Hospital progress最新文献

Theology can contribute to pastoral care by interpreting experiences in a faith context, reinforcing the pastoral care giver's identity, and orienting one's ministry style to be more congruent with that of Jesus. Models for theological reflection generally begin with an analysis of the patient's experience. In addition to gathering information on the factual level, the pastoral care giver seeks to discern the experience's dominant theological meaning. The next step is to identify and explore a theological parallel to the experience. For example, images of "stopping for a stranger" or "taking a detour " would suggest the theological parallel of the Good Samaritan. The final step is to enact the reflection, that is, to apply the theological interpretation to the patient's situation. Besides sharing the interpretation with the patient, the enactment may include changing one's style of ministry.

Religious health care's involvement in public policy is an essential part of Christian life. The most important way in which Catholic hospitals and health care systems can contribute to public policy is through faith-reflection upon their identity and calling. To guide the shaping of public policy, several theological models have been set forth. The theology of democratic capitalism is based on individual human creativity. As a system of political economy organized to prevent the centralization of government power, it thrives on free competition. Well- intentioned social programs that seek to equalize results, according to democratic capitalists , inevitably lead to greater government control and should be avoided. Inequality, in fact, according to this theory, can create incentive for individuals and industry to be more productive. The stewardship approach to theological reflection calls for a distribution of goods and services based on need. The right to health care, for example, is founded in God's gift of creation to all inhabitants. The resources of creation are allotted to individuals as property in a sense of cooperation and sharing. Thus, according to this notion, government programs that help society steward its resources wisely should be promoted. The U.S. bishops ' 1981 pastoral letter on health and health care presents a third model, which reflects on the dignity of human beings as images of God to guide public policy. Models, however, must not replace personal theological reflection. Catholic health care providers share a responsibility to evaluate social issues from their perspective as members of the healing ministry and to participate in public policy development.

As St. Francis-St. George opened its doors in January 1982 as a result of the merger of two former facilities, it faced numerous challenges to its ability to communicate with physicians, staff, and community. The previous hospitals had been sponsored by different congregations , the new facility had 50 fewer aggregate beds, and two sets of management personnel were competing for one set of positions. The communication initiatives taken to surmount these difficulties may prove helpful to other hospitals, for close communication--particularly with medical staffs--is essential in coping with the DRG system. To unsnarl the communications tangle at St. Francis-St. George, a committee was appointed to coordinate planning while also ensuring that each department maintained essential control over its own plans. Regular newsletters were published for hospital staff, physicians, managers, and the community. Monthly breakfasts and informal lunches provided for relaxed give-and-take discussions. In response to a December 1982 survey, many staff physicians, while expressing overall satisfaction with the hospital, also indicated that management and the board of trustees did not seem interested in the medical staff's views, that communication between management and physicians had been inadequate, and that the hospital's administration was more concerned with profits than with patient care.(ABSTRACT TRUNCATED AT 250 WORDS)

As hospitals attempt to survive in today's new competitive environment, they will find that the traditional organizational structure does not work. This structure can be characterized as a three-legged stool. Governance, management, and medical staff existed in relative harmony, with each able to attend to its own distinct, separate responsibilities. The medical staff regulated itself, the governing board had no serious difficulties in coping with the institution's finances, and the CEO was concerned solely with the physical plant and hospital personnel. In a riskless economic environment, this three-legged stool could remain stable. In the coming years,however, a hospital will need a clear-cut, identifiable leader if it is to survive. To centralize authority primarily in the CEO's hands will be a difficult step for nonprofit hospitals, particularly those sponsored by religious institutions, because of their tradition of operating much as a charitable social agency rather than a business. But this step must be taken, even to the extent of naming the CEO as chairman of the board, for a leader is required who has the authority to make quick decisions in the competitive marketplace. Timeliness is of strategic importance in such an environment, and governing boards increasingly will find it impossible to make timely decisions on a collective basis. Moreover, CEOs will have to coordinate the activities of management, medical staff, and the governing board. They will need to play a strong role in ensuring that target levels in DRG costs are met, and they will need the authority to mediate in issues in which the hospital's economic interests are pitted against physicians'.(ABSTRACT TRUNCATED AT 250 WORDS)

Like all department heads, the pastoral care director must develop a budget, negotiate its approval, and keep expenditures within it. Knowing that planning and control are the budget's functions, the director can follow simple steps in preparing a thorough budget. After establishing goals according to quantitative and qualitative resources needed, the director relates these to the services produced. The services budget forms the foundation of the dollar budget. After establishing goals according to quantitative and qualitative resources needed, the director relates these to the services produced. The services budget forms the foundation of the dollar budget. Resources and services are then broken down into the paper major and minor accounts. Estimating numbers of full- and part-time personnel needed is the major task, along with determining costs of nonsalary items such as supplies. The director then presents the budget to management, showing the relationship of goals to dollars and avoiding "highballing" and "lowballing" strategies that undermine personal integrity. With good accounting and control reports the director can use the approved budget to keep the pastoral care department within bounds in providing services.