Baylor University Medical Center system

In today's health care environment, the hospital's relationship to its medical staff can mean the difference between success and failure. As opposed to the current system, the medical staff of the future must be organized and strong, yet flexible enough to undergo the changes necessary for "venturing." This article describes how one University Medical Center organized its physicians and medical staff to meet the changing needs of the surrounding Texas community and the organization itself. Focusing on today's health care environment and the concept of venturing, this article unveils the special relationship between a medical center and its medical staff.

Hospital-physician joint ventures: a strategic approach for both dimensions of success

Joint ventures between hospitals and the physicians on their medical staffs have produced successes and failures. Each joint venture has two very different dimensions of success--financial and collaborative. The most successful ventures are able to accomplish both of these often conflicting goals. To enhance hospital executives' success in joint ventures with physicians, a strategic approach with a series of six steps and their corresponding models or maps is proposed. The steps in this strategic approach are: (1) identify key stakeholders and linkages among them; (2) surface stakeholder conflict using problem-oriented maps; (3) diagnose the venture on both dimensions of success; (4) classify the venture using both dimensions of success; (5) select a strategy to optimize the venture's current potential for success; and (6) select an approach to transform the venture with limited potential for success.

Product line management in hospitals: an exploratory study of managing change

Hospitals often have looked to industry as a source of solutions to business problems. In recent years, they have begun to adopt a concept that has been used by manufacturers for more than 50 years--product line management (PLM). One characteristic of PLM is the designation of a product champion whose responsibility it is to promote the product both inside and outside the organization as well as to view for organizational resources to support the product. This article presents the findings of an exploratory study that indicates that although many hospitals are successfully utilizing PLM, a number of barriers to the implementation of this concept remain.

Hospital culture--why create one?

Hospitals, to survive, must be transformed into responsive, participative organizations capable of new practices that produce improved results in both quality of care and service at reduced costs. Creating, managing, and changing the culture are critical leadership functions that will enable the hospital to succeed. Strategic planning and effective implementation of planned change will produce the desired culture. Work restructuring, a focus on quality management along with changes in clinical practices, as well as the care and support processes, are all a part of the necessary hospital cultural revolution.

Total quality management: defining a process for quality improvement

An effective total quality management system is the outcome of a well-defined process for QI. The Toledo Hospital seven-step QI process provides a systematized, databased approach to problem solving. The process has been shown to work for all types of QI teams throughout the hospital.

The Florida breastfeeding promotion project: a coalition effort to improve hospital practices and policies

The Florida Healthy Mothers, Healthy Babies-Coalition initiated a breastfeeding promotion project. The Coalition focused on hospital policies because of their impact on breastfeeding success and because of the potential for working with other state efforts directed at pregnant women or new mothers. The Florida Healthy Mothers, Healthy Babies Coalition developed a three-part program. It consists of model hospital policies concerning breastfeeding, a lecture series which educates hospital nursing staff on the implementation of these model policies and a workshop through which trainers are prepared to present the educational program. Nurses' Association of the American College of Obstetrics and Gynecology (NAACOG), Special Supplemental Food Program for Women, Infants, and Children (WIC), and Florida Lactation Consultant Association (FLCA) all contributed to this project.

Institutional and strategic choice perspectives on board involvement in the strategic decision process

The level of a board of directors' involvement in strategic decisions can be viewed as an institutional response or as a strategic adaptation to external pressures for greater board involvement. We examined the antecedents and effects of board involvement from both the institutional and strategic choice perspectives. Data obtained from personal interviews with 114 board members and archival records indicated that board size and levels of diversification and insider representation were negatively related to board involvement, and organizational age was positively related to it. Furthermore, we found board involvement to be positively related to financial performance after controlling for industry and size effects. Overall, the results suggest that both theoretical perspectives are necessary for a comprehensive description of the strategic role of boards.

Nursing involvement in hospital governance: 1990 and 1995

The integration of nursing into organizational governance structures has been advocated to improve practice and enhance the quality of patient care. In 1990, department of nursing involvement in hospital governance occurred primarily through the activities of the CNE. Projections for 1995 suggest that both staff RNs and CNEs will be more involved in governing health care organizations.

Nursing power and practice in the United Kingdom National Health Service

Over the last decade the National Health Service (NHS) in the United Kingdom has experienced major organizational change. Successive government initiatives designed to improve local management of hospitals have tended to marginalize nurses. Resource Management, a major initiative, which is the model adopted in the NHS Review for hospital management for the 1990s, appeared initially to offer nurses an opportunity to influence decision-making directly. In practice, nurses' experiences of Resource Management were mixed. This study of the six hospitals which piloted the introduction of Resource Management showed that nurses did not always grasp the opportunity to enhance their power and practice. There was evidence from the study that the introduction of information technology curbed innovations in practice, and removed nurses from patient care delivery.

