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Volume 9 (2024-25)
Each volume of Management in Healthcare consists of four quarterly 100-page issues. Articles scheduled for Volume 9 are available to view at the 'Forthcoming content' page.
The Articles published in Volume 9 include:
Volume 9 Number 2
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Editorial
Simon Beckett, Publisher -
Case Studies
Empowering physician leaders: UPMC’s breakthrough leadership development programme
Martina Bison-Huckaby, Manager Physician Learning and Development, Ashley Southworth, Senior Learning Coordinator, Alexandra Kortz, Learning Associate, Christine Hughes, Senior Learning Specialist, and Heather Reading, Senior Director Human Resources, UPMC
In the ever-changing landscape of healthcare management, the role of physician leaders has become increasingly important. Physicians with strong leadership and management skills are well positioned to bring medical expertise to the business side of healthcare, benefiting their organisations immensely. Effective physician leaders also foster a healthier team environment, making a positive impact on their care team and patients. Traditional medical education, while strong in clinical training, typically falls short in adequately preparing physicians for leadership roles. This prompted the University of Pittsburgh Medical Center (UPMC) to launch an internal initiative to support physician leadership development. This case study looks at the journey from concept to successful implementation of UPMC’s inaugural leadership development programme for physicians. It also addresses the challenges of deploying the programme during a global pandemic and the lessons learned from the experience. Through internal surveys, UPMC recognised that physicians wanted professional growth and development opportunities. In 2017, UPMC formed an internal board of physician leaders to identify the specific learning needs of that population. In 2018, UPMC hired individuals dedicated to the creation of a leadership programme for physicians, now branded Physician Leadership Essentials (PLE). Before the programme’s launch, physicians were left to seek development outside the organisation. Following a pilot in 2019, the programme was deployed on a larger scale, starting in January 2020. As of 29 February 2024, 482 participants from various speciality and practice locations participated in 26 rolling cohorts of PLE. Twenty cohorts have completed the programme, resulting in 314 alumni. Today, there are six ongoing cohorts with 139 active participants. The programme exhibits 99.5 per cent favourability and a 92 per cent retention rate. Participants have completed 247 leadership challenge projects. This programme has fostered a culture of growth and development for physicians across UPMC and enhanced cross-functional and cross-departmental collaboration. It has also unlocked some of the untapped leadership talent of physician leaders, increasing not only their effectiveness but also their sense of professional fulfilment and engagement.
Keywords: leadership development; physicians; case study; healthcare management; advisory board; global pandemic; engagement; lessons learned -
Strategies for a successful collaboration between a rural hospital and an academic medical centre
Erik Thorsen, Chief Executive Officer, Columbia Memorial Hospital, and James Heilman, Vice President for Strategic Outreach, Oregon Health and Science University
Rural hospitals are facing unprecedented financial challenges in the United States. The many factors contributing to the economic headwinds for rural hospitals result in reduced clinical services offered in local communities. Affiliations, mergers and acquisitions are a path for rural facilities to keep their doors open. Maintaining independence as a rural hospital by employing an affiliation approach with a larger health system can be a sustainable path under the right circumstances. This paper outlines a successful 12-year affiliation between a critical access hospital (CAH) and an academic medical centre (AMC) in Oregon. This paper outlines the underlying structure and governance of the collaboration, important management approaches, lessons learned and the results over the life of the affiliation. The results for the CAH include the growth of annual ambulatory visits from 15,000 to 131,000, adding 430 new employees, and increasing the total annual operating revenue from US$51m to US$193m. The results for the AMC include the development of an innovative joint venture rural cancer centre, the growth of rural graduate medical education rotations, and expanding clinical department faculty who work in a rural community setting. Enhancing health care in underserved areas aligns with the AMC’s statewide mission to serve all Oregonians as the AMC. There have been significant benefits to patients by increasing access to speciality services locally, including reducing miles travelled for cancer care. Our case study demonstrates that an affiliation structure between a CAH and an AMC can be a sustainable and beneficial approach to improving access to quality health care in rural communities and can strengthen the financial performance of both organisations.
