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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.
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