|
Executive
Summary
Adverse Drug Events in the Elderly Population Admitted to a Tertiary Care
Hospital
Nahid Azad, MD, associate professor, Faculty of Medicine, Geriatric
Assessment Unit, The Ottawa Hospital Civic Campus, Canada; Michael Tierney,
MSc, director, Pharmacy, The Ottawa Hospital General Campus; Gary Victor,
MD, program director, Internal Medicine Residency Training Program, The
Ottawa Hospital General Campus; and Parul Kumar, MD, MSc, research assistant,
Internal Medicine, University of Western Ontario, London
Older adults
take almost one-third of the drugs prescribed today yet represent only
about 12 percent of the population. Adverse drug events are common in
this population, but often these events appear to be preventable. Interest
in adverse events related to the use of prescription drugs has rarely
been higher or broader. The research community continues to develop new
tools to study adverse effects of drugs in individuals and populations.
However, the published literature on drug-related adverse events is fraught
with problems, starting with the original reports and extending to systematic
reviews. Prospective data are missing, drug adverse events are poorly
described, and analytic methods are questionable. This leads to problems
with imprecise estimates and generalizability of results.
Executive
Summary
The Effect of Governing Board Composition on Rural Hospitals' Involvement
in Provider-Sponsored Managed Care Organizations
Shadi S. Saleh, Ph.D., assistant professor, Department of Health Policy,
Management and Behavior, School of Public Health, State University of
New York at Albany; Thomas Vaughn, Ph.D., assistant professor, Department
of Health Management and Policy, College of Public Health, University
of Iowa, Iowa City; and James E. Rohrer, Ph.D., professor and chair, Department
of Health Services Research and Management, Texas Tech University Health
Sciences Center, Lubbock
Rural hospitals
are actively pursuing various strategic alternatives to confront the dramatic
changes taking place in the delivery, organization, and financing of healthcare.
One of these strategic alternatives is involvement in provider-sponsored
managed care organizations. Studies have argued that this form of managed
care would enhance public trust and might improve the performance of hospitals.
The changing healthcare environment has also increased the importance
of the competence and composition of hospital boards. This article examines
the effect of the governing board's composition on rural hospitals' involvement
in provider-sponsored managed care organizations. The study sample consisted
of 140 rural hospitals in Iowa and Nebraska whose CEOs responded to a
survey conducted by the Center for Health Services Research at the University
of Iowa between June and December 1997.
The principal finding was that the likelihood of a hospital owning any
form of managed care organization increases with the number of community
leaders and health professionals on the board. The number of business
leaders had no effect on the likelihood of involvement in such an arrangement.
Other factors that affected the likelihood of owning a managed care organization
were the health status of the population and ownership type. Key recommendations
to managers are to (1) revisit the hospital board's composition before
actively pursuing a strategic action, (2) examine the compatibility of
the type of strategic activity pursued with the background of board members
and the interests of the populations they represent, and (3) use the governing
board as a resource in determining which new strategic activities to undertake.
Executive
Summary
Organizational Design Consistency: The PennCARE and Henry Ford Health
System Experiences
Nicole L. Dubbs, Ph.D., assistant professor, Joseph L. Mailman School
of Public Health, Department of Health Policy and Management, Columbia
University, New York
There has
been much discussion of the appropriateness of various organizational
strategies for today's healthcare industry. This article presents case
studies of two healthcare organizations that have pursued very different
configurations. PennCARE uses a virtually integrated, loose contract-based
arrangement, while Henry Ford Health System employs a vertically integrated,
tight ownership model. Despite these different approaches, their overall
designs are strikingly similar. In essence both systems demonstrate a
property called organizational design consistency; they simply approach
it from different ends of the spectrum.
This article presents the notion of organizational design consistency
and defines it as the steady pursuit of a single preferred configuration
strategy across key elements of organizational design. To illustrate the
framework the case studies target four key elements of organizational
design (governance structure, organizational culture, strategic planning
processes, and decision-making procedures) and explain how consistency
across these components adds value to both of these differently configured
healthcare systems. There is room enough for diverse configurations of
organizations in the current healthcare environment. Consistency does
not mandate conformity; value can be derived from both tight and loose
models. Furthermore, when fashioning organizational design consistency
strategies, healthcare systems should carefully choose tightly or loosely
modeled configurations to appropriately suit their aims, their markets,
and the capabilities and resources available to them.
|
