Volume 7 (2022-23)

Each volume of Management in Healthcare consists of four quarterly 100-page issues. 

The Articles published in Volume 7:

  • Volume 7 Number 4
    • Editorial
      Simon Beckett
    • Papers
      Scaling innovative solutions during times of transformation
      Marque Macon, VP and Administrator of Ambulatory Operations and Provider Services at Inova Health System

      Atrium Health is a nationally recognised leader in shaping health outcomes through innovative research, education and compassionate patient care. As the health system experiences rapid growth with a larger geographical footprint owing to multiple strategic combinations, it has identified and designed an organisational structure that strategically drives systemic change and creates buy-in for integrated, large-scale value-based initiatives. The population health division effectively applies population health data and analytics to formulate a strategy to address health-care disparities, identify community needs and provide access to high-quality care.
      Keywords: population health; value-based care; system change; care management.

    • The Bias Time Out: A practical tool for advancing DEIB in the healthcare space
      Gina Calder, President, BJC HealthCare et al

      ‘I know my own mind. I am able to assess others in a fair and accurate way’. In the book Blindspot: Hidden Biases of Good People, the authors (Banaji and Greenwald) challenge us to accept the reality that bias is universal (Banaji, M. R., Greenwald, A. G., (2013), ‘Blindspot: Hidden Biases of Good People’, Delacorte Press, Excerpt on book cover, 272 pp). Even when fully aware of our biases, they cannot be eliminated. This paper posits that the focus is less about eliminating bias and more about increasing self-awareness and learning about ourselves and the biases we hold but cannot see. Addressing negative bias in healthcare is about adapting our behaviours and decisions to minimise and control the harmful consequences of bias. In this paper, the authors provide examples and scenarios demonstrating bias and strategies to increase self-awareness and focus on behaviours, institutional practices, policies, systems and structures that perpetuate and reinforce bias and its adverse effects. They discuss how to mitigate and manage these biases by utilising the Bias Time Out. The Bias Time Out is a framework that provides a stepwise method that lends itself to easy adoption, application and translation while establishing a process to manage and control bias in real time. Healthcare organisations, systems and oversight bodies all play an important and central role in improving and transforming health, equity and the lives of patients, communities and the nation. Recognising and accepting this role is crucial in managing the negative and deleterious outcomes of bias and the structural and institutional forms of discrimination lurking just beneath the surface.
      Keywords: bias; healthcare; equity; inclusion; time out; induction

    • Establishment of an innovation centre within an Irish acute hospital
      Natalie Cole, Head of Innovation at Tallaght University Hospital, Dublin, et al

      This paper explores the creation of a healthcare innovation centre, Innovate Health, in a large teaching hospital, Tallaght University Hospital (TUH), from inception to implementation. It sets the context in terms of Health Innovation globally as well as the Irish Health Innovation ecosystem and shares the roadmap for the development of an innovation centre such as Innovate Health. Innovate Health strives to provide a ‘one-stop shop’ for innovation in TUH. This supports and fosters frontline healthcare staff ideas in the organisation to come forward for assistance in development and scaling. It also provides a dedicated point of entry for industry with innovative solutions and products to engage with the hospital for scoping and co-development, and to act as a potential test bed or early adopter. The authors identify opportunities and barriers to the development of innovation and describe the approach taken to break down the work plan into five workstreams: governance, culture and awareness, developing partnerships, funding and awards, and development of a pipeline of innovation projects. Benchmarking and the use of the ISO 56000 scorecard were found to be beneficial in providing targeted areas for improvement and monitoring advances of innovation within the organisation. The paper concludes with some broad recommendations for others embarking on this journey or interested in replicating a model similar to Innovate Health at Tallaght University Hospital.
      Keywords: Healthcare; Innovation; Acute Hospital.

