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Biomedical subjects

A R Kovner

Publications and source records attributed to A R Kovner.

33 records · Page 2Linked to original sources
PubMed1981

Hospital governance and market share.

The organizational structure of nonprofit hospitals has remained fixed while hospital technology and financing have changed. Caught between competitive pressures from other organizations not subject to the same government regulation to contain costs and assure quality, and physician resistance to organizational change, hospital boards lack the capacity to make effective and timely decisions to retain market share. Governing structure will have to change for nonprofit hospitals to sustain growth and to achieve adequate standards of cost containment, quality assurance, and patient service. Accountability for hospital performance should be maintained through increased control of the governing board by physicians and managers. The board and medical official should agree on the nature of the latter's accountability for departmental or committee performance. The board should hold medical officials so accountable. If regulators, trustees, physicians, and managers are genuinely interested in sustaining the nonprofit hospital's share of the market, they must pay more attention to the structure and function of hospital governance, so that boards can more effectively respond to market opportunities, contain costs, and assure quality.

Decision Making↗
PubMed1979

Point of view: readings for the chairperson of your board.

The chairperson of the board and the hospital's chief executive officer need to read about the forces threatening their hospital's survival and growth. These suggested readings cover such vital issues as National Health Insurance, hospital rate settings and health care access.

Bibliographies as Topic↗
PubMed1978

Improving community hospital board performance.

There has been little focus on improving hospital governance as an approach to controlling costs and improving the quality of care in community hospitals. The author examines assumptions underlying such an approach, describes various proposals, and presents criteria to be used in evaluating them. The author recommends governing board involvement in goal setting and monitoring activities. This requires the development of standards on hospital performance and governing board performance, as well as methodology for external monitoring and external impact on the boards in these respects.

Decision Making↗
PubMed1978

How--and how not--to improve board performance.

There is little serious discussion of how governing board performance can be improved as a means to resolving the problems of high costs, uneven quality, and unequal access to care. Four categories of proposals for improving board performance are discussed, and four criteria for judging these proposals are presented. The board should set down goals and performance standards and be held accountable for them by the appropriate licensing, accrediting, and reimbursement agencies.

Goals↗
PubMed1975

State regulation of health care costs.

State regulation of health care costs has been increasing at the same time as criticism of governmental regulation in other sectors of the economy has been increasing. The authors examine major system elements necessary to effect cost control in health care, present normative models of value preferences which underlie alternative state cost control systems, and indicate control foci and intervention strategies for state government under the alternative models. The authors conclude that state governments should assume responsibility for controlling health care costs. Presently, state regulatory agencies should emphasize development of adequate information systems, strengthening of state regulatory capability, and implementation of experimental reimbursement programs rather than comprehensive and detailed rate setting.

Fees and Charges↗
PubMed1975

Governing boards.

Explore the source record for details and available documents.

Governing Board↗
PubMedDate not supplied

The case of the unhealthy hospital.

On a cold March morning, Bruce Reid, Blake Memorial Hospital's new CEO, visited the Lorris housing project clinic, one of six off-site clinics operated by Blake Memorial. He was not encouraged by what he saw: peeling paint, leaking pipes, and cramped conditions. When he asked Renée Dawson, the clinic's primary care physician, how she endured the conditions, she just stared at him. "What are my options?" she asked. That was a good question. Blake Memorial was in poor financial health, due to rising costs and stagnating revenue. The hospital's quality of care was also a major problem. In addition, the clinics were losing over $250,000 a year. As Reid worked on Blake Memorial's 1992 budget, he saw he would have to cut some services in order to fund others. One of the services he was considering cutting was the clinic program. But there were a number of conflicting forces that Reid had to consider. On the political front, the recently appointed commissioner of health services said she would challenge Blake Memorial's tax-exempt status if Reid dismantled the clinics. Within the hospital were two warring factions. One wanted more high-tech services for the hospital and favored closing the clinics. "Instead of clinics, we should have a shuttle bus from the housing projects to the hospital," one doctor suggested. The other faction wanted to expand the clinics. "Wherever the service is most needed, that is where the hospital should be," argued the clinics' director. Reid must decide what to cut and what to keep. But to do so, he must first settle on Blake Memorial's long-term mission.(ABSTRACT TRUNCATED AT 250 WORDS)

Budgets↗
PubMedDate not supplied

Physician leadership in hospital strategic decision making.

In this article, three models of hospital strategic decision making are presented. These models focus on the role of physician leaders, particularly chiefs of clinical services, in decision making regarding major changes in the nature and scope of hospital services. The recommended model of decision making for any individual hospital is contingent on the competitive environment which the hospital faces, the complexity of decisions which must be made, and the characteristics of the physician leadership.

Decision Making, Organizational↗
PubMedDate not supplied

Better information for the board.

Healthcare managers are making quicker, riskier decisions in an increasingly competitive and regulated environment. Questions have been raised regarding the accountability and performance of boards of these organizations, as board members are not always selected based on their competencies to guide such decisions. Adapting mission and strategy and monitoring organizational performance require information that boards get mostly from management. The purpose of this study was to examine the information that boards regularly get to carry out their functions. I obtained board documents from four not-for-profit hospitals and health systems in different boroughs of New York City. At each institution, I conducted one-hour interviews with at least three board members and three top managers. I also attended at least one board or executive committee meeting and one additional meeting, usually of the finance committee. Principal findings were that the boards get too much data, the same data that management gets, and little comparative data on performance of similar benchmarked organizations. Board members and managers are satisfied with the information that board members get and have no plans to improve their system of shaping, or the quality of, information. Key recommendations to boards and managers are: (1) boards must take greater responsibility for identifying the information that they get and how they wish to get it, (2) managers must ensure that measurable objectives are developed, against which organizational performance can be evaluated, (3) boards must get information that is targeted and shaped to better fit board functions, (4) managers must develop information sets for main service lines, (5) boards must get information on the expectations and satisfaction levels of key stakeholders, (6) boards must get better and more focused information on performance of benchmarked institutions, and (7) boards must get less hospital operating data on a monthly basis.

Decision Making, Organizational↗