Building Advocacy in Transformative Change by Putting the Human in the Loop.

An academic practice partnership was formed to develop a new RN-to-BSN program with a Unitary Caring Science (UCS) framework. The target population consisted of registered nurses in a large integrated health system in northern California who had not enrolled in one of the numerous RN-to-BSN options available. The nurses worked in a strong union environment with high salaries and low turnover. The primary return on investment sought by the practice partner was transformational cultural change. A mindfulness-based stress reduction course, offered in the first term, served as an experiential introduction to UCS. The faculty prioritized the affective learning domain to nurture phronesis and chose a cohort model to develop communitas. New ontological competencies were developed through a value-added proposition with four pillars to help nurses discover their vision, find their voice, tell their stories, and own their practice. Students gave examples of how the program changed their personal and professional lives. Practice leaders reported transformative behaviors in graduates and transformative changes in the culture. The academic-practice partnership achieved the goals of both organizations.

Work environment and organisational culture have recently experienced major shifts towards virtual and hybrid settings. The underlying transformational changes pose new challenges to the leadership and business management which need to adapt to the changing environment. Especially the insights on how to successfully lead hybrid teams and manage related organisational changes in small and medium-sized enterprises (SMEs) are still lacking and require a different approach to leadership than in traditional teams. This paper employs a quantitative approach with mediation analysis to better understand the underlying adaptation and transformation processes. Specifically, it deals with the organisational culture in the context of hybrid teams and explores empirically its mediating role in the relationship between transformational leadership and change management in the context of German SMEs. Our results suggest that organisational culture partially mediates this relationship between transformational leadership and change management in hybrid teams. The effect is slightly stronger than for virtual teams. Accordingly, managers should actively shape and reinforce a strong, adaptable culture to facilitate smoother change initiatives. Moreover, since transformational leadership is crucial for effective change management, especially in hybrid teams, managers should focus on inspiring a shared vision, fostering innovation, and providing individual support to drive change. Finally, managers should take advantage of in-person interactions in hybrid settings to reinforce cultural values and leadership presence.

Patient-provider communication through the patient portal has markedly increased in recent years. Some health care facilities implemented programs to enable providers to bill for responding to patient-initiated messages that require substantive medical decision making through an e-visit. To evaluate the effect of billing eligible patient-initiated portal messages as e-visits using a mixed-methods approach. Retrospective observational pre-post comparison and prospective survey. Large integrated health system with sites in 4 U.S. states. Patients initiating portal message threads and health system providers completing an online survey. E-visit billing was implemented 18 August 2023. The volume of patient-initiated medical advice message threads pre- versus postimplementation of e-visit billing was compared. Health system provider perceptions of e-visit billing were assessed using an online survey. In the 6 months after e-visit billing implementation (18 August 2023 through 18 February 2024), the volume of patient-initiated medical advice message threads decreased by 8.8% (from 1 813 818 to 1 653 708) compared with the same dates the year prior (P = 0.002). A total of 5183 (0.3%) medical advice messages were billed. There was no difference in 7-day use of emergency services (emergency department visits or hospitalizations) in patients who proceeded with sending a message versus those that did not send a message after viewing the billing disclaimer on the patient portal. Providers reported overall acceptance of e-visit billing but expressed concerns about increased workload with the current process. Cannot assess changes in other forms of contact, including telephone calls. These findings suggest that implementation of e-visit billing was associated with a modest decrease in patient-initiated portal message volume and was overall acceptable to providers in a large integrated health system. None.

Introduction/Main Objectives: This study aims to determine the value of the direct influence between transformational leadership and change management, transformational leadership and organizational culture, organizational culture and change management, and deal with the indirect effect of organizational culture on transformational leadership and change management. Background Problems: In the era of globalization that is increasingly fast and dynamic, an organization must be able to adapt to changes in the environment, where changes in the organization must be managed properly and efficiently. Change management is a systematic and complex process carried out by an organization. One of the steps in determining the direction of change is to select the transformational leadership model, change management, and organizational culture. Research Methods: Review articles on the relationship between transformational leadership, change management, organizational culture, organizational change, and the mediating role of organizational culture on transformational leadership and change management. Finding/Results: There is a positive and significant correlation between transformational leadership and change management, transformational leadership and organizational culture, and organizational culture and change management, where organizational culture has a mediating role in the relationship between transformational leadership and change management. Conclusion: Transformational leadership are very influential on organizational changes and play an essential role in determining the direction of change management and organizational culture, using organizational culture to manage these changes.

