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Increasingly, addressing healthcare's grand challenges requires complex system-level adaptations involving continuously evolving teams and leaders. Although leadership development strategies have been shown to improve individual leader effectiveness, much less is known about how organization-level leadership development affects organization-level outcomes. To begin building an evidence base as well as encouraging evidence-based practices, the US-based National Center for Healthcare Leadership developed a program capitalizing on leaders' demonstrated interest in organizational competitiveness: the biennial Best Organizations for Leadership Development (BOLD) program. In this chapter, we describe the philosophy behind this unique survey program and summarize research to date on relationships between survey dimensions and organizational outcomes such as patient experience and financial performance. We conclude with a description of promising areas for future study.

Interest has grown among U.S. academic medical centers in developing international benchmarks for excellence in process and outcomes. Drivers behind this trend, as well as barriers to the development of useful benchmarks, are explored in this invited commentary.

The commentary is based on the authors’ conversations with members of the U.S. Cooperative for International Patient Programs as well as the University Healthsystem Consortium (UHC).

Six key themes are summarized in this commentary, including four key drivers and two barriers.

The practice-based perspectives this commentary summarizes provide a useful starting point for researchers and practitioners interested in establishing international comparison with the United States.

Personnel costs typically account for 60% or more of total operating expenses in health systems, and as such beome a necessary focus in most if not all substantive health reform adaptations. This study sought to assess whether strategic alignment of the human resource (HR) and learning functions was associated with greater adaptive capacity in U.S. health systems.

Data were gathered using a survey that was distributed electronically to chief human resource officers from two U.S.-based associations. The survey included questions about organizational structure, strategic human resource management, strategic learning, and organizational response to health reform.

Significant correlations were found between strategic alignment of HR and HR’s involvement in responses related to cost control (r=0.46, p<0.01); quality improvement (r=0.45, p<0.01), and patient access (r=0.39, p<0.01). However, no significant relationships were found between strategic alignment of organizational learning and HR involvement with these responses.

Results suggest that HR structure may affect an organization’s capacity for adaptive response. Top-management teams in health systems should consider positioning HR as part of the core leadership team, with a reporting relationship that allows HR to maximally participate in formulating and implementing organizational adaptation.

Despite hospitals’ efforts to reduce health care-associated infections (HAIs), success rates vary. We studied how leadership practices might impact these efforts.

We conducted eight case studies at hospitals pursuing central line-associated blood stream infection (CLABSI)-prevention initiatives. At each hospital, we interviewed senior leaders, clinical leaders, and line clinicians (n=194) using a semi-structured interview protocol. All interviews were transcribed and iteratively analyzed.

We found that the presence of local clinical champions was perceived across organizations and interviewees as a key factor contributing to HAI-prevention efforts, with champions playing important roles as coordinators, cheerleaders, and advocates for the initiatives. Top-level support was also critical, with elements such as visibility, commitment, and clear expectations valued across interviewees.

Results suggest that leadership plays an important role in the successful implementation of HAI-prevention interventions. Improving our understanding of nonclinical differences across health systems may contribute to efforts to eliminate HAIs.

Health care in the United States is on the verge of substantial change. Health reform legislation, and the goals it seeks to pursue, are likely to drive transformational change across many corners of the health care system. Preparing for and navigating these changes will, in turn, require health care leaders to learn new approaches to many of the core parts of their jobs (Clark, Savitz, & Pingree, 2010; Shortell & Casalino, 2010). The sheer magnitude of change and uncertainty also seems a likely driver of the uptick in CEO retirement, which rose almost to an annual rate of 18% in 2009, the highest rate increase since the American College of Health care Executives began tracking the statistic in 1981 (American College of Healthcare Executives, 2010). Taken together, these trends suggest the need for leadership development and succession planning has never been greater.