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Volume 48, Number 2
March/April 2003

Volume 48, Number 2
March/April 2003

I. INTERVIEW
Interview with Mary Starmann-Harrison, FACHE, regional president and CEO, SSM Health Care of Wisconsin, Madison, Kyle Grazier

II. CAREERS
Creating and Implementing a Reality-Based Career Plan, Mike Broscio and Jay Scherer

III. ARTICLES

  • Understanding the Impact of Variation in the Delivery of Healthcare Services Charles E. Noon, Charles T. Hankins, and Murray J. Cote
  • The Perils of Healthcare Workforce Forecasting: A Case Study of the Philadelphia Metropolitan Area, David Barton Smith and William Aaronson
  • Relationship-Centered Administration: Transferring Effective Communication Skills from the Exam Room to the Conference Room, Kim Marvel, Austin Bailey, Carol Pfaffly, William Gunn, and Howard Beckman

IV. Fellow Project
Changing Business Practice for Appointing in Military Outpatient Medical
Clinics: The Case for a True Open Access Appoint Scheme for Primary Care,
Micah L. Meyers

Executive Summary
Understanding the Impact of Variation in the Delivery of Healthcare Services Charles E. Noon, Charles T. Hankins, and Murray J. Cote

In the past several years, healthcare providers have coped with the financial aspects of
managed care and the resultant constraints on revenue. In fact, working with decreasing margins of return has become routine for many providers. Beyond straightforward cost cutting, providers must also consider a variety of other operational factors to achieve success. To this end, higher patient satisfaction and improved utilization and efficiency of resources are natural objectives. Ironically, fundamental to the pursuit of better operations management is the fact that the delivery of healthcare services can vary between and among patients, providers, and organizations for many reasons. Unfortunately, such variation may be overlooked or trivialized if the phenomenon is not well understood by healthcare managers. Knowing how variation affects the delivery of services creates opportunities for focused improvement.

Executive Summary
The Perils of Healthcare Workforce Forecasting: A Case Study of the Philadelphia Metropolitan Area, David Barton Smith and William Aaronson

In 1996, a widely circulated and influential forecast for the Philadelphia Metropolitan Area stated that a decline in hospital and healthcare employment in the region would occur over the next five years. It also suggested that this decline would exacerbate the problem of an oversupply of nurses seeking hospital employment. The forecast reflected a regional leadership and expert consensus on the impact of the managed care transformation on workforce needs and was supported by short-term statistical trends in regional utilization and employment. Confounding these predictions was that hospital and healthcare employment actually grew. By the end of 2001, hospitals in the region were experiencing problems in recruiting sufficient nurses, pharmacists, and technicians. The forecast failed to anticipate the impact of a strong regional economy on supply and underestimated the resilience of underlying forces that have driven the long-term growth in healthcare workforce demand. More effective ongoing monitoring can help moderate the fluctuation of workforce shortages and surpluses.

Executive Summary
Relationship-Centered Administration: Transferring Effective Communication Skills from the Exam Room to the Conference Room, Kim Marvel, Austin Bailey, Carol Pfaffly, William Gunn, and Howard Beckman

Medical researchers have shown that relationship-centered healthcare increases patient satisfaction and improves health outcomes. The components of relationship-centered healthcare-listening, sharing decision making, and respecting others-improve patient motivation and commitment to a plan of action. Currently, no data are available on the extent to which medical administrative settings adhere to relationship-centered principles. To begin to answer this question, we observed a convenience sample of 45 meetings in healthcare settings to assess the frequency and types of relationship-centered behaviors shown by group leaders. Our results provide preliminary data that leaders, especially female leaders, praised the value of group member efforts and encouraged members to provide input. Less frequently employed relationship-centered behaviors included providing a verbal summary of a discussion, responding to feelings expressed by members, and setting explicit agendas. Finally, we found some provocative associations. Female leaders received higher satisfaction ratings, and male leaders were more verbally dominant. Similar to physician-patient interaction, new topics for discussion are less likely to arise spontaneously late in a meeting if early agenda-setting is utilized. To our knowledge, this is the first such study in a medical setting. Our findings encourage those who chair meetings to reflect on the extent to which they use a collaborative approach and offers specific content areas on which to focus. Further research on the concept and outcomes of relationship-centered administrative approach is warranted.