Skeff KM, Brown-Johnson CG, Asch SM
… +3 more, Zionts DL, Winget M, Kerem Y
J Healthc Manag
· 2022 Sep-Oct 01 · PMID 35984408
·
Full text
GOAL: Occurrences of physician burnout have reached epidemic numbers, and the electronic health record (EHR) is a commonly cited cause of the distress. To enhance current understanding of the relationship between burnout...GOAL: Occurrences of physician burnout have reached epidemic numbers, and the electronic health record (EHR) is a commonly cited cause of the distress. To enhance current understanding of the relationship between burnout and the EHR, we explored the connections between physicians' distress and the EHR. METHODS: In this qualitative study, physicians and graduate medical trainees from two healthcare organizations in California were interviewed about EHR-related distressing events and the impact on their emotions and actions. We analyzed physician responses to identify themes regarding the negative impact of the EHR on physician experience and actions. EHR "distressing events" were categorized using the Accreditation Council for Graduate Medical Education (ACGME) Physician Professional Competencies. PRINCIPAL FINDINGS: Every participating physician reported EHR-related distress affecting professional activities. Five main themes emerged from our analysis: system blocks to patient care; poor implementation, design, and functionality of the EHR; billing priorities conflicting with ideal workflow and best-practice care; lack of efficiency; and poor teamwork function. When mapped to the ACGME competencies, physician distress frequently stemmed from situations where physicians prioritized systems-based practice above other desired professional actions and behaviors. Physicians also reported a climate of silence in which physicians would not share problems due to fear of retribution or lack of confidence that the problems would be addressed. PRACTICAL APPLICATIONS: Physicians and administrators need to address the hierarchy of values that prioritizes system requirements such as those required by the EHR above physicians' other desired professional actions and behaviors. Balancing the importance of competing competencies may help to address rising burnout. We also recommend that administrators consider qualitative anonymous interviews as an effective method to uncover and understand physician distress in light of physicians' reported climate of silence.
Shanafelt T, Trockel M, Wang H
… +2 more, Mayer T, Athey L
J Healthc Manag
· 2022 Sep-Oct 01 · PMID 35984407
·
Full text
GOAL: The objective of this study was to evaluate the prevalence of burnout and professional fulfillment among healthcare administrative leaders and examine the association between burnout and professional fulfillment an...GOAL: The objective of this study was to evaluate the prevalence of burnout and professional fulfillment among healthcare administrative leaders and examine the association between burnout and professional fulfillment and personal and professional characteristics. METHODS: Between June 7 and June 30, 2021, we performed a national survey of CEOs and other senior operational leaders to evaluate their personal work experience. Burnout and professional fulfillment-as well as a sleep-related impairment and self-valuation-were assessed using standardized instruments. PRINCIPLE FINDINGS: Of the 5,994 members of the American College of Healthcare Executives who were sent an invitation to participate, 1,269 (21.2%), including 279 CEOs, submitted usable responses. The mean overall burnout score was 2.71 (range: 0-10), and 33% of participants had burnout scores that fell in the high range (unfavorable). Mean professional fulfillment score was 7.29 (range: 0-10), with 56.6% scoring in the high range (favorable). Burnout and professional fulfillment scores varied by role. On multivariable analysis, sleep-related impairment (OR for each 1-point increase = 1.29, 95% CI [1.19-1.41]; p < .001) and self-valuation (OR for each 1-point increase = 0.63, 95% CI [0.57-0.68]; p < .001) were independently associated with burnout after adjusting for all other variables. APPLICATIONS TO PRACTICE: Results of this study suggest that healthcare leaders had lower burnout and professional fulfillment scores than clinicians. Nonetheless, one third of healthcare leaders had burnout scores that fell in the high range. At the individual level, improved sleep health and self-valuation appear to reduce risk of burnout and promote professional fulfillment.
