Leading Healthcare Organizations Research Articles

Global consensus statement on simulation-based practice in healthcare

Simulation plays a pivotal role in addressing universal healthcare challenges, reducing education inequities, and improving mortality, morbidity and patient experiences. It enhances healthcare processes and systems, contributing significantly to the development of a safety culture within organizations. It has proven to be cost-effective and successful in enhancing team performance, fostering workforce resilience and improving patient outcomes. Through an international collaborative effort, an iterative consultation process was conducted with 50 societies operating across 67 countries within six continents. This process revealed common healthcare challenges and simulation practices worldwide. The intended audience for this statement includes policymakers, healthcare organization leaders, health education institutions, and simulation practitioners. It aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally. Key recommendations Advocating for the benefits that simulation provides to patients, staff and organizations is crucial, as well as promoting its adoption and integration into daily learning and practice throughout the healthcare spectrum. Low-cost, high-impact simulation methods should be leveraged to expand global accessibility and integrate into system improvement processes as well as undergraduate and postgraduate curricula. Support at institutional and governmental level is essential, necessitating a unified and concerted approach in terms of political, strategic and financial commitment. It is imperative that simulation is used appropriately, employing evidence-based quality assurance approaches that adhere to recognized standards of best practice. These standards include faculty development, evaluation, accrediting, credentialing, and certification. We must endeavor to provide equitable and sustainable access to high-quality, contextually relevant simulation-based learning opportunities, firmly upholding the principles of equity, diversity and inclusion. This should be complemented with a renewed emphasis on research and scholarship in this field. Call for action We urge policymakers and leaders to formally acknowledge and embrace the benefits of simulation in healthcare practice and education. This includes a commitment to sustained support and a mandate for the application of simulation within education, training, and clinical environments. We advocate for healthcare systems and education institutions to commit themselves to the goal of high-quality healthcare and improved patient outcomes. This commitment should encompass the promotion and resource support of simulation-based learning opportunities for individuals and interprofessional teams throughout all stages and levels of a caregiver’s career, in alignment with best practice standards. We call upon simulation practitioners to champion healthcare simulation as an indispensable learning tool, adhere to best practice standards, maintain a commitment to lifelong learning, and persist in their fervent advocacy for patient safety. This statement, the result of an international collaborative effort, aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.

Global consensus statement on simulation-based practice in healthcare

Simulation plays a pivotal role in addressing universal healthcare challenges, reducing education inequities, and improving mortality, morbidity and patient experiences. It enhances healthcare processes and systems, contributing significantly to the development of a safety culture within organizations. It has proven to be cost-effective and successful in enhancing team performance, fostering workforce resilience and improving patient outcomes.Through an international collaborative effort, an iterative consultation process was conducted with 50 societies operating across 67 countries within six continents. This process revealed common healthcare challenges and simulation practices worldwide. The intended audience for this statement includes policymakers, healthcare organization leaders, health education institutions, and simulation practitioners. It aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.Key recommendations Advocating for the benefits that simulation provides to patients, staff and organizations is crucial, as well as promoting its adoption and integration into daily learning and practice throughout the healthcare spectrum. Low-cost, high-impact simulation methods should be leveraged to expand global accessibility and integrate into system improvement processes as well as undergraduate and postgraduate curricula. Support at institutional and governmental level is essential, necessitating a unified and concerted approach in terms of political, strategic and financial commitment.It is imperative that simulation is used appropriately, employing evidence-based quality assurance approaches that adhere to recognized standards of best practice. These standards include faculty development, evaluation, accrediting, credentialing, and certification.We must endeavor to provide equitable and sustainable access to high-quality, contextually relevant simulation-based learning opportunities, firmly upholding the principles of equity, diversity and inclusion. This should be complemented with a renewed emphasis on research and scholarship in this field.Call for action We urge policymakers and leaders to formally acknowledge and embrace the benefits of simulation in healthcare practice and education. This includes a commitment to sustained support and a mandate for the application of simulation within education, training, and clinical environments.We advocate for healthcare systems and education institutions to commit themselves to the goal of high-quality healthcare and improved patient outcomes. This commitment should encompass the promotion and resource support of simulation-based learning opportunities for individuals and interprofessional teams throughout all stages and levels of a caregiver’s career, in alignment with best practice standards.We call upon simulation practitioners to champion healthcare simulation as an indispensable learning tool, adhere to best practice standards, maintain a commitment to lifelong learning, and persist in their fervent advocacy for patient safety.This statement, the result of an international collaborative effort, aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.

