From the Editor CHANGE, PEOPLE, AND THE BOTTOM LINE
health care that cost and quality exist in a direct relationship to each other: that one cannot reduce cost without reducing quality. In these days of constant cost-control demands, one cannot disIf ever there was a time when the health cuss the subject long before hearing, from clincare environment caused many employees to ical and nonclinical personnel alike, that curtailing feel as though they were no more than another certain expenditures will negatively affect the cost of doing business, the present is likely to quality of care. be that time. As health care workers everywhere For a variety of reasons, most having to do awaken to the hard fact that health care is being with escalating costs and various payers’ relachanged by forces largely beyond their control, it tive ability to pay, health care has come under becomes more apparent that significant change intense bottom-line scrutiny. And a great deal in health care will continue to alter the way of what has all along occurred in nonhealth many of our health care organizations function. organizations has come to bear in health care Much of this continuing change disturbs longorganizations. All too often it seems that as held paradigms so severely that some people who emphasis on the bottom line increases, apparent are affected may simply leave health care. concern for people—employees in particular— Health care organizations are continuing decreases. to change in size, complexity, structure, and A bottom-line focus is of course essential to scope of service. Some organizations of tradisurvival; the organization that consistently loses tional forms are vanishing; new organizations money will no longer exist to provide services of forms unanticipated not too long ago are to anyone. On the other hand, a positive bottom proliferating. line may do little good, or it may vanish quickly Much of what lies in the future for health care if motivated people of healthy morale and with workers remains unclear if not unknown. Howa reasonable sense of job security are not on hand ever, it has been apparent for some time that the to permit the organization to function. What is emphasis on inpatient care will continue to dihappening in these days of mergers and reenminish. The hospital as a provider of inpatient gineering and such is that the bottom line services is steadily becoming a less significant sometimes receives a disproportionate amount factor in health care delivery. This suggests a of attention while people concerns are left behind. major collision with one of the health care parToday’s executives include an increasing adigms that pertained for years: the acute care number of ‘‘tough’’ managers who may somehospital will always be the center of the health times be referred to as change agents or turncare system. So strongly held has this belief around specialists. Some seem well suited to been that we still tend to see most other forms the task because they can readily lay off emof care as extensions of or adjuncts to the acute ployees without being appreciably bothered care hospital. by doing so. After all, the bottom line dictates. Another paradigm under constant assault is What is needed, of course, are rational reenthe cost-quality paradigm, the belief of many in gineering processes that look at the budget for next year and the years beyond—not just looking for what can be saved this year—and that balance bottom-line concerns with concern for people, The author has no conflict of interest. recognizing that ultimately it is people that drive the bottom line. DOI: 10.1097/HCM.0000000000000013 181 Copyright # 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
182
THE HEALTH CARE MANAGER/JULY–SEPTEMBER 2014
This issue of The Health Care Manager (33:3, July-September 2014) offers the following articles for the reader’s consideration. ‘‘Enhancing Learning, Innovation, Adaptation, and Sustainability in Health Care Organizations: The ELIAS Framework’’ presents a practical performance management framework that can be utilized to develop sustainable health care organizations, a multistep process premised on accountability, performance management, and other foundational elements. ‘‘Analysis and Recommendations for Reducing Risks of Patient Cross-Contaminations via Noncritical Medical Devices’’ addresses the problem of health care–associated infections and provides insight into likely source of cross-contamination, probable causes, and identification of areas for additional investigation. ‘‘New York’s Health Care Workforce Recruitment and Retention Act: An Investigation of the Effects of Nonrecurring Increases in Health Worker Wages on Health Worker Supply’’ analyzes this particular legislation for its intended effects and actual results and provides suggestions for future directions in supporting recruitment and retention. ‘‘Dimensions of Quality Care Affecting Career Satisfaction of Pediatricians’’ reports on an investigation of factors affecting career satisfaction among pediatricians and further identified specific factors having negative effects on career satisfaction. Case in Health Care Management: ‘‘The New Broom’’ asks the reader to address the apparent difficulties encountered by a newly placed manager whose initial efforts emphasize the need to bring what
appears to be a slack operation quickly into line with existing policies. ‘‘Foundation of Evidenced-Based Decision Making for Health Care Managers—Part II: Meta-analysis and Applying the Evidence,’’ in following up on part I, which defined systematic reviews and outlined the process of conducting them, explains the additional procedures associated with meta-analyses and describes the potential shortcomings of both systematic review and meta-analyses. ‘‘Foreign Trained Nurses’ Experiences and Socioprofessional Integration Best Practices: An Integrative Literature Review’’ examines the evidence available concerning obstacles and facilitating factors involved in the socioprofessional integration of internationally educated nurses and endeavors to identify best practices concerning their workforce integration. ‘‘Medicare Fraud in the United States: Can It Ever Be Stopped?’’ reports on a research study undertaken to explore the current state of Medicare fraud in the United States, identify policies and laws that foster such fraud, and assess the financial impact of Medicare fraud. ‘‘Factors Influencing Consumer Satisfaction With Health Care’’ reports on a study undertaken to examine factors that impact consumer satisfaction with health care, addressing treatment issues, financial issues, family-related issues, sources of health care information, and other factors of relevance. ‘‘The Affordable Care Act: The Ethical Call to Transform the Organizational Culture’’ suggests that the successful health care organizations and health care systems of the coming years will be defined largely by their adaptability in the new valuebased marketplace created by the Act.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