The current situation in Ukraine is characterized by a high level of uncertainty. Such uncertainty creates a large number of chaotic situations of a problematic nature that domestic business has not yet encountered. This requires certain transformational changes for most domestic business structures in conducting their activities. In order to implement high-quality and relevant transformational changes in business, it is necessary to establish factors that have a significant impact on them. Identification of such factors is an urgent need for the timely development of an appropriate model or system for managing transformational changes in business. This determines the relevance of the research on the selected topic. The purpose of the scientific research was to identify factors that have a significant impact on the management of transformational changes in domestic business. Given the formulated goal, the following scientific tasks were solved in the process of carrying out the research: based on an expert survey of managers, factors that have a significant impact on the management of transformational changes in domestic business were identified; a detailed analysis of the most significant factors of influence on the management of transformational changes in domestic business was performed. The research methodology used to solve the research problem involved the use of such methods as abstract-logical (for a thorough analysis of the problem and generalization of the research results), monographic (for an in-depth study of the definition of "business transformation"), expert survey (to establish the most significant factors of influence on the management of transformational changes in domestic business). The research was based on compliance with general scientific principles, in particular terminological, systemic and cognitive (cognitive). The results of the study should be considered as follows. Based on the results of an expert survey of managers (representatives of small and medium-sized businesses), the factors that most strongly encourage business to transformative changes were identified. These factors were: globalization of markets, development of information technologies, rapid development of artificial intelligence, increased competition from foreign firms and companies, the COVID 19 pandemic, military aggression against the country, the emergence of new diverse information and communication technologies. It was established that the leading factors with a significant impact on business changes included military aggression against the country (I level of significance), the emergence of new information and communication technologies (II level of significance), and globalization of markets (III level of significance). The threats of market globalization to transformational changes for the domestic business environment were identified and their gradation by significance of impact was performed using an expert method. The scientific novelty of the research is the identification of factors that have a significant impact on the management of the transformation of domestic business. This will enable business owners, managers of enterprises, firms and companies to choose or change the management model, and adjust the strategy of activity in the selected market segment. The practical significance of the research results is that, taking into account the specified list of influencing factors, managers will be able to choose more priority operational and functional strategies that require immediate adjustment, work out and make more balanced management decisions regarding transformational changes in the business. A further direction of the research is to establish the relationship between the specified influencing factors on the processes of business transformation management with the development of the competitive strategy of an enterprise, firm or company.

Differences in outcomes by race/ethnicity after thoracic surgery in a large integrated health system

Introduction:Standardized screening, objective evaluation, and management of behavioral health conditions are major challenges in primary care. The Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire (PHQ-9), and Mood Disorder Questionnaire (MDQ) provide standardized screening and symptom management tools for generalized anxiety disorder (GAD), major depressive disorder (MDD), and Mood Disorders (MD), respectively. This study explores family physicians’ knowledge, attitudes, and practices regarding the utilization of GAD-7, PHQ-9, and MDQ in outpatient primary care offices.Methods:The study method was a cross-sectional electronic and paper survey utilizing a self-administered questionnaire that assessed primary care physicians’ demographics, knowledge, attitudes, and practices in rural and urban outpatient clinical settings regarding GAD-7, PHQ-9, and MDQ. Statistical software SAS 9.4 was used for descriptive and Chi-Square statistics.Results:Out of 320 total participants,145 responded (45.3%). Responding family physicians demonstrated a high level of familiarity with the GAD-7 (97.9%), PHQ-9 (97.9%), and MDQ (81.3%) assessment tools. However, the reported utilization rates were relatively lower than knowledge, with 62.7%, 73.1%, and 31.9% extremely likely or likely to utilize the GAD-7, PHQ-9, and MDQ as screening and monitoring tools, respectively. Less than a quarter of the total respondents use the objective score for the future management of GAD, with significantly more residents utilizing the score for GAD-7 compared to attendings (P < .05). There was no statistical significance difference between residents and attendings for the objective evaluation of Major Depressive Disorder (P = .26) and Mood Disorders (P = .05).Conclusions:Despite being knowledgeable of the utility of GAD-7, PHQ-9, and MDQ, the primary care physicians in a large integrated health system in Central Pennsylvania and Northern Maryland report inconsistent utilization in their practice. Further studies are needed to determine the underlying factors contributing to the suboptimal usage of these screening tools and ways to increase it.

