Volume 8 (2023-24)

Each volume of Management in Healthcare consists of four quarterly 100-page issues. Articles scheduled for Volume 8 are available to view at the 'Forthcoming content' page.

The Articles published in Volume 8 include:

Volume 8 Number 1

Editorial
Simon Beckett, Publisher
Building strategic value with your medical group
David Goldberg, Mon Health System and David W. Miller, HSG Advisors

Despite massive investments by health systems in employed physician networks, these networks are often poorly aligned with the health system. At their worst, they operate as a loose conglomeration of practices, with suboptimal quality, financial and operational performance. This paper discusses Mon Health, a growing five-hospital system in West Virginia, and the development of its transformation plan. That effort first addressed the development of a vision of how the physician network would evolve to meet the mutual objectives of the stakeholders and the demands of the market, defined jointly by physicians and executives. The resulting roadmap further addressed issues like quality, provider well-being, strategic growth and physician leadership. The organisation ensured employed physicians would be integrated into the organisation’s leadership and operations, through vehicles like the physician leadership council and dyad leadership of services. Tactics include engaging physicians in service line leadership dyads and advisory board roles, building a shared vision for evolution, defining behavioural expectations for a common culture, and building the management infrastructure to drive these initiatives. The paper also addresses early performance improvements facilitated by this initiative. Ultimately, we will provide a road map for developing a transformation plan to build an accountable, multi-specialty group.
Keywords: physician network; strategy; leadership; shared vision; retention; health system
Get your diverse team to outperform: Navigating through affinity bias
Marzena Buzanowska, River City Sports and Spine Specialists, Mary Rensel, Cleveland Clinic

While gender and racial diversity of healthcare organisations has been increasing, and improvements in representation have been made, significant disparities still exist, especially with pipeline progression in organisational rank and leadership level. In addition, once under-represented minority individuals become a part of a team, obstacles continue to inhibit those individuals, in subtle ways, from being fully able to contribute to the teams. One such major unconscious process is affinity bias, which is our subconscious preference for people who resemble ourselves or belong to our social group, as well as distrust and negative attitudes towards those different from us or not part of our group. Subconscious heuristics drive our brain’s cognitive processes for efficiency with the goal of keeping us safe in an uncertain environment, and we need these heuristics in order to function. In highly advanced organisations, however, when relying on the strengths of diverse teams determines the organisation’s competitive edge and financial profitability, affinity bias can undermine the organisation’s performance, and it is crucial that leaders are skilled in navigating its pitfalls.
Keywords: affinity bias; team performance; diversity; inclusion; culture of belonging
Integrating innovation into occupational evaluation to adjust to the changing healthcare workforce
Jamal Khan, Rebecca Ashbeck, Laura Breeher, Melanie Swift, Caitlin Hainy, Heidi Shedenhelm, and Chris Tommaso, Mayo Clinic

The COVID-19 pandemic disrupted the workforce, resulting in a shift to a largely remote working population. As a result of this shift, Employee Occupational Health Services (EOHS) was required to develop a solution to evaluate new employees and provide occupational medical clearance without the physical presence of the candidate. An online candidate portal was created where individuals could complete evaluation paperwork and screenings asynchronously. The evaluation forms and screenings were then reviewed by occupational health nursing staff, and testing was conducted in the candidate’s home location. The virtual evaluation solution expedited the assessment process, added convenience for candidates and reduced the amount of time needed from EOHS staff. It is imperative that EOHS departments adjust to the changing workforce by offering virtual evaluation solutions that provide candidates with a seamless and efficient solution to complete required paperwork, testing and immunisations.
Keywords: healthcare; occupational clearance; post-offer placement assessment
Educating patients on value-based health care to improve clinical outcomes
Lucinda A. Hines, Air Force Medical Readiness Agency

Patient education and health literacy are essential components of the effort to improve a patient’s health and assist them with meeting their medical goals of improved health and wellness. This paper provides actionable recommendations on educating patients on how value-based health care improves clinical outcomes. The qualitative exploratory case study outlined healthcare professionals’ experiences, perceptions and opinions regarding educating their patients about the value-based healthcare system. Fifteen healthcare professionals currently or previously providing patient care in the United States shared multiple perspectives on educating patients about value-based health care. Two recurring themes identified were (a) reimbursement is based on patient outcomes and (b) patient education and comprehension. Patient education allows healthcare professionals to collaborate with patients to improve their health. Gaps in the literature exist on whether or how healthcare professionals educate patients on value-based health care. The findings and recommendations from this study could raise consciousness about the clinical and business benefits of educating patients on value-based health care. Educating patients on this topic presents opportunities to engage patients as partners in promoting compliance and positive clinical outcomes.
Keywords: value-based health care; healthcare professionals; patient education; positive clinical outcome; reimbursement
Accelerating systemness through shared vision and culture
Jennifer Tomasik, CFAR, Brooke Tyson Hynes, Possibility Partners, and Rosa M. Colon-Kolacko, Tufts Medicine

