Organizational aspects of physician joint ventures.

This article describes organizational forms of physician joint ventures. Four models are described that typify physician involvement in health care joint ventures: limited partnership syndication, venture capital company, provider network, and alternative delivery system. Important practical issues are discussed.

Participatory management at Boston's Beth Israel Hospital.

In the mid-1980s, the senior management of Boston's Beth Israel Hospital became concerned that continuous cost-cutting efforts could lower the quality of the hospital's services and the morale of its staff. This led them to investigate organizational approaches to "participatory management" to determine whether any of these might be of value to the hospital. They decided that an approach developed in the 1930s called the "Scanlon Plan" would be compatible with the workplace culture of Beth Israel, could help the hospital meet the ongoing problems of change, and could help the staff at all levels develop a sense that they owned the problems of quality, productivity, and efficiency, which would motivate them to address these problems constructively in the face of necessary budget constraints. This plan has two mechanisms to foster employees' positive participation: (1) a process to ensure that all members of the organization have the opportunity to improve productivity, primarily through an open suggestion system and a responsive committee structure, and (2) a means of providing equitable rewards for all members of the organization as productivity and quality improve. This essay describes in some detail the plan and why it was selected, explains how it was adapted, prepared for, and finally implemented in 1989, and reports its success, lessons learned, and future plans as of early 1992. The authors believe Beth Israel's experience with the Scanlon Plan is noteworthy as an example of a leading teaching hospital's taking a quality improvement program seriously and making it work.

The Florida breastfeeding promotion project: a coalition effort to improve hospital practices and policies.

The Florida Healthy Mothers, Healthy Babies-Coalition initiated a breastfeeding promotion project. The Coalition focused on hospital policies because of their impact on breastfeeding success and because of the potential for working with other state efforts directed at pregnant women or new mothers. The Florida Healthy Mothers, Healthy Babies Coalition developed a three-part program. It consists of model hospital policies concerning breastfeeding, a lecture series which educates hospital nursing staff on the implementation of these model policies and a workshop through which trainers are prepared to present the educational program. Nurses' Association of the American College of Obstetrics and Gynecology (NAACOG), Special Supplemental Food Program for Women, Infants, and Children (WIC), and Florida Lactation Consultant Association (FLCA) all contributed to this project.

Institutional and strategic choice perspectives on board involvement in the strategic decision process.

The level of a board of directors' involvement in strategic decisions can be viewed as an institutional response or as a strategic adaptation to external pressures for greater board involvement. We examined the antecedents and effects of board involvement from both the institutional and strategic choice perspectives. Data obtained from personal interviews with 114 board members and archival records indicated that board size and levels of diversification and insider representation were negatively related to board involvement, and organizational age was positively related to it. Furthermore, we found board involvement to be positively related to financial performance after controlling for industry and size effects. Overall, the results suggest that both theoretical perspectives are necessary for a comprehensive description of the strategic role of boards.

Better management of Irish hospitals.

The establishment of the Dublin Hospitals Initiative and the Efficiency Review Group as first steps in an "action" plan was based on the report in 1989 of the Commission of Health Funding which suggested that "the solution to the problem facing the Irish health services...(lies) primarily...in the way that services are planned, organised and delivered". Our health service is in transition from the phase of facility management into that of functional management. This will involve facing the fact of the limit on resources, introducing information systems and getting the co-operation of hospital doctors. The most senior executive in a hospital must firstly be a good general manager with sufficient power to manage. Hospitals should be divided into centres of responsibility made up of one or more centres of activity. Formal education for hospital administrators should be extended. There is a need for training at all levels, particularly of those administrative and medical staff who have direct interaction with the computer-based system. There should be a commitment to management development particularly by means of teamwork and action learning.

The market research encyclopedia.

Market research can be a complicated and complex process nowadays, especially when it involves sophisticated techniques with names like probabilistic sampling, Box-Jenkins, or conjoint analysis. There is a need for a guide that will help managers determine the dimensions of the task, the resources that must be summoned, the data required, and other key elements. Here, from the head of market research at General Motors, is such a guide in outline form. Vincent P. Barabba walks the reader through the five major stages of the research effort. Each stage is represented in one table, and together the tables combine into a mammoth foldout for easy perusal. The stages are: 1. Assess the market information needs. 2. Measure the marketplace. 3. Store, retrieve, and display the data. 4. Describe and analyze market information. 5. Evaluate the research and assess its usefulness. Comprehensiveness is a hallmark of the "encyclopedia." In the second table, for example, one of the headings under "nonprobabilistic data" is "central location interviewing." Barabba lists the limitations of this kind of research: "Very expensive; responses in this artificial environment may not reflect responses in the market; complicated logistics; development of test product can be time consuming and expensive."

Hospital culture--why create one?

Hospitals, to survive, must be transformed into responsive, participative organizations capable of new practices that produce improved results in both quality of care and service at reduced costs. Creating, managing, and changing the culture are critical leadership functions that will enable the hospital to succeed. Strategic planning and effective implementation of planned change will produce the desired culture. Work restructuring, a focus on quality management along with changes in clinical practices, as well as the care and support processes, are all a part of the necessary hospital cultural revolution.

Redesigning hospitals around patients and technology.

Hospitals must drastically redesign themselves and revise their operations to be successful. Four major redesign initiatives will enable the traditional hospital to provide effective patient care while attaining its own profitability goals.

