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Biomedical subjects

M D Fottler

Publications and source records attributed to M D Fottler.

At least 19 recordsLinked to original sources
PubMed2000

Does system membership enhance financial performance in hospitals?

While hospitals continue to join multi-institutional systems, empirical data on the benefits of system membership are ambiguous. This study examines the same 166 Florida hospitals in 1986 and 1992. System membership, in general, did not enhance financial returns (measured by operating margin, total margin, and return on assets) for the pooled data or for either year. In fact, a significant negative relationship is noted in 1986. However, when only hospitals affiliated with national systems (in this study, American Medical International, Hospital Corporation of America, or Humana) are analyzed, a positive statistically significant association is found for two of the above three profitability indicators for both the pooled data and for 1986. However, there was no statistically significant impact noted for 1992. Reasons for the apparent discrepancy in the impact of national versus local/regional systems on hospital financial performance and the apparent declining ability of national systems to generate above-average returns are explored.

Financial Management, Hospital↗
PubMed1999

Transformation of an academic medical center: lessons learned from restructuring and downsizing.

This article reviews management literature on health care transformation and describes the processes, including restructuring, job redesign, and downsizing, involved in one academic medical center's experience. The article concludes with lessons learned at each of the stages of the transformation process: planning, implementation, and process continuation. Managerial implications for similar transformation efforts in other health care organizations are suggested.

Academic Medical Centers↗
PubMed1999

A framework for doctoral education in health administration and policy.

The fundamental building block upon which the whole edifice of education for health services administration rests is doctoral education. Programs can be no better than the quantity and quality of doctoral graduates available to them. In turn, these graduates can be no better than the programs in which they were trained. The purpose of the present paper is to propose a framework for analyzing five different types of doctoral programs in health services administration and policy. First, five models of doctoral education in health services administration and policy are proposed and described. Second, the advantages and disadvantages of each of these models are described fro the viewpoint of the producer. Third, the most appropriate matches of program types and customer orientations are outlined. The basic premise of the paper is that the employers of doctoral graduates occupy (implicitly or explicitly) a limited set of market niches. No single doctoral program can meet the needs of all potential employers. Nor should the potential employer expect that all program types will produce graduates equally capable of meeting their needs.

Curriculum↗
PubMed1997

Methods of measuring patient satisfaction in health care organizations.

Patient perceptions of the quality of services provided is a key factor (along with cost effectiveness) in determining a health care organization's competitive advantage and survival. This article examines the advantages, disadvantages, and problems associated with nine different methods of measuring patient satisfaction with service quality. The appropriateness of each of these techniques under different organizational conditions is also discussed. The article concludes with guidelines for measurement of patient satisfaction and implementation of managerial follow-up.

Cost-Benefit Analysis↗
PubMed1996

Determinants of maternal mortality in rural China.

A case-control study of maternal mortality was conducted in selected rural areas of two provinces in China: Henan province, which has a relatively lower socio-economic status and higher maternal mortality rates, and Jiangsu province with higher socio-economic status and lower maternal mortality rates. The major cause of maternal mortality in the two provinces was postpartum hemorrhage and the largest proportion of deaths occurred on the road between the women's home and the health care facility. Results indicate that the expectant mother's socio-economic status, knowledge of maternal care, and the nature and level of maternal care provided all influence rural maternal death rates. However, socio-economic factors were only significant predictors of mortality in the poorer province. Implications for health policy and future research are discussed.

Age Factors↗
PubMed1996

The role and impact of multiskilled health practitioners in the health services industry.

The utilization of multiskilled health practitioners (MSHPs) is one method of enhancing employee productivity and cost effectiveness of health services delivery. This article reviews the trend toward increasing specialization of health personnel in this century as well as its limitations and the potential of the MSHP to enhance productivity. Then research on factors that inhibit or facilitate adoption of the concept, the effectiveness of the concept, and implementation strategies that impact effectiveness are presented. The article concludes with guidelines and future challenges for health care executives, public policymakers, and researchers as regards implementation of the multiskilled concept.

Cost-Benefit Analysis↗
PubMed1996

The impact of flooding on the delivery of hospital services in the southeastern United States.

A survey and three case studies were conducted of hospitals in Alabama, Georgia, and Florida affected by flooding in July 1994. Our findings suggest that the existence or quality of hospital or community plans for disaster did not seem related to the effect of the flood or the hospitals' response to flooding. Recommendations for preparation and problem avoidance in future flood disasters are provided.

Academic Medical Centers↗
PubMed1995

Intention of inactive registered nurses to return to nursing.

