Impact of C-level positions on hospital performance: a scoping review protocol.

INTRODUCTION: The objective of this scoping review is to identify evidence of the impact of hospital managers in top management (c-suite) on hospital performance. Managers generally have various effects on organisational objectives of their organisations. In recent years, the healthcare sector has experienced alterations in hospital governance structures, together with the emergence of new c-suite positions, aligning more closely with those found in private organisations. Their impact on hospital performance (ie, quality of care) is not well known. This scoping review seeks to identify all the available evidence of their impact on the organisational objectives. This scoping review will include primary studies, reviews and commentaries that describe the impact of top management team members on organisational outcomes in a hospital setting. METHODS AND ANALYSIS: The search strategy aims to locate both published and unpublished documents (ie, grey literature) using a three-step search strategy. An exploratory search of Medline and Google Scholar identified keywords and Medical Subject Headings terms. A second search of Medline (PubMed), Web of Science Core Collection, ScienceDirect, Business Source Premier (EBScoHost), JSTOR, BASE, Lens.org and the Google Search Engine will be performed. The scope of the search will cover 1990-present time using English search terms. Manual searching by two reviewers will be added to the search strategy. The identified documents will be independently screened, selected by two researchers and extracted by one researcher. The data are then presented in tables and graphics coupled with a descriptive summary. ETHICS AND DISSEMINATION: As this study neither involves human participants nor unpublished secondary data, an ethics approval is not required. Findings will be disseminated through professional networks, conference presentations and publication in a scientific journal. TRIAL REGISTRATION NUMBER: The protocol was registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/EBKUP).

Building ontology-based temporal databases for data reuse: An applied example on hospital organizational structures.

Keeping track of data semantics and data changes in the databases is essential to support retrospective studies and the reproducibility of longitudinal clinical analysis by preventing false conclusions from being drawn from outdated data. A knowledge model combined with a temporal model plays an essential role in organizing the data and improving query expressiveness across time and multiple institutions. This paper presents a modelling framework for temporal relational databases using an ontology to derive a shareable and interoperable data model. The framework is based on: OntoRela an ontology-driven database modelling approach and Unified Historicization Framework a temporal database modelling approach. The method was applied to hospital organizational structures to show the impact of tracking organizational changes on data quality assessment, healthcare activities and data access rights. The paper demonstrated the usefulness of an ontology to provide a formal, interoperable, and reusable definition of entities and their relationships, as well as the adequacy of the temporal database to store, trace, and query data over time.

Real-time management of intra-hospital patient transport requests.

This paper addresses the management of patients' transportation requests within a hospital, a very challenging problem where requests must be scheduled among the available porters so that patients arrive at their destination timely and the resources invested in patient transport are kept as low as possible. Transportation requests arrive during the day in an unpredictable manner, so they need to be scheduled in real-time. To ensure that the requests are scheduled in the best possible manner, one should also reconsider the decisions made on pending requests that have not yet been completed, a process that will be referred to as rescheduling. This paper proposes several policies to trigger and execute the rescheduling of pending requests and three approaches (a mathematical formulation, a constructive heuristic, and a local search heuristic) to solve each rescheduling problem. A simulation tool is proposed to assess the performance of the rescheduling strategies and the proposed scheduling methods to tackle instances inspired by a real mid-size hospital. Compared to a heuristic that mimics the way requests are currently handled in our partner hospital, the best combination of scheduling method and rescheduling strategy produces an average 5.7 minutes reduction in response time and a 13% reduction in the percentage of late requests. Furthermore, since the total distance walked by porters is substantially reduced, our experiments demonstrate that it is possible to reduce the number of porters - and therefore the operating costs - without reducing the current level of service.

Applications of data envelopment analysis in acute care hospitals: a systematic literature review, 1984-2022.

