Integration of nurse executives into executive level administration in Utah hospitals.

Nurse executives (NEs) in Utah acute care hospitals perceive that they are integrated into executive level administration. This perception is shared by NEs' career supporters and hinderers. To integrate NEs, influential colleagues used active methods, especially involvement. NEs add value to the administrative team by combining clinical and managerial expertise. NE integration is manifest in decision making, participation and interaction. Continued integration depends upon commitment from the chief executive officer (CEO), leadership in organizational change, addressing "glass ceiling" issues, and NEs' continuous demonstration of competence.

Enrollee satisfaction with HMOs and its relationship with disenrollment.

Relying on 1997 data from a universe of 740 HMOs, this study uniquely documented, from the perspective of health plan administrators, rates of enrollee satisfaction and disenrollments. On the basis of various reporting totals per variable or indicator, the average level of satisfaction was 83.9%; the average number of disenrollments was 20,996 per plan. Among different datasets, an average of 18.9% members disenrolled per plan; an average of 10.2% were voluntary disenrollments; and an average of 18.3% were involuntary disenrollments. Plans with higher satisfaction enrollees had predominantly lower disenrollment rates, more enrollees likely to recommend plans to family or friends, fewer older enrollees, fewer male enrollees, and higher overall plan performance. To enhance the gaining and retaining of enrollees, plan administrators should closely monitor the various dimensions of satisfaction, such as services complement, quality of care, administrative efficiency, care management, enrollees' complaints, plan performance, appointment convenience, and waiting times.

Effectiveness of nurse executives: measurement of role factors and attitudes.

This article describes the outcome of a survey of 40 nurse executives and 56 influential colleagues. Both groups agreed that leadership was the most important quality for the executive role. The nurses' primary focus was resolution of patient care problems. Influential colleagues stated resource allocation and initiation of change were two qualities needing improvement. The nurses rated themselves high in confidence about their job responsibilities, scored relationships as the most satisfying attribute, and cited provision of quality health care as the greatest advantage of their position. The greatest disadvantage was lack of administrative support. The results suggest the educational preparation needed for nurse executives.

Nurse executives' leadership roles. Perceptions of incumbents and influential colleagues.

The authors present a leadership profile of employed nurse executives (NEs). Interviews and survey data show that the typical NE is a married, middle-aged woman who has a masters degree in clinical nursing and extensive clinical experience. When comparing NEs' and influential colleagues' perceptions of the effectiveness of NEs leadership skills, the former rate themselves higher than the latter, and both groups perceive that NEs' leadership styles are more "task motivated" than "relationship motivated." The authors apply these findings to the career planning of NEs, chief executive officers, and educators in healthcare fields.

Hospital CEOs, CFOs, and nurse executives: opportunities for a new alliance.

This article examines the involvement of Utah acute care hospital nurse executives (NEs) in financial management roles. The authors surveyed NEs and their career supporters and hinderers. Findings suggest that NFs: 1. lack financial management skills, support, involvement, and satisfaction; 2. recognize financial management's importance and desire to improve performance; and 3. consider chief executive officers (CEOs) as their major supporters and chief financial officers (CFOs) their major hinderers in financial management. These "supporters" and "hinderers" of NEs showed consensus regarding the primacy of NEs' leadership and patient advocacy roles. These findings contrast with major professional association policy directives and expert opinions that advocate expanded financial management roles for NEs that will enable them to fully realize their executive potential. CEOs are positioned to establish norms that balance the traditional leadership-patient advocacy roles of NEs with newer financial management roles. CEOs can offer NEs and CFOs opportunities to improve NEs' financial management participation and performance. CEOs can provide empowerment and encourage CFOs to offer NEs "power tools" (for example, information, expertise, resources, and support). The three groups, however, must negotiate reasonable expectations for NEs in financial management and adequate preparation for these consequent responsibilities. Together, CEOs, CFOs, and NEs can successfully take hospitals into the future by leading them in ongoing learning and change.

Academic preparation for healthcare executive-track personnel.

