Volume 8 (2023-24)

Each volume of Management in Healthcare consists of four quarterly 100-page issues. Articles scheduled for Volume 8 are available to view at the 'Forthcoming content' page.

The Articles published in Volume 8 include:

Volume 8 Number 4

Editorial
Simon Beckett, Publisher
Practice Papers
Next skilling talent for the intelligent automation revolution
Aniket A. Ramekar, Health Systems Engineer, Emily J. Bloomquist, Senior Manager, Janine R. (Coelho) Kamath, Executive Director, and Dorothy A. Larsen, Director, Mayo Clinic

The increased use of intelligent automation (IA) is challenging organisations to rethink their business models and focus on agility, consumer centricity, innovation and operations excellence. Recognising the global impact of COVID-19, rapid changes in technology, data-driven decision-making and competition for differentiated talent, the Department of Management Engineering and Consulting (ME&C) prioritised the next skilling of talent to proactively prepare for the increased use of IA. This paper discusses our strategic approach, best practice interventions and diversity of methods to prepare ME&C staff. In alignment with Mayo Clinic’s new strategy to the year 2030, which is a catalyst for staff to develop the skills needed to transform healthcare, ME&C leveraged the 70-20-10 model for learning and development. Various next skilling interventions were adopted to disseminate knowledge and accelerate skill building across the IA continuum of discovery, translation and application. Commercial digital offerings were used, and various Mayo Clinic offerings (eg a series of artificial intelligence [AI] seminars, a journal club and an IA community of practice) were introduced. A crowdsourcing website was created to promote learnings focused on industry insights on AI, robotics, cloud computing, digital transformation and platform scalability. ME&C staff engaged with multidisciplinary teams on the execution of IA strategic priorities. Through diverse interventions, ME&C validated the importance of experimenting, learning from experiences (inside and outside Mayo Clinic) and developing reusable assets such as frameworks and playbooks. While engaging in initiatives that covered a constellation of technologies, staff learnt about the applied value of emerging technologies, business implications and considerations for consumer and staff experiences. We believe that our project will inform other organisations in their quest to build IA capabilities to accelerate business transformation while developing talent.
Keywords: artificial intelligence; intelligent automation; learning; next skilling; talent; upskilling
Utilising the New Technology Add-on Payment (NTAP): Improving Medicare-insured patients’ access to innovative therapeutics
Jeffrey G. Johnson, Fourth-Year Medical Student, and Elisabeth A. Siegert, Associate Professor of Medicine, Cooper Medical School of Rowan University; Division Head, Geriatric Medicine, Cooper University Hospital, The Evergreens

Andexanet alfa (Andexxa) is the first reversal agent for direct factor Xa inhibitors. It qualified as a new, novel therapeutic for the New Technology Add-on Payment (NTAP) reimbursement from the Centers for Medicare and Medicaid Services (CMS) in October 2018. This paper is the first analysis of a healthcare system (HCS) reporting its implementation and utilisation of the NTAP for a new therapeutic. The number of patients treated with Andexxa at the level 1 trauma centre of southern New Jersey, Cooper University Hospital (CUH) was analysed. This paper highlights the successful implementation of Andexxa as a treatment option for (non)traumatic intracranial haemorrhage and acute, nongastrointestinal haemorrhage requiring surgical management at CUH. This paper looked at how well CUH obtained the Andexxa NTAP from CMS for Medicare patients. During the 4-year reimbursement period, CUH treated a total of 88 patients with Andexxa, of which 53 were Medicare patients treated before the expiry of the Andexxa NTAP. The study found that CUH received NTAP for 81 per cent of Andexxa-treated Medicare patients and that CUH received the maximal NTAP amount of US$18,281.25 for 43 per cent of those same patients. The paper discusses how a large trauma centre implemented and received the NTAP for Andexxa and evaluates the effect of cost on reimbursement amounts during the Andexxa NTAP period. Finally, this paper should help healthcare providers, stakeholders and administrators better understand the process through which to obtain NTAP reimbursements from CMS and improve their HCS with new, innovative therapies for their patients.
Keywords: reimbursement mechanisms; prospective payment system; Medicare Part A; anticoagulation reversal
Case Studies
Healthcare without borders: Creating a shared medical decision-making model to support global patients at Northwestern Memorial Hospital
Lindsey Kreutzer, Program Director, M. Jeanne Wirpsa, Program Director, Medical Ethics, Gloria Frank, Lead Self-Pay and Insured Coordinator, and Rebecca Rodriguez, Lead Embassy and Insured Coordinator, Northwestern Memorial Hospital

Individuals from across the globe increasingly elect to travel to the USA for the primary purpose of receiving healthcare. These border crossings create opportunities for rich cultural exchange, as well as for direct conflict between the basic values and preferences of global patients and their healthcare team(s). A series of ethics cases at Northwestern Memorial Hospital, where clinicians were morally distressed by the request of families of global patients to withhold medical information about life-threatening disease from the patient, led to a new partnership between the International Health and Medical Ethics teams. This paper describes the development, implementation and outcome of that creative collaboration: an innovative upstream preventive ethics initiative that honours the primary obligation of Western healthcare providers to uphold informed consent and patient autonomy while honouring a wide scope of preferences in communication and decision making identified among this patient population.
Keywords: medical ethics; autonomy; decision making; global healthcare; culture; respect
Tampa General Hospital case study: Harnessing authentic leadership to transform an academic health system
John Couris, President and CEO, Florida Health Sciences Center (DBA Tampa General Hospital), Tampa General Hospital

