Is management essential to improving the performance and sustainability of health care systems and organizations? A systematic review and a roadmap for future studies

Exploring grandiose narcissism among surgeons: a comparative analysis

The concept of narcissism encompasses various personality traits, including cognitive, emotional and behavioural characteristics, which often lead to difficulties in maintaining a healthy self-esteem. This study examines the prevalence of narcissism traits (Admiration and Rivalry) in the surgical profession and their association with age, gender and professional experience. A total of 1390 participants (408 women, 982 men) took part in an online survey. The results show that female participants have significantly lower levels of rivalry than male colleagues. Additionally, age was found to be inversely correlated with both facets of narcissism, demonstrating that levels of narcissism decrease as age increases. Participants who are still in education tend to show higher levels of both facets. These results improve our understanding of personality traits in surgery and provide valuable insights for researchers and practitioners.

Economic Impact of Lean Healthcare Implementation on the Surgical Process

OBJECTIVES

The objective of this study was to analyse and detail surgical process improvement activities that achieve the highest economic impact.

METHODS

Over 4 years, a team of technicians and healthcare professionals implemented a set of Lean surgical process improvement projects at Vall d'Hebron University Hospital (VHUH), Barcelona, Spain. Methods employed in the study are common in manufacturing environments and include reducing waiting and changeover time (SMED), reducing first time through, pull, and continuous flow. Projects based on these methods now form part of the daily routine in the surgical process. The economic impact on the hospital's surgical activity budget was analysed.

RESULTS

Process improvements have led to annual operational savings of over EUR 8.5 million. These improvements include better patient flow, better management of information between healthcare professionals, and improved logistic circuits.

CONCLUSIONS

The current cultural shift towards process management in large hospitals implies shifting towards results-based healthcare, patient-perceived value (VBHC), and value-added payment. A Lean project implementation process requires long-term stability. The reason a considerable number of projects fail to complete process improvement projects is the difficulty involved in establishing the project and improving management routines. Few studies in the literature have investigated the economic impact of implementing Lean management a posteriori, and even fewer have examined actual cases. In this real case study, changes to surgical block management were initiated from stage zero. After being carefully thought through and designed, changes were carried out and subsequently analysed.

Measuring healthcare payor management practices in England

Good management practice in healthcare payors and providers is considered central to ensuring health systems respond to population needs, contain costs, and improve both quality and outcomes. However, the evidence to support this assertion is sparce. While a quantitative link between better management practice and improved patient outcomes has been demonstrated for healthcare providers, no such link has been identified for healthcare payors. The lack of a robust tool to assess the management practices of healthcare payors has impeded such quantitative assessments. We report upon a novel tool developed to measure and assess 11 management practices in all 152 healthcare payors within England's National Health Service in 2010. We have tested the acceptability, reliability and validity of this tool using rigorous analytic methods and present four key findings. First, performance of the tool is strong and comparable to management practice scorecards used in other settings. Second, exploratory factor analysis indicates the tool measures two distinct latent factors of healthcare payor management practice with high internal consistency and reliability. Third, there is evidence of assessment and score validity. Fourth, payor management practice variations are associated with the degree of supervisory oversight. While deploying such a tool is challenging, these results suggest that healthcare payor management practices can be measured and assessed robustly. This could enable governments, and others, to identify how payor management practices influence health system performance and to estimate what health system performance improvements they should expect from interventions designed to improve the management practices of their local healthcare payors.

Interest and competence in leadership and management among newly qualified specialists in Finland

BACKGROUND

Medical faculties in Finland are responsible for the quality and content of continuous medical education programmes that also includes compulsory management studies (10 European Credit Transfer and Accumulation System). The aim of this study is to evaluate medical specialists' experiences of the compulsory management studies and their attitudes towards leaders and managers.

METHODS

The Universities of Turku and Tampere conducted a survey among doctors who completed their specialist training between 1 January 2016 and 1 January 2019. Of these doctors, 83 completed the survey (response rate 25%). The analysis was carried out using a cross-table, and in the visual analysis, a box plot has been used.

RESULTS

Of the respondents, 38% were content with management and leadership studies, and they reported a particular need for improving skills in human resources management, healthcare economy, legislation, organisational management, and social and healthcare systems. Most respondents (83%) showed interest in future leadership roles.

CONCLUSIONS

The findings of this study show that newly qualified doctors do wish for added education and training in management and leadership.

Sustainable quality management in hospitals: The experiences of healthcare quality managers

BACKGROUND

Quality management systems are essential in hospitals, but evidence shows a real literature gap on the sustainable implementation of quality.

PURPOSE

This study aimed to explore and identify enablers towards sustainable quality management in hospitals. Research design and Study Sample: Interviews were conducted with 23 healthcare quality managers from 20 hospitals. Data collection and/or Analysis: Data collection and analysis were conducted simultaneously by using the Qualitative Analysis Guide of Leuven and following the COREQ Guidelines. Thematic analysis from interview transcripts was performed in NVivo 12.

RESULTS

The results reveal two categories: (1) quality in the organisation's DNA and (2) quality in the professional's DNA. The first category consists of: bottom-up and top-down management, the organisation-wide integration of quality and an organisational culture shift. The second one consists of: quality awareness, understanding the added value, the encouragement and engagement, the accountability and ownership for quality. Moving towards sustainable quality management systems in hospitals requires a good interaction between a bottom-up approach and leadership to ensure continuous support from healthcare stakeholders.

CONCLUSIONS

This study contributes to existing conceptual and theoretical foundations with practical insights into sustainable quality management. The findings can guide quality departments and hospital management to regain professionals' commitment to quality and to establish a sustainable quality management system.

Profile of the cohort of people being treated for HIV infection in the SUS, Brazil, 2015-2018

OBJECTIVE

To build an integrated database of individual and service data from the cohort of people who started antiretroviral therapy (ART), from 2015 to 2018, in Brazil.

METHODS

Open cohort study that includes people aged 15 years or older who started ART from 2015 to 2018, with follow-up in services of the Brazilian Unified Health System (SUS), and who responded to the 2016/2017 Qualiaids national survey. The source of individual data was the related HIV database, derived from the probabilistic linkage between data from the SUS systems of diagnostic information, medication, tests, and deaths. The data source for the services was the services' response database to the Qualiaids survey. After analysis of consistency and exclusions, the database of individuals was deterministically related to the database of services.

RESULTS

The cohort comprised 132,540 people monitored in 941 SUS services. Of these services, 59% are located in the Southeast region and 49% followed 51 to 500 cohort participants. The average performance of organization and management of patient care ranged from 29% to 75%. Most of the cohort participants are male, black and mixed, aged between 20 and 39 years old, and have between 4 and 11 years of schooling. Median baseline T-CD4 was 419 cells/mm3, 6% had an episode of tuberculosis, and 2% died of HIV disease.

CONCLUSION

For the first time in Brazil, this cohort provides the opportunity for a joint analysis of individual factors and services in the production of positive and negative clinical outcomes of HIV treatment.

