Capitalizing strategic planning costs to recognize future value

As healthcare organizations devote more resources to strategic planning, financial managers should consider capitalizing, rather than expensing, planning costs. Traditionally, healthcare organizations have absorbed these costs in the year a plan is developed. However, a strategic plan may be viewed as an intangible asset that provides the organization with future benefits. Therefore, its costs can be amortized over the plan's life.

Lessons learned from a prospective meta-analysis

OBJECTIVE

To describe the unique aspects of and the lessons learned in planning and conducting a pooled analysis of multiple trials evaluating interventions to reduce functional decline in hospitalized older persons. Specific examples from the Hospital Outcomes Project for the Elderly (HOPE) meta-analysis are discussed.

DESIGN

A prospective meta-analysis (PMA) that compiled and pooled data from concurrently conducted clinical trials testing related but distinct interventions.

SETTING

The Data Coordinating Center for the prospective meta-analysis coordinated the collection and analysis of common outcome data from five university-affiliated hospitals and one community hospital conducting the clinical trials.

PARTICIPANTS

Acutely ill hospitalized elderly participants at least 65 to 75 years old.

INTERVENTIONS

Treatments being evaluated included exercise, physical therapy, a multidisciplinary geriatric care unit, a multidisciplinary in-hospital intervention with post-discharge care, a nursing-based geriatric care program, and a program to improve detection and evaluation of delirious patients.

CONCLUSION

The prospective meta-analysis provides selected advantages over independently conducted clinical trials and retrospective meta-analyses. It does, however, pose special design and operational challenges that must be addressed well before initiation of the individual trials. Specific issues of concern include: maintaining scientific integrity of both the individual trials and the PMA; reaching consensus on PMA goals, what data to collect, how and when to collect them and how to maintain uniformly high quality data across all sites; defining the role of the Data Coordinating Center in a multicenter project that utilizes different trials and protocols; and establishing policies concerning analyses of the pooled data, publication of pooled analyses, and ownership of the pooled database.

Project management: putting continuous quality improvement theory into practice

A growing number of projects required by a changing national health care environment and an increased awareness of continuous quality improvement methodologies provided the impetus for the department of nursing at a 265-bed academic children's hospital to develop a standardized project management approach. The article describes how the project management process unfolded from beginning to end utilizing the plan-do-check-act cycle.

Delivering the message. Communications is a vital link in the strategic chain

Healthcare providers often treat communications as an afterthought when it comes to strategic planning. But that is a mistake in the 1990s. As providers adapt to the new managed care environment, marketing will be more important than ever. In recent years, providers have tended to devote much of their marketing budgets to advertising. The need to advertise will continue, but hospitals are increasingly using communications skills to educate consumers about changes in the healthcare system, the services available, and ways to get access to them. Hospitals are also marketing their staffs of associated physicians. They are launching community outreach efforts, both in city neighborhoods and in affluent suburbs. Realizing that women make most family healthcare decisions, hospitals are putting healthcare information booths in local shopping malls. Providers also need to keep in mind the changing nature of their "customers." Frequently, customers are not individuals but employers, insurers, and health maintenance organizations. To remain competitive, providers must demonstrate their cost-effectiveness to such payers through skillful communications.

Project 2000: a modular approach to course planning

Project 2000 has given nurse educators an opportunity to consider and plan educational programmes that will endure until the year 2000 and beyond. The United Kingdom Central Council for Nursing, Midwifery and Health Visiting (1986) highlighted the need for preparing practitioners for uncertainty by developing structures that adapt to rapid change. This includes planning smaller units of study, that are accessible and allow for credit transfers. This article describes the development of a semester based, modular programme of study, for Project 2000. The idea of modularity, both from the higher education and nurse education perspective is examined. An outline of the course is offered and for the benefit of colleagues who may be considering embarking on a similar remit, areas of difficulty encountered on implementation are highlighted with some resolutions.

Principles of health infrastructure planning in less developed countries

This article proposes a number of key principles for health infrastructure planning, based on a literature review on the one hand, and on a process of internal deduction on the other. The principles discussed are the following: an integrated health system; a thrifty planning of tiers within that health system; a specificity of tiers; a homogeneity of the tiers' structures; a minimum package of activities; a territorial responsibility and/or an explicit and discrete responsibility for a well-defined population; a necessary and sufficient population basis; a partial separation of administrative and public health planning bases; and, finally, rules for a geographical division and integration of non-governmental organizations. The definition of two strategies, primary health care and district health systems, is also revisited.

Management techniques at primary care health centers: the impact of management innovation

Long-term financial viability was a goal of The Program to Strengthen Primary Care Health Centers. To accomplish this, it was expected that participant centers would increase their management capabilities. We evaluated 32 management techniques in five principal areas: budgeting, strategic planning, general financial management, collections, and general health services management. Eight of the techniques showed change over the course of the demonstration (six increases and two decreases). It appears that there was somewhat more improvement among study centers than in a comparison group. Management sophistication has been expanding among health centers in general; Program participation appears to have accelerated this growth.

The change experience of a long-term care centre

This article highlights the methodology and approaches chosen in preparing for a major change in orientation at La Pietà in Hull, Quebec, devising the content for change and facilitating the implementation of new directions. It is based on the observations of the change seen within the organization, research and interviews with management and the hired consultant involved in the change process. The first part of the article establishes the situation confronting the organization. It then describes the frame of reference that was to guide the centre through the change process. The conclusion sums up the La Pietà experience in the light of the guiding principles and elements that together formed the frame of reference for the change.

Reengineering: how to create radical organization-wide improvement

Although reengineering may be considered by some as "the latest management fad," when applied broadly and boldly across the organization it can be a powerful driver to create sustainable and dramatic improvement throughout the organization. Thought-leading managers in healthcare should gain an understanding of the principles and concepts of reengineering and learn how to apply them to their individual situations when seeking improvements to quality, cost, timeliness, and customer satisfaction. Today's successful reengineers in healthcare, like Lori, will be tomorrow's leaders.

Transforming a hospital facility company into an integrated medical care organization

This article outlines the steps a major integrated health delivery system in Chicago has undertaken to transition from a primarily hospital-based fee-for-service organization to an integrated medical care organization operating under full-risk capitation. The focus is on vision setting, building a foundation for change, structural building blocks, network building steps, and lessons learned to date.