The US healthcare industry is changing faster than ever before, and its evolution should be expected to continue — and at an even more accelerated rate. Research shows that to adapt and thrive in this ever-changing landscape and best meet the needs of patients, healthcare leaders must be prepared to navigate present-day challenges, including unprecedented levels of burnout and turnover, talent shortages and cost pressures while simultaneously anticipating future needs such as digital transformation, new care models and strategic growth initiatives. To act on this framework, healthcare leaders must also lead their organisations with authenticity, transparency, kindness and vulnerability to unite and activate their teams around a common vision and realistic expectations for how it will be achieved. This paper, in case study format, defines the enterprise leadership and AKTiVe leadership models; details how this authentic leadership framework was deployed at Tampa General Hospital to accelerate growth and innovation; and provides an overview of outcomes, influence and lessons learned through implementation.
Keywords: authentic leadership, enterprise leadership, transformation, academic health system
Medical group governance for better organisational integration
Kara Witalis, Principal, Via Healthcare Consulting, and Tamara Brown, Chief Executive, Providence Medical Group Alaska Region

Today, three of four US physicians are employed by hospitals, health systems or corporations. Forward-thinking healthcare leaders are looking for ways to leverage the intellectual capital of their employed and affiliated physicians and tighten physician–hospital integration as a means to improve care management and coordination, improve access and quality and reduce costs. Structured medical group governance is one such approach taken by healthcare leaders to enable meaningful and intentional physician–hospital joint decision making and better integration. Governance enables providers to unify and speak with one collective voice, influence the business side of clinical matters, build a unified brand and culture within the organisation and set policy or standards needed to be adopted at scale, to name just a few. Since 2019, Providence Health, a national not-for-profit Catholic Health System providing services across seven states with nearly 9,000 employed or affiliated physicians, has developed a multi-tiered medical group governance structure to coalesce on strategic direction and the major decisions that influence the clinical practice. This paper describes Providence Health’s journey in designing and maturing its medical group governance structure. In this case study, the authors describe the why, the what and the how of medical group governance and provide lessons learned and specific examples of the impact Providence Medical Group boards have had on clinician integration, engagement and alignment across the system.
Keywords: physician; medical group governance; integration; leadership
Improving ambulatory patient access through strategic reorganisation and implementation of innovative ambulatory care best practices
Maureen Stevenson, Senior Vice President, John Muir Health Foundation Practice Operations, and Jessica Hazard, Senior Director, Advisory Services, OptumInsight

John Muir Health, a large health system in northern California, struggled with a complex practice management structure that lacked role clarity and core positions, making it difficult to bring about positive change within the ambulatory setting. As part of a broader, strategic partnership to improve operations and deliver healthcare, health system leaders partnered with Optum Advisory to reorganise the practice management structure and optimise primary care patient access. Across its duration, the partnership improved access within primary care while reducing the administrative burden on providers through care team redesign, and with a new structure, physicians received administrative clarity and practice managers have leaders providing support for access, project management and innovation. These changes led to greater innovation and efficiency, resulting in higher satisfaction for patients, providers and staff. Optimising access and productivity, John Muir Health primary care practices have decreased the amount of time it takes for patients to get into the practice, increasing the overall number of patients they have been able to see. In addition, centralised prescription refills have allowed patients to receive their medications quicker while enabling physicians to concentrate on direct patient care. The overall result has been less administrative burden for providers and staff, allowing for more top-of-licence work and time with patients.
Keywords: patient access; centralised prescription refill; schedule optimisation; ambulatory practice management structure; top-of-licence work; dyad partnerships
Research Papers
How far is too far? Rural hospital closures and emergency room travel distances
James Dockins, Professor, and Dave Lingerfelt, Program Director, Rockhurst University

In the past decade, rural hospital closures have been occurring at an increasing pace. This paper explores historical key health policies that resulted in hospital bed growth over the past 75 years and the subsequent factors that have resulted in hospital closures, particularly in rural locations. These closures have reduced the number of licensed hospital emergency rooms available in rural locations and have resulted in new challenges for emergency medical service providers attempting to transport rural residents over increased distances for emergency care. Today’s healthcare literature does an excellent job of documenting the increased rate of rural hospital closures and explores the subsequent increases in emergency room travel distances and access issues for emergency services consumers living in rural areas that have experienced hospital closures. This paper examines hospital emergency room closures from 2014 to 2023 in rural Missouri. The paper then goes beyond a retrospective review of closed rural Missouri hospitals and mapping of hospital locations to establish a process for identifying rural Missouri hospitals at risk of closure in 2024 and beyond, mapping the potential impact on emergency room travel distances should these hospital closures actually occur. The model presented in the research is designed to be easily utilised by regional health planners, helping them to identify potential hospital closures and communicate the potential healthcare access impact to community stakeholders.
Keywords: rural hospital closure; emergency room travel distance; facility location; healthcare access
Effectiveness of self-check-in kiosk use in a community-based clinic setting
Pawan Bhandari, Assistant Professor, Minnesota State University, Abraham A. Doolhoff, Executive Director, UT Health Austin, Laura E. Landwer, Associate Coordinator, Patrick S. Culhane, Operations Manager, Lindsey K. Garvin, Operations Manager, Mayo Clinic Health System, and Ryan R. Johnson, Chief Operating Officer, University of Texas Health Austin

