Showing papers in "The health care manager in 2003"

The interrelationship of organizational characteristics of magnet hospitals, nursing leadership, and nursing job satisfaction.

Abstract: This study examined whether magnet hospitals continue to provide higher levels of job satisfaction and empowerment among nurses when compared with non-magnet hospitals. Also studied at both types of hospitals was whether job satisfaction discrepancy was interlinked with leadership effectiveness and support of professional nursing practice. Nurses employed at magnet hospitals experienced higher levels of empowerment and job satisfaction due to greater access to work empowerment structures. The elements accounting for differences in empowerment and job satisfaction scores included: (1) greater accessibility of magnet nurse leaders, (2) better support of clinical nurse autonomous decision making by magnet nurse leaders, and (3) greater access to work empowerment structures such as opportunity, information, and resources at magnet hospitals.

Retention: it's all about respect.

Abstract: Retention of employees is often overlooked in developing strategies to deal with worker shortages in health care. Managers mistake requests for more money as the key indicator of job satisfaction. This article examines research conducted by three health service administration graduate students who looked at reasons staff were leaving their jobs or their occupations. Using three different research tools, the students found that job satisfaction is not all about money, or even benefits. Respect, recognition, and organizational commitment are what employees want in their jobs. The article describes the research methods used in the studies and the similarities in results.

Hospital restructuring, workload, and nursing staff satisfaction and work experiences.

Abstract: This study examined changes in patient-nurse ratios resulting from hospital restructuring and the relationship of such changes to nursing staff satisfaction, psychological health, and perceptions of hospital functioning. Data were obtained from 744 hospital-based nursing survivors using questionnaires. Fifty-three percent of staff nurses indicated an increased patient-nurse ratio. Nursing staff indicating increased ratios generally reported less job satisfaction, poorer psychological (but not physical) health, and less effective hospital functioning.

Addressing the phenomenon of disruptive physician behavior.

Abstract: This timely article provides current information on an age-old issue of disruptive physician behavior within the hospital setting. Documented in medical literature over 100 years ago, disruptive physician behavior has been an ongoing challenge to the hospital staff and the quality of patient care in the hospital. Covered in this article are the negative consequences of disruptive physician behavior and the call to respond. If allowed to go unchecked, a physician exhibiting disruptive behavior may threaten a hospital's image, staff morale, finance, and quality of care. Failure to respond undermines the leadership of the hospital and the trust of the community in the hospital's mission. Included in this article are suggestions obtained from the literature and from the author's experience in responding to disruptive physician behavior. Of emphasis is a methodology that includes supporting bylaws and policies to manage disruptive physician behavior.

Telemedicine: an emerging health care technology.

Abstract: Telemedicine uses advanced telecommunication technologies to exchange health information and provide health care services across geographic, time, social, and cultural barriers. All telemedicine applications require the use of the electronic transfer of information. Telemedicine encompasses computer technologies using narrow and high bandwidths for specific types of information transmission, broadcast video, compressed video, full motion video, and even virtual reality. There are many types of common medical devices that have been adapted for use with telemedicine technology, and many clinical services can be provided via telemedicine to patients who live in physician shortage areas. The greatest challenges for telemedicine in the twenty-first century are financing, safety standards, security, and infrastructure.

The causes and consequences of conflict and violence in nursing homes: working toward a collaborative work culture

Abstract: Interpersonal conflict, often spiraling to violence and abuse, is one of the most daunting challenges facing nursing home administrators and their departmental heads. Mounting evidence documents how they spend an inordinate amount of time dealing with angry families, adversarial ombudsmen, regulators, and other hostile parties as well as handling the aftermath of the ubiquitous conflict between the residents and their direct caregivers. All this is in addition to coping with the normal interdepartmental and line staff forms of conflict that typify any organization. This paper details the special dynamics that accelerate dysfunctional conflict in nursing homes and presents strategies, tactics, and style recommendations that will help nursing home leaders build more collaborative work cultures to minimize the effects of dysfunctional conflict.

Health informatics: ethical issues.

Abstract: Ethics is a component of the education of health care mangers and supervisors. Recent advances in the technologies of health informatics present these leader with new ethical challenges. Holding the promise of beneficence, these technologies are purported to increase access, improve quality, and decrease the costs of care. Aspects of these technologies, however, create conflicts with the ethical principles of autonomy, fidelity, and justice. Infoethics is suggested as a means to examine these conflicts. A multipronged solution that incorporates adherence to regulations and standards, promotion of codes of conduct and ethics, and creation of a culture of infoethics is recommended.

The manager's approach to employee performance problems.