Keywords: affiliations; finance; governance; physician workforce; rural healthcare -
Practice Papers
Optimising healthcare transactions: Tactics for success in a complex deal environment
Feby Abraham, Executive Vice President, Chief Strategy and Innovations Officer, Ross Clements, Vice President, Strategy, Memorial Hermann Health System, and Chris Shea, Vice President and Deputy General Counsel, Memorial Hermann Health System
The healthcare landscape is increasingly complex, characterised by economic uncertainty, regulatory challenges and rising operational costs. This paper provides a strategic framework for healthcare leaders to navigate this challenging deal environment. Despite economic pressures, merger and acquisition (M&A) activities remain robust, driven by strategic considerations rather than pure expansion motives. Important trends include horizontal and vertical consolidation, innovative joint ventures, strategic partnerships and direct equity investments, all aimed at enhancing operational efficiency, expanding into emerging value pools, and fostering innovation. This paper also delves into the evolving transaction strategies within healthcare systems, highlighting the importance of programmatic capital allocation and structured innovation investments. It outlines the crucial factors for successful execution, such as modernising capital allocation; creating effective governance structures; and building capabilities to test, learn and scale innovations. By leveraging these strategies, healthcare systems can better position themselves for sustainable growth, improve patient outcomes and create value in an increasingly dynamic and competitive market.
Keywords: innovation; M&A; partnerships; strategy; transactions; trends; value-based care -
Leveraging RTLS to assess clinical space utilisation
Laura Younan, Instructor of Health Care Systems Engineering, Adam Resnick, Instructor of Health Care Systems Engineering, and Chris Schieffer, Assistant Professor of Health Care Systems Engineering, Mayo Clinic College of Medicine and Science
Investment in physical space is a key strategic decision for healthcare managers. Understanding the current utilisation of clinical space is a significant input for this decision. Historically, direct observation or analysis of electronic health record (EHR) timestamps has been used to assess ambulatory space utilisation. Manual observation is prohibitively expensive, prospective and infeasible for large spaces. EHR data is limited to electronically captured workflows and to the quality of data capture. Two pilots explored the efficacy of real-time location systems (RTLS) to assess outpatient space utilisation to assist healthcare management professionals to make space allocation decisions. RTLS was shown to be viable, with accuracy that was not different from EHR-derived utilisation. RTLS had the following benefits: (a) more granular information, (b) data coverage in areas without EHR timestamps and (c) real-time assessment of utilisation. RTLS is an option for ambulatory care managers to understand the needed space for clinical operations.
Keywords: facilities; real-time location systems; space utilisation -
Using simulations to prepare healthcare leaders for an environmentally sustainable future
Andrew N. Garman, Professor, Rush University, Carmen Menéndez Calzada, Senior Project Officer, IHF Geneva Sustainability Centre, Aoife Kirk, Clean Air Lead, World Economic Forum, Irish Doctors for Environment, Tim Rogmans, Managing Director, Sim Institute, and Sonia Roschnik, Executive Director, IHF Geneva Sustainability Centre
With growing recognition that climate change is a significant threat to human health, healthcare leaders are increasingly recognised as critical allies in addressing this threat. This paper describes the approach that the International Hospital Federation’s Geneva Sustainability Centre is pursuing to better prepare healthcare leaders for this reality and the evidence-based principles informing the team’s work. We also share lessons learned so far, as well as recommendations for health system leaders pursuing work within their own organisations and communities.
Keywords: computer-based simulations; environmental sustainability; leadership development -
Development of nurses’ critical thinking skills: Implications for clinical practice
Janet Sternberg, Adjunct Faculty, University of Phoenix, Arizona, and Ferris State University, Big Rapis, Michigan
Critical thinking skills of registered nurses are important to improve patient safety through recognition of an adverse change in a patient’s condition and initiation of appropriate action. The purpose of this study was to determine whether participation in case scenario simulation exercises significantly increased the critical thinking skills of registered nurses. The study used a simulation program developed by the American Association of Critical Care Nurses. Sixty registered nurses in an acute care hospital participated in the study. Although the results failed to indicate a significant statistical difference in the critical thinking skills of the registered nurses following completion of the assigned modules, limitations of the study may have adversely affected findings. Additional research is warranted to further explore the potential of using case-based simulation exercises to promote critical thinking skills in registered nurses. Wider implications include promoting an environment of continual learning to strengthen the critical thinking skills of staff. Implementation of case scenario simulation exercises may be an effective way to develop critical thinking skills and reduce incidences of registered nurses failing to rescue a patient when intervention is required. The actionable findings of this research may generate further studies to enhance the practice of nursing, improve patient safety and reduce the number of adverse events involving hospitalised patients.
Keywords: adverse events; case scenarios; critical thinking skills; sentinel events; simulation; education and training of registered nurses; quality of care -
Leading with kindness: A systems approach to subjective well-being and healthspan
Stephen J. Swensen, Emeritus Member, Mayo Clinic
The aim of this paper is to present a systems approach to support leaders in creating a satisfying and meaningful career experience for colleagues which promotes optimal subjective well-being and healthspan. The intention is to help people do better. Kindness is helping people do better. There is an occupational health challenge in healthcare, with high rates of professional burnout, moral distress, turnover and work–life disintegration. An evidence synthesis of a narrative literature review identified subjective well-being and healthspan determinants primarily in the sphere of control of organisations. They are categorised into four domains: agency (control over work–life), collective effervescence (meaning, energy and harmony in groups of people with shared purpose), camaraderie (social connectedness) and positivity (optimism and caring). Ten systems that can improve staff subjective well-being and healthspan are presented.
