Leading Healthcare Organizations Research Articles

Integrating Data Mining Techniques into Telemedicine Systems

The medical system is facing a wide range of challenges nowadays due to changes that are taking place in the global healthcare systems. These challenges are represented mostly by economic constraints (spiraling costs, financial issues), but also, by the increased emphasis on accountability and transparency, changes that were made in the education field, the fact that the biomedical research keeps growing in what concerns the complexities of the specific studies etc. Also the new partnerships that were made in medical care systems and the great advances in IT industry suggest that a predominant paradigm shift is occurring. This needs a focus on interaction, collaboration and increased sharing of information and knowledge, all of these may is in turn be leading healthcare organizations to embrace the techniques of data mining in order to create and sustain optimal healthcare outcomes. Data mining is a domain of great importance nowadays as it provides advanced data analysis techniques for extracting the knowledge from the huge volumes of data collected and stored by every system of a daily basis. In the healthcare organizations data mining can provide valuable information for patient's diagnosis and treatment planning, customer relationship management, organization resources management or fraud detection. In this article we focus on describing the importance of data mining techniques and systems for healthcare organizations with a focus on developing and implementing telemedicine solution in order to improve the healthcare services provided to the patients. We provide architecture for integrating data mining techniques into telemedicine systems and also offer an overview on understanding and improving the implemented solution by using Business Process Management methods.Keywords: Telemedicine, Data Mining, Healthcare, Data Warehouse, Business Process Man-agement, Architecture1 IntroductionIn our current society, the healthcare do-main is at a critical crossroads and faces a wide number of challenges. There are for ex-ample, the threatening of the continuous in-crease of costs, the expand of the govern-ment-funded healthcare coverage, the contin-uous number of the uninsured, a very slow process of quality care improvement, the de-mographic trends, especially the number of senior population that keeps increasing and therefore putting strain on the system, a non-optimized health insurance framework etc.The research that is being done in the innova-tion direction, especially in what concerns the provisioning and administration of offer-ing remote healthcare services has conducted to the appearance and development of a new domain which represents a key enabler that can improve the quality of medical services by enhancing the operational effectiveness and achieving improved outcomes. This do-main was named telemedicine and represents a solution to the large number of challenges that the medical system confronts with.Telemedicine represents a combination of expertise and technology that provides ser-vices and information over distance. [1] IT technology delivers this information in the form of voice, data or video image and its main objective consists in the utility and effi-cacy of the technology itself, as it is applied to hospitals problems and their infrastructure. The use of telemedicine for providing care services has been rapidly increasing and with the latest innovation in the information and computer technologies, it has become an im-portant part of the medical development pro-cess with a high potential of improving the economic prosperity of the country.Information and technology resources are having a very important contribution in the process of avoiding and reducing clinical er-rors but also in the optimization process of the medical health provider's processes and workflows. [2] These resources are mostly being used for activities concerning the pro-cess of:* collecting medical data from patients;* providing the required medical infor-mation to the physicians, patients or other members of the medical community;* real-time monitoring of patients* diagnosing patients using expert systems. …

Nursing Burnout Interventions

Many studies have documented high prevalence of burnout and compassion fatigue in oncology nurses. Burnout has detrimental effects on nurses, patients, and healthcare organizations. However, burnout interventions have been shown to improve the physical and mental health of nurses, patient satisfaction, and the organizational bottom line by reducing associated costs of burnout. Although treatment centers may prevent and correct burnout in oncology nurses by providing various interventions, few articles focus on those interventions. This article compiles and describes interventions that will serve as a reference to nurses and healthcare organization leaders interested in implementing similar programs.

Expanding Our Green Horizons: Sustainability in Schools of Nursing

Leading nursing and healthcare organizations across the nation are adopting a shared vision of a more environmentally sustainable healthcare sector that does not harm, but instead works to promote human and environmental health. In 2011, the American Association of Colleges of Nursing Task Force on Environmental Sustainability produced a report, Toward an Environmentally Sustainable Academic Enterprise: An AACN Guide for Nursing Education. The University of Maryland School of Nursing (UMSON) is implementing the recommendations of the AACN Task Force. The Sustainability Initiative will strive to educate all at UMSON to address the environment within the school, workplace, and profession.

The most effective leadership style for the new landscape of healthcare.

