Burned out or fired up?

As CEOs face the biggest challenges of their career, many are energized but some are ready for retirement.

Seeking the mission-minded

A rural hospital attracts clinicians who want to care for the underserved at home and abroad.

Minding your manners. Don't overlook the importance of CEO-board etiquette--it's a pillar of good governance

Brushing up on CEO-board etiquette strengthens the relationship.

Promoting employee voice and upward communication in healthcare: the CEO's influence

As noted by the Institute of Medicine (2004), a lack of critical upward feedback in the hospital setting has adverse effects on direct patient care and health outcomes. Employees are oftentimes reluctant to share information, as those above them might interpret the information to be negative or threatening. Leaders then may make important decisions based on assumptions or inaccurate feedback. The situation is especially significant in the healthcare setting, where hierarchical structures (Nembhard and Edmondson 2006), divisions between administrators and clinicians, and lack of collaboration across teams reinforce employee silence and undermine organizational learning (Ramanujam and Rousseau 2006). Chief executive officers play a key role in developing a culture that fosters employee voice and upward communication (Ashford, Sutcliffe, and Christianson 2009). Hospitals winning performance excellence awards, such as those utilizing the Malcolm Baldrige National Quality Award Criteria for Performance Excellence, present a model of high performance with demonstrated results. The purpose of this study was to understand specific CEO behaviors and actions promoting employee voice and upward communication in performance excellence award-winning healthcare organizations. Results suggested the award-winning CEOs facilitated employee voice by being approachable, mainly achieved through their regular presence throughout the organization. By being consistently visible and available to employees these CEOs fostered relationships, built trust, and promoted open communication. Leaders in the study created a cultural focus on continuous improvement largely built around transparency of information, particularly looking for the bad news from their employees. Voice invitation and positive voice response from leaders reinforced that critical upward feedback is not only welcome, but expected.

Brief tenure, lasting benefits: an interim CEO can stabilize an organization and provide the foundation for long-term success

Interim leaders can set the stage for long-term success.

Building the "fable hospital"--the CEO's perspective: an interview with Michael H. Covert, president and chief executive officer, Palomar Pomerado Health. Interview by David A Tam

Hospital construction is a significant event in any health system. The financial implications are great, especially at a time of shrinking capital resources. Personnel are affected, as are the processes to perform their tasks. Often, new facilities are catalysts that change organizational culture; it has been clearly shown that new facilities have a positive impact on patient satisfaction scores. The members of the C-suite of a hospital/health system play important roles in construction projects. However, no one is more critical to the success of such major endeavors than the chief executive officer (CEO). The CEO sets the tone for the project, giving direction to the design and construction process that may have implications for the rest of the organization. Palomar Pomerado Health (PPH) is the largest public health district in California. In 2002, the PPH governing board authorized the creation of a new facility master plan for the district, which included the construction of a replacement facility for its tertiary care trauma center. The new Palomar Medical Center is slated to open in August 2012. HERD had the opportunity to speak with PPH CEO Michael H. Covert on the role of the CEO in the building of this "fable hospital".

Closing the leadership gap: Boards drive the CEO succession process. Is your transition plan ready?

CEO succession planning is a board function. Is your plan current and ready to deploy?

[Vocational training of future GPs in Swiss hospitals: the view of chief physicians]

BACKGROUND

We sought to assess the way future general practitioners are promoted by their chief physicians.

METHODS

Semi quantitative questionnaires sent to 54 chief physicians (hospitals in cantons Zurich and Berne).

RESULTS

42 (77.8%) questionnaires were returned. 41 (97.6%) chief physicians asked the assistant physicians about their intended career. 23 (54.8%) discussed with future general practitioners (GPs) specific learning objectives. 32 (76.2%) chief physicians would have appreciated an official catalogue of learning objectives for future GPs. A GP-specific traineeship was lacking in most of the hospitals.

CONCLUSIONS

The upcoming shortage of future GPs could be inhibited by an appropriate GP curriculum during the vocational training.

How CEOs drive the clinical transformation and information technology agenda

The United States' healthcare model is in a serious period of change and redirection. This era holds the potential for transformations equal in significance to the introduction of prospective payment system or even the initiation of Medicare. This article describes the considerable and unique role that hospital and health system CEOs must play to position their organizations to not only survive but lead the transformation journey, with particular emphasis on the information technology investment imperative. Healthcare delivery is a multidimensional, multidisciplinary, and matrixed model. Change is hard. Information technology is evolving. Add these together and we begin to see the challenges ahead.

From the perspective of CEOs: what motivates hospitals to embrace cultural competence?

The quality domains of patient-centered and equitable care are increasingly relevant to today's healthcare leaders as hospitals care for patients with increasingly diverse cultural and linguistic needs. Hospital leaders face substantial tensions in defining their organization's strategic priorities to improve care for diverse populations with limited resources, increased competition, and complex regulatory and accreditation requirements. We sought to understand what motivates hospitals to focus on and commit resources to supporting the delivery of culturally competent care by analyzing interviews with chief executive officers (CEOs) in 60 hospitals across the United States. Hospital CEOs in our study most often embraced cultural competence efforts because doing so helped them achieve the organization's mission and priorities and/ or meet the needs of a particular patient population. Less often, they were motivated by perceived benefits and legal or regulatory issues. Many CEOs articulated a link between quality and cultural competence, and a smaller number went on to link cultural competence efforts to improved financial outcomes through cost savings, increased market share, and improved efficiency of care. However, the link between quality and cultural competence is still in the early stages. Fortunately, frameworks for hospitals to adopt and steps that hospitals can take to improve the quality of care for all patients have been identified. They begin with a commitment from hospital leaders based on understanding the needs of patients and communities and are propelled by data that reveal the impact of efforts to improve care. Leaders must communicate and shepherd organizations to align the congruence between improvement efforts and business strategies.