During the COVID-19 pandemic, severity-adjustment systems lacked longitudinal data for the coronavirus and thus could not specify diagnosis-specific risk. Without risk adjustment for the patient’s diagnosis and presenting condition, outcomes such as morbidity, mortality, and length of stay become challenging to interpret. APACHE, which risk-adjusts for acute physiology, age, and chronic health, is a widely used ICU benchmarking tool, and participating institutions identified rising and concerning standardized mortality rates in 2020. Following up on previously reported results that severity-adjusted outcomes were worse than expected for patients with COVID-19 versus traditional viral pneumonia during the first two years of the pandemic, the authors now report data that suggest the COVID-19 mortality penalty versus other viral pneumonia lessened once the Omicron variant became the predominant pathogen in early 2022. They present implications for benchmarking hospital performance and public reporting.
{"title":"APACHE-adjusted ICU Outcomes Have Returned to Pre-pandemic Values","authors":"Thomas Higgins, Eric Ringle, K. Henson","doi":"10.55834/plj.1833280043","DOIUrl":"https://doi.org/10.55834/plj.1833280043","url":null,"abstract":"During the COVID-19 pandemic, severity-adjustment systems lacked longitudinal data for the coronavirus and thus could not specify diagnosis-specific risk. Without risk adjustment for the patient’s diagnosis and presenting condition, outcomes such as morbidity, mortality, and length of stay become challenging to interpret. APACHE, which risk-adjusts for acute physiology, age, and chronic health, is a widely used ICU benchmarking tool, and participating institutions identified rising and concerning standardized mortality rates in 2020. Following up on previously reported results that severity-adjusted outcomes were worse than expected for patients with COVID-19 versus traditional viral pneumonia during the first two years of the pandemic, the authors now report data that suggest the COVID-19 mortality penalty versus other viral pneumonia lessened once the Omicron variant became the predominant pathogen in early 2022. They present implications for benchmarking hospital performance and public reporting.","PeriodicalId":91157,"journal":{"name":"Physician leadership journal","volume":"109 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141697109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joseph Kleinsmith, Tyler Connely, Lindsay Madej, Kristy Carlson, Samuel Pate
Hospital systems across the United States have implemented quality improvement initiatives designed to mitigate unnecessary waste and decrease healthcare costs that are frequently passed on to patients. One key source of waste is excess sterile instrumentation in surgical operating rooms. This quality improvement project identified waste by auditing and updating surgical instrumentation preference cards (SIPCs) for the three most common procedures at a multi-center academic health system. Unnecessary items were recorded and savings calculated using 2022 supplier price data. Forty-nine procedures were audited, resulting in changes to 111 unique SIPCs. Although this process produced significant savings for the health system, it was limited to fewer than 10% of the total cases performed. Total savings were observed at $337,007 with savings of $56,254 for open instrumentation. A manual audit of all SIPCs across the institution and regular updates has the potential to decrease instrumentation waste and annual expenditures by approximately $4 million.