When leaders in healthcare organizations are asked, What's the one word that best characterizes the impact of the Affordable Care Act (ACA) on the U.S. healthcare delivery most will answer Change. And when midto lowerlevel employees in those same organizations are asked to describe the one thing they dislike or fear most about the ACA, they, too, say Change. As if they are not already challenged by implementing the ACA, today's healthcare leaders are faced with the challenge of overcoming staffs resistance to change. Furthermore, too many leaders do not understand just how change resistant many of employees are, although these employees are the very people who will be charged with implementing the tremendous changes the ACA will require.Some leaders have tried to persuade staff that surviving healthcare reform is the latest burning platform threatening the prosperity and security of organizations. But they generally find that change management challenges, such as ACA implementation, do not come with a one-size-fits-all solution or that staff do not view the ACA as their problem.WHAT'S A LEADER TO DO?Changes in every aspect of healthcare delivery-from reimbursement to quality control to elimination of wasteful and inefficient practices-are having a tremendous impact on the U.S. healthcare delivery system, with many more changes to come. But the impact of all of these changes on the people who will be implementing them may get overlooked in all the haste for compliance. Add to the mix the initial rocky launch of the reform law and uncertainty regarding its sustainability, and the suggestion that a profound shift is ahead could easily be regarded as an understatement.People at every level of provider organizations are stressed, confused, and bewildered by the blizzard of changes occurring, and many-perhaps most-are ill suited to absorb these changes, and the organizational dysfunction that will likely accompany them, easily or gracefully. The result is a growing insecurity, anxiety, and outright resistance among these workers, leading to a demoralized workforce and compromised compliance.Healthcare leaders must understand the value and critical importance of delivering an emotionally and behaviorally intelligent style of leadership to ensure that staff feel empowered and supported as they work through and implement some of the greatest changes in the delivery of healthcare in this country since the introduction of Medicare. For many leaders, maintaining the status quo in leadership style simply will not get the job done.WHY EMOTIONALLY AND BEHAVIORALLY INTELLIGENT LEADERSHIP?In 2003, the Harvard Business Review examined data supporting emotional intelligence. In that article, it stated that:In hard times, the soft stuff goes away. But emotional intelligence, it turns out, isn't so soft. If emotional obliviousness jeopardizes your ability to perform, fend off aggressors or be compassionate in a crisis, no amount of attention to the bottom line will protect your career. Emotional intelligence isn't a luxury you can dispense with in tough times. It's a basic tool that, deployed with finesse, is the key to professional success.While some leaders may deem the subject of emotional intelligence to be too squishy for any practical value in leading people, enlightened leaders in business, industry, and even the military are finding strong value and return on investment in not just understanding emotional intelligence but incorporating it into leadership style.A study by the Center for Creative Leadership (2010) reported that the need to improve skills in leading employees and work teams was a top priority among senior healthcare leaders. However, those same leaders indicated that such skills-including self-awareness-were rated the lowest of those regularly demonstrated by leaders in healthcare.In his book Primal Leadership, Daniel Goleman (2002, p. …

Expanding Our Green Horizons: Sustainability in Schools of Nursing

Leading nursing and healthcare organizations across the nation are adopting a shared vision of a more environmentally sustainable healthcare sector that does not harm, but instead works to promote human and environmental health. In 2011, the American Association of Colleges of Nursing Task Force on Environmental Sustainability produced a report, Toward an Environmentally Sustainable Academic Enterprise: An AACN Guide for Nursing Education. The University of Maryland School of Nursing (UMSON) is implementing the recommendations of the AACN Task Force. The Sustainability Initiative will strive to educate all at UMSON to address the environment within the school, workplace, and profession.

