Biomedical subjects
Publications and source records attributed to R R McDaniel.
A new study performed in conjunction with THA uncovers how different types of hospitals involve physicians in strategic planning and operations decisions, and how they can do a better job of getting doctors to play a role in making key decisions.
Organizational design is presented as a decision process, with specific structures seen as providing alternative choices. To illustrate this, the authors present the case of a major metropolitan hospital that used the process to coordinate service delivery (nursing care versus patient care) and service focus (product oriented versus function oriented). Through interviews with more than 40 hospital administrators and staff, the authors created a list of 20 attributes, and used simple multi-attribute utility analysis to generate six design alternatives. The decision makers unanimously chose one alternative, even though potential for significant conflict existed because of differing values and objectives. The authors find decision analytic techniques useful for both the problem formulation and for generating and evaluating structural alternatives, and conclude that in this case consensus was facilitated by the decision process used.
The nature of the strategic problem faced by health care institutions is identified. Physicians are urged to be involved in the strategic decision-making process and are offered several alternative roles that they might play in strategy development. A set of conceptual frameworks from the generic management decision-making literature is used to organize the analysis in addition to the literature of health care management. This combination affords a different perspective into the nature of the problems and new insights into these critical issues.
Historically, there has been very little management in medicine. The author suggests that the nature of medicine has changed recently, and changed in such a way that medicine needs management. The people who practice medicine need to use increasingly sophisticated management techniques. The clients of the system, particularly black clients, cannot be served well unless medicine is well managed.
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In this study of 14 effective nursing homes, patterns of participation were found to be different from those proposed by traditional organizational theories; environmental turbulence was positively correlated with participation in decision making by RNs and negatively correlated with participation by LVNs. The findings suggest that RNs are the focus of information processing when environmental turbulence is high. Information processing and decision-making theories are used to explain the results describing the theoretical implications of relevant characteristics of nursing practice settings.