Abstract
In the highly competitive, perennially-changing healthcare industry, management prowess is vitally needed by those in positions of authority, but in isolation it is insufficient for delivering optimal results. Instead, management proficiencies must be complemented by leadership skills which amplify managerial efforts and outcomes. One avenue for building leadership acumen in healthcare organizations involves the establishment of leadership development programs. These programs generally assemble a range of opportunities permitting managers to learn about leadership and acquire associated proficiencies. Leadership development programs afford many benefits for healthcare providers, but in order to capitalize fully, thoughtful assembly is required. To shed light on this important topic, this article provides an overview of leadership development programs, noting a formal definition, stipulating associated benefits, and discussing options for assembly, all through the lens of Willis Knighton Health’s leadership development initiatives and experiences.
Keywords
Background
Leadership is perhaps the most critical ingredient for success in healthcare organizations. It pervades the entirety of establishments, supporting virtually every element of operation, heavily influencing what is and is not possible. When it is exceptional, extraordinary things can be accomplished in health and medicine; when it is deficient, healthcare organizations face missed opportunities and impending peril.1–4 Leadership is most closely associated with management in healthcare organizations, as managerial personnel are charged with overseeing operations and effectively are in positions to lead. But leadership is a very different concept than management.1,5–9 Management is defined as “a range of activities (i.e., planning, organizing, staffing, directing, coordinating, reporting, and budgeting) which are carried out by formally appointed individuals (e.g., chief executive officers, vice presidents, directors, managers, supervisors) for purposes of aiding organizations in realizing their missions.” 1 (p6) Leadership is defined as “a skill, composed of a series of appealing qualities, which permits a person to establish productive relationships with others, affording opportunities to influence them in a manner to achieve goals and objectives.” 1 (p32) Healthcare managers obviously must possess managerial talents, but in order for optimal results to be achieved, they must also possess leadership talents. Indeed, leadership acumen amplifies managerial acumen.1,5,7,10–13 This has motivated healthcare organizations far and wide to adopt practices designed to enhance the leadership prowess of their managers.
One method for building leadership acumen in healthcare organizations involves the establishment of leadership development programs. These programs generally assemble a range of opportunities permitting managers to learn about leadership and acquire associated proficiencies. Methods for developing leadership skills include tuition reimbursement plans permitting managers to enroll in leadership degree programs at colleges and universities, seminars conducted on or offsite featuring noted leadership experts, mentorships between senior and junior managers permitting leadership skills to be shaped and honed, and similar endeavors.1,14–16 The commitment of organizations to build leadership in the ranks is decidedly high, with more than $60 billion being spent on leadership development programs globally. 17 As with any investment, care must be taken to ensure that resources directed toward leadership development programs deliver value, necessitating well designed and thoughtfully planned offerings. This article sheds light on leadership development programs, providing a definition, stipulating associated benefits, and discussing options for assembly, all through the lens of Willis Knighton Health’s leadership development initiatives and experiences, permitting healthcare establishments desirous of initiating or revising such programs a helpful account which can inform decision making.
