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1.
J Healthc Manag ; 67(5): 303-305, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36074696
2.
Vet Rec ; 191(2): iii, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35866964
3.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2022 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-35680639

RESUMO

PURPOSE: This study explores interactional dynamics and relational tensions within English NHS Foundation Trust board meetings that are influenced by governance structure and the board composition. DESIGN/METHODOLOGY/APPROACH: This paper draws upon an ethnonarrative approach to enable the understanding of the nuances of boardroom interactions. Data was collected through participant observation of board of directors' and board of governors' meetings and narrative interviews from directors and governors of two NHS Foundation Trusts. Data was analyzed through thematic narrative analysis to enable the identification and understanding of the patterns and the hidden tensions in boards. FINDINGS: Findings reveal that board interactions are influenced strongly by the nexus of structural, contextual and human elements of governance. Three main findings are highlighted: a lack of clarity of the governors' and chairpersons' roles which create ambiguities within board processes; the large size of the board of governors disrupts meaningful discussions in board meetings; the unacceptability and avoidance of governors' accountability by the directors creates a struggle for supremacy and legitimacy in boards. RESEARCH LIMITATIONS/IMPLICATIONS: Future research can explore both the positive and negative outcomes of board behaviors, which are influenced by the perceived built-in tensions in governance structures. In addition, access to other spaces of governance, such as, subcommittee meetings and private board meetings can further enrich our understanding of board dynamics. ORIGINALITY/VALUE: This study attempts to uncover the neglected modes of interactions within boards through a combination of two disparate perspectives: board structures/composition and interactions through an ethnonarrative approach.


Assuntos
Conselho Diretor , Medicina Estatal , Humanos , Responsabilidade Social
4.
Healthc Q ; 25(1): 28-33, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35596761

RESUMO

Boards are a powerful resource in overseeing our health system. This resource is limited in the amount of available time; therefore, boards should be as productive as possible. Boards should focus their energy on tangible, measurable results. Using natural language processing tools and quantitative outcome measures allows us to measure the impact of board focus. This analysis finds no significant relationship between a higher focus on finance or quality as measured by the board minutes and organizational performance in finance or quality. Boards focus much more on finance than quality or any other focus area with no substantive difference in outcomes. The study indicates that, at least in Ontario, boards may need to revise their approach and allocation of time to these topics.


Assuntos
Conselho Diretor , Hospitais , Humanos , Ontário
5.
Lancet ; 399(10336): 1673-1675, 2022 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-35429997
8.
J Craniofac Surg ; 33(4): e439-e443, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34980836

RESUMO

INTRODUCTION: The diagnosis and therapy of oral squamous cell carcinoma (Osee) in Germany is according to guidelines and relies on interdisciplinary board meetings. Standard examination techniques are computed tomography (CT) and magnet resonance imaging (MRI). These technologies are used as objective tools for serial presentation in an oncologic board meeting. The presentation of multiple series at different time points can be time consuming and might not often depict a patients case clearly for all involved disciplinaries. A conclusive image fusion could improve the communication. Thus, this study aims to introduce a novel idea of image fusion into the field of craniomaxillofacial surgery in order to ease understanding and improve therapy in complex Osee patients' cases. MATERIALS AND METHODS: Three key data sets of a patient with OSCC at the right tongue have been merged by image fusion of 3 MRi of head and neck with 3 CT thorax and abdomen using Syngo via (Siemens). Fused images were used as at a glance picture for presenting and discussion a patients case. Focus was on presenting a case of a primary manifestation of OSCC with the potential of a local relapse and distant metastases in an interdisciplinary oncol-ogic board meeting. RESULTS: Image fusion enabled to visualize the primary tumor, local relapse as well as distant pulmonary metastasis and within the suprarenal gland, which have been occurred in a linear time line of 13 months. DISCUSSION: Image fusion of different modalities that is CT and MRi, which were gathered at different time points, presents a new approach within the field of craniomaxillofacial surgery and helped to understand cancer localization and relapse at 1 glance. This new approach will enable a compact data set of patients oncological history as a more decisive tool for all involved disciplinaries. CONCLUSIONS: Image fusion might have the potential to become a standard approach in order to ease multiple therapists to make therapy decisions in oncologic board meetings on basis of current three-dimensional ready CT imaging and MRI.


Assuntos
Neoplasias de Cabeça e Pescoço , Processamento de Imagem Assistida por Computador , Comunicação Interdisciplinar , Oncologia , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Alemanha , Conselho Diretor , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional , Imageamento por Ressonância Magnética , Neoplasias Bucais/diagnóstico por imagem , Neoplasias Bucais/patologia , Neoplasias Bucais/cirurgia , Tomografia Computadorizada por Raios X
10.
J Nurs Adm ; 52(2): 106-111, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-35060952

RESUMO

OBJECTIVE: The study objective was to identify nurses' perceptions of their impact while serving on boards. BACKGROUND: Nurse leaders serving as voting board members are key experts for board effectiveness and may be associated with stronger performing organizations. Extant research indicates that nurse leaders are qualified for board service; however, no research explores the impact of nurses on boards. METHODS: We conducted an exploratory qualitative study by interviewing 20 nurses serving on boards. Hermeneutic analysis of the data resulted in 1 overarching pattern and 7 traversing themes. RESULTS: Nurses who serve on boards reported leveraging expert knowledge of healthcare and caring wisdom to influence strategic thinking to meet stakeholder needs. CONCLUSION: Nurses promote effective board governance by ensuring that the perspectives and needs of all stakeholders are represented in board processes. We recommend health-related organization executives and board leaders appoint nurses as voting members of their governing boards.