Keywords: allostatic load; leadership; management; occupational health; organisational democracy; participative management
Volume 9 Number 1
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Editorial
Simon Beckett, Publisher -
Practice Papers
Charting a new course for nurse education: Adapting to the evolving demands of healthcare
Kitty Kautzer, Chief Academic Officer, Herzing University
How we educate nurses in modern America is at a crucial juncture as healthcare evolves, demographics shift and technological advancements reshape the landscape. In this paper, we advocate for a fundamental shift in how nurse candidates are enrolled and trained, emphasising collaboration among educators, employers and policymakers. Addressing systemic challenges in nurse education, we examine the impact of ageing demographics, increasing diversity and the rise of nontraditional learners. Proposing alternative pathways for enrolment and leveraging technology for personalised learning experiences, we argue for inclusivity, diversity and adaptability in nurse education. Through effective collaboration between stakeholders, we envision a future where nurse education meets the demands of a changing healthcare industry. Our goal is to inspire transformative action, foster innovation and promote equitable access to quality education for all who want to become a nurse. This paper aims to spark discussions and guide stakeholders towards developing a resilient, adaptable and community-connected nursing workforce.
Keywords: enrolment; healthcare system; nurse education; partnerships; technology; training -
Exploring innovative revenue-enhancing and cost-saving initiatives for medical practices
Michael O’Connell, Principal Consultant, Healthcare Solutions
Health systems and medical groups are currently facing unprecedented challenges, including the highest inflation rates in four decades. These challenges are compounded by post-pandemic issues, such as the Great Resignation, staffing shortages, financial constraints and increased competition in new markets. Moreover, there is a pressing need to work towards achieving the Triple Aim of healthcare: improving the individual experience of care, enhancing population health and reducing per capita costs. Against this backdrop, this paper aims to explore successful strategies implemented by health systems and medical groups across the USA. It will highlight numerous initiatives focused on either enhancing revenue or reducing costs, all aimed at achieving long-term, sustainable outcomes. By drawing upon the experiences of high-performing healthcare organisations and medical groups, readers can gain insights into reimagining patient care delivery through effective dyad partnerships, innovative team-based care models and the cultivation of a positive organisational culture.
Keywords: Cost; medical groups; performance improvement; revenue; teamwork -
Case Studies
The hospital leadership model of the future: How an organisation is using the triad/dyad model to drive performance excellence and culture transformation
Dennis Delisle, Executive Director, Naeem Ali, Medical Director, Deana Sievert, Chief Nursing Officer, and J. J. Kuczynski, Senior Consultant, The Ohio State University Wexner Medical Center
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.
Keywords: change leadership; performance excellence; talent development; teamwork; triad/dyad model; triad leadership -
A high-performance framework to integrate primary care and behavioural health
Roshini Moodley Naidoo, Professor of Practice, Kailey Love, Senior Project Manager, College of Health Solutions, Arizona State University, George Runger, Professor, School of Computing and Augmented Intelligence, Arizona State University, Cameron Adams, Program Administrator, Targeted Investment Program, Arizona Health Care Cost Containment System, Michael Franczak, Director of Population Health, Copa Health, and William Riley, Professor, College of Health Solutions, Arizona State University
This paper describes a large statewide initiative in Arizona led by the Arizona Medicaid programme to integrate the delivery of primary care and behavioural services. Healthcare in the USA remains fragmented, as reflected in no small measure by the separation of primary care and mental health services, in both structure and delivery. The fact that this historical separation continues to be perpetuated is detrimental to the goals of the Triple Aim. The fragmentation between both clinical service lines is further compounded by the high rate of co-occurring physical and mental illness, shortage of mental health professionals, under-skilling of primary care providers in the management of mental health, and stigma associated with mental illness. Underserved communities, where trust deficits of healthcare systems are commonplace, are especially vulnerable to the untoward effects of fragmented services. In this paper a framework is described to integrate primary care and behavioural health, implemented as a multi-year, multi-stakeholder programme at microsystem level, with policy implications for improving access, outcomes, costs and disparities.
