Healthcare Boards Research Articles

Why-UD? Assessing the requirement to trial an intrauterine device as a condition for elective sterilisation in female patients

Some National Health Service healthcare boards in the UK will approve a request for female sterilisation only if the patient first accepts a trial period of 1 year with an...

Starting Points for Promoting Disaster Resilience in Home Nursing Care in Germany–A Participatory Development Process

Introduction:In Germany, more than 3.3 million people in need of long-term care are receiving home care. Although not all of them use professional home care providers, their services are essential especially to those who need skilled nursing care and medical-technical assistance in addition to everyday support–such as approximately 30,000 people who receive home mechanical ventilation. Little is known about the disaster resilience of home care infrastructures and ways to strengthen them. A research consortium called AUPIK, funded by the German Federal Ministry of Education and Research from 2020-2023, sought to close this gap.Method:A participatory process was initiated as part of the AUPIK project based on results of a multi-perspective empirical baseline analysis which resulted in a first draft text about measures to promote disaster resilience in home care. 37 representatives of home nursing care providers and community health-care services, professional boards, scientific and education institutions participated in a web-based survey on the draft text, followed by two digital group discussions. Finally, the gradually revised, condensed and consented starting points were published and distributed.Results:Eight starting points were defined. Among others, there is an urgent need to strengthen risk awareness and resource management among home care providers, to promote individual disaster competence and preparedness among all parties involved and, not least, to strengthen community-based networking initiatives between home care providers, emergency and disaster organizations and local authorities. Institutions or persons who should take responsibility for implementation at different levels are addressed directly.Conclusion:The final version of the starting points represents a consensus on urgently needed initiatives to promote disaster resilience in home nursing care in Germany. The participatory development process should support commitment on the part of all stakeholders and thus promote effective implementation of disaster resilience initiatives in home nursing care.

The Disparity Challenge: How Governance Can Lead the Way on Diversity, Equity, and Inclusion.

Hospitals, health systems, pharmaceutical companies, device makers, and payers have a responsibility to provide high-quality, innovative, cost-effective care and services to their patients and communities. The governing boards of these institutions provide the vision, strategy, and resources and choose the best leaders to achieve those outcomes. Healthcare boards can play a vital role in ensuring that resources are distributed where they are most needed. The need is great in communities of racial and ethnic diversity, which are almost always underserved-a preexisting condition that came into stark relief during the COVID-19 pandemic. Widespread inequities in access to care, housing, nutrition, and other components of good health were documented, and boards promised to pursue change, including becoming more diverse themselves. More than two years later, healthcare boards and senior executives remain mostly white and male. This continuing reality is especially unfortunate because diversity in governance and the C-suite has positive implications for financial, operational, and clinical success, including solving persistent inequities and disparities experienced in disadvantaged communities.

Cybersecurity: Guiding Principles and Risk Management Advice for Healthcare Boards, Senior Leaders and Risk Managers.

In recent years, the average cost of healthcare-related data breaches increased from approximately US$7 million in 2020 to over US$9 million in 2021. Moreover, breaches in healthcare have been consistently more costly than in other sectors for 11 consecutive years. With the frequency and costs of cyberattacks expected to rise, healthcare organizations must carefully plan for and identify strategies to mitigate cyber-related risks. This paper provides practical guidance for boards, senior leaders and risk managers in the development and implementation of organization-specific cybersecurity measures, with a focus on the identification, mitigation and management of risks.

Reflective practice and psychotherapy case experience of Specialty Doctors and Associate Specialists (SAS) working in psychiatry: UK-wide survey.

To survey nationwide opportunities for Balint-type and reflective support group participation and psychotherapy training among doctors classified as Specialty Doctors and Associate Specialists in psychiatry ('SAS psychiatrists') and the professional benefits and barriers to access. Approximately 9% of SAS psychiatrists responded, from all UK regions. A minority reported participating in a Balint-type group (27.3%) or reflective practice/support group (30.9%), and only 6.5% were not interested in participating. Although 44.8% planned to see a psychotherapy case, most reported barriers, particularly time constraints, job plans and lack of support. The 22.1% who reported already gaining psychotherapy case experience reported many benefits, including becoming a better listener (84.8%), more empathetic (81.2%), enjoying work more (78.8%) and overall becoming a better psychiatrist (90.9%). The reported interest in Balint group and psychotherapy training opportunities exceeded existing provision; psychotherapy case experience benefited professional development and self-reported clinical capabilities. Healthcare trusts and boards need to consider more actively supporting SAS psychotherapy training and reflective practice.

