Hospital Leaders Research Articles

Closing the Gap: Implementing Gender-Sensitive Care to Address Healthcare Disparities

Abstract Background Women still face a higher mortality rate after a heart attack compared to men, and the reasons remain unknown. The project HeartGap aims to investigate the disparity between evidence-based guidelines and the integration of Gender-Sensitive Care (GSC+) in clinical settings. By exploring healthcare providers’ attitudes and knowledge on GSC+, the project seeks to develop holistic recommendations for its effective implementation. Methods The project HeartGap employs a mixed-methods approach, including a scoping review, qualitative focus group interviews, and quantitative surveys. The focus of this abstract will be on the qualitative survey. From June 13, 2023, to April 26, 2024, a total of 18 focus group interviews were conducted in 9 hospitals of varying sizes and levels of care in Germany. These interviews involved separate groups of 3-8 nurses or physicians to explore attitudes, knowledge including the european guidelines for cardiology and current implementation of GSC+ into clinical practice. Facilitating factors and barriers were also discussed and in which fields measures should be applied. The results were evaluated using a qualitative content analysis. Results The interviews revealed discrepancies in healthcare providers’ awareness of GSC+ and identified both facilitating and hindering factors in its implementation. Facilitating factors included increased awareness, more evidence by considering gsc+ in research, university and professional education, support from hospital leadership and politics. Barriers included a lack of time and knowledge, other priorities and vague content on GSC+ in medical and nursing guidelines. Conclusions Gender-sensitive care is crucial for personalized healthcare, yet its implementation remains inconsistent in clinical practice. Targeted strategies are necessary to enhance awareness, knowledge, and guidelines and policy support for GSC+. The Identified recommendations for action are transferable throughout Europe. Key messages • Gender-sensitive care is pivotal for addressing healthcare disparities but faces implementation challenges. • Comprehensive strategies, including awareness, teaching and policy support, are indispensable for integrating gender-sensitive care into clinical practice.

04 Care for adolescents with substance use: A national survey of paediatric hospitals

Abstract Background Substance use is a recognized Paediatric health care issue. More than 9 in 10 individuals receiving treatment for substance use disorders report that their first use of substances occurred by young adulthood. The Canadian Institute for Health Information reported that 5% of hospital stays among Canadian youth in 2017-2018 were related to harmful substance use. In a study of youth with a first-time emergency department visit for a mental health problem between 2010 and 2014, most visits were due to substance related disorders. Despite this, little is known about practices relating to substance use in children's hospitals. Objectives 1. To describe how adolescents who present to Paediatric hospitals with substance use disorders or substance-related health issues are identified, assessed, and treated. 2. To identify best-practices that can inform national standards of care. Design/Methods An online questionnaire was utilized to obtain information on: 1. Clinical practices in the emergency department, inpatient services and ICU; 2. Hospital policies and practice guidelines; and 3. Hospital and community programs and resources. Recruitment emails were sent to hospital leaders (CEO or equivalent) at all 13 Paediatric hospitals. Leaders were asked to identify one individual to complete the survey on behalf of their hospital with input from relevant stakeholders in the various clinical areas. The survey was developed iteratively by a national group of 9 adolescent medicine clinicians and 2 Paediatric trainees. The survey was piloted at a single Paediatric hospital and refined. The survey was administered via RedCap technology. Results Survey response rate was 70% (9/13 hospitals). The mean number of contributors to each survey was 9 (range of 1-35). Overall, few hospitals utilized best practices consistently. There was inconsistency in the use of validated screening tools, use of clinical practice guidelines for monitoring and ongoing care and prescribing of nicotine replacement therapy and opioid agonist therapy. These inconsistencies were noted within each clinical setting (emergency department, inpatient services, and ICU), across services in each hospital, and between hospitals. With respect to hospital services, 5/9 had some type of consult team related to substance use (e.g., adolescent medicine), 4/9 had specialized substance use outpatient services, and 2/9 offered partial hospitalization/day treatment for patients with substance use issues. Local community-based substance use resources were identified as insufficient to address needs by 8/9 hospitals. Conclusion Inconsistencies in the care of adolescents with substance use disorders or substance-related health issues highlights the need for national guidelines for Paediatric hospital-based assessment and care, and enhanced coordination between services and systems of care for this patient population.

