The practitioner-teacher model revisited

Much of the recent literature on the future of health administration education notes the importance of strengthening linkages with practitioners by incorporating them into more formal roles within programs. This article describes the Rush University Department of Health Systems Management's process of implementing the practitioner-teacher model. The results of a faculty time commitment study support the conclusion that practitioners can play a key role in the development and administration of a graduate health care management program while maintaining their operational responsibilities. The implications of operating a fully integrated practitioner-teacher model and those aspects transferable to other graduate education settings are discussed.

The differential effects of a change in reimbursement on public and private university hospitals

The primary purpose of the government's prospective payment system was to decrease the rate of federal spending for Medicare patients by paying fixed prices for services and by transferring the financial risk for the care provided to the hospital. While PPS certainly has affected all hospitals, this article has attempted to identify some of the expected and unexpected consequences of the change in reimbursement on publicly and privately owned university hospitals. Of importance is the discussion that has analyzed the specific effects of PPS on the components of the UHs' missions. The implementation of PPS may exaggerate the effects of the payment change on both types of UHs. The provision of broadly based primary and specialty care services may be in question as institutions find themselves potentially unable to deliver these services on a price-competitive yet profitable basis. The costs associated with educational, research, and community service programs can no longer be subsidized by excess patient care revenues as payers streamline payments to reflect only the costs of clinical care. Thus, university hospitals may be forced to reexamine their missions and change their operating plans to reflect the current fiscal environment. If taken to an extreme, it is likely that the local society may be negatively affected by these actions. Clinical and community services that increase access, assure continuity of care, or provide needed but costly (public) health services may be eliminated or reduced in scope in an effort to contain costs. Even those services that are cost beneficial from a societal perspective may be eliminated without some form of subsidy or direct payment as institutions are forced to reallocate their limited funds from these types of public health services to support nonprofitable, but critical clinical or academic programs. The potential impact on access, continuity of care, and morbidity and mortality will not be known for many years. Although it is not known how these changes will eventually affect university hospitals, two outcomes seem clear. University hospitals with different governance and management structures may not change their missions and means for achieving institutional goals as much as might have been expected. The interdependence of the university hospitals' goals and the role they play in their local communities may force them to begin to explore new ways to achieve their missions. Public-private sector cooperation is suggested as one approach to use in response to the demands of payers and patients while the institution remains true to its historical mission.(ABSTRACT TRUNCATED AT 400 WORDS)

The effect of competitive environments on university hospital-medical faculty/staff relationships

The change in reimbursement and turbulence in the external environment are elements of uncertainty to all hospitals, including university hospitals. The organizational character of the university hospital presents it with substantial challenges as it strives to continue to meet its traditional role in society. Changes in policy may indeed be enacted with specific outcomes in mind--but they may result in totally unexpected longer-term effects on the institutions affected. This article--an attempt to develop a model and a set of propositions through which such changes can be analyzed as they affect the university hospital and its relationship to its medical faculty/staff--focuses primarily on the effects of such changes on the delivery of clinical services. While individuals viewing the same problem from different perspectives could reach other conclusions regarding academic activities and community services, the approach may be useful as an analytic tool for these areas of concern as well. For the sake of simplicity and because patient care is important both clinically and financially to the university hospital, it was chosen as the critical variable on which to focus the analysis. The analysis was predicated on the interaction of two perspectives from the general area of exchange theory. While each can contribute to an understanding of the dynamics of organizational change, their complementary nature allows one to analyze organizational environments from a more inclusive perspective. It is suggested that changes in policy that result in changes in organizational performance should utilize frameworks that integrate perspectives--focusing on commonalities, identifying differences and, in essence, triangulating on the management of critical relationships--to ensure successful implementation of the policy change. In this way, the analytic framework developed in this article should be useful as a close reflection of organizational reality. Prospective payment, price competition, alternative sources of care, and the oversupply of physicians threaten to change the balance of influence among the university hospital's influential actors. Depending on the decisions made, any of the four goals of the university hospital (patient care, education, research, and community service) may have to be modified or eliminated. The university hospital's historical role as the last resort for the severely ill, developer of new basic and clinical knowledge, and provider of indigent care may be in jeopardy. While the long-term effects of PPS and competition for patients cannot be predicted, speculation can be offered regarding the possibility of changes in the traditional physician-patient and faculty/staff-university hospital relationships as both institutional and external regulators and purchasers of care exert increased control over UH physicians. Such changes may lead to an under-supply of physician educators and physician scientists as a result of a change in policy

A case study approach to health care facility construction projects

In this paper, the authors present a useful overview of the planning, design, and construction process, emphasizing the importance of the practical application of management skills to that process. They suggest that health administration students develop "real life" skills by participating in case studies and role playing, led by planning and health care professionals. Educators frequently look for ways to assist the student in transferring the didactic skills learned in the classroom to their practical application. Case studies and role playing have been used in the management curriculum for this purpose. In this article, the authors use the construction project management process as a model for exploring the many interactions which take place during this process and relate those interactions to specific management skills needed by the health care executive. The use of the construction project as a case study allows the student an opportunity to experience a multidisciplinary team effort and to relate the principles of such academic disciplines as economics, organizational behavior, financial management, and labor relations to a real life setting.

Pricing hospital units of service using microcosting techniques

Traditionally, pricing of hospital-based ancillary and diagnostic services has been a reactionary response to a cost-based budgeting system. Revenue objectives have been determined by budgeted costs, new development, contractual allowances, and required net income. Since hospitals have found it difficult to accurately measure the costs of specific services, price setting has been reserved solely for senior management or for the financial division. Thus, operating managers and their professional (medico-administrative) counterparts have had little opportunity to participate in the price-setting process and, for the most part, have had little understanding of the cost components which should be analyzed before the rates are set. A great deal of confusion and questioning has developed surrounding the establishment of prices at the departmental level. Although hospitals have given some consideration to market forces, this element in the new competitive environment will have a greater impact on the services purchased by the various payors.

Faculty/staff contracts: an alternative for academic medical centers

Contracts such as those at Rush Medical College can help management set goals and evaluate progress, especially in manpower planning.

Study behaviors and their relationships to test anxiety and academic performance

Multivariate regression analysis of academic aptitude, test anxiety, and self-report study data from 122 undergraduates indicated high school rank to be the best predictor of grade point average. The number of days Ss reported studying and one test anxiety scale also added significantly to the prediction. Analysis of the study-relevant variables across the semester indicated differential patterns of study existed for students with good, average, and poor grades. The relative independence of test anxiety and study behaviors suggested that the latter class of variables might profitably be used to increase prediction of academic performance.