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Executive
Summary
Physicians and Hospital Managers as Cofiduciaries of Patients: Rhetoric
or Reality?
Frank A. Chervenak, and Laurence B. McCullough
The reality
of physicians and hospital managers as cofiduciaries of patients is of
vital importance today. In this article we develop the concept of physicians
as fiduciaries of patients based on the work of John Gregory and of hospitals
as fiduciaries of patients based on the work of Thomas Percival to supplement
the recent literature on organizational ethics in healthcare. To be a
fiduciary of patients means that (1) one possesses expert knowledge and
skills on how to protect and promote the health-related interests of patients
and (2) one is committed to using that expertise primarily for the benefit
of the patient and to making self-interest a systematically secondary
consideration. This concept is accepted in contemporary medical ethics
and law (McCullough and Chervenak 1994).
We identify two core virtues-diffidence and compassion-as vital to the
fiduciary role. We use these virtues to develop preventive ethics strategies
for dealing with two major problems in physician-hospital administrator
interactions, what we call strategic procrastination and strategic ambiguity.
The main preventive ethics response to both strategic procrastination
and strategic ambiguity is to point them out when they occur and to emphasize
that they compromise cofiduciary responsibility. As a preventive ethics
response to strategic procrastination, physicians and managers should
provide role models of accountability and change policy and practice in
a timely manner when intellectually obligated to do so. As a preventive
ethics response to strategic ambiguity, physicians and managers should
be role models of transparency by being explicit in their communications.
Executive
Summary
Organizational Downsizing: A Review of Literature for Planning and Research
Jullet A. Davis, Grant Savage, and R. Thomas Stewart
The use of
downsizing as management's strategic response to environmental and institutional
changes is prevalent in all U.S. industries, including healthcare. The
popular and research literature is inundated with reports on companies
undergoing various stages of restructuring, which often include one or
more staff reductions. This article provides a review of downsizing literature
published from 1985 to 2002. Although the findings and conclusions of
these articles are generally inconsistent, the prevailing opinion is that
for downsizing to be successful, effective planning must occur long before,
during, and post downsizing. Additionally, a downsizing plan should be
included in the strategic management plan of all organizations, regardless
of whether they plan to downsize or not. By including such a plan, the
organization will be better prepared to begin the staff-reduction process
should it be forced to do so in response to environmental changes. Finally,
providing ample support and protection for staff is key to the organization's
recovery and growth. The lessons provided in this literature review should
assist healthcare managers in deciding how to plan and structure potential
staff reductions.
Executive
Summary
A Profile of Hospital Acquisitions
Jeffrey P. Harrison, Michael J. McCue, and Bill B. Wang
The number
of hospitals acquired by hospital systems has declined from 99 facilities
in 1996 to less than 63 facilities between 1999 and 2000. We evaluated
the market, operating and organizational factors, and their relationship
to these hospital acquisitions that occurred during this period of decline.
We found that acquired hospitals, on average, operated at a loss, incurred
higher debt levels, and were more likely to be located in markets with
a large number of health maintenance organizations. Older, for-profit
hospitals with fewer occupied beds were also likely targets for hospital
acquisitions.
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