Hospitalists are physicians who spend at least 25% of their professional time serving as the physicians-of-record for inpatients, during which time they accept "hand-offs" of hospitalized patients from primary care providers, returning the patients to their primary care providers at the time of hospital discharge. The hospitalist movement is only about 5 years old, yet at least 7000 hospitalists practice today and an estimated 19,000 will ultimately practice, approximately the current number of emergency medicine physicians. The emerging positivist literature on hospitalists' impact is the subject of this review. It traces the nature and evolution of the hospitalist movement; summarizes empirical evidence about costs, clinical outcomes, patient satisfaction, and education; and appraises whether the hospitalist model is indeed novel. The review concludes by outlining research questions about the hospitalist model's viability over time, the mechanisms by which it produces benefits, and especially hospitalists' longitudinal effect on continuity of patient care. A literature "scorecard" might rank evidence to date on costs as positive, evidence on clinical outcomes and education as nonnegative, and evidence on patient satisfaction and continuity of care as inconclusive. Above all, longitudinal research must illuminate whether hospitalists' advantages comeat the cost of the doctor-patient relationship.
Effective reward and recognition programs are important in order to retain well qualified hospital employees and actively engage them in satisfying patients, managing scarce resources, and improving performance. The rewards and recognition bestowed may be modest in scale but must be symbolic of genuine caring and appreciation by management. This article outlines a number of reward and recognition tactics that can be used singly or in combination to begin demonstrating management's commitment to improving employee satisfaction.
Ever-increasing complexity and contradiction in the health care industry often leave hospital administrators wondering whether they can still make a positive difference for patients. In this context, hospital administrators can regain both perspective and enthusiasm by revitalizing their direct connections with the patients, caregivers, and organizations they serve. Hospital administration remains a special calling, and this article profiles 10 core competencies that will keep health professionals close to their customers, colleagues, and the reasons they entered the helping professions. This intimate knowledge of the organization and its resources coupled with the ability to communicate effectively typically trump advanced education or technical skills in successfully navigating genuinely consequential situations. Hospital administrators who master and practice the 10 competencies can indeed make a positive difference for patients and find great personal reward in doing so.
Management is surprised when big investments in hospital information technology fail to produce expected results. Although failure appears to be sudden, it is actually the cumulative result of many subtle acts of omission by multiple parties over an extended period. Unfortunately, many senior managers recognize, but few confront the early warning signals of impending disaster. This article outlines 10 common predictors of hospital information system failure plus effective antidotes in each case. A carefully defined project outcome, appropriate project governance structure, and rigorous adherence to a structured systems development methodology are particularly critical management tools for assuring return on investment.
Hospital turnarounds are an increasing phenomenon in an era of unrelenting financial pressure on the health care delivery system. However, the literature about hospital turnarounds contains more theories and case reports than research studies, and repeat turnarounds suggest that there is inadequate evidence about what really works. The essential role of the turnaround agent in strategy formulation and especially strategy implementation is the subject of this article. It casts a wide net over the literature of strategy, change, leadership, and management. The article traces the nature and evolution of hospital turnarounds plus the agents that effect them; summarizes the turnaround agent's 10 most potent approaches to strategy analysis and synthesis; and outlines 3 research questions about first, the recurring need for hospital turnarounds altogether; second, longitudinal evidence to support different turnaround approaches; and third, the mechanisms by which the turnaround agent both changes and is changed by the distressed hospital.
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