Leading in a chaotic health care environment

How can physician executives be effective leaders during a time of such upheaval in health care? How does anyone lead in a confusing environment where planning seems impossible? Is effective leadership even possible when no one seems to understand what is going on? These important questions are addressed in this article. Health care is a confusing field. But it still needs effective leadership. Even though nobody really knows what is going on, physician leaders can play a beneficial role by encouraging everyone they work with to experiment and innovate with ways to make health care work better for patients. Physician executives can insist on accountability and on implementing what really works in their given context, rather than what the latest theory states should work.     

Community rating--an approach that works

How our current system works and what changes need to be made are the subjects of intense scrutiny by policy makers today. One of the primary areas of concern with our present health care system is its accessibility to the average American, in terms of both price and ability to obtain insurance. With an estimated 37 million Americans without health care insurance, and countless others severely underinsured, this issue will lie at the core of any health care reform that results from the current debate. One possible approach to the uninsured problem that might alleviate the situation is community rating.     

Applied health services research: responding to the changing health care environment

Health care in America is changing rapidly. The forces that are reforming our health care system are both numerous and compelling. Americans are requesting access to more affordable health care. At the same time, many Americans want to build upon what is considered the best and most technologically advanced health care system in the world. Especially during economically troubled times, innovative and well-formulated solutions to respond to these fundamental challenges are needed to improve the quality and accessibility of health care. It is essential that policy markers base their health care decisions on sound medical research that specifically examines which aspects of medical care improve patient outcomes.     

Lessons from industry.

Rapidly emerging in public debate as the key to the future of the health care industry is quality. One can hardly pick up a health care magazine or journal or listen to a discussion among health care professionals without quality becoming a concern. Despite virtually universal agreement on the importance of the generic term and secondary agreement on the importance of being able to measure it, discussion bogs down in either of two ways. It may become overwhelmed by the sheer magnitude of the task of describing all the elements of health care quality, or the different viewpoints of individuals will yield quite variable understandings of what the term "quality of health care" means. To make substantial progress in improving health care quality, we will need to come to an agreement on terms.     

Reporting quality of health care to the board

The reporting of quality of health care to the governing board has long been an enigma. Now we are in the midst of a revolution in health care, as we shift our focus from solely the clinical performance of individuals to a broader scope of assessing and improving all activities around patient services and patient care--i.e., management outcomes integrated with clinical outcomes to help identify opportunities to improve patient care. In addition, apprised of corporate liability for the quality of care provided in health care organizations, governing boards are raising questions and demanding more information. To maintain this high degree of interest in quality of health care, information should be restricted to what the board needs to know. This article will be confined to the hospital's organizationwide quality system of monitoring and evaluating. While medical staff credentialing and privileging are also board responsibilities and quality management activities should be used in the privileging and credentialing process, they will not be addressed in this article.     

25 Health care trends. What's hot,what's not,and what does the future hold

As we usher in 2003, America's health care system remains in a chaotic state. Will managed care live or die? Will quality improvement efforts pay off? Are we ready for the next bioterrorism attack? Will the shortage of physician soon rival the shortage of nurses? To help gauge where health care stands today and what the future holds, The Physician Executive asked doctors who serve on ACPE's peer review panel to list the hottest health care trends in the U.S right now. Then, we took the list to three respected health care futurists -- Leland Kaiser, PhD, Jeff Goldsmith, PhD, and Russel Coile, MBA -- and asked them for their insights on the trends. Yes, Kaiser, Goldsmith and Coile are opinionated. Yes, they're controversial. But no matter whether you agree or disagree with their views, the three health care futurists' comments could spark discussions that will help shape U.S. health care this year and beyond. The trends are presented in no particular order.     

