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Volume 47, Number 1
January/February 2002

    Interview with John G. King, Advisor, Legacy Health System, Kyle L. Grazier
    Managing Threats from Venture Capitalists, Earl Simendinger, Boone Powell, Jr., and Diane Vizzi
    The Roles of the Senior-Level Executive, Gail Scott
    • The Relationship Between Hospital Unit Culture and Nurses' Quality of Work Life, Blair D. Gifford, Raymond F. Zammuto, and Eric A. Goodman
    • Urban U.S. Hospitals and the Mission to Provide HIV-Related Services: Changes and Correlates, Kenneth R. White, Susan D. Roggenkamp, and Allen J. LeBlanc
    • Measuring Comparative Hospital Performance, John R. Griffith and Jeffrey A. Alexander
  5. Fellow Project
    Computer Simulation: A Methodology to Improve the Efficiency in the Brooke Army Medical Center Family Care Clinic, Major John F. Merkle

Executive Summary: The Relationship Between Hospital Unit Culture and Nurses' Quality of Work Life
Blair D. Gifford, Ph.D., associate professor of health administration & management, College of Business, University of Colorado at Denver; Raymond F. Zammuto, professor of management, University of Colorado at Denver; and Eric A. Goodman, assistant professor, Management Department, Colorado Technical University, Colorado Springs, Colorado

Turnover rates for hospital nurses have been increasing in recent years, which is partially a result of increasing pressure on nurses from higher productivity expectations in a managed care environment. Improving nurse retention is a difficult challenge to managers since the bureaucratic cultural norm of hospitals, with its hierarchical structures, rules, and regulations, and heavy emphasis on measurement of outcomes and costs, may not be the culture most conducive to enhancing nurses' job satisfaction and commitment. Accordingly, this study investigates the relationships between unit organizational culture and several important job-related variables for nurse retention in the labor and delivery units of seven hospitals. Data analysis shows that unit organizational culture does affect nurses' quality of work life factors and that human relations cultural values are positively related to organizational commitment, job involvement, empowerment, and job satisfaction, and negatively related to intent to turnover. These findings suggest that although increasing recruitment of nurses and improved compensation and benefits strategies may offset hospital nurse shortages in the short term, improving quality of work life may be a more practical and long-term approach to improving hospital nurse retention.

Executive Summary: Measuring Comparative Hospital Performance
John R. Griffith, FACHE, Andrew Pattullo Collegiate Professor, The University of Michigan School of Public Health, Ann Arbor; and Jeffrey A. Alexander, Ph.D., Richard C. Jelinek Professor of Healthcare Management, The University of Michigan School of Public Health, Ann Arbor

Leading healthcare provider organizations now use a "balanced scorecard" of performance measures, expanding information reviewed at the governance level to include financial, customer, and internal performance information, as well as providing an opportunity to learn and grow to provide better strategic guidance. The approach, successfully used by other industries, uses competitor data and benchmarks to identify opportunities for improved mission achievement. This article evaluates of one set of nine multidimensional hospital performance measures derived from Medicare reports (cash flow, asset turnover, mortality, complications, length of inpatient stay, cost per case, occupancy, change in occupancy, and percent of revenue from outpatient care). The study examines the content validity, reliability and sensitivity, validity of comparison, and independence and concludes that seven of the nine measures (all but the two occupancy measures) represent a potentially useful set for evaluating most U.S. hospitals. This set reflects correctable differences in performance between hospitals serving similar populations, that is, the measures reflect relative performance and identify opportunities to make the organization more successful.

Executive Summary: Urban U.S. Hospitals and the Mission to Provide HIV-Related Services: Changes and Correlates
Kenneth R. White, Ph.D., FACHE, associate professor and director, Graduate Program in Health Administration, Department of Health Administration, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond; Susan D. Roggenkamp, Ph.D.
assistant professor, Department of Management, Appalachian State University, Boone, North Carolina; and Allen J. LeBlanc, Ph.D., senior research associate, MDRC, San Francisco, California

In 1988, the vast majority of urban U.S. hospitals (84 percent) exhibited some formal response to the demand for HIV-related services. Despite the fact that HIV-related care is now normative in many respects and the demand for inpatient care has decreased, nearly half of hospitals surveyed in 1997 (42 percent) report no formalized service provision, suggesting a heightened distinction between hospitals in terms of their varying commitments to providing HIV-related services. Certain organizational variables (such as ownership, size, system affiliation, and stigmatized services and post-acute care services indices) were connected to HIV-related services provision. When the sample was controlled for other variables, the study found that changes in teaching status, changes in bed size, and changes in post-acute services from 1988 to 1997 did influence the provision of HIV-related services. Despite significant changes over the study period in the treatment of persons living with HIV/AIDS, and structural changes in the delivery of U.S. healthcare the organizational-level predictors of HIV-related service provision have remained remarkably stable among U.S. hospitals in urban settings. These data also suggest that organizational missions consistent with serving indigent and socially marginalized populations continue to influence the ways that the pluralistic U.S. hospital system organizes HIV-related care.