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 1

• 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
  Abstract

  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
  Abstract

  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
  Abstract

  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
  Abstract

  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
  Abstract

  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
  Abstract

  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
  Abstract

  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