bluuebunny/crossref_metadata_2025 huggingface dataset:
Home Health Care Aides as Extenders of Therapy Services: A Managed Care Pilot Program
Authors: Treml Linda A. , Schulman Carrie Carter
Published: January 2017

The purpose of this project was to examine the feasibility of utilizing the home health care aide as extender of therapy services. The pilot was conducted over a one-year period involving four Kaiser home health agencies. A scope of practice analysis was completed. A resource manual and training program for home health care aides were developed. Data were collected using questionnaires, tracking logs, chart audits, and telephone case conferencing. A case study approach was used to evaluate the feasibility and cost-effectiveness of this program in lieu of skilled nursing home rehabilitation. The findings of this study showed that therapists' attitudes, perceptions, and practice patterns are critical to successful implementation of this practice. Furthermore, management buy-in and leadership were also found to have a significant impact on the use of home health care aides. Recommendations included documentation and competency testing procedure redesign. Overall, this study concluded that there is opportunity to increase the therapist to home health care aide skill mix with positive clinical outcomes, but that further study is needed to identify optimum skill mix and appropriate case mix indicators.
Improving Working Relationships between Certified Nursing Assistants and Professionals
Authors: Sullivan Elaine D.
Published: January 2017

The isolation of home health care practice can create barriers to communication among the home care team members. This project was an attempt to improve collaboration among professionals and paraprofessionals through a series of sessions, including self-assessment, didactic presentations by a multidisciplinary team, and interactive exercises. The results included self-report of increased positive feelings about work, increased appreciation of coworkers' perspectives and value, improved ability to cope with stress, increased self-awareness, improved ability to give and receive feedback, and increased receptivity to change. This was a creative approach to team building that merits further study.
Marketing Healthcare: Lessons for Smaller Hospitals
Authors: Chowdhary N. R.
Published: January 2017

Recently, I have noted ubiquitous trends that lead me to conclude that we are on the brink of a fundamental change in the structure of healthcare delivery. Hospitals are changing. The hospital, that enduring and pervasive organization, which for decades has delivered the vast majority of acute care services is being re-conceptualized. Administrators and executives in today's hospitals are beginning to recognize the disaffection of constituents and the necessity to change from placing their own agenda or that of their profession over the needs of the customer. A lesson that is increasingly being heeded, particularly by the leading hospitals, is that a belief in one's own importance or a feeling of invulnerability represents an anachronistic stance. No hospital today can afford to retain a view that it is more important than the patients it serves, or that it is invulnerable.

The external pressures are already clear—the actors, factors and forces in the external environment are forcing hospitals to re-evaluate efficiency, effectiveness and delivery arrangements. The rise to prominence of the outcomes movement is part of this trend. The present study was an attempt to assess the practices and trends in the modern smaller hospitals as a part of their strategy to match the competitive pressures.
Hospital Re-Admissions: An Empirical Analysis of Quality Management in Taiwan
Authors: Tsai Kai-Li , Lee Ay-Chen , Rivers Patrick Asubonteng
Published: January 2017

This retrospective study uses discharge-level data to analyse and assess the situation of re-admissions within 15 days of discharge, for quality evaluation. The re-admission rate of the study period was 3.22%. Among those re-admission cases, 45.7% patients were re-admitted within five days of discharge, and 33.5% cases returned to hospital six to 10 days after discharge. The average length of stays of re-admissions (9.86 days for previous stay and 8.10 days for re-admitted stay) were both longer than the hospital's overall average (7.63 days) at the same period. Paediatric patients comprised the greatest number of re-admissions. Re-admissions were more likely to have higher percentage of emergency admission. Significant relationships were found between factors for re-admissions and patient characteristics (e.g. age and insurance status), admitted department, and diagnosis. Further investigation and strategies, combined with the application of severity adjustment technique to better monitor and avoid unnecessary re-admissions, need to be developed.
Towards Benchmarking in British Acute Hospitals
Authors: Jones C. S.
Published: January 2017

The 1997 White Paper — The New NHS — on the future of the National Health Service accorded a high profile to the use of benchmarking as a means of improving efficiency over the following decade. Here, I examine the prospects for the successful adoption of benchmarking in the acute-hospital sector. A benchmarking model is superimposed upon a model of receptive contexts for change, and the components are used to explore the background to the development of benchmarking and likely attitudes towards its implementation. Where appropriate, empirical evidence is introduced to shed light on the ideas explored. I conclude that the wider political agenda accompanying benchmarking has potentially far-reaching implications for the re-distribution of resources on regional, or even national, bases. However, the steady drip—drip on stone is necessary to achieve results at local operational levels. Only by harnessing the strengths of extant cultures will efforts to identify and adopt the most efficient/effective medical practices succeed and potentially conflicting social tensions be resolved.
Planning for Alternative Futures in the NHS
Authors: Ferlie Ewan , McKee Lorna
Published: January 2017

