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Volume 56, Number 1
January/February 2011

  • INTERVIEW
    Interview with Eugene S. Schneller, PhD, Professor and Dean's Council of 100 Distinguished Scholars, W.P. Carey School of Business, Arizona State University
    Stephen J. O'Connor

  • REFORM
    Changing Economics in an Era of Healthcare Reform
    Nathan S. Kaufman
  • ARTICLES
    Health Technology Assessment at the University of California- San Francisco
    Christina Gutowski, John Maa, Kent Soo Hoo, and Kevin Bozic
    Safety Issues Related to the Electronic Medical Record (EMR): Synthesis of the Literature from the Last Decade, 2000-2009
    Linda Harrington, Donald Kennerly, and Constance Johnson
    Characteristics of Acute Care Hospitals with Diversity Plans and Translation Services
    Charles B. Moseley, Jay J. Shen, and Gregory O. Ginn
    Lessons of Experience: Key Events and Lessons Learned of Effective Chief Medical Officers at Freestanding Children's Hospitals
    Donald P. Nowill

Executive Summary
Health Technology Assessment at the University of California- San Francisco, Christina Gutowski, John Maa, Kent Soo Hoo, and Kevin Bozic

Over the past thirty years, various efforts have been made to align the incentives of hospitals and physicians to control healthcare costs while assuring the provision of high-quality patient care. One innovative strategy used by some hospitals involves the creation of technology assessment programs to develop a more thorough and objective review process for new clinical technology. The University of California–San Francisco Medical Center has been a pioneer in this area. Its physician-led healthcare technology assessment program has been successful in changing the culture of how innovative technology is evaluated and adopted by
the hospital and fostering an increased awareness among physicians of the clinical, financial, and programmatic implications of their technology decisions. We explore the operational characteristics and various effects of this program and highlight the
key components to its success and opportunities for improvement in the context of its reproduction at other medical centers.
           

Executive Summary
Safety Issues Related to the Electronic Medical Record (EMR): Synthesis of the Literature from the Last Decade, 2000-2009, Linda Harrington, Donald Kennerly, and Constance Johnson

Healthcare is a complex industry burdened by numerous and complicated clinical and administrative transactions that require many behavioral changes by patients, clinicians, and provider organizations. While healthcare information technology (HIT) is intended to relieve some of the burden by reducing errors, several aspects of systems such as the electronic medical record (EMR) may actually increase the incidence of certain types of errors or produce new safety risks that result in harm. Healthcare leaders must appreciate the complexity surrounding EMRs and understand the safety issues in order to mandate sound EMR design, development, implementation, and use. This article seeks to inform executives, clinicians, and technology professionals what has been learned through published research on the safety of HIT systems during the last decade, focusing on computerized physician order entry (CPOE), clinical decision support systems (CDSS), and bar-coded medication administration (BCMA).

Executive Summary
Characteristics of Acute Care Hospitals with Diversity Plans and Translation Services, Charles B. Moseley, Jay J. Shen, and Gregory O. Ginn

Hospitals provide diversity activities for a number of reasons. The authors examined community demand, resource availability, managed care, institutional pressure, and external orientation related variables that were associated with acute care hospital
diversity plans and translation services. The authors used multiple logistic regression to analyze the data for 478 hospitals in the 2006 National Inpatient Sample (NIS) dataset that had available data on the racial and ethnic status of their discharges. We
also used 2004 and 2006 American Hospital Association (AHA) data to measure the two dependent diversity variables and the other independent variables. We found that resource, managed care, and external orientation variables were associated with
having a diversity plan and that resource, managed care, institutional, and external orientation variables were associated with providing translation services. The authors concluded that more evidence for diversity’s impact, additional resources, and more
institutional pressure may be needed to motivate more hospitals to provide diversity planning and translation services.

Executive Summary
Lessons of Experience: Key Events and Lessons Learned of Effective Chief Medical Officers at Freestanding Children's Hospitals,
Donald P. Nowill

As the healthcare environment changes, physician executives who are effective leaders and agents of change are needed. Healthcare organizations that are successful at developing effective physician leaders will be at an advantage. This article examines how physician leaders develop on the job. Such knowledge and insight can be useful to healthcare systems looking to develop a new physician leadership development program or improve an existing one. This study identified that learning from other people (e.g., mentors, role models, bosses) and key events involving hardships are valuable means in developing leadership
acumen for chief medical officers (CMOs) at freestanding children’s hospitals. Most of the hardships CMOs reported were a result of mistakes made when they were trying to institute change. CMOs reported a disproportionately low number of learning events from developmental job assignments. This finding may indicate a lost opportunity on the part of healthcare organizations in developing leaders. The most frequent lessons learned pertained to handling relationships, interpersonal skills, and executive temperament. Skills in handling relationships and interpersonal skills were best learned through business mistakes made in dealing with
others. Lessons in executive temperament, self confidence, and handling adversity were most often learned from role models and bosses. These findings indicate that physician leadership development initiatives should intentionally and systematically incorporate job assignments, role models, and mentors.