    • Importance of staff engagement in a post-COVID-19 world
      Michael Tsang, Director of Operations, Rusk Rehabilitation

      Healthcare workers are the backbone of any medical system and are vital to healthcare delivery and the patient experience. Although more than two years removed from the height of COVID-19, the reverberation set in motion will be felt for years, possibly decades, to come. The pandemic has taken a heavy toll on healthcare teams who have been on the front lines of the pandemic, with many suffering from stress, trauma, burnout and increased behavioural health challenges. Systems have negotiated staffing shortages and the mental health of their workforce and have also redefined diversity. A 2021 Washington Post-Kaiser Family Foundation survey found that nearly 30 per cent of healthcare workers are considering leaving their profession altogether, and nearly 60 per cent reported adverse effects of their work on their mental health during the pandemic. Central to these struggles is the complex task of re-engaging a workforce that has largely been fragmented and isolated and recovering personally and professionally from the most devastating pandemic since 1918. It is incumbent on all healthcare leaders to prioritise staff engagement to ensure that a gap in healthcare delivery is not experienced. There are practical ways to accomplish this, most of which are initiated by leadership being available and prompt in their interactions with staff. Importance of staff engagement in a post-COVID-19 world.
      Keywords: engagement; staff; COVID; wellness; culture

    • Improving healthcare access and availability with matching of care
      Catharina Wingner Leifland Lecturer and Researcher in Health Management, Lund University and Lars Nordgren, Professor in Health Management at Halmstad University, Sweden

      The purpose of this study was to contribute to the development of a model including parameters for matching health-care services to patients. Inspired by ‘engaged scholarship’, the researchers practised continuous and close collaboration with practitioners at Region Skane in Sweden. The agenda was based on questions and experiences that evolved from theory and experience gained during previous research, while the practitioners’ agenda was based on problems and solutions arising within the organisation. As a result, mutual interpretations and concept creation were created and thus also the exchange of knowledge, information and competence between researchers and practitioners. The thoughts concerning the parameters included in a matching model emerged during meetings. The supportive data was conceptualised, converted and incorporated into an array of parameters illustrating coordination and matching in healthcare. T he healthcare matching concept, meaning a specified form of coordination, was applied as the main concept in the study. One contribution regarded how the coordination of health-care services occurs in Region Skane. An additional contribution was a discussion about which parameters are essential to include in the development of a matching model. Finally, there was a consideration concerning what kind of social values the matching model created. A fruitful way of implementing a matching model in healthcare is making use of a pilot project at a smaller organisation in a Swedish region.
      Keywords: coordination; healthcare; matching; parameters; Sweden; value-creating service

    • Technology in leading and maintaining organisational change
      Amanda Trask, the national leader for clinical institutes, clinical service lines and community research services, CommonSpirit Health, et al

    • In the pandemic and post-pandemic environment, the shift in patient care needs alongside physician and advanced practice provider burnout and staffing challenges has heightened the need for health-system-driven solutions for both temporary and intermittent physician and advanced practice provider staffing solutions. The solution must not simply be a staffing solution but must also meet quality of care delivery, cultural alignment and cost standardisations. This transformation requires technological and adaptive processes to achieve a sustainable solution. Patients need high-quality, consistent care, and health systems need reliable transformations. During a time of ministry alignment and pandemic adaptations, CommonSpirit Health leadership implemented a technological solution alongside adaptive changes to achieve such a transformation. This paper illustrates a process that has endured a pandemic and demonstrates the importance of technology and adaptive transformation in leading and maintaining organisational change.
      Keywords: physician staffing; locums; technology; innovation; adaptive; transformation; advanced practice provider

    • Creating value in patient-centred care by aligning the supply chain with service provision: Experiences with RITMOCORE
      Sofía Moreno-Pérez Sofía Moreno Pérez is a founding partner at VALDE Innova et al