With current and projected staffing shortages, healthcare settings must find innovative ways to address workload problems. One possible solution in the outpatient setting is the use of patient self-check-in kiosks. This paper aimed to understand the effectiveness of the use of self-check-in kiosks in a rural community-based clinic setting. Data was gathered retrospectively on patients seen in our clinic during 2022. Two-sample z-tests were used to compare the use of kiosks before and after the implementation of intentional interventions to help motivate patients to check in using kiosks. Binomial logistic regression was used to determine factors that influence use of kiosks. We then analysed patient satisfaction surveys to determine whether the interventions affected patient satisfaction. A total of 143,208 patients were included in the study. Significantly more patients used the self-check-in kiosks during the post-intervention period (24.9 per cent) than during the pre-intervention period (6.5 per cent) ( z = −102.79, P < 0.001). The outcome of the binomial logistic regression in the form of a model was significant ( χ2(9) = 2,274, P < 0.001) and showed that gender, age, financial (insurance) class and time of check-in significantly affect the likelihood of patients using the self-check-in kiosks. Patient satisfaction was not affected by the interventions. The study findings suggest that it is possible to increase the use of self-check-in kiosks with intentional interventions in a community-based clinic setting without negatively affecting patient satisfaction. Expecting that patients will use technology just because it is there may not be feasible, as evidenced by this case. Non-use of the technology by patients could lead to negative consequences, such as longer wait times and effects on overall patient flow.
Keywords: check-in; digital; kiosk; patient satisfaction; strategy technology

Volume 8 Number 3

Editorial
Simon Beckett, Publisher
Practice Papers
Understanding and resolving conflict to create cultures of well-being in diverse teams
Marzena Buzanowska, Leadership Breakthroughs Academy, and Mary Rensel, Cleveland Clinic Lerner College of Medicine and Pediatric Multiple Sclerosis and Wellness

The 2022 American Hospital Association (AHA) Study, published by the Task Force on Workforce, reported that 75–93 per cent of healthcare workers reported stress, anxiety, frustration, exhaustion and burnout.1 The AHA Task Force recommendations included an immediate focus on creating a culture of well-being and an ongoing focus on leadership development. Team well-being is a broadly defined term related to team happiness and success. Various teamwork and leadership interventions are used to achieve team well-being, and this has been a high priority for organisations in the last few years as the COVID-19 pandemic resulted in massive rates of burnout and exodus from healthcare. We specifically focus here on diverse teams and the effect of negative conflict resolution on team well-being, specifically through its damaging effect on the formation of a culture of safety and belonging. Belonging and safety are created through subtle cues and messages as well as through the outcomes of threshold moments, such as a conflict. Belonging is particularly important for diverse teams because it is not automatically assumed by team members in the way that homogeneous teams do more easily. Studies have shown that diverse teams are more prone to conflict and that the process of conflict resolution can lead to either an increase in team belonging and connection (and well-being) or further distancing, which is then linked to burnout, disengagement and exodus from the workplace. Therefore, how conflict is managed in diverse teams is of crucial importance for team leaders in order to achieve team belonging and well-being.
Keywords: conflict resolution; team well-being; diversity; culture; trust; psychological safety
Operationalising personalisation in a healthcare system
Thomas Jackiewicz, University of Chicago Health Systems, and Glenn Llopis, GLLG

The balance of power is shifting away from traditional institutions into the hands of individuals. A top priority for every hospital leadership team is the need to provide a much more personalised experience for two primary constituencies: leaders and staff (internal) and patients, including members of the broader communities served (external). Personalisation is seeing and treating people as individuals, whether those people are patients or staff. It is achieved when people know they matter. Operationalising personalisation is the act of adapting the way an organisation functions to make it more likely that both internal and external constituencies at all levels build the skills and have the tools to see and treat people as individuals. Many barriers to personalisation exist within organisational cultures that are designed, instead, for standardisation; however, there is a methodical approach to identifying and overcoming those barriers and to creating an environment where people know they matter as individuals. One private, not-for-profit clinical research centre, hospital and graduate school embarked on this approach, examined organisational systems over a year, identified actions to take and behaviours to change, and improved their personalisation readiness scores across four categories by 17, 21, 32 and 32 percentage points. The experiences of this organisation give other organisations a blueprint to follow in their own pursuits of operationalising personalisation across the enterprise.
Keywords: personalisation; organisational culture; workforce resilience
Models of care insight study showcases need for better change management and a renewed focus on staffing and retention
Quint Studer, Healthcare Plus Solutions Group, Katie Boston-Leary, American Nurses Association, and Hunter Joslin

It is incredibly tough working in healthcare these days. People are feeling overworked, stressed out, burned out and, at times, traumatised. These challenges are driving huge employee turnover rates in many organisations. Alarmed by this unfolding crisis, many organisations are working hard to create better experiences for caregivers and patients alike. They seek to answer the question How do you create a healthcare system that’s sustainable for both the human element and the financial side? This paper overviews the Models of Care Insight Study, which was conducted with nurses and nurse leaders in response to these issues to identify new models of care, identify disconnects inside organisations, and ultimately use the ideas and data to improve working conditions for all in healthcare. It presents some of the important findings of the study, zeroing in on the widespread resistance to change, the differences between the perceptions of leadership and front-line staff, and the need for more emphasis on and clarity around development opportunities. Finally, the paper delves into some solutions. It provides some best practices for helping organisations overcome resistance to needed change and moving people through the defiance, compliance, reliance cycle. And it tackles the turnover issue head on, sharing tactics for improving staff retention by creating a sense of belonging from the very beginning of the interview process.
Keywords: models of care insight study; registered nurses; change management; nursing crisis; turnover; development
Grappling with growth: A partnership journey
Imran Andrabi, ThedaCare, David Olson, Froedtert Health, and Chris Masone and Sarah Hereford, FORVIS