‘The NHS needs the ability to move much more quickly’ (The Griffiths Report, 1983, p13)

This paper grew out of preliminary research undertaken for the research project on which we both work, entitled the Management of Change in the NHS. The project is based in the Centre for Corporate Strategy and Change at the University of Warwick, and is directed by Professor Andrew Pettigrew, who has previously undertaken a longitudinal study of strategic change in ICI (Pettigrew, 1985), and also a pilot study within the NHS which identified the implementation of strategic intent as the jugular problem confronting NHS managers. But a central research problem is why it is that some Health Districts manage to achieve a faster rate of change than others. Hence there was a need to trace the evolution of local systems through time, with the result that the historical analysis of changing is a key aspect of this research. The project is financed jointly by the NHSTA and a consortium of eight of the English Regions and ten case study districts are included.

The research design focusses on strategic service changes in both the acute and priority group sectors and incorporates developments and contractions. The choice of strategic changes was informed by a detailed review of the most recent regional strategic plans and the review itself prompted this paper. It led us to a number of observations about the content of the change agenda.

First, there is a high rate of change projected in the current strategic round and earlier studies of incrementalist approaches to change may have to be revised (Hunter, 1980; Ham, 1981). Secondly, these regional change agendas to a great extent reflect national/central policy and the pattern is one of uniformity. These standard agendas include RAWP; the construction of a DGH network; the run-down of long-stay mental illness/handicap hospitals; cost improvements and an increase in health promotion activity. Thirdly, alongside the top-down mechanisms to secure implementation of national objectives, another mode of planning emerges which more closely approaches the concept of ‘local learning’ (Glennester et al, 1983) where organisations seek to explore possible forces for change and how they might respond. Planning here is seen as a means of ‘problem-sensing’ and awareness building (Quinn, 1980) and getting new issues onto the agenda (Pettigrew, 1985).

The paper will explore the content of the change agenda in detail and the nature of the planning process. It will discuss an alternative methodology, scenario-building and sketches some themes which could form the basis of future health care scenarios. It argues that the standard national agenda is reaching exhaustion and that there is inadequate succession planning for ‘sunrise issues’.
The Use of Cost and Management Information to Improve the Efficiency of an out Patients Clinic
Authors: Stilwell J. A. , Hamlyn A. N.
Published: January 2017

The Project described in this paper was the development of a micro-computerised database of the management of patients presenting to a hospital clinic with abdominal pain. The database contains clinical, resource use and cost information, and was used to aid the consultant in charge to assess and monitor his patterns of management. During the course of this project, and arguably partly because of the information provided, the overall cost per patient fell by 25%. The project was carried out by the Health Services Research Unit at the University of Warwick between 1982 and 1986, the principal investigator being J. A. Stilwell. The collaborating Health Authority was Dudley, and the Consultant Gastroenterologist was Dr A. N. Hamlyn. Finance was provided by the Department of Health and Social Security.
Management Information and Self-Governing NHS Hospital Trusts
Authors: Dreachslin Janice L. , Zernott Marjorie , Fenwick Len , Canning Bernard
Published: January 2017

The proposal for self-governing hospital trusts within the NHS, announced in the White Paper Working for Patients on 31 January 1989 and enacted through passage of the National Health Service and Community Care Act 1990 last July, introduces free market incentives to NHS hospitals. Hospitals applying for self-governing status must first demonstrate that they have an information system appropriate to support decision making in the new context. An overall information systems flow and an approach to information systems development are recommended based upon the Freeman Hospital model. The Freeman Hospital is a national pilot site selected by the NHS Management Executive for development of information systems for NHS hospitals.
Pricing and Openness in Contracts for Health Care Services
Authors: Ferguson Brian , Posnett John
Published: January 2017

This paper explores the objective of increased competition and considers whether different types of competition are likely to lead to desirable market outcomes. Potential sources of market failure, and hence inefficiency, are examined. The paper then considers what type and degree of regulation may be necessary if the forces of unrestrained competition cannot be expected to achieve desirable outcomes. A number of different options, ranging from minimal regulation to central pricing schedules, are then discussed. Consideration is given to whether openness in costing and/or pricing is necessary and desirable in both short and long term. The paper raises a number of practical problems which may be faced and suggests ways in which incentives can be created to mimic the characteristics of a competitive market.
Monopolistic Competition and the Health Care Sector
Authors: Hilsenrath Peter
Published: January 2017

