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Biomedical subjects

N F Piland

Publications and source records attributed to N F Piland.

At least 19 recordsLinked to original sources
PubMed1999

Benchmarking patient relations within ambulatory care: lessons from a high-risk pregnancy program.

Ambulatory care providers are being challenged to deliver high-quality care at low cost with easy access. Patient satisfaction with services hinges on the ability of providers to meet these often elusive benchmarks. This article focuses on the barriers to benchmarking patient relations in ambulatory care organizations and strategies for improving patient relations through internal benchmarking that encourages service innovation and performance emphasis. A case study of programmatic benchmarking in the Lovelace Health System is used to illustrate how patient relations can benefit from establishing internal performance thresholds that guide service delivery. Examples from Lovelace's High Risk Pregnancy Program demonstrate the value of benchmarking efforts. The implications for patient relations benchmarking in other ambulatory care settings are discussed.

Ambulatory Care↗
PubMed1994

Considerations in predicting mental health care use: implications for managed care plans.

Managed care plans and other health care providers face a difficult task in predicting outpatient mental health services use. Existing research offers some guidance, but our knowledge of which factors influence use is confounded by methodological problems and sampling constraints. Consequently, available findings are insufficient for developing accurate predictions, which managed care plans need in order to formulate fiscally responsible service delivery contracts. This article reviews the primary data sources and research on ambulatory mental health services. On the basis of this review, the probability and intensity of outpatient visits are estimated. The primary predictors of use are also examined because they may help managed care plans forecast use by a given population or group of enrollees. Gender, age, race, education, health status, and insurance coverage are several variables surfacing as statistically significant predictors of use. The implications for planning capitated mental health services are discussed.

Age Factors↗
PubMed1994

Leadership and quality of working life in home health care.

Home health care has undergone startling changes in the past decade and, in the process, become a strategically important ingredient of health care delivery. However, the question remains whether home health care organizations can deliver the benefits anticipated for integrated care delivery systems. The answer to this question depends to a great extent on whether home health care organizations build vibrant, visionary leadership capable of transforming organizations and motivating staff to deliver high quality and low cost services. This paper examines a case study of transformational leadership as it relates to the quality of working life for nurses, homemakers, and staff. The findings indicate that leader behaviour is strongly associated with homemakers', and to a lesser extent staff members', job satisfaction, job involvement, and propensity to remain with the organization. These job attitudes have been shown to be related to higher job performance. The implications for leadership in home health agencies are discussed.

Analysis of Variance↗
PubMed1994

Supervisors' concern for staff: opportunities and outcomes.

Numerous ideas are constantly surfacing on how to manage organizations better. As health care supervisors familiarize themselves with these concepts and consider implementing new strategies, it is important not to forget the basics. This is especially true when considering staff motivation. The value of demonstrating personal concern, or consideration, for staff is examined from the perspective of transformational leadership. It has been suggested that transformational leaders are visionary and demonstrate concern for individual staff members. The association of leader support for personal concern with enhanced job attitudes is analyzed and then illustrated in several health care supervisor situations. A case study of these relationships is presented for a home health agency. The results point to the value of supervisors actively demonstrating concern for staff.

Administrative Personnel↗
PubMed1993

Does planning pay off? A look at the experience of New Mexico's rural hospitals.

When Medicare's prospective payment system (PPS) was implemented, hospitals faced the prospect of diminishing reimbursement. Added to other fundamental changes involving medical practice, consumerism, competition, and medical technology, hospitals had significant incentives to focus more attention on strategic planning. This article examines how rural hospitals altered their strategic planning in response to PPS and the extent to which planning is related to better performance. It presents results from a case study of rural New Mexico hospitals. The implications of these results for other hospitals are discussed by the authors.

Chief Executive Officers, Hospital↗
PubMed1993

Nursing department strategy, planning, and performance in rural hospitals.

Do strategic planning and nursing department strategies explain major differences in hospital performance? Answers to this question surfaced in a study of nursing directors of rural New Mexico hospitals. The results indicate that managerial strategies, cost-control strategies, and strategic planning by the nursing department explain differences in net income and operating margin. These results imply that nursing directors can take an active role in influencing the strategic direction and fiscal achievements of rural hospitals.

Analysis of Variance↗
PubMed1993

Assessing hospital administrators' responses to prospective payment. A case study in New Mexico.

Few studies have assessed the relationship between hospital administrators' efforts at planning and subsequent performance of health care organizations. Nonetheless, planning is viewed as an important mechanism for aligning health services delivery efforts with community needs and operating constraints. When prospective payment (PPS) was first introduced, hospital administrators had little choice other than to plan how they would respond to the new reimbursement policies. However, it is unclear whether they actively undertook planning in an effort to address prospective payment and related pressures. This article presents a case study of rural New Mexico hospital administrators' efforts to respond to prospective payment. Two dimensions of planning effort by administrators--intensity and formality--are analyzed within rural hospitals during the PPS transition (i.e., 1983 to 1987) and after its full implementation (i.e., since 1988). The findings suggest that planning intensity during the PPS transition is associated with higher performance; notably, higher net patient care revenues, lower costs per patient day, higher operating margins, higher net income, and higher planning effectiveness. However, the strength of these associations weakened as PPS was fully implemented. Given the exploratory nature of this evaluative case study, the results should be viewed as preliminary until confirmed by larger studies. The implications for research that evaluates planning-performance relationships in the health care field are discussed.