Trust: The Key to Building Stronger Physician Relationships

The transition from volume to value in healthcare has highlighted the importance of strong and genuine alliances between healthcare organizations and physicians. However, the absence of established guidelines for building such relationships has resulted in failed attempts, miscommunication, and missed expectations. This article discusses the varying degrees and levels of trust, and the importance of distinguishing between personal and impersonal perspectives. Trust-building behaviors are provided, including empowering physician colleagues, communicating often using multiple modalities, promoting transparency and sharing information, and developing clinical leadership among colleagues. The article concludes that healthcare organization leaders must be courageous enough to extend trust, which is much more than a magnanimous gesture, but an invitation to a collaborative future. The potential rewards of building trust can be enormous and well worth the effort, and trust as a foundation for high performance means trust comes first.

Telesupervision in genetic counseling education during COVID-19 and beyond.

The COVID-19 pandemic led healthcare organizations to pivot to telemedicine, precipitating the shift to telesupervision, defined as supervision over video-conferencing platforms and telephone, for genetic counseling students. This study aimed to (1) characterize the impact of the COVID-19 pandemic on genetic counseling supervision, (2) ascertain genetic counseling supervisor experiences with telesupervision, and (3) examine the association between years of genetic counseling experience and preferences related to supervision modality. Certified genetic counselors were recruited through the National Society of Genetic Counselors (NSGC), Pennsylvania Association of Genetic Counselors (PAGC), and Association of Genetic Counseling Program Directors (AGCPD) listservs and by purposive sampling via emails to Genetic Counseling Program Directors in program-rich regions. An investigator-created survey was administered online to elicit descriptions of supervision during the pandemic, including modifications to rotations, changes to the number of students supervised, and mode of supervision preference. The survey was completed by 122 genetic counselors. The 54-question survey included multiple-choice, ranking, and open-ended questions. The majority (95.9%) of the participants were female, with an average age of 32 years. Most (86%) of participants reported changes in their supervision practices due to COVID-19, including sole use of telesupervision (54.4%), decreases in rotation lengths (25.4%), and delays in rotation start dates (24.6%). Interestingly, 19.3% (22/114) supervised more students than before the pandemic, and 18.4% (21/114) of participants supervised fewer students. Approximately two thirds (67.5%) of supervisors preferred supervising students in-person, while 2.6% preferred telesupervision, and 29.8% had no preference. Those who preferred to supervise in-person had fewer years of experience than those who had no preference (median = 4 years vs. median = 7 years respectively, Wilcoxonp-value = 0.0418, effect size rpb = 0.19, small). Given the persistence of telemedicine beyond the pandemic, telesupervision may be necessary to train genetic counseling students. However, additional research is needed to determine the effectiveness of telesupervision in facilitating student skill development and attainment of the Accreditation Council for Genetic Counseling (ACGC) Practice-Based Competencies (PBCs).

Adaptive leadership in health care organizations: Five insights to promote effective teamwork.

Adaptive leadership in health care organizations: Five insights to promote effective teamwork.

Top-level leaders and implementation strategies to support organizational diversity, equity, inclusion, and belonging (DEIB) interventions: a qualitative study of top-level DEIB leaders in healthcare organizations

