Hospital Administrators Research Articles

Assessment of Facility Readiness for Pediatric Emergency and Critical Care Utilizing a 2-Phase Survey Conducted in Six Hospitals in Uganda and Cameroon: A Quality Improvement Study.

Each year, 5.3 million children under 5 years of age die in low-resource settings, often due to delayed recognition of disease severity, inadequate treatment, or a lack of supplies. We describe the use of a comprehensive digital facility-readiness survey tool, recently developed by the Pediatric Sepsis Data CoLaboratory, which aims to identify target areas for quality improvement related to pediatric emergency and critical care. Facility-readiness surveys were conducted at six sub-Saharan African hospitals providing pediatric emergency and critical care in Uganda (n = 4) and Cameroon (n = 2). The tool is a 2-phase survey to assess readiness to provide pediatric essential emergency and critical care: (1) an "environmental scan," focusing on infrastructure, availability, and functionality of resources, and (2) an "observational scan" assessing the quality and safety of care through direct observation of patients receiving treatment for common diseases. Data were captured in a mobile application and the findings analyzed descriptively. Varying levels of facility readiness to provide pediatric emergency care were observed. Only 1 of 6 facilities had a qualified staff member to assess children for danger signs upon arrival, and only 2 of 6 had staff with skills to manage emergency conditions. Only 21% of essential medicines required for pediatric emergency and critical care were available at all six facilities. Most facilities had clean running water and soap or disinfectants, but most also experienced interruptions to their electricity supply. Less than half of patients received an appropriate discharge note and fewer received counseling on postdischarge care; follow-up was arranged in less than a quarter of cases. These pilot findings indicate that facilities are partially equipped and ready to provide pediatric emergency and critical care. This facility-readiness tool can be utilized in low-resource settings to assist hospital administrators and policymakers to determine priority areas to improve quality of care for the critically ill child.

Exploring the correlation between airborne pollen levels and respiratory conditions in Jaipur, India.

Airborne pollen, a significant natural pollutant, restricts outdoor activities and impacts quality of life for sensitive individuals with pulmonary disorders. This study examines trends in airborne pollen concentrations and explores whether air pollution, pollen concentration, or both impact patient counts. The annual pollen trend in Jaipur shows peaks in pollen concentration in March (due to trees, 66%), September (due to weeds, 45%), and December (due to grass, 50%). Among the fifteen taxa examined, Holoptelea integrifolia is the largest pollen emitter in Jaipur, followed by Poaceae, among others. The count of patients arriving for clinical consultations in a hospital shows a strong and positive correlation with weed (Asteraceae spp. and Argemone mexicana) and grass pollen. A linear regression equation is developed (R2 value = 0.835) for forecasting consulting patient counts based on Cassia siamea pollen concentration. This can assist hospital administration in resource management, especially during peak allergy seasons.

UNDERSTANDING THE LEVEL OF KNOWLEDGE AMONG NURSES ABOUT FIRE SAFETY IN TERTIARY CARE HOSPITAL LAHORE

Fire safety in healthcare facilities is an important but frequently disregarded part of hospital administration and patient care. Despite substantial study on different aspects of healthcare delivery, there is still a significant gap in understanding and measuring fire safety knowledge and practices among healthcare personnel, particularly in Pakistan's tertiary care facilities. Objective: The purpose of this study was to assess the degree of fire safety knowledge among medical personnel at a tertiary care hospital in Lahore, Pakistan, to identify any shortcomings that may affect their capacity to respond effectively in the event of a fire. Methods: A cross sectional quantitative descriptive study was conducted at Public Tertiary care hospital in Lahore involving 202 nurses. A customized questionnaire was administered to assess the participant’s fire safety knowledge, selected through successive sampling. Data analysis was performed using SPSS version 22.0, categorizing knowledge level as poor, average and good. Results: 85% of survey participants were aware of fire response procedures. However, only 15% knew the fire department contact numbers, and 25% were unaware that foam or water extinguishers are ineffective against grease fires. Additionally, a significant proportion of participants struggled to correctly identify different types of fire extinguishers (65%) and fire categories (50%). The finding underscore the importance of comprehensive fire safety training to address significant knowledge gaps. Conclusions: Healthcare institutions should develop comprehensive fire safety training programs that extend beyond basic emergency protocols. Regular fire drills and simulations should be held to check staff members' understanding and reinforce fire safety procedures. Administrators should examine and update fire safety protocols on a regular basis to reflect new technology, legislation, and lessons learnt from previous events.

