Frontiers of Health Services Management最新文献

All healthcare systems are challenged to provide sufficient access to appropriate care for the individuals and communities they serve. Among the commonly discussed interventions in an era of clinical shortages is the establishment of team-based care, where team members can practice at the top of their license. This solution ensures that talent and ability are amplified. However, this vision has been thwarted by several barriers. Recognizing that complex causes prevent team-based care, CommonSpirit Health leadership has embarked on a multifaceted implementation of tactics to mitigate the barriers. The strategy addresses issues ranging from regulations, laws, and payment practices to a lack of knowledge and understanding between professions. A combination of solutions, rather than discrete tactics, holds the key to the system's strategy. The complement of actions put in place at CommonSpirit Health has included new executive roles, dyad leadership models, shared multidisciplinary education, targeted advocacy, best practice playbooks, and the flexibility to individualize local models as part of the journey to a more effective and efficient model of care.

Nurses are the backbone of healthcare. Their retention and recruitment are essential to the success and sustainability of healthcare providers. For many years, Portland, Oregon-based Legacy Health enjoyed the luxury of a registered nurse (RN) turnover rate consistently as low as 7.6 percent and a vacancy rate of 2.49 percent. Suddenly, COVID-19 and a confounding exodus of nurses from the profession overran this excellent track record. Today, Legacy Health is rebuilding its RN workforce and staff resilience through new initiatives. Even with a dwindling RN talent pool and vacancy rates rapidly growing into the double digits, the leadership is closing the gap. For example, a coach model for precepting new graduate nurses has allowed the RN residency program to grow by more than 300 percent. Programs such as Schwartz Rounds, Code Lavender, and an inpatient throughput initiative are also improving RN wellness, reducing stress, and increasing retention.

If you are not confused, you don't know what's going on. -Jack Welch In commenting on the business environment today (1994), Jack Welch could have been talking about healthcare organizations experiencing the double-barreled assault on two sweeping changes simultaneously. Not only are hospitals preparing for yet-to-be-determined changes in national healthcare delivery systems but they are doing so in the midst of shifting demographics in both the population and employee base. While many make the case for managing diversity, we would like to go one step further in offering a framework for developing an organization's ability to build an inclusive environment that gets the best from its staff and provides the best service to its customers.

Healthcare can benefit immensely from implementing an Agile mindset. Specifically, Agile principles of value-driven delivery, adaptive planning, and continuous improvement can exert a positive impact on projects-especially amid the constant changes in laws, evidence-based practices, and technology in healthcare. The best way to apply Agile is to combine the discipline and structure of a traditional linear model with the adaptability of iterative development. That mix allows for certain controls but with the flexibility for stakeholders to provide input and call for adjustments at different stages. To start, an organization must build teams of multidisciplinary personnel with diverse perspectives. Delivering value should be addressed as soon as possible by considering stakeholder priorities, using tools for continuous project planning, and employing retrospectives to provide feedback and identify root causes. When leaders embrace value-driven delivery, adaptive planning, and continuous improvement, healthcare projects can lead to positive results and ultimately improve patient care.

All leaders of healthcare organizations, individually and collectively, must make critically important decisions every day. But how are those decisions made? What factors must leaders take into account? And how has the way they make those decisions changed over the years? In today's fast-moving world, healthcare leaders face increasing pressures to make far-reaching decisions not only accurately, but also more quickly than ever. Especially for a small critical access hospital, there is little room for error or delay. At Nemaha County Hospital, we have found that clinical and business decisions drawn from more reliable data are much better than those based on anecdotal information.

Healthcare organizations are facing exponential growth in change-not just to compete, but to survive. Amid the widening gap between expenses and reimbursements, hospitals must manage the adoption of expensive advanced technologies, continuous synthesis of emerging clinical knowledge, intensive regulatory readiness, and public ranking of quality outcomes. And they must handle all this as patient expectations grow. At Methodist Le Bonheur Healthcare (MLH), we have approached these challenges by nurturing an organizational mindset of transformational innovation. The ability to harness the collective brainpower of 12,000 MLH associates to find cost reductions, operational efficiencies, and better ways to provide patient care has proven invaluable when facing the demands to do more with less. Achieving this degree of engagement began with full transparency of the challenges we face as an organization, clearly articulating the need to change, and providing a structured approach to capture and respond to suggestions from the workforce. The Power of One Idea program, a platform for listening and learning, has enabled the workforce to answer that call and make an impressive impact: $17 million in cost savings and previously untapped revenues. In return, the forward-thinking associates submitting those ideas have shared in those savings and realized more than $1.5 million in extra income. The Performance Excellence Award, a program to seek out best practices in safety, efficiency, or effectiveness, also has enriched the business with at least 100 proven approaches to advance care delivery.

Healthcare leaders have two especially profound responsibilities. In addition to ensuring quality, they must also drive sustainable practices that benefit their organizations, communities, and the planet. Environmental, social, and governance (ESG) principles-along with sustainability and corporate social responsibility (CSR) concepts-have gained significant prominence in recent years, and an understanding of their nuances within healthcare and in the general business context is essential for effective governance and implementation. To fully integrate ESG principles into their operations, healthcare leaders should understand the essential role of governance in ESG and the differences among ESG, sustainability, and CSR. The concrete examples provided here will illustrate the relevance of ESG reporting frameworks to healthcare operations.