Leadership and priority setting: the perspective of hospital CEOs

The role of leadership in health care priority setting remains largely unexplored. While the management leadership literature has grown rapidly, the growing literature on priority setting in health care has looked in other directions to improve priority setting practices--to health economics and ethical approaches. Consequently, potential for improvement in hospital priority setting practices may be overlooked. A qualitative study involving interviews with 46 Ontario hospital CEOs was done to describe the role of leadership in priority setting through the perspective of hospital leaders. For the first time, we report a framework of leadership domains including vision, alignment, relationships, values and process to facilitate priority setting practices in health services' organizations. We believe this fledgling framework forms the basis for the sharing of good leadership practices for health reform. It also provides a leadership guide for decision makers to improve the quality of their leadership, and in so doing, we believe, the fairness of their priority setting.     

A profile of the structure and impact of nursing management in Canadian hospitals

The purpose of this study was to describe the profile of nursing leadership structures in Canada and to assess relationships among structures, processes and outcomes pertaining to nurse leaders' work. Data were collected from nurse leaders in 28 academic health centres and 38 community hospitals in 10 Canadian provinces (n = 1,164). The results of this study revealed that the current contingent of nursing leaders in Canada see themselves as an empowered and influential group within their organizations. Despite very large spans of control, nurse leaders at all levels were positive about their work life and confident in their ability to provide effective leadership on nursing affairs within their organizations. Structural and process factors significantly affected nurse manager outcomes at all levels. Senior nurse leaders' work-life factors had a significant effect on middle and first-line managers' perceptions of patient care quality in the organization. Nurse leaders averaged 49 years of age highlighting the need for succession planning.     

Passion in today's health care leaders

Passion in today's health care leaders is essential as health care organizations face increasing demands for survival. Leaders in health care have been educated, selected, promoted, and retained based on their analytical and creativity skills. Today's health care leaders must also have emotional intelligence. Emotional intelligence is primal for passion. Emotional intelligence, which leads to passion, is crucial to the survivability of today's health care organizations. In order for health care organizations to go from good to great, the leader must inspire followers through passion. This article encourages health care leaders to gain awareness of emotional intelligence and to use emotional intelligence as part of their leadership to inspire passion. Through passion, leaders and followers become more motivated to accomplish the health care mission of serving others.     

Organizational Leadership For Building Effective Health Care Teams

The movement toward accountable care organizations and patient-centered medical homes will increase with implementation of the Affordable Care Act (ACA). The ACA will therefore give further impetus to the growing importance of teams in health care. Teams typically involve 2 or more people embedded in a larger social system who differentiate their roles, share common goals, interact with each other, and perform tasks affecting others. Multiple team types fit within this definition, and they all need support from leadership to succeed. Teams have been invoked as a necessary tool to address the needs of patients with multiple chronic conditions and to address medical workforce shortages. Invoking teams, however, is much easier than making them function effectively, so we need to consider the implications of the growing emphasis on teams. Although the ACA will spur team development, organizational leadership must use what we know now to train, support, and incentivize team function. Meanwhile, we must also advance research regarding teams in health care to give those leaders more evidence to guide their work.     

Increasing the relevance of research to health care managers: hospital CEO imperatives for improving quality and lowering costs

BACKGROUND: Evidence-based management assumes that available research evidence is consistent with the problems and decision-making conditions faced by those who will utilize this evidence in practice. PURPOSE: This article attempts to identify how hospital leaders view key determinants of hospital quality and costs, as well as the fundamental ways these leaders "think" about solutions to quality and cost issues in their organizations. The objective of this analysis is to better inform the research agenda and approaches pursued by health services research so that this research reflects the "realities" of practice in hospitals. METHODS: We conducted a series of semistructured interviews with a convenience sample of eight hospital and three health system leaders. Questions focused on current and future challenges facing hospitals as they relate to hospital quality, costs, and efficiency, and potential solutions to those challenges. FINDINGS: Nine major organizational and managerial factors emerged from the interviews, including staffing, evidence-based practice, information technology, data availability and benchmarking, and leadership. Hospital leaders tend to think about these factors systemically and consider process-related factors as the important drivers of cost and quality. PRACTICE IMPLICATIONS: The results suggest a need to expand the methods utilized by health services researchers to make their research more relevant to health care managers. Expanding research methods to reflect the systemic way that managers view the challenges and solutions facing their organizations may enhance the application of research findings into management practice. Finally, better communication is needed between the research and practice communities. Researchers must learn to think more like managers if their research is to be relevant, and managers must learn to more effectively communicate their issues with the research community and frame their problems in researchable terms.     