The model of monopolistic competition is appropriate for describing the behavior of the health care sector in the United States. Uncertainty about quality of medical and related services promotes product differentiation especially when consumers do not bear the full costs of care. New technologies can be used to signal quality even when their clinical usefulness is unproven. Recent cost containment measures may reduce employment of ineffective technologies but may also inhibit the adaptation of genuinely useful developments.
Structural and Political Models of Analysis of the Introduction of an Innovation in Organizations: The Case of the Change in the Method of Payment of Physicians in Long-Term Care Hospitals
Authors: Champagne François , Denis Jean-Louis , Pineault Raynald , Contandriopoulos André-Pierre
Published: January 2017

This article presents the results of a study on the introduction of sessional fees remuneration for physicians working in Quebec long-term care hospitals. More generally, this research was concerned with the determinants of the capacity of an organization to implement an innovation. Both a political and a structural model of analysis were empirically probed. We found strong support for the political model and moderate support for the structural model. This article contributes to the understanding of the relative contribution of structural and political determinants in the implementation of changes in organizations.
Service Patterns in Local Hospital Markets: Complementarity or Medical Arms Race?
Authors: Hughes Robert G. , Luft Harold S.
Published: January 2017

In this paper we investigate how the availability of selected services in individual hospitals is influenced by the number of neighbors who are potential or actual competitors. Hospitals offer a wide range of services, and some services may display a complementary pattern while others may contribute to a competitive medical arms race. We will examine the types of services that show these opposite patterns to analyze the dynamics that have characterized local hospital service decisions.
The Use of the FHSA Registration Index for a Health Needs Survey
Authors: Page Hilary
Published: January 2017

The FHSA patient registration index was used as a sampling frame for a population questionnaire survey. The main survey of 3,359 was preceded by a pilot study of 250. Ethical issues such as anonymity and release of data were addressed in order to obtain the approval of the ethical committee and LMC. The acceptability to GPs and the public of using FHSA Registration data was tested. The validity of the survey was indicated by the proportion of wrong addresses, the response rate and the representativeness of the sample and responders. Appropriate software is needed for selecting a random sample and producing address labels.
Hospital Closures: What is the Story?
Authors: Topping Sharon
Published: January 2017

This paper examines the data and research findings on hospital closures in order to understand better the phenomenon and to evaluate the seriousness of its impact. It presents a description of the patterns and trends and, from this, attempts to identify the factors which contribute to closings and the effects on the community, the physicians, and other hospitals. In examining the research findings, a number of managerial and research propositions are identified.
A Statistical Study of Factors Influencing Outpatient Service in Health Districts
Authors: Hindle Tony , Al-Hamad Alaa
Published: January 2017

This paper describes a statistical study within NHS health districts, using routinely available data, of the supply of outpatient services, the demands made on these services and the resulting balance of supply and demand. Indicators of supply have been investigated which aim to reflect the resources available within a district for outpatient services and indicators of demand have been studied which link to the number of general practitioners who are considered likely to make use of the services provided. Some preliminary analysis is attempted of relationships between the observed balance of supply and demand and the predictions based on the statistical models developed.
Clinicians into Management: On the Change Agenda or Not?
Authors: Fitzgerald Louise , Sturt John
Published: January 2017

This article examines the issue of drawing medical consultants into managerial decision making. It commences by examining both historically and comparatively the influences on doctors and their reluctance to adopt managerial roles and responsibilities.

It progresses to an analysis of the impact of the NHS and Community Care Act particularly in relation to the separation of purchaser and providers and the development of contracting mechanisms. The argument presented suggests that the rapid adoption of the clinical directorate model, as the favoured mode of organisation in acute units, has led to clinicians assuming ‘imitation’ general manager roles. The authors question whether this is the best use of the unique skills and time of clinicians. They compare with experience in the USA and propose that collaborative working between doctors and general managers is essential in health care. The article suggests a set of tasks for clinician managers and then dicusses the issues of training support and development which will be required if clinicians are to perform these tasks effectively.
Shifting the Financial Burden: The VA Ambulatory Care Discharge Policy
Authors: Wakefield Douglas S. , Ludke Robert L. , Rohrer James E. , Booth Brenda M. , Breese Steven , Moen Andrea , Fortney John , Zeitler Rodney
Published: January 2017

