A closer look at lay sponsorship. A CHA survey reveals some problems with two established models

The private association of the Christian faithful (PACF) and private juridic person (PJP) are two lay sponsorship options for healthcare organizations that find traditional sponsorship unavailable. Today two questions relate to these models: Are the PACF and the PJP still realistic and attractive models of sponsorship? Can Catholic identity be maintained in them? Last summer CHA surveyed the seven member organizations that use either the PACF or the PJP as sponsorship models. In addition, CHA conducted four site visits, which corroborated the survey findings. Most respondents said their organizations had adopted the lay model as a means of remaining Catholic after their original sponsors withdrew. Most said they had a good relationship with the local diocese, although formal meetings with the diocesan leaders were infrequent. Each organization had a clearly articulated mission and reinforced their mission and values in various ways. Leadership development appeared somewhat weak. Some respondents spoke favorably of the PACF and PJP models of sponsorship, but others saw limitations, including isolation, lack of clarity in reporting mechanisms between the organization and the diocese, and lack of board education about the models. Even those who saw a future for lay sponsorship on the PACF and PJP models said that, although it is important for Catholic healthcare to develop lay leadership, these models are not promising steps in that direction.     

Prevailing issues in long-term care. CEOs see urgent need for adequate funding and better communications among Catholic organizations

The ongoing crisis in long-term care has forced administrators and chief executive officers (CEOs) to reassess their position within the U.S. healthcare system and define their response to the challenges they face. This article identifies the issues that Catholic long-term care CEOs find most pressing based on two recent opinion surveys conducted by the Catholic Health Association (CHA). In the area of management and governance, the subject of a 1990 CHA survey, respondents rated as their top concern the inadequacy of funds to treat chronically ill elderly persons. Other important issues included threats to the tax-exempt status of healthcare providers, availability of healthcare for the poor, and scarcity of nursing staff. Respondents to a 1991 survey that focused on collaboration within the Catholic healthcare ministry cited the lack of a forum for communications as the greatest hindrance to collaborative enterprises. A lack of available time to pursue and develop collaborative projects and the absence of compelling reasons to collaborate with other Catholic organizations were also identified as important issues. Overall, the consensus among long-term care CEOs was strong on the importance of certain management and governance issues and on the need for Catholic organizations to work together more closely.     

Years of transition. Internal developments under Fr. Schwitalla, 1928-1947

Dedicated to helping Catholic hospitals keep pace with rapid changes in the healthcare field, CHA flourished under the leadership of its first president, Rev. Charles B. Moulinier, SJ, who served from 1915 to 1928. The second in a series of Health Progress articles on the Catholic Health Association's history (March 1990) recounted Fr. Moulinier's efforts to expand CHA's role as a national organization serving Catholic hospitals. This article describes the work of Rev. Alphonse M. Schwitalla, SJ, to reorganize CHA and to develop a program for evaluating Catholic schools of nursing. In May, a fourth article will focus on CHA's developing relationships with other national Catholic organizations and its expanded role as an advocate of healthcare policy reform.     

Supporting information technology across health boards in New Zealand: themes emerging from the development of a shared services organization

Shared services organizations are ascribed with adding value to business in several ways but especially by sharing resources and leading to economies of scale. However, these gains are not automatic and in some instances, particularly healthcare, they are difficult to achieve. This article describes a project to develop a shared services information technology infrastructure across two district health boards in New Zealand. The study reveals valuable insight into the crisis issues that accompany change management and identifies emergent themes that can be used to reduce negative impact.     

