Global mHealth policy arena: status check and future directions.

In this review, we examine an important piece of the mHealth puzzle that has received scant attention-health policy. The question is whether health policy ultimately will serve to unite nations in advancing global mHealth or, as Mars and Scott suggested in 2010, keep nations isolated and ultimately making their policy decisions in "eHealth silos". Such a non-collaborative approach seriously hampers the potential for using mobile health technologies to deliver health care across borders, assuring individuals access to affordable, convenient, and quality healthcare in underserved regions. From a global perspective, mHealth policy review is difficult as some important policies may be subsumed in comprehensive planning and strategy documents. Political, environmental, economic, organizational, and technology disparities across nations represent a significant impediment to developing mHealth products and services that can be deployed globally. To date, there is modest evidence that such challenges are being addressed. Even though payers can encourage adoption of mHealth with financial incentives for use, it appears that payment or reimbursement tends to be a roadblock for almost all nations, whether they are emerging or developed. If payment for mHealth services is not guaranteed, business models will not be sustainable and providers will have fewer opportunities for scalability. Furthermore, because mHealth policies typically are subject to some type of government scrutiny and oversight, many product developers and entrepreneurs may turn elsewhere for their investments. Global resource scarcity also challenges optimal mHealth deployment, and governments seek to ensure improved population health outcomes as return on their mHealth investments. Unfortunately, such justification is difficult as evaluation methods simply have not kept pace with mHealth technology capability. Requisite measurement tools are sorely lacking when it comes to evaluating efficacy of mHealth interventions, due in part to insufficient research to inform development of needed measurement tools. Because most robust mHealth research trials have been conducted in the developed world with its impressive technology infrastructure and not in developing nations where the health needs are greatest, evaluation of mobile technology intervention from a global perspective tends to be insufficient to inform policy decisions.

A model for mHealth skills training for clinicians: meeting the future now.

We describe the current state of mHealth skills acquisition, education, and training available to clinical professionals in educational programs. We discuss how telemedicine experienced exponential growth due in large part to the ubiquity of the mobile phone. An outcome of this unprecedented growth has been the emergence of the need for technology skills training programs for clinicians that address extant curricula gaps. We propose a model to guide the development of future training programs that incorporate effective training strategies across five domains: (I) digital communication skills; (II) technology literacy and usage skills; (III) deploying telehealth products and services; (VI) regulatory and compliance issues; and (V) telehealth business case. These domains are discussed within the context of interprofessional teams and broader organizational factors.

Developing a measure of engagement with telehealth systems: The mHealth Technology Engagement Index.

Introduction Telehealth systems and mobile health (mHealth) devices allow for the exchange of both physical and mental healthcare data, as well as information from a patient to a practitioner, or care recipient to caregiver; but there has been little research on why users are motivated to engage with telehealth systems. Given this, we sought to create a measure that satisfactorily assesses human motivation to use telehealth devices. Methods 532 survey responses were used in an exploratory factor analysis and confirmatory factor analysis, which tested and retested the feasibility of this new measure. Convergent and divergent validity analyses indicated that the mHealth Technology Engagement Index (mTEI) is a unique measure of motivation. Results The results indicated that autonomy, competence, relatedness, goal attainment, and goal setting underpin motivation to use telehealth systems. Discussion The mTEI shows promise in indexing human motivation to use telehealth technologies. We also discuss the importance of developing measurement tools based on theory and how practitioners can best utilize the mTEI.

Considerations for the Telehealth Systems of Tomorrow: An Analysis of Student Perceptions of Telehealth Technologies.

BACKGROUND: While much is known about factors that facilitate telehealth adoption, less is known about why adoption does or does not occur in specific populations, such as students. OBJECTIVE: This study aims to examine the perceptions of telehealth systems within a large student sample. METHODS: Undergraduate students (N=315) participated in a survey of the perceived advantages and disadvantages of telehealth technologies. The responses to the survey were analyzed using thematic analysis. RESULTS: We found that students were likely to adopt telehealth systems for the following reasons: (1) the system worked efficiently, (2) the convenience of telehealth, and (3) to gain access to health services. Students also perceived several disadvantages to telehealth systems, such as issues of trust (ie, security, privacy), the impersonal nature of telehealth systems, and they were concerned about the potential for major system errors. CONCLUSION: By understanding the current barriers to telehealth adoption in a cohort of students, we can not only better anticipate the future needs of this group, but also incorporate such needs into the design of future telehealth systems.