While growth means different things to different organisations, the accelerating scale of consolidation within the healthcare industry indicates that innovation and flexibility will be paramount when developing future strategies. Driving long-term organisational performance requires dedication to mission-aligned, profitable growth. Today’s leaders are positioning their organisations to capitalise on present and future opportunities to drive improved systems of care and long-term financial success. But those opportunities may come in non-traditional forms with unexpected partners at times. When approaching growth opportunities, the best practice strategy for a growth-forward organisation relies on the results of five important steps: align, design, navigate, integrate and optimise. Once completed and the growth opportunity is clearly defined, deploying an effective governance structure and engagement strategy are critical next steps. With these steps completed, opportunity defined and the right team in place, execution and optimisation can begin. This case study addresses the importance of establishing guiding principles and define six to live by: trust and transparency, exceptional quality, innovative transformation, community focus, value creation and disciplined execution. With these principles to guide the way, the group envisioned the various partnership opportunities across the two organisations and prioritised a successful quaternary partnership and joint venture. The successful partnership continues to pursue benefits for partners and patients with improved access across the continuum of care and enhanced outcomes through better continuity and integration. Through openness to unexpected opportunities and the agility to pivot to those opportunities, healthcare leaders are enabling themselves to capitalise on present and future opportunities to drive improved systems of care as well as long-term financial success, as exemplified in this case study.
Keywords: joint venture; value based care; health equity; acute care; growth strategy; partnership
Barriers to successful change management
Darshi Bassi and Archana Shinde, Mayo Clinic

Change management plays a crucial role in an organisation’s ability to adapt and thrive in today’s ever-evolving and fast-changing technologically enabled business landscape. Many organisations continue to struggle with effective change management, resulting in failed projects and missed opportunities for growth and development. This paper analyses the reasons why organisations frequently falter in change management efforts and provides insights into overcoming these barriers. The paper identifies a host of significant barriers to effective and successful change management. Each barrier is discussed in detail, explaining the negative effect it can have on change initiatives. Among these barriers are the lack of change management role accountability, a culture where change management is not embraced at all levels, a lack of change champions and leadership support, resistance to change, limited employee involvement, inadequate and poorly designed communications and a failure to properly integrate change management with other complementary approaches. The paper provides practical recommendations to overcome these barriers. It emphasises the crucial role of leadership in championing the change, communicating the vision and actively involving employees in the change process. It underscores the importance of a well-crafted, clear and consistent communication that can help build trust, ensure buy-in and reduce resistance. The paper also highlights the need for robust integration of change management with other complementary approaches. Furthermore, the paper underscores the significance of a centralised change management approach, incorporating tools, best practices and standardised change management practices, and setting realistic expectations to sustain change efforts over time. It stresses the need for organisations to provide the necessary resources, authority and support to staff to effectively fulfil their change management roles. In conclusion, this paper provides insights into overcoming the main barriers to successful change implementation. By implementing the suggested strategies, organisations can enhance their change management capabilities and increase their adaptability, thereby ensuring long-term success in a rapidly changing business landscape.
Keywords: change management; barriers; employee engagement; leadership; remote and hybrid work; employee involvement; change fatigue
Case Studies
Improving patient outcomes while reducing readmissions with data analytics
Margie Latrella, Real Time Medical Systems, and Lavana Baldasare, St. Joseph’s Health

As post-acute care spend continues to rise and the Centers for Medicare and Medicaid Services (CMS) moves forward with promoting both value-based and risk-bearing models of care, it is essential for accountable care organisations (ACOs), payers and hospital providers to take proactive measures to find innovative and data-driven strategies to meet the future demands of healthcare. Yet disparate electronic health record (EHR) systems between acute and post-acute providers continue to pose challenges in the ability to access live patient data across care settings, which enables clinical line of sight to manage both patient and population-level quality outcomes. Utilisation of an EHR-agnostic platform, which mitigates interoperability issues, can improve care transitions, provide data analytics to manage the patient care journey, foster seamless implementation of standardised care pathways and ultimately reduce total costs within post-acute networks by decreasing readmissions and length of stay. St. Joseph’s Health implemented such a data analytics platform and instituted a post-acute nurse navigator, social worker and care manager roles to manage their value-based patients in the postacute setting. As a result, their Medicare Shared Savings Plan ACO, Mission Health Coordinated Care, achieved a significant reduction in readmissions from 24 per cent to 17.8 per cent, as well as a total cost of care savings of US$1.6m in its first year. Currently, the readmission rate is down to 13.6 per cent, and there has also been a 3.2-day reduction in average length of stay. Owing to their successful post-acute strategy and programming, the project was scaled to include all patients in value-based contracts.
Keywords: value-based care; post-acute care; skilled nursing facilities (SNFs); accountable care organisations (ACOs); data transparency; interventional analytics; high-performing network
Building a unified communications centre to improve the distribution of EMS patients to a large multi-hospital health system
Joshua Gray, Cassie Mueller, and Jessica Hobbs, Prisma Health Greenville Memorial Hospital

In 2023, hospital care-based models are faced with increasing patient volumes, limited physical space and limited resources. These constraints, felt in almost all acute-based care models, is leading to a crucial crossroads in acute care delivery. Balancing capacity and availability of hospital and system resources is almost impossible in this environment, as need greatly exceeds access to resources and patient care delivery can be significantly hindered. Historically, emergency medical services (EMS) brought patients to the nearest available emergency department (ED), and load balancing could only be accomplished after arrival in the ED. Intervening earlier in patient’s care by providing EMS with destination recommendations based on available resources optimises patient outcomes and decreases the burden on any individual hospital. This change can also greatly affect EMS processes to improve transport times and decrease wall time, the time that EMS crews spend at the hospital waiting to offload their patients into a hospital bed. Wall times can exceed several hours depending on location, time of day and patient resource needs. Reduction of this waiting time has the potential to profoundly improve throughput and patient-centred metrics like patient satisfaction, length of stay and admission rates, as well as reduce overall risk. This also allows health systems to maintain community resources by decreasing EMS crews’ idle time at the hospital. Through the creation of a unified communication centre (UCC), we sought to create a structure that appropriately stratified patients to the most appropriate system hospitals while still in the care of EMS. Our team’s goal was to optimise patient treatment, decrease wall time with EMS, and route patients to the most appropriate facility based on the patient’s medical complaints, hospital capacity and hospital capability in the community.
Keywords: communication centre; healthcare delivery and systems; capacity management; load balancing; EMS; throughput
Ready Reliable Care, Defense Health Agency’s approach to high reliability
Shari Silverman, Defense Health Agency, and Meaghan Meeker, JJR Solutions