Health Management: Evaluating the Relationship between Organizational Factors, Psychosocial Risks at Work, Performance Management, and Hospital Outcomes

Introduction-Health system (HS) health organizations are complex and are in constant dynamic interaction with multiple elements, including political, environmental, societal, legal, and organizational factors, along with human components, such as human resources, patients, and other stakeholders. Objective-This research aimed to study three HS organizations, identifying and characterizing the elements of health organizations and the factors related to professionals, determining their influence on economic and financial performance results, as well as results related to the professionals and to the patients comprising the institutions. Method-A quantitative study was conducted in which data were collected through questionnaires from various sources to better understand and characterize the factors related to organizations, professionals, and patients (470 health professionals and 768 patients). To test the integrated evaluation model for health organizations, path analysis was used. Results-The results reveal that the organizational culture (OC) presents a positive relationship between the professional's quality of life (QL) and the performance management (PM) of the professionals, along with a negative relationship with the psychosocial work risks (PWR). There is also a relationship between the OC and patient satisfaction (PS), professional job satisfaction (PJS), and economic and financial results (EFR). In the relationship between the processes and the results, there are significant relationships between PM and PJS and PWR and PJS. In terms of the results, there is a significant relationship between the EFR and the PS. Conclusions-This study contributes to a deeper knowledge of the factors that influence the quality of health organizations and their results and produces recommendations for health organizations to address the current challenges.

Exploring physician engagement in health care organizations: a scoping review

RATIONALE

Enhancing health system effectiveness, efficiency, and appropriateness is a management priority in most world countries. Scholars and practitioners have focused on physician engagement to facilitate such outcomes.

OBJECTIVES

Our research was intended to: 1) unravel the definition of physician engagement; 2) understand the factors that promote or impede it; 3) shed light on the implications of physician engagement on organizational performance, quality, and safety; and 4) discuss the tools to measure physician engagement.

METHOD

A scoping review was undertaken. Items were collected through electronic databases search and snowball technique. The PRISMA extension for Scoping Reviews (PRISMA-ScR) statement and checklist was followed to enhance the study replicability.

RESULTS

The search yielded 16,062 records. After an initial screening, 300 were selected for potential inclusion in this literature review. After removing duplicates and records not meeting the inclusion criteria, full-text analysis of 261 records was performed, yielding a total of 174 records.

DISCUSSION

Agreement on the conceptualization of physician engagement is thin; furthermore, scholars disagree on the techniques and approaches used to assess its implementation and implications. Proposals have been made to overcome the barriers to its adoption, but empirical evidence about implementing physician engagement is still scarce.

CONCLUSIONS

Our scoping review highlights the limitations of the extant literature about physician engagement. Physician engagement is a relatively ill-defined concept: developing an evidence base for its actual implementation is necessitated to provide reliable guidance on how the governance of health care organizations could be improved. Although we did not assess the quality or the robustness of current empirical research, our findings call for further research to: 1) identify potential drivers of physician engagement, 2) develop dependable assessment tools providing health care organizations with guidance on how to foster physician engagement, and 3) evaluate engagement's actual impact on health care organizations' performance.

Preventing and developmental factors of sustainability in healthcare organisations from the perspective of decision makers: an exploratory factor analysis

BACKGROUND

UN Sustainable Development Goals are part of the political agenda of most developed countries. Being a developing country, Albania has only recently adhered to this trend. Prior research at national level has sporadically focused on environmental sustainability, neglecting a holistic view of the phenomenon. To fill this gap, this study aims to explore preventing and developmental factors of sustainability in healthcare organisations from the perspective of decision makers by relying to a Triple Bottom Line approach.

METHODS

Data were collected through a questionnaire administered to healthcare facilities and analysed through the Exploratory Factor Analysis. Findings revealed that the factors influencing the sustainability of the national healthcare system were five: Barriers of Organisational Sustainability; Stakeholders Pressure (regarding sustainable issues); Awareness (knowledge and measures taken for sustainability); Institutional Engagement; and Personal Interest and Involvement. The underlying factors included 19 items suitable for this sample, representing 64.371% of the total variance.

RESULTS

The findings show the existence of 4 factors: Barriers of Organisational Sustainability, Stakeholders Pressure regarding Sustainable issues, Awareness/knowledge and measures taken for sustainability, Personal Interest and Involvement.

CONCLUSIONS

It is evident that national health organisations should continuously improve its strategies to be consistent with the sustainable development goals of international organisations, so that their initiatives could reflect the integration of sustainability approaches at the organisational level.

Theoretical Frameworks of Leadership in Nursing: Critical Reflections

OBJECTIVES

The objective of this article is to present a comprehensive view on the topic of nursing leadership discussing the theoretical frameworks that underpin its manifestation, the leadership styles in nursing, the overall landscape in nursing leadership including the context where leadership is being practiced, and finally looking at the educational pathways for building leadership capacity and sustainability DATA SOURCES: Relevant studies on the topic as well professional associations, national and international organizations' evidence have formed the basis for this article.

CONCLUSION

The role of the nurse leaders is complex and demanding within the context of health care. Its value has been increasingly drawing the attention of national and international organizations. The nurse leader is performing tasks within rapidly shifting environments that require constant changes to best address the organizational goals but remain true to the values and perspectives envisioned by the nursing profession. Through the implementation of corresponding competency frameworks, the capacity and preparedness of nurse leaders can be cultivated ideally in a multidisciplinary context.

IMPLICATIONS FOR NURSING PRACTICE

Nurse leaders are increasingly assuming positions of authority across the structures of health care organizations. There is need to timely and appropriately increase the preparedness of nurse leaders to assume and sustain these challenging and dynamic roles.

Operational flexibility impact on hospital performance through the roles of employee engagement and management capability

BACKGROUND

Very limited empirical research has been done on operational flexibility management in the healthcare industry, especially in hospital settings. This study aimed to propose a model of the effects of operational flexibility on hospital performance through management capability and employee engagement as mediating variables.

METHODS

The proposed model is validated through an empirical study among 480 clinical and administrative staff from five hospitals in Jordan. Structural equation modeling and confirmatory factor analysis were the main techniques used to validate the model and examine the hypotheses.

RESULTS

Operational flexibility was demonstrated to have a positively significant impact on hospital performance, management capability, and employee engagement. Employee engagement was demonstrated to positively impact hospital performance. Management capability had a significant result on hospital performance without having a clear impact. In addition, management capability and employee engagement played a major role as partial mediating effects between operational flexibility and hospital performance, and there is a role for employee engagement as a partial mediating effect between management capability and hospital performance.

CONCLUSION

Significant progress has been achieved in hospital management, especially in terms of operational flexibility, management capability, and staff engagement.

How digital health documentation transforms professional practices in primary healthcare in Denmark: A WPR document analysis

Historically, recordkeeping has been an essential task for health professionals. Today, this mandatory task increasingly takes place as digital documentation. This study critically examines problem constructions in practical documents on digital documentation strategies in Danish municipal healthcare and how these problem constructions imply particular solutions. A document analysis based on the approach presented in Bacchi's "What's the problem represented to be?" was applied. Forty practical documents in the form of guidelines, strategies, and quality control documents were included. The analysis uncovered three problem representations: lack of coherence between health services in a complex healthcare system, lack of assessable data for management and political prioritization, and inefficiency in the healthcare system. The proposed solution is a digitalized and standardized practice that transforms recordkeeping in the municipalities. However, municipal healthcare is at risk of being fragmented due to digital documentation's focus on the organizational management of health with task-oriented practices supplied by an anonymous health professional. We find that digital documentation functions as an organizational micromanagement approach that assigns the health professional a subject position as an employee acting according to the organization's framework rather than the profession's normative framework.

Harnessing a clinician-led governance model to overcome healthcare tribalism and drive innovation: a case study of Northumbria NHS Foundation Trust

PURPOSE

Healthcare tribalism refers to the phenomenon through which different groups in a healthcare setting strictly adhere to their profession-based silo, within which they exhibit stereotypical behaviours. In turn, this can lead to deleterious downstream effects upon productivity and care delivered to patients. This study highlights a clinician-led governance model, implemented at a National Health Service (NHS) trust, to investigate whether it successfully overcame tribalism and helped drive innovation.

