Spirituality and the physician executive

The "s" word can now be spoken without flinching in health care organizations. Spirituality is becoming a common topic in management conferences around the world. Many U.S. corporations are recognizing the role of spirituality in creating a new humanistic capitalism that manages beyond the bottom line. Spirituality refers to a broad set of principles that transcend all religions. It is the relationship between yourself and something larger, such as the good of your patient or the welfare of the community. Spirituality means being in right relationship to all that is and understanding the mutual interdependence of all living beings. Physician executives should be primary proponents of spirituality in their organizations by: Modeling the power of spirituality in their own lives; integrating spiritual methodologies into clinical practice; fostering an integrative approach to patient care; encouraging the organization to tithe its profits for unmet community health needs; supporting collaborative efforts to improve the health of the community; and creating healing environments.     

Overcoming barriers to access and utilization of hospice and palliative care services in African-American communities

While there is ample evidence to support the need for hospice and palliative care services for African Americans, only 8% of patients who utilize those services are from African-American communities. The underutilization of end-of-life and palliative care can be attributed to several barriers to service access including incompatibility between hospice philosophy and African-American religious, spiritual, and cultural beliefs; health care disparities; distrust of the medical establishment; physician influence; financial disincentives, and hospice admission criteria. Suggestions for dismantling barriers to care access include developing culturally competent professionals in the health and human services, expanding the philosophy of hospice to include spiritual advisors from client communities, and funding national initiatives to promote improved access to health care at all stages in the life cycle of members of all underserved communities.     

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.     

Hospice and the politics of spirituality

Within the hospice literature, spirituality and religion are usually defined in opposition to one another, with religion negatively associated with the external, authoritarian doctrines of Christianity and spirituality positively associated with the free search for truth, meaning, and authenticity. According to survey data, however, most Americans integrate spirituality and traditional religious commitments. The hospice literature is promoting spirituality to its own detriment by alienating potential patients and depriving religious patients of the resources that religious traditions and their affiliated religious communities have to offer.     

Looming threats to the intimate bond in hospice care? Economic and organizational pressures in the case study of a hospice

Hospice organizations are assailed by stiff competition, ever-rising costs, limited funding, and policy changes. Do such pressures stifle the high quality of care these organizations strive to provide? As a case-in-point, we draw from the mid-1990s accounts of caregivers at a nonprofit hospice in a Midwestern city in the United States. We maintain that economic pressures drive organizational restructuring, which then weakens working conditions and, thereby, weakens the staff-client relationship. We discuss effects upon worker behaviors, the worker-client relationship, and client care. This ethnographic case study signals the need to closely examine the threats that current economic and organizational pressures in the United States may pose to the quality of hospice care.     

"A sound track of your life": music in contemporary UK funerals

This article considers the role that music plays in contemporary UK funerals and the meaning that the funeral music has for bereaved families. It is based on findings from a recently completed study of 46 funerals funded by the UK Arts and Humanities Research Council. Music contributes to the public ceremony and the personal existential quest of the bereaved. It is important to both the content and process of the contemporary funeral, an event of deep cultural significance in our response as individuals and communities to death and the loss of a significant relationship. There is evidence that for many people, the music chosen and used also evokes and conveys their spirituality. Spirituality may not be intrinsic to the music but spiritual experience may result from the meaning that the music has for that particular person.     

Defining Spirituality of Work

There is a current surge of writings on spirituality and related topics. For instance, Woodward (1997) has pointed out that since Thomas Moore's publication of Care of the Soul in 1994 there have been nearly 800books published with the word soul in the title. These run all the way from Chicken Soup for theWoman's Soul (Canfield et al., 1996) to A Guide to Liberating YourSoul (Barrett, 1995). Spirituality of work is a big part of this surge. Definitionsof spirituality of work seem to vary widely. Bowman (1998, p. 8) in his `reviewof the phenomenon of spirituality of work' found `Definitions of the term spirituality in the context of the Spirituality of Work troublesome and particularly subjective. Many writers do not even attempt definitions.' The purpose of this article is to review the concept of spirituality of work in its historical and current use and to propose a comprehensive definition.     

