Managing hospital census through physician/administrator teamwork.

This article describes the process of successful implementation of a system to manage and control a hospital's inpatient census. The system has implications not only for every department, but for every profession within a hospital environment. Described here is the overall impact of the system within a hospital. Also presented are important factors which have contributed to the success of implementation in this complex setting.

Substitution among nurses: its impact on charge nurses' perceptions of quality of care.

The results of the study suggest that both independent variables influence the charge nurses' perceptions. The relationship between the independent and dependent variables provides an understanding of the decision-making process that a charge nurse follows in making substitution decisions. The management policy implications of the study are as follows. Allowing charge nurses the flexibility for nurse substitutions is helpful in dealing with problems associated with nurse shortages and varying patient needs. Charge nurses observe specific decision rules for substitutions among nurses to balance staff availability with patient need while preserving standards of quality of care. Finally, nurse substitutions have a potential for cost savings.

Productivity-based relative value units for radiology procedures. A Delphi approach.

This paper presents a methodology to develop relative value units (RVUs) for radiology procedures. The RVUs were developed to measure and to monitor the productivity of radiologists and technologists in a large HMO. In all, 13 radiologists and 33 technologists participated in a Delphi process to develop relative weights for 595 procedures in eight different radiology modalities, including CAT scanner and ultrasound. The RVUs generated were readily accepted by the users and are currently being implemented in the computerized information system at the HMO.

Measurement of task delegations among nurses by nominal group process analysis.

Task delegations among different nursing skill levels (RNs, LPNs, NAs) are empirically measured in this study by performing a nursing activity analysis. Instead of relying on conventional techniques of time study and work sampling, this study incorporates Nominal Group Process and specially designed questionnaires for analyzing nursing activities. Approximately 100 nurses from a 193-bed short-term general hospital participated in the study. The resulting task delegation rates are compared with hospital policy, and a comparison is also made between different nursing units.

A mixed-integer goal programming model for nursing service budgeting.

This paper presents a mixed-integer goal programming model for expense budgeting in a hospital nursing department. The model incorporates several different objectives based upon such considerations as cost containment and providing appropriate nursing hours for delivering quality nursing care. Also considered are possible trade-offs among full-time, part-time and overtime nurses on weekdays as well as weekends. The budget includes vacation, sick leave, holiday, and seniority policies of a hospital and various constraints on a hospital nursing service imposed by nursing unions. The results are based upon data from a study hospital and indicate that the model is practical for budgeting in a hospital nursing department.

Planning and decision making for ambulatory surgery.

There has been rapid growth in the number of ambulatory surgical centers in the United States over the past few years. Yet little research has been done to assist community health planners and surgeons in decision making and planning for ambulatory surgery. In this paper, an analytical framework is developed to assist surgeons in deciding whether to perform a procedure on a ambulatory or an inpatient basis. The Hospital Discharge Survey data collected by the National Center for Health Statistics are also analyzed to investigate their applicability in this analytical framework as well as to aid planners in developing community-wide ambulatory surgery projections. In spite of the limitations on the available data, the models developed here suggest possible future avenues for planning ambulatory surgeries.

Measurement of Nursing Work Load Using Head Nurses' Perceptions.

A methodology for measuring and predicting work load on nursing units utilizes perceptions of head nurses as measured by a specially designed questionnaire. The data were collected in a 300-bed shortterm general hospital over a seven week period. The results indicated that head nurses' perceptions of need on nursing units were predominantly influenced by unit census and available staff on the unit. Other patient load affecting variables, such as patient classification, number of new admissions, or postoperative patients, did not play a major role in shaping head nurses' perceptions.