Chief executive officers retention model for Australian hospitals

Objective This study aims to develop a comprehensive chief executive officer (CEO) retention model for Australian hospitals, addressing high turnover rates by integrating key retention strategies to promote organisational stability and enhance patient care. Methods The study employed a sequential exploratory design with four stages: a scoping review, qualitative interviews, a quantitative survey, and comprehensive data analysis. The scoping review examined existing literature on CEO turnover and retention. Qualitative interviews with 14 Australian hospital CEOs provided in-depth insights. A quantitative survey with 51 CEOs validated the findings. Data triangulation ensured a robust and contextually relevant model aligned with Transformational Leadership Theory and a systems approach. Results Five key factors influencing CEO retention were identified: mutual respect and clear roles between CEOs and boards, fostering a positive organisational culture, competitive rewards, robust recruitment and retention practices, and ongoing professional development and mentorship. The model emphasises a supportive environment, equitable compensation, effective succession planning, and leadership development. Findings indicate a holistic approach addressing both professional environment and personal growth is essential for improving CEO retention rates. Conclusions The CEO retention model provides practical solutions to reduce turnover and enhance stability in Australian hospitals. By incorporating Transformational Leadership Theory and a systems approach, the model offers a comprehensive framework that addresses the multifaceted nature of CEO retention. Future research should refine these strategies and explore their applicability in different healthcare settings to further enhance effectiveness.

Factors associated with health CEO turnover - a scoping review

BACKGROUND

Chief Executive Officer's (CEO) are integral leaders of health care organisation. Over the last two decades in United States (US) hospitals, it has been noted that CEO turnover rates are increasing, and it was reported that the CEO turnover rates have augmented from 14% in 2008 to 18% in 2017 in the private sector. In Australia, it was discovered that during two years, 41 executives had 18 distinct positions. It has been highlighted that the increasing CEO turnover is a major issue for Australian and international health care organisations. Some of the negative consequences of CEO turnover include organisational instability, high financial costs, loss of human capital and adverse effects on staff morale and patient care.

OBJECTIVE

Our scoping review aimed to map and summarise the evidence associated with CEO turnovers in both health and non-health setting, and answer the following questions: 1. What are the reasons for CEO departure?, 2. What are the strategies to minimise CEO turnover?

RESULTS

A protocol explaining the objectives, inclusion criteria and methods for this scoping review were specified in advance and published. This scoping review included 17 studies (13 health and 4 non-health setting) published over a 31-year period that investigated and described the increasing CEO turnover rates. All 17 studies identified causes of CEO turnover along with certain studies identifying facilitators of CEO retention. We classified CEO's departure reasons into three major themes: organizational, performance, and personal. Organisational factors include CEO departures due to issues within the organisation, performance factors include issues with CEO's work and personal factors captures personal reasons for CEO's leaving their job.

CONCLUSION

CEOs are under immense pressure to deliver good results and drive growth while satisfying the interests of internal and external stakeholders. There are various reasons for CEO's departure however the most common factor identified is organisational.

Four System Enablers of Large-System Transformation in Health Care: A Mixed Methods Realist Evaluation

Policy Points The implementation of large-scale health care interventions relies on a shared vision, commitment to change, coordination across sites, and a spanning of siloed knowledge. Enablers of the system should include building an authorizing environment; providing relevant, meaningful, transparent, and timely data; designating and distributing leadership and decision making; and fostering the emergence of a learning culture. Attention to these four enablers can set up a positive feedback loop to foster positive change that can protect against the loss of key staff, the presence of lone disruptors, and the enervating effects of uncertainty.

CONTEXT

Large-scale transformative initiatives have the potential to improve the quality, efficiency, and safety of health care. However, change is expensive, complex, and difficult to implement and sustain. This paper advances system enablers, which will help to guide large-scale transformation in health care systems.

