Assessing Planetary Health Curricular Needs Across Health Professions Programs.

With growing recognition that climate change is a significant threat to human health, allied health professionals are increasingly recognized as critical allies in addressing this threat. This article describes the approach that Rush University's College of Sciences is pursuing to better prepare health sciences students for this reality. Faculty and students enrolled across all programs of the College were surveyed regarding their levels of concern about global warming using items from the Six Americas Survey, as well as perceived importance of planetary health curricular elements adapted from the Planetary Health Report Card. Faculty were additionally asked about perceived opportunities to bring planetary health education into each of the degree programs offered by the university. A total of 37 faculty and 43 students completed the survey, collectively representing all programs in the college. Responses reflected widespread interest in expanding planetary health education, but topic priorities and optimal methods for implementation differed between programs. Although the survey process had limitations, it demonstrated the need for greater attention to planetary health across curricula and offered more efficient approaches implementing this essential content across programs.

Future-ready healthcare leadership: the revised International Hospital Federation competency model.

BACKGROUND: Major global trends are reshaping health services delivery, and preparing current and future healthcare leaders requires an understanding of these trends. A well-designed leadership competency model can provide guidance for individuals, as well as for system-level leadership development and integration programmes. OBJECTIVE: To describe the process of updating the International Hospital Federation's (IHF) Global Healthcare Management Competency Directory. METHODS: Revisions were informed by a recent foresight study of major trends in health services delivery, and an evidence-informed framework of leadership competencies. The original framework competencies were reviewed by 45 subject-matter experts from 30 countries and regions, who provided feedback through electronic surveys and online interviews. We incorporated this iterative feedback to revise the framework design, competencies within the framework and their associated behavioural descriptions. RESULTS: A total of 45 subject-matter experts from 30 countries and regions participated in 1 or more phases of the survey process. The resulting leadership competency model includes 32 competencies organised into a framework of 6 domains: values, self-development, execution, relations, context management and transformation. CONCLUSION: The updated IHF Leadership Model provides a robust, evidence-based and up-to-date resource for assessing and developing future-ready healthcare leaders.

Does Climate Change Affect Health? Beliefs from the Health Information National Trends Survey.

Climate change is currently and will continue impacting human health, however, beliefs about the level of threat vary by demographics, region, and ideology. The purpose of this study was to assess factors related to climate change and health beliefs using cross-sectional data from the Health Information National Trends Survey (HINTS). Data from 5,075 respondents in the 2022 iteration of HINTS was used for this study. Chi-square tests were used to evaluate demographic differences among those who believe climate change will harm health a lot compared to some, a little, or not at all. Generalized ordinal logistic regression models were used to examine the relationship between the belief that climate change will harm health and independent variables regarding trust in scientists, health recommendations from experts, and demographic characteristics. Female, Black, Hispanic, and college graduate respondents had higher odds and people in the Southern U.S. those aged 35-49, 50-64, and 75years or older had significantly lower odds of believing climate change would harm their health. Those who trust information about cancer from scientists and those that believe health recommendations from experts conflict or change had higher odds of believing climate change would harm health. Our analysis highlights factors that impact climate change and health beliefs, which may provide targets for tailoring public health messages to address this issue.

Turning Concern Into Confidence: Planetary Health Needs in Nursing Education.

BACKGROUND: Climate change is a recognized global threat to human health, and nurses must be prepared to mitigate its negative effects. This article describes nursing student and faculty opinions about climate change and associated planetary health curricular needs. METHOD: A survey including the Six Americas Super Short Survey and an adaptation of the Planetary Health Report Card was developed and emailed to nursing students and faculty. RESULTS: Student (n = 72) and faculty (n = 56) responses showed that although they were concerned about climate change, they were not confident in preparation of nurses student to climate change and its impact. Students and faculty shared perceptions about specific curricular areas are to be included in curricula. CONCLUSION: In response to the updated Essentials, which include specific reference to climate change, widespread curricular change is imminent in nursing education. This study offers insight for integrating climate change and planetary health into nursing curricula. [J Nurs Educ. 2024;63(3):178-181.].

The Role of Work as a Social Determinant of Health in Mother's Own Milk Feeding Decisions for Preterm Infants: A State of the Science Review.