Definition and overview
Formally defined, a leadership development program is a vital educational initiative offered by an organization for purposes of building the leadership skills and abilities of personnel, permitting them to be more effective in the workplace. These programs work intensively to develop and enhance the leadership qualities of personnel (e.g., vision, competence, charisma, courage, empathy, honesty, and ambition), with the particular attributes emphasized in leadership development programs being dependent on the needs of given organizations. Leadership development programs, in keeping with the formal definition of leadership, specifically concentrate on transformational processes, which center on developing the potential of leaders to compel followership, courtesy of their appealing qualities.1,5,18 Such processes are quite distinctive from the transactional processes associated with the discipline of management, as referenced in Luther Gulick’s classic POSDCORB model (i.e., planning, organizing, staffing, directing, coordinating, reporting, budgeting), influenced notably by the work of Henri Fayol.19–21 As leadership prowess amplifies managerial performance, leadership development programs are considered to be strategic assets of healthcare institutions, warranting associated investment and hastening their proliferation in the halls of medicine. 1
Leadership development programs are highly diverse between and among healthcare organizations. Indeed, even across broad business and industry, leadership development programs are highly varied. 16 Some define their leadership development programs very narrowly, essentially as compartmentalized training programs, operating in similar fashion to that of college courses, which emphasize leadership principles. Others define their leadership development programs more broadly, essentially as conglomerations which feature multiple types of leadership training opportunities (i.e., a “program of programs” model). Some focus exclusively on content that is firmly centered on leadership, as formally defined, and others thread managerial topics into leadership content, offering somewhat of a hybrid leadership and management development program. 15 Delivery methods used by leadership development programs are numerous and highly varied, including workshops, seminars, mentorships, coaching, guest speaker series, book clubs, certificate programs, college and university degree programs, and more. While leadership development programs typically are enduring, being offered continuously over time, individual learning opportunities vary in length, with duration being dependent on institutional preferences.1,14–16 Program diversity between and among healthcare institutions also extends to structural matters. Some healthcare organizations centralize oversight of leadership development programs within single departments (e.g., placement of the program within an organization’s human resources department). Others opt for a decentralized approach, with two or more departments having oversight responsibilities (e.g., shared responsibilities between an organization’s human resources department and a dedicated leadership development department). 1
Options abound for defining, populating, structuring, and operating leadership development programs. Such flexibility can be somewhat daunting, but it should be viewed as an opportunity for healthcare establishments to develop programs which are custom tailored to address their specific leadership needs. This is especially vital as leadership development programs must be aligned with the needs of given establishments, permitting them to offer training for managers which builds skills that specifically benefit institutional operations. 16 Creativity can be especially helpful in program design, given teeming options. It is up to given organizations to make selections prudent for institutional and individual advancement.1,22,23
For those healthcare organizations desirous of establishing and operating leadership development programs, the associated benefits are powerful and highly desirable. The programs have the potential to (1) enhance leadership acumen by advancing the leadership skills of managers, (2) heighten institutional performance by populating the ranks with more capable managers who possess enhanced abilities to lead, (3) strengthen recruitment and retention by providing educational opportunities to both new and seasoned managers which attract interest and attention, and (4) improve succession planning by helping to build a pipeline of managers who are proficient leaders able to step into vacancies occurring through terminations, resignations, and retirements.14–16,24 The noted benefits of leadership development programs are entirely possible for healthcare organizations to realize. The caveat is that the associated programs must be well designed and well operated, placing a premium on excellent decision making, investment, oversight, and management.
To further bolster an understanding of leadership development programs, it is helpful to examine real-world operations for associated enlightenment. One particular healthcare institution with extensive experience operating a well-designed and managed leadership development program is Willis Knighton Health.
Leadership development at Willis Knighton Health
Established in 1924, Willis Knighton Health is a nongovernmental, not-for-profit healthcare provider offering comprehensive health and wellness services through multiple hospitals, numerous general and specialty medical clinics, an all-inclusive retirement community, and more. Licensed hospital beds number nearly 1000, complemented by nearly 300 long term care beds. Based in Shreveport, Louisiana, the institution holds market leadership in its served region, centered in the heart of an area known as the Ark-La-Tex, where the states of Arkansas, Louisiana, and Texas converge. The lofty position held by Willis Knighton Health resulted largely from decades of successful leadership, permitting patients to be served well, operations to be run proficiently, and institutional performance to thrive. Given the historic role which leadership has played in the institution’s prosperity, Willis Knighton Health understandably deeply values leadership excellence and has taken intensive steps to educate its managers on associated principles and practices, bolstering their leadership acumen and intelligence.1,25 This most notably has been facilitated by the health system’s leadership development program.
Program structure and design
Willis Knighton Health’s leadership development program is one of many educational offerings provided by the institution. Oversight of systemwide education rests with three organizational units—the Department of Human Resources, the Office of Training and Development, and the Office of Recruiting, Engagement, and Development—which work collaboratively to deliver Willis Knighton Health’s educational needs. Of these units, the Office of Recruiting, Engagement, and Development holds primary authority for the oversight and management of Willis Knighton Health’s leadership development program, with the other units providing supplemental foundational assistance.
Willis Knighton Health’s leadership development program is defined very broadly, structured to incorporate all opportunities offered by Willis Knighton Health, whether delivered internally or externally, that entail leadership training and development. This arrangement essentially makes it a “program of programs” focused on leadership, as the health system’s leadership development program effectively contains multiple sub-programs (e.g., classroom-based training opportunities, a tuition reimbursement program, mentorships, etc.). Such an arrangement is highly scalable, permitting components to be added or subtracted as needed or desired. This is beneficial as leadership is not a static discipline. New tools and techniques regularly appear, courtesy of a burgeoning pool of researchers from both academia and practice who are committed to advancing associated knowledge and understanding.7,10,26 When superior tools or techniques emerge, they can be incorporated with ease within a “program of programs” model, with this arrangement aiding Willis Knighton Health in the all-important task of ensuring that its leadership development program remains meaningful and relevant.
