This project was aimed at defining, quantifying and analyzing the value of uncompensated care provided by physicians as part of the Yale Medical Group for the 2008 fiscal year. Using an opportunity cost model, uncompensated care was calculated for each department as a total of bad debt and free care and then compared to existing estimates of such care. Another aim of this study was to conduct an interdepartmental comparison of the value of such care as a percentage of departmental earnings. To undertake this study, a literature search was performed to determine previous estimates and models of uncompensated care by physicians. Primary financial data (including charges, payments and write-offs for Bad Debt and Free Care) from the Yale Medical Group for fiscal year 2008 was then collected, fed into the opportunity cost model and compared to published estimates. The results of this study showed that, as a whole, physicians at the Yale Medical Group provided $6,510,373.65 of Uncompensated Care (or 2.75% of Total Payments) with a departmental range of 0.57%-15.29% of Total payments. These results show that Faculty physicians at Yale provided a larger amount of Uncompensated care than the published estimates obtained from random sampling of almost 4000 physicians. The results also reveal large differences in levels of uncompensated care between departments at Yale.

Thesis (M.H.A.)--University of Michigan, 1975.

Thesis (M.H.A.)--University of Michigan, 1975.

High faculty morale and job satisfaction are vital for optimum performance and important to the quality and vitality of the academic enterprise. However, research on faculty morale and job satisfaction has historically been limited to faculty at traditional comprehensive institutions and specific professional programs. Faculty who conduct biomedical research at academic health centers experience substantial differences in employment expectations and how they are funded than other faculty. The purpose of this study was to explore how personal and professional factors contribute toward positive morale and job satisfaction for faculty in biomedical research programs at one academic health center. This qualitative study used individual semi-structured interviews to explore work-life aspects associated with self-reported levels of morale and job satisfaction. Results from this study indicated that biomedical research faculty enjoy their work and highly value collaborating with their colleagues. The persistent need to fund at least half of their salaries through soft money, the loss of valued colleagues due to turnover, and a lack of identity with their institution decreases job satisfaction. It was also found that job satisfaction is expressed differently by gender and length of employment at one's current institution. Female faculty expressed feelings of limited support for those raising families while faculty employed longer expressed lower satisfaction than those recently hired. Better understanding of what influences job satisfaction and morale for this population will help academic health centers further support their research faculty as well as increase positive faculty identification with the institution.

Thesis (Ed.D.)--Baylor University, 2008. / Includes bibliographical references (p. 150-156).

As the delivery and management of healthcare continues to become increasingly complex, confronted by numerous economic, political and public health challenges, it is crucial for healthcare organizations to effectively develop and support their clinical and administrative leaders. A national staffing shortage in healthcare coupled with a global pandemic has increased burnout for healthcare providers. Retaining, engaging, and developing talent has taken on an urgency not seen before in healthcare organizations. The academic healthcare system has additional layers of intricacy with its tripartite clinical, educational, and research missions. Collaboration – and the behaviors and attitudes that enable it – is key for all leaders to negotiate across disciplinary boundaries within the academic health enterprise. Healthcare organizations must carefully consider how to develop and empower leaders capable of both leading teams and leading collaboratively, with peer leaders across the system. This study used a mixed-method case study approach to evaluate an interprofessional, team-based leadership development program in an academic health system to identify the program elements and learning experiences that influenced the participants’ ability to demonstrate the tenets of collaborative leadership and the factors that fostered or inhibited their abilities. Mid-level level leadership teams were nominated to the 10-month program, which utilized a blended learning approach of in-person days, live virtual sessions and online content and interaction. Teams were also required to complete a capstone project to allow the opportunity for integrating program learning through action while contributing to organizational change and innovation. Historical data from focus groups, evaluations and pre and post self-efficacy assessments from six cohorts were analyzed for this study. Ten semi-structured interviews comprised the new data collected. Focus group and evaluation data was derived from all program participants from six cohorts, consisting of 145 participants, in which 97/145 (67%) were females and 48/145 (33%) were males. Physicians comprised 28% of the group, nurses/other clinical specialists 31%, and 40% were administrators. The pre and post self-efficacy assessment data was limited to 65 participants. It is evident from the findings that leadership development as an interprofessional team, and as part of a larger cohort, is a powerful way to improve team cohesion, build relationships across the healthcare system, and enable boundary crossing – all vital capabilities to collaborative leadership. Learning as a team revised participants’ mental models by enabling an appreciation of diverse perspectives and self-awareness. The design of the program, particularly the program’s length and the action learning experience, were key factors in allowing the leadership ability of teams to mature. The program gave participants the dedicated time and space to build trust, solve problems, and reflect as individuals and as team. During the program and after, the most prevalent challenge for leaders was finding the time to establish and maintain relationships, which is critical to collaborative leadership. Other limiting factors were leadership turnover, lack of senior leadership support, and barriers to physician engagement. The organization in this study, like other academic health systems, employs a matrixed structure. While the matrixed structure necessitates collaboration, inherent stressors such as ambiguity around roles, decision-making abilities, power, and competing priorities emerged as a challenge to collaborating with peer leaders. The major recommendations for leadership development in an academic health system derived from this study are to: 1) design leadership development learning experiences within the context of an interprofessional team, 2) consider how participants may be enabled and inhibited in their leadership practice by organizational structures and cultures and, 3) ensure that the program length allows for the adequate time and space to learn, integrate and apply new ways of leading.

