Health System Leaders Research Articles

Comprehensive Assessment of Clinical Learning Environments to Drive Improvement: Lessons Learned from a Pilot Program

Problem : Recognition of the importance of clinical learning environments (CLEs) in health professions education has led to calls to evaluate and improve the quality of such learning environments. As CLEs sit at the crossroads of education and healthcare delivery, leadership from both entities should share the responsibility and accountability for this work. Current data collection about the experience and outcomes for learners, faculty, staff, and patients tends to occur in fragmented and siloed ways, and available tools to assess clinical learning environments are limited in scope. In addition, from an organizational perspective oversight of education and patient care is often done by separate entities, and not infrequently is there a sense of competing interests. Intervention : We aimed to design and pilot a holistic approach to assessment and review of CLEs and establish whether such a formative assessment process could be used to engage stakeholders from education, departmental, and health systems leadership in improvement of CLEs. Utilizing concepts of implementation science, we planned and executed a holistic assessment process for CLEs, monitored the impact of the assessment, and reflected on the process. We focused the assessment on four pillars characterizing exemplary learning environments: 1) Environment is inclusive, promotes diversity and collaboration; 2) Focus on continuous quality improvement; 3) Alignment between work and learning; and 4) Integration of education and healthcare mission. Context : At our institution, medical trainees rotate through several different health systems, but clinical and educational leadership converge at the departmental level. We therefore focused this proof-of-concept project on two large clinical departments at our institution, centering on medical learners from undergraduate and graduate medical education. For each department, a small team of champions helped create an assessment grid based on the four pillars and identified existing quantitative evaluation data sources. Champions subsequently collected qualitative data through observations, focus groups, and interviews to fill any gaps in available quantitative data. Impact : The project teams shared reports summarizing findings and recommendations with departmental, clinical, and educational leadership. Subsequent meetings with these stakeholders led to actionable plans for improvement as well as sustained structures for collaborative work between the different stakeholder groups. Lessons Learned : This project demonstrated the feasibility and effectiveness of collating, analyzing, and sharing data from various sources in engaging different stakeholder groups to initiate actionable improvement plans. Collating quantitative data from existing resources was a powerful way to demonstrate common issues in CLEs, and qualitative data provided further detail to inform improvement initiatives. Other institutions can adapt this approach to guide assessment and quality improvement of CLEs. As a next step, we are creating a comprehensive learning environment scorecard to allow for comparison of clinical learning environment quality across institutions and over time.

Boarding for Youth Mental Health Conditions: How Can Hospitalists Be Part of the Solution?

Boarding for Youth Mental Health Conditions: How Can Hospitalists Be Part of the Solution?

Supporting each other: Pacific emergency care clinicians navigate COVID-19 pandemic challenges through collaboration

Supporting each other: Pacific emergency care clinicians navigate COVID-19 pandemic challenges through collaboration