As health systems across the United States consolidate, tremendous potential exists to expand and optimise their breadth and depth by integrating services so that patient care is coordinated, supportive and equitable. The financial pressures and workforce crisis resulting from the COVID-19 pandemic have further exacerbated the need for fiscal discipline and operational efficiencies that can come from effective, system-wide integration. Yet many health systems continue to fall short of achieving the promise of post-merger integration and the value it can create for the diverse communities they serve. This paper explores one health system’s journey from ‘operational synergies’ to full ‘systemness’ enabled by a shared vision laser focused on a commitment to frictionless, patient-centred care through enabling care teams to do their best work, accelerating integrated operations and building an inclusive culture. It will explore the journey of a system in name only (Wellforce) to a unified team with a single brand (Tufts Medicine) and a shared commitment to the future with a mission to empower people to live their best lives. This case study will describe how the system evolved, starting from the development of a transformational Strategic Vision, through the shared trials of the COVID-19 pandemic and its effect on patients and providers. Having a shared vision is an essential first step to building systemness. Bringing that vision to life requires significant discipline and culture change. It requires a systemic approach and unwavering leadership, rooted in a shared philosophy, deep commitment and aligned behaviour. The case study will continue with an exploration of the path system and entity leaders took to identify shared priorities, adapt organisational and governance structures, and engage more than 14,000 clinical and administrative staff and physicians in building an inclusive culture with a clear and actionable commitment to anti-racism. It is a story about moving from words and ideas to action and removing the barriers that impeded progress.
Keywords: systemness; culture; strategy; vision; health equity; leadership
Is environmental sustainability training fundamental to healthcare leadership? State of the art with health students and health leaders
Marine Sarfati, University of Medicine Lyon 1 Claude Bernard, Alessia Lefébure, L’Institut AgroRennes Angers, Cyrille Harpet, University of Rennes, Estelle Baurès, Institut Agro, and Laurie, Marrauld, University of Rennes

This paper addresses the relevance of climate change and environmental learning in health professional training. Recent publications have shown the importance of understanding sustainability and environmental issues in healthcare management. Indeed, after years of underestimation, medical and public health professionals today acknowledge that the environment has a strong effect on human health. Conducted between April and June 2021, a quantitative study among 3,384 French medical and health students shows that the need for training on energy and climate issues is urgent and crucial. The findings are consistent with the international literature. The contrast is sharp between students’ expectations about environmental skills and the reality of the available course offer. Learning about energy, climate and environment is currently not a priority in the curriculum of healthcare professionals, including managers. Sustainability, however, clearly appears as a ‘must’ among the essentials in healthcare leadership. What these findings suggest is that healthcare managers can no longer afford to ignore environmental sustainability as an essential skills domain in their long-term capacity to contribute to the necessary healthcare environmental adaptation, mitigation and resilience.
Keywords: professional training; public health; healthcare; environmental sustainability; climate change; leadership skills
Achieving health equity: A patient safety imperative
Ronald Wyatt, Achieving Health Equity and Tara Gerstacker, MCIC Vermont

Achieving health equity requires achieving zero preventable harm for all people. Health inequity must be inextricably linked to safety if all people are to be free from harm. There is no safety without equity and no equity without safety. Health inequity is an unsafe condition. Equity-related near misses, adverse events and sentinel events must undergo a comprehensive systematic analysis. Each root cause should have a strong corrective action(s). Measurable actions might include the collection and stratification of race, ethnicity and language data, or addressing stereotype bias, implicit bias, structural competency and institutional and structural racism. Leadership committed to creating a culture of equity is required. Measures of success should be linked to payment and restoring trust.
Keywords: inequity; root causes; REaL; racism; structural competency; trust
Community engagement for early recognition and immediate action in stroke (CEERIAS): Pre and post COVID-19
Knitasha V. Washington, ATW Health Solutions, Neelum T. Aggarwal, Rush University Medical Center, Shyam Prabhakaran, The University of Chicago, Desiree Collins Bradley, ATW Health Solutions, Kellie Goodson, ATW Health Solutions, Alexis Malfesi, Center for Medicare and Medicaid Innovation, US Department of Health and Human Services, and Theresa Schmidt, Discern Health, Real Chemistry

Engagement science can help healthcare providers understand promising practices that address health disparities. The Community Engagement in Early Recognition and Immediate Action in Stroke (CEERIAS) study began in 2014 with the aim of improving health outcomes related to stroke and addressing racial inequities among at-risk South Side Chicago neighbourhoods by engaging community members called ‘Stroke Promoters’ in designing and implementing a stroke preparedness programme. Launched in 2020, Phase II (2CEERIAS) furthered this aim by developing a replicable virtual platform for the programme in response to challenges prompted by the COVID-19 pandemic. The CEERIAS community engagement programme results provided meaningful data to South Side Chicago communities; nearly 40,000 ‘Pact to Act FAST’ pledges were collected over 11 months, and although early hospital arrival and emergency medical services (EMS) usage for confirmed stroke did not increase overall, early arrivals for suspected stroke increased significantly for men, younger people and black community members along with EMS usage for suspected stroke. The 2CEERIAS virtual programme collected nearly 3,800 new pledges in a 90-day window during the onset of the COVID-19 pandemic. The engagement of trusted nonclinical laypeople during both phases of the CEERIAS study demonstrates that community engagement can positively influence clinical outcomes and increase reach and sustainability for such efforts. The use of engagement science can also generate a deep sense of co-creation among community members, and the ‘social contract’ approach can effect behavioural change. The virtual adaption reinforced important engagement science principles for interventions aimed at eliminating stroke disparities. To this day, eight years after research support ended for the CEERIAS programme, community members trained as ‘Stroke Promoters’ remain connected to the researchers and continue to educate family and neighbours about stroke preparedness.
Keywords: equity; health disparities; stroke; community engagement; improvement; quality