The role of eLearning in health management and leadership capacity building in health system: a systematic review.

BACKGROUND: Health leadership and management are essential for ensuring resilient health systems. Relevant training opportunities are often scarce, and the use of digital education could help address this gap. Our aim was to assess the effectiveness of eLearning for healthcare leadership and management capacity building. METHODS: We performed a systematic review on the effectiveness of eLearning for health leadership and management training. We also reviewed literature on relevant competencies and training programmes. We conceptualise the role of health leadership and management capacity building in health system strengthening and explore the use of eLearning in this area. RESULTS: No evidence was found on the effectiveness of eLearning for health leadership and management capacity guiding. Evidence on health leadership and management education effectiveness in general is scarce and descriptive and reports learning outcomes. We explore how various forms of eLearning can help meet specific requirements of health leadership and management training. CONCLUSIONS: Literature on the effectiveness of health leadership and management education is scarce. The use of eLearning could support this type of training by making it more accessible and tailored. Future research should be carried out in diverse settings, assume experimental designs, evaluate the use of information technology and report health system outcomes.

Assessing the predictors for training in management amongst hospital managers and chief executive officers: a cross-sectional study of hospitals in Abuja, Nigeria.

BACKGROUND: There is a compelling need for management training amongst hospital managers in Nigeria mostly because management was never a part of the curricula in medical schools and this has resulted in their deficiencies in effective policymaking, planning and bottom line management. There has been no study to the best of our knowledge on the need and likely factors that may influence the acquisition of such training by hospital managers and this in effect was the reason for this study. METHODS: Data for this study came from a cross-sectional survey distributed amongst management staff in twenty five (25) hospitals that were purposively selected. One hundred and twenty five (125) questionnaires were distributed, out of which one hundred and four (104) were answered and returned giving a response rate of 83.2%. Descriptive and Inferential statistics were used to summarize the results. Decisions were made at 5% level of significance. A binary logistic regression was performed on the data to predict the logit of being formally and informally trained in health management. These statistical techniques were done using the IBM SPSS version 20. RESULTS: The result revealed a high level of formal and informal trainings amongst the respondent managers. In formal management training, only few had no training (27.9%) while in informal management training, all had obtained a form of training of which in-service training predominates (84.6%). Most of the administrators/managers also had the intention of attending healthcare management programme within the next five years (62.5%). Socio-demographically, age (p = .032) and academic qualification (p < .001) had significant influence on training. Number of hospital beds (p < .001) and number of staff (p < .001) including managers' current designation (p < .001) also had significant influence on training. CONCLUSION: Our work did establish the critical need for both formal and informal trainings in health management for health care managers. Emphasis on training should be directed at younger managers who are the least likely to acquire such trainings, the smaller and private hospitals who are less likely to encourage such trainings amongst their staff and the least educated amongst health managers.

Opportunities to Improve Informed Consent with AHRQ Training Modules.

BACKGROUND: Informed consent is a process of communication between clinician and patient that results in the patient's decision about whether to undergo a specific intervention. However, patients often do not understand the risks, benefits, and alternatives, even after signing a consent form. METHODS: Mixed-methods pilot test of two Agency for Healthcare Research and Quality (AHRQ) informed consent training modules implemented in four hospitals. Methods included staff and patient surveys, interviews, site visits, and pre- and posttests of the modules. RESULTS: A low proportion of clinicians reported using teach-back (40.0%) or high-quality decision aids (55.0%). Patients reported limited use of best practices, including being asked to teach-back (58.4%), having other options described (54.9%), viewing decision aids (37.4%), and finding the form very easy to understand (66.8%). Content of the training modules aligned well with identified deficiencies. Barriers to completing the modules included staff turnover, competing demands, and lack of accountability. Facilitators included committed champions with available time, motivation, and release time for staff to take modules. Knowledge increased for leaders (p <0.05) and staff (p <0.001) who completed the training modules. Hospitals reported the effects of piloting the modules included fostering dialogue and identifying opportunities for improvements, identifying and rectifying policy ambiguity and noncompliance, reinforcing the use of interpreter services, and using modules' strategies and tools to improve informed consent. CONCLUSION: Many opportunities exist for hospitals to improve their informed consent practices. AHRQ's two training modules, have face validity, addressed demonstrated deficiencies in hospitals' informed consent policies and processes, and stimulated improvement activity in motivated hospitals.

Tailoring an educational program on the AHRQ Patient Safety Indicators to meet stakeholder needs: lessons learned in the VA.