This study reviews scholarly publications on data envelopment analysis (DEA) studies on acute care hospital (ACH) efficiency published between 1984 and 2022 in scholarly peer-reviewed journals. We employ systematic literature review (SLR) method to identify and analyze pertinent past research using predetermined steps. The SLR offers a comprehensive resource that meticulously analyzes DEA methodology for practitioners and researchers focusing on ACH efficiency measurement. The articles reviewed in the SLR are analyzed and synthesized based on the nature of the DEA modelling process and the key findings from the DEA models. The key findings from the DEA models are presented under the following sections: effects of different ownership structures; impacts of specific healthcare reforms or other policy interventions; international and multi-state comparisons; effects of changes in competitive environment; impacts of new technology implementations; effects of hospital location; impacts of quality management interventions; impact of COVID-19 on hospital performance; impact of teaching status, and impact of merger. Furthermore, the nature of DEA modelling process focuses on use of sensitivity analysis; choice of inputs and outputs; comparison with Stochastic Frontier Analysis; use of congestion analysis; use of bootstrapping; imposition of weight restrictions; use of DEA window analysis; and exogenous factors. The findings demonstrate that, despite several innovative DEA extensions and hospital applications, over half of the research used the conventional DEA models. The findings also show that the most often used inputs in the DEA models were labor-oriented inputs and hospital beds, whereas the most frequently used outputs were outpatient visits, followed by surgeries, admissions, and inpatient days. Further research on the impact of healthcare reforms and health information technology (HIT) on hospital performance is required, given the number of reforms being implemented in many countries and the role HIT plays in enhancing care quality and lowering costs. We conclude by offering several new research directions for future studies.

Reflexões acerca do uso da metodologia lean em serviços hospitalares / Reflections on the use of lean metodhodoly in hospital services

Introdução: A metodologia Lean é contemporânea e vem sendo utilizada em ambientes hospitalares, principalmente em serviços de urgências e emergências. Objetivo: Refletir acerca da metodologia Lean na perspectiva de suas ferramentas e estratégias, desafios, limitações e potencialidades, para a atenção hospitalar. Método: Estudo reflexivo fundamentado em base teórica e científica acerca da metodologia Lean na atenção hospitalar. Resultados: São discutidas considerações sobre a utilização da metodologia Lean com enfoque na implementação, monitoramento, potencialidades e limitações das ferramentas/estratégias utilizadas. Conclusão: Conclui-se que a implementação da metodologia Lean contribui para obtenção de melhores resultados nos principais indicadores da gestão de leitos, diminuição da superlotação nos serviços e do tempo de permanência nos leitos hospitalares, fortalece a atuação da regulação de leitos que, por sua vez, contribuem para uma melhoria da qualidade da assistência e satisfação dos usuários

Introduction: The Lean methodology is contemporary and has been used in hospital environments, especially in emergency services. Objective: To reflect on the Lean methodology from the perspective of its tools and strategies, challenges, limitations and potentialities for hospital care. Method: Reflective study based on theoretical and scientific basis about the Lean methodology in hospital care. Results: Considerations are discussed about the use of the Lean methodology focusing on the implementation, monitoring, potentialities and limitations of the tools/strategies used. Conclusion: It is concluded that the implementation of the Lean methodology contributes to obtain better results in the main indicators of bed management, reduction of overcrowding in services and length of stay in hospital beds, the regulation of beds, which in turn contribute to an improvement in the quality of care and user satisfaction

Introducción: La metodología Lean es contemporánea y ha sido utilizada en ambientes hospitalarios, principalmente en servicios de urgencias y emergencias. Objetivo: Reflexionar sobre la metodología Lean desde la perspectiva de sus herramientas y estrategias, desafíos, limitaciones y potencialidades para la atención hospitalaria. Método: Estudio reflexivo basado en bases teóricas y científicas sobre la metodología Lean en la atención hospitalaria. Resultados: Se discuten consideraciones sobre el uso de la metodología Lean, con foco en la implementación, seguimiento, potencialidades y limitaciones de las herramientas/estrategias utilizadas. Conclusión: Se concluye que la implementación de la metodología Lean contribuye a obtener mejores resultados en los principales indicadores de gestión de camas, reduciendo el hacinamiento en los servicios y el tiempo de estancia en camas hospitalarias, fortaleciendo el desempeño de la regulación de camas, que a su vez contribuyen a una mejora en la calidad de la atención y la satisfacción del usuario

Development of a Hospital-Stakeholder Collaboration Tool Using Mixed Methods to Assess Stakeholder Perspectives for Hospital Service Improvement.

