The Effect of Certificate of Need Laws on All-Cause Mortality.

OBJECTIVE: To test how Certificate of Need laws affect all-cause mortality in the United States. DATA SOURCES: The data of 1992-2011 all-cause mortality are from the Center for Disease Control's Compressed Mortality File; control variables are from the Current Population Survey, Behavioral Risk Factor Surveillance System, and Area Health Resources File; and data on Certificate of Need laws are from Stratmann and Russ (). STUDY DESIGN: Using fixed- and random-effects regressions, I test how the scope of state Certificate of Need laws affects all-cause mortality within US counties. PRINCIPAL FINDINGS: Certificate of Need laws have no statistically significant effect on all-cause mortality. Point estimates indicate that if they have any effect, they are more likely to increase mortality than decrease it. CONCLUSIONS: Proponents of Certificate of Need laws have claimed that they reduce mortality by concentrating more care into fewer, larger facilities that engage in learning-by-doing. However, I find no evidence that these laws reduce all-cause mortality.

Building the "fable hospital"--the CEO's perspective: an interview with Michael H. Covert, president and chief executive officer, Palomar Pomerado Health. Interview by David A Tam.

Hospital construction is a significant event in any health system. The financial implications are great, especially at a time of shrinking capital resources. Personnel are affected, as are the processes to perform their tasks. Often, new facilities are catalysts that change organizational culture; it has been clearly shown that new facilities have a positive impact on patient satisfaction scores. The members of the C-suite of a hospital/health system play important roles in construction projects. However, no one is more critical to the success of such major endeavors than the chief executive officer (CEO). The CEO sets the tone for the project, giving direction to the design and construction process that may have implications for the rest of the organization. Palomar Pomerado Health (PPH) is the largest public health district in California. In 2002, the PPH governing board authorized the creation of a new facility master plan for the district, which included the construction of a replacement facility for its tertiary care trauma center. The new Palomar Medical Center is slated to open in August 2012. HERD had the opportunity to speak with PPH CEO Michael H. Covert on the role of the CEO in the building of this "fable hospital".

The challenge of innovation and the high-performance team.

PURPOSE: This paper describes the use of a high-performance team model in the leadership of a healthcare construction project with a vision of fostering innovation in the design and building process. This model facilitated the effective implementation of = Lean principles and a joint governance model combining stakeholders under a shared vision. BACKGROUND: The healthcare facility discussed is a California healthcare district in San Diego. Because of state seismic safety legislation, the district elected to build a replacement hospital for its tertiary care trauma facility. The organization's leadership decided to pursue a course that demanded innovation in both the design and construction process. The owner, architects, construction manager, and trade contractors adopted a high-performance team model to meet this challenge. CONCLUSIONS AND RECOMMENDATIONS: The governance and leadership of a construction project should reflect the design and ultimate intent of the facility. The vision of building the most innovative hospital under constrained resources required the implementation of an innovative approach to leading the construction process.

Acute mental health care according to recent mental health legislation. Part III. Structuring space for acute mental health care.

OBJECTIVE: This is the third of three reports on the follow-up review of mental health care at Helen Joseph Hospital (HJH). The study reviewed existing South African standards for mental health care facilities. Architectural principles and implications for the use of space were deducted from recent legislation. Objectives were to evaluate the use of space in the existing physical facilities, to identify appropriate architectural solutions considering identified human rights requirements and to provide provisional cost estimates to align the unit towards its designated functions. METHOD: Personal interviews were conducted. An on-site assessment and survey was made of existing and potential new spaces. RESULTS: Spatial requirements for implementing the Mental Health Act, No. 17 of 2002 (MHCA) were explored. Principles for spatial design of acute facilities include that: - spaces should communicate clear individual identity; - space should be segregated into zones according to user functionality and privacy; - communal leisure spaces should open into safe contained outdoor spaces; - circulation routes should preferably be circular; - sufficient visual connection should exist between circulation space and group activities; and - open lines of sight should be provided to all access points. The potential options for extension included: - an extensive unused single storey structural shell for a potential office wing on the same floor; - a huge vacant double volume space which could be accessed across the existing flat roof for potential occupational therapy activities; and - the existing roof area could be altered and secured to become an adequate outside leisure and garden area. A proposed concept design in two phases - based on these principles - was submitted to hospital and provincial management. CONCLUSION: To implement the MHCA without violating the human rights of mental health care users at HJH will require specific adjustment and extension of the current use of space at HJH.

Institutional transfer from the European design practices to Ukraine and Moldova: the case of hospital design.

This article explores the development of post-soviet hospital design through the analysis of recent modernisations in Moldova and Ukraine. It consists of two parts. First, an introduction of the definition of hospital design as well as its main characteristics during the Soviet period. Secondly, a presentation of two hospital modernisations in Ukraine and Moldova. In a comparative perspective, the paper presents the actors involved, the difficulties in modernising the hospital regarding the inherited rules as well as the solutions advanced in order to implement a change. An introduction to the hospital design in Moldova and Ukraine will allow an in-depth study of the involvement of international actors in the post-communist transformations.

The development of certificate of need legislation.

This article examines the development of Certificate of Need (CON) legislation in the United States. Over time, CON legislation developed into efforts to contain rising health care costs, while maintaining quality of care. In recent years, numerous states have begun to reevaluate the current impact of CON regulations, and ask whether the programs should be discontinued. State regulators as well as academic researchers must address the costs vs. benefits of such legislation. Specific measures within such regulations must be addressed in order for health policy makers, administrators, and researchers to help meet the escalating demand for health services.