2001 salary survey

Boards are coming to respect how challenging it is to run a hospital, and increasingly view it as too big a job for one person. In our annual compensation survey report, Hay Group analysts assert that lower-level executives, senior managers and even middle managers have seen their stock rise in health care organizations, and that's reflected in the pay structure. Even so, CEOs aren't exactly struggling--but their total compensation still lags behind that of their counterparts in other industries.     

Building departmental influence in health care organizations

This article has outlined several steps to follow in assessing and building department influence at the top management levels of health care organizations. Identifying and contributing to resolving the organization's key areas of uncertainty are strategies that have improved the influence of many departments in recent years. Individual strategies, such as developing one's expertise and sharing that expertise with other departments and top management (an example of the "involvement" technique), also are being used daily by effective department managers. Decentralized management, which entails the assignment of greater responsibilities to middle managers, is increasingly popular in health care organizations. This trend will no doubt facilitate the building of departmental influence in organizational decision making. However, the steps outlined in this article can be implemented whether or not top management endorses a decentralized management style. In a critical sense, departmental influence is too important to be left to top management. It is up to department managers to exert their influence for the good of their employees, the organization as a whole, and their own careers.     

System characteristics of healthcare organizations conducting successful improvements.

PURPOSE: In a previous study, based on a survey to all clinical department and primary care center managers in Sweden, it was concluded that the prevailing general improvement strategy is characterized by: drivers for improvement are staff needs; patients and data are not as important; improvements mainly focus on administrative routines and stress management; improvements are mainly reached, by writing guidelines, and conducting meetings; the majority of managers perceive outcomes from this strategy as successful. The purpose of current research in this paper is to investigate whether there is any other improvement strategy at play in Swedish health care. DESIGN/METHODOLOGY/APPROACH: Data from the study of all Swedish managers were stratified into two populations based on an instrument predicting successful improvement. One population represented organizations with exceptionally high probability of successful imrpovement and remaining organizations represented the general improvement strategy. FINDINGS: The paper finds that organizations with high probability for successful change differed from the comparison population at the p = 0.05 level in many of the surveyed characteristics. They put emphasis on patient focus, measuring outcomes, feedback of data, interorganizational collaboration, learning and knowledge, communication/information, culture, and development of administration and management. Thus these organizations center their attention towards behavioral changes supported by data. PRACTICAL IMPLICATIONS: Organizations predicted to conduct successful improvement apply comprehensive improvement strategies as suggested in the literature. Such actions are part of the Patient Centered Task Alignment strategy and it is suggested that this concept has managerial implications as well, as it might be useful in further studies on improvement work in health care. ORIGINALITY/VALUE: This paper provides empirically based findings on a successful improvement strategy that can aid research-informed policy decisions on organizational improvement strategies.     

Organizational/office politics training: a managerial necessity

The ability of managers to succeed in health care organizations depends in part on their "political" skills. Memorial Hospital of South Bend, a 526-bed tertiary care facility, supports the professional development of its managers and secretarial staff by offering an in-service program to (1) sensitize participants to the need for political skills, (2) suggest techniques to succeed politically, and (3) emphasize the importance of ethical political actions. The in-service is upbeat and concrete and focuses on solving real problems of participants. This article has described an in-service program that was taught to over 250 managers and secretarial staff from 1985 to 1989.     

Challenges, benefits and weaknesses of intermediate care: results from five UK case study sites

The authors explore the views of practitioners and managers on the implementation of intermediate care for elderly people across England, including their perceptions of the challenges involved in its implementation, and their assessment of the main benefits and weaknesses of provision. Qualitative data were collected in five case study sites (English primary care trusts) via semistructured interviews (n = 61) and focus group discussions (n = 21) during 2003 to 2004. Interviewees included senior managers, intermediate care service managers, clinicians and health and social care staff involved in the delivery of intermediate care. The data were analysed thematically using an approach based on the 'framework' method. Workforce and funding shortages, poor joint working between health and social care agencies and lack of support/involvement on the part of the medical profession were identified as the main challenges to developing intermediate care. The perceived benefits of intermediate care for service-users included flexibility, patient centredness and the promotion of independence. The 'home-like' environment in which services were delivered was contrasted favourably with hospitals. Multidisciplinary teamworking and opportunities for role flexibility were identified as key benefits by staff. Insufficient capacity, problems of access and awareness at the interface between intermediate care and 'mainstream' services combined with poor co-ordination between intermediate care services emerged as the main weaknesses in current provision. Despite reported benefits for service-users and staff, the study indicates that intermediate care does not appear to be achieving its full potential for alleviating pressure within health and social care systems. The strengthening of capacity and workforce, improvements to whole systems working and the promotion of intermediate care among doctors and other referrers were identified as key future priorities.     

