DECIDE: A Decision-Making Model for More Effective Decision Making by Health Care Managers.

The purpose of this article is to describe a step-by-step process for decision making, and a model is developed to aid health care managers in making more quality decisions, which ultimately determines the success of organizations. The DECIDE model is the acronym of 6 particular activities needed in the decision-making process: (1) D = define the problem, (2) E = establish the criteria, (3) C = consider all the alternatives, (4) I = identify the best alternative, (5) D = develop and implement a plan of action, and (6) E = evaluate and monitor the solution and feedback when necessary. The DECIDE model is intended as a resource for health care managers when applying the crucial components of decision making, and it enables managers to improve their decision-making skills, which leads to more effective decisions.

Cultural Diversity Training: The Necessity of Cultural Competence for Health Care Providers and in Nursing Practice.

The purpose of this article is to discuss the need to provide culturally sensitive care to the growing number of diverse health care consumers. A literature review of national standards and research on cultural competency was conducted and specifically focused on the field of nursing. This study supports the theory that cultural competence is learned over time and is a process of inner reflection and awareness. The domains of awareness, skill, and knowledge are essential competencies that must be gained by health care providers and especially for nurses. Although barriers to providing culturally sensitive care exist, gaining a better understanding of cultural competence is essential to developing realistic education and training techniques, which will lead to quality professional nursing practice for increasingly diverse populations.

Cultural Diversity Training: The Necessity of Cultural Competence for Health Care Providers and in Nursing Practice.

The purpose of this article is to discuss the need to provide culturally sensitive care to the growing number of diverse health care consumers. A literature review of national standards and research on cultural competency was conducted and specifically focused on the field of nursing. This study supports the theory that cultural competence is learned over time and is a process of inner reflection and awareness. The domains of awareness, skill, and knowledge are essential competencies that must be gained by health care providers and especially for nurses. Although barriers to providing culturally sensitive care exist, gaining a better understanding of cultural competence is essential to developing realistic education and training techniques, which will lead to quality professional nursing practice for increasingly diverse populations.

Implications of DSM-5 for Health Care Organizations and Mental Health Policy.

The American Psychiatric Association (APA) has made major changes in the way mental illness is conceptualized, assessed, and diagnosed in its new diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published in 2013, and has far reaching implications for health care organizations and mental health policy. This paper reviews the four new principles in DSM-5: 1) A spectrum (also called "dimensional") approach to the definition of mental illness; 2) recognition of the role played by environmental risk factors related to stress and trauma in predisposing, precipitating, and perpetuating mental illness; 3) cultural relativism in diagnosis and treatment of mental illness; and 4) recognizing the adverse effects of psychiatric medications on patients. Each of these four principles will be addressed in detail. In addition, four major implications for health care organizations and mental health policy are identified as: 1) prevention; 2) client-centered psychiatry; 3) mental health workers retraining; and 4) medical insurance reform. We conclude that DSM- 5's new approach to diagnosis and treatment of mental illness will have profound implications for health care organizations and mental health policy, indicating a greater emphasis on prevention and cure rather than long-term management of symptoms.

Using a social entrepreneurial approach to enhance the financial and social value of health care organizations.

In this study, a conceptual framework was developed to show that social entrepreneurial practices can be effectively translated to meet the social needs in health care. We used a theory-in-use case study approach that encompasses postulation of a working taxonomy from literature scanning and a deliberation of the taxonomy through triangulation of multilevel data of a case study conducted in a Taiwan-based hospital system. Specifically, we demonstrated that a nonprofit organization can adopt business principles that emphasize both financial and social value. We tested our model and found comprehensive accountability across departments throughout the case hospital system, and this led to sustainable and continual growth of the organization. Through social entrepreneurial practices, we established that both financial value creation and fulfilling the social mission for the case hospital system can be achieved.

Electronic health systems: challenges faced by hospital-based providers.

The purpose of this article is to discuss specific challenges faced by hospitals adopting the use of electronic medical records and implementing electronic health record (EHR) systems. Challenges include user and information technology support; ease of technical use and software interface capabilities; compliance; and financial, legal, workforce training, and development issues. Electronic health records are essential to preventing medical errors, increasing consumer trust and use of the health system, and improving quality and overall efficiency. Government efforts are focused on ways to accelerate the adoption and use of EHRs as a means of facilitating data sharing, protecting health information privacy and security, quickly identifying emerging public health threats, and reducing medical errors and health care costs and increasing quality of care. This article will discuss physician and nonphysician staff training before, during, and after implementation; the effective use of EHR systems' technical features; the selection of a capable and secure EHR system; and the development of collaborative system implementation. Strategies that are necessary to help health care providers achieve successful implementation of EHR systems will be addressed.

