Objective: To qualitatively describe a use case at Yale New Haven Health System (YNHHS) illustrating the need for and effective deployment of innovative technologies to manage an enterprise-owned shared device (EOSD) management program. EOSD management provides clinicians with secure, rapid access to enterprise mobile devices and applications, maintains devices in functional, use ready condition for clinicians, and enables enterprise tracking and reduced loss of devices.
Methods: Executive leaders in clinical information technology and informatics management at YNHHS were interviewed through written and telephonic communication. Qualitative data was gathered through communications between clinical and information technology executives and the implementation support team of a leading identity and access management (IAM) solutions and EOSD management solution provider. Use case information was gathered, integrated and shared with health system executives and health IT/informatics leaders to verify the description of unmet needs, solution objectives and impact/value delivered after implementation of the EOSD management solution.
Results: Benefits realized from implementation of an enterprise-shared mobility management solution included establishment of a cohesive and comprehensive enterprise-owned, shared device management strategy. This included effective monitoring and dynamic management of the system’s mobile device fleet, and better IT resource management with reduced mobile device loss. The IT administrative burden was reduced. While not surveyed systematically, improved clinician experience and satisfaction were reported to IT leaders anecdotally. EOSD management solution deployment was rapid, as was the time to improved clinician mobile experience and clear demonstration of value.
Conclusions: A leading US health system was able to rapidly deploy a shared mobile device management solution that enabled effective monitoring and dynamic management of the enterprise mobile device fleet, with easier and faster clinician device access and workflows, and reduced IT administrative demand and costs. While the complexities associated with increased clinical mobility in healthcare will likely continue to grow, issuing future device and mobile management challenges that require effective hospital system response, technologies have emerged that enable more effective, efficient and satisfactory organizational mobility performance.

Objective: The study aims to determine the facilitators and barriers to conducting large-scale CRM-based training in a national health care system (VHA). While there are some studies on this topic, none review training in a federal system or provide data on changes within the system.
Methods: Design: Focus Groups collecting qualitative data. Review Methods: We held focus-groups for Clinical Team Training (CTT) facility Points of Contact (POC) and CTT Master Trainers. Responses were collected live and presented to all participants in each focus group session to ensure participant comfort and accuracy. All subgroup leaders agreed on iteratively and qualitatively reviewing participant responses from the four open-ended and three poll questions. Each subgroup leader was assigned a question to conduct a preliminary review of participant responses. After the initial review, a second leader also reviewed the participant responses. Over multiple iterations, themes emerged and were formalized by the team.
Results: The focus groups revealed that Leadership engagement in cultural change is imperative. The focus groups also identified that language and examples used in the curriculum may have inadvertently marginalized individuals by making some non-clinical team members feel excluded as part of the team. Our results support the need for highly visible leadership engagement, adequate time to undertake and complete projects, and overcoming skepticism. See table 1 for themes from each question.
Conclusions: Qualitative analysis revealed that Leadership engagement in cultural change is imperative. Focus groups identified that specific language and examples used in the curriculum may have inadvertently marginalized individuals who do not have clinical backgrounds. In addition, some participants felt that the use of the term “Projects” created a negative connotation for the required quality improvement project on each unit and instead preferred the terms “micro-project,” “safety strategy,” or “quick wins.”
Implemented changes: The program’s name has been rebranded to NCPS Team Training, taking the word clinical out to be more inclusive of all team members who engage in the care of a patient in the clinical setting. A complimentary video series was developed for facility Master Trainers to use as a supplement to their teaching or exclusively as the teaching tool as they facilitate the tabletop simulation exercises. Another change is that the Unit Based Safety Project has been renamed as Unit Based Safety Initiative (UBSI) to remove the stigma of a “project.”