Meeting mission challenges in IDNs. Through integrated delivery networks, organizations can continue their ministry and extend its reach

Whatever the final shape of healthcare reform, providers and sponsors are already collaborating with each other in various network arrangements. As they pursue these arrangements, they are asking questions about their role in a reformed system and whether the networks they participate in will strengthen their mission and ministry. Documents published about five years ago by the Catholic Health Association (CHA) and the Commission on Catholic Health Care Ministry provided the rationale for CHA's proposal to form integrated delivery networks (IDNs) as part of a national healthcare reform plan. The documents called for a continuum of care with comprehensive community- and institution-based services and challenged Catholic healthcare leaders to work for a healthcare system that guarantees access to the needy and most vulnerable in society. The central task for administrators today is to determine whether participating in an IDN enables Catholic healthcare providers to fulfill their original mission and purpose. To determine this, organizations must clarify their mission and evaluate their beliefs. They must also develop a shared vision of motives and goals among everyone with whom they collaborate. IDNs' success in furthering the healthcare ministry will depend on leaders' ability to ensure that new corporate cultures which arise in cooperative ventures and arrangements support Catholic values and mission. In making the transition to a new environment, leaders should remember that aspects of IDNs support many of the goals of the Catholic healthcare ministry.     

After the downsizing. How to build loyalty and productivity in the wake of restructuring

The restructuring forced on many healthcare organizations today increases employees' stress and threatens their loyalty and productivity. To restore trust and improve morale, and maintain hope, healthcare leaders can implement six strategies: Clearly communicate decisions that affect employees, using verbal and written methods, and show compassion to displaced workers and acknowledge their contributions. Support remaining employees. Tell them why they survived and provide them with new challenges. Allow employees to participate in developing a shared vision of the organization's future. Empower employees by rewarding their accomplishments appropriately. Workers perform better when they develop their "personal power" and believe they are part of a team facing new challenges. Focus on learning and professional growth. New knowledge sparks workers' imaginations and helps them find better ways to accomplish their goals. Ask employees to reflect on their professional legacies-what they wish to be remembered for.     

The balanced scorecard: a potent tool for energizing and focusing healthcare organization management

The current environment for healthcare organizations contains many forces demanding unprecedented levels of change. These forces include changing demographics, increased customer expectations, increased competition, and intensified governmental pressure. Meeting these challenges will require healthcare organizations to undergo fundamental changes and to continuously seek new ways to create future value. This article provides explanation of a potent new management tool-the balanced scorecard-that can be used by healthcare organizations to meet these challenges. The article also presents the opinions of many high-level healthcare administrators that the balanced scorecard can be highly beneficial to healthcare organizations. It also summarizes these administrators' suggestions regarding the goals and measures that can make up an effective scorecard for a hospital as a whole, as well as for a specific subunit of a hospital. Interestingly, while no published report of balanced scorecard implementations in healthcare organizations exists, a number of administrators stated that they had fully implemented systems similar to the scorecard. These actions can be considered support for the scorecard's potential usefulness; at the same time, they suggest that some sharing of experiences will likely be available in the future. As all administrators are well aware, moving from concept to practice is often difficult. While the article includes some suggestions for scorecard development and implementation, each organization must engage in the full range of activities, from defining its mission to the selection of goals and strategies, and develop its own unique scorecard to assist progress toward the selected goals. As a starting point, Table 3 provides a timeline of some general events that may be common to all organizations during this process.     

Manager-physician relationships: an organizational theory perspective

Manager-physician relationships are a critical determinant of the success of health care organizations. As the health care industry is moving toward a situation characterized by higher scarcity of resources, fiercer competition, more corporitization, and strict cost-containment approaches, managers and physicians should, more than ever, work together under conjoint or shared authority. Thus, their relationship can be described as one of high rewards, but also of high risk because of the wide range of differences that exist between them: different socializations and trainings resulting in different worldviews, value orientation and expectations and different cultures. In brief, managers and physicians represent different "tribes," each with its language, values, culture, thought patterns, and rules of the game. This article's main objective is to determine the underlying factors in the manager-physician relationship and to suggest ways that make this relationship more effective. Four different organizational perspectives will be used. The occupational perspective will give insights on the internal characteristics of the occupational communities of managers and physicians. The theory of deprofessionalization of physicians will also be discussed. The structuring perspective will look at the manager-physician relationship as a structure in the organization and will determine the effects of contextual factors (size, task uncertainty, strategy, and environment) on this relationship and the resulting effect on performance and effectiveness of the organization. The culture and control perspective will help detect the cultural differences between managers and physicians and how these interact to affect control over the decision-making areas in the hospital. The power, conflict, and dialectics perspective will shed the light on the conflicting interests of managers and physicians and how these shape the "power game" in the organization. Consequently, a theoretical model of manager-physician relationships that encompasses all these perspectives is developed.     

