essay on healthcare management

Preparing Your Online MHA Application: Essay Tips & Tricks

As you think about applying or starting your application to NYU Wagner’s Online Master of Health Administration (MHA) degree program , you will notice the application requires two essays. 

The essays are an opportunity to showcase your commitment to advancing healthcare in the United States and how you will bring your experiences to bear to make an impact on the communities and organizations you aspire to serve. Your responses also give the reader insight into your academic and professional experience, future goals, and why pursuing healthcare management is an important step forward in your career. 

Read the essay questions and review our recommendations for this critical component of your Online MHA application.  

Online MHA Essay Questions

Essay 1: .

Tell us about your short-term and long-term professional goals. How are your professional strengths, past experiences, and personal attributes aligned with these goals? Why is now the right time for you to pursue graduate school at NYU Wagner?

For MHA program applicants not currently working in a US healthcare-related position, be sure to articulate your interest in pursuing a career in healthcare management in the US.

Essay 2: 

At NYU Wagner, we believe that the practice of healthcare management is complicated and messy, and issues are often interconnected. Write an essay that begins to explore the complexities of a healthcare issue of your choice. How do you think the MHA program at NYU Wagner will aid you in addressing this issue?

How to Write an Online MHA Application Essay that’s Ready to Submit

Answer the essay questions.

A good MHA application essay is well-organized and directly addresses the question. Focus your responses on your academic and professional goals and how NYU Wagner’s Online MHA program will help you achieve them. Tell us about your commitment to making an impact on the US healthcare system.  

Use specific examples

Set yourself apart from other applicants: tell your unique story and use specific examples. Was there a clear moment you knew you wanted to pursue a career in healthcare adminstration? Did volunteering, work, or a particular project spark your interest? You don’t need to write about a life-changing experience. Sometimes the smallest moments lead us to the biggest breakthroughs. 

Be honest 

Your application essay is also an opportunity to expand on the academic and professional history in your resume or CV. For example, if you worked full-time to help fund your undergraduate education, that shows us important context to your experience and achievements. We want to see your experience as a whole, and the more detailed and honest you are, the more the MHA admissions committee and faculty will see you as an individual ready for the next step in your healthcare career.

Make the most of the Additional Information section

The Additional Information section of the application is an optional opportunity to expand on particular circumstances related to your application of which we should be aware. For example, you might want to provide more information about unexplained gaps in your employment history, weak academic performance, the relevance of your choice of recommenders, or other significant factors that may impact your application. The additional information section is a great tool for us to get to know you and your specific circumstances better. 

Set aside time to prepare

Before you start your essay, formulate your plan and brainstorm what you want to say. We recommend setting aside 30 minutes each day to work on your essay. Before you know it you will have a complete, 400-500 word essay. 

Proofread, revise, and proofread again

Make sure your essay is well-organized and comprehensive. Double-check your grammar and spelling. A poorly written essay suggests a lack of care and subpar communication skills. Ask your colleagues, professors, managers, or friends for their feedback and edits. Having a second set of eyes will improve your essay. 

Remember, these essays are your only opportunity to express who you are, and why NYU Wagner’s Online MHA program is the right choice for you. If you have any other questions regarding admissions, please reach out to us! Our Enrollment Advisors are here to provide one-on-one application assistance about the program, online student experience, financial aid , and more.

Interested in learning more?

Request more info, ready to take the next step.

• - Google Chrome

Intended for healthcare professionals

• Access provided by Google Indexer
• My email alerts
• BMA member login
• Username * Password * Forgot your log in details? Need to activate BMA Member Log In Log in via OpenAthens Log in via your institution

Search form

• Advanced search
• Search responses
• Search blogs
• News & Views
• How to improve...

How to improve healthcare improvement—an essay by Mary Dixon-Woods

Read the full collection.

• Related content
• Peer review
• Mary Dixon-Woods , director
• THIS Institute, Cambridge, UK
• director{at}thisinstitute.cam.ac.uk

As improvement practice and research begin to come of age, Mary Dixon-Woods considers the key areas that need attention if we are to reap their benefits

In the NHS, as in health systems worldwide, patients are exposed to risks of avoidable harm 1 and unwarranted variations in quality. 2 3 4 But too often, problems in the quality and safety of healthcare are merely described, even “admired,” 5 rather than fixed; the effort invested in collecting information (which is essential) is not matched by effort in making improvement. The National Confidential Enquiry into Patient Outcome and Death, for example, has raised many of the same concerns in report after report. 6 Catastrophic degradations of organisations and units have recurred throughout the history of the NHS, with depressingly similar features each time. 7 8 9

More resources are clearly necessary to tackle many of these problems. There is no dispute about the preconditions for high quality, safe care: funding, staff, training, buildings, equipment, and other infrastructure. But quality health services depend not just on structures but on processes. 10 Optimising the use of available resources requires continuous improvement of healthcare processes and systems. 5

The NHS has seen many attempts to stimulate organisations to improve using incentive schemes, ranging from pay for performance (the Quality and Outcomes Framework in primary care, for example) to public reporting (such as annual quality accounts). They have had mixed results, and many have had unintended consequences. 11 12 Wanting to improve is not the same as knowing how to do it.

In response, attention has increasingly turned to a set of approaches known as quality improvement (QI). Though a definition of exactly what counts as a QI approach has escaped consensus, QI is often identified with a set of techniques adapted from industrial settings. They include the US Institute for Healthcare Improvement’s Model for Improvement, which, among other things, combines measurement with tests of small change (plan-do-study-act cycles). 8 Other popular approaches include Lean and Six Sigma. QI can also involve specific interventions intended to improve processes and systems, ranging from checklists and “care bundles” of interventions (a set of evidence based practices intended to be done consistently) through to medicines reconciliation and clinical pathways.

QI has been advocated in healthcare for over 30 years 13 ; policies emphasise the need for QI and QI practice is mandated for many healthcare professionals (including junior doctors). Yet the question, “Does quality improvement actually improve quality?” remains surprisingly difficult to answer. 14 The evidence for the benefits of QI is mixed 14 and generally of poor quality. It is important to resolve this unsatisfactory situation. That will require doing more to bring together the practice and the study of improvement, using research to improve improvement, and thinking beyond effectiveness when considering the study and practice of improvement.

Uniting practice and study

The practice and study of improvement need closer integration. Though QI programmes and interventions may be just as consequential for patient wellbeing as drugs, devices, and other biomedical interventions, research about improvement has often been seen as unnecessary or discretionary, 15 16 particularly by some of its more ardent advocates. This is partly because the challenges faced are urgent, and the solutions seem obvious, so just getting on with it seems the right thing to do.

But, as in many other areas of human activity, QI is pervaded by optimism bias. It is particularly affected by the “lovely baby” syndrome, which happens when formal evaluation is eschewed because something looks so good that it is assumed it must work. Five systematic reviews (published 2010-16) reporting on evaluations of Lean and Six Sigma did not identify a single randomised controlled trial. 17 18 19 20 21 A systematic review of redesigning care processes identified no randomised trials. 22 A systematic review of the application of plan-do-study-act in healthcare identified no randomised trials. 23 A systematic review of several QI methods in surgery identified just one randomised trial. 56

The sobering reality is that some well intentioned, initially plausible improvement efforts fail when subjected to more rigorous evaluation. 24 For instance, a controlled study of a large, well resourced programme that supported a group of NHS hospitals to implement the IHI’s Model for Improvement found no differences in the rate of improvement between participating and control organisations. 25 26 Specific interventions may, similarly, not survive the rigours of systematic testing. An example is a programme to reduce hospital admissions from nursing homes that showed promise in a small study in the US, 27 but a later randomised implementation trial found no effect on admissions or emergency department attendances. 28

Some interventions are probably just not worth the effort and opportunity cost: having nurses wear “do not disturb” tabards during drug rounds, is one example. 29 And some QI efforts, perversely, may cause harm—as happened when a multicomponent intervention was found to be associated with an increase rather than a decrease in surgical site infections. 30

Producing sound evidence for the effectiveness of improvement interventions and programmes is likely to require a multipronged approach. More large scale trials and other rigorous studies, with embedded qualitative inquiry, should be a priority for research funders.

Not every study of improvement needs to be a randomised trial. One valuable but underused strategy involves wrapping evaluation around initiatives that are happening anyway, especially when it is possible to take advantage of natural experiments or design roll-outs. 31 Evaluation of the reorganisation of stroke care in London and Manchester 32 and the study of the Matching Michigan programme to reduce central line infections are good examples. 33 34

It would be impossible to externally evaluate every QI project. Critically important therefore will be increasing the rigour with which QI efforts evaluate themselves, as shown by a recent study of an attempt to improve care of frail older people using a “hospital at home” approach in southwest England. 35 This ingeniously designed study found no effect on outcomes and also showed that context matters.

Despite the potential value of high quality evaluation, QI reports are often weak, 18 with, for example, interventions so poorly reported that reproducibility is frustrated. 36 Recent reporting guidelines may help, 37 but some problems are not straightforward to resolve. In particular, current structures for governance and publishing research are not always well suited to QI, including situations where researchers study programmes they have not themselves initiated. Systematic learning from QI needs to improve, which may require fresh thinking about how best to align the goals of practice and study, and to reconcile the needs of different stakeholders. 38

Using research to improve improvement

Research can help to support the practice of improvement in many ways other than evaluation of its effectiveness. One important role lies in creating assets that can be used to improve practice, such as ways to visualise data, analytical methods, and validated measures that assess the aspects of care that most matter to patients and staff. This kind of work could, for example, help to reduce the current vast number of quality measures—there are more than 1200 indicators of structure and process in perioperative care alone. 39

The study of improvement can also identify how improvement practice can get better. For instance, it has become clear that fidelity to the basic principles of improvement methods is a major problem: plan-do-study-act cycles are crucial to many improvement approaches, yet only 20% of the projects that report using the technique have done so properly. 23 Research has also identified problems in measurement—teams trying to do improvement may struggle with definitions, data collection, and interpretation 40 —indicating that this too requires more investment.

Improvement research is particularly important to help cumulate, synthesise, and scale learning so that practice can move forward without reinventing solutions that already exist or reintroducing things that do not work. Such theorising can be highly practical, 41 helping to clarify the mechanisms through which interventions are likely to work, supporting the optimisation of those interventions, and identifying their most appropriate targets. 42

Research can systematise learning from “positive deviance,” approaches that examine individuals, teams, or organisations that show exceptionally good performance. 43 Positive deviance can be used to identify successful designs for clinical processes that other organisations can apply. 44

Crucially, positive deviance can also help to characterise the features of high performing contexts and ensure that the right lessons are learnt. For example, a distinguishing feature of many high performing organisations, including many currently rated as outstanding by the Care Quality Commission, is that they use structured methods of continuous quality improvement. But studies of high performing settings, such as the Southmead maternity unit in Bristol, indicate that although continuous improvement is key to their success, a specific branded improvement method is not necessary. 45 This and other work shows that not all improvement needs to involve a well defined QI intervention, and not everything requires a discrete project with formal plan-do-study-act cycles.

More broadly, research has shown that QI is just one contributor to improving quality and safety. Organisations in many industries display similar variations to healthcare organisations, including large and persistent differences in performance and productivity between seemingly similar enterprises. 46 Important work, some of it experimental, is beginning to show that it is the quality of their management practices that distinguishes them. 47 These practices include continuous quality improvement as well as skills training, human resources, and operational management, for example. QI without the right contextual support is likely to have limited impact.

Beyond effectiveness

Important as they are, evaluations of the approaches and interventions in individual improvement programmes cannot answer every pertinent question about improvement. 48 Other key questions concern the values and assumptions intrinsic to QI.

Consider the “product dominant” logic in many healthcare improvement efforts, which assumes that one party makes a product and conveys it to a consumer. 49 Paul Batalden, one of the early pioneers of QI in healthcare, proposes that we need instead a “service dominant” logic, which assumes that health is co-produced with patients. 49

More broadly, we must interrogate how problems of quality and safety are identified, defined, and selected for attention by whom, through which power structures, and with what consequences. Why, for instance, is so much attention given to individual professional behaviour when systems are likely to be a more productive focus? 50 Why have quality and safety in mental illness and learning disability received less attention in practice, policy, and research 51 despite high morbidity and mortality and evidence of both serious harm and failures of organisational learning? The concern extends to why the topic of social inequities in healthcare improvement has remained so muted 52 and to the choice of subjects for study. Why is it, for example, that interventions like education and training, which have important roles in quality and safety and are undertaken at vast scale, are often treated as undeserving of evaluation or research?

How QI is organised institutionally also demands attention. It is often conducted as a highly local, almost artisan activity, with each organisation painstakingly working out its own solution for each problem. Much improvement work is conducted by professionals in training, often in the form of small, time limited projects conducted for accreditation. But working in this isolated way means a lack of critical mass to support the right kinds of expertise, such as the technical skill in human factors or ergonomics necessary to engineer a process or devise a safety solution. Having hundreds of organisations all trying to do their own thing also means much waste, and the absence of harmonisation across basic processes introduces inefficiencies and risks. 14

A better approach to the interorganisational nature of health service provision requires solving the “problem of many hands.” 53 We need ways to agree which kinds of sector-wide challenges need standardisation and interoperability; which solutions can be left to local customisation at implementation; and which should be developed entirely locally. 14 Better development of solutions and interventions is likely to require more use of prototyping, modelling and simulation, and testing in different scenarios and under different conditions, 14 ideally through coordinated, large scale efforts that incorporate high quality evaluation.

Finally, an approach that goes beyond effectiveness can also help in recognising the essential role of the professions in healthcare improvement. The past half century has seen a dramatic redefining of the role and status of the healthcare professions in health systems 54 : unprecedented external accountability, oversight, and surveillance are now the norm. But policy makers would do well to recognise how much more can be achieved through professional coalitions of the willing than through too many imposed, compliance focused diktats. Research is now showing how the professions can be hugely important institutional forces for good. 54 55 In particular, the professions have a unique and invaluable role in working as advocates for improvement, creating alliances with patients, providing training and education, contributing expertise and wisdom, coordinating improvement efforts, and giving political voice for problems that need to be solved at system level (such as, for example, equipment design).

Improvement efforts are critical to securing the future of the NHS. But they need an evidence base. Without sound evaluation, patients may be deprived of benefit, resources and energy may be wasted on ineffective QI interventions or on interventions that distribute risks unfairly, and organisations are left unable to make good decisions about trade-offs given their many competing priorities. The study of improvement has an important role in developing an evidence-base and in exploring questions beyond effectiveness alone, and in particular showing the need to establish improvement as a collective endeavour that can benefit from professional leadership.

Mary Dixon-Woods is the Health Foundation professor of healthcare improvement studies and director of The Healthcare Improvement Studies (THIS) Institute at the University of Cambridge, funded by the Health Foundation. Co-editor-in-chief of BMJ Quality and Safety , she is an honorary fellow of the Royal College of General Practitioners and the Royal College of Physicians. This article is based largely on the Harveian oration she gave at the RCP on 18 October 2018, in the year of the college’s 500th anniversary. The oration is available here: http://www.clinmed.rcpjournal.org/content/19/1/47 and the video version here: https://www.rcplondon.ac.uk/events/harveian-oration-and-dinner-2018

This article is one of a series commissioned by The BMJ based on ideas generated by a joint editorial group with members from the Health Foundation and The BMJ , including a patient/carer. The BMJ retained full editorial control over external peer review, editing, and publication. Open access fees and The BMJ ’s quality improvement editor post are funded by the Health Foundation.