Attitude of Health Personnel↗
PubMed1993

Marketing strategy determinants in rural hospitals.

Rural hospitals confront an inauspicious environment due to changes in patient reimbursement and medical practice. Facing a situation of declining revenues, marketing presents an option for rural hospitals to adapt to the growing constraints. This paper analyzes the determinants of marketing strategy emphasis in rural hospitals. The conceptual model adopted in this study predicts that prior performance and contextual variables explain marketing strategy emphasis. The relationships are examined in a case study of rural New Mexico hospitals. Results suggest that prior performance and several contextual variables explain variations in marketing strategy emphasis. In particular, higher gross patient revenues are associated with more emphasis on television and radio advertising. Furthermore, rural New Mexico hospitals with high numbers of licensed beds and medical staff members, or that are affiliated with a chain organization, place greater emphasis on market research and market planning. The implications for marketing practice in rural hospitals are discussed.

Advertising↗
PubMed1993

Reflections on total quality management and health care supervisors.

Total quality management (TQM) has become an integral process in service delivery for many health care organizations. This article reviews the fundamental concepts underlying TQM and how TQM is relevant to health care supervisors. In many respects TQM represents a contemporary approach to supervising innovation and change, to analytically solving customer problems, and to implementing continuous quality improvement. Several strategies are examined that health care supervisors can adopt for improving service quality, including cultivating a climate for innovation, motivating by example, leading staff to do what is right and to tolerate no service delivery errors, retraining staff, developing control systems, and creating barrier-free organizations. These strategies are examined from the perspective of achieving continuous improvement in health care settings.

Health Maintenance Organizations↗
PubMed1992

A comparison of financial performance, organizational characteristics and management strategy among rural and urban nursing facilities.

Despite efforts to deinstitutionalize long-term care, it is estimated that 43 percent of the elderly will use a nursing facility at some point. Whether sufficient nursing facility services will be available to rural elderly is debatable due to cutbacks in governmental expenditures and recent financial losses among nursing facilities. This paper explores the challenges confronting rural nursing facilities in maintaining their viability and strategies that might be considered to improve their longevity. A comparative analysis of 18 urban and 34 rural nursing facilities in New Mexico is used in identifying promising strategic adaptations available to rural facilities. Among other considerations, rural facilities should strive to enhance revenue streams, implement strict cost control measures, emphasize broader promotional tactics, and diversify services commensurate with the constraints of the communities and populations served.

Costs and Cost Analysis↗
PubMed1992

Strategic planning in rural health care organizations.

Is strategic planning associated with higher levels of performance in health care organizations? Is strategic planning effective? This article examines strategic planning's impact on rural hospital and rural nursing facility performance, organizational characteristics, and strategy. The findings suggest that strategic planning in rural hospitals is strongly associated with higher profits, operating margins and planning effectiveness, and associated to a lesser extent with lower costs and higher revenues per patient day. However, strategic planning does not appear to be associated with higher performance in nursing facilities. The implications for strategic planning in rural health care organizations are discussed.

Financial Management↗
PubMed1991

Cultivating physician relations to enhance rural hospital utilization.

Rural hospitals are searching for new strategies to enhance utilization in view of constraints introduced by prospective payment and other environmental pressures. Developing physician relations is an approach that is reportedly leading to better hospital-physician collaboration and subsequently to improved utilization. This paper examines rural hospital-physician relations and the association with utilization. The findings suggest that rural hospitals emphasize quality care as well as diagnostic and treatment equipment procurement as methods for building relationships with physicians. These strategies are correlated with efforts to build a larger medical staff. Higher rural hospital utilization, in terms of occupancy, discharges and patient days provided, is associated with a larger medical staff. The results suggest that rural hospitals' attempts to cultivate physician relations have the potential for making significant differences in utilization outcomes. However, the linkages between utilization and physician relations are complex and require further research.

Hospitals, Rural↗
PubMed1991

Building productive relationships with movers and shakers.

Movers and shakers often demonstrate capabilities that health care managers should recognize before attempting to build productive relationships with them. First, the charisma associated with outstanding leaders is reflected in superior communication skills and presence. Next, a broad experiential base coupled with penetrating analytical skills allows movers and shakers to earn exceptional authority and power. Third, movers and shakers are able to focus on strategic visions. Movers and shakers work through other team members to select and implement solutions that are consistent with organizational mission statements. Fourth, their entrepreneurial mindset enables them to take calculated risks and design creative solutions in response to formidable challenges. Finally, movers and shakers are not reticent to face facts and make tough decisions. Not all movers and shakers possess all of these characteristics equally. Nor are they all concerned about the same issues. As individuals, they bring differing interests and capabilities to health care organizations. Health care managers may strive to cultivate one or more of these characteristics themselves. Self-improvement begins with identifying personal deficiencies and systematically planning to overcome them. Until health care managers mature into movers and shakers, they can coopt the influence and power associated with movers and shakers. By establishing a trusting relationship and using borrowed power constructively, they can earn the respect and confidence of movers and shakers. A third approach promotes power transfer through a continuing viable relationship. Health care managers may need to use some combination of these methods. Additionally, they can consider tailoring various methods into a coordinated strategy. Health care managers have a variety of promising strategies available for building productive relationships with movers and shakers. Pursuit of these strategies may improve personal prospects and promote the achievement of organizational missions and objectives.

Commerce↗
PubMed1991

Responses to prospective payment by rural New Mexico hospitals.

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.

Cross-Sectional Studies↗