Assuntos
Conselho Diretor , Liderança , Papel do Profissional de Enfermagem/psicologia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa
11.
J Gen Intern Med ; 37(10): 2462-2468, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34472019

RESUMO

BACKGROUND: Early studies of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) suggested that physician leadership was an important driver of ACO success, but it is unknown whether the demographic and professional composition of current MSSP ACO governing boards is associated with ACOs' publicly reported outcomes. OBJECTIVE: To investigate whether governing boards with higher physician participation and greater female involvement have better outcomes. DESIGN: Cross-sectional observational study. PARTICIPANTS: All 2017 MSSP ACOs identified by the Center for Medicare and Medicaid Services ACO Public Use Files (PUF). MAIN MEASURES: We collected governing board composition from ACO websites in 2019. Outcome metrics included risk-standardized readmission and unplanned admissions rates. We used descriptive statistics and linear regression models to examine the association between board composition and outcomes. KEY RESULTS: Of the 339 ACOs that still existed in 2019 and had available data, 77% had physician-majority boards and 11.5% had no women on their boards. Eighty-nine percent reported a Medicare beneficiary on their board, of which about one-third had a woman representative. The average number of members on MSSP ACO boards was 12, with a mean of 67% physicians and 24% women. Board composition varied minimally by ACO characteristics, such as geographic region, number of beneficiaries, or type of participants. Higher levels of physician participation in ACO governing boards were associated with lower all-cause unplanned admission rates for patients with heart failure (p = - 0.26, p < 0.001) and for patients with multiple chronic conditions (p = - 0.28, p = 0.001). The number of women on the board was not associated with any outcome differences. CONCLUSIONS: MSSP ACO governing boards were predominately male and physician-led. Physician involvement may be important for achieving quality goals, while lack of female involvement showcases an opportunity to diversify boards.


Assuntos
Organizações de Assistência Responsáveis , Idoso , Centers for Medicare and Medicaid Services, U.S. , Redução de Custos , Estudos Transversais , Feminino , Conselho Diretor , Humanos , Masculino , Medicare , Estados Unidos
12.
J Nurs Adm ; 52(1): 51-56, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34910708

RESUMO

OBJECTIVES: The aims of this study were to identify the differences in nurses' perceptions of their professional practice work environment (PPWE) related to their participation in shared governance (SG) councils and to examine the perception of effectiveness of SG councils among nurses who participate in them. BACKGROUND: Research suggests that adopting SG in nursing can lead to significant, positive outcomes, such as patient and nurse satisfaction and enhanced nurse empowerment, engagement, and a PPWE. METHODS: The study used a cross-sectional design in a Magnet®-designated urban Jordanian cancer care hospital. A convenience sample of 580 direct care nurses was used. The data were collected using self-administered questionnaires, the Council Health (CH) instrument, and the Professional Practice Work Environment Inventory (PPWEI). RESULTS: Results demonstrated a significant difference in the total score of PPWE between the SG council members (4.85) and nonmembers (4.68) (t = 2.906, P = 0.004). The results also indicated small to strong correlations of the total overall council health mean and all domain means of council effectiveness with total overall PPWEI mean and all domain means of PPWE (P < 0.05) among nurses who participated in SG councils. CONCLUSION: Findings support involving more staff in SG councils and that enhancing the SG councils' effectiveness positively affects the PPWE.


Assuntos
Conselho Diretor/organização & administração , Enfermeiras e Enfermeiros/psicologia , Percepção , Prática Profissional/organização & administração , Engajamento no Trabalho , Local de Trabalho , Estudos Transversais , Humanos , Jordânia , Enfermagem Oncológica , Autorrelato , Inquéritos e Questionários , Local de Trabalho/organização & administração , Local de Trabalho/psicologia
13.
J Nurs Adm ; 51(12): 626-629, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34789688

RESUMO

OBJECTIVE: The purpose of this qualitative survey was to document executive nurse leaders' perception of their own leadership qualities in the context of the American Hospital Association (AHA) recommended membership requirements for executive hospital board appointment. BACKGROUND: Hospital boards of trustees are increasingly responsible for the quality of care and its impact on financial performance. High-performing boards are focused on the accountability of chief executive officer for quality metrics. Nurse leaders have valuable insight into key shared governance issues such as quality of care, financial performance, legal requirements, and regulatory oversight. METHODS: Fifty senior-level nurse executive members polled from the American Organization of Nurse Leaders, the Texas Organization of Nurse Leaders, and the Texas Nurse Practitioners Association completed an online quantitative survey using The Center for Healthcare Governance (CHG) Assessment Tool© of the AHA, which details a list of skills, experience, and personal qualities for executive hospital board placement. Respondents ranked their individual knowledge and skills on a 4-point Likert scale. RESULTS: Participant responses indicated that senior-level nurse executives have significant expertise in the key areas of quality, patient safety and performance, healthcare administration and policy, and business management. Areas ranking lower are those associated with organizational specialties: legal, construction project management, and finance. CONCLUSION: This information can be used to educate executive hospital boards regarding the qualifications of nurse leaders members. Nursing leaders, professional organizations, and academia can use this information to assess the skills of senior nursing leaders as it relates to potential board appointments.


