Valuing Diversity and Inclusion in Healthcare: Pathways to Equip Workforces in the Post-COVID-19 New Normal (Preprint)

2021 ◽  
Author(s):  
Jiban Khuntia ◽  
Xue Ning ◽  
Wayne Cascio ◽  
Rulon Stacey
Keyword(s):  
United States ◽  
Health System ◽  
Health Systems ◽  
The United States ◽  
Mediating Effect ◽  
New Normal ◽  
Diversity And Inclusion ◽  
Healthcare Workforce ◽  
The Us ◽  
Service Oriented

BACKGROUND The COVID-19 pandemic, with all its virus variants, remains a serious situation. Health systems across the United States are trying their best to respond. The healthcare workforce remains relatively homogenous, even though they are caring for a highly diverse array of patients (6-12). It is a perennial problem in the US healthcare workforce that has only been accentuated during the COVID-19 pandemic. Medical workers should reflect the variety of patients they care for and strive to understand their mindsets within the larger contexts of culture, gender, sexual orientation, religious beliefs, and socioeconomic realities. Along with talent and skills, diversity and inclusion (D&I) are essential for maintaining a workforce that can treat the myriad needs and populations that health systems serve. Developing hiring strategies in a post-COVID-19 “new normal” that will help achieve greater workforce diversity remains a challenge for health system leaders. OBJECTIVE Our primary objectives are (1) to explore the characteristics and perceived benefits of US health systems that value D&I; (2) to examine the influence of a workforce strategy designed to balance talent and D&I; and (3) to explore three pathways to better equip workforces and their relative influences on business- and service-oriented benefits: (a) improving D&I among existing employees (IMPROVE), (b) using multiple channels to find and recruit a workforce (RECRUIT), and (c) collaborating with universities to find new talent and establish plans to train students (COLLABORATE). METHODS During February–March 2021, we surveyed 625 health system chief executive officers, in the United States, 135 (22%) of whom responded. We assessed workforce talent and diversity-relevant factors. We collected secondary data from the Agency for Healthcare Research and Quality’s (AHRQ) Compendium of the US. Health Systems, leading to a matched data set of 124 health systems for analysis. We first explored differences in talent and diversity benefits across the health systems. Then, we examined the relationship between IMPROVE, RECRUIT, and COLLABORATE pathways to equip the workforce. RESULTS Health system characteristics, such as size, location, ownership, teaching, and revenue, have varying influences on D&I and business and service outcomes. RECRUIT has the most substantial mediating effect on diversity-enabled business- and service-oriented outcomes of the three pathways. This is also true of talent-based workforce acquisitions. CONCLUSIONS Diversity and talent plans can be aligned to realize multiple desired benefits for health systems. However, a one-size-fits-all approach is not a viable strategy for improving D&I. Health systems need to follow a multipronged approach based on their characteristics. To get D&I right, proactive plans and genuine efforts are essential.

Integration vs. Collaborative Redesign Strategies of Health Systems’ Supply Chains in the Post-COVID-19 New Normal using Cross-Sectional Survey Across the United States (Preprint)

2021 ◽  
Author(s):  
Jiban Khuntia ◽  
Frances Mejia ◽  
Xue Ning ◽  
Jeff Helton ◽  
Rulon Stacey
Keyword(s):  
United States ◽  
Supply Chain ◽  
Health System ◽  
Supply Chains ◽  
Health Systems ◽  
The United States ◽  
Supply Chain Integration ◽  
Strategic Choices ◽  
New Normal ◽  
Service Outcomes