      An ageing European population translates into a steady growth in the demand for pacemakers. Budgetary constraints in healthcare systems call for innovative solutions to meet this rising demand while safeguarding the quality of care. The current approach generally consists in reducing the price per device by aggregating buys, but this creates a misalignment in the value chains of suppliers and healthcare providers. Clinicians, already overworked, do not have access to technologies that could significantly decrease the time required per patient in the follow-up stages of the care pathway. Patients, on the other hand, receive lower-quality follow-up in a care pathway that is already fragmented and where general practitioners lack the necessary information to provide them with comprehensive care. RITMOCORE, a Public Procurement of Innovation (PPI) project funded by the European Union under Horizon2020, was set up in 2016 to transform the care pathway of patients suffering from bradycardias and implanted with a pacemaker. The model proposed by RITMOCORE posits a shift from buying devices to buying services, where payments are outcome based (thus distributing the risk between the parties) and where services are supported by advanced information and communications technology (ICT) systems that make remote monitoring possible.
      Keywords: value-based healthcare; risk-sharing procurement contracts; innovation procurement; remote monitoring

  • Volume 7 Number 3

    • Editorial
      Simon Beckett
    • Papers
      Scaling innovative solutions during times of transformation
      Sanjeev Agrawal, President and COO and Jonathan Turner, Product Implementation Manager, LeanTaaS

      Operating at optimal capacity is more critical than ever for hospitals and health systems. Sophisticated capacity management allows healthcare organisations to create the right availability in intensive care units (ICU) and floor units, meet demand for elective surgeries and infusion treatments in a timely way, and adjust staff and nursing rosters nimbly to avoid burnout. But why are health systems so challenged to address these issues now, let alone during crises? In healthcare, the foundational math of capacity management, matching supply with demand and linking multiple services, is largely broken. This paper discusses how the healthcare industry can learn much from the successes other industries have achieved in these areas. It will, however, require fundamentally revamping existing tools and processes for health systems not only to overcome capacity shocks like future COVID-19 surges but also to maximise the use of existing assets and create value for patients and the organisation. Essential to delivering value-based care in today’s dynamic environment is deploying proven and scalable AI-driven, virtual and distributed systems and creating an organisational culture of innovation that embraces the change. Hundreds of health systems across the USA have already adopted digital transformation solutions that empower them to make real-time capacity optimisation decisions. Results include an 8 per cent decrease in opportunity days (difference between Med/Surg LOS & CMS LOS), US$500,000 more revenue earned per operating room (OR) per year, and significantly decreased patient wait times and increased patient volumes for infusion centres.
      Keywords: Digital healthcare; healthcare delivery and systems; transformation; administration and operations; capacity management; throughput; lean

    • Development and deployment of a new operating model: A framework to engage leaders and align them with execution
      Brian Sweeney, President and COO, Jefferson Health

      Healthcare systems are complex organisations. Therefore, well-defined systems and processes are necessary to achieve and sustain desired quality, safety, patient experience and financial outcomes. Success depends on aligning members of the workforce, producing robust action plans and creating a culture of accountability. These aims can be accomplished by use of an operating model that organises daily work and coordinates the completion of priorities via an annual operating plan. In that model, an operational excellence team — built on existing resources — identifies and manages important projects and initiatives. Their focus is to develop standardised, templated project plans, support project teams through execution and organise regular performance reviews with senior executives to monitor important performance indicators and act upon barriers or project vulnerabilities. Such a simple, low-cost, structured approach is used to engage leaders, initiate change and create a high-performing organisational culture. This model was developed and deployed across an operating division of Jefferson Health, an 18-hospital health system with US$10bn in annual revenue, to accelerate transformation. This paper, in a case study format, details the framework, tactics, results and learning through implementation.
      Keywords: operating model; operational excellence; operating plan; leadership execution; management accountability; project management; process improvement; integration

    • The value of perioperative surgical home: How scaling a PSH improved surgeon engagement and saved one US hospital up to US$12m in just one year
      Rob M. Shakar, Corporate Medical Director, North American Partners in Anesthesiology (NAPA), and Chief of Perianesthesia Care, New Hanover Regional Medical Center and Grant Rush, Vice President, Cardiovascular and Surgical Services, Novant Health

