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PubMed1996

Negotiating. Biases physicians bring to the table.

What are some of the obstacles that physicians face as they seek to become more effective at the bargaining table? The author's thesis, based on experience in both the classroom and the front lines of medical practice, is that physicians face a set of systematic "biases" derived from physician training and professional culture that make negotiation especially difficult for them. They outline the biases they have observed, explore some possible explanations, and suggest solutions for physicians who wish to negotiate more effectively.

Cooperative Behavior↗
PubMed1997

Physicians as executives: boon or boondoggle?

It should come as no surprise to any observer of trends in the U.S. healthcare delivery system that physicians are taking a keener interest in the organization and management of that system. The practice of medicine has become, to a large degree, overtaken by events. Managed care and system integration have tended to place decision making at points further and further removed from patient care, the natural purview of the physician. It is to regain the initiative on how patient care is provided that physicians are moving in greater numbers into management. It is our contention that this move portends well for the future of the system. The unique advantage of the physician executive is the ability to bring to bear on healthcare management an understanding of the clinical processes that are its essential content. With strong clinical credentials and excellent management training, the physician is poised to make significant contributions to a healthcare organization's success.

Career Mobility↗
PubMed1997

Weight loss. A painless approach to a sleeker governance model.

Slimming down your board structure to meet the demands of system governance doesn't have to be painful. The seven tips offered here provide a "heart-healthy" diet for systems that don't want to alienate longtime trustees who won't be serving on the parent board.

Community-Institutional Relations↗
PubMedDate not supplied

The quest for professional recognition.

OBJECTIVES: To assess the progress clinical laboratory science has made toward achieving professional status. DATA SOURCES: Books, professional journals. STUDY SELECTION: Not applicable. DATA EXTRACTION: Survey of literature. DATA SYNTHESIS: Characteristics of clinical laboratory science as a profession were compared to a model of professionalization developed by Houle to assess the extent to which clinical laboratory science has acquired and refined selected attributes of a profession. CONCLUSION: Although clinical laboratory science has attained some of the characteristics associated with a profession, several critical issues must be addressed before it can achieve full professional status and recognition.

Certification↗
PubMedDate not supplied

Physician resiliency?

The profound changes in the health care industry have led to the anger, frustration, and unhappiness that physicians are feeling. It is important to examine physicians' responses to the threats to their professional autonomy, image, lifestyles, and relationships with their patients. The "learned helplessness" behavior exhibited by physicians is astounding, considering the education, status, and reputation of physicians as healers for those in need. This article explores the concept of resiliency among physicians and describes why physicians as a group may be less resilient than other individuals. In fact, the structure and training of the medical profession stacks the deck against those who want to change or to be resilient in the face of the changing environment.

Adaptation, Psychological↗
PubMed1980

Nursing the dying: implications of Kübler-Ross' staging theory.

Society's failure to value the work of nurses, the professionals most frequently involved in the care of the dying, is attributed to a cultural definition of nursing as a second-class occupation and the public's need to deny the realities of the suffering and indignities often associated with the process of dying. Efforts within the field of nursing to improve the care of the dying, by shifting emphasis from a narrow physical focus to a more holistic patient and family focus, preceded the past decade's contributions of Elisabeth Kübler-Ross. Although her staging theory has been cited as having limitations in development and in interpretation, Kübler-Ross' influence towards increasing awareness of the needs of the dying and others experiencing major losses has been substantial as evidenced by many references to staging theory in nursing literature, by a marked increase in attention to holistic care of the dying in the basic and continuing education programs of nursing, and by specialty role development in nursing care of the dying. This decade has also witnessed the major growth of professionalism in nursing, including strides towards professional autonomy. Conflict with the traditional pattern of medical dominance and bureacratic constraints in institutions is inevitable, especially when the medical goal of cure is not attainable. Change to an interdisciplinary model of care is viewed as essential for optimal care of the dying and their families.

Attitude to Death↗
PubMed1984

Intramural health care budgeting.

In the last years endeavours have been made in several health systems to get a firm grip on the explosive cost development in hospitals which amounts to nearly half of all health care expenditures. The fee-for-service system for doctors coupled with the professional autonomy leads to expansion of quality and quantity of services provided. In many systems hospitals are financed on basis of output items as patient days, examinations and therapies. As hospital costs are in the short run preponderantly constant prices fixed at average costs are higher than marginal costs. This situation favours expansion of services as in that case marginal revenue exceeds marginal cost. Inversely the decrease of services provided generates losses for the hospital. In systems, where financing takes place in the way of budgets like the U.K., Denmark and Italy, the authorities have more influence on the cost development in the system. In systems where the hospitals are financed by social security on basis of output, arrangements are now made to bring budgetary elements in the financing of these institutions. In France the "Budget Global" will be applied to services financed by the Sécurité sociale. In Belgium arrangements have been made to contain the amount of patient days allowed for reimbursement and in the Netherlands in 1983 budget-financing has been introduced for all general and teaching hospitals. In 1984 this system also applies to all other intramural institutions. If a way has been found to focus the financing mechanism of these institutions on budgeted costs, the way is open for budgeting these institutions. A very important problem in this context is the budget formula, which will be used to determine the budgets. In this respect a distinction can be made between internal and external budgeting. Internal budgeting is understood here as a process whereby the hospital itself puts a limit to the use of resources or adapts its resources to budget constraints coming from the outside. External budgeting can be defined as the budgetary constraint given from the outside by third parties to the hospitals. Of course, both internal and external budgeting are narrowly interrelated. The distinction between these two ways of budgeting should be sought in the character of the budget formula. External budgeting should be based on global indications whilst internal budgeting should be more differentiated than the external budget formula.(ABSTRACT TRUNCATED AT 400 WORDS)

Budgets↗