Hospital Chief Executive Officers Research Articles

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Integrating administrative and clinical datasets to improve patient outcomes.

Integrating electronic health records (EHR) with health administrative data offer opportunities for enhanced decision support, health systems evaluations and research for improved patient care. We describe the process of integrating EHR data from 12 hospitals in Southwestern Ontario, Canada and present a health systems evaluation enabled by this linkage.
 With support and buy-in from the hospital Chief Executive Officers, a data sharing agreement (DSA) with ICES was executed, outlining the process to approve data transfer requests. Due to the complexity and volume of the EHR, complete data were not immediately transferred to ICES; instead, a project subcommittee comprising of physician leadership, local and regional privacy and risk officers, and ICES staff was assembled to review and approve project-specific data integration requests. An evaluation of the adoption of an electronic medication reconciliation system within the EHR on potentially inappropriate prescribing after hospital discharge was conducted using interrupted time-series analyses.
 The data integration request process begins with confirmation of data availability and accuracy within the EHR, enabled by a dedicated health information analyst and institutional decision support teams. Once data feasibility is confirmed, project rationale is submitted to the project subcommittee approval. Following approval, the request undergoes privacy and legal assessment as per the DSA and a project-ready dataset is submitted for linkage.
 An evaluation of the adoption of an electronic medication reconciliation system demonstrated an immediate and dramatic reduction in inappropriate medication prescribing and associated adverse events such as a fall or fracture among elderly patients discharged following acute inpatient stays.
 Administrative data are valuable at assessing population-based health, but often lack key clinical information present in EHRs. Integrating both data sources offers a more comprehensive picture of patient care and allows for robust analyses. Rigorous investigations generate trusted evidence for decision makers to inform policy and quality improvements within the healthcare system.

Perceptions of Ontario health system leaders on single-entry models for managing the COVID-19 elective surgery backlog: an interpretive descriptive study.

Background:The COVID-19 pandemic has exacerbated pre-existing challenges with respect to access to elective surgery across Canada, and a single-entry model (SEM) approach has been proposed as an equitable and efficient method to help manage the backlog. With Ontario’s recent investment in centralized surgical wait-list management, we sought to understand the views of health system leaders on the role of SEMs in managing the elective surgery backlog.Methods:We used the qualitative method of interpretive description to explore participant perspectives and identify practical strategies for policy-makers, administrators and clinical leaders. We conducted semistructured interviews with health system leaders from across Ontario on Zoom between March and June 2021. We used snowball and purposive sampling. Inclusion criteria included Ontario health care leaders, fluent in English or French, in positions relevant to managing the elective surgery backlog. Exclusion criteria were individuals who work outside Ontario, or do not hold relevant roles.Results:Our interviews with 10 health system leaders — including hospital chief executive officers, surgeons, administrators and policy experts — resulted in 5 emergent domains: perceptions of the backlog, operationalizing and financing SEMs, barriers, facilitators, and equity and patient factors. All participants emphasized the need for clinical leaders to champion SEMs and the utility of SEMs in managing wait-lists for high-volume, low-acuity, low-complexity and low-variation surgeries.Interpretation:Although SEMs are no panacea, the participants in our study stated that they believe SEMs can improve quality and reduce variability in wait times when SEMs are designed to address local needs and are implemented with buy-in from champions. Health care leaders should consider SEMs for improving surgical backlog management in their local jurisdictions.

Teams of rural physicians matter: Testing a framework of team effectiveness.

