The U.S. Department of Veterans Affairs (VA), a large public-sector healthcare delivery system, is following the lead of the private sector in seeking a more integrated approach to providing patient care. The belief is that new entities known as organized delivery systems (ODSs) will produce better, more cost-effective care. Toward this end, VA has reorganized its facilities into 22 networks. The purpose of this paper is to provide VA policymakers and managers with information about building and managing an integrated delivery system for the nation's veterans based on findings from the Health Systems Integration Study (HSIS).
This study analyzed four prominent organizational factors thought to influence service quality in nursing homes. Perceptions of service quality were collected from over 400 family members who regularly visited residents in 41 nursing homes. Service quality was measured along five dimensions identified by marketing research on customers in service industries. These five dimensions were responsiveness, reliability, assurance, empathy, and tangibles. Perceptions of service quality exhibited significant associations with each of the four organizational factors: ownership, funding mix, facility size, and nurse staffing. Implications for health services administration are discussed.
Nursing home administrators represent wide variations in academic training. General education levels do not seem to affect administrative preparation in key domains of practice--specific academic fields of study are more relevant. Hence, sole emphasis on higher educational requirements for licensure appears to be a misdirected strategy for improving quality of care and enhancing management efficiencies in nursing homes. Educational paradigms studied have strengths and weakness in furnishing various job skills. These results are helpful in defining strategic actions for addressing both current deficiencies and future training needs. A specialized long-term care model that incorporates appropriate clinical and business skills is recommended. The roles of continuing education and executive educational offerings also need streamlining. These initiatives would require a joint effort from policymakers, academicians, and practitioners.
This study examined the anticipation of salaried hospital physicians in Israel to retain hospital membership for a long term until their retirement. Examined are attitudinal and position factors, as well as hospital standing personal and situational factors that relate to this anticipation. The data collected from 195 full-time salaried physicians in Israeli hospitals indicated that about one-third of the physicians anticipate to retain hospital membership until retirement. It was found that factors reflecting the physician's standing within the hospital were the main predictors of this anticipation, whereas work-related attitudes had little or no effect on it. The implications of these finding to hospital-physician integration strategies in the United States are discussed.
Our Lady of the Way Hospital, like most hospitals in the late 1980s and early 1990s, exemplified the bureaucratic organization represented by the traditional "line and box organization chart." Additionally, as in most small hospitals, the CEO of Our Lady of the Way Hospital--a 39-bed, JCAHO accredited, general, acute care hospital in Martin, Kentucky--had direct management responsibility for several functional departments. In 1992, administration replaced the traditional, hierarchical organization chart with a circular structure that reflected its increased reliance on team processes throughout the organization. The new structure also significantly reduced the number of reporting assignments to the CEO. This article describes the hospital's transition to a team-based organization, illustrates the application of a circular organization chart, and assesses its value and limitations.
In this article, we investigate the relationship between hospital length-of-stay (LOS) and quality of care. We use hospital claims records from Medicare beneficiaries in Michigan to estimate condition-specific models for predicting patients' LOSs. With these models and a data set provided by Michigan Peer Review Organization, Inc. (MPRO), each patient's risk-adjusted LOS is then linked to a quality-of-care judgment (good care, poor care) from physician peer reviewers. LOS is a widely used indicator of hospital performance. Most commonly, it is viewed as an indicator of hospital efficiency and as a surrogate measure for costs, with hospitals having long average LOSs considered relatively inefficient in the use of resources and those with low LOSs considered to be efficient. Sometimes, however, LOS is assumed to relate to quality. For example, if hospitals were to respond to the financial incentives of prospective payment by attempting to lower costs by prematurely discharging patients, LOSs significantly lower than expected might be considered indicative of poor quality care. On the other hand, if poor quality of care causes complications, it would tend to extend LOSs. Under this assumption, longer than expected LOSs could be viewed as indicative of poor quality care. This article shows that in every one of the 13 clinical conditions examined, cases that received poor quality care had significantly longer risk-adjusted LOSs than cases whose care was of acceptable quality.
Strategic alliances are proving to be effective strategies for responding and adapting to changing environments, and as such they offer the U.S. Department of Veterans Affairs (VA) healthcare system valuable opportunities for accomplishing the goals of its major reorganization effort. This article begins with an examination of basic strategic-alliance structures that are employed across many different types of industries. Next, consideration is given to the ways in which these basic alliance structures may be adapted to the unique organizations and individuals that serve as providers, purchasers, and consumers of health services. Finally, this article explores how models of strategic alliance in healthcare can be tailored to the specific needs and constraints of the VA healthcare system through an examination of existing and potential alliance opportunities.
This article identifies the components that contribute to a healthcare organization's costs in controlling quality. A central tenet of our argument is that at its core, quality is the result of a series of transactions among members of a diverse network. Transaction cost economics is applied internally to analyze intraorganizational transactions that contribute to quality control, and questions for future research are posed.
As hospitals continue to face intense pressure to control operating costs, many have resorted to staff reductions and other redesign efforts. The remaining employees are frequently asked to do more with less. In these uncertain times, it is important that hospital administrators understand the concept of organizational citizenship behavior (OCB) and attempt to attract and retain those employees capable of exhibiting such behaviors. This study examined the relationships between three organizational commitment components, as well as job satisfaction (including specific facet measures) and two separate forms of OCB. Usefulness analyses indicated that satisfaction with coworkers and affective commitment were the two most important predictors of one dimension of citizenship behavior, as each construct contributed unique variance in the dependent variable. Implications for future research and practice are provided.
The emergence of visiting consultant clinics (VCC) represents an unstudied but potentially important mechanism for importing specialty physician services into rural areas. An analysis of five years of one state's VCC experience reveals a substantial increase in both availability and geographic accessibility. This study documents the market's response to the oversupply and hypercompetition among urban-based physician specialists. Patterns of VCC growth have varied markedly for different specialties.
