Changes in hospital CEO profiles in Poland-Professionalisation of management?

PURPOSE

To present and discuss the findings of surveys on the profiles of hospital CEOs in Poland, as carried out in 2012 and 2017, involving over a hundred hospital CEOs at various reference levels.

FINDINGS

The findings indicate appreciable changes in the group under study. While until recently, a typical hospital CEO was a male physician; presently, there is a fair proportion of women (36%). The majority of CEOs are non-physicians (63%), whereas previously, they accounted for approximately 63% of them. Mean work experience in public health care for male CEOs tends to decrease, whereas an opposite trend is well manifested with regard to female CEOs. It was also established that hospital CEOs were steadily less keen on improving their professional qualifications through postgraduate courses.

CONCLUSION

These changes may imply a kind of "stabilisation" within the sector itself or a departure from the all-male, medicine-centred model of hospital management. They may have been caused by climbing expectations regarding overall management expertise and a higher salary level offered to physicians. Changes in individual work experience seem to indicate that men are more often "transplanted" from other industry sectors, whereas women tend to pursue their entire career path in public health care institutions.

Prevalence and compensation of academic leaders, professors, and trustees on publicly traded US healthcare company boards of directors: cross sectional study

OBJECTIVE

To identify the prevalence, characteristics, and compensation of members of the boards of directors of healthcare industry companies who hold academic appointments as leaders, professors, or trustees.

DESIGN

Cross sectional study.

SETTING

US healthcare companies publicly traded on the NASDAQ or New York Stock Exchange in 2013.

PARTICIPANTS

3434 directors of pharmaceutical, biotechnology, medical equipment and supply, and healthcare provider companies.

MAIN OUTCOME MEASURES

Prevalence, annual compensation, and beneficial stock ownership of directors with affiliations as leaders, professors, or trustees of academic medical and research institutions.

RESULTS

446 healthcare companies met the study search criteria, of which 442 (99%) had publicly accessible disclosures on boards of directors. 180 companies (41%) had one or more academically affiliated directors. Directors were affiliated with 85 geographically diverse non-profit academic institutions, including 19 of the top 20 National Institute of Health funded medical schools and all of the 17 US News honor roll hospitals. Overall, these 279 academically affiliated directors included 73 leaders, 121 professors, and 85 trustees. Leaders included 17 chief executive officers and 11 vice presidents or executive officers of health systems and hospitals; 15 university presidents, provosts, and chancellors; and eight medical school deans or presidents. The total annual compensation to academically affiliated directors for their services to companies was $54,995,786 (£35,836,000; €49,185,900) (median individual compensation $193,000) and directors beneficially owned 59,831,477 shares of company stock (median 50,699 shares).

CONCLUSIONS

A substantial number and diversity of academic leaders, professors, and trustees hold directorships at US healthcare companies, with compensation often approaching or surpassing common academic clinical salaries. Dual obligations to for profit company shareholders and non-profit clinical and educational institutions pose considerable personal, financial, and institutional conflicts of interest beyond that of simple consulting relationships. These conflicts have not been fully addressed by professional societies or academic institutions and deserve additional review, regulation, and, in some cases, prohibition when conflicts cannot be reconciled.

Rural mental health workforce needs assessment - a national survey

INTRODUCTION

A variety of studies have indicated that rural communities have fewer mental health services and professionals than their urban counterparts. This study will examine the shortages of mental health professionals in rural communities as well as the impact of inadequate mental health services access on rural hospitals.

METHODS

A sample frame of 1162 rural hospitals was compiled, and a two-page survey was mailed to each hospital Chief Executive Officer (CEO).

RESULTS

Of the 1162 surveys mailed, 228 were returned. The majority of CEOs agreed that there was a shortage of mental health professionals, that referral centers were too distant, and that there were many barriers to care including infrastructure, poverty, and substance abuse. Solutions offered by CEOs included telemedicine and residency training programs.

