Physician Executives Research Articles

The Gap Between AI and Bedside: Participatory Workshop on the Barriers to the Integration, Translation, and Adoption of Digital Health Care and AI Startup Technology Into Clinical Practice.

Artificial intelligence (AI) and digital health technological innovations from startup companies used in clinical practice can yield better health outcomes, reduce health care costs, and improve patients' experience. However, the integration, translation, and adoption of these technologies into clinical practice are plagued with many challenges and are lagging. Furthermore, explanations of the impediments to clinical translation are largely unknown and have not been systematically studied from the perspective of AI and digital health care startup founders and executives. The aim of this paper is to describe the barriers to integrating early-stage technologies in clinical practice and health care systems from the perspectives of digital health and health care AI founders and executives. A stakeholder focus group workshop was conducted with a sample of 10 early-stage digital health and health care AI founders and executives. Digital health, health care AI, digital health-focused venture capitalists, and physician executives were represented. Using an inductive thematic analysis approach, transcripts were organized, queried, and analyzed for thematic convergence. We identified the following four categories of barriers in the integration of early-stage digital health innovations into clinical practice and health care systems: (1) lack of knowledge of health system technology procurement protocols and best practices, (2) demanding regulatory and validation requirements, (3) challenges within the health system technology procurement process, and (4) disadvantages of early-stage digital health companies compared to large technology conglomerates. Recommendations from the study participants were also synthesized to create a road map to mitigate the barriers to integrating early-stage or novel digital health technologies in clinical practice. Early-stage digital health and health care AI entrepreneurs identified numerous barriers to integrating digital health solutions into clinical practice. Mitigation initiatives should create opportunities for early-stage digital health technology companies and health care providers to interact, develop relationships, and use evidence-based research and best practices during health care technology procurement and evaluation processes.

The Impact of COVID-19 on Benchmarking ICU and Hospital Performance During the Pandemic

The COVID-19 pandemic created unprecedented demand for hospital and intensive care unit (ICU) services, with excess mortality and length-of-stay (LOS) that may not be attributable to COVID-19 patients alone. We examined risk-adjusted outcomes in adult ICU patients overall, and for subgroups with and without COVID-19. Severity-adjusted mortality, LOS, and ventilator days in COVID-19 patients were higher than expected when adjusted by APACHE for age, chronic illness, and physiology. Non-COVID-19 patients had worse outcomes during high COVID-19 census. These findings have implications for physician executives evaluating and presenting hospital and ICU outcomes during the pandemic.

Stay on Top of the Latest Breakthroughs with the ANESTHESIOLOGY® 2021 Research Track

Article| June 2021 Stay on Top of the Latest Breakthroughs with the ANESTHESIOLOGY® 2021 Research Track Jeffrey R. Kirsch, MD, FASA Jeffrey R. Kirsch, MD, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor June 2021, Vol. 85, 24–25. https://doi.org/10.1097/01.ASM.0000754236.65424.a9 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Jeffrey R. Kirsch; Stay on Top of the Latest Breakthroughs with the ANESTHESIOLOGY® 2021 Research Track. ASA Monitor 2021; 85:24–25 doi: https://doi.org/10.1097/01.ASM.0000754236.65424.a9 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest search filter All ContentAll PublicationsASA Monitor Search Advanced Search Topics: covid-19, information management, mentors, neuroscience, neurotoxicity syndromes, pain, peer group, perioperative medicine, physician executives, posters Meet us in San Diego this October to explore the latest science in the specialty, delivered by leading researchers and subject matter experts, and connect with the greatest minds in anesthesiology. Emerging research will continue to receive greater prominence as we drive to always deliver top-tier, relevant education. This year's research track includes more than 20 research-focused sessions and events, including Anesthesiology journal activities and FAER sessions, as well as paper and electronic abstract presentations. Plus, the research lounge is back by popular demand. It's the ideal spot to network with peers or meet with a mentor while on site in San Diego. The ANESTHESIOLOGY 2021 research track includes: John W. Severinghaus Lecture on Translational Science: Gadgeteering for Pain Relief James C. Eisenach, MD FAER-Helrich Research Lecture: Crisis and Opportunity in Clinical Trials Daniel I. Sessler, MD Celebration of Research Evan D. Kharasch, MD, PHD Journal Symposium: SARS-CoV-2 and COVID19:... You do not currently have access to this content.