Objective: The purpose of this study was to evaluate nurse knowledge about the risks of exposure to patient bodily waste, nurse perceptions about procedures and reporting, and current levels of satisfaction with how risks of exposure to patient waste are managed. Patient bodily waste management impacts healthcare workers and healthcare organizations. For nurses and other healthcare workers, the risk of exposure to pathogens can have adverse health effects, increase stress, and reduce satisfaction with their job, potentially leading to issues related to retention. Evidence suggests that proper training and using devices to reduce exposure risks and improve shorter bedside toileting, may reduce stress, and improve work satisfaction. Reducing risk of increased healthcare associated infections of patients and healthcare workers may have a positive impact on the organization with reduced cost of care.
Methods: A survey focused on nurses’ knowledge about their risk of exposure, nurse understanding of procedures and incident reporting, and morale and satisfaction with their job was conducted. Results. The findings suggest that there were conflicting responses related to the acknowledgement of risk, reporting incidents, and the use of personal protective equipment.
Results: The findings suggest that there were conflicting responses related to the acknowledgement of risk, reporting incidents, and the use of personal protective equipment.
Conclusions: Organizations benefit from addressing these concerns to improve morale and satisfaction, nurse retention, healthcare worker dignity, and the quality of patient care.

Background: Diagnosis Related Group (DRG) costing enables more efficient therapeutic choices. For this to occur, staff must be aware of the costs of the resources used in the process.
Objective: The paper aims to identify potential information gaps of physicians, nurses, and administrative staff regarding economic aspects. It explores the intersection of financial awareness and the perceived importance of economic factors to evaluate the information deficiencies across these professional groups.
Methods: The costs of DRG 546 different phases are estimated. Data on economic factors awareness (EFA) and economic factors importance (EFI) are gathered through a questionnaire. The survey involved 61 Italian employees of an Italian children’s hospital among physicians, nurses, and administrative staff.
Results: A trade-off emerges between the scarce knowledge of the DRG economic aspects and their importance for physicians and nurses. Awareness of economic aspects does not depend on years of seniority.
Conclusions: Economic factors awareness is low, although the staff considers this issue important. An information gap needs to be addressed. Clinical staff are partially aware of the costs of the activities in which they are directly involved, but they are unaware of other economic aspects of the therapeutic process. Nurses are the professional group with the lowest cost awareness. Different professional groups require different financial information. Physicians and nurses should be aware of relevant costs and the cost of activities with negligible impact on patient outcomes.
Potential implications: Administrative offices often do not know what economic data could be helpful in the physicians’ or nurses’ decisions. In addition, medical and nursing staff do not know precisely what information to ask for. Workgroups composed of administrative and healthcare staff should define what relevant financial data should be provided and how.

Objective: Improving the performance of healthcare organizations is a major concern within health systems. This study aims to explore the relationship between hospital staff’s knowledge and attitudes about continuous quality improvement (CQI) and their perceived job performance while determining if professional groups moderate this relationship.
Methods: A total of 250 questionnaires were distributed among three main job groups at a public hospital in Iran. Statistical analysis included variance-based structural equation modeling and Pearson correlation coefficients.
Results: Of the 250 distributed questionnaires, 196 were returned (response rate: 78%). The path coefficient between staff knowledge and performance was 0.390 higher in the physician group than in the non-physician group, and 0.207 higher in the administrative-financial group. The path coefficient for the non-physician group was 0.120 higher than that of the administrativefinancial group. For staff attitudes and performance, the path coefficient was 0.160 higher in the physician group than in the non-physician group, and 0.090 higher than in the administrative-financial group. The administrative-financial group had a 0.070 higher path coefficient than the non-physician group.
Conclusions: The study indicates positive relationships between hospital employees’ knowledge and attitudes about quality improvement and their job performance. These relationships were not significantly moderated by professional groups.