Can inbound and domestic medical tourism improve your bottom line? Identifying the potential of a U.S. tourism market.

In large part due to current economic conditions and the political uncertainties of healthcare reform legislation, hospitals need to identify new sources of revenue. Two potentially untapped sources are inbound (international) and domestic (within the United States) medical tourists. This case study uses data from a large, urban healthcare system in the southeastern United States to quantify its potential market opportunities for medical tourism. The data were mined from electronic health records, and descriptive frequency analysis was used to provide a preliminary market assessment. This approach permits healthcare systems to move beyond anecdotal information and assess the relative market potential of their particular geographic area and the diagnostic services they offer for attracting inbound and domestic medical tourists. Implications for healthcare executives and guidance on how they can focus marketing efforts are discussed.

The fear factor in healthcare: employee information sharing.

This study looks at employee information sharing among hospitals, a topic that is underresearched, underreported, and under the radar for most healthcare leaders. We initiated the research under the assumption that executives in healthcare are reluctant to share employment reference information about staff beyond the employee's name, dates of employment, and position held. We believed executives take this precaution because they fear being sued by the employee for defamation. However, not obtaining the necessary and critical information to hire a competent employee can open the potential employer up to a negligence lawsuit if it hires someone who jeopardizes the safety of patients or staff. Hence, the hiring organization faces a double-edged sword: On one side, it cannot get the critical information on a potential applicant from the previous employer due to a culture of "fear in sharing" information; on the other side, if it unwittingly hires a poor or dangerous applicant who threatens safety, it runs the risk of a negligence lawsuit for failure to ascertain information before the hire. Prior studies demonstrate that the likelihood of a successful defamation lawsuit is low and information sharing of factual incidents is unlikely to result in successful lawsuits. Why, then, are healthcare executives unwilling to provide comprehensive references when they should be aware that sustaining a culture of silence increases the potential for hiring a bad employee and seriously jeopardizes the security and safety of patients, other staff, and the public? This article's primary contribution to the literature is to offer the first nationwide study to empirically test the current levels of employee information sharing among hospitals. It is also the first study to focus exclusively on healthcare. Furthermore, this research considers factors that might influence executives in their willingness to share employee reference information. The study reveals that a culture of silence is pervasive among hospitals. Although many hospital executives are reluctant to share information, they tend to overestimate the likelihood of being sued (successfully or otherwise) by previous employees for defamation. In addition, this study shows that some hospital executives share negative information about former employees but may do so off the record.

Sustainability and the health care manager: Part II.

Are there additional costs associated with achieving goals of sustainable health care? Will going green enhance or impede financial performance? These are questions that all health care managers should confront, yet there is little evidence to show that health care sustainability is affordable or profitable. This article considers what is presently known and suggests that health care managers use an assessment framework to determine whether they are ready to achieve health care sustainability.

Sustainability and the health care manager: part I.

Given the current operating climate, organizations are coming under pressure to develop and implement sustainability programs and projects, yet few managers truly understand what is meant by sustainability and its implications for managing organizations. This article examines the concept of sustainability and provides a broader definition of the term than going "green." Using a puzzle metaphor, the authors outline and explain the different components of sustainability and provide a checklist for achieving sustainability goals. In addition, resources such as guides and tools are reviewed and offered to assist managers in gaining more insight into the challenges and complexity of sustainability.

Health care globalization: a need for virtual leadership.

As health care organizations expand and move into global markets, they face many leadership challenges, including the difficulty of leading individuals who are geographically dispersed. This article provides global managers with guidelines for leading and motivating individuals or teams from a distance while overcoming the typical challenges that "virtual leaders" and "virtual teams" face: employee isolation, confusion, language barriers, cultural differences, and technological breakdowns. Fortunately, technological advances in communications have provided various methods to accommodate geographically dispersed or "global virtual teams." Health care leaders now have the ability to lead global teams from afar by becoming "virtual leaders" with a responsibility to lead a "virtual team." Three models of globalization presented and discussed are outsourcing of health care services, medical tourism, and telerobotics. These models require global managers to lead virtually, and a positive relationship between the virtual leader and the virtual team member is vital in the success of global health care organizations.

Blogging and the health care manager.

