Causes & Consequences of Health Care CEO Turnover in Australia and Retention Strategies: A Qualitative Study.

It has been highlighted the increasing CEO turnover is a major issue for Australian and international health care organizations. Some of the negative consequences of CEO turnover includes organizational instability, high financial costs, and affecting patient care. On average, CEOs leave their role within 1 to 2 years after commencement, which can be detrimental to the hospital's overall functioning. Therefore, this study aims to identify the causes and consequences of increasing CEO turnover in health care, so retention strategies could be devised. Fourteen hospital CEOs across Australia were interviewed online to answer 5 open ended questions related to qualities of a CEO, challenges of the CEO role, Causes and consequences of increasing CEO turnover and recommendation for CEOs retention. Interviews followed a semi-structured schedule to prompt discussion in relation to the above. The study has identified that CEOs possess certain qualities such as self-awareness, leadership style, resilience that enable them to perform their role well. Challenges of this role such as COVID-19, managing organizational change staff management has been found and discussed. Broadly, causes have been divided into 5 major categories such as Organization, Performance, Pressure, Personal and Health reform. It was found that increasing CEO turnover can be damaging to the hospital, not just the staff and patients suffer but the surrounding community gets adversely affected. To minimize CEO turnover, it was suggested that the board needs to support their CEO by advocating and investing in organizational culture and leadership programs. The findings of this study aid, the board with certain strategies through which CEO can be supported. CEOs made certain recommendations in this study to minimize the turnover which can make such a big impact on health care as this may lead to better functioning hospitals in Australia. Moreover, these strategies could be used internationally to help them CEOs retain in their position.

Training needs assessment of hospital CEOs in a developing country: the example of Iran.

BACKGROUND: It is essential to identify the necessary competencies of hospital CEOs in order to improve the quality and efficiency of services they provide. Expert leadership skills and competencies can have a significant impact on the success of an organization, benefiting both patients and staff. This study aimed to assess the competencies and training needs of hospital CEOs in Iran public hospitals. METHODS: We conducted this cross-sectional analytical study through a self-assessment questionnaire, which was a web-based platform developed by the WHO country office in Iran, between July 2018 and September 2018. The questionnaire was completed by 180 hospital CEOs and included a core set of 81 items based on Assessing the Competency of Hospital CEO. These items were categorized into five superordinate categories: leadership, personality and quality of individual behavior, knowledge and business skills, social responsibility, and healthcare environment. In addition, we conducted focus groups with 30 hospital CEOs, supervisor assessments with 10 hospital managers, and interviews with 10 supervisors. RESULTS: Of the 180 questionnaires distributed, 78% were returned, and most respondents were medical specialists. The need for leadership competencies such as individual behavior skills and change management received the highest priority. Most respondents required training in management skills, including financial management, governance, strategic thinking, quality improvement, and disaster management. CONCLUSION: Providing needs-based education is crucial, especially in developing countries. In this study, leadership and strategic thinking were found to be the most needed competencies among hospital CEOs in Iran. These findings serve as reference points for developing countries with similar backgrounds and healthcare environments as Iran.

Few Primary Care Physicians Lead Hospitals, Despite Their Immense Value: Systems Change and Delivery System Evolution Can Reverse This Trend.

Primary care physicians (PCPs) inherently offer a tremendous range of skills that would serve them well as chief executive officers in hospitals. Despite their immense value, very few serve in these top posts for a variety of reasons. Making changes in how we train, mentor, and support PCPs throughout their careers can reverse this trend.

Comparison of Quality Measures From US Hospitals With Physician vs Nonphysician Chief Executive Officers.

Importance: Patient experience and patient safety are 2 major domains of health care quality; however empirical data on the association of physician vs nonphysician chief executive officers (CEOs) with public and private quality measures are rare but critical to evaluate as hospitals increasingly seek out physician CEOs. Objectives: To evaluate whether there is an association of CEO background with hospital quality and to investigate differences in hospital characteristics between hospitals with a physician CEO vs those with a nonphysician CEO. Design, Setting, and Participants: This cross-sectional study used 2019 data from 3 sources (ie, the American Hospital Association [AHA] Annual Survey, the Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS], and the Leapfrog Hospital Safety Grades) to identify statistical differences in hospital characteristics and outcomes. Data were analyzed from April to December 2021 . Main Outcomes and Measures: Multivariable ordinal logistic regression was used to examine the association of physician CEOs with hospital quality assessment outcomes while controlling for other confounding factors. Characteristics from the AHA Annual Survey database were assessed as potential confounders, including hospital control, bed size, region, teaching status, and patient volume. Results: The AHA database contained 6162 hospitals; 1759 (29%) had HCAHPS ratings, 1824 (30%) had Leapfrog grades, and 383 (6%) had physician CEOs. A positive Spearman correlation coefficient was found between physician CEOs and HCAHPS patient willingness to recommend the hospital (ρ = 0.0756; P = .002), but the association between CEO medical background and Leapfrog safety grades or HCAHPS ratings did not reach a level of significance in the multivariable ordinal logistic regression models. Conclusions and Relevance: In this study, a positive correlation was found between physician CEOs and HCAHPS patient willingness to recommend the hospital, but the multivariable analysis did not find an association between hospital physician CEOs and the examined quality and safety outcomes.

