The Role and Value of Corporate Medical Directors in Employer Benefits Management: Current Perceptions of Corporate Medical Directors and Benefits Professionals.

OBJECTIVE: Knowledge of health-related employer benefits is considered a core competency by the American College of Occupational and Environmental Medicine. This study seeks to understand how this translates into practice. METHODS: An electronic survey was e-mailed to members of American College of Occupational and Environmental Medicine Corporate Medicine and Health and Human Performance Sections; Integrated Benefits Institute; and Employer Health Innovation Roundtable. RESULTS: One hundred nineteen responses were received, including 54 from corporate medical directors (CMDs) and 43 from employee benefits professionals, from a variety of industries. Fifty percent of CMDs reported expertise in designing benefits, but only 25% are engaged with health benefits. The majority of CMDs thought that their involvement was important, while the majority of benefits professionals thought that it was not important. CONCLUSIONS: Many CMDs report having benefits expertise but being underutilized while others report not having expertise.

Hospital-Level Cardiovascular Management Practices in Kerala, India.

Background Hospital management practices are associated with cardiovascular process of care measures and patient outcomes. However, management practices related to acute cardiac care in India has not been studied. Methods and Results We measured management practices through semistructured, in-person interviews with hospital administrators, physician managers, and nurse managers in Kerala, India between October and November 2017 using the adapted World Management Survey. Trained interviewers independently scored management interview responses (range: 1-5) to capture management practices ranging from performance data tracking to setting targets. We performed univariate regression analyses to assess the relationship between hospital-level factors and management practices. Using Pearson correlation coefficients and mixed-effect logistic regression models, we explored the relationship between management practices and 30-day major adverse cardiovascular events defined as all-cause mortality, reinfarction, stroke, or major bleeding. Ninety managers from 37 hospitals participated. We found suboptimal management practices across 3 management levels (mean [SD]: 2.1 [0.5], 2.0 [0.3], and 1.9 [0.3] for hospital administrators, physician managers, and nurse managers, respectively [ P=0.08]) with lowest scores related to setting organizational targets. Hospitals with existing healthcare quality accreditation, more cardiologists, and private ownership were associated with higher management scores. In our exploratory analysis, higher physician management practice scores related to operation, performance, and target management were correlated with lower 30-day major adverse cardiovascular event. Conclusions Management practices related to acute cardiac care in participating Kerala hospitals were suboptimal but were correlated with clinical outcomes. We identified opportunities to strengthen nonclinical practices to improve patient care.

Attitudes of Family Medicine Program Directors Toward Osteopathic Residents Under the Single Accreditation System.

BACKGROUND: Between 2015 and 2020, residency programs accredited through the American Osteopathic Association (AOA) are preparing the single graduate medical education (GME) system through the Accreditation Council for Graduate Medical Education (ACGME). OBJECTIVES: (1) To assess the attitudes of family medicine program directors in programs accredited dually by the AOA and ACGME (AOA/ACGME) or ACGME only toward the clinical and academic preparedness of osteopathic residency candidates and (2) to determine program director attitudes toward the perceived value of osteopathic-focused education, including osteopathic manipulative treatment (OMT) curricula. METHODS: A survey was sent to program directors of AOA/ACGME and ACGME-only accredited family medicine residency programs. Items concerned program directors' perception of the academic and clinical strength of osteopathic residents at the onset of residency, the presence of osteopathic faculty and residents currently in the program, and the presence of formal curricula for teaching OMT. The perceived value of osteopathic focus was obtained through a composite score of 5 items. RESULTS: A total of 38 AOA/ACGME family medicine residency program directors (17%) and 211 ACGME family medicine residency program directors (45.6%) completed the survey (N=249). No difference was found in the ranking of the perceived clinical preparation of osteopathic residents vs allopathic residents in programs with and without OMT curricula (P=.054). Directors of programs with OMT curricula perceived the academic preparation of their osteopathic residents vs allopathic residents more highly than those without OMT curricula (P=.039). Directors of AOA/ACGME programs perceived both the academic preparation and clinical preparation of their osteopathic residents more highly than those at ACGME-only programs (P=.004 and P=.002, respectively). CONCLUSION: Directors of AOA/ACGME programs, as well as those whose programs have an osteopathic focus in curricular offerings, were more likely to rank the academic preparation of osteopathic residents higher than directors of ACGME-only programs and those without OMT curricula. Further research is needed to determine the value of osteopathic recognition in attracting strong family medicine residency candidates.