CONCLUSIONS

This study shows that many rural areas have great need for more mental health professional recruitment and retention.

Responses of Massachusetts hospitals to a state mandate to collect race, ethnicity and language data from patients: a qualitative study

BACKGROUND

A Massachusetts regulation implemented in 2007 has required all acute care hospitals to report patients' race, ethnicity and preferred language using standardized methodology based on self-reported information from patients. This study assessed implementation of the regulation and its impact on the use of race and ethnicity data in performance monitoring and quality improvement within hospitals.

METHODS

Thematic analysis of semi-structured interviews with executives from a representative sample of 28 Massachusetts hospitals in 2009.

RESULTS

The number of hospitals using race, ethnicity and language data internally beyond refining interpreter services increased substantially from 11 to 21 after the regulation. Thirteen of these hospitals were utilizing patient race and ethnicity data to identify disparities in quality performance measures for a variety of clinical processes and outcomes, while 16 had developed patient services and community outreach programs based on findings from these data. Commonly reported barriers to data utilization include small numbers within categories, insufficient resources, information system requirements, and lack of direction from the state.

CONCLUSIONS

The responses of Massachusetts hospitals to this new state regulation indicate that requiring the collection of race, ethnicity and language data can be an effective method to promote performance monitoring and quality improvement, thereby setting the stage for federal standards and incentive programs to eliminate racial and ethnic disparities in the quality of health care.

Executive career paths

Climbing the ladder of hospital management takes commitment, flexibility and continuous learning. This foldout section looks at the three stages of career development and offers advice from current hospital leaders.

Board engagement in quality: findings of a survey of hospital and system leaders

Hospital governing boards assume an important role in improving delivery of quality care in the hospital. More knowledge about the prevalence and impact of particular board activities can help them perform this role more effectively. This study draws from a survey of hospital and system leaders (presidents/chief executive officers [CEOs]) that was conducted in the first six months of 2006 with a total of 562 respondents. The survey contained 27 questions on various aspects of board engagement in quality. More than 80 percent of the responding CEOs indicated that their governing boards establish strategic goals for quality improvement, use quality dashboards to track performance, and follow up on corrective actions related to adverse events. The adoption of other practices was reported less frequently. Only 61 percent of the respondents indicated that their governing boards have a quality committee. The existence of a board quality committee was associated with higher likelihoods of adopting various oversight practices and lower mortality rates for six common medical conditions measured by the Agency for Healthcare Research and Quality's Inpatient Quality Indicators and the State Inpatient Databases. Hospital governing boards appear to be actively engaged in quality oversight, particularly through use of internal data and national benchmarks to monitor the quality performance of their organizations. Having a board quality committee can significantly enhance the board's oversight function. Other potentially useful activities-such as board involvement in setting the agenda for the discussion on quality, inclusion of the quality measures in the CEO's performance evaluation, and improvement of quality literacy of board members-are currently performed infrequently.

Controversy, salaries rise. Ranking of CEO pay at publicly traded companies shows that as pay rises, so does federal interest in compensation policies

The scrutiny of executive pay is ratcheting up. More healthcare companies have gotten subpoenas on stock options, and the SEC is making it easier for investors to understand how executives are paid. The heat already has UnitedHealth easing some of its practices. Others may follow suit. "Most compensation policies seem to be driven primarily by what a company's peers are doing," says Paul Hodgson, left.

What really matters most. Care for uninsured, reimbursement payments and staffing rank high on hospital CEOs lists of key healthcare issues, says the ACHE

When the ACHE asked what pressing problems they were facing, hospital CEOs had a common refrain: money. Staffing shortages and care for the uninsured were also top concerns. Funding for Medicare and Medicaid is especially worrisome, given the current budget problems in Washington. "There's no way to know what's going to happen in 2006," says hospital President Joe Hodges, left.