BACKGROUND How are health systems shaping strategies to restore the supply chain disruptions in 2021? Do they want to improve the supply chain integration? Do they want to collaborate with new start-ups to revamp the supply chain? Given the widespread disruptions to supply chains in 2020 because of the COVID-19 pandemic, these questions are essential to have confidence in health systems’ supply chain model strategies. Plausibly, health systems have an opportunity for redesign, growth, and innovation by utilizing collaborative strategies now, compared to the usual strategies of integrating their existing supply chains to reduce inefficiencies. This study is focused on teasing out the nuance of supply chain integration vs. collaboration strategies for health systems in the post-COVID “new normal.” OBJECTIVE We focus on two research questions. First, we explore the impact of perceived supply chain challenges and disruptions on health systems’ supply chain integration (SC-INTEGRATION) and collaborative redesign (SC-REDESIGN) strategies. Second, we examine the outcomes of integration and collaborative redesign strategic choices on growth and service outcomes. METHODS We surveyed a robust group of health system chief executive officers (CEOs) (N=625) across the United States from February to March 2021. Twenty-two percent of the CEOs (135) responded to our survey. We considered supply chain relevant strategy and outcome variables from the literature and ratified them via expert consensus. We collected secondary data from the AHRQ Compendium of the U.S. Health Systems, leading to a matched data set from the 124 health systems. Then, we employed ordered logit model estimation to examine CEO preferences for partnership strategies to address current supply disruptions and the outcomes of strategy choices. RESULTS Health systems with higher disruptions would choose integration over redesign, indicating that they still trust the existing partners. Integration strategy is perceived to result in better service outcomes while collaborations are perceived to lead to greater growth opportunities; however, the role of integration on growth is not completely ruled out. Plausibly, some health systems would choose both integration and collaborative redesign models, which have a significant relationship with both service and growth, establishing the importance of mixed strategies for health systems. CONCLUSIONS The cost of healthcare continues to rise, and supply-related costs constitute a large portion of a hospital’s expenditure. Understanding supply chain strategic choices are essential for the success of a health system. Although collaborative revamp is an option; but still focusing on and improving existing integration dynamics is helpful to foster both growth and services for health systems.

The Rate and Costs Attributable to Intravenous Patient-Controlled Analgesia Errors

2009 ◽  
Vol 44 (4) ◽  
pp. 312-324 ◽  
Author(s):  
Brian Meissner ◽  
Winnie Nelson ◽  
Rodney (Rod) Hicks ◽  
Vanja Sikirica ◽  
Josh Gagne ◽  
...  
Keyword(s):  
United States ◽  
Health System ◽  
The United States ◽  
Error Rates ◽  
Error Reporting ◽  
Patient Controlled Analgesia ◽  
System Perspective ◽  
Medication Error Reporting ◽  
The Us ◽  
Integrated Health

Purpose To estimate the rates and costs of intravenous patient-controlled analgesia (IV PCA) errors from the hospital or integrated health system perspective. Methods This study used a cost-accounting methodology to estimate the costs attributable to IV PCA errors in the United States. Data for the study were obtained from the MEDMARX and Manufacturer and User Facility Device Experience (MAUDE) datasets, published literature, and expert opinions. MEDMARX is a voluntary, anonymous, medication-error-reporting database owned and operated by the United States Pharmacopeia. MAUDE is a mandatory, device-error-reporting database maintained by the US Food and Drug Administration. Levels of care rendered as a result of the IV PCA errors were estimated by applying clinical assumptions (validated by an expert advisory panel) to each of the 7 error consequences considered in this analysis. Variable and opportunity costs (2006 values) were considered, including medication, laboratory, lost revenue, and labor. The corresponding costs were applied to the error consequences to derive the estimated mean cost for each error cause. The numbers of errors documented in each dataset and the published literature were used to extrapolate the rate of IV PCA errors annually. Results The average cost per error event was $733 in the MEDMARX dataset and $552 in the MAUDE dataset. Harmful IV PCA errors were 120 to 250 times more costly than nonharmful errors. The annual error rates were estimated as 407 IV PCA-related errors and 17 device-related errors per 10,000 people within the United States. Conclusion: Analysis of 2 datasets, MEDMARX and MAUDE, revealed that IV PCA medication- and device-related errors are costly to hospitals and integrated health systems and represent a significant burden on the US health system. This study provided a novel approach to estimating the associated costs of undesired IV PCA-related events. Additional research is needed to validate the methodology (as applied to this area) and results.

scholarly journals Gender-Inclusive Fellowship Naming and Equity, Diversity, and Inclusion in Radiology: An Analysis of Radiology Department Websites in Canada and the United States

2022 ◽  
pp. 084653712110661
Author(s):  
Tyler D. Yan ◽  
Lauren E. Mak ◽  
Evelyn F. Carroll ◽  
Faisal Khosa ◽  
Charlotte J. Yong-Hing
Keyword(s):  
United States ◽  
Breast Imaging ◽  
The United States ◽  
Radiology Department ◽  
Imaging Data ◽  
Body Imaging ◽  
Cross Sectional ◽  
Diversity And Inclusion ◽  
The Us ◽  
The Impact