[Integration of Palliative and Hospice Care Structures in the Care of Neurological Patients: Opinion of Chief Consultant Neurologists in Germany]. / Integration von Palliativ- und Hospizstrukturen in die Versorgung neurologischer Patienten ­ Meinungsbild neurologischer Chefärzte in Deutschland.

An online survey of chief neurological consultants was conducted to find out how they judged the demand for and access to palliative and hospice care (PHC) structures for their neurological patients (NP) as well as their collaboration with PHC structures. 110 of 881 chief consultants who were contacted participated in the survey. About 10 % of their NP were considered suitable for PHC. They estimated that 9 % of the deceased had died from their underlying neurological disease. The integration of PHC structures into the management of various neurological diseases was considered worthwhile but 51.9 - 78.5 % indicated that there was no or little collaboration with PHC structures. 12 % of the participants were trained in palliative care (PC). To guarantee an adequate PHC also for NP, PHC knowledge should be integrated into the curriculum and training of neurologists and the PC community should further extend its services to NP, adapting their knowledge and structures to these patients' special needs.

Attitudes Toward Acupuncture Among Pain Fellowship Directors.

OBJECTIVES: The purpose of this survey was to evaluate attitudes toward acupuncture among pain medicine fellowship directors. Additional goals were to assess the availability of acupuncture at academic medical centers and ascertain the inclusion of this modality in fellowship curricula. METHODS: Electronic and paper surveys were distributed to the 97 American College of Graduate Medical Education pain medicine fellowship directors during January and February, 2014. Directors were queried about their referral patterns to acupuncture, as well as their perceptions of the utility of acupuncture for common pain conditions. They were asked about the availability of acupuncture at their institution, and whether acupuncture was included in the fellowship curriculum. RESULTS: Sixty-seven percent of fellowship directors (65/97) completed the questionnaire. A majority of directors (83%) reported acupuncture is available to patients at their institution, and reported that acupuncture is a modality that they discuss with patients when creating a treatment plan for chronic pain (72%). The majority of programs include acupuncture as part of didactic (63%) and clinical (52%) education. Time constraints, lack of qualified teaching personnel, and cost to patients were cited as barriers to inclusion. The majority of fellowship directors considered acupuncture a safe and worthwhile option for common pain conditions. CONCLUSION: Results from this survey indicate that acupuncture is widely available to patients at academic medical centers, integrated into many pain fellowship curricula, and considered a useful modality by physician leaders in the field of pain medicine. This sentiment, paired with the flexibility of national guidelines for pain fellowship curricula, suggests a trend toward greater inclusion of this modality in academic medicine.

Management and leadership competence in hospitals: a systematic literature review.

Purpose - The purpose of this study is to describe the characteristics of management and leadership competence of health-care leaders and managers, especially in the hospital environment. Health-care leaders and managers in this study were both nursing and physician managers. Competence was assessed by evaluating the knowledge, skills, attitudes and abilities that enable management and leadership tasks. Design/methodology/approach - A systematic literature review was performed to find articles that identify and describe the characteristics of management and leadership competence. Searches of electronic databases were conducted using set criteria for article selection. Altogether, 13 papers underwent an inductive content analysis. Findings - The characteristics of management and leadership competence were categorized into the following groups: health-care-context-related, operational and general. Research limitations/implications - One limitation of the study is that only 13 articles were found in the literature regarding the characteristics of management and leadership competence. However, the search terms were relevant, and the search process was endorsed by an information specialist. The study findings imply the need to shift away from the individual approach to leadership and management competence. Management and leadership need to be assessed more frequently from a holistic perspective, and not merely on the basis of position in the organizational hierarchy or of profession in health care. Originality/value - The authors' evaluation of the characteristics of management and leadership competence without a concentrated profession-based approach is original.

The Role of the Medical Director A more collaborative, multidisciplinary oversight is called for in the future.

Because of the expanded role EMS providers may paly in the community, medical direction in EMS 3.o should appropriately be a collaborative effort led by EMS subspecialty-certified physicians specially trained in emergency medicine, but also physicians who specialize in disciplines such as internal/family medicine, critical care, cardiology, nephrology, endocrinology and pulmonary medicine. The EMS 3.0 medical director should be able to build patient-centered coalitions of physicians to help meet the care coordination goals of the patient, their physicians and the EMS system.

