Does Climate Change Affect Health? Beliefs from the Health Information National Trends Survey.

Climate change is currently and will continue impacting human health, however, beliefs about the level of threat vary by demographics, region, and ideology. The purpose of this study was to assess factors related to climate change and health beliefs using cross-sectional data from the Health Information National Trends Survey (HINTS). Data from 5,075 respondents in the 2022 iteration of HINTS was used for this study. Chi-square tests were used to evaluate demographic differences among those who believe climate change will harm health a lot compared to some, a little, or not at all. Generalized ordinal logistic regression models were used to examine the relationship between the belief that climate change will harm health and independent variables regarding trust in scientists, health recommendations from experts, and demographic characteristics. Female, Black, Hispanic, and college graduate respondents had higher odds and people in the Southern U.S. those aged 35-49, 50-64, and 75years or older had significantly lower odds of believing climate change would harm their health. Those who trust information about cancer from scientists and those that believe health recommendations from experts conflict or change had higher odds of believing climate change would harm health. Our analysis highlights factors that impact climate change and health beliefs, which may provide targets for tailoring public health messages to address this issue.

A Seat at the Table: An Examination of Hospital Governing Board Diversity, 2011-2021.

GOAL: Board diversity is increasingly important for hospitals and healthcare systems, with national attention focused on eliminating health disparities and improving health equity. Yet, it remains a challenge despite concerted efforts by leading professional associations (e.g., American College of Healthcare Executives) to galvanize their constituents around the importance of the issue. METHODS: This study used survey data from The Governance Institute to explore the ethnoracial and gender diversity of hospital boards spanning 2011 through 2021. PRINCIPAL FINDINGS: The results showed modest gains in the mean number of female board members, although a small proportion of hospital boards still have no female representation. There was little change in the number of boards with ethnic minority representation until an uptick in 2021, likely in direct response to high-profile racial incidents and protests. PRACTICAL APPLICATIONS: Intentional and sustained efforts are necessary to increase diversity and create a culture of inclusion that fosters meaningful engagement of diverse board members.

Closing the Gender Gap in Healthcare Leadership: Can Administrative Fellowships Play a Role?

GOAL: Although women make up most of the healthcare workforce, they are underrepresented in higher levels of leadership positions. Leadership development programs for early careerists, such as administrative fellowships, have been suggested as one strategy for accelerating gender equity in leadership roles. However, the potential impact of these programs has not yet been the subject of systematic evaluation. In this study, we examined the (1) benefits of administrative fellowship programs on career attainment and (2) differences in attainment by gender. METHODS: We completed this study using a data set involving alumni from a consortium of 11 graduate healthcare management programs whose students frequently pursue administrative fellowships. Our data included individual-level demographic and career attainment data for graduating classes from 5, 10, and 20 years prior to the reference year. Using multiple regression analysis, we tested the relationship of three independent variables-graduation year, gender, and completion of a fellowship-on career attainment. This analysis enabled us to determine differences in overall career attainment by gender, evaluate the role of fellowships in career attainment, and consider the differential impact of fellowships on attainment by gender. PRINCIPAL FINDINGS: Our findings suggest that fellowship programs accelerate leadership career paths for individual leaders, but that the effect is stronger for males than their female counterparts. PRACTICAL APPLICATIONS: These findings not only support the value of administrative fellowships for early careerist leadership development but also suggest that closing the gender disparity gap in leadership may require additional and focused career-supportive strategies. We provide recommendations for healthcare organizations in developing their administrative fellowship programs to help minimize the gender disparity in healthcare leadership positions. Furthermore, we discuss research implications and future areas of research in administrative fellowships.

How Do Healthcare Executives Understand and Make Decisions about Spiritual Care Provision?

