Management lessons through an interactive online discussion about hospital management during the COVID-19 pandemic.

Background: In light of the COVID-19 pandemic and resulting demand for innovative hospital management we organized an interactive online discussion for medical students and healthcare professionals about hospital management during the crisis. Objective: The event offered an opportunity to learn from a hospital crisis management. We looked at how this new online format compares to a traditional discussion event. Methods: We used an online platform with four guests, a moderator and about 100 attendees. During the event we gathered demographic facts through an interactive questionnaire tool and an extensive evaluation afterwards. Results: The event was rated with an overall grade of 1.4 (Likert from 1 to 6, 1 best grade; SD 0.5) and participants agreed that this format should be organized again (1.2; SD 0.5). 70% of audience members preferred the online format of the event. Due to the high volume, only about 30% (total n~35) of the questions posed by the audience were addressed. Conclusion: Firstly, most participants preferred the event to be online, contrary to our expectation. Secondly, the handling of the amount of individual questions posed significant challenges. Finally, the number of attendees and questions suggested a continuing demand among students and physicians for further education regarding hospital management, especially regarding COVID-19. These findings also require a critical look at future formats and topics of podium discussions in medical education. The online format might be a good alternative to face-to-face lectures.

Educational Challenges in Healthcare Design: Training Multidisciplinary Professionals for Future Hospitals and Healthcare.

BACKGROUND: Healthcare environments are one of the most complex and demanding fields of work. Scientific, technological and research developments along with new discoveries within health promotion and prevention strategies are increasingly requiring a multidisciplinary and interdisciplinary approach. Therefore, it is likely that the current professions will need to be significantly adapted to accommodate new and more specialized roles. OBJECTIVES: To present an overview of the current educational and training courses of the emerging professions, such as hospital planner, physician-engineer, doctor-architect, nurse-architect or engineer, we review the present global training courses (BSc, MSc, specialization and PhD courses) related to healthcare design focusing on the fields of Medicine and Nursing, Architecture and Engineering sciences. RESULTS: The paper analyses the literature review and website analysis about active teaching programs and courses. Several academic institutions offer BSc, MSc and PhD degree programs in Healthcare Design, Environmental and Building Hygiene, and Public Health. In addition, there are several professional postgraduate courses, either in classroom, hybrid-based or online. CONCLUSIONS: A considerable number of international training experiences addresses the topic of training multidisciplinary professionals. Further in-depth investigations are needed to examine the content, teaching format and impact of the courses, student outcomes and professional careers, fields of interest and the degree of collaborations with other institutions.

Management of medical care, a fundamental tool for resident doctors.

In the area of medical education, and particularly in our country, medical residencies are the best educational programs for a graduated physicians; however, when young medical doctors begin a residence at hospitals, they hardly possess knowledge about the way medical services work as well as the processes they involve, which directly affects the fulfillment of their tasks, their process of learning and more importantly, it interferes in the services provided by the hospital. Therefore, it is imperative to immerse residents in the management of medical care and let them know that its main function is to harmoniously articulate every medical-administrative process related to patients as well as human, material and financial resources. One of the main goals is to achieve the fulfillment of the hospital's mission and vision with operational efficiency and humanism. This path will help physicians to make the best decisions, as well as achieving an adequate management of resources always remembering that quality in medical services and patient's safety are important.

En el área de la enseñanza médica, y particularmente dentro de nuestro país, las residencias médicas en hospitales son el mejor modelo para realizar un posgrado; sin embargo, cuando un médico joven inicia su residencia y arriba a un hospital, difícilmente posee los conocimientos de los servicios, tipo de pacientes y procesos que se realizan en dicho lugar, lo que repercute directamente en el cumplimiento de sus tareas, aprendizaje y, más importante, los servicios que ofrece el hospital. Por lo tanto, es imperante hacer partícipes a los médicos residentes en la gestión de la atención médica, darles a conocer que esta es la encargada de articular de forma armónica todos los procesos médico-administrativos en los que participan pacientes, recursos humanos, materiales y financieros, para alcanzar el cumplimiento de la misión y la visión hospitalaria con eficiencia operativa y sentido humano. De esta manera será posible orientarlos a realizar una correcta toma de decisiones y una gestión adecuada de los recursos, y a que su contribución en los procesos médico-administrativos brinde un servicio de calidad y seguridad para el paciente.

