Integrating emergency services in an urban health system.

When planning for growth and management efficiency across urban health systems, economic and market factors present significant service line challenges and opportunities. This article describes the evolutionary integration of emergency services in St John Health System, a large, religious-sponsored health care system located in Detroit, Michigan. Critical business elements, including the System's vision, mission, and economic context, are defined as the framework for site-specific and System-wide planning. The impact of managed care and market changes prompted St John's clinicians and executives to explore how integrating emergency services could create a competitive market advantage.

Achieving success: assessing the role of and building a business case for technology in healthcare.

As the healthcare market continues to evolve, technology will play an increasingly important role in an integrated delivery system's ability to provide high-quality, cost-effective care. Healthcare leaders must be proactive and forward thinking about their technology investments. The financial investment for technology innovation can be significant. Therefore, it is important that healthcare executives deliberately design the role of technology and develop a consistent method for evaluating, identifying, and prioritizing technology investments. The article begins by describing technology's role in a healthcare organization as a window to the organization, a key driver of business strategy, and a high-performance enabler, and it develops a seven-step process for building a business case to ensure that an organization's technology investments are wise, well-reasoned, and will provide value to its customers. In addition, the article discusses the importance of combining people and process reengineering with new technology to exponentially increase the value to an organization. Healthcare leaders must understand the multiple roles of technology and consistently develop a business case when making technology investment decisions. Organizations driven by such an understanding will have a robust infrastructure of enabling technology designed to integrate people and process elements with technology to achieve the goals and initiatives of the organization. These organizations will lead the healthcare industry into the next millennium.

Physician contracts. Business and legal challenges.

There is no doubt that PPMCs are here to stay, at least for the near future. This article in no way addresses all of the legal and clinical concerns that the CNE may have when facing an arrangement with a PPMC. Even so, if the CNE can help forge agreements with PPMCs that are legally reliable, that are fiscally sound, that can be managed efficiently, and that are supportive of quality patient care, he or she will have made an invaluable contribution to the future of healthcare delivery.

Design or default? On becoming a 'big six' partner.

At one time, it was inconceivable to think of a nurse as a partner in a large, nationally known consulting firm. That has changed, and this courageous and tenacious woman tells of her journey to "Big Six" partner status.

Integration of emerging designs for the practice and management of nursing.

Work redesign and shared governance represent two of the most popular administrative innovations in contemporary nursing. Whereas work redesign creates changes in the content of nurses' jobs, shared governance addresses the organizational context within which nurses are employed. Although the content and context of nurses' work are closely interrelated, many organizations have attended to one of these issues, but failed to give consideration to the other. Building on this background, the state of the art in nursing redesign and restructuring is summarized, and emerging directions in job and organizational design are identified.

The nurse entrepreneur. Legal aspects of owning a business.

For those nurse executives and managers with an innovative flair and a desire for increased personal and professional autonomy and flexibility, becoming an entrepreneur holds promise of potential financial and personal rewards. The freedom associated with flexible hours and job setting enables many nurses to balance work, family, or school commitments. Along with these rewards come the legal responsibilities of owning and managing a business--something many nurse entrepreneurs believe is well worth the investment.

Managing a culturally diverse staff. Legal considerations.

Effective human resource management practices with an increasingly diverse work force must include consideration of relevant employment law. But leading organizations will venture beyond simply avoiding discriminatory practices. Managing staff differences that emerge from cultural diversity begins with awareness, moves toward sensitivity, evolves into understanding, and concludes with respect.

Revisiting collective bargaining.

Over the past 3 years, the massive unionizing campaigns forecasted have not materialized. Even so, the parameters of the AHA case are still being established. For example, the NLRB currently is attempting to determine if nurse practitioners still should be placed in a bargaining unit with registered nurses or physicians. Until this and other issues are resolved more clearly, nurse administrators must play a key role in balancing the professional concerns of patient care quality and staff satisfaction with the reality of current economics and healthcare reform. Clearly, unionization cannot be ignored in attempting to achieve that balance.