Abstract: Employee performance problems essentially take two forms: those that are motivational in origin and those resulting from skill deficiencies. Both fall within the province of the department manager. Performance problems differ from problems of conduct in that traditional disciplinary processes do not apply. Rather, performance problems are addressed through educational and remedial processes. The manager has a basic responsibility to ensure that everything reasonable is done to help each employee succeed. There are a number of steps the manager can take to address employee performance problems.

Length of stay at an all-time low.

Abstract: Most health care professionals agree that the decreasing length of stay in hospitals is detrimental to the quality of care given to the patient. The growing trend over the past decade is to discharge the patient as quickly as possible. The decreasing length of stay has spurred many questions and controversies in both public and medical domains. It has brought about changes in service delivery and technology. Still, the question remains: Does shortened length of stay decrease the quality of care given? Understanding the factors of change and their effect on the medical environment is beneficial to all health care professionals.

Patient-physician e-mail: passion or fashion?

Abstract: This article surveys the nature, prevalence, and risks and benefits of patient-physician e-mail as a prelude to critically evaluating what will be required for it to become a truly transformational technology. Diverse materials from both the popular press and various clinical domains are consulted in order to appraise patient-physician e-mail's efficacy in different contexts and among different patient and physician users. Early evidence that patient-physician e-mail has lasting power includes its use in niche clinical applications, appearance of unsolicited patient e-mail, historical patterns of medical technology adoption, and increasing use of the Internet in general. Patient-physician e-mail will become genuinely transformational if it affirmatively improves the patient-physician encounter, contributes to better clinical outcomes, makes patient-physician communication more convenient for both parties, demonstrably transcends existing reimbursement and medicolegal concerns, and promotes patient empowerment. Like all technologies, use and misuse of patient-physician e-mail will determine whether its possibilities will become realities.

Strategies to decrease medication errors.

Abstract: Medication errors present a significant hazard to patient safety and have been increasingly in the news as studies correlate the nursing shortage and patient death. This article discusses strategies to decrease medication errors and increase patient safety during medication administration.

A study of the skills and roles of senior-level health care managers.

Abstract: This study identifies the most essential skills and roles of senior-level health care managers. The study first reviews the literature to describe major forces in the healthcare environment that impact management and then discusses the skills and roles of managers. From this, a descriptive list of skills and roles is created. Ten senior-level managers were interviewed to reveal six roles and associated skills necessary for managing in the current health care environment.

Caring: utilizing the Watson theory to transcend culture.

Abstract: The United States is increasingly becoming a multicultural pluralistic society. This is especially true in Florida where the present manuscript was written. Nurse practitioners must respond to growing diversity with competency and theory-based practice strategies. This paper describes application of theoretical models of caring to a diverse population in Florida with emphasis on the Giger and Davidhizar model of transcultural nursing.

Marital status and health care expenditures among the elderly in a managed care organization.

Abstract: The purpose of this study was to determine the relationship of marital status in and health care expenditures among the elderly in a managed care organization. The study population consisted of 277 functionally impaired elderly people who were 75 years and older enrolled in a managed care organization. In separate analyses, the relationship between marital status and total expenditure per enrollee, the number of outpatient visits, hospital admissions, and emergency department (ED) visits during the two-year study period was examined. The results indicate that married individuals had significantly higher health care expenditures than the unmarried. However, there were no significant differences in number of hospital admissions, number of outpatient visits, and number of ED visits. It would behoove health care administrators and policy makers to take into consideration marital status when planning, designing, and implementing health care policies for the elderly.

Wireless communication in health care: who will win the right to send data boldly where no data has gone before?

Abstract: Increasingly, health care professionals will need to retrieve, store, share, and send data using several types of wireless devices. These devices include personal digital assistants, laptops, Web tablets, cell phones, and clothing that monitor heart rate and blood pressure. Regardless of the device, several standards will vie for the right to provide the wireless communications link between the health care professional and the wired data resources located within a health care organization. This article identifies the top three technologies in the wireless communications field: Wireless Fidelity (WiFi), Mobile Communications, and Bluetooth; breaks down each according to its strengths and weaknesses; and makes recommendations for their use by health care professionals located inside and outside a health care facility. Where appropriate the discussion includes an explication of how a specific technology can be made secure from hackers and other security breeches.

Hospital restructuring stressors: support and nursing staff perceptions of unit functioning.