BackgroundThe Black Lives Matter movement and COVID-19 pandemic motivated the wide-scale adoption of diversity, equity, inclusion, and belonging (DEIB) initiatives within healthcare organizations and the creation of DEIB top-level leader positions. The next step is to understand how these leaders contribute to the implementation of DEIB interventions, a task with notable salience due to not only the historical difficulties associated with DEIB strategy execution, but also the substantial evidence that leadership plays a significant role in implementation processes. Therefore, the objective of this qualitative study is to understand the role of top-level DEIB leaders in the implementation of healthcare organizational DEIB interventions.MethodsA qualitative research approach which used an in-depth semi-structured interview approach was employed. We conducted thirty-one 60–90-min semi-structured interviews with DEIB top-level leaders between February 2022 and October 2022 over Zoom. An iterative coding process was used to identify the key implementation strategies and activities of DEIB top-level leaders.ResultsInterviewees were mostly Black, majority female, and mostly heterosexual and had a variety of educational backgrounds. We identified the DEIB top-level leader as the DEIB strategy implementation champion. These leaders drive five DEIB implementation strategies: (1) People, (2) Health Equity, (3) Monitoring and Feedback, (4) Operational Planning and Communication, and (5) External Partners. Within these, we identified 19 significant activities that describe the unique implementation strategies supported by the DEIB top-level leaders.ConclusionsTo move toward sustained commitment to DEIB, the organization must focus on not only establishing DEIB interventions, but on their successful implementation. Our findings help explicate the implementation activities that drive the DEIB initiatives of healthcare organizations and the role of DEIB leaders. Our work can help healthcare organizations systematically identify how to support the success of DEIB organizational interventions.

More Data Drives Strategy at a Rural Hospital.

All leaders of healthcare organizations, individually and collectively, must make critically important decisions every day. But how are those decisions made? What factors must leaders take into account? And how has the way they make those decisions changed over the years? In today's fast-moving world, healthcare leaders face increasing pressures to make far-reaching decisions not only accurately, but also more quickly than ever. Especially for a small critical access hospital, there is little room for error or delay. At Nemaha County Hospital, we have found that clinical and business decisions drawn from more reliable data are much better than those based on anecdotal information.

Workplace Belonging of Women Healthcare Professionals Relates to Likelihood of Leaving.

There is a high rate of attrition of professionals from healthcare institutions, which threatens the economic viability of these institutions and the quality of care they provide to patients. Women professionals face particular challenges that may lower their sense of belonging in the healthcare workplace. We sought to test the hypothesis that workplace belonging of women healthcare professionals relates to the likelihood that they expect to leave their institution. Participants of a continuing education course on women's leadership skills in health care completed a survey about their experiences of belonging in workplace and their likelihood of leaving that institution within the next 2 years. An association between workplace belonging (measured by the cumulative number of belonging factors experienced, scale 0-10) and likelihood of leaving (measured on a 5-point Likert scale) was evaluated using ordinal logistic regression. The relative importance of workplace belonging factors in predicting the likelihood of leaving was assessed using dominance analysis. Ninety-nine percent of survey participants were women, and 63% were clinicians. Sixty-one percent of participants reported at least a slight likelihood of leaving their healthcare institution within the next 2 years. Greater workplace belonging was found to be associated with a significant reduction in the reported likelihood of leaving their institution after accounting for the number of years having worked in their current institution, underrepresented minority status, and the interaction between the latter two covariates. The workplace belonging factor found to be most important in predicting the likelihood of leaving was the belief that there was an opportunity to thrive professionally in the institution. Belonging factors involving feeling able to freely share thoughts and opinions were also found to be of relatively high importance in predicting the likelihood of leaving. Greater workplace belonging was found to relate significantly to a reduced likelihood of leaving their institution within the next 2 years. Our findings suggest that leaders of healthcare organizations might reduce attrition of women by fostering workplace belonging with particular attention to empowering professional thriving and creating a culture that values open communication.

Reclaiming Healthcare’s Healing Mission for a Sustainable Future

Healthcare in the United States has reached a point where it is unsustainable for the long term, particularly for the poor, the elderly, and healthcare workers (HCWs) themselves. We propose a framework for making U.S. healthcare more sustainable, whereby the service returns to its core mission of healing. The framework casts that healing mission in broadly applicable, practical terms, whereby leaders of healthcare organizations and in the wider for-profit, not-for-profit, and governmental healthcare ecosystem take concrete steps to improve outcomes for patients and HCWs. Those steps involve aligning healthcare resources, incentives, and policies with the core mission of healing and then implementing change in specific ways that particular organizations have already shown are achievable and sustainable. We use those examples to illustrate how healing-oriented innovations in healthcare delivery get deployed and how progress toward sustainability then ensues. Lessons from these efforts can be tailored to individual healthcare contexts and institutions—and then applied on a national scale. The discussed initiatives can also guide the direction of future research on healthcare sustainability.