A Professional Development Course Improves Unprofessional Physician Behavior

In 2008 The Joint Commission issued a Sentinel Event Alert that further defined "behaviors that undermine a culture of safety," stating that "intimidating and disruptive behaviors" can result in medical errors that affect patient care and safety. The American College of Physician Executives found that more than 95% of respondents encountered "disturbing . . . and potentially dangerous" behaviors on a regular basis. The purpose of this study is to evaluate the effectiveness of a professional development program on unprofessional physician behaviors using the B29™, a reliable and valid tool to assess workplace behaviors. A pre-post study design was used to measure changes in physicians' unprofessional behaviors using the B29, a 35-item, Web-based survey. The survey is completed as a 360° assessment by peers, colleagues, administrators, and staff, and the physician completes a self-assessment. In most cases, the survey is voluntary. Those who completed both a precourse and a postcourse survey made up a convenience sample or subset of the larger number of physicians who completed the course. Twenty-four of 28 physicians in the study experienced an improvement in professional behavior, demonstrated as a decrease in the number of lowest-rated items. The mean decrease for all 28 physicians was 51.1%. Lowest-rated items improved an average of 53.5% overall. T-scores increased (also improved) for 24 of 28 physicians over the six-month period. Unprofessional behavior by physicians, as observed and reported by their peers and colleagues, can be positively modified by a relatively brief education program focused on teaching professionalism.

Did we learn the lesson after 60 years of Management by Objectives? A survey among former physician executives in German hospitals.

Management by Objectives (MbO) has been shown to establish efficient team work in both industry and medicine. Its most important prerequisite for success is target agreements between managers and medical professionals on equal footing. In medicine, lump-sum financing urges the delivery of a health care service with minimal effort. Consequently, daily clinical life changed, with economic goals seeming to become priority over medical principles. To determine how well MbO can still be practiced in hospitals with lumped treatment prices. We used an anonymized questionnaire for already retired physician executives who completed their active leadership positions between 2010 and 2015 in Saxony (Germany). We asked various type of target agreements that had been used in order to achieve medical or economic targets. Out of 111 former executives, the questionnaires of 25 respondents could be analysed. Eight respondents confirmed target agreements that were mostly set by managing directors. If used, most targets had not been adapted to the infrastructure and personnel strength, nor were they coordinated with neighbouring departments. Four respondents received financial incentives. Most medical executives were unsatisfied and preferred to abandon further goal setting. Due to the low number of cases, the representativeness of the study is limited. Nevertheless, it might be questioned if a flat-rate remuneration system facilitates the change into an authoritarian leadership concept.

Talking the Talk: Financial Skills for Nurse Leaders

The importance of effective execution of financial management may be more arguably more relevant today than when first established by the Healthcare Leadership Alliance (HLA) over a decade ago. Since the 6 key health care agencies (American College Healthcare Executives [ACHE], American College of Physician Executives [ACPE], American Organization of Nurse Executives [AONE], Healthcare Finance Management Association [HFMA], Healthcare Information Management Systems Society [HIMSS], and Medical Group Management Association [MGMA]) convened and identified 5 core competencies shared by all health care leaders. The key imperatives included communication and relationship management, professionalism, knowledge of the health care environment, leadership, and business acumen. 1 Although the health care landscape has continued to evolve, these essential skills remain relevant today. Administrators must lead through ever-changing reimbursement models, work to continually improve patient satisfaction indicators, affect hospital quality metrics, and close the labor shortage gap during a time of political unknowns of health care reform. The demand for care, coupled with comorbidities of an aging population, and a diminishing supply as Baby Boomer nurses retire, has led to stress on health care systems across the nation. As the general population ages, so, too, does the nursing workforce. The average age of the registered nurse is 50 years or greater. 2 The Bureau of Labor Statistics estimates a nurse vacancy rate of 1.09 million by 2024. 3

Competitive Advantage of MBA for Physician Executives: A Systematic Literature Review.

