Reliability and Validity of a Further Tested Appreciative Management Scale.

BACKGROUND AND PURPOSE: Managers need evidence-based methods to evaluate their management skills. To further test the appreciative management scale (AMS 1.0) to create a practical instrument to be used in evaluating appreciative management. METHODS: For further testing, a new survey was conducted among social and healthcare managers (n = 734) in Finland. Confirmatory factor analysis (CFA) was used to assess the scale validity and Cronbach's alpha coefficients the internal consistency. RESULTS: The validated AMS 2.0 scale includes 24 items. The values measuring validity and reliability were good, with an Rool Mean Square Error of Approximation (RMSEA) of 0.072, Average Variance Extracted (AVE) values between 0.532 and 0.634, and Composite Reliability (CR) values ranging between 0.850 and 0.914. The Cronbach's alpha of the whole scale was 0.944. CONCLUSIONS: AMS 2.0 is a reliable and valid means to measure appreciative management as proved by confirmatory factor analysis.

An assessment of management competencies for primary health care managers in Timor-Leste.

BACKGROUND: This study aims to assess the levels of management competencies of primary health care (PHC) managers in Timor-Leste. Timor-Leste is a young country. It has made important improvements in reconstructing its health system since its independence in 2002. However, most managers still learn through their failures, and few studies have described the perceptions of managers in Timor-Leste. METHODS: This study used quantitative methods, using a cross-sectional survey involving a structured self-administered questionnaire. The Cochran formula was used in calculating the sample size. The sample included 183 PHC managers in Timor-Leste. Stratified random sampling was adopted to conduct the survey. The researcher used confirmatory factor analysis (CFA) to confirm the validity and reliability of the tools and create new dimensions. The data were analyzed using the frequency and percentage. RESULTS: This study was initially designed to include seven dimensions, but after confirming it using the CFA, it was reduced to six dimensions. The result of CFA was used. This study found that PHC managers in Timor-Leste had rated themselves "not competent" in knowing the organization, professionalism in the workplace, problem solving on financial management, and effective leadership and only "competent" in managing human resources and communicating effectively. CONCLUSION: This study determined that policy makers and stakeholders must give more attention to knowing the organization, professionalism in the workplace, problem solving on financial management, and effective leadership. Managers need to be competent and have various skills to perform managerial functions effectively and efficiently.

What a discursive understanding of interprofessional team meetings might reveal: an exploration of intellectual (learning) disability managers' performances.

Clinical and academic understandings of interprofessional working are focused mainly on individual factors such as knowledge about different professional roles, and organisational opportunities for interprofessional working (IPW). Less research has examined what happens between people at an interactional level, that is, how interprofessional working is conducted in everyday face-to-face interactions in clinical practice. The current paper proposes a discursive framework for understanding what constitutes IPW in interprofessional meetings at this interactional level. Clinical effectiveness meetings held in intellectual (learning) disability services were used as an example site for IPW. The analysis explored how agenda change points were negotiated, appropriate as agenda change points require collaboration (or agreement) between practitioners to progress to the next point The study found changes in agenda points were accomplished by practitioners conjointly through using discursive strategies including closing questions, and resources such as professional identity and laughter. The agenda provided a frame for the institutional order of the meetings, invoking a trajectory towards timely completion. However, this institutional order was at times subordinated to an 'order of concern', which seemed to enable challenges by managers to the meeting Chair and the agenda that demonstrated adherence not only to the procedural nature of the meetings, but also to the needs of service users and the services discussed. We suggest discursive strategies, resources, and both institutional orders, and order of concerns might provide a framework for developing future training and research, that is able to illuminate how IPW might be enacted in face-to-face team meetings.

Development and Validation of the LEADS Scale.

LEADS in a Caring Environment has been adopted as the primary leadership framework by the Canadian Health Leadership Network. This study developed and validated a 20-item behaviourally anchored rating scale to assess the twenty LEADS capabilities. Canadian healthcare employees and support staff (N = 156) were asked to rate their managers using the scale and also completed measures of transformational leadership, job-related affective well-being, and intent to stay for validation purposes. Exploratory factor analysis suggested that the scale was best represented by a single factor structure. A shorter five-item scale was also developed and tested based on factor loadings. Internal consistency of both tools was high (α ≥ 0.96) and results supported their criterion validity for predicting turnover intentions and job-related affective well-being and convergent validity with a measure of transformational leadership.