Improving quality in long-term care facilities through increased regulations and enforcement.

This research addresses the origins and motivations that drive long-term-care regulations and enforcement. It outlines the historical development of the US long-term-care system and describes regulations that focus on improving quality of care. Current long-term-care regulations are inadequate and ineffective because of fragmentation and inconsistencies that have resulted in conflicts of interest, inequitable services, underfunded care, low reimbursement, cumbersome and duplicative processes, and inadequate training and compensation for providers. Reforms such as establishing higher standards and modifying enforcement procedures are necessary to bring about increased quality of care for long-term-care consumers.

A framework for cultural competence in health care organizations.

Increased racial and ethnic diversity in the United States brings challenges and opportunities for health care organizations to provide culturally competent services that effectively meet the needs of diverse populations. The need to provide more culturally competent care is essential to reducing and eliminating health disparities among minorities. By removing barriers to cultural competence and placing a stronger emphasis on culture in health care, health care organizations will be better able to address the unique health care needs of minorities. Organizations should assess cultural differences, gain greater cultural knowledge, and provide cultural competence training to deliver high-quality services. This article develops a framework to guide health care organizations as they focus on establishing culturally competent strategies and implementing best practices aimed to improve quality of care and achieve better outcomes for minority populations.

Consumer-directed health care: understanding its value in health care reform.

The purpose of this article is to describe the importance of consumer-directed health care as the essential strategy needed to lower health care costs and support its widespread adoption for making significant strides in health care reform. The pros and cons of health care consumerism are discussed. The intent is to show that the viability of the US health care system depends on the application of appropriate consumer-directed health care strategies.

Consumer-directed health care: implications for health care organizations and managers.

This article uses a pyramid model to illustrate the key components of consumer-directed health care. Consumer-directed health care is considered the essential strategy needed to lower health care costs and is valuable for making significant strides in health care reform. Consumer-directed health care presents new challenges and opportunities for all health care stakeholders and their managers. The viability of the health system depends on the success of managers to respond rapidly and with precision to changes in the system; thus, new and modified roles of managers are necessary to successfully sustain consumerism efforts to control costs while maintaining access and quality.

Quality of health care in the US managed care system: comparing and highlighting successful states.

PURPOSE: This paper aims to examine the issue of quality of care in the US managed care system and to compare state-level policies and programs. Specifically, it aims to describe five states which are making the most quality of care improvements. DESIGN/METHODOLOGY/APPROACH: This study examines the literature to identify states' care quality rankings. Additionally, five state case studies are presented to illustrate various programs approach to quality. FINDINGS: The paper finds that some states are better than others in their strategies to enhance quality of care. California, Florida, Maryland, Minnesota and Rhode Island are considered among the best. Thus, their programs are described. RESEARCH LIMITATIONS/IMPLICATIONS: From a research perspective the study brings a renewed focus on various methods in which states invest to improve residents' quality of care. PRACTICAL IMPLICATIONS: From a practical standpoint, since quality of care is an important topic and interesting to all stakeholders in health care--policymakers, consumers, providers, and payers--readers can use the study's results to compare states' strategies and develop new ways to increase quality. ORIGINALITY/VALUE: This study's value lies in the way it helps states to compare their performance over time and against other states as they make improvements to enhance quality.

Entrepreneurship management in health services: an integrative model.

This research develops an integrated systems model of entrepreneurship management as a method for achieving health care organizational survival and growth. Specifically, it analyzes current health care environment challenges, identifies roles of managers and discusses organizational theories that are relevant to the health care environment, outlines the role of entrepreneurship in health care, and describes the entrepreneurial manager in the entrepreneurial management process to produce desirable organizational outcomes. The study concludes that as current health care environment continues to show intense competition, entrepreneurial managers are responsible for creating innovations, managing change, investing in resources, and recognizing opportunities in the environment to increase organizational viability.

The new health care paradigm: roles and competencies of leaders in the service line management approach.

PURPOSE: The purpose of this paper is to discuss the need for the service line management approach in health care. Service line management is increasingly utilized by US health care organizations as an innovative method for providing the needed stimulus to increase viability and profitability for the ailing health care sector. DESIGN/METHODOLOGY/APPROACH: Using current literature, this study describes a paradigm shift from traditional health care management approaches to focus on the importance of a service line management approach with its specific emphasis on competencies of leaders. RESEARCH LIMITATIONS/IMPLICATIONS: Four essential competencies--conceptual, participation, interpersonal, and leadership--must be gained by leaders to bring about organizational growth. PRACTICAL IMPLICATIONS: Health care managers must understand and practice these four key competencies to become effective health care leaders. ORIGINALITY/VALUE: This paper provides useful information on the need for the service line management approach in health care.

