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Volume 51, Number 2
March/April 2006

  • INTERVIEW
    Interview with Richard J. Umbdenstock, CHE, executive vice president, Providence Health & Services, Kyle L. Grazier
    Pay for performance
    Paying for Efficiency, Kaveh Safavi
  • COMPETENCIES
    Business Knowledge and Skills, Andrew N. Garman, Teresa Burkhart, and
    Jeremy Strong
  • ARTICLES
    Do Not Go Gentle: Intractable Value Differences in Hospices, Brian M. Harmer

    The Nursing Shortage: Is it Really About Image? Jean Ann Seago, Joanne Spetz, Andrew Alvarado, Dennis Keane, and Kevin Grumbach

    Community Orientation, Strategic Flexibility, and Financial Performance in Hospitals, Gregory O. Ginn and Ruby P. Lee

    Exploring Strategies for Reducing Hospital Errors, Kathleen L. McFadden, Gregory N. Stock, and Charles R. Gowen III
    Regression Analysis Table for the article by McFadden and colleagues.
  • Fellow Project
    Improving OB/GYN Physician Coverage Through a Redesigned Call System, Ann Holt
  • Executive Summary
    Do Not Go Gentle: Intractable Value Differences in Hospices, Brian M. Harmer

    As hospices have evolved and grown, from small community-based cottage institutions to larger and more complex healthcare providers, they have begun to acquire staff with characteristics that are significantly different from those of their founding members. Because the timeline of the modern hospice movement is so short, many still have founding members at work, and institutions find themselves employing people with diverse aspirations and motivations. Such value differences would normally be a sufficient basis for conflict in most organizations. In the particular context of hospices, and perhaps other healthcare institutions, such conflict often goes underground, as each protagonist tries to live up to its image of what is appropriate. This narrative research, based in five New Zealand hospices, explores the problem of hidden but unresolved tensions and suggests some possible avenues for management involvement.

    Executive Summary
    The Nursing Shortage: Is it Really About Image? Jean Ann Seago, Joanne Spetz, Andrew Alvarado, Dennis Keane, and Kevin Grumbach

    A poor public “image” of the nurse is believed to contribute to nurse shortages. We surveyed more than 3,000 college students in science and math courses in a seven-county region of California’s Central Valley to assess their perceptions of a career as a nurse in relation to a career as a physical therapist, a high school teacher, or a physician. Students generally had favorable perceptions of nursing, with two-thirds agreeing that nursing has good income potential, job security, and interesting work. However, nursing lagged behind the other occupations in perceptions of independence at work and was more likely to be perceived as a “women’s” occupation. Our findings suggest that these college students have generally gotten the message that nursing is a financially rewarding and desirable career, although they also perceive nursing to be less attractive on some important occupational characteristics such as job independence.
    Unless nursing training capacity expands substantially, the projected nurse shortage will occur. With continued aggressive marketing of nursing as a career, there is a risk of engendering a backlash from prospective students frustrated in their effort to find a slot in a nursing training program. Much work remains to be done to alter the image of nursing as a women’s occupation and to transform the work environment of nurses to make a career in nursing more attractive.

    Executive Summary
    Community Orientation, Strategic Flexibility, and Financial Performance in Hospitals, Gregory O. Ginn and Ruby P. Lee

    The objective of this study was to examine how community orientation and strategic flexibility affect accounting measures of financial performance in acute care hospitals. This cross-sectional study used organizational data from the American Hospital Association, environmental data from the Area Resource File, and financial data from the Healthcare Cost Report Information System. We tested our hypotheses on 1,779 hospitals using OLS regression models that controlled for organizational and environmental factors that might affect financial performance. The community orientation of a hospital had a negative impact on its short-term financial performance. However, the strategic flexibility of a hospital with regard to structure and resources was significantly and positively associated with hospital performance.

    Our findings are important to healthcare managers. Specifically, although a community orientation is thought to be essential for improving the health of populations, the healthcare market may lack clarity concerning the wants and needs of patients and payers to such a degree that this orientation does not result in improved short-term financial performance. In contrast, when a hospital maintains flexibility in its resource allocations and organizational structure, it can meet changing needs and uncertainties and thereby enhance financial performance.

    Executive Summary
    Exploring Strategies for Reducing Hospital Errors, Kathleen L. McFadden, Gregory N. Stock, and Charles R. Gowen III

    The purpose of this study is to explore current strategies for reducing errors at U.S. hospitals. Reports by the Institute of Medicine highlight concerns about the staggering number of medical errors that occur in the U.S. healthcare system. These reports have exerted considerable pressure on hospitals to establish programs that reduce errors and improve patient safety.

    A previous research study identifies seven critical strategies for reducing hospital errors based on a case study of four Chicago-area hospitals. These strategies include (1) partnership with stakeholders, (2) reporting errors free of blame, (3) open discussion of errors, (4) cultural shift, (5) education and training, (6) statistical analysis of data, and (7) system redesign. This article reports the results of our nationwide survey of 525 hospitals. We examined the perceptions of healthcare quality directors about the importance of these seven patient safety strategies, the factors that act as barriers, the level of adoption of these strategies, and the benefits resulting from implementation of these strategies.

    Our results indicate that a considerable gap exists between current hospital practices and the perceived importance of various approaches to improving patient safety. Results of our regression analysis reveal that internal organizational barriers are associated with a larger gap between perceived importance and actual implementation. Moreover, the regression analysis also reveals that smaller gaps are associated with better error outcomes such as reduction in the frequency and severity of errors. The findings provide specific directions for enhancing patient safety programs at hospitals in the future.