In response to systemic challenges facing the US healthcare system, many medical students, residents and practicing physicians are pursuing a Master in Business Administration (MBA) degree. The value of such proposition remains poorly defined. The aim of this review is to analyze current literature pertaining to the added value of MBA training for physician executives (PEs). We hypothesized that physicians who supplement their clinical expertise with business education gain a significant competitive advantage. A detailed literature search of four electronic databases (PubMed, SCOPUS, Embase and ERIC) was performed. Included were studies published between Jan 2000 and June 2017, focusing specifically on PEs. Among 1580 non-duplicative titles, we identified 23 relevant articles. Attributes which were found to add value to one's competitiveness as PE were recorded. A quality index score was assigned to each article in order to minimize bias. Results were tabulated by attributes and by publication. We found that competitive domains deemed to be most important for PEs in the context of MBA training were leadership (n=17), career advancement opportunities (n=12), understanding of financial aspects of medicine (n=9) and team-building skills (n=10). Among other prominent factors associated with the desire to engage in an MBA were higher compensation, awareness of public health issues/strategy, increased negotiation skills and enhanced work-life balance. Of interest, the learning of strategies for reducing malpractice litigation was less important than the other drivers. This comprehensive systemic review supports our hypothesis that a business degree confers a competitive advantage for PEs. Physician executives equipped with an MBA degree appear to be better equipped to face the challenge of the dynamically evolving healthcare landscape. This information may be beneficial to medical schools designing or implementing combined dual-degree curricula.

Exploring Attitudes and Attitudes Change Towards Performance Appraisal: A Longitudinal Q-Method Analysis of Physician Executives

The use of performance appraisal is especially controversial in public sector organizations where professionalism norms contribute shaping individual identity and behavior. This study provides a longitudinal analysis of the attitudes of physician executives towards performance appraisal in a public health organization. By using Q method on 2013 and 2016 data, the analysis identifies three different attitudes towards PA held by physician executives. The analysis, moreover, provides evidence that attitudes change over time, and that individuals become more critical towards PA and more inclined to make amendments to PA practices. Findings from this study form indications for a dynamic theory of performance appraisal.

The impact of economic rationalization, prioritization and rationing on job satisfaction, motivation and team cohesion in hospitals: a survey among retired physician executives in Germany

BackgroundThe growing economization of the health care system and implication of market principles in the medical field have risen new and serious questions on the meaning of the medical profession, the doctor-patient relationship and the orientation of medicine itself. The impact of the dynamic clinical structures on the doctor-doctor and the doctor-patient interaction appear even unpredictable. Therefore, the impact of market-based methods, i.e. rationalization, prioritization and rationing, on job satisfaction, motivation and team cohesion should be quantified.MethodsThe experiences of former and now retired physician executives in numerous hospitals in Saxony were determined. For this purpose, an anonymously written survey using a standardized questionnaire was conducted in the first quarter of 2016.ResultsRationalization measures were confirmed by 88% of respondents. In more than a third of cases, former executives also experienced prioritization and rationing. The impact of these management techniques on job satisfaction, motivation and team cohesion was carried out in a differentiated manner. There was a tendency to regard rationalization and prioritization measures indifferently to rather disadvantageous, while rationing was predominantly rated negatively.ConclusionsIn addition to rationalization, prioritization and rationing measures have now been part of working strategy at the hospitals. On one hand, the conceptual distinction between the terms still seems imprecise; on the other hand, a creeping and imperceptible medico-ethical transgression of the prioritization to rationing seems to have already taken place.

Leading together: Collaboration among senior healthcare executives

Healthcare systems across the world face the dual challenge of balancing between the provision of affordable, good quality and timely healthcare on the one hand; while innovating constantly to enhance efficiency amid increasing resource shortfalls, on the other. Their success is contingent upon the presence of strong organisational leadership that harnesses the inherent collaborative potential of both physician and non-physician executives. This study sought insight into the day-to-day experiences of healthcare leaders in the NHS. We conducted 24 in-depth interviews with senior NHS physician and non-physician leaders around their experiences of working together, opportunities and challenges to effective collaboration, and identification of best practices relating to shared decision-making. The executives interviewed had job titles including chief operating officer, medical director, and clinical director. Our findings suggest that collaborative leaders in healthcare are not born but created through a complex interplay of personal, cultural, and structural best practices that require active attention in the everyday leadership setting. Our research has direct implications for healthcare practice and will be useful to healthcare executives and decision-makers across the UK, and healthcare systems internationally.

Disruptive physician behaviors and their impact on patient care in a health insurance hospital in Alexandria, Egypt.