GOAL: The overarching aim of this systematic review was to offer guidelines for organizations and healthcare providers to create psychological safety in error reporting. The authors wanted to identify organizational fact...GOAL: The overarching aim of this systematic review was to offer guidelines for organizations and healthcare providers to create psychological safety in error reporting. The authors wanted to identify organizational factors that promote psychological safety for error reporting and identify gaps in the literature to explore innovative avenues for future research. METHODS: The authors conducted an online search of peer-reviewed articles that contain organizational processes promoting or preventing error reporting. The search yielded 420 articles published from 2015 to 2021. From this set, 52 full-text articles were assessed for eligibility. Data from 29 articles were evaluated for quality using Joanna Briggs Institute critical appraisal tools. PRINCIPAL FINDINGS: We present a narrative review of the 29 studies that reported factors either promoting error reporting or serving as barriers. We also present our findings in tables to highlight the most frequently reported themes. Our findings reveal that many healthcare organizations work at opposite ends of the process continuum to achieve the same goals. Finally, our results highlight the need to explore cultural differences and personal biases among both healthcare leaders and clinicians. APPLICATIONS TO PRACTICE: The findings underscore the need for a deeper dive into understanding error reporting from the perspective of individual characteristics and organizational interests toward increasing psychological safety in healthcare teams and the workplace to strengthen patient safety.
GOAL: The national Baldrige program has supported performance excellence in healthcare since 1999. Previous studies have compared the performance of Baldrige hospital recipients to nonrecipients. This study, however, sou...GOAL: The national Baldrige program has supported performance excellence in healthcare since 1999. Previous studies have compared the performance of Baldrige hospital recipients to nonrecipients. This study, however, sought to address the question of whether the mere pursuit of the Baldrige award provides value. METHODS: This study used propensity score matching with linear and quantile regression techniques to understand the impact of hospitals applying the Baldrige Excellence Framework across a comprehensive set of standardized industry performance measures, regardless of award recognition. PRINCIPAL FINDINGS: The analysis demonstrated that Baldrige applicants outperformed non-Baldrige applicants in select operational measures of efficiency (such as inpatient average length of stay), patient experience, and financial measures (including return on net assets, days in accounts receivable, and expenses as a percentage of patient revenues). However, there was no statistically significant difference in clinical performance between Baldrige applicants and nonapplicants. PRACTICAL APPLICATIONS: The findings from this study suggest that hospital leaders can realize significant gains with select operational and financial measures without compromising clinical outcomes when applying the Baldrige Excellence Framework to their organizations.
GOAL: Physician leadership has been associated with improved patient outcomes, increased provider satisfaction, and decreased physician burnout as well as more profitable, higher-quality healthcare delivery. However, phy...GOAL: Physician leadership has been associated with improved patient outcomes, increased provider satisfaction, and decreased physician burnout as well as more profitable, higher-quality healthcare delivery. However, physicians frequently struggle when assuming leadership positions, given the dissonance between their administrative and clinical roles. Informed by social identity theory, we aimed to identify why physicians lead, how they experience leadership roles, and the challenges they face during the transition into those roles. METHODS: We conducted 27 semistructured interviews with primary care physician leaders between January and April 2020. Interviews were transcribed and analyzed using the constant comparative method. PRINCIPAL FINDINGS: Four themes were developed from the analysis, including (1) desire for change, (2) desire for growth, (3) challenges experienced during the transition to a leadership role, and (4) changes to professional identity. The results of this study identified aspects of leadership perceived by physicians as attractive and motivating. The study also revealed challenges that occur during the transition into leadership as well as shifts in professional identity experienced by physicians. APPLICATIONS TO PRACTICE: The results can be used by healthcare managers and executives to empower more physicians to take on leadership roles and implement changes that alleviate stresses associated with physicians transitioning into leadership roles.
The dawn of the crypto age has highlighted the potential of blockchain technology in an array of functions for multiple industries. Blockchain technology disrupts existing architecture by offering an efficient and decent...The dawn of the crypto age has highlighted the potential of blockchain technology in an array of functions for multiple industries. Blockchain technology disrupts existing architecture by offering an efficient and decentralized data management platform. It provides a potential solution to current health information technology problems. The strengths of blockchain are interoperability, data accuracy, security, and transparency. Its weaknesses include a lack of standardization, accessibility, ownership, and change management. Applications in healthcare include revenue cycle management, physician credentialing, electronic health records, and supply chain management, although potential government regulation and internal attacks pose threats to its wider adoption.
Prior to the COVID-19 pandemic, the U.S. healthcare sector was facing challenges that threatened the sustainability of its workforce. These challenges included changing demographics, competition from other employers, and...Prior to the COVID-19 pandemic, the U.S. healthcare sector was facing challenges that threatened the sustainability of its workforce. These challenges included changing demographics, competition from other employers, and burnout. Now in the wake of the pandemic, the labor market is seeing more disruption with the exacerbation of these issues. Healthcare organizations have a responsibility to prevent further labor shortages so that they can continue to deliver high quality care and achieve positive health outcomes. Given the changes in people's values and behaviors, healthcare leaders can consider four innovative strategies to meet the needs of their current and future employees: flexible work arrangements, alternative benefits packages, career pathways, and mental health services. Organizations need to take into account their employee populations and the ability to invest in these changes when considering how to move forward.
