Mentoring junior healthcare administrators: a description of mentoring practices in 127 U.S. hospitals

A survey instrument about mentoring junior healthcare administrators was mailed to 485 senior-level executives-chief executive officers, hospital administrators, and presidents. Completed surveys were returned by 127 senior executives (26 percent response rate). On average, the respondents were 53 years old, had nine years of organizational tenure in their current position, and had 16.5 years of career tenure as a senior healthcare executive. The mean age of when the respondents first had a mentor was 28 years old. The average length of the respondents' relationship with their mentor was 3.56 years. Although healthcare executives believed mentoring benefits the healthcare industry as a whole, they reported that the benefits were even greater for the hospital where mentoring was done. Personal satisfaction was cited as the primary reason for serving as a mentor. In the 127 organizations represented by the respondents, informal mentoring programs were more prevalent than formal mentoring programs. Our findings suggest that healthcare executives in formal mentoring programs may be more likely to support mentoring than individuals who entered informal mentoring relationships. Those who reported being mentors or engaging in mentoring-supportive activities had a longer job tenure and career tenure than did individuals who had not served as mentors. The study suggests that mentoring--in particular, informal mentoring--is a popular activity in U.S. hospitals and is carried out by experienced healthcare executives whose primary motivation is personal satisfaction.     

Hospital administrator's perspectives regarding the health care industry.

Based on responses from 52 hospital administrators, four areas of managerial concern have been addressed, including: (1) decision-making factors; (2) hospital service offerings: current and future; (3) marketing strategy and service priorities; and (4) health care industry challenges. Of the total respondents, 35 percent indicate a Director of Marketing has primary responsibility for making marketing-related decisions in their hospital, and 19 percent, a Vice-President of Marketing, thus demonstrating the increased priority of the marketing function. The continued importance of the physician being the primary market target is highlighted by 70 percent of the administrators feeling physician referrals will be more important regarding future admissions than in the past, compared to only two percent feeling the physicians' role will be less important. Of primary importance to patients selecting a hospital, as perceived by the administrators, are the physician's referral, the patient's previous experience, the hospital's reputation, and the courtesy of the staff. The clear majority of the conventional-care hospitals surveyed offer out-patient surgery, a hospital pharmacy, obstetrics/maternity care, and diabetic services. The future emphasis on expanding services is evidenced by some 50 percent of the hospital administrators indicating they either possibly or definitely plan to offer long-term nursing care, out-patient substance abuse programs, and cancer clinics by 1990. In addition, some one-third of the respondents are likely to expand their offerings to include wellness/fitness centers, in-patient substance abuse programs, remote or satellite primary care clinics, and diabetic services. Other areas having priority for future offerings include services geared specifically toward women and the elderly. Perceived as highest in priority by the administrators regarding how their hospital can achieve its goals in the next three years are market development strategies, followed by product/service development and finally, market penetration strategies. Clearly, the role of marketing will increase as new targets and new offerings dominate future, strategic decision-making. Specific hospital services having the highest future priority include out-patient services, in-patient care, cardiology, cancer/oncology, obstetrics, and services geared specifically to women and the elderly. Finally, when asked to identify the three most significant challenges facing the health care/hospital industry over the next five years, 12 challenges emerged, with five being mentioned by the majority of the administrators and seven by the minority.(ABSTRACT TRUNCATED AT 400 WORDS)     

Pattullo Lecture 2006. Crossing the educational chasm: preparing healthcare leaders for interprofessional practice

Despite marked differences in training and professional interests, physicians and hospital administrators face similar problems: failure of reimbursement to keep pace with rising costs, new therapeutic modalities, critical workforce shortages, increasing government and managed care regulation, heightened consumerism, & an aging patient population. In the face of these mounting challenges, both physicians and hospital administrators could benefit significantly from a climate of collaboration and interdependence to optimize interprofessional practice. Teaching people to work with other healthcare professionals who play key roles in healthcare delivery is an important educational mission for the Association of University Programs in Health Administration (AUPHA) and for society in general.     