Linking organizational cronyism, time theft and nurse's proactive behavior: an evidence from public sector hospitals of Pakistan.

The main objective of this study was to understand why employees engage in time theft behavior and what is the behavioral consequence of this deviant behavior. To do this, the conservation of resources theory helps to examine the role of organizational cronyism behind employee time theft behavior and decreased proactive behavior. A three-wave self-administered employee survey was used for data collection. The data were collected through an adopted questionnaire from nurses working in the public sector hospitals of Pakistan. Structural equation modeling (SEM) was used to analyze data collected from 256 respondents. The results of this three-wave study supported the hypotheses which are: (1) Organizational cronyism positively predicts employee involvement in time theft behavior. (2) Employee time theft behavior negatively impacts their proactive behavior. (3) Organizational cronyism is detrimental to employee proactive behavior. (4) The relationship between organizational cronyism and proactive behavior is mediated by time theft. In the presence of organizational cronyism, employees use time theft as a dysfunctional coping strategy to conserve their valued resources rather than allowing the organization to consume them. Organizational leaders of public sector hospitals must promote merit-based HRM practices to discourage time theft behavior as well as to improve the proactive performances of the nurses. This study is one of the initial attempts to extend the scant literature on the antecedents and consequences of time theft behavior and its dimensions in the South Asian context.

Assessment of the Psychometric Properties of the Hospital's Culture of Nursing Research Scale Among Nurses.

Background and Purpose: The "Hospital's Culture of Nursing Research Scale" (HCNRS) is a critical assessment tool in health care research. It was created in response to the rising acknowledgment of nursing research's critical role in improving patient care outcomes. This study aimed to develop the HCNRS to assess the nurses' perceptions of the hospital's culture of nursing research. Methods: This study utilized the instrument development design in developing the HCNRS. The study was conducted in Astana, Kazakhstan, from May to September 2023. The study followed three major stages of scale development: "item development," "scale development," and "scale evaluation." "Principal component analysis" (PCA; n = 387) and "confirmatory factor analysis" (CFA; n = 362) were performed in this study. Cronbach's coefficient α was computed for reliability. Results: The PCA on the 32-item HCNRS revealed five factors with an eigenvalue of above 1, contributing 66.0% of the model's total variance. The CFA revealed the following findings supporting the five subscales of the HCNRS-R: χ 2 /df = 2.65, root mean square error of approximation = .068 (90% CI [0.063, 0.072]), comparative fit index = 0.92, Tucker-Lewis index = 0.91, and standardized root mean square residual = .04. Based on the items that loaded in each factor, the subscales were labeled "Research Ethics, Integrity, and Supportive Culture," "Nursing Research Institutionalization," "Hospital's Financial Support and Incentives for Research Initiatives," "Nursing Research Engagement and Innovation," and "Nursing Research Integration and Career Support." The computed Cronbach's coefficient α of the entire scale was .963. For its subscales, the Cronbach's coefficient α ranged from .833 to .953. Conclusions: The study developed a five-factor HCNRS to evaluate the multifaceted aspects of nursing research culture in hospital settings. Health care institutions can utilize this scale to identify areas for improvement in research culture and implement strategies to foster research ethics, integrity, and innovation. This tool can also be used by hospital leaders, policymakers, and nurse researchers seeking to evaluate the research culture within their health care organizations.

The development of a tool for the assessment of oral health program in a pediatric cancer unit