In its everyday actions, high reliability is the overarching framework guiding the Military Health System (MHS), comprised of the Defense Health Agency (DHA), the three Military Medical Departments and the Uniformed Services University. The High Reliability Organisation (HRO) framework, branded Ready Reliable Care (RRC) in the MHS, is based on process design, building culture and structures that promote safety, and improving outcomes to optimise HRO maturity. HROs achieve top outcomes and remain largely error free despite operating in complex or high-risk environments. Operations in HROs are characterised by repeatable processes that are regularly evaluated for change and improvement in collaboration with other affected areas of the organisation. DHA looks to other top health systems for leading HRO practices and characteristics to adapt and implement with the goal of achieving top outcomes in standardising processes; improving team communication; eliminating redundancies and gaps; and elevating the quality of care, safety and access for our beneficiaries. As part of that HRO journey, the DHA seeks to achieve system effectiveness across units through analysis, innovation and the sharing of information and knowledge. RRC provides a unified lens through which functional areas can learn from past experiences to build on and mature interoperable HRO capabilities that support service members and facilitate a consistent, safe, quality patient experience across the DHA. The DHA aims to ensure system maturity by conducting an assessment that will guide the development of capabilities needed to advance HRO principles and behaviours. In conjunction with functional subject matter experts, DHA developed an RRC Military Medical Treatment Facility (MTF) Maturity Index-Model to assess organisational HRO maturity at inpatient medical centres and community hospitals. The capability components of the RRC MTF Maturity Index-Model will align existing DHA and trusted national data sources and benchmarks to determine the current phase of RRC maturity at individual MTFs and across the system. Adaptation of this maturity index-model by other healthcare systems is possible and could provide other health systems with a tool to measure maturity of these healthcare systems as HROs.
Keywords: HRO; HRO maturity; high reliability; health care; patient safety

Volume 8 Number 2

Editorial
Simon Beckett, Publisher
Practice papers
Buying into healthcare: Why the industry must learn to appeal to consumers to survive and thrive
Harold L. Paz, Stony Brook University Medicine, et al

This paper explores the transformative changes required to address patient needs in innovative and personalised ways. The discussion delves into innovative and personalised solutions, including digital applications, virtual visits, artificial intelligence and machine learning capabilities. The authors emphasise the importance of meeting patients where they are through state-of-the-art digital solutions and propose transforming from a traditional health system to an integrated health platform. The paper includes topics such as the recent surge in digital applications and virtual visits during the COVID-19 pandemic, as well as the potential of artificial intelligence and machine learning in helping consumers better understand and manage their own health.
Keywords: Digital Health; Care in the Home; Health Care Strategy
Medical leadership and artificial intelligence: Hope or hype?
Jim Austin, Anthony Napoli, School of Professional Studies, Brown University and Alan O’Neil, Unity Medical Center

Healthcare systems face unprecedented labour supply issues. In the United States, for example, it is estimated that 117,000 physicians left the workforce, while fewer than 40,000 joined it post-COVID. Many commentators point to artificial intelligence (AI) as the technological fix to reduce medical personnel ‘burnout’. We disagree. While AI has the potential to aid in medical decision making through its data integration capabilities, it should be seen as an adjunct to the medical care team. The larger the team and the more complex the world, the more important it is for the medical professionals to be skilled, transformational leaders. Thus, future medical leaders need more leadership development, not better analytic tools, especially in the areas of leading ‘horizontally’. Physicians are no longer just the tip of the spear in medical care but are the leaders of teams of individuals (including the patient) that make decisions by consensus. That team now includes AI as support, not ultimate decision making.
Keywords: AI; medical burnout; medical leadership development; future of medical leadership capabilities
Evaluating pandemic telehealth access: Funding and policy implications
Thomas Martin, Department of Decision and System Sciences, Saint Joseph’s University amd Hamlet Gasoyan, Cleveland Clinic

Access to telehealth services remains dependent on several underlying technological services, regional policies and demographic characteristics. This study evaluates telehealth service use during and after the COVID-19 pandemic using univariate and multivariate analyses. Survey data originated from the Medicare Current Beneficiary Survey COVID-19 supplement conducted by the Centers for Medicare and Medicaid Services. We found that telehealth utilisation was higher in the northern and western regions of the United States, as well as among beneficiaries residing in urban locations. Non-White race, lower income and Medicare/Medicaid dual eligibility were also associated with larger odds of telehealth use during the pandemic. In addition, we identify potential funding shortfalls by the Federal Communications Commission in response to the pandemic, particularly in the Midwest region, and examine the effect of internet access on telehealth utilisation. Finally, we discuss the policy factors associated with accessing telehealth services.
Keywords: telemedicine; telehealth; internet access; utilisation; health policy
Managing the OR: Tools, resources and guidelines to effectively manage operative suites
Michael D. Pederson, Mayo Clinic Health System, et al

As modern medicine offers novel surgical therapies for conditions simple and complex, the proper resource allocation of operating rooms, surgical staff and supporting services is becoming increasingly important for healthcare organisations. Surgical services are one of the most essential parts of any healthcare system, substantially influencing patient choice of healthcare services. These services are typically the centre for revenue but also impart considerable costs. Given the complexity of surgical schedule planning, expectations of high reliability and demand on resources, many healthcare organisations have resorted to using a static block schedule based on historic utilisation patterns. This is based on the dogma that surgical schedules are not predictable, surgical blocks are stable, and surgical yield has no direct correlation with outpatient schedules. Here we share our two-year experience with a Surgical Predictor Tool using our surgical practice management principles and the cost-effective use of these means to meet the needs of patients and our surgical staff in an integrated community health system.
Keywords: guidelines; operating room; OR schedule; tools
Case studies
Transforming Healthcare Leadership: Integrating Sponsorship Ideals Into Pipeline Development
Faith Eatman, Brenda Battle, University of Chicago Medicine and Jason Keeler, University of Chicago Medicine