GOAL: Assessing barriers to vaccination among healthcare workers may be particularly important given their roles in their respective communities. We conducted a mixed methods study to explore healthcare worker perspectiv...GOAL: Assessing barriers to vaccination among healthcare workers may be particularly important given their roles in their respective communities. We conducted a mixed methods study to explore healthcare worker perspectives on receiving COVID-19 vaccines at a large multisite academic medical center. METHODS: A total of 5,917 employees completed the COVID-19 vaccine confidence survey (20% response rate). Most participants were vaccinated (93%). Compared to vaccinated participants, unvaccinated participants were younger (60% < 44 years), more likely to be from a non-Asian minority group (48%), and more likely to be nonclinical employees (57% vs. 46%). Among the unvaccinated respondents, 53% indicated they would be influenced by their healthcare provider, while 19% reported that nothing would influence them to get vaccinated. Key perceived barriers to vaccination from the qualitative analysis included the need for more long-term safety and efficacy data, a belief in the right to make an individual choice, mistrust, a desire for greater public health information, personal health concerns, circumstances such as prior COVID-19 infection, and access issues. PRINCIPAL FINDINGS: Strategies endorsed by some participants to address their concerns about safety and access included a communication campaign, personalized medicine approaches (e.g., individual appointments to discuss how the vaccine might interact with personal health conditions), and days off to recover. Mistrust and a belief in the right to make an individual choice may be harder barriers to overcome; further dialogue is needed. APPLICATIONS TO PRACTICE: These findings reflect potential strategies for vaccine requirements that healthcare organizations can implement to enhance vaccine confidence. In addition, organizations can ask respected health professionals to serve as spokespeople, which may help shift the perspectives of unvaccinated healthcare workers.
GOAL: Perceived organizational support (POS) may promote healthcare worker mental health, but organizational factors that foster POS during the COVID-19 pandemic are unknown. The goals of this study were to identify acti...GOAL: Perceived organizational support (POS) may promote healthcare worker mental health, but organizational factors that foster POS during the COVID-19 pandemic are unknown. The goals of this study were to identify actions and policies regarding COVID-19 that healthcare organizations can implement to promote POS and to evaluate the impact of POS on physicians' mental health, burnout, and intention to leave patient care. METHODS: We conducted a cross-sectional national survey with an online panel of internal medicine physicians from the American College of Physicians in September and October of 2020. POS was measured with a 4-item scale, based on items from Eisenberger's Perceived Organizational Support Scale that were adapted for the pandemic. Mental health outcomes and burnout were measured with short screening scales. PRINCIPAL FINDINGS: The response rate was 37.8% (N = 810). Three healthcare organization actions and policies were independently associated with higher levels of POS in a multiple linear regression model that included all actions and policies as well as potential confounding factors: opportunities to discuss ethical issues related to COVID-19 (β (regression coefficient) = 0.74, p = .001), adequate access to personal protective equipment (β = 1.00, p = .005), and leadership that listens to healthcare worker concerns regarding COVID-19 (β = 3.58, p < .001). Sanctioning workers who speak out on COVID-19 safety issues or refuse pandemic deployment was associated with lower POS (β = -2.06, p < .001). In multivariable logistic regression models, high POS was associated with approximately half the odds of screening positive for generalized anxiety, depression, post-traumatic stress disorder, burnout, and intention to leave patient care within 5 years. APPLICATIONS TO PRACTICE: Our results suggest that healthcare organizations may be able to increase POS among physicians during the COVID-19 pandemic by guaranteeing adequate personal protective equipment, making sure that leaders listen to concerns about COVID-19, and offering opportunities to discuss ethical concerns related to caring for patients with COVID-19. Other policies and actions such as rapid COVID-19 tests may be implemented for the safety of staff and patients, but the policies and actions associated with POS in multivariable models in this study are likely to have the largest positive impact on POS. Warning or sanctioning workers who refuse pandemic deployment or speak up about worker and patient safety is associated with lower POS and should be avoided. We also found that high degrees of POS are associated with lower rates of adverse outcomes. So, by implementing the tangible support policies positively associated with POS and avoiding punitive ones, healthcare organizations may be able to reduce adverse mental health outcomes and attrition among their physicians.