Redesigning our future: whose responsibility is it?

To thrive in the midst of health care chaos, restructuring is mandatory. By focusing on problem systems, to create the systems hospital executives can successfully empower staff to delivery high quality care while controlling costs.

Nursing involvement in hospital governance: 1990 and 1995.

The integration of nursing into organizational governance structures has been advocated to improve practice and enhance the quality of patient care. In 1990, department of nursing involvement in hospital governance occurred primarily through the activities of the CNE. Projections for 1995 suggest that both staff RNs and CNEs will be more involved in governing health care organizations.

Cooperation project in basic nursing education--the introduction of a new nursing education program in Tianjin, China.

Over the last few decades, traditional basic nursing education has taken place in nursing schools in China. In 1988, a new cooperation project for basic nursing education was tried between a Tianjin nursing school and several hospitals (Tianjin is one of the industrial cities in China). In this paper, an experiment in nursing education in Tianjin is described. In order to help readers to understand the Cooperation Project, the preparation courses are also described. Several advantages and disadvantages are discussed; some new proposals are also put forward at the end of the paper.

A conceptual framework for evaluating joint venture opportunities between hospitals and physicians.

This paper reviews the changes in the competitive and regulatory environment and examines the impact of those changes on the relationships between hospitals and physicians. Transaction cost economics (TCE) provides a conceptual framework for examining the emergence of closer linkages between hospitals and physicians than the traditional independent hospital and medical staff organisations. TCE predicts that as investments in support of transactions become more specialised, closer linkages are more efficient. To illustrate, two case studies of successful hospital-physician joint ventures are presented. The first case study describes a joint venture between hospitals and physicians to purchase durable medical equipment. The second case describes the breakdown of an informal arrangement and the subsequent formation of a joint venture to organise a clinical programme. The discussion reports the rationale for choosing these structural arrangements and their key features, pointing out how TCE would account for the decision to establish a joint venture. The conclusion discusses the implications of this argument for the strategic decisions of health care managers.

Hospital food service: is a chilled meal system best?

Royal Prince Alfred Hospital, Sydney, introduced the first chilled meal system into a major Australian hospital twenty years ago. Recently the food service has been converted back to a centralised system with conventional food production. The change has resulted in reduced operating costs and better quality food. This suggests that a chilled food system is not always the most economical form of hospital food service.

A successful physician referral service.

Developing a successful hospital-based physician referral service can create a win-win-win venture involving the hospital, its medical staff, and the community at large. As a marketing tool for the hospital, it effectively targets two of the hospital's most important markets: physicians and the consumers of health services, the general public.

The treatment center: a model for competitive clinical practice.

The treatment center model described in this article was developed with the intent of providing a high technology practice environment that would attract patients to an academic center for their medical care. It was also intended to create an environment that would result in the retention of the best clinicians within the academic framework. Appropriate goals and incentives had to be determined by both the hospital and the professional groups involved. Many preconceived ideas regarding traditional academic structures needed to be revised to implement this program.

A new partnership: joint ventures and high-tech imaging.

Today joint ventures are a viable option for acquiring high-tech, high-priced imaging equipment. In this article based on his RSNA Associated Sciences presentation, Mr. Rutherford discusses a variety of issues concerning joint ventures: planning, tax considerations, structure and the ethics question.

Structuring freestanding diagnostic imaging centers for profitability.

Many hospitals have or are contemplating establishing freestanding diagnostic imaging centers with members of their medical staff. Some earlier joint ventures between hospitals and their physicians have not met expectations or financial projections. This article describes guidelines for evaluating the operating performance of freestanding imaging centers and is based on the author's assessment of several freestanding centers; it is not intended to depict the results of any one study or operational review. The areas addressed during an operations review should include: management and organizational structure, technologist and support staffing, equipment utilization, non-salary costs, and outside contracts.

Effective management strategy for establishing an operating room satellite pharmacy.

The steps involved in justifying and implementing an operating room (OR) pharmacy satellite are described. A hospital administrator's viewpoint on the project is included. Objectives of the satellite were to reduce inventory costs, improve control of distribution, reduce loss of revenue and improve patient charging, improve IV compounding and labeling, and significantly improve narcotic control and accountability. The satellite provides comprehensive services 12 hours a day, five days a week. Effective after-hours procedures have been developed to provide efficient drug distribution when the pharmacy is closed. Achieved benefits of the satellite include decreased drug inventory, improved patient charging, accurate labeling, improved IV compounding, and improved pharmacy/surgery relations. The OR pharmacy satellite is a successful cost-effective operation.

An exchange cart supply-distribution system employed on an institution-wide basis.

This paper describes a drug distribution system developed for replenishment of stock supplies for hospital patient-care units, ambulatory care areas, and clinical support service areas. The method employed, a modified exchange cart system in which duplicate sets of supplies are exchanged at regular and predetermined intervals, utilizes unit-of-use packaging whenever feasible and is an extension of our centralized unit dose drug distribution system. Various supply-distribution techniques and inventory surveillance and control techniques, as well as cost identification and charge recovery procedures, are discussed.

Ways to avoid mistakes during diversification.

Two alternative approaches to avoiding errors during diversification efforts have proved economical and effective. They are the increased use of consultants and the hiring of "Temp-Execs," free-lance executives with the necessary management experience to guide a provider past potential problems.