Here Comes Price Transparency.

The public reporting of clinical and operational performance measures is old news for chief nurse executives (CNEs). Since the advent of value-based purchasing and patient experience measures, CNEs have partnered with other executives to ensure organizational readiness and success with the performance measures being publicly shared. In 2018, healthcare organizations face a new wave of public reporting expectations-price. Once again, executives will need to ensure organizational readiness. Chief nurse executives must analyze the impact of this trend on the nursing enterprise and carefully consider how to best prepare for healthcare price transparency.

Managers' role in maximising investment in continuing professional education.

Healthcare organisations face the challenge of delivering care in increasingly complex environments. To do so they depend on competent professionals, and continuing professional education (CPE) plays a major part in ensuring that staff maintain and develop their knowledge and skills. However, there is limited evidence of the effect of CPE on healthcare outcomes, and an emphasis on outcomes has overlooked the contribution of the processes that underlie effective CPE. This article reports the results of a study that explored a range of stakeholders' perceptions of the processes that maximise the positive effects of CPE on practice. Analysis of results shows that CPE can help improve care when supported by positive organisational cultures, effective partnership working between stakeholders and supportive learning environments that enable individuals to maximise their learning. This article discusses how managers play a pivotal role in creating positive cultures in which CPE can flourish by being role models and change agents, ensuring organisational strategic objectives are aligned with personal development plans, and by working collaboratively with education colleagues to ensure that learning from CPE is embedded in practice.

Impact of a productivity-based compensation system on faculty clinical teaching scores, as evaluated by anesthesiology residents.

STUDY OBJECTIVE: To determine whether financial incentives given to faculty members for favorable teaching scores improve the quality of clinical education. DESIGN: Retrospective analysis. SETTING: Large U.S. academic anesthesiology department. STUDY SUBJECTS: 61 academic and 72 clinical faculty members. MEASUREMENTS: Since, academic year (AY) 2004, as part of a comprehensive clinical and academic productivity-based compensation system, academic faculty members receiving higher operating room (OR) teaching evaluation scores from the residents have been rewarded financially. Clinical Faculty members also have been rated, but have not received incentives based on scores. Annual averaged OR teaching scores of each faculty member on a 0-9 scale, where 9 = best, were gathered anonymously with faculty classification (academic or clinical). Average overall scores and percentage of faculty with each score category (8.51-9.00, 8.01-8.50, 7.00-8.00, or <7.00) were compared between the pre-implementation (AY2002-AY2003) and post-implementation (AY2004-AY2005) periods. Scores between the academic and clinical faculty also were compared. MAIN RESULTS: No significant difference was noted in the average scores between the pre-implementation and post-implementation periods in a paired comparison (academic: 7.83 ± 0.48 vs 7.85 ± 0.50, P = 0.61; clinical: 7.54 ± 0.75 vs 7.66 ± 0.60, P = 0.21). No statistically significant change was noted in the composition of score categories in the academic (P = 0.63) or clinical faculty (P = 0.20) members. Overall, the academic faculty received significantly higher scores than the clinical faculty (7.84 ± 0.49 vs 7.60 ± 0.67, P = 0.0003). CONCLUSIONS: A productivity-based faculty compensation system did not appear to influence faculty OR teaching scores.

Certifying clinical ethics consultants: who pays?

The movement advocating the formal certification of clinical ethics consultants may result in major changes to the field of clinical ethics consultation by creating a new standard of care. The actual certification process is still in the development phase, but unanswered questions include: What will certification cost, and, Who will pay? Currently there is little salary support for ethics consultants and no regulation requiring healthcare institutions to offer clinical ethics consultation. Without the support of healthcare administrators and accreditation bodies, this may remain unchanged. Healthcare administrators may be unwilling to pay for certification or professional services if accreditation bodies do not require healthcare institutions to provide certified ethics consultants' services. If consultants will not be reimbursed or paid, they may not seek certification. If certified consultants are required, healthcare administrators may look for ways to cover the costs for providing this service, including insurance or third-party reimbursement and direct billing of patients for consultations, which may affect who performs and who participates in ethics consultation. However, this is less than ideal, as bioethicists believe ethics consultation should be available to all as part of providing safe, quality ethical care and support and guidance for patients, families, and healthcare staff. Going forward, bioethicists should study quality improvement, patient safety, and cost-savings resulting from certification-eligible clinical ethics consultants' activities. Administrators and financial personnel can be surveyed regarding their support for the certification process. Bioethicists should enlist the help of patient rights and safety advocacy groups, professional medical associations, and healthcare administrators. Bioethicists should invite accreditation bodies, healthcare administrators, and financial personnel to collaborate in the development of the certification process. Without their support, certification may be of value only to the bioethics community, and may have little standing in actual clinical healthcare institution settings.