Abstract: Hospital restructuring and downsizing have taken place in most developed countries during the past ten years. A small but growing body of research findings has identified aspects of these changes that serve as sources of stress for nursing staff during these transitions as well as organizational initiatives that facilitate those transitions. This study reports results from a longitudinal study of hospital restructuring and downsizing on nursing staff perceptions of hospital functioning. Data were collected in November 1996, and again in November 1999, from hospital-based nursing staff using questionnaires. The findings showed moderate but statistically significant relationships between restructuring stressors and organizational support in 1996 and perceptions of hospital functioning in 1999. Nursing staff reporting higher levels of restructuring stressors and lower hospital support in 1996 indicated more negative perceptions of unit and hospital functioning in 1999.

Personality conflicts and objectivity in appraising performance.

Abstract: A daunting challenge for any health care manager is to be involved in a personality conflict with an employee and then maintain objectivity in appraising that employee's performance. This article explores the relationship between personality conflicts and performance appraisal. Types of perceptual problems, such as recent behavior bias and horn effect, are discussed. Methods for involving input from appropriate individuals other than the manager and ways managers can improve objectivity in appraising performance are covered.

Ideal and perceived satisfaction of patient care providers.

Abstract: This study compared the ideal job satisfaction and perceived job satisfaction levels of patient care providers from labor and delivery, coronary intensive care, pediatric outpatient, and perioperative areas. Of the 243 surveys distributed, 112 (46%) patient care providers responded. The respondents included registered nurses, licensed practical nurses, patient care assistants, and a scrub technician. A dependent t test revealed a statistically significant difference in the providers' ideal job satisfaction and perceived job satisfaction (t = 16.66, df = 87, p = < .001). The mean ideal satisfaction as compared to the mean perceived satisfaction was 88.70 to 65.65.

The hospital manager and game theory: chess master, poker player, or cooperative game player?

Abstract: Hospital management can be seen as a game, and doctors, nurses, and health maintenance organizations are its players. The astute hospital manager realizes the interdependence of individual career strategies and the hospital's success, just as players in a game are interdependent on each other. Managers familiar with game theory may successfully transfer that knowledge to the hospital realm. They may recognize patterns and calculate outcomes like chess players, bluff other hospitals into folding services as poker players do, and cooperate with their own team to maximize productivity. Knowledge of game theory may also make the hospital manager's job.

Clinical supervision: a working model for substance abuse acute care settings.

Abstract: Clinical supervision is a general practice with multiple implications for health care settings. Applying clinical supervision is often determined by various organizational elements. David Powell offers a working model called the blended model. This article outlines the blended model and discusses its utilization in substance abuse acute care settings (SAACS). Furthermore, the dynamics of the model are dissected and identified, stressing its application. These dynamics include contextual variables, descriptive dimensions, organizational treatment philosophies, and leadership.

The movement for diversity in health care management.

Abstract: Efforts of health care management leaders to increase the diversity of its ranks have had limited success. A combination of factors, including emphasis on simply focusing on numeric goals and compliance with existing regulatory requirements, has given rise to the loss of an ethical and moral basis for why diversity should be embraced as a concept. The article suggests that a movement for diversity needs to be embraced at all levels of management and those impacting the healthcare management workforce, including academia and public policy makers.

Consumers devise drug cost-cutting measures: medical and legal issues to consider.

Abstract: Health care costs in general, and prescription drug costs in particular, are rapidly rising. Between 1996 and 2007 the average annual per capita health care cost is projected to increase from dollar 3,781 to dollar 7,100. [AQ1] The single leading component of health care cost is the cost of prescription drugs (currently 10% of total health care spending, projected to become 18% in 2008). The average cost per drug increased 40% during the 1993-1998 period. Forty-one million Americans have no health insurance, and those who have, have inadequate prescription drug coverage. [AQ2] To cope with this situation, many consumers are trying to economize by doing without the prescriptions or the appropriate doses, buying generics or medicines from Canada or Mexico, or splitting pills of higher doses to take advantage of the pricing policy of drug manufacturers. Some of these approaches are medically and/or legally acceptable, while some are dubious. Most adversely affected are the seniors and poor; for certain groups of seniors prescription drugs account for 30% of their health care spending. The problem must receive prompt concerted attention from consumers, insurers, pharmaceutical companies, and lawmakers before it gets out of hand.

The economic impact of several hospitals on their community.

Abstract: This study quantifies the value that several hospitals in a hospital system have on their local communities. Also included is an analysis of the types of value-added services and resources offered by the hospitals. The hospitals are assessed in 3 arenas: as an employer, as a major provider of healthcare services, and as a contributor to the quality of life of the region through the involvement of its employees in community services activities. The results indicate that the hospital system contributes almost dollars 1.7 billion (or 6.6%) toward the dollars 25 billion local economy.

