Journal of Healthcare Leadership最新文献

Purpose: The widespread adoption of telemedicine tools poses new and little-known challenges for healthcare professionals, who are required to adapt their knowledge, skills, and work practices to this innovative scenario. Understanding healthcare professionals' expectations and concerns about adopting telemedicine can facilitate its effective integration. Therefore, drawing upon the Value Co-Creation in Healthcare model, the current study aims to investigate pediatricians' expectations regarding antecedents, outcomes, and management activities relevant to the implementation of a telehomecare service.

Methods: Interviews invitations were sent to all pediatricians (n=13) involved in a pilot study using the TytoCare device, a telehomecare tool that enables remote medical examinations, at an Italian pediatric hospital. All invited pediatricians agreed to participate. The semi-structured interviews, each lasting approximately 30 to 45 minutes, were conducted remotely via Microsoft Teams prior to the use of the TytoCare device. All interviews were recorded and transcribed verbatim. The content was subsequently analyzed through thematic analysis using MAXQDA software.

Results: Five overarching thematic areas emerged from the interviews: factors influencing the adoption of the telehomecare device, advantages of its use, impacts on work practices, changes in the patient-professional relationship, and management activities. While concerns exist about the adequacy of telehomecare compared to in-person visits, the device offers potential benefits, such as improving the hospital experience for children by shortening hospital stays. However, it may lead to an increased workload and necessitate stronger trust and communication in remote care. Successful integration requires dedicated support staff, regulatory adjustments, and effective leadership, with active involvement of healthcare professionals in decision-making.

Conclusion: By shedding light on healthcare professionals' expectations about telehomecare device, this study provides useful insights to healthcare leaders to tailor interventions to accompany technology within care practices to valorize its benefits and promote value co-creation processes.

Introduction: Professionalism among healthcare professionals is often defined in terms such as altruism, humanism, and excellence. The integration of such professionalism ideals to healthcare professionals' practice poses a challenge to medical tutors. We examined the assessment of professionalism among physicians and nurses by their peers and evaluated the significance of each professional role component within each sector. We also performed a cross-sector assessment whereby physicians assessed nurses' professionalism and vice versa.

Methods: A survey among physicians, interns, and nurses. The participants were asked to rate the extent that each of the 12 characteristics contributes to physicians' and nurses' professionalism of on a scale of 1 (does not contribute at all) to 10 (highly contributes). Each participant rated the contribution of each component to the professionalism of their own occupation (direct scoring) and to the professionalism of the other occupation (cross scoring).

Results: In total, 300 healthcare professionals (mean age 36.6, 46% males) responded to the survey. The most highly contributing characteristics to physicians' professionalism were knowledge, responsibility, decision-making and leadership, clustered as "strategic judgment". The most highly contributing characteristics to nurses' professionalism were responsibility, personal attention, empathy, and skills, clustered as "bedside approach" and "performance abilities". Cross-assessment among professionals was different: Nurses assigned higher ratings in general, interns assigned higher ratings to physicians' characteristics, whereas physicians assigned lower ratings to professionalism characteristics, and especially to those of nurses. Nurses emphasized patient centeredness and communication skills more than physicians. Nurses and interns appreciated teamwork compared to physicians. Major differences in how physicians and nurses perceive professionalism revealed physicians' emphasis on "strategic judgment" while nurses emphasis on "bedside approach".

Conclusion: Physicians and nurses hold differing viewpoints on many topics, including the objectives of their mission, expected performance, and activity types. Medical professionals can assess their colleagues and partners, recognizing both strengths and weaknesses in themselves and others.

Introduction: Healthcare is experiencing a global period of profound transformation, and digital health shows the promise of dispensing innovative and contemporary service models. However, changes are required to improve the capabilities of health managers in driving successful digital transformation.