Healthcare Analytics: Applications and Challenges

Present day decision making in healthcare has become a data-intensive process leading to the rise of healthcareanalytics. These analytics involve the integration and analysis of data collected from multiple heterogenoussources including biomedical data (electronic health records), experimental (R&D) data, patient lifestyle andbehavior data (store records, social media, wearable electronic devices etc) and financial data. Healthcareanalytics is further being transformed by the application of current - omics technologies (genomics,epigenomics, transcriptomics, proteomics, metabolomics, pharmacogenomics etc), shifting healthcare to asystem that is “predictive, preventive, participatory, and personalized”, referred to as the P4 medicineparadigm. The omics revolution is generating a huge amount of data that needs to be collected, stored,transformed, analyzed and ultimately delivered in a format that is understandable to the clinicians. Properlyapplied, healthcare analytics provide actionable insights that can lead to improvement in healthcaremanagement and delivery, clinical outcomes, health policies and allocation of health resources to communitiesin need.
 Medical institutions worldwide are facing many challenges. There is a shortage of trained human resource,patients are more demanding and regulators are becoming more stringent. The healthcare systems are underpressure to provide better and safer healthcare that is also more cost-effective. This is leading to thedevelopment of a whole new healthcare analytics industry to capture, store and analyze big data for healthcareproviders, health system leaders, and those in government health and human services to improve healthcaredelivery and outcomes. A report by McKinsey Global Institute published in 2011 estimated that if US healthcarewere to use big data creatively and effectively, the sector could create more than $300 billion in value everyyear.1
 While innovative new technologies and platforms are making it possible to capture vast amounts ofinformation of individual patient over a large timescale, a large amount of data remains underutilized andwasted. It is estimated that healthcare providers discard around 90% of the data that they produce.1 One of thegreatest challenges in healthcare analytics is harvesting the data from multiple complex and heterogenoussources spread across different healthcare systems, health insurers, scientists, government bodies etc. andtransforming it to generate meaningful information. Moreover, the personal and financial data and medicalrecords of patients required to contribute to effective analytical platforms may be confidential and private andtherefore inaccessible. Hospitals are also reluctant to share their financial and clinical audits. There is the issuealso of ownership of the data and in many countries patient data is legally possessed by the patient. Even so thehealthcare industry, slow to transition towards data mining and IT solutions, has now begun to adapt to thedigital data age. Algorithms for collecting, compressing, anonymizing and sharing medical data are beingdeveloped by different groups in addition to various platforms specific to healthcare analytics.
 The implementation of healthcare analytics, particularly in developing countries like Pakistan where mosthealthcare facilities lack even the most basic form of EHRs is a formidable challenge. Pakistan has a robust ITcommunity with a special interest and investment by the government sector in IT and Artificial Intelligenceplatforms. Pakistan government last year announced seed money of Rs 1.1 billion, to carry out a three-yearproject on AI, through the Higher Education Commission to be conducted by six universities. One of theseprojects, related to medical imaging and diagnostics, is a step in the right direction. However, we still have a long way to go if we are to reap the benefits of healthcare analytics in Pakistan. There is a need for the involvement and commitment of all stakeholders including healthcare facilities, academicians, researchers and industry etc to contribute to this endeavor. There is no shortage of qualified human resource in the country. All that is required is the will of the health sector to invest in this golden opportunity for healthcare analytics to play a role in improving the delivery of cost-effective care, save lives and define health policies in Pakistan.
 Editor-in-Chief 
 How to cite this: Alamgir W, Mohyuddin A . Healthcare Analytics: Applications and Challenges. Life and Science. 2022; 3(3): 97-98. doi: http://doi.org/10.37185/LnS.1.1.263

Be the Solution: Sell Your C-Suite on the Value and Leadership of Anesthesiologists

Article| July 2022 Be the Solution: Sell Your C-Suite on the Value and Leadership of Anesthesiologists Theresa Hill, MSJ Theresa Hill, MSJ Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor July 2022, Vol. 86, 33–34. https://doi.org/10.1097/01.ASM.0000842080.74322.81 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share MailTo Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Theresa Hill; Be the Solution: Sell Your C-Suite on the Value and Leadership of Anesthesiologists. ASA Monitor 2022; 86:33–34 doi: https://doi.org/10.1097/01.ASM.0000842080.74322.81 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: leadership As an anesthesiologist, you are uniquely trained for the critical moments in health care – in the OR, delivery room, intensive care unit, pain clinic, and the outpatient setting. Yet many of you acknowledge facing an uphill battle in positioning yourselves as leaders in hospitals and health systems and promoting your value with the C-suite. In a Monitor article published last August, ASA Committee on Communications (COC) Chair Adam Striker, MD, provided a sneak peek at a new ASA initiative – Be the Solution – to demonstrate your value to your health care executives. The initiative is vital because many health care executives do not recognize the specialty's impact on the hospital and health system. According to a 2019 ASA survey, 11 of 31 health care executives expressed “no preference” between an anesthesiologist and a nurse to diagnose and treat complications during a procedure. Yet 69% expressed a personal preference... You do not currently have access to this content.

Virtual care and the influence of a pandemic: Necessary policy shifts to drive digital innovation in healthcare.

The potential for virtual healthcare to improve access to primary care services in Canada has long been a topic of discussion; however, implementation has been slow despite growing interest among the public. Non-essential service lockdowns implemented in 2020 in response to the COVID-19 pandemic catalyzed rapid and widespread uptake of virtual healthcare delivery. It is important to consider how to maintain equitable access to virtual care following the pandemic. We conducted a narrative scoping review to understand barriers related to the sustained adoption of virtual primary care delivery in Canada. Barriers at the system, healthcare provider, and patient levels were related to digital health infrastructure, and the regulatory environment governing virtual care provision and remuneration for healthcare professionals. The article identifies areas where policy shifts by health system leaders could sustain the longer-term availability of Canadian virtual care services.

