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Rohit Pradhan,1 Bradley Beauvais,1 Zo Ramamonjiarivelo,1 Diane Dolezel,2 Dan Wood,3 Ramalingam Shanmugam1 1School of Health Administration, Texas State University, San Marcos, TX, 78666, USA; 2Department of Health Informatics and Information Management, Texas State University, Round Rock, TX, 78665, USA; 3Army-Baylor University MHA/MBA Program, U.S. Army Medical Center of Excellence, San Antonio, TX, 78234, USACorrespondence: Rohit Pradhan, ENC 264, School of Health Administration, Texas State University, 601 University Dr, San Marcos, TX, 78666, USA, Tel +1 (512) 245-6529, Email pradhan@txstate.eduIntroduction: Staffing is critical to hospital performance. However, in recent years, hospitals have struggled with severe staffing shortages, forcing them to rely on expensive agency staff to meet urgent patient care needs. This substitution of agency staff for permanent employees has raised concerns over its potential impact on financial stability. This study investigated the association of agency labor with hospital financial performance.Methods: Utilizing tenets from agency theory and transaction cost theory, data for the calendar year 2022 for active short-term acute care hospitals (n=2771) in the United States were analyzed using multivariable linear regression analysis. Hospital financial performance was assessed using three variables: net patient revenue, operating revenue per bed, and operating expense per bed. The independent variable was agency labor cost, representing the total expenditure on agency labor. Additionally, organizational and market-level control variables that may independently affect hospital financial performance were included.Results: Our regression findings indicated that agency labor cost was significantly associated with all three dependent variables: net patient revenue (β = 0.224, p < 0.001), operating revenue per bed (β = 0.042, p < 0.001), and operating expense per bed (β = 0.032, p < 0.001).Discussion: The results indicated that increased agency labor was associated with higher revenues, but it also corresponded with increased expenses. Therefore, hospitals should strategically use agency staffing to meet immediate operational needs while remaining cognizant of its financial implications. The judicious use of agency labor can help hospitals balance the benefits of increased revenue against higher costs, while ensuring that they still meet immediate patient needs.Keywords: agency staff, contract labor, hospital financial performance, healthcare staffing

Objectives: To address urgent staffing shortages, hospitals increasingly rely on agency labor. Given that staffing can significantly impact hospital performance, the aim of this study was to understand the organizational and market factors associated with agency labor utilization in US hospitals. Methods: Utilizing concepts from the Resource Dependence Theory (RDT), data for the calendar year 2022 for short-term acute care in United States hospitals (n = 2756) were analyzed with logistic regression analysis. We explored total agency labor expense (operationalized as a dichotomous variable at the 75th and 90th percentiles) in the presence of numerous organizational and market independent variables. Results: The results revealed that as markets become less complex (as measured by market concentration), the level of agency labor expense increases (β: 0.843, p < 0.001), while our chosen variables related to munificence (rural location; β: −1.634, p < 0.001) and dynamism (Medicare payor mix; β: −0.025, p < 0.001) were negatively associated with an increase in total agency labor expense. Conclusions: In general, our results appear to support the tenets of the RDT. We find that increased use of agency labor in hospitals is predicated on the hospital having the financial resources and flexibility to be able to afford the higher cost of agency labor. [ABSTRACT FROM AUTHOR]

Objectives: To address urgent staffing shortages, hospitals increasingly rely on agency labor. Given that staffing can significantly impact hospital performance, the aim of this study was to understand the organizational and market factors associated with agency labor utilization in US hospitals. Methods: Utilizing concepts from the Resource Dependence Theory (RDT), data for the calendar year 2022 for short-term acute care in United States hospitals (n = 2756) were analyzed with logistic regression analysis. We explored total agency labor expense (operationalized as a dichotomous variable at the 75th and 90th percentiles) in the presence of numerous organizational and market independent variables. Results: The results revealed that as markets become less complex (as measured by market concentration), the level of agency labor expense increases (β: 0.843, p < 0.001), while our chosen variables related to munificence (rural location; β: −1.634, p < 0.001) and dynamism (Medicare payor mix; β: −0.025, p < 0.001) were negatively associated with an increase in total agency labor expense. Conclusions: In general, our results appear to support the tenets of the RDT. We find that increased use of agency labor in hospitals is predicated on the hospital having the financial resources and flexibility to be able to afford the higher cost of agency labor.

