GOAL: Journal rankings play a critical role in guiding academic publishing decisions, assessing the productivity of health administration (HA) faculty, and informing their tenure and promotion evaluations. Healthcare exe...GOAL: Journal rankings play a critical role in guiding academic publishing decisions, assessing the productivity of health administration (HA) faculty, and informing their tenure and promotion evaluations. Healthcare executives and practitioners rely on rankings to help them assess the quality of empirical analyses and the underlying peer-review process of published articles. Despite periodic assessments in the HA field, journal prestige-an important metric for faculty success-has not been evaluated in more than a decade, leaving a gap in understanding current perceptions amid the rapidly evolving landscape of scholarly publishing. The objective of this current study is to update perceptions of journal prestige among HA faculty and examine changes over the past decade. METHODS: As part of a larger, periodic, anonymous online survey distributed to a nationally representative group of HA faculty members in 2024, respondents were asked to list three journals they considered most prestigious in the HA field. Data were coded and analyzed to identify top journals, assess changes in rankings since 2012, and examine variations by faculty characteristics and areas of expertise using logistic regression models. PRINCIPAL FINDINGS: The top-ranked journal was Health Affairs (35.1%), followed by Health Services Research (20.7%), Journal of the American Medical Association (JAMA) (15.9%), and Journal of Healthcare Management (10.9%). Rankings largely aligned with previous findings, though JAMA experienced a notable rise in prestige (+5 positions since 2012), partially driven by the emergence of its open access subjournal, JAMA Health Forum. Journal prestige was not correlated with journal impact factors (Spearman's Rho [ρ] = 0.053; p = .41). Variations in journal selection were observed among faculty with expertise in informatics and outcomes research, who ranked discipline-specific journals higher. PRACTICAL APPLICATIONS: This study's findings provide faculty with a current reference for selecting publication outlets and for documenting scholarly impact in promotion and tenure reviews. For department chairs and program directors, the findings offer a field-specific benchmark that can inform evaluation standards. For healthcare executives and practitioners, the top-ranked journals highlight priority sources for evidence-based decision-making and practice-oriented dissemination. The growing prominence of newer and open access journals further underscores the need for periodic reassessment of preferred outlets to ensure continued relevance in the HA field.
GOAL: Violence against psychiatric healthcare workers in inpatient units is prevalent and often the result of a series of behaviors exhibited by the attacker while the victim is in a vulnerable position. Therefore, a bet...GOAL: Violence against psychiatric healthcare workers in inpatient units is prevalent and often the result of a series of behaviors exhibited by the attacker while the victim is in a vulnerable position. Therefore, a better understanding of situational awareness, the thought processes with which attackers engage, and the importance of mental and physical readiness may reduce the number and severity of attacks and better prepare residents and other workers for this threat. METHODS: All residents enrolled in the psychiatry residency program (N = 27) from March to May 2021 were invited to participate in a study evaluating their perceptions of violence and confidence in managing it during their inpatient psychiatric rotations. A total of 22 residents responded (response rates were 66.7% pretraining and 81.5% posttraining). Participants completed surveys at three time points: immediately before, 1 week after, and 1 month after completing 3-hour proactive, hands-on, self-defense training. PRINCIPAL FINDINGS: Residents had realistic expectations about exposure to violence, with 43% expressing concern about their rotation due to fear of violence. However, only 14% felt this fear negatively affected their performance. While most residents felt underprepared to manage violence in healthcare settings, 90% reported that the training improved their confidence. Self-assurance also increased significantly, rising from 38% before the course to 83% after completion. PRACTICAL APPLICATIONS: Incorporating comprehensive hands-on training into the psychiatry residency curriculum can significantly enhance residents' confidence and ability to manage potentially violent encounters. This training, modeled after protocols used by law enforcement and conducted by a former police officer, should be further researched in various hospital-based settings and populations to evaluate its broader impact.
