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Volume 47, Number 5
September/October 2002

I. INTERVIEW
Interview with Joseph A. Zaccagnino, president and CEO, Yale New Haven Health System, Kyle Grazier

II. QUALITY AND SAFETY
Comparing Clinical Resources and Outcomes to Understand Best Practices, Alan E. Cudney, Jack Cox, and Kathleen Baugh

III. STAFFING
Retaining Our Workforce, Regaining Our Potential, Steven M. Barney

IV. ARTICLES

  • Adverse Drug Events in the Elderly Population Admitted to a Tertiary Care Hospital, Nahid Azad,Michael Tierney,Gary Victor, and Parul Kumar
  • The Effect of Governing Board Composition on Rural Hospitals' Involvement in Provider-Sponsored Managed Care Organizations, Shadi S. Saleh, Thomas Vaughn, and James E. Rohrer
  • Organizational Design Consistency: The PennCARE and Henry Ford Health System Experiences, Nicole L. Dubbs

V. Fellow Project
Development and Implementation of an Endovascular Surgery Program in a Community General Hospital, Jeanne Sanders

Executive Summary
Adverse Drug Events in the Elderly Population Admitted to a Tertiary Care Hospital
Nahid Azad, MD, associate professor, Faculty of Medicine, Geriatric Assessment Unit, The Ottawa Hospital Civic Campus, Canada; Michael Tierney, MSc, director, Pharmacy, The Ottawa Hospital General Campus; Gary Victor, MD, program director, Internal Medicine Residency Training Program, The Ottawa Hospital General Campus; and Parul Kumar, MD, MSc, research assistant, Internal Medicine, University of Western Ontario, London

Older adults take almost one-third of the drugs prescribed today yet represent only about 12 percent of the population. Adverse drug events are common in this population, but often these events appear to be preventable. Interest in adverse events related to the use of prescription drugs has rarely been higher or broader. The research community continues to develop new tools to study adverse effects of drugs in individuals and populations. However, the published literature on drug-related adverse events is fraught with problems, starting with the original reports and extending to systematic reviews. Prospective data are missing, drug adverse events are poorly described, and analytic methods are questionable. This leads to problems with imprecise estimates and generalizability of results.

Executive Summary
The Effect of Governing Board Composition on Rural Hospitals' Involvement in Provider-Sponsored Managed Care Organizations

Shadi S. Saleh, Ph.D., assistant professor, Department of Health Policy, Management and Behavior, School of Public Health, State University of New York at Albany; Thomas Vaughn, Ph.D., assistant professor, Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City; and James E. Rohrer, Ph.D., professor and chair, Department of Health Services Research and Management, Texas Tech University Health Sciences Center, Lubbock

Rural hospitals are actively pursuing various strategic alternatives to confront the dramatic changes taking place in the delivery, organization, and financing of healthcare. One of these strategic alternatives is involvement in provider-sponsored managed care organizations. Studies have argued that this form of managed care would enhance public trust and might improve the performance of hospitals. The changing healthcare environment has also increased the importance of the competence and composition of hospital boards. This article examines the effect of the governing board's composition on rural hospitals' involvement in provider-sponsored managed care organizations. The study sample consisted of 140 rural hospitals in Iowa and Nebraska whose CEOs responded to a survey conducted by the Center for Health Services Research at the University of Iowa between June and December 1997.
The principal finding was that the likelihood of a hospital owning any form of managed care organization increases with the number of community leaders and health professionals on the board. The number of business leaders had no effect on the likelihood of involvement in such an arrangement. Other factors that affected the likelihood of owning a managed care organization were the health status of the population and ownership type. Key recommendations to managers are to (1) revisit the hospital board's composition before actively pursuing a strategic action, (2) examine the compatibility of the type of strategic activity pursued with the background of board members and the interests of the populations they represent, and (3) use the governing board as a resource in determining which new strategic activities to undertake.

Executive Summary
Organizational Design Consistency: The PennCARE and Henry Ford Health System Experiences

Nicole L. Dubbs, Ph.D., assistant professor, Joseph L. Mailman School of Public Health, Department of Health Policy and Management, Columbia University, New York

There has been much discussion of the appropriateness of various organizational strategies for today's healthcare industry. This article presents case studies of two healthcare organizations that have pursued very different configurations. PennCARE uses a virtually integrated, loose contract-based arrangement, while Henry Ford Health System employs a vertically integrated, tight ownership model. Despite these different approaches, their overall designs are strikingly similar. In essence both systems demonstrate a property called organizational design consistency; they simply approach it from different ends of the spectrum.
This article presents the notion of organizational design consistency and defines it as the steady pursuit of a single preferred configuration strategy across key elements of organizational design. To illustrate the framework the case studies target four key elements of organizational design (governance structure, organizational culture, strategic planning processes, and decision-making procedures) and explain how consistency across these components adds value to both of these differently configured healthcare systems. There is room enough for diverse configurations of organizations in the current healthcare environment. Consistency does not mandate conformity; value can be derived from both tight and loose models. Furthermore, when fashioning organizational design consistency strategies, healthcare systems should carefully choose tightly or loosely modeled configurations to appropriately suit their aims, their markets, and the capabilities and resources available to them.