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To mark the 25th anniversary of the journal, each issue in 2020 will include an interview with a healthcare thought leader. For the April issue, we turned to Sherry Glied, PhD, dean of New York University's Robert F. Wagner Graduate School of Public Service.

Because of increased electronic health record use, many organizations are hiring medical scribes as a way to alleviate provider burnout and increase clinical efficiency. The providers and scribes have unique relationships and thus, this study's purpose was to examine the scribe-provider interaction/relationship through the perspectives of scribes, providers, and administrators utilizing qualitative research techniques. Participants included 81 clinicians (30 providers, 27 scribes, and 24 administrators) across five sites. Analysis of the scribe-provider interaction data generated six subthemes: characteristics of an ideal scribe, characteristics of a good provider, provider variability, quality of the scribe-provider relationship, negative side of the scribe-provider relationship, and evaluation and supervision of scribes. Future research should focus on additional facets of the scribe-provider relationship including optimal ergonomic considerations to allow for scribes and providers to work together harmoniously., (©2019 AMIA - All rights reserved.)

Quality and safety are the top priorities of every hospital and health system. Patients put their trust in us as healthcare leaders, often in the most vulnerable moments of their lives, and we must respond with high-quality, highly reliable, and compassionate care.Patients have the right to expect the best return for their healthcare dollars. Recognizing that expectation, progressive hospitals and health systems are embracing the move to value-based care and are enhancing affordability. The goal is to provide greater value to patients by improving quality, lowering costs, and enhancing the patient experience.Ever-changing market forces affect how hospitals and health systems deliver care and may also affect how much they are reimbursed for services. We must stretch to transform, improve, and even redefine care delivery for all of our patients as well as our teams of caregivers and staff.Carilion Clinic demonstrates this commitment in our continuing evolution as an integrated delivery system, along with our participation in new national collaborations to improve affordability and advance innovation. We are catalysts for change in a sector that is ripe for it.

Background: Spearheaded by the industry's transition from volume- to value-based care, the health care reform movement has spurred both unprecedented challenges and opportunities for developing more effective and sustainable health care delivery organizations. Whereas the formidable challenges of leading hospitals and health systems have been widely discussed, including reimbursement degradation, the rapidly aging workforce, and the imminent wave of executive retirements, the opportunity to leverage succession management and talent development capabilities to overcome these challenges has been largely overlooked., Purpose: To address this key research and practice need, this multiphase study develops and validates an assessment of succession management practices for health care organizations., Methodology: Utilizing data collected from two national samples of hospital organizations, the results provide a 32-item succession management assessment comprising seven distinct sets of succession management practices., Results: The results indicate that succession management practices are strongly associated with multiple hospital performance metrics, including patient satisfaction and Medicare Spending per Beneficiary, leadership bench strength, and internal/external placement rate for executive level positions., Practice Implications: The author concludes this article with a discussion of several practical implications for health care executives and boards, including employing the succession management assessment for diagnosing development opportunities, benchmarking succession planning and talent development practices against similar hospitals or health systems, and elevating the profile of succession management as a strategic priority in today's increasingly uncertain health care landscape.

Healthcare CEOs are hiding behind industry lobbying groups instead of publicly using their power to push for changes in the Republicans' healthcare reform bill.