To examine how rural physician team effectiveness predicts outcomes of team performance, team commitment, and intentions to stay. Surveys measuring team climate, team efficacy, and team performance were sent to rural physician team members. Surveys measuring team performance were sent to external observers in supervisory positions. Northern Ontario communities. Rural physicians and external observers, the latter including hospital chief executive officers, family health team executive directors, and clinic managers. Total scale scores were generated using mean substitution. Cronbach α was used to assess internal consistencies of team member-level measures. Team-level measures were created by averaging the responses across team members, and intraclass correlation coefficients for each scale of each team of 2 or more members were calculated to yield a measure of rating consistency. A t test was used to assess the possible difference between team performance ratings by team members and external observers. Team-level relationships within the team effectiveness model were assessed using mediated regression, and generalized estimating equations were used to assess the relationships in the model between team-level (team efficacy) and individual-level (affective team commitment and intentions to stay) variables to address the nonindependence of these data. Overall, 70 rural physicians from 26 Rural and Northern Physician Group Agreement communities with 2 or more physicians and 25 external observers from 19 of the 26 Rural and Northern Physician Group Agreement communities participated in the study. The findings showed that team climate (composed of decision making, communication, and conflict resolution measures) positively predicted team efficacy, which in turn positively predicted team performance. This fully mediated set of relationships held whether team performance was rated by the physicians themselves or by the external observers. Team efficacy significantly predicted affective team commitment (b value=0.69, standard error=0.08, Wald =13.89, P<.001) in the first analysis and intentions to stay (b value=0.34, standard error=0.15; Wald =5.42, P=.020) in the second analysis. However, when the other variables impacting physician retention were added to the model in predicting intentions to stay, team efficacy did not predict it above and beyond these additional predictors. The findings support initiatives that attempt to enhance physician team effectiveness in rural physician teams by influencing team decision making, communication, and conflict resolution to improve team performance, physician attitudes, and commitment.

What do nonprofit hospitals reward? An examination of CEO compensation in nonprofit hospitals.

Nonprofit hospital chief executive officer (CEO) compensation has received considerable attention in light of nonprofits’ tax-favored status as well as the high costs of hospital care. Past studies have found that hospital financial performance is a significant determinant of CEO pay but nonprofit performance, including quality and charity care, are not. Using post-ACA data, we re-examine whether a variety of hospital performance measures are important determinants of nonprofit hospital CEO compensation. We found mixed evidence with respect to the significance of the association between financial performance and uncompensated care and CEO compensation. Among the other nonprofit performance measures, patient satisfaction was significantly associated with CEO compensation, but other measures were not significant determinants of CEO compensation. Our results suggest nonprofit hospitals balance their financial health against their mission when setting CEO incentives. Additional policy targeting transparency in hospital CEO compensation may be warranted to help policymakers understand the specific factors used by hospital boards to incentivize CEOs.

Strategies for enhancing the functionality of hospital management boards in central hospitals: Evidence of a developing economy

Zimbabwe’s public hospitals have been in a declining mode for three consecutive decades marred by economic hardships rooted in the deteriorating governance structures and systems at a provincial and national level. The decline is purported to weaken the strategies that enhance the functionality of board management (Gilson &amp; Agyepong, 2018). Efforts by the government to introduce effective strategies to revamp and enhance the functionality of public hospital boards have been in vain (Moyo, 2016; Sikipa, Osifo-Dawodu, Kokwaro, &amp; Rice, 2019). The aim of the study is to explore strategies for enhancing the functionality of hospital management boards (HMBs) in central hospitals of Zimbabwe using a survey in order to improve performance, and service delivery overall. The study employed a qualitative research design gathering data by interviewing 12 respondents as the sample for the study selected from a target population of 66 hospital chief executive officers (CEOs) and board chairs. The 12 respondents were selected using the purposive sampling technique based on experience and knowledge as the inclusion and exclusion criteria of participants. The study revealed 6 critical strategies as gaps that hospitals need to enhance to improve on performance. These include networking, monitoring and evaluation, revenue generation, public-private partnerships (PPPs), HMB operational plan, and transparency in the selection and appointment of board members. The gaps identified required policy review to strengthen the appointment and performance of HMBs.

Measuring social capital of hospital management boards in European hospitals: A validation study on psychometric properties of a questionnaire for Chief Executive Officers