BACKGROUND: Given that patient safety measures are increasingly used for public reporting and pay-for performance, it is important for stakeholders to understand how to use these measures for improvement. The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) are one particularly visible set of measures that are now used primarily for public reporting and pay-for-performance among both private sector and Veterans Health Administration (VA) hospitals. This trend generates a strong need for stakeholders to understand how to interpret and use the PSIs for quality improvement (QI). The goal of this study was to develop an educational program and tailor it to stakeholders' needs. In this paper, we share what we learned from this program development process. METHODS: Our study population included key VA stakeholders involved in reviewing performance reports and prioritizing and initiating quality/safety initiatives. A pre-program formative evaluation through telephone interviews and web-based surveys assessed stakeholders' educational needs/interests. Findings from the formative evaluation led to development and implementation of a cyberseminar-based program, which we tailored to stakeholders' needs/interests. A post-program survey evaluated program participants' perceptions about the PSI educational program. RESULTS: Interview data confirmed that the concepts we had developed for the interviews could be used for the survey. Survey results informed us on what program delivery mode and content topics were of high interest. Six cyberseminars were developed-three of which focused on two content areas that were noted of greatest interest: learning how to use PSIs for monitoring trends and understanding how to interpret PSIs. We also used snapshots of VA PSI reports so that participants could directly apply learnings. Although initial interest in the program was high, actual attendance was low. However, post-program survey results indicated that perceptions about the program were positive. CONCLUSIONS: Conducting a formative evaluation was a highly important process in program development. The useful information that we collected through the interviews and surveys allowed us to tailor the program to stakeholders' needs and interests. Our experiences, particularly with the formative evaluation process, yielded valuable lessons that can guide others when developing and implementing similar educational programs.

Partnering to develop a talent pipeline for emerging health leaders in operations research.

In initiating its first central office for Quality Improvement (QI), The Scarborough Hospital (TSH) sought to accelerate momentum towards achieving its "Quality and Sustainability" strategic priority by building internal capacity in the emerging QI specialty of operations research. The Scarborough Hospital reviewed existing models of talent management in conjunction with Lean and improvement philosophies. Through simple guiding principles and in collaboration with the University of Toronto's Centre for Healthcare Engineering, TSH developed a targeted approach to talent management for Operations Research (OR) in the Office of Innovation and Performance Improvement, reduced the time from staffing need to onboarding, accelerated the development of new staff in delivering QI and OR projects, and defined new structures and processes to retain and develop this group of new emerging health leaders.

Team-Based Learning: A New Approach Toward Improving Education.

 Team-based learning is designed to provide students with both conceptual and procedural knowledge, aiming to enhance active learning and critical thinking. In the present study, team-based learning and lecture methods in teaching the "hospital organization and management" course among hospital management students were compared. This quasi-experimental study was conducted on 25 undergraduate students of management. Teaching sessions were divided into two parts. The first part was taught with interactive lectures and the second part with team-based learning method. The students' knowledge was measured before, immediately and two months (late post-test) after teaching. Finally, the mean scores of the final exam and students' satisfaction towards the methods of teaching were measured. There was an improvement in test scores of the students after the TBL sessions when compared to the test scores after lecture sessions (P<0.001). Also, TBL group had significantly a higher amount of knowledge retention compared to the lecture group (P<0.001), but no significant relationship was found between the mean scores of the final exam in the TBL and lecture groups (P=0.116). Finally, the majority of the respondents were more satisfied with TBL sessions compared to the ones held through lecture (P=0.037). The results indicated that TBL provides a better outcome for students. We found that the TBL approach allowed us to create an active learning environment that contributed to the improvement of the students' performances.

[Learning from the USA Affordable Healthcare Act: The New York 2016 Hospital Executive Study Tour].

From June 27th to July 1st 2016, the International Hospital Federation (IHF) and Health Investment & Financing hosted a Hospital Executive Study Tour in New York City, NY, USA. The objective of the Hospital Executive Study Tour was to enable participant to learn how the US hospital sector addresses some of the key challenges and solutions in transforming the way hospital care is delivered in the 21st Century. The New York Study Tour was part of a series of premier events offered by the IHF. This Study Tour was a collaborative effort among regional members and partner organizations in hosting various events to allow an exchange of ideas, knowledge, experiences and best practices in the delivery of healthcare services, and in the leadership and management of their organizations.

Hospital management training for the Eastern Mediterranean Region: time for a change?

