A life cycle model of public policy issues in health care: the importance of strategic issues management.

Public policy affects health and social services organizations. Senior management has a responsibility to prevent inappropriate demands of stakeholders from predominating and to influence the outcome of public policy to the benefit of their organization through the strategic issues management process. This article presents a public policy issue life cycle model, life-cycle stages and suggested strategies, paths issues can take in the life cycle, and factors that affect issue paths. An understanding of these dynamics can aid senior managers in shaping and changing public policy issues and lessening external environment threats to their organization.

Quality, CQI, and reengineering in health services organizations.

Quality in health care is defined with a focus on satisfying customer needs. The contemporary management philosophies of continuous quality improvement (CQI) and reengineering are defined; attributes and applications of each are described. Criticism of reengineering appearing in the literature is presented. It is likely that CQI will remain a predominate management philosophy in health services, while reengineering may not endure in its form of radical change.

Managed care liability and ERISA preemption.

Patients enrolled in managed care organizations (MCOs) are concerned about quality of care and restrictions imposed. There is concern about being harmed due to the negligence of MCOs. Meanwhile, MCOs are protected by the federal Employment Retirement Income Security Act (ERISA) of 1974, which preempts state law claims and results in eliminating many of the recoveries otherwise available to a harmed beneficiary in non-MCOs. This article reviews the ERISA exemption and legal theories for patient redress.

Accreditation and continuous quality improvement in athletic training education.

OBJECTIVE: To apply the continuous quality improvement model commonly associated with the business sector to entrylevel athletic training education program accreditation. DATA SOURCES: We applied athletic training educational program accreditation as a tool for ensuring quality in the entrylevel athletic training education programs accredited by the Commission on the Accreditation of Allied Health Education Programs. Literature from the business, education, and athletic training fields is integrated to support this paradigm shift in athletic training education. DATA SYNTHESIS: The advent of mandated entry-level athletic training educational program accreditation has forced institutions to evaluate their educational programs. Accreditation will promote continuous quality improvement in athletic training education through mechanisms such as control measures and process improvement. CONCLUSIONS/RECOMMENDATIONS: Although accreditation of entry-level athletic training education programs has created some dissonance among athletic training professionals, it will strengthen the profession as a whole. Athletic training educators must capture the synergy generated from this change to ensure quality educational experiences for all our students as we move forward to secure a strong position in the allied health care market.

Problem solving in health services organizations.

Health services organization managers at all levels are constantly confronted with problems. Conditions encountered that initiate the need for problem solving are opportunity, threat, crisis, deviation, and improvement. A general problem-solving model presenting an orderly process by which managers can approach this important task is described. An example of the model applied to the current strategic climate is presented.

Organizational leadership in hospitals.

Hospitals face very dynamic environments and must meet diverse needs in the communities they serve and respond to multiple expectations imposed by their stakeholders. Coupled with these variables, the fact that leadership in these organizations is a shared phenomenon makes organizational leadership in them very complicated. An integrative overview of the organizational leadership role of CEOs in hospitals is presented, and determinants of success in playing this role are discussed.

An integrated model for continuous quality improvement and productivity improvement in health services organizations.

The health services paradigm with respect to quality has shifted to that of conformance to requirements (the absence of defects) and fitness for use (meeting customer expectations and needs). This article presents an integrated model of continuous quality improvement (CQI) (often referred to as total quality management) and productivity improvement for health services organizations. It incorporates input-output theory and focuses on the CQI challenge--"How can we be certain that we do the right things right the first time, every time?" The twin pillars of CQI are presented. Achievement of both will result in productivity improvement and enhancement of the health services organization's competitive position.

State health insurance initiatives: what the literature is telling us.

The absence in the United States of a comprehensive national health insurance system has left a significant number of people either without coverage or with only partial (and inadequate) coverage. Individual states have sought to remedy this through a number of initiatives, but the majority have been incremental in nature, not universal. Sifting through the extensive literature on what states are doing and have been doing, the author reveals the nature of their attempts (and their infrequent successes) and provides issues and questions that must be dealt with before a system acceptable--and accessible--to all can be achieved.

