BACKGROUND

One of the ways to improve the quality of services in the health system is through clinical governance. This method aims to create a framework for clinical services providers to be accountable in return for continuing improvement of quality and maintaining standards of services.

OBJECTIVE

To evaluate the success rate of clinical governance implementation in Kerman teaching hospitals based on 9 steps of Karsh's Model.

METHODS

This cross-sectional study was conducted in 2015 on 94 people including chief executive officers (CEOs), nursing managers, clinical governance managers and experts, head nurses and nurses. The required data were collected through a researcher-made questionnaire containing 38 questions with three-point Likert Scale (good, moderate, and weak). The Karsh's Model consists of nine steps including top management commitment to change, accountability for change, creating a structured approach for change, training, pilot implementation, communication, feedback, simulation, and end-user participation. Data analysis using descriptive statistics and Mann-Whitney-Wilcoxon test was done by SPSS software version 16.

RESULTS

About 81.9 % of respondents were female and 74.5 have a Bachelor of Nursing (BN) degree. In general, the status of clinical governance implementation in studied hospitals based on 9 steps of the model was 44 % (moderate). A significant relationship was observed among accountability and organizational position (p=0.0012) and field of study (p=0.000). Also, there were significant relationships between structure-based approach and organizational position (p=0.007), communication and demographic characteristics (p=0.000), and end-user participation with organizational position (p=0.03).

CONCLUSIONS

Clinical governance should be implemented by correct needs assessment and participation of all stakeholders, to ensure its enforcement in practice, and to enhance the quality of services.

Research overwhelmingly shows that facial appearance predicts leader selection. However, the evidence on the relevance of faces for actual leader ability and consequently performance is inconclusive. By using a state-of-the-art, objective measure for face recognition, we test the predictive value of CEOs' faces for firm performance in a large sample of faces. We first compare the faces of Fortune500 CEOs with those of US citizens and professors. We find clear confirmation that CEOs do look different when compared to citizens or professors, replicating the finding that faces matter for selection. More importantly, we also find that faces of CEOs of top performing firms do not differ from other CEOs. Based on our advanced face recognition method, our results suggest that facial appearance matters for leader selection but that it does not do so for leader performance.

It's hard for chief executives to trust their chief information officers. Blame technophobia or just bad experiences. But now that information technology has become the linchpin for an organization's success, CEOs and CIOs are asking, "How do we make this work?"

In 1989 the Catholic Health Association, in conjunction with the University of Iowa Center for Health Services Research, surveyed chief executive officers (CEOs) of rural hospitals regarding their hospital's viability and strategic behaviors and orientations. An extensive questionnaire was sent to the CEOs of all Catholic, all other religious not-for-profit, and all investor-owned rural hospitals, as well as to a 50 percent random sample of government and other not-for-profit rural hospitals. CEOs on average perceived that their hospital's viability relative to that of other rural hospitals was higher in 1989 than it had been in 1987. Ninety-four percent of hospitals whose CEOs perceived an increase in viability had been medium- or low-viability hospitals two years earlier. Thus, despite reports of deteriorating conditions for rural hospitals, rural hospital CEOs appeared to be relatively optimistic regarding their institution's viability. Changes in strategic direction accompanied these perceived increases in viability. The predominant strategic orientation adopted by rural hospitals in 1987 was that of the defender, but many hospitals that used this approach switched to the analyzer orientation by 1989. Significant shifts also occurred toward the reactor orientation from the analyzer and defender orientations. A greater percentage of hospitals with a perceived increase in viability between 1987 and 1989 altered their organizational role. The most common change for these hospitals was from limited care to basic care.

Making sure the relative roles of the board and management are clear and agreed upon is becoming more important as market and regulatory forces compel boards to govern at levels of detail once considered micromanagement, but are now required and necessary in the current environment of heightened governance accountability. A clear understanding of each other's roles and responsibilities is step one in building a solid partnership between the board and chief executive. A second element of building a strong foundation for the board-CEO relationship is taking time early on to establish mutual expectations about working together. The board's responsibilities in CEO performance management and compensation include setting performance expectations and goals that are clear and measurable and coaching and motivating the CEO. When a CEO fails, one of the most important steps for the board to take is to look in the mirror and commit to the rigorous due diligence needed to avoid future mistakes. Boards should always have CEO succession on their agenda.

