Information systems: the direction of things to come

In the past, very little emphasis was placed on the development of high quality information systems support producing useful information. However, in an increasingly competitive environment, managers will need good information to make sound business decisions and to survive. Good information will be the result of an information system that is easy to use and can gather information from many different sources. Hence, in the future, information systems will move in the direction of decision support assistance, integrated patient care systems, stand-alone application systems, and increased access and integration, to help the manager in the decision-making process.

The anatomy of change

Hospitals face the critical need to examine managerial styles in practice and perception. One institution did so and saw the dramatic effect in improved attitudes and performance that occurred after the self-examination and a resultant commitment to institute the necessary changes. A realization of the process of change may encourage other administrators to look inward as the first step in increasing organizational effectiveness. This process also has its trauma and pitfalls, but the results are well worth the effort.

The new generation of executive performance research: its implications for health care

Much recent attention in the business press has focused on how executives think. That is a radical departure from the traditional research emphasis on simple behavior. This article reviews current research to document what is different about the way successful executives think. Many common assumptions about executives being rational, deliberate, and systematic have been disproven. Instead, executives are found to think in ways not suspected by most researchers. As health care enters times of rapid change, lessons learned from executives in other sectors can offer much to our understanding of executive performance. Current documents from the academic and popular business presses are reviewed in this article.

Planning and management for health in periods of economic stringency and instability: a contingency approach

The mid-1970s marked the end of the longest period of uninterrupted economic growth in history, and initiated in Europe--and other parts of the world--a period of economic stagnation and instability. Along with the prosperity explosion of the past, the pattern of health problems has changed and is still changing. Moreover, the demand for health care has kept on rising, without much improvement of health status in general. Thus, there is a critical need to rethink policies, and to ensure that future changes occur within the limits of shrinking resources and the allotted time-span. In particular, the change in priorities envisaged by the Health for All 2000 (HFA 2000) strategies will need to take place against the background of an ageing population, social instability, and continuing development of new lifestyles and persistent economic scarcity. It is by analysing that background that this article seeks to make recommendations as to how health planning and management might successfully cope with the policy reorientation of the HFA 2000 strategy. The structure of this article is as follows. Firstly, the changes taking place in planning conditions will be reviewed, and form the basis of a framework for subsequent analysis of the planning environment. Following this framework, some of the conflicts likely to be faced in planning and management will be discussed, many of which are the consequence of economic stringency and instability. Also the requirements for an improvement of the effectiveness and efficiency of planning will be identified. Finally, a limited number of approaches to planning will be considered, for their appropriateness to the present-day economic circumstances. The point of view elucidated throughout is that there is no single solution which is 'best' under all circumstances. The conclusion, rather, is that the selection of particular theory or method of planning and management should depend both on the objectives of the decision maker and on the determinants of the planning environment. General prescriptions should not be made. At the same time, some elements have to be stressed in all types of planning, namely: the orientation towards outcomes or outputs of problems; the attention to long-term strategic thinking; and, the application of more efficient, flexible and less bureaucratic approaches.

Measuring the extent of gerontological home care staff participation in agency policy making and planning

A survey study of the work experience and views of administrative and direct service program staff (N = 91) in both small scale and large scale Older Americans Act-funded home care programs in New York City sheds light on the extent to which various categories of personnel in the field of community home care have opportunities to participate in a range of agency policy making and planning functions. Findings reveal that home care staff in small scale programs were more directly involved in both client-centered and program-centered policy/making activities. In particular, these workers felt they were significantly more active in: changing service plans; discussing changes that need to be made in how the agency operates; planning new services and programs at the agency; and helping to train or orient new workers in the program. A strong negative correlation between level of organizational complexity and worker participation rates was discovered. Additional data suggest that all staff, regardless of their status or work responsibility, would like to be granted more of a voice in planning decision. Those who participate least in such activities were most adamant over being given a greater role in this aspect of program life. Heightened levels of job satisfaction were also associated with greater measures of worker involvement in organizational decision-making. Study findings are seen to have implications for the design of more equitable decision-making mechanisms in gerontological home care specifically and human service programs generally.

Marketing linen services to hospitals: a conceptual framework and empirical investigation

In light of the recent diagnosis related groups of illnesses (DRG) regulation, a very timely problem must be addressed concerning how linen service contractors can increase their penetration into the health care market. A conceptual framework is developed to understand the decision making porcess of hospitals with respect to linen services. An empirical investigation is reported, which assesses the relative importance of the factors involved in various phases of the decision making process using Thurstone's Case V analysis. Implications of the findings are discussed.

