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Volume 53, Number 1
January/February 2008

  • INTERVIEW
    Interview with Marilyn B. Tavenner, FACHE, Secretary of Health and Human Resources, Virginia State Government, Kyle L. Grazier
  • TECHNOLOGY
    Clinical Documentation Systems: Another Link Between Technology and Quality, Christina Beach Thielst and John H. Gardner
  • DIVERSITY
    Racial and Ethnics Disparities: Why Diversity Leadership Matters, Janice L. Dreachslin and Fred Hobby
  • ARTICLES
    Nurses' Assessment of Pediatric Physicians: Are Hospitalists Different?, David M. Pressel, David I. Rappaport, and Norine Watson
    Cultural and Linguistic Competence in Healthcare: The Case of Alabama General Hospitals, Marilyn V. Whitman and Jullet A. Davis
    The Organizational Costs of Ethical Conflicts, William A. Nelson, William B. Weeks, and Justin M. Campfield
    The Impact of PPS on Hospital-Sponsored Post-Acute Services: A Case Study of Delaware Medicare Providers, Robert R. Kulesher and Margaret G. Wilder

Executive Summary

Nurses’ Assessment of Pediatric Physicians: Are Hospitalists Different? David M. Pressel, David I. Rappaport, and Norine Watson

The interaction between physicians and nurses represents a critical aspect of patient care. The numbers and influence of hospitalists—physicians who provide care to hospitalized patients—continue to increase. However, studies of interactions between nurses and hospitalists are limited. As a bridge to that gap, we studied pediatric nurses’ assessment of pediatric hospitalists along with other categories of pediatric physicians (e.g., residents, surgeons) in terms of these physicians’ interactions with nurses and patients and the quality of care they provide.

Pediatric nurses at a tertiary children’s hospital were invited to complete an anonymous online survey. They were asked to rate different categories of physicians according to various qualities of the nurse–physician relationship and patient care. Nurses were also given an opportunity to provide feedback regarding pediatric hospitalists’ role in comanaging medically complex surgical patients.

Our findings indicate that nurses ranked pediatric hospitalists and residents at the top in terms of nurse–physician interaction. In addition, nurses rated pediatric hospitalists highest for patient care qualities and indicated their overwhelming preference for hospitalists to comanage medically complex surgical patients. As our findings suggest, nurses may interact differently with hospitalists than with other types of physicians. As hospitalists become more influential in U.S. hospitals, it is important that positive relationships (through better communication) are carefully developed between nurses and hospitalists. Hospitalist programs may be key to improving the nursing practice environment and may lead to the retention of nurses.

Executive Summary

Cultural and Linguistic Competence in Healthcare: The Case of Alabama General Hospitals, Marilyn V. Whitman and Jullet A. Davis

As the nation’s foreign-born population continues to increase, the importance of understanding cultural, ethnic, and religious differences to combat racial/ethnic disparities in access to and utilization of healthcare services intensifies. In Alabama, specifically, the shifting migration patterns and the growth of the foreign-born population have altered the state’s demographics, introducing new cultures and languages to this traditionally biracial state. Because Alabama general hospitals are not immune to the widespread cost, access, and quality paradox that plagues every healthcare organization, they too must consider the value of cultural and linguistic competence in providing high-quality, cost-effective care.

This exploratory study examined the awareness of and preparedness for the diversifying patient population of general medical and surgical hospitals in Alabama. Questionnaires were mailed to the chief executive officers of 101 general medical and surgical hospitals. A sample of 53 respondents provided data on the measures and resources that the hospitals currently use to meet cultural and linguistic competence standards. Our findings indicate that, although these hospitals are taking the initial steps to prepare for the diversifying patient population, a great deal needs to be accomplished before they are able to meet the National Standards for Culturally and Linguistically Appropriate Services in Health Care established by the U.S. Department of Health and Human Services’s Office of Minority Health.

Executive Summary

The Organizational Costs of Ethical Conflicts, William A. Nelson, William B. Weeks, and Justin M. Campfield

Ethical conflicts are a common phenomenon in today’s healthcare settings. As healthcare executives focus on balancing quality care and cost containment, recognizing the costs associated with ethical conflicts is only logical. In this article, we present five case vignettes to identify several general cost categories related to ethical conflicts, including operational costs, legal costs, and marketing and public relations costs. In each of these cost categories, the associated direct, indirect, and long-term costs of the ethical conflict are explored as well.

Our analysis suggests that organizations have, in addition to philosophical reasons, financial incentives to focus on decreasing the occurrence of ethical conflicts. The cost categories affected by ethical conflicts are not insignificant. Such conflicts can affect staff morale and lower the organization’s overall culture and profit margin. Therefore, organizations should develop mechanisms and strategies for decreasing and possibly preventing ethical conflicts.

The strategies suggested in this article seek to shift the organization’s focus when dealing with conflicts, from just reacting to moving upstream—that is, understanding the root causes of ethical conflicts and employing approaches designed to reduce their occurrence and associated costs. Such an effort has the potential to enhance the organization’s overall culture and ultimately lead to organizational success.

Executive Summary

The Impact of PPS on Hospital-Sponsored Post-Acute Services: A Case Study of Delaware Medicare Providers, Robert R. Kulesher and Margaret G. Wilder

Hospitals were the first providers to experience the change in Medicare reimbursement from a cost basis to the prospective payment system (PPS). In the 1980s, this switch was accomplished through the development of diagnosis-related groups, a unique formula for Medicare reimbursement of inpatient hospital services. During that time, the concern was that, with the anticipated reduced payments to hospitals, adverse impacts on Medicare beneficiaries were likely, including premature release of patients from hospital care resulting in medical complications, increased readmissions, prolonged episodes of recuperation, and preventable mortality.

The Balanced Budget Act of 1997 (BBA) mandated the implementation of the PPS for Medicare providers of skilled nursing home care and home health care. This change from cost-based reimbursement to PPS raised concerns that these providers would react as hospitals had done—that is, skilled nursing homes might limit their admission of Medicare patients and home health agencies might cut back on visits. As a result of that, hospitals might be faced with providing care for these post-acute patients without receiving additional reimbursement, and these changes in utilization patterns would be of critical importance to both providers and Medicare beneficiaries.

This article examines the decisions that providers made in response to the perceived impact of the BBA. Qualitative data were derived from provider interviews. The article concludes with a discussion of how changes in Medicare reimbursement policy have influenced providers of post-acute care services to alter their level of participation in Medicare and the impact this may have on the general public as well as on Medicare beneficiaries.