The politics of action research: “If you don't like the way things are going,get off the bus”

Participatory action research is lauded for its emancipatory potential and practice relevance. Little research has focused on the ethical and political dimensions of power relations between management gatekeepers and staff in large organizations in the negotiation of action research. To illuminate the dynamics of this engagement, this paper is informed by Aristotle's practical ethics of phronesis, arguing that ethics emerge through human interaction. The paper reports on a multi-method study and intervention in inter-professional learning and collaboration, conducted between 2008 and 2010, across an Australian health system. It draws on results from researchers' progress notes, 139 semi-structured interviews and focus groups (492 participants), more than 200 h of organizational document analysis, and more than 200 h of ethnographic observation. From conventional thematic analysis, we note that the project had considerable support from senior managers who were gatekeepers for the research. Such support stemmed from managerialist tendencies, with senior managers explicitly aligning inter-professionalism with prospective health reforms and improvements to quality of care and patient safety. Senior managers were also enthusiastic about standardized processes. Many frontline staff were less supportive, and some were suspicious of or hostile towards management-led processes to improve and evaluate care. Some senior managers' self perceived alignment with and support for the research process changed to resistance once this finding was presented. This paradox in the interplay of research findings and research process evinces the inherent tension between organizational politics and conducting action research that reflexive researchers need to negotiate in knowledge translation, exchange or mobilization exercises.     

Stakeholder management in a hyperturbulent health care environment

The fast-paced change in today's health care environment presents an unsettling organizational climate within which managers must make important decisions that affect key stakeholders. This ambiguousness has resulted in the proliferation of health care organizations that are bundling together to find a sense of environmental stability in which they can achieve common goals. This means that health care managers need to view stakeholders as parts of larger bundles rather than only as individual organizations.     

Resource-based and strategic group influences on hospital performance

Uncovering the determinants of the performance of health care organizations is a key concern of managers and scholars alike. Using a regional sample of 85 hospitals, this study examines the effects of organizational resources, strategic group membership, and the interaction of these factors on performance. Our results show that managers' attention needs to be focused on different areas depending on what aspect of performance needs improvement.     

After reduction in force: reinvigorating the survivors

In these days of reengineering health care and downsizing many health organizations, a great deal of attention is given to means of reducing the work force. Not nearly as much attention is paid to the survivors of a staff reduction and the problems that arise in the wake of a generally demotivating activity. However, it is the survivors--those who remain after downsizing--that will have the greatest influence on the organization's future performance. Therefore, the survivors must be remotivated and reinvigorated. Such is the task of surviving supervisors and middle managers, and their primary tools are communication, education, and people-centered management.     

Health information management in the computer era

Medical record professionals are confronted with change at practically every front. Technologic advancements are changing the technical aspects of our job responsibilities. These advancements also have implications for the interpersonal aspects of our jobs. The effect of new technology on working relationships is exacerbated by the introduction of TQM, which also encourages a change in organizational relationships through a move away from traditional heirarchical management by fostering teamwork and staff empowerment. The changes that are transforming health care organizations can be viewed in two lights: (1) as unwanted hindrances to accomplishment or (2) as opportunities to enhance accomplishment. Medical record professionals are presented with unprecedented opportunities to enhance our accomplishments and maximize our position in health care facilities. We cannot long for the way things were or be satisfied with the status quo. Such action (or lack thereof) will only ensure that our role on the health care team will be taken over by someone else. To capitalize on the opportunities presented, medical record professionals must hone the knowledge and skills we already possess, gain other knowledge and skills necessary to function in the computerized environment, and, most of all, be proactive rather than reactive. Such action will ensure that we truly become health information managers.     

Organizational leadership and its relationship to regional health authority actions to promote health.

PURPOSE: The purpose of this paper is to examine organizational leadership and its relationship to regional health authority actions to promote health. DESIGN/METHODOLOGY/APPROACH: Through use of four previously developed measures of Perceived Organizational Leadership for Health Promotion, this paper focused on leadership as a distributed entity within regional health authority (RHA) jurisdictions mandated to address the health of the population in the province of Alberta, Canada. FINDINGS: First, examination of differentials between organizational levels (i.e. board members, n = 30; middle/senior management, n = 58; and service providers, n = 56) on ratings of the four leadership measures revealed significant differences. That is, board members tended to rate leadership components significantly higher than service providers and middle/senior managers: from across all 17 RHAs; and in low health promotion capacity and high health promotion capacity RHAs. Second, regression analyses identified that the leadership measures "Practices for Organizational Learning" and "Wellness Planning" were positively associated with health authority actions on improving population heart health (heart health promotion). The presence of a "Champion for Heart Health Promotion" and the leadership measures "Workplace Milieu" and "Organization Member Development" were also positively associated with health authority actions for health promotion. A subsidiary aim revealed low to moderate positive relationships of the dimensions of Leadership, Infrastructure and Will to Act with one another, as proposed by the Alberta Model on "Organizational Capacity Building for Health Promotion." ORIGINALITY/VALUE: This paper, conducted on the baseline dataset (n = 144) of the "Alberta Heart Health Project's Dissemination Phase", represents a rare effort to examine leadership at a collective organizational level.     

Towards an organization with a memory: exploring the organizational generation of adverse events in health care.