Technology as an occasion for structuring: evidence from observations of CT scanners and the social order of radiology departments

New medical imaging devices, such as the CT scanner, have begun to challenge traditional role relations among radiologists and radiological technologists. Under some conditions, these technologies may actually alter the organizational and occupational structure of radiological work. However, current theories of technology and organizational form are insensitive to the potential number of structural variations implicit in role-based change. This paper expands recent sociological thought on the link between institution and action to outline a theory of how technology might occasion different organizational structures by altering institutionalized roles and patterns of interaction. In so doing, technology is treated as a social rather than a physical object, and structure is conceptualized as a process rather than an entity. The implications of the theory are illustrated by showing how identical CT scanners occasioned similar structuring processes in two radiology departments and yet led to divergent forms of organization. The data suggest that to understand how technologies alter organizational structures researchers may need to integrate the study of social action and the study of social form.

Product-line management: systems and strategies

Over the last two years, the healthcare delivery system has become much more competitive from the perspectives of both price and internal management control. The environment has led many hospital managers to consider product-line management organizational changes. This article defines product-line management as "the organizational structure, management control systems, and delivery strategies for healthcare services structured around case types or major clinical services." The article also delineates the organizational issues influenced by product-line management and the management tools necessary for product-line managers. An actual example of how product-line management can be delivered is presented using The Johns Hopkins Hospital experience. An action plan for implementation is also presented for hospital managers desiring to develop product-line management philosophies in their hospitals.

A group decision making process for facility layout in hospital clinical laboratories

While quantitative and computer-based models can be used for developing alternative clinical laboratory layout plans, consideration should be given to qualitative and personal factors during the layout finalization phase. Described here is a group decision making process used for planning facility layout. The process is applied to a case study Chemistry/Hematology department.

Design of a management support system for hospital strategic planning

Recent changes in the health care industry that foster competition are drastically affecting hospital planning and marketing activities. Increased price competition, the development of less costly alternative health care delivery systems and providers, and the shift to prospective average-cost reimbursement for Medicare beneficiaries are major factors promoting a new emphasis on strategic hospital planning. Hospital information systems do not currently support the sophisticated data-collection and analysis requirements that will be needed to implement strategic planning activities. New data must be collected and old data must be analyzed and stored in new ways. New hospital information systems designs are needed to cope with the change in the economic structure of the health care industry and its effects on hospital information needs. This paper proposes a system design for a management support system that will assist hospital administrators and planners in analyzing internal organizational data and external industry data to develop strategic planning objectives, strategies, and business plans. Analysis of the structure and process of hospital strategic planning was performed to identify the information needs of hospital planners. A prototype system is currently being implemented at the University of Arizona. The system provides an integrating framework for data base management systems, executive information systems, model management systems, and dialogue management systems. Objective analytical models and subjective strategic planning models are available to assist with idea structuring and decision processing.

Shared governance: a strategy for transforming organizations. Part 2

Nursing leaders know change is not easy: it produces varying degrees of chaos and ambiguity. Maintaining control and traditional structure to minimize either chaos or ambiguity, however, does not achieve the final goal: organizational transformation and effective responses to changes in the environment and the organization. Given our current environment and its demands, we must remember that superficial changes will not address the fundamental problems. Transforming philosophies are relevant and needed in organizations. Transformation requires a shift in our perspectives, our attitudes, and our beliefs. Shared governance is one strategy for assisting in transforming nursing organizations. By sharing power and control with staff, leaders can effectively help to empower the whole and provide leadership that is visionary and creative. The end result of this transformation is meaningful collaboration and a humane, quality nursing system responsive to client needs.

Market model addresses hospitals' need for decision support

A Decision Support System should be approached, not as "starting over," but as a natural extension of the design and development of a hospital's current HIS. Integrated, real-time HISs generate reams of information that, when combined with relevant external data, provide the essential information base for a hospital DDS. The Travenol Market Model is discussed as an example of a DSS specific to hospital needs.

Controllership in the public sector

Ineffective or incompetent controllership is, perhaps, the most common managerial failure found in the public sector. This failure affects outcomes and achievements in every area of public policy--often profoundly. Controllers design and operate management control systems. The effectiveness of alternative control system designs depends upon the cost and production behavior of the good or service in question. But control strategies are seldom consciously or effectively matched to circumstances. As a consequence, public programs are too often simultaneously overcontrolled and out of control.

The strategic management of hospitals: toward an integrative approach

Evidence indicates that hospital planners do not widely practice strategic management. An integrative approach to strategic management may, however, enable them to better operate in today's increasingly turbulent environment, and hospital strategists can learn from the mistakes of businesses in the corporate sector.

