Leadership development practices and hospital financial outcomes.

Affordable Care Act legislation is requiring leaders in US health systems to adapt to new and very different approaches to improving operating performance. Research from other industries suggests leadership development can be a helpful component of organizational change strategies; however, there is currently very little healthcare-specific research available to guide design and deployment. The goal of this exploratory study is to examine potential relationships between specific leadership development practices and health system financial outcomes. Results from the National Center for Healthcare Leadership survey of leadership development practices were correlated with hospital and health system financial performance data from the 2013 Medicare Cost Reports. A general linear regression model, controlling for payer mix, case-mix index, and bed size, was used to assess possible relationships between leadership practices and three financial performance metrics: operating margin, days cash on hand, and debt to capitalization. Statistically significant associations were found between hospital-level operating margins and 5 of the 11 leadership practices as well as the composite score. Relationships at the health system level, however, were not statistically significant. Results provide preliminary evidence of an association between hospital financial performance and investments made in developing their leaders.

Analysis of the evaluation of a new glucose meter with integrated self-management software and USB connectivity.

Glucose meter technology has not kept up with the advances that have occurred in other sectors in mobile and health care technology. A new device that combines strip-based capillary blood glucose monitoring and USB flash drive technology is evaluated in an industry-funded study in a cohort of patients and health care professionals. The expanded memory capacity of flash drives allows the software program to be stored on the device for analyzing the blood glucose readings in memory. The study analyzes the device for precision and accuracy as well as for ease of adaptability and usage. This analysis focuses on shortcomings in the design of the study and methodology in addition to features of the hardware device itself. Although the device has distinct advantages over many devices on the market, a challenge is made to device manufacturers to encourage further innovation.

Analysis of studies that compare the dose accuracy of prefilled insulin pens.

Multiple industry-sponsored studies have been published about the accuracy of insulin delivery using prefilled insulin pens. Although the study by Weise and colleagues in this issue of Journal of Diabetes Science and Technology found that the Novo Nordisk device was slightly more accurate than the Sanofi-Aventis device, one can anticipate a Sanofi-Aventis-funded study that may find the opposite, because no internationally acceptable, publicly funded, unbiased scientific organization exists to perform head-to-head comparisons of drugs and devices in an evidence-based manner. Currently, clinicians are left on their own to determine whether a study on this topic was conducted in an accurate, unbiased manner. A fundamental redesign of clinical research could reinvigorate and revolutionize the process by which innovations travel from the bench to the bedside. As we anticipate changes in healthcare in the future, it is imperative that the approval and postmarketing surveillance process is revised to support the practice of true evidence-based medicine.