Rural Health Research Community Perceptions of the Effects of Rural Hospital Closure on Access to Care

The purpose of this case study was to ascertain the perceptions of health professionals who were located in six rural communities where hospital closure occurred, regarding the impact of closure on community residents. These health professionals were asked to respond to questions about effects of hospital closures on the availability of medical services such as emergency care, physician services, hospital services and nursing home care. To control for trends in medical services utilization that were unrelated to hospital closure, the study design included comparison areas where similar hospitals remained open. A standardized questionnaire was administered to three health professionals in each of the areas that experienced a hospital closure and also in the matched comparison areas. Interviews of the health professionals in closure areas provide evidence suggestive of some perceived negative effects of hospital closure on these communities. These negative effects include difficulty recruiting and retaining physicians, concern of residents about the loss of their local emergency room, and increased travel times to receive hospital services. The perceived effects of closure appeared to be mediated by the distance required for travel to the nearest hospital. Respondents perceived increased travel times to most significantly affect vulnerable populations, such as the elderly, the disabled and the economically disadvantaged. Respondents in the majority of comparison areas also reported access barriers for vulnerable populations. These barriers primarily center on problems of obtaining transportation and enduring the rigors of travel. Improvements in the availability of transportation to medical care may offer some stabilization to communities where hospitals closed; however, it also is the case that transportation improvements are needed to increase access to care in rural communities where hospitals remained open.     

Mental healthcare for rural seniors. An outreach program in Cedar Rapids, IA, uses an integrated approach to break down barriers to care

Several barriers prevent elderly persons, especially those living in rural areas, from receiving mental health services. The Abbe Center for Community Mental Health is breaking down some of these barriers in the Cedar Rapids, IA, area. The center's Elderly Outreach Project identifies and provides mental health services to the area's rural elderly. A multidisciplinary team (psychiatrist, nurse, and social worker) assesses and treats home-bound clients. Four major barriers prevent seniors from using traditional mental healthcare services: A lack of trained professionals. Because many professionals have not received training in geriatrics, those working with elderly clients should be encouraged to attend educational conferences to fill gaps in their knowledge. Organizational barriers. Transportation and cost may prohibit elderly persons from seeking mental healthcare. Facilities must revise policies detrimental to clients' well-being. Ageism. Many elderly persons have internalized negative and incorrect beliefs about what aging is or should be. Education about "normal" aging is essential. Stigma. The stigma of mental illness is particularly troublesome. Services such as in-home counseling allow clients to get the help they need while keeping their mental illness confidential. To eliminate the barriers to mental healthcare, increased financial resources are necessary to develop, implement, and maintain innovative programs that can reach frail, isolated, hard-to-find persons in need of mental health, medical, and social services.     

Nexus Ethics,Law, and Management: Uncircling the Wagons: Informing Patients about Unanticipated Outcomes

The American society is a very “mobile” society. It is estimated that Americans move (i.e., relocate to a different city, state, or country) on average every five years—more often than any other culture except nomadic tribes (Lewis 2003). Frequent mobility of individuals can have a direct impact on employers even though employee mobility may be due solely to personal factors. If the rate of employee mobility is repeatedly more prevalent in some industries than in others, then the organizations within those industries may be viewed negatively by potential as well as current employees. Therefore, it is imperative for healthcare organizations to do their best to retain their employees, particularly health professionals who are perhaps the backbone of any healthcare institution. Unfortunately, the healthcare industry has been struggling to retain its quality health professionals because of the current economic conditions of the United States. The void created by the mobility of health professionals, such as a nursing shortage, may have a devastating long-term effect on the organization affected directly by it, as well as contributing to an overall negative impact on the healthcare industry. For this reason, I want to identify the various reasons why nurses move and then identify some strategies to retain these valued and highly desired professionals.     

