Exploring the gender gap in healthcare management.

A 1990 study by ACHE and the University of Iowa compared the career attainments and attitudes of a group of male and female healthcare executives. The research showed that among men and women who had entered the field at the same time and had achieved similar educational levels, women did not fare as well as men in terms of salary, position level, or job satisfaction. A follow-up to this study, which consisted of two parts, was conducted in 1995 by ACHE, the University of Alabama at Birmingham, and Lamalie Amrop International to learn whether the gender gap had narrowed. The 1990 study divided respondents into groups according to the year they entered healthcare management: 1971-1975, 1976-1980, or 1981-1985. The first part of the 1995 project was a replication study that paralleled the 1990 study, dividing a new pool of respondents into three groups: 1976-1980, 1981-1985, and 1986-1990. The second part of the follow-up project was a panel study, in which respondents from the 1990 study were surveyed again. Following are highlights from the 1995 study.

The impact of CQI on human resources management.

If CQI is to become a mind-set and not simply a management fad, adjustments need to be made in all aspects of management, especially human resources management. This article will consider the impact of CQI on human resources philosophy and practice in health services organizations. The effects will be illustrated by the experiences of a group of human resources managers and the organizations in which they work.

Quality in the interorganizational setting.

For many patients, important health services are delivered by a process of care that spans several service organizations. Issues influencing the quality of care delivered across organizations are infrequently discussed in the health care quality literature. In this paper, interorganizational quality problems that detract from the care received by children with spina bifida, lead poisoning, and children who have been sexually abused are identified. Using concepts from the organizational behavior literature, both structural and group process approaches to addressing these problems are discussed to enhance the care received by children. A broader conceptualization of care delivery is required if patients whose care spans institutions are to benefit from quality improvement efforts.

Knowledge and self-reported use of universal precautions in a university teaching hospital.

This article reports a study of knowledge and self-reported use of universal precautions by professionals (individuals on the medical staff, in nursing service, in the laboratory, and in the social service, pastoral care, and respiratory care departments) and nonprofessionals (individuals working in the dietary and environmental services departments) in a university teaching hospital. Nonprofessional workers were found to be less knowledgeable about universal precautions than were professional workers. Appropriate use of universal precautions significantly correlated with a worker's perceived risk of exposure (positively correlated), the belief that HIV is easy to "catch" (negatively correlated), and the extent of the worker's involvement with HIV-infected patients (positively correlated). Use of universal precautions was not found to be significantly correlated with belief in universal precautions as a reasonable way to protect oneself from contracting HIV in the workplace. Recommendations are made for increasing appropriate use of universal precautions.

HIV-related knowledge, attitudes, and stress among health care providers: a literature review and research agenda.

The role of health services administrators in assuring high quality care for HIV-positive individuals and a physically safe, psychologically comfortable work environment for providers is an important one. Administrators need sound information on which to base policy and operational decisions about treatment of infected individuals. While the current literature provides some information in this regard, significant limitations and gaps remain. We have reviewed this literature and suggested a number of research issues that are relevant to administrative decision making. As the epidemic grows and changes in geographic diffusion and patient populations affected, empirical information to inform decision making will become even more critical. In addition, this information and the methods developed for data collection and interpretation in this area may be applicable to providers caring for a broader range of chronic conditions.

Cross-functional, integrative team decision making: essential for effective QI in health care.

Quality improvement methods first developed in industry can be applied in health care, but major adjustments in the traditional health care organization are needed for continuous improvement processes to work. One change is establishing cross-functional or multidisciplinary teams to carry out integrative decision making in the place of departmental hierarchical decision making within the functional areas and disciplines. This article cites examples from experience with one service process--delivery of care to newborns--and examines techniques from the group behavior and conflict resolution literature which could enhance the success of cross-functional teams in health care organizations.

Physician executives' characteristics and attitudes.

This monograph reports on a survey of physician executives who are members of the American College of Physician Executives. The survey emphasized four areas--factors in an individual's move into management as a career choice; satisfaction with management as a career or as an element of a career; factors that prepare a physician to manage; and factors in future development of physician managers.

Achieving the top: women in management.