GOAL: High turnover and turnover intention among nurses persists worldwide, necessitating a study of deterrents such as personal spiritual beliefs and posttraumatic growth (PTG). PTG refers to positive psychological chan...GOAL: High turnover and turnover intention among nurses persists worldwide, necessitating a study of deterrents such as personal spiritual beliefs and posttraumatic growth (PTG). PTG refers to positive psychological changes that occur in response to struggle with highly stressful or traumatic experiences. This study aims to verify a hypothetical model that explains nurse turnover intention in South Korean hospitals since the start of the COVID-19 pandemic. METHODS: This descriptive study used path and content analyses and surveyed 268 nurses working in hospitals in Seoul and Busan, South Korea, between March and June 2022, immediately after the height of the COVID-19 pandemic. IBM SPSS Amos was used for the path analysis, and content analysis of open question responses was used to identify the nurses' personal spiritual beliefs. The study follows the reporting guidelines of STrengthening the Reporting of OBservational studies in Epidemiology (STROBE). PRINCIPAL FINDINGS: Factors affecting nurse turnover intention with direct effects were job satisfaction, burnout, and PTG. Employer support, job satisfaction, PTG, posttraumatic stress, and importance of spiritual beliefs had indirect effects on turnover intention. Job satisfaction, posttraumatic stress, burnout, PTG, employer support, and importance of spiritual beliefs contributed to total effects. Content analysis identified how 56.9% (of 144 responses) recognized the interplay of spiritual beliefs and PTG; however, 43.1% reported being unaffected spiritually by the pandemic experience. The importance of spiritual beliefs and PTG emerged as deterrents of turnover intention. PRACTICAL APPLICATIONS: Positive practices, such as spiritual beliefs, employer support of nurse well-being, and PTG, directly and indirectly affected nurse turnover intention. This suggests that interventions are needed to enhance nurses' positive psychological and spiritual resources and practices during times of extreme workplace stress, as was prevalent during the pandemic.
GOAL: "Burnout" is defined as chronic and unmanageable workplace stress. While leadership quality is crucial in the workplace, little research has examined leaders' experiences with burnout. This mixed-methods study focu...GOAL: "Burnout" is defined as chronic and unmanageable workplace stress. While leadership quality is crucial in the workplace, little research has examined leaders' experiences with burnout. This mixed-methods study focuses on a healthcare setting and examines leaders' experiences of burnout. Our research centered on what burnout looks like for supervisors and senior managers, outcomes associated with leader burnout, and the lived experience of burned-out leaders. METHODS: Data are from the Veterans Health Administration. We analyzed quantitative and qualitative data from a 2023 organizational census survey that assessed employees' workforce attitudes and perceptions. The quantitative analysis comprised 18,000 respondents who were supervisors and senior managers in clinical roles. We conducted random effects modeling for each of three survey measures (i.e., perceptions toward leadership, employee engagement, and turnover intention), regressed on burnout (i.e., none, some, high), and supervisory role. The qualitative analysis included thematic content analysis of text comments. PRINCIPAL FINDINGS: Those classified as experiencing some burnout symptoms (b = -.39, SE = .02) and as experiencing high burnout symptoms (b = -1.07, SE = .03) provided lower ratings of senior leaders than respondents with low burnout symptoms. Respondents with some burnout symptoms (OR = 2.85, 95% CI = 2.85, 3.35) and high burnout symptoms (OR = 11.80; 95% CI = 10.35, 13.46) also reported a greater likelihood of leaving their current position. Senior managers had more engagement when experiencing high burnout compared to supervisors (b = .08). For the qualitative results, supervisors and senior managers experienced burnout similarly, along with the issues related to it. Specifically, they saw their own leaders' poor performance as problematic. Acute areas of concern included micromanagement, an inability or unwillingness to enforce accountability throughout the organization, and failure to listen to staff subject-matter experts in decision-making. PRACTICAL APPLICATIONS: Considering our findings on burnout among clinical workplace leaders and given the impact of leadership behaviors on burnout experience, organizations should make additional investments in educational and practical experiences to improve leadership effectiveness. These investments may be particularly important in clinical settings, given previous findings of associations between providers' burnout and patients' experience of quality of care.
GOAL: The purpose of this study was to enhance access to medication assistance programs (MAPs), which are crucial for providing free medications to patients who cannot afford them. These programs are particularly benefic...GOAL: The purpose of this study was to enhance access to medication assistance programs (MAPs), which are crucial for providing free medications to patients who cannot afford them. These programs are particularly beneficial for the management of chronic conditions such as diabetes, heart failure, and cancer, for which medication adherence is vital for positive patient outcomes, and cost is a common barrier. METHODS: This quality improvement project aimed at optimizing the MAP enrollment process. Interventions included the development of frequently asked questions documents, standardized templates for documentation, establishment of MAP technician office spaces, and standardization of patient referrals. A Mann-Whitney U test and a chi-square test were used to summarize the data in this study. PRINCIPAL FINDINGS: The project resulted in a 56% increase in new patient enrollments (p < .01) and a 33% increase in medications provided, with a significant reduction in the average time from patient referral to application approval. PRACTICAL APPLICATIONS: The project improved patient access to MAPs, optimized pharmacy technician resources, and significantly reduced processing times, an important factor in preventing treatment delays and improving patient care. Future plans include expanding the new enrollment process to annual reenrollments, formally establishing the MAP technician within departments, and considering additional pharmacy technician support in response to increasing demand for MAPs.