The role of organizational factors in the generation of adverse events, and the manner in which such factors can also inhibit an organization's abilities to learn, have become important agenda items within health care. The government report 'An organization with a memory' highlighted many of the problems facing health care and suggested changes that need to be made if the sector is to learn effective lessons and prevent adverse events from occurring. This paper seeks to examine some of these organizational factors in more detail and suggests issues that managers need to consider as part of their wider strategies for the prevention and management of risk. The paper sets out five core elements that are held to be importance in shaping the manner in which the potential for risk is incubated within organizations. Although the paper focuses its attention on health care, the points made have validity across the public sector and into private sector organizations.     

A stakeholder approach to community health management

Although community health management has become an important issue for health care organizations, there is little information on the roles that they and other community institutions ought to play in this area. This article develops a stakeholder approach to community health management, identifies the set of community health stakeholders, determines their salience to health care organizations, discusses the strategies they use to influence organizational involvement in community health management, and examines the responses of health care organizations. Implications for community institutions, health care managers, and researchers are discussed.     

A summation of online recruiting practices for health care organizations

Worker shortage is among the foremost challenges facing US health care today. Health care organizations are also confronted with rising costs of recruiting and compensating scarce workers in times of declining reimbursement. Many health care organizations are adopting online recruitment as a nontraditional, low-cost method for hiring staff. Online recruitment is the fastest growing method of recruitment today, and has advantages over traditional recruiting in terms of cost, reach, and time-saving. Several health care organizations have achieved great success in recruiting online. Yet awareness of online recruiting remains lower among health care managers than managers in other industries. Many health care organizations still search for job candidates within a 30-mile radius using traditional methods. This article describes the various aspects of online recruitment for health care organizations. It is meant to help health care managers currently recruiting online by answering frequently asked questions (eg, Should I be advertising on national job sites? Why is my Web site not attracting job seekers? Is my online ad effective?). It is also meant to educate health care managers not doing online recruiting so that they try recruiting online. The article discusses the salient aspects of online recruiting: (a) using commercial job boards; (b) building one's own career center; (c) building one's own job board; (d) collecting and storing resumes; (e) attracting job seekers to one's Web site; (f) creating online job ads; (g) screening and evaluating candidates online; and (h) building long-term relationships with candidates. Job seekers in health care are adopting the Internet faster than health care employers. To recruit successfully during the current labor shortage, it is imperative that employers adopt and expand online recruiting.     

The Joint Commission has provided a tool to change your work force: are you paying attention?

Most health care managers wonder how to change employee "attitudes" so that their staff will be more accountable for patient satisfaction, cost reduction, and quality of care. Employees were trained to function in an industry where the power players were the physician and the administrator and now it is exceedingly difficult to get them to switch their attention to the patient and the payer in a market-driven economy. For hospital managers, the answer may be right at their fingertips: The Joint Commission on Accreditation of Healthcare Organizations' standards demanding that employee competence be objectively measured, proven, tracked & trended, improved, and age specific. A comprehensive competence assessment system can save the health care manager enormous work in measuring fewer things, focusing performance assessment on the 20 percent of things that are true problems, and helping to specifically define certain competencies such as customer focus and cost consciousness so that coaching, training, and giving performance feedback is easier. Developing a comprehensive competence assessment system is a powerful tool to change the culture of organizations. Consequently, it is important that managers be aware of those possibilities before they embark on developing "competencies" or before their organizations get too carried away on redesigning systems to satisfy standards.     

Hospital administrator perceptions of health information managers as future leaders in health care reform

The article examines hospital administrators' perceptions of health information professionals moving into leadership positions within health care organizations. Data for this study were collected from a national random sample of hospital administrators (N = 62). Findings from the study suggest that, although health information managers are viewed as integral to the success of the health care organization, health information managers are perceived as lacking appropriate educational training to move into administrative or leadership positions. For the health information professional to move into a leadership position, educational training (at the master's level) must focus on quality management, statistical process control, and performance evaluation.     

Health care and health promotion in southern Italian communities.

Health promotion projects may be regarded as responses to insufficient health care in Europe, where modern health problems, consumer needs, participation and life quality are neglected. In Southern Italy and especially in Naples the situation is particularly difficult (poverty, poor accessibility of health care, high infant mortality, epidemics etc.); nevertheless there exist elements of everyday life which are advantageous for health promotion. The health projects described started around Naples in the 'seventies. They focused on the psychosocial problems of marginalized people (elderly people, women, mentally and physically handicapped men, big families etc.). Different elements of health care (prevention, primary health care, health education), social work and political and cultural activation were linked together in the local centres of social medicine. Thus the accessibility of health care was improved, social distance between suppliers and users reduced, and poor and disadvantaged people better integrated into the social life of the community. One important step in the realization of such aims was the stimulation of politically and socially defined homogeneous target groups with similar interests and needs. The specific measures, organizational structures and the personal staff are directed to these target groups in an integrated way. They are based on the teamwork of different professions and cooperation with other related organizations, and they include explicitly political, social and cultural activities, different from the self-help activities related only to health in most of Central Europe.(ABSTRACT TRUNCATED AT 250 WORDS)