The Department of Veterans Affairs is a primary source of health care services for many of the nation's uninsured and underinsured. Changes in congressionally mandated eligibility criteria and limited increases in appropriations have forced the Department to adopt a policy of discharging chronic but stable outpatients who have been treated for non-service-connected health conditions. Survey data from one VA medical center suggest that many, but not all, of those discharged: 1) have either Medicare or private insurance coverage; 2) have not sought or found alternative physician services in then-local communities; 3) have discontinued taking previously prescribed medications; 4) report worsened health status since discharge; and, 5) have been hospitalized. In general, discharged patients from the lowest income group report the greatest financial access barriers. Preliminary analyses of the discharge policy suggest the potential for decreased access to needed medical services due to financial factors and cost-shifting from the VA to patients and other federal, state and local payers and providers.
Is There a Future for Planning Teams?
Authors: Mullen Penelope M.
Published: January 2017

Health care planning in the NHS is undergoing a revolution. The proposals in Working for Patients, which involve the separation of funding from the provision of services, and the proposals for community care in Caring for People have profound consequences for the planning and provision of services for the so-called priority groups. Planning teams, which were first established after the 1974 reorganisation, have been one of the main vehicles for planning coordinated care for such groups. The current study, which updates earlier findings, was carried out shortly before the publication of Working for Patients. It found an increased number of planning teams catering for a wider range of client groups, increasing unit involvement in care group planning and more emphasis on joint planning with local authorities. The implications of the findings for the post-review NHS are discussed, in particular the future of joint planning, the future of CHC involvement in planning and the future of planning teams themselves.
Project Risk Definition and Measurement in a Not-for-Profit Setting
Authors: Gapenski Louis C.
Published: January 2017

The health care finance literature on capital investment decisions generally applies conventional market risk concepts without distinguishing between proprietary and not-for-profit forms of organization. Since proprietary firms have shareholder wealth maximization as their primary goal, a project's relevant risk is its contribution to the riskiness of the equity investors' well diversified stock portfolios, or its market risk. However, not-for-profit organizations do not have shareholder wealth maximization as their primary goal, and thus market risk concepts are not applicable. Rather, the relevant risk in a not-for-profit setting is a project's corporate risk; that is, the project's contribution to the riskiness of the organization. The difference in risk definition and measurement between proprietary and not-for-profit firms has two implications for managerial decisions: (1) in making capital investment decisions, a manager must define and measure a project's riskiness on the basis of the firm's organizational form; and (2) although diversification for the sole purpose of risk reduction is not a valid rationale for proprietary firms because stockholders can achieve the same result at less cost, risk-reducing diversification does make sense for not-for-profit firms.
Routine Low-Cost Pathology Tests: Measuring the Value in Use of Bacteriology Tests in Hospital and Primary Care
Authors: Szczepura Ala
Published: January 2017

The introduction of a managed market in health care in the NHS will encourage managers and clinicians to examine clinical services, such as pathology, more closely. However, simple cost-minimization may not be sufficient; the recent Audit Commission report on pathology emphasises a need to measure and monitor cost-effectiveness of clinical services such as pathology. This paper presents the findings of a study to measure the cost-effectiveness of one routine pathology test; the culture and antibiotic susceptibility test performed by all microbiology laboratories. Over 2,900 requests were examined and test results tracked in hospitals and general practices served by three laboratories. The findings show that, although average test costs are low for the three main user groups (£4.3–5.9), the cost of producing an effect on patient management (change to therapy) is high at £54–67. In addition to therapy changes, the one major effect recorded was that of clinician reassurance. If all measured effects are weighted by their reported clinical utility, cost-utility ratios of £27.0 ± £1.0, £45.5 ± £4.5 and £44.5 ± £3.5 per patient management effect are calculated for general practitioner, outpatient and inpatient use respectively. A theoretical model is presented which will allow the comparative cost-effectiveness of a range of routine diagnostic tests to be measured through the use of a test-utility index, similar to the health index which is currently used to measure the outcome of medical interventions (QALYs).
RMI and Quality — Getting the Climate Right
Authors: Carswell Leslie
Published: January 2017

The literature on the Resource Management Initiative (RMI) identifies an improvement in the quality of patient care as one of its principal aims. Successful implementation of RMI requires a change in behaviour. The mechanism or process by which this is to be achieved is not clear. This paper explores the possible nature of this relationship. We suggest that an understanding of the mechanisms through which an acute hospital can influence quality is best viewed from the perspective of organisational climate. The paper suggests a normative model for exploring climate and quality linkages through the operation of six key organisational levers. The applicability of the model is discussed throughout with reference to a RM acute hospital.
Profitable and Unprofitable DRGs: The Implications for Access
Authors: Long Michael J. , Chesney James D. , Fleming Steven T.
Published: January 2017

