Differentiating between average and high-performing public healthcare managers: implications for public sector talent management.

Objective Ensuring sufficient qualified and experienced managers is difficult for public sector healthcare organisations in Australia, with a limited labour market and competition with the private sector for talented staff. Although both competency-based management and talent management have received empirical support in association with individual and organisational performance, there have been few studies exploring these concepts in the public healthcare sector. This study addresses this gap by exploring the perceived differences in demonstration of core competencies between average and higher-performing managers in public sector healthcare organisations. Methods Mixed methods were used to define and measure a set of competencies for health service managers. In addition, supervisors of managers were asked to identify the differences in competence between the average and high-performing managers reporting to them. Results Supervisors could clearly distinguish between average and higher-performing managers and identified related competencies. Conclusions The consistent pattern of competence among community health and hospital public sector managers demonstrated by this study could be used to develop a strategic approach to talent management for the public healthcare sector in Australia. What is known about this topic? Although there are validated competency frameworks for health service managers, they are rarely used in practice in Australia. What does this paper add? This paper illustrates the perceived differences in competencies between top and average health services managers using a validated framework. What are the implications for practitioners? The public health sector could work together to provide a more effective and efficient approach to talent management for public hospitals and community health services.

Examining the role of value congruence, professional identity, and managerial job engagement in the budgetary participation-performance link.

BACKGROUND: In health care, important phenomena of perceived incompatibility between professional and managerial values have emerged as consequences of New Public Management reforms. Although there is a growing evidence on the variation in the enactment of hybrid roles by medical managers, existing research in health care management is mostly descriptive with little emphasis on the conditions under which hybrid roles are enacted and, importantly, on the effects of this variation on performance. PURPOSE: In this article, we seek to fill this research gap by empirically examining (a) whether budgetary participation aligns professional and organizational values, (b) the impact of this alignment on employees' work-related feelings and managerial performance, and (c) the effect of professional identity on value congruence. METHODOLOGY: Data were collected by a survey conducted in an Italian hospital, and partial least square was used to test the relationships among variables. RESULTS: Overall, results show that (a) high involvement in budgeting is instrumental in facilitating medical managers' value congruence, and this, in turn, positively effects managerial job engagement; (b) the effect of budgetary participation on value congruence depends on the extent of professional identity; and (c) as a result of enhanced value congruence and managerial job engagement, employees tend to deliver superior role performance. PRACTICE IMPLICATION: Findings of this study provide some guidance for managers on how organizations can take steps to guarantee effective support to hybrid professionals.

Succession Planning and Perceived Barriers to Achieving Career Optimization Among Health Care Administrators.

Achieving career optimization is especially important for health care administrators working in United States (US) hospitals. Succession planning is a critical and essential process for nurturing future leaders. Succession planning occurs when there is an immediate change in leadership such as when a leader voluntarily or involuntarily vacates a position resulting in substantial loss of organizational knowledge and experience. This descriptive quantitative study fulfilled gaps in knowledge pertaining to the role of succession planning and perceived barriers to achieving career optimization among health care administrators working in US hospitals. Succession planning is imperative to the health care workforce for sustainability.

Does hospital information technology infrastructure promote the implementation of clinical practice guidelines? A multicentre observational study of Japanese hospitals.

OBJECTIVES: It remains unclear whether insufficient information technology (IT) infrastructure in hospitals hinders implementation of clinical practice guidelines (CPGs) and affects healthcare quality. The objectives of this study were to describe the present state of IT infrastructure provided in acute care hospitals across Japan and to investigate its association with healthcare quality. METHODS: A questionnaire survey of hospital administrators was conducted in 2015 to gather information on hospital-level policies and elements of IT infrastructure. The number of positive responses by each respondent to the survey items was tallied. Next, a composite quality indicator (QI) score of hospital adherence to CPGs for perioperative antibiotic prophylaxis was calculated using administrative claims data. Based on this QI score, we performed a chi-squared automatic interaction detection (CHAID) analysis to identify correlates of hospital healthcare quality. The independent variables included hospital size and teaching status in addition to hospital policies and elements of IT infrastructure. RESULTS: Wide variations were observed in the availability of various IT infrastructure elements across hospitals, especially in local area network availability and access to paid evidence databases. The CHAID analysis showed that hospitals with a high level of access to paid databases (p<0.05) and internet (p<0.05) were strongly associated with increased care quality in larger or teaching hospitals. CONCLUSIONS: Hospitals with superior IT infrastructure may provide higher-quality care. This allows clinicians to easily access the latest information on evidence-based medicine and facilitate the dissemination of CPGs. The systematic improvement of hospital IT infrastructure may promote CPG use and narrow the evidence-practice gaps.