No description available.

This dissertation examined how complexity theory might offer insight into the behavior of a population of large-scale networked organizational groups. Academic medical centers (AMCs), a large-scale social and policy system that plays a key role in the education of physicians, the conduct of research, and the provision of specialized clinical care, were chosen as an example to demonstrate the enhanced understanding that can be obtained from the application of complexity theory. Graphical and nonlinear mathematical tools were chosen to place this research study in contrast to studies that metaphorically apply the concepts of complexity theory to social systems. Complexity science suggests that AMCs will demonstrate both nonlinearity and the emergence of patterned behaviors characteristic of self-organization in complex adaptive systems. Changes in the fiscal environment of AMCs, influenced by federal policy and the health care delivery market, were hypothesized to be among the factors that mediated changes in AMCs' activities and organizational relationships during a twenty-year period. The collection and examination of multiple indicators within the framework of a study model allowed development of a rich description of the AMC system and identification of patterned behaviors. Graphical analysis was used to identify underlying periodic and chaotic attractors in the AMC system. A logistic equation was used to confirm the presence of nonlinearity. The presence of nonlinearity and the emergence of patterned behavior within schools in different managed care market groups suggested that it is appropriate to treat the population of AMCs as a complex adaptive system. The results of this research study also showed that AMCs have responded to the rise of managed care in the health care delivery marketplace by leveraging their institutional strengths. Identification of nonlinear properties offers a new perspective for understanding the behavior of a population of networked organizations, the management of large-scale systems, strategic planning, and policy formulation. Until researchers and managers recognize the coexistence of nonlinear and linear processes in social systems, they will make decisions on the basis of incomplete information. / Ph. D.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 4 uppsatser. Även tryckt utgåva.

The characteristics of nurses acting as organizational champions, as well as the ways that clinical leaders systematically harness the energy of these champions in support of innovation, were explored in this qualitative descriptive study. The specific aims were guided by prior empirical evidence and identified research needs. Semi-structured interviews were conducted with 14 formal nursing leaders (e.g. managers, educators, administration) in an academic medical center. This study, including the interview guide, was informed by Kouzes and Posner’s (2007) Five Practices of Exemplary Leadership. Two models were developed to describe the data. Overall, participants echoed prior empirical findings identifying a need for organizational champions’ support of innovation and explained how some nurses seem to have “innate” characteristics that make them champions. Participants identified the champion as the “go to” person who can see the bigger picture and who seems to “own their own practice”. They described the importance of being truly present on the unit in order to harness the energy of these champions. Once champions are identified, leaders match the champions’ talents to the innovation planned, secure buy in from the champions, and actively work to support champions and get a culture of innovation “in the drinking water.” This work enhances the leader’s experience and makes him/her feel inspired and engaged. The two models developed based on the participants’ description of their experience working with staff nurses acting as organizational champions provide a framework for clinical leaders to identify and engage organizational champions in their clinical areas in support of innovation.