Quality assurance and organizational effectiveness in hospitals.

The purpose of this paper is to explore some aspects of a general theoretical model within which research on the organizational impacts of quality assurance programs in hospitals may be examined. Quality assurance is conceptualized as an organizational control mechanism, operating primarily through increased formalization of structures and specification of procedures. Organizational effectiveness is discussed from the perspective of the problem-solving theory of organizations, wherein effective organizations are those which maintain at least average performance in all four system problem areas simultaneously (goal-attainment, integration, adaptation and pattern-maintenance). It is proposed that through the realization of mutual benefits for both professionals and the bureaucracy, quality assurance programs can maximize such effective performance in hospitals.     

A network approach to outpatient service delivery systems: resources flow and system influence.

OBJECTIVE: The study tests a path model for the effects on organizational influence of an organization's centrality in four resource exchange networks in order to gain insight into the network relations that may affect coordination and effectiveness of outpatient health and mental health service systems. DATA SOURCES: Primary data are used from face-to-face interviews with the directors of every organization in the predefined service systems in three urbanized counties in Oregon. Each system consisted of 19 to 20 organizations. Data were collected during 1986 and 1987. STUDY DESIGN: The path model contains five variables: the major dependent variable is attributed organizational influence; the independent variables are three sets of primary resource exchanges: funds allocation, client referrals, and client inflow. An intervening variable of general network contacts, as an informational resource, is modeled as an outcome of the three primary resource exchanges, as well as one of the predictors of influence. DATA COLLECTION: Organizations were identified as system members through a modified snowball sampling procedure. Measures of organizational influence and centrality in each of the exchange networks were derived from interviews with all directors about their interactions with each organization in the system. Multiple regression analysis was used to test the path model. PRINCIPAL FINDINGS: The most important resource in predicting centrality in a general contact network is centrality in a client referral network, while contacts and funds allocation centrality are significant predictors of organizational influence. CONCLUSIONS: The organization with the greatest influence within the system (because of its ability to allocate funds) may not be the organization that takes the largest role in terms of coordinating routine contacts (because of its ability to refer clients). This disjuncture may signal a weakness in the coordination network and system effectiveness, since the more influential organization may not be the most knowledgeable one in terms of the needs of the system.     

Effectiveness in professional organizations: the impact of surgeons and surgical staff organizations on the quality of care in hospitals.

In this research, we examine the relative importance of different structural units in a professional organization, the hospital, as they affect organizational effectiveness. The difficulties of measuring effectiveness in a complex professional organization are discussed, and an adjusted measure of surgical outcome is developed. Data are drawn from a prospective study of over 8,000 surgical patients treated by more than 500 surgeons in 15 hospitals throughout the nation. Two different types of analyses are presented, both indicating that hospital features have more impact on surgical outcomes than do surgeon characteristics. The second analysis assesses the relative importance of specific attributes of the hospital, surgical staff organization, and surgeon characteristics on surgical outcomes.     

一院多区护理区域协同与同质化管理模式

部队体制编制调整改革后,新组建医院呈现多城多区1+X模式,各院区间在资源配置、管理模式、职能任务和医疗水平上等参差不齐。医院借助信息化手段,协同院区间的优质资源,围绕同质化管理,标准化建设,规范化运行、差异化发展四个方面,统一组织管理架构和质量标准体系,建立人才培养长效机制。深度融合缩小区域间的差异,实现弹性调配资源共享,提升官兵不同院区间的就诊品质,有效促进一院多区护理工作的协同发展。     

北京市基层医疗卫生机构组织能力及其成熟度评价研究

目的：评价北京市基层医疗卫生机构组织能力及其成熟度现状,为提升基层医疗卫生机构组织能力,促进其可持续发展提供参考依据。方法：基于前期建立的组织能力指标体系设计自评问卷,选取北京市D区(城区)和S区(郊区)所有基层医疗卫生机构为研究对象,每家机构选择10名熟悉本机构运营情况的中层管理者作为问卷调查对象,共收回有效调查问卷295份,在验证问卷信度和效度的基础上进行组织能力及成熟度评价。结果：纳入的33家基层医疗卫生机构组织能力分数为4.10±0.40分,D区的组织能力在各维度上均高于S区。总体上看,一级指标中核心能力最高,发展能力最低;二级指标中传染病防控能力最高,资源管理能力最低。大多数机构均处于基本稳定型与稳步发展型阶段。结论：北京市基层医疗卫生机构间组织能力存在差异,发达地区的机构更可能具有较高的组织能力;北京市基层医疗卫生机构已摆脱初级发展阶段,但仍应重点提高资源管理能力与学习能力;各机构也应重视发展能力的培养。     

