Creating a culture of safety: why CEOs hold the key to improved outcomes

When the nonprofit VHA foundation, created by VHA Inc., Irving, Texas, embarked on a national patient safety initiative it looked first to outside industries, gathering information and ideas from pioneers in nuclear energy, aviation, the military and other innovation-rich fields known for safety excellence.

Strategic planning processes and hospital financial performance

Many common management practices in healthcare organizations, including the practice of strategic planning, have not been subject to widespread assessment through empirical research. If management practice is to be evidence-based, evaluations of such common practices need to be undertaken. The purpose of this research is to provide evidence on the extent of strategic planning practices and the association between hospital strategic planning processes and financial performance. In 2006, we surveyed a sample of 138 chief executive officers (CEOs) of hospitals in the state of Texas about strategic planning in their organizations and collected financial information on the hospitals for 2003. Among the sample hospitals, 87 percent reported having a strategic plan, and most reported that they followed a variety of common practices recommended for strategic planning-having a comprehensive plan, involving physicians, involving the board, and implementing the plan. About one-half of the hospitals assigned responsibility for the plan to the CEO. We tested the association between these planning characteristics in 2006 and two measures of financial performance for 2003. Three dimensions of the strategic planning process--having a strategic plan, assigning the CEO responsibility for the plan, and involving the board--are positively associated with earlier financial performance. Further longitudinal studies are needed to evaluate the cause-and-effect relationship between planning and performance.

Joint working. Can they do the double?

Chris Bull has been appointed chief executive of Herefordshire public service trust--the country's first partnership between a PCT and county council. One of Mr Bull's first tasks is to look at the management structure. The organisations will remain distinct legal entities.

Institutional academic industry relationships

CONTEXT

Institutional academic-industry relationships have the potential of creating institutional conflicts of interest. To date there are no empirical data to support the establishment and evaluation of institutional policies and practices related to managing these relationships.

OBJECTIVE

To conduct a national survey of department chairs about the nature, extent, and consequences of institutional-academic industry relationships for medical schools and teaching hospitals.

DESIGN, SETTING, AND PARTICIPANTS

National survey of department chairs in the 125 accredited allopathic medical schools and the 15 largest independent teaching hospitals in the United States, administered between February 2006 and October 2006.

MAIN OUTCOME MEASURE

Types of relationships with industry.

RESULTS

A total of 459 of 688 eligible department chairs completed the survey, yielding an overall response rate of 67%. Almost two-thirds (60%) of department chairs had some form of personal relationship with industry, including serving as a consultant (27%), a member of a scientific advisory board (27%), a paid speaker (14%), an officer (7%), a founder (9%), or a member of the board of directors (11%). Two-thirds (67%) of departments as administrative units had relationships with industry. Clinical departments were more likely than nonclinical departments to receive research equipment (17% vs 10%, P = .04), unrestricted funds (19% vs 3%, P < .001), residency or fellowship training support (37% vs 2%, P < .001), and continuing medial education support (65% vs 3%, P < .001). However, nonclinical departments were more likely to receive funding from intellectual property licensing (27% vs 16%, P = .01). More than two-thirds of chairs perceived that having a relationship with industry had no effect on their professional activities, 72% viewed a chair's engaging in more than 1 industry-related activity (substantial role in a start-up company, consulting, or serving on a company's board) as having a negative impact on a department's ability to conduct independent unbiased research.

CONCLUSION

Overall, institutional academic-industry relationships are highly prevalent and underscore the need for their active disclosure and management.

Honesty in leadership. Interview by Mary Grayson

From health care reform to institutional stewardship, Thomas Priselac, president and CEO of Cedars-Sinai Health System in Los Angeles and chair-elect of the American Hospital Association, believes it's time to set aside ideological perspectives and make an honest, fact-based assessment of our health care system.

Leadership. Trading places

Two acute and PCT chief executives swapped jobs for a week with a view to getting closer to improve services. During the swap both chief executives took the full responsibility for the role they had stepped into. Both think all at their level should try this experience.

ED physicians group ousted, sues--power struggle with CEO blamed

Serious contract problems with administration should never come as a surprise. The ED manager who is part of a physicians group should communicate regularly with key audiences within the hospital, and keep an ear to the ground for potential issues. Have routine meetings with senior administration, and work to gain a seat on the hospital's executive committee. Participate in community activities with hospital leadership, including family activities. Work to develop a professional working relationship with the nurse manager.

Creating a culture of patient safety

This foldout provides a five-step process for strengthening your safety efforts, offers a checklist for CEOs and describes a successful program you can adapt.

What makes a great board chair?

The chair creates the climate of the board--and great ones can make virtually every aspect of their organization better.

How CEOs use management information systems for strategy implementation in hospitals

Institutional and market changes seem to force hospitals across the Western world to revitalize their corporate strategies towards more cost efficiency on the one hand, and more flexibility towards customer demands on the other hand. Hospitals, however, apparently differ in the extent to which they are able to implement such strategies effectively. This paper explores whether these different levels of effectiveness depend on how hospitals' top managers' use of the available management information systems (MIS). Based on data obtained from the 218 CEOs of public hospitals in Spain, we analyze how CEOs' professional and educational backgrounds affect their use of MIS, and how the use of the MIS subsequently supports or inhibits the implementation of these strategic goals. The results indicate that CEOs with a predominant clinical background focus more on non-financial information for decision-making and prefer an interactive style of using MIS, which together support flexibility strategies. CEOs with a predominant administrative background seem more effective in establishing cost-reduction strategies, through their larger inclination to emphasize financial information in combination with a diagnostic use of the MIS. Implications for the strategic management of hospitals are outlined.

Increasing the relevance of research to health care managers

BACKGROUND

Evidence-based management assumes that available research evidence is consistent with the problems and decision-making conditions faced by those who will utilize this evidence in practice.

PURPOSE

This article attempts to identify how hospital leaders view key determinants of hospital quality and costs, as well as the fundamental ways these leaders "think" about solutions to quality and cost issues in their organizations. The objective of this analysis is to better inform the research agenda and approaches pursued by health services research so that this research reflects the "realities" of practice in hospitals.

METHODS

We conducted a series of semistructured interviews with a convenience sample of eight hospital and three health system leaders. Questions focused on current and future challenges facing hospitals as they relate to hospital quality, costs, and efficiency, and potential solutions to those challenges.

FINDINGS

Nine major organizational and managerial factors emerged from the interviews, including staffing, evidence-based practice, information technology, data availability and benchmarking, and leadership. Hospital leaders tend to think about these factors systemically and consider process-related factors as the important drivers of cost and quality.

PRACTICE IMPLICATIONS

The results suggest a need to expand the methods utilized by health services researchers to make their research more relevant to health care managers. Expanding research methods to reflect the systemic way that managers view the challenges and solutions facing their organizations may enhance the application of research findings into management practice. Finally, better communication is needed between the research and practice communities. Researchers must learn to think more like managers if their research is to be relevant, and managers must learn to more effectively communicate their issues with the research community and frame their problems in researchable terms.

Attributes of a high-performing culture

Setting specific goals, making sure the entire staff is committed to achieving them, and understanding that the process is long-term are the first steps in becoming a high-performing hospital. Here are tips to help you get there.