Competing interests: I have read and understood BMJ policy on declaration of interests and a statement is available here: https://www.bmj.com/about-bmj/advisory-panels/editorial-advisory-board/mary-dixonwoods

Provenance and peer review: Commissioned; not externally peer reviewed.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

• Neuburger J ,
• Hutchings A ,
• Stewart K ,
• Buckingham R
• Castelli A ,
• Verzulli R ,
• Allwood D ,
• Sunstein CR
• Healthcare Quality Improvement Partnership
• Shortell SM
• Martin GP ,
• Dixon-Woods M
• Donabedian A
• Himmelstein DU ,
• Woolhandler S
• Woolhandler S ,
• Himmelstein DU
• Dixon-Woods M ,
• Ioannidis JPA ,
• Marshall M ,
• Pronovost P ,
• Glasgow JM ,
• Scott-Caziewell JR ,
• Nicolay CR ,
• Deblois S ,
• Moraros J ,
• Lemstra M ,
• Amaratunga T ,
• Dobranowski J
• van Leijen-Zeelenberg JE ,
• Elissen AMJ ,
• Taylor MJ ,
• McNicholas C ,
• Nicolay C ,
• Morgan DJ ,
• Diekema DJ ,
• Sepkowitz K ,
• Perencevich EN
• Benning A ,
• Ouslander JG ,
• Huckfeldt P ,
• Westbrook JI ,
• Hooper TD ,
• Middleton S ,
• Anthony T ,
• Murray BW ,
• Sum-Ping JT ,
• Portela MC ,
• Pronovost PJ ,
• Woodcock T ,
• Ramsay AIG ,
• Hoffman A ,
• Richardson A ,
• Hibbert P ,
• Matching Michigan Collaboration & Writing Committee
• Tarrant C ,
• Pearson M ,
• Hemsley A ,
• Blackwell R ,
• Custerson L
• Goodman D ,
• Watson SI ,
• Taylor CA ,
• Chazapis M ,
• Gilhooly D ,
• Liberati EG ,
• Davidoff F ,
• Leviton L ,
• Johnston M ,
• Abraham C ,
• “Psychological Theory” Group
• Clay-Williams R ,
• Braithwaite J
• Bradley EH ,
• Willars J ,
• Mahajan A ,
• Aveling EL ,
• Thibaut BI ,
• Ramtale SC ,
• Boozary AS ,
• Shojania KG
• Pronovost PJ
• Armstrong N ,
• Herbert G ,
• Purkayastha S ,
• Greenhalgh A ,

Health Care Comes Home: The Human Factors (2011)

Chapter: 7 conclusions and recommendations.

7 Conclusions and Recommendations

Health care is moving into the home increasingly often and involving a mixture of people, a variety of tasks, and a broad diversity of devices and technologies; it is also occurring in a range of residential environments. The factors driving this migration include the rising costs of providing health care; the growing numbers of older adults; the increasing prevalence of chronic disease; improved survival rates of various diseases, injuries, and other conditions (including those of fragile newborns); large numbers of veterans returning from war with serious injuries; and a wide range of technological innovations. The health care that results varies considerably in its safety, effectiveness, and efficiency, as well as its quality and cost.

The committee was charged with examining this major trend in health care delivery and resulting challenges from only one of many perspectives: the study of human factors. From the outset it was clear that the dramatic and evolving change in health care practice and policies presents a broad array of opportunities and problems. Consequently the committee endeavored to maintain focus specifically on how using the human factors approach can provide solutions that support maximizing the safety and quality of health care delivered in the home while empowering both care recipients and caregivers in the effort.

The conclusions and recommendations presented below reflect the most critical steps that the committee thinks should be taken to improve the state of health care in the home, based on the literature reviewed in this report examined through a human factors lens. They are organized into four areas: (1) health care technologies, including medical devices and health information technologies involved in health care in the home; (2)

caregivers and care recipients; (3) residential environments for health care; and (4) knowledge gaps that require additional research and development. Although many issues related to home health care could not be addressed, applications of human factors principles, knowledge, and research methods in these areas could make home health care safer and more effective and also contribute to reducing costs. The committee chose not to prioritize the recommendations, as they focus on various aspects of health care in the home and are of comparable importance to the different constituencies affected.

HEALTH CARE TECHNOLOGIES

Health care technologies include medical devices that are used in the home as well as information technologies related to home-based health care. The four recommendations in this area concern (1) regulating technologies for health care consumers, (2) developing guidance on the structure and usability of health information technologies, (3) developing guidance and standards for medical device labeling, and (4) improving adverse event reporting systems for medical devices. The adoption of these recommendations would improve the usability and effectiveness of technology systems and devices, support users in understanding and learning to use them, and improve feedback to government and industry that could be used to further improve technology for home care.

Ensuring the safety of emerging technologies is a challenge, in part because it is not always clear which federal agency has regulatory authority and what regulations must be met. Currently, the U.S. Food and Drug Administration (FDA) has responsibility for devices, and the Office of the National Coordinator for Health Information Technology (ONC) has similar authority with respect to health information technology. However, the dividing line between medical devices and health information technology is blurring, and many new systems and applications are being developed that are a combination of the two, although regulatory oversight has remained divided. Because regulatory responsibility for them is unclear, these products may fall into the gap.

The committee did not find a preponderance of evidence that knowledge is lacking for the design of safe and effective devices and technologies for use in the home. Rather than discovering an inadequate evidence base, we were troubled by the insufficient attention directed at the development of devices that account, necessarily and properly, for users who are inadequately trained or not trained at all. Yet these new users often must

rely on equipment without ready knowledge about limitations, maintenance requirements, and problems with adaptation to their particular home settings.

The increased prominence of the use of technology in the health care arena poses predictable challenges for many lay users, especially people with low health literacy, cognitive impairment, or limited technology experience. For example, remote health care management may be more effective when it is supported by technology, and various electronic health care (“e-health”) applications have been developed for this purpose. With the spectrum of caregivers ranging from individuals caring for themselves or other family members to highly experienced professional caregivers, computer-based care management systems could offer varying levels of guidance, reminding, and alerting, depending on the sophistication of the operator and the criticality of the message. However, if these technologies or applications are difficult to understand or use, they may be ignored or misused, with potentially deleterious effects on care recipient health and safety. Applying existing accessibility and usability guidelines and employing user-centered design and validation methods in the development of health technology products designed for use in the home would help ensure that they are safe and effective for their targeted user populations. In this effort, it is important to recognize how the line between medical devices and health information technologies has become blurred while regulatory oversight has remained distinct, and it is not always clear into which domain a product falls.

Recommendation 1. The U.S. Food and Drug Administration and the Office of the National Coordinator for Health Information Technology should collaborate to regulate, certify, and monitor health care applications and systems that integrate medical devices and health information technologies. As part of the certification process, the agencies should require evidence that manufacturers have followed existing accessibility and usability guidelines and have applied user-centered design and validation methods during development of the product.

Guidance and Standards

Developers of information technologies related to home-based health care, as yet, have inadequate or incomplete guidance regarding product content, structure, accessibility, and usability to inform innovation or evolution of personal health records or of care recipient access to information in electronic health records.

The ONC, in the initial announcement of its health information technology certification program, stated that requirements would be forthcom-

ing with respect both to personal health records and to care recipient access to information in electronic health records (e.g., patient portals). Despite the importance of these requirements, there is still no guidance on the content of information that should be provided to patients or minimum standards for accessibility, functionality, and usability of that information in electronic or nonelectronic formats.

Consequently, some portals have been constructed based on the continuity of care record. However, recent research has shown that records and portals based on this model are neither understandable nor interpretable by laypersons, even by those with a college education. The lack of guidance in this area makes it difficult for developers of personal health records and patient portals to design systems that fully address the needs of consumers.

Recommendation 2. The Office of the National Coordinator for Health Information Technology, in collaboration with the National Institute of Standards and Technology and the Agency for Healthcare Research and Quality, should establish design guidelines and standards, based on existing accessibility and usability guidelines, for content, accessibility, functionality, and usability of consumer health information technologies related to home-based health care.

The committee found a serious lack of adequate standards and guidance for the labeling of medical devices. Furthermore, we found that the approval processes of the FDA for changing these materials are burdensome and inflexible.

Just as many medical devices currently in use by laypersons in the home were originally designed and approved for use only by professionals in formal health care facilities, the instructions for use and training materials were not designed for lay users, either. The committee recognizes that lack of instructional materials for lay users adds to the level of risk involved when devices are used by populations for whom they were not intended.

Ironically, the FDA’s current premarket review and approval processes inadvertently discourage manufacturers from selectively revising or developing supplemental instructional and training materials, when they become aware that instructional and training materials need to be developed or revised for lay users of devices already approved and marketed. Changing the instructions for use (which were approved with the device) requires manufacturers to submit the device along with revised instructions to the FDA for another 510(k) premarket notification review. Since manufacturers can find these reviews complicated, time-consuming, and expensive, this requirement serves as a disincentive to appropriate revisions of instructional or training materials.

Furthermore, little guidance is currently available on design of user

training methods and materials for medical devices. Even the recently released human factors standard on medical device design (Association for the Advancement of Medical Instrumentation, 2009), while reasonably comprehensive, does not cover the topic of training or training materials. Both FDA guidance and existing standards that do specifically address the design of labeling and ensuing instructions for use fail to account for up-to-date findings from research on instructional systems design. In addition, despite recognition that requirements for user training, training materials, and instructions for use are different for lay and professional users of medical equipment, these differences are not reflected in current standards.

Recommendation 3. The U.S. Food and Drug Administration (FDA) should promote development (by standards development organizations, such as the International Electrotechnical Commission, the International Organization for Standardization, the American National Standards Institute, and the Association for the Advancement of Medical Instrumentation) of new standards based on the most recent human factors research for the labeling of and ensuing instructional materials for medical devices designed for home use by lay users. The FDA should also tailor and streamline its approval processes to facilitate and encourage regular improvements of these materials by manufacturers.

Adverse Event Reporting Systems

The committee notes that the FDA’s adverse event reporting systems, used to report problems with medical devices, are not user-friendly, especially for lay users, who generally are not aware of the systems, unaware that they can use them to report problems, and uneducated about how to do so. In order to promote safe use of medical devices in the home and rectify design problems that put care recipients at risk, it is necessary that the FDA conduct more effective postmarket surveillance of medical devices to complement its premarket approval process. The most important elements of their primarily passive surveillance system are the current adverse event reporting mechanisms, including Maude and MedSun. Entry of incident data by health care providers and consumers is not straightforward, and the system does not elicit data that could be useful to designers as they develop updated versions of products or new ones that are similar to existing devices. The reporting systems and their importance need to be widely promoted to a broad range of users, especially lay users.

Recommendation 4. The U.S. Food and Drug Administration should improve its adverse event reporting systems to be easier to use, to collect data that are more useful for identifying the root causes of events

related to interactions with the device operator, and to develop and promote a more convenient way for lay users as well as professionals to report problems with medical devices.

CAREGIVERS IN THE HOME

Health care is provided in the home by formal caregivers (health care professionals), informal caregivers (family and friends), and individuals who self-administer care; each type of caregiver faces unique issues. Properly preparing individuals to provide care at home depends on targeting efforts appropriately to the background, experience, and knowledge of the caregivers. To date, however, home health care services suffer from being organized primarily around regulations and payments designed for inpatient or outpatient acute care settings. Little attention has been given to how different the roles are for formal caregivers when delivering services in the home or to the specific types of training necessary for appropriate, high-quality practice in this environment.

Health care administration in the home commonly involves interaction among formal caregivers and informal caregivers who share daily responsibility for a person receiving care. But few formal caregivers are given adequate training on how to work with informal caregivers and involve them effectively in health decision making, use of medical or adaptive technologies, or best practices to be used for evaluating and supporting the needs of caregivers.

It is also important to recognize that the majority of long-term care provided to older adults and individuals with disabilities relies on family members, friends, or the individual alone. Many informal caregivers take on these responsibilities without necessary education or support. These individuals may be poorly prepared and emotionally overwhelmed and, as a result, experience stress and burden that can lead to their own morbidity. The committee is aware that informational and training materials and tested programs already exist to assist informal caregivers in understanding the many details of providing health care in the home and to ease their burden and enhance the quality of life of both caregiver and care recipient. However, tested materials and education, support, and skill enhancement programs have not been adequately disseminated or integrated into standard care practices.

Recommendation 5. Relevant professional practice and advocacy groups should develop appropriate certification, credentialing, and/or training standards that will prepare formal caregivers to provide care in the home, develop appropriate informational and training materials

for informal caregivers, and provide guidance for all caregivers to work effectively with other people involved.

RESIDENTIAL ENVIRONMENTS FOR HEALTH CARE

Health care is administered in a variety of nonclinical environments, but the most common one, particularly for individuals who need the greatest level and intensity of health care services, is the home. The two recommendations in this area encourage (1) modifications to existing housing and (2) accessible and universal design of new housing. The implementation of these recommendations would be a good start on an effort to improve the safety and ease of practicing health care in the home. It could improve the health and safety of many care recipients and their caregivers and could facilitate adherence to good health maintenance and treatment practices. Ideally, improvements to housing design would take place in the context of communities that provide transportation, social networking and exercise opportunities, and access to health care and other services.

Safety and Modification of Existing Housing

The committee found poor appreciation of the importance of modifying homes to remove health hazards and barriers to self-management and health care practice and, furthermore, that financial support from federal assistance agencies for home modifications is very limited. The general connection between housing characteristics and health is well established. For example, improving housing conditions to enhance basic sanitation has long been part of a public health response to acute illness. But the characteristics of the home can present significant barriers to autonomy or self-care management and present risk factors for poor health, injury, compromised well-being, and greater dependence on others. Conversely, physical characteristics of homes can enhance resident safety and ability to participate in daily self-care and to utilize effectively health care technologies that are designed to enhance health and well-being.

Home modifications based on professional home assessments can increase functioning, contribute to reducing accidents such as falls, assist caregivers, and enable chronically ill persons and people with disabilities to stay in the community. Such changes are also associated with facilitating hospital discharges, decreasing readmissions, reducing hazards in the home, and improving care coordination. Familiar modifications include installation of such items as grab bars, handrails, stair lifts, increased lighting, and health monitoring equipment as well as reduction of such hazards as broken fixtures and others caused by insufficient home maintenance.

Deciding on which home modifications have highest priority in a given

setting depends on an appropriate assessment of circumstances and the environment. A number of home assessment instruments and programs have been validated and proven to be effective to meet this need. But even if needed modifications are properly identified and prioritized, inadequate funding, gaps in services, and lack of coordination between the health and housing service sectors have resulted in a poorly integrated system that is difficult to access. Even when accessed, progress in making home modifications available has been hampered by this lack of coordination and inadequate reimbursement or financial mechanisms, especially for those who cannot afford them.

Recommendation 6. Federal agencies, including the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services, along with the U.S. Department of Housing and Urban Development and the U.S. Department of Energy, should collaborate to facilitate adequate and appropriate access to health- and safety-related home modifications, especially for those who cannot afford them. The goal should be to enable persons whose homes contain obstacles, hazards, or features that pose a home safety concern, limit self-care management, or hinder the delivery of needed services to obtain home assessments, home modifications, and training in their use.

Accessibility and Universal Design of New Housing

Almost all existing housing in the United States presents problems for conducting health-related activities because physical features limit independent functioning, impede caregiving, and contribute to such accidents as falls. In spite of the fact that a large and growing number of persons, including children, adults, veterans, and older adults, have disabilities and chronic conditions, new housing continues to be built that does not account for their needs (current or future). Although existing homes can be modified to some extent to address some of the limitations, a proactive, preventive, and effective approach would be to plan to address potential problems in the design phase of new and renovated housing, before construction.

Some housing is already required to be built with basic accessibility features that facilitate practice of health care in the home as a result of the Fair Housing Act Amendments of 1998. And 17 states and 30 cities have passed what are called “visitability” codes, which currently apply to 30,000 homes. Some localities offer tax credits, such as Pittsburgh through an ordinance, to encourage installing visitability features in new and renovated housing. The policy in Pittsburgh was impetus for the Pennsylvania Residential VisitAbility Design Tax Credit Act signed into law on October 28, 2006, which offers property owners a tax credit for new construction

and rehabilitation. The Act paves the way for municipalities to provide tax credits to citizens by requiring that such governing bodies administer the tax credit (Self-Determination Housing Project of Pennsylvania, Inc., n.d.).

Visitability, rather than full accessibility, is characterized by such limited features as an accessible entry into the home, appropriately wide doorways and one accessible bathroom. Both the International Code Council, which focuses on building codes, and the American National Standards Institute, which establishes technical standards, including ones associated with accessibility, have endorsed voluntary accessibility standards. These standards facilitate more jurisdictions to pass such visitability codes and encourage legislative consistency throughout the country. To date, however, the federal government has not taken leadership to promote compliance with such standards in housing construction, even for housing for which it provides financial support.

Universal design, a broader and more comprehensive approach than visitability, is intended to suit the needs of persons of all ages, sizes, and abilities, including individuals with a wide range of health conditions and activity limitations. Steps toward universal design in renovation could include such features as anti-scald faucet valve devices, nonslip flooring, lever handles on doors, and a bedroom on the main floor. Such features can help persons and their caregivers carry out everyday tasks and reduce the incidence of serious and costly accidents (e.g., falls, burns). In the long run, implementing universal design in more homes will result in housing that suits the long-term needs of more residents, provides more housing choices for persons with chronic conditions and disabilities, and causes less forced relocation of residents to more costly settings, such as nursing homes.

