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.

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.

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.

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.

[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.

A profile of hospitals with leadership development programs.

Community hospitals face increasing organizational and environmental complexities that challenge effective leadership. Hospitals are embracing leadership development programs in efforts to ensure leadership talent. While prior literature has described the intent and availability of these programs, the characteristics and performance of hospitals having such programs and their associated market characteristics have not been fully addressed. This article identifies significant differences in organizational, operational, performance, and market factors that are associated with hospitals offering a leadership development program, compared with those hospitals lacking such a program. The authors used American Hospital Association Survey data for 2008, the Area Resource File, and Centers for Medicare & Medicaid data to identify hospitals with and without leadership development programs and analyzed the differences for a number of organizational, operational, performance, and market variables. Findings indicate that hospitals having leadership development programs were large-bed-size facilities, had not-for-profit ownership, were system affiliated, were located in metropolitan statistical areas, and were teaching affiliated facilities. These hospitals also generated higher patient discharges, had higher occupancy, and had a longer average length of stay, compared with hospitals without such programs. In addition, these hospitals had higher net patient revenue per adjusted discharge and higher total profit margins relative to the comparison group.

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.

Hospital chief executive officer perspective on professional development activities.

A study was undertaken to develop understanding of hospital chief executive officers' (CEOs') perspectives concerning importance and impact of professional development activities in US hospitals. It was also intended to reveal CEO preferences for various modalities of professional development including membership in professional societies, attainment of credentials, and coaching by mentors. A mail survey of 582 hospital CEOs made use of a pilot-tested questionnaire with 30 close ended multipart questions. Results showed that most CEOs assigned a high level of importance to professional development and favored conferences, seminars, and networking opportunities, but low priority assigned to online activities such as webinars. They reported lending support to senior managers for participation in these activities by providing financial resources and by allowing time off to engage in these activities. The respondents indicated that the importance of various modalities of professional development has either increased or remained high over the recent 5 years. Conclusions suggest that verifiable quantitative data are needed for understanding of the frequency of participation and resource commitment of health care organizations toward the professional development of CEOs and senior managers. The results of this perceptual study reveal a high level of importance accorded to various forms of professional development activities by the participating CEOs.

[Which tools should be used to identify learning objectives for the health service? The experience of the Emilia-Romagna Region (Italy)]. / Quali strumenti per l'individuazione degli obiettivi formativi? L'esperienza della Regione Emilia-Romagna.

The main health education target of the Emilia-Romagna Region for the period 2008-2010 is to develop pathways of continuous learning for healthcare workers and managers in hospitals. The pathways have the aim of governing the innovation process, improving services, developing new skills, spreading good managerial and professional working practices and integrate knowledge and cooperation between professions at institutional and service levels. This paper synthetically illustrates the role of the different regional institutions (primary care trusts and NHS trusts) in establishing the objectives and the preferable procedures for teaching. The main difficulties concern the effective planning of homogeneous teaching, as well as the ways to translating the needs of the health of the patients into educational projects.

[Which tools should be used to identify educational objectives? The experience of the Tuscany Region]. / Quali strumenti per l'individuazione degli obiettivi formativi? L'esperienza della Regione Toscana.

The tools used by the Tuscany Region to identify its training objectives show the Region's training network. Continuing education is planned, delivered, and evaluated by an "educational networking". This means that people involved in the educational process are not alone but are part of a network constituting a system, which is linked at three interconnected levels: Regional, sub-Regional (consortia of local health units linked together according to their geographical position), and "Area Aziendale". The three levels contribute to outline strategies, to bring into focus the information needs, to match them and to evaluate the effectiveness of the CME.

[Which tools should be used to identify educational objectives in the regional health service? The experience in Marche Region (Italy)]. / Quali strumenti per l'individuazione degli obiettivi formativi? L'esperienza della Regione Marche.

Through a specific methological path, educational objectives of Regional interest have been identified with a punctual analysis of Health Planning documents. While organizing each educational acrivities, all SSR departments indicate the Regional educational objectives they are linked with, each connected to national educational objectives. Continuing Medical Education program in the Marche Region is strictly connected with the acts of health planning from 2006. Each SSR department report accompanying the balance sheets from 2006 to 2009 must contain a section specifically dedicated to ECM Program, indicating the annual budget for ECM Program. All training activities are systematically monitored through a single information tool, shared by all SSR Departments and linked to the SSR Health Operators registry office. Strenghts of the ECM Educational Program of the Marche Region can be summarized as follows: guidance of Educational Program linked in a structured way to the Health Planning goals; punctual indications of redaction modes for PFA and Educational Reports; analytical scanning of activities/costs of the whole Regional Health Service training system, allowing Executive monitorings and reports, i.e. data that General Management can (... should) use to redirect not only training but their Company management as well.

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.

The skills gap in hospital management in the South African public health sector.

A lack of management capacity has been identified as the key stumbling block to the transformation and reconceptualization of the public sector in South Africa into a more effective, efficient, and responsive system of health delivery. As part of the overall management development process, this research aimed to identify the skills important for public sector health management and to evaluate managers' self-assessed proficiency in each of these skills. A cross-sectional survey using a self-administered questionnaire was conducted among hospital managers in the South African public health sector. Respondents were asked to rate the level of importance that each proposed competency had in their job and to indicate their proficiency in each skill. Self-assessment of levels of competency showed that managers felt most competent in strategic planning, people management, and self-management, and relatively less competent in the task-related skills and their ability to deliver healthcare. People management, self-management, and task-related skills were rated as being most important, followed by strategic management and health delivery skills, respectively. The largest differences between mean importance rating and mean skill rating were for people management skills, task-related and self-management skills. These findings reflect the reality of the local health service environment and the needs of health managers and will be useful in the conceptualization, design, and delivery of health management programs aimed at enhancing current and future management and leadership capacity in the public health sector in South Africa.