      Perioperative value is the foundation of value-based care delivery. The era of bundled payment models demands standardisation and reliability in perioperative services — which account for 45–60 per cent of a hospital’s expenses — yet many hospitals struggle with high variability in surgical processes, outcomes and costs. Perioperative Surgical Home (PSH) offers an evidence-based strategy to reduce variability and optimise cost-effective patient experiences by aligning multiple specialties in a patient-centred episode of care. Anaesthesiologists, who interface with patients, surgeons, medical staff and hospital administrators, are well positioned to develop and implement a PSH programme in both inpatient and outpatient settings. This paper describes how Novant Health New Hanover Regional Medical Center (NHRMC) developed a pilot PSH programme in orthopaedics that produced outstanding clinical and financial outcomes, inspiring the hospital to expand PSH to 17 service lines. From inception, a co-management agreement structured on an independent valuation motivated and rewarded stakeholders, including physician anaesthesiologists, surgeons and administrators, to build the PSH and participate in standardising protocols. PSH has since produced millions of dollars in annual cost savings and better clinical outcomes, as well as increased surgeon and patient satisfaction.
      Keywords: patient safety; value; perioperative; ERAS; enhanced recovery after surgery; hospital safety; operational efficiencies; value-based care; standardisation

    • Medical University of South Carolina case study: A structured approach to improving quality metrics for achieving maximum pay-for-performance incentive payments
      Danielle Bowen Scheurer, Chief Quality Officer, Medical University of South Carolina, et al.

      To get healthcare costs under control and ‘bend the cost curve’, the Centers for Medicare & Medicaid Services is driving a shift from the fee-for-service (FFS) reimbursement model, which rewards quantity over quality, to value-based care payment models that encourage efficient delivery of high-quality, lower-cost care. Commercial payers are also shifting away from FFS and tying payment to quality metric scores and performance. The Medical University of South Carolina (MUSC) participates in one of the state’s largest pay-for-performance (P4P) initiatives. The payer uses a scorecard that assigns points, associated with incentive dollars, for meeting or exceeding benchmarks in publicly reported quality metrics. In late 2020, MUSC and ECG Management Consultants partnered to assess MUSC’s flagship hospital performance, analysing historical scorecard performance and improvement opportunities. MUSC’s biggest challenges included clinical practice variation, data accessibility and competing priorities, particularly during the COVID-19 pandemic. The hospital was leaving money on the table for process and outcomes measures for harm avoidance and patient safety, unplanned readmissions and appropriate use of emergency department and outpatient cardiac imaging. To overcome quality improvement (QI) barriers, multidisciplinary workgroups were established for each of the focus areas. Workgroup participants used MUSC’s IMPROVE methodology, incorporating Lean, Six Sigma and continuous process improvement best practices to effect change. From this foundational, structured QI approach — focused on a select group of metrics — MUSC is projected to earn US$11.6m in incentives between fiscal years 2023 and 2025, while improving clinical outcomes and patient safety. MUSC will apply the critical success factors and lessons learned to other QI opportunities across the entire MUSC Health system as the organisation strives to reduce process and outcome variability. Hospitals and health systems that engage in efforts similar to those undertaken in the ECGMUSC collaboration can build a foundation of strong QI capabilities and realise improved incentive payment dollars under P4P arrangements.
      Keywords: pay for performance; quality metrics; performance improvement; incentive payment; clinical outcomes; value-based care

    • The role of sponsorship in developing diverse leadership talent
      Diane L. Dixon, Managing Principal, D. Dixon & Associates and Brett D. Lee, President, Texas Health Hospital Frisco

      The business case for greater leadership diversity in healthcare executive positions is well documented. Many healthcare organisations recognise its importance and are working towards achieving specific diversity, equity and inclusion goals as part of their overall strategic plans. However, there continues to be a significant gap between the executive leadership diversity and the diversity of the populations that many healthcare organisations serve. Sponsorship can play a valuable role in developing diverse leadership talent. Sponsorship is often confused with mentorship, and while these leadership development practices are related, they are distinct. Sponsorship is an investment in actively advocating for the career advancement of high-potential talent. It goes beyond providing guidance and support and sharing knowledge, which are common features in mentorship. Sponsors provide or recommend sponsored talent for challenging assignments, high-visibility projects, connections to networks and other powerful executives who can facilitate their career advancement. Racial/ethnic and indigenous professionals and other traditionally underrepresented and marginalised groups may be overlooked in the talent development pipeline for executive-level positions, as they may not be included in traditional talent development pools. A formal sponsorship programme with a specific focus on identifying and advancing diverse leadership talent can assist organisations in identifying high-potential individuals in these historically marginalised groups. As healthcare organisations work to become more inclusive and meet the needs of diverse populations, sponsorship of diverse high-potential talent can play an important role in increasing executive diversity.
      Keywords: sponsorship; diverse leadership talent; diversity; equity and inclusion (DEI); leadership diversity; advancement