Background: The purpose of this study was to develop the Hospital-Stakeholder Collaboration (HSC) Tool and Hospital Performance Factor (HPF) Tool to explore stakeholder perception and value for hospital service improvement. Methods: This exploratory mixed-method study involved three steps: initial tool development (Step 1), validity testing (Step 2), and module development (Step 3). In Step 1, qualitative data collection through literature reviews, focus group discussions, and interviews with hospital management experts led to the creation of the preliminary tools. Step 2 involved qualitative analysis by α 5-member expert panel, followed by quantitative analysis with 36 respondents for validity (Pearson correlation, α = 0.05) and reliability (Cronbach's Alpha, α = 0.6) tests. Step 3 encompassed the final module development. Results: The HSC tool contains 6 domains and the HPF tool contains 4 perspectives. The 6 HSC domains were: 1) stakeholder identification, 2) interactive dialogue, 3) commitment, 4) planning, 5) implementation, 6) change in action and behavior. The 4 HPF perspectives were: 1) stakeholder perspective, 2) financial perspective, 3) internal business process, and 4) staff and organizational capacity. The values of the HSC tool validity and reliability tests were around 0,0046 and around 0,995, respectively. Additionally, the values of the HPF tool validity and reliability tests were around 0,0062 and around 0,995, respectively. Conclusion: This study offers a practical tool for needs assessment for the improvement of service by analyzing direct feedback from hospital stakeholders and measuring hospital performance factors.

Digital Technology in Hospital Administration: A Strategic Choice.

Digital technology has encompassed all aspects of healthcare. There are many international and national organizations, guidelines, and formats available in health information systems (HIS), but many are presently still not being used in India. The aim is to give a flawless, secure, and user-friendly health information technology (IT) system for Indian healthcare. We discuss the timeline of digital technology in hospital administration, administrative applications, and the importance of clinical quality in health. Clinical perspectives of clinical information systems (CIS), both in acute as well as chronic clinical care models. Cross-integration of healthcare in IT (HIT) in electronic health records (EHR) or electronic medical records (EMRs), in chronic disease management (CDM) systems, and in clinical decision support systems (CDSS) are elaborated. Also, practical strategic application methods are discussed. The limitations of the current HIS software in India are mostly used for transaction reporting, prescription, and administrative tools. They lack CIS and strategic business applications as compared to mature multinational company (MNC) HIS software. Along with this, various features and levels of HIS Software, challenges of HIT adoption, Indian health IT standards, and the future framework of IT in health in India are systematically analyzed. We aim at all physicians in India and at all levels of practice, from individuals, group practices, health institutes, or corporate hospitals, and to encourage them to make strategic use of CIS and strategic IT applications in their individual practice and hospital management. This will improve clinical outcomes, patient safety, practitioner performance, adherence to treatment guidelines, and reduction in medical errors, along with efficiency improvements and cost reductions. How to cite this article: Taneja D, Kulkarni SV, Sinha S, et al. Digital Technology in Hospital Administration: A Strategic Choice. J Assoc Physicians India 2023;71(10):83-88.

Passagem de plantão, comunicação efetiva e o método sbar, na percepção dos enfermeiros de uma unidade coronariana / El cambio de turno, la comunicación efectiva y el método sbar en la percepción de los enfermeros de una unidad de cuidados coronarios / Shift handover, effective communication, and the sbar method, in the perception of nurses in a coronary care unit

RESUMO Objetivo: identificar as percepções dos enfermeiros de uma unidade coronariana sobre a relação entre a passagem de plantão, comunicação efetiva e o método SBAR. Método: estudo descritivo exploratório com abordagem qualitativa que buscou identificar as percepções dos enfermeiros sobre a relação entre a passagem de plantão, a comunicação efetiva e o método SBAR na unidade de terapia intensiva no processo realizado entre os turnos de trabalho, com indicativos para a construção de um instrumento estruturado para orientar e conduzir a troca de turnos, com a participação de 12 enfermeiros de uma unidade intensiva coronariana. Os dados foram obtidos no período de janeiro a julho de 2020 por meio oficina presencial antes da pandemia, e questionários foram submetidos à análise temática. Resultados: foram elencadas três categorias: Organização da passagem de plantão com enfermeiro e técnico de Enfermagem; Instrumentalização da passagem de plantão entre as equipes de Enfermagem; e Método SBAR na passagem de plantão, como base para a elaboração do instrumento de passagem de plantão. Evidenciou-se que a comunicação efetiva é um fator influenciador na passagem de plantão para a realização do cuidado de Enfermagem de forma continuada, evitando eventos adversos aos pacientes. Conclusão: confirma-se que, estratégias envolvendo a gestão hospitalar, como instrumentalizar e capacitar a equipe que está na linha de frente da atividade do plantão, acrescentam e enriquecem o cuidado sistematizado e humanizado.

