Journal of Healthcare Management最新文献

Goal: Burnout, decreased professional fulfillment, and resultant attrition across the medical professions are increasingly recognized as threats to sustainable and cost-effective healthcare delivery. While the skill level of leaders as perceived by their direct reports has been correlated with rates of burnout and fulfillment, no studies, to our knowledge, have directly evaluated whether intervention via leadership training impacts burnout and fulfillment among direct reports. The goal of this study was to evaluate the effectiveness of a leadership training intervention on direct reports' perceptions of the leadership skills of supervising residents and subsequently on the well-being of the direct reports.

Methods: We implemented a leadership training program with supervising (i.e., chief) resident volunteers in two surgical residency programs. The leadership training included two sessions of approximately 2 hours each that consisted of interactive didactic and small group activities. The training focused on the following themes: defining leadership (i.e.,characteristics and behaviors), team building, fostering trust, managing conflict, navigating difficult conversations, and feedback. We administered pretraining and posttraining surveys to the direct reports (i.e., junior residents) to assess the perceived leadership skills of supervising residents, as well as burnout and professional fulfillment.

Principal findings: Leadership scores significantly improved following the leadership training intervention. Additionally, improvement in leadership scores following training was positively correlated with professional fulfillment among the junior residents (direct reports).

Practical applications: The results of this study suggest that incorporating leadership training into residency programs may serve as an appropriate initial intervention to improve the leadership skills of supervising residents, and in turn, improve professional fulfillment and retention among medical professionals. This intervention involved minimal cost and time investment, with potentially significant returns in combating the well-being and attrition crisis. These findings may be applicable across the healthcare field to tackle the impending healthcare worker crisis.

Goal: While studies have examined quality and health outcomes related to the Centers for Medicare & Medicaid Services' (CMS's) Hospital Value-Based Purchasing (HVBP) Program, a significant gap exists in the literature regarding the relationship between pay-for-performance initiatives and hospital financial performance in the program's Efficiency and Cost Reduction domain. This study examined the association between hospitals' cost inefficiency and participation in the HVBP Program by estimating the probability and magnitude of improvement or achievement in the program's Efficiency and Cost Reduction domain.

Methods: The 2014-2019 Efficiency and Cost Reduction domain data were obtained from CMS and merged with the American Hospital Association's Annual Survey Database. We conducted a zero-inflated negative binomial regression to account for the excessive number of zeros in the data.

Principal findings: The negative binomial component of the model assessed the magnitude of the impact on the Efficiency and Cost Reduction improvement from each covariate, while the zero-inflated component assessed the odds of being in the "certain-zero" group, meaning no chance to improve or achieve. Hospital ownership, location, size, safety-net status, percentage of Medicare patients, and the number of registered nurses per bed were statistically significant. Additionally, the Herfindahl-Hirschman Index and teaching status significantly influenced efficiency performance.

Practical applications: Changes in hospital performance in this domain exist and have evolved. Hospitals might be at a disadvantage with this performance measure because of their inherent organizational structure. The HVBP Program may not provide clear enough direction or actionable incentive to address the needs of stakeholders influenced primarily by measures of Medicare spending per beneficiary. This study's findings hold practical value for policymakers, healthcare administrators, and researchers. Policymakers can use this information to tailor future pay-for-performance programs and effectively allocate resources. Healthcare administrators can identify areas for improvement and benchmark their performance against similar institutions. Researchers can explore the program's long-term sustainability and investigate cost drivers within different hospital groups. By understanding the link between hospital characteristics and cost reduction, all stakeholders can contribute to a more efficient healthcare system.

Goal: To evaluate long-term outcomes of Better Together Physician Coaching, a digital life-coaching program to improve resident well-being.

Methods: We performed a secondary analysis of survey data from the pilot program implementation between January 2021 and June 2022. An intention-to-treat analysis was completed for baseline versus post-6 months and baseline versus post-12 months for all outcome measures.

Principal findings: Of 101 participants, 95 completed a baseline survey (94%), 66 completed a 6-month survey (65%) and 36 completed a 12-month survey (35%). There were no significant differences in burnout scale scores between baseline to 6 or 12 months. Self-compassion scores (i.e., means) improved after 6 months, from 33.2 to 38.2 (p < .001) and remained improved after 12 months at 36.7 (p = .020). Impostor syndrome score means decreased after 6 months, from 5.41 to 4.38 (p = .005) but were not sustained after 12 months (4.66, p = .081). Moral injury score means decreased from baseline to 6 months from 41.2 to 37.0 (p = .018), but reductions were not sustained at 12 months (38.1, p = .166).

Practical applications: This study showed significant, sustained improvement in self-compassion for coaching program participants.

Goal: This study aimed to compare the value of tax exemptions and community benefits across various nonprofit hospitals and show how hospital and geographical characteristics can explain the values.

Methods: Data from 2017 to 2021 Internal Revenue Service Form 990s were used to evaluate 17 types of community benefits in nonprofit hospitals and assess six categories of tax benefits. Descriptive analyses compared charity care, community benefits, and estimated tax exemptions among nonprofit hospitals while considering variations in teaching status, location (rurality), and US region. Additionally, random effect regression analyses, both unadjusted and adjusted, explored the connection between the community benefit-to-expense ratio and a range of hospital and geographical features.

Principal findings: Between 2017 and 2021, nonprofit hospitals allocated, on average, 8.8% of their total expenses to 17 types of community benefits, with 1.8% of their expenses dedicated to charity care; 5.2% benefited from tax exemptions. There were significant disparities among nonprofit hospitals, as 24.0% received more tax benefits than they spent on community benefits, and 81.0% received more than their charity care expenditures. The characteristics and location of nonprofit hospitals influenced the provision and composition of community benefits. Teaching hospitals allocated a higher percentage of total community benefits compared to nonteaching hospitals (9.2% vs. 8.6%). The top three categories in teaching hospitals were Medicaid shortfall, charity care, and unreimbursed education, whereas nonteaching hospitals focused more on charity care and subsidized health services, in addition to Medicaid shortfall. Furthermore, the location of a nonprofit hospital impacted the distribution of community benefits. Rural hospitals prioritized Medicaid shortfall, subsidized health services, and charity care, while urban hospitals concentrated more on Medicaid shortfall, charity care, and subsidized health service (in that order). The regression results showed that system affiliation and location in the Southern region of the United States were positive predictors of charity care spending at nonprofits.

Practical applications: Lack of transparency and explicit requirements from federal agencies and states for what is necessary to receive tax benefits results in wide variations in community benefits spending by nonprofit hospitals. Some receive more in tax benefits than they provide in community benefits, and three-quarters of all nonprofit hospitals receive more in tax benefits than they provide in charity care. Developing a more explicit definition of community benefits can make all nonprofit hospitals more accountable.