METHODS

A realist study of the implementation of a value-based health care program between 2017 and 2021 was undertaken in every public hospital (n = 221) in New South Wales (NSW), Australia. Four data sources were used to elucidate initial program theories beginning with a set of literature reviews, a program document review, and informal discussions with key stakeholders. Semistructured interviews were then conducted with 56 stakeholders to confirm, refute, or refine the theories. A retroductive analysis produced a series of context-mechanism-outcome (CMO) statements. Next, the CMOs were validated with three health care quality expert panels (n = 51). Synthesized data were interrogated to distill the overarching system enablers.

FINDINGS

Forty-two CMO statements from the eight initial program theory areas were developed, refined, and validated. Four system enablers were identified: (1) build an authorizing environment; (2) provide relevant, authentic, timely, and meaningful data; (3) designate and distribute leadership and decision making; and (4) support the emergence of a learning culture. The system enablers provide a nuanced understanding of large-system transformation that illustrates when, for whom, and in what circumstances large-system transformation worked well or worked poorly.

CONCLUSIONS

System enablers offer nuanced guidance for the implementation of large-scale health care interventions. The four enablers may be portable to similar contexts and provide the empirical basis for an implementation model of large-system value-based health care initiatives. With concerted application, these findings can pave the way not just for a better understanding of greater or lesser success in intervening in health care settings but ultimately to contribute higher quality, higher value, and safer care.

Causes & Consequences of Health Care CEO Turnover in Australia and Retention Strategies: A Qualitative Study

It has been highlighted the increasing CEO turnover is a major issue for Australian and international health care organizations. Some of the negative consequences of CEO turnover includes organizational instability, high financial costs, and affecting patient care. On average, CEOs leave their role within 1 to 2 years after commencement, which can be detrimental to the hospital's overall functioning. Therefore, this study aims to identify the causes and consequences of increasing CEO turnover in health care, so retention strategies could be devised. Fourteen hospital CEOs across Australia were interviewed online to answer 5 open ended questions related to qualities of a CEO, challenges of the CEO role, Causes and consequences of increasing CEO turnover and recommendation for CEOs retention. Interviews followed a semi-structured schedule to prompt discussion in relation to the above. The study has identified that CEOs possess certain qualities such as self-awareness, leadership style, resilience that enable them to perform their role well. Challenges of this role such as COVID-19, managing organizational change staff management has been found and discussed. Broadly, causes have been divided into 5 major categories such as Organization, Performance, Pressure, Personal and Health reform. It was found that increasing CEO turnover can be damaging to the hospital, not just the staff and patients suffer but the surrounding community gets adversely affected. To minimize CEO turnover, it was suggested that the board needs to support their CEO by advocating and investing in organizational culture and leadership programs. The findings of this study aid, the board with certain strategies through which CEO can be supported. CEOs made certain recommendations in this study to minimize the turnover which can make such a big impact on health care as this may lead to better functioning hospitals in Australia. Moreover, these strategies could be used internationally to help them CEOs retain in their position.

I became a leader by coincidence: specialised nurses as leaders in the field of mental health and substance abuse

PURPOSE

This study aims to examine nurses' motivation for leadership and explore important challenges nurses face in leadership positions.

DESIGN/METHODOLOGY/APPROACH

Semi-structured interviews were conducted with 20 nurses in leading positions. Thematic analysis was used to analyse the data.

FINDINGS

Nurse leaders are recruited from clinical settings, and the transition process from clinical nurse to leader is demanding. Their motivation for leadership seems to be in human values and caring for others. Lack of strategic focus might be a challenge. Nurses in leadership positions emphasize the importance of good relationships with the staff and require an increased focus on strategic leadership.

RESEARCH LIMITATIONS/IMPLICATIONS

Studies have revealed the frustration associated with the role of a nursing leader. According to an evaluation of a clinical leadership development programme, nurses were found to be inadequately prepared for their roles. They had not experienced positive role models, they felt overwhelmed and they regarded colleagues and nursing management structures as unsupportive. There is a need for further research into effective measures to strengthen nurse managers.