BackgroundThe commitment of hospital managers plays a key role in decisions regarding investments in quality improvement (QI) and the implementation of quality improvement systems (QIS). With regard to the concept of social capital, successful cooperation and coordination among hospital management board members is strongly influenced by commonly shared values and mutual trust. The purpose of this study is to investigate the reliability and validity of a survey scale designed to assess Social Capital within hospital management boards (SOCAPO-B) in European hospitals.MethodsData were collected as part of the EU funded mixed-method project “Deepening our understanding of quality improvement in Europe (DUQuE)” from 210 hospitals in 7 European countries (France, Poland, Czech Republic, Germany, Portugal, Spain, and Turkey). The Chief Executive Officers (CEOs) completed the SOCAPO-B scale (six-item survey, numeric scale, 1=‘strongly disagree’ to 4=‘strongly agree’) regarding their perceptions of social capital within the hospital management board. We investigated the factor structure of the social capital scale using exploratory and confirmatory factor analyses. Internal consistency was assessed using Cronbach’s alpha, while construct validity was assessed through Pearson’s correlation coefficients between the scale items.ResultsA total of 188 hospitals participated in the DUQuE-study. Of these, 177 CEOs completed the questionnaire(172 observations for social capital) Hospital CEOs perceive relatively high social capital among hospital management boards (average SOCAPO-B mean of 3.2, SD = 0.61). The exploratory factor analysis resulted in a 1-factor-model with Cronbach’s alpha of 0.91. Pearson’s correlation coefficients between the single scale items ranged from 0.48 to 0.68.ConclusionsThe SOCAPO-B−scale can be used to obtain reliable and valid measurements of social capital in European hospital management boards, at least from the CEO’s point of view. The brevity of the scale enables it to be a cost-effective and tool for measuring social capital in hospital management boards.Trial registrationThis validation study was not registered.

Student leadership in medical school and its implications for health care and policy-making.

Approximately 5% of hospital chief executive officers are physicians, and that number is growing. Leadership is a vital skill for future physicians. We conducted a narrative review of the literature on student leadership in medical school and its implications for health care and policy-making. Qualities a good leader should possess include accountability, empathy, positivity, teamwork, and organization. Leadership skills need to be taught to students in their formative pre-clinical years so they can build upon this foundation during their clinical and residency years. Leadership is a multifaceted quality because unlike other lessons, it cannot be measured on a scale or under the microscope; it is largely developed through practice. Furthermore, among physicians, psychiatrists are especially well-trained to serve in active leadership roles because psychiatry training emphasizes interpersonal dynamics and emotional intelligence, qualities that are vital to the skill set of an effective leader. Medical leadership is essential because physicians relate best to other physicians, and those adept in administrative skills can help bridge the gap between administration and clinicians. There is a need for teaching an evidence-based leadership curriculum and training techniques that will fill a recognized educational void in medical student education (as well as for residents and junior faculty).

Representation of Women in Top Executive Positions in General Medical-Surgical Hospitals in the United States.

Background: Earlier surveys have reported a lack of representation of women in hospital leadership positions. This study sought to investigate the proportion of women in senior hospital leadership positions and to investigate whether hospital and community factors are associated with the likelihood of having women in executive positions.Methods: The main data of 4397 hospitals were sourced from the American Hospital Association. The study calculated the proportion of women for each position, with county-level adjusted standard errors and logistic transformed confidence intervals to determine the variation of women in chief officer positions across hospitals. The study also used multilevel mixed-effects logistic regressions to estimate the probability of having a female chief officer.Results: Women executives generally were underrepresented in all positions except in chief human resources and chief nursing officer positions, 73% (95% confidence interval [CI] 7175) and 91% (95% CI 8694), respectively. Women accounted for 13% (95% CI 821) of system chief executive officers (CEOs) and only 27% (95% CI 2628) of hospital CEOs. System size (number of hospitals) and hospital size (beds capacity) variables were statistically significant in five of the eight positions investigated. Overall, women were less likely to hold chief positions in large hospitals (400 beds and over) compared to small hospitals (under 100 beds).Conclusion: Women were underrepresented in hospital top positions and were less likely to hold executive positions in large systems or hospitals. The results suggest structural barriers that hinder women from advancing to top hospital positions.

Survey of hospital Chief Executive Officer research and translation priorities.

Survey of hospital Chief Executive Officer research and translation priorities.

New Evidence on the Compensation of Chief Executive Officers at Nonprofit U.S. Hospitals.

Chief executive officer (CEO) compensation is highly scrutinized, with nonprofit organizations often receiving additional attention due to their tax-exempt status. Understanding hospital CEO compensation is of increasing importance as health care costs remain high and strong leadership is required to implement new health policies. This study documents CEO compensation at nonprofit hospitals in the United States for 2010 and 2015. We compare hospital CEO compensation with CEO compensation in other institution types, including nonhospital health care. We also explore changes in hospital CEO compensation over time and differences across states. We find CEOs at hospitals earn substantially less than CEOs of publicly traded companies though more than presidents of nonprofit institutions of higher education. Additionally, we find that the relationship between CEO compensation and hospital size was weaker in 2015 than in 2010, and substantial variation in CEO compensation exists across states.