Board level “Picture-Understanding-Action”: a new way of looking at quality

PurposeThe purpose of this study is to present a quality improvement approach titled “Picture-Understanding-Action” used in Ireland to enhance the role of healthcare boards in the oversight of healthcare quality and its improvement.Design/methodology/approachThe novel and practical “Picture-Understanding-Action” approach was implemented using the Model for Improvement to iteratively introduce changes across three quality improvement projects. This approach outlines the concepts and activities used at each step to support planning and implementation of processes that allow a board to effectively achieve its role in overseeing and improving quality. This approach matured over three quality improvement projects.FindingsThe “Picture” included quantitative and qualitative aspects. The quantitative “Picture” consisted of a quality dashboard/profile of board selected outcome indicators representative of the health system using statistical process control (SPC) charts to focus discussion on real signals of change. The qualitative picture was based on the experience of people who use and work in health services which “people-ised” the numbers. Probing this “Picture” with collective grounding, curiosity and expert training/facilitation developed a shared “Understanding”. This led to “Action(s)” from board members to improve the “Picture” and “Understanding” (feedback action), to ask better questions and make better decisions and recommendations to the executive (feed-forward action). The Model for Improvement, Plan-Do-Study-Act cycles and a co-design approach in design and implementation were key to success.Originality/valueTo the authors’ knowledge, this is the first time a board has undertaken a quality improvement (QI) project to enhance its own processes. It addresses a gap in research by outlining actions that boards can take to improve their oversight of quality of care.

Nevada Healthcare Boards: Violations of Public Record Act and Inaccessibility of Licensee Information

The Nevada Public Records Act (NRS 239) enables the public’s right to inspect, copy or receive a copy of records and non-confidential information on healthcare providers. However, because each Neva...

The opioid-impaired provider: A call for national guidance to maximize rehabilitation while protecting patient safety.

The opioid-impaired provider: A call for national guidance to maximize rehabilitation while protecting patient safety.

Legacy of COVID‐19 – the opportunity to enhance surgical services for patients with colorectal disease

The COVID-19 crisis has undoubtedly taken a toll on the care of patients with colorectal disease. Elective services, be that face to face contact, endoscopy or operating all but ceased during the pandemic.

Compliance of Nevada State Healthcare Boards with Open Meeting Law and Public Records Act

The legislature finds and declares that all public bodies exist to aid in the conduct of the people’s business. It is the intent of the law that the public body’s actions be taken openly and that t...

Roles and behaviours of diligent and dynamic healthcare boards.

Variation persists in the quality of board-level leadership of hospitals. The consequences of poor leadership can be catastrophic for patients. The year 2019 marks 50 years of public inquiries into healthcare failures in the UK. The aim of this article is to enhance our understanding of context-specific effectiveness of healthcare board practices, drawing on an empirical study of changes in hospital board leadership in England. The study suggests leadership behaviours that lay the conditions for better organisation performance. We locate our findings within the wider theoretical debates about corporate governance, responding to calls for theoretical pluralism and insights into the effects of discretionary effort on the part of board members. We conclude by proposing a framework for the ‘restless’ board from a multi-theoretic standpoint, and suggest a repertoire specifically for healthcare boards. This comprises a suite of board roles as conscience of the organisation, sensor, shock absorber, diplomat and coach, with accompanying dyadic behaviours to match particular organisation aims and priorities. The repertoire indicates the importance of a cluster of leadership practices to fulfil the purposes of healthcare boards in differing, complex and challenging contexts.

Why you should fire your board (maybe): How boards underperform and what executives can do

This paper outlines what healthcare executives can do when their governing boards are not fulfilling their fiduciary duties or providing adequate oversight to the organisation. Many healthcare boards are not recruiting the right people, spending enough time on strategy or following other recognised industry best practices. Making the board more effective may require ‘firing’ a person from the board or ‘firing’ a practice the board has been engaging in. The paper focuses on signs executives should look for in diagnosing subpar board performance and principles they can follow to make their boards more effective. If executives help hold boards to a high standard, the board can become a thought partner to executives and an asset to the organisation.

Con or Common Sense? A review of asymptomatic carotid artery screening

Stroke is the second highest cause of death and third leading cause of disability worldwide. Ischaemic strokes are caused by embolism and cerebrovascular disease, the latter of which can be detected at high rates of sensitivity and specificity with duplex ultrasound. Screening for asymptomatic carotid artery stenosis (ACAS) remains highly controversial. Partly to blame is the prevalence of for-profit organisations encouraging the public to have ‘check-up’ style imaging that may detect ACAS. This is one of the reasons for numerous healthcare boards, most notably the US Preventive Task Board in 2014, issuing recommendations against asymptomatic carotid artery screening, citing that it would yield too many false positives and may actually do more harm than good. There are contrasting opinions on the screening of ACAS in Australia however there is no official position on this topic. A properly designed program that selects asymptomatic patients based on risk factors with scans performed by accredited vascular laboratories can provide for the assessment of overall cardiovascular health. This has been demonstrated by The Atherosclerosis Risk in Communities study. We propose a multidisciplinary program for these select patients that may improve outcomes, at risk patient awareness and empower long term lifestyle modification.

