Leading by listening. How Scripps Health turned defeat around.

Scripps Health in San Diego has seen its ups and downs this decade. The system's fall and rise are both stories in leadership--first done wrong, then done right. Today, they're back on top, thanks to a CEO who listens to his staff, especially his physicians.

Six Sigma: adapting GE's lessons to health care.

By using a manufacturing management approach to improving quality and efficiency, a New Jersey health system is transforming its culture of quality and seeing highly positive results.

How intermediate tax sanctions may be applied to IDSs.

Recently issued proposed regulations describing how the IRS intends to enforce the intermediate tax sanctions statute of the Internal Revenue Code have important ramifications for integrated delivery systems (IDSs). The regulations' interpretation of who within an IDS may be subject to excise taxes under the statute is broad, basing an individual's risk of being taxed on his or her degree of influence over a given entity within the organization, rather than over the organization as a whole. To protect individuals within an IDS from exposure to intermediate tax sanctions, the organization should understand who is likely to be at risk and take steps to ensure that all transactions with such persons are in compliance with the conditions set forth in the proposed regulations.

Which way to the frontier? Physician executives talk about the future.

The author interviewed trustees, senior managers, and physicians at Moses Cone Health System in Greensboro, North Carolina, Legacy Health System in Portland, Oregon, and Henry Ford Health System in Detroit, Michigan. These three successful health care systems bracket the national market in size, geography, and managed care penetration. The comments of physicians are presented here, drawn from the book, Designing 21st Century Health Care: Leadership in Hospitals and Healthcare Systems. What emerges most clearly from their comments is the enormity of the task ahead. There is wide-spread agreement that substantial improvements in the quality and cost of care are possible, an encouraging stream of anecdotes and ideas about how to proceed, but a lack of consensus on critical components of how to organize practices and promote effective care.

New relationships with physicians: an overview for trustees.

As resources become increasingly scarce and tightly controlled, health care organizations must integrate their services with those of other providers in order to use those resources more efficiently and to reduce costs relentlessly. One of the most critical and difficult aspects of this integration is with physicians. To effect the level of integration that is needed, new relationships and partnerships between providers and physicians must be created--even as the old models are destroyed. Why is integration with doctors so critical to the success of the health care organization as well as the physicians? The answer comes from a core principle of business economics that states that the fundamental means of production must be controlled by the business. This is absolutely essential if the business has any chance of controlling costs and thriving in a more efficient market.

Bye-bye big boards. Bogged down by too many trustees, health systems streamline to set clearer goals and speed up decisions.

As health systems grow, the number of trustees and governing boards often must shrink to cut back on red tape and budget bottlenecks. Hospital management also typically needs restructuring, with fewer CEOs and more regional managers taking care of business.

Putting a new SPIN (Sentara Physician Information System) on information systems. When was the last time you invested in your system's future?

Once you have a vision and strategy for the future, an information system will probably be your biggest and most important investment. Information systems that can track clinical data are critical to providing employers with the data they're demanding and doctors with the data they need. See how and why Sentara Health System developed the Sentara Physician Information System (SPIN).

How does your CEO spell "relief"? Leadership survey shows how execs are dealing with change.

As a health care trustee, you volunteer your time, exhaust yourself trying to keep up with the ins and outs of the industry and do your best to provide an objective sounding board for the chief executive. But your job might make more sense and be a lot more valuable if you could put yourself in your CEO's shoes and understand what gets him up in the morning and keeps him awake at night. And how does that differ among leaders of hospitals, HMOs, and medical group practices? To give you the insights you need, here are the results from a Hospitals & Health Networks leadership survey (see "Who, What, Where, How, When?" page 10).