Management lessons through an interactive online discussion about hospital management during the COVID-19 pandemic

Background: In light of the COVID-19 pandemic and resulting demand for innovative hospital management we organized an interactive online discussion for medical students and healthcare professionals about hospital management during the crisis. Objective: The event offered an opportunity to learn from a hospital crisis management. We looked at how this new online format compares to a traditional discussion event. Methods: We used an online platform with four guests, a moderator and about 100 attendees. During the event we gathered demographic facts through an interactive questionnaire tool and an extensive evaluation afterwards. Results: The event was rated with an overall grade of 1.4 (Likert from 1 to 6, 1 best grade; SD 0.5) and participants agreed that this format should be organized again (1.2; SD 0.5). 70% of audience members preferred the online format of the event. Due to the high volume, only about 30% (total n~35) of the questions posed by the audience were addressed. Conclusion: Firstly, most participants preferred the event to be online, contrary to our expectation. Secondly, the handling of the amount of individual questions posed significant challenges. Finally, the number of attendees and questions suggested a continuing demand among students and physicians for further education regarding hospital management, especially regarding COVID-19. These findings also require a critical look at future formats and topics of podium discussions in medical education. The online format might be a good alternative to face-to-face lectures.

Assessing the predictors for training in management amongst hospital managers and chief executive officers: a cross-sectional study of hospitals in Abuja, Nigeria

BACKGROUND

There is a compelling need for management training amongst hospital managers in Nigeria mostly because management was never a part of the curricula in medical schools and this has resulted in their deficiencies in effective policymaking, planning and bottom line management. There has been no study to the best of our knowledge on the need and likely factors that may influence the acquisition of such training by hospital managers and this in effect was the reason for this study.

METHODS

Data for this study came from a cross-sectional survey distributed amongst management staff in twenty five (25) hospitals that were purposively selected. One hundred and twenty five (125) questionnaires were distributed, out of which one hundred and four (104) were answered and returned giving a response rate of 83.2%. Descriptive and Inferential statistics were used to summarize the results. Decisions were made at 5% level of significance. A binary logistic regression was performed on the data to predict the logit of being formally and informally trained in health management. These statistical techniques were done using the IBM SPSS version 20.

RESULTS

The result revealed a high level of formal and informal trainings amongst the respondent managers. In formal management training, only few had no training (27.9%) while in informal management training, all had obtained a form of training of which in-service training predominates (84.6%). Most of the administrators/managers also had the intention of attending healthcare management programme within the next five years (62.5%). Socio-demographically, age (p = .032) and academic qualification (p < .001) had significant influence on training. Number of hospital beds (p < .001) and number of staff (p < .001) including managers' current designation (p < .001) also had significant influence on training.

CONCLUSION

Our work did establish the critical need for both formal and informal trainings in health management for health care managers. Emphasis on training should be directed at younger managers who are the least likely to acquire such trainings, the smaller and private hospitals who are less likely to encourage such trainings amongst their staff and the least educated amongst health managers.

Delivering on the Promise of CLER: A Patient Safety Rotation That Aligns Resident Education With Hospital Processes

PROBLEM

Residency programs must provide training in patient safety. Yet, significant gaps exist among published patient safety curricula. The authors developed a rotation designed to be scalable to an entire residency, built on sound pedagogy, aligned with hospital safety processes, and effective in improving educational outcomes.

APPROACH

From July 2015 to May 2017, each second-year resident completed the two-week rotation. Residents engaged the foundational science asynchronously via multiple modalities and then practiced applying key concepts during a mock root cause analysis. Next, each resident performed a special review of an actual adverse patient event and presented findings to the hospital's Special Review Committee (SRC). Multiple educational outcomes were assessed, including resident satisfaction and attitudes (postrotation survey), changes in knowledge via pre- and posttest, quality of the residents' written safety analyses and oral presentations (per survey of SRC members), and organizational changes that resulted from the residents' reviews.