A longitudinal look at social work leadership in hospitals: the impact of a changing health care system

This article examines the responses of social work administrators to the changes occurring throughout their hospitals over three time periods in the 1990s; the major accomplishments of social work services in their facilities; and the failures, frustrations, and obstacles in the delivery of social work services. It compares the reports of social work director cohorts on the changes they experienced over an eight-year period with what they had expected in their settings. It also analyzes their perceptions over time of obstacles and opportunities for hospital social work administrators in response to these changes. The authors present the ways in which social work administrators understand and address the complexities they face.     

Innovative teaching for health law: a case study of a hospital medical malpractice lawsuit simulation

In this article we describe a case study of a learning exercise for healthcare management students to more effectively understand how the legal process impacts healthcare organizations and healthcare professionals. Through a semester-long mock trial, we illustrate how healthcare executives can better understand and prepare their employees, their organization, and fellow administrators for the financial, emotional, and time investment that a lawsuit requires. Students participate as a member of the plaintiff team, defendant team, or juror in a simulated lawsuit brought by a patient against a hospital. We explain how students who participate in the simulated lawsuit gain a better understanding of difficult legal principles discussed throughout the course. We further indicate how the mock trial simulation may support achievement of current Commission on Accreditation of Healthcare Management Education (CAMHE) criteria. Next, we highlight how the mock trial allowed students to put into practice many of the health law principles discussed in class through role playing the different stages of medical malpractice trial. The article concludes with examples of how a simulated mock trial may also provide similar interdisciplinary educational, performance improvement, and cost saving benefits to healthcare professionals and their organizations.     

Updates: protecting home health workers; dealing with abortion violence

The need for security off hospital premises has been the focus of growing concern by health professionals in two areas--home healthcare and abortions. With the advent of managed care, hospital stays are growing shorter and shorter, and home healthcare is growing more popular. As a result, nurses and ancillary staff are finding themselves in diverse, sometimes risky, environments--from homeless shelters, to retirement centers, to homes and apartments, and sometimes to remote, rural locations where security can be a major issue. And while most abortions are performed in nonhospital-run clinics off premises, an estimated 6% of abortions are performed by hospitals. What abortion providers have learned about violence and the threat of violence should be noted by hospital security professionals.     

Won't you stay just a little bit longer? A discrete choice experiment of UK doctors’ preferences for delaying retirement

Introduction and aimsHealth systems around the world face difficulties retaining their workforce, which is exacerbated by the early retirement of experienced clinicians. This study aims to determine how to incentivise doctors to delay their retirement.MethodsWe used a discrete choice experiment to estimate the relative importance of job characteristics in doctors’ willingness to delay retirement, and the number of extra years they were willing to delay retirement when job characteristics improved. 2885 British Medical Association members aged between 50 and 70 years, registered with the General Medical Council, practising in Scotland (in December 2019), and who had not started to draw a pension were invited. We compared the preferences of hospital doctors (HDs) and general practitioners (GPs).ResultsThe response rate was 27.4% (n = 788). The number of extra years expected to work was the most important job characteristic for both respondents, followed by work intensity for GPs, whereas working hours and on-call were more important for HDs. Personalised working conditions and pension taxation were the least important characteristics for both groups. Setting all characteristics to their BEST levels, GPs would be willing to delay retirement by 4 years and HDs by 7 years.ConclusionsCharacteristics related to the job rather than pension could have the greatest impact on delaying retirement among clinicians.     

Physician recruitment: understanding what physicians want.

One of the more dramatic changes in the healthcare industry has been the movement of physicians, particularly younger professionals, from private practice to some type of healthcare organization. In this study we examine the importance attached to specific incentives by physicians in making an affiliation decision and healthcare administrators. Our results suggest significant differences between the importance placed on certain recruiting incentives by physicians and healthcare administrators. Further, they suggest distinct differences in importance ratings by different types of physicians. Implications of this study argue for developing different compensation packages to appeal to different segments of physicians.     