PRACTICAL IMPLICATIONS

The role of leaders has changed over time. There are now increasing requirements and objectives with regard to laws, action plans, improvement projects and cost-effectiveness. A nurse leader has both many tasks and great responsibility. Good leadership relies on skilled nurse leaders meeting statutory requirements in patient care and delivering good quality and patient-safe services. Engaging in process-oriented guidance, such as mentoring, is one way to become more aware of oneself as a professional leader (Mathena, 2002).

ORIGINALITY/VALUE

By identifying and understanding the specific challenges that nurse leaders face, this study can contribute to the development of interventions and strategies to improve leadership practices, thereby enhancing organizational effectiveness.

The impact of healthcare executive seniority on implementation of innovative methods of diagnosis and prevention

Innovative methods of diagnosis and prevention play a key role in the survival of healthcare systems as well as the wellbeing of patients. Effective healthcare management is a critical factor in implementing hospital innovation. Healthcare executive (HE) personal and job characteristics such as age and seniority have been found to affect innovative decision-making. However, no study has yet investigated age and seniority effects on the propensity to implement innovation in health prevention strategies. This study fills the literature gap by providing evidence for the effect of HE age and seniority on the implementation of innovative methods for diagnosis and prevention. Predicated on 57 in-depth interviews with HEs, we employ mixed methods research, combining qualitative and quantitative analysis. Structural Equation Modeling was used to test the model's goodness-of-fit. Results show that while HE age and number of years in the organization positively affect job tenure, job tenure, in turn, negatively affects willingness to implement innovative methods of diagnosis and prevention in hospitals. This study extends the Upper-Echelon Theory to health workforce management. Practical implications are discussed.

The Challenge of Employee Retention in Medical Practices across the United States: An Exploratory Investigation Into the Relationship between Operational Succession Planning and Employee Turnover

Employee turnover is a growing challenge for health-care providers delivering patient care today. US population demographics are shifting as the population ages, which leaves the field of health care poised to lose key leaders and employees to retirement at a time when patient care has grown more complex. This means health care will lose its core of key employees at a time when skilled leadership and specialized knowledge is most needed and directly impacts health care's ability to deliver quality care. Operational succession planning (OSP) may be one solution to manage this looming challenge in health care, as the process identifies and develops the next generation of leadership. Thus, this exploratory national study used a quantitative and cross-sectional design to examine the relationship between OSP and employee turnover. Demographic and 10-point Likert scale data were collected from n = 66 medical practices, using an online survey instrument. Data were analyzed using various descriptive and inferential statistical methods. Distribution (frequency and chi-square) analyses of the study sample, one-way analysis of variance (ANOVA), and regression analyses were performed across seven demographic characteristics of the medical practices: Specialty, Ownership Structure, Number of full-time equivalent (FTE) Physicians, Number of FTE Clinical Employees, Number of FTE Nonclinical Employees, Number of FTE Employees Left Position, and Region. Study results provided statistically significant evidence to support the relationship between OSP and employee turnover, highlighting that OSP was associated with lower employee turnover. The finding suggests that OSP can serve as an effective mechanism for increasing employee retention.

Institutional change of compensation policy and its impact on CEO turnover and firm performance

The existing corporate governance literature has mostly focused on micro-level studies of executive compensation, with limited attention paid to influential macro-level factors such as institutions and institutional changes and their impacts on corporate governance and performance. The implementation of the new compensation policy that restricts CEO compensation ceiling in state-owned firms in China offers an ideal context for us to study how institutional changes and firms’ adoption of these changes can influence CEO turnover and firm performance. Our empirical analyses reveal that the positive impact of new compensation policy adoption on CEO turnover is stronger for CEOs with originally higher compensation. The impact of new compensation policy adoption on firm performance, however, is negative, and the negative impact is contingent upon a firm’s market share and tech intensity. Our research contributes to the literature on corporate governance by theorizing and empirically demonstrating the critical role that institutions play in corporate governance.