Professional quality of life profiles and its associations with turnover intention and life satisfaction among nurses: a prospective longitudinal study

BackgroundNursing shortage is a global issue. Turnover intention and life satisfaction are significant predictors of turnover. The specific nature of nursing and stressful work schedules lead to impaired professional quality of life (ProQOL), and existing studies have confirmed the effect of a dimension of ProQOL (such as secondary trauma stress, burnout and compassion satisfaction) on turnover intention and life satisfaction. Yet the heterogeneity of ProQOL across individuals is not known. A lack of research on the relationship between potential ProQOL subgroups and turnover intention and life satisfaction, and the mechanisms underlying this relationship remain understudied. The study aimed to determine different ProQOL profiles, and their cross-sectional and longitudinal effects on turnover intention and life satisfaction, while exploring the mediating roles of job satisfaction and work engagement within the relationship.MethodsData were collected at a tertiary hospital in a northeastern province of China. An online questionnaire was administered twice over the course of six months. 1832 and 900 participates provided cross-sectional and longitudinal data respectively. We used latent profile analysis (LPA) and K-means clustering to identify ProQOL profiles, and used the PROCESS macro program to conduct mediation analysis.ResultsThe LPA results supported a 4-profile solution, including balanced protection, good quality, traumatic satisfaction and burnout problem. ProQOL profiles directly predicted nurses’ current and subsequent turnover intention and life satisfaction. In addition, job satisfaction and work engagement mediated the effects of ProQOL profiles on turnover intention and life satisfaction in cross-sectional sample, and mediated the effects of ProQOL profiles on turnover intention in longitudinal sample.ConclusionThe findings suggest that nurses’ ProQOL has distinct categorical characteristics and is strongly associated with turnover intention and life satisfaction. Hospital administrators should implement individualized, join management and interventions according to each profile. Furthermore, more attentions should focus on improving nurses’ job satisfaction and work engagement levels to promote good work and life outcomes.

UPDATE KNOWLEDGE: PERAN GENDER DAN MASA KERJA TERHADAP MOTIVASI KERJA PERAWAT DI RAWAT INAP RUMAH SAKIT

<p><em>Quantitative workload can be expressed as the amount of work required to fulfil a patient's medical needs. High-quality workload represents a high level of responsibility in patient care. Nurses' workload is the most important predictor of mental health, stress, job dissatisfaction, fatigue, and the presence of burnout. This service activity aims to provide and increase student knowledge about the Effect of Gender and Years of Service on Work Motivation of Nurses in Hospital Inpatients to Students of the Hospital Administration Study Program, Undergraduate Program, Faculty of Health Sciences, Kusuma Husada University, Surakarta by using a pre-experiment design with a research design of one group pretest and post-test design with a total of 35 students and the activity time in May 2024. This service uses quantitative research with multiple linear regression. There is an increase in the knowledge of participants before and after the provision of material marked by the pre-test and post test which shows that the level of knowledge before being given the material is 69% but after being given the material has increased to 89%. There is a significant difference between students' knowledge about gender roles and tenure on nurses' work motivation in hospital inpatient care.</em></p><p><strong><em>Keywords: Workload, Gender, Work motivation, Nurses, Hospitalisation</em></strong><em></em></p>

The price of pressure: nationwide survey on lifestyle disturbances, occupational burnout and compromised perceived-competency among radiology residents in China