In the United States, 10% of infants are born preterm (PT; <37 weeks gestational age) each year and are at higher risk of complications compared to full term infants. The burden of PT birth is borne disproportionately by Black versus non-Black families, with Black mothers significantly more likely to give birth to a PT infant. One proven strategy to improve short- and long-term health outcomes in PT infants is to feed mother's own milk (MOM; breast milk from the mother). However, mothers must make decisions about work and MOM provision following PT birth, and more time spent in paid work may reduce time spent in unpaid activities, including MOM provision. Non-Black PT infants are substantially more likely than Black PT infants to receive MOM during the birth hospitalization, and this disparity is likely to be influenced by the complex decisions mothers of PT infants make about allocating their time between paid and unpaid work. Work is a social determinant of health that provides a source of income and health insurance coverage, and at the same time, has been shown to create disparities through poorer job quality, lower earnings, and more precarious employment in racial and ethnic minority populations. However, little is known about the relationship between work and disparities in MOM provision by mothers of PT infants. This State of the Science review synthesizes the literature on paid and unpaid work and MOM provision, including: (1) the complex decisions that mothers of PT infants make about returning to work, (2) racial and ethnic disparities in paid and unpaid workloads of mothers, and (3) the relationship between components of job quality and duration of MOM provision. Important gaps in the literature and opportunities for future research are summarized, including the generalizability of findings to other countries.

A Seat at the Table: An Examination of Hospital Governing Board Diversity, 2011-2021.

GOAL: Board diversity is increasingly important for hospitals and healthcare systems, with national attention focused on eliminating health disparities and improving health equity. Yet, it remains a challenge despite concerted efforts by leading professional associations (e.g., American College of Healthcare Executives) to galvanize their constituents around the importance of the issue. METHODS: This study used survey data from The Governance Institute to explore the ethnoracial and gender diversity of hospital boards spanning 2011 through 2021. PRINCIPAL FINDINGS: The results showed modest gains in the mean number of female board members, although a small proportion of hospital boards still have no female representation. There was little change in the number of boards with ethnic minority representation until an uptick in 2021, likely in direct response to high-profile racial incidents and protests. PRACTICAL APPLICATIONS: Intentional and sustained efforts are necessary to increase diversity and create a culture of inclusion that fosters meaningful engagement of diverse board members.

Closing the Gender Gap in Healthcare Leadership: Can Administrative Fellowships Play a Role?

GOAL: Although women make up most of the healthcare workforce, they are underrepresented in higher levels of leadership positions. Leadership development programs for early careerists, such as administrative fellowships, have been suggested as one strategy for accelerating gender equity in leadership roles. However, the potential impact of these programs has not yet been the subject of systematic evaluation. In this study, we examined the (1) benefits of administrative fellowship programs on career attainment and (2) differences in attainment by gender. METHODS: We completed this study using a data set involving alumni from a consortium of 11 graduate healthcare management programs whose students frequently pursue administrative fellowships. Our data included individual-level demographic and career attainment data for graduating classes from 5, 10, and 20 years prior to the reference year. Using multiple regression analysis, we tested the relationship of three independent variables-graduation year, gender, and completion of a fellowship-on career attainment. This analysis enabled us to determine differences in overall career attainment by gender, evaluate the role of fellowships in career attainment, and consider the differential impact of fellowships on attainment by gender. PRINCIPAL FINDINGS: Our findings suggest that fellowship programs accelerate leadership career paths for individual leaders, but that the effect is stronger for males than their female counterparts. PRACTICAL APPLICATIONS: These findings not only support the value of administrative fellowships for early careerist leadership development but also suggest that closing the gender disparity gap in leadership may require additional and focused career-supportive strategies. We provide recommendations for healthcare organizations in developing their administrative fellowship programs to help minimize the gender disparity in healthcare leadership positions. Furthermore, we discuss research implications and future areas of research in administrative fellowships.

Management and leadership competencies among spiritual care managers.