The Best of Both Models: Key Components of a Successful Hybrid Project Management Office Model in a Health Care Organization.

Project management (PM) is considered an important competency for improving organizational efficiencies, and its practice is evolving in health care organizations. As a medium-sized health care organization, Ontario Shores Centre for Mental Health Sciences used a hybrid PM office model and created a PM network to connect the small, centralized PM office to the decentralized project leaders. The key components to create the PM network were (1) skilled leader, (2) organizational support, (3) infrastructure, and (4) session content. Membership grew from 12 to 45 members within the first year. The network continues to evolve to meet member and organizational needs.

Understanding the role of physicians within the managerial structure of Russian hospitals.

This article examines the role of physicians within the managerial structure of Russian hospitals. A comparative qualitative methodology with a structured assessment framework is used to conduct case studies that allow for international comparison. The research is exploratory in nature and comprises 63 individual interviews and 49 focus groups with key informants in 15 hospitals, complemented by document analysis. The material was collected between February and April 2017 in five different regions of the Russian Federation. The results reveal three major problems of hospital management in the Russian Federation. First, hospitals exhibit a leaky system of coordination with a lack of structures for horizontal exchange of information within the hospitals (meso-level). Second, at the macro-level, the governance system includes implementation gaps, lacking mechanisms for coordination between hospitals that may reinforce existing inequalities in service provision. Third, there is little evidence of a learning culture, and consequently, a risk that the same mistakes could be made repeatedly. We argue for a new approach to governing hospitals that can guide implementation of structures and processes that allow systematic and coherent coordination within and among Russian hospitals, based on modern approaches to accountability and organisational learning.

An Analysis of Key Challenges Encountered by Various Stakeholders in the Evolving Private Hospital Ecosystem in India.

Private hospitals and medical institutions play an important role in bridging the health care delivery gap in India. In addition to prescribing physicians, various stakeholders such as nurses, pharmacists, and hospital administrators working in these institutions contribute to the efficient delivery of health care services. The current survey was conducted with the aim of evaluating work-related challenges faced by these individual hospital stakeholders and gauging potential engagement opportunities with industry to improve the quality health care services delivered. This survey included 60 private hospitals with more than 250 beds, located in 12 Indian cities. A 2-stage approach involving in-depth qualitative discussions followed by structured quantitative interviews of all the internal stakeholders was adopted. The study delineated the roles assayed by individual hospital stakeholders as well as the major challenges encountered by them. The responses of major classes of hospital workforce on possible solutions to bridge these need gaps were also recorded. The survey identified significant gaps existing in hospitals in areas of cross-functional collaboration, scientific and technical knowledge upgrade, training of staff, and communication and coordination with internal and external stakeholders. Value-based hospital-industry partnerships can go a long way in addressing the scientific and training needs of private hospitals.

Greek hospital environments.

PURPOSE: The purpose of this paper is three-fold: first, to assess nurse satisfaction levels with working environment (known as favourability) in five Greek public hospitals using the practice environment scale (PES); second, to compare perceptions among nurses employed in surgical and medical departments; and third, to examine relationships between perceptions and nurse educational level and experience. DESIGN/METHODOLOGY/APPROACH: In total, 532 nurses from five major public hospitals in Greece completed the PES. Descriptive statistics, t-tests and Spearman correlations were employed to analyse the data. FINDINGS: Nurses perceived their work settings as unfavourable in all five hospitals, with collegial nurse-physician relations emerging as the only positive factor. Compared to medical wards, surgical departments emerged as slightly more positive working environments. Work department notwithstanding, in some cases, education and experience levels affected their perceptions on management, poor care quality, limited nurse involvement in hospital affairs and nursing shortage. PRACTICAL IMPLICATIONS: Hospital managers do not provide sufficient support for Greek nurses in their working environments. ORIGINALITY/VALUE: The authors attempted to evaluate nursing practice environments in Greek hospitals, viewed from nurse perspectives. The authors identified insufficient support for nurses' working in these hospitals.

Hospital Responses to Mortality Measures: A Survey of Hospital Administrative Leaders.