OUTCOMES

Twenty-two residents completed the rotation. Most components were rated favorably; 80% (12/15 respondents) indicated interest in future patient safety work. Knowledge improved by 44.3% (P < .0001; pretest mean 23.7, posttest mean 34.2). Compared to faculty, SRC members rated the quality of residents' written reviews as superior and the quality of the rated oral presentations as either comparable or superior. The reviews identified a variety of safety vulnerabilities and led to multiple corrective actions.

NEXT STEPS

The authors will evaluate the curriculum in a controlled trial with better measures of change in behavior. Further tests of the curriculum's scalability to other contexts are needed.

Design of a Hospital Simulation Software for Nursing Education

This work aims to describe the inception and design for a hospital simulator based on data and cases provided by teachers and other randomized data. The main goal is to develop a computer software tool that simulates a hospital as a tool for nursing student. The system is based on a multi-agent model and multi threaded parallel processing. Other parts includes the interfaces for teacher and student, reports and fixed constraints like Laws and other rules. This is a work in progress project and will be released as open source software after the final validation.

Tips for Working With External Reviewers

Leaders are responsible for creating a culture of quality and safety within a highly regulated industry. Five tips for working with regulators are presented from a leadership coaching framework.

Training hospital managers for strategic planning and management: a prospective study

BACKGROUND

Training is the systematic acquisition of skills, rules, concepts, or attitudes and is one of the most important components in any organization's strategy. There is increasing demand for formal and informal training programs especially for physicians in leadership positions. This study determined the learning outcomes after a specific training program for hospital management teams.

METHODS

The study was conducted during 2006 and 2007 at the Centre School of Public Health and Management, Faculty of Medicine, University of Belgrade and included 107 participants involved in the management in 20 Serbian general hospitals. The management teams were multidisciplinary, consisting of five members on average: the director of the general hospital, the deputy directors, the head nurse, and the chiefs of support services. The managers attended a training program, which comprised four modules addressing specific topics. Three reviewers independently evaluated the level of management skills at the beginning and 12 months after the training program. Principal component analysis and subsequent stepwise multiple linear regression analysis were performed to determine predictors of learning outcomes.

RESULTS

The quality of the SWOT (strengths, weaknesses, opportunities and threats) analyses performed by the trainees improved with differences between 0.35 and 0.49 on a Likert scale (p < 0.001). Principal component analysis explained 81% of the variance affecting their quality of strategic planning. Following the training program, the external environment, strategic positioning, and quality of care were predictors of learning outcomes. The four regression models used showed that the training program had positive effects (p < 0.001) on the ability to formulate a Strategic Plan comprising the hospital mission, vision, strategic objectives, and action plan.

CONCLUSION

This study provided evidence that training for strategic planning and management enhanced the strategic decision-making of hospital management teams, which is a requirement for hospitals in an increasingly competitive, complex and challenging context. For the first time, half of state general hospitals involved in team training have formulated the development of an official strategic plan. The positive effects of the formal training program justify additional investment in future education and training.

[Student hospital managers and the provision of care for the elderly]

During their training in public health care higher education institutes, future hospital managers carry out several work placements in health care institutes, including one in a geriatric unit. While they often having negative preconceptions of this sector, their experience in the departments, in contact with the patients/residents and the professionals working there, is the opportunity to deconstruct their prejudices and to discover a sector which is dynamic, innovative and very rich in human terms. They thereby become aware of the specificity of the provision of care for the elderly and the need to integrate it into the future strategies of public health institutes.

A Model for Physician Leadership Development and Succession Planning

Although the presence of physicians in formal leadership positions has often been limited to roles of department chiefs, MAC chairs, etc., a growing number of organizations are recruiting physicians to other leadership positions (e.g., VP, CEO) where their involvement is being genuinely sought and valued. While physicians have traditionally risen to leadership positions based on clinical excellence or on a rotational basis, truly effective physician leadership that includes competencies such as strategic planning, budgeting, mentoring, network development, etc., is essential to support organizational goals, improve performance and overall efficiency as well as ensuring the quality of care. In this context, the authors have developed a physician leader development and succession planning matrix and supporting toolkit to assist hospitals in identifying and nurturing the next generation of physician leaders.