The transition to regional networks. Changes in reimbursement and approaches to care favor cooperative arrangements among providers

As costs escalate and the delivery system becomes more fragmented, organizations throughout the United States have begun to call for basic reform of the healthcare system. Several national organizations, including the American Hospital Association and the Catholic Health Association, have presented working proposals advocating coordinated regional healthcare delivery systems. The proposed networks would provide a full continuum of services from prevention through aftercare and long-term care, and from primary through tertiary care. In the past few years, providers themselves have begun to see the value of cooperative efforts. Collaborative ventures such as group purchasing and sharing mobile equipment have increased as hospitals look for ways to reduce costs and control overhead. Mergers and affiliations are also becoming more common. As they develop, different networks will allow for various kinds of interrelationships among components. In general, these systems will provide high-volume, low-cost services at a number of sites and low-volume, high-cost services at a central location. Secondary and tertiary campuses will focus increasingly on specialty care, and as volume increases at primary campuses, secondary and tertiary organizations will establish more primary affiliations. To make the transition from a competitive to a cooperative healthcare delivery system, providers will have to reexamine their mission and values and, in many cases, refocus their vision of the future.     

Overcrowding and Fiscal Pressures in Emergency Medicine

The Physician Group Practice (PGP) Demonstr-ation Project was designed to try to establish whether high-quality healthcare can be delivered to Medicare patients, while simultaneously lowering overall Medicare costs. In this project, participating healthcare organizations were provided a portion of any savings achieved, provided that certain quality goals were also achieved. The results of this project were used to provide evidence as to the feasibility of Accountable Care Organizations (ACOs), a healthcare delivery approach, which is rapidly becoming more prevalent. While the quality measures achieved by the vast majority of participants in the PGP Demonstration Project were widespread, the financial performance of these organizations was quite mixed. Many participating organizations received no shared savings whatsoever, while one received more “shared savings” payment that the others combined. Problems with the evidence supporting PGPs’ cost savings are discussed, and, based on these concerns, the future success of ACOs is questioned.     

Values and vision--CHA's plan for healthcare reform is based on two unique perspectives

The Catholic Health Association (CHA) Leadership Task Force on National Health Policy Reform has offered a proposal that, if enacted by Congress, would result in profound changes in the way providers deliver healthcare in the United States. The proposal would result in fewer acute healthcare facilities, challenge some acute care facilities to provide additional services and require each Catholic healthcare provider to collaborate with Catholic providers and others. Two features distinguish CHA's plan from the many other healthcare proposals that have been offered. First, CHA's plan is rooted in six tenets of Catholic healthcare. Second, the plan primarily focuses on client-centered delivery reform rather than on financing issues as other proposals have done. The task force believed it first had to create a vision of what the nation's future healthcare delivery system should look like. The task force decided that providers must do a better job of meeting clients' healthcare needs. To be a credible leader in the healthcare reform debate, the task force believes that CHA must offer a plan that primarily focuses on the needs of people and, second, controls costs effectively.     

Protecting children's health. CHA's immunization program helps organizations increase vaccination rates in their communities

In response to the increasing outbreaks of vaccine-preventable diseases in the United States, the Catholic Health Association (CHA) has developed a new resource to help its members launch programs that will increase immunization rates among children in their service area. Vaccines are the building blocks of basic primary care. But society and the healthcare system have erected barriers that prevent children from being fully immunized. Impediments include missed opportunities, cost barriers, and facility and resource barriers. Catholic healthcare providers can help eliminate these barriers and ensure that all children in their service areas are vaccinated by assessing their immunization resources, seeking out unvaccinated children, and collaborating with community organizations and agencies. CHA's immunization campaign will guide Catholic healthcare providers as they protect children from preventable diseases. Immunization may help reduce the costs of emergency and acute care for conditions that could have been prevented.     