A mail survey of inactive registered nurses who indicated they were either not employed or employed in a nonnursing field was conducted in the state of Alabama. Results of a multiple regression prediction model indicate their intention to return to nursing is affected by career satisfaction/commitment, demographic, and work history variables. The primary reasons for leaving the nursing field were more personal (i.e., pregnancy/child rearing) than professional. However, professional factors predominated when all the reasons for leaving or returning to the field were identified. Implications for management and policy are discussed.

Alabama↗
PubMed1995

Evaluating nurse turnover: comparing attitude surveys and exit interviews.

High turnover rates among hospital nurses demand rigorous and valid processes of research to determine the reasons motivating such attrition. In most hospitals, the exit interview often provides the only relevant data. The case study reported here examines the relative effectiveness of exit interviews and an employee attitude survey in generating data that are useful in managing nurse retention. The conclusion reached is that the attitude survey generates more data and higher-quality data. Further, the study shows that the use of open-ended questions can provide useful information and probably should be the starting point in developing or supplementing an attitude survey for nurses. Recommendations for improving the usefulness and validity of nurse attitude surveys and exit interviews in managing nurse retention are provided.

Attitude of Health Personnel↗
PubMed1994

Determinants of physician vacancy rates in rural hospitals.

This study examines the determinants of physician vacancy rates in rural hospitals from the perspective of the rural hospital administrator. Data on community characteristics, hospital characteristics, and hospital recruitment strategies are examined for 50 rural hospitals in Kentucky using questionnaire and archival data. Physician vacancy rates in this sample were quite high (mean of 37 percent). Results indicate lower physician vacancy rates in hospitals with a chain affiliation. In addition, the "job shopping" model for physicians decisions on where to practice (Johnson, 1978) is supported. Hospitals that target physician candidates with more work experience display lower physician vacancy rates. Generally, hospital characteristics were more significant predictors of physician vacancy rates than were community characteristics. Implications for rural hospital physician recruitment/retention strategies are discussed.

Career Choice↗
PubMed1994

The development of a state-level health manpower database using an employer-based survey: a pilot project.

State health care reform may provide a better approach to meeting the health care needs of rural communities than does federal reform because the planning is closer to the needs of local communities. However, state health reform requires a health manpower database (along with other data) that includes all health occupations and such databases are often nonexistent. This study reports on one element of such a database--a survey of a wide range of rural health care employers covering the full range of health occupations in Alabama. Information on current and future employment of the most significant health occupations is reported here. It was found that the greatest numbers of new health personnel employees needed in the future were, in descending order, nursing assistants, registered nurses, licensed practical nurses, radiological technicians, specialist physicians, nurse practitioners, physical therapists, primary care physicians, and respiratory care therapists. While an employer survey has limitations and should be supplemented by data on community needs and health status indicators, it does provide useful information for planning educational programs to prepare health personnel.

Alabama↗
PubMed1994

The process of managerial control in quality improvement initiatives.

The fundamental intent of strategic management is to position an organization with in its market to exploit organizational competencies and strengths to gain competitive advantage. Competitive advantage may be achieved through such strategies as low cost, high quality, or unique services or products. For health care organizations accredited by the Joint Commission on Accreditation of Healthcare Organizations, continually improving both processes and outcomes of organizational performance--quality improvement--in all operational areas of the organization is a mandated strategy. Defining and measuring quality and controlling the quality improvement strategy remain problematic. The article discusses the nature and processes of managerial control, some potential measures of quality, and related information needs.

Data Collection↗
PubMed1993

The impact of the changing healthcare environment on the attitudes of nursing staff: a longitudinal case study.

Attitude surveys of registered nurses were conducted in 1984 (just prior to implementation of prospective payment) and in 1989 (after implementation of changes responsive to prospective payment and increased competition) in an academic medical center. Results indicate more negative attitudes toward hospital administration, pay and promotional opportunities in 1989. However, overall job satisfaction, job variety, job market alternatives, participation in decision making, and intention to leave were unchanged while job variety and perceptions of job market alternatives were more positive in 1989. Implications for health-care management and future research are discussed.

Attitude of Health Personnel↗
PubMed1992

Determinants of HMO success: the case of Complete Health.

The health maintenance organization (HMO) industry has experienced a variety of difficulties and criticisms in recent years. Various hybrid models have been proposed to alleviate these problems. This article presents an in-depth case study of factors associated with the success of one such hybrid: an individual practice association (IPA)-model HMO affiliated with an academic health center. The major success factors identified include the plan design/structure, the strategic orientation/practices, and the stakeholder management orientation practices.

Academic Medical Centers↗