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These are challenging times for health care executives. The health care field is experiencing unprecedented changes that threaten the survival of many health care organizations. To successfully navigate these challenges, health care executives need committed and productive physicians working in collaboration with organization leaders. Unfortunately, national studies suggest that at least 50% of US physicians are experiencing professional burnout, indicating that most executives face this challenge with a disillusioned physician workforce. Burnout is a syndrome characterized by exhaustion, cynicism, and reduced effectiveness. Physician burnout has been shown to influence quality of care, patient safety, physician turnover, and patient satisfaction. Although burnout is a system issue, most institutions operate under the erroneous framework that burnout and professional satisfaction are solely the responsibility of the individual physician. Engagement is the positive antithesis of burnout and is characterized by vigor, dedication, and absorption in work. There is a strong business case for organizations to invest in efforts to reduce physician burnout and promote engagement. Herein, we summarize 9 organizational strategies to promote physician engagement and describe how we have operationalized some of these approaches at Mayo Clinic. Our experience demonstrates that deliberate, sustained, and comprehensive efforts by the organization to reduce burnout and promote engagement can make a difference. Many effective interventions are relatively inexpensive, and small investments can have a large impact. Leadership and sustained attention from the highest level of the organization are the keys to making progress.

The authors review challenges arising in malpractice litigation related to software errors to inform health care organizations and physicians about liability risk from AI adoption and about strategies to mitigate risk.

Health care is responsible for approximately 8.5% of U.S. greenhouse-gas emissions. The authors note the need to measure and report emissions from health care organizations and propose ways to facilitate this.

Myriad anecdotes—of a Nobel laureate who sold his medal to pay medical bills, or the more than 250 000 GoFundMe medical campaigns last year —attest to the financial toll of illness on American families. National surveys confirm that medical bills frequently cause financial hardship, and the US Consumer Financial Protection Bureau reported that they were by far the most common cause of unpaid bills sent to collection agencies in 2014, accounting for more than half of all such debts. Less evidence is available on the medical causes of bankruptcy, a public and stigmatizing confession of impoverishment. In surveys conducted by researchers with the Consumer Bankruptcy Project in 2001 and 2007, a majority of recently bankrupt debtors implicated medical bills or illness-related work loss as causes of their bankruptcy, findings that President Obama used to argue for passage of the Affordable Care Act (ACA). The ACA both expanded and upgraded health insurance coverage, banning preexisting illness exclusions, imposing a cap on out-of-pocket spending, and mandating coverage for essential benefits. Although these reforms might attenuate the risk of medical bankruptcy, increasing medical costs and stagnant incomes could have the opposite effect.

Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using frame-work analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries. La mauvaise gouvernance a été identifiée comme un obstacle à l’intégration effective des soins de santé mentale dans les pays à revenu faible ou à revenu intermédiaire. La gouvernance comprend le cadre politique et législatif nécessaire pour promouvoir et protéger la santé mentale d’une population, ainsi que l’élaboration d’un système de santé et d’assurance de qualité afin d’assurer une mise en œuvre optimale des politiques. L’objectif de la présente étude est d’identifier les principaux défis, les besoins et les stratégies potentielles de gouvernance qui peuvent faciliter une intégration adéquate de la santé mentale dans les établissements de soins de santé primaires des pays à revenu faible ou à revenu intermédiaire. Des entrevues qualitatives avec des témoins privilégiés ont été réalisées avec 141 personnes dans six pays protagonistes du programme de recherche sur les systèmes émergents de santé mentale dans les pays à revenu faible ou intermédiaire (Emerald): l’ Éthiopie, l’Inde, le Népal, le Nigeria, l’Afrique du Sud et l’Ouganda. Les données ont été transcrites (et, le cas échéant, traduites en anglais) et analysées thématiquement à l’aide de l’analyse du cadre, d’abord au niveau des pays, puis synthétisées au niveau transfrontalier. Si tous les pays ont obtenu des résultats positifs en ce qui concerne la vision stratégique sous forme de mise œuvre de politiques nationales de santé mentale, les principales stratégies de gouvernance identifiées pour relever les défis sont les suivantes: renforcement des capacités des gestionnaires aux niveaux infranationaux afin d’élaborer et de mettre en œuvre des plans intégrés; consolidation des aspects clés des blocs essentiels du système de santé pour promouvoir la réactivité, l’efficacité et la productivité; développement de mécanismes efficaces de collaboration intersectorielle, ainsi que l’engagement de la communauté et des utilisateurs des services; et développement de modèles d’approches novatrices pour mieux se familiariser à la santé mentale et réduire la stigmatisation. L’insuffisance des financements constitue le plus grand défi à la bonne gouvernance. Outre la nécessité d’une bonne gouvernance globale du système de soins de santé, la présente étude identifie un certain nombre de stratégies spécifiques permettant d’améliorer la gouvernance des soins intégrés de santé mentale dans les pays à revenu faible ou à revenu intermédiaire. 治理不善是中低收入国家实现精神卫生保健有效整合的障 碍。治理包括提供必要的政策和法律框架来促进和保护人群 精神卫生, 以及通过卫生体系设计和质量保证来确保最佳政策 实施。本研究目的是辨明关键的治理挑战、需求和潜在策略, 有助于中低收入国家将精神卫生整合至初级保健中。关键知 情人定性访谈的对象共141名, 均参与了中低收入国家新兴精 神卫生体系 （Emerald） 研究项目。这些访谈对象来自六个 国家：埃塞俄比亚、印度、尼泊尔、尼日利亚、南非和乌干 达。转录访谈数据 （必要时翻译成英文）, 采用框架分析方法 分析主题, 首先进行国家层面分析, 然后整合至跨国家分析。 在战略方面, 所有国家均表现良好, 制定了全国精神卫生政策, 关键的治理策略解决以下问题：加强地方管理者制定和实施 整合规划的能力；强化基本卫生体系模块的关键部分, 以提高 反应性、效率和有效性；建立可操作的部门间合作机制, 提高 社区和服务使用者参与度；形成创新方法, 提高精神卫生知识 水平, 减少污名化。研究显示筹资不足是治理的最大挑战。除 卫生保健体系整体治理良好外, 本研究还明确了一些中低收入 国家改善治理、整合精神卫生保健的具体策略。 La mala gobernanza ha sido identificada como una barrera para la integración efectiva de la atención de salud mental en los países de ingresos bajos y medios. La gobernanza incluye proporcionar el marco político y legislativo necesario para promover y proteger la salud mental de una población, así como el diseño del sistema de salud y la garantía de la calidad para asegurar una implementación óptima de políticas. El objetivo de este estudio fue identificar los desafíos, necesidades y estrategias claves de la gobernanza, que podrían facilitar la integración adecuada de la salud mental en la atención primaria en los países de ingresos bajos y medios. Se realizaron entrevistas cualitativas con 141 informantes claves de seis países participantes en el programa de investigación de los sistemas emergentes de salud mental en países de bajos y medios ingresos (‘Emerald’): Etiopía, India, Nepal, Nigeria, Sudáfrica y Uganda. Los datos se transcribieron (y donde fue necesario, traducidos al inglés) y se analizaron temáticamente usando el análisis del marco, primero a nivel de país, luego se sintetizaron entre países. Si bien todos los países obtuvieron buenos resultados con respecto a la visión estratégica en la forma de desarrollo de las políticas nacionales de salud mental, las estrategias claves de gobernanza identificadas para abordar los desafíos incluyeron: el fortalecimiento de la capacidad de los gerentes a niveles subnacionales para desarrollar e implementar los planes integrados; el fortalecimiento de los aspectos claves de los elementos esenciales del sistema de salud para promover la capacidad de respuesta, la eficiencia y la eficacia; el desarrollo de mecanismos viables para la colaboración intersectorial, así como el compromiso de los usuarios en la comunidad y los servicios; y el desarrollo de enfoques innovadores para mejorar la alfabetización en salud mental y la reducción del estigma. Una financiación inadecuada surgió como el mayor desafío para la buena gobernanza. Además de la necesidad general de una buena gobernanza de un sistema de salud, este estudio identifica una serie de estrategias específicas para mejorar la gobernanza de la atención integral de salud mental en los países de ingresos bajos y medios.