Both the healthcare and religious landscapes in the United States are rapidly changing. Despite the dynamic environment that spiritual care managers face, many do not receive management training prior to assuming their roles and many receive little or no training once they are in their roles. This study used mixed methods to examine the applicability of the National Center for Healthcare Leadership (NCHL) competency model to spiritual care manager roles. Interviews were conducted with 10 spiritual care managers across the country, using a Behavioral Event Interviewing (BEI) methodology. Interviews were quantitatively analyzed by using Natural Language Processing and qualitatively analyzed by thematic approach using NVIVO. The results found the EXECUTION domain to be the most discussed theme, followed by RELATIONS, TRANSFORMATION, and BOUNDARY SPANNING. Collectively these analyses suggest the NCHL Leadership Competency Model can provide a useful framework for understanding the roles and development needs of spiritual care managers.

What organizational and business models underlie the provision of spiritual care in healthcare organizations? An initial description and analysis.

Two-thirds of American hospitals have chaplains. This article explores the organizational and business models that underlie how chaplains are integrated into hospitals. Based on interviews with 14 chaplain managers and the 11 healthcare executives to whom they report at 18 hospitals in 9 systems, we identify three central findings. First, there is significant variation in how spiritual care programs are staffed and integrated into their hospitals. Second, executives and chaplain managers see the value of chaplains in terms of their quality of care, reliability and responsivity to emergent patient and staff needs, and clinical training and experience working within a complex environment. Third, few departments rely on empirical data when making decisions about staffing, tending instead to default to the budgetary status quo. These findings provide the basis for a larger more systematic study.

NCHL's "Best Organizations for Leadership Development" Program: A Case Study in Improving Evidence-based Practice through Benchmarking and Recognition.

Increasingly, addressing healthcare's grand challenges requires complex system-level adaptations involving continuously evolving teams and leaders. Although leadership development strategies have been shown to improve individual leader effectiveness, much less is known about how organization-level leadership development affects organization-level outcomes. To begin building an evidence base as well as encouraging evidence-based practices, the US-based National Center for Healthcare Leadership developed a program capitalizing on leaders' demonstrated interest in organizational competitiveness: the biennial Best Organizations for Leadership Development (BOLD) program. In this chapter, we describe the philosophy behind this unique survey program and summarize research to date on relationships between survey dimensions and organizational outcomes such as patient experience and financial performance. We conclude with a description of promising areas for future study.

How Do Healthcare Executives Understand and Make Decisions about Spiritual Care Provision?

OBJECTIVES: This pilot study explores how healthcare leaders understand spiritual care and how that understanding informs staffing and resource decisions. METHODS: This study is based on interviews with 11 healthcare leaders, representing 18 hospitals in 9 systems, conducted between August 2019 and February 2020. RESULTS: Leaders see the value of chaplains in terms of their work supporting staff in tragic situations and during organizational change. They aim to continue to maintain chaplaincy efforts in the midst of challenging economic realities. CONCLUSIONS: Chaplains' interactions with staff alongside patient outcomes are a contributing factor in how resources decisions are made about spiritual care.

The Impact of Hospital and Health System Leadership Development Practices on Bond Ratings.

EXECUTIVE SUMMARY: Shifts in healthcare policy, patient consumerism, and organizational consolidation are driving the need for hospitals and health systems to adapt if they are to achieve sustainability. Prior research has suggested that businesses with strong leadership development practices also demonstrate greater financial success and competitive performance. However, few studies have examined the impact of leadership development on organization-level outcomes, generally, or in the healthcare industry, specifically.Our goal in this study was to examine the association between organizational leadership development practices and external perceptions of creditworthiness in the form of bond ratings. Data were drawn from the 2014 and 2016 distributions of the National Center for Healthcare Leadership's National Health Leadership Survey; organizational credit ratings were obtained from Moody's Investors Service and S&P Global Solutions. Spearman's rho correlations and polynomial ranked regressions were used to determine the significance of the relationships between leadership development practices and bond ratings. Results provide preliminary evidence of associations between investing in leadership development and organizational creditworthiness. They also suggest, however, that the most financially successful health systems may de-emphasize certain kinds of leadership development practices relative to their peers. We discuss implications of these findings for organizational leaders investing in human capital as well as healthcare executives evaluating the development potential of prospective employers.

Understanding Student Preferences in the Selection of a Graduate Allied Health Program: A Conjoint Analysis Study.