Assuntos
Conselho Diretor/normas , Liderança , Enfermeiras Administradoras/psicologia , Enfermeiras Administradoras/normas , Papel do Profissional de Enfermagem/psicologia , Competência Profissional/normas , Adulto , American Hospital Association , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
16.
J Am Coll Surg ; 233(6): 722-729, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34438078

RESUMO

BACKGROUND: Program directors use US Medical Licensing Exam (USMLE) scores as criteria for ranking applicants. First-time pass rates of the American Board of Surgery (ABS) Qualifying (QE) and Certifying (CE) Examinations have become important measures of residency program quality. USMLE Step 1 will become pass/fail in 2022. STUDY DESIGN: American Board of Surgery QE and CE success rates were assessed considering multiple characteristics of highly ranked (top 20) applicants to 22 general surgery programs in 2011. Chi-square, t-test, Wilcoxon Rank sum, linear and logistic regression were used, as appropriate. RESULTS: The QE and CE first attempt pass rates were 96% (235/244) and 86% (190/221), respectively. QE/CE success was not significantly associated with sex, race, research experience, or publications. Alpha Omega Alpha (AΩA) status was associated with success on the index CE (98% vs 83%; p = 0.008). Step 1 and Step 2 Clinical Knowledge (CK) scores of surgeons who passed QE on their first attempt were higher than scores of those who failed (Step 1: 233 vs 218; p = 0.016); (Step 2CK: 244 vs 228, p = 0.009). For every 10-point increase in Step 1 and 2CK scores, the odds of passing CE on the first attempt increased 1.5 times (95% CI 1.12, 2.0; p = 0.006) and 1.5 times (95% CI 1.11, 2.02, p = 0.008), respectively. For every 10-point increase in Steps 1 and 2CK scores, the odds of passing the QE on the first attempt increased 1.85 times (95% CI 1.11, 3.09; p = 0.018) and 1.86 times (95% CI 1.14, 3.06, p = 0.013), respectively. CONCLUSIONS: USMLE Step 1 and Step 2 CK examination scores correlate with American Board of Surgery QE and CE performance and success. The USMLE decision to transition Step 1 to a pass/fail examination will require program directors to identify other factors that predict ABS performance for ranking applicants.


Assuntos
Avaliação Educacional/estatística & dados numéricos , Licenciamento em Medicina/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Feminino , Cirurgia Geral/educação , Cirurgia Geral/legislação & jurisprudência , Cirurgia Geral/organização & administração , Conselho Diretor/legislação & jurisprudência , Conselho Diretor/estatística & dados numéricos , Humanos , Internato e Residência/estatística & dados numéricos , Candidatura a Emprego , Licenciamento em Medicina/legislação & jurisprudência , Masculino , Estudos Retrospectivos , Cirurgiões/economia , Cirurgiões/legislação & jurisprudência , Estados Unidos
17.
19.
N Z Med J ; 134(1537): 36-42, 2021 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-34239160

RESUMO

AIM: The outcomes from research should guide the decisions of healthcare providers, policymakers and funders. This study sought the perspectives of senior hospital clinicians and researchers from a New Zealand district health board (DHB). METHOD: A series of interviews asked participants about the purpose and benefits of research to the DHB, and to reflect upon the enablers and barriers they had experienced in conducting and translating research in a DHB context. RESULTS: Three key themes were identified. The first theme suggested research should inform the DHB's purpose. The second theme identified how the general busyness, lack of research funding and the differing motivations of clinicians and business leaders doesn't make it easy to do research in a DHB. The third theme suggested that research barriers could be seen as opportunities. Participants placed importance on an environment that inspires enquiry; that permits staff to stop and question what they do; that overtly informs its community that research is done to improve the delivery of care; that communicates a purposeful research agenda; and that regularly discusses the intersection of research and the purpose of the DHB. CONCLUSION: This study found the absence of an organisation-wide research ethos affected staff engagement in and with research. As a consequence, the effective transfer and translation of knowledge from research was disrupted. Key recommendations were for the DHB to integrate research activity into practice, regularly discuss research evidence and celebrate research achievements.


Assuntos
Pesquisa Biomédica/normas , Conselho Diretor/normas , Pessoal de Saúde/normas , Pesquisadores/normas , Humanos , Nova Zelândia , Pesquisa Qualitativa , Inquéritos e Questionários
20.
Eur J Nucl Med Mol Imaging ; 48(10): 3029-3032, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34164728
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