Success Factors for Strategic Change Initiatives: A Qualitative Study of Healthcare Administratorsʼ Perspectives

Success factors related to the implementation of change initiatives are well documented and discussed in the management literature, but they are seldom studied in healthcare organizations engaged in multiple strategic change initiatives. The purpose of this study was to identify key success factors related to implementation of change initiatives based on rich qualitative data gathered from health leader interviews at two large health systems implementing multiple change initiatives. In-depth personal interviews with 61 healthcare leaders in the two large systems were conducted and inductive qualitative analysis was employed to identify success factors associated with 13 change initiatives. Results from this analysis were compared to success factors identified in the literature, and generalizations were drawn that add significantly to the management literature, especially to that in the healthcare sector. Ten specific success factors were identified for the implementation of change initiatives. The top three success factors were (1) culture and values, (2) business processes, and (3) people and engagement. Two of the identified success factors are unique to the healthcare sector and not found in the literature on change models: service quality and client satisfaction (ranked fourth of 10) and access to information (ranked ninth). Results demonstrate the importance of human resource functions, alignment of culture and values with change, and business processes that facilitate effective communication and access to information to achieve many change initiatives. The responses also suggest opportunities for leaders of healthcare organizations to more formally recognize the degree to which various change initiatives are dependent on one another.

Educating for Quality: Quality Improvement as an Activity of Daily Learning to Improve Educational and Patient Outcomes

THE QUALITY OF care delivered to children is suboptimal, with opportunities for improving quality and value across care settings and conditions. Leading health care organizations have recognized that quality improvement (QI) should play a vital role in improving the quality of care delivered to all populations, including children. For this strategy to succeed, all health professionals, including physicians, should become proficient in QI. Recognizing the need for widespread and dramatic improvements in health care delivery systems, the American Board of Pediatrics (ABP) designed their program of Maintenance of Certification to include that all diplomates must at a minimum be active participants in critically analyzing and improving the care of the patients they care for. Most recently, the Accreditation Council for GraduateMedical Education (ACGME) developed specific milestones for competencies related to QI and instituted the Clinical Learning Environment Review (CLER) Program to help identify and disseminate best practices on how residents and fellows can become better engaged in institutional safety and QI to enhance their training while simultaneously improving care for the patient populations they care for. What is the state of QI education in pediatric graduate medical education?Mann et al conducted a survey to better understand the perspective of pediatric residency program directors. In recent years, an increasing proportion of program directors report providing education in QI, and that curricula typically include several elements conducive to learning QI, including an experiential component. Program directors reported a variety of process improvement methodologies as the basis of their curriculum. However, only a minority of resident QI projects had support for project management. As institutional resources become more constrained, it will become even more challenging to support QI in areas that are exciting to trainees but are not aligned with institutional priority areas. Only a minority of program directors reported being satisfied with their QI curricula.

Factors contributing to evidence-based pressure ulcer prevention. A cross-sectional study

BackgroundImplementation of evidence-based care for pressure ulcer prevention is lacking. As the hospital organization is complex, more knowledge is needed to understand how nursing care in this area can be improved. ObjectivesThe present study investigated the associations between variables on different levels in the healthcare setting (patient, unit, hospital) and the documentation of (1) risk assessment and (2) skin assessment within 24h of admission, the use of (3) pressure-reducing mattresses and (4) planned repositioning in bed. DesignA cross-sectional study. SettingsOne university hospital and one general hospital. ParticipantsGeriatric (n=8), medical (n=24) and surgical (n=19) units. All adult patients (>17 years), in total 825, were included. MethodsA one-day prevalence study was conducted using the methodology specified by the European Pressure Ulcer Advisory Panel, together with the established methods used by the Collaborative Alliance for Nursing Outcomes. Independent variables were patient characteristics, hospital type, unit type, nurse staffing and workload. Dependent variables were documented risk and skin assessment within 24h of admission, pressure-reducing mattresses and planned repositioning in bed. The data were analysed with Logistic regression using the Generalized Estimating Equation (GEE) approach. ResultsPatients at risk of developing pressure ulcers (Braden<17) had higher odds of having risk assessment documented, and of receiving pressure-reducing mattresses and planned repositioning. Patients at the general hospital were less likely to have risk and skin assessment documented and to receive pressure-reducing mattresses. On the other hand, planned repositioning was more likely to be used at the general hospital. When total hours of nursing care was lower, patients had higher odds of having pressure-reducing mattresses but were less likely to have planned repositioning. ConclusionPatient characteristics (high age and risk score) and hospital type were associated with pressure ulcer prevention. Surprisingly, nurse staffing played only a minor role. Leaders in healthcare organizations should establish routines on different levels that support evidence-based pressure ulcer prevention, and registered nurses need to assume responsibility for bedside care.

Issues in researching leadership in health care organizations.