Issues related to housing accessibility have been acknowledged at the federal level. For example, visitability and universal design are in accord with the objectives of the Safety of Seniors Act (Public Law No. 110-202, passed in 2008). In addition, implementation of the Olmstead decision (in which the U.S. Supreme Court ruled that the Americans with Disabilities Act may require states to provide community-based services rather than institutional placements for individuals with disabilities) requires affordable and accessible housing in the community.

Visitability, accessibility, and universal design of housing all are important to support the practice of health care in the home, but they are not broadly implemented and incentives for doing so are few.

Recommendation 7. Federal agencies, such as the U.S. Department of Housing and Urban Development, the U.S. Department of Veterans Affairs, and the Federal Housing Administration, should take a lead role, along with states and local municipalities, to develop strategies that promote and facilitate increased housing visitability, accessibil-

ity, and universal design in all segments of the market. This might include tax and other financial incentives, local zoning ordinances, model building codes, new products and designs, and related policies that are developed as appropriate with standards-setting organizations (e.g., the International Code Council, the International Electrotechnical Commission, the International Organization for Standardization, and the American National Standards Institute).

RESEARCH AND DEVELOPMENT

In our review of the research literature, the committee learned that there is ample foundational knowledge to apply a human factors lens to home health care, particularly as improvements are considered to make health care safe and effective in the home. However, much of what is known is not being translated effectively into practice, neither in design of equipment and information technology or in the effective targeting and provision of services to all those in need. Consequently, the four recommendations that follow support research and development to address knowledge and communication gaps and facilitate provision of high-quality health care in the home. Specifically, the committee recommends (1) research to enhance coordination among all the people who play a role in health care practice in the home, (2) development of a database of medical devices in order to facilitate device prescription, (3) improved surveys of the people involved in health care in the home and their residential environments, and (4) development of tools for assessing the tasks associated with home-based health care.

Health Care Teamwork and Coordination

Frail elders, adults with disabilities, disabled veterans, and children with special health care needs all require coordination of the care services that they receive in the home. Home-based health care often involves a large number of elements, including multiple care providers, support services, agencies, and complex and dynamic benefit regulations, which are rarely coordinated. However, coordinating those elements has a positive effect on care recipient outcomes and costs of care. When successful, care coordination connects caregivers, improves communication among caregivers and care recipients and ensures that receivers of care obtain appropriate services and resources.

To ensure safe, effective, and efficient care, everyone involved must collaborate as a team with shared objectives. Well-trained primary health care teams that execute customized plans of care are a key element of coordinated care; teamwork and communication among all actors are also

essential to successful care coordination and the delivery of high-quality care. Key factors that influence the smooth functioning of a team include a shared understanding of goals, common information (such as a shared medication list), knowledge of available resources, and allocation and coordination of tasks conducted by each team member.

Barriers to coordination include insufficient resources available to (a) help people who need health care at home to identify and establish connections to appropriate sources of care, (b) facilitate communication and coordination among caregivers involved in home-based health care, and (c) facilitate communication among the people receiving and the people providing health care in the home.

The application of systems analysis techniques, such as task analysis, can help identify problems in care coordination systems and identify potential intervention strategies. Human factors research in the areas of communication, cognitive aiding and decision support, high-fidelity simulation training techniques, and the integration of telehealth technologies could also inform improvements in care coordination.

Recommendation 8 . The Agency for Healthcare Research and Quality should support human factors–based research on the identified barriers to coordination of health care services delivered in the home and support user-centered development and evaluation of programs that may overcome these barriers.

Medical Device Database

It is the responsibility of physicians to prescribe medical devices, but in many cases little information is readily available to guide them in determining the best match between the devices available and a particular care recipient. No resource exists for medical devices, in contrast to the analogous situation in the area of assistive and rehabilitation technologies, for which annotated databases (such as AbleData) are available to assist the provider in determining the most appropriate one of several candidate devices for a given care recipient. Although specialists are apt to receive information about devices specific to the area of their practice, this is much less likely in the case of family and general practitioners, who often are responsible for selecting, recommending, or prescribing the most appropriate device for use at home.

Recommendation 9. The U.S. Food and Drug Administration, in collaboration with device manufacturers, should establish a medical device database for physicians and other providers, including pharmacists, to use when selecting appropriate devices to prescribe or recommend

for people receiving or self-administering health care in the home. Using task analysis and other human factors approaches to populate the medical device database will ensure that it contains information on characteristics of the devices and implications for appropriate care recipient and device operator populations.

Characterizing Caregivers, Care Recipients, and Home Environments

As delivery of health care in the home becomes more common, more coherent strategies and effective policies are needed to support the workforce of individuals who provide this care. Developing these will require a comprehensive understanding of the number and attributes of individuals engaged in health care in the home as well as the context in which care is delivered. Data and data analysis are lacking to accomplish this objective.

National data regarding the numbers of individuals engaged in health care delivery in the home—that is, both formal and informal caregivers—are sparse, and the estimates that do exist vary widely. Although the Bureau of Labor Statistics publishes estimates of the number of workers employed in the home setting for some health care classifications, they do not include all relevant health care workers. For example, data on workers employed directly by care recipients and their families are notably absent. Likewise, national estimates of the number of informal caregivers are obtained from surveys that use different methodological approaches and return significantly different results.

Although numerous national surveys have been designed to answer a broad range of questions regarding health care delivery in the home, with rare exceptions such surveys reflect the relatively limited perspective of the sponsoring agency. For example,

• The Medicare Current Beneficiary Survey (administered by the Centers for Medicare & Medicaid Services) and the Health and Retirement Survey (administered by the National Institute on Aging) are primarily geared toward understanding the health, health services use, and/or economic well-being of older adults and provide no information regarding working-age adults or children or information about home or neighborhood environments.
• The Behavioral Risk Factors Surveillance Survey (administered by the Centers for Disease Control and Prevention, CDC), the National Health Interview Survey (administered by the CDC), and the National Children’s Study (administered by the U.S. Department of Health and Human Services and the U.S. Environmental Protection Agency) all collect information on health characteristics, with limited or no information about the housing context.
• The American Housing Survey (administered by the U.S. Department of Housing and Urban Development) collects detailed information regarding housing, but it does not include questions regarding the health status of residents and does not collect adequate information about home modifications and features on an ongoing basis.

Consequently, although multiple federal agencies collect data on the sociodemographic and health characteristics of populations and on the nation’s housing stock, none of these surveys collects data necessary to link the home, its residents, and the presence of any caregivers, thus limiting understanding of health care delivered in the home. Furthermore, information is altogether lacking about health and functioning of populations linked to the physical, social, and cultural environments in which they live. Finally, in regard to individuals providing care, information is lacking regarding their education, training, competencies, and credentialing, as well as appropriate knowledge about their working conditions in the home.

Better coordination across government agencies that sponsor such surveys and more attention to information about health care that occurs in the home could greatly improve the utility of survey findings for understanding the prevalence and nature of health care delivery in the home.

Recommendation 10. Federal health agencies should coordinate data collection efforts to capture comprehensive information on elements relevant to health care in the home, either in a single survey or through effective use of common elements across surveys. The surveys should collect data on the sociodemographic and health characteristics of individuals receiving care in the home, the sociodemographic attributes of formal and informal caregivers and the nature of the caregiving they provide, and the attributes of the residential settings in which the care recipients live.

Tools for Assessing Home Health Care Tasks and Operators

Persons caring for themselves or others at home as well as formal caregivers vary considerably in their skills, abilities, attitudes, experience, and other characteristics, such as age, culture/ethnicity, and health literacy. In turn, designers of health-related devices and technology systems used in the home are often naïve about the diversity of the user population. They need high-quality information and guidance to better understand user capabilities relative to the task demands of the health-related device or technology that they are developing.

In this environment, valid and reliable tools are needed to match users with tasks and technologies. At this time, health care providers lack the

tools needed to assess whether particular individuals would be able to perform specific health care tasks at home, and medical device and system designers lack information on the demands associated with health-related tasks performed at home and the human capabilities needed to perform them successfully.

Whether used to assess the characteristics of formal or informal caregivers or persons engaged in self-care, task analysis can be used to develop point-of-care tools for use by consumers and caregivers alike in locations where such tasks are encouraged or prescribed. The tools could facilitate identification of potential mismatches between the characteristics, abilities, experiences, and attitudes that an individual brings to a task and the demands associated with the task. Used in ambulatory care settings, at hospital discharge or other transitions of care, and in the home by caregivers or individuals and family members themselves, these tools could enable assessment of prospective task performer’s capabilities in relation to the demands of the task. The tools might range in complexity from brief screening checklists for clinicians to comprehensive assessment batteries that permit nuanced study and tracking of home-based health care tasks by administrators and researchers. The results are likely to help identify types of needed interventions and support aids that would enhance the abilities of individuals to perform health care tasks in home settings safely, effectively, and efficiently.

Recommendation 11. The Agency for Healthcare Research and Quality should collaborate, as necessary, with the National Institute for Disability and Rehabilitation Research, the National Institutes of Health, the U.S. Department of Veterans Affairs, the National Science Foundation, the U.S. Department of Defense, and the Centers for Medicare & Medicaid Services to support development of assessment tools customized for home-based health care, designed to analyze the demands of tasks associated with home-based health care, the operator capabilities required to carry them out, and the relevant capabilities of specific individuals.

Association for the Advancement of Medical Instrumentation. (2009). ANSI/AAMI HE75:2009: Human factors engineering: Design of medical devices. Available: http://www.aami.org/publications/standards/HE75_Ch16_Access_Board.pdf [April 2011].

Self-Determination Housing Project of Pennsylvania, Inc. (n.d.) Promoting visitability in Pennsylvania. Available: http://www.sdhp.org/promoting_visitability_in_pennsy.htm [March 30, 2011].

In the United States, health care devices, technologies, and practices are rapidly moving into the home. The factors driving this migration include the costs of health care, the growing numbers of older adults, the increasing prevalence of chronic conditions and diseases and improved survival rates for people with those conditions and diseases, and a wide range of technological innovations. The health care that results varies considerably in its safety, effectiveness, and efficiency, as well as in its quality and cost.

Health Care Comes Home reviews the state of current knowledge and practice about many aspects of health care in residential settings and explores the short- and long-term effects of emerging trends and technologies. By evaluating existing systems, the book identifies design problems and imbalances between technological system demands and the capabilities of users. Health Care Comes Home recommends critical steps to improve health care in the home. The book's recommendations cover the regulation of health care technologies, proper training and preparation for people who provide in-home care, and how existing housing can be modified and new accessible housing can be better designed for residential health care. The book also identifies knowledge gaps in the field and how these can be addressed through research and development initiatives.

Health Care Comes Home lays the foundation for the integration of human health factors with the design and implementation of home health care devices, technologies, and practices. The book describes ways in which the Agency for Healthcare Research and Quality (AHRQ), the U.S. Food and Drug Administration (FDA), and federal housing agencies can collaborate to improve the quality of health care at home. It is also a valuable resource for residential health care providers and caregivers.

Welcome to OpenBook!

You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

Do you want to take a quick tour of the OpenBook's features?

Show this book's table of contents , where you can jump to any chapter by name.

...or use these buttons to go back to the previous chapter or skip to the next one.

Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

Switch between the Original Pages , where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

To search the entire text of this book, type in your search term here and press Enter .

Share a link to this book page on your preferred social network or via email.

View our suggested citation for this chapter.

Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

Get Email Updates

Do you enjoy reading reports from the Academies online for free ? Sign up for email notifications and we'll let you know about new publications in your areas of interest when they're released.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Int J Environ Res Public Health

Leadership Effectiveness in Healthcare Settings: A Systematic Review and Meta-Analysis of Cross-Sectional and Before–After Studies

Vincenzo restivo.

1 Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy

Giuseppa Minutolo

Alberto battaglini.

2 Vaccines and Clinical Trials Unit, Department of Health Sciences, University of Genova, Via Antonio Pastore 1, 16132 Genova, Italy

Alberto Carli

3 Santa Chiara Hospital, Largo Medaglie d’oro 9, 38122 Trento, Italy

Michele Capraro

4 School of Public Health, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy

Maddalena Gaeta

5 Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy

Cecilia Trucchi

6 Planning, Epidemiology and Prevention Unit, Liguria Health Authority (A.Li.Sa.), IRCCS San Martino Hospital, Largo R. Benzi 10, 16132 Genoa, Italy

Carlo Favaretti

7 Centre on Leadership in Medicine, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy

Francesco Vitale

Alessandra casuccio, associated data.

Data will be available after writing correspondence to the author.

To work efficiently in healthcare organizations and optimize resources, team members should agree with their leader’s decisions critically. However, nowadays, little evidence is available in the literature. This systematic review and meta-analysis has assessed the effectiveness of leadership interventions in improving healthcare outcomes such as performance and guidelines adherence. Overall, the search strategies retrieved 3,155 records, and 21 of them were included in the meta-analysis. Two databases were used for manuscript research: PubMed and Scopus. On 16th December 2019 the researchers searched for articles published in the English language from 2015 to 2019. Considering the study designs, the pooled leadership effectiveness was 14.0% (95%CI 10.0–18.0%) in before–after studies, whereas the correlation coefficient between leadership interventions and healthcare outcomes was 0.22 (95%CI 0.15–0.28) in the cross-sectional studies. The multi-regression analysis in the cross-sectional studies showed a higher leadership effectiveness in South America (β = 0.56; 95%CI 0.13, 0.99), in private hospitals (β = 0.60; 95%CI 0.14, 1.06), and in medical specialty (β = 0.28; 95%CI 0.02, 0.54). These results encourage the improvement of leadership culture to increase performance and guideline adherence in healthcare settings. To reach this purpose, it would be useful to introduce a leadership curriculum following undergraduate medical courses.

1. Introduction

Over the last years, patients’ outcomes, population wellness and organizational standards have become the main purposes of any healthcare structure [ 1 ]. These standards can be achieved following evidence-based practice (EBP) for diseases prevention and care [ 2 , 3 ] and optimizing available economical and human resources [ 3 , 4 ], especially in low-industrialized geographical areas [ 5 ]. This objective could be reached with effective healthcare leadership [ 3 , 4 ], which could be considered a network whose team members followed leadership critically and motivated a leader’s decisions based on the organization’s requests and targets [ 6 ]. Healthcare workers raised their compliance towards daily activities in an effective leadership context, where the leader succeeded in improving membership and performance awareness among team members [ 7 ]. Furthermore, patients could improve their health conditions in a high-level leadership framework. [ 8 ] Despite the leadership benefits for healthcare systems’ performance and patients’ outcomes [ 1 , 7 ], professionals’ confidence would decline in a damaging leadership context for workers’ health conditions and performance [ 4 , 9 , 10 ]. On the other hand, the prevention of any detrimental factor which might worsen both team performance and healthcare systems’ outcomes could demand effective leadership [ 4 , 7 , 10 ]. However, shifting from the old and assumptive leadership into a more effective and dynamic one is still a challenge [ 4 ]. Nowadays, the available evidence on the impact and effectiveness of leadership interventions is sparse and not systematically reported in the literature [ 11 , 12 ].

Recently, the spreading of the Informal Opinion Leadership style into hospital environments is changing the traditional concept of leadership. This leadership style provides a leader without any official assignment, known as an “opinion leader”, whose educational and behavioral background is suitable for the working context. Its target is to apply the best practices in healthcare creating a more familiar and collaborative team [ 2 ]. However, Flodgren et al. reported that informal leadership interventions increased healthcare outcomes [ 2 ].

Nowadays, various leadership styles are recognized with different classifications but none of them are considered the gold standard for healthcare systems because of heterogenous leadership meanings in the literature [ 4 , 5 , 6 , 12 , 13 ]. Leadership style classification by Goleman considered leaders’ behavior [ 5 , 13 ], while Chen DS-S proposed a traditional leadership style classification (charismatic, servant, transactional and transformational) [ 6 ].

