Budgeting for Results.

Budgeting is a mandatory yet misunderstood function in most organizations because of its current focus on estimating revenues and expenses. A budget should be a roadmap specifying in dollars and cents organizational goals and how management performance will be assessed. Like a roadmap, its value is entirely dependent on whether the plan is followed. Improving treatment and controlling costs require implementing budgets that focus managers' attention on the elements of production systems that they control and lead directly to better results. The choice between using an incremental, flexible, zero-base, program, or activity-based budget to chart the desired path of departments and organizations should be made in light of organizational goals and the role of the manager within the organization.

Here Comes Price Transparency.

The public reporting of clinical and operational performance measures is old news for chief nurse executives (CNEs). Since the advent of value-based purchasing and patient experience measures, CNEs have partnered with other executives to ensure organizational readiness and success with the performance measures being publicly shared. In 2018, healthcare organizations face a new wave of public reporting expectations-price. Once again, executives will need to ensure organizational readiness. Chief nurse executives must analyze the impact of this trend on the nursing enterprise and carefully consider how to best prepare for healthcare price transparency.

Sustaining Health Care Interventions to Achieve Quality Care: What We Can Learn From Rapid Response Teams.

Rapid response team (RRT) adoption and implementation are associated with improved quality of care of patients who experience an unanticipated medical emergency. The sustainability of RRTs is vital to achieve long-term benefits of these teams for patients, staff, and hospitals. Factors required to achieve RRT sustainability remain unclear. This study examined the relationship between sustainability elements and RRT sustainability in hospitals that have previously implemented RRTs.

Managers' role in maximising investment in continuing professional education.

Healthcare organisations face the challenge of delivering care in increasingly complex environments. To do so they depend on competent professionals, and continuing professional education (CPE) plays a major part in ensuring that staff maintain and develop their knowledge and skills. However, there is limited evidence of the effect of CPE on healthcare outcomes, and an emphasis on outcomes has overlooked the contribution of the processes that underlie effective CPE. This article reports the results of a study that explored a range of stakeholders' perceptions of the processes that maximise the positive effects of CPE on practice. Analysis of results shows that CPE can help improve care when supported by positive organisational cultures, effective partnership working between stakeholders and supportive learning environments that enable individuals to maximise their learning. This article discusses how managers play a pivotal role in creating positive cultures in which CPE can flourish by being role models and change agents, ensuring organisational strategic objectives are aligned with personal development plans, and by working collaboratively with education colleagues to ensure that learning from CPE is embedded in practice.

[Rationing in German health care with particular consideration of oncology: view points of German stakeholders--a qualitative interview study]. / Rationierung im deutschen Gesundheitswesen unter besonderer Berücksichtigung der Onkologie: Sichtweisen deutscher Entscheidungsträger--eine qualitativen Interviewstudie.

AIM: Germany is at the beginning of a discussion about possible rationing in the health-care system. Cancer treatment, which is often cost-intensive but not always cost-effective, is frequently considered as a field for rationing. METHODS: Against this background, we conducted semi-structured, guideline-based interviews with different stakeholders of the German health-care system and analysed them with the help of grounded theory techniques. The goal of the study was to collect the experiences and opinions of members of the German Medical Review Board of the Statutory Health Insurance Funds (MDK), leading officials in central administrations of the German health-care sector and health politicians (members of the Parliamentary Committee for Health of the Federal German Parliament, the Bundestag) regarding cost-considerations in treatment decisions in health care with a special focus on oncology. RESULTS: (1) Cost-considerations have a limited role in the daily routine of the interviewed experts; (2) the interviewed personnel of the MDK were open to discuss rationing, while the group of leading officials was ambivalent and the health politicians rejected rationing and its discussion altogether; (3) the awareness of the opportunity costs of medical services varied with the profession of the interviewee: the members of the MDK saw opportunity costs primarily within the field of medicine, the leading officials noted the opportunity costs for other social services, and the health policy makers interpreted opportunity costs under fiscal budgetary aspects; (4) according to the interviewees, decisions on rationing require a legal basis, which should be based on a broad public discussion and an interdisciplinary debate among experts; (5) defining criteria for rationing was regarded as being outside of the professional competence of the interviewees; however, a preference with regard to the criterion of cost-effectiveness became apparent. CONCLUSIONS: The results of this study indicate that the strongest opposition to a debate on rationing in Germany does not stem from the medical, but rather from the political sector. The criteria for rationing suggested in the theoretical debate are in need of a context-sensitive examination and specification for the field of oncology. A possible approach to constructively promote the debate on rationing is a stronger focus on social opportunity costs of health care. The exact role of experts in a discourse on rationing, which was emphasised by the interviewees, requires a thorough determination. It is necessary to differentiate between the roles of impartial experts and stakeholders. Decisions on rationing can ultimately only be legitimised politically by parliament.

Effects of Market, E-Marketing, and Technology Orientations on Innovativeness and Performance in Turkish Health Organizations.