Innovating in a crisis: a qualitative evaluation of a hospital and Google partnership to implement a COVID-19 inpatient video monitoring program.

ObjectiveTo describe adaptations necessary for effective use of direct-to-consumer (DTC) cameras in an inpatient setting, from the perspective of health care workers.MethodsOur qualitative study included semi-structured interviews and focus groups with clinicians, information technology (IT) personnel, and health system leaders affiliated with the Mount Sinai Health System. All participants either worked in a coronavirus disease 2019 (COVID-19) unit with DTC cameras or participated in the camera implementation. Three researchers coded the transcripts independently and met weekly to discuss and resolve discrepancies. Abiding by inductive thematic analysis, coders revised the codebook until they reached saturation. All transcripts were coded in Dedoose using the final codebook.ResultsFrontline clinical staff, IT personnel, and health system leaders (N = 39) participated in individual interviews and focus groups in November 2020–April 2021. Our analysis identified 5 areas for effective DTC camera use: technology, patient monitoring, workflows, interpersonal relationships, and infrastructure. Participants described adaptations created to optimize camera use and opportunities for improvement necessary for sustained use. Non-COVID-19 patients tended to decline participation.DiscussionDeploying DTC cameras on inpatient units required adaptations in many routine processes. Addressing consent, 2-way communication issues, patient privacy, and messaging about video monitoring could help facilitate a nimble rollout. Implementation and dissemination of inpatient video monitoring using DTC cameras requires input from patients and frontline staff.ConclusionsGiven the resources and time it takes to implement a usable camera solution, other health systems might benefit from creating task forces to investigate their use before the next crisis.

Engaging people with lived experience on advisory councils of a national not-for-profit: an integrated knowledge translation case study of Heart & Stroke Mission Critical Area Councils

BackgroundIn 2018, the Heart and Stroke Foundation of Canada transformed its approach to organizational strategic planning and priority-setting. The goal was to generate impact from bench to bedside to community, to improve the health of Canadians. It engaged researchers, clinician scientists, health systems leaders, and community members including people with lived experience (PWLE) on six Mission Critical Area (MCA) councils, each of which was co-chaired by a researcher or clinician scientist and a person with lived experience. Together, council members were tasked with providing advice to Heart & Stroke about the most relevant and impactful priorities of our time. The aim of this research was to explore the value of the MCA councils to Heart & Stroke, and to council members themselves. The research questions focused on understanding the process of managing and participating on the councils, the challenges and outcomes.Methods Using an integrated knowledge translation approach, we conducted a case study with developmental evaluation over a 2-year time period (2018–2020). We collected qualitative data from various sources (Heart & Stroke team responsible for managing the councils, council co-chairs, council members, and key informants). We collected documents and analysed them for contextual background.Results Participants noted that the MCA councils continuously evolved over the 2 years in various ways: from an uncertain direction to a concrete one, better integrating the voice of PWLE, and increased cohesiveness within and across MCA councils. This evolution was achieved in parallel with successes and challenges at three levels: the MCA councils and its members, Heart & Stroke, and Canadians. The MCA councils were disbanded in 2020, yet learnings, developments, initiatives and established partnerships remain as their legacy.Conclusions Heart & Stroke’s intended objectives for the MCA councils, to promote engagement and dialogue among community members including PWLE, clinician scientists, and researchers, and to provide advice into Heart & Stroke’s strategic renewal process, were achieved. This collaborative structure and process for PWLE engagement within a community of multidisciplinary clinician scientists and researchers is possible yet requires flexibility, commitment to stakeholder relationship management, and considerable resources. These findings may be helpful for other not-for-profit and funding organizations interested in engaging the public and other stakeholders into their organizational activities.

Business acumen for nursing leaders: An exploratory qualitative study.