BACKGROUND: Standardized hospital mortality ratios (SHMRs) are widely used for quality improvement, hospital ratings, and health care payment. OBJECTIVES: (1) To characterize the programs implemented at hospitals in response to SHMRs.(2) To describe hospital leaders' perceptions of SHMRs as indicators of care quality. METHODS: Electronic survey of administrative leaders at US academic medical centers who subscribed to Vizient leadership networks. RESULTS: Forty-seven administrative leaders from 37 US academic medical centers completed the survey. Respondents reported that SHMRs had the largest role in the decision to implement inpatient hospice programs, electronic early warning systems, and clinical documentation specialist programs at their institution. Respondents perceived clinical documentation specialist programs and condition-specific care pathways as the most effective programs to improve performance on SHMRs. Only 29% of respondents agreed that SHMRs accurately reflect the number of preventable deaths in hospitals, but 78% agreed that SHMRs have helped their hospital reduce preventable deaths. CONCLUSIONS: Hospitals have employed various strategies in response to SHMRs-including clinical programs that focus on reducing preventable deaths and other programs that target improvement in SHMR performance without reducing preventable deaths. Hospital administrative leaders identify significant benefits and flaws of SHMRs as quality indicators.

Health literacy of commercial industry managers: an exploratory qualitative study in Germany.

Managers have been neglected in health literacy research. There still is little known about the health-literacy status and needs of commercial industry managers. This article reduces the existing knowledge gap by presenting findings of an exploratory qualitative study. We conducted 23 separate semi-structured interviews of managers from all management levels (low, middle and top) and experts in the field of health management and/or personnel management. The qualitative interviews were analysed according to Mayring's content analytic approach using MAXQDA. The findings indicate that managers do have considerable information levels about existing health topics and relevant problems but have difficulties of discernment as to which sources of information can be activated or accessed in a timely fashion due to work and information overload. Even those who devise strategies often fail in implementing health-literate behavior. Experts and managers had fairly consistent views on the importance of health literacy among managers. Most agreed that mental health was neglected and that company conditions were important in influencing the ability to act in a way that promoted health literacy. The findings also show that strengthening of managerial self-perception, self-regulation and self-control, raising awareness and ability to take personal responsibility for one's own health, developing skills in handling large amounts of information and fostering open and trusting communication are all essential.

Effective quality systems: implementation in Australian public hospitals.

PURPOSE: The purpose of this paper is to review the implementation of seven components of quality systems (QSs) linked with quality improvement in a sample of Australian hospitals. DESIGN/METHODOLOGY/APPROACH: The authors completed a systematic review to identify QS components associated with measureable quality improvement. Using mixed methods, the authors then reviewed the current state of these QS components in a sample of eight Australian hospitals. FINDINGS: The literature review identified seven essential QS components. Both the self-evaluation and focus group data suggested that none of the hospitals had all of these seven components in place, and that there were some implementation issues with those components that were in use. Although board and senior executives could point to a large number of quality and safety documents that they felt were supporting a vision and framework for safe, high-quality care, middle managers and clinical staff described the QSs as compliance driven and largely irrelevant to their daily pursuit of safe, high-quality care. The authors also found little specific training in quality improvement for staff, lack of useful data for clinicians on the quality of care they provide and confusion about how organisational QSs work. PRACTICAL IMPLICATIONS: This study provides a clearer picture of why QSs are not yet achieving the results that boards and executives want to achieve, and that patients require. ORIGINALITY/VALUE: This is the first study to explore the implementation of QSs in hospitals in-depth from the perspective of hospital staff, linking the findings to the implementation of QS component identified in the literature.

What are the motivating and hindering factors for health professionals to undertake new roles in hospitals? A study among physicians, nurses and managers looking at breast cancer and acute myocardial infarction care in nine countries.

BACKGROUND: Many European countries experience health workforce skill-mix changes due to population ageing, multimorbidity and medical technology. Yet, there is limited cross-country research in hospitals. METHODS: Cross-sectional, observational study on staff role changes and contributing factors in nine European countries. Survey of physicians, nurses and managers (n = 1524) in 112 hospitals treating patients with breast cancer or acute myocardial infarction. Group differences were analysed across country clusters (skill-mix reform countries [England, Scotland and the Netherlands] versus no reform countries [Czech Republic, Germany, Italy, Norway, Poland and Turkey]) and stratified by physicians, nurses and managers, using Chi-squared, Mann-Whitney U and Kruskal Wallis tests. RESULTS: Nurses in countries with major skill-mix reforms reported more frequently being motivated to undertake a new role (66.5%) and having the opportunity to do so (52.4%), compared to nurses in countries with no reforms (39.2%; 24.8%; p < .001 each). Physicians and nurses considered intrinsic motivating factors (personal satisfaction, use of qualifications) more motivating than extrinsic factors (salary, career opportunities). Reported barriers were workforce shortages, facilitators were professional and management support. Managers' recruitment decisions on choice of staff were mainly influenced by skills, competences and experience of staff. CONCLUSION: Managers need to know the motivational factors of their employees and enabling versus hindering factors within their organisations to govern change effectively.