Abstract Background Oral diseases and associated illnesses interfere with cancer treatment, increase morbidity, prolong hospital stay, and increase costs. Oral care of children with cancer is essential to prevent oral diseases and decrease its symptoms. Standardized oral health and hygiene (OHH) practices must be a priority and incorporated as a routine cancer care quality. To improve OHH, baseline information of practices, processes and institutional support are necessary. Here, we report the steps we followed to develop a tool for evaluating OHH practices, support, and resources available in a pediatric cancer unit. Methods We conformed a working group (WG) integrated by healthcare professionals in pediatric, infectious diseases, oncology, and dentistry acquainted with the care of children with cancer. The steps proposed by the WG included: (1) literature review of published surveys in OHH; (2) interviews with practicing healthcare providers regarding OHH in pediatrics; (3) identification, adoption and adaptation of the Hand Hygiene Self-assessment framework (HHSAF), a survey model based on the multimodal improvement strategy (MMIS); (4) building of OHH tool; (5) validation test of OHH tool; and (6) pilot testing in recruited pediatric hematology and oncology centers. Google form version 0.8. Microsoft office excel 2021 (18.0) was used to build the OHH survey and obtain the WG member responses. The final draft of the survey was approved by WG members. We will evaluate survey validity in the pilot test among members of the PRINCIPAL network, a community of pediatric infectious disease experts and preventionists of Latin America. Results We found few reports on OHH practices in children cancer surveys. The WG met virtually and monthly from March to December 2023 to build the OHH survey. Our final survey version was organized following the model of the HHSAF and integrated into five main sections. These sections had items (Q) that requested answers regarding OHH practices and resources and institutional support (6Q); training and education of patients, families, and healthcare providers (6Q); evaluation and feedback of OHH processes in pediatric oncology unit and OHH practices of patients (6Q); reminders of OHH practices in the workplace (3Q); and hospital leadership support (2Q). The survey was made up of multiple choice and Likert scale questions. Each of the answers had a weight, and if all the items were present, the total was 400 points. Based on the total points obtained, we categorized the quality of the OHH practices of the pediatric oncology unit in inadequate (0-100); basic (101-200), intermediate (201-300), advanced (>300). The survey tool must be answered by an assigned team of the pediatric oncology unit oral health including a family member representative, and it could take less than 15 minutes to complete. Conclusion We developed a 21-item OHH practices survey following the WHO recommendations to use a MMIS model. We found that our newly developed tool was comprehensive and potentially helpful to assess OHH practices and identify success factors in best practices in OHH in pediatric oncology units. Our next step is pilot testing to evaluate our survey tool validity and reliability.

Physician Altruism and Spending, Hospital Admissions, and Emergency Department Visits

Altruism-putting the patient first-is a fundamental component of physician professionalism. Evidence is lacking about the relationship between physician altruism, care quality, and spending. To determine whether there is a relationship between physician altruism, measures of quality, and spending, hypothesizing that altruistic physicians have better results. This cross-sectional study that used a validated economic experiment to measure altruism was carried out between October 2018 and November 2019 using a nationwide sample of US primary care physicians and cardiologists. Altruism data were linked to 2019 Medicare claims and multivariable regressions were used to examine the relationship between altruism and quality and spending measures. Overall, 250 physicians in 43 medical practices that varied in size, location, and ownership, and 7626 Medicare fee-for-service beneficiaries attributed to the physicians were included. The analysis was conducted from April 2022 to August 2024. Physicians completed a widely used modified dictator-game style web-based experiment; based on their responses, they were categorized as more or less altruistic. Potentially preventable hospital admissions, potentially preventable emergency department visits, and Medicare spending. In all, 1599 beneficiaries (21%) were attributed to the 45 physicians (18%) categorized as altruistic and 6027 patients were attributed to the 205 physicians not categorized as altruistic. Adjusting for patient, physician, and practice characteristics, patients of altruistic physicians had a lower likelihood of any potentially preventable admission (odds ratio [OR], 0.60; 95% CI, 0.38-0.97; P = .03) and any potentially preventable emergency department visit (OR, 0.64; CI, 0.43-0.94; P = .02). Adjusted spending was 9.26% lower (95% CI, -16.24% to -2.27%; P = .01). This cross-sectional study found that Medicare patients treated by altruistic physicians had fewer potentially preventable hospitalizations and emergency department visits and lower spending. Policymakers and leaders of hospitals, medical practices, and medical schools may want to consider creating incentives, organizational structures, and cultures that may increase, or at least do not decrease, physician altruism. Further research should seek to identify these and other modifiable factors, such as physician selection and training, that may shape physician altruism. Research could also analyze the relationship between altruism and quality and spending in additional medical practices, specialties, and countries, and use additional measures of quality and of patient experience.

