Hospital & health services administration最新文献

Most healthcare organizations are currently or will shortly be composed of a multicultural and multilingual workforce. In attempting to manage such diverse workforces. English-only work rules may be necessary to ensure effective communication among workers. However, care must be taken to insure that the employees' rights to free speech and a harassment-free workplace are not infringed by utilizing English-only work rules. This article attempts to assist the healthcare manager in dealing with the legal aspects of English-only work rules. Specifically, an examination of two legal cases is provided to illustrate the various legal aspects of such work rules. Also, suggestions are offered as to how and when, or when not, to implement English-only work rule in order to avoid possible liability.

Using a sample of California hospitals, the effect of church ownership was examined as it relates to nonprofit hospital efficiency. Efficiency scores were computed using a nonparametric method called data envelopment analysis (DEA). Controlling for hospital size, location, system membership, and type of church ownership, church-owned hospitals were found to be more frequently in the efficient category than their secular nonprofit counterparts. The outcomes have policy implications for reducing healthcare expenditures by focusing on increasing outputs or decreasing inputs, as appropriate, and bolstering the case for church-sponsored hospitals to retain the tax-exempt status due to their ability to manage their resources as efficiently as (or more efficiently than) secular hospitals.

Many hospitals are eager to incorporate practices of boards in business organizations. Yet little evidence exists on the desirability of "corporate" board features in hospital settings. We examined the effects of two characteristics of corporate boards--the relative dominance of insiders and of directors with business-related occupations on strategic changes within hospitals. We studied 335 hospitals in California immediately following legislative reforms in 1982. We found that hospital boards with a higher proportion of insiders and business directors made more changes in their mix of services in response to legislative reform. In addition, this relationship held for nonproprietary hospitals but not for proprietary hospitals. Limitations and implications of the results are discussed.

Healthcare administrators endeavor to maximize the productivity of employees in an era of chaotic change and financial pressure. This study examines five leadership behaviors that were identified through the research of James Kouzes and Barry Posner and measures the use of these behaviors by hospital managers. It then identifies the relationships (both correlational and predictive) between the use of these behaviors and employee productivity, job satisfaction, and organizational commitment. The findings of this study have implications for health care managers and executives in identifying critical skills needed by leaders.

CQI is a management paradigm adopted by many health care organizations. This paradigm can be helpful as health care organizations respond to the ethical demands created by the workplace, particularly respect for empowerment of the worker, shared levels of power, subsidiarity, collegiality, and the production of goods and services that meet the needs of the community served. An analysis of the workplace reveals other ethical questions that require the attention of managers, owners, and trustees. Some of these are not addressed by the CQI paradigm.

This study identifies a group of financially distressed hospitals and tracks them over time to identify the consequences of their financial distress and the factors that may precipitate different events. Of 2,547 that supplied complete financial data to the American Hospital Association for the period 1983-1985, a total of 340 community hospitals met our definition for distress. The most striking finding is that 91.2 percent of hospitals that were distressed in 1983-1985 survived through the end of 1990. Distressed hospitals also had significantly higher rates of system acquisition and merger, as well as higher rates of system divesture. Growing competition in a market appeared to be a major factor in the closure of a distressed hospital. The results of this study suggest that financially distressed hospitals have a remarkable resiliency that allows them to continue operation without dramatic change. This may be good news to local community officials concerned about maintaining financially weakened hospitals. Alternatively, it may be bad news if poor financial performance is a signal of unneeded capacity.

Two recent National Labor Relations Board decisions, Electromation and DuPont, may very well be used to declare many health care organizations' employee empowerment and participation programs (including TQM and CQI groups) in violation of U.S. labor laws. This article provides a detailed explanation of the NLRB's two-part inquiry that will now be used to determine whether a health care institution's employee participation programs are under the NLRB's jurisdiction as a labor organization, and if so, whether the institution is engaged in unlawful employer domination. This article will also provide guidance from the NLRB as to what form of employee participation may be permitted under the National Labor Relations Act.

If CQI is to become a mind-set and not simply a management fad, adjustments need to be made in all aspects of management, especially human resources management. This article will consider the impact of CQI on human resources philosophy and practice in health services organizations. The effects will be illustrated by the experiences of a group of human resources managers and the organizations in which they work.

This study investigates factors associated with the adoption of corporate restructuring by hospitals in Massachusetts, where restructuring occurred much more rapidly than it did nationally. Drawing on studies of management innovation in hospitals, this article hypothesizes that early adopters will differ from those that adopt later on the basis of individual and organizational factors, and that institutional forces will explain later adoption. The findings show no differences between early and later adopters but do show that after an intense period of restructuring, hospitals became less likely to adopt the innovation. The article concludes with a discussion of the impact of reimbursement laws on the adoption pattern and the implications for the diffusion of management innovation, particularly under health care reform.