After the shaking stops. Catholic healthcare workers should prepare for seismic changes

In an attempt to cap spiraling costs and remain competitive, both providers and insurers are going through a frenzy of consolidation. Experts are predicting these changes: The integrated delivery system (IDS) will be the prevailing type of healthcare organization. There will be fewer acute care beds and fewer hospitals. Hospitals will be subsidiary to IDSs. Catholic and non-Catholic providers will join together to form IDSs. Regional IDSs will join statewide networks. The Catholic healthcare ministry can survive in such an era of consolidation if its leaders (1) collaborate with others on a basis of shared values, (2) have a well-defined mission, (3) provide holistic care, and (4) ensure that the organization remains true to its mission and demonstrates core values in its decisions and behaviors. Sponsors will need to find ways to share management of IDSs with non-Catholic organizations; to collaborate in the formation of regional and statewide IDSs; to urge other Church leaders to support social justice, human dignity, and community service; to be mindful of the stresses these changes will place on physicians and employees; to encourage dialogue about other changes in religious life; and to prepare laypersons to be their successors in the leadership of Catholic healthcare.     

How to improve hospital-physician relationships

For healthcare organizations (HCOs), successfully partnering with physicians is the strategic imperative. A number of misperceptions and limiting beliefs compromise partnering initiatives. To pursue a more successful approach to partnering, it is important to understand some of the forces that are affecting the healthcare industry. The accelerating pace of change demands that healthcare leaders serve as change agents, evoking resentment from the majority of healthcare stakeholders. Demands for measured accountability and the shift of control from provider to consumer threaten the physician perception as "captain of the ship." Cultural differences between the expert culture of physicians and the affiliative culture of the HCO perpetuate feelings of distrust and compromise efforts to actualize interdependencies. Economic pressures and an unwillingness to make time to engage in dialog prevent the provider community from serving as a creative force in shaping its own future and restrict the ability to build the mutual trust that is necessary for the establishment of successful relationships. Measures that would enhance the likelihood of forming successful and lasting relationships include the following. Adopting an orchestration model would allow a flexible way to bring services to a community. It may be the only way to simultaneously integrate and specialize. Budgeting to reflect service-line functioning would allow the systematic integration of patient care throughput and provide a necessary metric for assessing clinical and operational performance. Segmenting the medical staff would allow the establishment of pluralistic relationships based on shared goals and values and allow change agents to lead to critical mass rather than consensus. Focusing on the customer would ensure relevance in the changing medical marketplace. Adopting a complexity science metaphor rather than continuing in a command-and-control, top-down organizational structure would enhance adaptability and help maximize human capital. Most importantly, forming relationships that center around shared purpose and values will lay the foundation for excellence and sustainability while restoring a sense of meaning, pride, and joy to the healthcare professions.     

Church and society. developments during the Schwitalla years, 1928-1947

As CHA evolved and expanded in the 1930s, it became a more complex organization with wider responsibilities--and more intractable problems--than it had had before. The third article in the six-part Health Progress series on the history of CHA (April 1990) described the struggles of Rev. Alphonse M. Schwitalla, SJ, the association's second president, to develop effective CHA programs and policies on nursing education. CHA's relations with other national Catholic organizations, the growth and eventual autonomy of its Canadian member hospitals, and its role as an advocate of federal healthcare legislation during the Depression and World War II are covered in this article. Next month's installment will describe CHA's modernization and expansion under the leadership of Rev. John J. Flanagan, SJ.     