Because of its unique structure, the health-care industry can take the lead in creating a responsive organizational environment where women can achieve top-level positions. This requires greater flexibility from both the organization and the individual. This article examines gender-related obstacles (e.g., a male-defined workplace and the inability of women to divorce themselves from family responsibilities) to career advancement and suggests some options to eliminate and overcome these obstacles (e.g., compressed and flexible time and mentoring).

Who really profits from not-for-profits?

In a Harvard Business Review (1987) article, Herzlinger and Krasker suggested that not-for-profit hospitals do not return more benefit to society than do for-profit hospitals, and the authors questioned the legitimacy of social subsidization of not-for-profits. Our article reports findings from an empirical reconsideration of the question, "Who profits from nonprofits?" We used hospital data from the same time period (1982) as that used by Herzlinger and Krasker; however, our investigation analyzed a larger data set (including both system and nonsystem hospitals) and used a different statistical technique (discriminant analysis). Our findings suggest that not-for-profits return more social benefit (e.g., in the areas of services provided, access to care, and involvement in professional education) than do for-profits. Like Herzlinger and Krasker, we find that for-profit hospitals may be more efficient than not-for-profits. We caution that public policy regarding social subsidization of not-for-profit hospitals should be made only after more intensive study and thoughtful consideration.

The relationship between technology and task design in hospital nursing units.

An empirical assessment of the use of the Hackman, Oldham, Janson, and Purdy (1975) implementing principles as a theoretical link between hospital nursing unit technology and job design is presented in this paper. While support for the implementing principles as an integrating mechanism was found to be weak, some insights into organization theory are noted and suggestions for future research resulting from this study are outlined.

Who profits from not-for-profits: a reconsideration.

'Who profits from nonprofits?' asked Herzlinger and Krasker in a recent Harvard Business Review article. Their study examined whether not-for-profit hospitals achieve the intended social goals for which they are subsidised by society. In this paper, we report a reconsideration of Herzlinger and Krasker's question. Using a larger data set and a different statistical method, our findings are at variance with those of Herzlinger and Krasker and in general agreement with their critics.

Career development of women in health care administration: a preliminary consideration.

As greater numbers of women enter health care administration, it is important to understand their career perceptions so that organizations can assist them in becoming effective leaders. This article reports findings from focused interviews of women administrators regarding their career development and expectations and suggests issues that require attention.

Leadership: implications of the literature for health services administration research.

In reviewing the literature and research on leadership, as conceptualized in the rational and natural system perspectives, we identified major trends and issues in the organizational literature on leadership. Our discussion of the implications of this literature for the study of health services organizations raised several questions, and identified them for future research.

Transformational leadership and the employee discipline process.

This article discusses what is meant by the term "transformational leadership" and suggests a method of employee discipline consistent with the transformational leadership concept. This nonpunitive method of employee discipline, called discipline without punishment, encourages worker commitment and facilitates transformational leadership. A description of the philosophy and procedures of discipline without punishment is presented, and potential advantages to employers are outlined.

The diffusion of two diagnostic technologies among hospitals in New York state.

Using combined data from an independent survey by the American Hospital Association and the State of New York, the diffusion of two diagnostic technologies--the automated chemistry analyzer and the computed tomography (CT) scanner--among hospitals in New York State was analyzed. A linearized form of the logistic function was estimated using cumulative diffusion data for each. Diffusion patterns of both technologies fit the logistic curve well, with the coefficient of diffusion for the CT scanner being greater than that for the automated analyzer. Further analysis examined characteristics of early adopters of each technology. Similar hospital characteristics (e.g., high volume of admissions and medical school affiliation) were important in explaining early adoption of both technologies.

Value-based leadership: are Catholic hospitals a step ahead?

An organization's culture is a pattern of beliefs and expectations shared by its members. It produces norms that shape behavior to ensure that the organization's day-to-day operations reflect the shared values. If the organization's performance is to be enhanced, these values not only must be communicated to all members but also must be internalized by them. Do managers in the Catholic health care ministry have sufficient understanding of their organization's culture as well as that of the sponsoring religious institute? A recent study to assess managers' educational needs contained a set of questions that addressed this particular issue. Responses to the survey, offered to acute care hospitals in the St. Louis metropolitan area, indicated that managers in Catholic health care organizations consider finance and accounting, planning, and interpersonal skills to be more important than the sponsoring religious institute's values in performing their jobs. Such a finding suggests the need for formal training in the mission and role of the Catholic health care ministry and for the continued use of mission effectiveness programs to assist in imparting the religious sponsor's charism and values to employees.

