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Biomedical subjects

S M Shortell

Publications and source records attributed to S M Shortell.

At least 73 records · Page 4Linked to original sources
PubMed1993

Trends in hospital/physician relationships.

Findings from two surveys of all physicians in Pima County, Arizona, in 1985 and 1990 to determine the trajectory of hospital/physician relationships suggest that conflicts have increased in almost all areas. Physicians report the greatest number of and increase in conflicts in traditional problem areas such as the quality of nursing and response to equipment requests. They report a smaller increase in conflicts relating to the new competitive marketplace, including hospital efforts to influence medical practice. Both types of problems are most prevalent among younger physicians. The new marketplace thus appears to exacerbate traditional hospital/physician conflicts more than it generates new areas of contention.

Arizona↗
PubMed1993

Creating organized delivery systems: the barriers and facilitators.

An organized delivery system is a network of organizations that provides or arranges to provide a coordinated continuum of services to a defined population and is willing to be held clinically and fiscally accountable for the outcomes and the health status of the population served. As such, organized delivery systems are at the center of efforts to implement health care reform. Based on analysis of 12 such systems, this article identifies key characteristics that influence what organized delivery systems are able to do, outlines the major obstacles or challenges to achieving greater levels of integration, and then discusses a number of approaches for effectively dealing with these obstacles.

Administrative Personnel↗
PubMed1993

Conceptualizing and measuring integration: findings from the health systems integration study.

Given the pressures for health care reform, interest in the concept of integrated or organized delivery systems as a means to offer more coordinated cost-effective care is growing. This article has two primary objectives: (1) to clarify the different types of integration associated with the notion of an organized delivery system, and (2) to share the results from an ongoing study of 12 organized delivery systems. The findings indicate a moderate level of integration overall, particularly in the areas of culture, financial planning, and strategic planning. The study found that corporate staff respondents perceive their systems to be more integrated and effective than do operating unit managers, and that some functional integration areas are positively associated with both physician-system and clinical integration that, in turn, are positively related to each other. Overall, perceived integration was found to be positively associated with perceived effectiveness.

Administrative Personnel↗
PubMed1993

Improving intensive care: observations based on organizational case studies in nine intensive care units: a prospective, multicenter study.

OBJECTIVE: To examine organizational practices associated with higher and lower intensive care unit (ICU) outcome performance. DESIGN: Prospective multicenter study. Onsite organizational analysis; prospective inception cohort. SETTING: Nine ICUs (one medical, two surgical, six medical-surgical) at five teaching and four nonteaching hospitals. PARTICIPANTS: A sample of 3,672 ICU admissions; 316 nurses and 202 physicians. MATERIALS AND METHODS: Interviews and direct observations by a team of clinical and organizational researchers. Demographic, physiologic, and outcome data for an average of 408 admissions per ICU; and questionnaires on ICU structure and organization. The ratio of actual/predicted hospital death rate was used to measure ICU effectiveness; the ratio of actual/predicted length of ICU stay was used to assess efficiency. MEASUREMENTS AND MAIN RESULTS: ICUs with superior risk-adjusted survival could not be distinguished by structural and organizational questionnaires or by global judgment following on-site analysis. Superior organizational practices among these ICUs were related to a patient-centered culture, strong medical and nursing leadership, effective communication and coordination, and open, collaborative approaches to solving problems and managing conflict. CONCLUSIONS: The best and worst organizational practices found in this study can be used by ICU leaders as a checklist for improving ICU management.

Critical Care↗
PubMed1992

Continuously improving patient care: practical lessons and an assessment tool from the National ICU Study.

Pressure for hospitals to maintain quality while lowering cost or provide greater quality at a given level of cost is particularly critical in intensive care services for which it is increasingly difficult to match revenues with costs, given reimbursement limits. At the same time, twofold to threefold differences in intensive care unit risk-adjusted mortality have been reported. This article provides a model for thinking about continuous improvement of intensive care services, draws on the National ICU Study to identify fundamental organizational and managerial processes associated with better performance, and offers a validated assessment instrument to be used as a tool for continuous improvement.

Communication↗
PubMed1992

Regional variation in Medicare hospital mortality.

This study examines variation in severity-adjusted Medicare hospital mortality rates across nine U.S. census regions. The extent to which regional variation is reduced by controlling for differences in hospital resources and structure, county-level population characteristics, and the level of federal SuperPRO-identified hospital quality problems is estimated. Hospital resources, population characteristics, and SuperPro process quality scores are significant predictors of hospital mortality rates, but they do not explain the important, highly significant regional differences observed after controlling for hospital case-mix severity.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

Organizational assessment in intensive care units (ICUs): construct development, reliability, and validity of the ICU nurse-physician questionnaire.

Health Services Research has a growing need for reliable and valid measures of managerial practices and organizational processes. A national study of 42 intensive care units involving over 1,700 respondents provides evidence for the reliability and validity of a comprehensive set of measures related to leadership, organizational culture, communication, coordination, problem solving-conflict management and team cohesiveness. The data also support the appropriateness of aggregating individual respondent data to the unit level. Implications for further research are discussed.

Analysis of Variance↗
PubMed1990

Revisiting the garden: medicine and management in the 1990s.

The importance of effective hospital-physician relationships is acknowledged by all. Yet few empirically based guidelines exist for strengthening such relationships. Based on an in-depth examination of ten sites' experience, this article suggests a number of approaches and ideas for forming more effective hospital-physician relationships in the 1990s. Among the issues addressed include the nature of hospital-physician collaboration and competition, embracing risk, forging new forms of partnership, creating value for purchasers, and grooming younger physicians for leadership roles.

Consumer Behavior↗
PubMed1990

Perceptual and archival measures of Miles and Snow's strategic types: a comprehensive assessment of reliability and validity.

Despite the widespread research use of Miles and Snow's typology of strategic orientations, there have been no systematic attempts to assess the reliability and validity of its various measures. The present work provides such an assessment using data collected at two points from over 400 organizations in the hospital industry. We examined dimensions of the typology using both perceptual self-typing and archival data from multiple sources. The results generally support predictions across a variety of measures. Implications for further testing and research are discussed.

Analysis of Variance↗
PubMed1990

The effect of hospital control strategies on physician satisfaction and physician-hospital conflict.

This article examines several strategies that hospitals use to control their medical staffs. Such strategies include placing physicians on salary, developing exclusive hospital affiliations with physicians, and involving physicians in decision-making bodies. Using regression techniques, we investigate which hospitals are more likely to utilize these strategies and whether such strategies are effective in promoting physician-hospital integration. Contrary to our expectations, corporate hospital structures (e.g., for-profit hospitals, membership in multihospital systems) generally do not employ these strategies more often and oftentimes employ them less. There is also little evidence that control strategies are effective levers for increasing physician satisfaction or decreasing physician-hospital conflict. We suggest that control strategies are useful for purposes other than promoting physician-hospital integration. Finally, hospital ownership appears to exert the biggest effect on physician satisfaction and conflict.

Age Factors↗
PubMed1989

The impact of corporate structures on physician inclusion and participation.

This study examines the impact of corporate arrangements on the hospital-physician relationship. Specifically, it investigates the effects of for-profit ownership and membership in a multihospital system on physician inclusion (salaried employment, hospital-based practice) and participation (involvement in governance and management). Contrary to common perceptions and several hypotheses drawn from the literature, corporate arrangements are associated with low physician inclusion and high participation. There is no indication that corporatization of healthcare restricts the physician's freedom of movement or decision-making role. It is instead argued that health care corporations do just the opposite in order to please physicians, promote physician welfare, and to gain legitimacy.

Data Collection↗