Turning the tide: The shift to climate change mitigation

In the United States, a growing number of companies are taking progressive steps to reduce greenhouse gas (GHG) emissions. Already, more than half of all Fortune 100 companies have announced clean energy targets, signaling climate change risk reduction is becoming a top priority. Climate change is not without controversy, yet it is a real business concern among corporate executives and health care leaders alike. From fears stoked by devastating wildfires in California to a rising tide of financial hardships due to hurricane flooding in the Southeast, it seems no region is immune to Mother Nature's growing cost to business. This report addresses how health care leaders are approaching climate change initiatives across the country by examining research articles, key opinion leaders, and health care organizations on the bleeding edge of climate change reduction. In an already complex industry, health care leaders have a special responsibility to do no harm to the patients they serve and a financial responsibility to drive monetary returns for invested stakeholders. Significant cost savings, long‐term risk reduction, and improved population health are a few of the benefits health care organizations around the country can gain from building a sound climate change mitigation strategy.     

Developing Tomorrow's Integrated Community Health Systems: A Leadership Challenge for Public Health and Primary Care

As the nation's health system moves away from earlier models to one grounded in population health and market-based systems of care, new challenges arise for public health professionals, primary care practitioners, health plan and institutional managers, and community leaders. Among the challenges are the need to develop creative concepts of organization and accountability and to assure that dynamic, system-oriented structures support the new kind of leadership that is required. Developing tomorrow's integrated community health systems will challenge the leadership skills and integrative abilities of public health professionals, primary care practitioners, and managers. These leaders and their new organizations must, in turn, assume increased accountability for improving community health.     

A strategic approach for managing conflict in hospitals: responding to the Joint Commission leadership standard, Part 1

BACKGROUND: The Joint Commission's leadership standard for conflict management in hospitals, LD.02.04.01, states, "The hospital manages conflict between leadership groups to protect the quality and safety of care." This standard is one of numerous standards and alerts issued by The Joint Commission that address conflict and communication. They underscore the significant impact of relational dynamics on patient safety and quality of care and the critical need for a strategic approach to conflict in health care organizations. Whether leadership conflicts openly threaten a major disruption of hospital operations or whether unresolved conflicts lurk beneath the surface of daily interactions, unaddressed conflict can undermine a hospital's efforts to ensure safe, high-quality patient care. DEVELOPING A STRATEGIC APPROACH TO CONFLICT MANAGEMENT: How leaders manage organizational conflict has a significant impact on achieving strategic objectives. Aligning conflict management approaches with quality and safety goals is the first step in adopting a strategic approach to conflict management. A strategic approach goes beyond reducing costs of litigation or improving grievance processes--it integrates a collaborative mind-set and individual conflict competency with nonadversarial processes. UNDERTAKING A CONFLICT ASSESSMENT: Conflict assessment should determine how conflicts are handled among the leaders at the hospital, the degree of conflict competence already present among the leaders, where the most significant conflicts occur, and how leaders think a conflict management system might work for them. CONCLUSIONS: Strategically aligning a conflict management approach that addresses conflict among leadership groups as a means of protecting the quality and safety of patient care is at the heart of LD.02.04.01.     

Ethics: the evidence of leadership

Today's leaders in health care are being challenged by many demands and issues. To confront these many demands, health care leaders must have the ability to make decisions based on ethics. To ensure the survivability of an organization, the leadership must have values grounded on ethical principles. The problem in today's health care organizations is that not enough emphasis is being placed on a culture of ethics within the organization and within the behavior of the leadership. This article addresses the ethical issues facing today's health care leaders. In this article, an overview of the history and philosophy of ethics is provided along with definitions, guidelines, and a model to assist the leadership in health care organization to pursue and to adhere to a more ethical course.     