    • Stanford Medicine Partners journey in creating an IDHE strategic plan
      Rochelle Noone, Vice President, Stanford Medicine Partners and Michael O’Connell, Interim Chief Operating Officer, RWJBarnabas Health Medical Group

      Inclusion, Diversity, and Health Equity (IDHE) are important strategies that healthcare organisations must address to ensure that the communities they serve are heard, well represented and cared for in the most appropriate way. At Stanford Medicine Partners (SMP), a medical foundation founded by Stanford University School of Medicine and Stanford Health Care (SHC), we embraced and committed to having a diverse workforce through creation of a culture of inclusion, professional fulfilment and respect. In caring for a diverse population throughout the San Francisco Bay Area, we are unified by excellence as the standard of care, and, together, we are healing humanity through science and compassion one patient at a time. We recognised the importance of creating a clear roadmap and development of a strategic plan to set the foundation, practical vision and strategies needed to advance IDHE initiatives. This paper will share our strategies of elevating IDHE as a Strategic Priority; Positioning the Organisation as an IDHE Thought Partner; Investing in Our People; and Measuring for Accountability and Success and in Creating New Ways to Seek a Balanced Input on Solving IDHE Matters and Developing Mechanisms to Measure the IDHE Culture. These four strategies have guided us in co-creating an action plan with specific measurable accomplishments related to each strategy. Learnings have centred around developing progressive, inclusive processes; advancing continuous, comprehensive learning and development; providing effective and meaningful IDHE events and activities; implementing an IDHE dashboard tool; creating IDHE leadership programmes for under-represented staff; and forming strategic partnerships to address medical disparities. And we have seen the value and benefit of incorporating diversity, equity and inclusion into the organisation’s values through a creative strategic planning process and three-year plan.
      Keywords: inclusion; diversity; health equity; strategic planning; culture; respect

    • Harnessing our greatest asset: Solving margin issues by investing in frontline leaders
      Tim Alba, Partner, Caldwell Butler & Associates and Mark F. Slyter, President and CEO, Dignity Health Arizona East Valley Market

      The rate of change in combination with the scope and magnitude and the need for increased efficacy in healthcare operations are on the rise, especially with the advent of a plethora of patient needs in the post-COVID-19 world. Senior leaders in the field are faced with various operational and financial challenges on account of the new and rapidly rising patient requirements in the healthcare sector, and, instead of optimising existing resources to meet current challenges, they are often persuaded to just add on new programmes, leaving the existing programmes to languish. Thus, to circumvent some of the major issues in healthcare operations, a more effective strategy has to be pursued than the usual one of simply buying and implementing a new productivity system with updated targets or performance benchmarks. The solution is to assess the efficacy and profitability of existing improvement programmes and resources in the advent of a new set of requirements: deploying burst versus incremental improvement; engaging middle managers to enable their solutions; and achieving organisation speed, spread and scalability across the organisation [Caldwell, C., Cook, K., (2020), ‘Achieving speed, spread, scalability, and sustainability in health systems’, American College of Healthcare Executives-Cluster Session, Clearwater, FL, 17–20th January]. This paper describes how Dignity Health East Valley was able to optimise the use of existing performance improvement resources and deploy an accelerated improvement structure to achieve rapid gains, followed by incremental improvement to both sustain and further the gains made. The approach included mentoring middle managers to become adaptive change agents and achieve 5 per cent improvement in margins in six months. The burst method described in this paper is based on the findings from the research undertaken by top-performing hospitals that identified five essential characteristics that healthcare’s frontline leaders are expected to possess and which are a clear mark of their leadership skills and competence [Caldwell, C., Cook, K., (2020), ‘Achieving speed, spread, scalability, and sustainability in health systems’, American College of Healthcare Executives-Cluster Session, Clearwater, FL, 17–20th January]. The paper presents the background to this research as well as the structure that builds these top-performer capabilities in the front-line team in order for them to lead change and drive its implementation. The positive results that emerged from the leadership training provided to frontline leaders are substantial, including improved margin, higher patient experience and higher employee engagement.
      Keywords: leadership development; margin improvement; accountability; change leadership; process improvement