This article investigates the effects of strategic orientation on innovativeness and performance in health organizations in Turkey. We hypothesize that market, e-marketing, and technology orientations positively affect innovativeness and performance. Market and technology orientations are found not have a significant effect on performance, but e-marketing orientation and innovativeness have a significant and positive effect. We also investigate indirect effects on innovativeness and performance. The analyses of direct and indirect effects are an important contribution to understanding relationships among research variables.

Working capital management, corporate performance, and strategic choices of the wholesale and retail industry in China.

We examine the influence of strategic choice on working capital configurations and observe how the relationship between working capital ratio and operational performance differs depending on strategy. By clustering the strategic factors of the wholesale and retail industry, we find three categories of strategies: terminal market strategy, middle market strategy, and hybrid strategy. Using the panel data of the listed companies of the wholesale and retail industry as our sample, we analyze the differences in the ways companies configure working capital, the speed with which working capital adjusts to its target, and the effects of working capital on performance for companies that make different strategic choices. The empirical results suggest that working capital is configured and adjusted to its target in different ways under different competitive strategic choices. This effect is finally transferred to influence the relationship between working capital configuration and operational performance.

Developing a culture of philanthropy to support your mission.

Nonprofit organizations and institutions should recognize and embrace the important role that philanthropy plays in our society. The key to success in fund-raising is nurturing a culture of philanthropy in your organization, which means that every member of your community must understand that philanthropy is critical to your mission, that each person has a role to play in fund-raising, and that donors are valued for more than just money. The focus should be on developing lasting relationships between you and your donors-a relationship that develops over time, enables deeper engagement, and ultimately results in more support for your mission. Common pitfalls to avoid are also reviewed.

Strategic planning processes and financial performance among hospitals in Lebanon.

BACKGROUND: Strategic planning has been presented as a valuable management tool. However, evidence of its deployment in healthcare and its effect on organizational performance is limited in low-income and middle-income countries (LMICs). The study aimed to explore the use of strategic planning processes in Lebanese hospitals and to investigate its association with financial performance. METHODS: The study comprised 79 hospitals and assessed occupancy rate (OR) and revenue-per-bed (RPB) as performance measures. The strategic planning process included six domains: having a plan, plan development, plan implementation, responsibility of planning activities, governing board involvement, and physicians' involvement. RESULTS: Approximately 90% of hospitals have strategic plans that are moderately developed (mean score of 4.9 on a 1-7 scale) and implemented (score of 4.8). In 46% of the hospitals, the CEO has the responsibility for the plan. The level of governing board involvement in the process is moderate to high (score of 5.1), whereas physician involvement is lower (score of 4.1). The OR and RPB amounted to respectively 70% and 59 304 among hospitals with a strategic plan as compared with 62% and 33 564 for those lacking such a plan. No statistical association between having a strategic plan and either of the two measures was detected. However, the findings revealed that among hospitals that had a strategic plan, higher implementation levels were associated with lower OR (p < 0.05). CONCLUSIONS: In an LMIC healthcare environment characterized by resource limitation, complexity, and political and economic volatility, flexibility rather than rigid plans allow organizations to better cope with environmental turbulence.

When a health system develops its own road map.

Key considerations facing a hypothetical and typical health system as it transitions to value-based payment provide a guide for systems as they undertake this transition. The health system's first step is to review its current environment and strategies and the building blocks it has in place. Next, the system needs to add more building blocks, build a financial cushion, and revise targets and dashboards. Next steps include testing value-based payment contracting, realigning incentives, implementing new care management strategies, and communicating extensively. All of these steps will be unique to each organization.

Developing healthcare facilities for a changing environment.

When approaching facility and real estate development, healthcare leaders should: Enhance clinical integration and ensure more patient-friendly facilities. Focus on a facility's business requirements and operating needs. Create a business plan that demonstrates how a project would help deliver better care at lower cost during a time of declining payment levels. Develop an approach that balances the needs of all stakeholders, including payers, staff, and patients.

[Strategic planning: an important economic action for German hospitals]. / Strategische Planung - Eine wichtige ökonomische Handlungsweise für deutsche Krankenhäuser.

In medical systems, economic issues and means of action are in the course of dwindling human (physicians and nurses) and financial resources are more important. For this reason, physicians must understand basic economic principles. Only in this way, there may be medical autonomy from social systems and hospital administrators. The current work is an approach to present a model for strategic planning of an anesthesia department. For this, a "strengths", "weaknesses", "opportunities", and "threats" (SWOT) analysis is used. This display is an example of an exemplary anaesthetic department.

Faith-based social services: saving the body or the soul? A research note.

Faith-based organizations might be ideal social service providers, claiming to transform clients' lives with holistic support while meeting immediate needs. While organizations have such goals, their success is impacted by constituencies with differing goals for the organization. Clients with goals not commensurate with an organization's may compromise its ability to attain its goals. Three questions are examined here: What are the goals of faith-based service providers? When asked what they think about the services, do clients share the organizational goals? Are organizations likely to meet either set of goals? Homeless persons patronizing faith-based soup kitchens were interviewed; service activities of organizations were observed. Clients' goals focused on survival in their current situation. Organizations' goals ranged from meeting clients' immediate needs to transforming clients through spiritual restoration. Congregations studied met clients' immediate needs. However, clients' accommodational goals were potentially problematic for organizations with spiritual goals.