The Influence of Organizational Characteristics and Campaign Design Elements on Communication Campaign Quality: Evidence from 91 Ugandan AIDS Campaigns

This research proposes and tests a model of the relationship between organizational factors, campaign design elements, and campaign quality of communication campaigns. It is the first quantitative study to test these relationships across many organizations. The context for the study was AIDS education and outreach campaigns in Uganda, during a time of successful decrease in the spread of HIV infection. Ninety-one organizations were surveyed. Since only 14% of the organizations collected exposure or outcome data, the study focused on the factors affecting campaign quality. Quality was examined by measuring goal specificity, execution quality, and message quality. The results show that financial resources, professional training, participation of outreach workers in planning the campaign, and audience participation in planning and executing the campaign were key organizational variables affecting the quality of the campaigns. The important campaign design elements affecting campaign quality were conducting research, using multiple channels, targeting only a few groups, and pretesting messages. The results have import for campaign planners, managers of organizations conducting campaigns, and funders. In addition, it is vital that organizations collect exposure and outcome data in the future to provide feedback on each campaign.     

The influence of organizational characteristics and campaign design elements on communication campaign quality: evidence from 91 Ugandan AIDS campaigns

This research proposes and tests a model of the relationship between organizational factors, campaign design elements, and campaign quality of communication campaigns. It is the first quantitative study to test these relationships across many organizations. The context for the study was AIDS education and outreach campaigns in Uganda, during a time of successful decrease in the spread of HIV infection. Ninety-one organizations were surveyed. Since only 14% of the organizations collected exposure or outcome data, the study focused on the factors affecting campaign quality. Quality was examined by measuring goal specificity, execution quality, and message quality. The results show that financial resources, professional training, participation of outreach workers in planning the campaign, and audience participation in planning and executing the campaign were key organizational variables affecting the quality of the campaigns. The important campaign design elements affecting campaign quality were conducting research, using multiple channels, targeting only a few groups, and pretesting messages. The results have import for campaign planners, managers of organizations conducting campaigns, and funders. In addition, it is vital that organizations collect exposure and outcome data in the future to provide feedback on each campaign.     

The value of spiritual health

Spiritual health is that aspect of our well-being which organizes the values, the relationships, and the meaning and purpose of our lives. Patients and healthcare professionals alive have experienced a growing recognition of the importance of spiritual health as a foundation for physical health and well-being. As a reformed healthcare system places greater emphasis on etiology and prevention as opposed to relief of symptoms, creative and holistic partnerships between the medical profession and spiritual care givers can and will emerge. In studying the etiology of illnesses, healthcare providers must examine the underlying social problems of the day: violence, divorce, unemployment, and a host of other factors that lead to disintegrating relationships. In the past many physicians and nurses refrained from discussing spiritual matters with patients. But given the importance of the relationship between physical and spiritual well-being, providers must make spiritual assessments at the time of any triage. The medical record needs to include references to the patient's spiritual history. And healthcare institutions must seek partnerships with community organizations and leaders to monitor the effects of societal issues that lead to physical and spiritual distress.     

Barriers and opportunities for developing sustainable relationships for health improvement: The case of public health and primary care in the UK

The British National Health Service has enjoined public health and primary care via a series of policy initiatives. Inter-organizational relationships provide the foundation for managing the system changes required to deliver policy, but are often taken for granted. This article reports on a study that sought to answer three key questions. First, which relationships are important for improving health? Second, what are the key areas in these relationships that might impact on delivery of improved public health? Third, what issues should be addressed in developing emerging relationships? Following a questionnaire to a sample of primary care organizations and a series of intensive workshops with key informants, findings indicate that there is an extensive network of relationships in which public health staff may participate. However, active participation is problematic in terms of identifying the most relevant relationships and ensuring protected time to develop these. Key relationship dimensions impacting on improved public health included different organizational perceptions of relationships and limited mutual understanding. However, despite a lack of a shared view of public health, the diversity of skills and backgrounds was viewed as an asset to joint working. Emerging relationships were generally perceived to be quite effective and expected to significantly improve though capacity issues and the frequency of organizational change appeared to make relationships more difficult to sustain. These issues needed to be recognized in developing and implementing policy, with further clarity needed as to which relationships are key for public health development and the costs and dividends of supporting these.