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Volume 50, Number 3
May/June 2005

I. INTERVIEW

Interview with Ronald G. Spaeth, FACHE, president, Evanston Northwestern Healthcare Foundation, Kyle L. Grazier

II. Funding

The Link Between a Formal Debt Policy and Replacement Reserves, William O. Cleverley and James O. Cleverley

III. Communication

Proxemics in Clinical and Administrative Settings, Paul Preston

IV. ARTICLES

  • What Do We Owe the Dying? Strategies to Strengthen End-of-Life Care, Sara Imhof and Brian Kaskie
  • Practitioner Application: Todd Linden
  • The Revolution in Hospital Management, John R. Griffith and Kenneth R. White
  • Practitioner Application: David L. Bernd
  • The Financial Performance of Integrated Health Organizations, Lawton R. Burns, Gilbert Gimm, and Sean Nicholson
  • Practitioner Application: Ralph W. Muller

Executive Summary
What Do We Owe the Dying? Strategies to Strengthen End-of-Life Care, Sara Imhof and Brian Kaskie

More than 2.5 million Americans died last year, and a majority of these persons died within an inpatient hospital setting. The demand for inpatient hospital care at the end of life (EOL) will increase appreciably as the population continues to age; several leading bodies, including the Institute of Medicine, have called for an expansion of evidence-based, patient-centered EOL care. In an attempt to assist healthcare executives to meet the needs of the increasing number of dying patients, we reviewed four hospital-based, best-practice EOL programs. Following this review, we defined an operational planning process that yields three ways to improve EOL care programs. The improvement of EOL care programs should constitute a great benefit to those organization concerned with improving the quality of patient care, reducing the costs associated with the treatment of dying patients, and responding to the standards of national credentialing bodies.


Executive Summary
The Revolution in Hospital Management, John R. Griffith and Kenneth R. White

Five healthcare systems that have either won the Malcolm Baldrige National Quality Award in Health Care or been documented in extensive case studies share a common model of management: they all emphasize a broadly accepted mission; measured performance; continuous quality improvement; and responsiveness to the needs of patients, physicians, employees, and community stakeholders. This approach produces results that are substantially and uniformly better than average, across a wide variety of acute care settings. As customers, courts, and accrediting and payment agencies recognize this management approach, we argue that it will become the standard for all hospitals to achieve.

This article examines documented cases of excellent hospitals, using the reports of the three winners of the Baldrige National Quality Award in Health Care and published studies of other institutions with exceptional records.

Executive Summary
The Financial Performance of Integrated Health Organizations, Lawton R. Burns, Gilbert Gimm, and Sean Nicholson

This study examines the impact of integration strategies on the financial performance of hospitals, physicians, and health plans over time. Results from a study of 36 large integrated health organizations (IHOs) suggest that financial performance is adversely affected by the scale of investment in integration but not necessarily by the timing or sequencing of the investments made. The results also suggest that some integration strategies have more detrimental effects on financial performance than do others. Finally, the results show that centralized integrative structures appear more financially successful than are less centralized structures.