Health Care Management 2019 Style: Are We Having Fun Yet?

Something important seems to have been lost that once made adversity in the health care workplace tolerable or even enjoyable. Many of the same tasks that used to be surrounded by fun no longer have that aura. This article explores eight structural factors that collectively explain why health care managers report having much less fun at work recently. It suggests redefining what having fun at work means in the first instance and proposes a new conception focused on pursuing worthwhile health care goals. Health care managers should abandon many former notions of fun, let fun evolve from the work itself, and trust staff members to determine what they consider to be fun at work.

Ten Core Competencies for Hospital Administrators.

Ever-increasing complexity and contradiction in the health care industry often leave hospital administrators wondering whether they can still make a positive difference for patients. In this context, hospital administrators can regain both perspective and enthusiasm by revitalizing their direct connections with the patients, caregivers, and organizations they serve. Hospital administration remains a special calling, and this article profiles 10 core competencies that will keep health professionals close to their customers, colleagues, and the reasons they entered the helping professions. This intimate knowledge of the organization and its resources coupled with the ability to communicate effectively typically trump advanced education or technical skills in successfully navigating genuinely consequential situations. Hospital administrators who master and practice the 10 competencies can indeed make a positive difference for patients and find great personal reward in doing so.

Eight Leadership Emergency Codes Worth Calling.

Hospitals have a contemporary opportunity to change themselves before attempting to transform the larger US health care system. However, actually implementing change is much more easily described than accomplished in practice. This article calls out 8 dysfunctional behaviors that compromise professional standards at the ground level of the hospital. The construct of calling a code when one witnesses such behaviors is intended to make it safe for leaders to "See something, say something" and confront them in real time. The coordinated continuum of services that health care reform seeks to attain will not emerge until individual hospital organizations prepare themselves to operate better in their own spaces and the ones that immediately surround them.

Certain death: ten predictors of hospital information system failure.

Management is surprised when big investments in hospital information technology fail to produce expected results. Although failure appears to be sudden, it is actually the cumulative result of many subtle acts of omission by multiple parties over an extended period. Unfortunately, many senior managers recognize, but few confront the early warning signals of impending disaster. This article outlines 10 common predictors of hospital information system failure plus effective antidotes in each case. A carefully defined project outcome, appropriate project governance structure, and rigorous adherence to a structured systems development methodology are particularly critical management tools for assuring return on investment.

Hospital turnarounds: agents, approaches, alchemy.

Hospital turnarounds are an increasing phenomenon in an era of unrelenting financial pressure on the health care delivery system. However, the literature about hospital turnarounds contains more theories and case reports than research studies, and repeat turnarounds suggest that there is inadequate evidence about what really works. The essential role of the turnaround agent in strategy formulation and especially strategy implementation is the subject of this article. It casts a wide net over the literature of strategy, change, leadership, and management. The article traces the nature and evolution of hospital turnarounds plus the agents that effect them; summarizes the turnaround agent's 10 most potent approaches to strategy analysis and synthesis; and outlines 3 research questions about first, the recurring need for hospital turnarounds altogether; second, longitudinal evidence to support different turnaround approaches; and third, the mechanisms by which the turnaround agent both changes and is changed by the distressed hospital.

Hospitalists: Evolution, evidence, and eventualities.

Hospitalists are physicians who spend at least 25% of their professional time serving as the physicians-of-record for inpatients, during which time they accept "hand-offs" of hospitalized patients from primary care providers, returning the patients to their primary care providers at the time of hospital discharge. The hospitalist movement is only about 5 years old, yet at least 7000 hospitalists practice today and an estimated 19,000 will ultimately practice, approximately the current number of emergency medicine physicians. The emerging positivist literature on hospitalists' impact is the subject of this review. It traces the nature and evolution of the hospitalist movement; summarizes empirical evidence about costs, clinical outcomes, patient satisfaction, and education; and appraises whether the hospitalist model is indeed novel. The review concludes by outlining research questions about the hospitalist model's viability over time, the mechanisms by which it produces benefits, and especially hospitalists' longitudinal effect on continuity of patient care. A literature "scorecard" might rank evidence to date on costs as positive, evidence on clinical outcomes and education as nonnegative, and evidence on patient satisfaction and continuity of care as inconclusive. Above all, longitudinal research must illuminate whether hospitalists' advantages comeat the cost of the doctor-patient relationship.

Patient-physician e-mail: passion or fashion?

This article surveys the nature, prevalence, and risks and benefits of patient-physician e-mail as a prelude to critically evaluating what will be required for it to become a truly transformational technology. Diverse materials from both the popular press and various clinical domains are consulted in order to appraise patient-physician e-mail's efficacy in different contexts and among different patient and physician users. Early evidence that patient-physician e-mail has lasting power includes its use in niche clinical applications, appearance of unsolicited patient e-mail, historical patterns of medical technology adoption, and increasing use of the Internet in general. Patient-physician e-mail will become genuinely transformational if it affirmatively improves the patient-physician encounter, contributes to better clinical outcomes, makes patient-physician communication more convenient for both parties, demonstrably transcends existing reimbursement and medicolegal concerns, and promotes patient empowerment. Like all technologies, use and misuse of patient-physician e-mail will determine whether its possibilities will become realities.