The Nature and Extent of Hospital Competition in a Government-Funded Health SystemFried, Bruce J.; Leatt, Peggy; Gelmon, Sherril B.
doi: 10.1177/095148489000300301pmid: 10125072
A national study of Canadian hospitals assessed the perceived level and types of competition and the strategies pursued by these hospitals. Questionnaire data were obtained from chief executive officers in 715 hospitals, yielding a national response rate of 68%. Respondents indicated the perceived level of competition in the environment, the content of competition, and stated hospital strategies. Additional data were obtained on market share and hospital type. Close to half of the respondents indicated little or no competition in their environment, while 30% indicated substantial levels of competition. This represents a significant deviation from conventional wisdom about the Canadian health services environment. Respondents in hospitals with more than 75% of the market share were less likely to perceive competition than those with a smaller market share. CEOs in teaching hospitals and in hospitals located in larger communities reported higher levels of competition. Hospitals competed mostly for capital, programs, and staff; about a third of hospitals competed for patients and no differences were found by type of institution. Those hospitals in more competitive environments were more likely to indicate the use of diversification and horizontal integration as organizational strategies.
Occupational Stress in Health Service EmployeesRees, David W.; Cooper, Cary L.
doi: 10.1177/095148489000300302pmid: 10125073
Levels of occupational stress were examined in 383 employees of various occupations in one health district, as a preliminary to devising a strategy to reduce the negative effects of stress in the workplace. In comparison with white collar and professional workers in industry, health workers reported significantly greater pressure at work, higher ratings of physical and mental ill health, lower job satisfaction, less internal control over their working environment but used more coping strategies. Approximately one in eight of the subjects has stress symptoms of equal magnitude to patients attending clinical psychology outpatient clinics. It was also found that job satisfaction and psychosomatic ill health were related to sickness absence amongst health employees. The implications of these findings and the consequent challenges facing health service managers are discussed.
The Effects of For-Profit Multihospital System Ownership on Hospital Financial and Operating PerformanceLynch, Janet R.; McCue, Michael J.
doi: 10.1177/095148489000300304pmid: 10125075
The financial and operating performance of independent not-for-profit hospitals acquired by US for-profit multi-hospital systems in 10 Southern states between the years 1978 and 1982 was explored. The impact of system ownership on acquired hospitals was investigated by comparing the average financial performance of hospitals in the two years immediately prior to acquisition to the average for 1984 and 1985 and by comparing changes in the performance of acquired hospitals with changes in matched independent facilities.Findings suggest that for-profit multi-hospital systems were able to improve many of the financial and operating problems of acquired facilities. In comparison to independent not-for-profit hospitals, acquired hospitals were found to increase access to long-term debt, make improvements to plant and equipment, improve profitability, and increase efficiency to a greater extent. Prices in acquired hospitals rose more than those in independents and liquidity decreased to a greater extent.
Determining the Skills Training Needs of NHS Graduate General Management TraineesSzczepura, Ala K.
doi: 10.1177/095148489000300305pmid: 10125076
In 1986 a new graduate training program (GMTSI) was set up in the NHS for general management trainees. The completion of the two year program by the first intake of graduates in the summer of 1988 indicated that more thought needed to be given to identifying the skills and competence training needs in a program of this type. Accordingly, the NHS Training Authority commissioned Warwick Health Services Research Unit to carry out a study into the skills training needs of graduates entering the general management program. The methods adopted involved firstly group and individual semi-structured interviews with participants and managers to identify a wide range of possible skills and competences, and secondly a postal survey of all 230 trainees and mentors who had experience of the training program to help prioritize these skills. In this manner an extensive amount of information was collected on the preferred principal method of delivery for training in each of the 60 plus skills identified (district placement or management education centre), the optimal timing within the 22 month program for training in each of the skills identified and the relative importance of training for each skill. The present paper presents a selection of the study findings. Furthermore, it outlines the manner in which the project findings are being implemented in one education centre based regional consortium to provide graduate trainees with skills training geared to their immediate and short-term training needs.
Hospital CEO Turnover: Modelling More or Less Durable Places to WorkWeil, Peter; Timmerberg, John
doi: 10.1177/095148489000300306pmid: 10125077
This study documents the rising rate of hospital CEO turnovers between 1978 and 1988, a trend that has accelerated since the introduction of Medicare's prospective payment system. Using data from the American Hospital Association, we identify characteristics of hospitals experiencing rapid CEO turnover. Results show that full utilization along with a positive operating margin can prolong the CEO's tenure but ownership and system membership specify the findings.For example, CEO turnover is higher in investor-owned, multihospital systems hospitals if they are small, if their costs are high and if they have recently joined a multi-hospital system. By contrast, in not-for-profit multihospital systems, turnover is higher if they have low occupancy and low operating margins.CEO turnover in not-for-profit, freestanding hospitals is higher in metropolitan areas and in the Western region of the US as well as in hospitals with low occupancy, low operating margins and lower costs per patient day. Governmental hospitals experiencing higher CEO turnover are small, metropolitan and tend to be located in any region except the Midwest. Many have recently joined a multi-hospital system and have experienced low operating margins.
Graduate Recruitment in the FutureKey, Peter
doi: 10.1177/095148489000300307pmid: 10125078
Many organizations face increasing difficulty, not to mention direct competition, in recruiting the appropriate quality and number of graduates. This paper examines the basic demographic position and then records the approaches organizations are taking to overcome the shortfall in graduate recruitment. Finally, some options and alternatives are considered.