Timothy Rotarius

Governance of Integrated Delivery Systems/Networks: A Stakeholder Approach

The health care environment is complex and turbulent, and traditional governance forms face many challenges. As integrated delivery systems/ networks are formed, governance structures must be responsive to both internal and external stakeholders. Both internal efficiencies and socially responsible actions are required of these relatively new organizational forms. To meet these needs, a two-tier governance structure is presented that consists of overarching and facilitating boards.

The problematic fit of diagnosis and strategy for medical group stakeholders--including IDS/Ns.

This article extends stakeholder management theory using data from 270 medical practice executives to identify key stakeholders and determine the “fit” between stakeholder diagnosis and stakeholder management strategy. Four optimal and 12 suboptimal situations are identified.

Stakeholder management in a hyperturbulent health care environment.

The fast-paced change in todays health care environment presents an unsettling organizational climate within which managers must make important decisions that affect key stakeholders. This ambiguousness has resulted in the proliferation of health care organizations that are bundling together to find a sense of environmental stability in which they can achieve common goals. This means that health care managers need to view stakeholders as parts of larger bundles rather than only as individual organizations.

Emergency department utilization by insured users: a study of motivating factors.

Emergency departments (EDs) represent a critical entryway into Americas health care delivery system and are under significant pressure. This study seeks to understand why insured patients use EDs rather than more appropriate medical alternatives available to reduce the strain they are placing on this critical portal of entry. This exploratory research study surveyed insured patients presenting to 1 of 4 Central Florida EDs. Factor analysis and cluster analysis were used to identify groups of insured ED users defined by motivating factors. This study found that there exists a disconnect between insured individuals and the primary care system.

Not-for-profit versus for-profit health care providers--Part II: Comparing and contrasting their records.

The debate over which health care providers are most capably meeting their responsibilities in serving the publics interest continues unabated, and the comparisons of not-for-profit (NFP) versus for-profit (FP) hospitals remain at the epicenter of the discussion. From the perspective of available factual information, which of the two sides to this debate is correct? This article is part II of a 2-part series on comparing and contrasting the performance records of NFP health care providers with their FP counterparts. Although it is demonstrated that both NFP and FP providers perform virtuous and selfless feats on behalf of Americas public, it is also shown that both camps have been accused of being involved in potentially willful clinical and administrative missteps. Part I provided the background information (eg, legal differences, perspectives on social responsibility, and types of questionable and fraudulent behavior) required to adequately understand the scope of the comparison issue. Part II offers actual comparisons of the 2 organizational structures using several disparate factors such as specific organizational behaviors, approach to the health care priorities of cost and quality, and business-focused goals of profits, efficiency, and community benefit.

The laboratory workforce shortage: a managerial perspective.

Most clinical laboratories in the nation report severe difficulties in recruitment and retention of most types of personnel. Other important factors impacting this problem include work complexities, increased automation, and a graying workforce. As a further challenge, institutional needs for clinical laboratory personnel are expected to grow significantly in the next decade. This article examines the current situation of the clinical laboratory workforce. It analyzes the different types of personnel; the managerial, supervision, and line positions that are key for different types of laboratories; the job outlook and recent projections for different types of staff; and the current issues, trends, and challenges of the laboratory workforce. Laboratory managers need to take action with strategies suggested for overcoming these challenges. Most importantly, they need to become transformational leaders by developing effective staffing models, fostering healthy and productive work environments, and creating value with a strategic management culture and implementation of knowledge management.

An RBRVS approach to financial analysis in health care organizations.

Resource-based relative value scales (RBRVS) have altered the outpatient reimbursement system of Americas health care system and established a method of standardization whereby the efficiency of medical practices of varying size and complexity can be compared using a standard (the cost conversion factor) for analysis. This article compares the utility of RBRVS with earlier systems of reimbursement and concludes with a brief speculative assertion regarding the emergence of the next stage of ambulatory care reimbursements through ambulatory payment classifications.

Behavioral contract management: a prescription for employee and patient compliance.

A health care managers responsibilities of offering efficient service while ensuring effective outcomes is hampered frequently by both employees and patients whose unacceptable behaviors are detrimental to one or both of these mandates. Behavioral contracts offer a structured method that allows both patients and employees to self-actualize the required behavioral changes. When noncompliant behavior is diagnosed, behavioral contracts are the prescription that places the responsibility for corrective action squarely on the shoulders of the offending individual.

Administrative decision making: a stepwise method.

Todays health care organizations face tremendous challenges and fierce competition. These pressures impact the decisions that managers must execute on any given day, not to mention the ever-present constraints of time, personnel, competencies, and finances. The importance of making quality and informed decisions cannot be underestimated. Traditional decision making methods are inadequate for todays larger, more complex health care organizations and the rapidly changing health care environment. As a result, todays health care managers and their teams need new approaches to making decisions for their organizations. This article examines the managerial decision making process and offers a model that can be used as a decision making template to help managers successfully navigate the choppy health care seas. The administrative decision making model will enable health care managers and other key decision makers to avoid the common pitfalls of poor decision making and guide their organizations to success.

Uncompensated care and emergency department utilization: a local study having national implications.

This article provides a comprehensive picture of the manner in which uncompensated care patients utilize the emergency departments (EDs) of two Central Florida hospitals. Specifically, this study assesses the impact of treating uncompensated and primary care patients in ED settings on scarce hospital and community resources. Recommendations are being offered to manage a troubling situation that is occurring with alarming frequency in todays health care system throughout the United States. Special emphasis is placed on recommendations addressing alternative triage and financing models that are considered to be both socially responsible and economically viable. The results of this study suggest strongly that health care organizations must find an alternative to the current trend in ED utilization, in order to meet the primary care needs of patients and not compromise the care provided to those with emergent conditions. The recommendations emanating from this study outline a mechanism that can improve the timeliness of emergency care to those in need, while at the same time, making available primary care resources to those seeking services through an emergency department.