Objective: This paper aims to explore the organizational barriers that health service managers have encountered when realizing the benefits of a digitally transforming environment. This is part of a larger research study exploring digital competencies for health service managers, with the findings from focus group discussions providing a baseline from which to address the organizational improvements and changes in system capabilities required to assist in realizing the benefits of digital health transformation.

Methods: The study is qualitative in nature. It employs focus group discussions to gain an in-depth understanding of the experiences and views of health service managers and identify the benefits and barriers that managers have experienced in introducing digital health in their workplace.

Results: Barriers encountered in realizing digital health benefits in the workplace were evidenced across five major themes: (1) change resistance and usage, (2) trust and uniformity, (3) resourcing and procurement, (4) digital literacy, and (5) siloed systems.

Discussion: Findings from this study demonstrate that in driving the realization of digital health transformation benefits, health service managers need organizational and system-wide efforts to support managing in the digital health context. The key identified barriers experienced by health service managers include facing human and technical challenges with system adoption and the governance of data-driven decision-making in the digital context.

Conclusion: The importance of digital transformation in healthcare is evident and will increasingly become a necessity for organizational survival and success. This study adds important insights into the organizational barriers that health service managers have encountered when realizing the benefits resulting from digital transformation. Addressing these barriers requires macro-, meso- and micro-level system investments. These benefits are enhanced by enabling factors critical for digital health adoption that have been described in key categories involving health system related: (1) policy and system, (2) organizational structure and processes, and human resource management, and (3) people factors. The importance of ensuring the organizational factors driving the realization of benefits in a digitally transforming environment is also addressed and capitalized upon for health service managers.

Aim: This study explores the experiences of mentors and mentees participating in a mentor program for nurses in leadership positions, aiming to identify areas for program improvement.

Design and methods: A qualitative approach was used, with semi-structured interviews conducted with 20 nurses in leadership roles. The participants, 10 mentees and 10 mentors, were involved in the Norwegian Nurses Organization's "Mentor Program for Nurses as Leaders". Thematic analysis was applied to the data.

Results: Participants in the mentorship program reported increased leadership awareness, stronger motivation, better stress-coping mechanisms, and greater confidence as leaders. They received valuable feedback and support from their mentors, boosting their motivation to pursue leadership roles. Both mentees and mentors expressed a desire for a longer program and emphasized the importance of networking opportunities, along with the need for predictability and long-term planning to improve program effectiveness.

Conclusion: Participants reported that the mentorship program increased their awareness, motivation, coping skills, and confidence as leaders, encouraging them to pursue leadership roles. The results show that the NNO's mentor program positively influences leadership aspirations of new nurse leaders, with potential for further development in networking and program duration.

Background: Although US research agencies have instituted peer review processes to require participant diversity in clinical trials before funding decisions are made, the underrepresentation of certain populations (eg, racial and ethnic minorities) in clinical trials remains a persistent challenge in biomedical research. This issue has the potential to affect the generalizability of findings and impede efforts to ensure the provision of high-quality healthcare across all populations. In this study, we examined barriers to the recruitment and retention of underrepresented populations in cancer clinical trials from the perspective of research coordinating staff.

Methods: Semi-structured interviews were conducted at a US-based academic cancer center and included 6 patient-facing staff (clinical research coordinators) and 6 non-patient-facing staff (regulatory and financial specialists). Interview data were subjected to thematic analysis. To provide additional organizational context, descriptive data were obtained on the characteristics of clinical trials undertaken at the cancer center.

Results: The following themes emerged from the staff interviews: 1) absence of a consistent structure for decision-making and problem-solving related to recruitment and retention, 2) staff shortages, 3) administrative burden, and 4) lack of resources. In addition, descriptive data revealed that nearly half the trials, 64/134 (48%), offered informed consent only in English, and only 3/134 (2%) offered participant incentives or reimbursement (eg, for transportation). These interrelated organizational issues were indicative of inadequate systems for ensuring diverse and equitable representation in cancer clinical trials.