The aim of this study was to explore the status of and need for business acumen of nurse leaders. Health systems globally continue to reform to deliver better care while working within sustainable budgets. However, beyond leadership and management expertise, nurse leaders need strong business acumen to appreciate the complexity of the system. Two groups, emerging nurse leaders and established health system leaders, were interviewed for their perspective on four elements related to business acumen. Business in healthcare was defined and therefore valued with variation across both groups. Adequate business education for nurse leaders was considered lacking by both groups. Inconsistent business acumen was seen as a barrier for nursing inclusion at the system level. Business acumen is a skillset more valuable for the nursing profession than the current educational preparation allows, creating a reputational barrier for nursing's full participation in health system-level leadership, but is considered an opportunity for the future. Improving the foundation business acumen across the nursing profession will not only raise the profile of nurse leader capability to input and influence across the health system but also improve the wider nursing team's understanding around nurse leader advocacy and decision making.

Intersectionality and nursing leadership: An integrative review.

This review aimed to synthesise international research about how intersectionality has been used to explore issues within the nursing profession. The objectives were to determine which intersecting variables have been explored, how intersectionality has been operationalised, and the implications for nursing leadership. Barriers to health system leadership created at the intersection of gender, race, ethnicity, professional cadre and other socially constructed categories exist in the health workforce. Consequently, an intersectionality paradigm has been recommended to explore power, privilege and oppression issues in the nursing profession. An integrative systematic review method was selected for its ability to include diverse methodologies. The review complies with the PRISMA guidelines for reporting systematic reviews. The search terms nurs* nurses nursing AND Intersectionality intersectional intersectionalism, intersect were used in December 2021 to search the Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus) PsycINFO, PubMed, Ovid, ProQuest and the first ten pages of Google Scholar from 2011 to 2021. Directed content analysis was applied to the data. Access to education, absence of expectations as a career and patriarchal structures support male nurses into positions of leadership in healthcare systems. Intra-group differences highlight the paradox of homogenous categories for ethnicity and gender. Being a member of an ethnic minority group hinders career progression regardless of gender. The aftereffects of colonisation exist within the nursing space. This review is the first to synthesise research using intersectionality to explore the impact of socially constructed identities on nursing leadership. There is a dearth of evidence specific to this topic, ignoring the diversity within this professional group. Future research should include intersectionality to discover how social categories empower or impede a nurse's career progression to leadership roles. An intersectionality paradigm can encourage nurses to attend to issues of power, privilege and oppression in the profession and their practice.

Valuing Diversity and Inclusion in Health Care to Equip the Workforce: Survey Study and Pathway Analysis.

BackgroundThe COVID-19 pandemic, with all its virus variants, remains a serious situation. Health systems across the United States are trying their best to respond. On average, the health care workforce is relatively homogenous, even though it cares for a highly diverse array of patients. This perennial problem in the US health care workforce has only been accentuated during the COVID-19 pandemic. Medical workers should reflect on the variety of patients they care for and strive to understand their mindsets within the larger contexts of culture, gender, sexual orientation, religious beliefs, and socioeconomic realities. Along with talent and skills, diversity and inclusion (D&I) are essential for maintaining a workforce that can treat the myriad needs and populations that health systems serve. Developing hiring strategies that will help achieve greater workforce diversity remains a challenge for health system leaders.ObjectiveThe primary aims of this study were to: (1) explore the characteristics of US health systems and their associations with D&I practices and benefits, (2) examine the associations between D&I practices and three pathways to equip workforces, and (3) examine the associations between the three pathways to better equip workforces and business and service benefits. The three pathways are: (1) improving D&I among existing employees (IMPROVE), (2) using multiple channels to find and recruit the workforce (RECRUIT), and (3) collaborating with universities to find new talent and establish plans to train students (COLLABORATE).MethodsDuring February to March 2021, 625 health systems in the United States were surveyed with the help of a consultant, 135 (21.6%) of whom responded. We assessed workforce talent- and diversity-relevant factors. We collected secondary data from the Agency for Healthcare Research and Quality Compendium of the US Health Systems, leading to a matched data set of 124 health systems for analysis. We first explored differences in diversity practices and benefits across the health systems. We then examined the relationships among diversity practices, pathways, and benefits.ResultsHealth system characteristics such as size, location, ownership, teaching, and revenue have varying associations with diversity practices and outcomes. D&I and talent strategies exhibited different associations with the three workforce pathways. Regarding the mediating effects, the IMPROVE pathway seems to be more effective than the RECRUIT and COLLABORATE pathways, enabling the diversity strategy to prompt business or service benefits. Moreover, these pathway effects go hand-in-hand with a talent strategy, indicating that both talent and diversity strategies need to be aligned to achieve the best results for a health system.ConclusionsDiversity and talent plans can be aligned to realize multiple desired benefits for health systems. However, a one-size-fits-all approach is not a viable strategy for improving D&I. Health systems need to follow a multipronged approach based on their characteristics. To get D&I right, proactive plans and genuine efforts are essential.