Even if leadership style improvement depends on the characteristics and mission of a workplace [ 6 , 13 , 14 ], a leader should have both a high education in healthcare leadership and the behavioral qualities necessary for establishing strong human relationships and achieving a healthcare system’s goals [ 7 , 15 ]. Theoretically, any practitioner could adapt their emotive capacities and educational/working experiences to healthcare contexts, political lines, economical and human resources [ 7 ]. Nowadays, no organization adopts a policy for leader selection in a specific healthcare setting [ 15 ]. Despite the availability of a self-assessment leadership skills questionnaire for aspirant leaders and a pattern for the selection of leaders by Dubinsky et al. [ 15 ], a standardized and universally accepted method to choose leaders for healthcare organizations is still argued over [ 5 , 15 ].

Leadership failure might be caused by the arduous application of leadership skills and adaptive characteristics among team members [ 5 , 6 ]. One of the reasons for this negative event could be the lack of a standardized leadership program for medical students [ 16 , 17 ]. Consequently, working experience in healthcare settings is the only way to apply a leadership style for many medical professionals [ 12 , 16 , 17 ].

Furthermore, the literature data on leadership effectiveness in healthcare organizations were slightly significant or discordant in results. Nevertheless, the knowledge of pooled leadership effectiveness should motivate healthcare workers to apply leadership strategies in healthcare systems [ 12 ]. This systematic review and meta-analysis assesses the pooled effectiveness of leadership interventions in improving healthcare workers’ and patients’ outcomes.

2. Materials and Methods

A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement guidelines [ 18 ]. The protocol was registered on the PROSPERO database with code CRD42020198679 on 15 August 2020. Following these methodological standards, leadership interventions were evaluated as the pooled effectiveness and influential characteristic of healthcare settings, such as leadership style, workplace, settings and the study period.

2.1. Data Sources and Search Strategy

PubMed and Scopus were the two databases used for the research into the literature. On 16th December 2019, manuscripts in the English language published between 2015 and 2019 were searched by specific MeSH terms for each dataset. Those for PubMed were “leadership” OR “leadership” AND “clinical” AND “outcome” AND “public health” OR “public” AND “health” OR “public health” AND “humans”. Those for Scopus were “leadership” AND “clinical” AND “outcome” AND “public” AND “health”.

2.2. Study Selection and Data Extraction

In accordance with the PRISMA Statement, the following PICOS method was used for including articles [ 18 ]: the target population was all healthcare workers in any hospital or clinical setting (Population); the interventions were any leader’s recommendation to fulfil quality standards or performance indexes of a healthcare system (Intervention) [ 19 ]; to be included, the study should have a control group or reference at baseline as comparison (Control); and any effectiveness measure in terms of change in adherence to healthcare guidelines or performances (Outcome). In detail, any outcome implicated into healthcare workers’ capacity and characteristics in reaching a healthcare systems purposes following the highest standards was considered as performance [ 19 ]. Moreover, whatever clinical practices resulted after having respected the recommendations, procedures or statements settled previously was considered as guideline adherence [ 20 ]. The selected study design was an observational or experimental/quasi-experimental study design (trial, case control, cohort, cross-sectional, before-after study), excluding any systematic reviews, metanalyses, study protocol and guidelines (Studies).

The leaders’ interventions followed Chen’s leadership styles classification [ 6 ]. According to this, the charismatic leadership style can be defined also as an emotive leadership because of members’ strong feelings which guide the relationship with their leader. Its purpose is the improvement of workers’ motivation to reach predetermined organizational targets following a leader’s planning strategies and foresights. Servant leadership style is a sharing leadership style in whose members can increase their skills and competences through steady leader support, and they have a role in an organization’s goals. The transformational leadership style focuses on practical aspects such as new approaches for problem solving, new interventions to reach purposes, future planning and viewpoints sharing. Originality in a transformational leadership style has a key role of improving previous workers’ and healthcare system conditions in the achievement of objectives. The transactional leadership style requires a working context where technical skills are fundamental, and whose leader realizes a double-sense sharing process of knowledge and tasks with members. Furthermore, workers’ performances are improved through a rewarding system [ 6 ].

In this study, the supervisor trained the research team for practical manuscript selection and data extraction. The aim was to ensure data homogeneity and to check the authors’ procedures for selection and data collection. The screening phase was performed by four researchers reading each manuscript’s title and abstract independently and choosing to exclude any article that did not fulfill the inclusion criteria. Afterwards, the included manuscripts were searched for in the full text. They were retrieved freely, by institutional access or requesting them from the authors.

The assessment phase consisted of full-text reading to select articles following the inclusion criteria. The supervisor solved any contrasting view about article selection and variable selection.

The final database was built up by collecting the information from all included full-text articles: author, title, study year, year of publication, country/geographic location, study design, viability and type of evaluation scales for leadership competence, study period, type of intervention to improve leadership awareness, setting of leader intervention, selection modality of leaders, leadership style adopted, outcomes assessed such as guideline adherence or healthcare workers’ performance, benefits for patients’ health or patients’ outcomes improvement, public or private hospitals or healthcare units, ward specialty, intervention in single specialty or multi-professional settings, number of beds, number of healthcare workers involved in leadership interventions and sample size.

Each included article in this systematic review and meta-analysis received a standardized quality score for the specific study design, according to Newcastle–Ottawa, for the assessment of the quality of the cross-sectional study, and the Study Quality Assessment Tools by the National Heart, Lung, and Blood Institute were used for all other study designs [ 21 , 22 ].

2.3. Statistical Data Analysis

The manuscripts metadata were extracted in a Microsoft Excel spreadsheet to remove duplicate articles and collect data. The included article variables for the quantitative meta-analysis were: first author, publication year, continent of study, outcome, public or private organization, hospital or local healthcare unit, surgical or non-surgical ward, multi- or single-professionals, ward specialty, sample size, quality score of each manuscript, leadership style, year of study and study design.

The measurement of the outcomes of interest (either performance or guidelines adherence) depended on the study design of the included manuscripts in the meta-analysis:

• for cross-sectional studies, the outcome of interest was the correlation between leadership improvement and guideline adherence or healthcare performance;
• the outcome derived from before–after studies or the trial was the percentage of leadership improvement intervention in guideline adherence or healthcare performance;
• the incidence occurrence of improved results among exposed and not exposed healthcare workers of leadership interventions and the relative risks (RR) were the outcomes in cohort studies;
• the odds ratio (OR) between the case of healthcare workers who had received a leadership intervention and the control group for case-control studies.

Pooled estimates were calculated using both the fixed effects and DerSimonian and Laird random effects models, weighting individual study results by the inverse of their variances [ 23 ]. Forest plots assessed the pooled estimates and the corresponding 95%CI across the studies. The heterogeneity test was performed by a chi-square test at a significance level of p < 0.05, reporting the I 2 statistic together with a 25%, 50% or 75% cut-off, indicating low, moderate, and high heterogeneity, respectively [ 24 , 25 ].

Subgroup analysis and meta-regression analyses explored the sources of significant heterogeneity. Subgroup analysis considered the leadership style (charismatic, servant, transactional and transformational), continent of study (North America, Europe, Oceania), median cut-off year of study conduction (studies conducted between 2005 and 2011 and studies conducted between 2012 and 2019), type of hospital organization (public or private hospital), type of specialty (surgical or medical specialty) and type of team (multi-professional or single-professional team).

Meta-regression analysis considered the following variables: year of starting study, continent of study conduction, public or private hospital, surgical or non-surgical specialty ward, type of healthcare service (hospital or local health unit), type of healthcare workers involved (multi- or single-professional), leadership style, and study quality score. All variables included in the model were relevant in the coefficient analysis.

To assess a potential publication bias, a graphical funnel plot reported the logarithm effect estimate and related the standard error from each study, and the Egger test was performed [ 26 , 27 ].

All data were analyzed using the statistical package STATA/SE 16.1 (StataCorp LP, College 482 Station, TX, USA), with the “metan” command used for meta-analysis, and “metafunnel”, “metabias” and “confunnel” for publication bias assessment [ 28 ].

3.1. Studies Characteristics

Overall, the search strategies retrieved 3,155 relevant records. After removing 570 (18.1%) duplicates, 2,585 (81.9%) articles were suitable for the screening phase, of which only 284 (11.0%) articles were selected for the assessment phase. During the assessment phase, 263 (92.6%) articles were excluded. The most frequent reasons of exclusion were the absence of relevant outcomes ( n = 134, 51.0%) and other study designs ( n = 61, 23.2%). Very few articles were rejected due to them being written in another language ( n = 1, 0.4%), due to the publication year being out of 2015–2019 ( n = 1, 0.4%) or having an unavailable full text ( n = 3, 1.1%).

A total of 21 (7.4%) articles were included in the qualitative and quantitative analysis, of which nine (42.9%) were cross-sectional studies and twelve (57.1%) were before and after studies ( Figure 1 ).

Flow-chart of selection manuscript phases for systematic review and meta-analysis on leadership effectiveness in healthcare workers.

The number of healthcare workers enrolled was 25,099 (median = 308, IQR = 89–1190), including at least 2,275 nurses (9.1%, median = 324, IQR = 199–458). Most of the studies involved a public hospital ( n = 16, 76.2%). Among the studies from private healthcare settings, three (60.0%) were conducted in North America. Articles which analyzed servant and charismatic leadership styles were nine (42.9%) and eight (38.1%), respectively. Interventions with a transactional leadership style were examined in six (28.6%) studies, while those with a transformational leadership style were examined in five studies (23.8%). Overall, 82 healthcare outcomes were assessed and 71 (86.6%) of them were classified as performance. Adherence-to-guidelines outcomes were 11 (13.4%), which were related mainly to hospital stay ( n = 7, 64.0%) and drug administration ( n = 3, 27.0%). Clements et al. and Lornudd et al. showed the highest number of outcomes, which were 19 (23.2%) and 12 (14.6%), respectively [ 29 , 30 ].

3.2. Leadership Effectiveness in before–after Studies

Before–after studies ( Supplementary Table S1 ) involved 22,241 (88.6%, median = 735, IQR = 68–1273) healthcare workers for a total of twelve articles, of which six (50.0%) consisted of performance and five (41.7%) of guidelines adherence and one (8.3%) of both outcomes. Among healthcare workers, there were 1,294 nurses (5.8%, median = 647, IQR = 40–1,254). Only the article by Savage et al. reported no number of involved healthcare workers [ 31 ].

The number of studies conducted after 2011 or between 2012–2019 was seven (58.3%), while only one (8.3%) article reported a study beginning both before and after 2011. Most of studies were conducted in Northern America ( n = 5, 41.7%). The servant leadership style and charismatic leadership style were the most frequently implemented, as reported in five (41.7%) and four (33.3%) articles, respectively. Only one (8.3%) study adopted a transformational leadership style.

The pooled effectiveness of leadership was 14.0% (95%CI 10.0–18.0%), with a high level of heterogeneity (I 2 = 99.9%, p < 0.0001) among the before–after studies ( Figure 2 ).

Effectiveness of leadership in before after studies. Dashed line represents the pooled effectiveness value [ 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ].

The highest level of effectiveness was reported by Weech-Maldonado R et al. with an effectiveness of 199% (95%CI 183–215%) based on the Cultural Competency Assessment Tool for Hospitals (CCATH) [ 39 ]. The effectiveness of leadership changed in accordance with the leadership style ( Supplementary Figure S1 ) and publication bias ( Supplementary Figure S2 ).

Multi-regression analysis indicated a negative association between leadership effectiveness and studies from Oceania, but this result was not statistically significant (β = −0.33; 95% IC −1.25, 0.59). On the other hand, a charismatic leadership style affected healthcare outcomes positively even if it was not statistically relevant (β = 0.24; 95% IC −0.69, 1.17) ( Table 1 ).

Correlation coefficients and multi-regression analysis of leadership effectiveness in before–after studies.

3.3. Leadership Effectiveness in Cross Sectional Studies

A total of 2858 (median = 199, IQR = 110–322) healthcare workers were involved in the cross-sectional studies ( Supplementary Table S2 ), of which 981 (34.3%) were nurses. Most of the studies were conducted in Asia ( n = 4, 44.4%) and North America ( n = 3, 33.3%). All of the cross-sectional studies regarded only the healthcare professionals’ performance. Multi-professional teams were involved in seven (77.8%) studies, and they were more frequently conducted in both medical and surgical wards ( n = 6, 66.7%). The leadership styles were equally distributed in the articles and two (22.2%) of them examined more than two leadership styles at the same time.

The pooled effectiveness of the leadership interventions in the cross-sectional studies had a correlation coefficient of 0.22 (95%CI 0.15–0.28), whose heterogeneity was remarkably high (I 2 = 96.7%, p < 0.0001) ( Figure 3 ).

Effectiveness of leadership in cross-sectional studies. Dashed line represents the pooled effectiveness value [ 30 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ].

The effectiveness of leadership in the cross-sectional studies changed in accordance with the leadership style ( Supplementary Figure S3 ) and publication bias ( Supplementary Figure S4 ).

Multi-regression analysis showed a higher leadership effectiveness in studies conducted in South America (β = 0.56 95%CI 0.13–0.99) in private hospitals (β = 0.60; 95%CI 0.14–1.06) and in the medical vs. surgical specialty (β = −0.22; 95%CI −0.54, −0.02) ( Table 2 ).

Multi-regression analysis of leadership effectiveness in cross-sectional studies.

* 0.05 ≤ p < 0.01.

4. Discussion

Leadership effectiveness in healthcare settings is a topic that is already treated in a quantitative matter, but only this systematic review and meta-analysis showed the pooled effectiveness of leadership intervention improving some healthcare outcomes such as performance and adherence to guidelines. However, the assessment of leadership effectiveness could be complicated because it depends on the study methodology and selected outcomes [ 12 ]. Health outcomes might benefit from leadership interventions, as Flodgren et al. was concerned about opinion leadership [ 2 ], whose adhesion to guidelines increased by 10.8% (95% CI: 3.5–14.6%). On the other hand, other outcomes did not improve after opinion leadership interventions [ 2 ]. Another review by Ford et al. about emergency wards reported a summary from the literature data which acknowledged an improvement in trauma care management through healthcare workers’ performance and adhesion to guidelines after effective leadership interventions [ 14 ]. Nevertheless, some variables such as collaboration among different healthcare professionals and patients’ healthcare needs might affect leadership intervention effectiveness [ 14 ]. Therefore, a defined leadership style might fail in a healthcare setting rather than in other settings [ 5 , 13 , 14 ].

The leadership effectiveness assessed through cross-sectional studies was higher in South America than in other continents. A possible explanation of this result could be the more frequent use of a transactional leadership style in this area, where the transactional leadership interventions were effective at optimizing economic resources and improving healthcare workers’ performance through cash rewards [ 48 ]. Financing methods for healthcare organizations might be different from one country to another, so the effectiveness of a leadership style can change. Reaching both economic targets and patients’ wellness could be considered a challenge for any leadership intervention [ 48 ], especially in poorer countries [ 5 ].

This meta-analysis showed a negative association between leadership effectiveness and studies by surgical wards. Other research has supported these results, which reported surgical ward performance worsened in any leadership context (charismatic, servant, transactional, transformational) [ 47 ]. In those workplaces, adopting a leadership style to improve surgical performance might be challenging because of nervous tension and little available time during surgical procedures [ 47 ]. On the other hand, a cross-sectional study declared that a surgical team’s performance in private surgical settings benefitted from charismatic leadership-style interventions [ 42 ]. This style of leadership intervention might be successful among a few healthcare workers [ 42 ], where creating relationships is easier [ 6 ]. Even a nursing team’s performance in trauma care increased after charismatic leadership-style interventions because of better communicative and supportive abilities than certain other professional categories [ 29 , 47 ]. However, nowadays there is no standardized leadership in healthcare basic courses [ 5 , 6 , 12 ]. Consequently, promoting leadership culture after undergraduate medical courses could achieve a proper increase in both leadership agreement and working wellness as well as a higher quality of care. [ 17 ]. Furthermore, for healthcare workers who have already worked in a healthcare setting, leadership improvement could consist of implementing basic knowledge on that topic. Consequently, they could reach a higher quality of care practice through working wellness [ 17 ] and overcoming the lack of previous leadership training [ 17 ].

