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Fitness and wellness programs can be a strategic extension of a hospital's services, assist in attracting totally new patients to a facility, and help improve a hospital's image.
Not all rural hospitals are in a depressed financial situation. Many can and have achieved financial performance levels which match their urban counterparts. Cost control is the single most important management strategy which differentiates the successful from the unsuccessful rural hospital. Labor productivity is much higher in the financially successful rural hospital than in the unsuccessful hospitals. Reduced length of stay is also especially critical in the overall cost containment program.
To remain competitive, many not-for-profit hospitals have turned to joint ventures with for-profit and other not-for-profit entities. The authors examine the organizational structures that are used most often to form joint ventures (contractual agreements, subsidiary corporations, partnerships, and not-for-profit title-holding corporations), as well as the advantages and disadvantages associated with each form. Nurse executives must be aware of the opportunities that joint ventures provide their institutions. These arrangements can help improve and expand services and profitability.
Can hospitals successfully embark on large-scale organizational change without using outside consultants? Nursing administrators have an intense interest in the answer to this question. If change can be designed from inside the organization, the chances are greater that the change will fit better with the organization as a whole, and that buy-in by staff will be significant. The authors review the elements that need to be in place to conduct a successful change process internally, and support their concepts with a case study.
Service or product diversification is a popular recommendation made to hospitals to increase profitability and reduce financial risk as they face a more hostile environment. This paper presents results from an empirical study of these claims. Using data from all California nonprofit hospitals, the study finds that diversification, regardless of whether it is related or unrelated to preexisting services, is not associated with either increased profitability or reduced financial risk. However, other variables that do have these effects are identified in the research. Future research should evaluate the effect of both the size of and the length of time since the initial diversifying investment on financial variables.
The primary aim of this study was to compare and contrast the predivestiture managerial and market characteristics of the following: Divested and nondivested hospitals of Hospital Corporation of America (HCA) and American Medical International (AMI). The findings indicated that HCA hospitals with 1) lower occupancy rates, 2) less growth in revenues, 3) higher debt to total asset position, 4) fewer beds, 5) less growth in their elderly populations, and 6) less growth in their markets' per capita incomes had a higher probability of being divested into HealthTrust. The results for the AMI model were similar to those for the HCA model. AMI hospitals with 1) fewer beds, 2) less growth in their markets' per capita incomes, 3) lower salary expenses per discharge, 4) lower occupancy rates, and 5) increased growth in populations had a higher probability of being divested into EPIC.
The authors report on a new system of care in which all patients who require psychiatric hospitalization are admitted to a day hospital with an inn and an intensive care unit. Data on use of services, length of stay, recidivism, security, medical emergencies, staff accidents, and seclusion and restraint over a 4-year period suggest that the new delivery system provides care which is at least as effective as the previous system of care. Evidence is presented that the new system offers certain advantages, including less seclusion and restraint, fewer episodes of escape, and substantial cost savings.
After briefly reviewing the current dynamic status of corporate for-profit multihospital chains, the author traces their historical antecedents from early 20th century advances in medical care and medical education to the present economic and political environment that is so conducive to their growth. The chains' success in increasing their profitability in the general health care field through pricing and marketing strategies and efficient use of personnel has raised several concerns, but in combination with several other factors it has ensured the movement of for-profit corporations into the psychiatric field. The implications of this movement for the provision of psychiatric services are discussed, particularly the thrust to define psychiatry as a group of separately marketable products.
Managed care organizations have become significantly involved in health care in the Denver metropolitan area. Their presence has challenged psychiatric hospitals to reduce costs and length of stay. In 1990, a locked private psychiatric unit was reorganized into locked, open, and partial care services through which patients progress at individualized rates. One treatment team manages patients in all settings, allowing a reduction in staffing costs and flexibility in treatment design. The hospital administration takes an active role in facilitating collaborative decision making between hospital clinicians and managed care representatives. In the first year after reorganization, length of stay was significantly reduced; 90 percent of patients were discharged from 24-hour care within ten days or less, whereas only 40 percent were discharged within that time in the original program. Staffing costs were reduced by 15 percent. No increase in recidivism was noted.
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While broad parallels have been noted between the current "corporatization" of health care and developments in U.S. manufacturing in the late 19th century, there has been little in-depth analysis of these parallels. This article explores trends in the industrial organization of the hospital industry from the perspective of the manufacturing experience. Efforts to use corporate managerial techniques to rationalize hospitals have played an important role in the development of the modern structure of the hospital industry since the 1920s. But the emergence of multihospital systems is a new phenomenon. Some significant similarities exist between current conditions in the hospital industry and conditions in manufacturing at the time of the great industrial merger boom at the turn of the century. The subsequent experience of multiplant manufacturing firms created during the great industrial merger boom varied considerably. The characteristics of successful industrial consolidations are not present in the hospital industry; but motives for consolidation exist that were not present in manufacturing, while changes in the organization of production loom in the future.
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The reform decentralizing the special care of the mentally retarded in Norway has caused concern within the Norwegian psychiatric community. The frequency of psychiatric disturbances and behaviour problems in this population is known to be high, and closing down special institutions may eventually direct more mentally retarded persons to psychiatric hospitals. Behaviour problems like poor communication skills, lack of social skills and self-care, and disruptive behaviours seem to cause more concern than the actual diagnosis. However, the same behaviour problems are found in psychiatric hospital populations, for instance among chronic schizophrenics. From a behaviour modification point of view these behaviours can be treated regardless of diagnosis. The article describes how a psychiatric hospital unit can apply behaviour modification resulting in a better life for an otherwise untreatable patient. It is recommended that behaviour modification techniques should be used concurrently with other methods of treatment used in psychiatry. As well as being potentially helpful to psychiatric patients, behaviour modification techniques will make psychiatry better equipped to treat mentally retarded people in need of psychiatric care.
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In 1990 a new organizational structure based on decentralization and team leadership, where the leader (usually a doctor) is responsible for the final decision, was introduced at the regional and university hospital of Tromsø. This structure replaces the traditional dual structure of leadership where the leaders (a doctor and a nurse) did not share responsibility for the whole department. In order to analyze organizational practices after the reform we constructed three different organization models of the hospital: the hierarchical model, the professional model and the workshop model. Of five teams, one functioned hierarchically, three resembled the professional model, and the fifth came close to the workshop model. The leader of the hierarchical team behaves autocratically and the employees are dissatisfied. In the three remaining teams conditions have changed very little compared with the situation before the reorganization. In the workshop team decisions are reached jointly. This team functions in an innovative way. Even though the new organizational structure has quite divergent consequences and some leaders have problems, the majority of the hospital employees support the new structure.
A cross-sectional study is used to determine how rural New Mexico hospitals altered service diversification, inpatient service emphasis, and service promotion during Medicare's prospective payment system (PPS) transition and posttransition phases. Results suggest that the hospitals implemented distinct strategies in response to PPS. The posttransition strategies were examined for their association with improved revenue and utilization indicators. Few of the service diversification and promotional strategies were consistent predictors of performance. Emphasis on fine-tuning inpatient services was the most promising predictor of higher utilization and revenue measures. The implications for other rural hospitals are discussed.
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