OBJECTIVES: This pilot study explores how healthcare leaders understand spiritual care and how that understanding informs staffing and resource decisions. METHODS: This study is based on interviews with 11 healthcare leaders, representing 18 hospitals in 9 systems, conducted between August 2019 and February 2020. RESULTS: Leaders see the value of chaplains in terms of their work supporting staff in tragic situations and during organizational change. They aim to continue to maintain chaplaincy efforts in the midst of challenging economic realities. CONCLUSIONS: Chaplains' interactions with staff alongside patient outcomes are a contributing factor in how resources decisions are made about spiritual care.

The Impact of Hospital and Health System Leadership Development Practices on Bond Ratings.

EXECUTIVE SUMMARY: Shifts in healthcare policy, patient consumerism, and organizational consolidation are driving the need for hospitals and health systems to adapt if they are to achieve sustainability. Prior research has suggested that businesses with strong leadership development practices also demonstrate greater financial success and competitive performance. However, few studies have examined the impact of leadership development on organization-level outcomes, generally, or in the healthcare industry, specifically.Our goal in this study was to examine the association between organizational leadership development practices and external perceptions of creditworthiness in the form of bond ratings. Data were drawn from the 2014 and 2016 distributions of the National Center for Healthcare Leadership's National Health Leadership Survey; organizational credit ratings were obtained from Moody's Investors Service and S&P Global Solutions. Spearman's rho correlations and polynomial ranked regressions were used to determine the significance of the relationships between leadership development practices and bond ratings. Results provide preliminary evidence of associations between investing in leadership development and organizational creditworthiness. They also suggest, however, that the most financially successful health systems may de-emphasize certain kinds of leadership development practices relative to their peers. We discuss implications of these findings for organizational leaders investing in human capital as well as healthcare executives evaluating the development potential of prospective employers.

Bridging worldviews: Toward a common model of leadership across the health professions.

BACKGROUND: As the pace of health sector transformation accelerates, the importance of leadership continues to grow across all health professions. Advances in a variety of disciplines can inform effective leadership development. However, at present, most health sector leadership competency models do not incorporate these advances and are instead developed using consensus-based methods within specific professions. An interprofessional approach to leadership competencies could help incorporate these advances and support better interdisciplinary leadership development. PURPOSE: This study was pursued to revise and revalidate a widely used health sector leadership competency model and assess its potential for providing greater interoperability across the professions. METHODOLOGY/APPROACH: Using the National Center for Healthcare Leadership's interprofessional competency model Version 2.1 as the starting point, we developed a revised and revalidated model in four phases: (a) we completed a future scan using methods described in Garman et al. [Garman, A. N., Johnson, T. J., & Royer, T. (2011). The future of healthcare: Global trends worth watching. Chicago, IL: Health Administration Press.]; (b) we collected behavioral event interview data from pairs of leaders representing different organizational and performance levels, using methods developed by Boyatzis [Boyatzis, R. E. (1982). The competent manager: A model for effective performance. New York, NY: John Wiley & Sons.]; (c) we conducted a validity study via electronic survey of 145 working managers and calculated content validity ratios using methods described by Lawshe [Lawshe, C. H. (1975). A quantitative approach to content validity. Personnel Psychology, 38(4), 563-575.]; and (d) we used natural language processing to assess the extent to which existing leadership models in the health professions will crosswalk to the new model. FINDINGS: All competencies in the revised model successfully met criteria for validity. The revised model also successfully crosswalked against, on average, 85% of the competencies in the other five health professions leadership models. PRACTICE IMPLICATIONS: Based on the results of this research, we conclude the revised model can provide a "common language" framework in support of interdisciplinary leadership development. The availability of such a model may also assist human resource and development executives in better aligning learning resources with organizational goals.

Toward a high-performance management system in health care, part 4: Using high-performance work practices to prevent central line-associated blood stream infections-a comparative case study.

