George H. Pink

A Balanced Scorecard for Canadian Hospitals

Managing a health care organization on the basis of one set of information alone (e.g., financial information) does not give a full view of the impact of changes on the organization. A balanced scorecard approach can provide management with a comprehensive framework that turns an organizations strategic objectives into a coherent set of performance measures. This approach has been used extensively in industry, but seldom in health care organizations. By developing a scorecard approach, these organizations could obtain feedback providing a balanced view of organizational performance, letting them see if improvements in one area may have been achieved at the expense of another. It also demands that managers translate their general mission statement on customer service into specific measures that reflect the factors that really matter to customers.

Is the grass any greener? Canada to United States of America nurse migration

AIM Little or no attempt has been made to determine why nurses leave Canada, remain outside of Canada, or under what circumstances might return to Canada. The purpose of this study was to gain an understanding of Canadian-educated registered nurses working in the USA. DATA SOURCES Data for this study include the 1996, 2000 and 2004 USA National Sample Survey of Registered Nurses and reports from the same time period from the Canadian Institute for Health Information. FINDINGS This research demonstrates that full-time work opportunities and the potential for ongoing education are key factors that contribute to the migration of Canadian nurses to the USA. In addition, Canada appears to be losing baccalaureate-prepared nurses to the USA. DISCUSSION These findings underscore how health care policy decisions such as workforce retention strategies can have a direct influence on the nursing workforce. Policy emphasis should be on providing incentives for Canadian-educated nurses to stay in Canada, and obtain full-time work while continuing to develop professionally. CONCLUSION Findings from this study provide policy leaders with important information regarding employment options of interest to migrating nurses. STUDY LIMITATIONS This study describes and contrasts nurses in the data set, thus providing information on the context of nurse migration from Canada to the USA. Data utilized in this study are cross-sectional in nature, thus the opportunity to follow individual nurses over time was not possible.

Classifying psychiatric inpatients: Seeking better measures

BACKGROUND Use of case-mix reimbursement in psychiatric inpatients has been limited as a result of a lack of systems which effectively group patients according to required resource needs. In recognition of the fact that many patient factors, in addition to diagnosis influence delivery of care in psychiatry, new measures of patient need are emerging. OBJECTIVE This study compared improvement realized by using a multidimensional measure of patient severity, the Computerized Severity Index (CSI), to predict length of stay (LOS) in psychiatric inpatients over that achieved by using patient variables routinely collected in the discharge abstract. METHOD Through retrospective chart review, severity ratings were made on 355 psychiatric discharges with primary diagnoses of psychotic or major depressive disorders. Those ratings were combined with demographic and diagnostic data available in discharge abstracts and were then entered into multivariate regression analyses to model LOS. RESULT CSI ratings significantly contributed to prediction models, which accounted for an additional 9% to 11% of variation in LOS over discharge abstract data. Among patients with psychotic disorders, maximum severity during hospitalization was the best predictor of LOS, whereas among patients with depressive disorders, it was an increase in severity following admission. CONCLUSION Severity ratings, based on chart review, improved prediction of LOS over discharge abstract variables for psychiatric inpatients in two diagnostic groups. Further research is needed to estimate the impact of incorporating severity ratings into a grouping system for all psychiatric inpatients. Estimation of predictive accuracy is important to determine the amount of risk passed on to providers in a payment system based on psychiatric case mix.

Are managers compensated for hospital financial performance

Management compensation in a sample of 213 nonprofit hospitals in Ontario, Canada, is examined. Management compensation is determined first and foremost by hospital size and teaching status. Results indicate only a weak relationship between management compensation and hospital financial performance.

Prediction of the financial performance of Ontario hospitals: A test of environmental determinist and adaptationist perspectives

While other industries for many years have been concerned with the problem of financial distress, it is only recently that this issue has become a matter of interest to hospital managers, policy makers, and the general public. However, the determinants of hospital financial performance are neither well studied nor understood. The objectives of this study were to identify factors that affect the financial performance of Ontario hospitals and to construct a model that could be used to predict financial performance in the future. A number of organization and environmental factors that could influence financial performance were postulated and then tested for their statistical impact and predictive ability. Cross-sectional data over the 3-year-period 1986–1988 for 223 Ontario public hospitals were used. The first 2 years of data served as a derivation sample for hypothesis testing and development of a predictive model. The third year of data was used as a holdout sample for cross validation. Information on the variables investigated came from secondary sources, in particular Statistics Canadas Annual Hospital Returns. Univariate analyses revealed distressed hospitals were more likely to earn more revenues from non-government sources, to be non-teaching institutions and have longer chronic lengths of stay, and to be found in areas with higher per capita incomes, number of females in the population, physician supply, and area wage rates. A five variable prediction model was developed which accounted for 25% of the variance in financial performance in the derivation sample and on cross validation dropped to 21%. The model identified greater hospital size, older plants, higher technological complexity, more intensive care services, and location in areas with more females to be significant predictors of financial distress. Overall, environmental factors (community and structural characteristics) were more important in influencing financial performance. The implication for hospital managers is to underscore that an important dimension of successful leadership requires they remain outwardly focused and involved in managing the external environment. For policy makers the need is to develop funding formulae which encourage efficiency and are also responsive to differences in community and structural characteristics across hospitals.

Developing a nursing management practice atlas: Part 1, Methodological approaches to ensure data consistency.

Challenges associated with the use of secondary data sources for benchmarking in nursing administration research are identified. A methodological approach for ensuring data consistency is presented in part one of this two-part series. Part two (September 2000) will provide an analysis of the nursing management data, based on a set of nursing and financial resource benchmarking variables identified by the senior nurse executives of these sites. Initial findings show evidence of data consistency across similar hospitals.

The Canadian Hospital Executive Simulation System (CHESS)

The Canadian Hospital Executive Simulation System (CHESS) is a computer-based management decision-making game designed specifically for Canadian hospital managers. The paper begins with an introduction on the development of business and health services industry-specific simulation games. An overview of CHESS is provided, along with a description of its development and a discussion of its educational benefits.

Relative performance evaluation of non-profit hospitals.

In this paper, we use the relative performance evaluation model of Gibbons and Murphy (1990) to examine the relationship between management compensation and the absolute and relative financial performance of 223 non-profit hospitals in Ontario, Canada for the year 1985–86. We find support for the hypothesis of a positive relationship between absolute hospital performance and management compensation and a negative relationship between relative hospital performance and management compensation. Management compensation is also influenced by the size, teaching status, and religious affiliation of the hospital.

Sale and Leaseback by Canadian Hospitals: Theory and Practice

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