Protótipo de um Ambiente Virtual de Aprendizagem para utilização da metodologia Lean Healthcare em unidades de internação hospitalar / Prototype of a Virtual Learning Environment for use of the Lean Healthcare methodology in hospital admission units

A gestão dos hospitais tem sido cada vez mais difícil. Os problemas são causados, principalmente, em função da escassez de recursos financeiros, aumento da demanda, que resulta em longas filas de espera para iniciar tratamentos, falta de vagas em leitos de internação, aumento dos custos operacionais e limitações do espaço físico. No cenário hospitalar, o custo com internação é um dos maiores, sendo apontado como um dos principais responsáveis pelo aumento dos gastos médico-hospitalares que crescem acima da inflação geral. Partindo dessa dificuldade, faz-se necessário adotar um novo método capaz de eliminar os desperdícios e gerar valor para o paciente. O lean healthcare demonstrou ser um método capaz de solucionar os principais problemas nas instituições hospitalares, tratando-se de metodologia com foco na geração de valor para o cliente e, com isso, reduzindo os desperdícios nas atividades das instituições. Contudo, os gestores encontram dificuldades para implementá-la, haja vista que se trata de uma metodologia muito complexa, que demanda profissionais que contemplem o completo domínio da temática, a fim de obter êxito nos resultados. Nesse contexto, as tecnologias de informação e comunicação se apresentam como um recurso estratégico no processo de ensino-aprendizagem, sendo o ambiente virtual de aprendizagem (AVA) uma das mais importantes. Este estudo tem como objetivo desenvolver um protótipo de um AVA que contemple os passos para a implementação de melhores ferramentas e práticas da metodologia lean healthcare para setor de internação em instituições hospitalares. Para o desenvolvimento do AVA, este trabalho baseou-se no Modelo do Design Institucional. Como primeira etapa, foi realizada a revisão integrativa da literatura visando identificar na literatura problemas nos processos de trabalho do setor de internação de instituições hospitalares, bem como as ferramentas utilizadas nas implementações da metodologia lean healthcare. Dentre os problemas identificados, destaca-se o tempo de permanência do paciente, levando a uma sobrecarga dos leitos de internação, o atraso nas altas hospitalares, e os erros durante a prestação do cuidado. A partir desse resultado, o protótipo do AVA foi desenvolvido e está disponível no endereço eletrônico: < https://diangelessilva.wixsite.com/website>. Como proposta futura, o ambiente virtual será avaliado por especialistas na metodologia lean, por especialistas em informática e novas demandas para setor de internação relacionadas ao lean healthcare serão identificadas e acrescentadas

The management of hospitals has been increasingly difficult. The problems are caused, mainly, by the role of financial resources, resulting in long lines to start treatments, lack of places in hospital beds, some increase in operating costs and restriction in physical space. In the hospital set, the cost of hospitalization is one of the largest, being appointed as one of the main responsible for the increment in medical and hospital that grow above the general inflation. Beginning form this difficulty, it is necessary to adopt a new method capable to eliminate waste and to generate value for the patient. The lean healthcare proved to be a capable method of solving problems in hospital institutions, being a methodology focused on generating of value for the client and, therefore, reducing the waste in the activities of the institutions. However, the managers find difficulties to implement it, because it is a very complex methodology that demands professionals who can complete the mastery of the subject in order to achieve the results. In this context, the technologies of information and communication are presented as a strategic resource in the teaching-learning process, being the virtual learning environment (VLE) one of the most important. This study has as aim to develop a prototype of a VLE that look on the steps for the implementation of the better tools and practices of the methodology of lean healthcare for the hospitalization sector in hospital institute. For the development of VLE, this research was based on the Institutional Design Model. As the first step, an integrative review of literature was fulfilled objecting to identify in the literature problems in the processes of the work of the hospitalization sector of hospital institutions, as well the tools used in the implementations of the lean healthcare methodology. Among the problems identified, stands out the length of stay of the patient, leading to an overload of hospital beds, delays in hospital discharge, and the errors during the care installment. From this result, the VLE prototype was developed and it is available at the electronic address: < https://diangelessilva.wixsite.com/website>. As a future proposal, experts in lean methodology, by computer experts, will evaluate the virtual environment and new demands for hospitalization related to lean healthcare will be identified and added

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.