Disruptive behavior is the use of inappropriate words, actions, or inactions by physicians that interferes with their ability to function well with others. It is a current problem in the medical profession and has become a focus of public health attention due to its destructive impact on hospital staff, institutions, and quality patient care. The aim of the present study was to evaluate the perceptions of physicians about disruptive physician behaviors, and their frequency and impact on clinical outcomes. This cross-sectional, descriptive study was carried out in one of the hospitals of the Health Insurance Organization in Alexandria, Egypt. A self-administered questionnaire based on the American College of Physician Executives and QuantiaMD Survey on disruptive physician behavior was used to measure the physicians' perceptions. It was distributed to all physicians in all the departments (n=183). The number of returned questionnaires was 120, with a response rate of 65.6%. Most of the respondents (93.3%) were concerned about disruptive physician behavior, 39.2% previously had such behaviors, and 78.3% had one incident at least monthly. Most respondents (98.3%) said that disruptive physician behavior affects patient care. Physicians agreed that they needed training on how to deal with disruptive behavior. The most frequent behavior was refusal to cooperate with other providers (74.2%). Disruptive behavior was attributed to workload by 35% of the respondents. Disruptive physician behaviors are common in healthcare settings, with the most frequent behavior being refusal to cooperate with other providers. Training of physicians on team dynamics, communication skills, conflict management, and stress management is highly recommended.

Drivers of ED efficiency: a statistical and cluster analysis of volume, staffing, and operations

Study objectiveThe percentage of patients leaving before treatment is completed (LBTC) is an important indicator of emergency department performance. The objective of this study is to identify characteristics of hospital operations that correlate with LBTC rates. MethodsThe Emergency Department Benchmarking Alliance 2012 and 2013 cross-sectional national data sets were analyzed using multiple regression and k-means clustering. Significant operational variables affecting LBTC including annual patient volume, percentage of high-acuity patients, percentage of patients admitted to the hospital, number of beds, academic status, waiting times to see a physician, length of stay (LOS), registered nurse (RN) staffing, and physician staffing were identified. LBTC was regressed onto these variables. Because of the strong correlation between waiting times measured as door to first provider (DTFP), we regressed DTFP onto the remaining predictors. Cluster analysis was applied to the data sets to further analyze the impact of individual predictors on LBTC and DTFP. ResultsLOS and the time from DTFP were both strongly associated with LBTC rate (P<.001). Patient volume is not significantly associated with LBTC rate (P=.16). Cluster analysis demonstrates that physician and RN staffing ratios correlate with shorter DTFP and lower LBTC. ConclusionVolume is not the main driver of LBTC. DTFP and LOS are much more strongly associated. We show that operational factors including LOS and physician and RN staffing decisions, factors under the control of hospital and physician executives, correlate with waiting time and, thus, in determining the LBTC rate.

Report of the Working Group of Physician Executives of Psychiatry and Psychotherapy Clinics in German General Hospitals

Wer einen gedruckten Hinweis auf die Kommende-Tagung vor sich hat und nicht bereits gehört hat, wovon die Rede ist, geht in der Regel davon aus, es handele sich um die Ankündigung einer kommenden Tagung. Die Betonung ist jedoch auf der 2. Silbe, also Komménde-Tagung. Wie das? Die Bezeichnung geht auf die Kommende zurück, den ersten Tagungsort in Dortmund-Brakel, ehemals Sitz des Deutschen Ritterordens und heutzutage eine Bildungseinrichtung, wo die halbjährlichen Treffen ab 1985 stattfanden.

The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente

BackgroundPatient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited.MethodsThis paper uses qualitative methods to advance our understanding of the organizational dynamics that influence the impact of a patient portal on organizational performance and patient health. The study setting is Kaiser Permanente, the world’s largest not-for-profit integrated delivery system, which has been using a portal for over ten years. We interviewed eighteen physician leaders and executives particularly knowledgeable about the portal to learn about how they believe the patient portal works and what organizational factors affect its workings. Our analytical framework centered on two research questions. (1) How does the patient portal impact care delivery to produce the documented effects?; and (2) What are the important organizational factors that influence the patient portal’s development?ResultsWe identify five ways in which the patient portal may impact care delivery to produce reported effects. First, the portal’s ability to ease access to services improves some patients’ satisfaction as well as changes the way patients seek care. Second, the transparency and activation of information enable some patients to better manage their care. Third, care management may also be improved through augmented patient-physician interaction. This augmented interaction may also increase the ‘stickiness’ of some patients to their providers. Forth, a similar effect may be triggered by a closer connection between Kaiser Permanente and patients, which may reduce the likelihood that patients will switch health plans. Finally, the portal may induce efficiencies in physician workflow and administrative tasks, stimulating certain operational savings and deeper involvement of patients in medical decisions. Moreover, our analysis illuminated seven organizational factors of particular importance to the portal’s development - and thereby ability to impact care delivery: alignment with financial incentives, synergy with existing IT infrastructure and operations, physician-led governance, inclusive decision making and knowledge sharing, regional flexibility to implementation, continuous innovation, and emphasis on patient-centered design.ConclusionsThese findings show how organizational dynamics enable the patient portal to affect care delivery by summoning organization-wide support for and use of a portal that meets patient needs.