Survey reveals emphasis on tying pay to quality. Physician executive pay increase holds steady near 7 percent

Double-digit increases were seen in three physician executive positions and there are strong indications that the patient safety movement is impacting the way physician executives are paid.

Family medicine anesthesia: sustaining an essential service

OBJECTIVE

To elicit the opinions of family physician anesthetists (FPAs) and hospital Chief Executive Officers (CEOs) regarding the structure of their organizations and the importance of family medicine anesthesia.

DESIGN

Mailed survey.

SETTING

Ontario hospitals.

PARTICIPANTS

The CEOs of Ontario hospitals and family physicians who provide anesthetic services in Ontario hospitals.

MAIN OUTCOME MEASURES

Demographics, practices, and opinions of FPAs and CEOs regarding family medicine anesthesia.

RESULTS

Responses were received from 159 of 195 practising FPAs (82%). Of the 128 hospitals in Ontario that offered anesthesia services, 59% used at least one FPA; in 39% of these hospitals, all services were provided by FPAs. Both FPAs and CEOs thought that FPAs were competent to meet the anesthesia needs of small community hospitals. Most FPAs and CEOs supported certification and maintenance of competence programs coordinated by a national body, such as the College of Family Physicians of Canada. Both FPAs and CEOs thought there should be support for additional training programs in family medicine anesthesia.

CONCLUSION

Small community hospitals rely completely on FPAs to provide essential anesthesia services. Additional training programs and a national structure to coordinate certification and maintenance of competence programs are important to maintain and enhance this essential service.

What do hospital decision-makers in Ontario, Canada, have to say about the fairness of priority setting in their institutions?

BACKGROUND

Priority setting, also known as rationing or resource allocation, occurs at all levels of every health care system. Daniels and Sabin have proposed a framework for priority setting in health care institutions called 'accountability for reasonableness', which links priority setting to theories of democratic deliberation. Fairness is a key goal of priority setting. According to 'accountability for reasonableness', health care institutions engaged in priority setting have a claim to fairness if they satisfy four conditions of relevance, publicity, appeals/revision, and enforcement. This is the first study which has surveyed the views of hospital decision makers throughout an entire health system about the fairness of priority setting in their institutions. The purpose of this study is to elicit hospital decision-makers' self-report of the fairness of priority setting in their hospitals using an explicit conceptual framework, 'accountability for reasonableness'.

METHODS

160 Ontario hospital Chief Executive Officers, or their designates, were asked to complete a survey questionnaire concerning priority setting in their publicly funded institutions. Eight-six Ontario hospitals completed this survey, for a response rate of 54%. Six close-ended rating scale questions (e.g. Overall, how fair is priority setting at your hospital?), and 3 open-ended questions (e.g. What do you see as the goal(s) of priority setting in your hospital?) were used.

RESULTS

Overall, 60.7% of respondents indicated their hospitals' priority setting was fair. With respect to the 'accountability for reasonableness' conditions, respondents indicated their hospitals performed best for the relevance (75.0%) condition, followed by appeals/revision (56.6%), publicity (56.0%), and enforcement (39.5%).

CONCLUSIONS

For the first time hospital Chief Executive Officers within an entire health system were surveyed about the fairness of priority setting practices in their institutions using the conceptual framework 'accountability for reasonableness'. Although many hospital CEOs felt that their priority setting was fair, ample room for improvement was noted, especially for the enforcement condition.

Rolling in dough. Despite the controversy surrounding CEO pay, healthcare leaders continue to enjoy generous compensation, with insurers leading the pack

Despite the controversy about pay for CEOs, leaders continue to enjoy highly lucrative compensation. Modem Healthcares second annual report on CEO pay shows healthcare chieftains fared nicely. Acute-care hospital CEOs, such as HCA's Jack Bovender Jr., left, saw their median compensation rise 12.50%

The doctor-exec is in. To quell physician unrest, some hospitals are dumping lay executives and replacing them with doctors

Several high-profile shake-ups in healthcare exemplify a strategy recently gaining popularity: Keep physicians happy during times of turmoil by making one the boss. Hospital boards find the move to be a magic elixir when trying to build trust with doctors concerned over rocky leadership. Larry Hollier, M.D. (left), chief physician at New York's Mount Sinai Medical Center, was made president to further that trust.

