The hidden competencies of healthcare: why self-esteem, accountability, and professionalism may affect hospital customer satisfaction scores.

Data from 103 for-profit, nonprofit, and government-owned hospitals, spread across about half of the United States clearly show that there are common elements and several core competencies in all hospitals, some probably driven by JCAHO accreditation standards, but others coming from universal experience stemming from the changes in healthcare. The common competencies that are not, in my opinion, driven directly by the JCAHO standards include professionalism, accountability, self-esteem, customer service/focus, communication, information management/using data in decision making, and teamwork. There are several possible connections among the core competencies that suggest that the effects of accountability and possibly self-esteem on such outcomes as patient satisfaction and quality of care should be the subject of more research in healthcare settings. There are, however, several possible interventions to increase the core competency base of any hospital, which can be applied without this research. Executives and managers who attempt to measure and change these common competencies through selection, assessment, organizational system change, or reward and compensation systems will change the competence base of their workforce in critical areas needed in the future healthcare economy. Using a competence model incorporating these competencies may change the culture of the organization toward that which will be needed for survival in the twenty-first century.

The Joint Commission has provided a tool to change your work force: are you paying attention?

Most health care managers wonder how to change employee "attitudes" so that their staff will be more accountable for patient satisfaction, cost reduction, and quality of care. Employees were trained to function in an industry where the power players were the physician and the administrator and now it is exceedingly difficult to get them to switch their attention to the patient and the payer in a market-driven economy. For hospital managers, the answer may be right at their fingertips: The Joint Commission on Accreditation of Healthcare Organizations' standards demanding that employee competence be objectively measured, proven, tracked & trended, improved, and age specific. A comprehensive competence assessment system can save the health care manager enormous work in measuring fewer things, focusing performance assessment on the 20 percent of things that are true problems, and helping to specifically define certain competencies such as customer focus and cost consciousness so that coaching, training, and giving performance feedback is easier. Developing a comprehensive competence assessment system is a powerful tool to change the culture of organizations. Consequently, it is important that managers be aware of those possibilities before they embark on developing "competencies" or before their organizations get too carried away on redesigning systems to satisfy standards.

Sexual harassment in health care: a major productivity problem.

Sexual harassment in health care is a problem because of exorbitant legal costs, lost productivity, poor morale, and nonproductive absenteeism or turnover. Sexual harassment is more prevalent in health care. Health care organizations often do little to prevent it and do not respond properly when it occurs. In this article, legal precedents are reviewed, and a model of sexual harassment is developed to illustrate the phenomenon and identify interventions. Harassing and stereotyping behavior can be changed. Victims' responses and willingness to report incidents can be changed. Policies, sanctions, accountability, training, the type of investigations, and changed organizational culture help reduce sexual harassment. It is argued that reduction of sexual harassment in health care is important because it is a major productivity issue.

Beyond JCAHO: using competency models to change healthcare organizations. Part 2: Developing competence assessment systems.

In 1996, JCAHO required hospitals to assess, prove, track, and improve the competence of all employees. This article is the second part of a review of the concept of competency assessment and the implications of meeting and exceeding the JCAHO standards. Part 1 (in the previous issue of Hospital Topics) provided the theory of competence assessment, the current situation in JCAHO surveys, and an overview of the problems inherent in competency assessment. This part puts competence assessment in the context of quality improvement and provides the details of developing competence assessment systems.

Beyond JCAHO: using competency models to improve healthcare organizations. Part I.

In 1996 the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) required hospitals to assess, prove, track, and improve the competence of all employees. Part 1 of this two-part series discusses competencies, their assessment, and the implications of meeting and going beyond JCAHO's requirements. Part 2, which will appear in the next issue of Hospital Topics, provides specific guidelines for the development of a competence assessment system and its practical application.

Retinal hemorrhages from septic emboli in a patient with a ventricular false chorda.

