Association of women leaders in the C-suite with hospital performance

BackgroundWomen comprise 50% of the healthcare workforce, but only about 25% of senior leadership positions in the USA. No studies to our knowledge have investigated the performance of hospitals led by women versus those led by men to evaluate the potential explanation that the inequity reflects appropriate selection due to skill or performance differences.MethodsWe conducted a descriptive analysis of the gender composition of hospital senior leadership (C-suite) teams and cross-sectional, regression-based analyses of the relationship between gender composition, hospital characteristics (eg, location, size, ownership), and financial, clinical, safety, patient experience and innovation performance metrics using 2018 data for US adult medical/surgical hospitals with >200 beds. C-suite positions examined included chief executive officer (CEO), chief financial officer (CFO) and chief operating officer (COO). Gender was obtained from hospital web pages and LinkedIn. Hospital characteristics and performance were obtained from American Hospital Directory, American Hospital Association Annual Hospital Survey, Healthcare Cost Report Information System and Hospital Consumer Assessment of Healthcare Providers and Systems surveys.ResultsOf the 526 hospitals studied, 22% had a woman CEO, 26% a woman CFO and 36% a woman COO. While 55% had at least one woman in the C-suite, only 15.6% had more than one. Of the 1362 individuals who held one of the three C-suite positions, 378 were women (27%). Hospital performance on 27 of 28 measures (p>0.05) was similar between women and men-led hospitals. Hospitals with a woman CEO performed significantly better than men-led hospitals on one financial metric, days in accounts receivable (p=0.04).ConclusionHospitals with women in the C-suite have comparable performance to those without, yet inequity in the gender distribution of leaders remains. Barriers to women’s advancement should be recognised and efforts made to rectify this inequity, rather than underusing an equally skilled pool of potential women leaders.

Discontinuing MRSA and VRE contact precautions: Defining hospital characteristics and infection prevention practices predicting safe de-escalation

Objective: To define conditions in which contact precautions can be safely discontinued for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Design: Interrupted time series. Setting: 15 acute-care hospitals. Participants: Inpatients. Intervention: Contact precautions for endemic MRSA and VRE were discontinued in 12 intervention hospitals and continued at 3 nonintervention hospitals. Rates of MRSA and VRE healthcare-associated infections (HAIs) were collected for 12 months before and after. Trends in HAI rates were analyzed using Poisson regression. To predict conditions when contact precautions may be safely discontinued, selected baseline hospital characteristics and infection prevention practices were correlated with HAI rate changes, stratified by hospital. Results: Aggregated HAI rates from intervention hospitals before and after discontinuation of contact precautions were 0.14 and 0.15 MRSA HAI per 1,000 patient days (P = .74), 0.05 and 0.05 VRE HAI per 1,000 patient days (P = .96), and 0.04 and 0.04 MRSA laboratory-identified (LabID) events per 100 admissions (P = .57). No statistically significant rate changes occurred between intervention and non-intervention hospitals. All successful hospitals had low baseline MRSA and VRE HAI rates and high hand hygiene adherence. We observed no correlations between rate changes after discontinuation and the assessed hospital characteristics and infection prevention factors, but the rate improved with higher proportion of semiprivate rooms (P = .04). Conclusions: Discontinuing contact precautions for MRSA/VRE did not result in increased HAI rates, suggesting that contact precautions can be safely removed from diverse hospitals, including community hospitals and those with lower proportions of private rooms. Good hand hygiene and low baseline HAI rates may be conditions permissive of safe removal of contact precautions.