RESUMEN Objetivo: identificar las percepciones del personal de enfermería de una unidad de cuidados coronarios sobre la relación entre el rostering, la comunicación efectiva y el método SBAR. Método: Estudio exploratorio descripti-vo con abordaje cualitativo, que buscaba identificar las percepciones de los enfermeros sobre la relación entre el paso de planta, la comunicación efectiva y el método SBAR, en la unidad de terapia intensiva en el proceso realizado entre los turnos de trabajo, con indicaciones para construir un instrumento estructurado para orientar y conducir la búsqueda de turnos con la participación de 12 enfermeros de una unidad intensiva coronaria. Los datos se obtuvieron de enero a julio de 2020, mediante un taller presencial antes de la pandemia y cuestionarios sometidos a análisis temáticos. Resultados: Se enumeraron tres categorías: Organización del paso de planta con el enfermero y el técnico de enfermería, instrumentalización del cambio de turno entre los equipos de enferme-ría y método SBAR en el cambio de turno, como base para la elaboración del instrumento de cambio de turno. Se demostró que la comunicación eficaz es un factor que influye en el paso de la planta para la realización del cuidado de la salud de forma continuada, evitando eventos adversos a los pacientes. Conclusión: Se confirma que las estrategias que implican a la dirección del hospital, como: potenciar y formar a este equipo que está en primera línea, en el liderazgo de la actividad de guardia, suma y enriquece la atención sistematizada y humanizada.

ABSTRACT Objective: to identify the perceptions of nurses in a coronary care unit about the relationship between shift change, effective communication, and the SBAR method. Method: descriptive exploratory study with a qualitative approach that sought to identify nurses' perceptions about the relationship between shift change, effective communication, and the SBAR method in the intensive care unit in the process carried out between work shifts, with indications for the construction of a structured instrument to guide and lead the shift change, with the participation of 12 nurses from a coronary intensive care unit. Data were obtained from January to July 2020 through a face-to-face workshop before the pandemic, and questionnaires were subjected to thematic analysis. Results: three categories were listed: Organization of the shift change with nurses and Nursing technicians; Instrumentalization of the shift change between the Nursing teams; and SBAR Method in the shift change, as a basis for the elaboration of the shift change instrument. It was evidenced that effective communication is an influencing factor in the shift change to carry out Nursing care in a continuous way, avoiding adverse events to patients. Conclusion: it is confirmed that strategies involving hospital management, such as equipping and training the team that is in the front line of the duty activity, add and enrich the systematized and humanized care.

Local COVID-19 Epicenter in Detroit Metropolitan Area Causing Profound and Pervasive Reorganization of Clinical, Educational, Research, and Financial Programs of a Large Academic Gastroenterology Division with a GI Fellowship and Primary Medical School Affiliation.

AIM: To report revolutionary reorganization of academic gastroenterology division from COVID-19 pandemic surge at metropolitan Detroit epicenter from 0 infected patients on March 9, 2020, to > 300 infected patients in hospital census in April 2020 and > 200 infected patients in April 2021. SETTING: GI Division, William Beaumont Hospital, Royal Oak, has 36 GI clinical faculty; performs > 23,000 endoscopies annually; fully accredited GI fellowship since 1973; employs > 400 house staff annually since 1995; tertiary academic hospital; predominantly voluntary attendings; and primary teaching hospital, Oakland-University-Medical-School. METHODS: This was a prospective study. Expert opinion. Personal experience includes Hospital GI chief > 14 years until 2020; GI fellowship program director, several hospitals > 20 years; author of > 300 publications in peer-reviewed GI journals; committee-member, Food-and-Drug-Administration-GI-Advisory Committee > 5 years; and key hospital/medical school committee memberships. Computerized PubMed literature review was performed on hospital changes and pandemic. Study was exempted/approved by Hospital IRB, April 14, 2020. RESULTS: Division reorganized patient care to add clinical capacity and minimize risks to staff of contracting COVID-19 infection. Affiliated medical school changes included: changing "live" to virtual lectures; canceling medical student GI electives; exempting medical students from treating COVID-19-infected patients; and graduating medical students on time despite partly missing clinical electives. Division was reorganized by changing "live" GI lectures to virtual lectures; four GI fellows temporarily reassigned as medical attendings supervising COVID-19-infected patients; temporarily mandated intubation of COVID-19-infected patients for esophagogastroduodenoscopy; postponing elective GI endoscopies; and reducing average number of endoscopies from 100 to 4 per weekday during pandemic peak! GI clinic visits reduced by half (postponing non-urgent visits), and physical visits replaced by virtual visits. Economic pandemic impact included temporary, hospital deficit subsequently relieved by federal grants; hospital employee terminations/furloughs; and severe temporary decline in GI practitioner's income during surge. Hospital temporarily enhanced security and gradually ameliorated facemask shortage. GI program director contacted GI fellows twice weekly to ameliorate pandemic-induced stress. Divisional parties held virtually. GI fellowship applicants interviewed virtually. Graduate medical education changes included weekly committee meetings to monitor pandemic-induced changes; program managers working from home; canceling ACGME annual fellowship survey, changing ACGME physical to virtual site visits; and changing national conventions from physical to virtual. CONCLUSION: Reports profound and pervasive GI divisional changes to maximize clinical resources devoted to COVID-19-infected patients and minimize risks of transmitting infection.

