Intraorganization conflicts of interest in hospitals adapting to a changing ecosystem.

PURPOSE: Health systems function in an ecosystem that is turbulent and competitive because of demographic, economic, political, technological and lifestyle changes and sociopolitical influences, requiring hospitals to adopt comprehensive business strategies. Failure to do so may result in duplication, waste and deficits. This original article uses the prism of agency theory to examine differences in approach at two levels of hospital management and the consequent problems in the incorporation of necessary changes. Agency theory posits an inherent conflict of interest in organizations, including health organizations: the managers (agents) always aim to maximize their profit or personal interest instead of that of the owner or organization (principal), potentially causing difficulty in managing the organization. The aim is to generate recommendations for policymakers. DESIGN/METHODOLOGY/APPROACH: The study is based on 30 semi-structured, in-depth interviews with key figures in the health system and on two levels of hospital management: senior managers and heads of selected departments. The analysis used a categorical qualitative methodology. FINDINGS: The main findings are five key themes: views of business behavior, asymmetry of interests, asymmetry of information, transparency and cooperation between various levels of management and ambivalence toward business in hospitals. The two levels of management are clearly divided in terms of interests, information and activity, leading to difficulty in cooperation, efficiency and achievement of organizational goals. ORIGINALITY/VALUE: Using agency theory, this study provides a systemic and organizational view of hospitals' management and environmental adaptation. Understanding the processes and increasing cooperation at various managerial levels can help make the system more efficient and ensure its survival in a dynamic market.

Behavioral Health in the Pandemic: Making the Shift from Mental Illness to Mental Well-Being.

SUMMARY: Fighting the global COVID-19 pandemic has shifted from immediate response efforts to recognition of the long-term effects on the mental health and well-being of the general population and healthcare workforce. Leaders need to understand the vital role of behavioral health services in a population-based, integrated healthcare framework and address the needs of the behavioral health workforce to successfully deploy services in their organizations and communities.During the ongoing national response to COVID-19, three major trends have emerged: (1) a shift to telehealth and digital care, (2) greater awareness of the impact on the workforce of the shift to digital care, and (3) an open dialogue to counteract the stigma and discrimination related to mental illness and to emphasize mental well-being instead. When they address stigma and discrimination, healthcare leaders embrace a more holistic approach that welcomes behavioral health professionals as equal, vital members of the care team. They help their organizations advance the mental well-being of all.

Pandemic Hastens Cleveland Clinic's Unified Well-Being Strategy.

SUMMARY: Across the healthcare landscape, the COVID-19 pandemic has been incredibly challenging. It also has been a catalyst for change. It has ignited a redesign of the US health system and presented opportunities in areas such as caregiver and patient communication, digital practice, telehealth and virtual care, and more. Notably, the pandemic also has shined a new light on caregiver well-being. As executive leaders of Cleveland Clinic's Caregiver Office, our top priority throughout the pandemic has been to support our caregivers professionally and personally-to help them be their best for themselves and for their fellow caregivers, our patients, our organization, and our communities. Today, Cleveland Clinic is realizing the profound impact of many of the strategies put in place during the pandemic and seeing how COVID-19 accelerated our organization's unified vision for caregiver well-being. This article offers insight into Cleveland Clinic's commitment to caregiver well-being, highlights actions we undertook during the pandemic, shares the resulting lessons we learned, and showcases how those lessons are shaping our future caregiver well-being strategy.

Employee Energy and Engagement: Keys to Clinician and Organization Well-Being in a Crisis.

SUMMARY: Well-being, engagement, and burnout among clinicians are interconnected, and the common denominator is energy. Decades of research show that employees' energy is a decisive factor in achieving organizational outcomes. Knowing this, healthcare leaders can create well-being programs with measurable outcomes that make a positive impact on the bottom line. Just as important, leaders can avoid wasting money on fruitless efforts. How can clinician well-being be incorporated in organizational culture and strategic and operational plans? What are the special challenges to achieving clinician well-being? What key leadership actions promote and protect the well-being of clinicians? Which approaches are most effective during a crisis such as the COVID-19 pandemic? This article addresses those questions by presenting the rationale and methodology behind well-being programs that also address engagement and burnout so that clinicians can succeed in times of crisis and beyond.

Critical Access Hospital Leaders Beat Challenges to Support Their Communities and Staffs.

SUMMARY: Critical access hospitals (CAHs) serve their rural communities as the main access points and communication centers for healthcare, typically with very limited financial, staffing, and support resources. Local residents rely on their CAHs as the only providers for many miles around. When the COVID-19 pandemic hit in early 2020, CAH leaders had to rethink operations and priorities, both internally with staffs and externally with community leaders and organizations. Few critical care beds were available when the need was greatest. Testing was problematic, and cultural barriers complicated care. Now, as virus variants strike where vaccination numbers are low, CAH leaders remain wary of financial hits to elective procedure income, limited resources, and added stress for their staffs. Working with community service organizations and larger regional healthcare centers is a crucial strategy for CAHs as they address care delivery issues and ensure that their caregivers can do their jobs now and in the future.

Learning from the Past to Face the Worst with Our Best.

SUMMARY: At Texas Health Resources, the well-being of our patients, our workforce, and our communities has long been at the core of who we are and the driving force behind business decisions, employee interactions, programs, practices, and the patient care we deliver. It is in our DNA, from our vision "to partner with you for a lifetime of health and well-being" to Our Texas Health Promise: Individuals Caring for Individuals, Together. That solid foundation-always the basis of our business preparations-made it possible for us to weather the challenges brought by the COVID-19 pandemic and to prepare ourselves for what comes next, emerging stronger and with sustained energy to transform the enterprise on the other end.

