Competencies for population-based clinical managers: A survey of managed care medical directors

Background: The evolution of American health care into integrated systems of delivery and finance requires a specialized set of population-based skills for physicians. The field of preventive medicine represents one source of this expertise. Specific competencies for the emerging area of managerial medicine have not been well delineated.Methods: Using concept documents from the Residency Review Committee for Preventive Medicine and the American Board of Preventive Medicine, a list of proposed competencies for managerial medicine was identified. Surveys were mailed to medical directors of all members of the American Association of Health Plans and to a random sample of diplomates of the American Board of Preventive Medicine. Respondents were asked to rate the importance of these competencies for a population-oriented clinician manager.Results: Areas rated highly by medical directors included health services research (including outcomes research), quality assurance and improvement, health risk assessment and reduction, programmatic skills, and clinical preventive skills. Responses from preventive medicine specialists were similar, but placed lower emphasis on these skills.Conclusion: Despite its limited response rate, this survey may be useful in the implementation of specialty training in managerial medicine. Residency training programs may choose to emphasize specific content areas that reflect the priorities expressed by physicians actively involved in management.     

Forecasting menu-item demand in foodservice operations

The state of the practice in forecasting menu-item demand in foodservice operations was determined. A survey to assess the forecasting techniques utilized by foodservice directors was administered to a random sample of 834 American Dietetic Association Members with Management Responsibilities in Health Care Delivery System. Statistical analysis of the 392 responses revealed that less than 25% of the practitioners were using mathematical models in forecasting menu-item demand. Naive models were utilized by the majority of the respondents. The moving average technique was the most frequently used (14.8%) mathematical model. Approximately 75% of the practitioners indicated that continuing education is needed relative to the forecasting techniques that may be employed in foodservice management.     

Books for health care managers

The selection of books reviewed here is a potpourri with something to interest almost everyone in the health care professions. The books cover computing in health care, an historical analysis of health care statistics, industrial ownership of hospitals, the formation of state health policies, hospice care and nursing homes; and there is a text on management and one on obstetrics/gynecology and the law.     

Managerial functions of college and university foodservice managers

This study examined managerial roles in college and university foodservice at three organizational levels. The study population included foodservice managers at National Association of College and University Food Services (NACUFS) member schools with a minimum annual budget of +3 million. The 999 managers from 80 colleges and universities who participated were categorized into three groups: assistant, associate, or director of foodservice; unit manager; and manager reporting to unit manager. They rated 51 activity statements on importance and time demand. Maintaining standards of quality was rated most important and most time demanding by all three groups of managers. Perceived importance and time demand of activities increased as managerial level increased. Activity statements were categorized into Mintzberg's 10 managerial roles. Significant differences in importance and time demand ratings among the three managerial groups were indicated for all 10 roles. However, perceived importance and time demand of roles increased as managerial level increased with two exceptions. Disturbance handler and leader roles were rated more time consuming by lower level managers.     

Characteristics of effective health care managers

This article provides an overview of traditional and contemporary management theories. Concerns, characteristics, and skills of effective managers are also presented. Further, a self-assessment (survey) of 7 highly effective health care managers in a South Georgia community was conducted to determine their ratings on 6 management indices. The assessment or Scale of Transformational Leadership uses a Likert-type scale to allow for the evaluation of managers. The scale contains 6 management elements for assessment: attention, meaning, trust, self, vision, and feeling. Individual ratings and group summary skills rating are presented. Findings revealed the order of managerial importance of the elements as follows (from highest to lowest): Management of Trust, Management of Attention, Management of Self, Management of Feeling, Management of Meaning, and Management of Risk. As a second tier, the final ratings are corroborated by health care management interns.     

Perception of health managers regarding collective health care

This study aims at identifying the perception of managers and administrators of health care services, concerning the health care provided by the public health sector within SUS in the Federal District. This is a qualitative research in which the data was obtained through semi-structured interviews with health management professionals. It was concluded that the implementation of guidelines developed by the SUS still represents a challenge for the community and health care workers alike. In short, these two entities must coordinate their efforts in order to implement strategies designed at improving the health service provided to population.     

Strategic modelling for health care managers

The Medical Director of a new HMO thinks the patient load warrants hiring three new internists. What additional factors should he consider? How will this move affect the other needs and plans of the HMO? What effect will it have on the organization's financial condition? Here's the way a large corporation would tackle these questions.     