health care that cost and quality exist in a direct relationship to each other: that one cannot reduce cost without reducing quality. In these days of constant cost-control demands, one cannot disIf ever there was a time when the health cuss the subject long before hearing, from clincare environment caused many employees to ical and nonclinical personnel alike, that curtailing feel as though they were no more than another certain expenditures will negatively affect the cost of doing business, the present is likely to quality of care. be that time. As health care workers everywhere For a variety of reasons, most having to do awaken to the hard fact that health care is being with escalating costs and various payers’ relachanged by forces largely beyond their control, it tive ability to pay, health care has come under becomes more apparent that significant change intense bottom-line scrutiny. And a great deal in health care will continue to alter the way of what has all along occurred in nonhealth many of our health care organizations function. organizations has come to bear in health care Much of this continuing change disturbs longorganizations. All too often it seems that as held paradigms so severely that some people who emphasis on the bottom line increases, apparent are affected may simply leave health care. concern for people—employees in particular— Health care organizations are continuing decreases. to change in size, complexity, structure, and A bottom-line focus is of course essential to scope of service. Some organizations of tradisurvival; the organization that consistently loses tional forms are vanishing; new organizations money will no longer exist to provide services of forms unanticipated not too long ago are to anyone. On the other hand, a positive bottom proliferating. line may do little good, or it may vanish quickly Much of what lies in the future for health care if motivated people of healthy morale and with workers remains unclear if not unknown. Howa reasonable sense of job security are not on hand ever, it has been apparent for some time that the to permit the organization to function. What is emphasis on inpatient care will continue to dihappening in these days of mergers and reenminish. The hospital as a provider of inpatient gineering and such is that the bottom line services is steadily becoming a less significant sometimes receives a disproportionate amount factor in health care delivery. This suggests a of attention while people concerns are left behind. major collision with one of the health care parToday’s executives include an increasing adigms that pertained for years: the acute care number of ‘‘tough’’ managers who may somehospital will always be the center of the health times be referred to as change agents or turncare system. So strongly held has this belief around specialists. Some seem well suited to been that we still tend to see most other forms the task because they can readily lay off emof care as extensions of or adjuncts to the acute ployees without being appreciably bothered care hospital. by doing so. After all, the bottom line dictates. Another paradigm under constant assault is What is needed, of course, are rational reenthe cost-quality paradigm, the belief of many in gineering processes that look at the budget for next year and the years beyond—not just looking for what can be saved this year—and that balance bottom-line concerns with concern for people, The author has no conflict of interest. recognizing that ultimately it is people that drive the bottom line. DOI: 10.1097/HCM.0000000000000013 181 Copyright # 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
182
THE HEALTH CARE MANAGER/JULY–SEPTEMBER 2014
This issue of The Health Care Manager (33:3, July-September 2014) offers the following articles for the reader’s consideration. ‘‘Enhancing Learning, Innovation, Adaptation, and Sustainability in Health Care Organizations: The ELIAS Framework’’ presents a practical performance management framework that can be utilized to develop sustainable health care organizations, a multistep process premised on accountability, performance management, and other foundational elements. ‘‘Analysis and Recommendations for Reducing Risks of Patient Cross-Contaminations via Noncritical Medical Devices’’ addresses the problem of health care–associated infections and provides insight into likely source of cross-contamination, probable causes, and identification of areas for additional investigation. ‘‘New York’s Health Care Workforce Recruitment and Retention Act: An Investigation of the Effects of Nonrecurring Increases in Health Worker Wages on Health Worker Supply’’ analyzes this particular legislation for its intended effects and actual results and provides suggestions for future directions in supporting recruitment and retention. ‘‘Dimensions of Quality Care Affecting Career Satisfaction of Pediatricians’’ reports on an investigation of factors affecting career satisfaction among pediatricians and further identified specific factors having negative effects on career satisfaction. Case in Health Care Management: ‘‘The New Broom’’ asks the reader to address the apparent difficulties encountered by a newly placed manager whose initial efforts emphasize the need to bring what
appears to be a slack operation quickly into line with existing policies. ‘‘Foundation of Evidenced-Based Decision Making for Health Care Managers—Part II: Meta-analysis and Applying the Evidence,’’ in following up on part I, which defined systematic reviews and outlined the process of conducting them, explains the additional procedures associated with meta-analyses and describes the potential shortcomings of both systematic review and meta-analyses. ‘‘Foreign Trained Nurses’ Experiences and Socioprofessional Integration Best Practices: An Integrative Literature Review’’ examines the evidence available concerning obstacles and facilitating factors involved in the socioprofessional integration of internationally educated nurses and endeavors to identify best practices concerning their workforce integration. ‘‘Medicare Fraud in the United States: Can It Ever Be Stopped?’’ reports on a research study undertaken to explore the current state of Medicare fraud in the United States, identify policies and laws that foster such fraud, and assess the financial impact of Medicare fraud. ‘‘Factors Influencing Consumer Satisfaction With Health Care’’ reports on a study undertaken to examine factors that impact consumer satisfaction with health care, addressing treatment issues, financial issues, family-related issues, sources of health care information, and other factors of relevance. ‘‘The Affordable Care Act: The Ethical Call to Transform the Organizational Culture’’ suggests that the successful health care organizations and health care systems of the coming years will be defined largely by their adaptability in the new valuebased marketplace created by the Act.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
