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Investigator Dorothy Hung, Ph.D., M.A., MPH

Dorothy Hung, Ph.D., M.A., MPH

Associate Scientist

 

Dorothy Hung, Ph.D., is Associate Scientist at the Palo Alto Medical Foundation Research Institute. She is Principal Investigator of an R01 study, “Impact of LEAN Management on Primary Care Efficiency, Affordability, and the Patient Experience,” funded by the Agency for Healthcare Research and Quality (AHRQ). Dr. Hung was also recipient of a K02 Career Development Award and multi-year AHRQ contract to study contextual factors affecting the implementation and spread of Lean in health systems. Her work has been published in peer-reviewed journals including Medical Care, Health Services Research, Health Care Management Review, American Journal of Managed Care, and The Milbank Quarterly.

Dr. Hung’s research focuses on organizational approaches to achieving high quality, high value care delivered in both ambulatory and hospital settings. This includes study of: 
 
    1. system redesign to enhance work processes;
    2. change management and organizational culture/climate, teamwork, and staff participation in decision making; and
    3. implementation of innovative models for delivering preventive and chronic care.

Dr. Hung’s current research includes evaluation of industry-based Lean techniques for improving value in the health care sector. She is investigating the effects of Lean on quality, cost and operational outcomes in outpatient care, and its use to streamline hospital discharge processes and workflows in the emergency department. Her research includes study of how health care organizations and care teams reinvent themselves as “learning systems” to continuously improve services delivered. This involves the important role of micro-systems (i.e., core teams of health professionals) and organizational environments as critical spaces for transformation. Consistent with this, Dr. Hung’s research has focused on practice innovations and prescriptions for enhancing care delivery, including how to best design systems and daily workflows to optimize patient care. She has also examined the influence of organizational context on provider adherence to evidence-based guidelines in over 100 primary care practices located across the U.S.

Dr. Hung is an Affiliated Faculty Member at the University of California San Francisco, Institute for Health Policy Studies (IHPS). She is also a Research Advisory Committee member with the Center for Lean Engagement and Research (CLEAR), housed in the School of Public Health at the University of California at Berkeley. Prior to joining PAMFRI, Dr. Hung was on faculty at the Columbia University Mailman School of Public Health in New York City. She earned both a Ph.D. in Health Services and Policy Analysis, and an M.A. in Political Science from UC Berkeley. She also holds a Master’s degree in Public Health from the University of Minnesota and a Bachelor’s degree from Stanford University.


Sutter Health Research Enterprise
795 El Camino Real
Ames building
Palo Alto, CA, 94301-2302
(650) 853-4807  
hungd@sutterhealth.org

Primary Research Interests

  • Aging and Longevity
  • Alcohol Epidemiology
  • COVID-19
  • Cancer
  • Child and Adolescent Health
  • Disease Management
  • Food and Nutrition
  • Health Disparities
  • Health Policy
  • Health Services
  • Lean Implementation
  • Lean Management
  • Lung Diseases
  • Medical Informatics
  • Mental Health
  • Obesity
  • Patient Satisfaction
  • Physician Efficiency
  • Prevention and Health Maintenance
  • Primary Care Redesign
  • Primary Care Teams
  • Primary Care
  • Quality Improvement
  • Smoking
  • Workflow / Task Completion

Publications

Ready for change? The role of physician and staff engagement, burnout, and workplace attributes.

Baseline levels of engagemt were associated with greater readiness for change. Job-related burnout correlated with greater need for change & lower self-efficacy

Medical assistants as flow managers in primary care: challenges and recommendations.

Drawing on an empirical study of a large, multispecialty delivery system engaged in reconfiguration of primary care, we found that using MAs as flow managers required overcoming several challenges.

Effect of organizational culture on patient access, care continuity, and experience of primary care.

Generalized regression was used to analyze pt access, care continuity, and reported experiences of care among 357 physicians in 41 primary care departments.

Purchasing patterns and smoking behaviors after a large tobacco tax increase: a study of Chinese Americans living in New York City.

Expanded legislation must be directed to minimize the availability of legal and illegal low-tax cigarette outlets. Public education is also needed.

Effectiveness of tobacco control among Chinese Americans: a comparative analysis of policy approaches versus community-based programs.

City-wide tobacco control policies are effective among high-risk urban communities, such as Chinese immigrants. In addition, community-based tailored tobacco control interventions may increase the reduction in smoking prevalence rates beyond that achieved from public policies.

The chronic care model and relationships to patient health status and health-related quality of life.

A practice's implementation of the chronic care model was significantly related to patient health status and health-related QOL.

Practice-level approaches for behavioral counseling and patient health behaviors.

Study suggests that practice-level approaches may enable primary care practices to help patients improve physical activity.

Common measures, better outcomes (COMBO): a field test of brief health behavior measures in primary care.

Brief set of health behavior measures was usable in primary care settings with adults and adolescents.

Acceptance of Lean redesigns in primary care: A contextual analysis.

Lean acceptance was influenced by time & intensity of exposure to changes, "top-down" vs "bottom-up" implementation styles, and degrees of employee engagement.

Patient experiences after implementing lean primary care redesigns

Lean primary care redesigns on patient satisfaction with care and timeliness of care received.

Implementing lean quality improvement in primary care: impact on efficiency in performing common clinical tasks

Lean redesigns led to improvements in timely completion of 3 out of 4 common clinical tasks.

The learning health system in crisis: lessons from the novel coronavirus disease pandemic

Advocating for a learning health network that promotes collaboration between health systems, community-based organizatons, and government agencies

Experiences of primary care physicians and staff following Lean workflow redesign.

Although teamwork and engagement increased with Lean redesign, longstanding burnout and stress remained.

Framework for research on implementation of process redesigns.

