Hospital & health services administration最新文献

Establishing specialty clinics staffed by visiting medical consultants is one way that rural hospitals can increase local access to specialty care. This example of private sector-driven regionalization of health care services typically involves an agreement among urban specialists, rural hospitals, and local primary care physicians. The urban-based physicians provide limited on-site specialty services in the rural community for patients who are referred by local physicians or self-refer to the specialty clinics. The trend toward formalization of regional relationships across large geographic areas prompts both opportunity and need for careful consideration of visiting specialty clinic arrangements in rural hospital communities. This article delineates advantages and disadvantages associated with the development of Visiting Consulting Clinics (VCC) along with some ¿ground rules¿ to consider when establishing this type of service.

The United States must soon address long-term care policy. Policymakers have sought cost containment through reimbursement policies that contain incentives for efficiency. Nursing facility administrators were surveyed twice following a significant change in Maine's Medicaid reimbursement policy to determine the effects of the change on their managerial practices. The administrators responded to some of the policy changes as profit maximizers, including instituting cost controls and benefiting from incentives. In other areas, such as staffing, staff pay, and accepting heavy care patients, the administrators did not seem to behave entirely as expected. Insights from organizational theory are useful for explaining some of the other behaviors. As long-term care reform is undertaken, a policy framework should include aspects of the internal environment of nursing facilities, such as administrator goals and organizational structure and mission.

This study examined how top managers view the prospects of success and resistance when using four implementation approaches in participative and control cultures that foster climates more or less conducive to change. An accommodation approach was viewed as having the best prospect of success and of lowering resistance in a participative culture. Bargaining and incentive approaches were thought to have successful and low resistance outcomes, which were just below those of accommodation, in a control type of culture. A persuasion approach was thought to be the least effective implementation approach in a control-oriented culture. These preferences differ from prescriptions found in the implementation literature. Assuming that preferences influence behavior, implementation success could be improved if managers selected an implementation approach according to the demands of the situation. More research is needed to appreciate fully the rationale that lies behind the preferences uncovered in this research.

With each congressional budget debate, hospital and health system executives are reminded of their vulnerability to Medicare reimbursement rates. As health maintenance organizations (HMOs) have entered into Medicare risk contracts and negotiated separate hospital reimbursement rates, hospital and health system executives have recognized even less control of their Medicare reimbursement. One way for health systems to regain control of the Medicare dollar is to develop a Medicare risk contract that directly receives and distributes the Medicare risk premium. Before hospital and health system executives invest in the start-up and operational capital necessary to bid for a risk contract, careful analysis of the efficacy of the contract's contribution to the margin should be undertaken. The following will review observations and lessons from HMO Medicare risk contracting and introduce a methodology that health system executives can use to evaluate the annual financial impact of entering the business of direct Medicare risk contracting.

This study investigates the ability of discriminant analysis to provide accurate predictions of hospital failure. Using data from the period following the introduction of the Prospective Payment System, we developed discriminant functions for each of two hospital ownership categories: not-for-profit and proprietary. The resulting discriminant models contain six and seven variables, respectively. For each ownership category, the variables represent four major aspects of financial health (liquidity, leverage, profitability, and efficiency) plus county marketshare and length of stay. The proportion of closed hospitals misclassified as open one year before closure does not exceed 0.05 for either ownership type. Our results show that discriminant functions based on a small set of financial and nonfinancial variables provide the capability to predict hospital failure reliably for both not-for-profit and proprietary hospitals.

Theory suggests that organizations should respond to external complexity with internal complexity. We examine whether "environmentally sensitive" hospitals are more internally complex than "environmentally insensitive" hospitals. Results show that environmentally sensitive and insensitive hospitals differed on three of the measures of internal complexity: goal complexity, strategic complexity, and relational complexity.

This article reviews the special position that health professionals have occupied and the ways in which changes threaten the foundations of professional work. The application of modern management principles to health care runs the risk of overriding the "action orientation" that is a defining component of professional work. One goal of health workforce design should be the engineering of opportunities for the preservation of "professional voice" as a countervailing force to ensure high quality health care. Contemporary models of change applied to health care workforce include: (1) the system of professions models in which securing and maintaining jurisdiction are the mechanisms that professions employ to sustain their position, (2) a strategic adaptation model by which professions attempt to adjust to changing environments, (3) a model of redesigning patient care which applies Total Quality Management (TQM) and other "industrial techniques" to the health care workplace, and, (4) model of "consumer sovereignty" in which groups of citizens come together to determine the nature of care services and professional work, with the participation of the organizations and providers.

Hospitals nationwide are beginning to implement continuous quality improvement (CQI) (Barsness et al. 1993; Kosta 1992). In large part this is due to the belief that the implementation of CQI will lead to higher quality patient care, improved patient satisfaction, better employee morale, and lower cost service delivery. However, to date there have been few empirical studies of CQI implementation efforts in healthcare (Shortell et al. 1994).

The utilization of multiskilled health practitioners (MSHPs) is one method of enhancing employee productivity and cost effectiveness of health services delivery. This article reviews the trend toward increasing specialization of health personnel in this century as well as its limitations and the potential of the MSHP to enhance productivity. Then research on factors that inhibit or facilitate adoption of the concept, the effectiveness of the concept, and implementation strategies that impact effectiveness are presented. The article concludes with guidelines and future challenges for health care executives, public policymakers, and researchers as regards implementation of the multiskilled concept.

Diversity and managing diverse workgroups have become strategic imperatives for many organizations. Corporations are developing programs and opportunities to increase the participation of their employees, especially those who have not been previously included in the mainstream of their organizations. Many health care institutions are also focusing on diversity management. This study was designed to examine the manner in which diversity management is perceived and implemented by hospital executives. To determine the perception of executives, a 16-item questionnaire was developed and distributed to hospital executives. The data showed that executives in urban teaching hospitals considered their workforce diverse, and many of these organizations had implemented diversity management programs in their facilities. Surprisingly, this study found that although most executives (68 percent) agreed they had a diverse workforce, less than one-third (30 percent) of these executives had specifically developed diversity management programs in their hospitals.