During the COVID-19 pandemic, healthcare workers are fighting a lethal virus with acute shortages of Personal Protective Equipment (PPE). These unprecedented circumstances have amplified the sources of emotional distress and worker burnout. However, many healthcare organizations (HCOs) in the United States, have opted for a “stoic approach” to healthcare worker support, i.e., no additional support beyond federal and state policy protections for the licensing and liability of healthcare workers. In this scenario, a key public health concern is sustaining an adequate healthcare workforce, both by way of quantity (adequate numbers) and quality (maximizing clinician resilience to provide safe care to large volumes of patients under challenging conditions). Therefore, it is imperative for HCO leaders to recognize that a limited view of worker psychological safety, without due consideration for the broader emotional distress created by the pandemic, could have the effect of restricting organizational resilience and adversely impacting patient safety and staff retention during and beyond the pandemic. This paper uses the organizational resilience framework to discuss the potential impact of a stoic approach to healthcare worker support on patient safety and staff retention in a hospital intensive care unit (ICU) during COVID-19. The discussion in turn, helps to develop recommendations for HCOs to overcome these challenges.

Background: The Consolidated Framework for Implementation Research (CFIR), introduced in 2009, has the potential to provide a comprehensive understanding of the determinants of implementation-effectiveness of health service innovations. Although the CFIR has been increasingly used in recent years to examine factors influencing telehealth implementation, no comprehensive reviews currently exist on the scope of knowledge gained exclusively from applications of the CFIR to telehealth implementation initiatives. This review sought to address this gap. Methods: PRISMA-ScR criteria were used to inform a scoping review of the literature. Five academic databases (PUBMED, PROQUEST, SCIDIRECT, CINAHL, and WoS) were searched for eligible sources of evidence from 01.01.2010 through 12.31.2021. The initial search yielded a total of 18,388 records, of which, 64 peer-reviewed articles met the inclusion criteria for the review. Included articles were reviewed in full to extract data, and data collected were synthesized to address the review questions. Results: Most included articles were published during or after 2020 (64%), and a majority (77%) were qualitative or mixed-method studies seeking to understand barriers or facilitators to telehealth implementation using the CFIR. There were few comparative- or implementation-effectiveness studies containing outcome measures (5%). The database search however, revealed a growing number of protocols for implementation-effectiveness studies published since 2020. Most articles (91%) reported the CFIR Inner Setting domain (e.g., leadership engagement) to have a predominant influence over telehealth implementation success. By comparison, few articles (14%) reported the CFIR Outer Setting domain (e.g., telehealth policies) to have notable influence. While more (63%) telehealth initiatives were focused on specialty (vs primary) care, a vast majority (78%) were focused on clinical practice over medical education, healthcare administration, or population health. Conclusions: Organized provider groups have historically paid considerable attention to advocating for telehealth policy (Outer Setting) reform. However, results suggest that for effective telehealth implementation, provider groups need to refocus their efforts on educating individual providers on the complex inter-relationships between Inner Setting constructs and telehealth implementation-effectiveness. On a separate note, the growth in implementation-effectiveness study protocols since 2020, suggests that additional outcome measures may soon be available, to provide a more nuanced understanding of the determinants of effective telehealth implementation based on the CFIR domains and constructs.

This article offers a scholarly review and perspective on the potential of "implementation research" to generate incremental, context-sensitive, evidence-based management strategies for the successful implementation of evidence-based practices (EBPs) (such as the "central line bundle"). Many hospitals have difficulty consistently implementing EBPs at the unit level. This problem has been broadly characterized as "change implementation failure" in health care organizations. The popular hospital response to this challenge has been to raise clinician awareness of EBPs through mandated educational programs. However, this approach has not always succeeded in changing practice. The health services research literature has emphasized the role of several organizational variables (eg, leadership, safety culture, organizational learning, teamwork and communication, and physician/staff engagement) in successful change implementation. Correspondingly, this literature has developed broad frameworks and programs for change in health care organizations. While these broad change frameworks have been successfully applied by some facilities to change practice, they are not incrementally actionable. As such, several facilities have not leveraged broad change frameworks because of resource and/or contextual limitations; a majority of hospitals continue to resort to mandated clinician education (awareness-building) for change implementation. The recent impetus toward "implementation research" in health care has the potential to generate incremental, context-sensitive, evidence-based management strategies for practice change. Authors discuss specific insights from a recently completed study on central line bundle implementation in 2 intensive care units in an academic health center. The study demonstrates that awareness of EBPs alone does not translate to implementation. More importantly, the study also identifies incremental, context-sensitive, evidence-based management strategies for successful implementation of EBPs at the unit level.