The effect of governing board composition on rural hospitals' involvement in provider-sponsored managed care organizations

Rural hospitals are actively pursuing various strategic alternatives to confront the dramatic changes taking place in the delivery, organization, and financing of healthcare. One of these strategic alternatives is involvement in provider-sponsored managed care organizations. Studies have argued that this form of managed care would enhance public trust and might improve the performance of hospitals. The changing healthcare environment has also increased the importance of the competence and composition of hospital boards. This article examines the effect of the governing board's composition on rural hospitals' involvement in provider-sponsored managed care organizations. The study sample consisted of 140 rural hospitals in Iowa and Nebraska whose CEOs responded to a survey conducted by the Center for Health Services Research at the University of Iowa between June and December 1997. The principal finding was that the likelihood of a hospital owning any form of managed care organization increases with the number of community leaders and health professionals on the board. The number of business leaders had no effect on the likelihood of involvement in such an arrangement. Other factors that affected the likelihood of owning a managed care organization were the health status of the population and ownership type. Key recommendations to managers are to (1) revisit the hospital board's composition before actively pursuing a strategic action, (2) examine the compatibility of the type of strategic activity pursued with the background of board members and the interests of the populations they represent, and (3) use the governing board as a resource in determining which new strategic activities to undertake.

Roles of hospital administrators in South Carolina

Using discriminant analyses of data on 916 returned questionnaires from a mailing to 1,650 administrators in 82 South Carolina hospitals, this study examines the allocation of interpersonal, informational, decisional, and treatment roles among executive, administrative, and clinical directors. Educational attainment, years of experience, and gender were found to influence respondents' positions. Results also indicate that executive directors assume responsibility for the organization and its relation to the environment. As expected, those in clinical and administrative positions assume more responsibility for interpersonal and treatment roles than do executive directors.

Texas hospital chief executive officers evaluate content areas in health administration education

Health care executives are confronted by a working environment that is increasingly difficult to manage. Skyrocketing health care costs, with shrinking reimbursement, threaten the existence of hospitals. A successful hospital chief executive officer (CEO) is one who can effectively manage his/her hospital in spite of industry challenges and problems. Graduate programs in health services administration must be designed to meet the needs of future health care executives. Many times, educators are criticized for not addressing "real world" issues within the curricular structure. The present study was conducted to gather information from executives who are the experts on what to expect in the health care industry regarding the appropriateness of curricular topics. Results indicate that practicing CEOs believe those curricular areas which focus on financial planning, budgeting, medical-legal issues, and strategic planning are more important than those that deal with international health care, epidemiology, or research methods. The information gathered in this study may be useful as a guide for educators, to evaluate and revise existing graduate programs in health care administration. Data presented here may also be used to assist in long-range planning for new health administration programs.

Career patterns of healthcare executives

This research examines the job and career changes of healthcare executives and managers working in different segments of the healthcare industry in the western United States. The results suggest that the job and career patterns in the healthcare delivery sector are undergoing significant transformation. One third of the respondents reports that at least one of their last four job changes was involuntary or unplanned. One half of those attempted to make a career change. This study identifies four different executive and management career patterns. The most common was one of multiple career changes. The second pattern was that of a single career change, followed by a 'traditional' career in which one did not seek a career change. The final pattern was characterized as a movement back and forth between two different segments of the healthcare industry. Age, gender, marital status and education were not associated with any specific career pattern. The need to achieve results early in the respondent's career had a strong influence on career patterns. This study confirms the fluidity of career movement and the changing permeability between the various segments of the healthcare industry. It also suggests that career success increasingly will require broad management experience in those different segments.