DESIGN/METHODOLOGY/APPROACH

This was a convergent mixed-methods study including qualitative and quantitative data collected in parallel. Qualitative data included 27 semi-structured interviews with representatives from four professional groups. Quantitative data were collected through a verbally administered survey and scored on a 10-point scale.

FINDINGS

The trust arranged its services under five autonomous business units, with a clinician and a manager sharing the leadership role at each unit. According to interviewees replies, this equivalent authority was cascaded down and enabled breaking down professional siloes, which in turn aided in the adoption of an innovative clinical model restructure.

PRACTICAL IMPLICATIONS

This study contributes to the literature by characterizing a real-world example in which healthcare tribalism was mitigated while reflecting on the advantages yielded as a result.

ORIGINALITY/VALUE

Previous studies from all over the world identified major differences in the perspectives of different healthcare professional groups. In the United Kingdom, clinicians largely felt cut off from decision-making and dissatisfied with their managerial role. The study findings explain a governance model that allowed harmony and inclusion of different professions. Given the long-standing strains on healthcare systems worldwide, stakeholders can leverage the study findings for guidance in developing and implementing innovative managerial approaches.

A modified Delphi study on establishing a curriculum content structure for the leadership and management competency cultivation for future nurse managers in China

Background

It is critical to train future nursing managers in advance for the prospective development of healthcare organizations, but a widely recognized curriculum content structure for leadership and management competency development for nurturing future nurse managers was lacking in China.

Objective

To establish a curriculum content structure for the leadership and management competency cultivation for future nurse managers in Chinese healthcare setting.

Methods

A modified Delphi study was conducted. 22 experts who have in-depth knowledge of nursing leadership and management from 4 main geographical regions in China were included. The initial curriculum content structure was constructed based on a previous qualitative study and two team meetings. Subsequently, a two-round Delphi survey was conducted with 22 panelists in the first round and 19 in the second round. Scores of importance and textual comments were collected and used to judge the achievement of consensus.

Results

After the two-round Delphi process, consensus was reached, as each item was rated ≥4 by 84.21-100% of the experts and each one had a coefficient of variance (CV) ≤ 0.174. The finalized curriculum content contains 9 modules and 27 items.

Conclusions

This study formed a curriculum content structure for leadership and management competency training for nurses preparing for managerial roles, which contribute to the establishment of a nursing management talent pipeline to meet the needs of healthcare institutions for contemporary nurse managers.

Primary Health Care Management Effectiveness as a Driver of Family Planning Service Readiness: A Cross-Sectional Analysis in Central Mozambique

INTRODUCTION

The effectiveness of facility-level management is an important determinant of primary health care (PHC) reach and quality; however, the nature of the relationship between facility-level management and health system effectiveness lacks sufficient empirical grounding. We describe the association between management effectiveness and facility readiness to provide family planning services in central Mozambique.

METHODS

We linked data from the Ministry of Health's 2018 Service Availability and Readiness Assessment and a second 2018 health facility survey that included the World Bank's Service Delivery Indicators management module. Our analysis focused on 68 public sector PHC facilities in Manica, Sofala, Tete, and Zambézia provinces in which the 2 surveys overlapped. We used logistic quantile regression to model associations between management strength and family planning service readiness.

RESULTS

Of the 68 facility managers, 47 (69.1%) were first-time managers and (18) 26.5% had received formal management training. Managers indicated that 63.6% of their time was spent on management responsibilities, 63.2% of their employees had received a performance review in the year preceding the survey, and 12.5% of employee incentives were linked to performance evaluations. Adjusting for facility type and distance to the provincial capital, facility management effectiveness, and urban location were significantly associated with higher levels of readiness for family planning service delivery.

CONCLUSIONS

We found that a higher degree of management effectiveness is independently associated with an increased likelihood of improved family planning service readiness. Furthermore, we describe barriers to effective PHC service management, including managers lacking formal training and spending a significant amount of time on nonmanagerial duties. Strengthening management capacity and reinforcing management practices at the PHC level are needed to improve health system readiness and outputs, which is essential for achieving global Sustainable Development Goals and universal health coverage targets.

Reasons for turnover of hospital managers in Iran: A qualitative study

BACKGROUND

Managerial stability is believed to play a crucial role in the success of health care organisations and health managers. High managerial turnover seems to be a common phenomenon of the Iranian health system. This study thus aimed to investigate the reasons for managerial turnover in Iranian hospitals.

METHODS

Following a qualitative approach, 53 semi-structured interviews were conducted with different managerial levels in the hospitals, the high officials of medical universities, and health policymakers. Interviewees were selected using the purposive sampling techniques. Interviews were continued up to the data saturation. Data analysis was conducted thematically using MAXQDA 10.

RESULTS

Four groups of reasons were identified leading into the managerial turnover in hospitals, ranging from the micro to macro level factors, that is, those related to the managers, hospitals, medical universities, and the country. Insufficient support from the officials, managerial poor performance, conflict with other managers and colleagues, changes of senior managers, and presidential and parliamentary elections representing the key reasons underlying the turnover of hospital managers in Iran.

CONCLUSION

Given the variety of reasons emerged behind the managerial turnover, the efforts to improve the awareness and engage the all actors ranging from health policymakers to organisational decision-makers could be a valuable step to regulate and optimise the managerial turnover and stability in health care organisations in order to enhance the productivity and accountability in healthcare industry, particularly in the hospitals.

How can the healthcare system deliver sustainable performance? A scoping review

BACKGROUND

Increasing health costs, demand and patient multimorbidity challenge the sustainability of healthcare systems. These challenges persist and have been amplified by the global pandemic.

OBJECTIVES

We aimed to develop an understanding of how the sustainable performance of healthcare systems (SPHS) has been conceptualised, defined and measured.

DESIGN

Scoping review of peer-reviewed articles and editorials published from database inception to February 2021.

DATA SOURCES

PubMed and Ovid Medline, and snowballing techniques.

ELIGIBILITY CRITERIA

We included articles that discussed key focus concepts of SPHS: (1) definitions, (2) measurement, (3) identified challenges, (4) identified solutions for improvement and (5) scaling successful solutions to maintain SPHS.

DATA EXTRACTION AND SYNTHESIS

After title/abstract screening, full-text articles were reviewed, and relevant information extracted and synthesised under the five focus concepts.

RESULTS

Of 142 included articles, 38 (27%) provided a definition of SPHS. Definitions were based mainly on financial sustainability, however, SPHS was also more broadly conceptualised and included acceptability to patients and workforce, resilience through adaptation, and rapid absorption of evidence and innovations. Measures of SPHS were also predominantly financial, but recent articles proposed composite measures that accounted for financial, social and health outcomes. Challenges to achieving SPHS included the increasingly complex patient populations, limited integration because of entrenched fragmented systems and siloed professional groups, and the ongoing translational gaps in evidence-to-practice and policy-to-practice. Improvement strategies for SPHS included developing appropriate workplace cultures, direct community and consumer involvement, and adoption of evidence-based practice and technologies. There was also a strong identified need for long-term monitoring and evaluations to support adaptation of healthcare systems and to anticipate changing needs where possible.

CONCLUSIONS

To implement lasting change and to respond to new challenges, we need context-relevant definitions and frameworks, and robust, flexible, and feasible measures to support the long-term sustainability and performance of healthcare systems.