Process redesign framework developed for AHRQ adds 2 domains and new constructs to the Consolidated Framewk for Implementation Research.

Hospital-community partnerships to aid transitions for older adults: applying the care transitions framework.

Transitional care program for seniors identified outcomes that included providing transition to more advanced care and more pt-centered perspectives.

Scaling Lean in primary care: impacts on system performance.

Lean redesigns can benefit primary care patients, physicians, and staff without negatively impacting the quality of clinical care.

Assessing the impact of behavioral risk factors and known-groups validity of the SF-12 in a US Chinese immigrant population.

SF-12 exhibited known-groups validity in a US Chinese immigrant pop. Behavioral risk factors were associated with progressive declines in physical health.

Multilevel analysis of the chronic care model and 5A services for treating tobacco use in urban primary care clinics.

Findings suggest that the chronic care model facilitates provider adherence to the Public Health Service 5A clinical guideline.

Implementing a Lean management system in primary care: facilitators and barriers from the front lines.

Drivers of change included empowerment of staff, visual display of performance metrics, and a culture of innovation and collaboration. Barriers also described.

Shared medical appointments: a promising innovation to improve patient engagement and ease the primary care provider shortage.

Although SMAs improve access, engagement with physicians and other patients, and knowledge of patients' health, they also help to ease the workload for physicians.

Implementing a transitional care program to reduce hospital readmissions among older adults.

Examine the implementation of an evidence-based intervention to prevent rehospitalization of seniors.

Paying for prevention: associations between pay for performance and cessation counseling in primary care practices.

Findings suggest that P4P is associated with recommended counseling for smoking cessation. Study limitations include small sample size and unavailability of information on the magnitude of P4P incentives and program design.

What's in a setting? Influence of organizational culture on provider adherence to clinical guidelines for treating tobacco use.

This study examines organizational culture as a contextual feature of primary care clinics and its impact on adherence to evidence-based guidelines for treating tobacco use.

Why do we observe a limited impact of primary care access measures on clinical quality indicators?

The study assessed the effects of enhanced primary care access and continuity on clinical quality in a large, multipayer, multispecialty ambulatory care organization with fee-for-service provider incentives.

Leveraging electronic health records to develop measurements for processes of care.

To assess the reliability of data in EHRs for measuring processes of care among PCPs and examine relationship of these measures and clinical outcomes.

Overcoming challenges to adoption of shared medical appointments.

A physician champion, management support, and financial sustainability were judged to be the primary enablers of successful implementations of shared med appts.

Recognition as a patient-centered medical home: fundamental or incidental?

We examined the motivations for seeking recognition in one group and assessed why the group allowed recognition to lapse 3 years later.

Contextual conditions and performance improvement in primary care.

Findings encourage evaluation of clinic characteristics and capacity to effectively implement redesigns, helping leaders select appropriate Lean interventions.

Sustainment of Lean redesigns for primary care teams.

Staff buy-in, change ownership, and availability of time for improvement activities are critical to long-term success of Lean implementation in primary care.

Nurses' perspectives on Lean redesigns to patient flow and inpatient discharge process efficiency.

We found that nurses experienced competing demands and tensions related to their time and professional roles and responsibilities as a result of Lean.

Physician engagement with metrics in Lean primary care transformation.

Effective strategies for selecting and presenting metrics to practicing physicians are an important part of a successful quality improvement effort.

Research Studies

Evaluation of Lean Implementation in Ambulatory Care

Monitor implementation progress and change management among physicians and staff, and assess impacts on performance metrics in primary and specialty care.

Investigator: Dorothy Hung Ph.D., M.A., MPH, Associate Scientist

Improving the Patient Experience and Hospital Staff Engagement: Lean Redesign of ED Workflow and Care Transfers

Examine Lean redesign of ED workflows, inter-unit care transfers, and d/c processes to improve patient satisfaction while engaging staff in process improvement.

Investigator: Dorothy Hung Ph.D., M.A., MPH, Associate Scientist

Multilevel Study of Lung Cancer Screening Guidelines Implementation (MUST)

Provide insights into preventive services for lung cancer. This research will contribute to the concurrent progress in lung cancer screening with LDCT.

Investigators: Dorothy Hung Ph.D., M.A., MPH, Associate Scientist, Jiang Li Ph.D., MPH, Assistant Scientist

Primary Care Transformation in a NCQA Certified Patient-Centered Medical Home

This study gathers information about the primary care transformation process and lessons learned by PAMF in its primary care transformation endeavors.

Investigator: Dorothy Hung Ph.D., M.A., MPH, Associate Scientist

Spreading Lean—Taking Efficiency Interventions in Health Services Delivery to Scale

Examine contextual factors that facilitate the implementation, spread and sustainability of Lean as a system-wide value improvement initiative.

Investigators: Dorothy Hung Ph.D., M.A., MPH, Associate Scientist, Harold (Hal) Luft Ph.D., Senior Scientist

Strategies for Improving the Quality of Preventive Services in Primary Care

This project examines organizational and financial approaches to improving the delivery of preventive services for patient behavior modification.

Investigator: Dorothy Hung Ph.D., M.A., MPH, Associate Scientist

The Impact of Lean Management on Primary Care Efficiency, Affordability, and the Patient Experience

The goal of this study is to investigate the impact of Lean on provider work efficiency, system affordability, and patient experiences in primary care.

Investigators: Dorothy Hung Ph.D., M.A., MPH, Associate Scientist, Su-Ying Liang Ph.D., Research Economist, Harold (Hal) Luft Ph.D., Senior Scientist

Transitional Care for Older Adults

This study evaluates a program to reduce hospital readmissions by engaging community-based resources to assist high-risk seniors.

Investigator: Dorothy Hung Ph.D., M.A., MPH, Associate Scientist

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