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2.
Clin Orthop Relat Res ; 476(10): 1910-1919, 2018 10.
Article in English | MEDLINE | ID: mdl-30001293

ABSTRACT

BACKGROUND: In an era of increasing healthcare costs, the number and value of nonclinical workers, especially hospital management, has come under increased study. Compensation of hospital executives, especially at major nonprofit medical centers, and the "wage gap" with physicians and clinical staff has been highlighted in the national news. To our knowledge, a systematic analysis of this wage gap and its importance has not been investigated. QUESTIONS/PURPOSES: (1) How do wage trends compare between physicians and executives at major nonprofit medical centers? (2) What are the national trends in the wages and the number of nonclinical workers in the healthcare industry? (3) What do nonclinical workers contribute to the growth in national cost of healthcare wages? (4) How much do wages contribute to the growth of national healthcare costs? (5) What are the trends in healthcare utilization? METHODS: We identified chief executive officer (CEO) compensation and chief financial officer (CFO) compensation at 22 major US nonprofit medical centers, which were selected from the US News & World Report 2016-2017 Hospital Honor Roll list and four health systems with notable orthopaedic departments, using publicly available Internal Revenue Service 990 forms for the years 2005, 2010, and 2015. Trends in executive compensation over time were assessed using Pearson product-moment correlation tests. As institution-specific compensation data is not available, national mean compensation of orthopaedic surgeons, pediatricians, and registered nurses was used as a surrogate. We chose orthopaedic surgeons and pediatricians for analysis because they represent the two ends of the physician-compensation spectrum. US healthcare industry worker numbers and wages from 2005 to 2015 were obtained from the Bureau of Labor Statistics and used to calculate the national cost of healthcare wages. Healthcare utilization trends were assessed using data from the Agency for Healthcare Quality and Research, the National Ambulatory Medical Care Survey, and the National Hospital Ambulatory Medical Care Survey. All data were adjusted for inflation based on 2015 Consumer Price Index. RESULTS: From 2005 to 2015, the mean major nonprofit medical center CEO compensation increased from USD 1.6 ± 0.9 million to USD 3.1 ± 1.7 million, or a 93% increase (R = 0.112; p = 0.009). The wage gap increased from 3:1 to 5:1 with orthopaedic surgeons, from 7:1 to 12:1 with pediatricians, and from 23:1 to 44:1 with registered nurses. We saw a similar wage-gap trend in CFO compensation. From 2005 to 2015, mean healthcare worker wages increased 8%. Management worker wages increased 14%, nonclinical worker wages increased 7%, and physician salaries increased 10%. The number of healthcare workers rose 20%, from 13 million to 15 million. Management workers accounted for 3% of this growth, nonclinical workers accounted for 27%, and physicians accounted for 5% of the growth. From 2005 to 2015, the national cost-burden of healthcare worker wages grew from USD 663 billion to USD 865 billion (a 30% increase). Nonclinical workers accounted for 27% of this growth, management workers accounted for 7%, and physicians accounted for 18%. In 2015, there were 10 nonclinical workers for every one physician. The cost of healthcare worker wages accounted for 27% of the growth in national healthcare expenditures. From 2005 to 2015, the number of inpatient stays decreased from 38 million to 36 million (a 5% decrease), the number of physician office visits increased from 964 million to 991 million (a 3% increase), and the number of emergency department visits increased from 115 million to 137 million (a 19% increase). CONCLUSIONS: There is a fast-rising wage gap between the top executives of major nonprofit centers and physicians that reflects the substantial, and growing, cost of nonclinical worker wages to the US healthcare system. However, there does not appear to be a proportionate increase in healthcare utilization. These findings suggest a growing, substantial burden of nonclinical tasks in healthcare. Methods to reduce nonclinical work in healthcare may result in important cost-savings. LEVEL OF EVIDENCE LEVEL: IV, economic and decision analysis.