Validation of a management competency assessment tool for health service managers.

Purpose The purpose of this paper is to report on the validation of a management competency assessment tool for health services managers (HSM), which resulted from the development and validation of the framework, addressed by a previous paper. Design/methodology/approach The management competency assessment tool (MCAP Tool) was validated using assessment data from a sample of 117 senior and middle managers working in two public hospitals and five community services in Victoria, Australia. The assessments were conducted between January 2013 and September 2014. Findings Both validity and reliability of the MCAP Tool were demonstrated. Practical implications The MCAP Tool has the potential to assist in the measurement of the competencies of HSM. Further research is required to determine if the framework and tool are applicable to HSM in other settings. Originality/value This is the first published study outlining the validity and reliability of an assessment tool to measure the management competencies of Australian health service managers.

Healthy lifestyle behaviours for people with intellectual disabilities: An exploration of organizational barriers and enablers.

BACKGROUND: The health-related behaviours of people with intellectual disabilities may be determined by organisational influences. This innovative study aimed to explore managers' and staffs' perspectives on organisational influences on the promotion of healthy behaviours for this population. METHOD: A qualitative methodology was employed. Four focus groups with staff and eleven telephone interviews with managers were undertaken across three residential services in one region (Northern Ireland) of the UK. Transcripts were analysed thematically. FINDINGS: The organisations involved in this study did not have the cultural ethos or capacity to sustain consistent support for staff involvement in health promotion. Organisational support and outcome-focused strategies are recommended for encouraging staff involvement in health promotion activities. CONCLUSION: These findings have implications for some organisations that support people with intellectual disabilities in improving the way they facilitate health promotion. They highlight the need for organisational cultures to facilitate knowledge translation and embrace evidence-based health promotion interventions.

Validation of the Implementation Leadership Scale (ILS) with Supervisors' Self-Ratings.

Although often discussed, there is a lack of empirical research on the role of leadership in the management and delivery of health services. The implementation leadership scale (ILS) assesses the degree to which leaders are knowledgeable, proactive, perseverant, and supportive during evidence-based practice (EBP) implementation. The purpose of this study was to examine the psychometric properties of the ILS for leaders' self-ratings using a sample of mental health clinic supervisors (N = 119). Supervisors (i.e., leaders) completed surveys including self-ratings of their implementation leadership. Confirmatory factor analysis, reliability, and validity of the ILS were evaluated. The ILS factor structure was supported in the sample of supervisors. Results demonstrated internal consistency reliability and validity. Cronbach alpha's ranged from 0.92 to 0.96 for the ILS subscales and 0.95 for the ILS overall scale. The factor structure replication and reliability of the ILS in a sample of supervisors demonstrates its applicability with employees across organizational levels.

SIMULATION DIRECTORS AS IMPROVEMENT LEADERS.

Physician leaders who oversee simulation labs play vital roles in the advancement of efficiency and effectiveness of their organizations.

Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout.

These are challenging times for health care executives. The health care field is experiencing unprecedented changes that threaten the survival of many health care organizations. To successfully navigate these challenges, health care executives need committed and productive physicians working in collaboration with organization leaders. Unfortunately, national studies suggest that at least 50% of US physicians are experiencing professional burnout, indicating that most executives face this challenge with a disillusioned physician workforce. Burnout is a syndrome characterized by exhaustion, cynicism, and reduced effectiveness. Physician burnout has been shown to influence quality of care, patient safety, physician turnover, and patient satisfaction. Although burnout is a system issue, most institutions operate under the erroneous framework that burnout and professional satisfaction are solely the responsibility of the individual physician. Engagement is the positive antithesis of burnout and is characterized by vigor, dedication, and absorption in work. There is a strong business case for organizations to invest in efforts to reduce physician burnout and promote engagement. Herein, we summarize 9 organizational strategies to promote physician engagement and describe how we have operationalized some of these approaches at Mayo Clinic. Our experience demonstrates that deliberate, sustained, and comprehensive efforts by the organization to reduce burnout and promote engagement can make a difference. Many effective interventions are relatively inexpensive, and small investments can have a large impact. Leadership and sustained attention from the highest level of the organization are the keys to making progress.