Retribution is often seen as a morally serious response to errors and undesirable behaviors, typically expressed through blame, punishment, and exclusion. These actions are meant to uphold professional standards, deter future wrongdoing, and restore moral balance. However, I argue that while retribution addresses certain ethical concerns, it is incomplete and can be counterproductive, particularly for patient safety and organizational learning. Systems that focus primarily on individual blame risk fostering underreporting, entrenching learning disabilities, and exacerbating harm. In this paper I propose that forgiveness — the foregoing of vindictive resentment toward a wrongdoer — offers a morally serious alternative. It facilitates accountability, restoration, and healing without trivializing the ethical weight of the harm done. By encouraging forward-looking accountability, forgiveness allows the wrongdoer to acknowledge their mistakes, make amends, and help improve practice. This not only respects the humanity of everyone involved, and addresses emotional and relational consequences, but also recognizes the systemic factors that contribute to errors. I outline concrete steps for integrating forgiveness into healthcare’s post-incident processes, balancing accountability with the need for healing and systemic change.

Objective: We sought to analyze public and private hospital patient cohorts in New York City (NYC) to assess differences in hospital access and outcomes from 2009-2022.
Methods: Inpatient neurosurgical discharges, as determined by APR-DRG codes, from 2009-2022 were aggregated for seven NYC hospitals, four private and three public, via the Statewide Planning and Research Cooperative System (SPARCS). Statistical analyses (Z-tests) were performed in Python.
Results: 325,351 patients were identified, 223,361 private and 101,990 public. Private hospitals had lower high-severity to low-severity and higher high-mortality to low-mortality risk ratios relative to public hospitals (p <.001). Public hospitals treated a higher proportion of stroke and trauma (p <.001). Average length of stay (LOS) was shorter at private hospitals compared to public (5.3 vs. 7.1 days, p <.001). Statistical significance remained when stratifying for illness severity and elective versus non-elective surgery status. Interestingly, cranial trauma cases were associated with a longer LOS in private hospitals relative to public (7.9 vs. 5.7 days, p <.001).
Conclusions: While many factors influence outcomes in private versus public hospitals, LOS can mark the efficiency of care. LOS was shorter at private hospitals in all instances except with cranial trauma. Care efficiency is important for hospital reimbursement, which can directly impact available resources for patient care. These findings emphasize the need to further analyze patient accessibility to neurosurgical care at private hospitals and the resources necessary to support neurosurgical practices within public hospitals.

Objective: The study examines whether patient health portal usage significantly increased during the COVID-19 pandemic between 2019 and 2022.
Methods: In order to measure patient usage of patient portals before and during the first year of the COVID-19 pandemic, this study used the Health Information National Trends Survey results for 2019, 2020, 2021, and 2022. It was compared, using a least square regression model, to see if there was a significant relationship between increased use of telehealth, the usage of health portals, and the number of times seen by a regular healthcare provider.
Results: The number of patients who saw their health care provider thrice a year and used their patient portal pre- and postpandemic increased. However, the overall increase in patients using their portals before and during the first two years of the pandemic remains below 50%.
Conclusions: Overall, the pandemic increased patients’ use of telemedicine but only significantly increased their usage of patient portals for those patients who saw their provider three or more times a year. These findings indicate that more interaction with providers might impact future portal usage.

Objective: This study examines the impact of telehealth nursing interventions on length of stay (LOS) and ratio of LOS to risk-adjusted length of stay comparing tele-acute and traditional units.
Methods: Retrospective data from 6,999 patient visits at tele-acute and traditional hospital units between Q2 2020 and Q4 2022 were collected. Bivariate analysis and the Mann-Whitney U Test were used to determine statistical significance. Multivariate regression was conducted to analyze the factors affecting both LOS and the ratio.
Results: Regardless of the model, the findings suggest that LOS was greater in the traditional unit. In the LOS model, the stay was 7 hours and 39 minutes longer per admission in the traditional unit. In the risk-adjusted ratio model, the LOS was 5 hours and 14 minutes longer per admission than in the tele-acute unit.
Conclusions: This study contributes to a body of literature that is lacking in the use of telehealth nursing in the acute care setting. Our research offers new perspectives on how telehealth can affect operational measures like LOS and discharge times. This contribution is important as it broadens the scope of telehealth’s benefits beyond traditional remote care, highlighting its potential in fast-paced, acute care settings.