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Executive
Summary
Perfect
Storm: Organizational Management of Patient Care Under Natural Disaster
Conditions, William Cass McCaughrin and Maria Mattammal
Managing uncertainty is an essential attribute of organizational leadership
and effectiveness. Uncertainty threatens optimal decision making by managers
and, by extension, reduces the quality of patient care. Variation in the
work flows of everyday patient caregiving reflects management's steps
to control uncertainty, which include strategies for contending with potential
disaster scenarios. Little exists in the literature that reveals how management's
strategic response to controlling uncertainty in a real disaster event
differs from strategies practiced in disaster simulations, with the goal
of protecting patient care. Using organization theory, this article presents
the application of uncertainty management to the catastrophic flooding
of a major teaching hospital. A detailed description of management's strategies
for patient rescue and evacuation is provided. Unique aspects of managing
uncertainty stemming from a natural disaster are highlighted. Recommendations
on organization responses to disasters that optimize patient care, safety,
and continuity are offered to managers.
Impact of Managed Care on Healthcare Delivery Practices: The Perception
of Healthcare Administrators and Clinical Practitioners, Mari Tietze
Managed care has introduced changes, such as cost effectiveness, access
to care, and quality of care, to many components of the U.S. healthcare
delivery system. These changes have affected how healthcare administrators
and clinical practitioners perceive the impact of managed care on healthcare
delivery practices. A survey was initiated to explore whether the perceptions
of administrators differed from those of practitioners and to discover
which organizational variables could explain the difference. A descriptive,
cross-sectional survey design was used for the target population of administrators
and practitioners in high, moderate, and low managed-care-penetration
markets. Two investigator-developed instruments-the Managed Care Perceptions
Inventory (MCPI) and the MCPI-Demographic-and an intact centralization
of decision-making assessment subscale were used for data collection.
Administrators had a statistically significant, more positive perception
of the impact of managed care on healthcare delivery than did practitioners.
When the distinction between administrator and practitioner was not used
as a grouping factor, managed care market penetration, nonprofit status,
and years in current employment position were factors that had statistically
significant associations with a more positive perception of managed care.
Based on these findings, both administrators and practitioners have a
role in maintaining awareness regarding their perceptions and should work
collaboratively to address issues of concern. Similarly, promoting trust
and commitment at the organizational level is important. Recommendations
for further research are also provided.
Assessing the Information Management Requirements for Behavioral Health
Providers
Leslie F. Major and Michael G. Turner
Behavioral health agencies will soon implement automated information-management
systems to support their administrative, financial, and clinical care
functions. Assessing current information-management capabilities and delineating
future needs are prerequisite to recommending a specific information technology
solution. Quantifying the discrepancy between current information-management
capabilities and future requirements highlights the areas of greatest
unmet need for information management. Selecting an information system
that addresses the most critical areas of unmet need is a prudent purchase
decision.
This article describes the results of a process to assess the information-management
requirements for agencies that were considering implementation of an integrated
behavioral health information-management system. The assessment revealed
that these agencies already employed automated systems to manage most
financial functions and many administrative functions. Few agencies, however,
utilized automated systems to manage clinical care functions. Selection
of a behavioral health electronic medical record (EMR) effectively addressed
clinical care information-management needs without duplicating existing
financial and administrative management functions. Also, the EMR included
features that addressed some administrative functions for which a discrepancy
between current capabilities and future needs was found. Selecting an
EMR instead of an integrated behavioral health information system was
associated with a significant reduction in information system acquisition
costs.
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