An assessment tool for developing healthcare managerial skills and roles.

This article is based on a study to identify, and by doing so help develop, the skills and roles of senior-level healthcare managers related to the needs of the current healthcare environment. To classify these roles and skills, a qualitative study was conducted to examine the literature on forces in the healthcare environment and their impact on managers. Ten senior managers were interviewed, revealing six roles as the most crucial to their positions along with the skills necessary to perform those roles. A pilot study was conducted with these senior managers to produce a final assessment tool. This assessment tool helps managers to identify strengths and weaknesses, develop in deficient areas, and promote competence in all areas as demanded by the market and organization. This tool can be used by organizations in the recruitment process and in the training process.

Quality improvement techniques to improve patient satisfaction.

This paper describes several approaches for implementing quality improvement initiatives to improve patient satisfaction, which enables health-care organizations to position themselves for success in today's global and increasingly competitive environment. Specifically, measuring the views of patients, improving patient satisfaction through a community-wide effort, and using a Six Sigma program are discussed. Each of these programs can be an effective mechanism for quality improvement. A key component to quality improvement techniques involves collaborative efforts by all health-care professionals and managers as they seek to increase patient satisfaction.

Leadership processes for re-engineering changes to the health care industry.

As health care organizations seek innovative ways to change financing and delivery mechanisms due to escalated health care costs and increased competition, drastic changes are being sought in the form of re-engineering. This study discusses the leader's role of re-engineering in health care. It specifically addresses the reasons for failures in re-engineering and argues that success depends on senior level leaders playing a critical role. Existing studies lack comprehensiveness in establishing models of re-engineering and management guidelines. This research focuses on integrating re-engineering and leadership processes in health care by creating a step-by-step model. Particularly, it illustrates the four Es: Examination, Establishment, Execution and Evaluation, as a comprehensive re-engineering process that combines managerial roles and activities to result in successfully changed and reengineered health care organizations.

Market-focused management: a model for US academic health centers.

This paper describes managed care, competition and high health care costs and reductions in funding as the major market forces that affect US academic health centers. As academic health centers continue to preserve their missions of providing patient care, educating and training health professionals and conducting research, they are negatively impacted by these market changes, thus, resulting in increased expenses and lowered revenue. A key component to surviving in difficult times is market-focused management. This paper develops a model to show the path of senior level management teams in their decision making. Through the performance of essential managerial roles, senior level managers are responsible for strategies that result in the long-term viability and growth of academic health centers.

Organizational and management strategies in response to U.S. market trends.

This paper describes major trends in the health care market. They include increased health care costs, the growth of managed care, emphasis on quality of care, consumer choice and the growth of the elderly and uninsured populations. The relationship between cost, quality, managed care and choice are explored in the Medicare and Medicaid programs. A clearer understanding of these trends enables managers in health care organizations to make strategic decisions resulting in organizations' survival and growth.

Core competencies of the entrepreneurial leader in health care organizations.

The purpose of this article is to discuss core competencies that entrepreneurial health care leaders should acquire to ensure the survival and growth of US health care organizations. Three overlapping areas of core competencies are described: (1) health care system and environment competencies, (2) organization competencies, and (3) interpersonal competencies. This study offers insight into the relationship between leaders and entrepreneurship in health care organizations and establishes the foundation for more in-depth studies on leadership competencies in health care settings. The approach for identifying core competencies and designing a competency model is useful for practitioners in leadership positions in complex health care organizations, so that through the understanding and practice of these 3 areas of core competencies, they can enhance their entrepreneurial leadership skills to become more effective health care entrepreneurial leaders. This study can also be used as a tool by health care organizations to better understand leadership performance, and competencies can be used to further the organization's strategic vision and for individual improvement purposes.

DECIDE: a decision-making model for more effective decision making by health care managers.

The purpose of this article is to describe a step-by-step process for decision making, and a model is developed to aid health care managers in making more quality decisions, which ultimately determines the success of organizations. The DECIDE model is the acronym of 6 particular activities needed in the decision-making process: (1) D = define the problem, (2) E = establish the criteria, (3) C = consider all the alternatives, (4) I = identify the best alternative, (5) D = develop and implement a plan of action, and (6) E = evaluate and monitor the solution and feedback when necessary. The DECIDE model is intended as a resource for health care managers when applying the crucial components of decision making, and it enables managers to improve their decision-making skills, which leads to more effective decisions.