Purpose: Transgender and gender non-binary (TGNB) individuals face numerous inequalities in healthcare and there is substantial work to be done in fostering TGNB culturally competent care in radiology. A radiology department’s online presence and use of gender-inclusive language are essential in promoting an environment of equity, diversity, and inclusion (EDI). The naming of radiology fellowships and continuing medical education (CME) courses with terminology such as “Women’s Imaging” indicates a lack of inclusivity to TGNB patients and providers, which could result in suboptimal patient care. Methods: We conducted a cross-sectional analysis of all institutions in Canada and the United States (US) offering training in Breast Imaging, Women’s Imaging, or Breast and Body Imaging. Data was collected from each institution’s radiology department website pertaining to fellowship names, EDI involvement, and CME courses. Results: 8 Canadian and 71 US radiology fellowships were identified. 75% of Canadian and 90% of US fellowships had gender-inclusive names. One (12.5%) Canadian and 29 (41%) US institutions had EDI Committees mentioned on their websites. Among institutions publicly displaying CME courses about breast/body or women’s imaging, gender-inclusive names were used in only 1 (25%) of the Canadian CME courses, compared to 81% of the US institutions. Conclusions: Most institutions in Canada and the US have gender-inclusive names for their radiology fellowships pertaining to breast and body imaging. However, there is much opportunity to and arguably the responsibility for institutions in both countries to increase the impact and visibility of their EDI efforts through creation of department-specific committees and CME courses.

scholarly journals Audio-/Videorecording Clinic Visits for Patient�s Personal Use in the United States: Cross-Sectional Survey (Preprint)

2018 ◽  
Author(s):  
Paul J Barr ◽  
Kyra Bonasia ◽  
Kanak Verma ◽  
Michelle D Dannenberg ◽  
Cameron Yi ◽  
...  
Keyword(s):  
United States ◽  
Health Systems ◽  
The United States ◽  
Clinic Visit ◽  
Cross Sectional ◽  
The Public ◽  
The Us ◽  
The Future ◽  
Personal Use ◽  
Clinic Visits

BACKGROUND Few clinics in the United States routinely offer patients audio or video recordings of their clinic visits. While interest in this practice has increased, to date, there are no data on the prevalence of recording clinic visits in the United States. OBJECTIVE Our objectives were to (1) determine the prevalence of audiorecording clinic visits for patients’ personal use in the United States, (2) assess the attitudes of clinicians and public toward recording, and (3) identify whether policies exist to guide recording practices in 49 of the largest health systems in the United States. METHODS We administered 2 parallel cross-sectional surveys in July 2017 to the internet panels of US-based clinicians (SERMO Panel) and the US public (Qualtrics Panel). To ensure a diverse range of perspectives, we set quotas to capture clinicians from 8 specialties. Quotas were also applied to the public survey based on US census data (gender, race, ethnicity, and language other than English spoken at home) to approximate the US adult population. We contacted 49 of the largest health systems (by clinician number) in the United States by email and telephone to determine the existence, or absence, of policies to guide audiorecordings of clinic visits for patients’ personal use. Multiple logistic regression models were used to determine factors associated with recording. RESULTS In total, 456 clinicians and 524 public respondents completed the surveys. More than one-quarter of clinicians (129/456, 28.3%) reported that they had recorded a clinic visit for patients’ personal use, while 18.7% (98/524) of the public reported doing so, including 2.7% (14/524) who recorded visits without the clinician’s permission. Amongst clinicians who had not recorded a clinic visit, 49.5% (162/327) would be willing to do so in the future, while 66.0% (346/524) of the public would be willing to record in the future. Clinician specialty was associated with prior recording: specifically oncology (odds ratio [OR] 5.1, 95% CI 1.9-14.9; P=.002) and physical rehabilitation (OR 3.9, 95% CI 1.4-11.6; P=.01). Public respondents who were male (OR 2.11, 95% CI 1.26-3.61; P=.005), younger (OR 0.73 for a 10-year increase in age, 95% CI 0.60-0.89; P=.002), or spoke a language other than English at home (OR 1.99; 95% CI 1.09-3.59; P=.02) were more likely to have recorded a clinic visit. None of the large health systems we contacted reported a dedicated policy; however, 2 of the 49 health systems did report an existing policy that would cover the recording of clinic visits for patient use. The perceived benefits of recording included improved patient understanding and recall. Privacy and medicolegal concerns were raised. CONCLUSIONS Policy guidance from health systems and further examination of the impact of recordings—positive or negative—on care delivery, clinician-related outcomes, and patients’ behavioral and health-related outcomes is urgently required.