Baccalaureate Education: The Foundation for Healthcare Board Participation.

The governance of healthcare organizations is becoming more complex and is prompting changes in board structure and membership. The presence and contributions of nurses on governance structures will favorably influence the future of health care. The essentials of baccalaureate nursing education, along with the general education curriculum, provide learning opportunities that result in nursing students developing the leadership skills needed to serve on hospital and healthcare boards. The purpose of this article is to present the perspective that graduates of baccalaureate nursing programs possess the foundation to participate as members of hospital and healthcare boards. This perspective is supported by the results of a survey of nursing faculty, many who have served or currently serve on healthcare boards and who provided overwhelming agreement that the foundational skills required for board participation are provided by the nursing curriculum.

Can a clinical senate enhance state-wide clinician engagement? A survey study.

Objective Clinician engagement correlates with quality, safety and efficacy outcomes. The aim of the present study was to explore whether a clinical senate model achieves clinical input into system manager and operational health service boards. Methods A mixed-methods survey was undertaken. Participants were current or immediate past members of the Clinical Senate of Western Australia (CS). For the 124 surveys sent out, the response rate was 60%. Results Respondents stated the CS played a role in clinician engagement (95%), contributed to healthcare reform (82%), knowledge of contemporary health issues (92%), feedback to decision makers (82%), clinician networking (94%), debate on important issues (93%), enabled clinicians to work on recommendations to improve health at a state level (87%), contributed to clinician thinking on health reform (88%) and enabled clinicians to share their knowledge (91%). Four major themes emerged in the qualitative analysis: (1) the need for a strong independent clinician forum and voice at a state level; (2) the need to strengthen clinician interactions with operational healthcare boards; (3) a strong belief that clinician engagement strengthened quality and safety outcomes at a state level; and (4) that membership was important and needed to be diverse, multidisciplinary and independent, but structurally representative of clinicians in the state. Conclusion A clinical senate model can facilitate state-wide clinician engagement. What is known about the topic? High levels of clinical engagement foster a culture within healthcare organisations that is associated with the delivery of sustained high-quality, safe and efficient services. This has led to a focus on strategies to optimise clinical engagement in healthcare planning and reform. However, there is limited data exploring how to achieve clinical engagement at a state, rather than local, level within the healthcare system. What does this paper add? This survey study evaluates the effectiveness of the Western Australian clinical senate model in achieving clinical engagement at a state level with regard to the outcomes of quality and safety, planning and reform. The survey findings suggest the clinical senate model is an effective strategy for state-based clinical engagement. What are the implications for practitioners? Clinical engagement is important. It is necessary to have in place strategies that address not only local engagement within a health service, but also system-wide engagement in order to promote quality and safety, planning and reform agendas at a state level.

PWE-030 The Inflammatory Bowel Disease (IBD) Audit Programme at The Royal College of Physcians Reports on 10 Years of Achievements and Demonstrates Improvements in Care Of People with IBD

Introduction The IBD audit programme, first established in 2004 has conducted several rounds of audit. The programme’s aim is to improve the care of people with IBD by; facilitating the collection of key aspects of data on patient care and organisational services, analysing and disseminating the results, providing recommendations for improvements based on the key findings in the analyses. Methods Since 2006 the programme has facilitated up to 4 rounds of data collection on adults and children for inpatient care, organisation of IBD services and administration of biological therapies. We also collected data on patients experiences of care and the provision of care in primary care services. In 2015 the programme team hosted 8 regional workshops and proactively helped hospital IBD teams to develop action plans on key aspects of care that required improvements in their local areas. Results Over the 10 years of the programme’s work - a high level of participation in the audit has been achieved, >90% participation rate from IBD hospital teams across the UK. There have been many improvements in patient care, the most notable since 2006 to date, are a reduction in mortality during admissions, reduction in unplanned surgery, increased patient contact with an IBD nurse, improved rates of prescribing heparin and bone protection. From the biological therapies audit, results clearly demonstrate biological therapies for IBD are effective and safe treatments. Patterns of prescribing are changing with earlier use in patients with less severe disease suggesting doctors have become more familiar with the treatment. Despite the positive improvements, the most recent audit, reported in 2014, identified that there were still aspects of care requiring improvements including treatment of anaemia, access to dietetic support and management of people attending out patient care. Also, the two audits on patient experience between 2010 and 2012 showed no improvements in patient’s experiences of care. The 8 regional workshops hosted in 2015 across the UK proved to be a successful initiative. They were attended by 84 trusts and healthcare boards. 74% of delegates surveyed at 6 months agreed that these had helped them to improve their service. Conclusion 10 years of intensive working and engagement with the IBD community, the programme could not boast of its achievements without acknowledging the support of the community. However further and continued improvements in patient care for people with IBD are necessary. In 2016 the IBD audit programme will be transitioning to the UK IBD Registry. There will be a continued emphasis to help hospital teams to make continued improvements in the quality of care of people with IBD through a number of initiatives. Disclosure of Interest None Declared