Beyond the operating room: do hospital characteristics have an impact on surgical site infections after colorectal surgery? A systematic review

Background Hospital characteristics have been recognized as potential risk factors for surgical site infection for over 20 years. However, most research has focused on patient and procedural risk factors. Understanding how structural and process variables influence infection is vital to identify targets for effective interventions and to optimize healthcare services. The aim of this study was to systematically review the association between hospital characteristics and surgical site infection in colorectal surgery. Main body A systematic literature search was conducted using PubMed, Scopus and Web of Science databases until the 31st of May, 2021. The search strategy followed the Participants, Exposure/Intervention, Comparison, Outcomes and Study design. The primary outcome of interest was surgical site infection rate after colorectal surgery. Studies were grouped into nine risk factor typologies: hospital size, ownership affiliation, being an oncological hospital, safety-net burden, hospital volume, surgeon caseload, discharge destination and time since implementation of surveillance. The STROBE statement was used for evaluating the methodological quality. A total of 4703 records were identified, of which 172 were reviewed and 16 were included. Studies were published between 2008 and 2021, and referred to data collected between 1996 and 2016. Surgical site infection incidence ranged from 3.2 to 27.6%. Two out of five studies evaluating hospital size adjusted the analysis to patient and procedure-related risk factors, and showed that larger hospitals were either positively associated or had no association with SSI. Public hospitals did not present significantly different infection rates than private or non-profit ones. Medical school affiliation and higher safety-net burden were associated with higher surgical site infection (crude estimates), while oncological hospitals were associated with higher incidence independently of other variables. Hospital caseload showed mixed results, while surgeon caseload and surveillance time since implementation appear to be associated with fewer infections. Conclusions Although there are few studies addressing hospital-level factors on surgical site infection, surgeon experience and the implementation of a surveillance system appear to be associated with better outcomes. For hospitals and services to be efficiently optimized, more studies addressing these variables are needed that take into account the confounding effect of patient case mix.

Factors for Adoption of Tracking Technology for Clinical and Supply Chain Use in US Hospitals: A Longitudinal Study (Preprint)

BACKGROUND Despite an increasing adoption rate of the tracking technologies (e.g., radio-frequency identification (RFID) and barcode) for hospitals in the United States (U.S.), scarce empirical studies examined hospital size, location, and types of hospital affiliations that are associated with the uptake, leaving the understanding towards the trend unclear. OBJECTIVE This study aimed to identify the hospital characteristics, geographic location, and hospital affiliation type attributive to adopting tracking technologies with a longitudinal dataset, and to compare critical factors associated with tracking technologies adoption for clinical and supply chain uses. We assume that hospital characteristics and hospital location have more impact on tracking technologies for clinical use, and types of hospital affiliation would have more impact on tracking technologies for supply chain use. METHODS This study was conducted based on national census data obtained from the American Hospital Association (AHA) Annual Survey and an AHA Information Technology Supplement survey. In the analysis, 3623 hospitals across 50 states in the U.S. from 2012 to 2015 were included. The effects of the hospital characteristics, location, and types of hospital affiliations were captured and assessed using population logistic regression models with the adjustment of the innate development of tracking technology over time. RESULTS We find that the proportion of hospitals where tracking technologies were implemented for clinical use increased from 36.3% to 54.6%, whilst that for supply chain increased from 28.6% to 41.3%. We also find that time effect and hospital size positively impact the hospital implementation of tracking technologies for both clinical and supply chain use. The implementation rate of tracking technologies for clinical use increased for the hospitals affiliated to the health systems compared to those that are not but decreased in the hospitals located in the rural area in contrast to those located in metro and micro areas. Over time, the implementation rate of tracking technologies for supply chain use increased for the hospital affiliated to a more centralized health system, against decentralized/independent or moderately centralized hospitals but decreased for for-profit hospitals compared to not-for-profit hospitals. CONCLUSIONS We provide a census assessment of tracking technologies adoption, including RFID and barcode in U.S. hospitals for clinical and supply chain uses, and offer a comprehensive overview of the hospital characteristics, location, and types of hospital affiliations associated with the tracking technology adoption. This study informs researchers, healthcare providers, and policymakers that hospital characteristics, location, and types of hospital affiliations have different impacts on both the level and rate of implementation of certain tracking technologies for clinical and for supply chain use. This study also has implications for developing smart hospitals using tracking technology infrastructure.