Covid-19' impacts on inpatient admission changes at National Hospital of Dermatology and Venereology, Hanoi, Vietnam

Objective: Since the Coronavirus disease in 2019 (COVID-19) was announced as a worldwide pandemic, it has affected all aspects of life, including the economy, society, and the healthcare system. The impact of COVID-19 on co-morbidities is a concern however, there are few studies on dermatological patients. To determine COVID-19's impact on the number of hospital admissions and the changes of common diseases at the National Hospital of Dermatology and Venereology. Methods: A cohort study is conducted to collect all admission over four years from Feb 2018 to Jun 2021. The dataset including 10506 records was extracted from the hospital information system database. Descriptive statistical was used to analyse the admission differences between the four- year periods. Results: The number of patients markedly decreased by about 30% in 2020 and about 60% in 2021. The male/female ratio did not change significantly between before and after the pandemic. Benign neoplasia was the greatest change from 5.9% (2018) to 21% (2021). The allergic/reactive group decreased from 40% (2018) to 25% (2021). The infectious group also decreased from 20% (2018) to 10.8% (2021). The autoimmune group fluctuated at 9%-10%. The top 10 common diseases show that the first position was psoriasis then switched to Carcinoma in situ of skin during the Covid-19 time. Conclusion: The results of this study are significant in predicting the trend of dermatology patients' admission during a pandemic. The results assist health system leaders and public health authorities in adjusting policies and procedures to suit the pandemic situation that is still complicated. Keywords: COVID-19, SARS-CoV-2, hospital admission, hospitalizations, dermatology service

Comparative salary-related costs of a brief app-directed delirium identification protocol by hospitalists, nurses, and nursing assistants.

Systematic screening can improve delirium identification among hospitalized older adults. Prior studies have shown clinicians and health system leaders may believe they do not have the time and resources for assessment. We conducted a comparative salary-related cost analysis of an adaptive delirium identification protocol directed by an iPad app. We recruited 527 older adult medicine patients from an urban academic medical center (n=269) and a rural community hospital (n=258). Physicians and nurses completed the two-step Ultra-brief Confusion Assessment Method (UB-CAM) protocol (with or without a skip pattern), while certified nursing assistants completed only the UB-2 ultra-brief screen. The sample included 527 patients (average age 80, 57% women, 35% with dementia). Time required to administer the protocol was collected automatically by the iPad app. Salary-related costs of screening were determined by multiplying the time required by the hourly wage for the three disciplines, as obtained from national and regional published healthcare salary cost data. Cost estimates for entire hospital implementation were also calculated. Participants were screened on 924 hospital days by 399 clinicians (53 physicians, 236 nurses, 110 CNAs). For the UB-2, CNAs cost per screen was lower than the other clinician types ($0.37 per screen vs. $0.73 for nurses and $2.39 for hospitalists). For the UB-CAM with skip (UB-CAM), costs per protocol were $1.10 for nurses vs. $3.61 for physicians. The annual salary-related costs of hospital-wide implementation of a nurse-based UB-CAM protocol in a medium-sized (300-bed) hospital was $63,015 plus $4356 for initial and annual training. CNAs and nurses had the lowest salary-associated costs for app-directed CAM-based delirium screening and identification, respectively. Salary-related annual hospital costs for the most efficient protocols in a medium-sized hospital were less than the annual cost of hiring 1 FTE of the discipline performing the protocols.

Sitting.

During a local COVID-19 surge in late 2021, salaried health system leaders were asked to volunteer for nonclinical hospital shifts to help alleviate staffing shortages. The author, a family physician by training now working largely in a population health administrative role, signed up to serve as a patient sitter. This story explores how taking on the vantage point of a sitter enabled the author to reflect on the premise of watching and being watched, the diverse team that keeps an emergency department running, and how human connection may even contribute to normalizing heart rate. (Note: Pseudonyms are used in place of actual names and some details withheld to protect the privacy of the individuals involved.).

Lessons learned from academic medical centers' response to the COVID-19 pandemic in partnership with the Navajo Nation.