Nursing surveillance and immediate jeopardy in Veteran Health Administration community living centers unannounced survey program 2018 to 2019.

BACKGROUND: The VA Community Living Center (CLC) Unannounced Survey Program aims to assess standards of care set by the government to protect residents. PURPOSE: To describe patterns of practice failures in nursing surveillance causing or having potential to cause immediate jeopardy, as defined by the Centers for Medicare and Medicaid Services. METHODS: Using CLC survey data consisting of 200 statements of deficiency (SODs) for 2018 to 2019, we collected a SOD sample (n = 20) of immediate jeopardy events. They were described using descriptive statistics and discourse content analysis. FINDINGS: We identified clinical events, their duration, work shift, and nursing skill mix for each SOD. Most to least common themes about failures in nursing surveillance were acquisition/transfer of information; decision-making; and early recognition of problems. DISCUSSION: Our analysis of nursing surveillance failures in CLC immediate jeopardy SODs provides insight into opportunities for registered nurses and the nursing skill mix to reduce avoidable harms.

Healthcare and education networks interaction as an indicator of social services stability following natural disasters.

Healthcare and education systems have been identified by various national and international organizations as the main pillars of communities' stability. Understanding the correlation between these main social services institutions is critical to determining the tipping point of communities following natural disasters. Despite being defined as social services stability indicators, to date, no studies have been conducted to determine the level of interdependence between schools and hospitals and their collective influence on their recoveries following extreme events. In this study, we devise an agent-based model to investigate the complex interaction between healthcare and education networks and their overall recovery, while considering other physical, social, and economic factors. We employ comprehensive models to simulate the functional processes within each facility and to optimize their recovery trajectories after earthquake occurrence. The results highlight significant interdependencies between hospitals and schools, including direct and indirect relationships, suggesting the need for collective coupling of their recovery to achieve full functionality of either of the two systems following natural disasters. Recognizing this high level of interdependence, we then establish a social services stability index, which can be used by policymakers and community leaders to quantify the impact of healthcare and education services on community resilience and social services stability.

Use of High-Reliability Principles in the Evolution of a Hospital Command Centre.

Hospitals and health systems across the world strive to achieve consistently safe care delivery and reduce patient harm. In November 2017, Humber River Hospital became one of the first hospitals in North America to implement a hospital command centre to manage patient access and flow. The command centre outputs relevant real-time data that have been integrated from multiple automated systems and uses predictive analytics to support early identification of patients at risk of harm and deterioration. The aim of this descriptive article is to present the conceptual development of Humber River Hospital's Command Centre.

US Hospital Preparedness to Manage Unidentified Individuals and Reunite Unaccompanied Minors with Family Members During Disasters: Results from a Nationwide Survey.

Unaccompanied minors and other unidentified individuals may present to hospitals during disasters and require reunification with family. Hospital preparedness for family reunification during disasters has never been assessed. We sent members of the Association of Healthcare Emergency Preparedness Professionals an anonymous online survey in July and August 2019 to assess their hospital's reunification readiness during a disaster. Scores on preparedness to manage unidentified patients were calculated based on 21 indicators, each with a score of 0 or 1. A multivariate linear regression was conducted to delineate factors associated with higher preparedness scores. In total, 88 individuals participated (response rate = 33.4%). All agreed that reunification preparedness is important, but far fewer (χ2 = 33.8, P < .001) believed their hospital was prepared to reunify unidentified individuals during a disaster (n = 58, 65.9%). Most (n = 56, 63.6%) had at least some written reunification plan. Preparedness scores ranged from 0 to 21 (mean = 8.0, standard deviation = 7.3). Predictors of preparedness included having a pediatrician on the hospital disaster planning committee, conducting a disaster exercise that simulated an unaccompanied minor scenario, and implementing the 2018 American Academy of Pediatrics Reunification Planning Tool. Findings from this study indicate that many US hospitals are not prepared to reunify unaccompanied minors or other separated family members during a disaster. The planning tool is a free resource that hospitals can use to improve their hospital reunification plans. Hospitals should prioritize development of reunification plans to ensure rapid response during a future event. Use of the planning tool can aid in development and improvement of these plans.