OBJECTIVE

To document the roles, the perceived skills and attributes and experience required of Medical Administrators in contemporary public hospitals.

METHODS

Interviews with Directors of Medical Services (DMS) from Victorian metropolitan public hospitals between March 2005 and May 2005.

RESULTS

A total of 14 of the 21 DMS in Victoria were interviewed. Key roles: Managing Medical Staff; Clinical Governance and Quality Improvement; Strategy and Service development; and Medical advisor to CEO. Key attributes and skills aligned with roles. Most respondents hold Fellowship of Royal Australasian College of Medical Administrators (FRACMA) with over half employed for less than 2 years.

CONCLUSIONS

Core roles identified mirrored in key international literature. Recommendations for further study includes systematic review of literature; the influence of the medically-trained Chief Executive on roles; and further analysis of high turnover.

CONCLUSIONS

This study clarifies the roles undertaken and skills required by Medical Administrators in contemporary public hospitals, providing: (1) role benchmarking for Chief Executives; (2) reduced ambiguity among the broader medical staff of the roles, to assist those who may need Medical Administrator assistance with providing patient care; (3) assisting the Medical Administration profession and RACMA to provide tailored education and training; and (4) to inform aspiring future Medical Administrators of the broad nature of such roles.

Healthcare CEOs recognize that managers are under increasing pressure to work smarter and more efficiently with fewer available resources. Jobs in the healthcare industry are in a constant state of change, requiring a workforce that is not only prepared to adjust quickly to the changing environment but to simultaneously maintain or improve overall organizational performance. Traditionally, trainers were viewed as the people with the primary responsibility for improving organizational performance. Today some CEOs believe healthcare managers should own that responsibility, and other CEOs believe the responsibility should be shared among healthcare managers and trainers. This shift in how accountability is viewed poses at least two important questions. Are managers aware of the various roles they need to enact to achieve successful organizational performance improvement? Do managers possess the competencies associated with those roles? The seven most contemporary trainer roles, now referred to as workplace learning and performance roles, are examined in this article to help managers increase their knowledge of the roles, competencies, and outputs expected of them. Based on findings of a study conducted to examine CEO's perceptions of managers' roles in the performance improvement process, this article provides theoretical backgrounds, includes verbatim study comments, and offers practical recommendations or tips for managers.

Empirical evidence is scarce on chief executive officer (CEO) turnover in U.S. hospitals, with potentially serious implications for many of these organizations. This study, based on a nationwide survey of CEOs at non-federal general surgical and medical community hospitals conducted in the spring of 2004, reports the perceptions of hospital CEOs regarding the circumstances and impact of CEO turnover on U.S. hospitals. In the opinion of the respondents, the impact includes competitors taking advantage of turnover by luring employees and physicians away from the target hospital, significantly increasing the likelihood of other senior executives leaving the hospital, and many of the important strategic activities being delayed or cancelled altogether. Interestingly, the perceptions of CEOs regarding the effects of turnover do not seem to differ regardless of voluntary or involuntary circumstances of turnover. However, there is a notable bias in emphasizing the perceived negative implications of respondents' own departures and allegedly positive effects of their predecessors' departures.

An experimental technique and analysis methodology for obtaining high-fidelity Hugoniot measurements with defined uncertainty bounds on powder compacts using optical velocimetry is presented. Impedance matching is used to calculate the shocked state in the powder from the measured initial compact density, ρ(00), impact velocity, V(Imp), and shock velocity, U(S). Detailed characterization of the powder thicknesses at precise locations results in improvements in characterization of the initial density state and accurate measurements of the powder thickness at locations corresponding to shock velocity measurements. These measurements result in high accuracies in the equilibrium Hugoniot state and reduced uncertainties in the measured and calculated Hugoniot parameters. Assumptions in this analysis include a constant and homogeneous initial porous density, and steady state wave propagation. The approach is applied to a system of CeO(2) powder pressed to 4.0 g/cm(3) (55% theoretical maximum density), and results indicate a complex dynamic response.

How do you transition from physician executive to physician CEO? Three physician CEOs were interviewed to explore the skills they needed to land in the top position. They share their views on what it takes to be a successful CEO. They describe the skills that they needed when they moved into the CEO role and how they acquired them. Some of the qualities it takes to be a CEO include the ability to: Articulate your values; use your people skills; describe a vision; solve problems; listen; walk around; and use analytical skills.

