Mentoring in health services management: reflections on an evolving training ground.

Since the University of Chicago Health Management program was first initiated in 1932, programs and health delivery organizations have dealt with the issue of how to best provide a meaningful transition from academia to entry-level management. Today, new challenges face the same old questions: New federal legislation and increased demand for a finite supply of services cause increased revenue and expense pressures and result in the need for a higher performance level by a well-coordinated management team. In addressing these challenges, mentoring is an essential requirement for survival and success in health services. The long-term success of future practitioners will require both an understanding and incorporation of mentoring in their skill set. The University of Virginia Medical Center recently sponsored a health management education summit to examine the role of mentoring in health services administration education. Leading the program were John Westerman, former interim president of Association of University Programs in Healthcare Administration and chief executive officer emeritus of the University of Minnesota Health System, and R. Edward Howell, chief executive officer of the University of Virginia Medical Center. Summit participants included individuals who had completed administrative fellowship training programs. What follows is a review of the discussions during the summit, including a valuation of the health services fellowship as a learning experience as well as structure and essential elements of administrative mentoring programs.

Operating room efficiency and hospital capacity: factors affecting operating room use during maximum hospital census.

BACKGROUND: Academic medical centers are faced with increasing volumes, higher acuity, and, as a consequence, capacity issues. These affect operating room (OR) use and patient throughput, with negative impact on finances and patient and physician satisfaction. We evaluated our experiences in dealing with OR efficiency at a time of maximum hospital capacity and occupancy. STUDY DESIGN: Using a multidisciplinary approach, we put in place seven agreed-upon strategies: daily communication, improved bed planning, discharge by noon program, internal staffing pool, special assignments for a patient transition unit, incentives, and stepped up environmental services. RESULTS: After institution of these strategies, we were able to realize a gain in OR patient volume of 8% and a decrease in OR holds of 37%. This resulted in a decrease in canceled OR cases from 4.3% to 3.1%. CONCLUSIONS: Academic medical centers face occupancy issues that are not likely to go away and will have an impact on OR volume and productivity. To improve the situation in a short-term fashion, a multidisciplinary approach involving several strategies will be needed.

Practice-based learning and improvement for institutions: a case report.

BACKGROUND: In 2006, the University of Virginia became one of the first academic medical institutions to be placed on probation, after the Accreditation Council for Graduate Medical Education (ACGME) Institutional Review Committee implemented a new classification system for institutional reviews. INTERVENTION: After University of Virginia reviewed its practices and implemented needed changes, the institution was able to have probation removed and full accreditation restored. Whereas graduate medical education committees and designated institutional officials are required to conduct internal reviews of each ACGME-accredited program midway through its accreditation cycle, no similar requirement exists for institutions. LEARNING: As we designed corrective measures at the University of Virginia, we realized that regularly scheduled audits of the entire institution would have prevented the accumulation of deficiencies. We suggest that institutional internal reviews be implemented to ensure that the ACGME institutional requirements for graduate medical education are met. This process represents practice-based learning and improvement at the institutional level and may prevent other institutions from receiving unfavorable accreditation decisions.

Resident duty hours: the rest of the story.

This article presents the complex set of considerations and influences that resulted in the Accreditation Council on Graduate Medical Education' s (ACGME) development of rules to govern the duty hours of residents. The process is demonstrative of the complexity associated with the self-regulation of graduate medical education. At the same time, the ACGME' s development of standards for resident duty hours suggests that self-regulation can be an effective alternative to governmental regulation.