Improving health and social systems for all children in LMICs: structural innovations to deliver high-quality services

Despite health gains over the past 30 years, children and adolescents are not reaching their health potential in many low-income and middle-income countries (LMICs). In addition to health systems, social systems, such as schools, communities, families, and digital platforms, can be used to promote health. We did a targeted literature review of how well health and social systems are meeting the needs of children in LMICs using the framework of The Lancet Global Health Commission on high-quality health systems and we reviewed evidence for structural reforms in health and social sectors. We found that quality of services for children is substandard across both health and social systems. Health systems have deficits in care competence (eg, diagnosis and management), system competence (eg, timeliness, continuity, and referral), user experience (eg, respect and usability), service provision for common and serious conditions (eg, cancer, trauma, and mental health), and service offerings for adolescents. Education and social services for child health are limited by low funding and poor coordination with other sectors. Structural reforms are more likely to improve service quality substantially and at scale than are micro-level efforts. Promising approaches include governing for quality (eg, leadership, expert management, and learning systems), redesigning service delivery to maximise outcomes, and empowering families to better care for children and to demand quality care from health and social systems. Additional research is needed on health needs across the life course, health system performance for children and families, and large-scale evaluation of promising health and social programmes.

No man is an island: management of the emergency response to the SARS-CoV-2 (COVID-19) outbreak in a large public decentralised service delivery organisation

Background

We wanted to better understand whether and how agility can be achieved in a decentralised service delivery organisation in Sweden. The pandemic outbreak of SARS-Cov-2 (Covid-19) provided an opportunity to assess decentralisation as a strategy to improve the responsiveness of healthcare and at the same time handle an unpredictable and unexpected event.

Methods

Data from in-depth interviews with a crisis management team (n = 23) and free text answers in a weekly survey to subordinated clinical directors, i.e. unit managers, (n = 108) were scrutinised in a directed content analysis. Dynamic capabilities as a prerequisite for dynamic effectiveness, understood as reaching strategic and operative effectiveness simultaneously, were explored by using three frameworks for dynamic effectiveness, dynamic capabilities and delegated authority in a decentralised organisation.

Results

Unpredictable events, such as the pandemic Covid-19 outbreak, demand a high grade of ability to be flexible. We find that a high degree of operational effectiveness, which is imperative in an emergency situation, also is a driver of seeking new strategic positions to even better meet new demands. The characteristics of the dynamic capabilities evolving from this process are described and discussed in relation to decentralisation, defined by decision space, organisational and individual capacity as well as accountability. We present arguments supporting that a decentralised management model can facilitate the agility required in an emergency.

Conclusions

This study is, to our knowledge, the first of its kind where a decentralised management model in a service delivery organisation in healthcare is studied in relation to crisis management. Although stemming from one organisation, our findings indicating the value of decentralisation in situations of crisis are corroborated by theory, suggesting that they could be relevant in other organisational settings also.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07716-w.

Developing a Leadership and Management Competency Framework for Nurse Champion: A Qualitative Study from Shanghai, China

AIM

To develop a leadership and management competency framework applicable to Chinese nurse champions guided by the competency matrix for clinical nurse leader (CNL).

BACKGROUND

As the clinical leaders and future nurse manager candidates in the Chinese clinical setting, nurse champions are in great need of leadership and management competency training, but it is unclear what content should be included in the training curriculum, a guiding framework applicable to Chinese nurse champions was needed to be constructed.

METHODS

This study used a qualitative descriptive design to explore nurse champions' competency requirements from clinical nurse managers' perspective. Semi-structure interviews guided by the CNL competency matrix were conducted with twenty-seven clinical nurse managers from six large-scale tertiary grade A hospitals in Shanghai, China. Interview transcripts were analyzed using deductive and inductive content analysis.

RESULTS

The data analysis yielded three main categories: nursing leadership, clinical outcome management and care environment management, containing fourteen subordinate themes, which represent the leadership and management competencies needed for nurse champions.

CONCLUSIONS

A leadership and management competency framework for Chinese nurse champion was built in this study, which covering the competencies needed by Chinese nurse champions to lead care teams, improve quality of care for patient outcomes, and enhance systems and equipment for the better care environment. This framework will be the direct basis for guiding the development of the nurse leadership curriculum for driving nurse champion to achieve role success.

IMPLICATIONS FOR NURSING MANAGEMENT

This framework provides a theoretical foundation for clarifying the role of nurse champion in clinical management. Training curriculum guided by this framework will help nurses in their clinical management role and share the burden of clinical nursing managers, as well as promote the development of a clinical nursing management reserve talents and support the future development of nursing staff in healthcare organizations.

The impact of management practices on relative patient mortality: Evidence from public hospitals

A small, but growing, body of empirical evidence shows that the material and persistent variation in many aspects of the performance of healthcare organisations can be related to variation in their management practices. This study uses public data on hospital patient mortality outcomes, the Summary Hospital-level Mortality Indicator (SHMI) to extend this programme of research. We assemble a five-year dataset combining SHMI with potential confounding variables for all English NHS non-specialist acute hospital trusts. The large number of providers working within a common system provides a powerful environment for such investigations. We find considerable variation in SHMI between trusts and a high degree of persistence of high- or low performance. This variation is associated with a composite metric for management practices based on the NHS National Staff Survey. We then use a machine learning technique to suggest potential clusters of individual management practices related to patient mortality performance and test some of these using traditional multivariate regression. The results support the hypothesis that such clusters do matter for patient mortality, and so we conclude that any systematic effort at improving patient mortality should consider adopting an optimal cluster of management practices.

Hospital management practices in county-level hospitals in rural China and international comparison

Background

Although management is important in healthcare, low- and middle-income countries (LMICs) have little experience measuring the competence of hospital management. While improving hospital management is the main focus of hospital reform in China, few studies have empirically documented the baseline situation to inform policy design.

Methods

We assessed the management practices of county-level hospitals in Guizhou in southwest China during 2015. We used the Development World Management Survey (D-WMS) instrument to interview 273 managers in 139 hospitals. We scored the management practices of the sampled hospitals, overall and in four dimensions (operations, monitoring, targets, personnel management) and three processes (implementation, usage, monitoring). We then converted the scores to the WMS scale and compared these with data from two other LMICs and seven high-income countries (HICs).

Results

On a scale of 1 (‘worst practice’) to 5 (‘best practice’), the mean (SD) hospital D-WMS scores were 2.57 (0.46) overall; 2.71 (0.48), 2.64 (0.58), 2.40 (0.64), and 2.56 (0.40) for operation, monitoring, target, and personnel, respectively; and 2.43 (0.48), 2.62 (0.48), and 2.66 (0.47) for implementation, usage, and monitoring, respectively. After conversion to WMS scores, China ranked seventh of 10 countries, after six HICs and higher than one HIC and two other LMICs (Brazil and India). China ranked higher than the two LMICs in each of the four dimensional scores.

Conclusions

Chinese county-level hospitals should improve their low quality of management by prioritizing target-setting and process implementation, particularly in personnel management. Meanwhile, modern management training should be given to most clinical managers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07396-y.

Perceived importance of competencies by nurse managers at all levels: A cross-sectional study

AIM

To explore nurse managers' perceived importance of competencies for their current job at different levels and the associated factors.

BACKGROUND

Little work to date has explored the perceived importance of competencies in nursing leadership and management or considered the related factors in the Taiwan healthcare context.

METHODS

Data collected from a previous large study comprising a cross-sectional web-based survey were analysed. Kruskal-Wallis test, two-sided Fisher exact test and multiple linear regression models were used for statistics analysis.

RESULTS

The mix of three skills in Katz's model indicated that human skills were equally important in all three managerial levels. Of the 23 competencies, effective communication and political astuteness were rated by nurse managers at all levels as the highest-scored (M = 4.88, SD = 0.34) and lowest-scored competency (M = 3.92, SD = 0.78), respectively. Managerial level was a significant predictor of the perceived importance of competency.