The use of blogs in the workplace has emerged as a communication tool that can rapidly and simultaneously connect managers with their employees, customers, their peers, and other key stakeholders. Nowhere is this connection more critical than in health care, especially because of the uncertainty surrounding health care reform and the need for managers to have access to timely and authentic information. However, most health care managers have been slow to join the blogging bandwagon. This article examines the phenomenon of blogging and offers a list of blogs that every health care manager should read and why. This article also presents a simplified step-by-step process to set up a blog.

Hidden workplace violence: what your nurses may not be telling you.

Violence in the health care workplace is occurring in a covert fashion; it is occurring at the patient bedside. However, data on workplace violence tend to be underreported and relatively scarce. This article identifies and examines the phenomenon of unreported and underreported workplace violence against nursing staff that is virtually hidden. Health care executives need to be attuned to this type of violence because it may significantly affect their ability to recruit and retain nursing staff. This article provides a synthesis of literature and data from health services administration and nursing and human resources, as well as the experience of the first author. Workplace violence in health care is a critical issue that must be addressed from legal, financial, ethical, and human resources management perspectives. It is a problem for staff providing direct care services to patients with Alzheimer disease. This article suggests strategies and offers a framework for meeting the challenges of managing hidden workplace violence. In addition to the more discrete consequences of violence including physical injury, physical disability, trauma, or even death, the complementary organizational effects call for thoughtful managerial planning and critical thinking. Guidelines for preventing and addressing workplace violence in health care organizations are also published by the Occupational Safety and Health Administration.

The retail revolution in health care: Who will win and who will lose?

Retailers are expected to profoundly affect health care delivery by providing an alternative site for basic medical care. Retail health services are described together with their potential impacts on patient's health care providers and payors. This article concludes with implications for health care executives.

E-service learning: A pedagogic innovation for healthcare management education.

This paper proposes an innovation in service learning that we identify as e-service learning. By adding the "e" to service learning, we create a service learning model that is dynamic, mediated by technology, and delivered online. This paper begins by examining service learning, which is a distinct learning concept. Service learning furnishes students with opportunities for applied learning through participation in projects and activities in community organizations. The authors then define and conceptualize e-service learning, including the anticipated outcomes of implementation such as enhanced access, quality, and cost effectiveness of healthcare management education. Because e-service learning is mediated by technology, we identify state of the art technologies that support e-service learning activities. In addition, possible e-service learning projects and activities that may be included in healthcare management courses such as finance, human resources, quality, service management/marketing and strategy are identified. Finally, opportunities for future research are suggested.

Bioterror events: preemptive strategies for healthcare executives.

Today's healthcare executives face challenges that their predecessors have never known: bioterror events. To prepare their organizations to cope with new and emerging strategic threats of bioterrorism, these executives must consider preemptive strategies. The authors present courses of action to assist executives' internal, external, and cross-sectional organizational preparedness. For example, stakeholder groups, internal resources, and competencies that combine and align efforts efficiently are identified. Twelve preemptive strategies are provided to guide healthcare executives in meeting these formidable and unprecedented challenges. The reputation of the healthcare organization (HCO) is at risk if a bioterror event is not properly handled, resulting in severe disadvantages for future operations. Justifiably, healthcare executives are contemplating the value of prioritizing bioterror preparedness, taking into account the immediate realities of decreasing reimbursement, increasing numbers of uninsured patients, and staffing shortages. Resources must be focused on the most valid concerns and must maximize the return on investment. Healthcare organizations can reap the benefits of a win-win approach by optimizing available resources, planning, and training. Bioterror preparedness will transcend the boundaries of bioterrorism and prepare for myriad mass healthcare incidents such as the looming potential for an avian (bird) influenza pandemic.

Evaluating stakeholder management performance using a stakeholder report card: the next step in theory and practice.

In the highly competitive health care environment, the survival of an organization may depend on how well powerful stakeholders are managed. Yet, the existing strategic stakeholder management process does not include evaluation of stakeholder management performance. To address this critical gap, this paper proposes a systematic method for evaluation using a stakeholder report card. An example of a physician report card based on this methodology is presented.

Toward a population health delivery system: first steps in performance measurement.

In spite of the technological sophistication and clinical excellence of the U.S. health care industry and annual health expenditures in excess of a trillion dollars, the overall health status of the American population is comparatively poor. The BCHS in west central Florida sought to improve the health status of the communities that it serves. Known by the acronym CHAPIR, an information-driven health status decision support system was developed, pilot tested, and is now fully implemented throughout the BCHS. The methodological approach, quantitative indicators, report format components, and management implications of the system are described.