Biomedical subjects
Publications and source records attributed to H S Zuckerman.
This article examines the role of multihospital systems and alliances as "innovation carriers." Drawing upon studies of interpersonal and interorganizational communications networks, the authors suggest how membership in a system or alliance, as well as network characteristics, affects innovation practices in general acute care hospitals.
The merger of rural primary care and home health services offers the potential for increasing the administrative efficiency of health care, and thereby enhancing the quality of care and increasing access to services, particularly health promotion. However, the proposed benefits of any merger can only be realized if the merger process is successfully completed. An analysis of the factors that were important in a case study of successful and unsuccessful mergers of rural health centers and home health care agencies in northeastern Vermont is presented. Three components were found to be necessary to start the merger process: complementary needs, opportunity, and common philosophy. The involvement and support of key individuals was crucial to sustaining merger interest. Good communication throughout the process contributed substantially to the maintenance of both community and staff support. Others considering similar mergers should recognize that the process of consolidating organizations and satisfying regulations takes some time to complete.
As many industries face uncertain and changing environments, strategic alliances are rapidly emerging as a vehicle for interorganizational cooperation. Similarly in health care, alliances represent a mechanism for organizations to seek collaborative solutions to common problems. Drawing on a general typology, alliances in health care are categorized as service, opportunistic, or stakeholder alliances. Existing health care alliances serve to illustrate and characterize the purpose, structure, and operation of each of the three types. Strategic alliances offer significant challenges in managing the inherently fragile relationships within these emerging organizational forms. These challenges center around issues of commitment (v. control) as the underlying managerial philosophy; expectations for alliance performance; managing relationships, communication, and operations; member participation in alliance programs and activities; and stability of alliances over time. Alliances require new ways of thinking about organizations. Sensitivity to their unique characteristics and understanding the factors that can lead to their success are essential to managing them effectively.
The resource dependence perspective is used to describe the formation of hospital alliances. Characteristics of alliances and their various strategies and structures are discussed. A life cycle model provides a framework for viewing the development and growth of alliances. Several dimensions for assessing alliance performance are proposed.
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An increasingly uncertain and turbulent environment, coupled with growing organizational complexity, suggest greater centrality of the role of the chief executive officer (CEO). In this article, the emerging role of the CEO is casts in terms of three metaphors. First, the CEO is seen as Perimeter Player, concerned with adaptation of the organization to its external environment. Next, the CEO is described as Interior Designer, focused on the management of internal operations of the enterprise. Finally, the CEO is viewed as Leader of the Band, serving as the keeper of corporate values and providing strategic vision and direction to the organization. Also addressed are the challenges and conflicts that emerge as the CEO plays out the multiple roles.
As the result of a study, in 1982 St. Benedict's Hospital, Ogden, UT, reorganized as St. Benedict's Health System. The results of the reorganization were disappointing, however. Within three years, major financial difficulties, the lack of success in diversification on programs and facilities, continuing environmental pressures, and unrest within the organization led St. Benedict's to seek assistance. After contacting a number of Catholic systems, St. Benedict's chose the Holy Cross Health System, South Bend, IN, as the preferred partner. In mid-June 1986 the two systems began negotiations on a possible affiliation. Holy Cross sent an acquisition team to St. Benedict's to obtain a perspective on mission continuity, profitability, market share, and operations. Discussions continued through July, with neither system proposing an affiliation agreement. St. Benedict's was still considering other options, while Holy Cross was concerned about the financial ramifications. On Aug. 20, 1986, the two negotiating teams met face to face for the first time, with a Catholic Health Association representative acting as facilitator. The two teams met again on September 8, and St. Benedict's accepted Holy Cross's terms. While awaiting antitrust review of the affiliation, Holy Cross operated St. Benedict's under a management contract. The consolidation was formally completed on Dec. 1, 1986. Holy Cross took over ownership of St. Benedict's Health System, cosponsored by the Sister of the Holy Cross and the Sisters of the Order of St. Benedict. Holy Cross established tactical objectives aimed at stabilizing and enhancing St. Benedict's Hospital. The new owners and managers report they have achieved the objective which has improved St. Benedict's operations.
This article reviews current activity of AUPHA programs in the areas of teaching, continuing education, and research in health care governance. Survey data from a sample of 61 AUPHA programs are used to relate these activities to trends in the practice of institutional governance and changes in the health care environment that affect such practices. Areas of concern are identified and recommendations for improvement made.
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Hospital federations are a form of multiorganizational collaboration in which a management group coordinates and directs the activities of three or more organizations. This paper introduces a life-cycle model of federations that focuses on factors that influence the transition from one stage to another.
Eight consecutive cases of adults with the diagnosis of early infantile autism and who were treated with a betablocker are presented. Each had been on various and multiple drug, educational, and behavioral regimens to help control aggressive and self-abusive behavior. Most had been institutionalized from an early age, and a broad range of IQs and speech capacities are represented. Results show the betablockers to have a remarkable effect potentiating measurable diminution in previously intractable aggressive behavior and in many cases the decrease or withdrawal of their neuroleptic.
The authors present data from four different institutions from open clinical trials of propranolol in 19 mentally retarded patients with IQs less than 50. When customary forms of treatment had failed, propranolol was initiated. A table showing changes in the patients' behavior is included. Twelve patients demonstrated a pronounced improvement in self-abusive and aggressive behavior, four made moderate gains, and three were considered unchanged. The authors postulate that at least some aspects of the behavioral improvement were due to the peripheral anxiolytic action of the beta-blockers. Contrary to other reports of using higher doses (greater than 520 mg/day range), the authors used a mean dose of 120 mg/day and consider the duration of time spent on the medication as a crucial factor in its effectiveness.
Previous studies have shown that external management by contract can improve the performance of managed hospitals. This article presents a conceptual framework which develops specific hypotheses concerning improved hospital operating efficiency, increased ability to meet hospital objectives, and increased ability to meet community objectives. Next, changes in the process and structure of management under contractual arrangements, based on observations from two not-for-profit hospital systems, are described. Finally, the effects of these management changes over time on hospital and community objectives are presented. These effects suggest progressive stages in the development of management contracts. The first stage focuses on stabilizing hospital financial performance. Stage two involves recruitment and retention efforts to secure necessary personnel. In the third stage, attention shifts to strategic planning and marketing.
The environment facing hospitals, generally supportive until the 1970s, may now be characterized as complex, turbulent, and constrained. In response to such environmental conditions, hospitals have adopted new strategies and structures. The strategies, described as corporate rationalization, have led away from the traditional structure of freestanding, autonomous hospitals and toward the formation of multi-institutional systems. These systems are designed to provide sufficient strength to cope with the environment, to acquire scarce and valued resources, to allow organizational stability, to achieve organizational purpose, to enable growth and/or survival, and to enhance market position. The impact of multi-hospital systems is viewed in two major areas: acquisition, retention, and utilization of economic and human resources, and organizational, political, and social factors.
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