[...]the Every Woman Every Child movement attracted more than US$60 billion dollars to women's and children's health between 2010 and 2015, with commitments from over 300 partners.6 The movement has spurred partnership mechanisms to support country-led implementation of the global strategy (2016-2030) - including the Global Financing Facility in support of Every Woman Every Child, the Innovation Marketplace, Unified Accountability Framework and the UN system's health agencies' H6 partnership.1 The global strategy (2016-2030) recognizes that human rights and other fundamental development principles - such as equity, community ownership and development effectiveness - are drivers of transformative change.1 In Peru, principles of equity underpinned a programme of poverty mapping to identify and prioritize reaching poor, rural and indigenous populations with social protection programmes and culturally appropriate, affordable care.7 In Kenya, the institutionalization of human rights principles is benefiting women's health following complaints alleging systematic violation of women's reproductive health rights in health facilities.

Predictive analytics, or the use of electronic algorithms to forecast future events in real time, makes it possible to harness the power of big data to improve the health of patients and lower the cost of health care. However, this opportunity raises policy, ethical, and legal challenges. In this article we analyze the major challenges to implementing predictive analytics in health care settings and make broad recommendations for overcoming challenges raised in the four phases of the life cycle of a predictive analytics model: acquiring data to build the model, building and validating it, testing it in real-world settings, and disseminating and using it more broadly. For instance, we recommend that model developers implement governance structures that include patients and other stakeholders starting in the earliest phases of development. In addition, developers should be allowed to use already collected patient data without explicit consent, provided that they comply with federal regulations regarding research on human subjects and the privacy of health information.

Since 1976, the Supreme Court has held that deliberate indifference to the serious medical needs of incarcerated people violates the constitutional prohibition against cruel and unusual punishment. What does this mean in practice?

I review the current status of transgender people’s access to health care in the United States and analyze federal policies regarding health care services for transgender people and the limitations thereof. I suggest a preliminary outline to enhance health care services and recommend the formulation of explicit federal policies regarding the provision of health care services to transgender people in accordance with recently issued medical care guidelines, allocation of research funding, education of health care workers, and implementation of existing nondiscrimination policies. Current policies denying medical coverage for sex reassignment surgery contradict standards of medical care and must be amended.

Background The majority of states have enacted price transparency laws to allow patients to shop for care and to prevent price discrimination of the uninsured. In California, hospitals must provide a price estimate to a requesting uninsured patient and cannot bill for an amount greater than the reimbursement the hospital would receive from a government payer. Objective To assess the response rate of California hospitals to a patient price request and to compare the price estimates received to Medicare reimbursement. Design We sent letters to California acute-care hospitals from a fictional uninsured patient requesting an estimate for one of three common elective procedures: a laparoscopic cholecystectomy, a hysterectomy, or routine screening colonoscopy. Participants Three hundred and fifty-three hospitals in California. Measurements Hospital response rates, difference between price estimates received, and Medicare reimbursement for equivalent procedures. Results Only 28% (98/353) of hospitals responded and their response varied in content. Of the 98 responses, 15 (15%) did not provide a quote and instead asked for more information such as the billing code, 55 (56%) provided a price estimate for hospital services only, 10 (10%) included both physician and hospital services, and 18 (18%) did not specify what was covered. The median discounted price estimate was higher than Medicare reimbursement rates for all procedures: hysterectomy ($17,403 vs. $5,569; p < 0.001), cholecystectomy ($14,014 vs. $7,196; p < 0.001) and colonoscopy ($2,017 vs. $216; p < 0.001). Conclusions Current California legislation fails to meet its objective of enabling uninsured patients to compare prices for hospital-based health care services.