Context: While efforts to promote use of evidence-based practices (EBPs) for cancer control have increased, questions remain whether this will result in widespread adoption of EBPs (eg, Guide to Community Preventive Services interventions) by comprehensive cancer control (CCC) programs., Objective: To examine use of EBPs among CCC programs to develop cancer control plans and select interventions., Design: Conducted Web-based surveys of and telephone interviews with CCC program staff between March and July 2012., Setting: CCC programs funded by the Centers for Disease Control and Prevention's National Comprehensive Cancer Control Program (NCCCP)., Participants: Sixty-one CCC program directors., Main Outcome Measures: 1) Use of and knowledge/attitudes about EBPs and related resources and 2) EBP-related technical assistance needs., Results: Seventy-five percent of eligible program directors reported use of EBPs to a moderate or great extent to address program objectives. Benefits of using EBPS included their effectiveness has been proven, they are an efficient use of resources, and they lend credibility to an intervention. Challenges to using EBPs included resource limitations, lack of culturally appropriate interventions, and limited skills adapting EBPs for local use. Most respondents had heard of and used Web sites for The Guide to Community Preventive Services (95% and 91%, respectively) and Cancer Control P.L.A.N.E.T. (98% and 75%, respectively). Training needs included how to adapt an EBP and its materials for cultural appropriateness (state 78%, tribe 86%, territory 80%) and how to maintain the fidelity of an EBP (state 75%, tribe 86%, territory 60%)., Conclusions: While awareness, knowledge, and use of EBPs and related resources are high, respondents identified numerous challenges and training needs. The findings from this study may be used to enhance technical assistance provided to NCCCP grantees related to selecting and implementing EBPs.

Health administration (HA) faculty members publish in a variety of journals, including journals focused on management, economics, policy, and information technology. HA faculty members are evaluated on the basis of the quality and quantity of their journal publications. However, it is unclear how perceptions of these journals vary by subdiscipline, department leadership role, or faculty rank. It is also not clear how perceptions of journals may have changed over the past decade since the last evaluation of journal rankings in the field was published. The purpose of the current study is to examine how respondents rank journals in the field of HA, as well as the variation in perception by academic rank, department leadership status, and area of expertise. Data were drawn from a survey of HA faculty members at U.S. universities, which was completed in 2012. Different journal ranking patterns were noted for faculty members of different subdisciplines. The health management-oriented journals (Health Care Management Review and Journal of Healthcare Management) were ranked higher than in previous research, suggesting that journal ranking perceptions may have changed over the intervening decade. Few differences in perceptions were noted by academic rank, but we found that department chairs were more likely than others to select Health Affairs in their top three most prestigious journals (β = 0.768; p < .01). Perceived journal prestige varied between a department chair and untenured faculty in different disciplines, and this perceived difference could have implications for promotion and tenure decisions.

Background: The establishment of accountable care organizations (ACOs) in the Affordable Care Act (ACA) was intended to support both cost savings and high-quality care. However, a key challenge will be to ensure that governance and accountability mechanisms are sufficient to support those twin ambitions., Purpose: This exploratory study considers how recently developed ACOs have established governance structures and accountability mechanisms, particularly focusing on attempts at collaborative accountability and shared governance arrangements., Methodology: Four case studies of ACOs across the United States were undertaken, with data collected throughout 2012. These involved 34 semistructured interviews with ACO administrative and clinical leaders, observation of nine meetings, and a review of documentary materials from each ACO., Findings: We identified very few examples of physicians being held to account as a collective and therefore only limited evidence of collaborative accountability impacting on behavior change. However, ACO leaders do have many mechanisms available to stimulate change across physicians. The challenge is to determine governance structure(s) and accountability mechanisms that facilitate the most effective combination of approaches, measures, incentives, and sanctions to achieve the goals of more accountable care., Practice Implications: Accountability structures and processes will need to be tailored to local membership composition, historical evolution, and current stage of development. There are also some common lessons to be drawn. Shared goals and incentives should be reflected through performance criteria. It is important to align measures and thresholds across payers to ensure ACOs are not unnecessarily burdened or compromised by reporting on different and potentially disjointed measures. Finally, emphasis needs to be placed on the importance of credible, transparent data. This exploratory study provides early evidence regarding how ACOs are establishing their governance and accountability arrangements and provides a foundation for future research and theory-building in this area.