Awareness of dying: an experience of Chinese patients with terminal cancer

Despite the effort to provide an alternate way to dying, there seems to be little effort to examine the real situation of hospice care. For example, the patients' desired outcomes are seldom addressed. It is recently that studies began to investigate the features of "good death." However, work in eastern cultures, such as Chinese, remains scarce. The purpose of this study is to gain an understanding of what it means to die a "good death" from the perspective of Chinese patients. Thirty-three Chinese hospice patients with terminal cancer were interviewed. Grounded in the analysis of qualitative data, seven elements that contribute to dying a good death emerged. Awareness of dying was identified as the foremost essential element of a good death. From the findings of this study, most respondents considered receiving a diagnosis of cancer as one of the significant points of psychological distress in the course of their illness. Half of the patients openly talked about their cancers and more than half of them discussed various issues related to death. That means, about one-third of the respondents talked about death and cancer with openness. These preliminary findings may reflect the progress of hospice work in Hong Kong. Meanwhile, 13 respondents did not mention the word "death" and 16 of them did not mention that they had cancer. They talked about their illness and future using the expressions that they preferred. It is important that health care professionals also respect people who show awareness of dying as much as those who do not present clear evidence of this awareness. Both groups of people can have a positive experience when they die.     

The spiritual framework of coping through the voices of cancer survivor narratives

Gall et al. (2005) developed a framework for spirituality by adapting and applying the transactional model of stress and coping, which is an interactive and fluid process spurred by a stressor involving spiritual appraisal, person factors, spiritual connections, spiritual coping behavior, and meaning-making impacting well-being. The components of the framework are examined through five cancer survivor narratives. The results showed that the components of the framework were experienced by the survivors, for example, various spiritual problem-solving styles were used, indication of spiritual connections to nature, others, and the transcendent. Meaning-making was common as they faced the life-threatening disease which often altered their worldview. The spirituality of the participants is reflected in the spiritual framework and the framework embraces these survivor experiences. This study has limitations due to its qualitative nature and small sample size.     

The remote practice network: new concept in health care delivery.

It is widely acknowledged that a trend toward greater competition is creating dramatic changes in the way that health care is provided in the United States. Physicians and hospitals, in particular, face a difficult period of adjustment as the nation's health care system increasingly turns toward the competitive model. Physicians, particularly those in leadership positions, must meet the challenge of competition by developing and implementing effective coping strategies. Medical directors and other physicians in key leadership and decision-making positions have a responsibility to their institutions, their patients, and indeed their own careers to recognize and understand the implications of current trends in health care delivery. This article discusses an innovative approach to competition in today's challenging health care marketplace.     

A Paradigm Shift in Healthcare: An Open Door for Organizational Behavior Management

The United States spends more money on healthcare each year than any other country in the world (OECD, 2015). Despite high costs, the quality of healthcare is below average, resulting in a society that is far from “getting what it pays for.” High costs and poor quality have resulted in a recent paradigm shift from traditional fee-for-service systems where hospitals and providers were paid by volume of patients to value-based care, to where they are now paid by quality of care (Andel, Davidow, Hollander, & Moreno, 2012). This shift has pressured organizations to improve quality of care at a rapid pace. This paper seeks to assess how Organizational Behavior Management has helped address the quality of healthcare thus far and discuss avenues for future research and practice.     

Making integrated health care work

This article summarizes the authors' thinking on value added in health care, and offers examples of the major strategies being implemented by integrated systems across the United States to increase their value and improve their competitive positioning. The research results are based on a review of published literature on 150 health care organizations in various stages of integration, and 20 in-depth case studies of integrating systems.     

Study tour examines health care systems in Germany, Holland--Part I: A comparison of three health care systems

In October 1992, the American College of Physician Executives sponsored a study tour to Berlin, Germany, and Amsterdam, Holland. Meetings were held with government officials, third-party payers, and providers, and onsite visits were made at hospitals, clinics, and academic centers. The purpose was to study the health care delivery system in those countries and to share some insights with the countries' hosts on the U.S. system. Beginning in this issue of the journal, 5 of the 10 study tour participants describe their impressions of the tour and of the health care systems in the countries that were visited. This first report compares the health care delivery systems of the United States, Germany, and Holland. In subsequent reports, the German and Dutch health care systems will be described in greater detail and the ability of the United States to adopt European health care systems will be assessed.     

