Just how integrated are integrated delivery systems? Results from a national survey.

This article examines three emergent processes in physician-hospital integrated delivery systems (IDSs). We find these processes are underdeveloped based on data gathered from a national sample of hospitals drawn from nine health care systems. These processes are also loosely coupled with the structures used to integrate physicians and hospitals, as well as with the environmental context in which they occur. Such loose coupling entails both advantages and disadvantages for IDSs.

Perceived effectiveness of teaching methods for heath services administration education.

This article brings to the forefront the challenges of establishing an empirical link between teaching methods and education outcomes in the classroom. In the health administration education field, precious little empirical data exist on the effectiveness of various teaching methods and approaches on achieving education outcomes. Results are reported from the 1998 National Survey of program directors of the AUPHA graduate programs on the perceived effectiveness of a wide range of teaching methods, using a Likert scale, ranging from very effective to not very effective. The authors elaborate on the highest- and lowest-ranked teaching methods, and propose a research agenda for measuring education outcomes in the classroom.

A framework for evaluating the impact of health services management education.

The objectives of this paper are three-fold. The first is to propose a conceptual and analytical framework for planning and evaluating health services management education programs. The framework was developed in response to the health care industry restructuring and the emerging questions and concerns regarding how to strategically redesign the educational programs for the twenty-first century. Additionally, it was used to develop a questionnaire for the 1998 National Survey of Program Directors. The second objective is to suggest variables for operationalizing the framework as the field considers initiatives such as, "Evidence-Based Health Administration Education" (AUPHA Education Outcomes Task Force 1999; Griffith 2000) and other more standardized, quantifiable approaches to assessing program quality. The third objective is to report selected results from the 1998 National Survey of Program Directors focusing on the major changes impacting the health services industry and the implications for management education and development. In the future, ACEHSA and other accrediting commissions will likely consider evidence-based evaluation criteria for assessing and improving education program quality. The framework presented in this paper can be used as a starting point for conceptualizing and developing valid and reliable measures.

Program directors' recommendations for transforming health services management education.

A survey of graduate program directors shows that they recognize major change taking place in the health services industry and the need for programs to respond with curriculum revision. The revisions proposed tend to emphasize more practice involvement and human resources management skills rather than increased quantitative and financial competencies. Is this the right direction for programs to take? Will such revisions produce graduates better able to manage and lead in the emerging health care environment? We need more evidence-based research to answer these questions. In the meantime we have developed an environmental typology suggesting some rather clear distinctions among programs according to their settings. We know that the resulting categories of programs vary according to their national reputations and the kind of students that they serve. Do these different categories of programs prepare their different students well for the changing health care environment? Our current evidence, again, is sparse, indicating the need for further research.

Physicians and organizations: strange bedfellows or a marriage made in heaven?

Underscoring the importance of physician-organization alignment as a necessary condition for building and sustaining integrated healthcare systems, this article provides information regarding the nature of such alignment, the key influential factors, and the processes employed to make alignment a reality. Structural and strategic factors address the influence of environmental, market, and organizational characteristics on alignment. The strategic intent of organizations and physicians, and physician perspectives on the effects of integration, are explored. Key processes examined include building trust, placing physicians in management and governance, and developing physician leadership. Continuing issues and challenges are considered, and a set of principles to help guide the journey of physicians and organizations toward successful alignment is suggested.

An exploratory analysis of market-based, physician-organization arrangements.

The growth of physician-organization arrangements (e.g., PHOs, MSOs) by physician specialty groups and delivery organizations is widely acknowledged. Yet, little is known about these new organizational forms. This paper presents a descriptive analysis of physician-organization arrangements (POAs) using survey data obtained from 79 organizations. The analysis examines the extent to which healthcare delivery organizations are engaged in the development of POAs, the number of physicians involved in POAs, and the decision-making control and strategies associated with POAs. These attributes are examined for the sample as a whole and relative to the institutional and market conditions facing study participants. Results are discussed in terms of their implications for health services managers.