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Volume 53, Number 6
November/December 2008

  • INTERVIEW
    Interview with William Petasnick, FACHE, President and Chief Executive Officer, Froedtert Hospital and Froedtert & Community Health System, and 2008 Chair, American Hospital Association, Kyle L. Grazier

  • CONSUMER-DRIVEN HEALTHCARE
    A Strategy Fit for a King: A Customer Experience Framework, Sandy Lutz and Serena Foong

  • ARTICLES
    Common Competencies for All Healthcare Managers: The Healthcare Leadership Alliance Model, Mary E. Stefl
    Development of an Interprofessional Competency Model for Healthcare Leadership, Judith G. Calhoun, Lorayne Dollett, Marie E. Sinioris, Joyce Anne Wainio, Peter W. Butler, John R. Griffith, and Gail L. Warden
    Effective Hosptial Revenue Cycle Management: Is There a Trade-off Between the Amount of Patient Revenue and the Speed of Revenue Collection?, Simone Rauscher and John R.C. Wheeler
  • Organizational Structure for Addressing the Attributes of the Ideal Healthcare Delivery System, Mark E. Cowen, Lakshmi K. Halasyamani, Daniel McMurtrie, Denise Hoffman, Theodore Polley, and Jeffrey A. Alexander

Executive Summary

Common Competencies for all Healthcare Managers: The Healthcare Leadership Alliance Model, Mary E. Stefl

Today’s healthcare executives and leaders must have management talent sophisticated enough to match the increased complexity of the healthcare environment. Executives are expected to demonstrate measurable outcomes and effectiveness and to practice evidence-based management. At the same time, academic and professional programs are emphasizing the attainment of competencies related to workplace effectiveness. The shift to evidence-based management has led to numerous efforts to define the competencies most appropriate for healthcare.

The Healthcare Leadership Alliance (HLA), a consortium of six major professional membership organizations, used the research from and experience with their individual credentialing processes to posit five competency domains common among all practicing healthcare managers: (1) communication and relationship management, (2) professionalism, (3) leadership, (4) knowledge of the healthcare system, and (5) business skills and knowledge. The HLA engaged in a formal process to delineate the knowledge, skills, and abilities within each domain and to determine which of these competencies were core or common among the membership of all HLA associations and which were specialty or specific to the members of one or more HLA organization. This process produced 300 competency statements, which were then organized into a Competency Directory, a unique and interactive database that can be used for assessing individual and organizational competencies. Overall, this work helps to unify the field of healthcare management and provides a lexicon and a basis for collaboration among different types of healthcare executives.

This article discusses the steps that the HLA followed. It also presents the HLA Competency Directory; its application and relevance to the practitioner and academic communities; and its strengths, limitations, and potential.

Executive Summary

Development of an Interprofessional Competency Model for Healthcare Leadership, Judith G. Calhoun, Lorayne Dollett, Marie E. Sinioris, Joyce Anne Wainio, Peter W. Butler, John R. Griffith, and Gail L. Warden

During the past decade, there has been a growing interest in competency-based performance systems for enhancing both individual and organizational performance in health professions education and the varied healthcare industry sectors. In 2003, the Institute of Medicine’s report Health Professions Education: A Bridge to Quality called for a core set of competencies across the professions to ultimately improve the quality of health care in the United States. This article reviews the processes and outcomes associated with the development of the Health Leadership Competency Model (HLCM), an evidence-based and behaviorally focused approach for evaluating leadership skills across the professions, including health management, medicine, and nursing, and across career stages.

The HLCM was developed from extensive academic research and widespread application outside healthcare. Early development included behavioral event interviewing, psychometric analysis, and cross-industry sector benchmarking. Application to healthcare was supported by additional literature review, practice analysis, expert panel inputs, and pilot-testing surveys. The model addresses three overarching domains subsuming 26 behavioral and technical competencies. Each competency is composed of prescriptive behavioral indicators, or levels, for development and assessment as individuals progress through their careers from entry-level to mid-level and advanced stages of lifelong development. The model supports identification of opportunities for leadership improvement in both academic and practice settings.

Executive Summary

Effective Hospital Revenue Cycle Management: Is There a Trade-off Between the Amount of Patient Revenue and the Speed of Revenue Collection?

Simone Rauscher and John R.C. Wheeler

Effective hospital revenue cycle management practices have gained in importance in today’s hospital business environment, in which many hospitals are confronted with stricter regulations and billing requirements, more thorough preauthorization and precertification, underpayments, and greater delays in payments. In this article, we provide a brief description of current hospital revenue cycle management practices. Next, we suggest measures of the financial benefits of revenue cycle management in terms of increases in the amount and speed of patient revenue collection. We consider whether there is a trade-off between the amount of patient revenue a hospital earns and the speed with which revenue is collected.

Using financial statement data from California hospitals for 2004 to 2006, we test empirically the relationships among key financial measures of effective hospital revenue cycle management. We find that hospitals with higher speeds of revenue collection tend to record higher amounts of net patient revenue per adjusted discharge, lower contractual allowances, and lower bad debts. Charity care provision, on the other hand, tends to be higher among hospitals with higher speeds of revenue collection. We conclude that there is no evidence of a trade-off between the amount of patient revenue and the speed of revenue collection but that these financial benefits of effective hospital revenue cycle management often go hand in hand. We thus provide early indication that these outcomes are complementary, suggesting that effective hospital revenue cycle management achieves multiple positive results.

Executive Summary

Organizational Structure for Addressing the Attributes of the Ideal Healthcare Delivery System,Mark E. Cowen, Lakshmi K. Halasyamani, Daniel McMurtrie, Denise Hoffman, Theodore Polley, and Jeffrey A. Alexander

The Institute of Medicine’s (IOM) report Crossing the Quality Chasm described the aims, characteristics, and components of the ideal healthcare system but did not provide the templates of organizational structures needed to achieve this vision. In this article, we review three principles of effective organizations to inform the design of a facilitative clinical care structure: a focus on the patient and caregiving team, the use of information, and connectivity with executive and operational leadership. These concepts can be realized in an organizational chart that is inverted to place patients and their care providers on top, flat with few degrees of separation between patients and executive leadership, and webbed to reflect connections to the professional and ancillary departments.

An example of a recently implemented clinical care infrastructure follows this discussion. This model divides the patient population into nonexclusive subgroups, each with an interdisciplinary collaborative practice team that oversees and advocates the subgroup’s clinical care activities. The organization’s interdisciplinary practice council, in conjunction with its physician and nursing practice councils, supports these teams, providing a second layer of support. The council layer is connected to the health system board through the clinical oversight group, whose core membership consists of council chairs, the chief executive officer, and the chief medical and nursing officers. Clinical information for planning and evaluation is available at all levels. This model provides a framework for identifying the individuals and processes necessary to achieve IOM’s vision.