Surgical Re-entry Strategy Following COVID-19 Pandemic: A Tiered and Balanced Approach.

Following the Presidential declaration of a national emergency, many health care organizations adhered to recommendations from the Centers for Medicare and Medicaid (CMS) as well as the American College of Surgeons (ACS) to postpone elective surgical cases. The transition to only emergent and essential urgent surgical cases raises the question, how and when will hospitals and surgery centers resume elective cases? As a large health care system providing multispecialty tertiary/quaternary care with across the Southeast United States, a collaborative approach to resuming elective surgery is critical. Numerous surgical societies have outlined a tiered approach to resuming elective surgery. The majority of these guidelines are suggestions which place the responsibility of making decisions about re-entry strategy on individual health care systems and practitioners, taking into account the local case burden, projected case surge, and availability of resources and personnel. This paper reviews challenges and solutions related to the resumption of elective surgeries and returning to the pre-COVID-19 surgical volume within an integrated health care system that actively manages 18 facilities, 111 operating rooms, and an annual operative volume exceeding 123,000 cases. We define the impact of COVID-19 across our surgical departments and outline the staged re-entry approach that is being taken to resume surgery within the health care system.

Exploration on the safe management of multi-hospital transportation in a large public hospital during the pandemic of 2019-nCoV.

During the pandemic of 2019-nCoV, large public hospitals are facing great challenges. Multi-hospital development will be the main mode of hospital administrative management in China in the future. West China Hospital of Sichuan University implemented multi-hospital integrated management, in which the branch district established the administrative multi-department collaboration mode. As an important part of the operation of branch district, how to effectively organize transportation of staffs and patients and to prevent and control the pandemic of 2019-nCoV simultaneously between different hospitals have been the key and difficult points, which should be solved urgently in the management of the branch district.

Estrategias hospitalarias frente a una pandemia / Hospital strategies against a pandemic

La humanidad, que a lo largo de la historia ha sufrido pandemias que han ocasionado la muerte de millones de personas, es actualmente azotada por la pandemia de COVID-19. El propósito de este artículo es brindar estrategias para un manejo oportuno y eficiente que contribuya a disminuir la morbilidad y mortalidad a nivel hospitalario. Para la elaboración de este artículo se revisó bibliografía de instituciones certificadas en el tema, encontrando que la mayor parte de publicaciones se centran en el abordaje de una pandemia como país; es muy poca la literatura que se centra en el abordaje hospitalario. Es por ello que, de acuerdo con la experiencia actual, en la que hemos observado serias debilidades en los hospitales de la red hospitalaria del sector público, se sugieren estrategias, adecuadas a nuestro medio, para que las autoridades hospitalarias puedan hacerle frente a una pandemia...(AU)

Finding a New Normal: Hospital Governance Best Practices during COVID-19.

COVID-19 is a significant risk that compels hospital boards to react in an agile manner. Good governance requires active and effective oversight as hospitals continue to manage the pandemic for an indefinite period. Emerging from the first wave of COVID, in the context of continuously evolving restrictions, hospital boards must transition from interim solutions to sustainable practices. This new environment requires agile practices grounded in clear roles, sound structures and transparent processes. Boards can seize this opportunity to reflect on best practices, extract underlying principles of good governance and elevate these practices into a "new normal" governance environment.

A model of workflow in the hospital during a pandemic to assist management.

We present a computational model of workflow in the hospital during a pandemic. The objective is to assist management in anticipating the load of each care unit, such as the ICU, or ordering supplies, such as personal protective equipment, but also to retrieve key parameters that measure the performance of the health system facing a new crisis. The model was fitted with good accuracy to France's data set that gives information on hospitalized patients and is provided online by the French government. The goal of this work is both practical in offering hospital management a tool to deal with the present crisis of COVID-19 and offering a conceptual illustration of the benefit of computational science during a pandemic.