Given a choice, hospitals would prefer to admit a patient with the potential to contribute to an accounting profit and prefer not to admit a patient with the potential to contribute to an accounting loss. It is suggested that if all hospitals found the same DRGs to be unprofitable, access to inpatient care would be denied those patient types. A set of 509 hospitals was stratified according to bedsize, Medicare load, type of control, teaching status and geographic location. The 10 most and 10 least profitable DRGs were identified for each hospital category and a Spearman's rank order correlation was used to determine the similarity or dissimilarity across hospital category. The results indicate that the more alike hospitals are in terms of bedsize, Medicare load and teaching status, the more alike are the DRGs that are determined to be unprofitable (or profitable). Conversely, the less alike they were on these characteristics, the less alike were the unprofitable (or profitable) DRGs. There were no differences evident when the hospitals were classified according to type of control or geographic location. These results are generally encouraging in terms of potential access but disturbing in terms of possible further financial threat to rural hospitals.
Comparing Surgical Efficiency in Independent Practice Association HMOS and Traditional Insurance Programs
Authors: Bradbury Robert C. , Golec Joseph H. , Stearns Frank E.
Published: January 2017

This study examines the effect of Independent Practice Association (IPA) HMO membership on hospital total charges, ancillary charges and length of stay (LOS) for surgical patients. Intrahospital comparisons of IPA and traditional insurance patients are made after adjusting for surgical procedure, admission severity of illness, age, sex and year of admission. Our multiple regression model indicates that IPA patients undergoing 12 frequently occurring surgical procedures have lower resource use. Eight (80%) of the 10 study hospitals exhibit a negative IPA beta coefficient for total charges, ancillary charges and LOS. Five (50%) hospitals have statistically significant (p <0.05) negative coefficients for total charges, while one (10%) hospital has a significant positive coefficient. IPA patients exhibit adjusted total charges that are 6% lower than traditional insurance, ancillary charges that are 4.3% lower, and LOS that is 10% shorter.
A Task Contingent Model of Medical Practice Organization
Authors: Sicotte Claude , Pineault Raynald , Lambert Jean
Published: January 2017

The treatment of acute episodes of morbidities in hospitalized patients is a complex and uncertain task. To accomplish this task, physicians organize themselves into teams in an effort to overcome two constraints: The necessity to offer both complete care and continuous care. This study examines the extent to which the nature and size of medical teams is explained by task difficulty and task variability, which are two dimensions of task uncertainty. The results support globally the hypothesis that the organization of medical practice is contingent upon the nature of the task defined in terms of uncertainty. However, the results also suggest that the task contingent model should be adjusted to take into account the fact that formal organizational characteristics may have an a priori influence on team structure.
General and Functional Level Health Care Managers: Neither ‘Manage’ Very Much
Authors: Duncan W. Jack , Ginter Peter M. , Capper Stuart A.
Published: January 2017

This paper reports the results of a study of 40 (20 paired general and functional level managers) in 20 health care organizations. The managers were personally interviewed and were asked to supply additional self-coded data from calendar entries, telephone logs, and in/out baskets. The results of this study indicated that health care managers, like their business counterparts, spend most of their time performing tasks other than traditionally defined management functions. In fact, major portions of the typical day of general and functional managers are spent exchanging routine information, processing paperwork, and interacting with others.

As the studies have confirmed with regard to business managers, the health care general managers in this study focused much of their attention on issues and events external to the organization. The information sources they valued most were primarily external to the organization. The functional managers, by comparison, were more oriented to internal issues and information sources. In general, this study indicated that the patterns of managerial work in health care organizations are similar to those in business organizations and that managers in both settings spend half their time doing things that are not ‘managerial’ in nature.
US Nursing-Home Population Composition in the PPS-ERA
Authors: Romeis James C.
Published: January 2017

This paper uses the 1987 National Medical Expenditure Survey – Institutional Population Component baseline public use data to compare US nursing-home population residents who were admitted in years adjacent to the 1982 Tax Equity and Fiscal Responsibility Act (TEFRA). This Act has been associated with claims of hospitals discharging Medicare patients quicker and sicker in order to gain financially under the prospective payment system (PPS), which would change the composition of nursing-home populations. The working hypothesis was that if PPS had an effect on the composition of nursing-home populations, those admitted during the PPS-era would have more reported deficits than those who were admitted in the pre-PPS period. Although the data are cross-sectional it was expected that differences in trends could be observed. The data do not show any general change in the composition of nursing-home populations that could be attributed to PPS. The explanation is that while PPS may have a discernible effect on short stayers, there have not been any clear effects to date on the long-stayer population represented by these data.
Waiting Lists in the Post-Review NHS
Authors: Mullen Penelope M.
Published: January 2017