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are among the most harmful health care-associated infections and a major patient safety concern. Nationally, CLABSI rates have been reduced through the implementation of evidence-based interventions; thus far, however, hospitals still differ substantially in their success implementing these practices. Prior research on high-performance work practices (HPWPs) suggests that these practices may explain some of the differences health systems experience in the success of their quality improvement efforts; however, these relationships have not yet been systematically investigated. PURPOSES: In this study, we sought to explore the potential role HPWPs may play in explaining differences in the success of CLABSI reduction efforts involving otherwise similar organizations and approaches. METHODOLOGY/APPROACH: To form our sample, we identified eight hospitals participating in the federally funded "On the CUSP: Stop BSI" initiative. This sample included four hospital "pairs" matched on organizational characteristics (e.g., state, size, teaching status) but having reported contrasting CLABSI reduction outcomes. We collected data through site visits as well as 194 key informant interviews, which were framed using an evidence-informed model of health care HPWPs. FINDINGS: We found evidence that, at higher performing sites, HPWPs facilitated the adoption and consistent application of practices known to prevent CLABSIs; these HPWPs were virtually absent at lower performing sites. We present examples of management practices and illustrative quotes categorized into four HPWP subsystems: (a) staff engagement, (b) staff acquisition/development, (c) frontline empowerment, and (d) leadership alignment/development. PRACTICE IMPLICATIONS: We present the HPWP model as an organizing framework that can be applied to facilitate quality and patient safety efforts in health care. Managers and senior leaders can use these four HPWP subsystems to select, prioritize, and communicate about management practices critical to the success of their CLABSI prevention efforts.

Care provider perspectives on medical travel: A three-country study of destination hospitals.

Despite growing interest in the current and potential role of medical travel in U.S. patient care, very little research has been conducted on clinician and other provider organizations' perspectives on providing international patient care. The present study sought to gain formative insights about medical travel from the providers' perspectives, by conducting structured interviews and focus groups in six hospitals from three countries catering to patients traveling from the United States. Findings highlighted the surprising role of international events and policies in the evolution of medical travel, as well as both the desire and need for more transparent quality standards.

The Relationship Between Hospital Value-Based Purchasing Program Scores and Hospital Bond Ratings.

Tax-exempt hospitals and health systems often borrow long-term debt to fund capital investments. Lenders use bond ratings as a standard metric to assess whether to lend funds to a hospital. Credit rating agencies have historically relied on financial performance measures and a hospital's ability to service debt obligations to determine bond ratings. With the growth in pay-for-performance-based reimbursement models, rating agencies are expanding their hospital bond rating criteria to include hospital utilization and value-based purchasing (VBP) measures. In this study, we evaluated the relationship between the Hospital VBP domains--Clinical Process of Care, Patient Experience of Care, Outcome, and Medicare Spending per Beneficiary (MSPB)--and hospital bond ratings. Given the historical focus on financial performance, we hypothesized that hospital bond ratings are not associated with any of the Hospital VBP domains. This was a retrospective, cross-sectional study of all hospitals that were rated by Moody's for fiscal year 2012 and participated in the Centers for Medicare & Medicaid Services' VBP program as of January 2014 (N = 285). Of the 285 hospitals in the study, 15% had been assigned a bond rating of Aa, and 46% had been assigned an A rating. Using a binary logistic regression model, we found an association between MSPB only and bond ratings, after controlling for other VBP and financial performance scores; however, MSPB did not improve the overall predictive accuracy of the model. Inclusion of VBP scores in the methodology used to determine hospital bond ratings is likely to affect hospital bond ratings in the near term.

Turning Concern Into Confidence: Planetary Health Needs in Nursing Education.