Delivery methods
Willis Knighton Health’s leadership development program incorporates both internally-delivered and externally-delivered learning opportunities. Key internally-delivered components of the program include managerial seminars which focus on leadership concepts, mentoring opportunities between experienced managerial leaders and less experienced personnel, coaching opportunities which pair managers with leadership experts who coach them toward achieving designated goals, periodic guest speaker presentations on topics of leadership, book clubs where personnel read selected leadership texts and share insights with one another at periodic meetings, and an intensive, classroom-based leadership course which follows a structured curriculum delivered over terms of several months, aimed at bolstering essential leadership skills and abilities in the managerial ranks.
Key externally-delivered components of the program—those opportunities provided by outside educational bodies—include leadership-related certificates offered by certification institutes and leadership-related degrees (e.g., MBA, MHA) offered by colleges and universities. Also included are seminars, workshops, and related learning events held by trade associations, accrediting bodies, and other entities which are aimed at advancing leadership prowess. Willis Knighton Health supports such pursuits through its tuition reimbursement and certification reimbursement programs which cover all or part of associated expenses for employees who enroll in courses of study deemed to be of benefit to the institution. Willis Knighton Health’s most unique externally-delivered leadership development initiative, however, concerned its collaboration with LSU Shreveport, with the health system providing funding for the establishment of the university’s AACSB-accredited Master of Health Administration (MHA) program. Since its inception in 2003, dozens of Willis Knighton Health employees have earned their MHA degrees from LSU Shreveport. This highly unique leadership development initiative has advanced the leadership acumen not only of Willis Knighton Health’s employees, but also of those serving in scores of other healthcare institutions who have benefited from the establishment’s investment in LSU Shreveport’s MHA program.
Willis Knighton Health’s combination of delivery methods facilitates organizational learning, aiding in its characterization as a learning organization; that is, an institution which has developed proficiencies in acquiring, circulating, deploying, and retaining knowledge, affording enhanced organizational performance.1,27–30 The internal learning experiences serve as exceptional knowledge sharing mechanisms, ensuring that leadership intelligence is distributed throughout the establishment, something highly desired as unshared intelligence diminishes the impact potential of knowledge. As the discipline of leadership continues to evolve, the external learning experiences provide a mechanism for bringing new knowledge from outside sources into the establishment, ensuring that leadership intelligence within the organization remains current.31–33
Subject matter
Content delivered through the various training opportunities of Willis Knighton Health’s leadership development program centers on teaching managers those leadership skills which the organization views to be essential to its operation. This is arguably the most critical determination in any leadership development program, given the multifaceted nature of leadership. As different contexts call for different leadership qualities, it is essential for healthcare organizations to reflect on their operations and identify those specific leadership qualities which are viewed to be most critical for success. This knowledge then drives the subject matter to be featured in leadership development programs, ensuring alignment between the establishment’s needs and the leadership skill sets being developed by managers.1,16 Leadership qualities of importance to Willis Knighton Health include vision, competence, dedication, work ethic, compassion, honesty, decision-making ability, mentoring expertise, role modeling, and personal development. Essential leadership qualities are not merely selected at random, but instead are derived from research conducted by Willis Knighton Health to identify a fit between the institution’s leadership needs and the subject matter featured in its leadership development program.
Importantly, arrays of essential leadership qualities should not be viewed as stationary collections. As healthcare institutions and their environments evolve, leadership priorities can change, necessitating efforts to ensure that leadership qualities and associated training opportunities remain current and applicable, facilitating the accomplishment of designated missions. Regular reviews are conducted by Willis Knighton Health to make certain that program content is focused on prevailing leadership needs. Such ongoing surveillance of leadership needs also has permitted Willis Knighton Health to proactively realize the emergence of timely leadership concerns, allowing them to be threaded into leadership development initiatives immediately. For example, following the COVID-19 pandemic, motivation broadly was discovered to be subdued as employees adjusted to the rigors of normal operation, with this calling for increased attention being directed toward motivation in Willis Knighton Health’s leadership development program. Such practices help the establishment to ensure that its leadership development program continues to deliver contemporary value.
