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Volume 47, Number 2
March/April 2002

  1. Interview
    Interview with Judy Pelham, FACHE, president and CEO Trinity Health, Kyle Grazier
  2. QUALITY AND SAFETY
    Providing High-Quality Healthcare: Are We Up To The Task? Alan E. Cudney
  3. STAFFING
    A Changing Workforce Calls for Twenty-first Century Strategies, Steven M. Barney
  4. ARTICLES
    • Ethical Dilemmas in Home Care Case Management, Elaine Gallagher, Denise Alcock, Elizabeth Diem, Douglas Angus, and Jennifer Medves
    • Rekindling the Flame: Routine Practices That Promote Hospital Community Leadership, Peter Weil and Rita Harmata
    • Racial/Ethnic Diversity Management and Cultural Competency: The Case of Pennsylvania Hospitals, Robert Weech-Maldonado, Janice L. Dreachslin, Kathryn H. Dansky, Gita de Souza, and Maria Gatto
V. FELLOW PROJECT
Development of a Capitated System for Reimbursing Physicians Under a Professional Risk HMO Contract, Barry Eisenberg

Executive Summary

Ethical Dilemmas in Home Care Case Management
Elaine Gallagher, Ph.D., School of Nursing, University of Victoria; Denise Alcock, Ph.D., faculty of health sciences, University of Ottawa; Elizabeth Diem, Ph.D., faculty of health sciences, University of Ottawa; Douglas Angus, M.A., faculty of administration, University of Ottawa; and Jennifer Medves, Ph.D., faculty of health sciences, University of Ottawa

The role of case manager is fraught with challenges in a healthcare environment characterized by rapid aging of the population, a move against institutionalization of seniors, and the need to contain healthcare costs. This study examined experiences of 89 case managers through focus groups in five urban and five rural regions of Canada to identify ethical dilemmas and issues encountered in the role. Overall, the case managers expressed frustration for the lack of support for their work as evidenced by inadequate resources and few agency policies. The analysis of the focus group data revealed four main themes in relation to ethical concerns and dilemmas: (1) issues related to equity, (2) beneficence, (3) non-maleficence, and (4) autonomy and power imbalances. The situation facing these workers is grave and steps must be taken to provide them with ongoing training, support, and resources to continue in this vital role. System changes that would reduce some of the ethical conflicts experienced by case managers include funding for long-term care to keep pace with growing demands, better management of client waitlists to ensure that the most needy are given the highest priority, more supportive housing options that provide for some on-site coordination of services, better opportunities for health promotion, and better interdisciplinary teamwork so that case managers are not left making decisions in the absence of other key service providers.

Executive Summary

Rekindling the Flame: Routine Practices That Promote Hospital Community Leadership
Peter Weil, Ph.D., FACHE, vice president of research and development, American College of Healthcare Executives, Chicago, and Rita Harmata, Ph.D., CHE, director, Trustee and Community Leadership, American Hospital Association, Chicago

Because of the need to focus on their financial survival, hospitals and health systems are not the popular community-oriented institutions they once were-too many have set aside their mission to promote and protect the health of their communities. . By conducting on-site interviews with CEOs, other executives, board members, and community partners in seven hospitals across the nation, we discovered 25 management and governance practices used by hospitals that excel in relating to their communities. We have grouped these practices for promoting community health into six functions: (1) identifying community needs; (2) setting goals; (3) allocating financial and human resources; (4) educating leaders, staff, and community members; (5) measuring outcomes; and (6) sustaining the mission. Specific examples are given that describe what we learned. Ultimately, we hope to engender a dialog about other management and governance practices that have proven successful in promoting hospitals' involvement in community health.

Executive Summary

Racial/Ethnic Diversity Management and Cultural Competency: The Case of Pennsylvania Hospitals, Robert Weech-Maldonado, Ph.D., assistant professor, department of health policy and administration, The Pennsylvania State University, University Park; Janice L. Dreachslin, Ph.D., associate professor of health policy and administration, Penn State Great Valley School of Graduate Professional Studies, Malvern; Kathryn H. Dansky, Ph.D., associate professor, department of health policy and administration, The Pennsylvania State University, University Park; Gita De Souza, Ph.D., assistant professor of business administration, Penn State-Delaware County Campus, Media; and Maria Gatto, health insurance specialist, Centers for Medicare and Medicaid Services, Chicago

Major demographic trends are changing the face of America's labor pool, and healthcare managers increasingly face a scarcer and more diverse workforce. As a result, healthcare organizations (HCOs) must develop policies and practices aimed at recruiting, retaining, and managing a diverse workforce and must meet the demands of a more diverse patient population by providing culturally appropriate care and improving access to care for racial/ethnic minorities. Ultimately, the goal of managing diversity is to enhance workforce and customer satisfaction, to improve communication among members of the workforce, and to further improve organizational performance. Research on diversity management practices in healthcare organizations (HCOs) is scarce, providing few guidelines for practitioners. This study attempted to close that gap. Results show that hospitals in Pennsylvania have been relatively inactive with employing diversity management practices, and equal employment requirements are the main driver of diversity management policy. The number and scope of diversity management practices used were not influenced by organizational or market characteristics. The results suggest that hospitals need to adopt diversity management practices for their workforces and need to pay particular attention to marketing and service planning activities that meet the needs of a diverse patient population.