The development of a multiplayer game for education of hospital management

This paper designed and prototyped a networked hospital management serious game for education, and evaluated the prototype. A player, the president of each hospital, makes management decisions under various clinical indicators, and the decision affects condition of the other hospitals as well as of his/her own. The interaction makes the players compete, and, at the same time, exchange their findings each other.

Leadership training for radiologists: a survey of opportunities and participants in MBA and MPH programs by medical students, residents, and current chairpersons

PURPOSE

The aim of this study was to determine opportunities for students and trainees to obtain an MPH or MBA degree during either medical school or radiology residency and to determine the prevalence of such degree possession by chairpersons in radiology.

METHODS

All allopathic medical schools in the United States were surveyed to chart the number of MD/MPH and MD/MBA degree programs available to students. Program directors were contacted to assess the number of MPH or MBA courses of study administratively related to their residencies. Also, an e-mail survey was sent to all members of the Society of Chairs of Academic Radiology Departments inquiring whether each chairperson had earned an additional degree.

RESULTS

Currently, 81 allopathic medical schools in the United States offer MD/MPH degrees, and 52 offer MD/MBA degrees. Six residencies provide access to MPH programs, and 3 residencies provide the opportunity to pursue an MBA in conjunction with residency. Of these, only 1 MPH program and no MBA programs had trainees enrolled at present. Twenty-six percent of the chairpersons surveyed possessed advanced degrees other than MDs.

CONCLUSION

There has been rapid growth in the number of MD/MPH and MD/MBA programs available to medical students. However, there is a scarcity of similar programs accessible to trainees during or just after residency training. To assist motivated radiologists interested in leading our profession, opportunities should expand both in formal degree-granting programs and through certificate-sanctioned course series to address relevant issues of leadership and management pertinent to our specialty.

[Which tools should be used to identify learning objectives for the health service? The experience of the Emilia-Romagna Region (Italy)]

The main health education target of the Emilia-Romagna Region for the period 2008-2010 is to develop pathways of continuous learning for healthcare workers and managers in hospitals. The pathways have the aim of governing the innovation process, improving services, developing new skills, spreading good managerial and professional working practices and integrate knowledge and cooperation between professions at institutional and service levels. This paper synthetically illustrates the role of the different regional institutions (primary care trusts and NHS trusts) in establishing the objectives and the preferable procedures for teaching. The main difficulties concern the effective planning of homogeneous teaching, as well as the ways to translating the needs of the health of the patients into educational projects.

[Which tools should be used to identify educational objectives in the regional health service? The experience in Marche Region (Italy)]

Through a specific methological path, educational objectives of Regional interest have been identified with a punctual analysis of Health Planning documents. While organizing each educational acrivities, all SSR departments indicate the Regional educational objectives they are linked with, each connected to national educational objectives. Continuing Medical Education program in the Marche Region is strictly connected with the acts of health planning from 2006. Each SSR department report accompanying the balance sheets from 2006 to 2009 must contain a section specifically dedicated to ECM Program, indicating the annual budget for ECM Program. All training activities are systematically monitored through a single information tool, shared by all SSR Departments and linked to the SSR Health Operators registry office. Strenghts of the ECM Educational Program of the Marche Region can be summarized as follows: guidance of Educational Program linked in a structured way to the Health Planning goals; punctual indications of redaction modes for PFA and Educational Reports; analytical scanning of activities/costs of the whole Regional Health Service training system, allowing Executive monitorings and reports, i.e. data that General Management can (... should) use to redirect not only training but their Company management as well.

