Workplace factors related to health care leader well-being in rural settings.

PURPOSE: To examine which workplace factors contribute to health care leader well-being in rural settings. METHODS: Working with two rurally focused organizations, we administered a Rural Leader Burnout survey to executive leaders. The survey contained 25 questions; 24 were closed-item multiple choice and 1 open-ended question. The survey was based on the Mini Z 10 item burnout survey with 5 additional items for leaders. Logistic regression and qualitative content analysis determined factors associated with job satisfaction, burnout, and intent to leave (ITL). FINDINGS: There were 288 respondents (response rate 22%). Of 272 with complete data, 61.4% were women and 51.8% had worked > 10 years. About 81% reported job satisfaction, 40.2% were burned out, and 49.8% intended to leave their administrative roles within 2 years. Factors statistically associated with satisfaction were work control (OR = 3.0), values alignment with leadership (OR = 2.1), and trust in organization (OR = 2.0). Work control (OR = 0.3), trust in organization (OR = 0.4), and stress (OR = 4.1) were associated with burnout. Trust in organization (OR = 0.5), feeling valued (OR = 0.6), and stress (OR = 1.8) associated with ITL. Qualitative data revealed three themes relevant to rural leaders: (1) industry challenges, (2) daily operational issues, and (3) difficult relationships. CONCLUSIONS: These exploratory analyses demonstrate practical ways to improve work conditions to mitigate burnout and turnover in rural leaders. Promoting thriving in leaders would be an important step in maintaining the rural health care workforce.

Primary Care Physician Leadership in Top Ranked US Hospitals.

This assessment of the "top hospitals" in the US according to 4 leading rankings reveals only 4 to 7% of represented CEOs are primary care physicians by training. Greater attention to leadership development from primary care residency through health system practice is needed to avoid diminishing primary care's critical role and salutary global benefits.

Primary care physician leaders' perspectives on opportunities and challenges in healthcare leadership: a qualitative study.

BACKGROUND: There is an increasing demand for physicians to assume leadership roles in hospitals, health systems, clinics and community settings, given the documented positive outcomes of physician leadership and the systemic shifts towards value-based care. The purpose of this study is to examine how primary care physicians (PCPs) perceive and experience leadership roles. Better understanding how PCPs perceive leadership affords the opportunity to influence changes in primary care training in order to more adequately prepare and support physicians for current and future leadership roles. METHODS: This study used qualitative interviews, conducted from January to May 2020. The participants included 27 PCPs, recruited via the Harvard Medical School Center for Primary Care newsletters and through snowball sampling techniques. Participants worked in 22 different organisations, including major urban health systems, corporate pharmacy, public health departments and academic medical centres. RESULTS: Using content analysis and qualitative comparative analysis methodologies, three major themes and seven subthemes emerged from the interviews. The primary themes included the advantage PCPs have in leadership positions, the lack of leadership training and development, and disincentives to leading. CONCLUSIONS: While PCPs perceive primary care to hold a unique position that would incline them towards leadership, the lack of training and other noted disincentives are barriers to leadership. Therefore, health organisations should seek to invest in, better train and promote PCPs in leadership.

Conceptual Framework for Integrating Family Caregivers Into the Health Care Team: A Scoping Review.

More than 80% of family care partners of older adults are responsible for coordinating care between and among providers; yet, their inclusion in the health care delivery process lacks recognition, coordination, and standardization. Despite efforts to include care partners (e.g., through informal or formal proxy access to their care recipient's patient portal), policies and procedures around care partner inclusion are complex and inconsistently implemented. We conducted a scoping review of peer-reviewed articles published from 2015 to 2021 and reviewed a final sample of 45 U.S.-based studies. Few articles specifically examine the inclusion of care partners in health care teams; those that do, do not define or measure care partner inclusion in a standardized way. Efforts to consider care partners as "partners" rather than "visitors" require further consideration of how to build health care teams inclusive of care partners. Incentives for health care organizations and providers to practice inclusive team-building may be required.

Engaging Physicians in Leadership: Motivations, Challenges, and Identity-Based Considerations.

