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Volume 57, Number 1
January/February 2012

  • INTERVIEW
    Interview with Scott E. Armstrong, FACHE, President and Chief Executive Officer, Group Health Cooperative
    Stephen J. O'Connor
  • TRENDS
    Nurse Leaders in the Boardroom: A Fitting Choice
    Susan Hassmiller and John Combes

  • REFORM
    Be Compliance-Ready: What to Consider When Acquiring a Physician Practice
    Aleta Jordan
  • ARTICLES
    Coevolution of Patients and Hospitals: How Changing Epidemiology and Technological Advances Create Challenges and Drive Organizational Innovation
    Federico Lega and Stefano Calciolari

    Setting the Stage for a Business Case for Leadership Diversity in Healthcare: History, Research, and Leverage
    Ebbin Dotson and Amani Nuru-Jeter
    Effective US Health System Websites: Establishing Benchmarks and Standards for Effective Consumer Engagement
    Eric W. Ford, Timothy R. Huerta, Richard A. M. Schilhavy, and Nir Menachemi

    Distinguishing Community Benefits: Tax Exemption Versus Organizational Legitimacy

    James B. Byrd and Amy Landry

Executive Summary
Coevolution of Patients and Hospitals: How Changing Epidemiology and Technological Advances Create Challenges and Drive Organizational Innovation
Federico Lega and Stefano Calciolari

Over the last 20 years, hospitals have revised their organizational structures in response to new environmental pressures. Today, demographic and epidemiologic trends and recent technological advances call for new strategies to cope with ultraelderly frail patients characterized by chronic conditions, high-severity health problems, and complex social situations. The main areas of change surround new ways of managing emerging clusters of patients whose needs are not efficiently or effectively met within traditional hospital organizations. Following the practitioner and academic literature, we first identify the most relevant clusters of new kinds of patients who represent an increasingly larger share of the hospital population in developed countries. Second, we propose a framework that synthesizes the major organizational innovations adopted by successful organizations around the world. We conclude by substantiating the trends of and the reasoning behind the prospective pattern of hospital organizational development.

Executive Summary
Setting the Stage for a Business Case for Leadership Diversity in Healthcare: History, Research, and Leverage
Ebbin Dotson and Amani Nuru-Jeter

Leveraging diversity to successfully influence business operations is a business imperative for many healthcare organizations as they look to leadership to help manage a new era of culturally competent, patient-centered care that reduces health and healthcare disparities. This article presents the foundation for a business case in leadership diversity within healthcare organizations and describes the need for research on managerial solutions to health and healthcare disparities. It provides a discussion of clinical, policy, and management implications that will help support a business case for improving the diversity of leadership in healthcare organizations as a way to reduce health and healthcare disparities. Historical contexts introduce aspects of the business case for leveraging leadership diversity based on a desire for a culturally competent care organization. Little research exists on the impact that the role of leadership plays in addressing health disparities from a healthcare management perspective. This article provides practitioners and researchers with a rationale to invest in leadership diversity. It discusses three strategies that will help set the stage for a business case. First, provide empirical evidence of the link between diversity and performance. Second, link investments in diversity to financial outcomes and organizational metrics of success. Third, make organizational leadership responsible for cultural competence as a performance measure. In order to address health and healthcare disparities, collaborations between researchers and practitioners are necessary to effectively implement these strategies.

Executive Summary
Effective US Health System Websites: Establishing Benchmarks and Standards for Effective Consumer Engagement
Eric W. Ford, Timothy R. Huerta, Richard A. M. Schilhavy, and Nir Menachemi

Hospitals and health systems are playing increasingly important roles as care coordination hubs and consumer information sources. In particular, the accountable care organization (ACO) and medical home models promoted in the Affordable Care Act place hospitals at the center of many activities related to health information exchange. Therefore, it is important for these organizations to have effective websites, and the need for a social media presence to connect with consumers is growing quickly. The purpose of this study is to assess the websites of hospitals and health systems on four dimensions: accessibility, content, marketing, and technology. In addition, an overall score is calculated to identify the top 25 hospital and health system websites. Specific website elements that healthcare managers can inspect visually are described for each dimension in the discussion section. Generally, hospital and health system websites can be more effective from an end user's perspective. In particular, hospitals and health systems lagged on the accessibility scale that measures the education level required to understand the language used on a site. The scale also assesses the extent to which web pages are designed for ease of movement from page to page using embedded links. Given that healthcare consumers come from every demographic and stratum of society, it is important that user-friendliness be optimized for a broadly defined audience. Hospital and health system websites can also be improved on the technology scale, as many sites do not return clear descriptions of links to search engines such as Google and Bing that use webcrawlers to collect information.

Executive Summary
Distinguishing Community Benefits: Tax Exemption Versus Organizational Legitimacy

James B. Byrd and Amy Landry

US policymakers continue to call into question the tax-exempt status of hospitals. As nonprofit tax-exempt entities, hospitals are required by the Internal Revenue Service (IRS) to report the type and cost of community benefits they provide. Institutional theory indicates that organizations derive organizational legitimacy from conforming to the expectations of their environment. Expectations from the state and federal regulators (the IRS, state and local taxing authorities in particular) and the community require hospitals to provide community benefits to achieve legitimacy. This article examines community benefit through an institutional theory framework, which includes regulative (laws and regulation), normative (certification and accreditation), and cultural–cognitive (relationship with the community including the provision of community benefits) pillars. Considering a review of the results of a 2006 IRS study of tax-exempt hospitals, the authors propose a model of hospital community benefit behaviors that distinguishes community benefits between cost-quantifiable activities appropriate for justifying tax exemption and unquantifiable activities that only contribute to hospitals' legitimacy.