    Volume 7 Number 2

    • Editorial
      Simon Beckett
    • Papers
      Advancing change agility in healthcare
      Wei (Sophia) Chen, Senior Health Systems Engineer, Strategy Department, Christa Y. Leung, Senior Principal Health Systems Engineer, Strategy Department and Janine R. (Coelho) Kamath, Executive Director, Mayo Clinic International, Mayo Clinic

      Agility has been adopted in the software development industry for decades and has been used in the business world for the past 10 years. In healthcare, however, agility has not been widely adopted or studied but is emerging as imperative for competitive advantage in a rapidly changing environment. Human-centred agility and change in the wake of the COVID-19 pandemic has become especially important. Change agility is composed of two aspects. While the first aspect is a mindset that embraces change, resiliency, flexibility and responsiveness to consumer needs, the second is an approach using collaborative efforts through self-organising teams. Healthcare organisations must adopt both aspects to leverage the collective value of change agility. To help staff embrace and develop a change agility mindset, healthcare organisations need to offer relevant educational courses and coaching; teach change agility principles and values by using case studies and real-life applications; and promote the right culture by building flexible systems, providing a safe learning environment and encouraging risk-taking. To grow and sustain change agility, healthcare organisations can benefit by using a continuous seven-step quest: examining the current state, defining the future state, assessing the gaps, developing strategies, executing the strategies, measuring progress and maintaining success. This paper addresses the strategy and iterative interventions developed by the Department of Management Engineering and Consulting (renamed the Strategy Department) at Mayo Clinic to prepare its professional staff to drive a business-focused, change agility mindset through benchmarking, education and experiential learning. The early experiences and lessons learned at Mayo Clinic in change agility are likely broadly transferable to other healthcare organisations.
      Keywords: agility; change; diverse; healthcare; iterative; mindset

    • Strategic adoption trends for automation across the revenue cycle
      Amy Raymond, Vice President of Revenue Cycle Operations, AKASA

      This paper analyses how, while many healthcare organisations are automating portions of the revenue cycle today, there is significant variation in the breadth and depth of automation technology deployed. While robotic process automation (RPA) is helpful, it also has limitations that are easily addressed by more advanced technology, namely artificial intelligence (AI) and machine learning (ML). Identifying best practices for the strategic adoption of advanced revenue cycle automation can help organisations leverage lean processes that reduce the cost to collect, promote strategic customer service tactics and redeploy employees to higher-value tasks that improve the overall patient financial experience.
      Keywords: revenue cycle management; RCM; revenue cycle automation; artificial intelligence; machine learning; robotic process automation; patient financial experience

    • Adaptive strategy for high-acuity home-based healthcare delivery
      Phil Mitchell, Chief Medical Officer, DispatchHealth and Christi McCarren, Senior Vice President, MultiCare Health System

