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PubMed1984

Survival of the fittest? The democratization of hospital administration in Quebec.

In 1973 the Canadian Province of Quebec "democratized" its hospital boards of directors by replacing their traditional lay community or religious members with individuals more representative of the hospitals' major interest groups. In the province's English-speaking hospitals, patients, community organizations, physicians and nonprofessional hospital employees elected representatives to boards that were formerly comprised mostly of business executives. After a brief description of the social organization of the former "elite" boards and their role in the distribution of power within hospitals, the paper demonstrates how the "elite" board members and hospital administrators retained control despite "democratization." Several theoretical explanations for this outcome are critically examined in the light of these empirical findings. One suggestion is that the "elite" administration survived democratization because it was "fitter" in terms of ability to influence the hospitals' major economic and political constraints.

Democracy↗
PubMed2005

Out-of-hospital administration of activated charcoal by emergency medical services.

STUDY OBJECTIVE: We assess the feasibility of activated charcoal provided by emergency medical services (EMS). METHODS: This was a 12-month follow-up study on the feasibility of a newly introduced protocol to administer activated charcoal by EMS to acutely poisoned patients before arrival at the hospital. Administration of activated charcoal (50 g or 1 g/kg orally or by nasogastric tube) was considered in 2,047 patients with acute poisoning. Main outcome measures were success rate and elapsed times in and adverse effects of administering charcoal. RESULTS: Activated charcoal was considered to be an indication for 722 patients (35% of the study population) and was administered to 555 patients. Median elapsed time from poison ingestion to activated charcoal administration was 88 minutes, and median time from activated charcoal administration to hospital arrival was 20 minutes. Activated charcoal was not given to 101 (15.4%) patients, although considered indicated, because of patient refusal (n=72), inability to ingest a charcoal mixture (n=23), technical problems (n=4), or recommendation by the hospital after telephone consultation (n=2). Charcoal caused no reported adverse effects. CONCLUSION: Out-of-hospital activated charcoal administration by EMS is feasible, even in severe poisonings. Adverse events were rare.

Acute Disease↗
PubMed1985

DRGs from the hospital administrator's point of view.

Diagnosis-Related Groups have been introduced as a reimbursement system in the United States. They may also be used as a highly effective management tool. Hospital administrators must be aware of the overall impact such a system may have on the organisation and management of the hospital.

Australia↗
PubMed1993

Rural hospital administrators and strategic management activities.

This study examines the association of characteristics of rural hospital administrators and the adoption of seven strategic activities in a national sample of 797 U.S. rural hospitals during the period 1983-1988. Based on the premise that managerial activities can affect organizational change, we test five hypotheses relating head administrator characteristics to strategic adaptation, controlling for environment-market and hospital-related variables. Bivariate analysis of the strategic adoption showed a positive association with administrative turnover and a negative association with head administrator age. Multivariate logistic regression showed that only high levels of turnover were associated with strategic activities, net of control variables. The implications of these findings and the lack of predictive power of other rural hospital administrator characteristics--especially affiliation with the American College of Healthcare Executives--are discussed within the context of a "strategic management policy" for rural hospitals.

Age Factors↗
PubMed1987

A hospital administrator's guide to successful HMO negotiations.

Many issues must be considered when hospitals negotiate with HMOs. Hospital administrators can improve negotiations with HMOs by understanding the philosophy and terminology of alternative delivery programs, as well as their hospital's own operating requirements.

Health Maintenance Organizations↗
PubMed1989

The hospital administrator versus the medical staff: ending the war of attrition.

These are difficult times for both physicians and hospital administrators--and for many of the same reasons. This article explores some of the factors making life and work hard for administrators and physicians, and suggests that it is in the medical staff's best interest to help the administrator do a good job of running the hospital.

Conflict, Psychological↗