CONCLUSIONS

Relationship-based competencies were prominent in the perceived importance of competencies among nurse managers at different levels. Managerial hierarchy influences the relative importance of the different managerial competencies.

IMPLICATIONS FOR NURSING MANAGEMENT

This study's results provide the talent strategy framework required for improving the competencies of nurse managers at all levels.

Leadership competencies of first-line nurse managers: a quantitative study

PURPOSE

This paper aims to examine the leadership competencies of first-line nurse managers (FLNMs) at the unit level in the eastern region of Ghana.

DESIGN/METHODOLOGY/APPROACH

The paper is a quantitative cross-section design.

FINDINGS

Nurse managers exhibited a moderate level of knowledge and ability to apply leadership competencies. Gender, rank, qualification, professional experience, management experience and management training jointly predicted the leadership competencies of FLNMs [(R² = 0.158, p = 0.016]. However, only management training was a significant predictor in the model.

PRACTICAL IMPLICATIONS

Inappropriate leadership competencies have severe consequences for patients and staff outcomes. This situation necessitates a call for a well-structured program for the appointment of FLNMs based on competencies.

ORIGINALITY/VALUE

This study is the first in Ghana which we are aware of that examined the leadership competencies at the unit level that identifies predictors of leadership competencies.

Improving access to health services through health reform in Lesotho: Progress made towards achieving Universal Health Coverage

In 2014 the Kingdom of Lesotho, in conjunction with Partners In Health, launched a National Health Reform with three components: 1) improved supply-side inputs based on disease burden in the catchment area of each of 70 public primary care clinics, 2) decentralization of health managerial capacity to the district level, and 3) demand-side interventions including paid village health workers. We assessed changes in the quarterly average of quality metrics from pre-National Health Reform in 2013 to 2017, which included number of women attending their first antenatal care visit, number of post-natal care visits attended, number of children fully immunized at one year of age, number of HIV tests performed, number of HIV infection cases diagnosed, and the availability of essential health commodities. The number of health centers adequately equipped to provide a facility-based delivery increased from 3% to 95% with an associated increase in facility-based deliveries from 2% to 33%. The number of women attending their first antenatal and postnatal care visits rose from 1,877 to 2,729, and 1,908 to 2,241, respectively. The number of children fully immunized at one year of life increased from 191 to 294. The number of HIV tests performed increased from 5,163 to 12,210, with the proportion of patients living with HIV lost to follow-up falling from 27% to 22%. By the end of the observation period, the availability of essential health commodities increased to 90% or above. Four years after implementation of the National Health Reform, we observed increases in antenatal and post-natal care, and facility-based deliveries, as well as child immunization, and HIV testing and retention in care. Improved access to and utilization of primary care services are important steps toward improving health outcomes, but additional longitudinal follow-up of the reform districts will be needed.

Examining health sector stakeholder perceptions on the efficiency of county health systems in Kenya

Efficiency gains is a potential strategy to expand Kenya's fiscal space for health. We explored health sector stakeholders' understanding of efficiency and their perceptions of the factors that influence the efficiency of county health systems in Kenya. We conducted a qualitative cross-sectional study and collected data using three focus group discussions during a stakeholder engagement workshop. Workshop participants included health sector stakeholders from the national ministry of health and 10 (out 47) county health departments, and non-state actors in Kenya. A total of 25 health sector stakeholders participated. We analysed data using a thematic approach. Health sector stakeholders indicated the need for the outputs and outcomes of a health system to be aligned to community health needs. They felt that both hardware aspects of the system (such as the financial resources, infrastructure, human resources for health) and software aspects of the system (such as health sector policies, public finance management systems, actor relationships) should be considered as inputs in the analysis of county health system efficiency. They also felt that while traditional indicators of health system performance such as intervention coverage or outcomes for infectious diseases, and reproductive, maternal, neonatal and child health are still relevant, emerging epidemiological trends such as an increase in the burden of non-communicable diseases should also be considered. The stakeholders identified public finance management, human resources for health, political interests, corruption, management capacity, and poor coordination as factors that influence the efficiency of county health systems. An in-depth examination of the factors that influence the efficiency of county health systems could illuminate potential policy levers for generating efficiency gains. Mixed methods approaches could facilitate the study of both hardware and software factors that are considered inputs, outputs or factors that influence health system efficiency. County health system efficiency in Kenya could be enhanced by improving the timeliness of financial flows to counties and health facilities, giving health facilities financial autonomy, improving the number, skill mix, and motivation of healthcare staff, managing political interests, enhancing anticorruption strategies, strengthening management capacity and coordination in the health sector.

Characterizing health care provider knowledge: Evidence from HIV services in Kenya, Rwanda, South Africa, and Zambia

BACKGROUND

Identifying approaches to improve levels of health care provider knowledge in resource-poor settings is critical. We assessed level of provider knowledge for HIV testing and counseling (HTC), prevention of mother-to-child transmission (PMTCT), and voluntary medical male circumcision (VMMC). We also explored the association between HTC, PMTCT, and VMMC provider knowledge and provider and facility characteristics.

METHODS

We used data collected in 2012 and 2013. Vignettes were administered to physicians, nurses, and counselors in facilities in Kenya (66), Rwanda (67), South Africa (57), and Zambia (58). The analytic sample consisted of providers of HTC (755), PMTCT (709), and VMMC (332). HTC, PMTCT, and VMMC provider knowledge scores were constructed using item response theory (IRT). We used GLM regressions to examine associations between provider knowledge and provider and facility characteristics focusing on average patient load, provider years in position, provider working in another facility, senior staff in facility, program age, proportion of intervention exclusive staff, person-days of training in facility, and management score. We estimated three models: Model 1 estimated standard errors without clustering, Model 2 estimated robust standard errors, and Model 3 estimated standard errors clustering by facility.

RESULTS

The mean knowledge score was 36 for all three interventions. In Model 1, we found that provider knowledge scores were higher among providers in facilities with senior staff and among providers in facilities with higher proportions of intervention exclusive staff. We also found negative relationships between the outcome and provider years in position, average program age, provider working in another facility, person-days of training, and management score. In Model 3, only the coefficients for provider years in position, average program age, and management score remained statistically significant at conventional levels.

CONCLUSIONS

HTC, PMTCT, and VMMC provider knowledge was low in Kenya, Rwanda, South Africa, and Zambia. Our study suggests that unobservable organizational factors may facilitate communication, learning, and knowledge. On the one hand, our study shows that the presence of senior staff and staff dedication may enable knowledge acquisition. On the other hand, our study provides a note of caution on the potential knowledge depreciation correlated with the time staff spend in a position and program age.

Seizing the moment to rethink health systems

The COVID-19 pandemic has made vivid the need for resilient, high-quality health systems and presents an opportunity to reconsider how to build such systems. Although even well resourced, well performing health systems have struggled at various points to cope with surges of COVID-19, experience suggests that establishing health system foundations based on clear aims, adequate resources, and effective constraints and incentives is crucial for consistent provision of high-quality care, and that these cannot be replaced by piecemeal quality improvement interventions. We identify four mutually reinforcing structural investments that could transform health system performance in resource-constrained countries: revamping health provider education, redesigning platforms for care delivery, instituting strategic purchasing and management strategies, and developing patient-level data systems. Countries should seize the political and moral energy provided by the COVID-19 pandemic to build health systems fit for the future.

