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Volume 49, Number 5
September/October 2004

I. INTERVIEW

Kevin Lofton, FACHE, president and chief executive officer, Catholic Health Initiatives, Kyle L. Grazier

II. PHYSICIAN-EXECUTIVE RELATIONS
Managing Physician Resistance to Change, Barbara LeTourneau

III. REPLACEMENT FACILITIES
Five Critical Strategies for Achieving Operational Efficiency, William J. Hejna and James E. Hosking

IV. ARTICLES

  • Community Health Orientation, Community-based Quality Improvement, and Health Promotion Services in Hospitals, Gregory O. Ginn and Charles B. Moseley
  • Development and Validation of a 360-degree Feedback Instrument for Healthcare Administrators, Andrew N. Garman, J. Larry Tyler, and Jodi S. Darnall
  • Improving Resource Efficiency Through Management Science, Lee Revere and Ralph Roberts
  • Nursing Home Administrators' Level of Job Satisfaction, Barbara Murphy

Executive Summary
Community Health Orientation, Community-based Quality Improvement, and Health Promotion Services in Hospitals, Gregory O. Ginn and Charles B. Moseley

The objective of the study presented in this article was to examine the relationship between hospital community orientation and the provision of health promotion services. The study used data from the 2000 American Hospital Association survey and the 2000 Area Resource File to examine acute care hospitals throughtout the United States. The study was a cross-sectional multiple regression analysis. Hospital community orientation was measured by two independent variables: (1) community health orientation and (2) community-based quality orientation. Health promotion services were represented by two dependent variables: (1) hospital-based health promotion services and (2)collaborative health promotion services. Organizational contorl variables included bed-size code, not-for-profit ownership, network participation, and joint venture/alliance membership. Environmental control variables included proportion of population over age 65, percent of population below the poverty level, the square root of the proportion of Medicaid inpatient revenue, the presence of state community benefit laws/guidlines, a Herfindahl-Hirschman Index of level of competition, and an index of managed care influence.
Results of regression analyses showed that community health and community-based quality orientations were positively and significantly related to both the direct provision of health promotion services by hospitals and the collaborative provision of health promotion services through systems, joint ventures, and networks. The study concludes that a community health orientation and a community-based quality orientation lead to greater provision of health promotion services.

Executive Summary
Development and Validation of a 360-degree Feedback Instrument for Healthcare Administrators, Andrew N. Garman, J. Larry Tyler, and Jodi S. Darnall

Multisource or 360-degree feedback has become a widely used component of leadership development in many organizations, and a growing body of research supports its use for this purpose. Unfortunately, most commercially available multisource surveys were developed in private-sector corporate settings, making their transferability to healthcare settings less than straightforward. This article describes a research project undertaken to develop a job-relevant, commercial-quality multisource feedback survey for use in health administration settings.
Suing critical incident methodology and enlisting the help of subject matter expert groups (i.e., executive search consultants, human resource executives, leadership development consultants, and administrative fellowship supervisors), a competency framework was developed containing 26 competencies arragned according to seven clusters. A third survey was then conducted with incumbent leaders to populate the competency framework with behavioral descriptors. The end result was a survey consisting of 128 total items that, when matrixed across four relationship types, create surveys ranging from 36 to 95 items in length.
Two pilot studies were then conducted to assess reliability as well as validity against other measures of leadership ability. Results from these studies suggest that the instrument can provide reliable and valid assessments of leadership effectiveness for development purposes.

Executive Summary
Improving Resource Efficiency Through Management Science, Lee Revere and Ralph Roberts

Optimal management of resources is a very complex and difficult task for healthcare systems. Nevertheless, healthcare providers can emply data-driven methodologies and management science tools, coupled with managerial insights, to significantly improve both their resource effectiveness and efficiency. Understanding the full technical complexities of management science models is a daunting task for healthcare managers, but they can be aided by the increased availability of management science software. Readily available software does not require extensive technical competencies and is easily adaptable to resource changes.
This article reports how a large healthcare system improved the cost of effectiveness and service efficiency of its laboratory courier service through the use of management science techniques and readily available software. The laboratory courier systme existed to serve a large multihospital healthcare system located in a major Texas metropolis. The routing and scheduling solution reported in this article yielded a very substantial 16.4 percent reduction in annual laboratory courier costs and a significant improvement in service levels. This study indicates that management science techniques and software are readily adaptable to the healthcare environment and are amenable to use by healthcare administrators.

Executive Summary
Nursing Home Administrators' Level of Job Satisfaction, Barbara Murphy

Job satisfaction has been shown to have a direct relationship to the quality of work. Are nursing home administrators satisfied with their work? How do they compare with their counterparts in other industries? The results of this survey, using the Job Description Index (JDI) and the Job in General (JIG) scale as published by Bowling Green State University, indicate that nursing home administrators have a more compressed rate of job satisfaction than their counterparts in other industries. They focus their dissatisfaction on their coworkers and pay. They demonstrate dissatisfaction by rotating their positions at a rate of every 31 months. This suggests some significant problems in the developement and maintenance of quality care and some areas that could be addressed to raise the level of satisfaction among nursing home administrators.