{"title":"Impact of Updating Surgical Instrumentation Preference Cards on Operating Room Operations","authors":"Joseph Kleinsmith, Tyler Connely, Lindsay Madej, Kristy Carlson, Samuel Pate","doi":"10.55834/plj.1906410156","DOIUrl":"https://doi.org/10.55834/plj.1906410156","url":null,"abstract":"Hospital systems across the United States have implemented quality improvement initiatives designed to mitigate unnecessary waste and decrease healthcare costs that are frequently passed on to patients. One key source of waste is excess sterile instrumentation in surgical operating rooms. This quality improvement project identified waste by auditing and updating surgical instrumentation preference cards (SIPCs) for the three most common procedures at a multi-center academic health system. Unnecessary items were recorded and savings calculated using 2022 supplier price data. Forty-nine procedures were audited, resulting in changes to 111 unique SIPCs. Although this process produced significant savings for the health system, it was limited to fewer than 10% of the total cases performed. Total savings were observed at $337,007 with savings of $56,254 for open instrumentation. A manual audit of all SIPCs across the institution and regular updates has the potential to decrease instrumentation waste and annual expenditures by approximately $4 million.","PeriodicalId":91157,"journal":{"name":"Physician leadership journal","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141706115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicole Goldhaber, Monica Gudea, Ron Skillens, Nicole Perez-Hall, Kepa Francisco, Linda Brubaker, Robert El-Kareh
Healthcare organizations commonly use mandatory online training modules to meet regulatory compliance and improve patient safety and quality of care. These well-intentioned efforts have increasingly burdened physicians and detracted from physician wellness. The authors aimed to characterize this burden and identify opportunities to redesign the module to reduce this burden while maintaining regulatory compliance. A cross-sectional cohort study analyzed module completion data for physicians from 18 clinical departments who completed at least one (of multiple assigned) mandatory online training modules between January 1, 2022, and February 14, 2023. More than 1,300 academic physicians completed at least one mandatory training module. Total time requirement and “off-hours” completion of mandatory training modules suggests that this uncompensated effort places a substantial burden on physicians. In response to these findings, healthcare organizations should take action to prioritize physician wellness alongside regulatory compliance and educational needs in any mandatory online training modules.
{"title":"Mountains of Modules: Assessment and Redesign of Online Mandatory Training to Promote Physician Wellness and Reduce Burnout","authors":"Nicole Goldhaber, Monica Gudea, Ron Skillens, Nicole Perez-Hall, Kepa Francisco, Linda Brubaker, Robert El-Kareh","doi":"10.55834/plj.5320166209","DOIUrl":"https://doi.org/10.55834/plj.5320166209","url":null,"abstract":"Healthcare organizations commonly use mandatory online training modules to meet regulatory compliance and improve patient safety and quality of care. These well-intentioned efforts have increasingly burdened physicians and detracted from physician wellness. The authors aimed to characterize this burden and identify opportunities to redesign the module to reduce this burden while maintaining regulatory compliance. A cross-sectional cohort study analyzed module completion data for physicians from 18 clinical departments who completed at least one (of multiple assigned) mandatory online training modules between January 1, 2022, and February 14, 2023. More than 1,300 academic physicians completed at least one mandatory training module. Total time requirement and “off-hours” completion of mandatory training modules suggests that this uncompensated effort places a substantial burden on physicians. In response to these findings, healthcare organizations should take action to prioritize physician wellness alongside regulatory compliance and educational needs in any mandatory online training modules.","PeriodicalId":91157,"journal":{"name":"Physician leadership journal","volume":"6 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141048295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Physician employment contracts are complex and often written to benefit the employer. Consequently, physicians should understand the ambiguities in employee contracts and be attuned to such elements as restrictive covenants, loopholes, malpractice insurance, compensations plans and bonuses, duties and obligations of physicians, and indistinct contract language.
{"title":"Exploring the Issues that Early Career Physicians Need to Understand When Presented with an Employment Contract","authors":"Timothy Paterick","doi":"10.55834/plj.7604779488","DOIUrl":"https://doi.org/10.55834/plj.7604779488","url":null,"abstract":"Physician employment contracts are complex and often written to benefit the employer. Consequently, physicians should understand the ambiguities in employee contracts and be attuned to such elements as restrictive covenants, loopholes, malpractice insurance, compensations plans and bonuses, duties and obligations of physicians, and indistinct contract language.","PeriodicalId":91157,"journal":{"name":"Physician leadership journal","volume":"12 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141044323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The board of directors is critical to a company’s organizational structure, overseeing management and protecting shareholders’ interests. In science-driven companies, the board’s role extends beyond traditional business and financial oversight to include scientific expertise that drives innovation, manages scientific risk, and ensures adherence to ethical standards. The board’s primary responsibilities include corporate governance, strategic guidance, and oversight of management activities, ensuring the company’s adherence to legal standards and ethical norms. The decisions made at this level can significantly affect not only the company but also public health, patients, research directions, and industry standards. Ultimately, board members in science-driven companies contribute their unique skills and knowledge to the board, always with transparency and a strong ethical compass.
