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Biomedical subjects

S M Shortell

Publications and source records attributed to S M Shortell.

At least 109 records · Page 6Linked to original sources
PubMed1984

Hospital rate review. A theory and an empirical review.

This paper presents a theory of the effects of rate review on hospital operations and organization. Its purpose is to explain the way in which hospitals have responded to regulation. In the development of this theory, the hospital product was viewed as a bundle of services, rate review was looked upon as a ceiling on the value of the bundle. The ceiling creates an incentive to remove elements from the bundle, i.e., to reduce 'quality'. When quality is variable, the effect on utilization becomes indeterminate. The model argues, among other things, that the hospital will change its service complement and its contractural arrangements with physicians and other hospitals. An extension of the organizational theory literature leads to implications concerning the ordering of hospital responses to regulation. The growing body of empirical literature on the effects of hospital rate review is used as an initial test of the major thrusts of the theory. A suggested agenda for further empirical work also is presented.

Cost Control↗
PubMed1984

How to create more humane and productive health care environments.

Value-based leadership--linking "managership" and leadership approaches--is needed to meet today's ever-proliferating challenges to the fundamental philosophy and mission of health care organizations. To work, however, it requires important changes from everyone in the organization.

Efficiency↗
PubMed1984

Hospital-sponsored primary care: I. Organizational and financial effects.

Findings are presented from a seven-year (1976-83) evaluation of the Community Hospital Program (CHP), a national demonstration program sponsored by the Robert Wood Johnson Foundation to assist 54 community hospitals in improving the organization of access to primary care. Upon grant expiration, 66 per cent of hospital-sponsored group practices continued under some form of hospital sponsorship; over 90 per cent developed or were planning to develop spin-off programs; and new physicians were recruited and retained in the community. About 9 per cent of hospital admissions were accounted for by group physicians and grantee hospitals experienced a greater annual increase in their market share of admissions than competing hospitals in the area. While only three of the groups generated sufficient revenue to cover expenses during the grant period, 21 additional groups broke even during the first post-grant year. Productivity and cost per visit compared favorably with most other forms of care. Hospitalization rates from the hospital-sponsored practices were somewhat lower than those for other forms of care. Medical director leadership and involvement and the organization design of the practice were among several key factors associated with higher performing practices. The ability of such joint hospital-physician ventures to meet the needs of the poor and elderly in a time of Medicare and Medicaid cutbacks is discussed along with suggestions for targeting future initiatives in primary care.

Evaluation Studies as Topic↗
PubMed1984

A survey of hospital medical staffs--Part 2.

As shown by the survey, from 1973 to 1982: . The percentage of hospitals requiring certification of some or all specialties has nearly quadrupled. . During the same period, the percentage of hospitals compensating the chief of the medical staff and the director of medical education approximately doubled. . In 1981, the primary care physicians at more than 50 percent of the responding hospitals sent over half of their admissions elsewhere. . Approximately 22 percent of hospital admissions were generated by the top five admitters in 1981.

Data Collection↗
PubMed1984

More hospitals compensate physicians for administrative role: survey. Part 2.

This is the second part of a two-part article reporting the results of the 1982 Medical Staff Organization Survey conducted by the American Hospital Association. Part 1, which appeared in the December 1983 issue of Trustee, discussed the size and specialty composition of the medical staff, its role in hospital governance and administration, and the nature of medical staff committees. This part addresses staff credentialing, compensation arrangements, physician multiple-hospital appointments, and the dependence of hospitals on the top five admitting physicians.

Data Collection↗
PubMed1984

Suggestions for improving the study of health program implementation.

More will be learned about health programs and the implementation of health policy in this country if we pay more attention to issues of program implementation. Of particular use would be more studies which explicitly link program implementation with program outcomes and which recognize the need to combine quantitative and qualitative analysis of program implementation; the use of triangulated methods in focusing on the relationship between program implementation and program outcomes; the incorporation and study of planned variation in the methods of implementing programs; recognition that the process is essentially one of organizational change and innovation, and the incorporation of existing theory and evidence relevant to these issues; and recognition that the ongoing nature of the implementation process requires longitudinal study designs for implementation as well as for outcome assessment. Cronbach [9] has remarked that evaluation research "lights a candle in the darkness, but it never brings dazzling clarity." It may be that more attention to program implementation and better research on the process, such as that suggested in this note, will provide a little more light and will bring if not dazzling , at least modest, improvements in clarity.

Health Plan Implementation↗
PubMed1983

A theory of organizational response to regulation: the case of hospitals.

This paper presents a general theory of organizational response to regulation, a theory that integrates adaptation and mutual selection perspectives. Two major forms of regulation in the hospital industry, certificate of need and rate review, are examined. Hypotheses are derived concerning the nature and timing of the various adjustments hospitals make both in internal organizational arrangements and in patterns of interorganizational activity in the face of regulatory constraints. Suggestions and data sources for testing the theory are presented.

Certificate of Need↗
PubMed1983

Survey of hospital medical staffs--Part 1.

Net data reveal surprises in size, composition, committee structure, and participation in governance. From 1973 to 1982: Medical staff size has grown by an average of 55 percent. The number of medical staff committees in the average hospital has nearly doubled. Nearly 30 percent more hospitals have made physicians voting members of their governing boards.

Data Collection↗
PubMed1982

Improving health care policy research.

Interest in health care policy research has grown significantly over the past decade. This paper makes a number of suggestions for improving the quality of health care policy research and its influence on policymaking. These include suggestions for: 1) improving the way in which problems are identified and defined; 2) merging qualitative and quantitative approaches to study design, data collection, and analysis; 3) developing more integrative strategies for disseminating research results; 4) changing the reward structure to encourage health policy research; and 5) developing a stronger standby research capability. Specific examples of each of the above are presented. Throughout, the need for greater interaction among researchers, analysts, policymakers and practitioners is emphasized, along with specific suggestions for ways of bringing this about.

Data Collection↗