Top-level leaders and implementation strategies to support organizational diversity, equity, inclusion, and belonging (DEIB) interventions: a qualitative study of top-level DEIB leaders in healthcare organizations.

BACKGROUND: The Black Lives Matter movement and COVID-19 pandemic motivated the wide-scale adoption of diversity, equity, inclusion, and belonging (DEIB) initiatives within healthcare organizations and the creation of DEIB top-level leader positions. The next step is to understand how these leaders contribute to the implementation of DEIB interventions, a task with notable salience due to not only the historical difficulties associated with DEIB strategy execution, but also the substantial evidence that leadership plays a significant role in implementation processes. Therefore, the objective of this qualitative study is to understand the role of top-level DEIB leaders in the implementation of healthcare organizational DEIB interventions. METHODS: A qualitative research approach which used an in-depth semi-structured interview approach was employed. We conducted thirty-one 60-90-min semi-structured interviews with DEIB top-level leaders between February 2022 and October 2022 over Zoom. An iterative coding process was used to identify the key implementation strategies and activities of DEIB top-level leaders. RESULTS: Interviewees were mostly Black, majority female, and mostly heterosexual and had a variety of educational backgrounds. We identified the DEIB top-level leader as the DEIB strategy implementation champion. These leaders drive five DEIB implementation strategies: (1) People, (2) Health Equity, (3) Monitoring and Feedback, (4) Operational Planning and Communication, and (5) External Partners. Within these, we identified 19 significant activities that describe the unique implementation strategies supported by the DEIB top-level leaders. CONCLUSIONS: To move toward sustained commitment to DEIB, the organization must focus on not only establishing DEIB interventions, but on their successful implementation. Our findings help explicate the implementation activities that drive the DEIB initiatives of healthcare organizations and the role of DEIB leaders. Our work can help healthcare organizations systematically identify how to support the success of DEIB organizational interventions.

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.

Effects of post-discharge telemonitoring on 30-day chronic obstructive pulmonary disease readmissions and mortality.

INTRODUCTION: Much attention has been focused on decreasing chronic obstructive pulmonary disease (COPD) hospital readmissions. The US health system has struggled to meet this goal. The objective of this study was to assess the efficacy of telehealth services on the reduction of hospital readmission and mortality rates for COPD. METHODS: We used a cross-sectional design to examine the association between hospital risk-adjusted readmission and mortality rates for COPD and hospital use of post-discharge telemonitoring (TM). Data for 777 hospitals were sourced from the Centers for Medicare & Medicaid Services and the American Hospital Association annual surveys. Propensity score matching using the kennel weights method was applied to calculate the weighted probability of being a hospital that offers post-discharge TM services. RESULTS: Hospitals with post-discharge TM had about 34% significantly higher odds (adjusted odds ratio (AOR) = 1.34; 95% confidence interval (CI) 1.06-1.70) of 30-day COPD readmission and 33% significantly lower odds (AOR = 0.67; 95% CI 0.50-0.90) of 30-day COPD mortality compared to hospitals without post-discharge TM services. DISCUSSION: Overall, hospitals that offer post-discharge TM services have seen an improvement in 30-day COPD mortality rates. However, those same hospitals have also experienced a significant increase in 30-day COPD readmissions. TM can potentially decrease mortality in patients recently admitted for acute exacerbation of COPD. The results provide further evidence that readmissions present a problematic assessment of health-care quality, as the need for readmission may or may not be directly related to the quality of care received while in hospital.

Learning Through Diversity: Creating a Virtuous Cycle of Health Equity in Health Care Organizations.

In the US, a growing number of organizations and industries are seeking to affirm their commitment to and efforts around diversity, equity, and inclusion (DEI) as recent events have increased attention to social inequities. As health care organizations are considering new ways to incorporate DEI initiatives within their workforce, the anticipated result of these efforts is a reduction in health inequities that have plagued our country for centuries. Unfortunately, there are few frameworks to guide these efforts because few successfully link organizational DEI initiatives with health equity outcomes. The purpose of this chapter is to review existing scholarship and evidence using an organizational lens to examine how health care organizations can advance DEI initiatives in the pursuit of reducing or eliminating health inequities. First, this chapter defines important terms of DEI and health equity in health care. Next, we describe the methods for our narrative review. We propose a model for understanding health care organizational activity and its impact on health inequities based in organizational learning that includes four interrelated parts: intention, action, outcomes, and learning. We summarize the existing scholarship in each of these areas and provide recommendations for enhancing future research. Across the body of knowledge in these areas, disciplinary and other silos may be the biggest barrier to knowledge creation and knowledge transfer. Moving forward, scholars and practitioners should seek to collaborate further in their respective efforts to achieve health equity by creating formalized initiatives with linkages between practice and research communities.