The impact of full practice authority on nurse practitioner compensation, collaboration, and billing.

Although there is a substantial body of evidence regarding full practice authority's (FPA) effects on health care access and quality, very little research has examined how nurse practitioner (NP) licensure laws affect the status of NPs as clinicians, employees, and leaders in health care organizations. This study examined whether states' implementation of FPA leads to higher pay, business ownership, assigned patient panel, and billing transparency for NPs' and whether NPs' gains from FPA increase over time in states where FPA has been in effect longer. Data from a nationwide survey of licensed NPs ( N = 5,770) were used to compare NPs' employment conditions between FPA and non-FPA states. After balancing the FPA and non-FPA groups on demographic characteristics (e.g., urbanicity, education), adjusted mean differences in outcomes between the groups were estimated using weighted multivariable regression. Compared with NPs in non-FPA states, NPs in FPA states had higher mean earnings ( p < .05), were more likely to be practice owners or shareholders ( p < .01), and billed a greater percentage of their patient visits under their own National Provider Identifier ( p < .001). Having FPA in place for ≥10 years was associated with greater improvements in conditions of employment compared with having FPA <10 years. States' adoption of FPA for NPs is associated with improved conditions of employment among NPs. Untethering NPs from physicians establishes a cascade of modest gains in income and practice ownership that may indicate changes over time. Additional research is needed to determine the trajectory of these increases and if they are consistent.

Neonatal intensive care nurses' accounts of care for mothers/families with substance-exposed pregnancies: A critical discourse analysis.

To explore the effects of power dynamics and hospital organizational structure upon neonatal intensive care nurses' experiences caring for infants and families from a substance-exposed pregnancy (SEP). This secondary data analysis further investigated the results of a primary study after the original analysis suggested differences in work environments may impact relationship-building opportunities between nurses and mothers/families. Critical discourse analysis served as both the theoretical lens and analytic technique. Nine (9) nurses from the southeast region of the United States (U.S.) were interviewed in 2019. Fifty-one (51) stories of caregiving experiences were analysed with a focus on narratives related to organizational structure and care delivery. Study findings revealed nurses experienced challenges providing high-quality, family-centered care for patients in the neonatal intensive care unit (NICU) affected by substances during pregnancy. Nurses described the central challenge of workload, exacerbated by power imbalances and structural constraints within the hospital's organizational structure. Findings suggest workload issues may endorse stigma by inhibiting opportunities to build relationships. Nurses report manageable workloads can support healthcare teams and recipients of care. The study suggests power imbalances between nurses, families and adjacent healthcare professionals can inhibit the delivery of high-quality care. Supporting healthcare teams and recipients of care while centering the role of organizational structure is critical. Questions emerged about workload demands impacting the potential production of stigma in clinical environments. This study examines the intersection of nurses' care experiences and hospital organizational structure. It identifies how the unique needs of caring for infants and families from a SEP increase the complexity of power imbalances and organizational constraints to further increase workload demands. Findings have implications for global healthcare organization leaders who build and maintain the structural integrity of clinical environments and nurse leaders who advocate and guide clinical teams to provide high-quality care in stressful healthcare environments. EQUATOR guidelines were followed, using the COREQ checklist. NICU nurses were interviewed about their care-provision experiences. Interviews were analysed in the primary study and the current analysis of secondary data.