{"title":"You Will Need a Different Kind of Board of Directors","authors":"Luis Pareras","doi":"10.55834/plj.1089588439","DOIUrl":"https://doi.org/10.55834/plj.1089588439","url":null,"abstract":"The board of directors is critical to a company’s organizational structure, overseeing management and protecting shareholders’ interests. In science-driven companies, the board’s role extends beyond traditional business and financial oversight to include scientific expertise that drives innovation, manages scientific risk, and ensures adherence to ethical standards. The board’s primary responsibilities include corporate governance, strategic guidance, and oversight of management activities, ensuring the company’s adherence to legal standards and ethical norms. The decisions made at this level can significantly affect not only the company but also public health, patients, research directions, and industry standards. Ultimately, board members in science-driven companies contribute their unique skills and knowledge to the board, always with transparency and a strong ethical compass.","PeriodicalId":91157,"journal":{"name":"Physician leadership journal","volume":"80 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141035359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Creating a culture of five-star customer service within medical practices centers on relationships and requires effective communication skills, patience, respect, and courtesy. Breaches in internal five-star service can create a vicious cycle of animosity that can intensify throughout the day, affecting patient care. Physicians play a crucial role in creating an environment where staff are motivated to provide outstanding customer service. Ultimately, a culture of internal and external five-star service can be achieved with the right training, tools, and commitment from everyone in the practice, resulting in better patient care and a more positive work environment. The authors suggest various strategies to promote this commitment, including in-service training, recognition, employee opinion surveys, and new employee orientation.
{"title":"How to Achieve Internal Five-Star Service","authors":"James Saxton, Maggie Finkelstein","doi":"10.55834/plj.4483629103","DOIUrl":"https://doi.org/10.55834/plj.4483629103","url":null,"abstract":"Creating a culture of five-star customer service within medical practices centers on relationships and requires effective communication skills, patience, respect, and courtesy. Breaches in internal five-star service can create a vicious cycle of animosity that can intensify throughout the day, affecting patient care. Physicians play a crucial role in creating an environment where staff are motivated to provide outstanding customer service. Ultimately, a culture of internal and external five-star service can be achieved with the right training, tools, and commitment from everyone in the practice, resulting in better patient care and a more positive work environment. The authors suggest various strategies to promote this commitment, including in-service training, recognition, employee opinion surveys, and new employee orientation.","PeriodicalId":91157,"journal":{"name":"Physician leadership journal","volume":"14 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141044465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leading healthcare organizations are using remote patient monitoring (RPM), which, according to some studies, is associated with improved patient outcomes and high patient and clinician satisfaction. The technology is evolving quickly, but most providers are sitting on the sidelines because reimbursement rates do not encourage its use. RPM advocates encourage all provider organizations to prepare for the day at-home monitoring becomes standard.
{"title":"Trends in Remote Patient Monitoring","authors":"Lola Butcher","doi":"10.55834/plj.1190892867","DOIUrl":"https://doi.org/10.55834/plj.1190892867","url":null,"abstract":"Leading healthcare organizations are using remote patient monitoring (RPM), which, according to some studies, is associated with improved patient outcomes and high patient and clinician satisfaction. The technology is evolving quickly, but most providers are sitting on the sidelines because reimbursement rates do not encourage its use. RPM advocates encourage all provider organizations to prepare for the day at-home monitoring becomes standard.","PeriodicalId":91157,"journal":{"name":"Physician leadership journal","volume":"43 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141053629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
While the term “financial forensics” is often reserved for the investigation and examination of the finances of a company for purposes of uncovering mismanagement or criminal activity, used here it refers to methods physician leaders can apply to determine how the idiosyncrasies of provider practice styles and practice management affect financial performance and related risk. The principal goal is to enhance the productivity potential of the relationship between the physician leader and practice management professionals, as both lead the management of medical services organizations. The model and philosophy presented are useful for independent medical practices of all specialties and sizes, as well as those integrated with community and academic health systems.