Home enteral tube feeding: I. The role of industry

Home enteral tube feeding in the UK has grown significantly over the past 10 years. At the end of 1998, the British Artificial Nutrition Survey estimated that there were at least 12 000 patients at home on enteral tube feeding. During this time, industry developed a range of homecare services, to meet the changing and rising expectations of both patients and health care professionals. Company personnel now play an important role in patient care, working along-side health care professionals to provide training on the use of equipment and managing simple problems. As a consequence the costs to industry of providing homecare services has increased. However, current changes in the organization of the National Health Service coupled with the continued growth in numbers and types of patients discharged into the community will mean that in the future, industry may not only have to develop more flexible services but also review funding arrangements.     

An assessment of rural hospital trustees' health care knowledge base.

Rural hospital trustees are usually volunteers who serve important roles in the governance of a hospital and, therefore, in defining health care policy in their communities. Because most trustees are not health professionals, their orientation to the hospital and continuing education about the hospital present a special challenge to administrators. One hundred and three trustees from 10 rural hospitals in western New York were surveyed to better understand their demographics, their knowledge base regarding the hospital, and their roles as trustees. Sixty-six percent of the respondents were male and the average age of the sample was 48 years. Trustees had served an average of six years and spent seven hours per month on hospital business. Eighty-three percent recalled receiving some orientation. Answers about average hospital census, length of stay, payor type, and hospital services were correct less than 50 percent of the time. Trustees were aware that recent quality assurance guidelines increased their liability and half believed it was their most important activity. We conclude that greater effort should be applied to the orientation and continuing education of hospital trustees. Given the significant time commitment already asked of trustees, this education should be woven into the hospital governance routine.     

A management information system to plan and monitor the delivery of health-care services in government hospitals in India

Governments all over the world are getting increasingly concerned about their ability to meet their social obligations in the health sector. In this paper, we discuss the design and development of a management information system (MIS) to plan and monitor the delivery of healthcare services in government hospitals in India. Our MIS design is based on an understanding of the working of several municipal, district, and state government hospitals. In order to understand the magnitude and complexity of various issues faced by the government hospitals, we analyze the working of three large tertiary care hospitals administered by the Ahmedabad Municipal Corporation. The hospital managers are very concerned about the lack of hospital infrastructure and resources to provide a satisfactory level of service. Equally concerned are the government administrators who have limited financial resources to offer healthcare services at subsidized rates. A comprehensive hospital MIS is thus necessary to plan and monitor the delivery of hospital services efficiently and effectively.     

Changes in the healthcare profession: from denial to acceptance

As the government and other factors seem to be increasingly gaining control over the healthcare industry, many hospital managers and staff feel as if they're increasingly losing control over their jobs and their futures. Indeed, some administrators and physicians are experiencing a kind of stress that may be seen as a grief for the way things once were. Using Elisabeth Kubler-Ross's stages of the grieving process, the author explains how such stress can be managed and some control regained.     

Knowledge translation in tri-sectoral collaborations: An exploration of perceptions of academia,industry and healthcare collaborations in innovation adoption

With the aging population and increase in chronic disease conditions, innovation to transform treatment pathways and service delivery will be necessary. The innovation adoption process however, can take 15 years before widespread adoption occurs in most healthcare systems. Current UK government policies to increase the facilitation of innovation adoption are under way. The aim of this study is to explore perceptions of tri-sectoral collaborations in the healthcare sector. The data in the study are drawn from a cross-sectional survey conducted in 2015 of professionals in academia, industry and the healthcare sectors in England, focusing on Diabetes care. Academia and healthcare respondents had the least work experience outside of their sectors compared to the industry respondents. Healthcare and academia respondents rated the industry sector less trustworthy, unethical, having different goals and less understanding of the other sectors. Industry respondents had a more positive perspective towards potential collaborators. The results from the study demonstrate greater potential challenges to tri-sectoral collaborations and the government’s knowledge translation policy, due to pre-conceived notions and lack of understanding of other sectors. The purely structural approach of establishing government mandated translational networks may be insufficient without active attempts to improve collaborative relationships. Mechanisms to facilitate trust building and collaboration are proposed.     

