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Biomedical subjects

B Arrington

Publications and source records attributed to B Arrington.

11 recordsLinked to original sources
PubMed1996

Financial performance of safety-net hospitals in a changing health care environment.

Safety-net hospitals serving the poor and indigent in inner-cities have received inadequate research attention regarding the determinants of their financial performance in the changing health care environment. We analyze how the 1990-92 financial performance of 275 such hospitals is related to exogenous and endogenous factors such as payer mix, service mix, staffing and ownership. Models of hospital financial performance are developed using operating margin, cost per discharge and revenue per discharge as measures of performance. Stepwise regression is used to test the model with data from the American Hospital Association (AHA) and Health Care Investment Analysts (HCIA). Results suggest that: 1) The profitability of inner-city hospitals appears positively related with technical complexity of care; 2) High interest and low operating surplus may constrain the addition of technically sophisticated services to enhance profitability; 3) There is some evidence that new governmental programs, e.g. Medicaid managed care and Medicaid Diagnosis Related Groups (DRGs), may not have improved operating margins, though Medicaid DRGs appear to have contained costs. Follow-up research is needed on this issue; 4) Given external fiscal realities, internal management strategies for inner-city hospitals require research, e.g. developing appropriate managed care systems and timely expansion of sub-acute services and; 5) Services such as AIDS treatment and community health education represent opportunities to respond to community needs, especially since unit cost of such services will decline with high volume.

American Hospital Association↗
PubMed1995

Inner-city hospitals: a call for research.

Inner-city hospitals serve as safety nets for poor and underserved populations. They cope with serious issues of uncompensated care, aging facilities, and inadequate reimbursement. Yet, little research exists on their needs and problems. The authors argue that research on inner-city institutions is necessary to obtain "policy" attention, legitimize demand for resources, reframe inner-city health issues as a delivery problem, and gain insights on better ways to manage inner-city hospitals. They provide data-based illustrations of future research questions related to issues of inefficiency, overstaffing, case severity, and facility renovation that can contribute to better policymaking on inner-city hospitals. The authors recognize systemic barriers to research including the unpopularity of access issues, lack of data, and absence of input from practitioners working in inner-city institutions. To remove such barriers, they suggest creation of a representative forum, original databases, increased linkage with research and policy agencies, and increased cooperation between inner-city professionals and researchers.

Catchment Area, Health↗
PubMed1995

Continually improving governance.

What can governance do to ensure the continual improvement of organizational performance? This article explores this question, with particular emphasis on two central considerations. First, what constitutes good governance? Second, what are the sources of and opportunities for leveraging performance available to governance? We argue that focusing on strategy, evaluating performance, and developing the means to learn are the key venues available to governance for leveraging its own and organizational performance.

Documentation↗
PubMed1995

Trends in managed care contracting among U.S. hospitals.

This article describes the changing profile of hospitals initiating managed care contracts as of 1992. Based on statistical tests, early contractors rank higher on profitability, case mix, bed size, affiliation, and urban location. In contrast, recent and noncontractors are predominantly rural, freestanding hospitals with low case mix, low profitability, high subacute services, and government ownership. A number of lessons for the future are drawn and a stage-by-stage approach to studying managed care issues is proposed.

Academic Medical Centers↗
PubMed1990

Who really profits from not-for-profits?

In a Harvard Business Review (1987) article, Herzlinger and Krasker suggested that not-for-profit hospitals do not return more benefit to society than do for-profit hospitals, and the authors questioned the legitimacy of social subsidization of not-for-profits. Our article reports findings from an empirical reconsideration of the question, "Who profits from nonprofits?" We used hospital data from the same time period (1982) as that used by Herzlinger and Krasker; however, our investigation analyzed a larger data set (including both system and nonsystem hospitals) and used a different statistical technique (discriminant analysis). Our findings suggest that not-for-profits return more social benefit (e.g., in the areas of services provided, access to care, and involvement in professional education) than do for-profits. Like Herzlinger and Krasker, we find that for-profit hospitals may be more efficient than not-for-profits. We caution that public policy regarding social subsidization of not-for-profit hospitals should be made only after more intensive study and thoughtful consideration.

Community-Institutional Relations↗
PubMed1989

Who profits from not-for-profits: a reconsideration.

'Who profits from nonprofits?' asked Herzlinger and Krasker in a recent Harvard Business Review article. Their study examined whether not-for-profit hospitals achieve the intended social goals for which they are subsidised by society. In this paper, we report a reconsideration of Herzlinger and Krasker's question. Using a larger data set and a different statistical method, our findings are at variance with those of Herzlinger and Krasker and in general agreement with their critics.

Discriminant Analysis↗
PubMed1988

Management education focuses on new leadership ideas.

A widely accepted new leadership approach concerns transactional and transformational leadership. Transactional leadership consists of planning, implementation, and evaluation. Transformational leadership consists of charisma, intellectual stimulation, and individualized consideration that can motivate followers. The six orientations that characterize the Catholic healthcare ministry imply both types of leadership. Fundamental values, knowledge, and skills required for healthcare organization management are acquired through health administration education. The themes prevalent in today's Catholic healthcare ministry and the leadership qualities they imply are addressed by all aspects of such education: degree programs, field experience, continuing education, and research and consultation. Much of a master's degree program concentrates on transactional leadership because its content is better formulated and easier to teach. The development of transformational leadership qualities during master's study primarily provides a foundation on which students can build. Health administration programs in cooperation with healthcare organizations have created three models for field experience: internships, residencies, and fellowships. Many master's programs deliver continuing education programs for both types of leadership, and research and consultation contribute to this education.

Catholicism↗
PubMed1988

Marketing-oriented organizations: an integrated approach.

Organizations can be oriented toward marketing from a production, product, sales, or marketing perspective. Strategies, structures, and cultures, which reflect a company's basic orientation, must be integrated to ensure that marketing efforts communicate a clear corporate position. In a study of 31 hospitals, the Center for Health Services Education Research, St. Louis University, found that no hospital's organization fit neatly into a single category. For example, a hospital may have some service lines that were marketing oriented while other lines were production oriented. The majority of hospitals, however, were product oriented, focusing on productivity and financial performance rather than on market factors. The most effective sales orientation was observed in the for-profits. Their selling efforts, however, tended to be internally focused, with product development activities divorced from the planning and marketing functions. Only the for-profit hospitals showed the beginning of a marketing orientation. Developing a marketing orientation, especially in line divisions, requires a careful, well-orchestrated effort and the presence of several key factors: Access to capital and an emphasis on long-range planning and strategic spending The availability of hospital-specific market research. Key distribution channels. Talented middle managers. Up-to-date systems and structures equipped to serve new values and strategies. Leaders capable of communicating to the organization a vision of its role in the community.

Hospital Administration↗