Journal of Healthcare Management - March/April 2014 - (Page 119)

l e a d e rs H i p p erceptions of s tructures , p rocesses , Medicare & Medicaid Services (CMS) Core Measures data by Premier/CareScience using hospital CMS Certification Numbers (formerly known as Medicare Provider Numbers). More than 600 hospitals responded; those that could not be linked to AHA data or performance measures or that did not include respondents from all three groups were excluded from statistical analyses. In total, 320 hospitals and 6,023 respondents (1,100 board members, 1,436 C-suite executives, and 3,487 clinical managers) constituted the analysis set. The clinical managers included 416 physicians, 1,138 nurses, and 1,933 other managers of clinical units (Table 2). The analysis set of hospitals represents a variety of institutions in terms of characteristics often associated with differences in hospital performance: bed size, system membership, ownership status, and teaching status (Table 2). Percent-positive scores for each respondent on each domain were derived by calculating the proportion of positive responses for all questions related to that domain. For example, on a 5-point response scale ranging from Strongly Agree to Strongly Disagree, Strongly Agree and Agree are considered positive responses. Using this methodology, percent-positive scores were calculated for every question, averaged over the domain items for each individual respondent, and then aggregated by respondent type at the hospital level. Differences could not be examined between clinical managers and the board or C-suite respondents on the three domains that were different between Form A and Form B. and p riorities for Q uality Confidence in the validity of the HLQAT domains was based on the multiple survey vettings. CMS Core Measures were used to create the dependent measure. The Core Measures were selected because they are employed in various programs, such as the Hospital Quality Initiative (Jha, Orav, Zhonghe, & Epstein, 2007; Jha, Orav, Dobson, Book, & Epstein, 2009), and are widely recognized through public reporting on CMS's Hospital Compare website. Werner, Bradlow, & Asch (2008) argue that the Core Measures may also reflect nonmeasured aspects of care. These metrics represent the percentage of hospital patients who receive appropriate care as measured against evidence-based processes for improving care. Metrics address acute myocardial infarction, heart failure, pneumonia, and the Surgical Care Improvement Project, as well as an overall score. The mean percentages of patients receiving the appropriate interventions across all of the Core Measures were combined to derive the Process Index score for each hospital. The Cronbach's alpha for this index was 0.81, which is generally considered strong enough to treat a set of items as an index (Nunnally, 1978). To address the first research question of whether higher domain scores are related to better clinical performance, "high" and "low" performing hospitals were designated by rank ordering the hospitals' Process Index scores. High-performing hospitals were those whose Process Index scores were in the top third. Low-performing hospitals were those in the bottom third, while the middle third were excluded from the comparisons to create a more clear 119

Table of Contents for the Digital Edition of Journal of Healthcare Management - March/April 2014

Journal of Healthcare Management - March/April 2014
Contents
Interview With Marna P. Borgstrom, FACHE, President and Chief Executive Officer, Yale New Haven Health System, and Chief Executive Officer, Yale-New Haven Hospital, Connecticut
Specialties: Missing in Our Healthcare Reform Strategies?
Costs and Benefits of Transforming Primary Care Practices: A Qualitative Study of North Carolina’s Improving Performance in Practice
Governing Board, C-suite, and Clinical Management Perceptions of Quality and Safety Structures, Processes, and Priorities in U.S. Hospitals
Use of Electronic Health Record Documentation by Healthcare Workers in an Acute Care Hospital System
Why Hospital Improvement Efforts Fail: A View From the Front Line

Journal of Healthcare Management - March/April 2014