Waiting lists for hospital inpatient treatment have existed since the foundation of the NHS. There have been many theories put forward to explain them and a wide range of proposals have been advanced to reduce or eliminate them. The effect of the recent changes in the NHS, coupled with the renewed political focus on waiting lists, is explored. It is concluded that access to waiting lists may be restricted, either by explicit rationing or as a result of contractual specifications. Further, the introduction of GP Fundholding, together with the purchaser-provider split, could result in a two-tier service, at least for non-urgent patients. These conclusions are illustrated by the findings from a simple simulation model.
Decentralisation of General Management within the New Zealand Health System
Authors: Malcolm Laurence , Bryson Jane
Published: January 2017

The radical organisation changes implemented in the New Zealand health system in recent years are discussed and analysed in this study which is based upon a review of documents and interviews with general managers of area health boards. Service management, which involves the decentralisation of general management to programme or product groupings (medicine, child health etc) has been widely implemented in almost all boards completely replacing the traditional disciplinary hierarchies. It is also leading to a population-rather than an institutional-based system of management. General managers report positively on the achievements of service management including greater accountability and commitment of clinical staff, innovation and team building, improved performance and service quality, the integration of hospital and community-based care and a customer rather than an occupational orientation. There is an increasing trend towards the recognition of primary health care as a key service entity.
Job Stress, Ill Health and Job Satisfaction among Health Service Employees
Authors: Rees David W. , Cooper Cary L.
Published: January 2017

The study examined the effects of occupational stressors, perceived locus of control, Type A behaviour pattern and use of coping strategies on well-being and job satisfaction of 1, 176 health service employees. Several stressors were identified as having a negative impact on health and job satisfaction although these differed between the various occupational groups included in the study.

The interactionist model of stress used in the study, and the diagnostic tool used (the Occupational Stress Indicator) proved to be useful in suggesting means of intervening to reduce ill health and increase job satisfaction among health service employees.
The Effect of Primary Nursing Job Design Dimensions on Caregiving Technology and Job Performance in Nursing Homes
Authors: Streit Andrea , Brannon Diane
Published: January 2017

Primary nursing job design, ie permanent assignment and increased job autonomy and communication, has been suggested as especially appropriate for long-term care. The present study examined its effects on nursing home assistants' (N=248) job performance and technology perceptions. Job design was found to have a significant effect on caregiving technology, even after controlling for individual differences. In particular, increased autonomy was significantly related to increased task variability which suggests that nursing assistants who have more job autonomy provide more customized care. Unexpectedly, increased duration of assignment was significantly related to increased homogeneity of tasks. Suggestions for future job design research in long-term care are made.
Structure, Environment and Strategic Outcome: A Study of Pennsylvania Nursing Homes
Authors: Aaronson William E. , Zinn Jacqueline S. , Rosko Michael D.
Published: January 2017

This study applies Porter's model of competitive advantage to the nursing home industry. Discriminant analysis is used to identify organizational and environmental characteristics associated with nursing homes which have demonstrated valued strategic outcomes, and to distinguish the more successful nursing homes from their rivals. The results of the discriminant analysis suggest that nursing homes with superior payer mix outcomes are distinguishable from their less successful rivals in areas associated with a focused generic strategy. The study suggests that nursing homes which are better staffed, of smaller size and lower price are more likely to achieve high levels of self-pay utilization. Independent living units, continuing care retirement communities in particular, are likely to act synergistically with nursing home organizational characteristics to enhance competitive advantage by linking the value chain of the nursing home to that of retirement housing. Nursing homes with higher proportions of Medicare were found to provide a unique product when compared to their rivals. Profit status does not discriminate better self-pay strategic utilization, but for-profit facilities are more likely to pursue a Medicare strategy. Concern was raised that, as nursing homes become more strategically oriented, Medicaid access may become more problematic.
The Development of Measures of Organizational Citizenship Behaviour and Changes in Job Behaviours Related to Quality Management in Health Care
Authors: Irvine Diane
Published: January 2017