Successful implementation of a CQI process

Managers and CQI facilitators must be equipped to understand both the pain and joy inherent in the organizational change process. The organizational caveats associated with successful implementation of CQI include the following: Expect resistance to change, especially if your current situation is comfortable. Be patient--the change process is an evolution, not a revolution. Plan well in a multidimensional format--you are changing more than policies and procedures when adopting CQI. Shape a culture that will support CQI, actively plan to expand communication opportunities, enhance training programs, and increase recognition modalities. Anticipate and deal with the stress that will accompany change. Don't forget to celebrate successes as transformation occurs!

Outline of hospital organization for a chemical warfare attack

A plan for hospital organization in the event of chemical warfare is described. The basic principles are: a) isolation of the hospital receiving the casualties, b) several levels of triage, and c) treatment according to simple therapeutic protocols using appropriate treatment sites. Triage is based upon walking feasibility, respiratory status, age, and additional conventional injuries. The nurse's diagnostic and treatment authority is extended. Auxiliary staff (numbering hundreds of people) are needed for decontamination, stretcher bearing, artificial ventilation, etc. A nation-wide educational program on the prevention, decontamination and treatment of chemical warfare casualties is conducted in Israeli hospitals and drills are exercised frequently. This scheme is suitable for nerve gas poisoning, but can be easily modified for other chemical agents.

Better management of Irish hospitals

The establishment of the Dublin Hospitals Initiative and the Efficiency Review Group as first steps in an "action" plan was based on the report in 1989 of the Commission of Health Funding which suggested that "the solution to the problem facing the Irish health services...(lies) primarily...in the way that services are planned, organised and delivered". Our health service is in transition from the phase of facility management into that of functional management. This will involve facing the fact of the limit on resources, introducing information systems and getting the co-operation of hospital doctors. The most senior executive in a hospital must firstly be a good general manager with sufficient power to manage. Hospitals should be divided into centres of responsibility made up of one or more centres of activity. Formal education for hospital administrators should be extended. There is a need for training at all levels, particularly of those administrative and medical staff who have direct interaction with the computer-based system. There should be a commitment to management development particularly by means of teamwork and action learning.

Redesigning hospitals around patients and technology

Hospitals must drastically redesign themselves and revise their operations to be successful. Four major redesign initiatives will enable the traditional hospital to provide effective patient care while attaining its own profitability goals.

Structuring freestanding diagnostic imaging centers for profitability

Many hospitals have or are contemplating establishing freestanding diagnostic imaging centers with members of their medical staff. Some earlier joint ventures between hospitals and their physicians have not met expectations or financial projections. This article describes guidelines for evaluating the operating performance of freestanding imaging centers and is based on the author's assessment of several freestanding centers; it is not intended to depict the results of any one study or operational review. The areas addressed during an operations review should include: management and organizational structure, technologist and support staffing, equipment utilization, non-salary costs, and outside contracts.

The well-structured hospital-physician partnership

Presbyterian Intercommunity Hospital began its journey along the right path toward successful diversification when it decided to modify, rather than destroy, the legal structure of InterHealth.

Minnesota's fifteen-year romance. Managed care: lessons learned and survival approaches for hospitals and physicians

For the last 15 years, Minnesota has lived with managed care. The Minnesota story is important because it is a singularly unique example of the natural history of managed care in the United States, from the indemnity response to HMOs to PPOs to "open-ended" HMOs to comprehensive managed care.

Primary care referral management: a marketing strategy for hospitals

With increasing competition among hospitals, primary care referral development and management programs offer an opportunity for hospitals to increase their admissions. Such programs require careful development, the commitment of the hospital staff to the strategy, an integration of hospital activities, and an understanding of medical practice management.

Weight-loss programs still fatten profits despite competition

Why are hospitals interested in weight-loss programs? Low start-up costs, combined with a high demand for services, mean almost instant profits in some cases. And in an increasingly competitive market, hospital affiliation seems to be an advantage. But experts say that word of mouth is the best promotion for weight-loss programs, which means that patients must lose weight and keep the pounds off. That's why hospitals have found that patient education is integral to a successful program.

Addiction. Help employees who help themselves

Employers are helping their employees overcome difficult times due to substance abuse. Find out how companies are dealing with substance abuse in the workplace, and what programs have been successful for their employees.