Hanlon AL, Pauly MV, Huang L
… +5 more, Lozano AJ, Hirschman KB, McCauley K, Press M, Naylor MD
J Healthc Manag
· 2022 May · PMID 35576444
·
Full text
GOAL: The objective of this retrospective, observational study was to assess the mediating effect of medical complexity on the relationship between social vulnerability and four acute care resource use outcomes-number of...GOAL: The objective of this retrospective, observational study was to assess the mediating effect of medical complexity on the relationship between social vulnerability and four acute care resource use outcomes-number of hospitalizations, emergency department (ED) visits, observation stays, and total visits. Such information may help healthcare managers better anticipate the effects of interventions targeted to the socially vulnerable in their patient population. METHODS: Electronic health records of 147,496 adults served by 27 primary care practices in one large health system from 2015 to 2017 were used. Descriptive statistics were applied to characterize patients and the primary care practices included in the study. Causal mediation analyses using a modified Baron and Kenny approach were performed. PRINCIPAL FINDINGS: Causal mediation analyses demonstrated that increased social vulnerability was associated with increased medical complexity (incidence rate ratio [IRR] = 1.57) and increased numbers of hospitalizations (IRR = 1.63), ED visits (IRR = 2.14), observation stays (IRR = 1.94), and total visits (IRR = 2.04). Effects remained significant, though attenuated, after adjusting for medical complexity (mediator), demographics, and medications (hospitalizations IRR = 1.44, ED visits IRR = 2.02, observation stays IRR = 1.74, total visits IRR = 1.86). Social vulnerability, given medical complexity, explained between 8% (ED visits) and 26% (hospitalizations) of the variation in outcomes. PRACTICAL APPLICATIONS: These findings reinforce the need to modify interventions for medically complex adults to address their social needs and, consequently, reduce costly health services. Health systems seeking to reduce costly care can use these results to estimate savings in the treatment of patients with high social vulnerability-before they get chronic conditions and later as they seek care.
GOAL: An organization's cultural competency reflects its ongoing capacity to provide high-quality, equitable, safe, and patient-centered care. Cultural competency leadership and training (CCLT) influences organizational...GOAL: An organization's cultural competency reflects its ongoing capacity to provide high-quality, equitable, safe, and patient-centered care. Cultural competency leadership and training (CCLT) influences organizational cultural competency, which could affect organizational performance. Policies regarding health disparities point to the need for hospitals to become culturally competent. This study aimed to explore if CCLT practices are associated with better financial performance. METHODS: Using secondary data from three sources-the American Hospital Association Annual Survey, the Health Care Cost Information System, and the Area Health Resource File-a longitudinal panel study design reviewed 3,594 hospital-year observations for acute care hospitals across the United States from 2011 to 2012. CCLT, the independent variable, was measured as a summated scale of strategy, execution, implementation, and training in diversity practices. For financial performance, the operating and total margins of hospitals were measured as dependent variables. Two random-effects regression models with year- and state-fixed effects were used to examine the relationship, with hospital being the unit of analysis. PRINCIPAL FINDINGS: The descriptive statistics showed that hospitals had an average CCLT score of approximately 2 (the range was 0-4). Regression analysis indicated that an increase in the CCLT score was associated with a 0.3% and 0.4% increase in total and operating margins, respectively (p < .05). Also, with each 10 additional staffed beds, hospitals on average experienced a 0.1% increase in both total and operating margins. Overall, for-profit hospitals experienced a 2.4% higher total margin and a 4.9% higher operating margin, as compared to not-for-profit hospitals. On the contrary, government hospitals showed 1% and 5.8% lower total and operating margins, respectively. APPLICATIONS TO PRACTICE: Results of our study support a business case for CCLT practices. Cultural competency makes good economic sense by helping to improve cost savings, increase market share, and enhance the efficiency of care. Therefore, healthcare leaders should consider investing in CCLT. With the growing emphasis on value-based purchasing related to patient outcomes and experience, hospitals that develop a high degree of cultural competency through CCLT can benefit from the changes in reimbursement. CCLT also affects financial performance through avoidance of costs related to employee absenteeism and turnover and improves team cohesiveness by reducing cultural conflicts. Other mechanisms by which CCLT assists in saving costs and affecting financial performance include avoidance of unnecessary readmissions and expensive hospitalizations through the proper screening of patients from diverse backgrounds. CCLT improves cultural competency and diversity management, thus creating a unique competitive advantage for hospitals.