Hospital financial performance in the recent recession and implications for institutions that remain financially weak.

The recent recession had a profound effect on all sectors of the US economy, including health care. We examined how private hospitals fared through the recession and considered how changes in their financial health may affect their ability to respond to future industry challenges. We categorized 2,971 private short-term general medical or surgical hospitals (both nonprofit and for-profit) according to their pre-recession financial health and safety-net status, and we examined their operational status changes and operating and total financial margins during 2006-11. We found that hospitals that were financially weak before the recession remained so during and after the recession. The total margins of nonprofit hospitals (both safety-net and other institutions) declined in 2008 but returned to their pre-recession levels by 2011. The recession did not create additional fiscal pressure on hospitals that were previously financially weak or in safety-net roles. However, both groups continue to have notable financial deficiencies that could limit their abilities to meet the growing demands on the industry.

Constructing a European healthcare market: the private healthcare company Capio and the strategic aspect of the drive for transparency.

This article analyses the private healthcare company Capio and its participation in the drive for transparency in the European healthcare field. An important point of departure for the paper is that technologies for transparency, such as accounting and auditing, are not neutral devices for increased openness, but carry with them programmatic dimensions that affect our norms and rules of how healthcare is to be organized and controlled. The drive for transparency engages different actors with various motives. To investigate this we carried out semi-structured interviews with 11 persons, mainly management members of Capio. We show that transparency in healthcare has been put forward by a private actor for strategic reasons. We argue that Capio's involvement in the drive for transparency should be seen as a 'second-order strategy' with the aim to create advantageous opportunities in a future European healthcare market. We show that Capio, through its propagation of various transparency technologies, has put forward programmatic ideals of industrialisation, marketisation and Europeanisation in healthcare. The main conclusion is that although Capio has engaged in the drive for transparency for business reasons, the company has also furthered certain political ideals in the field. This study contributes to the literature which problematizes the division between private and public, and between business and politics in healthcare, and is of interest to a broad health policy audience.

Implementing the clinical nurse leader role in a for-profit environment: a case study.

The Clinical Nurse Leader project marks the first time in 35 years that nursing has introduced a new role to the profession. The project has evolved to include partnerships between more than 90 universities and 190 clinical sites. The authors present a case study of how a for-profit medical center created a sense of urgency for change, built a business case, and redesigned professional nursing practice to implement the Clinical Nurse Leader role.

Infection control consultation in a 150-bed acute care hospital: making this unobserved and unmeasured critical job function visible.

BACKGROUND: One qualified infection control director, reporting directly to administration, was responsible for the Infection Prevention and Control Program of a 150-bed acute care, non-teaching, for-profit hospital. To observe for potential trending, questions (consultations) and determinations related to infectious processes were documented. OBJECTIVE: To explore the possibility of measuring the essential although "hidden" function of the infection control consultation (process), which is a role not formerly linked to infection rates (outcomes). METHODS: A 7-year retrospective study was conducted of all infection control consultations requiring more than a 5-minute intervention, as part of routine job responsibilities. The XmR Statistical Process Control charts (XmR Charts) and Pearson's Correlation Coefficient were used to analyze the activity of infection control consultations. RESULTS: From January 1, 1998 to December 31, 2004, there were 770 infection control consultations logged for 375.1 hours. Beginning with 2003, the variation in both the number and duration of infection control consultations in the XmR Charts become more standardized and has a smaller moving range between data points. The Pearson's Correlation Coefficient shows statistical significance (P <.05) between the number and duration of consultations. CONCLUSIONS: Assessment of infection control consultations at this 150-bed hospital illustrates that this essential component can be measured, and should be formerly tracked to document overall assessment of infection prevention and control interdisciplinary interaction. The consultation process became more efficient over the 7-year study period because, as the number of questions increased, the duration required to achieve closure decreased.