Health services administration

Health services administration (HSA) research is multidisciplinary and focuses on factors and issues effecting delivery of health services in a wide variety of settings from a systems perspective. HSA also focuses on the effect of health care processes on the health and well-being of clients and populations. Issues such as access to care, development of tools to measure health status, effectiveness of treatment modalities, health policy, delivery systems, professional practice, impact of magnet hospitals, outcomes of care, impact of managed care, financing of health care, and organizational change only partially represent the vast diversity of foci for HSA research. A breadth of issues, and intent to affect care delivery, are the hallmarks of HSA research.

Health services administration research, by its multidisciplinary nature, must address nursing issues for full impact on systems affecting care delivery. Nurses, as the largest health care delivery professional discipline, are integrally involved in all aspects of the health care system. Nurse researchers in nursing administration, practice specialties, nursing health policy, and community health can lead or participate in HSA research. These types of research reflect the team concept by including all disciplines involved in a specific project and by reflecting those disciplines’ perspectives in the study design and findings.

Health Services Administration

If quality of services is to be assured and improved, this type of research is necessary for improving care systems. Whether the research focus is smoking cessation or health policy, the HSA approach would be to investigate preferred systems for optimal client outcomes. Nurse researchers must shift their focus from studying individual adaptation to illness or disease to investigating the systems that facilitate maximizing such adaptation if they are participating in HSA research. The relevance to nursing comes in the ability to replicate such systems across practice settings and to extend the influence of research knowledge in practice. Magnet hospital research is attempting to do this by linking magnet characteristics to lower mortality rates and increased patient satisfaction as well as other outcome markers (Scott, J., Sochal-ski, & Aiken, 1999).
In this age of multidisciplinary emphasis, nurses’ participation in HSA research places them in a position to influence client out-comes on a larger scale than in the past. Many nursing research efforts have been hampered by not accounting for the influence of other disciplines on client outcomes. The contribution of nursing to those outcomes is difficult to measure in isolation from medical and al-lied health treatments. There is tremendous potential for nursing’s effects on client out-comes to be showcased by involvement in HSA research. Such research is presented in national and international multidisciplinary forums that have potential to influence health policy beyond the discipline of nursing.
Donabedian’s (1980) model of using a “structure, process, and outcome” framework for evaluating the quality of medical care has been widely adopted for many HSA studies. Structure relates to the physical and organizational framework of the setting where care is delivered. Process refers to the “dynamic exchange” between provider and client that includes all interchanges that occur in support of care events. Outcomes are the dependent variables, the “measurable events” that occur as a result of the structure and process of care (Scott, J. D., 1996). The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has used this framework to evaluate health care organizations for decades. In 1997, JCAHO shifted emphasis, through its Agenda for Change, to stress outcomes and to develop performance indicators that are less reliant on structure and process. Beginning in 2002,JCAHO has the ability for “rigorous comparison of the actual results of care across hospitals” (JCAHO, 2003b).
Health care delivery systems routinely engage in action research aimed at improving the quality of care. Quality improvement re-search has become ingrained in the very process of care delivery, and nurses are integrally involved in these studies. Although often not theoretically based, such studies have a direct impact on quality of care in our country and have potential to improve care broadly if the results are disseminated more widely, rather than serving solely as the basis for internal, proprietary improvement processes.
Insurers are using the results of treatment effectiveness studies to determine which procedures to cover. Health Maintenance Organizations (HMO) practices are evaluating the effect of their wellness plans on subsequent client illness patterns. Many of these studies examine cost-effectiveness. The federal government routinely invests in HSA research. Agencies such as the Agency for Healthcare Research and Quality (AHRQ), the Center for Medical Effective-ness Research, the Health Care Financing Administration, the National Institutes for Health, the Health Resources and Services Administration, and the National Institutes for Nursing Research, to name a few, are all engaged in funding and directing HSA re-search.
The Medical Treatment Effectiveness Program was begun in 1989 by the Agency for Health Care Policy and Research (now AHRQ) to investigate clinical conditions that are costly, have high incidence, evidence variation in clinical outcomes, and affect Medicare or Medicaid programs. There are, at present, 19 Clinical Practice Guidelines that review best practices for these clinical conditions. Government support for HSA research directly influences health policy by making study results available to policymakers, caregivers and the public. Information is available at governmental web sites. At its Research in Action site (AHRQ, 2003b), AHRQ-sponsored studies in the categories of cost, disease related, elderly, pharmaceuticals, and quality of care are synthesized for the purpose of making them generally available for the improvement of care.
A similar AHRQ page highlighting the National Quality Measures Clearinghouse provides “evidence-based quality measures and measure sets” (AHRQ, 2003a). Private foundations actively fund HSA research. The Robert Wood Johnson Foundation is notable for its efforts to improve nursing care delivery. The Commonwealth Fund, the Henry J. Kaiser Foundation, and the Pew Charitable Trusts are among the most notable organizations that support HSA research on an ongoing basis. Health Services Administration research can be found in almost every health care related journal.
 Journals that concentrate on this multidisciplinary focus include the following: Advances in Health Economics, American Journal of Public Health, Frontiers of Health Services Management, Health Care Financing Review, Health Care Forum Journal, Health Policy, Health Services Research, Inquiry, International Journal of Health Services, Journal of Health Economics, Journal of Health Politics, Policy and Law, and Quality Review Bulletin.
HSA research is engaged in investigating improvement of health care delivery and in discovering ways to provide more effective and efficient care, both of which can have a great impact on the health care system. Scarce resources can be more effectively utilized if we improve care delivery to “best demonstrated practices” levels. Of course, these levels continue to evolve and to be refined as knowledge expands. Thus, HSA research must continually expand understanding to maximize the potential of an evolving health care system. HSA research can provide a valuable check to the financial emphasis of our current managed care system. An emphasis on the population’s needs and how they might influence health care systems and health policy to maximize public health would be a welcome change from the financial emphasis of the past (Ingersoll, Spitzer, &Cook, 1999). Out-comes research can demonstrate unanticipated effects of limiting access to care, treatment options, and care provider choice.

Long-term outcomes can be monitored through systematic longitudinal studies to determine relative health status of client populations based on payer system, for-profit status, demographic variables, and treatment options. HSA research is needed to investigate these larger issues and to influence health policy for years to come.