A National Pediatric Telepsychiatry Curriculum for Graduate Medical Education and Continuing Medical Education.

Objectives: Our goal was to develop an open access nationally disseminated online curriculum for use in graduate and continuing medical education on the topic of pediatric telepsychiatry to enhance the uptake of telepsychiatry among child psychiatry training programs and improve access to mental health care for youth and families. Methods: Following Kern's 6-stage model of curriculum development, we identified a core problem, conducted a needs assessment, developed broad goals and measurable objectives in a competency-based model, and developed educational content and methods. The curriculum was reviewed by experts and feedback incorporated. Given the urgent need for such a curriculum due to the COVID-19 pandemic, the curriculum was immediately posted on the American Academy of Child and Adolescent Psychiatry and American Association of Directors of Psychiatric Residency Training websites. Further evaluation will be conducted over the next year. Results: The curriculum covers the six areas of core competence adapted for pediatric telepsychiatry and includes teaching content and resources, evaluation tools, and information about other resources. Conclusion: This online curriculum is available online and provides an important resource and set of standards for pediatric telepsychiatry training. Its online format allows for ongoing revision as the telepsychiatry landscape changes.

Advocacy for School Nurses and Student Health and Safety: Highlighting National and State Efforts.

Annually, the National Association of School Nurses (NASN) sets advocacy goals. The goals include legislative and policy priorities. The COVID-19 pandemic brought attention to the need to heighten advocacy efforts, specifically to provide for additional school nurses and supplies necessary to meet the challenge of safely returning students to school. While advocating at the national level, NASN also encouraged advocacy at the state and local levels. This article provides a brief summary of NASN's advocacy efforts as well as providing examples from two different state associations demonstrating the importance of collaboration in advocacy efforts in areas related to the pandemic and in general areas related to school nursing.

The International Council of Nurses in the time of the COVID-19 pandemic.

International Council of Nurses President Annette Kennedy reviews the organization's contribution to nursing during the COVID-19 pandemic. She describes the Council's efforts to support nurses around the world and bring its National Nursing Associations together to share their experiences and best practices, and the lessons learned with other nations who are at different stages of the pandemic.

How One Healthcare Organization Is Creating a True System.

SUMMARY: Founded in 1897 as a 12-bed hospital and training school in Springfield, Illinois, Memorial Health System (MHS) today serves communities throughout central Illinois with five affiliated hospitals, ambulatory care services, and behavioral health programs. The system includes Memorial Medical Center in Springfield, Abraham Lincoln Memorial Hospital in Lincoln, Taylorville Memorial Hospital in Taylorville, Passavant Area Hospital in Jacksonville, Decatur Memorial Hospital in Decatur, and the Memorial Physician Services, Memorial Home Services, and Memorial Behavioral Health network across central Illinois. The evolution of MHS from a system in name only-lacking full integration of organizational functions-to its current status as an optimized health system has been marked by challenges, from the initial doubts of employees and the community to the upheaval caused by the COVID-19 pandemic. Systemness requires visionary and sure-handed leadership to identify and realize economies of scale, share best practices for operational improvements, and reduce unwanted variation to improve quality of care. As the MHS story illustrates, that all starts, grows, and endures with strategic planning.

Systemness Taps the Power of Interdependence in Healthcare.

SUMMARY: While the term systemness has been used in the healthcare sector for decades, its definition varies from organization to organization. Still, the goals are consistent: to improve patient experience, lower costs, reduce risk, and provide insights into a wide range of care and management issues. Most health systems face similar challenges, such as margin enhancement, quality improvement, increased access, and fending off disruptive competition. Systemness is a way to address these challenges while improving the overall interdependence of the organization. Although embraced by and advantageous to healthcare organizations, systemness efforts often fail. The obstacles are surmountable when organizations thoroughly analyze the achievable scale of systemness, community resources, and current mindset regarding the good of the whole. Leaders must play a vital role in promoting systemness by providing education and a routine review of day-to-day organizational activities. Sometimes, systemness requires a change in leadership or an updating of leadership skills.Organizations must recognize and assess their culture as it relates to principles of independence versus interdependence, and refocus clinical standardization through best-practice protocols and policies as COVID-19 affects the already-fractured healthcare sector. Fortunately, current and developing artificial intelligence, wearables, at-home testing, and improved technologies promise to provide a needed break for a contracting physician field and fatigued front line, and they present an opportunity for those organizations poised to meet the systemness challenge.

Nurses Achieving the Sustainable Development Goals: The United Nations and Sigma.

This article is one in a series in which contributing authors discuss how the United Nations (UN) Sustainable Development Goals (SDGs) are linked to everyday clinical issues; national public health emergencies; and other nursing issues, such as leadership, shared governance, and advocacy. The 2030 Agenda for Sustainable Development, a 15-year plan of action to achieve the goals, was unanimously adopted by all UN member states in September 2015 and took effect on January 1, 2016. The Agenda consists of 17 SDGs addressing social, economic, and environmental determinants of health and 169 associated targets focused on five themes: people, planet, peace, prosperity, and partnership. The SDGs build on the work of the UN Millennium Development Goals, which were in effect from 2000 to 2015. The current article highlights SDGs 5 (gender equality), 8 (decent work and economic growth), and 17 (partnerships for the goals), along with the advocacy of these goals by Sigma Theta Tau International Honor Society of Nursing in the UN system.

A Most Welcome Spring.

The end of this year's winter brings much-needed hope.