Equality, accessibility, and availability of physical therapy services in Israel-Perception of national directors.

To date no research has described Israeli physical therapy (PT) services to determine whether they are provided in the spirit intended by the National Health Insurance Law (NHIL). This study aimed to assess the equality, accessibility, and availability of PT services in Israel. Qualitative research was based on semi-structured, personal interviews with all national directors of PT services in Israel, followed by content analysis of the data obtained. According to the findings, PT services are provided by all Health Maintenance Organisations (HMOs) throughout Israel. In peripheral areas, access to services is limited; availability of services at most clinics is poor, a problem which is solved mainly by referring patients to PT outsourcing. The number of treatment sessions is determined by the NHIL; however, all directors agreed that the number of treatments provided should be based on a professional decision following patient evaluation and progress, rather than on administrative considerations. Inequality of service to peripheral areas could be reduced by creating cooperation between HMOs, thereby establishing clinics capable of providing services that are both accessible and equitable. In addition, the number of sessions provided to patients in the health-care basket should be reassessed, and a set of uniform criteria should be created for determining the optimal number of PT sessions. This could lead to greater uniformity in distribution of PT services provided by the HMOs.

The evolving role of the medical director of a dialysis facility.

The medical director has been a part of the fabric of Medicare's ESRD program since entitlement was extended under Section 299I of Public Law 92-603, passed on October 30, 1972, and implemented with the Conditions for Coverage that set out rules for administration and oversight of the care provided in the dialysis facility. The role of the medical director has progressively increased over time to effectively extend to the physicians serving in this role both the responsibility and accountability for the performance and reliability related to the care provided in the dialysis facility. This commentary provides context to the nature and expected competencies and behaviors of these medical director roles that remain central to the delivery of high-quality, safe, and efficient delivery of RRT, which has become much more intensive as the dialysis industry has matured.

The medical director in integrated clinical care models.

Integrated clinical care models, like Accountable Care Organizations and ESRD Seamless Care Organizations, present new opportunities for dialysis facility medical directors to affect changes in care that result in improved patient outcomes. Currently, there is little scholarly information on what role the medical director should play. In this opinion-based review, it is predicted that dialysis providers, the hospitals in which the medical director and staff physicians practice, and the payers with which they contract are going to insist that, as care becomes more integrated, dialysis facility medical directors participate in new ways to improve quality and decrease the costs of care. Six broad areas are proposed where dialysis unit medical directors can have the greatest effect on shifting the quality-care paradigm where integrated care models are used. The medical director will need to develop an awareness of the regional medical care delivery system, collect and analyze actionable data, determine patient outcomes to be targeted that are mutually agreed on by participating physicians and institutions, develop processes of care that result in improved patient outcomes, and lead and inform the medical staff. Three practical examples of patient-centered, quality-focused programs developed and implemented by dialysis unit medical directors and their practice partners that targeted dialysis access, modality choice, and fluid volume management are presented. Medical directors are encouraged to move beyond traditional roles and embrace responsibilities associated with integrated care.

Arise the systems physician.

Healthcare in Australia faces significant challenges. Variations in care, suboptimal safety and reliability, fragmentation of care and unsustainable cost increases are compounded by substantial overuse and underuse of clinical interventions. These problems arise not from intentional actions of individual clinicians, but from deficiencies in the design, operations and governance of systems of care. Physicians play an important role in optimising systems of care and, in doing so, must rely on enhanced skills in a range of domains. These include: how to evaluate and improve quality and safety of clinical processes; analyse and interpret clinical and administrative data in ways that can be used to enhance care delivery; build and lead cohesive multidisciplinary teams capable of solving operational defects and inefficient workarounds; and implement new and effective innovations in clinical service delivery. While clinical skills are essential in individual patient care, skills that improve systems of care targeting whole patient populations will become increasingly desirable and recognised as core skills.

[Healthcare occupations are "different"]. / Gesundheitsberufe sind "anders"

Healthcare requires careful coordination of several occupations. In order to attain the best possible result, including effectiveness and cost-efficiency, the specific expertise of each of these occupations must be clearly defined. Healthcare occupations, physicians and nurses, are indeed professions as opposed to mere "jobs". They are concerned with living but ill human beings and not with things. Reliance on a personal capacity of judgment is a decisive aspect of professions. Healthcare professionals perform best if they are granted specific independence relative to their work.