Medical authority, managerial power and political will: A Bourdieusian analysis of antibiotics in the hospital.

Antibiotic resistance poses a significant global threat, yet clinically inappropriate antibiotic use within hospitals continues despite the implementation of abatement strategies. Antibiotic use and the viability of existing antibiotic options now sit precariously at the nexus of political will, institutional governance and clinical priorities 'at the bedside'. Yet no study has hitherto explored the perspectives of managers, instead of focusing on clinicians. In this article, drawing on qualitative interviews with hospital managers, we explore accounts of responding to antimicrobial resistance, managing antibiotic governance and negotiating clinical and managerial priorities. We argue that the managers' accounts articulate the problematic nexus of measurement and accountability, the downflow effects of political will, and core tensions within the hospital between moral, managerial and medical authority. We apply Bourdieu's theory of practice to argue that an understanding of the logics of practice within the 'hospital management classes' will be critical in efforts to protect antibiotics for future generations.

Partnering to develop a talent pipeline for emerging health leaders in operations research.

In initiating its first central office for Quality Improvement (QI), The Scarborough Hospital (TSH) sought to accelerate momentum towards achieving its "Quality and Sustainability" strategic priority by building internal capacity in the emerging QI specialty of operations research. The Scarborough Hospital reviewed existing models of talent management in conjunction with Lean and improvement philosophies. Through simple guiding principles and in collaboration with the University of Toronto's Centre for Healthcare Engineering, TSH developed a targeted approach to talent management for Operations Research (OR) in the Office of Innovation and Performance Improvement, reduced the time from staffing need to onboarding, accelerated the development of new staff in delivering QI and OR projects, and defined new structures and processes to retain and develop this group of new emerging health leaders.

Ineffective Healthcare Technology Management in Benin's Public Health Sector: The Perceptions of Key Actors and Their Ability to Address the Main Problems.

BACKGROUND: Low-income countries face many contextual challenges to manage healthcare technologies effectively, as the majority are imported and resources are constrained to a greater extent. Previous healthcare technology management (HTM) policies in Benin have failed to produce better quality of care for the population and costeffectiveness for the government. This study aims to identify and assess the main problems facing HTM in Benin's public health sector, as well as the ability of key actors within the sector to address these problems. METHODS: We conducted 2 surveys in 117 selected health facilities. The first survey was based on 377 questionnaires and 259 interviews, and the second involved observation and group interviews at health facilities. The Temple-Bird Healthcare Technology Package System (TBHTPS), tailored to the context of Benin's health system, was used as a conceptual framework. RESULTS: The findings of the first survey show that 85% of key actors in Benin's HTM sector characterized the system as failing in components of the TBHTPS framework. Biomedical, clinical, healthcare technology engineers and technicians perceived problems most severely, followed by users of equipment, managers and hospital directors, international organization officers, local and foreign suppliers, and finally policy-makers, planners and administrators at the Ministry of Health (MoH). The 5 most important challenges to be addressed are policy, strategic management and planning, and technology needs assessment and selection - categorized as major enabling inputs (MEI) in HTM by the TBHTPS framework - and installation and commissioning, training and skill development and procurement, which are import and use activities (IUA). The ability of each key actor to address these problems (the degree of political or administrative power they possess) was inversely proportional to their perception of the severity of the problems. Observational data gathered during site visits described a different set of challenges including maintenance and repair, distribution, installation and commissioning, use and training and personnel skill development. CONCLUSION: The lack of experiential and technical knowledge in policy development processes could underpin many of the continuing problems in Benin's HTM system. Before solutions can be devised to these problems, it is necessary to investigate their root causes, and which problems are most amenable to policy development.

Alignment between physicians and hospital administrators: historical perspective and future directions.

Unfortunately, the working relationship between physicians and hospital administrators is often not congruent and can even become contentious, resulting in antagonism across many Healthcare Organizations (HCOs). This treatise provides a broad, literature-based, descriptive overview in an evolving historical context, coupled with observations based on extensive professional experience. It highlights the root causes of the nonalignment between physicians and hospital administrators. Most importantly, this manuscript proposes a framework for short and long-term solutions toward a more cohesive and collaborative team approach, based on understanding the respective roles, as well as the strengths, and contributions of the two groups.