Facilitators and barriers to effective supervision of maternal and newborn care: a qualitative study from Shinyanga region, Tanzania

Background: Despite routine supportive supervision of health service delivery, maternal and newborn outcomes have remained poor in sub-Saharan Africa in general and in Tanzania in particular. There is limited research evidence on factors limiting the effectiveness of supportive supervision in improving the quality of maternal and newborn care.

Objective: This study explored enablers of and barriers to supportive supervision in maternal and newborn care at the district and hospital levels in Shinyanga region in Tanzania.

Methods: This study employed a qualitative case study design. A purposeful sampling approach was employed to recruit a stratified sample of health system actors: members of the council health management team (CHMT), members of health facility management teams (HMTs), heads of units in the maternity department and health workers.

Results: This study identified several barriers to the effectiveness of supportive supervision. First, the lack of a clear policy on supportive supervision. Despite the general acknowledgement of supportive supervision as a managerial mechanism for quality improvement at the district and lower-level health facilities, there is no clear policy guiding it. Second, limitations in measurement of progress in quality improvement; although supportive supervision is routinely conducted to improve maternal and newborn outcomes, efforts to measure progress are limited due to shortfalls in the setting of goals and targets, as well as gaps in M&E. Third, resource constraints and low motivation; that is, the shortage of resources – CHMT supervisors, health staff and funds – results in irregular supervision and low motivation.

Conclusion: Besides resource constraints, lack of clear policies and limitations related to progress measurement impair the effectiveness of supportive supervision in improving maternal and newborn outcomes. There is a need to reform supportive supervision so that it aids and measures progress not only at the district but also at the health facility level.

Development of a hub and spoke model for quality improvement in rural and urban healthcare settings in India: a pilot study

OBJECTIVE

Hub and spoke model has been used across industries to augment peripheral services by centralising key resources. This exercise evaluated the feasibility of whether such a model can be developed and implemented for quality improvement across rural and urban settings in India with support from a network for quality improvement.

METHODS

This model was implemented using support from the state and district administration. Medical colleges were designated as hubs and the secondary and primary care facilities as spokes. Training in quality improvement (QI) was done using WHO's point of care quality improvement methodology. Identified personnel from hubs were also trained as mentors. Both network mentors (from QI network) and hub-mentors (from medical colleges) undertook mentoring visits to their allotted facilities. Each of the participating facility completed their QI projects with support from mentors.

RESULTS

Two QI training workshops and two experience sharing sessions were conducted for implementing the model. A total of 34 mentoring visits were undertaken by network mentors instead of planned 14 visits and rural hub-mentors could undertake only four visits against planned 18 visits. Ten QI projects were successfully completed by teams, 80% of these projects started during the initial intensive phase of mentoring. The projects ranged from 3 to 10 months with median duration being 5 months.

DISCUSSION

Various components of a health system must work in synergy to sustain improvements in quality of care. Quality networks and collaboratives can play a significant role in creating this synergy. Active participation of district and state administration is a critical factor to produce a culture of quality in the health system.

That's how it should work: the perceptions of a senior management on the value of decentralisation in a service delivery organisation

PURPOSE

Decentralisation in health care has been proposed as a way to make services more responsive to local needs and by that improve patient care. This study analyses how the senior management team conceptualised and implemented a decentralised management model within a large public health care delivery organisation.

DESIGN/METHODOLOGY/APPROACH

Data from in-depth interviews with a senior management team were used in a directed content analysis. Underlying assumptions and activities in the decentralisation process are presented in the logic model and scrutinised in an a priori logic analysis using relevant scientific literature.

FINDINGS

The study found support in the scientific literature for the underlying assumptions that increased responsibility will empower managers as clinical directors know their local prerequisites best and are able to adapt to patient needs. Top management should function like an air traffic control tower, trust and loyalty improve managerial capacity, increased managerial skills release creativity and engagement and a system perspective will support collaboration and learning.

ORIGINALITY/VALUE

To the authors' knowledge this is the first a priori logic analysis of a decentralised management model in a healthcare delivery organisation in primary and community care. It shows that the activities consist with underlying assumptions, supported by evidence, and timely planned give managers decision space and ability to use their delegated authority, not disregarding accountability and fostering necessary organisational and individual capacities to avoid suboptimisation.

Psychometric properties and development of the competency inventory for Taiwanese nurse managers across all levels

AIMS

To describe the development and psychometric testing of the competency inventory for nurse managers across all levels in Taiwan.

BACKGROUND

The competency-based approach to develop nursing leadership and management competencies for the health care context is still insufficiently explored in terms of professional development in nursing administration.

METHODS

This study used mixed methods, including qualitative study for generating the preliminary inventory and a cross-sectional survey of 573 nurse managers for psychometric properties of the inventory.

RESULTS

Exploratory factor analysis revealed four domains with 23 items that explained 58.21% of the overall variance. The overall Cronbach's alpha coefficient was 0.93. Confirmatory factor analysis showed a well-fitting goodness-of-fit statistics. The construct validity was adequate, with an average variance extracted of 0.68 and composite reliability of 0.90.

CONCLUSIONS

Across different levels, nurse managers have 23 essential competencies. The competency inventory demonstrates adequate psychometric properties with good construct validity and internal consistency, thereby reliable and valid for guiding the competency development of nurse managers.

IMPLICATIONS FOR NURSING MANAGEMENT

The essential competencies of the inventory serve as a criterion-referenced measurement for competence proficiency in professional development of nursing administration and contribute to performance improvement of nurse managers in practice.

Involving clinicians in management: assessing views of doctors and nurses on hybrid professionalism in clinical directorates

BACKGROUND

Hybrid professionalism is one of the most effective ways to involve clinicians in management practices and responsibilities. With this study we investigated the perceptions of doctors and nurses on hybridization in clinical directorates (CDs) in hospitals.

METHODS

We investigated the attitudes of healthcare professionals (doctors and nurses) towards eight hospital CDs in the Local Health Authority (LHA) of Bologna (Emilia Romagna, Italy) 6 years after their implementation. We used a validated questionnaire by Braithwaite and Westbrook (2004). Drawing on Palmer et al. (2007), we added a section about the characteristics of department heads. In all, 123 healthcare professionals in managerial roles completed and returned the questionnaire. The return rate was 47.4% for doctors and 31.6% for nurses.

RESULTS

Doctors reported an increase in clinical governance, interdisciplinarity collaboration, and standardization of clinical work. Hybridization of practices was noted to have taken place. While doctors did not see these changes as a threat to professional values, they felt that hospital managers had taken greater control. There was a large overlap of attitudes between doctors and nurses: inter-professional integration in CDs fostered alignment of values and aims. The polarity index was higher for responses from the doctors than from the nurses.

CONCLUSION

The study findings have implications for policy makers and managers: mission and strategic mandate of CDs; governance of CDs, leadership issues; opportunities for engaging healthcare professionals; changes in managerial involvement during the COVID-19 pandemic. We also discuss the limitations of the present study and future areas for research into hybrid structures.

Cognitive Diversity as the Quality of Leadership in Crisis: Team Performance in Health Service during the COVID-19 Pandemic

The level of leadership skills of healthcare team leaders has long been the subject of interest and many discussions. Several studies have pointed to their inadequacy, which is becoming a serious problem during the global crisis due to the Covid-19 pandemic. There is a direct link between the leadership in the healthcare system and its performance, conditioned by the level of decisions of leaders of medical teams. It is they who determine the performance of healthcare delivery. The study published in this article contains the results from the examination of the dependence between crisis leadership and team performance in healthcare providers. The subject of the research is the impact of cognitive diversity and the quality of crisis-leadership decision-making on the performance of medical teams in the acute crisis phase. The study was conducted on a research sample of 216 healthcare providers after the outbreak of the COVID-19 pandemic in Slovakia (April 2020). The respondents to the research sample involved team leaders in healthcare providers, who have been involved in managing the crisis. The study has justified the positive association between crisis leadership and team performance, which is mediated by cognitive diversity, supporting the quality of decision-making in crisis leadership. The results of the research have proven that the performance of the medical team in the acute crisis phase can be positively influenced through qualified decision-making in crisis leadership amplified by the usage of cognitive diversity.