Although very few studies have included in a meta-analysis examined in private healthcare settings [ 35 , 38 , 40 , 41 , 42 ], leadership interventions had more effectiveness in private hospitals than in public hospitals. This result could be related to the continent of origin, and indeed 60.0% of these studies were derived from North America [ 38 , 41 , 42 ], where patients’ outcomes and healthcare workers’ performance could influence available hospital budgets [ 38 , 40 , 41 , 42 ], especially in peripheral healthcare units [ 38 , 41 ]. Private hospitals paid more attention to the cost-effectiveness of any healthcare action and a positive balance of capital for healthcare settings might depend on the effectiveness of leadership interventions [ 40 , 41 , 42 ]. Furthermore, private healthcare assistance focused on nursing performance because of its impact on both a patients’ and an organizations’ outcomes. Therefore, healthcare systems’ quality could improve with effective leadership actions for a nursing team [ 40 ].

Other factors reported in the literature could affect leadership effectiveness, although they were not examined in this meta-analysis. For instance, professionals’ specialty and gender could have an effect on these results and shape leadership style choice and effectiveness [ 1 ]. Moreover, racial differences among members might influence healthcare system performance. Weech-Maldonado et al. found a higher compliance and self-improvement by black-race professionals than white ones after transactional leadership interventions [ 39 ].

Healthcare workers’ and patients’ outcomes depended on style of leadership interventions [ 1 ]. According to the results of this meta-analysis, interventions conducted by a transactional leadership style increased healthcare outcomes, though nevertheless their effectiveness was higher in the cross-sectional studies than in the before–after studies. Conversely, the improvement by a transformational leadership style was higher in before–after studies than in the cross-sectional studies. Both a charismatic and servant leadership style increased effectiveness more in the cross-sectional studies than in the before–after studies. This data shows that any setting required a specific leadership style for improving performance and guideline adherence by each team member who could understand the importance of their role and their tasks [ 1 ]. Some outcomes had a better improvement than others. Focusing on Savage et al.’s outcomes, a transformational leadership style improved checklist adherence [ 31 ]. The time of patients’ transport by Murphy et al. was reduced after conducting interventions based on a charismatic leadership style [ 37 ]. Jodar et al. showed that performances were elevated in units whose healthcare workers were subjected to transactional and transformational leadership-style interventions [ 1 ].

These meta-analysis results were slightly relevant because of the high heterogeneity among the studies, as confirmed by both funnel plots. This publication bias might be caused by unpublished articles due to either lacking data on leadership effectiveness, failing appropriate leadership strategies in the wrong settings or non-cooperating teams [ 12 ]. The association between leadership interventions and healthcare outcomes was slightly explored or gave no statistically significant results [ 12 ], although professionals’ performance and patients’ outcomes were closely related to the adopted leadership style, as reported by the latest literature sources [ 7 ]. Other aspects than effectiveness should be investigated for leadership. For example, the evaluation of the psychological effect of leadership should be explored using other databases.

The study design choice could affect the results about leadership effectiveness, making their detection and their statistical relevance tough [ 12 ]. Despite the strongest evidence of this study design [ 50 ], nowadays, trials about leadership effectiveness on healthcare outcomes are lacking and have to be improved [ 12 ]. Notwithstanding, this analysis gave the first results of leadership effectiveness from the available study designs.

Performance and adherence to guidelines were the main two outcomes examined in this meta-analysis because of their highest impact on patients, healthcare workers and hospital organizations. They included several other types of outcomes which were independent each other and gave different effectiveness results [ 12 ]. The lack of neither an official classification nor standardized guidelines explained the heterogeneity of these outcomes. To reach consistent results, they were classified into performance and guideline adherence by the description of each outcome in the related manuscripts [ 5 , 6 , 12 ].

Another important aspect is outcome assessment after leadership interventions, which might be fulfilled by several standardized indexes and other evaluation methods [ 40 , 41 ]. Therefore, leadership interventions should be investigated in further studies [ 5 ], converging on a univocal and official leadership definition and classification to obtain comparable results among countries [ 5 , 6 , 12 ].

5. Conclusions

This meta-analysis gave the first pooled data estimating leadership effectiveness in healthcare settings. However, some of them, e.g., surgery, required a dedicated approach to select the most worthwhile leadership style for refining healthcare worker performances and guideline adhesion. This can be implemented using a standardized leadership program for surgical settings.

Only cross-sectional studies gave significant results in leadership effectiveness. For this reason, leadership effectiveness needs to be supported and strengthened by other study designs, especially those with the highest evidence levels, such as trials. Finally, further research should be carried out to define guidelines on leadership style choice and establish shared healthcare policies worldwide.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/ijerph191710995/s1 , Figure S1. Leadership effectiveness by leadership style in before after studies; Figure S2. Funnel plot of before after studies; Figure S3. Leadership effectiveness in cross sectional studies by four leadership style; Figure S4. Funnel plot of cross-sectional studies; Table S1. Before after studies included in this systematic review and meta-analysis; Table S2. Cross-sectional studies included in this systematic review and meta-analysis. All outcomes were performance.

Funding Statement

This research received no external funding.

Author Contributions

Conceptualization, V.R., A.C. (Alessandra Casuccio), F.V. and C.F.; methodology, V.R., M.G., A.O. and C.T.; software, V.R.; validation, G.M., A.B., A.C. (Alberto Carli) and M.C.; formal analysis, V.R.; investigation, G.M., A.B., A.C. (Alberto Carli) and M.C.; resources, A.C. (Alessandra Casuccio); data curation, G.M. and V.R.; writing—original draft preparation, G.M.; writing—review and editing, A.C. (Alessandra Casuccio), F.V., C.F., M.G., A.O., C.T., A.B., A.C. (Alberto Carli) and M.C.; visualization, G.M.; supervision, V.R.; project administration, C.F.; funding acquisition, A.C. (Alessandra Casuccio), F.V. and C.F. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Ethical review and approval were waived for this study due to secondary data analysis for the systematic review and meta-anlysis.

Informed Consent Statement

Not applicable.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The Importance of Healthcare Management

Many people need healthcare services every day, and it is a big challenge for healthcare organizations to provide care to each of them. In order to address this challenge, the profession of a healthcare manager was developed. Healthcare managers have many responsibilities in healthcare organizations, such as coordinating stakeholders, managing funds, educating the staff about policy changes, introducing new technologies, and empowering patients (Utica College, n.d.). All their duties are intended to ensure their organizations use the available resources efficiently, and patients receive high-quality, safe, timely, and cost-efficient healthcare. Any level healthcare facility should make use of healthcare management because it contributes to the efficiency of the healthcare organization and makes sure every patient is provided with world-class healthcare.

Healthcare organizations need healthcare management because healthcare nowadays requires high levels of coordination among multiple stakeholders. According to Begun et al. (2018), the need for coordination in healthcare is higher than in any other business because effective coordination ensures that patients are provided with timely and safe care. Researchers argue that healthcare managers’ coordination of such processes as “appointment scheduling, prior authorizations, and communication” improves the quality of care from mediocre to high levels (Begun et al., 2018, p. 146). According to Utica College (n.d.), which trains professionals in healthcare management, healthcare managers are needed at every organizational level, from supervisors overseeing everyday activities of the medical staff to executives managing the whole facility. Apart from coordinating medical professionals within an organization, healthcare managers play a significant role in establishing partnerships with other community organizations to provide comprehensive patient care. For example, healthcare managers can partner with social workers to help patients to cope with the social problems affecting their health. Overall, healthcare management makes a large contribution to healthcare organizations’ efficiency by means of coordination.

Apart from effective stakeholder coordination, healthcare management contributes to the success of healthcare organizations by improving the quality of care and, consequently, patient outcomes. Linnander et al. (2017) reviewed a number of studies and found out that effective healthcare management has a direct relationship to the excellent performance of healthcare systems. At the same time, poor healthcare management has been proven to prevent healthcare systems from achieving global healthcare goals, such as reducing child mortality or improving maternal health (Linnander et al., 2017). Qualified healthcare managers can help organizations allocate scarce resources and time more effectively, thus allowing for providing high-quality care to a larger number of patients. For example, if a healthcare manager notices that nurses are too busy and fatigued because they spend much of their time answering phone calls, he or she may consider delegating this task to medical assistants. This change will allow nurses to devote more time to their direct responsibilities, i.e., caring for patients, and it will improve the quality and safety of healthcare. Thus, healthcare managers are responsible for making decisions intended to improve patient outcomes.

Although the importance of healthcare management has been recognized by many researchers and practitioners, there is an opposite view of the need for healthcare managers. According to Begun et al. (2018), people often do not regard healthcare managers as professionals and believe that clinicians would cope with managing healthcare organizations better. However, it is the wrong view because management and care delivery require different skills and knowledge. Linnander et al. (2017) argue that in low-income countries, combining the roles of a healthcare manager and a clinician is a common practice, but it does not bring positive results. Clinicians in the position of managers cannot make the best decisions because they lack the necessary managerial skills. Moreover, the need to fulfill both roles leads to burnout, job dissatisfaction, and high attrition rates (Linnander et al., 2017). Indeed, it must be very exhausting for a clinician to accomplish managerial duties after he or she has seen dozens of patients during a day. Therefore, assigning clinicians to perform healthcare managers’ responsibilities is not a feasible option; healthcare organizations should consider hiring professional healthcare managers to address administrative issues.

To sum up, healthcare managers are essential employees within any healthcare facility. Healthcare management helps organizations operate more effectively due to coordination with multiple stakeholders. Effective coordination of the medical staff within an organization is also a responsibility of healthcare managers, and it ensures patients receive timely and high-quality care. Healthcare managers notice problems and challenges in a facility and make decisions on how to fix them. Thus, any healthcare organization that aims at improving cost-efficiency and quality of patient care should make use of healthcare management.

Begun, J., Butler, P., & Stefl, M. (2018). Competencies to what end? Affirming the purpose of healthcare management. The Journal of Health Administration Education , 35 (2), 133–155. Web.

Linnander, E. L., Mantopoulos, J. M., Allen, N., Nembhard, I. M., & Bradley, E. H. (2017). Professionalizing healthcare management: A descriptive case study. International Journal of Health Policy and Management , 6 (10), 555–560. Web.

Utica College. (n.d.). What do hospital health care managers do? Web.

Cite this paper

• Chicago (N-B)
• Chicago (A-D)

StudyCorgi. (2022, March 13). The Importance of Healthcare Management. https://studycorgi.com/the-importance-of-healthcare-management/

"The Importance of Healthcare Management." StudyCorgi , 13 Mar. 2022, studycorgi.com/the-importance-of-healthcare-management/.

StudyCorgi . (2022) 'The Importance of Healthcare Management'. 13 March.

1. StudyCorgi . "The Importance of Healthcare Management." March 13, 2022. https://studycorgi.com/the-importance-of-healthcare-management/.

Bibliography

StudyCorgi . "The Importance of Healthcare Management." March 13, 2022. https://studycorgi.com/the-importance-of-healthcare-management/.

StudyCorgi . 2022. "The Importance of Healthcare Management." March 13, 2022. https://studycorgi.com/the-importance-of-healthcare-management/.

This paper, “The Importance of Healthcare Management”, was written and voluntary submitted to our free essay database by a straight-A student. Please ensure you properly reference the paper if you're using it to write your assignment.

Before publication, the StudyCorgi editorial team proofread and checked the paper to make sure it meets the highest standards in terms of grammar, punctuation, style, fact accuracy, copyright issues, and inclusive language. Last updated: March 13, 2022 .

If you are the author of this paper and no longer wish to have it published on StudyCorgi, request the removal . Please use the “ Donate your paper ” form to submit an essay.

Healthcare Management: Career Paths and Requirements

Nowadays, healthcare has become one of the most dynamic and growing fields that provide various opportunities and challenges. Healthcare is changing faster than any other sphere. Some of the changes seen in this sector are how services are provided and how care is delivered and financed, among others. As a result, healthcare management requires talented personalities to address all the changes. Healthcare executives are entitled to contribute to improving the healthcare of communities and organizations they serve. Due to the growing diversity within the health care system, executives are more needed in diverse settings, such as clinics, hospitals, public health departments, rehabilitation centers, and health insurance organizations, to mention a few. Approximately 10,000 individuals occupy health management positions at numerous organizational levels. It is important to understand that the requirements for senior positions in healthcare settings are too demanding. However, these jobs offer ways of improving the system of care delivery. The following essay discusses top management careers in the healthcare field.

Hospital Chief Executive Officer

Requirements

A hospital CEO is the highest level job in health management. This position heads the facility. To become a hospital CEO, an individual must have a master’s degree. Some of the common master’s degrees held by CEOs include a Master of Business Administration (MBA), Master of Healthcare Administration (MHA), and Master of Medical Management (MMM). To compete in this industry, the master’s degree that an individual holds must be accredited by the Commission Accreditation of Healthcare Management Education (CAHME). To become a hospital CEO, an individual should have fifteen years of experience in a health management setting.

Further, they should also have five years of overall experience in a senior management position. Most CEOs hold the position of COO before becoming a CEO. Quality mentoring is highly recommended for those aspiring to become CEOs.

Job Description

It is the responsibility of a CEO to ensure the smooth running of the hospital. One of the key duties is ensuring patient safety. The security of patients is a significant aspect of a safe healthcare organization. Thus, CEOs play a primary role in developing, evaluating and implementing patient safety measures. Secondly, the CEO promotes the quality of healthcare. Notably, this factor is recognized as critical to any hospital’s functioning. Thirdly, CEO maintains financial health and stability. Hospital CEOs ought to be conversant with all management practices related to finances to support the Chief Finance Officer (CEO) in decision-making. The fourth responsibility is strategic planning. It is a critical function for the hospital CEO and entails regular meetings with other senior executives, such as Chief Medical Officer (CMO) and Chief Nursing Officer (CNO), alongside others, to discuss the future objectives and goals for the hospital.

Salary and Challenges

The average compensation salaries for hospital CEOs are $ 600,000 annually, while CEOs in small rural hospitals earn salaries and bonuses of $118,000 annually. On the other hand, those in the largest urban teaching hospital make an average of $1.7 million per year. Joining the hospital industry as a CEO is a challenging job. For one to qualify, an applicant must have a medical background. The number of experiences needed to become a CEO is also high, and one must have a prior experience in healthcare administration and management positions. One of the significant challenges that hospital CEOs face is the implementation of healthcare reforms. Hospital CEOs feel much pressure when reducing operating costs, shifting to value-based purchasing, aligning provider and payer incentives, and working closely with physicians. Despite their many challenges, they have a satisfying feeling in their work since they are the most paid. However, it is not easy to get into this industry for individuals who lack a master’s degree and years of experience, as stated above.

Hospital Administrator

In every hospital, skilled administrators ensure that all medical facilities run efficiently and deliver quality patient care. Depending on the size of a hospital, a facility can have one or more administrators. To qualify for a hospital administrator position, one must have completed a post-graduate course specifically in hospital administration or any equivalent experience and training. The required maximal number of years is approximately five. The qualification for the position is a diploma in hospital management and other three years of business experience. Most of the top hospitals hire individuals with master’s degrees. The candidates for hospital administrator jobs must be knowledgeable in public health and health services administration. Hospital administrators should also know personnel and business management principles, particularly in hospitals. They should be able to communicate effectively orally and in writing.

A hospital administrator is responsible for organizing, planning, directing, and controlling all resource services and departments of the center. They include personnel, facilities, equipment and supplies, and finances. Secondly, they also administer the hospital’s total budget. Besides, they actively plan with other government officials and senior health centers. A hospital administrator also develops and directs the implementation of programs and policies in the service of the center and resource departments. Additionally, they can act as chief advisors to the medical director, specifically in implementing and developing the center’s programs, procedures and policies. The hospital administrator also promotes and maintains effective public relations with community agencies, government, and individuals.

In the United States, the earnings for hospital administrators range from $96,000 per year on average, while the pay ranges between $48,000 and $177,000 yearly. The biggest paychecks entail nearly $25,000 from bonuses, though $12,000 comes from profit sharing. One of the challenges that hospital administrators face is staffing issues. Notably, this problem affects nearly every individual at the hospital, from an executive team to physicians and patients. Hospital administrators spend significant time ensuring that their institutions have the best healthcare professionals who meet the needs of the hospitals. The question of inadequate staffing leads to quality-related issues. Another challenge refers to changes in payment structure. Administrators are responsible for addressing all issues brought about by changes in this area. Over the past years, the pay-per-service payment model has been prevalent, but nowadays, the approach still needs to be updated. The new regulations ensure that hospital charges fees depending on the general outcome and quality of care delivered. The third challenge is hospital-physician relations. As baby boomers retire, the number of physicians available in the hospital also decreases. Thus, administrators are faced with a significant dilemma of needing more supply to meet the demands of the patients. Most physicians also prefer to work for short hours. Thus, only a few physicians are left to meet emergency cases at the hospital.