A study was conducted at two tertiary care hospitals in Canada for the purpose of developing instruments to measure organizational citizenship behaviours (OCB) and changes in job behaviours that occur as a result of participation on hospital quality improvement (CQI) teams. Semi structured interviews were conducted among 52 hospital employees in order to elicit critical incidents of OCB and changes in job behaviours related to CQI. The results of the staff interviews were used to develop a measure of OCB in the hospital setting, and a measure of changes in job behaviours related to CQI. 39 employees, who were drawn from the major departments within the two hospitals on the basis of their membership on CQI teams, participated in a test of the psychometric properties of the two research instruments. Exploratory factor analysis, employing an orthogonal rotation, yielded two factors that accounted for 30% of the variation among the OCB items. The Cronbach alpha for items loading highly on the first factor was .88. The factor was labelled ‘OCB directed towards individuals within the organization’. This factor was dominated by items reflecting the kinds of extra-role job behaviours employees engage in to assist patients, family members, visitors, and other employees within the organization. The Cronbach alpha for items loading highly on the second factor was 0.71. The second factor was labelled ‘organizationally directed OCB’, and consisted of behaviours that reflected an impersonal form of OCB in the hospital setting.

Factor analysis, employing an orthogonal rotation, yielded four factors that accounted for 48% of the variation among the items measuring changes in job behaviours related to CQI. The four factors were labelled ‘problem-solving’, Cronbach alpha 0.82; ‘customer awareness’, Cronbach alpha 0.79; ‘use of CQI knowledge’, Cronbach alpha 0.77; and ‘organizational interests’, Cronbach alpha 0.79. The two OCB factors were moderately correlated, there were no significant correlations among any of the factors measuring changes in job behaviours related to CQI, and the problem-solving job behaviours factor was moderately correlated with the two OCB factors. Directions for future research are discussed.
Organizational Change, Patient-Focused Care: An Australian Perspective
Authors: Braithwaite Jeffrey
Published: January 2017

Hospitals throughout the world are attempting to improve organizational performance through a variety of means. The focus in this paper is on a leading teaching hospital in Australia for a review of current management strategy. In a time of shrinking resources, management adopted a multi-faceted change management program including restructuring the organization, becoming more patient-focused via a product-line management approach and emphasising efficiency and cost-reduction measures. The next stage in management thinking is to place greater emphasis on patient-focused care. It is concluded this has the propensity to yield substantial further benefits, including improved financial and quality of care outcomes, in the Australian as well as the British and wider Organization for Economic Co-operation and Development (OECD) context.

‘Professionally, we have committed ourselves to creating caring environments that promote healing. We cannot meet this goal until we make a commitment to be patient-focused and give up being nurse-focused or facility-focused’ (Kerfort and LeClair, 1991).

‘In a customer-driven [organization], the distribution of roles is different. The organization is decentralized, with responsibility delegated to those who until now have comprised the order-obeying bottom level of the pyramid. The traditional, hierarchical corporate structure, in other words, is beginning to give way to a flattened, more horizontal structure’ (Carlzon, 1987).
Fundraising, Government Grants and Donations to Non-Profit Hospital Charities
Authors: Smith Dean G. , Wheeler John R. C. , Clement Jan P.
Published: January 2017

Using 1982–1987 tax return data from California hospital charities, this paper investigates the relationship between fundraising expenditures, government grants and donations, during a time in which significant changes were being made in the system of hospital reimbursement. Empirical results suggest that while donations have been declining, charities have been efficient in their solicitation of donations. Results also suggest that government grants worked to reduce charitable contributions in the period before the institution of Medicare's Prospective Payment System. In more recent years, government grants have been associated with increases in donations to hospital charities.
Determinants of Maternal Mortality in Rural China
Authors: Li Q. , Fottler M. D.
Published: January 2017

A case-control study of maternal mortality was conducted in selected rural areas of two provinces in China: Henan province, which has a relatively lower socio-economic status and higher maternal mortality rates, and Jiangsu province with higher socio-economic status and lower maternal mortality rates. The major cause of maternal mortality in the two provinces was postpartum hemorrhage and the largest proportion of deaths occurred on the road between the women's home and the health care facility. Results indicate that the expectant mother's socio-economic status, knowledge of maternal care, and the nature and level of maternal care provided all influence rural maternal death rates. However, socio-economic factors were only significant predictors of mortality in the poorer province. Implications for health policy and future research are discussed.
Demographic and Epidemiological Aspects of Plastic Surgery: Profile of a Supradistrict Specialty
Authors: Goldacre M. J. , Ferguson J. A. , Goodacre T. E. E.
Published: January 2017