Residents in difficulty: a mixed methods study on the prevalence, characteristics, and sociocultural challenges from the perspective of residency program directors.

BACKGROUND: The majority of studies on prevalence and characteristics of residents in difficulty have been conducted in English-speaking countries and the existing literature may not reflect the prevalence and characteristics of residents in difficulty in other parts of the world such as the Scandinavian countries, where healthcare systems are slightly different. The aim of this study was to examine prevalence and characteristics of residents in difficulty in one out of three postgraduate medical training regions in Denmark, and to produce both a quantifiable overview and in-depth understanding of the topic. METHODS: We performed a mixed methods study. All regional residency program directors (N = 157) were invited to participate in an e-survey about residents in difficulty. Survey data were combined with database data on demographical characteristics of the background population (N = 2399) of residents, and analyzed statistically (Chi-squared test (Χ (2)) or Fisher's exact test). Secondly, we performed a qualitative interview study involving three focus group interviews with residency program directors. The analysis of the interview data employed qualitative content analysis. RESULTS: 73.2 % of the residency program directors completed the e-survey and 22 participated in the focus group interviews. The prevalence of residents in difficulty was 6.8 %. We found no statistically significant differences in the prevalence of residents in difficulty by gender and type of specialty. The results also showed two important themes related to the workplace culture of the resident in difficulty: 1) belated and inconsistent feedback on the resident's inadequate performance, and 2) the perceived culturally rooted priority of efficient patient care before education in the workplace. These two themes were emphasized by the program directors as the primary underlying causes of the residents' difficulty. CONCLUSIONS: More work is needed in order to clarify the link between, on the one hand, observable markers of residents in difficulty and, on the other hand, immanent processes and logics of practice in a healthcare system. From our perspective, further sociological and pedagogical investigations in educational cultures across settings and specialties could inform our understanding of and knowledge about pitfalls in residents' and doctors' socialization into the healthcare system.

Quality of care and long-term care administrators' education: does it make a difference?

BACKGROUND: Long-term care administrators (administrators) can influence the care nursing home residents receive. However, little research has examined what factors of administrators are associated with how they influence care. PURPOSES: In this research, the association between administrators' education and quality of nursing home care is examined. In addition, the association between state educational and training requirements and quality of nursing home care is examined. METHODOLOGY: Information collected from 3,941 administrators was matched with secondary data, including Nursing Home Compare; the Online Survey, Certification and Reporting data; and the Area Resource File. The quality indicators restraint use, catheter use, inadequate pain management, low-risk residents with pressure ulcers, and high-risk residents with pressure ulcers were examined. FINDINGS: Positive, statistically significant associations were found between the education level of administrators and all five quality indicators. Likewise, positive statistically significant associations were found between state educational requirements and state training requirements and the five quality indicators. PRACTICE IMPLICATIONS: If these associations hold true, then promoting further educational attainment of individual administrators may influence quality of care. The state educational requirements and training requirements for administrators' licensure may represent an additional means of influencing the quality of care in nursing homes.

Healthcare managers in negative media focus: a qualitative study of personification processes and their personal consequences.

BACKGROUND: Over the last decade healthcare management and managers have increasingly been in focus in public debate. The purpose of the present study was to gain a deeper understanding of how prolonged, unfavorable media focus can influence both the individual as a person and his or her managerial practice in the healthcare organization. METHODS: In-depth interviews (n = 49) with 24 managers and their superiors, or subordinate human resources/information professionals, and partners were analyzed using a grounded theory approach. RESULTS: The conceptual model explains how perceived uncertainties related to the managerial role influence personification and its negative consequences. The role ambiguities comprised challenges regarding the separation of individual identity from the professional function, the interaction with intra-organizational support and political play, and the understanding and acceptance of roles in society. A higher degree of uncertainty in role ambiguity increased both personification and the personal reaction to intense media pressure. Three types of reactions were related to the feeling of being infringed: avoidance and narrow-mindedness; being hard on self, on subordinates, and/or family members; and resignation and dejection. The results are discussed so as to elucidate the importance of support from others within the organization when under media scrutiny. CONCLUSIONS: The degree of personification seems to determine the personal consequences as well as the consequences for their managerial practice. Organizational support for managers appearing in the media would probably be beneficial for both the manager and the organization.

