Hospital mega-mergers hit fast and furious in 1Q.

The need for scale and space is accelerating tie-ups between hospital giants.

'The idea of the stand-alone hospital is gone'.

Northwell Health, formerly known as North Shore-Long Island Jewish Health System, continues to pursue aggressive expansion moves throughout the New York City metropolitan area. CEO Michael Dowling is also stepping up the New Hyde Park, N.Y.-based system's investment in startup firms and innovative technologies that are launched in-house. Dave Barkholz, Modern Healthcare's Southern Bureau chief, caught up with Dowling at last month's J.P. Morgan Healthcare Conference in San Francisco. The following is an edited transcript.

Success factors for strategic change initiatives: a qualitative study of healthcare administrators' perspectives.

Success factors related to the implementation of change initiatives are well documented and discussed in the management literature, but they are seldom studied in healthcare organizations engaged in multiple strategic change initiatives. The purpose of this study was to identify key success factors related to implementation of change initiatives based on rich qualitative data gathered from health leader interviews at two large health systems implementing multiple change initiatives. In-depth personal interviews with 61 healthcare leaders in the two large systems were conducted and inductive qualitative analysis was employed to identify success factors associated with 13 change initiatives. Results from this analysis were compared to success factors identified in the literature, and generalizations were drawn that add significantly to the management literature, especially to that in the healthcare sector. Ten specific success factors were identified for the implementation of change initiatives. The top three success factors were (1) culture and values, (2) business processes, and (3) people and engagement. Two of the identified success factors are unique to the healthcare sector and not found in the literature on change models: service quality and client satisfaction (ranked fourth of 10) and access to information (ranked ninth). Results demonstrate the importance of human resource functions, alignment of culture and values with change, and business processes that facilitate effective communication and access to information to achieve many change initiatives. The responses also suggest opportunities for leaders of healthcare organizations to more formally recognize the degree to which various change initiatives are dependent on one another.

Staff nurse perceptions of the Magnet journey.

OBJECTIVE: The objective of this study was to compile a rich description of the phenomenon Magnet journey by registered nurses in clinical settings who provide direct patient care in community healthcare systems recently receiving Magnet designation. BACKGROUND: Evidence supports that Magnet designation leads to improved nursing, patient, and organizational outcomes. Descriptions abound regarding the organizational and cultural transformation during the time leading up to the Magnet designation, commonly referred to as the Magnet journey. There are no published reports regarding the impact of this transformational process on staff nurses. METHODS: Focus groups were conducted at recently designated Magnet hospitals; data were transcribed, reviewed, coded, and themed. The 58 subjects represented various work areas, specialties, and practice sites. RESULTS: Key themes emerged consistent with components of the Magnet model: relationships with leaders, professional accountability, staff voice, Magnet continuum, professional relationships, professional development, and resources/supports. Overall, staff nurses emphasized the positive impact of the transformation that occurred during the journey and the resultant Magnet designation on stakeholders. CONCLUSIONS: Results from this study offer guidance for Magnet project directors, chief nursing officers, managers, advanced practice nurses, and staff nurses involved in or considering the Magnet journey. "Magnet slippage" emerged as a new concept.

How satisfied are hospital systems with their ownership of retail clinics?

Retail clinics--while innovative--can no longer be considered a new model of healthcare delivery, as an increasing number of hospitals and health systems now own them. The purpose of this article is to explore the extent to which hospital systems are satisfied with their ownership of retail clinics. In terms of operational challenges, respondents to our survey, administered to representatives from 19 health systems, were relatively satisfied with clinic staffing and their relationship with the retailers regarding lease terms, store locations, and shopper demographics. They expressed mostly neutral levels of satisfaction with regulations and laws related to retail clinics and low satisfaction with insurance reimbursement and clinics' seasonal patterns. The two areas that received the lowest respondent satisfaction ratings were patient volume and response to marketing initiatives. When asked to share their perceptions of their organization's satisfaction with various strategic aspects of retail clinic ownership, respondents revealed that the clinics were achieving several important strategic goals, such as improved access, increased referrals, defense against competitors, and increased brand exposure. They indicated overall dissatisfaction with profitability and cost-reduction outcomes. We conclude that serious operational challenges and strategic threats must be overcome if retail clinics are to be a successful service line for hospitals and health systems.

Hospital publications: is this my link to a healthier life?

Hospitals use newsletters to reach their patient base. Within these newsletters, health narratives are communicated to inspire community members to choose that hospital for their health needs. Because health narratives inform our understanding of health care delivery, I employ Bakhtin's (1984) ideas on monologic and dialogic discourse to analyze newsletters published by a major hospital network. Results indicate a monologic rather than dialogic discourse, which excludes patient's unique experiences, advances normalization of medicine, and perpetuates hierarchical power dynamics. In summary, this study suggests practical implications for practitioners producing health knowledge for consumers of health information.

Competing for consumers. Coming coordinated-care squeeze prompts providers to push into insurance market.

Squeezed by coordinated-care initiatives, a number of hospital systems are looking to help fill beds and reap more revenue by offering insurance plans on the state exchanges set to launch this fall. Some will use narrow networks, a strategy that allows systems to create a captive customer base. "I think it's going to be a huge growth area in the exchanges," says Jonathan Gruber, left, a professor of economics at MIT.

Engineering a fail-safe health system. Memorial Hermann wants to eliminate health care errors (really).

Memorial Hermann Healthcare System is on an all-out mission to eliminate health care-acquired infections. Despite a bit of physician resistance, the results so far are astonishing.

Pursuing Magnet® designation as a system or as individual entities: what is the right decision?

When leaders of a system decide to pursue Magnet® designation, a required high-stake decision is whether to pursue this designation as a system or individual entities in the system. To assist leaders to make the best decision, the authors evaluate the pros and cons of system versus single-entity pursuit of Magnet status to assist a system chief nursing officer to determine if the risk is worth the gain.