Transgender and gender nonconforming (TGNC) patients have been seeking medical care in higher numbers and have faced unique social, personal, and health issues that affect the quality of care they receive. The purpose of this study was to conduct a mixed-methods study to describe TGNC care at Kaiser Permanente Mid-Atlantic States, a large integrated health system. We used a transgender registry to describe a TGNC patient population and compared healthcare utilization between TGNC patients and non-TGNC patients. Four focus groups were also conducted among 28 patients. Atlas.ti software was used to code and analyze themes for the qualitative analysis. Among the 282 adults TGNC patients, the mean age was 32.6 years. Of the study sample, 59% were White, and 27% were Black. TGNC patients demonstrated an increased use of email/telephone visits and the online patient portal and more cancellations and no-shows compared to non-TGNC controls. Of the 28 TGNC patients who participated in the focus groups, 39% identified as female, 21% as a transman, and 18% as non-binary/genderqueer. Participants were predominantly White (68%), highly educated (74%), and reported use of hormones (89%). Themes that emerged from our qualitative analysis included: limited availability of TGNC information; positive and negative sentiments regarding patient–provider interactions; issues with case management; limited access to care; lack of coordination of care; negative staff experiences. We identified specific areas in a health system to improve the quality of care of TGNC patients, including specific TGNC training for providers and staff, a source of TGNC information/resources, and hiring and training TGNC-specific case managers.

Clinical screening for basic social needs-such as food and housing insecurity-is becoming more common as health systems develop programs to address social determinants of health. Clinician attitudes toward such programs are largely unexplored. To describe the attitudes and experiences of social needs screening among a variety of clinicians and other health care professionals. Multicenter electronic and paper-based survey. Two hundred fifty-eight clinicians including primarily physicians, social workers, nurses, and pharmacists from a large integrated health system in Southern California. Level of agreement with prompts exploring attitudes toward and barriers to screening and addressing social needs in different clinical settings. Overall, most health professionals supported social needs screening in clinical settings (84%). Only a minority (41%) of clinicians expressed confidence in their ability to address social needs, and less than a quarter (23%) routinely screen for social needs currently. Clinicians perceived lack of time to ask (60%) and resources (50%) to address social needs as their most significant barriers. We found differences by health profession in attitudes toward and barriers to screening for social needs, with physicians more likely to cite time constraints as a barrier. Clinicians largely support social needs programs, but they also recognize key barriers to their implementation. Health systems interested in implementing social needs programs should consider the clinician perspective around the time and resources required for such programs and address these perceived barriers.

BackgroundInformation about telehealth versus in-office visits and how patient experience before compared to during the COVID-19 pandemic is important for healthcare planning.ObjectiveTo compare patient experience by visit type and before and during the pandemic.DesignSurvey of patients assessing ambulatory care before and during the pandemic.ParticipantsA total of 58,500 adult patients (13,928 primary care and 44,581 specialty physician visits) at a large integrated health system with 197 clinics on the west coast of the United States. The majority were female (59%), 55 or older (65%), and non-Hispanic White (55%), and had an in-office visit (87%) while 10% had a tele-video and 3% a phone visit.Main MeasuresConsumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey 3.0 doctor communication, care coordination, access, and office staff composites; an overall rating of the doctor; and whether the patient would recommend the doctor to family and friends.Key ResultsPatient experience with telehealth visits was as positive as or more positive than that with traditional office-based visits. Doctor communication on tele-video visits was viewed as slightly more positive than that of in-office or phone visits. Tele-video visits were also slightly more positive than in-office visits for care coordination, overall rating of the doctor, and willingness to recommend to family and friends. Office staff were viewed less positively on the phone than tele-video or in-office visits. Patient experience was similar before and during the COVID-19 pandemic (e.g., on a 0–100 possible range with a higher score being better, doctor communication was 94.4 before and 94.9 during).ConclusionsThe positive experiences with telehealth, especially tele-video, may be due to patient appreciation of efforts made to maintain access, the focused nature of telehealth visits, and help by staff for navigation technical issues. Lessons learned about delivering responsive telehealth care can be used to ensure high-quality care after the pandemic.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07196-4.

Review for "Associations of Weight Loss with Obesity‐Related Comorbidities in a Large Integrated Health System"

This preprint evaluates the risk of Myopericarditis associated with the Covid-19 booster. Reviewers found the study reliable and shows a low associated risk between Myopericarditis and the booster; however, this study lacks long-term follow-up or historical data comparison.

Review for "Associations of Weight Loss with Obesity‐Related Comorbidities in a Large Integrated Health System"

Review for "Associations of Weight Loss with Obesity‐Related Comorbidities in a Large Integrated Health System"

Decision letter for "Associations of Weight Loss with Obesity‐Related Comorbidities in a Large Integrated Health System"