The balanced scorecard in healthcare organizations: a performance measurement and strategic planning methodology.
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Biomedical subjects
Publications and source records attributed to J S Rakich.
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Quality in health care is defined with a focus on satisfying customer needs. The contemporary management philosophies of continuous quality improvement (CQI) and reengineering are defined; attributes and applications of each are described. Criticism of reengineering appearing in the literature is presented. It is likely that CQI will remain a predominate management philosophy in health services, while reengineering may not endure in its form of radical change.
Public policy affects health and social services organizations. Senior management has a responsibility to prevent inappropriate demands of stakeholders from predominating and to influence the outcome of public policy to the benefit of their organization through the strategic issues management process. This article presents a public policy issue life cycle model, life-cycle stages and suggested strategies, paths issues can take in the life cycle, and factors that affect issue paths. An understanding of these dynamics can aid senior managers in shaping and changing public policy issues and lessening external environment threats to their organization.
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Patients enrolled in managed care organizations (MCOs) are concerned about quality of care and restrictions imposed. There is concern about being harmed due to the negligence of MCOs. Meanwhile, MCOs are protected by the federal Employment Retirement Income Security Act (ERISA) of 1974, which preempts state law claims and results in eliminating many of the recoveries otherwise available to a harmed beneficiary in non-MCOs. This article reviews the ERISA exemption and legal theories for patient redress.
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Health services organization managers at all levels are constantly confronted with problems. Conditions encountered that initiate the need for problem solving are opportunity, threat, crisis, deviation, and improvement. A general problem-solving model presenting an orderly process by which managers can approach this important task is described. An example of the model applied to the current strategic climate is presented.
Hospitals face very dynamic environments and must meet diverse needs in the communities they serve and respond to multiple expectations imposed by their stakeholders. Coupled with these variables, the fact that leadership in these organizations is a shared phenomenon makes organizational leadership in them very complicated. An integrative overview of the organizational leadership role of CEOs in hospitals is presented, and determinants of success in playing this role are discussed.
The absence in the United States of a comprehensive national health insurance system has left a significant number of people either without coverage or with only partial (and inadequate) coverage. Individual states have sought to remedy this through a number of initiatives, but the majority have been incremental in nature, not universal. Sifting through the extensive literature on what states are doing and have been doing, the author reveals the nature of their attempts (and their infrequent successes) and provides issues and questions that must be dealt with before a system acceptable--and accessible--to all can be achieved.
This study reviews the new prospective Medicare Fee Schedule that will be used to pay United States physicians and compares it with the Canadian method of physician payment. The research basis and independent reviews of the resource-based relative value scale, and its conclusions and implications are also examined.
As an introduction to this Hospital Topics theme issue on international healthcare systems, our guest editor and one of our authors present aggregate health expenditures and public-satisfaction data from member nations of the Organization for Economic Cooperation and Development. Although healthcare funding is not the explicit focus of this issue, it underlies most of the points raised, and however the health systems examined here may vary in structure or impact, financing remains a shared challenge and one of our best base lines for comparison.
Comparisons are made in this article between the Canadian and U.S. health care insurance and delivery systems. Canada has universal, comprehensive, and publicly funded health insurance for medically necessary hospital and physician services. The United States does not. Aggregate health care expenditures for both countries are examined as are those for the hospital and physician services sectors. Policy differences between both systems, including system models, health insurance financing, resource commitment and control, and service limits, are presented. Observations are made regarding two elements of the Canadian model--prospective physician sector and prospective hospital global budgeting--and whether they are transplantable to the United States.
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During the three-year period 1985-1987, there were 238 elections in nongovernmental, short-term hospitals to determine whether or not unions would represent the employees. Unions had a success rate of 47.1 percent, similar to that of earlier years. This study reports these election results by hospital and election characteristics. For hospitals, the analysis includes elections by census region, ownership, bed size, and multi-institutional characteristics. For elections, the analysis includes the nature and type of election, employee organization, and employee bargaining-unit-size characteristics. This study concludes that the number of union elections decline as hospital bed size increases, and the union success rate is curvilinear and higher in both small and very large hospitals; union success declines as bargaining-unit size increases. Investor-owned and nonprofit, religious hospitals that are members of multi-institutional systems have lower union success rates than nonsystem hospitals do in their ownership category. However, unions are much more successful in multi-union and decertification elections compared with single-unit elections and initial recognition elections.
Our article in the July-August 1986 issue of Hospital & Health Services Administration described the evolution of hospital personnel management from the pre-1965 to the post-1985 period by examining four different models and predicted trends for the late 1980s (Robbins and Rakich 1986). This article will provide an update and look at emerging trends in hospital personnel management for the early 1990s. A very brief recapitulation of the salient points made in 1986, including the contemporary Matrix Model of hospital personnel management, is presented, and the model's attributes are reassessed. This is followed by an analysis, by category, of the initial predictions of trends, the assessment of whether those trends evolved as anticipated, and expectations for the early 1990s. Finally, new trends, previously unforeseen, are presented.
This study, using National Labor Relations Board data and American Hospital Association data, reports on the status of union election activity in the hospital industry for a 65-month period, January 1980-May 1985, and contrasts it with earlier data for a similar 65-month time period (1974-79). Together these data provide a comprehensive overview of union election activity in non-Federal, nongovernment hospitals since the passage of the 1974 Nonprofit Hospital Amendments to the Taft-Hartley Act. The study analyzes union, election, hospital, and environmental characteristics. Comparisons over the two time periods show that, while union victory rates in hospital elections have remained constant, the total number of elections has declined dramatically in the hospital industry.
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