GOAL: Physician leadership has been associated with improved patient outcomes, increased provider satisfaction, and decreased physician burnout as well as more profitable, higher-quality healthcare delivery. However, physicians frequently struggle when assuming leadership positions, given the dissonance between their administrative and clinical roles. Informed by social identity theory, we aimed to identify why physicians lead, how they experience leadership roles, and the challenges they face during the transition into those roles. METHODS: We conducted 27 semistructured interviews with primary care physician leaders between January and April 2020. Interviews were transcribed and analyzed using the constant comparative method. PRINCIPAL FINDINGS: Four themes were developed from the analysis, including (1) desire for change, (2) desire for growth, (3) challenges experienced during the transition to a leadership role, and (4) changes to professional identity. The results of this study identified aspects of leadership perceived by physicians as attractive and motivating. The study also revealed challenges that occur during the transition into leadership as well as shifts in professional identity experienced by physicians. APPLICATIONS TO PRACTICE: The results can be used by healthcare managers and executives to empower more physicians to take on leadership roles and implement changes that alleviate stresses associated with physicians transitioning into leadership roles.

Hospital Cultural Competency and Attributes of Patient Safety Culture: A Study of U.S. Hospitals.

OBJECTIVE: Given the increasing racial and ethnic diversity in the United States, hospitals face challenges in providing safe and high-quality care to minority patients. Cultural competency fostered through engagement in diversity programs can be used as a resourceful strategy to provide safe care and improve the patient safety culture. This article examined the association of cultural competency and employee's perceived attributes of safety culture. METHODS: A longitudinal study design was used with 283 unique hospital observations from 2014 to 2016. The dependent variables were percent composite scores for 4 attributes of perceived safety culture: (1) management support for patient safety, (2) teamwork across units, (3) communication openness, and (4) nonpunitive response to an error. The independent variable was an engagement in diversity programs, considered in 3 categories: (1) high, (2) medium, and (3) low. Controls included hospital characteristics, market characteristics, and percent. Ordinal logistic regression was used for imputation, whereas multiple linear regression was used for analyses. RESULTS: Results indicate that hospitals with high engagement have 4.64% higher perceptions of management support for safety, 3.17% higher perceptions of teamwork across units, and 3.97% higher perceptions of nonpunitive response, as compared with hospitals that have a low engagement in diversity programs (P < 0.05). CONCLUSIONS: Culturally competent hospitals have better safety culture than their counterparts. Cultural competency is an important resource to build a safety culture so that safe care for patients from minority and diverse backgrounds can be delivered.

An Exploration of Gender Bias Affecting Women in Medicine.

Women in medicine face barriers that hinder progress toward top leadership roles, and the industry remains plagued by the grand challenge of gender inequality. The purpose of this study was to explore how subtle and overt gender biases affect women physicians, physician leaders, researchers, and faculty working in academic health sciences environments and to further examine the association of these biases with workplace satisfaction. The study used a convergent mixed methods approach. Sampling from a list of medical schools in the United States, in conjunction with a list of each state's medical society, the authors analyzed the quantitative survey responses of 293 women in medicine. The authors conducted ordinary least squares multiple regression to assess the relationship of gender barriers on workplace satisfaction. Additionally, 132 of the 293 participants provided written open-ended responses that were explored using a qualitative content analysis methodology. The survey results showed that male culture, lack of sponsorship, lack of mentoring, and queen bee syndrome were associated with lower workplace satisfaction. The qualitative results provided illustrations of how participants experienced these biases. These results emphasize the obstacles that women face and highlight the detrimental nature of gender bias in medicine. The authors conclude by presenting concrete recommendations for managers endeavoring to improve the culture of gender equity and inclusivity.

Even Superheroes Need Rest: A Guide to Facilitating Recovery from Work for Health-care Workers during COVID-19 and beyond.