BACKGROUND: Climate change is a recognized global threat to human health, and nurses must be prepared to mitigate its negative effects. This article describes nursing student and faculty opinions about climate change and associated planetary health curricular needs. METHOD: A survey including the Six Americas Super Short Survey and an adaptation of the Planetary Health Report Card was developed and emailed to nursing students and faculty. RESULTS: Student (n = 72) and faculty (n = 56) responses showed that although they were concerned about climate change, they were not confident in preparation of nurses student to climate change and its impact. Students and faculty shared perceptions about specific curricular areas are to be included in curricula. CONCLUSION: In response to the updated Essentials, which include specific reference to climate change, widespread curricular change is imminent in nursing education. This study offers insight for integrating climate change and planetary health into nursing curricula. [J Nurs Educ. 2024;63(3):178-181.].

Future-ready healthcare leadership: the revised International Hospital Federation competency model.

BACKGROUND: Major global trends are reshaping health services delivery, and preparing current and future healthcare leaders requires an understanding of these trends. A well-designed leadership competency model can provide guidance for individuals, as well as for system-level leadership development and integration programmes. OBJECTIVE: To describe the process of updating the International Hospital Federation's (IHF) Global Healthcare Management Competency Directory. METHODS: Revisions were informed by a recent foresight study of major trends in health services delivery, and an evidence-informed framework of leadership competencies. The original framework competencies were reviewed by 45 subject-matter experts from 30 countries and regions, who provided feedback through electronic surveys and online interviews. We incorporated this iterative feedback to revise the framework design, competencies within the framework and their associated behavioural descriptions. RESULTS: A total of 45 subject-matter experts from 30 countries and regions participated in 1 or more phases of the survey process. The resulting leadership competency model includes 32 competencies organised into a framework of 6 domains: values, self-development, execution, relations, context management and transformation. CONCLUSION: The updated IHF Leadership Model provides a robust, evidence-based and up-to-date resource for assessing and developing future-ready healthcare leaders.

Assessing Planetary Health Curricular Needs Across Health Professions Programs.

With growing recognition that climate change is a significant threat to human health, allied health professionals are increasingly recognized as critical allies in addressing this threat. This article describes the approach that Rush University's College of Sciences is pursuing to better prepare health sciences students for this reality. Faculty and students enrolled across all programs of the College were surveyed regarding their levels of concern about global warming using items from the Six Americas Survey, as well as perceived importance of planetary health curricular elements adapted from the Planetary Health Report Card. Faculty were additionally asked about perceived opportunities to bring planetary health education into each of the degree programs offered by the university. A total of 37 faculty and 43 students completed the survey, collectively representing all programs in the college. Responses reflected widespread interest in expanding planetary health education, but topic priorities and optimal methods for implementation differed between programs. Although the survey process had limitations, it demonstrated the need for greater attention to planetary health across curricula and offered more efficient approaches implementing this essential content across programs.

Implementing high-performance work practices in healthcare organizations: qualitative and conceptual evidence.

Studies across industries suggest that the systematic use of high-performance work practices (HPWPs) may be an effective but underused strategy to improve quality of care in healthcare organizations. Optimal use of HPWPs depends on how they are implemented, yet we know little about their implementation in healthcare. We conducted 67 key informant interviews in five healthcare organizations, each considered to have exemplary work practices in place and to deliver high-quality care, as part of an extensive study of HPWP use in healthcare. We analyzed interview transcripts inductively and deductively to examine why and how organizations implement HPWPs. We used an evidence-based model of complex innovation adoption to guide our exploration of factors that facilitate HPWP implementation. We found considerable variability in interviewees' reasons for implementing HPWPs, including macro-organizational (strategic level) and micro-organizational (individual level) reasons. This variability highlighted the complex context for HPWP implementation in many organizations. We also found that our application of an innovation implementation model helped clarify and categorize facilitators of HPWP implementation, thus providing insight on how these factors can contribute to implementation effectiveness. Focusing efforts on clarifying definitions, building commitment, and ensuring consistency in the application of work practices may be particularly important elements of successful implementation.

The Role of Work as a Social Determinant of Health in Mother's Own Milk Feeding Decisions for Preterm Infants: A State of the Science Review.