We provide a review of the research in this volume and suggest avenues for future research. Review of the research in this volume and unstructured interviews with health care executives. We identified the three central themes: (1) trust in leadership, (2) leading by example, and (3) multi-level leadership. For each of these themes, we highlight the shared concerns and findings, and provide commentary about the contribution to the literature on leadership. While relation-oriented leadership is important in health care, there is a danger of too much emphasis on relations in an already caring profession. Moreover, in most health care organizations, leadership is distributed and scholars need to adopt the appropriate methods to investigate these multi-level phenomena. In health care organizations, hands-on leadership, through role modeling, may be necessary to promote change. However, practicing what you preach is not as easy as it may seem. We provide a framework for understanding current research on leadership in health care organizations.

Walk the talk: leaders' enacted priority of safety, incident reporting, and error management.

The main goal of the current research was to investigate whether and how leaders in health care organizations can stimulate incident reporting and error management by "walking the safety talk" (enacted priority of safety). Open interviews (N = 26) and a cross-sectional questionnaire (N = 183) were conducted at the Rotterdam Eye Hospital (REH) in The Netherlands. As hypothesized, leaders' enacted priority of safety was positively related to incident reporting and error management, and the relation between leaders' enacted priority of safety and error management was mediated by incident reporting. The interviews yielded rich data on (near) incidents, the leaders' role in (non)reporting, and error management, grounding quantitative findings in concrete case descriptions. We support previous theorizing by providing empirical evidence showing that (1) enacted priority of safety has a stronger relationship with incident reporting than espoused priority of safety and (2) the previously implied positive link between incident reporting and error management indeed exists. Moreover, our findings extend our understanding of behavioral integrity for safety and the mechanisms through which it operates in medical settings. Our findings indicate that for the promotion of incident reporting and error management, active reinforcement of priority of safety by leaders is crucial. Social sciences researchers, health care researchers and health care practitioners can utilize the findings of the current paper in order to help leaders create health care systems characterized by higher incident reporting and more constructive error handling.

Leadership practices and context: Two sides of the same coin

This article presents a theoretical and empirical analysis of the recursive relationship between leadership practices and contexts to help explain the dynamics of change in a Swiss healthcare organization. Central to the paper’s argument is the assumption that leadership is not only a contextually influenced, but also a context-producing practice. We develop this argument theoretically by building on the sociology of knowledge and practice theory. Empirically, we draw on three episodes of a longitudinal case study that shows the unfolding of leadership and traces the consequences of the leader’s micro-actions for the context and overall change success. We discuss our insights and outline their implications for understanding and doing leadership in healthcare organizations.

Open Questions Concerning Influences on Clinical Decision Making

Efforts to influence utilization of services to bring down spending and to improve quality of care have largely failed. A critical reason is that most attention has focused on dysfunctional financial incentives without considering other factors that also influence physicians' utilization decisions. In this article, after providing a framework for ideal physician-patient interactions, questions are also raised about other influences, including physicians' impulse to help patients, professional codes of ethics, the threat of malpractice claims, and the leadership of health care organizations. An Appendix contains a summary of the literature on these factors.

Career histories and managerial performance of health care chief executive officers

Organizational studies widely acknowledge the importance of the relationship between CEO's career histories and managerial performance. Although the health care management literature largely explores the role of CEOs, whether and how top managers' career histories affect their own performance remains still unknown in this industry. The aim of this study was to investigate the career histories of health care CEOs and to explore their impact on managerial performance. Primary data were collected from a sample of 124 CEOs leading health care organizations in the Italian National Health Service in 2008. Biographic data were accessed to gather information about relevant CEOs' demographics and their career histories. The relevance of CEOs' prior experience was considered, taking into account the prominence of health care organizations in which they passed through in their career histories. Regression analyses were employed to assess the impact of CEOs' career histories on their managerial performance. Top managers already appointed as CEOs were more likely to achieve higher levels of performance. Careers with long tenure within the National Health Service appear to increase managerial performance. Those CEOs who accumulated prior experience in a large number of health care structures and who spent time working at the most prominent hospitals were also more likely to achieve higher levels of managerial performance. In health care, a CEO's career history does impact his or her managerial performance. Specifically, patterns of career that imply higher mobility across health care organizations are important. Although interorganizational mobility is significant for CEO performance, the same does not hold for mobility across industries. These findings contribute to the current debate about the need for management renovation within health care organizations.