scholarly journals American and Canadian Health System Overview

2021 ◽  
pp. 32-37
Author(s):  
Ahmad Khan,
Keyword(s):  
United States ◽  
Infant Mortality ◽  
Life Expectancy ◽  
Maternal Mortality ◽  
Health System ◽  
Health Systems ◽  
Healthcare Services ◽  
The United States ◽  
Universal Healthcare ◽  
The World

Scientists have written numerous papers studying different aspects of health systems in the world. Comparing health systems in the world is essential for policymakers to learn from each other to make healthcare services effective with better outcomes and decrease the cost of healthcare services. In the world, countries have different health systems. The difference in the health systems is a combination of components that are specific to each country based on the financial status of healthcare, workforce, and infrastructures. This paper will evaluate the contrast of Canadian and American health systems payment systems, timely access, and healthcare quality outcomes. Both countries are well-developed countries that have a health system with excellent infrastructure and effective healthcare services. However, the system operates differently in both countries. America does not have a universal healthcare plan and spends more money per capita compared to Canada. The United States has a lower rank than its peer, underperforms in maternal mortality, infant mortality, preventable deaths, and life expectancy. On the other hand, Canada has a universal healthcare plan for all Canadian residents and performs better in life expectancy, infant mortality, and maternal mortality. However, waiting for specialized care is longer than in the United States.

An American Perspective of the Dental and Public Health Initiatives in Cuba

2021 ◽  
pp. 232020682110301
Author(s):  
Colleen Watson ◽  
Laura Rhein ◽  
Stephanie M. Fanelli
Keyword(s):  
Public Health ◽  
United States ◽  
Health Status ◽  
Health System ◽  
Healthcare System ◽  
National Health ◽  
National Health System ◽  
The United States ◽  
Healthcare Systems ◽  
The Us

Aim: To compare following the Cuban Revolution, Cuba’s economy and civil society was transformed by the initiation of a program of nationalization and political consolidation. The Cuban government operates a national health system and assumes fiscal and administrative responsibility for the healthcare of its citizens. Other industrialized nations continue to surpass the US in health-related outcomes indicating areas of improvement in its healthcare system. Assessing the successes and failures as well as the advantages and disadvantages of other countries’ healthcare systems may be instrumental in the development of modifications to the organization and delivery system of healthcare in the US. This paper aims to report the information attained from previous literature as well as from first-hand observations from a public health trip to Cuba in order to compare the healthcare systems in Cuba and the United States. Materials and Methods: A group of New York University College of Dentistry faculty and students traveled to Cuba in April 2019 for professional research and professional meetings (CFR 515.564). While in Cuba, the researchers took written notes of the lecture-based material and conversations. Upon return to the United States, published literature was searched for the collection of any additional data and all qualitative data and quantitative data was compiled and organized. Since 1959, Cuba has made continuous adjustments and improvements to its universal, free and accessible healthcare system. Results: There have been notable improvements to the country’s public health status, such as the implementation of an immunization program and subsequent eradication of communicable diseases, such as polio and rubella. Additionally, the implementation of the National Program on Dentistry guarantees dental care to all Cuban children under the age of 19. Today, the Cuban National Health System (NHS) initiatives have evolved to combat the novel coronavirus (COVID-19) pandemic. Conclusion: Recognizing the advantages as well as the disadvantages of the Cuba’s National Health System (NHS) would be useful for future policymakers in the United States. Cuban approaches to health could be tailored to the United States environment to improve healthcare effectiveness and population health status in the future.

scholarly journals Health-System Introductory Pharmacy Practice Experience as an online course in the United States

2020 ◽  
pp. 11-12
Author(s):  
M. Kawaguchi-Suzuki ◽  
J. Merlo ◽  
S. White ◽  
R. Gibbard ◽  
L. Ly ◽  
...  
Keyword(s):  
United States ◽  
Health System ◽  
Pharmacy Practice ◽  
The United States ◽  
Online Course ◽  
Executive Order ◽  
Practice Experience ◽  
The Us ◽  
Second Year

Introductory Pharmacy Practice Experiences (IPPEs) provide early experiential education in the Doctor of Pharmacy (Pharm.D.) curriculum in the United States (US). In response to Oregon's ‘Stay Home, Save Lives’ executive order issued during the COVID-19 pandemic, an online health-system IPPE course was developed to simulate the practice experiences that have historically been conducted in person. This case study describes experience from the online health-system IPPE course offered for incoming second-year student pharmacists enrolled in a three-year Pharm.D. programme at Pacific University in Oregon, US. The goals of the course were: 1) to expose students to pharmacy practice common in health-system settings in the US; and 2) for students to earn 50 experiential clock hours through simulation activities.