In the United States, 10% of infants are born preterm (PT; <37 weeks gestational age) each year and are at higher risk of complications compared to full term infants. The burden of PT birth is borne disproportionately by Black versus non-Black families, with Black mothers significantly more likely to give birth to a PT infant. One proven strategy to improve short- and long-term health outcomes in PT infants is to feed mother's own milk (MOM; breast milk from the mother). However, mothers must make decisions about work and MOM provision following PT birth, and more time spent in paid work may reduce time spent in unpaid activities, including MOM provision. Non-Black PT infants are substantially more likely than Black PT infants to receive MOM during the birth hospitalization, and this disparity is likely to be influenced by the complex decisions mothers of PT infants make about allocating their time between paid and unpaid work. Work is a social determinant of health that provides a source of income and health insurance coverage, and at the same time, has been shown to create disparities through poorer job quality, lower earnings, and more precarious employment in racial and ethnic minority populations. However, little is known about the relationship between work and disparities in MOM provision by mothers of PT infants. This State of the Science review synthesizes the literature on paid and unpaid work and MOM provision, including: (1) the complex decisions that mothers of PT infants make about returning to work, (2) racial and ethnic disparities in paid and unpaid workloads of mothers, and (3) the relationship between components of job quality and duration of MOM provision. Important gaps in the literature and opportunities for future research are summarized, including the generalizability of findings to other countries.

High-performance work systems in health care, part 3: the role of the business case.

BACKGROUND: Growing evidence suggests the systematic use of high-performance work practices (HPWPs), or evidence-based management practices, holds promise to improve organizational performance, including improved quality and efficiency, in health care organizations. However, little is understood about the investment required for HPWP implementation, nor the business case for HPWP investment. PURPOSE: The aim of this study is to enhance our understanding about organizations' perspectives of the business case for HPWP investment, including reasons for and approaches to evaluating that investment. METHODOLOGY/APPROACH: We used a multicase study approach to explore the business case for HPWPs in U.S. health care organizations. We conducted semistructured interviews with 67 key informants across five sites. All interviews were recorded, transcribed, and subjected to qualitative analysis using both deductive and inductive methods. FINDINGS: The organizations in our study did not appear to have explicit financial return expectations for investments in HPWPs. Instead, the HPWP investment was viewed as an important factor contributing to successful execution of the organization's strategic priorities and a means for competitive differentiation in the market. Informants' characterizations of the HPWP investment did not involve financial terms; rather, descriptions of these investments as redeployment of existing resources or a shift of managerial time redirected attention from cost considerations. Evaluation efforts were rare, with organizations using broad organizational metrics to justify HPWP investment or avoiding formal evaluation altogether. PRACTICE IMPLICATIONS: Our findings are consistent with prior studies that have found that health care organizations have not systematically evaluated the financial outcomes of their quality-related initiatives or tend to forget formal business case analysis for investments they may perceive as "inevitable." In the absence of a clearly described association between HPWPs and outcomes or some other external imperative, ongoing HPWP investment may be at risk relative to other quality-related initiatives, particularly if organizational resources are constrained.

Collaborating to improve the global competitiveness of US academic medical centers.

President Obama announced the National Export Initiative in his 2010 State of the Union address and set the ambitious goal of doubling US exports by the end of 2014 to support millions of domestic jobs. Understanding the competitive position of US health care in the global market for international patients, University Health System Consortium (UHC), an alliance of 116 academic medical centers and 272 of their affiliated hospitals, representing 90 percent of the nation's non-profit academic medical centers partnered with Rush University, a private University in Chicago, IL and the International Trade Administration of the US Department of Commerce International Trade Administration (ITA) to participate in the Market Development Cooperator Program. The goal of this private-public partnership is to increase the global competitiveness of the US health care industry, which represents over 16 percent of the GDP, amongst foreign health care providers. This article provides an overview of the US health care market and outlines the aims of the US Cooperative for International Patient Programs, the end result of the partnership between UHC, ITA and Rush University.