CEO performance appraisal: review and recommendations

CEO performance appraisal (PA) is very valuable to an organization, but the chances of obtaining a PA of high quality decrease as executive responsibility increases. The realities of CEO PA are that it: (1) is inevitable; (2) is creative and complex; (3) involves politics; and (4) has a significant effect on the organization and the executive. PA is conducted for legal and social requirements, to enhance communication, to provide opportunities for improvement, and to relate performance to compensation. This article discusses several problems with chief executive officer (CEO) PA and the contemporary approaches that seek to improve it. Three fundamental areas for evaluation are identified: (1) organizational success; (2) areawide health status; and (3) professional role fulfillment. These provide an outline for successful healthcare PA. In addition to a discussion of the strategic considerations behind a successful CEO PA system, several recommendations are offered for the implementation of the annual evaluation process. The final goal of CEO PA is to link its results to CEO incentive compensation. It is strongly recommended that some portion of the CEO's salary directly hinge on his performance in two critical areas: organizational effectiveness and community health status.     

军队医院组织结构创新模式

本文以现代管理理论为指导,研究医院组织结构创新模式,分析探讨军队医院组织结构变革趋势与作用;阐述了现代医院组织结构呈现扁平化、弹性化、网络化、分权化、流程化和平行化等多维结构格局,指出医院组织结构创新应以提高组织的有效性为目的;以建立学习型组织为先导,以坚持“以人为本”为原则,以医院发展战略为牵引并保持与战略的动态适应。     

探讨低流行区麻风病疫情监测的策略

放松低流行区疫情监测工作,麻风病极有可能卷土重来。文章探讨了在麻风病低流行区,特别是麻风病处于基本消灭后的地区应采取尽可能利用现有卫生资源、注重成本一效益、主要以被动方式早期发现病人的基本策略。阐述了疫情监测工作要充分利用防病体制改革带来的资源优势;基础工作应从专业机构转移到综合性医院;注重培训方法,提高综合性医院医生参与防病的意识与责任感;主动检查家庭内接触者;采取被动监测复发的策略并强调消除疫情监测中基本消灭不等于完全控制、LEC不能取代疫情监测以及基层防保人员不再是疫情监测的主力军的认识上的几个误区。     

Organizational Silence and Hidden Threats to Patient Safety

Organizational silence refers to a collective-level phenomenon of saying or doing very little in response to significant problems that face an organization. The paper focuses on some of the less obvious factors contributing to organizational silence that can serve as threats to patient safety. Converging areas of research from the cognitive, social, and organizational sciences and the study of sociotechnical systems help to identify some of the underlying factors that serve to shape and sustain organizational silence. These factors have been organized under three levels of analysis: (1) individual factors, including the availability heuristic, self-serving bias, and the status quo trap; (2) social factors, including conformity, diffusion of responsibility, and microclimates of distrust; and (3) organizational factors, including unchallenged beliefs, the good provider fallacy, and neglect of the interdependencies. Finally, a new role for health care leaders and managers is envisioned. It is one that places high value on understanding system complexity and does not take comfort in organizational silence.     

Local hospital systems: forerunners of regional systems?

Over the past several decades, the hospital industry has been undergoing a major organizational change that has until now been little examined. Local hospital systems (LHSs) are combinations of two or more hospitals that are in the same company and located in or around the same metropolitan areas in this country. This article presents the first detailed examination of the 402 such systems that have been identified to date. LHSs offer great potential for achieving the cost, quality, and access benefits that are often attributable to regional systems. The degree to which LHSs have attained some basic structural features expected of regional systems are examined. Differences are compared within ownership categories. Issues and challenges facing leaders in the field, should they hope to achieve the potential of regional systems, are discussed.     

现代医院物流系统及管理探析

文章建构了基本的医院物流系统模型框架和基本流程,认为医院物流可分为采购物流、库存管理、分发与供应、医用废弃品物流等4个主要活动领域.包含了医院物流设施/存货网络、物流组织网络、医院物流流程;医院物流运作规范、医院物流战略5个层次.准时制（JIT）、业务流程重组（BPR）、基于活动的成本分析（ABC）将为医院物流合理化提供有力工具.     

医院基层科室中非组织化倾向及引导

本文列述医院基层科室中非组织化的现象,在当前社会转型、利益驱动、矛盾交织时期,部分人员出现游离于组织目标之外的个人目标,如为私人诊所做手术,替药商推销药品等,其表现特点为组织形态不稳定性、组织环境的潜在性、组织人员的小团体性,分析了其成因,提出了加强科室“硬件”建设,实行浮动工资与医疗福利,发挥非正式组织领袖作用,落实科室制度等方面的相应措施。     

The development of a corporate philosophy in a mental health organization

The importance of a corporate philosophy for a mental health organization is addressed in light of concepts such as organizational climate and corporate culture. The functions, benefits, and potential drawbacks of a corporate philosophy are discussed along with a review of some of the executive skills required to manage a corporate culture. A case study of the development of an organizational philosophy in a mental health organization is presented along with a sample statement of philosophy and organizational credo. Outcomes are described and implications for decision making, service delivery, and management are discussed.     