Individuals interested in pursuing a career as a hospital administrator should know that it will be advantageous to them as the career offers a satisfying feeling. However, they must learn all the challenges administrators are likely to encounter. By analyzing the challenges, one can decide whether one still wishes to pursue a career in this field.

Chief Finance Officer

Hospital CFOs are responsible for making sure that entire medical facilities are run properly, especially from a financial point of view. However, the minimal requirement is a bachelor’s degree. The only choice a person has to make is whether they would like to major in healthcare or medicine. Ideally, one can become a hospital CFO with only a bachelor’s degree or even if an individual is a certified public accountant (CPA). However, the top hospitals are screening for more experienced personnel with a Master of Business Administration (MBA) or Master of Healthcare Administration (MHA). There is much competition for top-level executive jobs in hospitals. Demonstrable skills and experience are the most crucial aspects that employers and hospitals look for when recruiting a CFO.

Successful CFOs must possess significant experience in executive or managerial positions. In most cases, hospital CFOs must be visionaries and result oriented. They should have a considerable stake in the general direction of the hospital. They are more business partners rather than regularly paid employees. Those individuals who wish to work as CFO at hospitals must learn the technical aspects of personnel management, accounting, and finance.

CFOs are responsible for the maintenance of the financial well-being of their facility in both floundering and flourishing economies. Their leadership is significant since it allows hospitals to allocate resources appropriately to take on projects. CFO communicates their facility’s objectives and organizational goals concerning financial performance targets. In most hospitals, financial goals are set to decrease costs, increase revenues, or both. Thus, it is the responsibility of the CFO to communicate particular goals to the staff. CFOs also manage the delicate balance of benefits and costs of human capital. Thus, a CFO should be knowledgeable about the needs of their workers and, at the same time, balance the business needs. CFOs guide product development and marketing strategies based on market analysis and trends. This set of activities includes projections and supply management, cost estimates, human capital projections and ROI estimates, especially for new services and products.

Challenges and Salaries

An average salary of a CFO is $122,000 annually, while the profit-sharing proceeds to nearly $45,000 and bonuses approach $66,000. Thus, the overall income of a CFO ranges between $67,000 and $252,000, depending on how an individual performs.

On the other hand, CFOs face numerous challenges in the line of duty. Hospitals are preparing to change to value-based business models, and therefore, CFOs should facilitate physician employment arrangements. For this reason, they must be prepared to deal with all issues related to care coordination, ongoing performance measurements, and population health management. This is one of the biggest challenges for hospital leadership teams, and hence, CFO must play a key role in the transformation process. Due to health reforms, running a hospital finance department has always been challenging for CFOs. The use of electronic medical records has also posed a major challenge to hospitals. Getting into the healthcare industry as a CFO is easy. However, the candidate must meet all the requirements mentioned above. In contrast, being a CFO is a challenging job. Nonetheless, this post offers a satisfying feeling for those with the required experience.

Physician Practice Manager

Physician practice managers work within a group or medical practice to manage budgets, develop business strategies, and oversee the day-to-day operation, such as billing collections and scheduling. They also make sure that all business practices are integrated. In addition, they work dynamically to ensure that new patients receive high-quality care. Most hospitals prefer a candidate with a master’s degree in business management. In other hospitals, a candidate with a bachelor’s degree can qualify for the position. The preferred candidate should have at least five years of working experience. To be eligible for a physician practice manager, an individual must possess analytical and leadership skills. Apart from that, they should be knowledgeable in different computer software programs. The ideal candidate should be able to work as part of a team and have strong communication skills.

Whether it is a small or big facility, the primary responsibilities of physician practice managers entail planning, coordinating, directing, and supervising various elements of the medical institutions. They also oversee the billings and collections and sometimes implement work policies for their employees. Notably, these managers have daily interactions with patients and employees. Physician practice managers can specialize in a specific department or even manage an entire practice. In a small facility with minimal physicians, the manager handles scheduling the daily patient flow and technical issues. In a larger facility, only one top manager is required and several assistants. They all ensure that business day is handled according to the medical and office guidelines. These managers are also expected to have problem-solving skills to address all issues and complaints within the office. Since they are managers, they are supposed to be always organized and ensure a steady flow of work daily. Moreover, these managers must supervise office staff, including coders, medical billers, and receptionists, and the back office, such as medical assistants and nurses.

Salaries and Challenges

A physician practice manager earns $ 56,481 yearly on average. Notably, the pay for this job mostly stays the same depending on the individual’s experience. These managers encounter many challenges, just like any other healthcare professional. One of the challenges is patients dictating healthcare. Efforts to balance the desire to practice quality medicine and obtaining positive patient feedback have been a growing problem for physicians. Physician managers always expect patients to be satisfied with the services offered. The second challenge is staff retention. Physician managers always strive to make their workers happy. However, recruiting and retaining the best personnel remains challenging for many medical practices. The third problem is administrative burdens. Mounting paperwork prevents the physician from spending significant time with patients. Becoming a physician practice manager entails little. However, the nature of the work is satisfying since these managers spend considerable time interacting with their staff and patients.

Supply Chain Manager

Supply chain managers, also known as sourcing managers, are responsible for handling all the supply operations within facilities. Successful candidates must be able to improve and evaluate all supply chain activities by analyzing the company’s spending, supplying partnerships and any other new possibilities. An ideal candidate for the position of sourcing manager should have a Bachelor of Science degree in supply chain management, business administration, or logistics. The suitable individual for the position should also have strong leadership and project management skills. Besides, they ought to be able to negotiate and sustain all networking relationships. Sourcing managers should have solid judgment and be able to make the right decisions. Further, they must prove their prior working experience as a supply or procurement manager in any setting. A supply manager should know vendor management, sourcing, and relevant software. They must be comfortable with figures and able to interpret and analyze data. A supply manager should communicate openly.

Supply managers are entitled to several responsibilities. First, they are responsible for managing all facility’s supply portfolios. This will ensure transparency of spending. Supply managers also generate and implement efficient sourcing and category management strategies. They also calculate and analyze the costs of the supply chain and suggest other methods or ways of decreasing expenditure. They are responsible for determining the time and number of items and deliveries made. A sourcing manager must look for great deals and also invent negotiation strategies. They also optimize the procedures used in sourcing to attain maximum efficiency. Supply managers, too, perform all cost analyses and benchmarking. They also estimate risks and apply necessary risk management techniques to minimize the risks. They also ensure they discover and partner with all trustworthy suppliers and vendors. Finally, they cooperate with stakeholder and guarantees processes and terms.

The average pay for sourcing managers is $82,000 per year. It can also range from $123,000 on the higher end and $50,000 on the lower end. Bonuses and profit sharing range from 18,000 and 16,000, respectively. One of the challenges faced by sourcing managers is drug shortage. This issue has affected the supply chain and the health systems at large. In most instances, drug shortages occur with little or no warning to providers. However, advocacy efforts are improving early notification and responses. A shortage of drugs in hospitals causes many issues in supply chain management. The second challenge is multiplied and involves lacking a team, deep sourcing, and industry expertise. This can be a huge threat to the facility. The team could be experienced or talented, but their talents must be channeled better. Thus, individuals fit for the position should be able to elevate the sourcing to another level of maturity. The third challenge is finding compliance with contracts. Finding the right way to ensure the conformity of contracts becomes a major problem for sourcing managers. Most contracted suppliers are ignored, and this frustrates the managers. Supply managers require strong supplier, contract, and vendor management technologies. Being a supply manager in the healthcare industry takes work. This position comes with many challenges which only a few individuals can handle.

Similarly to any other organization or corporation, hospitals offer management careers. Some of these careers include hospital CEOs, administrators, chief finance officers, physician practice managers, and sourcing managers. These careers are of much significance in any industry. Today’s healthcare is rapidly changing. Thus, with the help of hospital management, the changes can be easily managed. The ideal candidates for the managerial position must have relevant experience, especially in the healthcare system. The primary responsibilities of individuals in the hospital management department are overseeing the efficient maintenance of quality healthcare delivery and utilizing hospital resources. In most instances, the persons in these managerial positions guide staff members toward achieving a positive healthcare environment. They ensure that rules and regulations are followed accordingly.

📎 References

1. Aldrich, J. (2013). Climbing the healthcare management ladder: Career advice from the top on how to succeed. Baltimore, MD: Health Professions Press. 2. American College of Healthcare Executive. (2013). Careers. 3. Broscio, M. A. (2014). Career management in today’s healthcare environment. Journal of Healthcare Management, 59(6), 395-398. 4. Friedman, L. H., & Kovner, A. R. (2013). 101 careers in healthcare management. New York, NY: Springer. 5. Gopee, N., & Galloway, J. (2013). Leadership and management in healthcare. Thousand Oaks, CA: Sage Publications. 6. Hubbard, R. L. (2015). What degree do I need to pursue a career in health care? New York, NY: Rosen Young Adult. 7. Mitchell, D., & Haroun, L. (2012). Introduction to health care. Clifton Park, NY: Delmar, Cengage Learning. 8. Public Health Online. (2013). Exploring growths, salaries and career paths for healthcare administration students and professionals. Retrieved from http://www.publichealthonline.org/healthcare-administration/#context/api/listings/prefilter 9. Stein, J. A., & Chiplin, A. J., Jr. (Eds.) (2016). 2016 Medicare handbook: Center for Medicare Advocacy. New York, NY: Wolters Kluwer. 10. UCDAVIS University of California (2016). 5+ top MBA Healthcare Management Careers + Salary Outlook. Retrieved from: http://mhadegree.org/mba-healthcare-management-salary/

Table of content

Crafted with Care:

Nursing Essays!

Precision, Passion, & Professionalism in Every Page.

Home — Essay Samples — Business — Leadership and Management — Healthcare Management and Leadership 

Healthcare Management and Leadership 

• Categories: Leadership and Management Leadership Styles

About this sample

Words: 1884 |

10 min read

Published: Jul 17, 2018

Words: 1884 | Pages: 4 | 10 min read

Table of contents

Health care essay outline, health care essay example, introduction.

• Broad concept of management and its importance
• Relationship between management and achieving goals
• The role of leadership in guiding individuals towards objectives

Management Theories and Systems Theory

• Definition of management theories
• Introduction to systems theory in management
• Open and closed systems in organizations
• Application of systems theory in healthcare

Leadership Styles and Autocratic Leadership

• Introduction to leadership styles
• Explanation of autocratic leadership
• Characteristics of autocratic leadership
• Advantages and disadvantages of autocratic leadership

Management Functions and Roles

• Key functions of management: organizing, staffing, leading, controlling
• Role of managers in healthcare organizations
• Responsibilities in healthcare management
• Challenges faced by healthcare managers

Effective Leadership Principles

• Principles of effective leadership
• Recognizing individual abilities and building strong relationships
• Expressing appreciation and gratitude
• Trusting others and promoting collaboration
• The significance of effective management and leadership in healthcare
• The roles and responsibilities of healthcare managers
• Challenges and opportunities in healthcare management roles

Cite this Essay

Let us write you an essay from scratch

• 450+ experts on 30 subjects ready to help
• Custom essay delivered in as few as 3 hours

Get high-quality help

Prof Ernest (PhD)

Verified writer

• Expert in: Business

+ 120 experts online

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

Related Essays

4 pages / 1692 words

1 pages / 465 words

3 pages / 1171 words

4 pages / 2036 words

Remember! This is just a sample.

You can get your custom paper by one of our expert writers.

121 writers online

Still can’t find what you need?

Browse our vast selection of original essay samples, each expertly formatted and styled

Related Essays on Leadership and Management

The Clayton Johnson case study is a fascinating and complex examination of the challenges and opportunities that arise in the world of business and leadership. This essay will provide a thorough analysis of the case study, [...]

Managers play a crucial role in the success of any organization. An ideal manager is someone who possesses a unique set of skills and qualities that enable them to effectively lead and inspire their team. In this essay, we will [...]

In today's fast-paced and competitive world, the ability to take disciplined initiative has become increasingly crucial for success in various aspects of life. Disciplined initiative can be defined as the willingness and ability [...]

What is business? From its most basic roots, business is producing or providing some form of good or service, and ideally trading that good or service for either money, or something else of value. Over time, the definition of [...]

Operation management can be defined as “a configuration of resources combined for the provision of goods or services” (Morris, 1978). It involves planning, organizing, and supervising processes, and make necessary improvements [...]

Management is the administration of a company, a not-for-profit organization, or government body. Personnel management has been formulated over the years and includes staff motivation as a part of the science. Therefore, [...]

Related Topics

By clicking “Send”, you agree to our Terms of service and Privacy statement . We will occasionally send you account related emails.

Where do you want us to send this sample?

By clicking “Continue”, you agree to our terms of service and privacy policy.

Be careful. This essay is not unique

This essay was donated by a student and is likely to have been used and submitted before

Download this Sample

Free samples may contain mistakes and not unique parts

Sorry, we could not paraphrase this essay. Our professional writers can rewrite it and get you a unique paper.

Please check your inbox.

We can write you a custom essay that will follow your exact instructions and meet the deadlines. Let's fix your grades together!

Get Your Personalized Essay in 3 Hours or Less!

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

• Instructions Followed To The Letter
• Deadlines Met At Every Stage
• Unique And Plagiarism Free

Healthcare Management Essays

Methods in how research findings can be disseminated, root cause analysis of medicare fraud: a case of timothy emeigh’s involvement, societal influences of the advanced practice nurse, an evidence-based research question regarding echocardiogram, consideration for extra shifts to address nurse shortage, system development lifecycle and nursing process, business finance – accounting assignment, quality improvement process, examination of organizational structure and its influence on healthcare delivery, managerial epidemiology in healthcare: creating a preliminary market analysis for a geriatric psychiatric unit, leading and managing in nursing, informational analysis: effective communication, creating a workplace culture of quality and safety, the fundamental principles of care coordination, healthcare finance: the cost of healthcare, popular essay topics.

• American Dream
• Artificial Intelligence
• Black Lives Matter
• Bullying Essay
• Career Goals Essay
• Causes of the Civil War
• Child Abusing
• Civil Rights Movement
• Community Service
• Cultural Identity
• Cyber Bullying
• Death Penalty
• Depression Essay
• Domestic Violence
• Freedom of Speech
• Global Warming
• Gun Control
• Human Trafficking
• I Believe Essay
• Immigration
• Importance of Education
• Israel and Palestine Conflict
• Leadership Essay
• Legalizing Marijuanas
• Mental Health
• National Honor Society
• Police Brutality
• Pollution Essay
• Racism Essay
• Romeo and Juliet
• Same Sex Marriages
• Social Media
• The Great Gatsby
• The Yellow Wallpaper
• Time Management
• To Kill a Mockingbird
• Violent Video Games
• What Makes You Unique
• Why I Want to Be a Nurse
• Send us an e-mail

Career in healthcare management

The United States has always been known for such a well-known country with strong development of healthcare, with all of the opportunities presented in college I decided to further my education and start a career in this area. Throughout my entire life, education has been one of the most important things for me to be successful. As I began to grow I often get asked by this one question was: ‘What do you want to be when you grow up?’, and as a teenager, my answer was ‘I don’t know, yet.

’ I was struggling to decide what is it that I wanted to do, after visiting my high school college fair, I found something that is interested me like a medical and health-related field. When I told my parents what I am going to study in college, I got questions from my family like ‘Are you going to pre-med? Are you going to be a doctor?’ those questions are like what my family always wanted me to be.

Then I realized my passion was not stopping at patient care like doctors and nurses. I want to be a part of the healthcare system that sets a solid and firm foundation for the hospital’s trust to save patients’ lives. Not only for doctors to feel comfortable at their highest productivity work, but also to keep patients to be cured well. As a matter of fact, I chose a path that I would embark myself in the future. Therefore, I found my burning desire is to become a healthcare manager, specifically a Medical and Health Service Manager.

Proficient in: Educational And Career Goals

“ Amazing as always, gave her a week to finish a big assignment and came through way ahead of time. ”

At first, I thought this is just a desk job, which means I will be sitting on a working desk and doing hospital paperwork from what is sounded like, but it just way more than that. Being a Medical and Health Service Manager has endless opportunities in practice medical technology, manage an entire facility, or a department, a specific clinical area, or a medical practice for a group of physicians. It is also a time where healthcare management is changing more rapidly than any of other fields.