Background: With the growing momentum toward hospital quality reporting by public payers, hospitals face increasing pressures to improve their medical record documentation and administrative data coding performance. The literature on "professional complex systems" has put forth various strategies for improving the performance of professional organizations. In doing so, it has emphasized the importance of creating effective structures for knowledge sharing and organizational learning. This study integrates knowledge networks and professional organizations literatures to develop hypotheses related to knowledge sharing network effectiveness in professional organizations. Purpose: Correspondingly, this study explores the relationship between the organizational knowledge sharing structure related to quality and hospital coding performance related to quality. Simultaneously, this study seeks to identify other organizational characteristics associated with coding for quality measurement. The purpose is to identify strategies not only for improving hospital coding performance but also for the organization to adapt to the changing environment. Methods: An exploratory and comparative research design is used. The sample is composed of four hospitals, two showing "good-coding" performance for quality measurement and two showing "poor-coding" performance. Interviews and surveys are conducted with administrators and staff in the quality, medical staff, and coding subgroups in each facility. Survey data are subjected to social network analysis to examine knowledge sharing structures. Findings and Implications: This study finds that good-coding performance is systematically associated with a knowledge sharing network structure rich in brokerage and hierarchy (with leaders connecting different professional subgroups to each other and to the external environment) rather than in density (where everyone is directly connected to everyone else). From a health care management perspective, this study suggests that to improve hospital coding performance, senior administrators must undertake proactive and unceasing efforts to coordinate knowledge exchange across physician and coding subgroups and connect these subgroups with the changing external environment.

Hospital and health system initiatives addressing Social Determinants of Health (SDOH) are essential for achieving whole-person care and advancing health equity. Building on prior research characterizing these efforts (Part 1), this scoping review (Part 2) evaluates the effectiveness of these initiatives, with a focus on SDOH data integration, EHR utilization, and the broader scope of hospital efforts in addressing individual- and system-level determinants of health. Using an integrated conceptual framework combining the DeVoe & Cottrell framework for operational assessment and the National Academy of Medicine (NAM) 5A framework for systemic evaluation, this study provides a multidimensional assessment of hospital-based SDOH interventions. Guided by PRISMA-ScR criteria, this review analyzed 41 U.S.-based studies published between 2018 and 2023, identified through three academic databases. Eligible studies examined hospital initiatives addressing SDOH with measurable outcomes. Analyses assessed SDOH data collection, integration into care practices, EHR use, and overall initiative effectiveness. Most studies (66%) were randomized controlled trials in urban settings (68%), targeting patients with chronic or mental health conditions (39%) or high-risk healthcare users (20%). Nearly half of initiatives (49%) addressed multiple SDOH domains, focusing on Social & Community Context, Economic Stability, and Neighborhood & Built Environment. Only 24% of initiatives utilized EHRs for SDOH data collection. EHR-based initiatives demonstrated significantly higher adherence to evidence-based practices, including use of community resource guides for referrals (90% vs. 45%, p = 0.013). Across all outcome measures, 79% demonstrated improvement, with no instances of worsening outcomes. However, 85% of initiatives lacked community-level SDOH data integration, and few employed upstream, universal strategies. Process, clinical, and social outcomes were unevenly prioritized, with only 10% of studies addressing all three outcome types. While these initiatives reflect progress in integrating SDOH into care workflows and improving whole-person care at the individual level, progress toward health equity remains insufficient. Persistent gaps in EHR use, community-level data integration, and upstream strategies hinder systemic impact, potentially perpetuating disparities. Strengthening SDOH-EHR integration, fostering community partnerships, and supporting policy advocacy are critical to bridging individual and community needs. Future research should emphasize long-term, sustainable, and community-level impacts of hospital-led SDOH interventions.

Prior to the COVID-19 pandemic, studies in the US have identified wide variations in telehealth use across medical specialties. This is an intriguing problem, because the US has historically lacked a standardized set of telehealth coverage and reimbursement policies, which has posed a barrier to telehealth use across all specialties. Although all medical specialties in the US have been affected by these macro (policy-level) barriers, some specialties have been able to integrate telehealth use into mainstream practice, while others are just gaining momentum with telehealth during COVID-19. Although the temporary removal of policy (coverage) restrictions during the pandemic has accelerated telehealth use, uncertainties remain regarding future telehealth sustainability. Since macro (policy-level) factors by themselves do not serve to explain the variation in telehealth use across specialties, it would be important to examine meso (organizational-level) and micro (individual-level) factors historically influencing telehealth use across specialties, to understand underlying reasons for variation and identify implications for widespread sustainability. This paper draws upon the existing literature to develop a conceptual framework on macro-meso-micro factors influencing telehealth use within a medical specialty. The framework is then used to guide a narrative review of the telehealth literature across six medical specialties, including three specialties with lower telehealth use (allergy-immunology, family medicine, gastroenterology) and three with higher telehealth use (psychiatry, cardiology, radiology) in the US, in order to synthesize themes and gain insights into barriers and facilitators to telehealth use. In doing so, this review addresses a gap in the literature and provides a foundation for future research. Importantly, it helps to identify implications for ensuring widespread sustainability of telehealth use in the post-pandemic future.