Cost analysis and feasibility of high-fidelity simulation based radiology contrast reaction curriculum.

RATIONALE AND OBJECTIVES: Radiology residents have variable training in managing acute nonrenal adverse reactions to iodinated contrast media because of their rarity. Preliminary results show positive feedback and knowledge gain with high-fidelity simulation-based training. Financial costs and the time required to implement a high-fidelity simulation curriculum are higher than for a lecture series. The objective of this study was to provide a financial and time cost-benefit analysis for high-fidelity simulation training of acute adverse reactions to iodinated contrast media. MATERIALS AND METHODS: Forty-four radiology residents were divided into lecture and simulation groups. Five simulation scenarios were created, with core education content mirrored in the lecture. Lengths of faculty time commitment and resident training were recorded. Financial costs, including manikin and simulation facility rates, were recorded and divided by the number of residents to obtain per resident simulation and lecture costs. A written evaluation of the experience, with Likert-type items and unstructured response items, was conducted. RESULTS: Cost per resident for simulation training setup was $259.76, and $203.46 for subsequent years, compared to <$5 for lecture. Faculty time was 7 academic days for simulation versus 2 days for lecture format. Resident simulation commitment was 3 hours 30 minutes. Time to train technologists to run the simulation was 3 hours. All residents provided positive feedback regarding the simulation curriculum, with mean feedback scores statistically higher than lecture group (P < .05). CONCLUSIONS: This study illustrates that financial costs of implementation are low compared to the potential cost of morbidity associated with the life-threatening event of an acute adverse reaction to iodinated contrast media.

Valuing volunteers: the impact of volunteerism on hospital performance.

BACKGROUND: Volunteers have been present in health care settings for centuries. However, there is little empirical evidence regarding the impact that volunteers make on hospital performance. Since the 1990s, hospitals in the United States have had a great deal of pressure to produce high-quality care at minimum expense. These pressures have enhanced the benefits of using volunteers in a hospital setting. PURPOSE: This study utilized multiple regression analysis to explore the impact of the use of volunteers and the level of professionalism of volunteer programs on cost effectiveness and patient satisfaction in hospitals. METHODOLOGY/APPROACH: Hospitals throughout the state of Florida were invited to participate in the study by completing a brief questionnaire about their volunteer programs. Performance indicators of volunteer cost savings and patient satisfaction scores for 50 Florida hospitals were analyzed using data sets from the American Hospital Association and Agency for Health Care Administration along with data obtained from a questionnaire. FINDINGS: Results indicate that the use of volunteers offers significant cost savings to hospitals and enhances patient satisfaction scores. DISCUSSION: Larger volunteer programs appear to enhance patient satisfaction while containing costs. Future research opportunities related to the impact of volunteers and volunteer professionalism on other hospital performance measures are suggested.

[Reasonable dispensing fee for patients].

The actual pharmacist workload is not always reflected in dispensing fees, while patients do not always understand the system of dispensing fees. In this study, the relation between the time required for dispensing and prescription details and that between the time required for instruction on drug administration and instruction details in nine pharmacies in Chiba prefecture were investigated. As a result of linear regression analysis, it was suggested that, compared with doses, the number of drug items more greatly affected the time required for dispensing. For oral drugs, the following relation was suggested in the study: [dispensing time (sec)]=29.3+27.5 x [number of items]+0.7 x[dosing days]+94.4 x [number of items]+7.1 x [dosing days]. Based on the actual dispensing fees claimed, fees per second of dispensing were estimated at 0.7 point. For drug administration instruction, it was considered reasonable to classify instructions into three categories according to the instruction details and set fees by the categories. When any further pharmaceutical expertise is required, fees should not be set according to the workload but additional fees should be provided to reward expertise.