Executive Involvement in Governing Boards and Hospital and Health System Performance.

Governing boards and executive leaders play important roles ensuring that their organizations work toward their missions and maintain their visions, while also meeting compliance and performance goals. The level of executive involvement in hospital governing boards varies across organizations, with little evidence to suggest whether and to what degree executive involvement influences hospital performance. The aim of this study is to determine the influence of executive involvement in governance on health system performance. The sample analyzed in this study were organizations responding to The Governance Institute's (TGI) Biennial Survey of Hospital and Health Systems in 2017. Bivariate and multivariate analyses were used to examine associations between self-reported executive leadership team involvement in governing boards and a composite metric of health system performance calculated by Truven Analytics as part of the "Top 100" program. Results indicate executive involvement is associated with several organizational characteristics, including whether an institution was defined as a hospital or health system, whether or not the board was appointed by the parent/system, and whether the board was accountable to the parent/system board. Although no significant direct relationship was found between executive team involvement in governance and overall health system performance, several promising pathways for future study were identified and are discussed, including examining specific organizational performance outcomes rather than composite measures.

A Bird in Hand: An Examination of the Influence of Nursing School Proximal Density on Hospital Quality of Care Outcomes in U.S. Hospitals.

While nurse staffing shortage is generally true, it is not universal, and it remains unclear the degree to which variation in local staffing markets might influence the relationship between nurse staffing and care quality. This study seeks to determine the effect of nurse staffing markets on the quality of hospital care delivered in U.S. hospitals by examining the relationship between the proximal density of nurse staffing resources to hospitals and patient-reported care quality outcomes. This examination analyzes hospital performance on (Hospital Consumer Assessment of Healthcare Providers and Systems) HCAHPS based on the proximal density of nursing schools. The analysis combines data from Centers for Medicare and Medicaid Services (CMS) Hospital Compare (N1 = 2959) and U.S. nursing school locations from the American Association of Colleges of Nursing (N2 = 811) via a series of binary logistic regressions to determine whether local nurse staffing availability is related to hospital's attainment of either low or high star quality ratings. A sensitivity analysis is also offered to determine the association with 1, 3, and 5-star ratings. The findings suggest that the odds of receiving both a low-star rating and a high-star rating of HCAHPS performance increase as proximal density increases while the odds of receiving a 3-star rating decrease. Hospitals are able to achieve the highest levels of performance as high performing hospitals in high-density markets seem to be taking advantage of resource availability to establish close, strong ties with nurse staffing resources as opposed to viewing nurses as an easily replaceable resource.

Women at the helm: Chief executive officer gender and patient experience in the hospital industry.

BACKGROUND: Health care scholars have recognized the important role leaders play in the improvement of health care delivery systems, yet few have explored the kind of leaders who make a difference or the conditions under which certain health care executives thrive. Recent work in the hospital industry suggests that the role of chief executive officer (CEO) gender may be particularly salient in the context of patient experience (Galstian, Hearld, O'Connor, & Borkowski, 2018). PURPOSE: In this article, we bring an explicit theoretical and empirical lens to the issue of CEO gender in the context of patient experience. Our framework provides an explanation of both why (differences between men and women in their tendency for relational orientation) and under what circumstances (the degree of complexity in the executive job environment) CEO gender is most influential. METHODOLOGY/APPROACH: We test these relationships using data on patient experience in 391 nonrural U.S. hospitals between 2007 and 2011. Our study relies on both archival (e.g., Hospital Consumer Assessment of Healthcare Providers and Systems survey) and collected (e.g., CEO characteristics) data. Fixed-effects regression models are used to estimate the relationship between CEO gender and the interpersonal care experience. RESULTS: We find evidence that female CEOs improve the interpersonal care experience faster than male CEOs, particularly in the most complex executive job environments, that is, in the most populous urban environments, and in the largest hospital facilities. CONCLUSION: Our results not only support the notion that executives tend to rely on personal values and preferences but also that women have an apparent propensity for transforming health care organizations in the direction of patient centeredness, particularly in the most demanding circumstances. PRACTICE IMPLICATIONS: Hospital boards seeking to improve the patient experience should give careful attention to promoting women to the role of CEO and consider how their own policies may be constraining both the promotion of female executives and the creation of more patient-centered health care organizations.

