Biomedical subjects
Publications and source records attributed to N F Piland.
Since the initiation of prospective payment, hospitals have been struggling to develop strategies that improve their prospects for long-run viability. Foremost among these strategy formulations have been efforts to build hospital-physician relations. This article reviews several popular strategies designed to achieve mutually satisfying hospital-physician relations.
Medicare's Prospective Payment System (PPS) has introduced a new environment in which hospitals must either alter their strategies for delivering services or face closure. This is a challenge for rural hospitals that often lack the resources and supportive economic climate of their urban counterparts. Few guidelines are available to assist rural hospitals in responding organizationally to PPS-induced constraints. This article examines the plight of rural hospitals from the perspective of strategic adaptation. A conceptual framework is proposed for studying strategic adaptations to PPS by rural hospitals. The implications for developing a sound research methodology are also discussed. On the basis of this research agenda, it may be possible to clarify how rural hospitals should adapt to PPS (and similar) constraints now, and in the future.
Explore the source record for details and available documents.
Managers in the public and private sectors have turned to Japanese management techniques as a means to improve quality and productivity. Many health care organizations have also adopted Japanese management concepts in the belief that performance will be improved. This article reviews the concepts, fundamental premises, and case studies of Japanese management in nursing. At issue is the value of Japanese management practices for nurses, patients, and organizations.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Organized in 1922, the Lovelace Clinic successfully provided health care services throughout the Southwest utilizing a group practice format under the aegis of a nonprofit foundation. In 1984, the Foundation contracted with Hospital Corporation of America to form a for-profit health care organization which allows the provision of high quality health care through a group practice professional corporation, a 238-bed inpatient facility, a 70,000-member health maintenance organization, and an independent research and education foundation.
Within medicine there is growing uneasiness and debate about changes in medical care delivery. Much of this concern centers on the evolution of organizations and the role of physicians. The emergence of multi-institutional organizations, the rise of investor-owned health care corporations, and the expansion of group medical practice illustrate the increasing organizational influence in medicine. Added to these trends are new financial incentives confronting both physicians and organizations so that the environment increasingly favors conflict. This article reviews the primary strategies for resolving physician-organization conflicts, including cooperation between physicians and organizations, having physician representatives in governance and management, restructuring incentives, and restructuring organizations. Although these strategies have various merits, we suggest that every physician has a personal responsibility to become more involved in organization and management issues. Physicians can play an important role in guiding the evolution of medicine.
The Veterans Administration and the United States Air Force hospitals in Albuquerque recently established a service- and facility-sharing arrangement. In this article, the authors share lessons learned from planning and executing the arrangement-lessons that any organization considering a large-scale joint venture will want to keep in mind.
Many hospitals and health care organizations are contending with fierce financial and competitive pressures. Consequently, programs that do not make an immediate contribution to master strategy are often overlooked in the strategic management process. Research programs are a case in point. Basic science, clinical, and health services research programs may help to create a comprehensive and fundamentally sound master strategy. This article discusses the evolving role of health care organizations in research relative to strategy formulation. The primary costs and benefits from participating in research programs are examined. An agenda of questions is presented to help health care organizations determine whether they should incorporate health-related research as a key element in their strategy.
There is growing public and corporate interest in health promotion programs. Available literature suggests that health promotion may contribute to greater longevity and life satisfaction while resulting in lower health care costs. Allied health professionals are perfectly positioned to make the difference between a successful or unsuccessful health promotion effort, whether in their own lives or in the lives of patients. However, allied health professionals need to commit themselves to making behavior changes to improve their own health so that they can effectively assist patients in making similar changes. These ideas are demonstrated through a study of an employee health promotion program for allied health professionals in a health maintenance organization.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
In brief, Obstetrics, like many other medical specialties, is experiencing the convergence of a number of diverse medical, social and economic trends. As a result there is increasingly intense turmoil in how these services are clinically delivered and in how they are managed--with a profound shift from basically inpatient, institutional care to outpatient care. Hospital executives must be alert to these changes if they expect their clinics and inpatient facilities to remain competitive and to deliver the best possible care under a rapidly changing set of expectations. If executives fail to recognize these pressures and thereby fail to create timely strategic reactions, their organizations may subsequently experience poor long run performance. The issue in obstetrics is not merely one of determining how best to manage obstetrics-related clinics, programs or departments; although this is a significant hospital management problem, it is important to recognize the changes and prevalent patterns, and to begin devising responsive management strategies. See strategies below.
Explore the source record for details and available documents.
Substance abuse among nurses can have significant ramifications for patient care, productivity, and personal well-being. Existing evidence suggests that critical care nurses are especially vulnerable to pressures that induce substance abuse. Consequently, critical care leaders and nurses need to be prepared to help their impaired colleagues. This paper provides several valuable guidelines for addressing substance abuse based on an exploratory study of the types of drugs or substances most frequently abused among nurses.