The COVID-19 pandemic burdens health-care workers (HCWs) worldwide. Amid high-stress conditions and unprecedented needs for crisis management, organizations face the grand challenge of supporting the mental health and well-being of their HCWs. The current literature on mental health and well-being primarily focuses on improving personal resilience among HCWs. However, this puts the responsibility for coping with COVID-19-related stress almost fully on the individual. This chapter discusses an important alternative framing of this issue - how health-care organizations (HCOs) can facilitate recovery from work processes (i.e., returning to a baseline level by engaging in nonwork activities after work) for their workers. Based on a narrative review of the occupational health psychology literature, we provide practical strategies for supporting the four key recovery experiences of detachment, control, mastery, and relaxation, as well as present general recommendations about how to promote recovery. These strategies can help HCOs facing the grand challenge of sustaining worker well-being and functioning during the COVID-19 pandemic, as well as during future pandemics and for workers facing high work pressure in general.

Addressing evolving patient concerns around telehealth in the COVID-19 era.

With a rapid shift to telehealth during the coronavirus disease 2019 (COVID-19) pandemic, clinicians, health care organizations, and policy makers must consider and address patients' evolving needs, concerns, and expectations.

Hospital staffing patterns and safety culture perceptions: The mediating role of perceived teamwork and perceived handoffs.

BACKGROUND: As hospitals are under increasing pressure to improve quality and safety, safety culture has become a focal issue for high-risk organizations, including hospitals. Prior research has examined how structural characteristics directly impact safety culture. However, and based on Donabedian's structure-process-outcome quality model, there is a need to understand the processes that intermediate the relationship between structural characteristics and safety culture perceptions. PURPOSE: The processes by which registered nurse (RN) and hospitalist staffing may affect safety culture perceptions were examined in this study. Specifically, this study investigates the processes of perceived teamwork across units and perceived handoffs. METHODOLOGY: Data sources for this research included Hospital Survey on Patient Safety Culture from the Agency for Healthcare Research and Quality, the American Hospital Association's Annual Survey Data, the American Hospital Association Information Technology supplement, and the Area Health Resource File. Two separate mediation models for each process were used. Propensity weights were assigned to each hospital in the sample ( N = 207) to adjust for potential nonresponse bias of hospitals that did not assess employee's safety culture perceptions. RESULTS: Results suggest that RN staffing influences safety culture perceptions, but hospitalist staffing does not. In addition, RN staffing has an indirect effect on safety culture perceptions through better processes. PRACTICE IMPLICATIONS: Our study sheds light on how staffing affects safety culture perceptions. Specifically, our findings suggest that positive perceptions of teamwork across units and handoffs are integral in the relationship between RN staffing and safety culture perceptions. Hospital managers should, therefore, invest resources in staff recruitment and retention. In addition, a targeted focus on perceived teamwork and handoffs may allow hospital managers to improve safety culture perceptions.

Readmission Rates and Their Impact on Hospital Financial Performance: A Study of Washington Hospitals.

This longitudinal study examines whether readmission rates, made transparent through Hospital Compare, affect hospital financial performance by examining 98 hospitals in the State of Washington from 2012 to 2014. Readmission rates for acute myocardial infarction (AMI), pneumonia (PN), and heart failure (HF) were examined against operating revenues per patient, operating expenses per patient, and operating margin. Using hospital-level fixed effects regression on 276 hospital year observations, the analysis indicated that a reduction in AMI readmission rates is related with increased operating revenues as expenses associated with costly treatments related with unnecessary readmissions are avoided. Additionally, reducing readmission rates is related with an increase in operating expenses. As a net effect, increased PN readmission rates may show marginal increase in operating margin because of the higher operating revenues due to readmissions. However, as readmissions continue to happen, a gradual increase in expenses due to greater use of resources may lead to decreased profitability.

Social identity and the prison health worker: Implications for practitioner satisfaction and turnover intentions.

