Books & Journals

Buy HAP Books
Online Now!
  Books & Journals Links:
 
 

Volume 48, Number 3
May/June 2003

I. INTERVIEW
Interview with David L. Bernd, FACHE, CEO, Sentara Healthcare, Norfolk, Virginia, Kyle Grazier

II. CAREERS
Building Job Security: Strategies for Becoming a Highly Valued Contributor, Mike Broscio and Jay Scherer

III. STRATEGIC MARKETING
The Value of Market Research, Howard J. Gershon and William C. Jackson

IV. ARTICLES

  • Physicians and Hospital Managers as Cofiduciaries of Patients: Rhetoric or Reality? Frank A. Chervenak, and Laurence B. McCullough
  • Organizational Downsizing: A Review of Literature for Planning and Research, Jullet A. Davis, Grant Savage, and R. Thomas Stewart
  • A Profile of Hospital Acquisitions, Jeffrey P. Harrison, Michael J. McCue, and Bill B. Wang

V. Fellow Project
Development of an Inpatient Rehab Facility in an Urban Safety-Net Hospital,
Robert G. Larrison, Jr.

Executive Summary
Physicians and Hospital Managers as Cofiduciaries of Patients: Rhetoric or Reality?
Frank A. Chervenak, and Laurence B. McCullough

The reality of physicians and hospital managers as cofiduciaries of patients is of vital importance today. In this article we develop the concept of physicians as fiduciaries of patients based on the work of John Gregory and of hospitals as fiduciaries of patients based on the work of Thomas Percival to supplement the recent literature on organizational ethics in healthcare. To be a fiduciary of patients means that (1) one possesses expert knowledge and skills on how to protect and promote the health-related interests of patients and (2) one is committed to using that expertise primarily for the benefit of the patient and to making self-interest a systematically secondary consideration. This concept is accepted in contemporary medical ethics and law (McCullough and Chervenak 1994).
We identify two core virtues-diffidence and compassion-as vital to the fiduciary role. We use these virtues to develop preventive ethics strategies for dealing with two major problems in physician-hospital administrator interactions, what we call strategic procrastination and strategic ambiguity. The main preventive ethics response to both strategic procrastination and strategic ambiguity is to point them out when they occur and to emphasize that they compromise cofiduciary responsibility. As a preventive ethics response to strategic procrastination, physicians and managers should provide role models of accountability and change policy and practice in a timely manner when intellectually obligated to do so. As a preventive ethics response to strategic ambiguity, physicians and managers should be role models of transparency by being explicit in their communications.

Executive Summary
Organizational Downsizing: A Review of Literature for Planning and Research
Jullet A. Davis, Grant Savage, and R. Thomas Stewart

The use of downsizing as management's strategic response to environmental and institutional changes is prevalent in all U.S. industries, including healthcare. The popular and research literature is inundated with reports on companies undergoing various stages of restructuring, which often include one or more staff reductions. This article provides a review of downsizing literature published from 1985 to 2002. Although the findings and conclusions of these articles are generally inconsistent, the prevailing opinion is that for downsizing to be successful, effective planning must occur long before, during, and post downsizing. Additionally, a downsizing plan should be included in the strategic management plan of all organizations, regardless of whether they plan to downsize or not. By including such a plan, the organization will be better prepared to begin the staff-reduction process should it be forced to do so in response to environmental changes. Finally, providing ample support and protection for staff is key to the organization's recovery and growth. The lessons provided in this literature review should assist healthcare managers in deciding how to plan and structure potential staff reductions.

Executive Summary
A Profile of Hospital Acquisitions
Jeffrey P. Harrison, Michael J. McCue, and Bill B. Wang

The number of hospitals acquired by hospital systems has declined from 99 facilities in 1996 to less than 63 facilities between 1999 and 2000. We evaluated the market, operating and organizational factors, and their relationship to these hospital acquisitions that occurred during this period of decline. We found that acquired hospitals, on average, operated at a loss, incurred higher debt levels, and were more likely to be located in markets with a large number of health maintenance organizations. Older, for-profit hospitals with fewer occupied beds were also likely targets for hospital acquisitions.