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Volume 48, Number 5
September/October 2003

I. INTERVIEW
Stephanie McCutcheon, FACHE, chief operating officer, Bon Secours Health System, Inc., Marriottsville, Maryland, Kyle Grazier

II. CAREERS
Managing Job Transitions: Thirteen Questions for a Successful Search, Mike Broscio and Jay Scherer

III. STRATEGIC MARKETING
The E in Marketing: Ethics in the Age of Misbehavior
Howard J. Gershon and Gary E. Buerstatte

IV. ARTICLES
Perfect Storm: Organizational Management of Patient Care Under Natural
Disaster Conditions, William Cass McCaughrin and Maria Mattammal

Impact of Managed Care on Healthcare Delivery Practices: The Perception of
Healthcare Administrators and Clinical Practitioners, Mari Tietze

Assessing the Information Management Requirements for Behavioral Health
Providers, Leslie F. Major and Michael G. Turner

V. FELLOW PROJECT
Developing a Culturally Competent Workforce: A Diversity Program in Progress, William J. Mott, Jr.

 

Executive Summary

Perfect Storm: Organizational Management of Patient Care Under Natural Disaster Conditions, William Cass McCaughrin and Maria Mattammal
Managing uncertainty is an essential attribute of organizational leadership and effectiveness. Uncertainty threatens optimal decision making by managers and, by extension, reduces the quality of patient care. Variation in the work flows of everyday patient caregiving reflects management's steps to control uncertainty, which include strategies for contending with potential disaster scenarios. Little exists in the literature that reveals how management's strategic response to controlling uncertainty in a real disaster event differs from strategies practiced in disaster simulations, with the goal of protecting patient care. Using organization theory, this article presents the application of uncertainty management to the catastrophic flooding of a major teaching hospital. A detailed description of management's strategies for patient rescue and evacuation is provided. Unique aspects of managing uncertainty stemming from a natural disaster are highlighted. Recommendations on organization responses to disasters that optimize patient care, safety, and continuity are offered to managers.


Impact of Managed Care on Healthcare Delivery Practices: The Perception of Healthcare Administrators and Clinical Practitioners, Mari Tietze
Managed care has introduced changes, such as cost effectiveness, access to care, and quality of care, to many components of the U.S. healthcare delivery system. These changes have affected how healthcare administrators and clinical practitioners perceive the impact of managed care on healthcare delivery practices. A survey was initiated to explore whether the perceptions of administrators differed from those of practitioners and to discover which organizational variables could explain the difference. A descriptive, cross-sectional survey design was used for the target population of administrators and practitioners in high, moderate, and low managed-care-penetration markets. Two investigator-developed instruments-the Managed Care Perceptions Inventory (MCPI) and the MCPI-Demographic-and an intact centralization of decision-making assessment subscale were used for data collection.
Administrators had a statistically significant, more positive perception of the impact of managed care on healthcare delivery than did practitioners. When the distinction between administrator and practitioner was not used as a grouping factor, managed care market penetration, nonprofit status, and years in current employment position were factors that had statistically significant associations with a more positive perception of managed care. Based on these findings, both administrators and practitioners have a role in maintaining awareness regarding their perceptions and should work collaboratively to address issues of concern. Similarly, promoting trust and commitment at the organizational level is important. Recommendations for further research are also provided.


Assessing the Information Management Requirements for Behavioral Health Providers
Leslie F. Major and Michael G. Turner

Behavioral health agencies will soon implement automated information-management systems to support their administrative, financial, and clinical care functions. Assessing current information-management capabilities and delineating future needs are prerequisite to recommending a specific information technology solution. Quantifying the discrepancy between current information-management capabilities and future requirements highlights the areas of greatest unmet need for information management. Selecting an information system that addresses the most critical areas of unmet need is a prudent purchase decision.
This article describes the results of a process to assess the information-management requirements for agencies that were considering implementation of an integrated behavioral health information-management system. The assessment revealed that these agencies already employed automated systems to manage most financial functions and many administrative functions. Few agencies, however, utilized automated systems to manage clinical care functions. Selection of a behavioral health electronic medical record (EMR) effectively addressed clinical care information-management needs without duplicating existing financial and administrative management functions. Also, the EMR included features that addressed some administrative functions for which a discrepancy between current capabilities and future needs was found. Selecting an EMR instead of an integrated behavioral health information system was associated with a significant reduction in information system acquisition costs.