scholarly journals Digital Orientation of Health Systems in the Post-COVID-19 New Normal: Insights from a Cross-Sectional Survey Across the United States (Preprint)

2021 ◽  
Author(s):  
Jiban Khuntia ◽  
Xue Ning ◽  
Rulon Stacey
Keyword(s):  
United States ◽  
Health Systems ◽  
Digital Technology ◽  
Digital Technologies ◽  
The United States ◽  
Transformative Power ◽  
New Normal ◽  
High Burden ◽  
Major Teaching ◽  
Almost All

BACKGROUND How are health systems in the United States embracing digital technologies? Many health systems are overwhelmed. Others have tried to stay current with the dramatic changes of the past year by leapfrogging selected digital technologies during the COVID-19 pandemic. It appears that almost all health systems have developed some form of customer-facing digital technologies and worked to align those to their existing electronic health records to accommodate the surge in remote and virtual care deliveries. Still, others have developed analytics-driven decision-making capabilities. However, even with all these developments, there seems to yet a gap in health systems’ ability to integrate workflows with expanding technologies to spur innovation and futuristic growth. There is a lack of a reliable and reported estimate of the current digital orientation of health systems. Periodic assessments will provide imperatives to policy formulation and align efforts to yield the transformative power of emerging digital technologies. OBJECTIVE To explore and assess US health systems’ differences in digital orientations in the post-COVID-19 “new normal” in 2021. Differences were assessed in four dimensions: 1) Analytics and Intelligence Oriented Digital Technologies (AODT) 2) Customer Oriented Digital Technologies (CODT) 3) Growth and Innovation Oriented Digital Technologies (GODT), and 4) Futuristic and Experimental Digital Technologies (FEDT) The earlier two are foundational to health systems’ digital orientation, while the latter two will prepare for future disruptions. METHODS We surveyed a robust group of health system CEOs (total 625) across the United States during Feb-Mar 2021. Twenty-two percent of the CEOs (135) responded to our survey. We considered the above four broad digital technology orientations and ratified with experts’ consensus. Secondary data was collected from AHRQ Hospital Compendium, leading to the matched usable dataset for 124 health systems for analysis. We examined the relationship of adopting the four digital orientations to specific hospital characteristics and factors that were earlier reported widely as barriers or facilitators to technology adoption. RESULTS We found that health systems have a lower level of customer (CODT mean= 4.70) or growth (GODT mean= 4.54) orientations, compared to analytics and intelligence digital orientation (AODT mean= 5.03); while health systems have the least futuristic digital orientation (FEDT mean= 4.31). The ordered logistic estimation results provided nuanced insights. Medium (P<.001) and large-sized(P<.05), major teaching (P<.001), and systems with a high burden hospital (P<.001) are doing worse in AODT orientations, raising some concerns. Health systems with medium (P<.001) and large sizes (P<.05), major teaching (P<.1), high revenue (P<.05), and with a high burden hospital (P<.001) have less customer-oriented digital technology or CODT. Interestingly, we found that health systems in Midwest (P<.05) and South (P<.05) are more likely to adopt growth-orientated technologies, while high revenue (P<.01) and investor ownership (P<.05) deters from GODT. Health systems in with the medium size and are in Midwest (P<.001), South (P<.001), and West (P<.05) are more adept to FEDT; while medium (P<.001) and high revenue (P<.001), and those with a high discharge (P<.05) or high burden hospital (P<.01) have subdued FEDT orientations. CONCLUSIONS Not surprisingly, almost all health systems have some current foundational digital technological orientations to glean intelligence or service delivery to customers, with some notable exceptions of lower adoptions in some sets of health systems. Comparatively, fewer groups of health systems have growth or futuristic digital orientations. The transformative power of digital technologies can be leveraged ONLY by adopting futuristic digital technologies. Thus, the disparities across these orientations suggest that a holistic, consistent, and well-articulated digital orientation direction across the United States remains elusive. This lack of consistency exacerbates different outcomes across different health systems and regions in the United States. Accordingly, the authors suggest that a policy strategy and financial incentives are necessary to spur a well-visioned and articulated digital orientation for all health systems across the United States. In the absence of such a policy to collectively leverage digital transformations, differences in care across the country will continue to be a concern.

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