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Executive
Summary
Kent V. Rondeau, Ph.D., assistant professor, health policy and management,
Department of Public Health Sciences, University of Alberta, Edmonton,
Canada, and Terry H. Wagar, Ph.D., LLB, professor, Department of Management,
Saint Mary's University, Halifax, Nova Scotia, Canada
Over the
past few years many nations have undertaken activities aimed at restructuring
and reengineering their health system as a means of achieving greater
cost effectiveness and consumer responsiveness. Most efforts at reforming
healthcare delivery have been accompanied by the downsizing of healthcare
organizations. Organizations that are undergoing decline or significant
workforce contractions are widely believed to experience a number of negative
or dysfunctional attributes as a consequence of reductions in, or redeployments
of, their labor force. For organizations undergoing planned workforce
reductions, much speculation has been made in an attempt to identify a
set of "best practices" that have the potential to mitigate
the dysfunctional consequences associated with large permanent reductions
in the workforce.
This article
explores the relationships among workforce-reduction practices and perceptions
of organizational dysfunction in a large sample of Canadian hospitals.
Results of the analysis suggest that the application of certain "progressive"
workforce-reduction practices preceding, during, and subsequent to the
downsizing process may play an important role in mitigating some of these
dysfunctional organizational consequences. This research provides some
evidence to suggest that how a workforce reduction is carried out may
have a greater effect on organizational effectiveness than either the
magnitude or severity of the overall workforce reduction.
Executive
Summary
Noorein Inamdar, doctoral candidate in health policy and management,
Harvard Business School, Boston, Massachusetts, and Robert S. Kaplan,
Marvin Bower Professor of Leadership Development, Harvard Business School,
Boston, Massachusetts
Several innovative
healthcare executives have recently introduced a new business strategy
implementation tool: the Balanced Scorecard. The scorecard's measurement
and management system provides the following potential benefits to healthcare
organizations:
- It aligns
the organization around a more market-oriented, customer-focused strategy
- It facilitates,
monitors, and assesses the implementation of the strategy
- It provides
a communication and collaboration mechanism
- It assigns
accountability for performance at all levels of the organization
- It provides
continual feedback on the strategy and promotes adjustments to marketplace
and regulatory changes
We surveyed
executives in nine provider organizations that were implementing the Balanced
Scorecard. We asked about the following issues relating to its implementation
and effect:
- The role
of the Balanced Scorecard in a well-defined vision, mission, and strategy
- The motivation
for adopting the Balanced Scorecard
- The difference
between the Balanced Scorecard and other measurement systems
- The process
followed to develop and implement the Balanced Scorecard
- The challenges
and barriers during the development and implementation process
- The benefits
gained by the organization from adoption and use
The executives
reported that the Balanced Scorecard strategy implementation and performance
management tool could be successfully applied in the healthcare sector,
enabling organizations to improve their competitive market positioning,
financial results, and customer satisfaction. This article concludes with
guidelines for other healthcare provider organizations to capture the
benefits of the Balanced Scorecard performance management system.
Executive
Summary
MAJ Linda W. Fisher, R.N., M.H.A., CHE, nurse methods analyst, Dwight
David Eisenhower Army Medical Center, Fort Gordon, Georgia
Difficulty,
perceived by 17 treatment facilities, of obtaining specialty referral
appointments to Dwight David Eisenhower Army Medical Center (DDEAMC),
a major referral center, prompted this study that utilizes provider profiling
as a tool to answer three questions that examine the problem: (1) Is the
difficulty in obtaining referral appointments real or perceived? (2) Are
the referral patterns of the providers contributing factors in the perceived
inability to meet the demand for specialty appointments? (3) If the providers'
referral patterns are a contributing factor, which provider behaviors
need to be modified? Major findings of the study included:
- the referral
rate of the primary care providers was 8 percent, compared to the national
average of 7.5 percent;
- interns
and residents were provider outliers with referral rates of 11.7 percent
and 13.5 percent, respectively; and
- of the
32,182 referral appointments requested during Fiscal Year 1999, slightly
less than 2.4 percent were disengaged.
Data analysis
indicates opportunities for improvement of referral rates in DDEAMC's
department of primary care by addressing the referral practices of residents
and interns, which will therefore decrease the number of disengaged patients.
By decreasing the number of referrals, the organization will more effectively
control internal costs in an era of shrinking budgets.
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