IntroductionStructural forces that drive health inequalities are magnified in crises. This was especially true during the COVID-19 pandemic, and minority communities were particularly affected. The University of California San Francisco and Health, Equity, Action, Leadership Initiative jointly sent volunteer teams of nurses and doctors to work in the Navajo Nation during the COVID-19 pandemic. This presented an opportunity to explore how academic medical centers (AMCs) could effectively partner with vulnerable communities to provide support during healthcare crises. Therefore, the aims of this study were to describe volunteers’ perspectives of academic-community partnerships by exploring their personal, professional and societal insights and lessons learned based on their time in the Navajo Nation during COVID-19.MethodsWe recruited key informants using purposeful sampling of physicians and nurses who volunteered to go to the Navajo Nation during the spring 2020 COVID-19 surge, as well as hospital administrators and leaders involved in organizing the COVID-19 efforts. We used in-depth qualitative interviews to explore key informants’ experiences pre-departure, during their stay, and after their return, as well as perspectives of the partnership between an AMC and the Navajo Nation. We used thematic analysis to systematically identify, analyze and report patterns (themes) within the data.ResultsIn total, 37 clinicians and hospital administrators were interviewed including 14 physicians, 16 nurses, and 7 health system leaders. Overall, we found 4 main themes each with several subthemes that defined the partnership between the AMC and the Navajo Nation. Mission and values incorporated civic duty, community engagement, leadership commitment and employee dedication. Solidarity, trust and humility encompassed pre-existing trust, workforce sustainability, humility and erasure of ‘savior narratives.’ Coordination included logistical coordination, flexibility, selectivity of who and what traveled to the response and coordination around media response. Workforce preparation and support encompassed understanding of historical context and providing healthcare in limited settings, dangers of inadequate preparation and the need for emotional support.ConclusionThis study provides guidelines which AMCs might use to develop and improve partnerships they have or would like to develop with vulnerable communities. These guidelines may even be broadly applied to partnerships outside of a pandemic response. Importantly, such partnerships need to be built with trust and with an eye towards sustainability and long-term relationships as opposed to ‘medical missions’.

517 Understanding Distinctions in the Implementation of Learning Health System (LHS)

OBJECTIVES/GOALS: The LHS concept has been promoted as a means for health systems to improve quality, safety, efficiency and equity. NAMs definition has been widely adopted, but is broad and has led to variation in how LHS is operationalized. Drawing on a taxonomy developed through a review of literature, we developed a tool that shows how LHSs are implemented in practice. METHODS/STUDY POPULATION: The LHS Implementation Assessment Tool (LHS-IAT) will indicate which forms of work are being carried out by a health system that purports to operate a LHS. LHS-IAT is based on the LHS Consolidated Framework (LHS-CF); which was developed through a qualitative analysis of LHS literature. LHS-CF contains 38 primary elements’ and 56 secondary elements’ that have been associated with the LHS construct. These elements are organized into 5 bodies of work• (e.g.; translating evidence into practice) and 4 enabling conditions• (e.g.; supportive culture). LHS-IAT assesses whether a health system operating as an LHS is implementing each of the key elements in LHS-CF. The usefulness of LHS-IAT will be demonstrated by applying the tool to 5 LHSs that have been described in the literature. RESULTS/ANTICIPATED RESULTS: LHS-IAT produces a quantitative profile for any given health system operating as a LHS; each LHS element is assessed as either emphasized; otherwise present; or absent. With this information, we create profiles for each implementation of LHS, using spider graphs. Systems that emphasize different elements will have different shapes for their spider graphs. Based on our initial coding of publications, we expect at least 4 distinct profiles within our sample, reflecting differences in emphasis on factors such as: continuous improvement practices, adoption of internally and externally tested interventions, research conducted to address patient care issues prioritized by institutional leaders, investigator-initiated research, clinician-engaged research, and engagement of patients and families. DISCUSSION/SIGNIFICANCE: The LHS-IAT will show differences in how health systems are translating the LHS concept into practice. This will allow for a shared language for those studying and/or implementing LHS. With the ability to map out an approach, health system leaders will have a tool to clarify intent and gain consensus as to which LHS model they want to implement and invest in.

Do Hospital Leaders Live in the Communities They Serve? A Comparative Analysis.