The microfoundations of physicians' managerial attitude

Background

Accountable care has profoundly changed the organizational models adopted by health care organizations and, consequently, the skill set required for doctor-managers who have become middle managers and must deal with the operational management of their units. The aim of this study was to identify the psychological microfoundations (i.e., traits) of physicians’ managerial attitude. Specifically, we analysed the roles played by narcissism, specialization choices and identification with the organization.

Methods

We collected primary data on a population of ward unit heads in the Italian National Health Service. A logistic regression model predicting the levels of managerial attitude was employed.

Results

The results indicate that high levels of narcissism and identification with the organization are related to higher managerial attitude (instead of clinical attitude). Additionally, we found that physicians with a technique-oriented specialization present a higher probability of manifesting managerial attitude (in comparison to clinical attitude).

Conclusions

Hospital managers can benefit from the use of these findings by developing a strategic approach to human resource management that allows them to identify, train and select the right mix of technical knowledge and managerial skills for middle-management roles.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06210-z.

Linking authentic leadership and management capability to public hospital performance: the role of work engagement

Purpose

This paper aims to propose a model of the effect of both authentic leadership and management capability on hospital performance. This model proposes work engagement as an intervening mechanism between the aforesaid links.

Design/methodology/approach

Data were collected from 380 medical staff working in Jordanian Public hospitals and were analysed using the structural equation modelling analysis technique.

Findings

The results suggest that both authentic leadership and management capability have a positive effect on hospital performance. Although positive, the direct effect of management capability on performance was not significant. Furthermore, work engagement demonstrated to play a full mediation effect between management capability and hospital performance and a partial mediation effect between authentic leadership and hospital performance.

Practical implications

This study may be of use for public medical services providers in general and other services sectors in terms of the role authentic leadership and management resources can play in contributing to positive work-related outcomes at the individual and organisational levels.

Originality/value

Considering the mainstream literature in health-care management, to the best of the authors’ knowledge, this is the first study to date to integrate the impact of both authentic leadership and management capabilities in the public health-care sector. Further, the research model has not previously been introduced when taking into account the role that work engagement can play between the examined variables.

Standards, Processes and Tools Used to Evaluate Health Information Systems Quality: A Systematic Literature Review (Preprint)

Background

Evaluating health information system (HIS) quality is strategically advantageous for improving the quality of patient care. Nevertheless, few systematic studies have reported what methods, such as standards, processes, and tools, were proposed to evaluate HIS quality.

Objective

This study aimed to identify and discuss the existing literature that describes standards, processes, and tools used to evaluate HIS quality.

Methods

We conducted a systematic literature review using review guidelines focused on software and systems. We examined seven electronic databases—Scopus, ACM (Association for Computing Machinery), ScienceDirect, Google Scholar, IEEE Xplore, Web of Science, and PubMed—to search for and select primary studies.

Results

Out of 782 papers, we identified 17 (2.2%) primary studies. We found that most of the primary studies addressed quality evaluation from a management perspective. On the other hand, there was little explicit and pragmatic evidence on the processes and tools that allowed for the evaluation of HIS quality.

Conclusions

To promote quality evaluation of HISs, it is necessary to define mechanisms and methods that operationalize the standards in HISs. Additionally, it is necessary to create metrics that measure the quality of the most critical components and processes of HISs.

Mediating Role of Knowledge Management in the Relationship between Organizational Learning and Sustainable Organizational Performance

Organizations operating in the intensive knowledge-based sector seek efficient management approaches and sustainable development practices to perform efficiently in the dynamic business environment. Knowledge management practice and organizational learning are significant factors in order to achieve sustainable organizational performance in a rapidly changing business environment. Based on the scientific literature analysis, there is still a lack of evidence related to the mediating role of the whole knowledge management cycle, including the five knowledge management processes (knowledge acquisition, creation, storage, sharing, and application) in the relationship between organizational learning and sustainable organizational performance for organizations operating in intensive knowledge-based sectors. This study aimed to examine the impact of the whole knowledge management cycle on the relationship between organizational learning and sustainable organizational performance in intensive knowledge-based sectors, specifically the audit and consulting companies in the Middle East region. Systematic scientific literature analysis, expert evaluation (structured questionnaire), and structural equation modeling (SEM) technique were used to develop and verify the research model. Data was collected through a structured questionnaire distributed among auditing experts working in a knowledge-based sector—audit and consulting companies in the Middle East region. The research results supported the hypotheses stating that organizational learning positively affects knowledge acquisition, storage, sharing, application processes, and sustainable organizational performance. However, the results verified that organizational learning has an insignificant impact on the Middle Eastern audit and consulting companies’ knowledge creation process.

Efficiency in chronic illness care coordination: public-private collaboration models vs. traditional management

Background

The aim of this paper is to analyze the differences in the coordination of chronic illness care between the different public hospital management models coexisting in the Spanish region of Madrid (25 hospitals) during the period 2013–2017.

Methods

The performance of hospitals might be affected by the characteristics of the population they serve and, therefore, this information should be taken into account when estimating efficiency measures. For this purpose, we apply the nonparametric Data Envelopment Analysis (DEA) conditioned to some contextual variables and adapted to a dynamic framework, so that we can assess hospitals during a five-year period. The outputs considered are preventable hospitalizations, readmissions for heart failure and readmissions for chronic obstructive pulmonary disease, whereas the inputs considered are the number of beds, personnel (physicians and other healthcare professionals) and total expenditure on goods and services.

Results

The results suggest that the level of efficiency demonstrated by the public-private collaboration models of hospital management is higher than traditionally managed hospitals throughout the analyzed period. Nevertheless, we notice that efficiency differences among hospitals are significantly reduced when contextual factors were taken into account.

Conclusions

Hospitals managed under public-private collaboration models are more efficient than those under traditional management in terms of chronic illness care coordination, being this difference attributable to more agile and flexible management under the collaborative models.

Supplementary Information

Supplementary information accompanies this paper at 10.1186/s12913-020-05894-z.

Improving Health Professionals’ Involvement Whilst Sustaining Work–Life Balance: Evidence from an Empirical Analysis

Most sustainability studies applied to healthcare primarily focus on external viability. In particular, they look at the ability of healthcare institutions to establish an economic, environmental, social, and political consonance with their context. Conversely, limited attention has been paid to issues related to internal sustainability. The article discusses health professionals’ involvement as a human resource management practice which contributes to the viability of healthcare organizations. A sequential mediation analysis was designed to shed light on the effects of employees’ involvement on work–life balance, which is an essential ingredient of the recipe for internal sustainability. The study findings suggest that health professionals’ involvement may determine an intensification and an extensification of work efforts, which undermine their work–life balance. Nevertheless, the implications of employees’ involvement on work–life balance are positively and significantly mediated by supportive relationships at work and positive organizational climate. From this standpoint, health professionals’ involvement may act as an effective strategy to enhance the internal sustainability of health care organizations if matched with better relationships with supervisors and improved organizational climate. Whilst calling for further research to enlighten issues and challenges related to internal sustainability, the article stresses that health professionals’ involvement should be paired with an improvement of the organizational climate to contribute to an increased viability of health care institutions.