Keywords: Multisector alignment; primary care and behavioural health integration; value-based contracting -
How to build and operationalise a hospital command centre
Mary Bany, Operations Administrator, Hospital Operations, Tamara Buechler, Consultant/Hospitalist, Hospital Practice Discharge Committee Chair, Assistant Professor of Medicine, Danielle Crawley, Senior Health Systems Engineer, Instructor in Healthcare Administration, Benjamin Dangerfield, Consultant/Hospitalist, Enterprise Operations Command Center Chair, Hospital Practice Subcommittee Vice Chair, Assistant Professor of Medicine, James Newman, Consultant/Hospitalist, Medical Director, Rochester Hospital Operations Command Center; Associate Professor of Medicine, Jessica Stellmaker, Supervisor, Instructor in Healthcare Administration, and Nicole Engler, Operations Manager, Instructor in Healthcare Administration, Mayo Clinic
In the ever-evolving healthcare landscape, hospitals routinely grapple with daily disruptions and unforeseen events affecting resources and capacity. This paper explores the implementation and impact of the Rochester Hospital Operations Command Center (RHOCC) as a strategic response to challenges faced by the Mayo Clinic Hospital campuses in Rochester. The RHOCC, developed with an expedited timeline in response to capacity issues, exacerbated by COVID-19, serves as a centralised hub for real-time monitoring, coordination and decision-making related to patient flow. The process of establishing the command centre involved role identification, skill set determination, location of important personnel in an organised central space and vendor selection to develop the necessary infrastructure. Dashboards were developed to provide real-time actionable insights into external transfers, surgical and other planned admissions, emergency department status, patient throughput and discharges. These dashboards include colour-coded keys highlighting thresholds related to patient flow metrics and are used to facilitate daily huddles and enhance transparency and data-driven decision-making among hospital stakeholders. The outcomes of implementing the RHOCC include improved efficiency and collaboration, as well as a significantly enhanced ability to proactively respond to factors affecting census. The development of a command centre — driven by leadership endorsement and a commitment to continuous improvement — emerges as a transformative strategy in healthcare innovation. The RHOCC’s approach of building capability, fostering inclusion and articulating a vision of providing superior care while driving impactful improvements, positions it as a leading force in creating operational efficiencies to define healthcare delivery.
Keywords: command centre; hospital management; hospital coordination; census management; hospital census; patient flow -
Virtually integrated nursing care: A case study in diffusion of innovations
Kathleen Huun, Associate Professor, Indiana State University, and Rachel Spalding, Healthcare Consultant, USA
Bedside nurses are suffering from nurse fatigue owing to excessive workload and work hours. Nurse fatigue results in missed nursing care, which has a direct impact on patient care and safety. Loss of experienced nurses also affects novice nurses, leaving them without strong mentoring. They may suffer from imposter syndrome, which instils self-doubt and limits their professional development, potentially resulting in burnout and attrition. A case study regarding the leadership of the Chief Nursing Officer as aligned with Rogers’ diffusion of innovations theory is presented. There is an initial accumulation of knowledge regarding the innovation, followed by persuasion (through perception of positive attributes to enhance speed of adoption), decision making, actual implementation and confirmation. Use of virtually integrated nursing helped alleviate bedside nurse fatigue by removing overtime hours and reducing workload. The virtually integrated nurses supported the bedside nurses, allowing them additional time in direct patient care, enhancing patient satisfaction and safety. The objective data indicates a decrease in patient fall by over 50 per cent. The integration of virtual nursing reversed the nurse attrition rates. Initial results revealed a 47 per cent reduction in registered nurse turnover. This allowed for retention of experienced nurses, which aids in mentoring novice nurses. The impact of virtually integrated nursing is yet to be completely realised. Based on this case study, the implementation of virtually integrated nursing is possible and beneficial to nursing, patient safety and the bottom line. This innovation had additional positive consequences and led to future considerations regarding continual process improvement and dissemination of knowledge.
Keywords: diffusion of innovation; nurse retention; patient safety; team-based models; virtual nursing; workflow -
CDI 2.0: Optimising CMI and risk-adjustment value through data analytics and provider education
Kalee Vincent, Enterprise System CDI Educator, West Virginia University Medicine, and Te
Accurate clinical documentation is vital for any healthcare facility. Documentation in the record plays a critical role in reimbursement, case mix index, risk adjusted quality outcomes, length of stay days, etc. The need for Clinical documentation improvement (CDI) specialists is high. In this article, we discuss the success we have had by transitioning from a traditional approach to capture severity reporting (CDI 1.0), which relies heavily on the concurrent review of medical records by the CDI team, to a patient population driven and provider focused approach (CDI 2.0).
Keywords: case mix index; CMI; severity reporting; CDI; clinical documentation; coding; inpatient; education; reimbursement; inpatient