A Study Examining the Influence of Proximity to Nurse Education Resources on Quality of Care Outcomes in Nursing Homes.

This examination seeks to determine the influence of proximal density to nurse education resources (nursing schools) on nursing home care quality outcomes in Alabama. Motivated by the social network theory, which highlights the influence of relational closeness on shared resources and values, we hypothesize that nursing homes that have higher levels of nursing education resources within a close proximity will exhibit significantly higher nursing home quality outcomes. As proximal density to nurse education resources increases, the opportunity for nursing homes to build closer, stronger ties increase, leading to higher quality outcomes. We examine this hypothesis via ordered logistic regressions of proximal density measures developed through geographic information systems (GIS) software, nurse education resource data from Johnson & Johnson's Campaign for Nursing's Future (n = 37), and nursing home quality outcome data from Centers for Medicare and Medicaid Services's (CMS) Nursing Home Compare from 2016 (n = 226). The results find that increases in proximal density to nurse education resources have a negative and significant association with nursing home quality outcomes in Alabama. Additional sensitivity analysis, which examines the degree to which the nature of this relationship is sensitive to health care facilities' location in high-density areas, is offered and confirms principal findings. Because nursing programs generally have stronger ties with hospitals, the findings suggest that the nursing homes in areas with higher nurse education resources may actually face greater competition for nurses.

The Moderating Role of Hospital Size on the Relationship Between Patient Experience and Patient Safety.

OBJECTIVES: Previous examinations of the relationship between patient experience and patient safety initiatives find that higher patient experience evaluations correspond to reduced incidence of adverse events. Little is known, however, about the impact of hospital organizational characteristics on this relationship. The purpose of this study is to examine the degree to which hospital size moderates the relationship between patient experience and patient safety. METHODS: A lagged cross-sectional ordinary least squares regression tests a hypothesis of a diminishing effect of hospital size on the relationship between patient evaluations of their interpersonal care experience and hospital's central-line associated bloodstream infection (CLABSI) is tested on a sample of 1740 US hospitals using data compiled from Hospital Compare and the American Hospital Association. RESULTS: The results find that the magnitude of the relationship between patient experience and patient safety initiatives is diminished as hospital size increases and suggest that care providers' ability to deliver care in a manner that is simultaneously responsive to individual patient needs and preferences and reliable in its avoidance of adverse events is influenced by hospital size. An additional fractional logit is presented, which accounts for restrictions in the dependent variable further support study findings.

Assessing the relationship between patient safety culture and EHR strategy.

Purpose - The purpose of this paper is to explore the relationship between hospitals' electronic health record (EHR) adoption characteristics and their patient safety cultures. The "Meaningful Use" (MU) program is designed to increase hospitals' adoption of EHR, which will lead to better care quality, reduce medical errors, avoid unnecessary cost, and promote a patient safety culture. To reduce medical errors, hospital leaders have been encouraged to promote safety cultures common to high-reliability organizations. Expecting a positive relationship between EHR adoption and improved patient safety cultures appears sound in theory, but it has yet to be empirically demonstrated. Design/methodology/approach - Providers' perceptions of patient safety culture and counts of patient safety incidents are explored in relationship to hospital EHR adoption patterns. Multi-level modeling is employed to data drawn from the Agency for Healthcare Research and Quality's surveys on patient safety culture (level 1) and the American Hospital Association's survey and healthcare information technology supplement (level 2). Findings - The findings suggest that the early adoption of EHR capabilities hold a negative association to the number of patient safety events reported. However, this relationship was not present in providers' perceptions of overall patient safety cultures. These mixed results suggest that the understanding of the EHR-patient safety culture relationship needs further research. Originality/value - Relating EHR MU and providers' care quality attitudes is an important leading indicator for improved patient safety cultures. For healthcare facility managers and providers, the ability to effectively quantify the impact of new technologies on efforts to change organizational cultures is important for pinpointing clinical areas for process improvements.