Dealing with pluralism: the managerial work of CEOs in Italian public healthcare organizations.

BACKGROUND: Healthcare organizations are extremely complex. The work of their CEOs is particularly demanding, especially in the public sector, though little is known about how the managerial work of a healthcare organization CEO unfolds. Drawing from scholarship on managerial work and management in pluralistic organizations, we sought to answer the questions: What is the content of managerial work of CEOs in public healthcare in Italy? How do healthcare CEOs perform their managerial work in complex interactions with multiple stakeholders? METHODS: For this study we adopted a multi-method approach in which we conducted a survey to investigate CEO behaviors, tracked CEO working time for 4 weeks, and conducted semi-structured interviews with senior CEOs. RESULTS: CEOs in public healthcare devote most of their time to interaction, which half of which is perceived as being occupied with apparently mundane problems. Nonetheless, devoting time to such activities is functional to a CEO's goals because change in pluralistic contexts can be achieved only if the CEO can handle the organization's complexity. CEOs do this by engaging in routines and conversations with professionals, creating consensus, and establishing networks with external stakeholders. CONCLUSIONS: CEOs are called to reduce fragmentation and foster cooperation across disciplines and professional groups, with the overarching aim to achieve integrated care. Using an analytical approach we were able to take into account the context and the relational dimension of the managerial work of healthcare CEOs and the specificities of this role. TRIAL REGISTRATION: This article does not report the results of a healthcare intervention on human participants, and the material used in the research did not require ethical approval according to Italian law.

What do nonprofit hospitals reward? An examination of CEO compensation in nonprofit hospitals.

Nonprofit hospital chief executive officer (CEO) compensation has received considerable attention in light of nonprofits' tax-favored status as well as the high costs of hospital care. Past studies have found that hospital financial performance is a significant determinant of CEO pay but nonprofit performance, including quality and charity care, are not. Using post-ACA data, we re-examine whether a variety of hospital performance measures are important determinants of nonprofit hospital CEO compensation. We found mixed evidence with respect to the significance of the association between financial performance and uncompensated care and CEO compensation. Among the other nonprofit performance measures, patient satisfaction was significantly associated with CEO compensation, but other measures were not significant determinants of CEO compensation. Our results suggest nonprofit hospitals balance their financial health against their mission when setting CEO incentives. Additional policy targeting transparency in hospital CEO compensation may be warranted to help policymakers understand the specific factors used by hospital boards to incentivize CEOs.

Gender differences in paediatric hospital chief executive officer compensation.

Though there is a well-established gender pay gap in medicine, studies on compensation disparities between women and men chief executive officers (CEO) showed mixed results. We conducted a cross-sectional study of children's hospitals in the USA to evaluate whether CEO gender was associated with compensation differences. Nine out of 31 children's hospitals employed a female CEO. There was no significant difference between men and women CEOs in terms of hospital characteristics (location, size or ranking in US News and World report) or CEO characteristics (advanced degrees, tenure or compensation). Gender was not associated with significant differences in CEO compensation.

Reported Clinical and Financial Performance of Hospitals With Physician CEOs Compared to Those With Nonphysician CEOs.

EXECUTIVE SUMMARY: Little work has been done comparing the performance of hospitals with physician CEOs versus nonphysician CEOs, despite the ease of identifying this characteristic and extant leadership theories suggesting a relationship between technical expertise and success in leading highly technical organizations. We performed a detailed analysis of several widely accepted measures of clinical and financial performance across a randomly selected group of U.S. acute care hospitals with more than 40 beds and found no statistically significant differences between the two groups. The 30-day acute myocardial infarction mortality rate showed a positive statistically significant difference in the bivariate analysis (p < .001), but the effect was nullified in the multivariable regression analysis.

Long-Term Care Nurse Leaders Find Calm in Chaos: Reflections from a CEO during a Global Pandemic.

Loch Lomond Villa is one of the largest long-term care communities within the province of New Brunswick. Our organization supports caring living environments for over 450 clients and their family members along with 354 employees.