Enrollment eligibility
With few exceptions, the various training opportunities of Willis Knighton Health’s leadership development program generally can be accessed by all managers by request, assuming they receive the support of their given supervisors. Most of the opportunities are voluntary, pursued at the discretion of given employees, but some are mandatory. One opportunity—Willis Knighton Health’s intensive, classroom-based leadership course—is accessible by invitation only, with invitations being prompted by supervisor recommendations, although employee participation remains voluntary. Careful consideration must be directed toward the “voluntary versus mandatory” participation decision. Research has shown that those who volunteer to participate in leadership development programs achieve more than those who are required to participate. 16 Therefore, Willis Knighton Health mandates only those initiatives which focus on core leadership skills and abilities necessary for all managers to possess. Initiatives which further enhance leadership proficiencies beyond baseline knowledge are reserved for those who wish to participate on their own accord.
Those currently serving in managerial capacities are the primary audience served by Willis Knighton Health’s leadership development program, but support also is extended to those serving in nonmanagerial roles who have demonstrated management potential. This enhances the succession planning potential afforded by the establishment’s leadership development program, with this being an often cited benefit of these initiatives.14–16 Leadership training opportunities collectively are organized into what essentially is an academic calendar, with promotion of such being the responsibility of Willis Knighton Health’s Office of Recruiting, Engagement, and Development, as well as department managers systemwide who convey opportunities to their subordinates.
Quality control measures
Willis Knighton Health’s leadership development program incorporates several quality control measures. The Office of Recruiting, Engagement, and Development works diligently to ensure educational excellence, working closely with managers to make certain that leadership priorities are addressed across various learning opportunities. Program content is driven by research. Leadership development personnel also stay abreast of the latest leadership training tools and techniques, permitting innovations to be incorporated whenever warranted. As noted earlier, leadership qualities identified by Willis Knighton Health as being essential for operations are regularly reviewed, with adjustments being made as needed to ensure that training opportunities remain impactful and applicable. Notably, the Office of Recruiting, Engagement, and Development is assisted by an oversight committee, providing a further measure to ensure quality.
Efforts to formally calculate return on investment generated by leadership development programs are inconsistent across business and industry, and even when analyses are conducted, findings of value derived are mixed.16,17,23,24 This is not surprising given the wide variation in program design and operation. Regardless, healthcare organizations should strive to identify indications that their leadership development programs are delivering results. Willis Knighton Health relies on the training evaluation system pioneered by Donald Kirkpatrick (i.e., the Kirkpatrick Model) which involves conducting assessments on four levels; namely, reaction (i.e., evaluating participant perspectives on training), learning (i.e., evaluating participant knowledge improvements resulting from training), behavior (i.e., evaluating participant behavioral changes resulting from training), and results (i.e., evaluating performance outcomes resulting from training).34–36 Findings gleaned from these evaluations are reviewed intensively, guiding continuous improvement efforts. Willis Knighton Health’s observations have consistently confirmed the value of its leadership development program, compelling continued investment.
Foundational resources
Willis Knighton Health’s leadership development program would not be possible without the ongoing support provided by top executives who have supplied funding, personnel, and other resources to ensure the success of this important offering. Adequate resourcing to fully execute leadership development initiatives is known to be a crucial factor of program success.1,15,16 The health system’s leadership development program is a robust offering, the product of decades of evolution, requiring substantial resources to operate. Foundational support, however, has never been in short supply. Willis Knighton Health historically has demonstrated an appreciation of the value of education and its ability to enhance practices and processes, including the quality of leadership, investing resources, accordingly, to capitalize on associated benefits.
Establishing a leadership development program
Willis Knighton Health’s leadership development program stands as the product of many decades of evolution and experience, yielding the offering of today. Examining the current program in the context of its development over time reveals a formal process which can assist other healthcare organizations in establishing or revising their own leadership development programs. This process, entailing six steps, is described as follows.