Black women,1 Hispanic women2 and other traditionally marginalised workers tend to be concentrated in the most labour-intensive, lowest-paid jobs in healthcare, underscoring the need for diversity, equity and inclusion efforts by health and hospital systems to include a significant focus on creating pipelines and pathways for professional advancement within administration and executive leadership roles. University of Chicago Medicine (UCM), a leading research hospital system, recently launched a pilot sponsorship programme, designed by members of an employee resource group for women of colour, to increase exposure to growth opportunities for women employees of colour and to elevate awareness among white male senior leaders of their workplace experiences. By establishing a structured, professionally mediated and metrics-backed sponsorship programme pilot, UCM was able to formally support a process through which hospital leaders were: (1) made aware of the effect of structural racism on their workforce and workplace; and (2) given the tools and directives necessary to transform their own views on allyship and convert them into tangible actions to increase visibility and opportunities for women of colour within the pilot. The broader objective of this initiative and others like it is to increase Black, Indigenous, and People of Color (BIPOC) diversity representation among senior leaders at UCM from 28 per cent in FY2023 to 35 per cent in FY2025, reflecting the hospital’s vision to have more leaders who are representative of the community in which the hospital serves on Chicago’s South Side.
Keywords: diversity; equity and inclusion; organisational values; workplace culture; sponsorship programmes; patient outcomes
Building the smart hospital of the future with technology bets
Debra F. Sukin, The Woodlands Hospital, Trent Fulin, Houston Methodist Cypress Hospital and Murat Uralkan, Houston Methodist Center for Innovation

Houston Methodist, a leading hospital system, has embarked on a transformative journey to implement smart hospital initiatives aimed at elevating healthcare delivery and enhancing patient experiences. Central to this strategy is the ‘Smart Hospital DNA’, a framework that marries technological innovation with collaboration. Within this structure, the institution has incorporated predictive artificial intelligence, integrated ambient intelligence for heightened patient safety, leveraged service robots for diverse operations, and initiated remote monitoring through advanced wearables. A recent and successful example of this integrated methodology is seen in the telenursing programme, introduced in response to the challenges faced owing to the nursing shortage. This programme harnessed technology to bolster patient care metrics and enhance operational efficiency. The experiences and insights derived from these endeavours find their destination in Houston Methodist’s Cypress Hospital, serving as a model for the future-oriented hospital. This paper provides an in-depth examination of the ‘future bets’, discussing their design, execution and observed or predicted outcomes. Readers will gain insights into the balancing act of technological innovation with collaboration and will garner tools and strategies to navigate the digital landscape of modern healthcare.
Keywords: innovation; smart hospital; hospital design; technology implementation; ambient intelligence; artificial intelligence
Talent mobility for accelerating diversity at leadership levels: A pilot study
Janine R. Kamath and Sarah R. Dhanorker, Mayo Clinic

Mayo Clinic is committed to reskilling and upskilling its workforce and to creating a strong, diverse leadership pipeline to advance its ‘Bold. Forward.’ strategy. In alignment with this commitment, the Mayo Clinic Shared Services Organization (MCSSO) launched a pilot offering staff the opportunity to work in a hybrid role and build new skills and connections. Pilot participants split their time equally between job roles in which the professional skill sets required were approximately the same. The pilot involved six MCSSO departments and six candidates (three pairs) from the participating departments. Staff were recruited for three roles: senior project manager, senior business analyst and call centre representative. Each of the three pairs worked in a hybrid assignment for six months. Candidates were offered opportunities to network with each other, MCSSO senior leaders and other diverse colleagues. Pilot evaluations were conducted at 0, 3 and 6 months with candidates and their supervisors. Additionally, benchmarking with external organisations allowed learning from advanced talent mobility and leadership diversity programmes. The evaluations highlighted that 50 per cent of the candidates were promoted by the end of their hybrid assignment. Most of them engaged in new projects, cross-trained and gained valuable insights, skills and expertise. Candidates and supervisors valued the opportunity to network with senior leaders and cross-functional colleagues. The pilot and external benchmarks emphasised the importance of a formal ‘talent mobility programme’ to build and sustain a diverse leadership pipeline. It is crucial to be intentional and bold with hybrid and mobility opportunities for intersectional candidates, under-represented groups and staff committed to equity, inclusion and diversity. All candidates and supervisors wanted the pilot to be expanded and operationalised. We believe that these early experiences, results and lessons on preparing diverse talent for leadership levels in the organisation are broadly transferable to other healthcare and non-healthcare organisations.
Keywords: diverse; intersectional; leadership; mobility; talent; under-represented
Research paper
Identifying the most common and costly medication errors: Implications for healthcare managers
Kalyn Jo Barton, Department of Audiology and Speech Pathology, University of Tennessee, Kourtney Nieves, School of Global Health Management and Informatics, University of Central Florida and Ronald P. Hudak Strategy Management Division, U.S. Department of Defense Health Agency