TOPICS Reports on …: Congress on Industrial Health

As the government and other factors seem to be increasingly gaining control over the healthcare industry, many hospital managers and staff feel as if they're increasingly losing control over their jobs and their futures. Indeed, some administrators and physicians are experiencing a kind of stress that may be seen as a grief for the way things once were. Using Elisabeth Kubler-Ross's stages of the grieving process, the author explains how such stress can be managed and some control regained.     

Work-related stress and occupational therapy

Occupational stress and burnout have been studied extensively in the human services. It has been suggested that healthcare professionals in particular are at risk of stress owing to the caring nature of their work. Articles related to occupational therapy and work-related stress were reviewed in regard to practice in Australia, Canada, the United Kingdom, the United States and Sweden. Although the empirical literature is relatively weak for occupational therapy, it has been argued that occupational therapists in health care share risk factors with other healthcare professionals. These risk factors include repeated exposure to distress and difficult behaviour, prolonged interventions and uncertain outcome. Issues such as professional status, staffing issues and the nature of the profession have been identified as additional risk factors for occupational therapists. However, empirical studies that enable burnout rates of occupational therapists to be compared with those of related occupational groups suggest that this may not be the case. Occupational therapists may in fact be protected from some stress and burnout factors. Further research is recommended to clarify the nature of stress experienced by occupational therapists and to identify both risk and protective factors characteristic of the profession.     

Forecasting the medical workforce: a stochastic agent-based simulation approach

Starting in the 50s, healthcare workforce planning became a major concern for researchers and policy makers, since an imbalance of health professionals may create a serious insufficiency in the health system, and eventually lead to avoidable patient deaths. As such, methodologies and techniques have evolved significantly throughout the years, and simulation, in particular system dynamics, has been used broadly. However, tools such as stochastic agent-based simulation offer additional advantages for conducting forecasts, making it straightforward to incorporate microeconomic foundations and behavior rules into the agents. Surprisingly, we found no application of agent-based simulation to healthcare workforce planning above the hospital level. In this paper we develop a stochastic agent-based simulation model to forecast the supply of physicians and apply it to the Portuguese physician workforce. Moreover, we study the effect of variability in key input parameters using Monte Carlo simulation, concluding that small deviations in emigration or dropout rates may originate disparate forecasts. We also present different scenarios reflecting opposing policy directions and quantify their effect using the model. Finally, we perform an analysis of the impact of existing demographic projections on the demand for healthcare services. Results suggest that despite a declining population there may not be enough physicians to deliver all the care an ageing population may require. Such conclusion challenges anecdotal evidence of a surplus of physicians, supported mainly by the observation that Portugal has more physicians than the EU average.     

Danger signs. Coalition points to causes and consequences of inadequate care of the dying

Dying patients and their families repeatedly express their need for supports based on compassion and caring, yet healthcare efforts focus on often ineffective technological interventions and procedures. Professional healthcare schools provide little or no formal training in pain and palliative symptom management or in the multidimensional approach to care of the dying. And the pace of change in healthcare leaves little time for communication between the patient, family, and caring team. Physician denial of death and dying has a significant impact on clinical decision making and misleads healthcare administrators about priorities. Even when clinicians want to practice holistic supportive care, they are often unable to because of competing productivity demands and lack of reimbursement. Inappropriate therapies may be initiated to justify continued care in acute and skilled nursing environments. Because healthcare professionals may not inform families about what can be done in the way of supportive care, they may choose to ?do everything,? which often means using inappropriate treatments. Supportive Care of the Dying: A Coalition for Compassionate Care is a unique collaborative effort to help change the culture of dying in healthcare and to help Catholic and other organizations offer appropriate care based on respect for the sanctity of life, regard for human dignity, and a commitment to stewardship. The coalition intends to develop a comprehensive supportive care model built on Catholic values and tradition.