Promoting Leadership by Women in Gastroenterology—Lessons Learned and Future Directions

Promoting Leadership by Women in Gastroenterology—Lessons Learned and Future Directions

Environmental market factors associated with electronic health record adoption among cancer hospitals.

Although recent literature has explored the relationship between various environmental market characteristics and the adoption of electronic health records (EHRs) among general, acute care hospitals, no such research currently exists for specialty hospitals, including those providing cancer care. The aim of the study was to examine the relationship between market characteristics and the adoption of EHRs among Commission on Cancer (CoC)-accredited hospitals. Secondary data on EHR adoption combined with hospital and environmental market characteristics were analyzed using logistic regression. Using the resource dependence theory, we examined how measures of munificence, complexity, and dynamism are related to the adoption of EHRs among CoC-accredited hospitals and, separately, hospitals not CoC-accredited. In a sample of 2,670 hospitals, 141 (0.05%) were academic-based CoC-accredited hospitals and 562 (21%) were community-based CoC-accredited hospitals. Measures of munificence such as cancer incidence rates (OR = 0.99, CI [0.99, 1.00], p = .020) and percentage population aged 65+ (OR = 0.99, CI [0.99, 1.00], p = .001) were negatively associated with basic EHR adoption, whereas urban location was positively associated with comprehensive EHR adoption (OR = 3.07, CI [0.89, 10.61], p = .076) for community-based CoC-accredited hospitals. Measures of complexity such as hospitals in areas with less competition were less likely to adopt a basic EHR (OR = 0.33, CI [0.19, 0.96], p = .005), whereas Medicare Managed Care penetration was positively associated with comprehensive EHR adoption (OR = 1.02, CI [1.00, 1.05], p = .070) among community-based CoC-accredited hospitals. Lastly, dynamism, measured as population change, was negatively associated with the adoption of comprehensive EHRs (OR = 0.99, CI [0.99, 1.00], p = .070) among academic-based CoC-accredited hospitals. A greater understanding of the environment's relationship to health information technology adoption in cancer hospitals will help stakeholders in these institutions make informed strategic decisions about information technology investments guided by their facilities' respective environmental factors. The results of this study may also be useful to hospital chief information officers and chief executive officers seeking to either improve their quality of care or achieve and maintain accreditation in providing cancer care.

The barriers and facilitators to the implementation of National Clinical Programmes in Ireland: using the MRC framework for process evaluations

BackgroundA major healthcare reform agenda in Ireland is underway which underpins the establishment of a series of National Clinical Programmes (NCPs), which aim to take an evidence based approach to improve quality, access and value. The current study aimed to determine the enablers and barriers to implementation of the NCPs.MethodsA qualitative methodology advocated by the Medical Research Council (MRC) framework on conducting process evaluations of complex interventions guided this research. Purposive sampling techniques were used to recruit participants from seven NCPs across both acute and chronic healthcare domains, comprised of orthopaedics, rheumatology, elective surgery, emergency medicine, paediatrics, diabetes and chronic obstructive pulmonary disease. A total of 33 participants were interviewed using a semi-structured interview guide. Participants included current and previous Clinical Leads, Programme Managers, Health Service Executive management, hospital Chief Executive Officers, representatives of General Practice, and a Nursing and a Patient representative. Thematic analyses was conducted.ResultsA range of factors of different combinations and co-occurrence were highlighted across a total of six themes, including (i) positive leadership, governance and clinical networks of the NCPs, (ii) the political and social context in which the NCPs operate, (iii) constraints on resources, (iv) a passive attitudinal resistance to change borne from poor consultation and communication, (v) lack of data and information technology, (vi) forces outside of the NCPs such as the general practitioner contract thwarting change of the model of care.ConclusionsThe MRC framework proved a useful tool to conduct this process evaluation. Results from this research provide real world experiences and insight from the people charged with implementing large-scale health system improvement initiatives. The findings highlight the need for measured responses that acknowledge both direct and non-direct challenges and opportunities for successful change. Combined, it is recommended that these elements be considered in the planning and implementation of large-scale initiatives across healthcare delivery systems, both in Ireland and internationally.