Toward hospital resilience: a qualitative study on the identification of hospital shocks during disruption era in Indonesia

BackgroundHospital resilience has been well recognized among healthcare managers and providers as disruption of hospital services that threatens their business environment. However, the shocks identified in the recent hospital resilience concept are mainly related to disaster situations. This study aims to identify potential shocks that hospitals face during disruptions in Indonesia.MethodThis qualitative study was conducted in Makassar, Indonesia in August-November 2022. Data was collected through semi-structured interviews with hospital managers and resilience experts using a semi-structured interview guide. 20 key informants were interviewed and data were analyzed by thematic analysis.ResultsThe study identified seven shocks to hospitals during the disruption era: policy, politics, economics, hospital management shifting paradigms, market and consumer behavior changes, disasters, and conflicts. It also identified barriers to making hospitals resilient, such as inappropriate organizational culture, weak cooperation across sectors, the traditional approach of hospital management, inadequate managerial and leadership skills, human resources inadequacies, a lack of business mindset and resistance to change.ConclusionThis study provides a comprehensive understanding of hospital shocks during disruptions. This may serve as a guide to redesigning the instruments and capabilities needed for a resilient hospital.

280 ‘What Are We Waiting For?’ Conflicting Perspectives on the Emergency Department Boarding Crisis: A Qualitative Analysis of Interviews With Patients, Frontline Providers and Hospital Leaders

280 ‘What Are We Waiting For?’ Conflicting Perspectives on the Emergency Department Boarding Crisis: A Qualitative Analysis of Interviews With Patients, Frontline Providers and Hospital Leaders

Organizational culture and leadership style in Spanish Hospitals: Effects on knowledge management and efficiency

Hospital culture and leadership style have attracted considerable attention in research, with compelling evidence indicating their potential competitive advantages, including their crucial role in ensuring the successful implementation of knowledge management and its impact on hospital efficiency. The aim of this paper is to identify the effects of organizational culture and leadership style on knowledge management and hospital efficiency. Fuzzy cognitive maps (FCMs) are relational models that can be used to represent the opinions and knowledge of expert to infer cause-effect relationships among different concepts. The use of FCMs as a simulation tool enables the evaluation of potential scenarios based on different organizational cultures and leadership styles in hospitals. Developing an FCM for this study involved several steps. Firstly, data were collected through interviews with 21 experts in hospital management. The interviews were conducted between May and September 2023 either face-to-face or via videoconference. Once individual cognitive maps had been created, consensus among them was achieved through a multicriteria decision-making process, wherein the expert opinions were averaged. The separate cognitive maps of each expert were then integrated to produce a single FCM using the augmented FCM approach. Reflecting expert insights from the FCM, hospitals with a hierarchy culture exhibit diminished levels of knowledge creation, management, and overall hospital efficiency, whereas those with an adhocracy culture show improvements in knowledge creation, knowledge exploitation, and overall hospital efficiency in comparison to alternative ones. From the experts' FCM perspective regarding leadership style, transformational leadership achieves the highest level of knowledge management and hospital efficiency in hospitals with an adhocracy culture. Finally, this paper offers a reference for practising knowledge management and improving hospital efficiency through adhocracy culture and transformational leadership.

Newly graduated and nurse resident competencies: Perceptions of nurse faculty and acute care hospital leaders in the state of Maryland

BackgroundThe many educational pathways to obtain a professional nursing degree create confusion among healthcare leaders about new graduate nurses' (NGNs) competency expectations when entering practice. PurposeThis research sought to identify, among Maryland nursing academic and practice leaders, a standard set of NGN competencies after completing their prelicensure program and nurse residency program (NRP) at 12 months. MethodA mixed-method approach was used, including a survey of 109 outcome statements and faculty and practice leader focus groups. ResultsResults suggested that 90 % of the nursing programs could collectively meet 18 of the 109 outcomes by NGN program completion, with few differences in responses from the varying academic programs. Faculty attributed these low results to the heavy focus on preparing students for the NCLEX examination, overloaded curricula, and competing priorities. Practice leaders perceived NGNs only partially met/did not meet most competencies, viewing many as unrealistic. Findings support requirements for NGNs to complete an NRP and the existence of a practice-education gap. ConclusionsResearch findings can help inform the development of a nationally accepted, competency-based educational framework for students, new-to-practice nurse residents, and professional nurses to help align entry-level nursing practice expectations with those of nursing programs and NRPs.