As the field is changing in terms of the care that is delivered to patients, the services that are provided, and how that care is being financed. This career is a great fit for me as I get to learn a bit of everything in terms of a medical career, I am also able to work with people that I always admire such as doctors, and most importantly, I am able to work and ensure that there is the best quality of healthcare services for patients. This is a field that will be in charge of managing and running a healthcare facility or a private medical center. Of course, in every field or career, there are many requires skills, experiences, and duties that are critical for success. First, I have to graduate college with a bachelor’s degree of Science in Healthcare Management major for at least four years to earn the perfection of skills, knowledge, as well as experiences required to enter the occupation. As I said this career is a good fit for me when I get to learn a bit of everything because this field is a combination of both medical/healthcare and business manager, it is required to courses such as health information systems, medical terminology, and hospital organization, law and ethics, research methods, human resources management, healthcare system, and operational management.

Moreover, the Healthcare Management degree also includes courses for business such as accounting, statistics, and strategic planning. There are also some basic skills that I have to be professionals such as communication, technical skills, and detail oriented that will help and support me for a firm background when I enter and commit myself in this occupation. Working in a healthcare system such as Medical and Health Service Management gives me the opportunity to care for patients as they recover, and assist other families when they are going through some of the most difficult times in lives. I also have the opportunity to work behind the scenes to keep up with patients’ records, and the medical facility running smoothly. As healthcare managers are needed in places like the hospital, nursing home or other healthcare centers, we are responsible and qualified for making sure that they are working effectively in order to ensure the best quality of healthcare for all patients.

Based on the Bureau of Labor Statistics, there is a growth of twenty percent of the employment in this field from 2016 to 2026 which is considered one of the fastest-growing than almost any other field. In May 2017, the median annual wage was reported for medical and health services managers was $98,350. Not to mention, the lowest ten percent of the employees earned less than $58,350, and the highest ten percent earned more than $176,130. With this in mind, Medical and Health Service Management is marked as one of the top medical industries for employment per year whereas Hospitals; state, local, and private made $107,230; the government made $106,230; offices of physicians made $89,760; nursing and residential care facilities made $82,950. After I spend full time studying and exploring in school, this field is ideal for me.

Cite this page

Career in healthcare management. (2021, Dec 10). Retrieved from https://paperap.com/career-in-healthcare-management/

"Career in healthcare management." PaperAp.com , 10 Dec 2021, https://paperap.com/career-in-healthcare-management/

PaperAp.com. (2021). Career in healthcare management . [Online]. Available at: https://paperap.com/career-in-healthcare-management/ [Accessed: 27 Mar. 2024]

"Career in healthcare management." PaperAp.com, Dec 10, 2021. Accessed March 27, 2024. https://paperap.com/career-in-healthcare-management/

"Career in healthcare management," PaperAp.com , 10-Dec-2021. [Online]. Available: https://paperap.com/career-in-healthcare-management/. [Accessed: 27-Mar-2024]

PaperAp.com. (2021). Career in healthcare management . [Online]. Available at: https://paperap.com/career-in-healthcare-management/ [Accessed: 27-Mar-2024]

• Career Seekers And / or Those Embarking On a New Career Path Pages: 4 (1016 words)
• Chapter 12 review healthcare management Ferris Pages: 2 (498 words)
• Healthcare Leadership and Management  Pages: 4 (959 words)
• Career In Event Management Pages: 3 (846 words)
• CMA Certification for Management Career Pages: 5 (1252 words)
• Healthcare and Financial Issues Pages: 3 (761 words)
• Healthcare, Cultural Beliefs and Pakistani Americans Pages: 13 (3886 words)
• Healthcare Industry Structure Pages: 2 (483 words)
• The Largest Expense Category For Most Healthcare Organizations Is Pages: 2 (501 words)
• Healthcare Erp Solutions Pages: 3 (646 words)

Enter search terms to find related medical topics, multimedia and more.

Advanced Search:

• Use “ “ for exact phrases.
• For example: “pediatric abdominal pain”
• Use – to remove results with certain keywords.
• For example: abdominal pain -pediatric
• Use OR to account for alternate keywords.
• For example: teenager OR adolescent

Management of Normal Labor

, MD, Children's Hospital of Philadelphia

Birthing Options

Beginning of labor, admission to labor unit, cervical examination, rupture of membranes, stages of labor.

• 3D Models (0)
• Calculators (0)

Labor consists of a series of rhythmic, involuntary or medically induced contractions of the uterus that result in effacement (thinning and shortening) and dilation of the uterine cervix. In 1996, the World Health Organization (WHO) defined normal birth as follows ( 1 General reference Labor consists of a series of rhythmic, involuntary or medically induced contractions of the uterus that result in effacement (thinning and shortening) and dilation of the uterine cervix. In... read more ):

The birth is spontaneous in onset and low risk at the start of labor and remains so throughout labor and delivery.

The infant is born spontaneously in the vertex position between 37 and 42 weeks of pregnancy.

After birth, mother and infant are in good condition.

The stimulus for labor is unknown, but digitally manipulating or stretching the cervix during examination enhances uterine contractile activity, most likely by stimulating release of oxytocin by the posterior pituitary gland.

In uncomplicated term pregnancies, labor usually begins within 2 weeks (before or after) of the estimated date of delivery. In a first pregnancy, labor lasts 12 to 18 hours on average; subsequent labors are often shorter, averaging 6 to 8 hours.

Management of labor protraction or arrest Protracted or Arrested Labor Protracted labor is abnormally slow cervical dilation or fetal descent during the first or second stage of labor. Arrested labor is a complete pause in progress of labor. Diagnosis is clinical... read more requires additional measures (eg, induction or augmentation of labor Induction of Labor Induction of labor is stimulation of uterine contractions before the onset of spontaneous labor to achieve vaginal delivery. Induction of labor can be Medically indicated (eg, for preeclampsia... read more , forceps or vacuum extractor delivery Operative Vaginal Delivery Operative vaginal delivery involves application of forceps or a vacuum extractor to the fetal head to assist during the second stage of labor and facilitate delivery. Indications for forceps... read more , cesarean delivery Cesarean Delivery Cesarean delivery is surgical delivery by incision into the uterus. The rate of cesarean delivery was 32% in the United States in 2021 (see March of Dimes: Delivery Method). The rate has fluctuated... read more ).

(See also Introduction to Intrapartum Complications Introduction to Intrapartum Complications Abnormalities and complications of labor and delivery should be diagnosed and managed as early as possible. In pregnancy, intrapartum complications may be caused by known risk factors that precede... read more .)

General reference

1. Care in normal birth: A practical guide . Technical Working Group, World Health Organization. Birth 24(2):121-123, 1997.

Settings for childbirth vary. Patients may have options of delivering at a hospital, birthing center, or at home. Hospital delivery has the advantage of having clinical staff and equipment immediately available if unexpected maternal and fetal complications occur during labor and delivery (eg, placental abruption Placental Abruption (Abruptio Placentae) Placental abruption (abruptio placentae) is premature separation of the placenta from the uterus, usually after 20 weeks gestation. It can be an obstetric emergency. Manifestations may include... read more , shoulder dystocia Fetal Presentation, Position, and Lie (Including Breech Presentation) Abnormal fetal lie or presentation may occur due to fetal size, fetal anomalies, uterine structural abnormalities, multiple gestation, or other factors. Diagnosis is by examination or ultrasonography... read more , need for emergency cesarean delivery Cesarean Delivery Cesarean delivery is surgical delivery by incision into the uterus. The rate of cesarean delivery was 32% in the United States in 2021 (see March of Dimes: Delivery Method). The rate has fluctuated... read more , fetal or neonatal distress or abnormality) or postpartum (eg, postpartum hemorrhage Postpartum Hemorrhage Postpartum hemorrhage is blood loss of > 1000 mL or blood loss accompanied by symptoms or signs of hypovolemia within 24 hours after childbirth. Diagnosis is clinical. Treatment depends on... read more ).

For many women, presence of their partner or another support person (eg, doula or perinatal support specialist) during labor is helpful and should be encouraged. Moral support and encouragement may decrease anxiety. Childbirth education classes can prepare parents for labor and delivery, including providing information about normal labor, monitoring equipment, and potential complications.

Labor usually begins with irregular uterine contractions of varying intensity and the cervix begins to efface and dilate. As labor progresses, contractions increase in duration, intensity, and frequency. Sometimes the chorioamniotic membranes rupture before the onset of contractions.

Bloody show (a small amount of blood with mucous discharge from the cervix) may be an early sign the labor will soon begin. However, bloody show may also occur as a result of sexual intercourse. Bloody show may precede onset of labor by as much as 72 hours. Any vaginal bleeding in pregnancy should be assessed to exclude complications. With bloody show, the amount of blood is very small and mucus is typically present, which usually differentiates it from abnormal third-trimester vaginal bleeding Vaginal Bleeding During Late Pregnancy Bleeding during late pregnancy (≥ 20 weeks gestation, but before birth) occurs in 3 to 4% of pregnancies. It should be evaluated promptly, because it may be associated with complications that... read more .

Typically, pregnant women are advised to call their health care team or go to the hospital if they believe their membranes have ruptured or if they are experiencing contractions lasting at least 30 seconds and occurring regularly at intervals of about 6 minutes or less for an hour. Patients are evaluated, and if it is uncertain whether labor has begun, they are observed for a time and sent home if labor has not begun.

Symptoms that are not associated with normal labor, such as persistent (rather than intermittent) abdominal or back pain, heavy vaginal bleeding, or hemodynamic instability, that suggest placental abruption Placental Abruption (Abruptio Placentae) Placental abruption (abruptio placentae) is premature separation of the placenta from the uterus, usually after 20 weeks gestation. It can be an obstetric emergency. Manifestations may include... read more (premature separation of the placenta) require immediate evaluation and management. Placenta previa Placenta Previa Placenta previa is implantation of the placenta over or near the internal os of the cervix. It typically manifests as painless vaginal bleeding after 20 weeks gestation; the source of bleeding... read more is typically ruled out with routine prenatal ultrasonography in the second trimester. However, if the location of the placenta is unknown or the placenta was low-lying on the most recent ultrasound, digital vaginal examination is contraindicated, and ultrasonography should be done as soon as possible.

When a pregnant patient is admitted to the labor unit, vital signs are measured. Blood is drawn for a complete blood count (CBC), blood typing, and antibody screening. If routine laboratory tests were not done during prenatal visits, they should be done. These tests include screening for HIV, hepatitis B, and syphilis; testing rubella and varicella immunity; and group B streptococcal infection.

The presence and rate of fetal heart sounds are recorded. A physical examination is done. While examining the abdomen, the clinician estimates size, position, and presentation of the fetus, using the Leopold maneuver (see figure ). If fetal presentation or lie Fetal Presentation, Position, and Lie (Including Breech Presentation) Abnormal fetal lie or presentation may occur due to fetal size, fetal anomalies, uterine structural abnormalities, multiple gestation, or other factors. Diagnosis is by examination or ultrasonography... read more is uncertain, ultrasonography may be done.

If labor is active, patients should receive little or nothing by mouth to prevent possible vomiting and aspiration during delivery or in case emergency delivery with general anesthesia is necessary. Some health facilities permit clear liquids in low-risk patients.

Shaving or clipping of vulvar and pubic hair is not indicated, and it increases the risk of wound infections.

An IV infusion of Ringer's lactate may be started, preferably using a large-bore indwelling catheter inserted into a vein in the hand or forearm. During a normal labor of 6 to 10 hours, women should be given 500 to 1000 mL of this solution. The infusion prevents dehydration during labor and subsequent hemoconcentration and maintains an adequate circulating blood volume. The catheter also provides immediate access for medications or blood products if needed. Fluid preloading is valuable if epidural or spinal anesthesia is planned.

Leopold Maneuver

If there are concerns about complications after the initial examination, fetal monitoring, and laboratory tests, additional testing or monitoring is done.

If the pregnancy is preterm ( < 37 weeks) and patients present with uterine contractions or leaking of fluid, they are assessed for preterm labor Preterm Labor Labor (regular uterine contractions resulting in cervical change) that begins before 37 weeks gestation is considered preterm. Risk factors include prelabor rupture of membranes, uterine abnormalities... read more or preterm prelabor rupture of membranes Prelabor Rupture of Membranes (PROM) Prelabor rupture of membranes is leakage of amniotic fluid before onset of labor. Diagnosis is clinical. Delivery is recommended when gestational age is ≥ 34 weeks and is generally indicated... read more and managed accordingly.

If the patient has regular, painful contractions, a cervical examination is done to assess cervical dilation.

In patients with placenta previa Placenta Previa Placenta previa is implantation of the placenta over or near the internal os of the cervix. It typically manifests as painless vaginal bleeding after 20 weeks gestation; the source of bleeding... read more , cervical examination can cause severe hemorrhage and, therefore, is not done. If placental location has not been determined during prenatal care, ultrasonography should be done before a pelvic examination.

Cervical dilation is recorded in centimeters as the diameter of a circle; 10 cm is considered fully dilated.

Effacement is estimated in percentages, from zero to 100%. Because effacement involves cervical shortening as well as thinning, it may be recorded in centimeters using the normal, uneffaced average cervical length of 3.5 to 4.0 cm as a guide.

Station is expressed in centimeters above or below the level of the maternal ischial spines. Level with the ischial spines corresponds to 0 station. Levels below the ischial spines are documented as ( + ); levels higher in the pelvis above the ischial spines are documented as ( − ). Levels are recorded in centimeter increments.

Fetal lie, position, and presentation are noted.

Lie describes the relationship of the long axis of the fetus to that of the mother (longitudinal, oblique, transverse).

Position describes the relationship of the presenting part to the maternal pelvis (eg, occiput left anterior for cephalic, sacrum right posterior for breech).

Presentation describes the part of the fetus at the cervical opening (eg, breech, vertex, shoulder).

Abnormal fetal lie, position, or presentation Fetal Presentation, Position, and Lie (Including Breech Presentation) Abnormal fetal lie or presentation may occur due to fetal size, fetal anomalies, uterine structural abnormalities, multiple gestation, or other factors. Diagnosis is by examination or ultrasonography... read more may be associated with intrapartum complications.

Occasionally, the membranes (amniotic and chorionic sac) rupture before labor begins, and amniotic fluid leaks through the cervix. Rupture of membranes at any stage before the onset of labor is called prelabor rupture of membranes Prelabor Rupture of Membranes (PROM) Prelabor rupture of membranes is leakage of amniotic fluid before onset of labor. Diagnosis is clinical. Delivery is recommended when gestational age is ≥ 34 weeks and is generally indicated... read more (PROM). Some women with PROM feel a gush of fluid from the vagina, followed by steady leaking ( 1 Rupture of membranes references Labor consists of a series of rhythmic, involuntary or medically induced contractions of the uterus that result in effacement (thinning and shortening) and dilation of the uterine cervix. In... read more ).

If the patient presents with possible rupture of membranes, but does not have regular and painful contractions, a sterile speculum examination is done initially to confirm rupture of membranes. To decrease the risk of infection, digital cervical examinations are delayed until it appears that labor has begun or if there are other indications to assess cervical dilation (eg, planning labor induction).

Further confirmation is sometimes needed to differentiate amniotic fluid from other fluids (eg, urine, vaginal discharge, semen). Rupture of membranes can be confirmed on pelvic examination if fluid is seen leaking from the cervix, and there is pooling in the posterior vagina. Fetal meconium (producing greenish-brown discoloration) should be noted if present, because it may be a sign of fetal stress.

If pooling is not seen, confirmation may require testing. For example, the pH of vaginal fluid may be tested with nitrazine paper, which turns deep blue at a pH > 6.5 (pH of amniotic fluid: 7.0 to 7.6); false-positive results can occur if vaginal fluid contains blood or semen or if certain infections are present. A sample of the secretions from the posterior vaginal fornix or cervix may be obtained, placed on a slide, air dried, and viewed microscopically for ferning. Ferning (crystallization of sodium chloride in a palm leaf pattern in amniotic fluid) usually confirms rupture of membranes. Commercial tests to evaluate for rupture of membranes are used by some institutions ( 2 Rupture of membranes references Labor consists of a series of rhythmic, involuntary or medically induced contractions of the uterus that result in effacement (thinning and shortening) and dilation of the uterine cervix. In... read more , 3 Rupture of membranes references Labor consists of a series of rhythmic, involuntary or medically induced contractions of the uterus that result in effacement (thinning and shortening) and dilation of the uterine cervix. In... read more ).