Subject(s)
Chief Executive Officers, Hospital/economics , Hospital Costs , Hospitals, Voluntary/economics , Medical Staff, Hospital/economics , Orthopedic Surgeons/economics , Pediatricians/economics , Salaries and Fringe Benefits/economics , Chief Executive Officers, Hospital/trends , Cost-Benefit Analysis , Hospital Costs/trends , Hospitals, Voluntary/trends , Humans , Medical Staff, Hospital/trends , Orthopedic Surgeons/trends , Pediatricians/trends , Retrospective Studies , Salaries and Fringe Benefits/trends , Time Factors , United States
3.
Health Care Manage Rev ; 43(1): 61-68, 2018.
Article in English | MEDLINE | ID: mdl-27280583

ABSTRACT

BACKGROUND: The relationship between Chief Executive Officer (CEO) succession and hospitals' competitive performance is an area of interest for health services researchers. Of particular interest is the impact on overall strategic direction and health system performance that results from selecting a CEO from inside the firm as opposed to seeking outside leadership. Empirical work-to-date has yielded mixed results. Much of this variability has been attributed to design flaws; however, in the absence of a clear message from the evidence, the preference for hiring "outsiders" continues to grow. PURPOSE: This paper investigates on the extent to which insider CEO succession versus outsider succession impacts hospitals' competitive advantage vis-à-vis a sample of organizations that compete in the same sector. METHODS: A hospital matching protocol based on propensity scores is used to control for endogeneity and makes comparisons of productivity across organizations through the use of stochastic frontier estimation. FINDINGS: Succession negatively impacts hospitals' productivity, and firms with outsider CEO succession events closed the gap toward the competitive advantage frontier faster than comparable firms with insider successions. PRACTICE IMPLICATIONS: More research needs to be done on succession planning and its impact on CEO turnover.


Subject(s)
Career Mobility , Chief Executive Officers, Hospital/trends , Efficiency, Organizational , Hospitals/statistics & numerical data , Administrative Personnel , Economic Competition/economics , Economic Competition/statistics & numerical data , Humans , Leadership , Personnel Selection/organization & administration , Surveys and Questionnaires
4.
Gac. sanit. (Barc., Ed. impr.) ; 31(5): 423-426, sept.-oct. 2017. tab
Article in Spanish | IBECS | ID: ibc-166622

ABSTRACT

Objetivo: Evaluar la cultura de seguridad del paciente en personas directivas/gestoras. Método: Estudio descriptivo transversal efectuado entre febrero y junio de 2011 en personal directivo/gestor del Servicio Aragonés de Salud mediante entrevistas semiestructuradas. Resultados: Se realizaron 12 entrevistas. Todos/as admitieron la existencia de diversidad de problemas de seguridad del paciente y coincidieron en reconocerla como prioritaria de forma más teórica que práctica. La excesiva rotación de directivos/as se consideró como una importante barrera que dificulta establecer estrategias a largo plazo y dar continuidad a medio plazo. Conclusiones Este trabajo recogió las percepciones sobre cultura de seguridad del paciente en directivos/as, hecho esencial para mejorar la cultura de seguridad del paciente en este colectivo y en las organizaciones que dirigen (AU)


Objective: To assess patient safety culture in directors/managers. Methods: Cross-sectional descriptive study carried out from February to June 2011 among the executive/managing staff of the Aragón Health Service through semi-structured interviews. Results: A total of 12 interviews were carried out. All the respondents admitted that there were many patient safety problems and agreed that patient safety was a priority from a theoretical rather than practical perspective. The excessive changes in executive positions was considered to be an important barrier which made it difficult to establish long-term strategies and achieve medium-term continuity. Conclusions: This study recorded perceptions on patient safety culture in directors, an essential factor to improve patient safety culture in this group and in the organizations they run (AU)


Subject(s)
Humans , Safety Management , Quality of Health Care/trends , Hospital Administration/trends , Patient Safety/standards , Organizational Culture , Chief Executive Officers, Hospital/trends , Leadership , Qualitative Research
6.
Gac. sanit. (Barc., Ed. impr.) ; 27(5): 388-397, sept.-oct. 2013. tab
Article in Spanish | IBECS | ID: ibc-116017

