Severity of Illness and Profitability: A Patient Level AnalysisCarpenter, C. E.; Rosko, M. D.; Louis, D. Z.; Yuen, E. J.
doi: 10.1177/095148489901200403pmid: 10622800
Crafting a payment mechanism for hospitals that provides for the legitimate operating needs of efficient institutions is an enduring health policy dilemma. The Prospective Payment System used by Medicare and some other payers in the US has been criticized for not adjusting for differences in severity of illness within diagnosis-related groups (DRGs). Previous studies have examined the relationship between profitability and severity of illness at the hospital level. This study examines the relationships between severity of illness and cost, revenue, and profit at the patient level. Two measures of severity (disease stage and number of unrelated diseases) were significant predictors of cost per case, and often had better predictive power than DRGs. In most instances, payers did not compensate adequately for severity so that higher values for the severity variables resulted in financial losses for the hospital.
Maximizing the Contribution Doctors Make to NHS ManagementHearing, S.; Dent, T.; Swann, J.; Gunaratna, I.; McLellan, I.; Ikidde, U.
doi: 10.1177/095148489901200404pmid: 10622801
Management is an increasingly important issue for many doctors. If doctors wish to influence resource allocation, they must involve themselves in health service management. This article describes the results of an enquiry action learning project involving six doctors. As part of the project, clinical directors and their business managers were interviewed. In addition, the Police Force and BAA (formerly the British Airport Authority) were visited and their management structure, out-of-hours activities and planning for emergencies assessed. This article examines the reasons why many doctors do not involve themselves in management, such as increased time commitment and negative peer pressure, and suggests some solutions to these problems, including the need for a wider understanding of the role of clinical directors. It also considers how some organizations are already starting to address these issues, and how both doctors and hospitals can benefit from greater involvement of doctors in health service management.
The Effects of Organizational Structure on Hospital PerformancePerryman-Starkey, M.; Rivers, P. Asubonteng; Munchus, G.
doi: 10.1177/095148489901200405pmid: 10622802
The relationship between organizational structure and organizational performance would seem at first to be straightforward and obvious. The more complex organizational structures will result in positive organizational performance (i.e. greater effectiveness or profitability). The premise is that the ability of an organization to achieve its mission successfully should be a result of the organizational structure. It is generally accepted that certain structural configurations are able to achieve certain goals better than others (i.e. a diversified structure as opposed to a simple structure). The research to date indicates that this is not necessarily true. The specific issue examined in this paper will be the effect of structural diversification on performance in industry and healthcare.
The Critical Success Factor Approach to Strategic Alignment: Seeking a Trail from a Health Organization's Goals to its Management Information InfrastructureTan, J. K. H.
doi: 10.1177/095148489901200406pmid: 10622803
The critical success factor (CSF) approach is a technique that will aid health administrators, planners and managers to identify, specify and sort among the most relevant and critical factors determining an organization's survival and success. Following a top-down management perspective, this paper discusses the CSF methodology as a strategic information management process comprising several important phases: (i) understanding the external factors such as the organization's industry, market and environment; (ii) achieving strong support and championship from top management; (iii) encouraging the proactive involvement of management and staff in generic CSF identification; (iv) educating and directing the participation of staff members in CSF verification and further refinement of generic CSFs into specific CSFs; and (v) aggregating, prioritizing and translating activity-related CSFs into organizational information requirements for the design of the organization's management information infrastructure. The implementation of this CSF approach is illustrated in the context of a British Columbia community hospital, with insights provided into key issues for future health researchers and practitioners.
Staffing Intensity, Skill Mix and Mortality Outcomes: The Case of Chronic Obstructive Lung DiseaseRobertson, R. H.; Hassan, M.
doi: 10.1177/095148489901200407pmid: 10622804
The hospital re-engineering movement has resulted in major changes in hospital staffing. These staffing changes have the potential to reduce staffing intensity and skill mix, both generally and within specific caregiver groups. Prior research has shown that both skill mix and staffing intensity are positively associated with outcomes indicative of the quality of hospital care. This study extends beyond prior research by expanding the scope of staffing intensity and skill mix measures beyond that of physicians and nursing personnel and by focusing on a specific diagnostic group, patients with chronic obstructive pulmonary disease (COPD). Multiple regression analysis was performed using the 30-day post-admission observed mortality rate for Medicare patients being treated for COPD relative to the predicted rate as the dependent variable. Analyses were repeated for 1989, 1990 and 1991. Among the explanatory variables were staffing intensity measures for health care workers that were thought to contribute significantly to the care needed by patients with COPD. The results indicate that the only group of health care workers which showed staffing intensities positively associated with better outcomes in this group of patients was respiratory care practitioners, respiratory therapists and respiratory therapy technicians. The results relative to skill mix were inconclusive. It was concluded that during the 19891991 period, hospitals with higher staffing intensities for both respiratory therapists and respiratory therapy technicians had better outcomes for their Medicare inpatients being treated for COPD.