PURPOSE: To demonstrate ophthalmic findings of bacterial endocarditis in a patient with a cardiac structural anomaly and to illustrate the potential usefulness of transesophageal echocardiography in the examination of such patients. METHODS: We examined a patient with bacteremia who had white-centered retinal hemorrhages. Complete clinical, laboratory, and echocardiographic evaluations were performed. RESULTS: Streptococcal bacteremia was proven and, by using transesophageal echocardiography, a ventricular false chorda was demonstrated. CONCLUSIONS: Patients with white-centered retinal hemorrhages should undergo thorough systemic examinations. In this unusual case of such hemorrhages caused by bacteremia in a patient with a ventricular false chorda, modern, high-resolution transesophageal echocardiography played an important role in confirming the diagnosis.

Care of patients.

Hospital accreditation standards have changed from focusing on capability to actual performance and outcomes. This shift in emphasis requires organization leaders and staff members to make significant paradigm shifts. In this series of articles, the authors will discuss the functional standards for 1994-1995 and their implications.

Functional standards. The walls come tumbling down.

Hospital accreditation standards have changed from focusing on capability to actual performance and outcomes. This shift in emphasis requires organization leaders and staff members to make significant paradigm shifts. In this series of articles, the authors will discuss the functional standards for 1994-1995 and their implications.

Angiotensin degradation products mediate endothelium-dependent dilation of rabbit brain arterioles.

This study demonstrates that the hexapeptide angiotensin II-(3-8) and L-arginine, generated through enzymatic degradation of angiotensin, mediate endothelium-dependent dilation in rabbit brain arterioles. Topical application of angiotensin II (10(-5) M) on the brain surface of anesthetized rabbits caused 21.6 +/- 4.5% (mean +/- SEM) cerebral arteriolar dilation. The cyclooxygenase inhibitor indomethacin did not change this dilation. The natural degradation product of angiotensin II in the brain, angiotensin III, also induced vasodilation at concentrations of 10(-7) to 10(-5) M. The dilation to angiotensin II and angiotensin III was eliminated in the presence of 10(-5) M methylene blue, a known inhibitor of endothelium-dependent vasodilation. Amastatin, an aminopeptidase inhibitor and blocker of enzymatic angiotensin degradation, also inhibited the response to angiotensin II and angiotensin III. The angiotensin fragment angiotensin II-(3-8), which lacks the amino-terminal L-arginine residue of angiotensin III, did not elicit an arteriolar response. When angiotensin II-(3-8) was topically applied subsequent to L-arginine, a 21.2 +/- 2.9% vasodilation was observed. L-Arginine itself induced only moderate vasodilation with a maximum of 4.0 +/- 0.9% at 10(-5) M L-arginine. The dilating response to angiotensin II-(3-8) after L-arginine was inhibited by methylene blue. It was not affected by amastatin. It is concluded that degradation products of angiotensin, rather than angiotensin II itself, induce endothelium-dependent dilation in rabbit brain arterioles without involvement of cyclooxygenase products.(ABSTRACT TRUNCATED AT 250 WORDS)

Channel leadership in health care marketing: a natural role for hospitals.

Health care has entered an era of rapid change. Most observers agree that important long-term changes will fundamentally reshape health care as we know it. To that end, health care providers should consider the benefits of operating vertically integrated marketing system with hospitals as the channel leader. Whether an administered VMS (hospitals have the power to gain compliance) or a corporate VMS (hospitals own successive levels of care providers), integrated channel management holds the promise of cost containment and quality patient care for the future. However, a great deal of integrating work must be done before VMSs will become a practical solution. Research studies are needed on each of the issues just discussed. As marketers, it is time we make a transition from treating health care marketing as a disjointed entity and instead treat it as an industry where all marketing principles are considered including channel management.

Assessment center technology. Selecting head nurses.

Assessment center technology is a selection method for supervisory personnel. It uses a candidate's performance in actual work sample exercises. The use of assessment centers in selecting head nurses is explained. Specific results, such as increases in productivity, establishment of standards of practice, and increases in employee satisfaction, are described. Recommendations for assessment center use and suggestions for implementing assessment centers to select nursing managers are presented.