How to deal with stress in organizations?--a health perspective on theory and practice

This review is focused on organizational aspects of stress reduction. Theoretical models are presented. The association with a few health outcomes (cardiovascular disease, musculoskeletal disorders, and functional gastrointestinal illness) is examined. A few examples of evaluations of health consequences of improved work organization are introduced. Realistic expectations are discussed against the background of etiologic fractions. Concepts like psychological demands, decision latitude, social support, and effort-reward balance or imbalance are discussed and related to practical reorganizational efforts.     

Managing meaning for strategic change: the role of perception and meaning congruence

This paper is a qualitative study of the cultural and strategic changes being made by a mid-sized hospital in the southwestern United States. The purpose of the paper is twofold. First, the paper examines the methods used by strategic managers in this hospital to manage meaning and create congruent interpretations of culture and strategy throughout the organization. This paper takes a social construction, interpretive position that culture and strategy are created through human interaction and involve shared meaning systems and interpretive schemes that individuals use to interpret and make sense of their world. Second, the study examines the effectiveness of the methods used by hospital management by examining perceptual similarities and differences among top leadership and other organizational members. This paper takes the position that perceptual and meaning congruence are necessary for the successful implementation of strategy that is given in a top-down fashion.     

Organizational rationality,performance, and social responsibility: results from the hospital industry

Drawing on stakeholder theory and Weber's distinction between formal and substantive rationality, we posit that: (1) for-profit organizations manage stakeholders in ways that result in the organization being more efficient and less socially responsible than organizations that are not as profit oriented, and (2) organizations with major corporate relationships that are not local manage stakeholders in a manner that results in the organization being more efficient and less socially responsible than organizations without such arrangements. We test these hypotheses with 1994 data on 4,705 of the nation's short-term general hospitals using two measures of hospital efficiency and four measures of social responsibility. Results confirm that for-profit hospitals and hospitals lacking local ties are managing stakeholder relationships in ways that increases the efficiency of these hospitals but decreases their social responsiveness. We conclude by speculating that organizational efficiency and social responsibility may be inversely related and then summarize some of the academic, managerial, and policy implications, with emphasis on the implications for stakeholder theory.     

Ways to improve the management of hospitals

The article "Ways of improving the management of in-patient facilities" examines the organizational structure of management in respect to hospitals. A systems approach is used for management analysis. A hospital facility is defined as an hierarchical multilevel system of management. In this connection some problems concerning hospital management are considered: the multi-level character of management system, the specificity of management at each echelon of decision making process, the development of curative and diagnostic process technology, the problem of assessing management effectiveness at each hierarchical level. Attention is given to the training of hospital staff. Ways of improving the management of hospitals are determined for the purpose of raising the quality and effectiveness of in-patient care.     

Effectiveness of a healthy work organization intervention: ethnic group differences

This study examined ethnic group differences in the effectiveness of a healthy work organization intervention on organizational climate and worker health and well-being. Our sample consisted of employees from 21 stores of a large national retail chain. The intervention involved establishing and facilitating employee problem-solving teams in 11 of the stores. Teams were charged with developing and implementing action plans tailored to the needs of their specific site. Pre- and postcomparisons of the treatment and control groups showed that the intervention produced positive effects on both the climate and health and well-being outcomes; however, these effects varied significantly by ethnic group. Particularly in terms of organizational climate, black and Hispanic employees were the primary beneficiaries of the participatory intervention process. These results are interpreted in terms of social identification and self-categorization theories and are contrasted with traditional participatory and diversity training approaches.     

Hospital Size, Complexity, and Formalization

Data on 704 United States short-term general hospitals are sorted into a set of dependent variables indicative of organizational formalism and a number of independent variables separately measuring hospital size (number of beds) and various types of complexity commonly associated with size. A series of regressions are performed on the data to determine whether size alone has significant influence on formal organization. The findings are discussed in terms of the probable relation between hospital complexity and professionalization and the possible relation between professionalization and formal bureaucratic mechanisms in organization control.     

Hospital graduate social work field work programs: a study in New York City

Twenty-seven hospital field work programs in New York City were studied. Questionnaires were administered to program coordinators and 238 graduate social work students participating in study programs. High degrees of program structural complexity and variation were found, indicating a state of art well beyond that described in the general field work literature. High rates of student satisfaction with learning, field instructors, programs, and the overall field work experience found suggest that the complexity of study programs may be more effective than traditional field work models. Statistically nonsignificant study findings indicate areas in which hospital social work departments may develop field work programs consistent with shifting organizational needs, without undue risk to educational effectiveness. Statistically significant findings suggest areas in which inflexibility in program design may be more beneficial in the diagnostic related groups era.