ObjectivesThe competency of radiology directly affects the quality and equity of medical services. Due to their different occupational characteristics compared to other specialists, this study aims to evaluate the impacts of lifestyles on competency and burnout in radiology residents in China.Materials and methodsA nationwide, cross-sectional survey was conducted from December 1, 2020 to April 30, 2021. A total of 12,208 radiology residents during their standardized residency training in China were invited. Multivariate linear regression and logistic regression were conducted to identify perceived competency and burnout associated with lifestyles.ResultsOf the 3,666 participants, 58.02% were female, 82.24% were aged <30 years, 40.53% were from the Eastern region, and 92.06% obtained a bachelor’s degree. The radiology residents with high-level lifestyles had higher competency (β = 0.16, 95% CI = [0.01, 0.32]), particularly in the realms of sleep, physical activity, and alcohol consumption. The correlation was stronger in residents with longer work hours and more night shifts. Residents with insomnia (OR = 7.69, 95% CI = [4.23, 14.67]) and less exercise (OR = 6.24, 95% CI = [1.33, 29.37]) had higher burnout risk, while residents who smoked had a lower risk (OR = 0.60, 95% CI = [0.40, 0.89]). And lifestyle factors had a slightly different impact on emotional exhaustion and depersonalization.ConclusionRadiology residents’ lifestyles can be emphasized, as it may reflect their pressure and wellbeing and influence their concentration, competency, burnout and performance. Policymakers and hospital administrators should incorporate practical and modifiable strategies into work routines to improve the lifestyle quality of residents.

Energy Consumption Trends and Determinants in Polish Hospitals: Implications for Energy Efficiency Strategies

In the construction sector, hospitals are the buildings with the highest energy consumption. Due to the high demand for energy, hospitals’ energy efficiency is becoming very important. This study aims to examine the trends and factors that determine energy consumption in Polish hospitals from 2010 to 2019, highlighting the impact of hospital size and medical activities on energy efficiency. The analysis was carried out using data from 3061 hospital reports obtained from the e-Health Center, a state budgetary unit established by the Minister of Health. To measure and compare the efficiency of energy usage in hospitals, we developed eight energy usage efficiency indexes based on hospital size and medical activity. The size of the hospitals was described by the number of beds, operation rooms, doctors, nurses, and fixed assets value. Hospital activity was measured by the number of person-days, patients, and operations. Statistical analysis was carried out using StatSoft Statistica software version 13.3. The results show that larger hospitals are more energy efficient across various measures of energy use than smaller hospitals. The findings revealed also several important relationships between energy usage and factors connected with size and hospital activity, such as the number of beds, patients and person-days, medical staff, operations, and fixed asset values, underscoring the necessity for customizing energy efficiency strategies. This research contributes empirical insights that can guide policymakers and hospital administrators in their endeavors to improve energy efficiency and promote sustainability within healthcare facilities.

Management of Emergency Department Services at a Secondary Level Hospital

Background: The primary purpose of the Emergency Department (ED) is to provide immediate medical attention and resuscitation to seriously ill patients. Prompt treatment and efficient service management play crucial roles in preventing fatalities and disabilities. Objective: To evaluate the management of emergency department services at a secondary-level hospital in Bangladesh. Methodology: A descriptive cross-sectional study was carried out in the emergency department at Narayanganj General Hospital from January to December 2018. The study involved 229 participants, including both service recipients and providers. Data was collected using a pre-tested, semi-structured questionnaire administered through face-to-face interviews. Results: The majority of participants easily identified the ED room (82.3%) and waited ≤15 minutes (91.2%) to see a doctor. They also felt that doctors listened attentively to their complaints (88.9%) and behaved well (92.5%). Service providers' behavior was also positively rated by patients, with 90.8% expressing satisfaction. Most patients did not receive all prescribed medicines from the pharmacy (81.4%), expressed dissatisfaction with the cleanliness of the environment (52.1%), and facilities in the waiting room (60.0%). Despite these concerns, they mostly stated satisfaction with the treatment received (51.6%) and the overall management of the ED (45.1%). Service providers identified several shortcomings across multiple areas, such as laboratory facilities (78.6%), staffing levels of doctors (78.6%), nurses (64.3%), and supporting staff (85.7%). Despite these challenges, they expressed satisfaction (64.3%) with their roles. Conclusion: The study demonstrated that both service recipients and service providers were satisfied with the management of medical services. However, hospital administration and health service providers should prioritize resolving deficiencies in order to improve patient satisfaction more substantially. Journal of Monno Medical College June, 2024; 10 (1):36-42

