Alternative indicators for measuring hospital productivity.

This article explores the premise that the appropriateness and usefulness of typical hospital productivity measures have been affected by three changes in delivery: Organizational restructuring and other definition and data source changes that make full-time equivalent employee (FTE) measurements ambiguous. Transition to prospective payment (diagnosis-related groups). Increase in capitation (prepaid, at risk) programs. The effects of these changes on productivity management indicate the need for alternative productivity indicators. Several productivity measures that complement these changes in internal operations and the external hospital business environment are presented. These are based on an analysis of four hospitals within a multihospital system, and an illustration and interpretation of an array of measures, based on ten months of actual data, is provided. In conclusion, the recommendation is made for hospital management to collect an expanded set of productivity measures and review them in light of changing expense and revenue management schemes inherent in new payment modes.

Organizationally sponsored health services research.

Organizations, particularly large multi-institutional health delivery systems, have begun to sponsor their own research programs as a consequence of the scope and complexity of management and governance decisions they face. These research programs are functionally integrated into the organization and serve as a strategic management planning and decision-making tool. Their primary purpose is seen to be the comprehension, analysis, synthesis, application, and evaluation of the vast amount of information available within the organization and from the health delivery system. Their emphasis is on making research results relevant to organizational goals and objectives, applicable to organizational decisions, and utilized. Organizationally sponsored researchers, it has been shown, face a particularly complex set of management and research requirements in building their programs. Developing the research agenda and establishing an infrastructure for the conduct of research are critical to success. Once accomplished, the organizationally sponsored researcher does have particular advantages in conducting the research and in seeing the findings used to improve health care delivery. We have cited and addressed a number of concerns or issues relating to the emergence of organizationally sponsored research. Some are specious in origin; others arise out of an incomplete understanding of the systems of evaluation and reward which have traditionally applied to professional researchers. It is in terms of the intended beneficiary of the research and the extent to which the results are made to apply directly to the organizational manager that differences emerge--not in the quality or quantity of research accomplished, in the use of inductive or deductive approaches, or in the objectivity of results.