Assessing the predictors for training in management amongst hospital managers and chief executive officers: a cross-sectional study of hospitals in Abuja, Nigeria

BackgroundThere is a compelling need for management training amongst hospital managers in Nigeria mostly because management was never a part of the curricula in medical schools and this has resulted in their deficiencies in effective policymaking, planning and bottom line management. There has been no study to the best of our knowledge on the need and likely factors that may influence the acquisition of such training by hospital managers and this in effect was the reason for this study.MethodsData for this study came from a cross-sectional survey distributed amongst management staff in twenty five (25) hospitals that were purposively selected. One hundred and twenty five (125) questionnaires were distributed, out of which one hundred and four (104) were answered and returned giving a response rate of 83.2%. Descriptive and Inferential statistics were used to summarize the results. Decisions were made at 5% level of significance. A binary logistic regression was performed on the data to predict the logit of being formally and informally trained in health management. These statistical techniques were done using the IBM SPSS version 20.ResultsThe result revealed a high level of formal and informal trainings amongst the respondent managers. In formal management training, only few had no training (27.9%) while in informal management training, all had obtained a form of training of which in-service training predominates (84.6%). Most of the administrators/managers also had the intention of attending healthcare management programme within the next five years (62.5%). Socio-demographically, age (p = .032) and academic qualification (p < .001) had significant influence on training. Number of hospital beds (p < .001) and number of staff (p < .001) including managers’ current designation (p < .001) also had significant influence on training.ConclusionOur work did establish the critical need for both formal and informal trainings in health management for health care managers. Emphasis on training should be directed at younger managers who are the least likely to acquire such trainings, the smaller and private hospitals who are less likely to encourage such trainings amongst their staff and the least educated amongst health managers.

Statewide cross-sectional survey of emergency departments’ adoption and implementation of the Ohio opioid prescribing guidelines and opioid prescribing practices

Study objectiveTo evaluate the implementation of the Ohio Emergency and Acute Care Facility Opioids and Other Controlled Substances Prescribing Guidelines and their perceived impact on local policies and practice.MethodsThe study...

The Commercialization of Patient-Related Decision Making in Hospitals.

Hospitals must make a profit to ensure their continued existence. The observed rises in case numbers and case-mix indices lead us to suspect that the admission, treatment, and discharge of patients are now being influenced not just by purely medical factors, but also by economic considerations with a view toward making a profit-i.e., that decision-making has become partially commercialized. In this study, we investigated whether doctors and hospital chief executive officers (CEOs) share this perception of their professional environment. In a qualitative study, doctors and hospital CEOs were interviewed. The survey was carried out in two waves over the period 2013-2016. 22 pilot interviews, 41 guided interviews, 3 focus groups, 1 written expert questionnaire and 1 workshop discussion were conducted. Responses were evaluated according to the "grounded theory" of the social sciences. Some of the doctors' and CEOs' perceptions of the patient-care situation differed markedly from each other. The CEOs mentioned the need for a profit orientation and stressed that they obeyed the legal requirement not to have any direct influence on medical decision-making, while acknowledging that physicians' actions might be influenced indirectly. The doctors, on the other hand, reported feeling increasing pressure to consider the economic interests of the hospital when making decisions about patient care, leading not only to overtreatment, undertreatment, and incorrect treatment, but also to ethical conflicts, stressful situations, and personal frustration. The doctors' responses indicate that the current economic framework conditions and the managers of hospitals are currently influencing medical care to the detriment of the patients, physicians, and nurses. It is important to acknowledge that economic pressure on hospitals can undermine the independence of medical decision-making. The dilemmas facing doctors and hospital CEOs should be openly discussed. The economic framework conditions and steering concepts should be changed as suggested by these findings.