Medication administration errors, although preventable, continue to have adverse effects on patient outcomes and healthcare facilities’ financial well-being. Researchers have demonstrated that, although process interventions have been implemented, new technology has been deployed, and training and education have increased, the errors persist. Limited research appears to have established the most prevalent, harmful and costly types of medication administration errors. Therefore, the purpose of this study is to assist healthcare managers of inpatient facilities to identify the most common and costly medication administration errors. Donabedian’s model for healthcare quality, derived from the three categories of structure, process and outcomes, was utilised to determine how mistakes persist despite numerous interventions targeted at these factors. A correlational analysis was conducted utilising Pearson’s R and multiple linear regression to define the relationships between the independent variable of ‘specific malpractice allegation’ (ie medication administration error type) and dependent variables of ‘severity of alleged injury’ and ‘total payment’. Results were determined by the correlation coefficient after regression diagnostics. Analysis of the data indicates a greater prevalence of administration errors related to wrong medication and wrong dose; of these, wrong medication errors resulted in greater harm to the patient, although medications administered via the wrong route resulted in the payment of greater amounts. In addition, payment amounts increase with greater severity of harm. Implications for healthcare managers include implementing processes to reduce medication administration errors as well as implementing targeted risk management programmes in inpatient settings.
Keywords: medication administration errors; malpractice; patient outcomes; patient harm

Volume 8 Number 1

Editorial
Simon Beckett, Publisher
Building strategic value with your medical group
David Goldberg, Mon Health System and David W. Miller, HSG Advisors

Despite massive investments by health systems in employed physician networks, these networks are often poorly aligned with the health system. At their worst, they operate as a loose conglomeration of practices, with suboptimal quality, financial and operational performance. This paper discusses Mon Health, a growing five-hospital system in West Virginia, and the development of its transformation plan. That effort first addressed the development of a vision of how the physician network would evolve to meet the mutual objectives of the stakeholders and the demands of the market, defined jointly by physicians and executives. The resulting roadmap further addressed issues like quality, provider well-being, strategic growth and physician leadership. The organisation ensured employed physicians would be integrated into the organisation’s leadership and operations, through vehicles like the physician leadership council and dyad leadership of services. Tactics include engaging physicians in service line leadership dyads and advisory board roles, building a shared vision for evolution, defining behavioural expectations for a common culture, and building the management infrastructure to drive these initiatives. The paper also addresses early performance improvements facilitated by this initiative. Ultimately, we will provide a road map for developing a transformation plan to build an accountable, multi-specialty group.
Keywords: physician network; strategy; leadership; shared vision; retention; health system
Get your diverse team to outperform: Navigating through affinity bias
Marzena Buzanowska, River City Sports and Spine Specialists, Mary Rensel, Cleveland Clinic

While gender and racial diversity of healthcare organisations has been increasing, and improvements in representation have been made, significant disparities still exist, especially with pipeline progression in organisational rank and leadership level. In addition, once under-represented minority individuals become a part of a team, obstacles continue to inhibit those individuals, in subtle ways, from being fully able to contribute to the teams. One such major unconscious process is affinity bias, which is our subconscious preference for people who resemble ourselves or belong to our social group, as well as distrust and negative attitudes towards those different from us or not part of our group. Subconscious heuristics drive our brain’s cognitive processes for efficiency with the goal of keeping us safe in an uncertain environment, and we need these heuristics in order to function. In highly advanced organisations, however, when relying on the strengths of diverse teams determines the organisation’s competitive edge and financial profitability, affinity bias can undermine the organisation’s performance, and it is crucial that leaders are skilled in navigating its pitfalls.
Keywords: affinity bias; team performance; diversity; inclusion; culture of belonging
Integrating innovation into occupational evaluation to adjust to the changing healthcare workforce
Jamal Khan, Rebecca Ashbeck, Laura Breeher, Melanie Swift, Caitlin Hainy, Heidi Shedenhelm, and Chris Tommaso, Mayo Clinic

The COVID-19 pandemic disrupted the workforce, resulting in a shift to a largely remote working population. As a result of this shift, Employee Occupational Health Services (EOHS) was required to develop a solution to evaluate new employees and provide occupational medical clearance without the physical presence of the candidate. An online candidate portal was created where individuals could complete evaluation paperwork and screenings asynchronously. The evaluation forms and screenings were then reviewed by occupational health nursing staff, and testing was conducted in the candidate’s home location. The virtual evaluation solution expedited the assessment process, added convenience for candidates and reduced the amount of time needed from EOHS staff. It is imperative that EOHS departments adjust to the changing workforce by offering virtual evaluation solutions that provide candidates with a seamless and efficient solution to complete required paperwork, testing and immunisations.
Keywords: healthcare; occupational clearance; post-offer placement assessment
Educating patients on value-based health care to improve clinical outcomes
Lucinda A. Hines, Air Force Medical Readiness Agency

Patient education and health literacy are essential components of the effort to improve a patient’s health and assist them with meeting their medical goals of improved health and wellness. This paper provides actionable recommendations on educating patients on how value-based health care improves clinical outcomes. The qualitative exploratory case study outlined healthcare professionals’ experiences, perceptions and opinions regarding educating their patients about the value-based healthcare system. Fifteen healthcare professionals currently or previously providing patient care in the United States shared multiple perspectives on educating patients about value-based health care. Two recurring themes identified were (a) reimbursement is based on patient outcomes and (b) patient education and comprehension. Patient education allows healthcare professionals to collaborate with patients to improve their health. Gaps in the literature exist on whether or how healthcare professionals educate patients on value-based health care. The findings and recommendations from this study could raise consciousness about the clinical and business benefits of educating patients on value-based health care. Educating patients on this topic presents opportunities to engage patients as partners in promoting compliance and positive clinical outcomes.
Keywords: value-based health care; healthcare professionals; patient education; positive clinical outcome; reimbursement
Accelerating systemness through shared vision and culture
Jennifer Tomasik, CFAR, Brooke Tyson Hynes, Possibility Partners, and Rosa M. Colon-Kolacko, Tufts Medicine