The impact of nurse staffing methodologies on nurse and patient outcomes: A systematic review

Aim

Aim of this study is to systematically review and synthesize available evidence to identify the association between nurse staffing methodologies and nurse and patient outcomes.

Design

Systematic review and narrative synthesis.

Data sources

A search of MEDLINE (EBSCO), CINAHL (EBSCO) and Web of Science was conducted for studies published in English between January 2000 and January 2020.

Review methods

The reporting of this review and narrative synthesis was guided by the preferred reporting items for systematic and meta‐analysis guidelines (PRISMA) statement and data synthesis guided by the Synthesis Without Meta‐analysis (SWiM) guideline. The quality of each article was assessed using the Mixed Methods Appraisal Tool.

Results

Twenty‐two studies met the inclusion criteria. Twenty‐one used the mandated minimum nurse‐to‐patient ratio methodology and one study assessed the number of nurse hours per patient day staffing methodology. Both methodologies were mandated. All studies that reported on nurse outcomes demonstrated an improvement associated with the implementation of mandated minimum nurse‐to‐patient ratio, but findings related to patient outcomes were inconclusive.

Conclusions

Evidence on the impact of specific nurse staffing methodologies and patient and nurse outcomes remains highly limited. Future studies that examine the impact of specific staffing methodologies on outcomes are required to inform this fundamental area of management and practice.

A comparison of middle managers' and paediatric nurses' satisfaction with organisational communication

AIMS

To explore the differences in organisational communication satisfaction between ward paediatric nurses and middle managers, and to assess whether there is a difference in organisational communication satisfaction between paediatric nurses and middle managers with different educational levels, years of nursing and managerial experience, contracted hours, area of work, age and gender.

BACKGROUND

Previous studies reported a connection between job satisfaction, work commitment and organisational communication; however, nurses' and nursing middle managers' satisfaction with organisational communication has not been extensively studied in recent years and not at all among paediatric nurses.

METHODS

A cross-sectional quantitative research design using online and hard copy self-reported questionnaires was used. Data were collected at one point in time from paediatric nurses and middle (nursing) managers working in a tertiary paediatric hospital in Australia. Statistical methods were employed for data analysis.

RESULTS

The middle management group were significantly more dissatisfied with organisational communication than the paediatric ward nurse group. Middle managers were found in this study to effectively manage and maintain communication lines with the personnel who reported to them; however, communication within the management cohort itself was found to be suboptimal.

CONCLUSION

Further research to understand how horizontal and vertical communications at the nurse manager and executive level can be optimised is required.

IMPLICATIONS FOR NURSING MANAGEMENT

It is anticipated that the findings from this study may increase the understanding of communication satisfaction between paediatric nurses and middle managers. The study has highlighted the need for improvement with information flow in the management cohort with the addition of extra managerial support and empowerment.

Introducing the 2020 Pathway to Excellence® manual

Building positive practice environments around the globe.

'It needs a complete overhaul…' district manager perspectives on the capacity of the health system to support the delivery of emergency obstetric care in an urban South African district