ABSTRACT

Objetivos: Identificar las competencias actuales y las necesarias para el futuro de los directivos y técnicos de salud pública de Cataluña. Métodos: Investigación cualitativa de perspectiva fenomenológica. Se realizaron 31 entrevistas individuales semiestructuradas a profesionales de la salud pública de Cataluña, entre noviembre de 2009 y febrero de 2010. La muestra fue teórica, intencionada y razonada para incluir la máxima pluralidad discursiva. Se realizó un análisis de contenido temático. Resultados: Se ha obtenido una amplia variedad de competencias actuales y necesarias para el futuro, clasificadas por perfil profesional. Como competencias transversales destaca la necesidad de compartir un marco teórico general sobre la disciplina y la institución. Las más enfatizadas son la gestión del conocimiento, las habilidades comunicativas, el trabajo en equipo interdisciplinario, la orientación intersectorial, los conocimientos jurídicos, las habilidades informáticas y el inglés. Es importante que cada profesional disponga de competencias específicas en su área de actuación. En las competencias específicas hay más diferencias entre técnicos y directivos. Los técnicos priorizan competencias en gestión de recursos humanos y materiales, por las dificultades que se encuentran diariamente. Los directivos dan más importancia a los valores profesionales y organizativos relacionados con la salud pública. Conclusiones: Se requieren competencias transversales, en consonancia con un profesional versátil, y competencias específicas según el ámbito de actuación. Estos resultados confirman que la salud pública es un área de conocimiento multidisciplinario que trabaja estableciendo alianzas y colaboraciones más allá de disciplinas, profesiones y organizaciones (AU)


Objectives: To identify current and future competencies (managers and technicians) for public health professionals in Catalonia (Spain). Methods: Qualitative research with a phenomenological approach. Between November 2009 and February 2010, 31 semistructured interviews were completed with public health professionals working in Catalonia. We purposely used a theoretical sample to include the maximum multiplicity of discourses. We conducted a thematic content analysis. Results: We obtained a wide range of current professional competencies, as well as those required for the future, classified according to professional profile. The participants highlighted transversal competencies, such as the importance of sharing a general theoretical framework of the discipline and the institution. Among the most frequently reported competencies were knowledge management, communication skills, teamwork, multidisciplinary and intersectoral orientation, legal knowledge, computer skills and languages, particularly English. It was also important for individual professionals to have specific skills in their areas of activity. In terms of differences between managers and technicians, the study showed that technicians prioritize management skills concerning human and material resources, while managers emphasize organizational and professional public health expertise. Conclusions: There is a need for transversal and specific competencies in distinct areas. Public health is a multidisciplinary field, which collaborates with a wide range of professionals and organizations (AU)


Subject(s)
Humans , Professional Competence , Public Health , Qualitative Research , Chief Executive Officers, Hospital/trends , Allied Health Personnel/trends , Personnel Management
12.
Health Care Manag (Frederick) ; 28(2): 134-41, 2009.
Article in English | MEDLINE | ID: mdl-19433931

ABSTRACT

A study was conducted to determine if workforce demographics of chief executive officers within hospitals in the United States were changing. It sought to analyze the retirement patterns and the current gender mix of chief executive officers in hospital settings within the United States. It also sought to capture the perspectives of those in top-level executive positions in regard to the educational requirements of future health care executives.


Subject(s)
Chief Executive Officers, Hospital/statistics & numerical data , Adult , Chief Executive Officers, Hospital/education , Chief Executive Officers, Hospital/trends , Data Collection , Female , Humans , Leadership , Male , Middle Aged , Professional Competence/statistics & numerical data , Retirement , United States
15.
Mod Healthc ; 32(39): 6-7, 12, 1, 2002 Sep 30.
Article in English | MEDLINE | ID: mdl-12389382

ABSTRACT

Several high-profile shake-ups in healthcare exemplify a strategy recently gaining popularity: Keep physicians happy during times of turmoil by making one the boss. Hospital boards find the move to be a magic elixir when trying to build trust with doctors concerned over rocky leadership. Larry Hollier, M.D. (left), chief physician at New York's Mount Sinai Medical Center, was made president to further that trust.