Women in Hospital Chief Executive Officer Positions: Fact or Fiction

Are women represented in hospital CEO positions? Twenty-three hospitals in three counties were surveyedto answer this question. Surveys were done to determine the number and percentage of women in hospitalCEO positions. Also identified were the beds controlled by women hospital CEOs within each county. Fromthe county with the lowest percentage of women in CEO positions, an American College of HealthcareExecutives survey, Gender and Career in Healthcare Management (GCHM), was conducted.Two counties were above the national average for women CEOs at 23.3%. One county was at 25% and theother county was at 33%. The first county was at 52% and the second county was at 27% for control ofpercentage of beds by women hospital CEOs. The third county which was below the national average forwomen was at 11% with 1.3% of the beds controlled by women. In the results of the GCHM, womenrespondents were satisfied with advancement, infrequently engaging in informal networking within theircurrent organizations, and perceived male stereotyping and preconceptions of women's roles and abilities asthe primary barrier to advancement. More research needs to be conducted on the counties with womenhospital CEOs to identify the strategies that helped make these women in CEO positions a fact.

The First 90 Days

Hospital chief executive officer (CEO) turnover in 2015 held steady at 18%, which is equal to that reported in 2014 and among the highest rates reported in the past 2 decades. 1 Hospital CEO Turnover Rate Remains Elevated. http://www.ache.org/pubs/Releases/2016/Hospital-CEO-Turnover-Rate-Remains-Elevated.cfmDate: 2016 Google Scholar The continuing trend of mergers and acquisitions, the emergence of new models of care, retirement of leaders from the Baby Boomer era, as well as increased financial challenges, may all be contributing factors to this level of turnover. According to Jones et al., 2 Jones CB Havens D Thompson PA Chief nursing officer retention and turnover: a crisis brewing? Results of a national survey. J Healthc Manag. 2008; 53: 89-106 PubMed Google Scholar there are 4 central themes for involuntary chief nursing executive (CNO) turnover: hospital financial concerns, conflict with senior leadership, appointment of a new CEO, and concerns about the CNO's financial management capabilities. As expected, CNO turnover is continuing to be high as CEO turnover continues to increase and is further impacted by retirements of many tenured CNOs. Hospital chief executive officer (CEO) turnover in 2015 held steady at 18%, which is equal to that reported in 2014 and among the highest rates reported in the past 2 decades. 1 Hospital CEO Turnover Rate Remains Elevated. http://www.ache.org/pubs/Releases/2016/Hospital-CEO-Turnover-Rate-Remains-Elevated.cfmDate: 2016 Google Scholar The continuing trend of mergers and acquisitions, the emergence of new models of care, retirement of leaders from the Baby Boomer era, as well as increased financial challenges, may all be contributing factors to this level of turnover. According to Jones et al., 2 Jones CB Havens D Thompson PA Chief nursing officer retention and turnover: a crisis brewing? Results of a national survey. J Healthc Manag. 2008; 53: 89-106 PubMed Google Scholar there are 4 central themes for involuntary chief nursing executive (CNO) turnover: hospital financial concerns, conflict with senior leadership, appointment of a new CEO, and concerns about the CNO's financial management capabilities. As expected, CNO turnover is continuing to be high as CEO turnover continues to increase and is further impacted by retirements of many tenured CNOs.

What is a hospital bed day worth? A contingent valuation study of hospital Chief Executive Officers

BackgroundDecreasing hospital length of stay, and so freeing up hospital beds, represents an important cost saving which is often used in economic evaluations. The savings need to be accurately quantified in order to make optimal health care resource allocation decisions. Traditionally the accounting cost of a bed is used. We argue instead that the economic cost of a bed day is the better value for making resource decisions, and we describe our valuation method and estimations for costing this important resource.MethodsWe performed a contingent valuation using 37 Australian Chief Executive Officers’ (CEOs) willingness to pay (WTP) to release bed days in their hospitals, both generally and using specific cases. We provide a succinct thematic analysis from qualitative interviews post survey completion, which provide insight into the decision making process.ResultsOn average CEOs are willing to pay a marginal rate of $216 for a ward bed day and $436 for an Intensive Care Unit (ICU) bed day, with estimates of uncertainty being greater for ICU beds. These estimates are significantly lower (four times for ward beds and seven times for ICU beds) than the traditional accounting costs often used. Key themes to emerge from the interviews include the importance of national funding and targets, and their associated incentive structures, as well as the aversion to discuss bed days as an economic resource.ConclusionsThis study highlights the importance for valuing bed days as an economic resource to inform cost effectiveness models and thus improve hospital decision making and resource allocation. Significantly under or over valuing the resource is very likely to result in sub-optimal decision making. We discuss the importance of recognising the opportunity costs of this resource and highlight areas for future research.