As health systems across the United States consolidate, tremendous potential exists to expand and optimise their breadth and depth by integrating services so that patient care is coordinated, supportive and equitable. The financial pressures and workforce crisis resulting from the COVID-19 pandemic have further exacerbated the need for fiscal discipline and operational efficiencies that can come from effective, system-wide integration. Yet many health systems continue to fall short of achieving the promise of post-merger integration and the value it can create for the diverse communities they serve. This paper explores one health system’s journey from ‘operational synergies’ to full ‘systemness’ enabled by a shared vision laser focused on a commitment to frictionless, patient-centred care through enabling care teams to do their best work, accelerating integrated operations and building an inclusive culture. It will explore the journey of a system in name only (Wellforce) to a unified team with a single brand (Tufts Medicine) and a shared commitment to the future with a mission to empower people to live their best lives. This case study will describe how the system evolved, starting from the development of a transformational Strategic Vision, through the shared trials of the COVID-19 pandemic and its effect on patients and providers. Having a shared vision is an essential first step to building systemness. Bringing that vision to life requires significant discipline and culture change. It requires a systemic approach and unwavering leadership, rooted in a shared philosophy, deep commitment and aligned behaviour. The case study will continue with an exploration of the path system and entity leaders took to identify shared priorities, adapt organisational and governance structures, and engage more than 14,000 clinical and administrative staff and physicians in building an inclusive culture with a clear and actionable commitment to anti-racism. It is a story about moving from words and ideas to action and removing the barriers that impeded progress.
Keywords: systemness; culture; strategy; vision; health equity; leadership
Is environmental sustainability training fundamental to healthcare leadership? State of the art with health students and health leaders
Marine Sarfati, University of Medicine Lyon 1 Claude Bernard, Alessia Lefébure, L’Institut AgroRennes Angers, Cyrille Harpet, University of Rennes, Estelle Baurès, Institut Agro, and Laurie, Marrauld, University of Rennes

This paper addresses the relevance of climate change and environmental learning in health professional training. Recent publications have shown the importance of understanding sustainability and environmental issues in healthcare management. Indeed, after years of underestimation, medical and public health professionals today acknowledge that the environment has a strong effect on human health. Conducted between April and June 2021, a quantitative study among 3,384 French medical and health students shows that the need for training on energy and climate issues is urgent and crucial. The findings are consistent with the international literature. The contrast is sharp between students’ expectations about environmental skills and the reality of the available course offer. Learning about energy, climate and environment is currently not a priority in the curriculum of healthcare professionals, including managers. Sustainability, however, clearly appears as a ‘must’ among the essentials in healthcare leadership. What these findings suggest is that healthcare managers can no longer afford to ignore environmental sustainability as an essential skills domain in their long-term capacity to contribute to the necessary healthcare environmental adaptation, mitigation and resilience.
Keywords: professional training; public health; healthcare; environmental sustainability; climate change; leadership skills
Achieving health equity: A patient safety imperative
Ronald Wyatt, Achieving Health Equity and Tara Gerstacker, MCIC Vermont

Achieving health equity requires achieving zero preventable harm for all people. Health inequity must be inextricably linked to safety if all people are to be free from harm. There is no safety without equity and no equity without safety. Health inequity is an unsafe condition. Equity-related near misses, adverse events and sentinel events must undergo a comprehensive systematic analysis. Each root cause should have a strong corrective action(s). Measurable actions might include the collection and stratification of race, ethnicity and language data, or addressing stereotype bias, implicit bias, structural competency and institutional and structural racism. Leadership committed to creating a culture of equity is required. Measures of success should be linked to payment and restoring trust.
Keywords: inequity; root causes; REaL; racism; structural competency; trust
Community engagement for early recognition and immediate action in stroke (CEERIAS): Pre and post COVID-19
Knitasha V. Washington, ATW Health Solutions, Neelum T. Aggarwal, Rush University Medical Center, Shyam Prabhakaran, The University of Chicago, Desiree Collins Bradley, ATW Health Solutions, Kellie Goodson, ATW Health Solutions, Alexis Malfesi, Center for Medicare and Medicaid Innovation, US Department of Health and Human Services, and Theresa Schmidt, Discern Health, Real Chemistry

Engagement science can help healthcare providers understand promising practices that address health disparities. The Community Engagement in Early Recognition and Immediate Action in Stroke (CEERIAS) study began in 2014 with the aim of improving health outcomes related to stroke and addressing racial inequities among at-risk South Side Chicago neighbourhoods by engaging community members called ‘Stroke Promoters’ in designing and implementing a stroke preparedness programme. Launched in 2020, Phase II (2CEERIAS) furthered this aim by developing a replicable virtual platform for the programme in response to challenges prompted by the COVID-19 pandemic. The CEERIAS community engagement programme results provided meaningful data to South Side Chicago communities; nearly 40,000 ‘Pact to Act FAST’ pledges were collected over 11 months, and although early hospital arrival and emergency medical services (EMS) usage for confirmed stroke did not increase overall, early arrivals for suspected stroke increased significantly for men, younger people and black community members along with EMS usage for suspected stroke. The 2CEERIAS virtual programme collected nearly 3,800 new pledges in a 90-day window during the onset of the COVID-19 pandemic. The engagement of trusted nonclinical laypeople during both phases of the CEERIAS study demonstrates that community engagement can positively influence clinical outcomes and increase reach and sustainability for such efforts. The use of engagement science can also generate a deep sense of co-creation among community members, and the ‘social contract’ approach can effect behavioural change. The virtual adaption reinforced important engagement science principles for interventions aimed at eliminating stroke disparities. To this day, eight years after research support ended for the CEERIAS programme, community members trained as ‘Stroke Promoters’ remain connected to the researchers and continue to educate family and neighbours about stroke preparedness.
Keywords: equity; health disparities; stroke; community engagement; improvement; quality