This study focuses on career aspirations of executive-track health care administrative personnel and their perceptions of the competencies required to become hospital chief executive officers (CEOs). This article examines these topics using the results of a 1994 survey of 162 junior- and mid-level healthcare managers who work in hospitals in a western state. Respondents included 34 CEO aspirants and 128 CEO nonaspirants. The majority of both groups reported high satisfaction with several work-related activities. Significantly more CEO nonaspirants than CEO aspirants perceived a need for additional self-development in several work areas. CEO aspirants reported that CEOs five years from now would need improved strategy formulation and negotiation skills. CEO aspirants also perceived that in the future, successful CEOs will have to be more proficient in several areas, such as interpersonal skills and medical staff relations. Three lists of academic subject matter considered important to career preparation were generated from (1) the Association of University Programs in Health Administration (AUPHA) undergraduate standards, combined with curriculum graduate standards of the Accrediting Commission on Education for Health Services Administration (ACEHSA); (2) study participants' responses; and (3) professional literature. When compared for relatedness, the contents of the three lists were not significantly different statistically. The implications of these findings for health administration education are discussed.

Hospital administrators' career paths: which way to the top?

This article examines career paths of aspirants to hospital administrator positions. It focuses on successful career objectives, barriers, and paths. The 1994 survey data from 162 hospital-employed executive track personnel in a western state facilitate comparisons with nonaspirants. Only 34 (21 percent) self-reported a goal to become an administrator. Aspirants require institutional and mentor support, and need to follow more proactive and diverse career paths than they have done previously.

Job satisfaction of selected categories of Utah hospital managers.

In a survey of managers in Utah hospitals, 85 percent responded overall satisfaction with their jobs. Surprisingly, women in the survey reported significantly greater satisfaction with their jobs than other respondents.

Revenue enhancement through total quality management/continuous quality improvement (TQM/CQI) in outpatient coding and billing.

To survive and thrive, rural hospitals are seeking enhanced revenues. This study focuses on outpatient laboratory and radiology coding and billing accuracy in a nonrandom sample of seven rural hospitals in a Western state. Information was gathered on (1) procedures incorrectly coded, (2) potential revenue increases from correct coding and billing, (3) barriers to implementing changes, and (4) perceived audit value. The identified major source of potential revenue enhancement was increased fees from private payers. Correct coding and billing to Medicare and Medicaid offered the potential of additional revenue. Participating administrators appreciated the validation of coding and billing practices and identification of potential enhanced revenues. Five of seven hospitals (71.4%) selectively implemented recommended changes. Complete compliance with recommended changes was limited by barriers of tradition, competition, and reimbursement, which must be overcome to realize successful implementation. Joint Commission on Accreditation of Healthcare Organization's (JCAHO) new Total Quality Management/Continuous Quality Improvement (TQM/CQI) emphasis provides an opportunity for revenue enhancement through coding/billing assessments and interdepartmental focus and coordination.

The new nurse executive. An emerging role.

In recent years, the nurse executive (NE) has become an integral part of the hospital administrative team. The position has taken on a higher profile, and many questions are surfacing about every facet of NE administration. Since 1991, the literature is replete with articles discussing the new NE role. This article is a review summary and consolidation of 19 recently published articles, selected from a much broader list of periodical articles. It also reflects the results of six focus groups with hospital administrators and NEs in both urban and rural healthcare delivery settings. The summary pinpoints attributes identified as essential to an NE and those areas in which more research is needed. It also discloses that to function effectively, the new NE must have flexible and action-oriented personality qualities, possess executive level business management skills, have completed some graduate level degree work, and be an expert on clinical affairs. Future research should concentrate on the diverse educational needs of NEs and how to best meet those needs.

Methods for optimizing revenue in rural hospitals.

Rural hospitals have been failing over the last two decades, and one of the biggest reasons has been lack of attention paid to detail and accuracy in the coding and pricing of services rendered. Most research that has explored the problems of coding accuracy and its impact on reimbursement has focused on coding by medical record professionals, but many coding procedures are performed by "front line" lower-level employees working in a hospital's laboratory, radiology department, pharmacy, or other ancillary service departments. This article explains how rural hospitals can optimize their reimbursement and adhere to Medicare/Medicaid and other third-party payer regulations by training coders properly and by reviewing their pricing policies to make sure that prices charged accurately reflect the true cost of services.