Redesigning financial management education for the nursing administration graduate student

The changes and expansion in the nurse administrator role indicate a need for a specialized body of financial knowledge and skills for making system focused decisions that integrate the clinical and business aspects of healthcare. A survey of nurse administrators and chief executive officers showed high agreement on the important financial management concepts to the nurse administrator role. A graduate level financial management course that includes concepts for course content and practice applications is proposed.

1999 salary survey. Is this the future of your bonus?

As pay trends go, one executive's bonus can be another's bane. Asked what they like about their compensation programs, health care execs and trustees say they're satisfied with the base salaries paid to their top people, but not with their bonus plans, especially for meeting long-term goals like stronger credit ratings and asset positions.

Administrative behavior of directors in hospitals: the Israeli case

This article presents research findings on the behavior of directors in hospitals in Israel. According to the findings, hospital directors devote most of their time to internal organization processes and less time to the management of the external organizational environment. The findings also reveal that the orientation of these directors is toward centralization of authority and concentration of the decision-making process.

Management education for nurses: hospital executives' opinions and hiring practices

Because registered nurses are assuming expanded roles in hospital management, the appropriate educational preparation for these roles has become a widely debated issue. A national survey of hospital CEOs and CNOs was conducted to assess their personal preferences for management education for nurses and to gather information about their hospitals' policies and practices in hiring nurses for management positions at various levels within the hospital (from unit-level management to executive level). Both CEOs and CNOs preferred the joint MSN/MBA degree option as the best model for graduate management education for nurses, and they perceived greater demand in the future for hospital nurses with graduate management degrees. However, hospital policies and practices with regard to degree requirements and preferences for nurses hired in management positions at all levels varied widely.

CEO turnover in rural northwest hospitals

This study examines rates of and reasons for turnover among administrators from 148 rural hospitals in four northwestern states. Data were obtained from a survey of CEOs who left their positions between 1987 and 1990 and from a survey of board members from those same hospitals. During the study period, 85 CEO turnovers occurred at 78 hospitals. High-turnover hospitals were generally smaller than those facilities with fewer turnovers. The annual rate of CEO turnover was 15 percent in 1988 and 16 percent in 1989. The reasons for turnover most often cited by those in their positions for less than four years were due to: seeking a better position elsewhere, an unstable health care system, conflict with hospital board members or with medical staff, and inadequate salary. High levels of self-reported job satisfaction and job performance by turnover CEOs contrasted to the much lower performance evaluations reported by hospital board members. Nearly three out of four board members indicated they would not rehire their departed CEOs. CEOs perceived their professional weaknesses to center on deficiencies in leadership and financial skills as well as problems with physician, hospital board, and community relations.

Rural hospital administrators and strategic management activities

This study examines the association of characteristics of rural hospital administrators and the adoption of seven strategic activities in a national sample of 797 U.S. rural hospitals during the period 1983-1988. Based on the premise that managerial activities can affect organizational change, we test five hypotheses relating head administrator characteristics to strategic adaptation, controlling for environment-market and hospital-related variables. Bivariate analysis of the strategic adoption showed a positive association with administrative turnover and a negative association with head administrator age. Multivariate logistic regression showed that only high levels of turnover were associated with strategic activities, net of control variables. The implications of these findings and the lack of predictive power of other rural hospital administrator characteristics--especially affiliation with the American College of Healthcare Executives--are discussed within the context of a "strategic management policy" for rural hospitals.

Hospital CEOs view their careers: implications for selection, training, and placement

A recent survey of hospital CEOs revealed that they seem content with their careers but apprehensive about the future, due particularly to their projections regarding contextual issues in the industry. Hospital CEOs believe that the industry will experience increased financial pressures and regulations and, as a result, anticipate the need to develop new skills. Their views on several career-related topics are compared, and the implications for selecting, training, and placing CEOs are discussed.