Leadership processes for re-engineering changes to the health care industry

As health care organizations seek innovative ways to change financing and delivery mechanisms due to escalated health care costs and increased competition, drastic changes are being sought in the form of re-engineering. This study discusses the leader's role of re-engineering in health care. It specifically addresses the reasons for failures in re-engineering and argues that success depends on senior level leaders playing a critical role. Existing studies lack comprehensiveness in establishing models of re-engineering and management guidelines. This research focuses on integrating re-engineering and leadership processes in health care by creating a step-by-step model. Particularly, it illustrates the four Es: Examination, Establishment, Execution and Evaluation, as a comprehensive re-engineering process that combines managerial roles and activities to result in successfully changed and reengineered health care organizations.     

Predictors of the level of personal involvement in an organization: a study of Slovene hospitals

BACKGROUND: The most important of the health system inputs, the performance and the benefits the system can deliver, depend largely upon the knowledge, skills, and motivation of those individuals responsible for delivering health services. PURPOSE: This article discusses a study that considered predictors of successful personal involvement in a health care organization. METHODOLOGY/APPROACH: The research included three independent variables (organizational culture, teamwork, and leadership) and one dependent variable (personal involvement). The sample included 734 respondents from 14 Slovene hospitals and three personnel categories: doctors, nurses, and non-health care professionals. FINDINGS:: The results of regression analysis have shown that the dependent variable "personal involvement" can be explained with four independent variables in 49.6% of cases, which are: teamwork (p < .001), level of education (p < .001), transformational leadership (p < .001), and transactional leadership (p = .004). The study has demonstrated that doctors, nurses, and non-health care professionals view their hospitals as having a culture of internal focus, stability, and control. All three groups viewed their level of personal involvement in the organizations as low, whereas nurses and non-health care professionals also expressed a sense of subordination to doctors. PRACTICAL IMPLICATIONS: In addition to other predictors of personal involvement in an organization, which have been researched and confirmed in other studies, our study has also shown the level of education and transactional leadership to be a statistically significant predictor. Managers and leaders must accept responsibility for the existing results regarding personal involvement and start to work on interprofessional collaboration within the organization and outside of it.     

Faith-based organizations, science, and the pursuit of health

Over the last three decades, there has been increasing interest in the role that faith-based organizations (FBOs) can play in promoting health and health care access among underserved populations. Although the research literature on church-based health interventions is growing, there are relatively few rigorous evaluations of their effectiveness in addressing health and health care outcomes. Establishing a national faith-based health research network is an excellent opportunity to create an evaluative infrastructure and generate new research on health programs and their effectiveness in FBO settings.     

Strengthening community leadership: evaluation findings from the california healthy cities and communities program

Collaborative approaches to community health improvement such as healthy cities and communities have the potential to strengthen community capacity through leadership development. The healthy cities and communities process orients existing local leadership to new community problem-solving strategies and draws out leadership abilities among residents not previously engaged in civic life. In an evaluation of the California Healthy Cities and Communities (CHCC) Program, leadership development was one of several outcomes assessed at the civic-participation level of the social ecology. Data collection methods included focus groups and surveys, semistructured interviews with coordinators and community leaders, and review of program documents. Findings suggest that the CHCC program enhanced capacity by expanding new leadership opportunities through coalition participation, program implementation, and civic leadership roles related to spin-off organizations and broader collaborative structures. Communities in rural regions were particularly successful in achieving significant leadership outcomes.     

