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Machiavelli's advice to the hospital chief executive officer.

Hospital chief executive oficers (CEOs) have demanding jobs in which they must, at tims, function as if they are potentates of small principalities. Their ability to elicit loyalty and allegiance, hand out discipline and praise, foster alliances with other organizations, and commit the occasional hostile yet (it is hoped) successful foray onto a competitor's turf are skills that must be mastered for success and longevity. We have taken the thoughts and strategies of the Renaissance political master, Niccolo Machiavelli, and applied them to the modern hospital CEO for whom we feel they still hold elements of wisdom and guidance.

Chief Executive Officers, Hospital↗

Texas hospital chief executive officers evaluate content areas in health administration education.

Health care executives are confronted by a working environment that is increasingly difficult to manage. Skyrocketing health care costs, with shrinking reimbursement, threaten the existence of hospitals. A successful hospital chief executive officer (CEO) is one who can effectively manage his/her hospital in spite of industry challenges and problems. Graduate programs in health services administration must be designed to meet the needs of future health care executives. Many times, educators are criticized for not addressing "real world" issues within the curricular structure. The present study was conducted to gather information from executives who are the experts on what to expect in the health care industry regarding the appropriateness of curricular topics. Results indicate that practicing CEOs believe those curricular areas which focus on financial planning, budgeting, medical-legal issues, and strategic planning are more important than those that deal with international health care, epidemiology, or research methods. The information gathered in this study may be useful as a guide for educators, to evaluate and revise existing graduate programs in health care administration. Data presented here may also be used to assist in long-range planning for new health administration programs.

Attitude of Health Personnel↗

Rural Illinois hospital chief executive officers' perceptions of provider shortages and issues in rural recruitment and retention.

BACKGROUND: It is important to assess rural health professions workforce needs and identify variables in recruitment and retention of rural health professionals. PURPOSE: This study examined the perspectives of rural hospital chief executive officers (CEOs) regarding workforce needs and their views of factors in the recruitment and retention process. METHODS: A survey was mailed to CEOs of 28 Illinois rural hospitals, in towns ranging from 3,396 to 33,530 in population size. The survey addressed CEO perceptions of number of physicians needed by specialty, need for other health professionals, and variables important to recruitment and retention. FINDINGS: Twenty-two CEOs (79%) responded to the survey. Eighty-six percent indicated a physician shortage in the community, with 64% reporting the need for family physicians. CEOs also indicated the need for physicians in obstetrics-gynecology, general and orthopedic surgery, general internal medicine, cardiology, and psychiatry. In terms of needs for other health professionals, most often mentioned were registered nurses (91%), pharmacists (64%), and nurses' aides (46%). Related to recruitment and retention, most often mentioned by the CEOs was community attractiveness in general, followed by practice and physician career opportunities. CONCLUSIONS: CEOs offer 1 important perspective on health professions needs, recruitment, and retention in rural communities. While expressing a range of opinions, rural hospital CEOs clearly indicate the need for more primary care physicians, call for an increased capacity in nursing, and point to community development as a key factor in recruitment and retention.

Attitude of Health Personnel↗

Multi-institutional arrangements: relationships between governing boards and hospital chief executive officers.

This investigation focuses on the impact of multi-institutional arrangements on the role of governing boards in limiting or enhancing the managerial autonomy of individual hospitals. Data from a 1979 Special Survey by the American Hospital Association (N = 4213) are used to examine governing board-administrator relationships as a function of the degree of autonomy and scope of responsibility of the hospital governing board. It is hypothesized that governing boards responsible for multiple hospitals or for multiple nonhospital organizations and those boards accountable to a higher organizational authority will exercise more formal control over hospital chief executive officers (CEOs) than will boards of single or autonomous hospitals. The analysis assumes that formal control by the governing board over the management function of the individual hospital is exercised partly through soliciting or limiting participation by hospital administrators in key policy decisions and through the evaluation of administrative performance. Therefore, it is anticipated that hospitals governed by boards with multiple responsibilities as well as hospitals governed by boards accountable to a higher authority will be (1) less likely to have CEOs who are members of the governing board executive committee, (2) more likely to have annual performance reviews of the CEO by the governing board, and (3) more likely to have such reviews conducted according to preestablished criteria. Study results provide general support for the hypotheses with respect to hospital boards with multiple responsibilities: the data suggest that such boards do exercise greater control over hospital administrators and these effects do appear to be stronger for hospitals in the private sector. Hospitals governed by boards accountable to a higher authority, however, are more likely to have CEOs who are members of the governing board executive committee--a pattern in direct opposition to that hypothesized. Furthermore, these boards are no more likely to conduct annual CEO performance reviews than are boards with more autonomy. Boards accountable to higher authorities are more likely, however, to use preestablished criteria when such reviews are conducted. This general pattern is similar whether hospital boards are accountable to religious authorities, to investor-owned corporate boards, or to the boards of not-for-profit multi-institutional systems. A different pattern emerges, however, for boards accountable to a state, county, or local government authority.(ABSTRACT TRUNCATED AT 400 WORDS)

Employee Performance Appraisal↗

Hospital chief executive officer turnover.

