Executive Involvement in Governing Boards and Hospital and Health System Performance.

Governing boards and executive leaders play important roles ensuring that their organizations work toward their missions and maintain their visions, while also meeting compliance and performance goals. The level of executive involvement in hospital governing boards varies across organizations, with little evidence to suggest whether and to what degree executive involvement influences hospital performance. The aim of this study is to determine the influence of executive involvement in governance on health system performance. The sample analyzed in this study were organizations responding to The Governance Institute's (TGI) Biennial Survey of Hospital and Health Systems in 2017. Bivariate and multivariate analyses were used to examine associations between self-reported executive leadership team involvement in governing boards and a composite metric of health system performance calculated by Truven Analytics as part of the "Top 100" program. Results indicate executive involvement is associated with several organizational characteristics, including whether an institution was defined as a hospital or health system, whether or not the board was appointed by the parent/system, and whether the board was accountable to the parent/system board. Although no significant direct relationship was found between executive team involvement in governance and overall health system performance, several promising pathways for future study were identified and are discussed, including examining specific organizational performance outcomes rather than composite measures.

Impact of Inpatient Unit Design Features on Overall Patient Experience and Perceived Room-Level Call Button Response.

This study explores the relationship between inpatient unit design and patient experience and how spatial features and visibility impact patients' perception of staff responsiveness. The first part of this study is a retrospective pre-post and cross-sectional study evaluating the impacts of unit design on patient experience at the unit level. This study compares patient experiences based on Press Ganey and HCAHPS surveys in two orthopedic units (existing unit in Atrium building and new unit in Tower) with differing design features at Rush University Medical Center. The chi-square test results show that when moving from the old orthopedic unit to the new unit, almost all patient survey items related to patient experience showed statistically significant improvements. The second part of this study is a room level on the new unit. The ANOVA and Pearson correlation tests revealed that the visibility measure of metric step depth had significant impacts on patients' perception of staff's "promptness in responding to call button" and "help with toileting". This study confirms that inpatient unit design plays a direct role in improvement for patient experience and should be considered as an important area of focus for future development.

Spinal Surgeon Variation in Single-Level Cervical Fusion Procedures: A Cost and Hospital Resource Utilization Analysis.

STUDY DESIGN: Retrospective analysis. OBJECTIVE: To compare perioperative costs and outcomes of patients undergoing single-level anterior cervical discectomy and fusions (ACDF) at both a service (orthopedic vs. neurosurgical) and individual surgeon level. SUMMARY OF BACKGROUND DATA: Hospital systems are experiencing significant pressure to increase value of care by reducing costs while maintaining or improving patient-centered outcomes. Few studies have examined the cost-effectiveness cervical arthrodesis at a service level. METHODS: A retrospective review of patients who underwent a primary 1-level ACDF by eight surgeons (four orthopedic and four neurosurgical) at a single academic institution between 2013 and 2015 was performed. Patients were identified by Diagnosis-Related Group and procedural codes. Patients with the ninth revision of the International Classification of Diseases coding for degenerative cervical pathology were included. Patients were excluded if they exhibited preoperative diagnoses or postoperative social work issues affecting their length of stay. Comparisons of preoperative demographics were performed using Student t tests and chi-squared analysis. Perioperative outcomes and costs for hospital services were compared using multivariate regression adjusted for preoperative characteristics. RESULTS: A total of 137 patients diagnosed with cervical degeneration underwent single-level ACDF; 44 and 93 were performed by orthopedic surgeons and neurosurgeons, respectively. There was no difference in patient demographics. ACDF procedures performed by orthopedic surgeons demonstrated shorter operative times (89.1 ±â€Š25.5 vs. 96.0 ±â€Š25.5 min; P = 0.002) and higher laboratory costs (Δ+$6.53 ±â€Š$5.52 USD; P = 0.041). There were significant differences in operative time (P = 0.014) and labor costs (P = 0.034) between individual surgeons. There was no difference in total costs between specialties or individual surgeons. CONCLUSION: Surgical subspecialty training does not significantly affect total costs of ACDF procedures. Costs can, however, vary between individual surgeons based on operative times. Variation between individual surgeons highlights potential areas for improvement of the cost effectiveness of spinal procedures. LEVEL OF EVIDENCE: 4.

Management Options and Outcomes for Neonatal Hypoplastic Left Heart Syndrome in the Early Twenty-First Century.

Without surgical treatment, neonatal hypoplastic left heart syndrome (HLHS) mortality in the first year of life exceeds 90 % and, in spite of improved surgical outcomes, many families still opt for non-surgical management. The purpose of this study was to investigate trends in neonatal HLHS management and to identify characteristics of patients who did not undergo surgical palliation. Neonates with HLHS were identified from a serial cross-sectional analysis using the Healthcare Cost and Utilization Project's Kids' Inpatient Database from 2000 to 2012. The primary analysis compared children undergoing surgical palliation to those discharged alive without surgery using a binary logistic regression model. Multivariate logistic regression was conducted to determine factors associated with treatment choice. A total of 1750 patients underwent analysis. Overall hospital mortality decreased from 35.3 % in 2000 to 22.9 % in 2012. The percentage of patients undergoing comfort care discharge without surgery also decreased from 21.2 to 14.8 %. After controlling for demographics and comorbidities, older patients at presentation were less likely to undergo surgery (OR 0.93, 0.91-0.96), and patients in 2012 were more likely to undergo surgery compared to those in prior years (OR 1.5, 1.1-2.1). Discharge without surgical intervention is decreasing with a 30 % reduction between 2000 and 2012. Given the improvement in surgical outcomes, further dialogue about ethical justification of non-operative comfort or palliative care is warranted. In the meantime, clinicians should present families with surgical outcome data and recommend intervention, while supporting their option to refuse.

The Relationship Between Work Relative Value Unit Awareness and Work Relative Value Unit Accumulation Among Physicians.

This was a retrospective, cross-sectional study to determine whether a relationship exists between work relative value unit(wRVU) awareness and wRVU accumulation among faculty physicians. Physician wRVU awareness was obtained by a distributed survey to faculty physicians in early 2016. wRVU accumulation was pulled from a faculty productivity database. Productivity data from FY14-FY15 was used to determine wRVU accumulation relative to each respondent's specialty-specific benchmark. Data were analyzed to investigate the nature, of the relationship between awareness and accumulation. The analysis showed that physicians with above-average awareness were significantly more likely to surpass their wRVU benchmark when compared to physicians with below-average awareness. Additionally, wRVU awareness accounted for a significant percentage of the variation in wRVU output. Considering the financial importance of wRVU generation for healthcare organizations, there is a need to devote more time and resources to developing physician awareness of wRVUs.