In this study, CeO2 was irradiated with 200 MeV Au ions at oblique incidence. Observation of as-irradiated samples by transmission electron microscopy (TEM) shows that hillocks are created not only at the wide surfaces, but also at the crack faces of the thin samples. Since the hillocks created at the crack faces can be imaged by TEM, their shape and crystallographic features can be revealed. From the images of hillocks created at the crack faces, many of the hillocks are found to be spherical. We present the first experimental evidence that hillocks created for CeO2 irradiated with swift heavy ions have a crystal structure whose lattice spacing and orientation coincide with those of the matrix. The mechanism of spherical crystalline hillock formation is discussed based on the present results.

This article examines the adoption of physician impact analysis (PIA) among active treatment hospitals in Ontario, Canada. The influence of variables from three different levels of analysis (individual, organizational and contextual) were included as well as measures of key stakeholders' (Chief Executive Officer (CEO) and Medical Chief of Staff) assessments of the attributes of the innovation. A number of conclusions were drawn. First, by adding information about the perceived attributes of the innovation the model was able to account for a larger percentage of explained variance than has been seen in related work. Secondly, the adoption of PIA within a context of written guidelines agreed to by senior management, specifying process and structure concerns, is most likely in organizations which are large and where the CEO positively evaluates the innovation.

In health care systems based on managed competition, insurers are expected to negotiate with providers about price, quantity, and quality of care. The Dutch experience shows that this expectation may be justified with regard to price and quantity, but for quality the results are less conclusive. To examine the incentives insurers face for enhancing quality of care, we conducted in-depth interviews with CEOs and organised separate focus groups with purchasers and marketers of five Dutch health insurers. Jointly these insurers account for more than 90 percent of the market. We distinguished three categories of both positive and negative incentives to steer on quality: social, competitive and financial incentives. The overall picture emerging is that insurers are caught in a struggle between positive and negative incentives, with CEOs being more positive about the incentives to steer on quality than purchasers and marketers. At present, the social mission perceived by insurers seems to be their most important driver to invest in quality enhancement. However, whether or not the role of the social mission is sustainable in a competitive market remains unclear. Improving publicly available information on quality therefore seems to be crucially important for reinforcing the positive as well as counteracting the negative incentives insurers face with respect to enhancing quality of care.

Despite widespread interest in narcissism, relatively little is known about the conditions that encourage or dampen it. Drawing on research showing that macroenvironmental conditions in emerging adulthood can leave a lasting imprint on attitudes and behaviors, I argue that people who enter adulthood during recessions are less likely to be narcissistic later in life than those who come of age in more prosperous times. Using large samples of American adults, Studies 1 and 2 showed that people who entered adulthood during worse economic times endorsed fewer narcissistic items as older adults. Study 3 extended these findings to a behavioral manifestation of narcissism: the relative pay of CEOs. CEOs who came of age in worse economic times paid themselves less relative to other top executives in their firms. These findings suggest that macroenvironmental experiences at a critical life stage can have lasting implications for how unique, special, and deserving people believe themselves to be.

OBJECTIVE

The aim of the present study was to describe the scope and degree of involvement of senior nurse leaders (SNLs) in executive level decisions in acute care organizations across Canada.

BACKGROUND

Significant changes in SNL roles including expansion of decision-making responsibilities have occurred but little is known about the patterns of SNL decision-making.

METHODS

Data were collected by mailed survey from 63 SNLs and 49 chief executive officers (CEOs) in 66 healthcare organizations in 10 Canadian provinces. Regression analyses were used to examine whether timing, breadth of content expertise and the number of decision activities predicted SNL decision-making influence and quality of decisions.

RESULTS

Breadth of content expertise and number of decision activities with which the SNL was involved were significant predictors of decision influence explaining 22% of the variance in influence. Overall, CEOs rated SNL involvement in decision-making higher than the SNL.

CONCLUSIONS

Senior nurse leaders contribute to organizational processes in healthcare organizations that are important for nurses and patients, through their participation in decision-making at the senior team level.

CONCLUSIONS

Findings may be useful to current and future SNLs learning to shape the nature and content of information shared with CEOs particularly in the area of professional practice issues.