      Patient care is rapidly shifting into the home. Based on a survey of physicians who serve predominantly Medicare fee-for-service (FFS) and Medicare Advantage (MA) patients, the global management consulting firm McKinsey and Company estimates that approximately 25 per cent (or US$265 billion) [Bestsennyy, O., Chmielewski, M., Koffel, A., Shah, A. and McKinsey and Company, (2022), ‘From facility to home: How healthcare could shift by 2025’, 1st February, available at: https://www.mckinsey.com/industries/healthcare-systems-and-services/our-... (accessed 5th August, 2022)] of the total cost of patient care could shift to the home. This shift is being propelled by payers, an ageing population, consumer preference and technological innovation. Payers have realised the cost savings opportunity of treating patients in the home. This is evidenced by large payer organisations investing in resources internally and externally in organisations that are elevating the acuity of care in the home. With approximately 10,000 Americans [United States Census Bureau, (2019), ‘By 2030, all Baby Boomers will be age 65 or older’, 10th December, available at: https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-... (accessed 5th August, 2022)] ageing into Medicare every day and seniors preferring to receive care in the home, the market will continue to grow for years to come. Improvements in both the capability and cost of technology are helping to enable higher acuity care to be performed in the home. The pandemic accelerated the movement by compelling CMS to institute the hospital at home waiver, spurring significant investment in high-acuity home care platforms, increasing payer openness to reimburse for high-acuity home care services, and increasing provider and patient comfort with these care options and associated technology, as patients avoided traditional healthcare facilities early in the pandemic. This paper discusses how healthcare systems such as MultiCare are looking to innovate and improve health outcomes for patients in the location where they want it most.
      Keywords: value-based care; healthcare at home; patient satisfaction; hospital level care at home

    • Look to the past to improve our future: Improving quality, safety and equity through community and patient engagement
      Knitasha V. Washington, President and CEO, ATW Health Solutions, et al.

      Healthcare administrators must ensure delivery of care that is high quality, safe and produces equitable outcomes while balancing business, workforce and community needs. To meet these challenges while guiding their organisations through COVID-19 recovery, administrators can look to a strategy with a strong track record for success: engaging patients, families and communities. This paper focuses on evidence, experience and best practices for improving quality, safety and equity by engaging people, patients, families and communities. Effective patient and family engagement (PFE) and community engagement strategies draw on research and experience across a wide variety of efforts, from nationwide federal programmes such as the Centers for Medicare and Medicaid Services Partnership for Patients initiative to health system- and neighbourhood-level programmes. Research demonstrates that commitment to PFE leads to measurable improvements in quality and safety. Experience shows that engagement, when practiced with attention to diversity, equity and inclusion, can reduce health disparities. Engagement best practices include: making engagement a strategic priority, embedding patients and families with diverse perspectives into improvement efforts, supporting continuous learning by adapting engagement efforts over time, benchmarking progress and measuring disparities. To continue the advances begun before the pandemic, healthcare administrators and leaders must redouble engagement efforts and implement best practices. Administrators can meet the many challenges of the moment by returning to the proven strategy of engaging patients, families and communities to drive integrated quality, safety and equity efforts.
      Keywords: quality; safety; equity; patient and family engagement; community engagement; improvement; high-reliability organisation; HRO

    • A framework for successfully navigating a series of unfortunate events
      Myra W. Norton, President and CEO, Arena and William G. ‘Bill’ Robertson, Chief Executive Officer, MultiCare Health System

      The effects of the ongoing COVID-19 pandemic, coupled with a staffing crisis and looming macroeconomic shifts, have created a climate of fear, uncertainty and doubt among healthcare professionals, the likes of which we have not seen in generations. In order to navigate these troubled waters while still providing the highest levels of patient care, healthcare organisations must take a diligent, thoughtful and multifaceted approach that balances short-term needs with long-term strategic goals. The strategic steps taken by MultiCare Health System and Arena Analytics amid the COVID strain and labour shortages provide an instructive example of how companies can respond proactively to economic uncertainty by affirming their core mission, vision and values, focusing relentlessly on win–win outcomes and exercising a ‘now, near and far thinking’ approach.
      Keywords: COVID-19; pandemic; staffing crisis; macroeconomic shifts; climate of fear; patient care; MultiCare Health System; Arena Analytics; labour shortages economic uncertainty; core mission

    • Organising social care initiatives within an urban academic medical centre
      Walter Rosenberg, Director of Social Work and Community Health, Rush University Medical Center and Associate Professor, Rush University College of Health Sciences, et al.