The Role of Clinical and Process Quality in Achieving Patient Satisfaction in Hospitals

Managers constantly struggle with where to allocate their resources and efforts in managing the complex service delivery system called a hospital. In the broadest sense, their decisions and actions focus on two important aspects of health care—clinical or technical medical care that emphasizes “what” the patient receives and process performance that emphasizes “how” health care services are delivered to patients. Here, we investigate the role of leadership, clinical quality, and process quality on patient satisfaction. A causal model is hypothesized and evaluated using structural equation modeling for a sample of 202 U.S. hospitals. Statistical results support the idea that leadership is a good exogenous construct and that clinical and process quality are good intermediate outcomes in determining patient satisfaction. Statistical results also suggest that hospital leadership has more influence on process quality than on clinical quality, which is predominantly the doctors' domain. Other results are discussed, such as that hospital managers must be mindful of the fact that process quality is at least as important as clinical quality in predicting patient satisfaction. The article concludes by proposing areas for future research.     

The quality debate: Consumer Bill of Rights

Inherent in any discussion on quality for a delivered service is understanding what outcomes you want to achieve and assuring that your consumer agrees. The Presidential Commission's Consumer Bill of Rights supports this principle. Its' goals include: strengthening consumer confidence by providing them with a system responsive to their needs and with a credible mechanism to address their concerns; reaffirming the importance of a strong relationship between patients and their health care providers; and, reaffirming the role consumers play in safeguarding their own health. Striking the balance between cost and quality requires all the stakeholders of the health care system to focus on the true issues that impact quality: outcomes, accountability, and consumer satisfaction, however defined.     

The Informatics Institute: why do we need it?

Why should physician executives care about medical informatics? For that matter, what is medical informatics anyway? Broadly defined, medical informatics is the study of the collection, storage, retrieval, and analysis of data and information in health care to support clinical and administrative decision making. Informatics is important because, in the past 10 years, powerful computer, software, and information technologies have been developed to enable health care organizations to automate some of the work of decision making, for improved quality of care and cost control, and for successful managed care contracting. This new emphasis on informatics in health care was the impetus for the founding by ACPE earlier this year of The Informatics Institute, which will be involved in educational and research activities in the growing area of medical informatics. In this new column in Physician Executive, Dr. Marshall Ruffin, President and CEO of the Institute, will discuss the role of medical informatics in health care delivery and financing and its relation to physician executives.     

The eternal triangle: cost, access, and quality

No matter who is in charge of health policy, no matter what his or her ideological bent, no matter whether the economy is in boom or bust, three concerns stubbornly dominate the discussion: the cost of care, access to care, and the quality of care. The main variation among them is that normally each in turn receives the most attention from policy makers, payers, and the public, over time.     

E-patients and the online health care revolution

Check out the latest statistics on the number of patients seeking health care advice on the Internet. Learn what your patients are looking for and what they find.     

Development of hospice and palliative care in the United States

More than 30 years have passed since palliative care was introduced in the United States, and what began as a small rebellion has evolved into a fairly large health care industry. Although the palliative care movement has considerably improved the care given to those at the end of life, many challenges remain for palliative care providers in the United States. This article discusses the history of hospice and palliative care in the United States, the Medicare Hospice Benefit, the growth of hospice and palliative care, and challenges such as the need for regulatory change, workforce issues, improving access to care, and improving the quality of palliative care.     

Defined contribution--the future for health care

Employers are seeing breathtaking health care premium increases. As action-oriented people, they are not going to cough up additional money to pay for these rate increases. The real question is what solution might employers move to? The most logical answer is defined contribution--a way that employers could give employees health benefit funding that resembles what they have already done in pension funding. Today, facing massive cost pressures from their health care premiums, many employers are wishing that they could create or use the equivalent of a defined contribution plan for health care. The next major evolution of defined benefit health financing needs the full-scope functional equivalent of a 401 (k) administrator to make the concept work--someone to give employers the tools needed for employees to make meaningful choices. Up until now, no one has been able to give consumers meaningful data about health care and health benefit alternatives. A viable 401 (k) health administrator will need to offer an array of choices that will work for all players.     

From managing access to managing care: the impact of primary care on health care delivery organizations.

