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This article examines the association between downsizing and financial performance in a national sample of 797 U.S. rural hospitals from 1983-1988. The results indicate that downsizing occurred in about 15 percent of all rural hospitals and that a positive association between downsizing and financial performance was unconfirmed.
This article reports on observations of the implementation of a patient-centered care (PCC) work reorganization model in a community hospital setting. Analysis of videotape, direct observation, and interviews with key informants demonstrated the similarities between organizations and families in times of change. We propose a family systems framework for understanding some of the complex relationships and transitional experiences we observed.
In the 1990s, acute care hospitals in the United States encountered an unstable operating environment created by a series of transformations in the health care delivery system and long-term-care market. Confronted with an array of economic pressures and demographic changes, hospitals were motivated to engage in long-term-care diversification, such as establishing a long-term-care unit or providing home health services, as a means of entering new markets and ensuring financial stability. This article examines the organizational, market, and community factors associated with this strategic activity among a national sample of urban and rural hospitals.
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While the need to realign the continuum and change the delivery system is one of the many factors driving health care reform, it is clear that a major transformation of the delivery system is already under way and that ambulatory care and home care are at the forefront of that movement. This trend is likely to continue regardless of the pace of health reform.
Since 1976, Clinical Engineering (CE) has been studied at the Simón Bolívar University (USB) as part of the Bioengineering Studies program developed at that University. However, it was not until 1996 that Clinical Engineering activities were established in a Venezuelan hospital. This paper describes how the USB, using its own human resources, has achieved the establishment of a Clinical Engineering Department in a national reference hospital for the first time.
To remain competitive, many not-for-profit hospitals have turned to joint ventures with for-profit and other not-for-profit entities. The authors examine the organizational structures that are used most often to form joint ventures (contractual agreements, subsidiary corporations, partnerships, and not-for-profit title-holding corporations), as well as the advantages and disadvantages associated with each form. Nurse executives must be aware of the opportunities that joint ventures provide their institutions. These arrangements can help improve and expand services and profitability.
Can hospitals successfully embark on large-scale organizational change without using outside consultants? Nursing administrators have an intense interest in the answer to this question. If change can be designed from inside the organization, the chances are greater that the change will fit better with the organization as a whole, and that buy-in by staff will be significant. The authors review the elements that need to be in place to conduct a successful change process internally, and support their concepts with a case study.
In response to societal, organization, and leadership changes, an innovative nursing structure was implemented and evaluated. An administrative support team was developed to provide specialized internal consultation and support to a flattened and decentralized nursing division. The four administrative support team roles provided an organization perspective that ensured constancy of purpose throughout the division. This structural innovation proved to be congruent with nursing shared governance and total quality management initiatives occurring in the organization. Evaluation studies indicated that the model has effectively supported 5 years of continuing organizational change.
In 1991, our University Hospital initiated a series of strategic changes designed to increase organizational effectiveness and efficiency, foster a culture of commitment to customer-driven service, and flatten the organizational structure, pushing decision making closer to the point of service. These events, although proactive and positive in their intent, triggered a significant, debilitating response among many members of the nursing staff. The authors discuss the experience of this organization, examines the process of transition and the responses of staff members to change, and provides recommendations for minimizing the sequelae of organizational transformation.
The healthcare system is under renovation and renewal. In the process, roles and structures are shifting to support a subscriber-based continuum of care. Alliances and partnerships are emerging as the models of integration for the future. But how do we structure to support these emerging integrated partnerships? As the nurse executive expands the role and assumes increasing responsibility for creating new frameworks for care, a structure that sustains the point-of-care innovations and interdisciplinary relationships must be built. Whole systems models of organization, such as shared governance, are expanding as demand grows for a sustainable structure for horizontal and partnered systems of healthcare delivery. The executive will have to apply these newer frameworks to the delivery of care to provide adequate support for the clinically integrated environment.
In this article, the authors report on a project that studied the impact of work redesign on the roles of hospital executives. Thirty-six in-depth interviews were conducted with executives from 13 VHA healthcare organizations that were considered excellent practice models in the area of work redesign. This report represents a broad, multidisciplinary perspective reflecting the ideas of various members of the healthcare management team. VHA hired Marie Manthey and Creative Nursing Management, Inc., to conduct the interviews in an objective manner and to assist with results interpretation.
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In a study at four teaching hospitals, nurse managers rated themselves most competent in activities related to the management of their unit, and believed these activities were most important. Nurse managers lacked some of the skills and knowledge needed to relate to the larger organization and external environment, activities that they rated as less important. Selection, education, and development efforts should be targeted to newly important roles and skills for which nurse managers have little preparation.
Building on redesign efforts that created case management, clinical care technicians, support service hosts, and pharmacy technician roles, this redesign focused on integrating case management, utilization management, and discharge planning functions into a new outcomes manager role. The authors describe the process of developing and implementing the new role and outline specific actions that eliminated redundancy and inefficiency. Results of the evaluation of the project are reviewed, including full-time equivalent and salary savings and employee and physician satisfaction improvements.
Responding to an enlarged span of control and an ever changing health care environment, the author describes the implementation of a unit-based shared governance model. Through study,literature review, and team consensus, a new management style emerged. Using Rosabeth Kanter's framework for work effectiveness, the unit governance structure was transformed. The process, progress, and outcomes are described, analyzed, and celebrated.
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