Falls screening and assessment tools used in acute mental health settings: a review of policies in England and Wales

ObjectivesThere is an urgent need to improve the care of older people at risk of falls or who experience falls in mental health settings. The aims of this study were to evaluate the individual falls risk assessment tools adopted by National Health Service (NHS) mental health trusts in England and healthcare boards in Wales, to evaluate the comprehensiveness of these tools and to review their predictive validity. MethodsAll NHS mental health trusts in England (n=56) and healthcare boards in Wales (n=6) were invited to supply their falls policies and other relevant documentation (e.g. local falls audits). In order to check the comprehensiveness of tools listed in policy documents, the risk variables of the tools adopted by the mental health trusts’ policies were compared with the 2004 National Institute for Health and Care Excellence (NICE) falls prevention guidelines. A comprehensive analytical literature review was undertaken to evaluate the predictive validity of the tools used in these settings. ResultsFalls policies were obtained from 46 mental health trusts. Thirty-five policies met the study inclusion criteria and were included in the analysis. The main falls assessment tools used were the St. Thomas’ Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY), Falls Risk Assessment Scale for the Elderly, Morse Falls Scale (MFS) and Falls Risk Assessment Tool (FRAT). On detailed examination, a number of different versions of the FRAT were evident; validated tools had inconsistent predictive validity and none of them had been validated in mental health settings. ConclusionsFalls risk assessment is the most commonly used component of risk prevention strategies, but most policies included unvalidated tools and even well validated tool such as the STRATIFY and the MFS that are reported to have inconsistent predictive accuracy. This raises questions about operational usefulness, as none of these tools have been tested in acute mental health settings. The falls risk assessment tools from only four mental health trusts met all the recommendations of the NICE falls guidelines on multifactorial assessment for prevention of falls. The recent NICE (2013) guidance states that tools predicting risk using numeric scales should no longer be used; however, multifactorial risk assessment and interventions tailored to patient needs is recommended. Trusts will need to update their policies in response to this guidance.

A Canadian perspective on clinical governance

Purpose – The purpose of this paper is to provide an overview of the state of clinical governance practices globally as well as a more detailed examination of the clinical governance landscape in Canada. The paper explores the concept that established clinical governance practices are more important than ever as healthcare systems are increasingly under pressure to reduce costs while dealing with the challenges of ageing populations. Additionally, it suggests that healthcare could benefit by studying and adopting some of the successful governance policies that exist in other jurisdictions or sectors where quality and safety are an integral part of their governance mandate, such as the airline or nuclear energy sectors. Design/methodology/approach – This paper explores the status of clinical governance practices in Canada. This is achieved through a combination of author experience in addition to the review of existing literature and assessments on clinical governance practices and patient safety. Findings – While individual success stories can be found, standardized clinical governance practices across the range of healthcare providers remain largely absent. By focussing on standardized processes, and by placing an emphasis on improved clinical governance, healthcare providers can control and in some cases lower costs while improving efficiency and increasing patient safety. While progress has been slow for many years, the authors speculate that healthcare has reached a tipping point. As information systems develop and become more reliable and robust, and systems move to a patient-centric collaborative approach to care, there is a tremendous opportunity for healthcare and life sciences organizations to exploit and capitalize on both their growing information repositories, and the big data trends that have been embraced and leveraged by other sectors in recent years. Practical implications – Managing costs and delivering safe, efficient care to patients remain top considerations for healthcare boards and healthcare systems alike. As healthcare systems grapple with the increasing costs and risk associated with ageing populations and a more complex healthcare delivery model, effective clinical governance policies focussed on quality outcomes are essential. Originality/value – This paper highlights the responsibility of healthcare boards to learn lessons from other safety-critical industries and develop their own capacity to evaluate progress toward the goals identified above. It also provides insight into the role that leaders on both the corporate and clinical sides of the industry have to play, and the need for meaningful measures that will drive a quality agenda. The paper also emphases the link between established clinical governance practices and greater efficiency, reduced costs and improved patient safety.