Role of servicescape in patients' clinic care waiting experience: Evidence from developing countries.

The aim of this research is to investigate the role of servicescape on re-patronage and recommended intention through pleasure feeling and satisfaction in healthcare settings that put substantial contribution in the process of healthcare service delivery. Data were collected through cross-sectional convenience sampling via a self-administered survey questionnaire from 431 clinical outpatients who revisit the same hospital of metropolitan areas of Punjab, Pakistan. Structural Equation Modeling (SEM) was carried out for path analysis through AMOS (24.0 V), while statistical measures were analyzed using SPSS (25.0 V). The present study results revealed that patients' intention optimistically triggered through partial mediation and affirm the direct and indirect association with servicescape. It also revealed that patient-recommended and re-patronage intentions to visit the clinic were statistically substantial and positively influenced by intervening constructs of pleasure feeling and satisfaction. Additionally, it is found that servicescape and pleasure feeling contributed to 30% change in satisfaction. Moreover, pleasure feeling, and satisfaction contributed to 50% change in re-patronage and 31% change in recommendation intention of the patients. The current study findings contribute significantly to servicescape literature from a theatrical perspective and reevaluate the patterns and operations in healthcare. It also helps managers and administrators of private hospitals to make strategies to increase patient satisfaction.

Organizational health literacy in German hospitals: a cross-sectional survey among hospital managers

BackgroundOrganizational health literacy (OHL) describes conditions and measures in healthcare institutions to enable patients to make good health-related decisions. By providing easy access to and appropriate communication of understandable information to use and navigate the facility, healthcare organizations can contribute to strengthening patients’ health literacy and self-management. The extent of OHL implementation in German hospitals remains largely unknown. This study aims to fill this gap in our knowledge by investigating OHL-related activities reported by hospital managers.MethodsBetween November and December 2022, we conducted a national online survey among medical, nursing and administrative hospital managers with hospitals that operate more than 50 beds. The data were collected via the health literate health care organization ten item questionnaire (HLHO-10) and supplemented by sociodemographic questions and an open-ended question. We applied variance and correlation analyses to investigate the data.ResultsOf 3,301 invited hospital managers, 371 participated in the survey (response rate 11%). The overall mean score for HLHO-10 was 4.6 (SD = 1.1) on a 7-point Likert scale, indicating a moderate level of OHL implementation. Hospital managers stated that hospitals concentrate on helping patients find their way around and communicating the costs of treatment transparently and clearly; conversely, that active patient participation in the design and evaluation of health information is rare in care settings, and that health information is seldom provided to patients through a range of media. For the practical implementation of the OHL, most hospital managers mentioned activities regarding communication standards, such as providing information materials.ConclusionsGiven their unique position as hubs of human interaction, hospitals provide an ideal opportunity to promote the adoption of OHL. By actively involving patients, hospitals can better tailor their approaches to meet patient needs and preferences. Compared to studies from oncology centres in Germany and 20 Italian hospitals, the average HLHO-10 score of this study is lower. While some aspects of OHL are already embedded in inpatient care, it is imperative that OHL is thoroughly embedded in the hospitals’ organizational culture and plays a fundamental role in the daily operations of the institution. This could be done, for instance, by more explicitly addressing the topic of health literacy in staff communication training.

