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doi: 10.1097/JHM-D-17-00154

The following abstracts are from presentations given at the Forum on Advances in Healthcare Management Research that took place March 29, 2017, during the 2017 Congress on Healthcare Leadership of the American College of Healthcare Executives. An annual event, the Forum presents theoretical and empirical research with the potential for high impact on healthcare management.

TITLE. Patient Experience and Hospital Financial Performance: A Longitudinal Analysis of U.S. For-Profit, Nonprofit, and Government Hospitals

AUTHOR. Lihua Dishman, DBA, assistant professor, A.T. Still University, Kirksville, Missouri

GOAL. To fill gaps in extant empirical literature, this study investigated the relationship between patient experience and financial performance at U.S. Medicare-certified inpatient acute-care for-profit, nonprofit, and government hospitals over 4 years.

METHODS. This study analyzed data reported by 1,377 U.S. hospitals to examine the effects of patient experience on hospital financial performance, as well as the moderating effects of hospital type on financial performance and the directions of these effects from 2009 to 2012. The independent variable was patient experience, as indicated by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. The moderating variable was hospital type. The dependent variable was hospital financial performance, as indicated by operating profit margin (OPM), cash flow margin (CFM), and other indicators. Secondary data were analyzed using various descriptive and inferential statistical methods.

PRINCIPAL FINDINGS. Empirical findings indicate positive impact of patient experience on hospital financial performance and moderating effects of hospital type on the relationship—especially with government hospitals. Additionally, descriptive findings from 2009 to 2012 indicate a gradual improvement in patient experience, along with consistent outperformance of for-profit and government over nonprofit hospitals, smaller over larger hospitals, and rural over urban hospitals.

APPLICATIONS TO PRACTICE. Improving patient experience is important to the financial performance of all U.S. hospitals—government hospitals, in particular. By providing better patient experience, hospitals can generate higher OPM and CFM that help sustain operations. Engaging hospital boards, executive leadership, employees, and patients may be critical to implementing strategies and practices to improve patient experience. Finally, healthcare management educators at higher learning institutions need to integrate patient experience topics into their curricula.

CONTACT. Lihua Dishman:

TITLE. Successful Leadership Hiring and Appointment Practices: Closing the Gap Between Healthcare Organizations

AUTHORS. Tom Olivo, president, Success Profiles, Inc., and founding partner, Healthcare Performance Solutions, Bozeman, Montana; Jeff Jamison, vice president of research and assessments, Success Profiles, Inc., Bozeman, Montana; and James Jiloty, talent development and performance improvement adviser, Healthcare Performance Solutions, Ormond Beach, Florida

GOAL. The rate at which vital healthcare leadership roles have grown in complexity has outpaced development strategies, causing more incumbents to struggle while leaving insufficient time for successor development relative to anticipated vacancies. We proposed future healthcare leaders will be a product of superior hiring and appointment practices and coaching, not products of training and development programs, and sought to prove why.

METHODS. To identify the common denominators that leaders must have to be perceived by others as more effective, we surveyed 30,000 bottom-up perspectives, 7,500 top-down perspectives, and 4,207 leader behavioral profiles. Collectively, we identified 1,168 leaders having all three results: 145 were at the executive level, 356 were at the director level, and 667 were frontline managers. Using a standardized top-down assessment for executives to evaluate leadership talent within their organization, we established the demonstrated talent and ability levels of leaders using six categorizations (A, B+, B, B-, C, D). Next, all leaders being assessed were given an overall performance rating of “Exceeding,” “Succeeding,” “Struggling,” or “Failing.” Lastly, role complexity was categorized as “High,” “Medium,” or “Low.” This revealed 383 leaders performing at the “A” level who were “Succeeding” or ”Excelling” in a “High” complexity assignment; they provided the prototype profile of an effective healthcare leader to be contrasted against the original population.

PRINCIPAL FINDINGS. Three of six macro behavioral factors proved most important for people to be perceived as “A”-level leaders. The most effective leaders tend to naturally be (1) more directing and somewhat assertive, (2) more challenging and somewhat impatient, and (3) more adventurous or competitive. Also, 24% of the total leadership population matched 0 of 6 factors while 12% matched 3 of 6 factors. Nearly 30% of all “A”-level leaders matched 3 of 6 factors. Persons naturally hardwired with any 2 of 3 most important factors are 10 times more likely to be successful.

APPLICATIONS TO PRACTICE. Prioritize leadership talent and acquire superior selection and appointment practices to improve competitiveness and succeed faster. Align the right people in the right roles where their natural and developed strengths are best suited for their career path.

CONTACT. James Jiloty at

TITLE. Critical Evaluation of the Influence of Leader Personality and Culture on Staff Nurse Retention

AUTHOR. Paulchris Okpala, DHSc, RCP, CRT, assistant professor, Department of Health Science and Human Ecology, California State University at San Bernardino

GOAL. The study assesses how leader personality and culture influence nurse retention and examines strategies that can be employed in the development of a leadership approach that promotes staff nurse retention.

METHODS. A total of 70 studies selected from online databases that contain primary data collected through well-constructed, randomized, controlled designs were quantitatively analyzed. Raw data were open-coded and tested for normality using the explore function of IBM SPSS Statistics version 23, after which ANOVA tests were used to assess the influence of leader personality and culture on the level of nurse retention at 0.05 level of significance.

PRINCIPAL FINDINGS. Leadership culture was observed to have a significant influence on nurse retention levels, accounting for up to 18.3% of retention (p = 0.037). The influence of leadership personalities on nurse retention levels, however, was found to be insignificant. The cultures of leadership as coordination and leadership by example were observed to have a significantly positive influence on retention, with p = 0.022 and p = 0.041, respectively. However, the study observed that leadership by example is less frequently practiced by healthcare managers compared to leadership as coordination, which was observed to have a significantly high frequency (59%, p = 0.002).

APPLICATIONS TO PRACTICE. To limit the effects associated with poor nurse retention, such as the high cost of hiring replacement staff, the study suggests that healthcare administrators should work toward putting in place strategies that promote the culture of leadership as coordination by ensuring that nurses are involved in decision making and enhancing organization leadership. The study also suggests that leaders who implement the organization’s policies through the adoption of the culture of leadership by example can increase nurse retention.

CONTACT. Paulchris Okpala: The article was published in 2016 in the International Journal of Health Research and Innovation, 4(2), 23–32. Retrieved from

© 2017 Foundation of the American College of Healthcare Executives