Health Policy & Management Theses and Dissertations
Permanent URI for this collectionhttp://hdl.handle.net/1903/7127
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Item The Role of Personal Integrity in Shaping Healthcare Worker Perceptions of Patient Safety Culture in US Hospitals During the Covid-19 Pandemic(2024) Edelstein, Lauren Michelle; Franzini, Luisa; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Abstract Overview: The COVID-19 pandemic strained hospitals in unprecedented ways that required healthcare workers to adapt to and endure challenges, testing their ability to do a good job with the human and technological resources available to them. Using a proxy variable for personal self-integrity (PSI), derived from questions on the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (HSOPS), this dissertation explores the way workers’ capacity to maintain alignment of their actions and morals shifted during the pandemic. Conceptual Framework: The investigations within this study can be understood through the Healthcare Workforce Integrity Model, an innovation based on the Job Demands and Resources Model that accounts for the deeply moral nature of healthcare work. The model holds that intensity of job demands and the strength of supportive job resources shape workers’ abilities to maintain PSI in their work. Over a sustained period, this impacts worker energy and motivation, and ultimately, organizational resilience. Methods: The study uses descriptive statistics and regression modeling based on data from the AHRQ’s HSOPS and data from the Hospital Cost and Utilization Project (HCUP), from timeframes before and during the COVID-19 pandemic, to analyze shifting perceptions about patient safety culture within the hospital workforce. Results: Workers’ capacity to maintain their PSI worsened steadily over the pandemic. When patient mortality was higher, workers’ PSI worsened, with particularly acute effects experienced in ICU settings. When hospital workers perceived teamwork and leadership support negatively, and when they perceived that staff were blamed for patient safety problems, their perceptions of their own personal integrity diminished by statistically significant margins. No significant associations indicate that hospital workers’ perceptions of teamwork, leadership support, or being blamed for safetyproblems were more closely tied with their ability to maintain positive PSI during the pandemic than they were before the pandemic. Conclusions: Organizational solutions are needed to support healthcare workers’ ability to thrive and maintain integrity in non-crisis moments just as much as they are needed during moments of crisis and uncertainty. Achieving this goal can better ensure that healthcare workers feel they can depend on their institutions and its people to do the right thing.Item Mental health and mental health services during the COVID-19 pandemic(2021) Benjenk, Ivy; Chen, Jie; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The COVID-19 pandemic significantly impacted mental health and mental health services in the United States. During February 2021, 42% of Americans experienced symptoms of depression or anxiety. During the pandemic, the largest and most sustained growth in telemedicine occurred in mental health services. The goal of this dissertation is to explore strategies for maintaining mental health services and promoting mental health during the COVID-19 pandemic. In this work, I review the literature on what is currently known about the impact of the COVID-19 pandemic on mental health and mental health services. I provide conceptual frameworks that posit how vulnerable populations are at highest risk for losing access to healthcare during the pandemic and how population-level strategies are needed to promote mental health recovery. In my first research paper, I use qualitative data collected from semi-structured interviews with twenty adults with serious mental illness (SMI) during the pandemic. I found that most study participants did not experience increases in unmet mental health or social service needs. However, several participants who lacked identification documents, housing, and/or a personal device reported significant increases in unmet needs, including inability to access mental health care and public benefits. As many participants in the qualitative study reported receiving audio-only telemental health services versus video telemedicine during the pandemic, I used data from the Medicare Current Beneficiary Survey COVID-19 Supplements to explore the use of audio-only telemedicine during the pandemic. Findings suggest that the high rate of audio-only telemedicine is not exclusively related to the digital divide or patient preferences, but also to provider behavior. Lastly, as the COVID-19 pandemic impacted the mental health of the entire population, I used data from the Census Bureau’s Household Pulse Survey to explore whether availability and receipt of an effective COVID-19 vaccine could promote mental health. Results suggest a reduction in the predicted probability of mental health symptoms after approval of the vaccine and a lower predicted probability of mental health symptoms among those who have been vaccinated, however these rates remain higher than what was seen prior to the pandemic. Overall findings suggest that the mental health care system has adapted fairly well to meet the needs of persons with SMI during the pandemic and mental health has improved since the approval of the vaccine, but additional work will be needed to reengage those who were disconnected from mental health services during the pandemic and to achieve pre-pandemic levels of mental health.