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Volume 56, Number 4
July/August 2011

  • INTERVIEW
    Interview with Kenneth D. Graham, FACHE, President and Chief Executive Officer of El Camino Hospital
    Stephen J. O'Connor
  • TRENDS
    On the Road to Find Out … Transparency and Just Culture Offer Significant Return on Investment
    Ian R. Lazarus

  • REFORM
    Medicare: Will It Last?
    William D. Petasnick
  • STUDENT ESSAYS
    The Great Divide: Social Media's Role in Bridging Healthcare's Generational Gap
    Meredith M. Sarringhaus
    Unveiling the Unicorn: A Leader's Guide to ACO Preparation
    Paul Aslin
  • ARTICLES
    Structure-Oriented versus Process-Oriented Approach to Enhance Efficiency for Emergency Room Operations: What Lessons Can We Learn?
    Taik Gun Hwang, Younsuk Lee, and Hojung Shin
    Relevant Factors to Consider Prior to an Investor-Owned Acquisition of a Nonprofit Healthcare Entity
    Kelvin Ault, Brad Childs, Charles F. Wainwright, and Marilyn Young

Executive Summary
The Great Divide: Social Media's Role in Bridging Healthcare's Generational Gap, Meredith M. Sarringhaus

Social media, a resource largely untapped in the healthcare field, presents opportunities and advantages and, if used properly, can innovate healthcare and create a competitive advantage for adopters. Many organizations have considered social media but dismissed its advantages as fleeting products of the new generation entering the workforce: the millennials. However, the millennial generation has assumed a greater presence in clinical and administrative positions as the baby boomer generation prepares for retirement. This article advocates the adoption of social media in healthcare organizations as a strategic advantage in connecting with their patient population and recruiting and retaining millennial staff amid the generational shift of the healthcare workforce.            

Executive Summary
Unveiling the Unicorn: A Leader's Guide to ACO Preparation, Paul Aslin

The great uncertainty surrounding healthcare reform provides little incentive for action. However, as healthcare leaders wait for final rules and clarity about accountable care organizations (ACOs), inaction is the inappropriate response. Several central themes emerge from research about beginning the ACO process. Leaders should be able to understand and articulate ACO concepts. They should champion embracing cultural change while partnering with physicians. Inventory of skills and capabilities should take place to understand any deficiencies required to implement an ACO. Finally, a plan should be formed by asking strategic questions on each platform needed to ensure performance and strategic goals are at the forefront of decisions regarding structure and function of an ACO. It takes a visionary leader to accept these challenges.

Executive Summary
Structure-Oriented versus Process-Oriented Approach to Enhance Efficiency for Emergency Room Operations: What Lessons Can We Learn?,Taik Gun Hwang, Younsuk Lee, and Hojung Shin

The efficiency and quality of a healthcare system can be defined as interactions among the system structure, processes, and outcome. This article examines the effect of structural adjustment (change in floor plan or layout) and process improvement (critical pathway implementation) on performance of emergency room (ER) operations for acute cerebral infarction patients. Two large teaching hospitals participated in this study: Korea University (KU) Guro Hospital and KU Anam Hospital. The administration of Guro adopted a structure-oriented approach in improving its ER operations while the administration of Anam employed a process-oriented approach, facilitating critical pathways and protocols. To calibrate improvements, the data for time interval, length of stay, and hospital charges were collected, before and after the planned changes were implemented at each hospital. In particular, time interval is the most essential measure for handling acute stroke patients because patients' survival and recovery are affected by the promptness of diagnosis and treatment. Statistical analyses indicated that both redesign of layout at Guro and implementation of critical pathways at Anam had a positive influence on most of the performance measures. However, reduction in time interval was not consistent at Guro, demonstrating delays in processing time for a few processes. The adoption of critical pathways at Anam appeared more effective in reducing time intervals than the structural rearrangement at Guro, mainly as a result of the extensive employee training required for a critical pathway implementation. Thus, hospital managers should combine structure-oriented and process-oriented strategies to maximize effectiveness of improvement efforts.

Executive Summary
Relevant Factors to Consider Prior to an Investor-Owned Acquisition of a Nonprofit Healthcare Entity
Kelvin Ault, Brad Childs, Charles F. Wainwright, and Marilyn Young

The purpose of this article is to explore the factors that affect the negotiations for an acquisition of a nonprofit system by an investor-owned entity. The recent economic downturn, accompanying credit crisis, and healthcare reform legislation will likely encourage and accelerate the pace of merger and acquisition (M&A) transactions between investor-owned entities and nonprofit hospitals. As many nonprofits are smaller, more financially vulnerable, and more limited in their access to capital than their investor-owned counterparts, nonprofits could be prime targets for investorowned acquirers during the healthcare reform implementation period. In M&A transactions of this type, the investor-owned acquirer typically is motivated to pursue an acquisition when the deal promises an acceptable return on investment and decreased operating costs from economies of scale. Alternatively, the nonprofit target is typically seeking funding for upgrades to facilities and information technology systems as well as a continued commitment to charity care and managed-care contracting leverage. A successful acquisition of a nonprofit hospital by an investor-owned company requires a careful analysis of relevant tax, economic, and strategic factors prior to closing the deal. This article lists the most significant factors to consider in these deals and explains how these factors should influence the purchase price and postacquisition cash flow.