Despite the positive benefits of innovation in healthcare, certain inertial forces exist that inhibit innovative processes and methods from improving access to quality patient care services while enhancing operational efficiencies and reducing overall cost. This qualitative conventional Delphi study focused on how institutional controls delineating the scope of practice of non-physician clinicians within hospitals may negatively influence innovative patient care models that potentially impact patient health outcomes, operational procedures, and the financial viability of major health systems. The research question focused on the effect of hospital privileging and credentialing policies and procedures for non-physician clinicians such as nurse practitioners, physician assistants, and pharmacists. The objective of this Delphi study was to reach a consensus of experts in determining the perceived impact of systematic and organizational factors, namely institutional privileging and credentialing practices for non-physician clinicians. The results highlighted financial constraints as systematic barriers to innovation and cultural resistance and educational shortfalls as organizational barriers to change. Experts concurred that hospital medical staff bylaws were outdated, and institutional policies and procedures were more restrictive than state scope of practice laws and regulations, with wide variations between hospitals. These barriers limited non-physician clinicians in hospitals from providing care to patients to their full scope of practice, which in turn affected quality of patient care, operational efficiencies, and hospital financial outcomes. Additionally, a developing theory posited that the ability of hospitals to innovate is dependent on the interrelation effects between organizations within the same healthcare industry. Understanding the perceived impact and the extent of utilizing non-physician clinicians in an acute care setting can help administrators and managers evaluate current credentialing and privileging practices to ensure hospitals achieve a strategic balance between quality patient care, operational improvements, and financial outcomes.
|Advisor:||Daniel, Teresa A.|
|Commitee:||Malka, S. Charles, Durso, Joan Combs|
|School Location:||United States -- Kentucky|
|Source:||DAI-A 81/5(E), Dissertation Abstracts International|
|Subjects:||Health care management, Medical personnel|
|Keywords:||Innovational inertia, Healthcare, Non-physician clinician privileging, Institutional setting|
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