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Volume 55, Number 6
November/December 2010

  • INTERVIEW
    Interview with Carrie Owen Plietz, FACHE, Chief Operating Officer, Mills-Peninsula Health Services/Sutter Health System
    Stephen J. O'Connor

  • TRENDS
    Hospitalist Programs in the Age of Healthcare Reform
    Martin Buser

  • ARTICLES
    Minimizing Deviant Behavior in Healthcare Organizations: The Effects of Supportive Leadership and Job Design
    C. Logan Chullen, Benjamin B. Dunford, Ingo Angermeier, R. Wayne Boss, and Alan D. Boss
    A Method for Defining Value in Healthcare Using Cancer Care as a Model
    Thomas W. Feeley, Heidi Albright, Ronald Walters, and Thomas W. Burke
    Factors Affecting the Continuing Education of Hospital CEOs and Their Senior Managers
    Stephen L. Walston, Ann F. Chou, and Amir A. Khaliq

Executive Summary
Minimizing Deviant Behavior in Healthcare Organizations: The Effects of Supportive Leadership and Job Design, C. Logan Chullen, Benjamin B. Dunford, Ingo Angermeier, R. Wayne Boss, and Alan D. Boss

In an era when healthcare organizations are beset by intense competition, lawsuits, and increased administrative costs, it is essential that employees perform their jobs efficiently and without distraction. Deviant workplace behavior among healthcare
employees is especially threatening to organizational effectiveness, and healthcare managers must understand the antecedents of such behavior to minimize its prevalence. Deviant employee behavior has been categorized into two major types, individual
and organizational, according to the intended target of the behavior. Behavior directed at the individual includes such acts as harassment and aggression, whereas behavior directed at the organization includes such acts as theft, sabotage, and voluntary
absenteeism, to name a few (Robinson and Bennett 1995). Drawing on theory from organizational behavior, we examined two important features of supportive leadership, leader–member exchange (LMX) and perceived organizational support (POS), and two important features of job design, intrinsic motivation and depersonalization, as predictors of subsequent deviant behavior in a sample of over 1,900 employees within a large US healthcare organization. Employees who reported weaker perceptions of LMX and greater perceptions of depersonalization were more likely to engage in deviant behavior directed at the individual, whereas
employees who reported weaker perceptions of POS and intrinsic motivation were more likely to engage in deviant behavior directed at the organization. These findings give rise to specific prescriptions for healthcare managers to prevent or minimize the
frequency of deviant behavior in the workplace.

Executive Summary
A Method for Defining Value in Healthcare Using Cancer Care as a Model, Thomas W. Feeley, Heidi Albright, Ronald Walters, and Thomas W. Burke

Value-based healthcare delivery is being discussed in a variety of healthcare forums. This concept is of great importance in the reform of the US healthcare delivery system. Defining and applying the principles of value-based competition in healthcare
delivery models will permit future evaluation of various delivery applications. However, there are relatively few examples of how to apply these principles to an existing care delivery system. In this article, we describe an approach for assessing the value created when treating cancer patients in a multidisciplinary care setting within a comprehensive cancer center. We describe the analysis of a multidisciplinary care center that treats head and neck cancers, and we attempt to examine how this center integrates with Porter and Teisberg’s (2006) concept of value-based competition based on the results analysis. Using the relationship between outcomes and costs as the definition of value, we developed a methodology to analyze proposed outcomes for a population of patients treated using a multidisciplinary approach, and we matched those outcomes to the costs of the care provided. We present this work as a model for defining value for a subset of patients undergoing active treatment. The method can be applied not only to head and neck treatments, but to other modalities as well. Public reporting of this type of data for a variety of conditions can lead to improved competition in the healthcare marketplace and, as a result, improve outcomes and decrease health expenditures.

Executive Summary
Factors Affecting the Continuing Education of Hospital CEOs and Their Senior Managers, Stephen L. Walston, Ann F. Chou, and Amir A. Khaliq

This article examines the influences on executives’ continuing education in hospitals. It uses data from a national survey on professional development conducted in 2009 by the American College of Healthcare Executives (ACHE) to explore how organizational and individual characteristics are related to the amount of continuing education (CE) taken by chief executive officers (CEOs) and the commitment to CE by their senior managers. Our findings suggest that the organizational characteristics of
ownership, size, and region and the individual characteristics of gender, professional affiliation, and the focus of CE may influence how much CE CEOs take. CEOs from for-profit, larger hospitals and ACHE members tend to take less CE. Likewise, senior
managers’ commitment to CE is influenced by region, gender, the CEO’s personal CE hours, and the focus of the CE.
Surprisingly, ACHE membership is associated with lower amounts of personal CEO CE. Also, female CEOs appear to engender greater commitment to CE in their senior managers. Finally, CE focused on change increases the senior managers’ commitment,
while a focus on new technology lessens it. For those organizations seeking to meet current and future challenges by creating
a learning organization, CE is essential. Understanding factors that influence the amount of and commitment to CE is important. We hope our research adds to this understanding and that leaders will seek to improve the dedication and value of CE
in their organizations.