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Executive
Summary
Understanding the Impact of Variation in the Delivery of Healthcare Services
Charles E. Noon, Charles T. Hankins, and Murray J. Cote
In the past
several years, healthcare providers have coped with the financial aspects
of
managed care and the resultant constraints on revenue. In fact, working
with decreasing margins of return has become routine for many providers.
Beyond straightforward cost cutting, providers must also consider a variety
of other operational factors to achieve success. To this end, higher patient
satisfaction and improved utilization and efficiency of resources are
natural objectives. Ironically, fundamental to the pursuit of better operations
management is the fact that the delivery of healthcare services can vary
between and among patients, providers, and organizations for many reasons.
Unfortunately, such variation may be overlooked or trivialized if the
phenomenon is not well understood by healthcare managers. Knowing how
variation affects the delivery of services creates opportunities for focused
improvement.
Executive
Summary
The Perils of Healthcare Workforce Forecasting: A Case Study of the Philadelphia
Metropolitan Area, David Barton Smith and William Aaronson
In 1996,
a widely circulated and influential forecast for the Philadelphia Metropolitan
Area stated that a decline in hospital and healthcare employment in the
region would occur over the next five years. It also suggested that this
decline would exacerbate the problem of an oversupply of nurses seeking
hospital employment. The forecast reflected a regional leadership and
expert consensus on the impact of the managed care transformation on workforce
needs and was supported by short-term statistical trends in regional utilization
and employment. Confounding these predictions was that hospital and healthcare
employment actually grew. By the end of 2001, hospitals in the region
were experiencing problems in recruiting sufficient nurses, pharmacists,
and technicians. The forecast failed to anticipate the impact of a strong
regional economy on supply and underestimated the resilience of underlying
forces that have driven the long-term growth in healthcare workforce demand.
More effective ongoing monitoring can help moderate the fluctuation of
workforce shortages and surpluses.
Executive
Summary
Relationship-Centered Administration: Transferring Effective Communication
Skills from the Exam Room to the Conference Room, Kim Marvel, Austin Bailey,
Carol Pfaffly, William Gunn, and Howard Beckman
Medical researchers
have shown that relationship-centered healthcare increases patient satisfaction
and improves health outcomes. The components of relationship-centered
healthcare-listening, sharing decision making, and respecting others-improve
patient motivation and commitment to a plan of action. Currently, no data
are available on the extent to which medical administrative settings adhere
to relationship-centered principles. To begin to answer this question,
we observed a convenience sample of 45 meetings in healthcare settings
to assess the frequency and types of relationship-centered behaviors shown
by group leaders. Our results provide preliminary data that leaders, especially
female leaders, praised the value of group member efforts and encouraged
members to provide input. Less frequently employed relationship-centered
behaviors included providing a verbal summary of a discussion, responding
to feelings expressed by members, and setting explicit agendas. Finally,
we found some provocative associations. Female leaders received higher
satisfaction ratings, and male leaders were more verbally dominant. Similar
to physician-patient interaction, new topics for discussion are less likely
to arise spontaneously late in a meeting if early agenda-setting is utilized.
To our knowledge, this is the first such study in a medical setting. Our
findings encourage those who chair meetings to reflect on the extent to
which they use a collaborative approach and offers specific content areas
on which to focus. Further research on the concept and outcomes of relationship-centered
administrative approach is warranted.
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