Leadership and Hierarchy in Hospitals

Leadership and Hierarchy IN HOSPITALS Better Health Scale Better managed hospitals generally have better clinical outcomes. For each 1-point increase in management score, there was a 6% to 7% decrease in 30-day mortality following myocardial infarction. Hospitals with more employees have higher management scores. Larger hospitals may more easily achieve economies of scale that allow for attracting top talent and more rigorous performance management. Clinical Best Practices Financial Performance Importance of Strong Management Hospitals with better management scores are more likely to have adopted clinical best practices. A 1-point increase in management score is associated with a 14% increase in EBITDA. Compelition Recommendations Hospitals with more competition have better management scores. The consequences of not performing well compared to competition can be damaging. A 1-point increase in management score is associated with a 0.8% increase in people who would recommend the hospital. Managerial Autonomy Education Hospitals with the highest proportion of clinically trained managers generally have the highest management scores. In the U.S., 74.11% of managers have a clinical degree. Hospitals where managers have autonomy to make decisions have higher management scores. The bottom quartile of management scores had an average managerial autonomy score of -0.31 whereas the top quartile of management scores had an average autonomy score of 0.29. Trends in Health Leadership DEPARTMENTAL RESPONSIBILITY How many departments are responsible for population health? How much time does leadership devote to population health? <25% 75%-100% The leadership position in larger 42% 41% hospitals (300+ beds) is more likely (45%) 31% 31% 1 DEPARTMENT to devote 75%-100% 3 OR MORE DEPARTMENTS of its time to population health 17% 22% 16% compared to smaller (<100 beds; 19%) or medium hospitals 2 DEPARTMENTS 25%-49% 50%-74% (100-299 beds; 33%) Who leads the department with primary responsibility for population health? 49% of hospiłals surveyed are led by a middle manager Rural hospitals are more likely than urban hospiłals Small hospiłals are more likely than medium and large hospitals to have executive managers leading the department to have executive managers leading the department 22% VS. 10% 22% VS. 10% VS. 6% PROFESSIONAL & EDUCATIONAL BACKGROUNDS Top 5 disciplines of highest academic degree for population health leaders Tenure 2. Business 4. Communications of leaders held the position 31% for |0 years of more 22% 20% 16% 13% 13% of leaders held the position 45% for 4 years or less 1. Nursing 3. Health care 5. Marketing administration of leaders held the position 10% for (e5s than I year of population health leaders elected "Other" as the field for 15% their highest academic degree (medicine, philosophy, etc.) NURSES In 2011, the Institute of Medicine published a landmark report, "The Future of Nursing: Leading Change, Advancing Health" that emphasized improving nurse leadership 6% of board members Were NURSES 20% of board members Were PHYSICIANS In a SURVEY of OVER 1,000 hospital boards ONE SURVEY OF OPINION LEADERS FOUND THAT 51% 50% 18% believe NURSES had influence on increasing access to care believe NURSES have a great deal of influence in reducing medical errors and improving patient safety believe NURSES exert significant influence on improving quality of patient care 69% 68% see PHYSICIANS as believe PHYSICIANS generate key decision makers over nurses revenue while nurses do not CEOS & Executives WOMEN comprise 73% of medical and health service managers but The 2013 top concerns ONLY 18% for hospital CEOS of hospital CEOS are women S Financial challenges Health care reform implementation 66% AA Only 39% A Governmental mandates of CEOS hired in 2013 came from another hospital CEO position Patient safety and quality of CEOS hired in 2014 are estimated to have little to no health care sector Care for the uninsured experience Top industries, health care HR and board members want their CEOS to come from ШП Venture Capital, Private Equity Finance and Accounting Marketing and Sales Banking Technology of new CEOS do not have extensive THE AVERAGE TENURE 94% The turnover for hospital CEOS of a hospital CEO is hospital backgrounds under 3.5 years 20% This indicates that 17% 56% are involuntary they do not believe health care expertise is required for replacing senior leadership of CEO exits 2012 2013 Terminations within 2 months of a new CEO's hire include: Terminations within 9 months of a new CEO's hire include: 50% of CFOS, CIOs and COOS 87% of Chief Medical Officers 32% of Chief Human Resource Officers 24% of CMOS PRODUCED BY: NORWICH UNIVERSITY 1819 Online nursing.norwich.edu Sources: http://www.ache.org/pubs/research/ceoissues.cfm http://www.ache.org/pubs/research/ceoturnover.cfm http://www.hpoe.org/resources/hpoehretaha-guides/1467 http://www.nursingcenter.com/Inc/static?pageid=1236963 http://www.prweb.com/releases/2013/12/prweb11421983.htm http://www.leadingsystemsnetwork.com/pdf/Management_Matters.pdf http://www.beckershospitalreview.com/hospital-management-administration/women-make-up-73-of-healthcare-managers-but-only-18-of- hospital-ceos.html www.mckinsey.com/global_locations/europe_and_middleeast/united_kingdom/en/our_people/~/media/mckinsey/dotcom/client_service/ healthcare%20systems%20and%20services/health%20international/hil1_80%20mgmtmatters_r5.ashx %24