The agenda of the organization. 1: A framework.
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It is difficult at times to know if the welfare and well-being of an organization is being best served by the individuals who make decisions on its behalf. Sometimes decisions made are driven more by the needs of individual persons rather than by the needs of the organization. Company politics, conflicts, work relationships, territory and turf, individual status and power and personality issues all influence what happens and how decisions are made. Major decisions in areas such as downsizing, re-organization and corporate strategy are often made by individuals. Do these decisions best suit the agenda of the organization or reflect the agenda of the individual? Who looks after the organizational agenda? Noer's (1993) model is used to illustrate how what is best for the organization, and not just individuals within it, can be attained. (+info)
Organizational and environmental factors associated with nursing home participation in managed care.
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OBJECTIVE: To develop and test a model, based on resource dependence theory, that identifies the organizational and environmental characteristics associated with nursing home participation in managed care. DATA SOURCES AND STUDY SETTING: Data for statistical analysis derived from a survey of Directors of Nursing in a sample of nursing homes in eight states (n = 308). These data were merged with data from the On-line Survey Certification and Reporting System, the Medicare Managed Care State/County Data File, and the 1995 Area Resource File. STUDY DESIGN: Since the dependent variable is dichotomous, the logistic procedure was used to fit the regression. The analysis was weighted using SUDAAN. FINDINGS: Participation in a provider network, higher proportions of resident care covered by Medicare, providing IV therapy, greater availability of RNs and physical therapists, and Medicare HMO market penetration are associated with a greater likelihood of having a managed care contract. CONCLUSION: As more Medicare recipients enroll in HMOs, nursing home involvement in managed care is likely to increase. Interorganizational linkages enhance the likelihood of managed care participation. Nursing homes interested in managed care should consider upgrading staffing and providing at least some subacute services. (+info)
Camelot or common sense? The logic behind the UCSF/Stanford merger.
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Many academic medical centers (AMCs) throughout the United States have established their own community-based integrated delivery systems by purchasing physician groups and hospitals. Other AMCs have merged with existing nonprofit community-based delivery systems. Still other AMCs have been sold to for-profit firms. The AMCs at Stanford and the University of California, San Francisco (UCSF), chose a different strategy: to merge with each other to respond to the unique characteristics of the Bay Area marketplace. (+info)
The effects of group size and group economic factors on collaboration: a study of the financial performance of rural hospitals in consortia.
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STUDY QUESTIONS: To determine factors that distinguish effective rural hospital consortia from ineffective ones in terms of their ability to improve members' financial performance. Two questions in particular were addressed: (1) Do large consortia have a greater collective impact on their members? (2) Does a consortium's economic environment determine the degree of collective impact on members? DATA SOURCES AND STUDY SETTING: Based on the hospital survey conducted during February 1992 by the Robert Wood Johnson Hospital-Based Rural Health Care project of rural hospital consortia. The survey data were augmented with data from Medicare Cost Reports (1985-1991), AHA Annual Surveys (1985-1991), and other secondary data. STUDY DESIGN: Dependent variables were total operating profit, cost per adjusted admission, and revenue per adjusted admission. Control variables included degree of group formalization, degree of inequality of resources among members (group asymmetry), affiliation with other consortium group(s), individual economic environment, common hospital characteristics (bed size, ownership type, system affiliation, case mix, etc.), year (1985-1991), and census region dummies. PRINCIPAL FINDINGS: All dependent variables have a curvilinear association with group size. The optimum group size is somewhere in the neighborhood of 45. This reveals the benefits of collective action (i.e., scale economies and/or synergy effects) and the issue of complexity as group size increases. Across analyses, no strong evidence exists of group economic environment impacts, and the environmental influences come mainly from the local economy rather than from the group economy. CONCLUSION: There may be some success stories of collaboration among hospitals in consortia, and consortium effects vary across different collaborations. RELEVANCE/IMPACT: When studying consortia, it makes sense to develop a typology of groups based on some performance indicators. The results of this study imply that government, rural communities, and consortium staff and steering committees should forge the consortium concept by expanding membership in order to gain greater financial benefits for individual hospitals. (+info)
Are MDs more intent on maintaining their elite status than in promoting public good?
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The message that philosopher John Ralston Saul delivered during a recent CMA policy conference may have been unpopular with many physicians, but it wasn't intended to win their support. Instead, organizers wanted him to provide food for thought. Charlotte Gray reports that he did just that. (+info)
The National Health Service in the UK: from myths to markets.
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This paper traces the introduction of economic principles into the NHS over the past 40 years. During this period the service has changed from one which specifically sought to distance the delivery of health care from homo-economicus to one which is increasingly shaped by economic motivation and market-oriented strategies. Three phases in this development are discussed: the administered phase 1948-74, the planning phase 1974-84, and the present management phase. Each phase required different systems of information to support the organization of the service according to the underlying beliefs and philosophy about the relevance of economics to health care. It is suggested that the impact of market provision of health care will need to be vigilantly monitored to ensure that standards of the nation's health care are effective and equitably distributed. (+info)
Surgeons find themselves on trial in forum featuring CMPA lawyers.
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During a recent forum, Ontario surgeons learned that the courtroom requires a much different form of behaviour than the operating room. These lessons hit home during a mock trial featuring CMPA lawyers. (+info)
Introducing a quality improvement programme to primary healthcare teams.
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OBJECTIVES: To evaluate a programme in which quality improvement was facilitated, based on principles of total quality management, in primary healthcare teams, and to determine its feasibility, acceptability, effectiveness, and the duration of its effect. METHOD: Primary healthcare teams in Leicestershire (n = 147) were invited to take part in the facilitated programme. The programme comprised seven team meetings, led by a researcher, plus up to two facilitated meetings of quality improvement subgroups, appointed by each team to consider specific quality issues. OUTCOME MEASURES: To assess the effect and feasibility of the programme on improving the quality of care provided, the individual quality improvement projects undertaken by the teams were documented and opportunities for improvement were noted at each session by the facilitator. The programme's acceptability was assessed with questionnaires issued in the final session to each participant. To assess the long term impact on teams, interviews with team members were conducted 3 years after the programme ended. RESULTS: 10 of the 27 teams that initially expressed interest in the programme agreed to take part, and six started the programme. Of these, five completed their quality improvement projects and used several different quality tools, and three completed all seven sessions of the programme. The programme was assessed as appropriate and acceptable by the participants. Three years later, the changes made during the programme were still in place in three of the six teams. Four teams had decided to undertake the local quality monitoring programme, resourced and supported by the Health Authority. CONCLUSIONS: The facilitated programme was feasible, acceptable, and effective for a few primary healthcare teams. The outcomes of the programme can be sustained. Research is needed on the characteristics of teams likely to be successful in the introduction and maintenance of quality improvement programmes. (+info)