Total factor productivity modeling in hospital foodservice operations

Total factor productivity (TFP) modeling, a ratio of outputs to inputs, was elaborated with terminology, resources, and outputs familiar to foodservice managers and evaluated for four hospital foodservice operations. Outputs and inputs (counts or currency) were converted to constant dollars for a defined base period by using base period rates and price indexes. After development, validation and pilot testing of a computer-assisted prototype, monthly TFP ratios were calculated from historical data. When TFP ratios were analyzed by regression against each of nine variables (six work force policies, two "demand for services" variables, and capital investment), few significant relationships were found. Although multiple regression analysis of those variables did not produce useful predictive equations, a similar analysis of partial and total factor productivity ratios yielded predictive equations that included up to four partial factor productivity ratios. Even though the labor statistic of meals per labor hour correlated positively with TFP ratios, the comparison provided incomplete and sometimes contradictory information. Total factor productivity measurement can provide foodservice managers with a more comprehensive analytical technique than is possible with only partial measures of productivity.     

Post-graduate medical education in training health care managers

Contemplations over the training of a modern healthcare manager are reflected in the article; the key organizational and methodological aspects of such training are analyzed; program-based measures related with personnel management are defined; training modules on training the healthcare personnel are designated; the experience and promising trends, as implemented in the above sphere by Semashko's Research Institute of the Russian Academy of Medical Sciences, as well as new program "Head Doctor of the 21st Century", offered by the department of academic educational programs of the People's Economy Academy of the Government of the Russian Federation, are discussed.     

Employment-at-Will: guidelines for health care managers

Employment-at-will is a doctrine that allows an employee or employer to terminate the employment relationship at any time for any reason. This doctrine has eroded over time with the enactment of federal legislation that gives workers job protection. Moreover, various states recognize 3 major exceptions to the doctrine. This article examines the historical development of employment-at-will, discusses the pros and cons of at-will employment, describes the exceptions to the doctrine, and discusses at-will employment issues in the health care industry.     

Salary discrepancies between male and female foodservice directors in JCAHO-accredited hospitals.

This study profiles foodservice directors employed in US hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and examines the effect of gender and work-related characteristics on salary. A 37-item questionnaire was sent to 1,002 randomly selected directors of foodservice programs at JCAHO-accredited hospitals in the United States and Puerto Rico. Usable data were received from 663 directors, a response rate of 66%. Foodservice directors answered questions on background information, work-related information, academic and professional certification, and salary range. Findings indicate that foodservice directors are predominantly white, female, college graduates, and more than half are registered dietitians. On the average, foodservice directors had 16 years of experience in foodservice, had spent 9 years with their current employer and 6 years in their present position, and worked a mean of 48 hours each week; more than two thirds earned greater than $30,000. Salaries, however, were significantly higher for men than for women. When controlling for experience (employment in foodservice, years with present employer and in present position), size of hospital, academic preparation, and professional certification, salaries remained consistently higher for men. Although the dietetics profession is predominantly female, gender appears to be the major factor accounting for inequalities in salaries. These findings may alert hospital administrators of the need to review hiring practices and establish standards that promote equitable salary opportunities for persons most qualified for positions, regardless of gender.     

An investigation of managed health care case managers

Managed care case management is a relatively new concept within health and rehabilitation. As such, it lacks both definition and profiles of those providing services. This paper constructs a definition of managed care case management and presents the detailed results of a survey that identified the characteristics of case managers in the Midwest. The survey was mailed to 250 subjects. The respondents of the survey (N = 56) were relatively young (the largest number of respondents were 30 to 39 years of age), relatively new to their jobs (means = 2.2 years), and were typically employed full-time. They primarily served mental health (n = 43) and physically impaired (n = 30) clients. The highest number of their service referrals were made to vocational rehabilitation specialists, social workers, occupational therapists, nurses, and physical therapists.     

Analyzing health care operations using ABC

The evolution of health care created a climate in which cost was subordinate to medical treatment. Current reimbursement constraints have increased the need for providers to be cost conscious, but they have discovered that current accounting practices do not provide the appropriate information to determine the cost of service or make decisions. This article argues that activity-based costing (ABC) can bridge the gap between the medical and financial communities and provide a foundation for performance improvement.