Nurse leaders’ experiences of remote leadership in health care

PurposeThis study aimed to describe nurse leaders’ experiences of remote leadership in health care sector.Design/methodology/approachSemistructured interviews were conducted among nurse leaders (N = 12) between January and March 2022. All of the interviewees had experiences of remote leadership and worked as immediate – (n = 5) or middle-level (n = 7) leaders in health care organizations across four provinces in Finland. The collected data were analyzed by inductive content analysis.FindingsThe leaders had experienced a rapid transition to remote leadership and highlighted the need for guidelines and joint discussions with different stakeholders. The interviewees felt that working life has changed in the last two years and that remote leadership will now be a key part of leadership in health care. The leaders’ experiences highlighted how important trust is in remote leadership. Furthermore, the interviewees pointed out a need for face-to-face contact and described other good practices for remote leadership. Overseeing work-related well-being was also stressed as important in the remote context; however, the interviewees expressed a need for instructions and tools concerning the management of employee well-being. The sudden change to remote leadership was not only described as interesting but also challenging, which has affected the leaders’ work-related well-being. Support – both from the organization and other employees – was found to be crucial to health care leaders’ work-related well-being.Originality/valueThe current study complements the little-researched topic of remote leadership in the health care sector. The results provide insights that can be used to develop remote leadership and/or guide future research.

Association of Patient Experience of Care and Radiation Therapy Initiation Among Women With Early-Stage Breast Cancer

For women diagnosed with early-stage breast cancer, lumpectomy followed by radiation therapy (RT) has been a guideline-recommended treatment. However, lumpectomy followed by hormonal therapy is also an approved treatment for certain women. It is unclear what patient-driven factors are related to decisions to receive RT. This study examined relationships between patient-reported experience of care, an important dimension of health care quality, and receipt of RT after lumpectomy. We used National Cancer Institute Surveillance, Epidemiology, and End Results data linked to the CMS Medicare Consumer Assessment of Healthcare Providers and Systems patient surveys (SEER-CAHPS) to examine experiences of care among women diagnosed with local/regional stage breast cancer 2000 to 2017 who received lumpectomy, were enrolled in fee-for-service Medicare, completed a CAHPS survey ≤18 months after diagnosis, and survived for this study period. Experience of care was assessed by patient-provided scores for physicians, doctor communication, care coordination, and other aspects of care. Multivariable logistic regression models assessed associations of receipt of external beam RT with care experience and patient sociodemographic and clinical characteristics. The study population included 824 women; 655 (79%) received RT. Women with higher experience of care scores for their personal doctor were significantly more likely to have received any RT (odds ratio [OR], 1.18; P=.033). Nonsignificant trends were observed for associations of increased RT with higher CAHPS measures of doctor communications (OR, 1.15; P=.055) and care coordination (OR, 1.24; P=.051). In contrast, women reporting higher scores for Part D prescription drug plans were significantly less likely to have received RT (OR, 0.78; P=.030). Patient experience of care was significantly associated with receipt of RT after lumpectomy among women with breast cancer. Health care organization leaders may want to consider incorporating experience of care into quality improvement initiatives and other activities that aim to improve patient decision-making, care, and outcomes.

STRATEGIES FOR IMPROVING THE IMPLEMENTATION OF ELECTRONIC HEALTH RECORDS- A SINGLE CASE STUDY

Electronic health records are a healthcare quality improvement strategy. Healthcare organizations in middle-income countries face significant challenges in adopting and implementing electronic health records. In Jordan, implementation challenges delayed achieving the objective of a national initiative titled Hakeem. The initiative’s objective was to implement the Hakeem electronic health record system in all healthcare sectors by 2020. Lack of clear implementation guidelines may have hindered some healthcare organizations’ efforts to adopt and use the system in Jordan. A successful pioneering implementer of the Hakeem system in Jordan is the King Hussein Cancer Center, which fully used it in all departments. This study used a single case study design to explore and codify the center’s strategies for system implementation. Data sources included a review of organizational documents related to the Hakeem system implementation at the center and individual interviews with six healthcare leaders involved in the implementation process. Thematic data analysis included manual analysis and verification using NVivo 12, QRS International software. The emerging themes included (1) phased approach and continuous planning, (2) stakeholders’ active involvement, (3) collaboration with the vendor, (4) training and continuous support, (5) managing resistance, and (6) recommendations for other organizations. The findings of this study may lay the foundation to lead healthcare organizations into successful implementation and effective use of electronic health records.