Computers in decision support for health service managers

This paper considers general features of computers as management aids, showing how they can be used to deliver concise, accurate, timely and relevant information to the manager. It also considers possible problems, both current and future, that may arise in computerised decision support.

Planning for hospitals: no focus, no strategy

This is a study of the role of long-range planning and strategic management in 400 hospitals in the United States. It examines not only the structural aspects of planning but also investigates how the data base generated through the planning process is actually used in making operating decisions. In addition to a questionnaire survey of 400 hospitals on the structural aspects of planning, 78 personal interviews with functional heads and hospital administrators were conducted to analyse the operational part of the study. The major findings are that the possibilities and constraints of planning are remarkably similar to those of industrial corporations. The linkage of planning with operational decisions was found to be lacking. There were wide divergences in views between the functional heads and the hospital administrators in terms of internal and external activities, and also in performance reward relationship. These divergences are thought to be counter-productive in realizing the strategic focus of cost containment. Implications of the findings are also discussed.

Physician leadership in hospital strategic decision making

In this article, three models of hospital strategic decision making are presented. These models focus on the role of physician leaders, particularly chiefs of clinical services, in decision making regarding major changes in the nature and scope of hospital services. The recommended model of decision making for any individual hospital is contingent on the competitive environment which the hospital faces, the complexity of decisions which must be made, and the characteristics of the physician leadership.

Venture profile analysis

Imposed restrictions on inpatient revenue have encouraged hospitals to seek alternative sources of revenue through diversification. The venture profile analysis is a low-cost, orderly process to help hospitals plan for service diversification. Potential business ventures are assigned a weighted score based on nine evaluation criteria. Potential business ventures with high relative scores should be those opportunities with the greater prospects of success and those deserving of serious consideration by the hospital. The format of the profile facilitates active involvement of board members in the decision making process and prudent management of risk in market-based strategic planning.

Delegation: a revelation

Every hospital administration grapples with the problem of delegation. The notion of delegating responsibility (and corresponding authority) is basic to management literature. In fact, the process of delegation underpins many concerns that today's management studies focus on. But more germane to hospital administration is the position of this article: The range of delegated authority as actually and specifically worked out in your hospital setting is an invaluable, concrete measure of and insight into the use of critical and costly human resources. Today, these factors are especially crucial because pressures brought to bear on the hospitals create situations that pit hospitals against each other in both a win-lose and a lose-lose situation (with the win-win alternative becoming more and more rare). This article addresses the notion of delegation in its depth and range, suggests two techniques to measure delegation concretely, and explores what different kinds of delegation reveal about administrators and their administrations.

Administration and the hospital pharmacist

What is administration anyway? Administration is just one damn thing after another! Why is it important? Good administration is necessary for a strong hospital pharmacy department. Weak departments don't get a lot of attention these days--until they really screw up! The average hospital pharmacist often overlooks the importance of good administration in the hectic day to day activities of providing pharmaceutical services. I will attempt to shed some light on the frequently misunderstood role of administration and the usually much maligned administrator.

Strategic planning in healthcare systems raises new management concerns

Strategic planning is increasingly necessary in the current healthcare environment. Systems, as well as individual organizations, are finding the need for formalized strategic planning. In this study, data from eight systems was gathered and a number of conclusions drawn about strategic planning in healthcare systems, including: no "right" design exists, but the process should be flexible and customized; the need for formalized planning increases as the system matures; effective planning requires adequate capabilities at the organizational level; and a mix of local and corporate goals is needed to decide key issues.

Formal relationships among governing boards, CEOs, and medical staffs in independent and system hospitals

This study examines the impact of hospital participation in multi-institutional arrangements on formal relationships between hospital governing boards and chief executive officers (CEOs) and between governing boards and hospital medical staffs. Hypotheses are derived from Mintzberg's general theory of organizational design and are tested using combined data from three American Hospital Association Surveys of nonfederal, short-term hospitals. Analysis results provide considerable support for the study hypotheses. CEOs were found in general to have more formal influence in decisionmaking but also were more likely to be held accountable for performance standards in those hospitals that are part of multi-institutional arrangements. In addition, analyses using both 1976 and 1982 survey data indicate that hospital participation in multi-institutional arrangements is associated with lower levels of formal involvement of the medical staff in institutional decisionmaking. Relationships, for the most part, remain unchanged after the introduction of statistical controls for hospital size. One important issue raised by these findings is the possible impact on hospital performance of less participation by medical staff in the governance of hospitals whose boards are either responsible for multiple hospitals or accountable to higher organizational authority.