Conclusion: Results indicate that overcoming barriers to underrepresentation may require dedicated support from sponsoring agencies in the form of evidence-based guidelines, learning collaboratives to facilitate implementation, technical support, resources, and oversight. For progress to be made therefore, both sponsors and cancer centers may need to assume joint responsibility for the implementation of effective systems for ensuring diverse and equitable representation in cancer clinical trials.

Purpose: The digitalization of healthcare is developing quickly. Every care provider needs to be up-to-date on this technology. The purpose of this research was to identify the digital literacy of nursing staff and nurse managers.

Methods: A cross-sectional study assessed nurses' digital literacy, specifically with regard to nursing informatics competencies in hospitals, primary healthcare, and clinics. The study sample included 100 nurses and 83 nurse managers. Researchers applied a modified questionnaire on nurses' informatics competencies from TIGER Nursing Informatics, with a validity range of 0.497-0.897 and a reliability value of 0.975.

Results: Participants showed an acceptable level of computer literacy, although their scores were below 80%. Their scores were unrelated to workplace, duration and type of technology used, or gender. Nursing informatics competencies correlated significantly with age and work experience (p = 0.001). Age correlated negatively with technical computer skills but positively with competence in the implementation of healthcare. There was a positive link with a nurse's position and education level, indicating that nurses with more education acquire higher levels of informatics competencies than those with less education. Additionally, those in higher positions tended to possess more advanced digital competence.

Conclusion: Nurse managers play a significant role in training nursing staff members to enhance their informatics competencies. This study's findings underscore the need to raise staff members' informatics competencies by providing additional training.

Background: Globally, billions of people lack access to safe surgical care. Women represent a valuable resource to tackle the healthcare workforce shortage which impedes the delivery of surgery. With women entering the global health workforce at an increasing rate, Operation Smile (OS) launched the Women in Medicine program to create women-led leadership and mentorship opportunities for women healthcare workers to empower them to become leaders in healthcare.

Purpose: This multi-regional study aims to evaluate the experiences of healthcare providers on OS all-women surgical programs and the impact of participation on leadership and mentorship opportunities.

Methods: In 2022, OS conducted four cleft surgical programs with all-women providers in Morocco, Peru, Malawi, and the Philippines. Providers from various specialties participating in the programs were surveyed. Participants were invited to complete the surveys anonymously in the final two days of each program. Analysis involved descriptive statistics and chi-square tests.

Results: Across all programs, 215 providers from 36 countries were surveyed. Ninety-seven percent of participants reported improvement in their technical and non-technical skills. Eighty-two percent reported that the program motivated them to seek leadership positions, despite only 37% having prior leadership experience on an OS program. Participating in an all-women team motivated 96% to seek mentorship from another woman and 99% to mentor others. Overall, 98% of providers across all regions and specialties supported the importance of women leadership, and 95% endorsed women mentorship.

Conclusion: Promoting gender equity is crucial to address the ongoing healthcare workforce shortage and improve access to safe surgical care. This study demonstrates the importance of mentorship between women to advance into leadership positions. Programs that provide women in healthcare with educational, mentorship, and leadership opportunities can effectively equip them with the skills needed to advance their careers and strengthen the global workforce.

Purpose: As the COVID-19 pandemic recedes, the importance of population health has come into sharp focus, prompting many health systems to explore leveraging population health data (PHD) for operational planning. This approach requires that healthcare leaders embrace the dual priorities of maintaining excellence in patient care while promoting the overall health of populations. However, many leaders are new to population-based thinking, posing a threat to successful operationalization if mental models are not aligned.

Patients and methods: This qualitative case study explored the alignment of mental models among 13 senior leaders at Trillium Health Partners (THP), one of Canada's largest community hospitals, as they embark on embedding PHD within operational workflows.