Leadership in academic health centers in the US: a review of the role and some recommendations.

The leadership of the US's most complex academic health centers (AHCs)/medical centers requires individuals who possess a high level of clinical, organizational, managerial, and interpersonal skills. This paper first outlines the major attributes desired in a dean/vice president of health affairs before then summarizing the educational opportunities now generally available to train for such leadership and management roles. For the most part, the masters in health administration (MHA), the traditional MBA, and the numerous alternatives primarily available at universities are considered far too general and too lacking in emotional intelligence tutoring to be particularly relevant for those who aspire to these most senior leadership positions. More appropriate educational options for these roles are discussed: (a) the in-house leadership and management programs now underway at some AHCs for those selected early on in their career for future executive-type roles as well as for those who are appointed later on to a chair, directorship or similar position; and (b) a more controversial approach of potentially establishing at one or a few universities, a mid-career, professional program (a maximum of 12 months and therefore, being completed in less time than an MBA) leading to a masters degree in academic health center administration (MHCA) for those who aspire to fill a senior AHC leadership position. The proposed curriculum as outlined herein might be along the lines of some carefully designed masters level on-line, self-teaching modules for the more technical subjects, yet vigorously emphasizing integrate-type courses focused on enhancing personal and professional team building and leadership skills.

Nursing home administrator self-assessed preparedness.

BACKGROUND: Nursing home administrators (NHAs) are in key positions to improve nursing home quality. NHAs require state-level licensure, which involves passing a national NHA licensure examination and fulfilling state-level licensure requirements that vary widely across states. With multiple pathways to NHA licensure, little is known about NHAs' preparation and training to meet the complex demands of this position. PURPOSE: The aim of this study was to explore NHAs' self-assessed person-job fit based on NHAs' self-rated preparedness and the importance of the activities that supported their preparation. METHODOLOGY/APPROACH: A descriptive cross-sectional design was used to collect data from NHAs (N = 175) randomly recruited from nursing homes in five states, with a mailed self-administered questionnaire. Data analysis included descriptive statistics, correlations, and t tests/ANOVA. FINDINGS: Thirty percent of respondents reported they were well prepared, overall, for their first NHA position. The findings suggest NHA preferences for more formalized ways to develop their entry-level competencies, with lower preference for On-the-job training, Previous job experience, and Self-study and higher preference for Administrator-in-training, Bachelor's degree programs, and Mentoring. PRACTICE IMPLICATIONS: There is an urgent need for NHAs who are well prepared to effectively address our nation's mandates for nursing home quality improvement. With multiple pathways to NHA licensure, this exploratory study provides initial insights about NHAs' self-assessed preparation and training. The findings suggest that NHAs prefer more formalized ways to prepare for the NHA position. Research is needed to identify specific teaching/learning practices and on-the-job training that maximize the NHAs' preparation to meet their job demands.

Development of a culture of sustainability in health care organizations.

PURPOSE: This paper aims to examine the concept of sustainability in health care organizations and the key managerial competencies and change management strategies needed to implant a culture of sustainability. Competencies and management development strategies needed to engrain this corporate culture of sustainability are analyzed in this document. DESIGN/METHODOLOGY/APPROACH: This paper draws on the experience of the authors as health care executives and educators developing managerial competencies with interdisciplinary and international groups of executives in the last 25 years, using direct observation, interviews, discussions and bibliographic evidence. FINDINGS: With a holistic framework for sustainability, health care managers can implement strategies for multidisciplinary teams to respond to the constant change, fine-tune operations and successfully manage quality of care. Managers can mentor students and provide in-service learning experiences that integrate knowledge, skills, and abilities. RESEARCH LIMITATIONS/IMPLICATIONS: Further empirical research needs to be conducted on these interrelated innovative topics. PRACTICAL IMPLICATIONS: Health care organizations around the world are under stakeholders' pressure to provide high quality, cost-effective, accessible and sustainable services. Professional organizations and health care providers can collaborate with university graduate health management education programs to prepare competent managers in all the dimensions of sustainability. SOCIAL IMPLICATIONS: The newly designated accountable care organizations represent an opportunity for managers to address the need for sustainability. ORIGINALITY/VALUE: Sustainability of health care organizations with the holistic approach discussed in this paper is an innovative and practical approach to quality improvement that merits further development.