Professional "revenge of the nerds" is currently taking place, as managed care evolves generalist physicians into new professional prominence. Primary care physicians are finding themselves at the center of health care market reform as health plans, insurers, and other financing organizations turn to them as the key to cost control. In short supply, they are prospering financially from the demand. As the source of patients, they are gaining in prestige from specialists and hospitals who once demeaned them. But these newfound roles are only the initial steps in the transformation of the primary care practitioner. The change that the generalists are experiencing is essentially managing access to care, not truly managing care itself. There are large and crucial differences between managing access to care and actually managing care. These differences are, in many ways, a higher calling for primary care practitioners as they refocus attention on patient outcomes, which will in itself result in a lower resource utilization above and beyond the crude controlling of access. What those differences are, what new roles they require, and what impact they will have on organizations that either house or contract with primary care physicians will be the focus of this article.     

Watching the falling barometer

How can physician executives create a vision, a strategy, in the face of such overwhelming forces for change? The answer has two pieces. The first is the Weather Channel: scanning the future for warning, for opportunities, for new business possibilities. The second leads us to such questions as: What is your situation? Financially? In market terms? It leads us, as well, back to the question: For you and your institution, what is your reason for being in this business? In other words, what is your foundation? If you can become clear about who you are and what you are here for in the long run, and match that with some sense of the technologies and the political and financial pressures headed your way, then you can begin to create a vision of a future that works for you. In the coming years, we will begin to create entire new ways of doing health care, new roles for hospitals, new types of medicine--and the time to begin the creation is now. If you wait until the hurricane hits, it will be too late.     

Promising, and delivering, health care value

It came as no surprise a year or so ago to read in Physician Executive that "Clinical decision-making is no longer the exclusive domain of the health care practitioner." The authors pointed out that consumers, as patients and as business-payers, are insisting on provider accountability, both in quality and in appropriate cost. They used the phrase "health care value" to show a balance between cost containment and quality. One managed care operation has decided to operate on the premise of health care value.     

What will future historians say about the Clinton health reform act

In a series of articles that began in the March-April 1992 issue of Physician Executive, the author has provided historical background on the debate that currently rages on the nature and course of national health reform. In addition to tracing past efforts to expand access to health care for Americans, Dr. Goldfield has provided unique insights into the American political process and into the American psyche. In this final article in the series, Dr. Goldfield provides his personal assessment of what the chances for real reform of the health care delivery system are and his views on what that reform will ultimately look like. He calls himself a skeptic, not a cynic, saying that the likelihood of meaningful change is small, given the numerous proponents of the status quo.     

Is health care ready for a full menu of prices?

Examine the emerging trend of price transparency in health care and learn what some states are doing to make prices widely available on the Web.     

Health care futures. What lies ahead? Where are we going? Panel discussion

Who would have guessed that managed care would dominate the health care industry in the final two decades of the millennium? That physicians would be joining labor unions? Or that they would be going back to school to become Fellows of the American College of Physician Executives? To find out what may be in store for health care in America five to 10 years hence, The Physician Executive asked nine health care experts to participate in a two-part panel discussion. Here's what they see ahead in managed care, information technology, and biotechnology. Part 2 will appear in the July/August Issue of The Physician Executive.     

Self-directed health plans: alternatives to managed care enabled by new technologies

Few people believed the Internet would have much impact on the delivery of health care services. However, combined with technological advances in how computer systems are structured and implemented and knowing what doesn't work in managed care from bitter experience, the Internet is being used to create a new paradigm of alternative health insurance products. These products hold the potential to change for the better the face of health care as we know it. Self-directed health plans will be less expensive than managed care programs and offer greater predictability in health care spending. For health care providers, SDHPs' reliance upon episode allowances will create a new market for packaged or bundled services. Providers will be paid to provide solutions, not just treatment. This could represent a new model in which physicians accept a risk-adjusted payment and provide a warranty that they will do whatever necessary until the patient has reached the reasonably expected health status. This is a radical departure from the fee-for-service or capitation system.