Is Management Essential to Improving the Performance and Sustainability of Health Care Systems and Organizations? A Systematic Review and a Roadmap for Future Studies

Recent studies have highlighted the importance of management in the health care sector. Positive correlations have been found between clinical and economic performance. Although there is still controversy regarding what kind of management and which managers should lead health care organizations and health systems, we now have interesting evidence to analyze. Starting with a systematic review of the literature, this article presents and discusses the streams of knowledge regarding how management can influence the quality and sustainability of health systems and organizations. Through the analysis of 37 studies, we found that the performance of health care systems and organizations seems to be correlated with management practices, leadership, manager characteristics, and cultural attributes that are associated with managerial values and approaches. There is also evidence that health care organizations run by doctors perform better than others. Finally, we provide a roadmap that indicates how the relationship between the management and performance of health systems and organizations can be further and more effectively investigated.

Patient-Centered Care: The Role of Healthcare Leadership

Throughout year, we have been discussing value of patient-centered care. The columns have focused on important aspects of this topic, such as evolution of patient-centered care, patient satisfaction, community engagement, and technology. At heart of all these components, however, is healthcare leadership.HEALTHCARE LEADERSHIP REVISITEDStrong leadership is critically important to organizations, regardless of setting. Researchers have defined leadership in many different ways, but it is often associated with risk taking, dynamic, creative, change, and vision (Hughes, Ginnett, and Curphy 1999). Applying many of these same concepts, Healthcare Leadership Alliance and American College of Healthcare Executives (2011) define healthcare leadership as the ability to inspire individual and organizational excellence, create a shared vision and successfully manage change to attain organization's strategic ends and successful performance. Leaders determine, communicate, and guide vision of any organization, and thus leadership engagement in any culture change initiative toward patient-centered care is crucial (Frampton et al. 2008).HEALTHCARE LEADERSHIP AND PATIENT-CENTERED CAREChanging paradigm of care to a patient-centered model represents one such organizational culture change and requires involvement of senior executives. Implementing a patient-centered model of care has profound implications for way care is planned, delivered, and evaluated. Although most leaders in healthcare organizations today embrace basic tenets of a patient-centered philosophy, it wasn't always that way. Prior to 2001, healthcare leaders frequently identified barriers to widespread adoption of patient-centered practices resulting from ( 1 ) a general resistance to change, (2) perception that implementation would cost too much time and resources, and (3) a lack of clarity on how to initiate and maintain a culture change of this magnitude (Frampton and Charmel 2009).The dynamics surrounding patient-centered care changed significantly when Institute of Medicine (2001) identified patient-centeredness as one of six aims of improvement for US healthcare system. Even today, however, leaders often find that moving toward a patient-centered model requires an unanticipated level of commitment and significant adjustments in organizational structures (Ponte et al. 2003).A study commissioned by The Picker Institute in 2007 explored what steps would be necessary to achieve more rapid and widespread implementation of patient-centered care in both inpatient and ambulatory healthcare settings. Its findings indicated that single most important factor contributing to patient-centered care is the commitment and engagement of senior leadership . . . organizational transformation required to actually achieve sustained delivery of patientcentered care will not happen without top leadership support and participation (Shaller 2007).The Institute for Healthcare Improvement embarked on a study in 2011 to identify key factors in achieving an exceptional patient and family experience of inpatient hospital care. It, too, found that a primary driver was leadership, and study's authors reinforced idea that effective leaders focus organization's culture on needs of patients and families (i.e., providing care that is patient-centered, rather than provider-centered), tap into innovative ideas, and have persistence and skills to create a patient and family-centered care culture. Leaders from executives to front-line managers share a commitment to this goal, and understand that it is led by senior leaders and is part of organization's core strategy (Balik et al. …

Leading from the middle: Constrained realities of clinical leadership in healthcare organizations

In many developed-world countries, there have been efforts to increase the 'leadership capacity' of healthcare professionals, particularly lower-status staff without formal managerial power. Creating frontline 'leaders' is seen as a means of improving the quality of healthcare, but such efforts face considerable challenges in practice. This article reports on a qualitative, interview-based study of 23 staff in two UK operating theatre departments, mostly nurses by professional background, who were given formal leadership responsibilities by their hospitals and redesignated as 'team leaders' and 'theatre co-ordinators'. While participants were familiar with leadership theory and could offer clear accounts of good leadership in practice, they were often limited in their ability to enact their leadership roles. Professional and managerial hierarchies constrained participants' leadership capacity, and consequently the exercise of leadership rested on alignment with managerial relationships and mandates. The findings highlight difficulties with accounts of leadership as something to be distributed across organizations; in healthcare organizations, established institutional structures and norms render this approach problematic. Rather, if fostering leadership capacity is to have the transformational effect that policymakers desire, it may need to be accompanied by other, wider changes that attend to institutional, organizational and professional context.