Delivering on the Promise of CLER: A Patient Safety Rotation That Aligns Resident Education With Hospital Processes.

PROBLEM: Residency programs must provide training in patient safety. Yet, significant gaps exist among published patient safety curricula. The authors developed a rotation designed to be scalable to an entire residency, built on sound pedagogy, aligned with hospital safety processes, and effective in improving educational outcomes. APPROACH: From July 2015 to May 2017, each second-year resident completed the two-week rotation. Residents engaged the foundational science asynchronously via multiple modalities and then practiced applying key concepts during a mock root cause analysis. Next, each resident performed a special review of an actual adverse patient event and presented findings to the hospital's Special Review Committee (SRC). Multiple educational outcomes were assessed, including resident satisfaction and attitudes (postrotation survey), changes in knowledge via pre- and posttest, quality of the residents' written safety analyses and oral presentations (per survey of SRC members), and organizational changes that resulted from the residents' reviews. OUTCOMES: Twenty-two residents completed the rotation. Most components were rated favorably; 80% (12/15 respondents) indicated interest in future patient safety work. Knowledge improved by 44.3% (P < .0001; pretest mean 23.7, posttest mean 34.2). Compared to faculty, SRC members rated the quality of residents' written reviews as superior and the quality of the rated oral presentations as either comparable or superior. The reviews identified a variety of safety vulnerabilities and led to multiple corrective actions. NEXT STEPS: The authors will evaluate the curriculum in a controlled trial with better measures of change in behavior. Further tests of the curriculum's scalability to other contexts are needed.

Design of a Hospital Simulation Software for Nursing Education.

This work aims to describe the inception and design for a hospital simulator based on data and cases provided by teachers and other randomized data. The main goal is to develop a computer software tool that simulates a hospital as a tool for nursing student. The system is based on a multi-agent model and multi threaded parallel processing. Other parts includes the interfaces for teacher and student, reports and fixed constraints like Laws and other rules. This is a work in progress project and will be released as open source software after the final validation.

Tips for Working With External Reviewers.

Leaders are responsible for creating a culture of quality and safety within a highly regulated industry. Five tips for working with regulators are presented from a leadership coaching framework.

A Model for Physician Leadership Development and Succession Planning.

Although the presence of physicians in formal leadership positions has often been limited to roles of department chiefs, MAC chairs, etc., a growing number of organizations are recruiting physicians to other leadership positions (e.g., VP, CEO) where their involvement is being genuinely sought and valued. While physicians have traditionally risen to leadership positions based on clinical excellence or on a rotational basis, truly effective physician leadership that includes competencies such as strategic planning, budgeting, mentoring, network development, etc., is essential to support organizational goals, improve performance and overall efficiency as well as ensuring the quality of care. In this context, the authors have developed a physician leader development and succession planning matrix and supporting toolkit to assist hospitals in identifying and nurturing the next generation of physician leaders.

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.

[Student hospital managers and the provision of care for the elderly]. / Spécificité de la prise en charge des personnes âgées vue par les élèves directeurs d'hôpital.

During their training in public health care higher education institutes, future hospital managers carry out several work placements in health care institutes, including one in a geriatric unit. While they often having negative preconceptions of this sector, their experience in the departments, in contact with the patients/residents and the professionals working there, is the opportunity to deconstruct their prejudices and to discover a sector which is dynamic, innovative and very rich in human terms. They thereby become aware of the specificity of the provision of care for the elderly and the need to integrate it into the future strategies of public health institutes.