If rupture is still unconfirmed, ultrasonography showing oligohydramnios (deficient amniotic fluid) provides further evidence suggesting rupture. Rarely, amniocentesis with instillation of dye is done to confirm rupture; dye detected in the vagina or on a tampon confirms rupture.

About 80 to 90% of women with PROM at term ( ≥ 37 weeks) and about 50% of women with preterm PROM (< 37 weeks) go into labor spontaneously within 24 hours; > 90% of women with PROM go into labor within 2 weeks. If membranes rupture at term but labor does not start within several hours, labor is typically induced to lower risk of maternal and fetal infection. When preterm PROM occurs (at < 37 weeks), the delay between rupture and labor onset increases with decreasing gestational age.

Rupture of membranes references

1. Prelabor Rupture of Membranes : ACOG Practice Bulletin, Number 217.  Obstet Gynecol 135(3):e80-e97, 2020. doi:10.1097/AOG.0000000000003700

2. Ramsauer B, Vidaeff AC, Hösli I, et al : The diagnosis of rupture of fetal membranes (ROM): a meta-analysis. J Perinat Med . 2013;41(3):233-240. doi:10.1515/jpm-2012-0247

3. Thomasino T, Levi C, Draper M, Neubert AG . Diagnosing rupture of membranes using combination monoclonal/polyclonal immunologic protein detection. J Reprod Med . 2013;58(5-6):187-194.

There are 3 stages of labor.

First stage

The first stage—from onset of labor to full dilation of the cervix (about 10 cm)—has 2 phases, latent and active.

The latent phase is the interval from the onset of labor to the onset of the active phase ( 1 Stages of labor references Labor consists of a series of rhythmic, involuntary or medically induced contractions of the uterus that result in effacement (thinning and shortening) and dilation of the uterine cervix. In... read more ). Irregular contractions become regular and more intense, discomfort is mild to moderate, and the cervix effaces and begins to dilate to 4 to 6 cm. The latent phase is difficult to define precisely and duration varies. For nulliparas, the mean is 7.3 to 8.6 hours (95th percentile, 17 to 21 hours) ( 2 Stages of labor references Labor consists of a series of rhythmic, involuntary or medically induced contractions of the uterus that result in effacement (thinning and shortening) and dilation of the uterine cervix. In... read more ). For multiparas, the mean is 4.1 to 5.3 hours (95th percentile, 12 to 14 hours).

There is no standard definition of a protracted latent phase . A commonly used standard is > 20 hours in nulliparous patients or > 14 hours in multiparous patients, although some studies have reported shorter and longer durations ( 3 Stages of labor references Labor consists of a series of rhythmic, involuntary or medically induced contractions of the uterus that result in effacement (thinning and shortening) and dilation of the uterine cervix. In... read more ).

The active phase is defined by accelerated cervical dilation. Regular contractions continue until the cervix becomes fully dilated.

Active-phase protraction Protracted or Arrested Labor Protracted labor is abnormally slow cervical dilation or fetal descent during the first or second stage of labor. Arrested labor is a complete pause in progress of labor. Diagnosis is clinical... read more is diagnosed when, after 6 cm dilation is reached, the cervix dilates < 1.2 cm/hour in nulliparous patients or < 1.5 cm/hour in multiparous patients ( 4 Stages of labor references Labor consists of a series of rhythmic, involuntary or medically induced contractions of the uterus that result in effacement (thinning and shortening) and dilation of the uterine cervix. In... read more ). Active-phase arrest Protracted or Arrested Labor Protracted labor is abnormally slow cervical dilation or fetal descent during the first or second stage of labor. Arrested labor is a complete pause in progress of labor. Diagnosis is clinical... read more is typically defined as no change in cervical dilation for 2 to 4 hours.

Pelvic examinations are done as needed in the latent phase and typically every 2 to 3 hours in the active phase to evaluate labor progress.

Standing and walking shorten the first stage of labor by > 1 hour and reduce the rate of cesarean delivery ( 5 Stages of labor references Labor consists of a series of rhythmic, involuntary or medically induced contractions of the uterus that result in effacement (thinning and shortening) and dilation of the uterine cervix. In... read more ).

If the membranes have not spontaneously ruptured, some clinicians use amniotomy (artificial rupture of membranes) routinely during the active phase. As a result, labor may progress more rapidly, and meconium-stained amniotic fluid may be detected earlier. Amniotomy during this stage may be necessary for specific indications, such as facilitating internal fetal monitoring to confirm fetal status. Amniotomy should be avoided in women with HIV infection or hepatitis B or C, so that the fetus is not exposed to these infections.

During the first stage of labor, maternal heart rate and blood pressure should be monitored frequently, and fetal heart rate should be checked continuously by electronic monitoring or intermittently by auscultation, usually with a portable Doppler ultrasound device (see fetal monitoring Fetal Monitoring During Labor and Delivery Fetal status must be monitored during labor. The main method is monitoring fetal heart rate patterns, usually in relation to uterine contractions. This is combined with ultrasonography in some... read more ). Women may begin to feel the urge to bear down as the presenting part descends into the pelvis. However, they should be discouraged from bearing down until the cervix is fully dilated so that they do not tear or cause swelling of the cervix.

Second stage

The second stage of labor is the time from full cervical dilation to delivery of the fetus. Mean duration is 36 to 57 minutes in nulliparous patients (95th percentile, 122 to 197 minutes) and 17 to 19 minutes in multiparous patients (95th percentile, 57 to 81 minutes) ( 2 Stages of labor references Labor consists of a series of rhythmic, involuntary or medically induced contractions of the uterus that result in effacement (thinning and shortening) and dilation of the uterine cervix. In... read more ). For spontaneous delivery, women must supplement uterine contractions by expulsively bearing down. In the second stage, women should be attended constantly, and fetal heart sounds should be checked continuously or after every contraction. Contractions may be monitored by palpation or electronically.

During the second stage of labor, perineal massage with lubricants and warm compresses may soften and stretch the perineum and thus reduce the rate of third- and fourth-degree perineal tears ( 6 Stages of labor references Labor consists of a series of rhythmic, involuntary or medically induced contractions of the uterus that result in effacement (thinning and shortening) and dilation of the uterine cervix. In... read more ). These techniques are widely used by midwives and birth attendants.

During the second stage, the mother's position does not affect duration or mode of delivery or maternal or neonatal outcome in deliveries without epidural anesthesia ( 7 Stages of labor references Labor consists of a series of rhythmic, involuntary or medically induced contractions of the uterus that result in effacement (thinning and shortening) and dilation of the uterine cervix. In... read more ). Also, the pushing technique (spontaneous versus directed and delayed versus immediate) does not affect the mode of delivery or maternal or neonatal outcome.

Second-stage arrest is typically defined as at least 3 hours of pushing in nulliparous women or at least 2 hours in multiparous women ( 8 Stages of labor references Labor consists of a series of rhythmic, involuntary or medically induced contractions of the uterus that result in effacement (thinning and shortening) and dilation of the uterine cervix. In... read more ). Use of epidural anesthesia delays pushing and may lengthen the second stage by an hour ( 9 Stages of labor references Labor consists of a series of rhythmic, involuntary or medically induced contractions of the uterus that result in effacement (thinning and shortening) and dilation of the uterine cervix. In... read more ). Duration of pushing may also be longer due to malposition (eg, occiput posterior).

Third stage

The third stage of labor begins after delivery of the infant and ends with delivery of the placenta. This stage usually lasts only a few minutes but may last up to 30 minutes.

Stages of labor references

1. American College of Obstetricians and Gynecologists (ACOG) : Obstetrics Data Definitions

2. Kilpatrick SJ, Garrison E, Fairbrother E: Normal labor and delivery. In: Landon MB, Galan HL, Jauniaux E, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies . 8th ed. Elsevier; 2021. eBook ISBN: 9780323613408

3. Tilden EL, Phillippi JC, Ahlberg M, et al : Describing latent phase duration and associated characteristics among 1281 low-risk women in spontaneous labor. Birth 46(4):592-601, 2019. doi:10.1111/birt.12428

4. Friedman EA, Cohen WR . The active phase of labor. Am J Obstet Gynecol . 2023;228(5S):S1037-S1049. doi:10.1016/j.ajog.2021.12.269

5. Lawrence A, Lewis L, Hofmeyr GJ, Styles C : Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev (8):CD003934, 2013. doi: 10.1002/14651858.CD003934.pub3

6. Aasheim V, et al : Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev 6:CD006672, 2017. doi: 10.1002/14651858.CD006672.pub3

7. Gupta JK, Sood A, Hofmeyr GJ, et al : Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev 5:CD002006, 2017. doi: 10.1002/14651858.CD002006.pub4

8. Obstetric care consensus no. 1 : safe prevention of the primary cesarean delivery. Obstet Gynecol . 123(3):693-711, 2014. doi:10.1097/01.AOG.0000444441.04111.1d

9. Lemos A, Amorim MM, Dornelas de Andrade A, et al : Pushing/bearing down methods for the second stage of labour. Cochrane Database Syst Rev 3:CD009124, 2017. doi: 10.1002/14651858.CD009124.pub3

Was This Page Helpful?

Test your knowledge

Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) — dedicated to using leading-edge science to save and improve lives around the world. Learn more about the MSD Manuals and our commitment to Global Medical Knowledge.

• Permissions
• Cookie Settings
• Terms of use
• Veterinary Manual

• IN THIS TOPIC

Wednesday Mar 27, 2024

Group News Sites

Dailymirror

Sunday Times

Tamil Mirror

Middleast Lankadeepa

Life Online

Home delivery

Advertise with us

eChannelling recognised with ‘Best Management Practices Company Awards 2024’

Wednesday, 27 March 2024 01:28 -     - {{hitsCtrl.values.hits}}

eChannelling, the country’s largest channelling network and subsidiary of SLT-MOBITEL, was honoured with the Merit award at the ‘Best Management Practices Company Awards 2024’, organised by the Institute of Chartered Professional Managers (CPM) of Sri Lanka recently.  Winning the Merit Award endorses eChannelling’s commitment and dedication to implementing best practices and innovative solutions in the healthcare sector. Being a total healthcare solutions provider in Sri Lanka, eChannelling recognition in this category emphasises the company’s significant impact on the healthcare industry through the implementation of cutting-edge solutions and best management practices. The CPM Awards is held annually to celebrate the growth and accomplishments of organisations, within both the public and private sectors of Sri Lanka.  The awards acknowledge the exemplary management practices adopted by companies throughout 2023, recognising their outstanding leadership, strategic policies, adept people management, collaborative partnerships, efficient resource utilisation, streamlined processes, and remarkable performances. The recognition is a testament to eChannelling’s successful implementation of the Running Number System in leading hospitals, providing patients with the ability to track live ongoing numbers in respective hospitals. The innovative system has been implemented in renowned healthcare institutions such as Nawaloka Hospital, Durdans Hospital, The Centre for Diabetes Endocrinology and Cardio-Metabolism (CDEM), Golden Key, Ceymed, Seth Sevena, Galle Co-operative Hospital, Channelled Consultation Centre (CCC), and leading pharmacies, enhancing the overall patient experience and operational efficiency. Additionally, eChannelling adoption of the eReceipt concept has further demonstrated the company’s commitment to digital transformation in healthcare. The eReceipt concept involves the digitalization of receipts or transaction records in electronic format, providing patients with electronic receipts for medical consultations, procedures, medications, and other healthcare services.  This initiative not only enhances the patient experience but also contributes to operational efficiency and environmental sustainability by transitioning from traditional paper-based receipts to digital transaction records in healthcare settings.

Inventory Management in Healthcare Essay

Inventory of various types is present in almost every organization, and I believe that it is essential to have the skills to handle the work and storage space in a given area successfully. It is especially true for hospitals, which use various tools and auxiliary equipment. I believe poor inventory management is a source of considerable problems, especially financial ones. It is relevant to the US healthcare system, which is growing dynamically, and healthcare expenditure is growing faster than GDP (Ahmadi, et. al., 2018). The easiest way to look at the effects of poor equipment management is with the example of a surgical department. Operating rooms are considered a significant source of revenue but also a major source of waste and operating costs (60 percent of all charges).

I am confident that the negative effects of poorly organized operating spaces are clear, and several pieces of evidence support this. The first source of cost overruns is the lack of a standardized approach to materials management. The amount and cost of consumables are determined based on the surgeon’s preoperative wishes. Based on observations, it was found by the researchers that the price of performing a laparoscopic cholecystectomy could be as high as $637 with a required cheque of $333 (Ahmadi, et. al., 2018). This fact demonstrates an obvious flaw in inventory management as overheads are unnecessarily increased.

In addition, the availability of materials is achieved not through quality accounting but by filling warehouses with consumables and equipment on reserve. Employees often accumulate excessive stocks of expensive consumables and tools, fearing future supply disruptions. Epidemics, natural disasters, and other unforeseen events can impact such logistical problems. Another problem that significantly affects hospital overhead is that the inventory of medical offices and attached storage areas is not tracked through information systems and databases (Farrokh, et. al., 2017). It makes it even more difficult to monitor medical facility inventory, not just that of surgery, creating a large information gap. The above evidence presents quite a serious problem for the financial situation of health care institutions, so it is necessary to provide possible options to improve the situation. Based on the research done by other scientists, I think that three approaches should be introduced in this case.

First, it is necessary to develop a model to account for possible risks to organizing the launches with anticipation of potential unnecessary expenditures. The models developed will better reflect the real problems. Hospitals also need the main storage facility and have some tools for the most popular surgeries or medical procedures directly in the wards (Ahmadi, et. al., 2018). People in emergencies tend to increase the demand for certain materials artificially, and spending increases accordingly. By having the right equipment on hand at once, doctors will spend fewer resources without worrying about the problem of possible shortages.

The last solution, which is expensive but pays for itself in the foreseeable future, is the introduction of modern technology. Data should be collected on cash instruments and supplies and their use, filling information gaps and systematizing reports on spending. Barcodes and RFID can be usefully used in this case (Farrokh, et. al., 2017). By and large, healthcare spending that is a consequence of poor inventory management significantly affects hospital revenues. In the case of private institutions, it also harms staff income and the quality of medical services. I believe implementing the abovementioned approaches can positively influence the solution to this urgent problem.

Ahmadi, E., Masel, D. T., Metcalf, A. Y., & Schuller, K. (2018). Inventory management of surgical supplies and sterile instruments in hospitals: a literature review. Health Systems, 1 (1), 1–18. Web.

Farrokh, M., Azar, A., Jandaghi, G., & Ahmadi, E. (2017). A novel robust fuzzy stochastic programming for closed loop supply chain network design under hybrid uncertainty . Fuzzy Sets and Systems , 341 , 69-91. Web.

• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2024, March 24). Inventory Management in Healthcare. https://ivypanda.com/essays/inventory-management-in-healthcare/

"Inventory Management in Healthcare." IvyPanda , 24 Mar. 2024, ivypanda.com/essays/inventory-management-in-healthcare/.

IvyPanda . (2024) 'Inventory Management in Healthcare'. 24 March.

IvyPanda . 2024. "Inventory Management in Healthcare." March 24, 2024. https://ivypanda.com/essays/inventory-management-in-healthcare/.

1. IvyPanda . "Inventory Management in Healthcare." March 24, 2024. https://ivypanda.com/essays/inventory-management-in-healthcare/.

Bibliography

IvyPanda . "Inventory Management in Healthcare." March 24, 2024. https://ivypanda.com/essays/inventory-management-in-healthcare/.

• Medical Equipment Production: Manufacturing Processes
• Prevention of Nosocomial Infection
• World Medical Relief After COVID-19
• Monitor Marketing Strategies and Tactics: BBQfun
• A Clinical Office Assistant's Attire
• Fast Foods Restaurant Business Plan: Full Services Geared Towards Full Customer Satisfaction
• Maintenance and Engineering Department for Wayward Hotel
• Chinese Military Modernization and Capabilities
• A Supply Chain for the Big Mac
• The Reasons for the Cost-Cutting Measures
• Policy Challenges Facing Healthcare Administrators
• Compliance in the Healthcare Industry
• Dualistic Governance Structure in Healthcare
• Healthcare Governance Structures
• Data Parameters in Healthcare Quality Improvement