Japanese hospitals--culture and competition: a study of ten hospitals

Japanese health care is characterized by a pluralistic system with a high degree of private producers. Central government regulates the prices and the financing system. All citizens are covered by a mandatory employment-based health insurance operating on a nonprofit basis. The consumer has a free choice of physician and hospital. A comparison between Japan, Sweden and some other countries shows significant dissimilarities in the length of stay, number of treatments per hospital bed and year and the staffing of hospitals. About 80 per cent of the hospitals and 94 per cent of the clinics are privately owned. The typical private hospital owned by a physician has less than 100 beds In this paper, data collected (1992/93) in an empirical study of Japanese hospitals and their leadership is presented. Also discussed are the hospitals' style of management, tools and strategies for competition and competences—personal and formal skills required of the leadership in the hospital There follows a study of ten hospitals, among which hospital directors and chief physicians were interviewed. Interviews are also made with key persons in the Ministry of Health and Welfare and other organizations in the health care field. The result is also analysed from a cultural perspective—‘what kind of impact does the Japanese culture have on the health care organization?’ and/or ‘what kind of sub-culture is developed in the Japanese hospitals’. Some comparisons are made with Sweden, USA, Canada and Germany. The different roles of the professions in the hospital are included in the study as well as the incentives for different kinds of strategies — specialization, growing in size, investments in new equipment, different kind of ownership and hospitals. Another issue discussed is the attempt to uncover whether there is an implicit distribution of specialities—silent agreements between hospitals, etc.     

Competencies for health management practice: a practitioner's perspective

The current health care environment will require executive leadership with a new set of management competencies to effectively lead and manage the various components of a restructured health care delivery system. The traditional management skills of planning, organizing, directing, controlling, and staffing resources will remain relevant, but the true measure of professional success will be the development of conceptual skills. This means the ability to look at the health care enterprise as a whole, and recognize how changes in the environment shape your strategic mission, goals, and objectives. The successful health care leader will have a demonstrated ability to apply these conceptual skills to the development of information systems and integrated networks that position their organization to accept capitated risks. This paper examines the United States and Canadian health care systems from the perspective of both the more traditional hospital and the emerging medical care organizations. New importance of the team approach to leadership and management and all that entails is stressed.     

Implementing a physician leader compensation program at a major community hospital

The roles of physician leaders in Canadian hospitals and health regions are becoming more complex and time consuming. Physician leaders are increasingly being seen by hospital boards and executives as key to achieving strategic and operational outcomes. Given the growing importance of these roles and the increasing performance expectations being placed on physician leaders, it is critical that organizations are able to recruit and retain individuals who demonstrate the skills required to fulfill these critical roles or commit themselves to acquiring them.     

Carspecken's critical approach as a way to explore nursing leadership issues

Nursing leaders are attempting to provide effective support for staff as well as optimal client care in the most challenging of times for the health care industry globally. Regardless of where leaders practice, their health care setting will have its own socially constructed way of getting the work done. In this article the authors suggest Carspecken's critical methodology, particularly his use of the pragmatic horizon, as a useful method to assist leaders in recognizing their own behaviors as a first step to providing leadership that is more emancipatory. The aim of this reflection and resulting action is increasing leadership effectiveness to improve health care outcomes.     

Bringing human resources to the table: utilization of an HR balanced scorecard at Mayo Clinic

Rather than viewing HR as a critical driver of organizational strategy and outcomes, most health care organizations see HR as a drain on the organization's bottom line. Only by aligning HR with the organizational strategy will HR leaders truly get a seat at the leadership table. HR professionals can overcome impediments and gain a seat at the table by learning the language of business and the ways in which organizational leaders use data to drive their decisions. This article shows how Mayo Clinic uses the popular Balanced Scorecard approach to align its measures of HR performance to the organization's strategic plan.     

“Creative Financing”: Funding Evidence-Based Interventions in Human Service Systems

Implementation and sustainment of evidence-based interventions (EBIs) is influenced by outer (e.g., broader environments in which organizations operate) and inner (e.g., organizations, their administrators, and staff) contexts. One important outer-context element that shapes the inner context is funding, which is complex and unpredictable. There is a dearth of knowledge on how funding arrangements affect sustainment of EBIs in human service systems and the organizations delivering them, including child welfare and behavioral health agencies. This study uses qualitative interview and focus group data with stakeholders at the system, organizational, and provider levels from 11 human service systems in two states to examine how stakeholders strategically negotiate diverse and shifting funding arrangements over time. Study findings indicate that, while diverse funding streams may contribute to flexibility of organizations and possible transformations in the human service delivery environment, a dedicated funding source for EBIs is crucial to their successful implementation and sustainment.