Optimizing the role of scrub nurses during robotic surgery console time

At our institution, scrub nurses leave the surgical field during the console time for robotic surgeries to attend to other duties. The first assistant then assumes their responsibilities, allowing for efficient use of staff time and resources. This practice improves teamwork and can be presented as a cost-saving measure for hospital administrations.

Environmental impact of intravenous versus oral administration materials for acetaminophen and ketoprofen in a French university hospital: an eco-audit study using a life cycle analysis.

The combination of acetaminophen with a nonsteroidal anti-inflammatory drug is the cornerstone of perioperative multimodal analgesia. These drugs can be administered intravenously or orally as premedication, consistent with the concept of pre-emptive and preventive analgesia. We aimed to assess the environmental impact of their intravenous and oral administration in a French university hospital. We carried out a life cycle assessment to determine the amount of greenhouse gas emissions and depletion of water resources resulting from the oral vs intravenous administration of 1g acetaminophen and 50mg ketoprofen. We assessed two schemes of intravenous administration, depending on the use of the same or a different infusion set for each drug. At our centre, the intravenous administration of both drugs was associated with the emission of 444-556g CO2 equivalent (CO2e), and with 9.8-12.2 L of water waste. The oral administration of both drugs generated 8.36g of CO2e emissions and consumed 1.16 L of water. At a national level, the switch from intravenous to oral premedication of the drugs could avoid the emission of 2,900-3,700 tons of CO2e and the waste of 58,000-74,000 m3 of water each year. This eco-audit indicates that oral administration of acetaminophen and ketoprofen results in significantly lower carbon emissions and water consumption than intravenous administration. These findings highlight the importance of using the oral route for most patients, limiting intravenous administration for those with specific needs because of higher environmental impact and cost.

Adjudication of Codes for Identifying Sepsis in Hospital Administrative Data by Expert Consensus

Adjudication of Codes for Identifying Sepsis in Hospital Administrative Data by Expert Consensus

Exploring barriers to and facilitators of infection prevention and control practices in the Pediatrics and Child Health Department of Tikur Anbessa Specialized Hospital, Ethiopia

BackgroundAdherence to infection prevention and control (IPC) standards and guidelines by healthcare workers is essential for reducing the spread of healthcare-associated infections (HAIs). However, IPC practices among healthcare workers in low- and middle-income countries (LMICs), including Ethiopia, are generally inadequate. This research aims to identify the barriers to and facilitators of IPC practices in the Pediatrics and Child Health Department of Tikur Anbessa Specialized Hospital (TASH) in Ethiopia.MethodsWe employed a rapid ethnographic assessment (REA) approach for this study, using focus group discussions (FGDs), in-depth interviews (IDIs), and observations to collect data. Participants were selected from the Pediatrics and Child Health Department of TASH, and data collection took place in March and April 2022. Two FGDs and eight IDIs were conducted in the participants’ workplace within the department. Unstructured guides were used to facilitate the FGDs and IDIs. Nvivo version 10 software was used for data organization and analysis. The data were coded deductively through thematic analysis to identify similar ideas and concepts, based on the Systems Engineering Initiative for Patient Safety (SEIPS) model.ResultA total of 23 healthcare workers participated, with 15 in FGDs and 8 in IDIs. The study identified several barriers to IPC practices, including nonadherence to IPC practice protocols, lack of pre-employment training, space constraints, insufficient maintenance and repair of equipment, limited management engagement and support, shortage of resources and budget, incidents of needle stick injuries and infections, high workloads for healthcare workers, shortages of personal protective equipment and water supply, and inadequate waste management. We also identified some facilitators, including the existence of an IPC team and committee, a health education schedule for patients and visitors, morning sessions for healthcare providers, and the presence of television screens in waiting areas. By addressing the identified barriers and leveraging the facilitators, department heads, IPC team leaders, and decision-makers can develop targeted strategies and interventions to improve infection control, reduce the spread of HAIs, and ultimately enhance the quality of healthcare services.ConclusionThis study explored several barriers that contribute to inappropriate and suboptimal IPC practices in the study area. These barriers create significant challenges for healthcare workers and hindering their ability to effectively implement IPC practices. The findings highlight the complex and multifaceted nature of the problems, which not only affect the current working environment but also compromise the overall quality of care. The hospital administrator should address these critical issues to improving IPC practices and ensuring a safer healthcare environment.