Physicians as executives: opportunities and strategies for health-system pharmacy leaders.

To deal with the pressures in health care that stress clinical excellence and profitability, health systems are increasingly recruiting physician executives or physicians in leadership and management positions. Physicians occupy less than 5% of all hospital leadership positions, but there is an apparent increase in the recruitment of physician executives. With the growth in the number of physician executives, pharmacy leaders must capitalize on their existing clinical relationship and apply it to health care leadership and management. By focusing on developing an executive presence, by clearly describing a patient-centered strategy and vision for pharmacy, and by nurturing the existing clinical relationships, the pharmacy director can work with physician executives to promote patient-centered pharmacy services.

The Power of Embedded Critics

The Power of Embedded Critics

Leading from the Front: Experiences of Canadian Physician Leaders

Edited by Chris Carruthers MD, Patricia Lightfoot DPhil (Canadian Society of Physician Executives and Canadian Medical Association). Recently our medical school introduced a unit with topics like governance of the health care system, public health and advocacy. Many students engage with the material

Nurses in the C-Suite

The US health care system is reaching a critical point. Consistent cost increases coupled with a struggling economy has illuminated the burden of more than $650 billion annually in health care expenditures. The ability to afford health care is a growing concern for individuals, businesses, and state and federal governments. In addition to costs, variability in quality, and utilization belie any claims of a rational and consistent system of care. Transformational change will require leaders to shape our future health care institutions. Nursing has historically not been considered as a leadership source for change of this magnitude. However, due to the sheer size of nursing, core skills, and competencies, nurses could be a viable resource. Competencies needed for nurse, health care, and physician executives were compared using the HealthCare Leadership Alliance data, which created a body of knowledge that identifies competencies in 5 domains. Findings demonstrate that nurses, health care executives, and physicians possess more than 80% of the competencies reviewed. To successfully take on the role of leading institutional response to the dramatically changing health care environment, nurses must not only have the requisite leadership skills and experience, they must also have an expectation of themselves to lead at this level.

Interdisciplinary teamwork in hospitals: A review and practical recommendations for improvement

Recognizing the importance of teamwork in hospitals, senior leadership from the American College of Physician Executives (ACPE), the American Hospital Association (AHA), the American Organization of Nurse Executives (AONE), and the Society of Hospital Medicine (SHM) established the High Performance Teams and the Hospital of the Future project. This collaborative learning effort aims to redesign care delivery to provide optimal value to hospitalized patients. With input from members of this initiative, we prepared this report which reviews the literature related to teamwork in hospitals. Teamwork is critically important to provide safe and effective hospital care. Hospitals with high teamwork ratings experience higher patient satisfaction, higher nurse retention, and lower hospital costs. Elements of effective teamwork have been defined and provide a framework for assessment and improvement efforts in hospitals. Measurement of teamwork is essential to understand baseline performance, and to demonstrate the utility of resources invested to enhance it and the subsequent impact on patient care. Interventions designed to improve teamwork in hospitals include localization of physicians, daily goals of care forms and checklists, teamwork training, and interdisciplinary rounds. Though additional research is needed to evaluate the impact on patient outcomes, these interventions consistently result in improved teamwork knowledge, ratings of teamwork climate, and better understanding of patients' plans of care. The optimal approach is implementation of a combination of interventions, with adaptations to fit unique clinical settings and local culture.

At the helm: resources for physician leaders

Lessons Learned: Reflections of Canadian Physician Leaders. Chris Carruthers, editor. Canadian Medial Association and Canadian Society of Physician Executives; 2009. Effective Medical Leadership. Bryce Taylor MD. Rotman/UTPress; 2010. Medicine in Canada is enjoying a resurgence of social