Open and opaque? The performativity of open priorities in a Norwegian hospital

Being open about priority-setting decisions is a central element of frameworks enhancing procedural fairness. While challenges in implementing priority-setting frameworks in general have been reported, few studies have empirically examined how the concept of openness is understood and enacted in the day-to-day functioning of hospitals. This paper explores the operationalisation of the policy of “open priorities”, based on long-term ethnographic fieldwork in a Norwegian hospital in 2022. Drawing on the concept of performativity, the study portrays how the ideal of open priorities translates into everyday practices related to why, for whom and which priorities are to be open. The paper shows how openness was portrayed as a central hospital policy, but was also seen as a source of conflicts, hindering effective governance and reducing public trust. Hence, hospital leaders transformed and diluted the ideal of openness into priority-setting decisions with multiple shields of opaqueness. Through omissions and rewritings of the notion of openness, health leaders enacted performativity. The paper adds to the growing body of knowledge of the multifaceted ways policy ideals are transformed by government institutions in the process of implementation and calls for further exploration of efforts to improve everyday and routinised procedural fairness.

Configurational Paths of Preconditions to Transformational Leadership Among Core Hospital Leaders: A Fuzzy-Set Qualitative Comparative Analysis.

Transformational leadership among core hospital leaders boosts medical organizations' competitiveness, adaptability, and sustainability, which is jointly affected by individual, organizational and environmental factors. This study aims to unpack its configurational framework and propose strategies to strengthen core hospital leaders' transformational leadership. Data were collected from an online questionnaire among 31 core hospital leaders. The fuzzy-set qualitative comparative analysis (fsQCA) was used to explore the causal mechanism of high-level transformational leadership. We enrich this mechanism by professional background, critical thinking, initiative spirit, family-work conflict, job satisfaction, subordinates' followership, and work pressure. Result shows initiative spirit is the only necessary condition (consistency=0.911) for the formation of high-level transformational leadership among core hospital leaders. Three configurations are the sufficient conditions that lead to high-level transformational leadership among core hospital leaders with two different professional backgrounds (overall solution consistency= 0.952). Core hospital leaders' initiative spirit is an indispensable condition for improving high-level transformational leadership, emphasizing the necessity for core leaders to be proactive in order to develop such leadership. Besides, the study also uncovered three configurations are the sufficient conditions for core hospital leaders with diverse professional backgrounds to achieve high-level transformational leadership. This finding offers significant insights into hospital management practices, suggesting that core hospital leaders' work should be managed in a personalized manner based on their professional backgrounds, thereby fostering favorable conditions conducive to the development of their high-level transformational leadership capabilities. Furthermore, the central insight of this study is that the formation of high-level transformational leadership contingent upon the collaboration of professional background, critical thinking, initiative spirit, family-work conflict, job satisfaction, subordinates' followership, and work pressure, contributing to a holistic and more rigorous view for the development of transformational leadership.

A nationwide mixed-methods study of gaps and barriers to implementation of antimicrobial stewardship programmes in hospitals in Indonesia

There is an urgent need to understand the implementation barriers of antimicrobial stewardship programs (ASP) in low- and middle-income countries. We conducted a mixed-methods study in public and private hospitals across all provinces in Indonesia (March-December 2023). We used a self-assessment questionnaire with a scoring system, and multilevel ordinal regression to assess associations with hospital and district-level characteristics. Focus group discussions (FGD) with hospital stakeholders examined barriers and enablers. We applied a patient safety framework to integrate results. 575 (19%) of 3026 hospitals completed the self-assessment, of whom 516 (89.7%) had a formal ASP (median 4 [IQR1-5] years), and 14 participated in FGD. The median overall ASP development score was 48.4% (35.9-62.5%), classifying 41 (8.0%) hospitals as inadequate (0-25%), 237 (45.9%) as basic (26-50%), 179 (34.7%) as intermediate (51-75%) and 59 (11.4%) as advanced (76-100%). Scores were highest for hospital leadership support (83.4% [66.7-100%]), followed by ASP team and infectious disease training (66.7% [55.6-77.8%]); education (50% [0.0-75.0%]); ASP interventions (43.8% [18.7-68.7%]); hospital infrastructure (42.9% [14.3-71.4%]); and monitoring, reporting and feedback (40.9% [27.3-54.5%]). A higher ASP development score was associated with higher hospital tiered level, longer ASP duration, and higher district-level public health development index and per capita domestic expenditure, but not with hospital ownership or geographic region. FGDs highlighted barriers related to hospital leadership support, staff technical and behavioral skills, cross-disciplinary collaboration, fear of loss of prescriber autonomy, microbiology and IT support, and hospital accreditation. Identified implementation barriers can inform actions for context-specific, sustainable improvement of ASPs.

Leveraging electronic medical record (EMR) changes and virtual care towards improving tobacco screening and referral rates.