Organizational and administrative factors influencing the adoption of consortia programs by rural hospitals

This study was designed to assess the effects of various hospital and environmental characteristics on the involvement of rural hospitals in forming and governing consortia and adopting consortia programs. The study focused on the 127 hospitals that are members of the nine rural consortia developed by grants from the Robert Wood Johnson Foundation during 1989 under its Hospital-Based Rural Hospital Consortia Program. Hospital involvement in the formation and governance of the consortia was found to be far less than expected for these grass-roots organizations. Only 38 percent of the administrators said that their hospitals were involved in developing the consortia, and 44 percent said that they played a role in determining the program menu. Governing board and medical staff involvement was even more limited. Program adoption rates were found to be related to both the types of programs offered by the consortia and the characteristics of the hospitals. In general, greater involvement of physicians and governing board members in hospital decisions was found to enhance program adoption rates, but the influence varied by type of involvement in the hospital and program content.

Decision making, goal consensus, and effectiveness in university hospitals

This article examines changes in the influence of several key actors (state and university officials, board members, and hospital and medical school administrators) in management and policy decisions for university hospitals (UHs). We propose that the decreasing influence of external actors in UH decision making and the increasing influence of UH and medical school actors as well as UH-medical school goal consensus will be related to higher levels of UH performance. Data are drawn from a national sample of 52 UHs that participated in a study of UH decision making in 1981 and 1985. Results indicate that state and university actors lost influence in UH policy decisions between 1981 and 1985, while actors internal to academic health centers (AHCs) gained influence in such decisions. The data indicate a similar trend, although not as strong, regarding influence in UH management decisions. Results from regression analyses indicate that decreasing levels of external influence on UH decision making are related to UH effectiveness, but increasing levels of AHC influence and goal consensus have weak or inconsistent relationships with UH effectiveness. Implications for improving the performance of UHs are discussed.

The effects of hospital executives' personality traits on their perceptions and trust

This field study examines the relationship between hospital executives' personality traits and both their perceptions of their subordinates' levels of skills and their level of trust in those subordinates. CEOs or senior executives of 37 acute care hospitals with at least 200 beds were surveyed. The high Nurturant manager did not perceive greater trust or skills than the low Nurturant manager. However, there was a significant and negative correlation between Person-Dominant managers and trust scores. Furthermore, the high Goal-Dominant managers varied significantly less than the low Goal-Dominant managers in their perceptions of their subordinates' skill. The study calls for a reexamination of the influence of personality traits on hospital executives' perceptions and trust. Power in the hands of certain managers may lead to the devaluation of the abilities and motivations of subordinates, and even the devaluation of their subordinates themselves.

Decision-making styles of a medical center's management group: a case study

It has been said that those in a position to hire select people like themselves. Is this true? The following article--a study of the decision-making styles of a medical center's management group--makes a compelling argument in favor of this idea.

Variables in effective CEO-medical director relations

It is becoming commonplace that physicians are not just working in hospitals but are helping run them as well. This means that chief executive officers are working side by side with chief medical officers. What are the factors that influence the working relationship between these roles? The author presents data from a survey that helps to answer this question.

Continuous quality improvement: a survey of American and Canadian healthcare executives

The continuous quality improvement (CQI) movement, while experiencing great popularity years ago, has been declining in interest across other industries. This article studied American and Canadian hospital executives who have embraced the concept of CQI and will continue to be committed to CQI efforts in the future. Executives of CQI hospitals strongly believe that CQI is not a fad and is essential to their organizations' survival. The majority of the hospital executives in the sample have a good understanding of CQI. The drive to provide quality service to both internal and external customers is the primary motivation for being involved with CQI. Some unsuccessful CQI efforts can be attributed to a lack of CQI skills, poor planning, and insufficient staffing. Close to 90 percent of the respondents expected their involvement with CQI to increase significantly in the future. This result implies that CQI is still being considered and will maintain its role as an effective management tool in the healthcare sector.