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Volume 53, Number 5
September/October 2008

  • INTERVIEW
    Interview with David A. Stark, Executive Vice President/Chief Operating Officer, Iowa Health—Des Moines, Kyle L. Grazier

  • CONSUMER-DRIVEN HEALTHCARE
    Choosing Your Charity, Sandy Lutz

  • ARTICLES
    Gender and Leadership in Healthcare Administration: 21st Century Progress and Challenges, Paula M. Lantz
    Sickle Cell Hospital Unit: A Disease-Specific Model, Patricia Adams-Graves, Elizabeth J. Ostric, Mary Martin, Pat Richardson, and James B. Lewis, Jr.
    Using Leadership Development Programs to Improve Quality and Efficiency in Healthcare, Ann Scheck McAlearney
  • The Early Indicators of Financial Failure: A Study of Bankrupt and Solvent Health Systems, Joseph S. Coyne and Sher H. Singh

Executive Summary

Gender and Leadership in Healthcare Administration: 21st Century Progress and Challenges, Paula M. Lantz

The need for strong leadership and increased diversity is a prominent issue in today’s health services workforce. This article reviews the latest literature, including research and proposed agendas, regarding women in executive healthcare leadership. Data suggest that the number of women in leadership roles is increasing, but women remain underrepresented in the top echelons of healthcare leadership, and gender differences exist in the types of leadership roles women do attain. Salary disparity prevails, even when controlling for gender differences in educational attainment, age, and experience.

Despite widespread awareness of these problems in the field, the current action and policy recommendations are severely lacking. Along with the challenges of cost, quality, and an aging population, the time has come for a more thoughtful, policy-focused approach to amend the discrepancy between gender and leadership in healthcare administration.

Executive Summary

Sickle Cell Hospital Unit: A Disease-Specific Model
Patricia Adams-Graves, Elizabeth J. Ostric, Mary Martin, Pat Richardson, and James B. Lewis, Jr.

American urban hospitals often serve large populations of sickle cell disease (SCD) patients. Those hospitals that choose to implement an adult SCD-specific inpatient unit have the opportunity to acquire multiple operational benefits. Such units may ultimately reduce patient morbidity and mortality; improve timely access to quality medical care in a cost-effective manner; reduce overcrowding in the emergency department; and increase patient, family, physician, and payer satisfaction.

SCD is a serious, painful, genetic blood disorder that affects a growing population of adults in the United States. A single mistake in the gene that codes for hemoglobin causes crescent-shaped red blood cells that are sticky, are stiff, and have a short life span. These cells cause blockages, tremendous pain brought on by lack of oxygen in the muscles, organ damage, stroke, and problems with infections. The cells’ short life spans often results in anemia. The unpredictable pain event— sickle cell disease with crisis—is the most common reason for presentation to the emergency department and for hospital admission. For many SCD patients, the emergency department process and the general, overly conservative approach to pain relief lead to a delay in treatment and prolong needless suffering.

Regional Medical Center at Memphis (Tennessee) established an SCD unit and developed an inpatient care delivery model that decreases the burden of caring for SCD patients on its busy emergency department, improves SCD patients’ satisfaction and access to timely quality care, and reduces the needless pain and suffering of SCD patients. This SCD model may be replicated in large urban hospitals with a daily SCD patient census of five or more.

Executive Summary

Using Leadership Development Programs to Improve Quality and Efficiency in Healthcare, Ann Scheck McAlearney

With heightened emphasis on the imperatives to improve the quality and efficiency of healthcare delivered in U.S. hospitals and health systems, healthcare managers are challenged to consider innovative approaches to address these issues. Leadership development programs are increasingly common offerings within healthcare organizations, but linking such initiatives to quality and efficiency improvement programs remains rare.

This article uses data from three qualitative studies of leadership development in healthcare to answer the question, “What opportunities might exist to use leadership development programs to improve quality and efficiency?” Interviews from 200 individuals were conducted between September 2003 and December 2007 with hospital and health system managers and executives, academic experts, consultants, individuals representing associations and vendors of leadership development programs, and program participants.

Analyses of these data showed that leadership development programs provide four important opportunities to improve quality and efficiency in healthcare: (1) by increasing the caliber of the workforce, (2) by enhancing efficiency in the organization’s education and development activities, (3) by reducing turnover and related expenses, and (4) by focusing organizational attention on specific strategic priorities. Several concrete examples of how to leverage leadership development in these ways are provided to help managers consider how to apply these research findings.

Healthcare managers can use the results reported from these studies to extend the reach of current leadership development programs or to inform the design of new initiatives that focus specifically on quality and efficiency improvement. Although quantitative metrics are required to measure definitive improvements in quality and efficiency in healthcare, these qualitative data highlight opportunities through which leadership development initiatives can contribute to improvement efforts.

Executive Summary

The Early Indicators of Financial Failure: A Study of Bankrupt and Solvent Health Systems, Joseph S. Coyne and Sher H. Singh

This article presents a series of pertinent predictors of financial failure based on analysis of solvent and bankrupt health systems to identify which financial measures show the clearest distinction between success and failure. In doing so, early warning signals are evident from the longitudinal analysis as early as five years before bankruptcy.

The data source includes seven years of annual statements filed with the Securities and Exchange Commission by 13 health systems before they filed Chapter 11 bankruptcy. Comparative data were compiled from five solvent health systems for the same seven-year period. Seven financial solvency ratios are included in this study, including four cash liquidity measures, two leverage measures, and one efficiency measure.

The results show distinct financial trends between solvent and bankrupt health systems, in particular for the operating cash-flow–related measures, namely Ratio 1: Operating Cash Flow Percentage Change, from prior to current period; Ratio 2: O perating Cash Flow to Net Revenues; and Ratio 4: Cash Flow to Total Liabilities, indicating sensitivity in the hospital industry to cash flow management. The high dependence on credit from third-party payers is cited as a reason for this; thus, there is a great need for cash to fund operations. Five managerial policy implications are provided to help health system managers avoid financial solvency problems in the future.