Hospital department heads and planning. Part II: Determining and answering the need for continuing education.

Planning skills are necessary to all line managers for effective performance of their jobs. It is doubtful whether hospital senior managers would disagree with this statement for any line managers whom they supervise. As with all management skills, continuing development and enhancement of planning skills are needed if a manager is to be up-to-date on current ideas and able to contribute fully to the organization's planning process. From this premise two questions arise: Do hospital line managers perceive a need for continuing development of their planning knowledge and skills? Does level in the organization (senior managers versus department heads) affect perception of these continuing education needs? This two part series describes a systematic investigation of the continuing education needs of hospital department heads in a Midwestern metropolitan area. Second, it compares department heads' perceptions of their own needs for continuing education in planning techniques and processes with the perceptions of senior managers regarding their department heads' needs. Differences in perceptions of the two management groups are explored and investigated. Finally, there are suggestions as to how department heads' continuing education needs can be effectively ascertained and met.

Survey. Part I. Hospital department heads and planning: determining and answering the need for continuing education.

Planning skills are necessary to all line managers for effective performance of their jobs. It is doubtful whether hospital senior managers would disagree with this statement for any line managers whom they supervise. As with all management skills, continuing development and enhancement of planning skills are needed if a manager is to be up-to-date on current ideas and able to contribute fully to the organization's planning process. From this premise two questions arise: Do hospital line managers perceive a need for continuing development of their planning knowledge and skills? Does level in the organization (senior managers versus department heads) affect perception of these continuing education needs? This two part series describes a systematic investigation of the continuing education needs of hospital department heads in a Midwestern metropolitan area. Second, it compares department heads' perceptions of their own needs for continuing education in planning techniques and processes with the perceptions of senior managers regarding their department heads' needs. Differences in perceptions of the two management groups are explored and investigated. Finally, there are suggestions as to how department heads' continuing education needs can be effectively ascertained and met.

Widowhood, sex, labor force participation, and the use of physician services by elderly adults.

This paper investigated the relationships of widowhood, sex, and labor force participation with the use of ambulatory physician services by elderly adults. Data on 18,441 individuals aged 55 and over were taken from the 1978 Health Interview Survey. Hierarchical regression results indicated that although these three factors are related to physician utilization at the zero- and first-partial levels, only sex remained significant when their two- and three-way interactions and other variables from the behavioral model (including living arrangements) were introduced. This suggests that the effects of widowhood and labor force participation are spurious. Widows are simply more likely to live alone and are less likely to work than widowers; those who live alone and do not work are more likely to use health services (and more of them) than those who live with others and are gainfully employed.

PIP: Studies typically report that widowed persons go to the doctor and to the hospital more often than married persons. Using data from the 1978 Health Interview Survey, the researchers studied 18,441 individuals aged 55 and older to clarify the effect of widowhood on physician use. They examined the unadjusted effects of widowhood, sex, and labor force participation on physician contact and the volume of physician visits. Next they adjusted the effect of each of the 3 factors for the other 2 and for the 2- and 3-way interactions among them. Finally, they introduced additional controls typically included in modelling the use of health services among elderly adults. 56% of the sample were women, 23% were widowed, and 34% were gainfully employed. 78% had seen a doctor at least once in the past 12 months. The controls used were taken from Anderson's behavioral model. Ordinary least squares regression analysis was used to obtain the unstandardized (and standardized) coefficients. Results show that although widowhood, sex, and labor force participation are related to physical utilization at the 0 and 1st- partial levels, only sex remained significant when their 2- and 3-way interactions and other variables from the behavioral model (including living arrangements) were introduced. Women are about 4% more likely to have seen a physician during the past year than men. Those who live alone are 5% more likely to have seen a doctor in the past year. Thus, the real effect is living alone, not being a widow. The researchers mention 2 cautions about the data: 1) generalization to other outcomes is tenuous; and, 2) the data do not indicate how long the widowed have been widowed.