Step 1: Secure foundational assets necessary for the successful operation of the leadership development program
Not surprisingly, leadership development programs require healthcare institutions to dedicate foundational assets sufficient for the proper establishment and operation of given initiatives. These essential resources include (1) the support and commitment of the healthcare establishment’s top officers, (2) financial resources necessary for sufficiently funding the program, and (3) capable personnel responsible for overseeing and managing the initiative. Not unlike any comprehensive institutional pursuit, the success of leadership development programs is highly dependent on the adequacy of foundational assets.1,15,16 Fortunately, though, scalability is very possible, especially if healthcare organizations follow the structural model embraced by Willis Knighton Health, as discussed earlier. Healthcare institutions can simply opt to deliver a limited array of initial offerings or even a single offering, permitting the establishment of an economical leadership development program which can be expanded and embellished over time. Viewing programs in this manner should give confidence even to the smallest healthcare organizations that establishment of these offerings is within reach.
Step 2: Determine the subject matter to be featured in the leadership development program
With adequate foundational assets secured, healthcare organizations next must direct attention toward determining the subject matter to be featured in the program. 1 Here, as discussed earlier, alignment between the leadership needs of institutions and the content delivered by their respective leadership development programs is imperative. 16 This first requires assessing the leadership needs of given healthcare organizations, with this knowledge then guiding the subject matter to be featured in their leadership development programs. A good starting point for this entails conducting interviews with senior executives as these individuals are ideally situated within their given healthcare organizations to understand leadership needs and priorities. Also helpful are surveys which query all personnel holding managerial responsibilities about the leadership needs of their particular work environments. Surveys asking managers to provide self-assessments of their leadership skills also can be deployed, potentially revealing developmental needs and opportunities.1,14–16 Revealed leadership needs from these analyses essentially become topics of focus for resulting leadership development programs.
Following the leadership needs assessment, an additional assessment can be helpful; namely, investigating external perspectives of trending leadership topics which might be useful for inclusion in given leadership development programs. As leadership is an ever-evolving discipline, looking outwardly for ideas can help to validate content selections or possibly indicate areas of opportunity. Such external perspectives can be acquired by reviewing content in the latest leadership books and journal articles, conducting curricular reviews of leadership and leadership-related degrees offered by colleges and universities, and whenever possible, reviewing the leadership topics featured in the leadership development programs of other institutions.1,14–16 This added step helps to ensure that subject matter selections do not inadvertently neglect trending concerns that could benefit resulting leadership development programs.
Step 3: Determine the methods which will be used to deliver leadership development training
With subject matter determined, healthcare establishments next focus on selecting the delivery methods which will be used to convey designated leadership content. Selections will be predicated on the resources dedicated to leadership development by given healthcare institutions, but as noted earlier, for those with restrictive budgets, economization is possible merely by making modest choices. This step essentially involves determining the most prudent ways to convey essential leadership knowledge to managers, developing their skill sets, accordingly. 1 Options abound regarding the methods which can be deployed. Examples include leadership seminars, short courses, guest speaker events, coaching, mentoring, institutionally-guided self-study, tuition and certification reimbursement plans, job rotations, business simulations, and more. Healthcare providers are encouraged to assemble a list of candidate delivery methods, intensively evaluating each for inclusion in given leadership development programs, assessing associated costs, appeal, and efficacy. Where applicable, the delivery format of opportunities (e.g., face-to-face, virtual) also must be decided.1,14–16,24 With this and other supportive information, healthcare providers then make their selections.
Step 4: Determine matters of strategy and organization design, including the program’s mission, placement within the organization, responsible parties, and quality control measures
With subject matter determined and methods of delivery decided, healthcare institutions next direct attention toward matters of strategy and organization design, specifying the program’s mission, its placement within the organization, the parties responsible for oversight and management, and the quality control measures that will be deployed. At this advanced stage of development, healthcare organizations have in their possession sufficient information to craft a mission statement for their leadership development programs, with this essentially entailing a brief narrative which describes the overall purpose of the program, its educational approach, designated goals, parties benefited, and similar details. Placement within healthcare organizations also must be determined, identifying the department or departments which will be responsible for overseeing and operating leadership development programs. The personnel within those units with responsibilities for program management also must be identified. Oversight committees, if desired, also should be assembled at this point.1,15,16,24
Importantly, quality control measures must be determined, offering a critical aid to ensure that leadership development programs stay on course. Here, healthcare institutions must prepare a plan that ensures ongoing alignment between the leadership needs of institutions and the training provided by their leadership development programs. A routine survey of senior, middle, and junior managers concerning the leadership needs of given healthcare organizations or similar types of inquiries can provide excellent insights for making any necessary programming adjustments. Leadership development personnel themselves must incorporate methods to assist them in staying abreast of the latest tools and techniques of leadership education. Here, involvement in leadership development trade associations, active efforts to review books and journal articles on the topic, and similar methods are invaluable in ensuring awareness of contemporary approaches.
