to HIT sourcing. Prioritizing application concentration and managing vendor turnover effectively can boost quality and efficiency. Although multisourcing offers flexibility, evidence favors concentration for performance gains. Future research should explore the broader impact of sourcing strategies on innovation, patient outcomes, and HIT adaptability in evolving health care environments.
BACKGROUND:High staff turnover in residential aged care threatens both care quality and workforce sustainability, highlighting the urgent need to understand factors that support employee well-being and performance. PURPOSE:Building on self-determination theory and the kaleidoscope career model, this study examines how psychological empowerment, authenticity, balance, and challenge predict career sustainability among eldercare staff. METHODOLOGY:Cross-sectional survey data from 370 staff in 21 facilities in metropolitan and regional Australia were analyzed. Participants completed validated measures of the predictor variables, job satisfaction, psychological distress, and task performance. Hypothesized relationships were tested using structural equation modeling. RESULTS:Psychological empowerment was positively related to job satisfaction and task performance and negatively related to psychological distress. Contrary to expectations, an authentic career orientation was negatively associated with job satisfaction and positively associated with psychological distress. Balanced career orientation was not associated with any sustainable career indicators. Challenge career orientation was positively associated with job satisfaction and negatively associated with psychological distress. PRACTICE IMPLICATIONS:Given the predictive value of psychological empowerment and challenge career orientation for workers' career sustainability, HR professionals and line managers need to be aware of the importance of fostering psychological empowerment in the workplace, and enabling opportunities for growth and development across the working life. In doing so, career sustainability can be protected and supported, which will be reflected in improved retention-relevant outcomes, well-being, and performance. Findings suggest that authenticity-oriented career priorities may be more difficult to realize in structurally constrained care settings.
Background: Organizational compassion (OC), the process in which members of an organization collectively notice, feel, and respond to distress within their organization, can buffer against the stressors experienced by health care professionals. A growing body of research has examined the experiences, outcomes, and contributing traits of organizational compassion in health care. Purpose: The purpose of this review was to synthesize this literature in order to illuminate the processes and practices that foster compassionate organizations and enhance providers’ well-being. Methods: We followed the JBI guidelines for mixed-methods reviews, using a convergent segregated approach. Two independent reviewers completed screening, quality assessment, and extraction. Conflicts were resolved by discussion or by a third reviewer. Meta-aggregation was used to synthesize qualitative findings; quantitative results were synthesized narratively. Results: Twenty-four studies (16 qualitative and eight quantitative) were included. Synthesized qualitative findings captured (1) the benefits and enablers of organizational compassion, and (2) the personal and shared journeys of organizational compassion through understanding, becoming, and embodying compassion. A variety of outcomes, predictors, and mediators of OC were identified from the quantitative studies. Notable points of convergence and divergence were found between qualitative findings and quantitative results. Practice Implications: A supportive work environment that nurtures sustainable leadership, procedural knowledge, workplace friendships, a culture of service, self-compassion, connections, and space can bring numerous benefits at both individual and organizational levels. Cultivating compassionate organizations is multifaceted and depends on individuals and the overall institutional context. When employees in health care settings experience compassion, it positively impacts their psychological and emotional well-being, enhancing their workplace behavior and performance.
