Howard L. Smith

The shocking cost of turnover in health care.

Review of turnover costs at a major medical center helps health care managers gain insights about the magnitude and determinants of this managerial challenge and assess the implications for organizational effectiveness. Here, turnover includes hiring, training, and productivity loss costs. Minimum cost of turnover represented a loss of >5 percent of the total annual operating budget. Editors Note: This article is being reprinted with permission from Health Care Management Review 29(1), 2-7.

Sources of organizational power for women: Overcoming structural obstacles

The ability of women (and men) to achieve success within organizational settings depends on their understanding structural and behavioral dimensions of power. However, the increased emphasis on educating women in the behavioral methods (e.g., assertiveness, aspirations, politics) of acquiring power invariably minimizes or omits the potential contribution of structural considerations. In their journey toward power acquisition, women must recognize and utilize the wide array of structural paths available to them. An analysis is undertaken of the main structural (organizational) sources of power — centrality, coping with uncertainty, and control over resources — with emphasis on their ramifications for women.

Considerations in predicting mental health care use: Implications for managed care plans

Managed care plans and other health care providers face a difficult task in predicting outpatient mental health services use. Existing research offers some guidance, but our knowledge of which factors influence use is confounded by methodological problems and sampling constraints. Consequently, available findings are insufficient for developing accurate predictions, which managed care plans need in order to formulate fiscally responsible service delivery contracts. This article reviews the primary data sources and research on ambulatory mental health services. On the basis of this review, the probability and intensity of outpatient visits are estimated. The primary predictors of use are also examined because they may help managed care plans forecast use by a given population or group of enrollees. Gender, age, race, education, health status, and insurance coverage are several variables surfacing as statistically significant predictors of use. The implications for planning capitated mental health services are discussed.

Managing system errors and failures in health care organizations: suggestions for practice and research.

The inherent design of health delivery systems predisposes them to errors and gradual rates of improvement. Health care executives and researchers should understand the importance of system errors and the role of leadership in removing perturbations that adversely affect health care organization performance. This article presents insights on strategies for addressing system errors and for reducing the magnitude of the problem.

The Impact of Emergent Network Structure on Organizational Socialization

Network analysis allows researchers to study patterns of roles or social relationships within organizations, and is especially usefulfor examining the impacts of informal systems on organizational socialization. This article presents a study of the level of connections within networks based on information flow, affect, influence, and the exchange of goods or services. Controlling for belief system, congregation size, and size of community, researchers selected 44 protestant churches for the sample and administered questionnaires randomly to congregation members. Researchers used the resulting data to analyze the effects of the four types of networks on knowledge, desire for growth, personal development, attendance rates, and outreach. The findings indicate that informal systems greatly affect socialization, especially when network connections are based on information flow. The authors conclude that further research should address additional network characteristics that may influence organizational socialization, should employ network analysis at the micro level, and should examine the actual process or organizational socialization.

Corporate Culture: The Missing Piece of the Healthcare Puzzle

Abstract The U.S. healthcare system requires radical, not incremental, change. Management issues in healthcare delivery are fundamentally different from those in the business world. Systems thinking forces a focus on corporate culture, about which there is little hard data. The use of cost/benefit analysis suffers from the lack of any accepted measure of long-term “benefit.” The authors make four observations: (1) corporate culture is both part of the cause and part of the cure for healthcare; (2) long-term financial and functional measures are necessary to make evidence-based decisions; (3) valid, nationwide data must be developed regarding the corporate culture of medicine; and (4) direct (unmodified) application of management theory or practices will not achieve sustainable improvements.

Does information technology make a difference in healthcare organization performance? A multiyear study.

N ow that Y2K worries are behind us, things will settle down as far as computers and information systems are concerned. Or will they? This question is certainly on the minds of healthcare administrators, whether they are managing hospitals or HMOs. One indication of the obsession with computer trends surfaced in a survey of medical group managers, who rated information technology (IT) as the most important of 23 key strategic and organizational issues that they face (Hospital 6. Health Networks 1997). The managers lacked confidence in their readiness and ability to deal with the IT issue. Given the economic and environmental pressures affecting the healthcare industry and the impact that IT may have on healthcare delivery, the medical group managers’ concern is not surprising. As consumers, regulators, insurers, and accrediting agencies continue to push for cost-effectiveness, open access, high clinical quality, and improved service, effective managed care demands that healthcare providers adopt IT, not just to manage costs but to aid clinical care as well (Davidoff 1997; Simpson 1999). Yet analyses by the Health Care Financing Administration (HCFA) and National Committee for Quality Assurance (NCQA) show that the most important factor contributing to rising healthcare costs and impaired quality of service is flawed healthcare information systems (Samuelson 1995). A range of perceptions and beliefs surround IT and its value to healthcare organizations. In this article we report the results of a study designed to shed light on the actual contribution of IT. Does IT make a difference in healthcare organization performance? A multiyear study of medical groups was undertaken to answer this question and provide guidance as healthcare organizations develop plans and make decisions about information technology.

Strategic planning in rural health care organizations

Is strategic planning associated with higher levels of performance in health care organizations? Is strategic planning effective? This article examines strategic plannings impact on rural hospital and rural nursing facility performance, organizational characteristics, and strategy. The findings suggest that strategic planning in rural hospitals is strongly associated with higher profits, operating margins and planning effectiveness, and associated to a lesser extent with lower costs and higher revenues per patient day. However, strategic planning does not appear to be associated with higher performance in nursing facilities. The implications for strategic planning in rural health care organizations are discussed.

Managing hospital-physician relations: a strategy scorecard.

Since the initiation of prospective payment, hospitals have been struggling to develop strategies that improve their prospects for long-run viability. Foremost among these strategy formulations have been efforts to build hospital-physician relations. This article reviews several popular strategies designed to achieve mutually satisfying hospital-physician relations.

A retrospective on Japanese management in nursing.

Managers in the public and private sectors have turned to Japanese management techniques as a means to improve quality and productivity. Many health care organizations have also adopted Japanese management concepts in the belief that performance will be improved. This article reviews the concepts, fundamental premises, and case studies of Japanese management in nursing. At issue is the value of Japanese management practices for nurses, patients, and organizations.