426 Background: Continued smoking after a cancer diagnosis is associated with poorer outcomes. Ontario Regional Cancer Centres are required to screen all new cancer patients for tobacco use and offer referrals for cessation support to patients using tobacco. At Princess Margaret Cancer Centre (Toronto, Canada), we leveraged an EMR change to Epic along with uptake in virtual care strategies from COVID-19, to improve both tobacco screening and referral rates for new patients. Methods: Following the EMR transition to Epic in June 2022, we piloted EMR and virtual care strategies from Jan 2023 to Mar 2024 to improve both tobacco screening and referral rates. Due to precautions during COVID-19, screening and referrals were completed using a hybrid pre-visit electronic tobacco use assessment questionnaire and in clinic paper-based referral system. Our interventions were co-developed by a team of hospital leadership, IT team members and clinicians. These included: 1) Collation of tobacco assessment data sources on Epic (Jan 2023); 2) Creation of an Epic referral inbox to track referrals (Aug 2023); 3) Assignment of electronic pre-visit tobacco assessments questionnaires to correct visit types (Sep 2023); 4) Creation of a half-day virtual nursing clinic to offer referrals for cessation support to patients initially declining support or those who were not offered using monthly reports from Epic (Nov 2023). Screening and referral rates were tracked monthly and quarterly during this period. Results: From Jan 2023 to March 2024, 15,063 new patients presented to our cancer centre. Baseline screening and referral rates before COVID-19 were 47% and 16%, respectively. Prior to this QI initiative, screening and referral rates were 18% and 1%, respectively. Post implementation, screening and referral rates improved to 42% and 25% (Table); rates of current tobacco use remained consistent from 12-16%. Collation of tobacco use assessments data on Epic had the greatest impact on improving screening rates from 18% to 39% (p<0.001), while the virtual nursing clinic helped to improve referral rates from 3% to 25% (p<0.001), with the greatest referral rate in Jan 2024 at 36%. Our virtual nursing clinic was feasible, where among patients contacted who initially declined or were not offered cessation support, 90% were contacted within 1-3 phone calls. Among patients contacted, 20% accepted a referral, while 41% of patients had already quit smoking by the time of contact. Conclusions: Both EMR and virtual care strategies helped to successfully improve both tobacco screening and referral rates for smoking cessation support; with the greatest impact from the collation of EMR data sources on tobacco use and development of a virtual nurse led clinic. Quarterly tobacco screening and referral rates. Jan-Mar 2023 Apr-Jun 2023 Jul-Sep 2023 Oct-Dec 2023 Jan-Mar 2024 Screening 33% 38% 39% 41% 42% Referrals 0% 1% 3% 20% 25%

Hospital Unit Type and Professional Roles as a Predictor of Relational Coordination in an Army Medical Center.

High-quality communication and relationships are associated with quality of care. Workflow differences across hospital units can impede communication and relationships among health care professionals. Relational coordination (RC) is a process of communication supported by shared goals, shared knowledge, and mutual respect and is associated with quality of care and better performance outcomes in civilian hospitals. However, RC has not been explored in military hospitals. The objective of our study was to determine whether RC differs between hospital units and professional roles. Specifically, we examined RC differences by unit type for nurses, resident physicians, and physicians working in an Army Medical Center. We conducted an exploratory analysis of a secondary question from a cross-sectional study using a convenience sample of active-duty and civilian licensed practical nurses (LPNs), registered nurses (RNs), physician residents, and physicians (n = 289). We received institutional review board approval from the study site. Data were collected from January 2020 to March 2020, and participants completed a 47-item survey regarding their experiences of RC in various hospital units. We used t tests and one-way analyses of variance to explore bivariate relationships between RC and other study variables, as well as multiple regression to explore whether RC varied by unit type. We controlled for education and experience by including them in the model because these variables may influence perceptions of nurse-physician RC and their interactions with each other. Seventy percent of participants were civilian (n = 203), 75% RNs (n = 217), and 78% female (n = 216). The mean age of respondents was 40 years (SD = 11.7), and the mean experience level was 11.9 years (SD = 9.5). RC was not associated with unit type. Total RC and between-role RC were associated with professional role. Physicians reported higher RC (β = .45, P = .01), and LPNs reported lower RC (β = -.06, P = .01). Education and experience were associated with RC. Participants with less experience reported higher RC (β = -.01, P = .00), and participants with graduate degrees reported lower RC (β = -.62, P = .00). We recommend hospital leaders consider interventions to build interprofessional relationships, including interdisciplinary meetings, huddles, and structured communication tools. Improving RC among health care professionals is a cost-effective and unique way to enhance communication and collaboration among health care professionals across hospital units.