Meeting the millennium development goals in Sub-saharan Africa: what about mental health?

Mental health is a crucial public health and development issue in sub-Saharan Africa (SSA), a region where little progress has been made towards achieving the Millennium Development Goals (MDGs). In this paper we argue that not only will limited progress in achieving these targets have a significant impact on mental health, but it will be impossible to achieve some of these aspirations in the absence of addressing mental health concerns. We consider the strong relationship of mental health with dimensions of human development represented in the MDGs, including reducing poverty, achieving universal primary education, decreasing child mortality rates, improving maternal health, HIV, environmental factors and improving the lives of those living in informal settlements. With these links in mind, we examine the mental health context in SSA settings and provide some specific examples of best practice for addressing mental health and the MDGs. It is recommended that the role of mental health interventions in accelerating the realization of the MDGs is investigated; further efforts are dedicated to probing the impact of different development projects upon mental health outcomes, and that mental health is declared a global development priority for the remainder of the MDG period and beyond.

Perceptions of occupational injury and illness costs by size of organization.

BACKGROUND: Little is known about how organizations perceive and monitor occupational injury and illness costs. AIMS: To explore perceptions of injury and illness costs, the extent to which organizations monitor their impact, attitudes towards this practice and views on using cost information in health and safety campaigns. METHODS: Interviews were conducted with 212 representatives from 49 small- and medium-sized enterprises (SMEs) and 80 large organizations from a range of industry sectors. RESULTS: Health and safety investments were driven by a range of factors, of which cost reduction was only one. Human costs were also considered important. Injuries were perceived to represent a substantial business cost by 10% of respondents from SMEs and 56% of those from large organizations. Most were uncertain about the financial impact of work-related illness. No organizations had attempted to monitor occupational illness costs. Injury costs had been assessed within 3 SMEs and 30 large organizations. Only 12% of SME representatives recognized the benefits of costing health and safety failures and around half were unreceptive to the use of cost information in health and safety promotions. Two-thirds of those from large organizations recognized some benefit in measuring costs, and over three-quarters welcomed the provision of industry-specific information. CONCLUSIONS: Provision of information that focuses solely on the economic implications of occupational injury and illness may be of limited value and agencies involved in the promotion of health and safety should incorporate a range of information, taking into account the needs and concerns of different sectors.

Developing and executing a strategic plan.

Because of the historic economic crisis, the past 18 months--2008 and the first half of 2009--have been challenging for many plastic surgery practices. Prior to the economic crisis in 2008, many practices enjoyed success with little synchronization between financial and productivity results, practice goals, and strategic planning. Now, suddenly, there is a great deal of interest in the alignment of budgets and financial reporting, marketing return on investment (ROI), staff accountability, and overhead management. The process of developing a business plan can serve to bring clarity and objectivity to the assessment of practice goals and market dynamics. The business planning process also provides assurance of more efficient use of the practice's human and capital resources. Ultimately, the process will bring order, discipline, and focus to practice stakeholders, thus increasing the likelihood of meeting or exceeding practice goals. The process: (1) defining the mission of the practice; (2) completing a competitive analysis for your market; (3) completing an assessment of your current environment; (4) completing an assessment of the financial health of your practice; (5) preparation of a SWOT (strengths, weakness, opportunity, threat) analysis; and (6) a translation of your mission statement into specific long-term goals and short-term performance objectives. The outcome of completing these tasks should be an actionable plan that will serve as a guide or road map for the practice. A well-articulated plan will solidify staff confidence, continue the advancement of a strong business foundation, and provide clear navigation through this new economic landscape in a way that preserves your ability to provide the care you have devoted yourselves to deliver. Today's needs, and yesterday's lessons, dictate that a well-documented strategic action plan be undertaken.

How do voluntary organizations foster protest? The role of organizational involvement on individual protest participation.

Prior research shows that members of voluntary organizations are more likely to protest than nonmembers. But why, among members, do some protest while others do not? I explore whether organizational involvement-the extent in which members engage in the "life" of their organizations-affects protest. I identify four dimensions of involvement-time and money contributions, participation in activities, psychological attachment, and embeddedness in interpersonal communication networks. Only the first dimension has robust effects on protest, and they are nonlinear: intermediate contributors have the highest protest rates. The three other dimensions substantially increase protest only under specific "involvement profiles."

Rushing the Value Cockpit.

The 2015 merger of health authorities in Nova Scotia was aggressive in pursuit of greater value. The goal was to create an integrated, accountable care network across the entire province. Years of pent-up frustration, death by a thousand cuts, declining service and growing expectations merged into a slow, insidious bleeding of support for change. The lessons learned from Nova Scotia are vital to achieving a value-based health system. The article describes some of the barriers to progress and the steps needed to achieve the goal of a value-based healthcare system for Canadians.