Identifying and Measuring Administrative Harms Experienced by Hospitalists and Administrative Leaders

Author:

Burden Marisha1,Astik Gopi2,Auerbach Andrew3,Bowling Greg4,Kangelaris Kirsten N.3,Keniston Angela1,Kochar Aveena5,Leykum Luci K.67,Linker Anne S.5,Sakumoto Matthew3,Rogers Kendall8,Schwatka Natalie9,Westergaard Sara10

Affiliation:

1. Division of Hospital Medicine, University of Colorado School of Medicine, Aurora

2. Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois

3. Division of Hospital Medicine, University of California, San Francisco

4. Division of Hospital Medicine, University of Texas Health, San Antonio,

5. Division of Hospital Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, New York

6. Medicine Service, South Texas Veterans Health Care System, Department of Veterans Affairs, San Antonio

7. Department of Medicine, Dell Medical School, The University of Texas at Austin

8. Division of Hospital Medicine, University of New Mexico, Albuquerque

9. Center for Health, Work & Environment, Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora

10. Division of Hospital Medicine, University of Wisconsin School of Medicine and Public Health, Madison

Abstract

ImportanceAdministrative harm (AH), defined as the adverse consequences of administrative decisions within health care that impact work structure, processes, and programs, is pervasive in medicine, yet poorly understood and described.ObjectiveTo explore common AHs experienced by hospitalist clinicians and administrative leaders, understand the challenges that exist in identifying and measuring AH, and identify potential approaches to mitigate AH.Design, Setting, and ParticipantsA qualitative study using a mixed-methods approach with a 12-question survey and semistructured virtual focus groups was held on June 13 and August 11, 2023. Rapid qualitative methods including templated summaries and matrix analysis were applied. The participants included 2 consortiums comprising hospitalist clinicians, researchers, administrative leaders, and members of a patient and family advisory council.Main Outcomes and MeasuresQuantitative data from the survey on specific aspects of experiences related to AH were collected. Focus groups were conducted using a semistructured focus group guide. Themes and subthemes were identified.ResultsForty-one individuals from 32 different organizations participated in the focus groups, with 32 participants (78%) responding to a brief survey. Survey participants included physicians (91%), administrative professionals (6%), an advanced practice clinician (3%), and those in leadership roles (44%), with participants able to select more than one role. Only 6% of participants were familiar with the term administrative harm to a great extent, 100% felt that collaboration between administrators and clinicians is crucial for reducing AH, and 81% had personally participated in a decision that led to AH to some degree. Three main themes were identified: (1) AH is pervasive and comes from all levels of leadership, and the phenomenon was felt to be widespread and arose from multiple sources within health care systems; (2) organizations lack mechanisms for identification, measurement, and feedback, and these challenges stem from a lack of psychological safety, workplace cultures, and ambiguity in who owns a decision; and (3) organizational pressures were recognized as contributors to AHs. Many ideas were proposed as solutions.Conclusions and RelevanceThe findings of this study suggest that AH is widespread with wide-reaching impact, yet organizations do not have mechanisms to identify or address it.

Publisher

American Medical Association (AMA)

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Administrative Harms—Common and Sometimes Preventable;JAMA Internal Medicine;2024-09-01

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