[Which tools should be used to identify educational objectives? The experience of the Tuscany Region]

The tools used by the Tuscany Region to identify its training objectives show the Region's training network. Continuing education is planned, delivered, and evaluated by an "educational networking". This means that people involved in the educational process are not alone but are part of a network constituting a system, which is linked at three interconnected levels: Regional, sub-Regional (consortia of local health units linked together according to their geographical position), and "Area Aziendale". The three levels contribute to outline strategies, to bring into focus the information needs, to match them and to evaluate the effectiveness of the CME.

Statistical process control for hospitals: methodology, user education, and challenges

The health care industry is slowly embracing the use of statistical process control (SPC) to monitor and study causes of variation in health care processes. While the statistics and principles underlying the use of SPC are relatively straightforward, there is a need to be cognizant of the perils that await the user who is not well versed in the key concepts of SPC. This article introduces the theory behind SPC methodology, describes successful tactics for educating users, and discusses the challenges associated with encouraging adoption of SPC among health care professionals. To illustrate these benefits and challenges, this article references the National Hospital Quality Measures, presents critical elements of SPC curricula, and draws examples from hospitals that have successfully embedded SPC into their overall approach to performance assessment and improvement.

Growing leaders in your own back yard

In seeking future hospital leaders, follow two overarching guidelines: start developing them from within and make leadership training ongoing.

Getting schooled in governance. N.J. enacts law that will require hospital trustees to receive certified training through class, special leadership curriculum

Those joining hospital boards of trustees in New Jersey will soon have to go to school, according to a new law aimed at boosting their financial and governance savvy. And it could start a trend, as more and more hospitals come under greater scrutiny. "I think trustee leadership is crucial to the survival of the hospitals in New Jersey," said Fred Jacobs, left, state health commissioner.

Clinical training. Doctors' new pet subject

Management is to be part of the training of all pre-registration doctors. The course will enable doctors to use management techniques in communicating with other professionals. It will enable doctors to formulate a business case for proposal.

[Strategic preparedness of selected hospitals to act during massive chemical disasters]

The aim of our study was the evaluation of strategic preparedness of twelve hospitals in Kraków, Warsaw and the Triple City to give aid during massive chemical accidents. The study was carried on 146 persons, including 9 managers, 31 ward heads, 75 assistants, and 31 ward nurses. In statistical analysis the generalized linear model extended by random factors, particularly the Poisson's regression has been used. In any of the investigated hospitals, there were no plans regarding of action in case of chemical accidents. The knowledge about sources of possible contamination as well as environment threats were insufficient. The majority of the medical staff did not know their role as well as the role of their hospitals in case of a chemical accident. There is an urgent need for courses about the procedures which should be used during chemical accidents. The lack of hospital preparedness to act during chemical disasters in the big cities suggests that a similar situation is common in other such medical units all over the country. Further investigations, especially in the hospitals which are placed near the potentially dangerous factories, should be carried on in the near future.

Interdisciplinary medical, nursing, and administrator education in practice: the Johns Hopkins experience

Reforming graduate medical, nursing and health administrators' education to include the core competencies of interdisciplinary teamwork and quality improvement (QI) techniques is a key strategy to improve quality in hospital settings. Practicing clinicians are best positioned in these settings to understand systems issues and craft potential solutions. The authors describe how, in ten months during 2004 and 2005 the school of medicine, the school of nursing, and an administrative residency program, all at Johns Hopkins University, implemented and evaluated the Achieving Competency Today II Program (ACT II), a structured and interdisciplinary approach to learning QI that was piloted at various sites around the United States. Six teams of learners participated, each consisting of a medical, nursing, and administrative resident. The importance of interdisciplinary participation in planning QI projects, the value of the patient's perspective on systems issues, and the value of a system's perspective in crafting solutions to issues all proved to be valuable lessons. Challenges were encountered throughout the program, such as (1) participants' difficulties in balancing competing academic, personal and clinical responsibilities, (2) difficulties in achieving the intended goals of a broad curriculum, (3) barriers to openly discussing interdisciplinary team process and dynamics, and (4) the need to develop faculty expertise in systems thinking and QI. In spite of these challenges steps have been identified to further enhance and develop interdisciplinary education within this academic setting.