Results: All leaders recognized the necessity of adopting a population health approach amid resource constraints and growing pressures. When discussing the operationalization of PHD, two distinct mental models emerged among leaders: one focused on patient care and the other on population health. While executive leaders demonstrated a fluidity in their thinking between the two, programmatic leaders favoured one over the other. For example, some viewed the organization's focus on PHD as competing with their patient care responsibilities, while others saw the use of PHD as a solution to the organization's operational pressures. Despite these divergences, leaders unanimously stressed the importance of increasing the organization's risk tolerance and devolving decision-making as a necessary precursor to realizing the transformation to a PHD-driven approach.

Conclusion: These divergent mental models highlight a need to clarify the shared vision for the use of PHD along with its impact on leadership roles and accountabilities. These findings illustrate the current state from which THP aims to evolve and underscore the importance of aligning leaders' mental models as a critical step to facilitating successful integration of PHD and advancing a collective vision for healthcare transformation.

Purpose: Transformational leadership among core hospital leaders boosts medical organizations' competitiveness, adaptability, and sustainability, which is jointly affected by individual, organizational and environmental factors. This study aims to unpack its configurational framework and propose strategies to strengthen core hospital leaders' transformational leadership.

Patients and methods: Data were collected from an online questionnaire among 31 core hospital leaders. The fuzzy-set qualitative comparative analysis (fsQCA) was used to explore the causal mechanism of high-level transformational leadership. We enrich this mechanism by professional background, critical thinking, initiative spirit, family-work conflict, job satisfaction, subordinates' followership, and work pressure.

Results: Result shows initiative spirit is the only necessary condition (consistency=0.911) for the formation of high-level transformational leadership among core hospital leaders. Three configurations are the sufficient conditions that lead to high-level transformational leadership among core hospital leaders with two different professional backgrounds (overall solution consistency= 0.952).

Conclusion: Core hospital leaders' initiative spirit is an indispensable condition for improving high-level transformational leadership, emphasizing the necessity for core leaders to be proactive in order to develop such leadership. Besides, the study also uncovered three configurations are the sufficient conditions for core hospital leaders with diverse professional backgrounds to achieve high-level transformational leadership. This finding offers significant insights into hospital management practices, suggesting that core hospital leaders' work should be managed in a personalized manner based on their professional backgrounds, thereby fostering favorable conditions conducive to the development of their high-level transformational leadership capabilities. Furthermore, the central insight of this study is that the formation of high-level transformational leadership contingent upon the collaboration of professional background, critical thinking, initiative spirit, family-work conflict, job satisfaction, subordinates' followership, and work pressure, contributing to a holistic and more rigorous view for the development of transformational leadership.

Introduction: Staffing is critical to hospital performance. However, in recent years, hospitals have struggled with severe staffing shortages, forcing them to rely on expensive agency staff to meet urgent patient care needs. This substitution of agency staff for permanent employees has raised concerns over its potential impact on financial stability. This study investigated the association of agency labor with hospital financial performance.

Methods: Utilizing tenets from agency theory and transaction cost theory, data for the calendar year 2022 for active short-term acute care hospitals (n=2771) in the United States were analyzed using multivariable linear regression analysis. Hospital financial performance was assessed using three variables: net patient revenue, operating revenue per bed, and operating expense per bed. The independent variable was agency labor cost, representing the total expenditure on agency labor. Additionally, organizational and market-level control variables that may independently affect hospital financial performance were included.

Results: Our regression findings indicated that agency labor cost was significantly associated with all three dependent variables: net patient revenue (β = 0.224, p < 0.001), operating revenue per bed (β = 0.042, p < 0.001), and operating expense per bed (β = 0.032, p < 0.001).

Discussion: The results indicated that increased agency labor was associated with higher revenues, but it also corresponded with increased expenses. Therefore, hospitals should strategically use agency staffing to meet immediate operational needs while remaining cognizant of its financial implications. The judicious use of agency labor can help hospitals balance the benefits of increased revenue against higher costs, while ensuring that they still meet immediate patient needs.