United States physician payment reform: background and comparison with the Canadian model.

This study reviews the new prospective Medicare Fee Schedule that will be used to pay United States physicians and compares it with the Canadian method of physician payment. The research basis and independent reviews of the resource-based relative value scale, and its conclusions and implications are also examined.

The Canadian and U.S. health care systems: profiles and policies.

Comparisons are made in this article between the Canadian and U.S. health care insurance and delivery systems. Canada has universal, comprehensive, and publicly funded health insurance for medically necessary hospital and physician services. The United States does not. Aggregate health care expenditures for both countries are examined as are those for the hospital and physician services sectors. Policy differences between both systems, including system models, health insurance financing, resource commitment and control, and service limits, are presented. Observations are made regarding two elements of the Canadian model--prospective physician sector and prospective hospital global budgeting--and whether they are transplantable to the United States.

International healthcare expenditures: spending totals and public satisfaction among the OECD nations.

As an introduction to this Hospital Topics theme issue on international healthcare systems, our guest editor and one of our authors present aggregate health expenditures and public-satisfaction data from member nations of the Organization for Economic Cooperation and Development. Although healthcare funding is not the explicit focus of this issue, it underlies most of the points raised, and however the health systems examined here may vary in structure or impact, financing remains a shared challenge and one of our best base lines for comparison.

An analysis of hospital union election activity: 1985-1987--by hospital ownership, size, and system, and employee organization and bargaining-unit size.

During the three-year period 1985-1987, there were 238 elections in nongovernmental, short-term hospitals to determine whether or not unions would represent the employees. Unions had a success rate of 47.1 percent, similar to that of earlier years. This study reports these election results by hospital and election characteristics. For hospitals, the analysis includes elections by census region, ownership, bed size, and multi-institutional characteristics. For elections, the analysis includes the nature and type of election, employee organization, and employee bargaining-unit-size characteristics. This study concludes that the number of union elections decline as hospital bed size increases, and the union success rate is curvilinear and higher in both small and very large hospitals; union success declines as bargaining-unit size increases. Investor-owned and nonprofit, religious hospitals that are members of multi-institutional systems have lower union success rates than nonsystem hospitals do in their ownership category. However, unions are much more successful in multi-union and decertification elections compared with single-unit elections and initial recognition elections.

Judicial review of NLRB rulemaking in the health care industry: implications for labor and management.

In 1987 the National Labor Relations Board set out to promulgate a rule to define the appropriate bargaining units for the health care industry, making the first use of its substantive rulemaking powers. This departure from the traditional process of adjudication of unit determination issues occurred because of thirteen years of NLRB frustration resulting from congressional admonition against proliferation of bargaining units and subsequent inconsistent judicial interpretation of that admonition. This article traces the factors that led to the decision to rulemake, discusses the development of the rule itself, and examines the rule's judicial experience to date. It presents empirical findings of hospital union election activity during the period from 1985 through 1987 that confirm the thesis that bargaining unit size is a significant variable in election outcomes. Finally, the authors assess the likely outcome of the impending Supreme Court decision on the rule, along with implications for labor and management.

Hospital personnel management in the early 1990s: a follow-up analysis.

Our article in the July-August 1986 issue of Hospital & Health Services Administration described the evolution of hospital personnel management from the pre-1965 to the post-1985 period by examining four different models and predicted trends for the late 1980s (Robbins and Rakich 1986). This article will provide an update and look at emerging trends in hospital personnel management for the early 1990s. A very brief recapitulation of the salient points made in 1986, including the contemporary Matrix Model of hospital personnel management, is presented, and the model's attributes are reassessed. This is followed by an analysis, by category, of the initial predictions of trends, the assessment of whether those trends evolved as anticipated, and expectations for the early 1990s. Finally, new trends, previously unforeseen, are presented.