GOAL: This study examines the impact of supportive processes, work-life balance, and leadership on employees' job satisfaction, intention to stay, and job engagement at US health centers. METHODS: This study utilizes sec...GOAL: This study examines the impact of supportive processes, work-life balance, and leadership on employees' job satisfaction, intention to stay, and job engagement at US health centers. METHODS: This study utilizes secondary data from the Health Center Workforce Well-Being Survey conducted by the Health Resources and Services Administration from late November 2022 to mid-February 2023. We conducted cross-sectional moderated mediation analyses using Model 60 from the Hayes PROCESS macro to examine the effects of supportive health center processes, work-life balance, and leadership on employee job satisfaction and, subsequently, employees' intentions to stay and job engagement. PRINCIPAL FINDINGS: The mediation analyses demonstrated that job satisfaction mediates the relationship between supportive processes and both intention to stay and job engagement. Moreover, work-life balance and leadership moderate the relationship between supportive processes and job satisfaction with different patterns. Leadership also plays a dual moderating role, reducing dependence on job satisfaction for employee intention to stay while amplifying its effect on job engagement. PRACTICAL APPLICATIONS: Our findings highlight the need for targeted workforce strategies in health center settings. Healthcare leaders should first enhance employees' job satisfaction by investing in workplace supportive processes, work-life balance initiatives, and leadership development tailored to their organizational context. After job satisfaction is strengthened, its influence on employees' intention to stay and job engagement remains contingent on leadership. The decision about how much to invest in leadership initiatives should be guided by the organization's current job satisfaction levels.
GOAL: Burnout in healthcare remains a significant problem, with implications not only for physicians and advanced practice providers but also for the entire US healthcare system, including patients and payers. Significan...GOAL: Burnout in healthcare remains a significant problem, with implications not only for physicians and advanced practice providers but also for the entire US healthcare system, including patients and payers. Significant work has been done to understand the antecedents of burnout and develop successful intervention strategies. Much of the attention has focused on either improving the work environment or enhancing individual resilience, with suboptimal results. Consequently, we examined individual fortitude-including resilience and other attributes-and its interaction with organizational support to extend the research into both individual- and workplace-level antecedent factors in burnout. METHODS: Physicians and advanced practice providers from six healthcare systems were invited to participate in this study, with 753 completing the survey. The survey included valid and reliable instruments for burnout, fortitude, and perceived organizational support. Multiple methods of assessment were used to triangulate the interactive effects of fortitude (i.e., individual attributes or factors) and organizational support (i.e., workplace-related factors) on burnout. First, correlation analyses were performed to identify statistically significant relationships between individual- and workplace-related factors. Next, stepwise regression modeling was used to test the simultaneous impact of individual- and workplace-related factors by examining the interaction between fortitude and organizational support on burnout. Finally, a path model was developed to test for the mediating effect of fortitude on the relationship between organizational support and burnout. PRINCIPAL FINDINGS: Significant negative correlations between both individual fortitude and perceived organizational support in the workplace on burnout were evident. Similarly, there was a positive association between fortitude and organizational support. Stepwise regression showed that the interaction of individual attributes and organizational support had the highest degree of significance (β = -.67, p < .01), with an adjusted R2 of .44. Fortitude was added in the second step (β = -.37, p < .01) and provided significant improvement over the previous model, consisting of the interaction variable. The adjusted R2 increased to .52 (X2 = 11.18, p < .01, Δ adj R2 = .08). While organizational support was significantly related to burnout, the addition of this variable to the model showed no significant improvement in explained variance (X2 = 0.18, ns, Δ adj R2 = .00). Subsequent path modeling showed that fortitude can partially mediate the relationship between organizational support and burnout. Empirically, this demonstrates that fortitude significantly affects the relationship between organizational support and reduced burnout. PRACTICAL APPLICATIONS: The causes of burnout are multifaceted and unique to individuals. Organizational attempts to improve the work environment or increase individual resilience have been suboptimal, as burnout rates have remained stubbornly elevated. By considering the interaction of individual fortitude and organizational support, leaders can develop more effective intervention strategies to support healthcare providers.