Increased access to pediatric specialist healthcare using eConsult: A retrospective observational cohort and case–control study

ABSTRACT Objectives Primary care practitioners (PCPs) report that using the Champlain BASE™ eConsult service (eConsult) averts one-third of face-to-face (FTF) specialist referrals, however, there are concerns about duplication of services and adverse patient outcomes. Following an eConsult, we evaluated patient healthcare utilization and associated treatment costs. Methods Retrospective cohort study (2014 to 2018) of patients (<18 years old) for whom an eConsult visit averted a FTF specialist referral. Patients were linked to provincial health administrative databases and hospital electronic medical records for healthcare use for the same diagnosis and specialty for the 18 months following the eConsult. Concurrently, a retrospective case–control study compared utilization and costs between an eConsult versus a matched FTF visit for the same diagnosis. We also assessed PCP satisfaction. Results In follow-up, <5% of the study cohort of eConsult patients (n = 242) later accessed the healthcare system for the identical diagnosis and specialty type. FTF visits generate more frequent outpatient visits (12.6 times more [95% CI: 2.28 to 69.66, P = 0.002]) and higher costs compared to eConsult visits. There were no hospital admissions or deaths in patients with eConsult. PCPs (98%) described eConsult as an excellent service. Conclusions Using eConsult is associated with <5% of patients subsequently having a FTF visit for the same reason. Matched FTF visits generated more healthcare utilization and higher costs compared with eConsult. eConsult in pediatrics is safe and can minimize FTF specialist visits in elective cases and increase capacity, towards a more efficient and cost-effective healthcare system.

Factors influencing medication errors among nurses at a tertiary level hospital in Bangladesh

Medication errors represent a significant global issue, leading to numerous fatalities each year and adding complexity to healthcare systems. In Bangladesh, the prevalence of medication errors stands at 38%. This study aimed to identify the factors that influence medication errors among nurses at a tertiary-level hospital in the country. A descriptive cross-sectional study was conducted involving 114 registered nurses at Dhaka Medical College Hospital, utilizing a convenience sampling method. Data were gathered through face-to-face interviews using a structured questionnaire and analyzed using both descriptive and inferential statistics. The findings indicated that nurses in Bangladesh exhibited moderate to high susceptibility to medication errors in a tertiary-level setting. Key factors identified as contributing to these errors included inadequate staffing levels (4.41 ± 0.81), patients being off the ward for other care (4.39 ± 0.74), communication issues between nurses and physicians (4.36 ± 0.95), nurses being pulled between teams and other units (4.32 ± 0.77), and insufficient in-service training on new medications (4.23 ± 0.87). Moreover, nurses working ward (F=11.51, P=.001) and working experience (t=4.13, P=.041) had a significant relationship with factors influencing medication errors. The research found several variables that cause medication mistakes, including nurses' service experience and working ward. This study's results might help hospital administrators establish effective intervention methods and mitigate medication error risk variables to improve patient safety and care. Asian J. Med. Biol. Res. 2024, 10(4), 131-140

The effect of work-family conflict on employee well-being among physicians: the mediating role of job satisfaction and work engagement