Organizational Transformation

Health care organization leaders and policy makers seeking ways to reform the delivery of health care have become increasingly interested in transformational change. To foster understanding of how organizational transformation occurs and to stimulate further research, we report findings from a systematic review of empirical research on transformational change in the health care and non-health care literature, with a focus on the antecedents, processes (or paths), and outcomes of transformational change. Fifty-six studies, of which 13 were in health care, met our selection criteria. With one exception, all were published since 1990, indicating the recent upsurge of interest in this area. Limited differences were found between health care and non-health care studies. Available research documents the multiplicity of factors affecting change and the complexity of their interactions, but less information is available about the processes of transformational change than about its antecedents and consequences. Research and practice implications are discussed.

The Leadership Challenge: Becoming Master Leaders in Healthcare Organizations

The healthcare system is in a state of substantial change and the need for transformational and transactional skills to meet the challenges for effective organizational transitions is explored in t...

Development and Testing of the Jakubik Mentoring Benefits Questionnaire Among Pediatric Nurses

The ability to measure the benefits of mentoring among bedside nurses is essential for leaders in health care organizations to evaluate the effectiveness of mentoring initiatives for nurses. This article describes the development and testing of the Jakubik mentoring benefits questionnaire (Jakubik MBQ). The instrument is a 36-item tool that uses a 5-point Likert scale to measure the individual and organizational benefits of mentoring from the nurse protégé's perspective. The original Jakubik MBQ was a 57-item tool developed and validated (validity = .96) with a panel of 6 expert judges prior to reliability testing in a pilot study with 11 subjects (Cronbach's alpha = .98). Subsequently, the 57-item instrument was used in 3 separate research studies (Jakubik, 2007a, 2007b; Jakubik, Eliades, Gavriloff, & Weese, 2011) with strong internal consistency reliability evidenced by Cronbach's alpha coefficients of .98, .98, and .97, respectively. Exploratory factor analysis was conducted on the 57-item instrument with the 453 subjects from the aforementioned 3 studies. Results of the factor analysis confirmed a total of 6 factors (subscales). Based on the factor analysis, the 4 original theoretical subscales were confirmed, 2 additional subscales were added, the original subscales were renamed, and the instrument was shortened to 36 items with each subscale containing 6 items and an overall Cronbach's alpha of .97. Based on these overall findings, the Jakubik MBQ provides a valid and reliable instrument for use in measuring the mentoring benefits among pediatric staff nurse protégés engaged in mentoring relationships.

Setting the Stage for a Business Case for Leadership Diversity in Healthcare: History, Research, and Leverage

Leveraging diversity to successfully influence business operations is a business imperative for many healthcare organizations as they look to leadership to help manage a new era of culturally competent, patient-centered care that reduces health and healthcare disparities. This article presents the foundation for a business case in leadership diversity within healthcare organizations and describes the need for research on managerial solutions to health and healthcare disparities. It provides a discussion of clinical, policy, and management implications that will help support a business case for improving the diversity of leadership in healthcare organizations as a way to reduce health and healthcare disparities. Historical contexts introduce aspects of the business case for leveraging leadership diversity based on a desire for a culturally competent care organization. Little research exists on the impact that the role of leadership plays in addressing health disparities from a healthcare management perspective. This article provides practitioners and researchers with a rationale to invest in leadership diversity. It discusses three strategies that will help set the stage for a business case. First, provide empirical evidence of the link between diversity and performance. Second, link investments in diversity to financial outcomes and organizational metrics of success. Third, make organizational leadership responsible for cultural competence as a performance measure. In order to address health and healthcare disparities, collaborations between researchers and practitioners are necessary to effectively implement these strategies.