Leveraging Womenʼs Leadership Talent in Healthcare

The lack of depth of women leaders in U.S. healthcare organizations continues to be a perplexing and challenging issue given the transformation taking place in the industry. With the impending departure of the baby boom generation from the workforce and the anticipated retirement of executives who postponed their departures as a result of the recent economic downturn, a significant shortage of experienced and qualified healthcare leaders is expected at the very time the Affordable Care Act is being fully implemented.Women, who make up the majority of the workforce in healthcare organizations, are largely an untapped resource for many of the leadership gaps that will result from this trend. The research presented in this column indicates that those organizations able to provide the support and sponsorship necessary to develop women in leadership roles are most likely to have a deep leadership pipeline and reap financial value from taking such measures.Although a majority of the healthcare workforce-74%-is female, women continue to be significantly underrepresented in the C-suite of healthcare organizations (Dunn, 2014). Figure 1 shows the percentage of women who hold positions in five levels of healthcare.Only 24% of senior executives-18% of hospital CEOs-are women. In addition, women make up only 14% of the population of healthcare boards of directors. These statistics were the backdrop for this research study, sponsored in early 2014 by Diversified Search, in which we sought to examine the career paths of male and female executives to identify any differences in their trajectories or backgrounds that might explain why fewer women than men are prepared for senior leadership roles. The study also examined the career paths of women in senior leadership positions to look for trends and insights that might help organizations as they seek to develop a deeper footprint for women in leadership roles and advise women interested in moving into the most senior positions.ABOUT THE STUDYDiversified Search, in collaboration with the Women's Leadership Center at Kennesaw State University Coles College of Business, conducted a quantitative online survey of 282 healthcare leaders (125 men and 157 women) to identify specific factors and trends that differ by gender and that influence the process of identifying, developing, retaining, and advancing healthcare talent.The real impetus for the study came from my own experience in conducting executive searches for healthcare organizations over the past 25 years. I recognized that there was a shortage of women who were ready and positioned appropriately for the most senior leadership roles, particularly CEO positions. Paying particular attention to the differences in the career paths of female executives, I observed anecdotally that many female CEOs had been named to their roles as the result of internal promotions. I began to wonder why more women were not in C-suite roles when half of the graduates of the large master of health administration programs over the past 25 years have been female. These considerations led to the decision to research the differences in career paths and trajectories.The institutions surveyed included secular not-for-profits (58%), religious not-for-profits (21%), government entities (9%), for-profit organizations (7%), and other (5%). The size of the organizations varied as well; however, nearly 40% were large, defined as those with more than 10,000 employees. The organizations represented a mix of urban, suburban, and rural locations.FINDINGSDiversified's research reveals that women and men in leadership positions come from different functional backgrounds (see Table 1). For example, data on the educational and functional backgrounds of the male and female CEOs surveyed show that 53.3% of the women had clinical (mostly nursing) backgrounds, whereas 14.3% of the male CEOs came from general administration and 35. …

A literature review of the Dutch debate on the nurse practitioner role: efficiency vs. professional development

To explore the debate on the development of the nurse practitioner profession in the Netherlands. In the Netherlands, the positives and negatives of nurse practitioners working in the medical domain have been debated since the role was introduced in 1997. The outcome of the debate is crucial for nurse practitioners' professional development and society's justification of their tasks. Review of 14 policy documents, 35 opinion papers from nurses, 363 opinion articles from physicians and 24 Dutch research papers concerning nurse practitioners from 1995 to 2012. Two discourses were revealed: one related to efficiency and one to the development of the profession. In both, the nurse practitioner role was presented as a solution for healthcare and workforce problems, while arguments differed. The efficiency discourse seemed most influential. Opinions of nurse practitioners were underrepresented; taking up new responsibilities was driven by the wish to improve patient care. While most physicians were willing to delegate tasks to nurse practitioners, they wished to retain final responsibility for medical care. All available publications were extensively studied, which could not include unpublished policy documents from the government or influential parties. This may have led to some selectivity. The case of the Netherlands shows that nurses in developing their advanced role are facing barriers, similar to those in other countries. The dominance of efficiency arguments combined with protection of medical autonomy undermines the development towards nursing care that really benefits patients. Nurse practitioners should strive to obtain positions in which they are allowed to make their own decisions and wise use of healthcare resources for the good of patients and society. Nurse practitioners should aim to become members of influential healthcare Boards in their countries, in which they can raise their voices and be involved in policy making.