This study indicates that the nationwide CEO turnover rate is lower than many people estimate but was still, in 1987, an uncomfortable 22 percent on average. Some of this turnover may help some hospitals, for example, those with incompetent administrators. Some turnover may be natural in that some CEOs may have retired or died. Other turnover is controlled, such as that in the investor-owned sector where planned movement is expected. The analysis of the data in this study indicates that smaller hospitals experience higher turnover rates than do their larger counterparts. In 1987 Sun Belt and western hospitals experienced greater turnover than upper midwestern and eastern hospitals. As a group, however, the investor-owned sector led in turnover rates among hospital CEO turnover rates.

Data Collection↗

The potential role of physicians in the management of hospital information systems.

The centralized management of manual and automated information systems in hospitals, including the medical record, is usually delegated to administrators rather than to physicians. It is also likely that the importance of automated information systems will increase rapidly as the medical record is electronified. Many significant changes have occurred in recent years relating to the manner in which information systems are managed in hospitals. To address the challenge of this new information environment, hospital Chief Executive Officers (CEOs) have begun to create a new executive hospital position called the Chief Information Officer (CIO). CIOs are included in the hospital executive cabinet and commonly direct all hospital information systems, telecommunications, and management engineering. Although the model of the physician-director of an information system is common at the departmental level with the Laboratory Information System as one example, physicians rarely serve within the central hospital administration as information specialists such as the CIO. Although many physicians would be suitably qualified to serve in this capacity, another option for them would be the position of Chief Medical Information Officer (CMIO) with responsibility for utilization review, medical records, and quality assurance. The CMIO would serve centrally on a part-time basis, continuing to practice simultaneously in a medical specialty. The medical information specialist must not be insulated from the flow of clinical information and discourse with medical colleagues because of the increasing use of information systems for improving work efficiency and the pursuit of quality goals.

Administrative Personnel↗

Family medicine residency programs. Evaluating the need for different third-year programs.

We asked hospital chief executive officers (CEOs) and District Health Council executive directors (DHCs) to compare third-year family medicine residency programs and judge which are more needed in their communities. Care for the elderly and emergency medicine ranked highest among CEOs, while DHCs ranked care for the elderly and mental health highest. Academic family medicine and northern programs ranked lowest for both groups.

Attitude of Health Personnel↗

What do hospital decision-makers in Ontario, Canada, have to say about the fairness of priority setting in their institutions?

BACKGROUND: Priority setting, also known as rationing or resource allocation, occurs at all levels of every health care system. Daniels and Sabin have proposed a framework for priority setting in health care institutions called 'accountability for reasonableness', which links priority setting to theories of democratic deliberation. Fairness is a key goal of priority setting. According to 'accountability for reasonableness', health care institutions engaged in priority setting have a claim to fairness if they satisfy four conditions of relevance, publicity, appeals/revision, and enforcement. This is the first study which has surveyed the views of hospital decision makers throughout an entire health system about the fairness of priority setting in their institutions. The purpose of this study is to elicit hospital decision-makers' self-report of the fairness of priority setting in their hospitals using an explicit conceptual framework, 'accountability for reasonableness'. METHODS: 160 Ontario hospital Chief Executive Officers, or their designates, were asked to complete a survey questionnaire concerning priority setting in their publicly funded institutions. Eight-six Ontario hospitals completed this survey, for a response rate of 54%. Six close-ended rating scale questions (e.g. Overall, how fair is priority setting at your hospital?), and 3 open-ended questions (e.g. What do you see as the goal(s) of priority setting in your hospital?) were used. RESULTS: Overall, 60.7% of respondents indicated their hospitals' priority setting was fair. With respect to the 'accountability for reasonableness' conditions, respondents indicated their hospitals performed best for the relevance (75.0%) condition, followed by appeals/revision (56.6%), publicity (56.0%), and enforcement (39.5%). CONCLUSIONS: For the first time hospital Chief Executive Officers within an entire health system were surveyed about the fairness of priority setting practices in their institutions using the conceptual framework 'accountability for reasonableness'. Although many hospital CEOs felt that their priority setting was fair, ample room for improvement was noted, especially for the enforcement condition.

Attitude of Health Personnel↗

Organizational characteristics associated with hospital CEO turnover.

Using a Probit regression model, this study examines organizational factors contributing to hospital chief executive officer (CEO) turnover. The study concludes that some organizational environments are more conducive to turnover. Hospitals that are smaller, are on the West Coast, are investor owned, are church related, offer many services, have high service usage, and larger hospitals with female CEOs are more likely to experience turnover.

Chief Executive Officers, Hospital↗

Job satisfaction among selected hospital CEOs.

The purpose of this study was to identify the contributors to job satisfaction of hospital chief executive officers (CEOs) using a multidimensional approach of demographic characteristics. environmental traits, and person environment fit traits. By analyzing the concept of hospital executive job satisfaction in a multidimensional approach, a more comprehensive model of the most salient determinants of job satisfaction was developed. CEOs ranked their performance highest on employee and staff relations and managerial team building and lowest on information management systems. The results of this study can be used to better understand the intricacies and uniqueness of being a hospital CEO as well as the professional and personal requirements of success.

Adult↗