Hospital & health services administration最新文献

Since its establishment in 1946, the veterans healthcare system has greatly expanded in both size and responsibility. It is now the largest integrated healthcare system in the United States, the nation's largest provider of graduate medical and other health professionals training, and one of the largest research enterprises in America. It is also the nation's largest provider of services to homeless persons, an essential provider in the public healthcare safety net, and an increasingly important element in the federal response to disasters and national emergencies. Patterned after what was considered the best in American healthcare, for most of the past 50 years the Department of Veterans Affairs (VA) healthcare has focused primarily on acute inpatient care, high technology, and medical specialization. Now, in response to societal and industrywide forces, the Veterans Health Administration (VHA) is reengineering the veterans healthcare system, changing the operational and management structure from individual hospitals to 22 integrated service networks and transitioning the system to one that is grounded in ambulatory and primary care. This article briefly describes the history and functions of the veterans healthcare system, its service population, and key aspects of its restructuring.

A recently concluded demonstration project examined efforts to improve the effectiveness of nonprofit boards. This article focuses on the interventions at two participating healthcare organizations and examines the outcomes of these efforts. Changes made at the Alpha Health Care system included: reduction in the number of boards, term limits established for board members, election of new board chairs for two of the fewer boards, reduction in the size of those boards, implementation of a consent agenda, and reorganization of the boards' committee structure. Fewer changes were implemented at the Beta Hospital, where several initiatives were started but only some of which were retained by the projects' conclusion. Key factors limiting the extent of changes there were the modest interest in an active board by a new CEO and the limited investment of trustees in change. The article concludes with a discussion of lessons learned about board assessment, the use of retreats to initiate board development, and the importance of time management and CEO support to strengthen board effectiveness.

This study examined the anticipation of salaried hospital physicians in Israel to retain hospital membership for a long term until their retirement. Examined are attitudinal and position factors, as well as hospital standing personal and situational factors that relate to this anticipation. The data collected from 195 full-time salaried physicians in Israeli hospitals indicated that about one-third of the physicians anticipate to retain hospital membership until retirement. It was found that factors reflecting the physician's standing within the hospital were the main predictors of this anticipation, whereas work-related attitudes had little or no effect on it. The implications of these finding to hospital-physician integration strategies in the United States are discussed.

Using a resource-dependence perspective, we analyze the association between organizational and environmental characteristics and the likelihood that non-profit hospitals will enter into one of two forms of interorganizational relationship (IOR): hospital alliance membership or contract management (n = 1,661). The former is representative of high autonomy IORs, while the latter is representative of low autonomy IORs. Results of logistic regression analysis indicate that hospitals with greater resources and more favorable payer mix are more likely to join alliances, an IOR form which minimizes loss of autonomy. In addition, facilities operating in less favorable environments are more likely to be contract managed and less likely to be alliance members.

The Under Secretary for Health asked the Health Services Research and Development (HSR&D) service to identify the managed care principles that would enable The Department of Veterans Affairs (VA) to most improve its efficiency and effectiveness while retaining its unique mission. In response to this request, HSR&D's Management Decision & Research Center (MDRC) prepared this article. This article represents the initial work done by the MDRC to determine the extent to which readily available published evidence on implementing managed care principles meets the Under Secretary's information needs and to outline potential areas for further work. It provides an overview and synthesis of existing literature. The document was prepared by the MDRC Technology Assessment Program, which took responsibility because of its expertise in systematic reviews and syntheses of the literature, with contributions from the MDRC's programs in information dissemination and management research.

Healthcare integrated delivery systems (IDSs) evolve through four observed stages of development, with each successive stage having greater levels of interdependence among facilities and between facilities and physicians. The cottage industry stage is characterized by competition among hospitals and little interdependence. Healthcare organizations in the next stage, horizontally integrated systems, have pooled interdependencies, and in the third stage, vertically integrated systems, have predominately sequential interdependence with reciprocal interdependence between physicians and hospitals. In the fourth stage, community healthcare, community systems have reciprocal interdependence among their facilities and other organizations providing services along the continuum of care. This reciprocal interdependence is characteristic of the level of integration that must be addressed for system effectiveness. Greater levels of interdependence require stronger organizational integrating mechanisms and processes. "Integrative management" or "service-line management" is one vehicle for providing this integration. Although few empirical studies are available, this article relates the available empirical and conceptual literature to analyze the interdependencies at each level of IDS development, as well as the organizational design characteristics to address those interdependencies. It then examines the organization of the Veterans Health Administration (VHA) in terms of the four stages of IDS evolution, and suggests organization designs to address VHA's increased needs for integration.

Middle Tennessee Medical Center (MTMC) is a not-for-profit community hospital located in Murfreesboro, Tennessee. Eleven years ago, a large investor-owned hospital company presented the institution's board of trustees with a purchase offer. As an alternative, two church-related institutions in Nashville--Baptist Hospital and Saint Thomas Hospital, which is part of the Daughters of Charity National Health System--presented the board of trustees with a plan whereby a new not-for-profit holding company sponsored jointly by Baptist Hospital and Saint Thomas Hospital would become the corporate member of Middle Tennessee Medical Center. Funds contributed by Baptist and Saint Thomas Hospitals would be infused into the Christy-Houston Foundation, a not-for-profit entity devoted to identifying and serving community needs in Murfreesboro and the surrounding area. Their proposal was accepted, and the two church-related institutions became partners in jointly sponsoring and governing an important not-for-profit healthcare institution in central Tennessee. In 1996, The Lewin Group, a healthcare consulting firm based in Fairfax, Virginia, was commissioned by Baptist Hospital, Saint Thomas Hospital, and Daughters of Charity National Health System to conduct a retrospective assessment of the progress of this jointly sponsored ministry in relation to the original vision and goals. Historical and operational data were analyzed, and interviews were conducted with 24 people who were directly involved in conceiving, developing, or implementing this ministry. This article summarizes the principal findings and conclusions of this ten-year assessment.

This study analyzed four prominent organizational factors thought to influence service quality in nursing homes. Perceptions of service quality were collected from over 400 family members who regularly visited residents in 41 nursing homes. Service quality was measured along five dimensions identified by marketing research on customers in service industries. These five dimensions were responsiveness, reliability, assurance, empathy, and tangibles. Perceptions of service quality exhibited significant associations with each of the four organizational factors: ownership, funding mix, facility size, and nurse staffing. Implications for health services administration are discussed.

Nursing home administrators represent wide variations in academic training. General education levels do not seem to affect administrative preparation in key domains of practice--specific academic fields of study are more relevant. Hence, sole emphasis on higher educational requirements for licensure appears to be a misdirected strategy for improving quality of care and enhancing management efficiencies in nursing homes. Educational paradigms studied have strengths and weakness in furnishing various job skills. These results are helpful in defining strategic actions for addressing both current deficiencies and future training needs. A specialized long-term care model that incorporates appropriate clinical and business skills is recommended. The roles of continuing education and executive educational offerings also need streamlining. These initiatives would require a joint effort from policymakers, academicians, and practitioners.

Intensified competition in healthcare is stimulating an enhanced focus on consumer satisfaction. Critical barriers to customer service are being dismantled and hospitals are instituting comprehensive models to promote consumer-oriented environments.