Subject(s)
Career Mobility , Chief Executive Officers, Hospital/trends , Hospital-Physician Relations , Physician Executives/trends , Chief Executive Officers, Hospital/statistics & numerical data , Humans , Leadership , Physician Executives/statistics & numerical data , Trust , United States
16.
La Paz; OPS/OMS; nov. 2000. 26 p.
Non-conventional in Spanish | LIBOCS, LIBOSP | ID: biblio-1301101

ABSTRACT

El alcance del trabajo de la presente consultoría, consistió en: promover y facilitar a los Directores de SEDES y Directores de complejos hospitalarios de las ciudades de Cochabamba, Potosí, Santa Cruz y Sucre, el diseño y puesta en marcha del proceso de desarrollo de la gestión autónoma de hospitales de tercer nivel de complejidad de atención en cumplimiento del D.S. Nº 25233. Sin embargo, la demanda de apoyo técnico por parte de los directores de SEDES de Pando y Oruro amplió el trabajo a seis ciudades. El presente informe recoge la situación encontrada en los distintos hospitales del país, el estado de motivación, las estrategias y los avances en materia de autogestión


Subject(s)
Chief Executive Officers, Hospital/trends , Health Management , Analysis of Situation , Bolivia , Health Strategies
18.
Physician Exec ; 23(8): 19-24, 1997.
Article in English | MEDLINE | ID: mdl-10176682

ABSTRACT

At the end of World War II, one-third of the nation's hospital administrators were physicians. During the 1950's through the mid-1980's a new breed of masters'level administrator, with well-honed coordinating skills, orchestrated a major expansion of new programs, services, and facilities. With the advent of the Medicare prospective payment system (PPS), more governing boards restructured their administrative staffs with corporate titles. Meanwhile, physicians sensed that trustees were becoming far more concerned with bottom line performance to repay a mounting debt that hospitals had incurred to remain technologically competitive. Since mergers and integrated health systems by themselves will be unable to generate significant operating efficiencies, governing boards will be forced to change direction and shift back to recruiting physicians as their CEOs or in other senior positions to assure themselves of the clinical leadership required to implement the managed care concepts of reducing utilization and cost, and simultaneously enhancing quality of patient care.


Subject(s)
Chief Executive Officers, Hospital/trends , Hospital-Physician Relations , Physician Executives/trends , Community Health Planning/organization & administration , Community Networks/organization & administration , Delivery of Health Care/trends , Delivery of Health Care, Integrated/organization & administration , Governing Board , Hospital Planning , Leadership , Managed Care Programs , United States
20.
Health Care Manage Rev ; 21(2): 62-73, 1996.
Article in English | MEDLINE | ID: mdl-8860042

ABSTRACT

This 1988-1992 study follows up on research on Utah hospital CEO turnover between 1973-1987. For both periods, the highest turnover rate was transfer/promotion, followed by force out, retirement, death, and quitting. There was one change: For-profits had significantly higher turnover than nonprofits. For both periods, the lowest rates of turnover and involuntary turnover were in the largest hospitals, all urban, all but one in a multihospital system, and one for-profit.


Subject(s)
Chief Executive Officers, Hospital/supply & distribution , Personnel Turnover/trends , Career Mobility , Chief Executive Officers, Hospital/economics , Chief Executive Officers, Hospital/trends , Employment , Health Services Research , Hospital Administration/classification , Hospital Administration/statistics & numerical data , Hospital Bed Capacity , Hospitals, Proprietary/organization & administration , Hospitals, Voluntary/organization & administration , Humans , Job Satisfaction , Organizational Affiliation , Prospective Studies , Retirement , Utah , Workforce
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