BackgroundWork-family conflict among physicians has many adverse consequences, like reduced work engagement and impaired well-being. However, relatively little research has been conducted on the impact of work-family conflict on specific pathways of physician well-being. The aim of this study was to determine the relationship between work-family conflict and employee well-being among physicians and to explore the mediating role of job satisfaction and work engagement in this relationship.MethodsUsing data from a cross-sectional survey of 2,480 physicians in Jilin Province, China, partial least squares structural equation modeling (PLS-SEM) was applied in this study to examine the direct and indirect effects of work-family conflict on employee well-being and to assess the mediating roles of job satisfaction and work engagement therein.ResultsThe employee well-being score of physicians in Jilin Province was 5.16 ± 1.20. The univariate analysis results indicated significant disparities in employee well-being scores across different age groups, marital statuses, and professional titles. Work-family conflict was significantly negatively associated with employee well-being, while job satisfaction and work engagement were significantly positively associated with employee well-being. In addition, job satisfaction and work engagement were found to mediate the association between work-family conflict and employee well-being, and work engagement was considered to mediate the association between job satisfaction and employee well-being.ConclusionsOur study confirms that work-family conflict negatively affects physicians’ employee well-being. Moreover, our investigation revealed that the association between work-family conflict and employee well-being is influenced by both job satisfaction and work engagement and that work engagement plays a mediating role in the link between job satisfaction and employee well-being. Therefore, we propose that hospital administrators should rationally allocate organizational resources and develop manageable schedules to enhance physicians’ employee well-being.

Changes in Patient Care Experiences and the Nurse Work Environment: A Longitudinal Study of U.S. Hospitals.

Addressing patient experience is a priority in the health care system. Hospital Consumer Assessment of Providers and Systems (HCAHPS) survey results incentivize hospitals to elevate patient experience, a factor in patient-centered care. Although hospital nursing resources have been positively associated with better HCAHPS ratings, it is unknown how changes in nursing resources are associated with changes in HCAHPS ratings over time. This two-period longitudinal study ranked the associations between changes in nurse staffing, skill mix, nurse education, and work environment on HCAHPS ratings and found that changes in the work environment had the strongest associations (β = 2.29; p < .001) with improved HCAHPS ratings. Our findings provide hospital administrators with empirical evidence that may help make informed decisions on how to best invest limited resources to improve HCAHPS ratings, including the potential utility of improving the work environment through enhancing Nursing Quality of Care and Nurse Participation in Hospital Affairs.

Working with Difficult Colleagues: Strategies for Managing Conflict and Maintaining Productivity

This article explores research-backed strategies for effectively managing workplace conflicts and collaborating productively even with difficult or disliked coworkers. While interpersonal disputes are inevitable in team environments where personalities and work styles differ, the research shows proper handling of conflicts can spark innovation, while improper addressing can breed toxicity. The article presents a framework for constructively channeling conflicts through establishing clear boundaries, addressing disagreements calmly and respectfully, avoiding personal criticisms, discreetly addressing issues to shield others, and upholding civility and professionalism at all times. Real-world examples from hospital administrators, project managers, and nonprofit CEOs illustrate applying these strategies in navigating philosophical divides and personality clashes. The conclusion is that with strategic relationship management focused on issue-solving over blaming, and principles-based leadership, leaders can work productively despite challenges from certain colleagues.

Empowering Health Care Providers: A Collaborative Approach to Enhance Financial Performance and Productivity in Clinical Practice.

The combination of inadequate financial training, limited benchmarks, and mindset contribute to many physicians prioritizing revenue below quality, outcomes, and safety. This creates a challenge as hospital administrators aim to motivate clinicians to improve RVU generation and increase revenue. Creating physician/administrator teams that defines and explores the gap between observed and expected financial performance in parallel with appreciating the physician's practice preferences can create new opportunities for billing. The proposed 3 phase approach emphasizes nonjudgmental communication, education and partnership. The most common and effective opportunities for improvement include billing optimization, scheduling and system infrastructure modifications. As reimbursement decrease, balancing revenue generation with physician satisfaction has become paramount. Promoting data drive bidirectional communication can lead to identifying previously unrecognized billing opportunities where change is driven by providers rather than by 1-dimensional institutional goals.