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Volume 55, Number 4
July/August 2010

    Interview with William C. Schoenhard,FACHE, Deputy Under Secretary for Health for Operations and Management, U.S.
    Department of Veterans Affairs
    Stephen J. O’Connor

    ARRA and Meaningful Use: Is Your Organization Ready?
    Kevin R. Burchill

    Unionization in Healthcare: Strategies
    Donna Malvey
    A Lack of Standardization: The Basis for the Ethical Issues Surrounding Quality and Performance Reports
    Kirsten Suchy
  • Hospital Readmissions Under the Spotlight
    Jillian J. Jweinat
    Quantifying the Economic Impact of Communication Inefficiencies in U.S. Hospitals
    Ritu Agarwal, Daniel Z. Sands, and
    Jorge Díaz Schneider

    Practitioner Application: Detlev H. Smaltz

    Healthcare Reform and the Hospital Industry: What Can We Expect?
    Dana S. Kellis and Jill S. Rumberger
    Practitioner Application: Bruce Bartels


Executive Summary
A Lack of Standardization: The Basis for the Ethical Issues Surrounding Quality and Performance Reports, Kirsten Suchy

Consumers in the United States are taking advantage of the proliferation of publicly available, internet-based performance reports and quality appraisals of health plans, healthcare organizations, hospitals, and physicians to aid in their healthcare decision
making. However, these appraisal practices have given rise to controversy and debate over certain distinctive ethical issues. This article advocates a standardized ethical framework to guide current and future development and implementation of performance
reports. This framework, which would resolve a number of the major issues, includes the following ethical principles to guide the practice of public reporting on the Internet and facilitate enhanced quality improvement in the healthcare industry:
legitimacy, data integrity and quality, transparency, informed understanding, equity, privacy and confidentiality, collaboration, accountability, and evaluation and continuous improvement.

Executive Summary
Hospital Readmissions Under the Spotlight, Jillian J. Jweinat

Healthcare leaders see the future of their dynamic industry through the eyes of patients, families, providers, clinicians, employers, health insurers, and policymakers. As healthcare organizations face growing economic challenges and the nation engages in comprehensive healthcare reform, reducing preventable readmissions is considered part of the solution to achieving new system-wide efficiencies.
Healthcare leaders can adopt a fresh approach to reducing preventable readmissions that includes three basic components: (1) identify patients at risk for readmission based on sociodemographic factors, care-related factors, and measures of severity of illness; (2) anticipate reform that aligns reimbursements and payment incentives for readmission reductions; and (3) structure coordinated, patient-centered
discharge planning. Three innovative programs can be used to coordinate care at discharge: the Society of Hospital Medicine’s Better Outcomes for Older Adults Through Safe Transitions project; Boston University Medical Center’s Reengineered Hospital Discharge project; and the Institute for Healthcare Improvement’s State Action on Avoidable Rehospitalizations initiative. This three-pronged approach will help organizations proactively create mechanisms that are aligned with the national agenda and that keep people healthy at
home after hospital discharge.

Executive Summary
Quantifying the Economic Impact of Communication Inefficiencies in U.S. Hospitals, Ritu Agarwal, Daniel Z. Sands, and
Jorge Díaz Schneider

Care delivery is a complex enterprise that involves multiple interactions among multiple stakeholders. Effective communication between these dispersed parties is critical to ensuring quality and safety and improves operational efficiencies. Time and motion studies in hospital settings provide strong evidence that care providers—
doctors and nurses—spend a significant proportion of their time obtaining or providing information (i.e., communicating). Yet, surprisingly, no studies attempt to quantify the economic waste associated with communication inefficiencies in hospital
settings at a national level. Our research focuses on developing models for quantifying the economic burden on hospitals of poor communications. We developed a conceptual model of the effects of poor communications in hospitals that isolates four outcomes:
(1) efficiency of resource utilization, (2) effectiveness of core operations, (3) quality of work life, and (4) service quality, identifying specific metrics for each outcome. We developed estimates of costs associated with wasted physician time, wasted nurse time, and increase in length of stay caused by communication inefficiencies across all U.S. hospitals, using primary data collected from interviews in seven hospitals and secondary data from a literature review, the Bureau of Labor Statistics (BLS), and the Agency for Healthcare Research and Quality (AHRQ). We find that U.S. hospitals waste over $12 billion annually as a result of communication inefficiency among care providers. Increase in length of stay accounts for 53 percent of the annual economic burden. A 500-bed hospital loses over $4 million annually as a result of communication inefficiencies. We note that our estimates are conservative as they do not include all dimensions of economic waste arising from poor communications. The economic burden of communication inefficiency in U.S. hospitals is substantial. Information technologies and process redesign may help alleviate some of this

Executive Summary
Healthcare Reform and the Hospital Industry: What Can We Expect? Dana S. Kellis and Jill S. Rumberger

Healthcare costs continue to increase dramatically, while quality remains a significant problem. Reform measures adopted by Congress will fuel expansion of these costs, further stressing taxpayers and employers and forcing hospitals to adopt transformational changes as they adjust to increased demands for services and shrinking reimbursement. Cost control and quality improvement can be achieved through increased competition or greater government intervention. Competition will require unpalatable changes to the healthcare system to decrease costs without further restricting access or decreasing quality. Increased government intervention will result in changes to reimbursement and hospital–physician relations and increased demands for improved care. To improve cost and quality while preserving increased access, we advocate for a universal standard coverage of Americans; accountable healthcare system leadership; leverage of information resources to make utilization decisions and evaluate performance; alignment of physician, hospital, and payer incentives to focus on care outcomes rather than profit maximization; and the use of quasicompetition to allow for consumer choice within this system.