Staff management challenges in the healthcare system are inherently different during pandemic conditions than under normal circumstances. Surge capacity must be rapidly increased, particularly in the intensive care units (ICU), to handle the increased pressure, without depleting the rest of the system. In addition, sickness or fatigue among the staff can become a critical issue. This study explores the lessons learned by first- and second-line managers in Sweden with regard to staff management during the COVID-19 pandemic. A mixed-methods approach was used, with preliminary qualitative interview (n = 38) and principal quantitative questionnaire (n = 272) studies, based on principal component and multiple regression analyses. The results revealed that the pandemic created four types of challenges relating to staff management: staff movement within hospitals; addition of external staff; addition of hours for existing staff through overtime and new shift schedules; and avoidance of lost hours due to sickness or fatigue. Furthermore, the effects of these managerial challenges were different in the first wave than in later waves, and they significantly differed between the ICU and other units. Therefore, a greater proactive focus on staff management would be beneficial in future pandemic situations. [ABSTRACT FROM AUTHOR]

AIM Mortality rates of COVID-19 patients hospitalised in intensive care units (ICUs) are generally high. Availability of ICU resources might influence clinical outcomes. The aim of this study was to examine the clinical course of the 42 patients treated during the first epidemic wave between 2 March and 20 May 2020 at the tertiary ICU of the Bern University Hospital, where staffing, equipment and drugs were not limited. METHODS For this descriptive study, retrospective data of the first COVID-19 wave in an interdisciplinary adult ICU of a Swiss University hospital was used. The study included data regarding healthcare staffing and COVID-19 patients. The primary outcome was the ICU mortality in COVID-19 patients. RESULTS Patients’ median age was 61 years (range 32–86), simplified acute physiology score (SAPS-II) was 46 (13–90), 81% of the patients were males, 79% were mechanically ventilated (3 of them on extracorporeal membrane oxygenation), 31% were under renal replacement therapy and 21% received steroids. All patients were fully anticoagulated from the time of admission. No off-label experimental antiviral or anti-inflammatory drugs were used with the exception of one patient, and antibiotic prescription was restrictive. Nurse-to-patient ratio was 1:1 during all shifts, and the physician-to-patient ratio was 1:4 (day shift) and 1:10 (night shift). Infectious disease specialists and physiotherapists were present every day. The median ICU length of stay was 10 days (1–38) days, and ICU and hospital mortality rates were 7% and 12%, respectively. CONCLUSION Careful intensive care treatment, without off-label drug use but including steroids in selected cases, combined with an interdisciplinary approach and provision of sufficient human resources, were associated with low ICU and hospital mortality rates despite high disease severity. Availability of qualified human resources may have an important impact on the outcome of COVID-19.

This paper examines the effect of Healthcare Management (HCM) on the satisfaction and loyalty of physicians from hospitals in Bangladesh. Five hundred physicians from both private and public hospitals were sampled, and 175 questionnaires were returned, giving a response rate of 35 per cent. Data collected was analyzed using descriptive statistics and structural equation modelling (SEM). Findings revealed that there are significant positive relationships between healthcare controlling, healthcare leading, healthcare organizing, healthcare staffing, and physicians' satisfaction in Bangladesh while healthcare planning is not supported. Results also show that 30.5 per cent variations in physicians' loyalty are explained by physicians' satisfaction. Practically, the findings of this study serve as inputs for policymakers in formulating policies to improve healthcare management practices as well as the entire health sector in Bangladesh. [ABSTRACT FROM AUTHOR]

This article uses a strategic foresight tool, megatrends, to examine forces infl uencing long-term healthcare staffi ng in the rural United States. Two megatrends--exponential advances in science and technology and the continued evolution of the decentralized global marketplace--will influence and ultimately help shape the future of rural healthcare. Successful health ecosystems of the future will need to be customer-driven, more affordable, and tech-savvy. Successful evolution in an era of continuous change will require a blend of intentional engagement with stakeholders, strategic foresight, and future-focused leadership. More research is needed to fully understand not only the challenges of rural healthcare but also the emerging opportunities. [ABSTRACT FROM AUTHOR]