The ethics of health care system reform

The United States is now engaged in a momentous national debate about health care. How can we provide the best care possible while simultaneously containing cost (to promote the general economic integrity of society) and somehow maintain a semblance of a free health care marketplace. This is not just a political question; it is also a question of ethics. It is an ethical consideration because the current debate is not just about designing or promoting health care systems that can best address our concerns for costs, quality, and accessibility. It appears that at least some participants in the debate would not stop at arguing their beliefs as valid; they would make their beliefs law. Some urge the creation of the right to health care as a matter of law. There are significant differences between beliefs and rights, however, and they need to be considered carefully in the ongoing debate over the future of this country's health care delivery and financing system.     

Primary care: the driver in health care reform

The changes occurring in the health care industry have resulted in a cost-quality competition that has not been present in the past. Because of this competition, managed care is a growing way of financing and providing health care to the people of the United States. Managed care depends heavily on competent primary care physicians. Because primary care physicians are in short supply, the status and financial rewards of primary care practice are increasing. The primary care physician will be the dominant force in medical practice in the immediate future. He or she is capable in a managed setting of resolving the perceived problems of the health care industry in responding to the drivers of health care reform. Costs are reduced while quality is maintained. Access to health care is improved, and fragmentation of health care is significantly lessened.     

Toward a theory of spiritual leadership

A causal theory of spiritual leadership is developed within an intrinsic motivation model that incorporates vision, hope/faith, and altruistic love, theories of workplace spirituality, and spiritual survival. The purpose of spiritual leadership is to create vision and value congruence across the strategic, empowered team, and individual levels and, ultimately, to foster higher levels of organizational commitment and productivity.I first examine leadership as motivation to change and review motivation-based leadership theories. Second, I note the accelerating call for spirituality in the workplace, describe the universal human need for spiritual survival through calling and membership, and distinguish between religion and spirituality. Next, I introduce a generic definition of God as a higher power with a continuum upon which humanistic, theistic, and pantheistic definitions of God can be placed. I also review religious- and ethics-and-values-based leadership theories and conclude that, to motivate followers, leaders must get in touch with their core values and communicate them to followers through vision and personal actions to create a sense of spiritual survival through calling and membership.I then argue that spiritual leadership theory is not only inclusive of other major extant motivation-based theories of leadership, but that it is also more conceptually distinct, parsimonious, and less conceptually confounded. And, by incorporating calling and membership as two key follower needs for spiritual survival, spiritual leadership theory is inclusive of the religious- and ethics and values-based approaches to leadership. Finally, the process of organizational development and transformation through spiritual leadership is discussed. Suggestions for future research are offered.     

Nursing home care: ensuring quality.

There are more than 17,000 nursing homes in the United States providing care for 1.7 million disabled and elderly individuals. Medicare and Medicaid paid $28 billion in 1997 for nursing home services, more than one half of all nursing home expenditures. Improvements in the quality of care in these facilities and ensuring value for public expenditures has been a long sought after goal. Recent actions by the federal government are designed to strengthen state and federal authority and processes to accomplish this goal. Physician leadership in this area is essential to its success.     

Health care costs tied to many issues

Although, in 1990, the United States spent about $750 billion (12.2 percent of the Gross National Product) on health care, 31-37 million people in this country are uninsured. Another 4 million people are thought to be underinsured. We have one of the highest infant mortality rates among developed industrialized nations and rank 19th in health care and well-being among those nations. Our life expectancy is lower than those of some third-world countries. The United States and South Africa are the only two industrialized nations without a national health care policy. In spite of these statistics, U.S. health care costs continue to rise and, by the year 2000, are expected to reach $1.5 trillion (15 to 17.5 percent of the GNP. Per capita spending on health care will reach $5,515 by the year 2000, compared with $2,425 in 1990 and $1,016 in 1980.     

Spreading the word ... hospice information systems

The rapid spread of Saunders' thinking across the world has been facilitated by the Hospice Information service and library at St Christopher's Hospice which she helped to create and further enhanced by Help the Hospices. We have set this article in the context of the Web and other information systems as they are developing today. "Connecting people" and "collecting people's experiences" were terms often used by Cicely Saunders when she described the work of Hospice Information, a service that has in some measure contributed to the rapid spread of her thinking across the world and which is currently in close contact with palliative care workers in over 120 countries. Connecting--or networking--putting people and organizations in touch with each other for mutual benefit and collecting and disseminating people's experiences are central to our work as a U.K. and international resource on hospice and palliative care for professionals and the public. Add to these the crucial role of information provision and advocacy for patients, carers, and health professionals alike and we hope that you may begin to appreciate how our respective organizations have contributed to the spread of Cicely Saunders' vision.