      Meaningfully addressing social risk factors that impact health outcomes is a complex and expensive endeavour. As healthcare systems across the USA pivot their operations to include upstream and downstream social care elements, they struggle with the operationalising screenings, intervention, staffing and sustainability. This paper shares the nearly decade-long experience of Rush Medical Center in Chicago in creating an infrastructure that identifies social needs, escalates patient cases to an interdisciplinary team intervening at different levels of intensity and simultaneously engages local community and medical entities to develop an enduring partnership to support these efforts.
      Keywords: social care; care coordination; integrated care; cross-sector collaboration; health equity

    • Patient-centred medication management: How to enhance patient safety and reduce the work burden for medical staff by digitalised closed-loop cabinets
      Maximilian C. von Eiff, Assistant Physician Urology, St. Josef Hospital, Clinic for Urology and Uro-Gynaecology, Wilfried von Eiff, Professor of Health Care Management and Regulation, HHL Leipzig Graduate School of Management and Director of the Center for Hospital Management and Mohamed Ghanem, Senior Consultant of Orthopaedic Surgery, Department for Orthopaedics, Traumatology and Plastic Surgery, University Hospital Leipzig

      Medication management is both an economic challenge and a patient safety issue. In German hospitals between 19 per cent and 35 per cent of all failures causing harm to patients are attributable to medication errors. As a consequence, an estimated 15,000 patients die each year. In addition, about 14 per cent of the average length of stay is assignable to unplanned drug interactions. Independent of patient risks, health impairments and outcome deficits, every non-fatal medication error leads to additional costs totalling €3,000 on average. Nurses, in particular, who typically suffer from work overload, are affected by error-prone medication logistics. Between 26 per cent and 44 per cent of all failures occurring in the medication administration process result from activities in which nurses are substantially involved. International best-in-class hospitals like the Mayo Clinic (Phoenix), Scripps (San Diego), OLVG (Amsterdam) and Guy’s and St. Thomas’ (London) have been using automated dispensing systems (smart cabinets) for medication safety reasons for many years. Moreover, in the USA, automated medication dispensing cabinets are ubiquitous in various types of hospitals and have an implementation rate of 89 per cent. But in German hospitals, this technology is still nowhere to be seen. In 2020, the German government, via legal act, decided that all hospitals must implement a closed-loop medication administration system in combination with a unit dose drug delivery by January 2025 in order to minimise medication errors. Otherwise, a penalty of 2 per cent of the total hospital revenue would have to be paid. Derived from best-practice reports in the literature, this paper explores the benefits of smart cabinets in terms of economic efficiency, patient safety, reduced work burden and employee acceptance. Furthermore, the reasons why many German hospital decision makers refuse to implement smart cabinets are presented and analysed. Finally, based on all this information, a generic medication administration process has been developed to provide a blueprint for a successful implementation of smart cabinets as an electronically based backbone in a closed-loop medication administration system.
      Keywords: adverse drug events; automated dispensing cabinets; closed-loop medication administration; medication errors; medication logistics; patient safety; smart cabinets

    • An evidence-based approach to virtual workforce programmes
      Ekta Vyas, Chief Human Resources Officer, Keck Medicine of USC, Adam Higman, Partner, Dragana Gough, Director and Dean Vanderhoof, Senior Associate, Press Ganey Associates

      Healthcare organisations across the country have or are currently exploring the potential for continued telework/flexible work environments for both staff and leaders. In this paper the authors share their experiences beginning with harnessing the employee voice to engage leaders and staff and better understand important infrastructural factors for successful telework. A focus of this listening strategy was in developing an inventory of best practices, technology needs and policies and processes to support digital telework for both leaders, medical, clinical and support staff. Space planning utilised these learnings to organise optimal work environments, understand efficiency and cost savings on leased space. The pandemic subsequently encouraged a wider adoption of remote practices by more groups, many of whom have since learned that remote work can be not only effective but also a talent recruitment and retention strategy for employees.
      Keywords: employee engagement; employee satisfaction; hybrid work; remote work

    Volume 7 Number 1