PURPOSE: The WHO Eastern Mediterranean Regional Office has emphasized health system strengthening among the top five strategic priorities. One of the integral elements of health systems are the hospitals. The purpose of this paper is to review the need for formalized training in hospital management to improve the quality of care. DESIGN/METHODOLOGY/APPROACH: Literature review and hands on experience of conducting a regional training in hospital management for Eastern Mediterranean Region (EMR) countries. FINDINGS: Majority of patients in EMR bypass Primary Health Care facilities due to inadequate quality of services and prefer seeking specialized care at a tertiary level. There is mounting evidence of mediocre to poor patient satisfaction due to inefficient health care practices in hospitals of EMR. Strengthening the management capacity of the hospitals through a formal training programme is therefore necessary for improving the performance of health care delivery and the overall health system. Hospital management encompasses hospital planning and operational activities including development and implementation of organizational strategies to ensure adequate numbers and quality of trained human resources and effective financial management, disaster management, health management information system utilization, support services, biomedical engineering, transport and waste management. Such training will prepare health care professionals with leadership skills to deliver quality hospital services. ORIGINALITY/VALUE: This is one of the first papers emphasizing the need for a formal structured regional training in hospital management for the countries of EMR. A modular incremental training approach developing an EMR Credit Transfer and Accumulation system is proposed.

Training hospital managers for strategic planning and management: a prospective study.

BACKGROUND: Training is the systematic acquisition of skills, rules, concepts, or attitudes and is one of the most important components in any organization's strategy. There is increasing demand for formal and informal training programs especially for physicians in leadership positions. This study determined the learning outcomes after a specific training program for hospital management teams. METHODS: The study was conducted during 2006 and 2007 at the Centre School of Public Health and Management, Faculty of Medicine, University of Belgrade and included 107 participants involved in the management in 20 Serbian general hospitals. The management teams were multidisciplinary, consisting of five members on average: the director of the general hospital, the deputy directors, the head nurse, and the chiefs of support services. The managers attended a training program, which comprised four modules addressing specific topics. Three reviewers independently evaluated the level of management skills at the beginning and 12 months after the training program. Principal component analysis and subsequent stepwise multiple linear regression analysis were performed to determine predictors of learning outcomes. RESULTS: The quality of the SWOT (strengths, weaknesses, opportunities and threats) analyses performed by the trainees improved with differences between 0.35 and 0.49 on a Likert scale (p < 0.001). Principal component analysis explained 81% of the variance affecting their quality of strategic planning. Following the training program, the external environment, strategic positioning, and quality of care were predictors of learning outcomes. The four regression models used showed that the training program had positive effects (p < 0.001) on the ability to formulate a Strategic Plan comprising the hospital mission, vision, strategic objectives, and action plan. CONCLUSION: This study provided evidence that training for strategic planning and management enhanced the strategic decision-making of hospital management teams, which is a requirement for hospitals in an increasingly competitive, complex and challenging context. For the first time, half of state general hospitals involved in team training have formulated the development of an official strategic plan. The positive effects of the formal training program justify additional investment in future education and training.

Health care managers learning by listening to subordinates' dialogue training.

PURPOSE: Middle managers in health care today are expected to continuously and efficiently decide and act in administration, finance, care quality, and work environment, and strategic communication has become paramount. Since dialogical communication is considered to promote a healthy work environment, the purpose of this paper is to investigate the ways in which health care managers experienced observing subordinates' dialogue training. DESIGN/METHODOLOGY/APPROACH: A qualitative study using semi-structured interviews and documents from eight middle managers in a dialogue programme intervention conducted by dialogue trainers. Focus was on fostering and assisting workplace dialogue. Conventional qualitative content analysis was used. FINDINGS: Managers' experiences were both enriching and demanding, and consisted of becoming aware of communication, meaning perceiving interaction between subordinates as well as own silent interaction with subordinates and trainer; Discovering communicative actions for leadership, by gaining self-knowledge and recognizing relational leadership models from trainers--such as acting democratically and pedagogically--and converting theory into practice, signifying practising dialogue-promoting conversation behaviour with subordinates, peers, and superiors. RESEARCH LIMITATIONS/IMPLICATIONS: Only eight managers participated in the intervention, but data afforded a basis for further research. PRACTICAL IMPLICATIONS: Findings stressed the importance of listening, and of support from superiors, for well-functioning leadership communication at work. ORIGINALITY/VALUE: Studies focusing on health care managers' communication and dialogue are few. This study contributes to knowledge about these activities in managerial leadership.