{"title":"Financial Forensics and the Medical Practice — The Role of the Physician Leader","authors":"Daniel Zismer, Gary Schwartz, Elliot Zismer","doi":"10.55834/plj.9023516632","DOIUrl":"https://doi.org/10.55834/plj.9023516632","url":null,"abstract":"While the term “financial forensics” is often reserved for the investigation and examination of the finances of a company for purposes of uncovering mismanagement or criminal activity, used here it refers to methods physician leaders can apply to determine how the idiosyncrasies of provider practice styles and practice management affect financial performance and related risk. The principal goal is to enhance the productivity potential of the relationship between the physician leader and practice management professionals, as both lead the management of medical services organizations. The model and philosophy presented are useful for independent medical practices of all specialties and sizes, as well as those integrated with community and academic health systems.","PeriodicalId":91157,"journal":{"name":"Physician leadership journal","volume":"47 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141038659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As contracts between health systems/hospitals and physician groups approach their renewal dates, negotiations for second-generation contracts must consider the lessons learned from previous contracts and the changes in the healthcare industry. While productivity is still a significant factor in these contracts, changes in reimbursement paradigms, structural changes, and corporate entities must also be considered. A thorough financial analysis, an issues tracker, a letter of intent, and definitive agreements are tools that can facilitate the negotiation process. Keys to a successful negotiation include respecting the changes in the industry, delineating the key needs and expectations of both parties, creating a negotiation subgroup, avoiding misunderstandings, and allowing for changes in the future post-transaction. Ultimately, the negotiation process should be collaborative, communicative, and transparent. These considerations, along with a give-and-take spirit by both parties, can lead to a successful second-generation contract.
{"title":"Negotiating Second-Generation Contracts","authors":"Max Reiboldt, Justin Chamblee, Ellis Knight","doi":"10.55834/plj.9461696294","DOIUrl":"https://doi.org/10.55834/plj.9461696294","url":null,"abstract":"As contracts between health systems/hospitals and physician groups approach their renewal dates, negotiations for second-generation contracts must consider the lessons learned from previous contracts and the changes in the healthcare industry. While productivity is still a significant factor in these contracts, changes in reimbursement paradigms, structural changes, and corporate entities must also be considered. A thorough financial analysis, an issues tracker, a letter of intent, and definitive agreements are tools that can facilitate the negotiation process. Keys to a successful negotiation include respecting the changes in the industry, delineating the key needs and expectations of both parties, creating a negotiation subgroup, avoiding misunderstandings, and allowing for changes in the future post-transaction. Ultimately, the negotiation process should be collaborative, communicative, and transparent. These considerations, along with a give-and-take spirit by both parties, can lead to a successful second-generation contract.","PeriodicalId":91157,"journal":{"name":"Physician leadership journal","volume":"33 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141043969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article explores how coaching, much like leadership, is a situational activity that requires coaches to adapt to the specific needs of their clients. It identifies four situational needs that coaches are asked to address: learning a skill, changing behavior, making decisions, and dealing with problem situations. It also emphasizes the importance of remaining objective and avoiding the righting reflex when helping clients with problem situations. Coaches must be flexible and adapt to the situational needs of the person they are helping while adhering to the fundamental nature of coaching.
{"title":"The Coach’s Corner: Situational Coaching","authors":"Robert Hicks","doi":"10.55834/plj.8471877282","DOIUrl":"https://doi.org/10.55834/plj.8471877282","url":null,"abstract":"This article explores how coaching, much like leadership, is a situational activity that requires coaches to adapt to the specific needs of their clients. It identifies four situational needs that coaches are asked to address: learning a skill, changing behavior, making decisions, and dealing with problem situations. It also emphasizes the importance of remaining objective and avoiding the righting reflex when helping clients with problem situations. Coaches must be flexible and adapt to the situational needs of the person they are helping while adhering to the fundamental nature of coaching.","PeriodicalId":91157,"journal":{"name":"Physician leadership journal","volume":"556 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141028170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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