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doi: 10.1097/JHM-D-22-00193
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TITLE. Innovational Inertia in Healthcare: Barriers Limiting Scope of Practice of Advanced Practice Providers in Institutional Settings

AUTHOR. Dan Fisher, PhD, University of North Carolina Wilmington, Wilmington, North Carolina.

GOAL. This research aimed to identify potential systematic and organizational factors that influence hospital innovation, with a focus on innovative practice models—specifically the utilization of advanced practice providers (APPs) in hospitals; the APPs' ability to provide patient care to their full scope of practice (SOP) or top of licensure; and their perceived effect on hospital operations, patient care quality, and financial outcomes.

METHODS. A conventional Delphi approach consisting of multiple phases was used to establish consensus among 60 administrative and clinical experts in the healthcare sector. In the initial phases, the participants brainstormed ideas by responding to open-ended questions via an online survey, grouping the responses into similar themes, and paring the list to central factors. The participants then ranked, from most to least important, the factors they believed were most impactful. Kendall's Coefficient of Concordance (W) measured how strongly the experts agreed with each other.

PRINCIPAL FINDINGS. The results highlighted financial constraints (e.g., reimbursement models, incentives, and funding) as key systematic barriers to APP utilization, along with cultural resistance and educational shortfalls as organizational barriers to change. Experts concurred that hospital medical staff bylaws are outdated, institutional policies and procedures (P&Ps) were more restrictive than state SOP laws and regulations, and wide variations existed between hospitals. In addition, a lack of understanding SOP laws and regulations and unfamiliarity with the capabilities and skills of APPs hindered hospital administrators' efforts to better utilize them in acute care settings. These barriers in hospitals limit APPs from practicing to their full SOP, which in turn affects hospital patient care quality, operational efficiencies, and financial outcomes. A developing theory posits that the ability of hospitals to innovate is dependent on the interrelation effects between healthcare stakeholders.

APPLICATIONS TO PRACTICE. Hospital administrators and clinical leaders should promote education on the SOP of APPs while addressing cultural resistance to change, evaluate outdated and perceived restrictive P&Ps, and review credentialing and privileging practices to ensure that hospitals achieve a strategic balance of quality patient care, operational efficiencies, and financial outcomes.

For more information, contact Dr. Fisher at [email protected].

TITLE. Predictors of Distress and Net Promoter Scores Among Healthcare Workers During Crises and Features of Recovery

AUTHOR. Katherine A. Meese, PhD, Department of Health Services Administration, The University of Alabama at Birmingham, Birmingham, Alabama.

GOAL. The goal of this research was to discern the factors associated with distress for different members of the healthcare team over time and to explore features of individual resilience and theoretical frameworks for disaster recovery.

METHODS. Two anonymous online surveys were conducted in a large health system during the summers of 2020 and 2021. The surveys asked healthcare workers about their work and nonwork experiences, stressors, and their individual resilience, well-being, willingness to recommend working in the organization (net promoter score), and relationships at work. A descriptive analysis of the 4,020 responses examined the incidence of distress and patterns of net promoter scores across healthcare roles and work locations. Stepwise regressions and dominance analyses were performed to determine the top factors explaining the variance of healthcare worker well-being and net promoter scores across roles.

PRINCIPAL FINDINGS. After controlling for nonwork and COVID-19 pandemic factors, we found that the factors associated with both well-being and net promoter score were largely related to the work environment. These factors included heavy workload, increased job demands, a sense of belonging, perceived organizational support, moral distress, and perceived inequity in the distribution of resources. Individual resilience was significantly associated with improved well-being in the 2020 survey but failed to reach statistical significance in 2021. The variance in net promoter scores was associated with individual resilience, discrimination, mistreatment by employees, and conflict with supervisors.

APPLICATIONS TO PRACTICE. The findings of this research highlight the importance of improving and maintaining employee well-being and net promoter scores. Although efforts to increase employee resilience may be important, the data suggest that those efforts will not substantially support well-being in the absence of organizational improvements to the work environment, workload, and culture.

For more information, contact Dr. Meese at [email protected].

TITLE. Measuring Empathy Training to Combat Provider Burnout

AUTHORS. Heather Noel Block, University of South Dakota, Vermilion, South Dakota, and Augsburg University, Minneapolis, Minnesota, and Carole South-Winter, EdD, ND, CNMT, RT, Beacom School of Business, University of South Dakota, Vermillion, South Dakota.

GOAL. We wanted to measure changes in student empathy toward an aging population that could affect the occurrence of caregiver burnout.

METHODS. Healthcare students were surveyed before and after completing an aging awareness activity to determine whether the activity increased empathy toward an aging population. The activity, developed at the University of South Dakota, applied tools to simulate hearing, visual, dexterity, and movement impairments for the students. Coded statistical analysis of activity results was performed using R Studio. Only surveys with completed pre-, post-, and identifiable names (n = 267) were used for analysis. Each name was assigned a number to facilitate correct pre- and postsurvey comparisons. Names were then erased to negate any potential bias. Surveys were shuffled to reduce bias based on profession, education, age, or researcher reaction to responses.

PRINCIPAL FINDINGS. Survey results indicated that this activity heightened awareness and thus helped introduce or reinforce students' awareness of geriatric struggles.

APPLICATIONS TO PRACTICE. The vast majority of participants in this activity were aged 21–30 years. This predominance of youth was expected, as our target audience was preprofessional healthcare students. Most students were traditional undergraduate or graduate students, which may have affected their perception of geriatric challenges. First, because these students were young, they generally did not struggle with the same ailments that geriatric individuals must face. Second, they were more likely to be early in their education and to have had limited interaction with older populations. The more interaction a person has with a population, the more likely they are to empathize with that population. This is important, as caregivers' decreased capacity to express empathy with the growing geriatric patient population can be directly correlated with increased burnout.

For more information, contact Dr. South-Winter at [email protected].

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