The workload of plastic surgery is often poorly understood by the public and those responsible for financing health care. The authors have used linked statistical data to analyse demographic and epidemiological profiles of workload in plastic surgery in Oxfordshire. The analyses were constructed for residents of the district and for patients treated from other districts. The former provides a profile of workload generated for plastic surgery from a geographically-defined population. The latter complements this by adding information about ‘imported’ workload. Admission rates for plastic surgery were higher for children and elderly people than for other age groups; higher for males than females; and they increased during the 11 years of the study. Most of the increase represented an increase in people treated by the service, rather than an increase in readmissions, although there was a modest increase in the latter too. Lengths of stay per admission and total time spent in hospital per person declined considerably. The bulk of the workload in plastic surgery is concerned with the treatment of trauma (including burns), cancer and congenital malformations. The main clinical conditions treated by the specialty are documented distinguishing, for each condition, the extent to which the patients came from outside the authority in which the provider unit is sited.
Prediction of the financial performance of Ontario hospitals: A Test of Environmental Determinist and Adaptationist Perspectives
Authors: Narine L. , Pink G. , Leatt P.
Published: January 2017

While other industries for many years have been concerned with the problem of financial distress, it is only recently that this issue has become a matter of interest to hospital managers, policy makers, and the general public. However, the determinants of hospital financial performance are neither well studied nor understood.

The objectives of this study were to identify factors that affect the financial performance of Ontario hospitals and to construct a model that could be used to predict financial performance in the future. A number of organization and environmental factors that could influence financial performance were postulated and then tested for their statistical impact and predictive ability.

Cross-sectional data over the 3-year-period 1986–1988 for 223 Ontario public hospitals were used. The first 2 years of data served as a derivation sample for hypothesis testing and development of a predictive model. The third year of data was used as a holdout sample for cross validation. Information on the variables investigated came from secondary sources, in particular Statistics Canada's Annual Hospital Returns.

Univariate analyses revealed distressed hospitals were more likely to earn more revenues from non-government sources, to be non-teaching institutions and have longer chronic lengths of stay, and to be found in areas with higher per capita incomes, number of females in the population, physician supply, and area wage rates. A five variable prediction model was developed which accounted for 25% of the variance in financial performance in the derivation sample and on cross validation dropped to 21%. The model identified greater hospital size, older plants, higher technological complexity, more intensive care services, and location in areas with more females to be significant predictors of financial distress.

Overall, environmental factors (community and structural characteristics) were more important in influencing financial performance. The implication for hospital managers is to underscore that an important dimension of successful leadership requires they remain outwardly focused and involved in managing the external environment. For policy makers the need is to develop funding formulae which encourage efficiency and are also responsive to differences in community and structural characteristics across hospitals.
Financial Performance of Safety-Net Hospitals in a Changing Health Care Environment
Authors: Gautam K. , Campbell C. , Arrington B.
Published: January 2017

Safety-net hospitals serving the poor and indigent in inner-cities have received inadequate research attention regarding the determinants of their financial performance in the changing health care environment. We analyze how the 1990–1992 financial performance of 275 such hospitals is related to exogenous and endogenous factors such as payer mix, service mix, staffing and ownership. Models of hospital financial performance are developed using operating margin, cost per discharge and revenue per discharge as measures of performance. Stepwise regression is used to test the model with data from the American Hospital Association (AHA) and Health Care Investment Analysts (HCIA).

Results suggest that: 1) The profitability of inner-city hospitals appears positively related with technical complexity of care; 2) High interest and low operating surplus may constrain the addition of technically sophisticated services to enhance profitability; 3) There is some evidence that new governmental programs, e.g. Medicaid managed care and Medicaid Diagnosis Related Groups (DRGs), may not have improved operating margins, though Medicaid DRGs appear to have contained costs. Follow-up research is needed on this issue; 4) Given external fiscal realities, internal management strategies for inner-city hospitals require research, e.g. developing appropriate managed care systems and timely expansion of sub-acute services and; 5) Services such as AIDS treatment and community health education represent opportunities to respond to community needs, especially since unit cost of such services will decline with high volume.
Auditing Senior Management Communication Practices in the NHS: A Regional Study
Authors: Hargie O. D. W. , Tourish D.
Published: January 2017

Increasingly, organizations are being confronted with significant strategic change. This process can only be managed effectively if human resource implications, including how effectively managers and staff communicate with each other, are taken into account. This paper outlines how communication audits provide managers with insights into patterns of communication within their organizations. The nature of communication audits are briefly delineated and explained. An investigation from within the National Health Service (NHS) is offered, which illustrates how a communication audit focusing on relationships between regional, district and local levels of management illuminated patterns of communication between senior managers at these levels. This resulted in the development of an action plan for the improvement of communication practices. The generalizability of these findings to the NHS is discussed.