Unlabelled: To understand the process of instituting culture change (CC) practices in nursing homes (NHs). NH Directors of Nursing (DONs) and Administrators (NHAs) at 4,149 United States NHs were surveyed about CC practices. Follow-up interviews with 64 NHAs were conducted and analyzed by a multidisciplinary team which reconciled interpretations recorded in an audit trail., Results: The themes include: (a) Reasons for implementing CC practices vary; (b) NH approaches to implementing CC practices are diverse; (c) NHs consider resident mix in deciding to implement practices; (d) NHAs note benefits and few costs to implementing CC practices; (e) Implementation of changes is challenging and strategies for change are tailored to the challenges encountered; (f) Education and communication efforts are vital ways to institute change; and (g) NHA and other staff leadership is key to implementing changes. Diverse strategies and leadership skills appear to help NHs implement reform practices, including CC innovations., (© The Author(s) 2013.)

A panel of hospital leaders and other experts discuss how organizations can reduce costs and enhance the value of their supply purchases--an imperative at a time of rising prices and tightening reimbursements. One major challenge: How to gain greater physician support for those efforts.

Outbound medical travel (MT) involves U.S. patients going abroad to seek medical care. Over the past decade, there has been much discussion about MT's broadening appeal to several segments of U.S. healthcare consumers, but little is known about its penetration in the employer-based coverage (EBC) marketplace. The objectives of this article are to fill this gap and identify (1) the current status of MT options in EBC, (2) the differences between adopters and nonadopters of MT options, and (3) the factors that impede adoption. The results were obtained from a nationwide survey of human resources (HR) professionals making decisions regarding medical benefits. In this sample (n = 608), 16.8% of the respondents offered outbound MT options to their employees, often bypassing their insurance providers. Besides benefiting from a strong HR function, these organizations tended to be more involved in global business transactions, more open to change, more sensitive to cost savings, and more flexible in implementing administrative innovations than nonadopters were. An organizational climate conducive to innovation may explain their propensity to downplay the importance of well-known obstacles to implementation, such as the effort required to make changes, an emphasis on short-term goals, and the fear of liability. The lessons to be learned by U.S. healthcare managers are clear. To attract a value-conscious market, they must offer an attractive package of outstanding quality (clinical outcomes and patient experience) at competitive costs. Operational excellence may thus be the key to slowing the inevitable diffusion of MT options in EBC and maintaining or even expanding the U.S. market share of elective surgeries.

The authors sought to explore the implications of the Patient Protection and Affordable Care Act's establishment of Accountable Care Organizations (ACO). Summit participants, who discussed best practices and issues to be addressed when designing and implementing ACOs. Healthcare leaders from across the country in charge of running, developing, and/or implementing ACOs for health systems. Participants were asked to consider the challenges, benefits, and strategies to ACO implementation.

Purpose: Recognition of the importance and difficulty of engaging physicians in organisational change has sparked an explosion of literature. The social identity approach, by considering engagement in terms of underlying group identifications and intergroup dynamics, may provide a framework for choosing among the plethora of proposed engagement techniques. This paper seeks to address this issue., Design/methodology/approach: The authors examined how four disparate organisations engaged physicians in change. Qualitative methods included interviews (109 managers and physicians), observation, and document review., Findings: Beyond a universal focus on relationship-building, sites differed radically in their preferred strategies. Each emphasised or downplayed professional and/or organisational identity as befit the existing level of inter-group closeness between physicians and managers: an independent practice association sought to enhance members' identity as independent physicians; a hospital, engaging community physicians suspicious of integration, stressed collaboration among separate, equal partners; a developing integrated-delivery system promoted alignment among diverse groups by balancing "systemness" with subgroup uniqueness; a medical group established a strong common identity among employed physicians, but practised pragmatic co-operation with its affiliates., Research Limitations/implications: The authors cannot confirm the accuracy of managers perceptions of the inter-group context or the efficacy of particular strategies. Nonetheless, the findings suggested the fruitfulness of social identity thinking in approaching physician engagement., Practical Implications: Attention to inter-group dynamics may help organisations engage physicians more effectively., Originality/value: This study illuminates and explains variation in the way different organisations engage physicians, and offers a theoretical basis for selecting engagement strategies.