Management and leadership competencies among spiritual care managers.

Both the healthcare and religious landscapes in the United States are rapidly changing. Despite the dynamic environment that spiritual care managers face, many do not receive management training prior to assuming their roles and many receive little or no training once they are in their roles. This study used mixed methods to examine the applicability of the National Center for Healthcare Leadership (NCHL) competency model to spiritual care manager roles. Interviews were conducted with 10 spiritual care managers across the country, using a Behavioral Event Interviewing (BEI) methodology. Interviews were quantitatively analyzed by using Natural Language Processing and qualitatively analyzed by thematic approach using NVIVO. The results found the EXECUTION domain to be the most discussed theme, followed by RELATIONS, TRANSFORMATION, and BOUNDARY SPANNING. Collectively these analyses suggest the NCHL Leadership Competency Model can provide a useful framework for understanding the roles and development needs of spiritual care managers.

What organizational and business models underlie the provision of spiritual care in healthcare organizations? An initial description and analysis.

Two-thirds of American hospitals have chaplains. This article explores the organizational and business models that underlie how chaplains are integrated into hospitals. Based on interviews with 14 chaplain managers and the 11 healthcare executives to whom they report at 18 hospitals in 9 systems, we identify three central findings. First, there is significant variation in how spiritual care programs are staffed and integrated into their hospitals. Second, executives and chaplain managers see the value of chaplains in terms of their quality of care, reliability and responsivity to emergent patient and staff needs, and clinical training and experience working within a complex environment. Third, few departments rely on empirical data when making decisions about staffing, tending instead to default to the budgetary status quo. These findings provide the basis for a larger more systematic study.

Leading for quality in healthcare: development and validation of a competency model.

Increased attention to healthcare quality and impending changes due to health reform are calling for healthcare leaders at all levels to strengthen their skills in leading quality improvement initiatives. To address this need, the National Association for Healthcare Quality spearheaded the development and validation of a competency model to support healthcare leaders in assessing their strengths and planning appropriate steps for development. Initial development took place over the course of several days of meetings by an advisory panel of quality professionals. The draft model was then validated via electronic survey of a national sample of 883 quality professionals. Follow-up analyses indicated that the model was content valid for each of the target samples and also distinguished differing levels of job scope and experience. The resulting model contains six domains spanning three organizational levels.

High-performance work systems in health care management, part 1: development of an evidence-informed model.

BACKGROUND: : Although management practices are recognized as important factors in improving health care quality and efficiency, most research thus far has focused on individual practices, ignoring or underspecifying the contexts within which these practices are operating. Research from other industries, which has increasingly focused on systems rather than individual practices, has yielded results that may benefit health services management. PURPOSE: : Our goal was to develop a conceptual model on the basis of prior research from health care as well as other industries that could be used to inform important contextual considerations within health care. METHODOLOGY/APPROACH: : Using theoretical frameworks from A. Donabedian (1966), P. M. Wright, T. M. Gardner, and L. M. Moynihan (2003), and B. Schneider, D. B. Smith, and H. W. Goldstein (2000) and review methods adapted from R. Pawson (2006b), we reviewed relevant research from peer-reviewed and other industry-relevant sources to inform our model. The model we developed was then reviewed with a panel of practitioners, including experts in quality and human resource management, to assess the applicability of the model to health care settings. FINDINGS: : The resulting conceptual model identified four practice bundles, comprising 14 management practices as well as nine factors influencing adoption and perceived sustainability of these practices. The mechanisms by which these practices influence care outcomes are illustrated using the example of hospital-acquired infections. In addition, limitations of the current evidence base are discussed, and an agenda for future research in health care settings is outlined. PRACTICE IMPLICATIONS: : Results may help practitioners better conceptualize management practices as part of a broader system of work practices. This may, in turn, help practitioners to prioritize management improvement efforts more systematically.