Medical group affiliations: interorganizational relationships and organizational performance.

Abstract: The hyperturbulent health care environment is causing health care organizations to create interorganizational relationships (IORs). This article reports on a study of 686 medical groups that assessed how 11 types of IORs affected 7 dimensions of organizational performance. Organizational performance was ascertained through self-reported questions about performance relative to local market competitors. Respondents believed that, to varying degrees, all IORs lead to a competitive advantage over local competitors in all seven performance categories. There was no consistent pattern for either loose or tight linkages to be associated with superior performance. Consequently, loose linkages may be preferable to tighter linkages (i.e., membership in a fully integrated delivery system) that require higher levels of resource commitment.

Managing effectively in the downsized organization.

Abstract: Many health care institutions have downsized in recent years for a variety of reasons including cost savings and the need to be proactive in restructuring the organization for more effective performance. In a downsized organization, top management must develop new strategies to enable line managers at all levels to operate effectively. New policies for human resource strategic planning, selective hiring, employee empowerment, training and development, reduction of status distinctions, sharing of appropriate information with employees, and paying for performance must be implemented.

Hospital-affiliated pediatric urgent care clinics: a necessary extension for emergency departments?

Abstract: This study analyzed whether a children's hospital urgent care clinic helped increase market share. Patient demographics and utilization patterns between the suburban clinic and urban emergency department were compared over a three-year period (July 1999 to June 2002). Using data from a standardized billing form, all patient visits (clinic: 36,924; emergency department: 160,888) were analyzed. Variables included patient visitation date, age, gender, race, primary insurance carrier, primary diagnosis, and primary residence Zip code. Differences between the after-hours clinic and emergency department included: more private insurance coverage (83% and 35%, respectively); less no insurance/Medicaid/State Children's Health Insurance Program (SCHIP) coverage (16.4% and 55%, respectively); and more Caucasian patients (80% and 35%, respectively) at the off-site clinic; thus usage was more similar with that of a physician's office than an outpatient clinic. Symptoms seen in the after-hours clinic were primarily respiratory, ear, and throat related. In the emergency department, the symptoms were more varied, primarily febrile, respiratory, ear, throat, gastrointestinal, and urinary tract problems. There was a 3.6% increase in the number of visits in the after-hours clinic and a 1.6% decrease in the number of emergency department visits between year one and year three--data combined giving an overall 4.8% increase in the number of visits. Data show that the offsite urgent care clinic located in a suburban area increased the overall number of visits with a large number of well-insured patients. Additionally, this study provided data on where the clinic could expand medical care for the community.

Relocating rheumatology patients to a new infusion center at Duke: a case study.

Abstract: This case study concerns relocating rheumatology patients at Duke University Medical Center to a new infusion center located in a physician based treatment setting. The case study follows the managerial decision-making process as it describes how the infusion center treatment site was chosen, how it was set up, how it functions, and what benefits to patient care it provides. A successful site-of-car relocation requires strong managers who are able to weigh objectively alternative courses of action. Moreover, the project champion must be able to distinguish key factors inside and outside the organization and chart the project's course accordingly.

A case study of organizational decline: lessons for health care organizations.

Abstract: This case study reports on an organizational decline situation involving a historically well-known and respected professional organization outside the health care field, with the intention of pointing to several implications for health care. We begin by discussing the results of a survey that involved both members of the organization and "outsiders." Our primary finding, both in the survey and in presenting the results to the membership, was that while those outside the organization perceived the organization as increasingly irrelevant and in decline, those inside it reacted with defensiveness to "meddling by outsiders." We then reviewed the literature on decline, with emphasis upon important findings by Guy, to further understand our results and to make recommendations. We then turn to the situation in health care organizations and point out why some organizations may be at risk and conclude with a series of recommendations with emphasis on health care.

Sexuality, sexual harassment, and sexual humor: guidelines for the workplace in health care.

Abstract: Sexual humor is common in the health care workplace. However, it may be used inappropriately and present a challenge to the manager. Managers must set appropriate standards for workplace humor. When sexual humor is not effectively handled, legal action may result, which wastes time and money for all involved and damages interpersonal relationships.

Electronic managed care: the utilization of information technology in a managed care environment.

Abstract: Health care managers must use information technology in managed care negotiations with all players in the managed care model-employers, managed care organizations, providers, and patients. Information technology effectuates these negotiations, provides a value added to all those involved in terms of efficiency and communication, and helps managers remain within regulations. This article describes each phase of the managed care model and how information technology is used. It also provides an operational overview of how to integrate the technology into health care settings.