GOAL: This retrospective study aims to understand the factors that are associated with healthcare workers' perceptions of senior leaders who maintain high standards of honesty and integrity. METHODS: We analyzed response...GOAL: This retrospective study aims to understand the factors that are associated with healthcare workers' perceptions of senior leaders who maintain high standards of honesty and integrity. METHODS: We analyzed responses from 180,663 Veterans Health Administration employees who completed the 2023 Veterans Affairs All Employee Survey. Ordinal logistic regression was used to examine the association between perceptions of senior leader honesty and integrity and various factors related to manager effectiveness, work group dynamics, personal work experiences, and employee demographics. Dominance analysis was performed to identify the relative importance of variables in explaining the overall variance in perceptions of senior leader honesty and integrity. PRINCIPAL FINDINGS: Factors that contributed most to healthcare workers' perceptions of senior leader honesty and integrity were satisfaction with the job performance of the manager above their direct supervisor (12.7% of variance), manager communication of organizational goals (12.4%), different work units collaborating well (10.5%), ability to disclose suspected violations without fear of reprisal (6.7%), satisfaction with recognition (5.9%), and satisfaction with involvement in decisions (5.81%). Demographic factors such as tenure, gender, minority status, age, and supervisory role were also associated with perceptions of senior leader integrity; however, these factors explained little of the overall variance. PRACTICAL APPLICATIONS: The findings highlight the critical role of midlevel leaders and organizational communication in shaping employee perceptions of senior leader honesty and integrity. Healthcare organizations should focus on selecting and training effective midlevel leaders to cultivate trust at higher levels. Developing a culture of frequent appreciation and recognition can improve trust in senior leaders and other important outcomes noted in the literature. Creating an environment where employees feel safe to report violations without fear of reprisal is essential for fostering trust in senior leadership. Healthcare leaders should consider these factors when designing strategies to enhance perceptions of senior leader honesty and integrity within their organizations.
Kunze KN, Sullivan SW, Bonnet-Eymard A
… +3 more, Herz C, Smyth K, Nwachukwu BU
J Healthc Manag
· 2026 Jan-Feb 01 · PMID 41486492
·
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GOAL: Consultations via commercial telemedicine platforms have enabled patients to access a larger network of providers whose secondary treatment recommendations may differ from those obtained by primary care providers....GOAL: Consultations via commercial telemedicine platforms have enabled patients to access a larger network of providers whose secondary treatment recommendations may differ from those obtained by primary care providers. Subsequent changes in treatment recommendations may have meaningful implications for cost value and quality of care. However, despite the increased use of telemedicine, the frequency and type of treatment changes that occur are not well understood. This study evaluates the association between digital expert medical opinions (EMOs), treatment strategy changes, and cost implications, using data derived from a specialized musculoskeletal telemedicine platform. METHODS: Musculoskeletal EMOs from a large commercial digital health organization were retrospectively reviewed between 2020 and 2024. Treatment metrics, including surgical diversion (i.e., declining a surgical procedure), as well as the frequency of diagnosis and treatment plan changes, were calculated using existing client records and reports. Subsequently, an economic analysis was done to extrapolate potential cost savings based on treatment changes. Projections were constructed using average consultation cost savings based on Current Procedural Terminology (CPT) billing data and annual capture rates for a real-world enterprise client. Projections were also extrapolated to clients of various carrier sizes. PRINCIPAL FINDINGS: Among the 544 musculoskeletal EMOs reviewed, 40.1% of consultations resulted in surgical diversion. More than half (53.0%) of treatment plans changed as a result of obtaining EMOs, while the diagnosis change rate was 22.5%. An average cost savings of $8,146.89 per EMO was estimated based on data from a current enterprise client. Extrapolation of this analysis to a medium-sized carrier (10,000 annual claims) and a large-sized carrier (30,000 annual claims) based on data from this enterprise client was estimated to be $754,558.44 and $2,263,675.33, respectively. PRACTICAL APPLICATIONS: Among secondary digital EMOs obtained through a telemedicine platform, more than half of treatment strategies were changed, with surgical diversion observed for 40% of patient cases. Resultant treatment and diagnosis strategy changes may result in increased value for patients, payers, and participating healthcare entities as demonstrated through the economic projections established using real-world data. Further extrapolation of savings based on claim volume, capture rate, and various client sizes may provide additional insights into the utility of telemedicine in other spaces as it pertains to defining appropriate treatment pathways and adjusting optimized costs.