In this article the author describes a situation in which the Nurse Executive's values were in direct opposition to those of the Chief Executive Officer (CEO). She describes how it took considerable courage on the part of the Nurse Executive to resolve this situation by demonstrating concern and respect for a chemically impaired staff member, rather than by focusing on the situation from a strictly "right versus wrong" perspective. After describing the situation the author emphasizes the importance of the leadership role of the Nurse Executive and shares the perspective of the agency's Chief Executive Officer. The author also explains how the American Association of Critical-Care Nurses' Framework (4 A's to Rise Above Moral Distress) was used as a resource to guide the Nurse Executive in moving the situation to a productive conclusion. Organizational outcomes of the situation are shared.

In this essay, business thinker Peter Drucker examines the changing dynamics of the workforce--in particular, the need for organizations to take just as much care and responsibility when managing temporary and contract workers as they do with their traditional employees. Two fast-growing trends are demanding that business leaders pay more attention to employee relations, Drucker says. First is the rise of the temporary, or contract, workers; 8 million to 10 million temp workers are placed each day worldwide. And they're not just filling in at reception desks. Today, there are temp suppliers for every kind of job, all the way up to CEO. Second, a growing number of businesses are outsourcing their employee relations to professional employee organizations (PEOs)--third-party groups that handle the ever mounting administrative tasks associated with managing a company's employees. (Managers can easily spend up to one-quarter of their time on employee-related rules, regulations, and paperwork.) Driving these trends, Drucker observes, is the shift from a dependency on manual labor to create wealth and jobs to a dependency on specialization and knowledge. Leaders are increasingly trying to keep up with the needs of many small groups of product or service experts within their companies. Temps and PEOs free up leaders to focus on the business rather than on HR files and paperwork. But if organizations outsource those functions, they need to be careful not to damage relationship with their people in the process, Drucker concludes. After all, developing talent is business's most important task--the sine qua non of competition in a knowledge economy.

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.

Health services continue to be seen as significant settings for health improvement, and developments continue to be made in the nature of such work, means of optimal delivery and outcomes. This paper builds on previous work by reporting on activity in a series of sites within 'NHS Health Scotland's (NHS HS)' Health Promoting Health Service (HPHS) initiative. The objectives of the review were to: describe the achievements of HPHS sites, assess the degree of influence and embedding of the HPHS approach, review the support functions provided by 'NHS HS' and identify the challenges to implementation and sustainability. The review identified a variety of activity associated with HPHS, ranging from a topic focused/behaviour change approach to efforts to re-orientate organizational features. The role that NHS HS played in developing settings capacity was largely endorsed, and there was, despite the existence of some barriers, evidence that HPHS was being successfully embedded within health service organizational policies and procedures. In particular, the role of a national level strategic guidance document to NHS CEOs ['Chief Executive Letter (14)'] is noted as having been significant in creating a conducive context for HPHS. In this context, the paper concludes by reflecting more broadly on the current status of settings-based health improvement and suggests that on the basis of this review there should be optimism in pursuing a relatively expansive vision of health improvement in this particular setting and potentially others.

We propose and demonstrate a novel linear procedure for measurement of the carrier-envelope offset (CEO) phase of femtosecond oscillators. The technique is based on a Mach-Zehnder interferometer, a ring resonator, and a spectrograph. In this scheme, interference between subsequent pulses from a pulse train may frustrate the interference between identical pulses in the Mach-Zehnder, resulting in a modification of interference contrast depending on the CEO phase. We suggest spectrally and spatially resolved interferometry for robust detection of the fringe visibility. It is shown by numerical simulations and experimentally demonstrated that the visibility of such fringes uniquely depends on the CEO phase of the pulse train. Since the method relies only on linear interactions and does not require any nonlinear conversion, it allows characterizing the CEO frequency of mode-locked oscillators with virtually arbitrarily low bandwidth and power levels.

A growing number of nurses are moving into leadership roles in hospital IT departments. Their patient care expertise is valuable as hospitals shift their IT focus from back-office functions to clinical processes. For RNs thinking about making the transition--and CEOs thinking about hiring an RN as CIO--there are important issues to consider.

Over the past two years as CEO of the Montreal Health Authority I have participated in the preparation and now the implementation of what I consider the first real reform in healthcare since the beginning of Medicare in 1970. In my opinion Quebec is undergoing a second "quiet revolution" in healthcare as important as the first one, a revolution not in structure but in the philosophy of how healthcare is provided to its population.