BACKGROUND: Delivering health care within the prison walls poses distinct and arduous challenges to the practitioner. Correctional health workers regularly face issues of overcrowding, increased prevalence of infectious disease, advancing age, deteriorating conditions, and patients with an inclination for violence. Still, regardless of the sizeable workforce, costs, and impact on community well-being, correctional health is often overlooked in health services delivery research. PURPOSE: The aim of this study was to better understand the unique nature of delivering services in the prison context through the lens of social identity theory and further explore practitioner satisfaction and retention. METHODOLOGY/APPROACH: A survey design was used in this study, sampling clinicians in a state department of corrections in the United States. Using the data from 317 respondents, the study explored the relationship between professional identification and perceived organizational support as they impact job satisfaction and turnover intention and while controlling for burnout. RESULTS: Using nested ordinary least squares regression and nested logistic regression, the results showed that professional identification and perceived organizational support were positively associated with job satisfaction. Perceived organizational support was negatively and significantly related to turnover intentions. CONCLUSION: This article adds originality and value to the literature by using social identity theory to address the occupational perceptions of a large, yet often underrepresented and underexplored, subsector of the health workforce. PRACTICE IMPLICATIONS: The results highlight several areas where health care managers, whether from correctional or noncorrectional environments, could implement policy and procedure changes to further engage and retain the clinical workforce. To engage and retain the health worker population, managers must consider identification-reinforcing interventions that align with the self-concept and visibly display gestures of organizational support.

Finding meaningful work in difficult circumstances: A study of prison healthcare workers.

Prisons are rigidly structured institutions housing-in some cases-violent and unstable residents. To discover the positive job attributes and perceived challenges in this extreme practice environment, we employed exploratory qualitative content analysis on the written-in responses of 269 prison health workers in one state's Department of Corrections. Two researchers independently analyzed and coded the data. Using an iterative process, we categorized the responses into themes and critical underlying meanings. Positive job attributes included meaningful work, stability, variety of ailments treated, and feelings of support. Perceived challenges included ineffective leadership, constraints on the ability to effectively execute the role, perceived inequity, and organizational culture. The results of our study suggest that there are lessons to be learned from correctional health workers that could inform policy and management outside of the prison walls specifically as it pertains to motivating and engaging providers through meaningful work. Specifically, health organizations would improve the experience of their clinicians by offering a broader scope of practice experience, schedule stability, reducing bureaucratic redundancies, and-ultimately-restoring the sense of purpose within the work itself.

Voice of the Clinician: the case of an Australian health system.

Purpose The Voice of the Clinician project commenced during an era when practitioner burnout, dissatisfaction, and turnover became an increasingly global health workforce concern. One key problem is clinical staff not being empowered to voice their concerns to decision-makers, as was found in this case study of an Australian public health organization. The following research question informed the present study: What is a better committee system for clinician engagement in decision-making processes? The paper aims to discuss this issue. Design/methodology/approach The Mid North Coast Local Health District in New South Wales aspired to improve engagement between frontline clinicians and decision-makers. Social network analysis methods and mathematical modeling were used in the discovery of how committees are connected to each other and subsequently to other committee members. Findings This effort uncovered a hidden organizational architecture of 323 committees of 926 members which overall cost 84,729 person hours and AUD$2.923 million per annum. Furthermore, frontline clinicians were located far from centers of influence, just 37 percent of committees had terms of reference, and clinicians reported that meeting agendas were not being met. Practical implications In response to the findings, a technological platform was created so that the board of directors could visually see all the committees and the connections between them, thus creating ways to further improve communication, transparency of process, and - ultimately - clinician engagement. Originality/value The breakthrough idea is that all organizational meetings can be seen as a system of engagement and should be analyzed to determine and describe the points and pathways where clinician voice is blocked.

Journey Toward Evidence-Based Status: Seeking Admission to Formal Program Registries.

In the past two decades, evidence-based status has been a coveted credential for many nonprofit organizations hoping to legitimize their programs or interventions. Several formal registries exist to provide a collection of health and prevention programs evaluated by experts and deemed "evidence-based." While registries offer positive benefits like allowing for a centralized listing of approved programs, there have been concerns about issues pertaining to the process of obtaining the evidence-based credential. Namely, some of the criticisms include the use of inappropriate study designs, the lack of consistent evaluation of evidence provided in support of programs, as well as program creators being involved in the evaluation that ultimately shows positive program effects. Using focus groups of prevention specialists, this study explores the quest for evidence-based status. The results show themes of vindication, acting as a resource, and perceptions of relevant others informing the deeper meaning of motivation for pursuit of evidence-based status. Additionally, emergent themes of program iteration and evolution inform program preparation. The article shows that while placement on an evidence-based registry is a highly sought-after achievement, many program creators fail to understand the evaluation process for admittance as well as the potential criticisms of the lists.