GOAL: Diversity, equity, and inclusion (DEI) policies have become central to corporate practices, particularly in the healthcare sector. This study employs signaling theory to explore how healthcare organizations communi...GOAL: Diversity, equity, and inclusion (DEI) policies have become central to corporate practices, particularly in the healthcare sector. This study employs signaling theory to explore how healthcare organizations communicate their commitment to DEI through their websites to external stakeholders. Signaling theory posits that organizations use signals to communicate information to stakeholders, and in healthcare, this information is important to prospective employees and patients. As a primary communication channel, the corporate website serves as a vital tool for conveying the organization's values, including DEI commitments. METHODS: This study analyzed a representative sample of 78 US hospitals and healthcare organizations, examining their websites for signals related to DEI. The signaling theory framework helped to evaluate the extent of signaling while considering variables such as gender and ethnic diversity in leadership; explicit diversity language in mission, vision, and values; and the presence of diversity statements. A composite measure scale quantified the magnitude of diversity signaling. PRINCIPAL FINDINGS: Our quantitative analysis found that while 89.74% of organizations exhibited observable C-suite diversity (i.e., gender or ethnicity), explicit diversity language in core statements was less common (10.26%). Most organizations (67.95%) lacked explicit diversity language in strategic statements, with value statements being the primary location for such language in organizations with diversity language. The composite score revealed a varied commitment to diversity signaling. Most organizations scored low (48.72%, with a score of 1 out 6). PRACTICAL APPLICATIONS: The potential implications of the absence of signals suggest a possible unintended projection of a lack of commitment to DEI. This study's findings emphasize the impact on potential employees and patients, as the absence of diversity signals may dissuade those seeking inclusive environments. This examination of C-suite diversity also underscores the role of diversity in shaping organizational culture and its potential influence on health equity efforts. Organizations that actively communicate their commitment to DEI through explicit language and diverse leadership are better positioned to attract talent and create inclusive healing environments for staff and patients.
Qureshi N, Hays RD, Slaughter ME
… +2 more, Talamantes E, Quigley DD
J Healthc Manag
· 2026 Jan-Feb 01 · PMID 41486490
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GOAL: Provider buy-in to leadership priorities, patient experience measurement, and quality improvement (QI) is necessary for sustained improvements in care. However, little is documented about provider perceptions of pa...GOAL: Provider buy-in to leadership priorities, patient experience measurement, and quality improvement (QI) is necessary for sustained improvements in care. However, little is documented about provider perceptions of patient experience measurement and QI in primary care. We examined provider perceptions of the work environment, patient care issues, measurement of and improvement in care quality, as well as their knowledge and perceived usefulness of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group (CG-CAHPS) Survey measures for QI. METHODS: We surveyed and interviewed providers about their use of CG-CAHPS for QI. Of the 143 providers at a large urban Federally Qualified Health Center (FQHC), 74 (52% response) completed a web-based survey; 19 were also interviewed. We asked questions about the clinic environment, use of the CG-CAHPS survey, patient interactions, burnout, job satisfaction, and compensation. We replicated measures from six relevant surveys. PRINCIPAL FINDINGS: Providers reported working in supportive environments that encouraged QI efforts, having leadership and colleagues who facilitated improvements that enabled them to do their job better (M = 3.8 on a 5-point scale), and serious efforts to solve problems (M = 3.7). Providers also reported significant barriers to patient care (e.g., time pressure and patient complexity). Interviews highlighted providers' difficulty in managing visit duration and ensuring effective patient-provider communication. Participants expressed mixed views on the usefulness of CG-CAHPS scores for QI (M = 2.5), suggesting a need for leadership to discuss and engage with CG-CAHPS performance more regularly. QI in primary care is often guided by patient experience outcomes. The time pressures faced by FQHC providers to care for patients with complex needs heighten the need for targeted interventions that enhance provider support. Providers also identified several areas that needed improvement, some of which are measured by CAHPS items: tools to communicate laboratory or other test results to patients, tools to elicit information on patient concerns, improved access to interpreter services, training for other care team staff, and more discussion of best practices. PRACTICAL APPLICATIONS: To improve the patient experience, primary care organizations should foster environments that support QI and invest more in QI that better incorporates patient feedback and experience measures in ways that are relevant to providers and actionable by organizations to improve care experiences. Addressing these issues has the potential to improve both patient care outcomes and provider satisfaction. This is both practical and important given that CAHPS measures or other standardized patient experience measures, although not mandated, are increasingly in use.