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PubMed1993

[The future of clinical laboratory medicine--a viewpoint from hospital administration].

Net profits estimated from the operation of about 10,000 public and private hospitals here in Japan, showed a 0.6 per cent decrease in 1991. This reflects the severity of hospital management under governmental policy requiring the rate of increase in medical expenses to be less than the rate of increase for the GNP. Changes in medical fee reimbursement in the National Health Insurance in April 1992, reduced the fees for many medical tests, resulting in decreased income especially in outpatient clinics. Because of this, it is necessary to review the maintainance or existence of hospital laboratories from the standpoint of medical needs and cost efficiency. Laboratory tests must be done promptly, even on holidays. Only hospital laboratories can do this. Many bedside tests will need to be instituted. Doctors preferably, or technicians should fully explain the need for tests to the patient. "Informed consent" is important. Test results should be reported to the doctors not only with the test data, but also with interpretation by clinical pathologists to expedite the doctor's decision or diagnosis. The need for commercial laboratories is increasing because of difficulty caused by new and expensive equipment and techniques of modern laboratory service even in large hospitals. Commercial laboratories should serve not only as a subcontractor, but also as symbiotic partner of hospitals, clinics or medical offices in both medical and business management.

Clinical Laboratory Techniques↗
PubMed1998

Executive skills 21: a forecast of leadership skills and associated competencies required by naval hospital administrators into the 21st century.

Those in the Naval Medical Department are experiencing an exciting time of bridled chaos and creative change. Many mid-career officers are uncertain of the leadership behaviors and skills that will be necessary for successful managerial careers. Changes in the method of health care delivery of this nation combined with the reengineering of the armed forces' world-wide mission has driven military medical leaders to expand their professional skills, knowledge, and abilities beyond the clinical sciences. This research identifies the most critical domains in the science of health care administration and differentiates and ranks job skill, knowledge, and ability requirements that will be necessary for successful health care management into the 21st century. Top Naval hospital executives responded to two iterations of a Delphi inquiry. These medical leaders identified 106 unique issues that were content-analyzed into nine domains by a neutral, expert panel. Domains, in order of ranked importance, were leadership, health care delivery systems, cost-finance, technology, accessibility, professional staff relations, marketing, quality-risk management, and ethics. In the second Delphi iteration, hospital executives reviewed domain results and rated identified job requirements on their required job importance. The top-10 rated skills, knowledge, and abilities are reported. Results indicated that although a business orientation is needed for organizational survival, an emphasis on person-oriented skills, knowledge, and abilities is required for future success as a health care administrator in the Naval health care system.

Delphi Technique↗
PubMed1990

Hospital administrators' response to AIDS. Results of a national survey.

Executives are just beginning to adapt to the presence of the epidemic. Two-thirds have been involved in AIDS care and these hospitals appear to be in the forefront in developing structural responses and initiating procedures to deal with the disease. Through the use of rating scale analysis, we were able to show a continuum of responses by which hospitals cope with the disease. First, educational efforts are begun, then human resource departments begin to refer employees with AIDS to caregivers. And the most developed response is for hospitals to establish specific policies for employees, ultimately requiring them to report whether or not they have the disease to their supervisor. Executives' attitudes also seem to be affected by whether or not their hospitals have cared for any AIDS patients. In contrast to the contact hypothesis used to explain prejudice, experienced administrators are more authoritarian in reacting to the crisis. For example, more experienced than inexperienced hospital administrators agree that all patients should be routinely tested for AIDS. Our findings are corroborated in a recently reported study of house staff who had been exposed to patients with AIDS. House officers who had cared for a greater number of AIDS patients showed a greater level of concern about acquiring the disease than those with less exposure. Just as experience among house officers serves to produce increasing concern for their personal safety, so too experience on the part of the executives appears to intensify anxiety in their attitudes. Experienced administrators are more likely to advocate specialized facilities for the care of AIDS patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