Early-stage implementation of peer-led interventions for emergency department patients with substance use disorder: Findings from a formative qualitative evaluation

IntroductionEmergency department (ED)-based peer recovery coach (PRC) programs can improve access to substance use disorder treatment (SUD) for ED patients. As literature on early stages of PRC implementation is limited, we conducted a qualitative assessment of ED PRC program implementation from several US-based PRC programs focusing on barriers and facilitators for implementation and providing recommendations based on the findings. MethodsWe collected qualitative data from 39 key informants (peer recovery coaches, PRC program managers, ED physicians and staff, representatives of community-based organizations) via 6 focus groups and 21 interviews in February–December 2023. We transcribed audio-recordings and analyzed data using codebook thematic analysis. ResultsWe identified the following major themes related to specific barriers and recommendations to address them. To facilitate timely linkage to PRCs, programs would regularly inform ED staff about the program and its linkage procedures, establish trust between PRC and ED staff, streamline the linkage procedures, and choose an “opt-out” linkage approach. To address barriers related to external referrals, programs use “warm handoff” and “warm line” strategies, maintain and update a comprehensive catalog of resources, and familiarize peer coaches with local service providers. Telehealth services implementation requires addressing logistical barriers, ensuring patients' privacy, and training peer coaches on building trust and rapport online. Peer coaches' wellness and quality of services can be improved by limiting PRC's workload, prioritizing quality over quantity, facilitating self-, peer- and professional care to mitigate stress and burnout; and, importantly, by providing supportive supervision and training to peer coaches and advocating for PRC team as an equal partner in the ED settings. To facilitate PRC program adoption and sustainment program managers engage local communities and program champions, seek diverse sources of funding, and advocate for structural changes to accommodate recruitment and retention of peer recovery coaches. ConclusionsWe compiled a wealth of best practices used by PRC programs to address numerous implementation barriers and challenges. These recommendations are intended for PRC program planners, managers and champions, hospital leadership, and state and local public health agencies leading SUD epidemic response.

Implementation of a rural emergency department-initiated buprenorphine program in the mountain west: a study protocol

BackgroundOpioid related overdose morbidity and mortality continue to significantly impact rural communities. Nationwide, emergency departments (EDs) have seen an increase in opioid use disorder (OUD)-related visits compared to other substance use disorders (SUD). ED-initiated buprenorphine is associated with increased treatment engagement at 30 days. However, few studies assess rural ED-initiated buprenorphine implementation, which has unique implementation barriers. This protocol outlines the rationale and methods of a rural ED-initiated buprenorphine program implementation study.MethodsThis is a two-year longitudinal implementation design with repeated qualitative and quantitative measures of an ED-initiated buprenorphine program in the rural Mountain West. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework outlines intervention assessments. The primary outcome is implementation measured by ED-initiated buprenorphine protocol core components. Reach, adoption, and maintenance are secondary outcomes. External facilitators from an academic institution with addiction medicine and prior program implementation expertise partnered with community hospital internal facilitators to form an implementation team. External facilitators provide ongoing support, recommendations, education, and academic detailing. The implementation team designed and implemented the rural ED-initiated buprenorphine program. The program includes OUD screening, low-threshold buprenorphine initiation, naloxone distribution and administration training, and patient navigator incorporation to provide warm hand off referrals for outpatient OUD management. To address rural based implementation barriers, we organized implementation strategies based on Expert Recommendations for Implementing Change (ERIC). Implementation strategies include ED workflow redesign, local needs assessments, ED staff education, hospital leadership and clinical champion involvement, as well as patient and community resources engagement.DiscussionMost ED-initiated buprenorphine implementation studies have been conducted in urban settings, with few involving rural areas and none have been done in the rural Mountain West. Rural EDs face unique barriers, but tailored implementation strategies with external facilitation support may help address these. This protocol could help identify effective rural ED-initiated buprenorphine implementation strategies to integrate more accessible OUD treatment within rural communities to prevent further morbidity and mortality.Trial RegistrationClinicalTrials.gov National Clinical Trials, NCT06087991. Registered 11 October 2023 – Retrospectively registered, https://clinicaltrials.gov/study/NCT06087991.