Análise do discurso dos gestores do Programa de Controle da Hanseníase / Speech analysis of the managers of leprosy control program

Objetivo: analisar o discurso dos gestores do Programa Nacional de Controle da Hanseníase (PNCH). Método: estudo descritivo, qualitativo, de abordagem discursiva. Os coordenadores dos pólos da PNCH do Rio Grande do Norte (RN), os coordenadores regionais e o coordenador estadual compuseram a população, foram incluídos aqueles com vínculo com o serviço por pelo menos seis meses, 12 gestores foram considerados adequados como amostra. O material empírico, coletado de novembro de 2015 a junho de 2016, foi analisado por meio da análise do discurso. Resultados: os enunciadores construíram discursos em torno de dois eixos: a questão dos médicos, com ênfase no centro de atenção à saúde, e a questão da gestão, apoiada nos princípios burocráticos com componentes legados do regime autoritário, tendo, ambos os eixos, influência do modelo sanitarista/ativista. Conclusão: entende-se que o PNCH pode melhorar a partir da profissionalização da gestão e da ênfase na promoção da saúde e no trabalho em equipe. (AU)

Objective: This study aimed to analyze the discourse of the managers of the National Leprosy Control Program (NLCP). Method: a descriptive and qualitative study with a discursive approach.The coordinators of the NLCP host cities of Rio Grande do Norte, the regional coordinators and the state coordinator composed the population, witch included those with bond to the service for at least six months, 12 managers were considered suitable as a sample. The empirical material, collected from November 2015 to June 2016, was investigated through discourse analysis. Results: The enunciators built speeches around two axes: the subject of the phisicyans, emphasizing the center of Health Care, and the subject of management, supported by the bureaucrats principles with legacy components of the authoritarian regime, with both axes having influence of the sanitary/activist model. Conclusion: It is understood that the NLCP can improve from the professionalization of management and the emphasis on health promotion and teamwork. (AU)

Objetivo: Este estudio tuvo como objetivo analizar el discurso de los gerentes del Programa Nacional de Control de la Lepra (PNCL). Método: estudio descriptivo e cualitativo con enfoque discursivo. Los coordinadores de las ciudades sede del PNCL en Rio Grande do Norte (RN), los coordinadores regionales y el coordinador estatal componían la población, se incluyeron aquellos con vínculos al servicio durante al menos seis meses, 12 gerentes se consideraron adecuados como muestra. El material empírico, recopilado desde noviembre de 2015 hasta junio de 2016, fue investigado mediante análisis del discurso. Resultados: Los enunciadores formularon discursos en torno a dos ejes: la cuestión de los médicos, con énfasis en el centro de atención de la salud, y la cuestión de la gestión, respaldada por principios burocráticos con componentes heredados del régimen autoritario, con ambos ejes influenciados por el modelo sanitario/activista. Conclusión: Se entiende que el PNCL puede mejorar en función de la profesionalización de la gestión y el énfasis en la promoción de la salud y el trabajo en equipo. (AU)

Are community health centers' chief executive officers' compensation related to clinical performance?

BACKGROUND: Most research of chief executive officer (CEO) compensation in the health care industry has been limited to hospitals. This study expands our knowledge of CEO compensation into the nonhospital areas of the industry, specifically community health centers (CHCs). CHCs are safety-net providers that are an integral part of the U.S. health delivery system for medically underserved populations. Since the passage of the Patient Protection and Affordable Care Act, the federal government has created financial incentives for CHCs to improve care through access and quality performance criteria. To promote quality improvement, CEOs need to set their organization's priorities. One method used to achieve this goal is to tie the CEO's compensation to the organization's quality performance. However, there is a gap in our knowledge if CHCs' CEOs compensation is associated with quality performance outcomes. PURPOSE: The primary aim of this study was to examine the relationship between clinical performance and CEO compensation in CHCs. METHODS/APPROACH: Agency, social comparison, and managerial power theories guided this research, which examines the relationship of clinical performance and CEO compensation. Secondary data on Uniform Data System's CHC clinical performance combined with CEO compensation from Internal Revenue Service Form 990 were analyzed using generalized estimating equations with state and year fixed effects on a national sample of section 330 grant-funded CHCs (N = 984) for the period 2011-2016. RESULTS: We found no evidence that clinical performance was associated with CHCs' CEO compensation. Except for race, all other CEO characteristics were positively associated with CEO compensation and in line with previous research. We found that non-White CEOs were compensated more than White CEOs. In addition, further subanalyses revealed that an increase in the highest paid employees' compensation was associated with an increase in CEO compensation. PRACTICE IMPLICATIONS: The findings of this study can assist Health Resources and Services Administration improve its assessment policies in funding allocation to CHCs, as well as help board members make informed decisions regarding tying CEO compensation to predetermined performance metrics.