Press Ganey

This article describes span of control (SOC) and organizational support for nurse managers (NMs) and impact on performance outcomes. NMs report excessive workloads that negatively affect personal well-being and performance outcomes. Understanding NM SOC is essential for informing strategies to enhance performance outcomes. This cross-sectional study explored the relationship between NM SOC, organizational support, and performance outcomes. Data from 255 NMs, overseeing 296 units across 47 hospitals, showed nurse turnover was significantly correlated with NM to full-time equivalent (FTE) and NM-to-bed ratios. Higher fall rates were associated with higher 24-hour census and NM-to-bed ratio. No significant associations were found between SOC and hospital-acquired pressure injuries. Wide variations in SOC and organizational support were noted among this sample. Findings from this study suggest that smaller units with smaller teams have an advantage in creating a better nurse workforce and clinical patient outcomes. Creating manageable NM workloads may yield better nurse and patient outcomes.

Some of the most daunting challenges facing health care today are complex (as opposed to complicated), and leadership approaches developed for merely complicated work (emphasizing measurement, efficiency, and standardized practices) have limited effectiveness. The decision-making processes honed by clinicians in medical school and residency, which emphasize teamwork, hypothesis-testing, and rapid adaptation, are better suited to complex problems than the processes typically taught in business and health administration programs, and organizations can benefit from harnessing their clinicians’ skills to address complex operational problems.

ObjectivesMany hospitals use fall prevention alarms, despite the limited evidence of effectiveness. The objectives of this study were (1) to identify, conceptualise and select strategies to deimplement fall prevention alarms and (2) to obtain feedback from key stakeholders on tailoring selected deimplementation strategies for the local hospital context.MethodsHospital staff working on fall prevention participated in group concept mapping (GCM) to brainstorm strategies that could be used for fall prevention alarm deimplementation, sort statements into conceptually similar categories and rate statements based on importance and current use. Hospital staff also participated in site-specific focus groups to discuss current fall prevention practices, strategies prioritised through GCM and theory-informed strategies recommended by the study team, and potential barriers/facilitators to deimplementing fall prevention alarms.Results90 hospital staff across 13 hospitals brainstormed, rated and sorted strategies for alarm deimplementation. Strategies that were rated as highly important but underutilised included creating/revising staff roles to support fall prevention (eg, hiring or designating mobility technicians) and revising policies and procedures to encourage tailored rather than universal fall precautions. 192 hospital staff across 22 hospitals participated in site-specific focus groups. Participants provided feedback on each strategy’s relevance for their site (eg, if site currently has a mobility technician) and local barriers or facilitators (eg, importance of having separate champions for day and night shift). Findings were used to develop a tailored implementation package for each site that included a core set of strategies (eg, external facilitation, education, audit-and-feedback, champions), a select set of site-specific strategies (eg, designating a mobility technician to support fall prevention) and guidance for how to operationalise and implement each strategy given local barriers and facilitators.ConclusionFindings from this study can be used to inform future programmes and policies aimed at deimplementing fall prevention alarms in hospitals.

This issue of NEJM Catalyst Innovations in Care Delivery includes articles, case studies, and research reports on public health programs, maternal and infant health care, community partnerships and grantmaking, cochlear implantation, hybrid and virtual care, cystic fibrosis care, and climate action at academic health systems.

This article is one in a series from Press Ganey-a health care performance improvement organization-that will discuss the many facets of the human experience in health care. Using the latest national data, the series will explore the intersections of safety, reliability, experience, and service, and their impact on engagement, work culture, and nurse-sensitive outcomes. Each installment will be designed as a "deep dive" into the most recent thinking and evidence-based approaches to improvement of the patient experience with a particular focus on practical and implementable tactics in each of the above subject areas.

A survey of the NEJM Catalyst Insights Council finds enthusiasm for technology innovation to improve care delivery, led by artificial intelligence, big data analytics, and virtual health.

This issue of NEJM Catalyst Innovations in Care Delivery includes articles, case studies, and research reports on health care buildings, at-home care, ambient AI, academic medical centers, anti-racism training, and workplace violence response.

Summary This issue of NEJM Catalyst Innovations in Care Delivery includes articles, case studies, and research reports on the impact of the U.S. Inflation Reduction Act, federal policy implications for prices and reimbursement, the role of appropriate benchmarks in payer-provider contracts, novel business models to address challenges in drug supply, critical care in rural settings, and health system finances.

To the Editor A recent Viewpoint1 made important points about how duress for physicians can be worsened if patient experience data are misused, but in doing it so misinterpreted or misrepresented available data.

Summary This issue of NEJM Catalyst Innovations in Care Delivery contains articles, case studies, and research reports on end-of-life planning, opioid use disorder care, physician sabbaticals, surgical team consistency, clinician collaboration with electronic-health-record vendors, and governance and decision-making within health care organizations.