Background: A high maternal mortality ratio persists in South Africa despite developments in emergency obstetric care (EmOC), a known effective intervention against direct causes of maternal deaths. Strengthening the health systems is one of the focus areas identified by the National Committee for Confidential Enquiries into Maternal Deaths in South Africa. District managers as immediate overseers of the frontline health system are uniquely positioned to provide insight into the overall health system processes that influence the delivery of EmOC. Objective: We sought to identify health system enablers and barriers to the delivery EmOC from the perspective of district managers. This would potentially unearth aspects of the health system that require strengthening to better support EmOC and improve maternal outcomes. Methods: Face-to-face audio-recorded key informant interviews were conducted with 19 district managers in charge of the delivery of EmOC in one urban district. Interviews were transcribed and coded. Related codes were inductively grouped into emerging themes. Deductive thematic analysis was then applied to categorise emergent themes into the WHO health system building blocks. Results: Themes included a weaknesses in the organisation of health services; a high vacancy and turnover of senior management; poor clinical accountability from EmOC providers; inadequate resources (including infrastructure, staffing, and funding); and the need to improve district health information system indicators. Conclusion: The functioning of the district health system was weak, affecting the delivery of EmOC. Unless staffing is effectively addressed, the health system is unlikely to reduce maternal mortality to the desired level. Coordination of EmOC services by managers needs to be strengthened to limit fragmentation of care and improve the continuity EmOC. Furthermore, a high turnover of senior leadership affects implementation priorities and continuity in the overall strategic direction of EmOC.

Changes to nurses' practice environment over time

AIMS

To examine changes in the nursing practice environment, retention-related factors, unit stability and patient care tasks delayed or left undone, over two periods between 2004 and 2013.

BACKGROUND

Positive nurse practice environments have been linked to nurse retention and care quality outcomes.

METHODS

The collection of the Practice Environment Scale of the Nursing Work Index, job satisfaction, intent to leave, unit instability and tasks delayed or not done at six acute-care hospitals across three Australian states, in two waves between 2004 and 2013; results from the two waves are compared.

RESULTS

On average, practice environment scores declined slightly; nurses reported a greater difficulty in finding another nursing position, lower intent to leave their current job and greater instability in their current position. Rates of delayed tasks increased over the period, whereas rates of tasks left undone have decreased over the period.

CONCLUSIONS

The decline in nurses' perceptions of the quality of the practice environment is disappointing, particularly given the protracted workforce shortages that have persisted. Significant organisational restructuring and turnover of nurse executives may have contributed to this decline.

IMPLICATION FOR NURSING MANAGEMENT

Managers need to apply existing evidence to improve nurse practice environments and manage instability.

The rate and cost of nurse turnover in Australia

Nurse turnover is a critical issue facing workforce planners across the globe, particularly in light of protracted and continuing workforce shortages. An ageing population coupled with the rise in complex and chronic diseases, have contributed to increased demands placed on the health system and importantly, nurses who themselves are ageing. Costs associated with nurse turnover are attracting more attention; however, existing measurements of turnover show inconsistent findings, which can be attributed to differences in study design, metrics used to calculate turnover and variations in definitions for turnover. This paper will report the rates and costs of nurse turnover across three States in Australia.

Nursing churn and turnover in Australian hospitals: nurses perceptions and suggestions for supportive strategies

Background

This study aimed to reveal nurses’ experiences and perceptions of turnover in Australian hospitals and identify strategies to improve retention, performance and job satisfaction. Nursing turnover is a serious issue that can compromise patient safety, increase health care costs and impact on staff morale. A qualitative design was used to analyze responses from 362 nurses collected from a national survey of nurses from medical and surgical nursing units across 3 Australian States/Territories.

Method

A qualitative design was used to analyze responses from 362 nurses collected from a national survey of nurses from medical and surgical nursing units across 3 Australian States/Territories.

Results

Key factors affecting nursing turnover were limited career opportunities; poor support; a lack of recognition; and negative staff attitudes. The nursing working environment is characterised by inappropriate skill-mix and inadequate patient-staff ratios; a lack of overseas qualified nurses with appropriate skills; low involvement in decision-making processes; and increased patient demands. These issues impacted upon heavy workloads and stress levels with nurses feeling undervalued and disempowered. Nurses described supportive strategies: improving performance appraisals, responsive preceptorship and flexible employment options.

Conclusion

Nursing turnover is influenced by the experiences of nurses. Positive steps can be made towards improving workplace conditions and ensuring nurse retention. Improving performance management and work design are strategies that nurse managers could harness to reduce turnover.