Balancing a seesaw – leaders perspectives on design and traditional quality improvement in healthcare

PurposeThe purpose of this paper is to explore and describe the perspectives and reasoning of senior development leaders in healthcare organizations, when reflecting on design as theory and practice in relation to more traditional methods and tools for improving quality and support innovation.Design/methodology/approachThe paper is based on a qualitative interview design with five development and innovation leaders from separate healthcare regions in Sweden. They have, to varying degrees, applied design theory and practice for quality improvement and innovation in their organizations. The interview transcript was analysed using a content analysis together with an interpretive approach.FindingsThe major findings are to be found in the balancing act for leadership and organizations in healthcare when it comes to introducing and combining different theories and practices for improving quality and support innovation. The balance is between the change in power dynamics and pushing traditional boundaries in a complex healthcare world.Practical implicationsThe narratives from the leaders' experience of applying design theory and practice for improving healthcare quality can help us create readiness and knowledge about how we prevent and/or facilitate planning and implementing design theories, practices, methods and tools in a healthcare context.Originality/valueThe study provides a unique insight when it captures and illustrates five different organizations' experiences when applying design for developing healthcare quality.

Designing A System for Safe Staffing

Developing effective systems to ensure safe and appropriate nurse staffing is a critical priority for both chief nursing officers as well as the governance and leadership of health care organizations. Bedside nurses will gain confidence in their employer’s commitment to ensuring safe nurse staffing if they are actively engaged in designing staffing systems in a meaningful way. Investment in comprehensive, well-integrated staffing systems can offer an effective and viable alternative to regulatory solutions.

What healthcare leadership can do in a climate crisis.

Healthcare governing boards, executives, medical staff, health professionals, and allied staff members should all play a role in devising, promoting, and implementing solutions for climate change mitigation, which must extend beyond the boundaries of their own workplaces and healthcare institutions. Such actions can potentially influence not only healthcare professionals and their patients but also healthcare supply chains and entire communities. Thus, leaders of healthcare organizations can play a vital role in leading by example. The authors herein propose some initiatives for promoting and implementing a culture of sustainability and climate action in medicine.

Staying Informed of Best Evidence to Guide Practice

Staying Informed of Best Evidence to Guide Practice

Exploring Workplace Incivility and Bullying in Healthcare Workers in a South Florida Community Hospital

Introduction: Workplace incivility and bullying are concerning issues in healthcare with detrimental consequences for healthcare workers (HCW) and healthcare organizations. Organizational leaders’ recognition of incivility/bullying within healthcare organizations, and their sources, is imperative to prevent and/or address issues by creating “zero tolerance” work environments. The purpose of this cross-sectional, descriptive study was to explore HCWs’ experiences with incivility and bullying at a South Florida community hospital. Methods: A convenience sample of HCWs at a South Florida community hospital were recruited to voluntarily complete the Nursing Incivility Scale. Results: A sample of 325 HCWs responded to the survey. The results showed general incivility as the highest source across all HCWs, with certified nursing assistants having the highest level of incivility across all sources (general, nurse, supervisor, physician, and patients). Correlative analysis showed statistically significant relationships between several sources of incivility (general, supervisor, physician, and patient; r = .250 to .390) for those reporting past experiences with incivility/bullying, and healthcare role and physician incivility (r = -.224). Independent t tests and one-way ANOVA showed statistically significant differences. Of note, compared to other HCW roles, registered nurses reported physicians as their highest source of incivility. Discussion: Workplace incivility/bullying is a serious issue in healthcare across all disciplines and roles, requiring healthcare organization leaders’ awareness and subsequent interventions to prevent and address its occurrence. The results of this study provide necessary insight for hospital organization leaders as they endeavor to create and nurture “zero tolerance” work environments. Keywords: workplace incivility, workplace bullying, workplace violence, zero tolerance

Magnet® Supporting Our Purpose.

The authors, Magnet® Commissioners, provide a reflection on their personal journeys in leading healthcare organizations where the role of nurses is valued by both the organization and those we serve. The authors believe that nurses, through the application of evidence-based leadership principles, are the cornerstone of passion and commitment to excellence in healthcare.