|
Executive
Summary
An
Early View of the Impact of Deregulation and Managed Care on Hospital
Profitability and Net Worth
W. Jack Jordan, Ph.D., professor, Department of Economics, School
of Business, Seton Hall University, South Orange, New Jersey
This
study shows the impact of the removal of hospital rate regulation followed
by the growth of managed care on hospitals' profitability and net worth.
New Jersey merged from a regulated prospective payment system in 1992.
The transition to a really competitive market structure had a negative
impact on hospital profitability, net worth, patient length of stay, and
other measures of capacity utilization. The doubling of the HMO penetration
rate in the state between 1995 and 1997 is shown to have negatively influenced
hospital financial viability. Hospitals have responded in part by increasing
usage of outpatient services. The use of dis-counted fee-for-service instead
of per diem reimbursement for outpatient services provides an incentive
for hospitals to favor outpatient over inpatient services. The effect
of these changes is detailed, along with data showing that the larger
disc-ounts given by hospitals to managed care organizations, Medicare,
and Medicaid played an important role in explaining the diminished profitability
of hospitals. The Journal regrets that Dr. Jordan passed away before the
publication of this article.
Executive
Summary
Nursing
Shortage: Building Organizational Commitment Among Nurses
Donna K. McNeese-Srnith, MN, Ed.D., CNAA, assistant professor and
coordinator, Nursing Administration Graduate Program School of Nursing,
University of California, Los Angeles
As a
major nursing shortage threatens healthcare organizations, the views of
30 staff nurses are examined to determine factors that contribute to their
commit-ment or lack of commitment to their employing hospital. Content
analysis iden-tified that organizational commitment is most related to
personal factors, opportu-nities for learning, job satisfaction, plan
for retirement, monetary benefits, patient care, coworkers, cultural factors,
and job secutity, in that order. Lack of organiza-tional commitment is
most related to conflict with personal needs. However lack of learning,
lack of appreciation and fairness, inadequate monetary benefits, patient
care situations, poor relations with coworkers, career developmental stage,
and lack of job security are also discussed. Application of these findings
to healthcare ad-ministration is discussed, with strategies for building
organizational commitment among nurses.
Executive
Summary
Developing
Leadership in Healthcare Administration: A Competency Assessment
Catherine J. Robbins, MBA, Brandeis University, Waltham, Massachusetts;
Elizabeth H. Bradley, Ph.D., Yale School of Public Health, New Haven,
Connecticut; and Maryanne Spicer, MA, Massachusetts General Hospital,
Boston, Massachusetts
Despite
the many graduate programs that specialize in health administration,
healthcare leaders and practitioners have expressed concern about
the quality of preparation of health administration graduates. The
purpose of this study was to facilitate one part of an integrated
approach to leadership development that spans academic and practitioner
settings. The approach was to design a competency assessment tool
for early careerists who have two to five years of postgraduate
experience and who aspire to fill senior leadership positions in
complex, provider-based healthcare organizations.
Open-ended
interviews with key informants and a comprehensive review of relevant
literature were done to identify and categorize a set of competencies
relevant to early careerists. Based on data from key informants,
specific work experience and academic courses were mapped to each
competency, indicating where and how such competencies might be
developed. A simple rating system was then added to assess each
competency, which resulted in the completion of the tool. Finally,
the tool was piloted in a practitioner setting at the Massachusetts
General Hospital Administrative Fellowship Program and in an academic
setting at the University Health Management Program.
The
resulting tool includes 52 competencies categorized into four domains:
(1) technical skills (operations, finance, information resources, human
resources, and strategic planning/external affairs); (2) industry knowledge
(clinical process and healthcare institutions); (3) analytic and conceptual
reasoning and (4) interpersonal and emotional intelligence. Early experience
with the tool suggests that it facilitates career planning among graduate
students, early careerists, and their mentors. Further, the tool can help
directors of both academic and practitioner programs identify strengths
and gaps in their existing curricula or training program. By offering
specific competencies linked to work experiences and graduate courses,
the tool is an initial step toward promoting collaborative efforts between
academic and practitioner programs.
Click
here to see the Competency Assessment
Tool mentioned in this issue.
|