Purpose:Many factors contribute to persistent intractable disparities in health care, but the geographic separation of health care executives and patient communities has not been explored. From Congresspeople to police officers, individuals engaged in public service often face criticism for not living in the neighborhoods where they work. These critiques stem from the belief that to engage meaningfully with a community, one has to understand its experiences and share its interests—and geographic proximity offers one opportunity to bridge such divides. This article seeks to determine whether the senior executive leadership of American hospitals live in the same communities as their patient populations.Methods:From August 2020 to January 2021, the research team identified the leadership of the “largest” and “best” hospitals in the United States (n=68). Public directories were used to locate residential addresses. Newly released U.S. Census data provided proportions of individuals identifying as black/African American and Hispanic/Latinx in each zip code. Respective demographic proportions of hospital communities and hospital leadership residence were compared.Results:Hospitals shared the same zip codes with only three health system leaders (4.41%), seven hospital leaders (10.45%), and six deans (10.91%) of respective institutions. Hospital leadership lived in zip codes with a significantly lower proportion of black/African American (p<0.0009) and Hispanic/Latinx (p<0.0036) residents than their hospital communities.Conclusion:This article reveals significant differences between where health care leaders live and where they work. Future research should investigate the impact of residential disparities and the consequences of potential remedies on health equity.

Stakeholder Engagement: Bridging Research and Policy to Improve Measurement and Dental Care for Children in Medicaid.

Stakeholder Engagement: Bridging Research and Policy to Improve Measurement and Dental Care for Children in Medicaid.

Healthcare Professional Perspectives on the Use of Remote Patient-Monitoring Platforms during the COVID-19 Pandemic: A Cross-Sectional Study.

The COVID-19 pandemic created an urgent need to act to reduce the spread of the virus and alleviate congestion in healthcare services, protect health professionals, and help them maintain satisfactory quality and safety of care. Remote monitoring platforms (RPM) emerged as potential solutions. In this study, we evaluate, from health professionals’ perspectives, the capacity and contribution of two different digital platforms to maintain quality, safety, and patient engagement in care. A cross-sectional study was conducted using a survey in which a total of 491 health professionals participated. The results show that, in general, user perceptions of the quality and safety of care provided through the platforms were positive. The ease of access to health professionals’ services in general and shorter waiting times for patients were the two main features that were highly appreciated by most participants. However, some problems were encountered during the use of these two platforms, such as a lack of training and/or direct support for users. To improve the two platforms and maximize their use, the areas for improvement and the issues identified should be addressed as part of a collaborative process involving health professionals and patients as well as health system leaders, decision-makers, and digital platform providers.

Aligning quality improvement efforts and policy goals in a national integrated health system.

To describe the design and impact of a systematic, enterprise-wide process for engaging US Department of Veterans Affairs (VA) leadership in prioritizing scarce implementation and evaluation resources. From 2017 to 2021, the VA Quality Enhancement Research Initiative (QUERI) identified priorities from local, regional, and national leaders through qualitative discussions and a national survey and tracked impacts via reports generated from competitively funded initiatives addressing these priorities. Guided by the Learning Health System framework and QUERI Implementation Roadmap, QUERI engaged stakeholders to nominate and rank-order priorities, peer-reviewed and funded initiatives to scale up and spread evidence-based practices (EBPs) using theory-based implementation strategies, and evaluated the impact of these initiatives using the QUERI Impact Framework. QUERI collected priority nominations through qualitative discussions and a web-based survey, and live voting was used to rank-order priorities. QUERI-funded teams regularly submitted progress reports describing the key activities, findings, and impacts of the quality improvement (QI) initiatives using a standardized form created in the VA Research Electronic Data Capture (REDCap). QUERI launched five QI initiatives to address priorities selected by VA leadership. In partnership with 28 health system leaders, these initiatives are implementing 10 EBPs across 53 sites, supporting 1055 VA employees in delivering evidence-based care. The success of these initiatives led to an expansion of QUERI's process to address 2021 VA leadership priorities: virtual care, health disparities, delayed or suppressed care due to COVID-19, employee burnout, long-term and home care options, and quality and cost of community care. QUERI, a unique program embedded in a national integrated health system, deployed a novel approach to inform policy making and enhance the real-world impact of research through prioritization of limited resources, rigorous peer-review, and assessment of impacts on the health system, employees, and Veterans.