Leadership support and satisfaction of healthcare professionals in China’s leading hospitals: a cross-sectional study

BackgroundHealthcare professionals’ job satisfaction is a critical indicator of healthcare performance, pivotal in addressing challenges such as hospital quality outcomes, patient satisfaction, and staff retention rates. Existing evidence underscores the significant influence of healthcare leadership on job satisfaction. Our study aims to assess the impact of leadership support on the satisfaction of healthcare professionals, including physicians, nurses, and administrative staff, in China’s leading hospitals.MethodsA cross-sectional survey study was conducted on healthcare professionals in three leading hospitals in China from July to December 2021. These hospitals represent three regions in China with varying levels of social and economic development, one in the eastern region, one in the central region, and the third in the western region. Within each hospital, we employed a convenience sampling method to conduct a questionnaire survey involving 487 healthcare professionals. We assessed perceived leadership support across five dimensions: resource support, environmental support, decision support, research support, and innovation encouragement. Simultaneously, we measured satisfaction using the MSQ among healthcare professionals.ResultsThe overall satisfaction rate among surveyed healthcare professionals was 74.33%. Our study revealed significant support from senior leadership in hospitals for encouraging research (96.92%), inspiring innovation (96.30%), and fostering a positive work environment (93.63%). However, lower levels of support were perceived in decision-making (81.72%) and resource allocation (80.08%). Using binary logistic regression with satisfaction as the dependent variable and healthcare professionals’ perceived leadership support, hospital origin, job role, department, gender, age, education level, and professional designation as independent variables, the results indicated that support in resource provision (OR: 4.312, 95% CI: 2.412 ∼ 7.710) and environmental facilitation (OR: 4.052, 95% CI: 1.134 ∼ 14.471) significantly enhances healthcare personnel satisfaction.ConclusionThe findings underscore the critical role of leadership support in enhancing job satisfaction among healthcare professionals. For hospital administrators and policymakers, the study highlights the need to focus on three key dimensions: providing adequate resources, creating a supportive environment, and involving healthcare professionals in decision-making processes.

Nurse experiences and perspectives with missed nursing care during COVID-19: A qualitative study.

This study aimed to determine clinical nurse and nurse manager perspectives on missed nursing care (MNC) during the COVID-19 pandemic. This study utilized a qualitative exploratory descriptive design. Data were obtained through focus groups and virtual interviews. Purposive sampling was used to select nurse and nurse manager participants in COVID-19 units and the Emergency Department in one large healthcare organization in the northeastern United States of America. A total of 15 nurses and nurse managers participated in the study. Results revealed five categories: medication delivery, turning patients, double checks, communication and rapport, and patient surveillance. A variety of factors contributed to the perceptions and experiences of MNC of COVID-19 patients during the early stage of the pandemic. The COVID-19 crisis put additional and unparalleled pressure on a strained nursing workforce. Hospital leaders are responsible for ensuring their frontline nurses have the resources they need to feel supported in their roles regardless of the presenting circumstances. Nurse leaders should employ evidence-based strategies such as promoting and championing teamwork to support staff and reduce incidences of MNC during crises. Our current work may serve as a basis for informing future revisions of pre-pandemic measurement tools when applied in a pandemic-specific context. This manuscript adheres to the standards for reporting qualitative research (SRQR); a synthesis of recommendations. There was not patient or public contribution for this study.

The hospital leadership model of the future: How an organisation is using the triad/dyad model to drive performance excellence and culture transformation

Healthcare organisations have been facing increasing complexity since the pandemic, demanding improved outcomes with fewer resources. Collaboration and alignment are crucial amidst evolving market dynamics and changing patient expectations. Innovative leadership models like the triad/dyad approach offer a solution, fostering interprofessional teamwork to enhance patient care and drive cultural transformation. The model promotes collaboration, innovation and continuous improvement, fostering a culture of shared accountability. Results demonstrate improvements in quality, culture and operational metrics, showcasing the model’s effectiveness in driving transformative change. While challenges exist, embracing triad/dyad leadership offers significant benefits for healthcare organisations. Prioritising collaboration and investing in leadership development are essential for sustained success and cultural transformation.