How previous epidemics enable timelier COVID-19 responses: an empirical study using organisational memory theory

INTRODUCTION

There has been little systematic exploration into what affects timeliness of epidemic response, despite the potential for earlier responses to be more effective. Speculations have circulated that previous exposure to major epidemics helped health systems respond more quickly to COVID-19. This study leverages organisational memory theory to test whether health systems with any, more severe, or more recent exposure to major epidemics enacted timelier COVID-19 policy responses.

METHODS

A data set was constructed cataloguing 846 policies across 178 health systems in total, 37 of which had major epidemics within the last 20 years. Hypothesis testing used OLS regressions with World Health Organization region fixed effects, controlling for several health system expenditure and political variables.

RESULTS

Results show that exposure to any major epidemics was associated with providing earlier response in the following policy categories: all policies, surveillance/response, distancing, and international travel policies. The effect was about 6-10 days earlier response. The significance of this variable was largely nullified with the addition of the other two independent variables. Neither total cases nor years since previous epidemics showed no statistical significance.

CONCLUSION

This study suggests that health systems may learn from past major epidemics. Policymakers ought to institutionalise lessons from COVID-19. Future studies can examine specific generalisable lessons and whether timelier responses correlated with lower health and economic impacts.

Changing to improve? Organizational change and change-oriented leadership in hospitals

PURPOSE

This paper aims to fill gaps in one's knowledge of the impact of organizational change on two outcomes relevant to hospital service quality (performance obstacles and physician job satisfaction) and in one's knowledge of the role of middle manager change-oriented leadership in relation to the same outcomes. Further, the authors aim to identify how physician participation in decision-making is impacted by organizational change and change-oriented leadership, as well as how it mediates the relationships between these two variables, performance obstacles and job satisfaction.

DESIGN/METHODOLOGY/APPROACH

The study adopted a cross-sectional survey design including data from Norwegian hospital physicians (N = 556). A hypothetical model was developed based on existing theory, confirmatory factor analysis was carried out in order to ensure the validity of measurement concepts, and the structural model was estimated using structural equation modelling.

FINDINGS

The organizational changes in question were positively related to performance obstacles both directly and indirectly through participation in decision-making. Organizational change was also negatively related to job satisfaction, both directly and indirectly. Change-oriented leadership was negatively related to performance obstacles, but only indirectly through participation in decision-making, whereas it was positively related to job satisfaction both directly and indirectly.

ORIGINALITY/VALUE

The authors developed a theoretical model based on existing theory, but to their knowledge no other studies have tested these exact relationships within one model. These findings offer insights relevant to current and ongoing developments in the healthcare field and to the question of how hospitals may deal with continuous changes in ways that could contribute positively towards outcomes relevant to service quality.

Towards an Integrated Care Organisation from a CEO Perspective

Many experimental projects towards Person-Centred Care (PCC) are successful in the early stages, but founder when the attempt is made to scale them up to encompass the whole organisation. This case study therefore focusses on one manager's attempts to extend the successes of a preliminary project 'Etxean Ondo' that aimed to provide adequate support for the elderly living at home or in nursing homes, as well as for their families and care professionals. Through in-depth interviews with stakeholders, this qualitative study, based on Grounded Theory, sets out to analyse which behaviours, attitudes and values on the part of management appeared to favour full-integration of PCC in this wider context. Analysis of the data gathered allowed the researcher to generate an experimental case model which suggests how the extrinsic, intrinsic and transcendent motivation of stakeholders can be aligned with the goals of upper management to promote full-integration of PCC in such a way as to generate trust, increase participant engagement and create a win-win situation for all. Whilst this is clearly an experimental project, it is hoped that the model provided may prove helpful to other researchers and managers interested in pioneering this type of comprehensive organisational strategic change towards integration.

Medical leadership: boon or barrier to organisational performance? A thematic synthesis of the literature

OBJECTIVE

The influx of management ideas into healthcare has triggered considerable debate about if and how managerial and medical logics can coexist. Recent reviews suggest that clinician involvement in hospital management can lead to superior performance. We, therefore, sought to systematically explore conditions that can either facilitate or impede the influence of medical leadership on organisational performance.

DESIGN

Systematic review using thematic synthesis guided by the Enhancing Transparency in Reporting the synthesis of Qualitative research statement.

DATA SOURCES

We searched PubMed, Web of Science and PsycINFO from 1 January 2006 to 21 January 2020.

ELIGIBILITY CRITERIA

We included peer-reviewed, empirical, English language articles and literature reviews that focused on physicians in the leadership and management of healthcare.

DATA EXTRACTION AND SYNTHESIS

Data extraction and thematic synthesis followed an inductive approach. The results sections of the included studies were subjected to line-by-line coding to identify relevant meaning units. These were organised into descriptive themes and further synthesised into analytic themes presented as a model.

RESULTS

The search yielded 2176 publications, of which 73 were included. The descriptive themes illustrated a movement from 1. medical protectionism to management through medicine; 2. command and control to participatory leadership practices; and 3. organisational practices that form either incidental or willing leaders. Based on the synthesis, the authors propose a model that describes a virtuous cycle of management through medicine or a vicious cycle of medical protectionism.

CONCLUSIONS

This review helps individuals, organisations, educators and trainers better understand how medical leadership can be both a boon and a barrier to organisational performance. In contrast to the conventional view of conflicting logics, medical leadership would benefit from a more integrative model of management and medicine. Nurturing medical engagement requires participatory leadership enabled through long-term investments at the individual, organisational and system levels.

The Organizational Aspect of Human Resource Management as a Determinant of the Potential of Polish Hospitals to Manage Medical Professionals in Healthcare 4.0

Industry 4.0 solutions have penetrated the healthcare sector, thus creating challenges that healthcare entities should meet. For this, a proper relationship between human resource management (HRM) within healthcare entities and Healthcare 4.0 is needed. In addition, organizations mainly focus on HRM practices, yet organizational issues are overlooked. In this context, the aim of the article was to analyze and evaluate the involvement and roles of key HRM actors, such as line managers and human resource (HR) specialists (HR departments) within strategic healthcare entities, namely hospitals. It was also important to identify the potential of hospitals to meet the requirements of Healthcare 4.0. A study was performed on a group of 285 Polish hospitals. Five respondents were recruited from each hospital. The total population amounted to 1425 interviewees. Due to the complexity of the research, it was outsourced. The results of the analysis identified that hospitals largely engage line managers in medical personnel management. However, a lack of managerial competence may become a major barrier in coping with challenges created by Healthcare 4.0. Organizational solutions do not support the strategic role of HR specialists; their anchoring in the organizational structures limits the possibility to support the changes required for the transformation towards Healthcare 4.0.

Environmental Management in German Hospitals—A Classification of Approaches

This paper analyzes organizational environmental performance and environmental management approaches in German hospitals. Based on data from an online survey and a subsequent cluster analysis, three groups of hospitals are identified: traditionalists, pragmatists, and environmentalists. The clusters differ regarding their organizational environmental performance, i.e., the environmental management elements adopted (policy, goals, structures, processes, and monitoring) and the environmental issues addressed (energy, water, material consumption, waste, emissions into water and air). The environmental management approaches hospitals adopt range from least to most active. Despite perceived stakeholder pressure being generally low, differences between the clusters can be observed. The most relevant stakeholders are internal ones, i.e., management and owners, rather than external ones. Furthermore, some organizational characteristics distinguish the clusters. This paper adds knowledge in the under-researched setting of hospitals and discusses managerial possibilities for the types of hospitals to increase their organizational environmental performance and to pursue a more holistic environmental approach.