ISSUE: As the healthcare landscape rapidly changes, graduate allied health programs must position themselves to educate the next generation of healthcare professionals in a highly competitive landscape. No studies have directly measured the relative importance of attributes in program selection by prospective healthcare students. METHODS: We surveyed graduate healthcare management program applicants in the 2018 admissions cycle (n=512) to determine which attributes were most important in program choice. We utilized conjoint analysis to estimate utilities and importance scores of six attributes: program ranking, cost, work experience, geography, distance to home, and salary. We then conducted a market simulation to predict relative market share of academic programs. OUTCOMES: The most important attribute to prospective students was the projected starting salary, with US News and World Report ranking and tuition cost the second and third most important attributes, respectively. Each attribute was relatively inelastic respective to tuition cost. CONCLUSION: While future leaders placed the most value on earnings when selecting a program, they also valued rankings and cost. By focusing on these factors, programs can target their marketing efforts to recruit the best potential future healthcare leaders, while this method can be replicated to gauge the most important relative attributes for a variety of healthcare professions.

Bridging worldviews: Toward a common model of leadership across the health professions.

BACKGROUND: As the pace of health sector transformation accelerates, the importance of leadership continues to grow across all health professions. Advances in a variety of disciplines can inform effective leadership development. However, at present, most health sector leadership competency models do not incorporate these advances and are instead developed using consensus-based methods within specific professions. An interprofessional approach to leadership competencies could help incorporate these advances and support better interdisciplinary leadership development. PURPOSE: This study was pursued to revise and revalidate a widely used health sector leadership competency model and assess its potential for providing greater interoperability across the professions. METHODOLOGY/APPROACH: Using the National Center for Healthcare Leadership's interprofessional competency model Version 2.1 as the starting point, we developed a revised and revalidated model in four phases: (a) we completed a future scan using methods described in Garman et al. [Garman, A. N., Johnson, T. J., & Royer, T. (2011). The future of healthcare: Global trends worth watching. Chicago, IL: Health Administration Press.]; (b) we collected behavioral event interview data from pairs of leaders representing different organizational and performance levels, using methods developed by Boyatzis [Boyatzis, R. E. (1982). The competent manager: A model for effective performance. New York, NY: John Wiley & Sons.]; (c) we conducted a validity study via electronic survey of 145 working managers and calculated content validity ratios using methods described by Lawshe [Lawshe, C. H. (1975). A quantitative approach to content validity. Personnel Psychology, 38(4), 563-575.]; and (d) we used natural language processing to assess the extent to which existing leadership models in the health professions will crosswalk to the new model. FINDINGS: All competencies in the revised model successfully met criteria for validity. The revised model also successfully crosswalked against, on average, 85% of the competencies in the other five health professions leadership models. PRACTICE IMPLICATIONS: Based on the results of this research, we conclude the revised model can provide a "common language" framework in support of interdisciplinary leadership development. The availability of such a model may also assist human resource and development executives in better aligning learning resources with organizational goals.

Preparing Future Healthcare Leaders through Graduate Education: Impact of Program Accreditation on Quality Improvement.

Accreditation is used by many health professions to ensure the adequacy of their training programs in preparing future leaders and practitioners. The impact of program accreditation, however, has not historically been the subject of systematic study, meaning the case for program accreditation has been more philosophical than empirical. We hypothesized that a healthcare management program's length of continuous accreditation (accreditation tenure) would be associated with factors related to applicant quality, program selectivity, and starting salaries of students upon graduation. We conducted a retrospective, correlational analysis to investigate the relationship between accreditation tenure and program quality and outcome metrics. The sample included all graduate programs (n=72) that were accredited in the 2013-2014 academic year and had completed a full annual report to the Commission on Accreditation of Healthcare Management Education (CAHME). As hypothesized, we found factors within each of our three areas of interest to be associated with accreditation tenure, providing at least preliminary evidence of an association between program-level accreditation and continuous quality improvement in programmatic outcomes.

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.

Care provider perspectives on medical travel: A three-country study of destination hospitals.