Additionally, evaluation methods for the healthcare organization’s various leadership training opportunities must be determined, with these importantly giving indications of the effectiveness of learning experiences. The Kirkpatrick Model, as noted earlier, is a very popular approach which involves assessments on four levels: reaction, learning, behavior, and results.34–36 Another useful technique is 360-degree feedback which collects ratings of a manager’s leadership effectiveness from multiple parties, such as subordinates, peers, and supervisors, giving indications of leadership prowess. When 360-degree surveys are implemented before and after leadership training experiences, the results can help determine the impact of the training on managerial leadership skills and abilities.14,16 Many options for assessment are available, ranging from simple and informal avenues to highly complex methodologies. Healthcare organizations must investigate these options and select a pathway based on their preferences in the context of available resources.
Step 5: Organize leadership development opportunities, specify enrollment eligibility criteria, and prepare an academic calendar
Healthcare institutions next go about organizing their leadership development initiatives, specifying enrollment eligibility criteria, followed by the preparation of an academic calendar. This activity is similar to that of a college or university organizing and scheduling activities and events for coming terms. 1 In specifying enrollment criteria, healthcare organizations note the target audiences of the learning experiences and any qualifications that must be possessed by enrollees. For example, a leadership bootcamp might be aimed at managers who do not possess master’s level academic training in leadership or a related area. This would permit the healthcare organization to focus the educational content of the workshop on areas fitting for personnel who lack advanced training in leadership. Another section of the course could be offered for managers who possess advanced educational credentials in leadership or related areas, with content structured for the given audience’s experience level. Additional enrollment qualifiers, like the need for participants to acquire supervisory approval, also should be determined. Healthcare organizations, too, must stipulate whether training experiences are mandatory or voluntary.
When various learning opportunities and their associated enrollment eligibility criteria are determined, they then can be added to an academic calendar which presents when they will occur over a designated period. This is a very important activity, as leadership development programs often are comprised of multiple learning opportunities provided by both internal and external sources. An academic calendar helps planners to visualize the opportunities that are offered, aiding them in maintaining conflict-free schedules. It also helps to ensure that training opportunities are distributed evenly over time. The operative time period of an academic calendar is dependent on the preferences of given healthcare providers. Finalized academic calendars can be used as internal references, with promotion of opportunities occurring through other means, or be circulated to personnel across institutions, communicating training opportunities directly. 1
Step 6: Operationalize the leadership development program
With the prior steps completed, healthcare organizations now have in their possession a leadership development program framework which is ready for implementation. Operationalization simply requires launching the framework, bringing life to the leadership development program. It is now up to the parties responsible for program oversight and operation to actively manage and monitor the leadership development program to ensure that it consistently and reliably delivers training experiences which successfully engage and inspire, guiding managers down avenues which will see them emerge and thrive as leaders. 1
Conclusions
Leadership development programs provide an exceptional avenue for shoring up leadership acumen among the managerial ranks. Willis Knighton Health, in fact, credits much of its success to its leadership development program, with the offering enabling its managers to shape and hone their leadership skills and abilities, permitting enhanced individual and institutional performance. Leadership development programs indeed require institutional resources to operate effectively, but if well designed and well developed, such expenditures represent investments that have the potential to pay dividends. Reaping associated benefits begins by proficient program assembly, with the establishment protocol presented in this article supplying helpful guidance that can be used by any healthcare institution desirous of initiating or enhancing their own leadership development programs. By sharing insights regarding Willis Knighton Health’s leadership development program, it is hoped that this article will help healthcare providers better understand options and be more capable and confident in their leadership development initiatives, enhancing operations and outcomes.
Footnotes
Acknowledgments
A special note of thanks is extended to Jaf Fielder, Bonnie Dubin, and the greater Willis Knighton Health family for their helpful assistance throughout the development and publication of this article.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This article is part of a supplement supported by the James K. Elrod Super Professorship in Health Administration at LSU Shreveport.