Despite growing interest in the current and potential role of medical travel in U.S. patient care, very little research has been conducted on clinician and other provider organizations' perspectives on providing international patient care. The present study sought to gain formative insights about medical travel from the providers' perspectives, by conducting structured interviews and focus groups in six hospitals from three countries catering to patients traveling from the United States. Findings highlighted the surprising role of international events and policies in the evolution of medical travel, as well as both the desire and need for more transparent quality standards.

Toward a high-performance management system in health care, part 4: Using high-performance work practices to prevent central line-associated blood stream infections-a comparative case study.

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are among the most harmful health care-associated infections and a major patient safety concern. Nationally, CLABSI rates have been reduced through the implementation of evidence-based interventions; thus far, however, hospitals still differ substantially in their success implementing these practices. Prior research on high-performance work practices (HPWPs) suggests that these practices may explain some of the differences health systems experience in the success of their quality improvement efforts; however, these relationships have not yet been systematically investigated. PURPOSES: In this study, we sought to explore the potential role HPWPs may play in explaining differences in the success of CLABSI reduction efforts involving otherwise similar organizations and approaches. METHODOLOGY/APPROACH: To form our sample, we identified eight hospitals participating in the federally funded "On the CUSP: Stop BSI" initiative. This sample included four hospital "pairs" matched on organizational characteristics (e.g., state, size, teaching status) but having reported contrasting CLABSI reduction outcomes. We collected data through site visits as well as 194 key informant interviews, which were framed using an evidence-informed model of health care HPWPs. FINDINGS: We found evidence that, at higher performing sites, HPWPs facilitated the adoption and consistent application of practices known to prevent CLABSIs; these HPWPs were virtually absent at lower performing sites. We present examples of management practices and illustrative quotes categorized into four HPWP subsystems: (a) staff engagement, (b) staff acquisition/development, (c) frontline empowerment, and (d) leadership alignment/development. PRACTICE IMPLICATIONS: We present the HPWP model as an organizing framework that can be applied to facilitate quality and patient safety efforts in health care. Managers and senior leaders can use these four HPWP subsystems to select, prioritize, and communicate about management practices critical to the success of their CLABSI prevention efforts.

The Relationship Between Hospital Value-Based Purchasing Program Scores and Hospital Bond Ratings.

Tax-exempt hospitals and health systems often borrow long-term debt to fund capital investments. Lenders use bond ratings as a standard metric to assess whether to lend funds to a hospital. Credit rating agencies have historically relied on financial performance measures and a hospital's ability to service debt obligations to determine bond ratings. With the growth in pay-for-performance-based reimbursement models, rating agencies are expanding their hospital bond rating criteria to include hospital utilization and value-based purchasing (VBP) measures. In this study, we evaluated the relationship between the Hospital VBP domains--Clinical Process of Care, Patient Experience of Care, Outcome, and Medicare Spending per Beneficiary (MSPB)--and hospital bond ratings. Given the historical focus on financial performance, we hypothesized that hospital bond ratings are not associated with any of the Hospital VBP domains. This was a retrospective, cross-sectional study of all hospitals that were rated by Moody's for fiscal year 2012 and participated in the Centers for Medicare & Medicaid Services' VBP program as of January 2014 (N = 285). Of the 285 hospitals in the study, 15% had been assigned a bond rating of Aa, and 46% had been assigned an A rating. Using a binary logistic regression model, we found an association between MSPB only and bond ratings, after controlling for other VBP and financial performance scores; however, MSPB did not improve the overall predictive accuracy of the model. Inclusion of VBP scores in the methodology used to determine hospital bond ratings is likely to affect hospital bond ratings in the near term.

Defining world-class care in academic medicine: enablers and challenges.

PURPOSE: Interest has grown among U.S. academic medical centers in developing international benchmarks for excellence in process and outcomes. Drivers behind this trend, as well as barriers to the development of useful benchmarks, are explored in this invited commentary. DESIGN/METHODOLOGY/APPROACH: The commentary is based on the authors' conversations with members of the U.S. Cooperative for International Patient Programs as well as the University Healthsystem Consortium (UHC). FINDINGS: Six key themes are summarized in this commentary, including four key drivers and two barriers. ORIGINALITY/VALUE: The practice-based perspectives this commentary summarizes provide a useful starting point for researchers and practitioners interested in establishing international comparison with the United States.