Senior Hospital Administrators Research Articles

Impact of a Transfer Center on Interhospital Referrals and Transfers to a Tertiary Care Center

The partnership of faculty physicians and senior clinical hospital administrators in the decision to accept interhospital transfers has not been fully studied. Transfers to academic medical centers on the basis of economics have been of particular concern. To evaluate the impact of joint decision making on transfer acceptance, and to evaluate the basis for decisions to transfer patients to an academic medical center. This was a database study of requested adult interhospital transfers, excluding psychiatric transfers, occurring between January 1, 2003, and December 31, 2003, by using data from a computerized patient-tracking system. Where possible, comparisons with the prior calendar year (i.e., prior to implementation of the administrative review process) were made. Incidence of refusal to accept requested transfers and payer mix of transfer patients were the main outcomes of interest. More than 90% of the adult patients were transferred for conditions that required tertiary care or met Emergency Medical Treatment and Labor Act (EMTALA) requirements. The patient conditions that did not meet tertiary care needs included obstetric patients who did not have prenatal care, patients who had hand and facial trauma, and patients who weighed more than 300 pounds. The payer mix of transfer patients remained stable when using the administrator and physician team to determine acceptance of transfers. During the evaluation period, approximately 91,500 patients statewide lost some level of Medicaid coverage. The value of an administrator and physician team as partners in the interhospital transfer process was demonstrated. Active management of interhospital transfers supports transfer of patients who require tertiary care or who meet EMTALA criteria, thus conserving limited bed capacity and ensuring financial equity, while caring for the uninsured and underinsured patients throughout the state.

Access to High‐Cost Drugs: Decision Makers' Perspectives

ABSTRACTAimTo explore the attitudes, perceptions and concerns among decision makers about equity of access to high‐cost drugs in public hospitals.Method25 in‐depth, semi‐structured interviews were conducted with senior hospital administrators, directors of pharmacy and senior medical doctors. Topics included the decision‐making process and associated problems, and solutions to issues of access to high‐cost drugs. Interviews were audiotaped, transcribed verbatim and thematically analysed.ResultsHealthcare funding models were perceived as obstacles to equity of access to high‐cost drugs. Participants were concerned that there were inequities in decisions for individual patients according to public or private sector status. Tertiary public hospitals were seen to be at the ‘cutting edge’ and therefore were required to fund new and expensive drugs. This meant prioritising between patient groups and individuals. Participants had difficulty in identifying solutions. They suggested that ethical principles should be considered in addition to safety, efficacy and cost. Most wanted a transparent, accountable, evidence‐based decision‐making process.ConclusionDecision makers were concerned about equity of access to high‐cost drugs in public hospitals. They were also concerned about processes for decision making and the outcomes of these decisions.

The Incident Reporting System Does Not Detect Adverse Drug Events: A Problem for Quality Improvement

The objectives of this study were 1) to determine the frequency with which adverse drug events result in an incident report (IR) in hospitalized patients; and 2) to determine if there were differences between quality assurance administrators, nurse leaders in quality assurance, and staff nurses as to whether an incident report should or would be filed for each adverse drug event. All patients admitted to five patient care units (one medical intensive care unit, two surgical intensive care units, and two medical general care units) in one academic tertiary care hospital were studied between February and July 1993. The main outcome measures used were adverse drug events (ADEs) and IRs. Consensus voting was used by senior hospital administrators, nursing leaders, and staff nurses to determine whether an adverse drug event should have been reported and would have been reported. Of 54 adverse drug events identified by the study, only 3 patients (6%) had a corresponding incident report submitted to the hospital's quality assurance program or called into the pharmacy hotline. One additional ADE was identified by an IR, but not by the ADE study. Of the 55 ADEs, 15 were preventable, and 26 were serious or life-threatening, yet only 2 of the 26 led to an incident report. The three voting groups agreed that most ADEs justified an IR, but judged that in actual practice, an IR would infrequently have been filed. Voluntary reporting identified only a small fraction of ADEs. Using IRs for quality assurance/quality improvement will lead to significant bias when assessing quality of care.

Quality wars: the triumphs and defeats of American business

The revolution in American industry, now more than a decade old, has produced an avalanche of books, but this is the first in-depth study reporting the struggles from inside the companies that have attempted large-scale improvement efforts. Jeremy Main has interviewed more than a dozen chief executives, all of whom have managed programs, including Charles Clough of Nashua, Robert Galvin of Motorola, James Hagen of Conrail, Roger Milliken of Milliken, Ray State of Analog Devices, and John Young of Hewlett-Packard, in addition to hundreds of other senior executives, workers, labor representatives, city officials, military officers, and hospital administrators. Through their experiences, Main reveals what works and what doesn't work when an organization attempts the transforming leap into Total Quality Management. Their message comes through loud and clear: it is a tough battle, but persistence can win priceless rewards. The notable successes at BancOne, L.L. Bean, Ford, Hewlett-Packard, Motorola, Saturn, Solectron, and Xerox prove it. However, Main shows that Motorola and Hewlett-Packard, among the earliest and best practitioners of total quality, are still finding obstacles to overcome. And some other early converts, such as Florida Power & Light, have stumbled badly along the way. Main's vivid descriptions of these setbacks capture the difficulties inherent in implementing a total system. His dramatic accounts of success and failure at companies such as Milliken and Intel convey valuable knowledge that is otherwise gained only by actual experience. The way to achieve the new quality of today, Main shows, is through a full commitment to TQM. He reveals through the experiences of these companies that TQM is not just a management tool, as it has often been used, but a management philosophy that is indispensable in attaining a high level of quality-- now a requisite for competing successfully. With the collaboration of the Juran Institute, Main demonstrates how TQM has transformed companies by improving at all levels. The accounts of these triumphs are direct evidence that world-class is attainable by American industry, and will inspire and point the way for executives, managers, and government officials in their timeless pursuit of total quality.

Hospital Case Management: Bridging Acute And Long-Term Care

Since the early 1980s, policymakers and analysts have urged hospitals to be more active in managing the care of their patients beyond the hospital walls. In particular, hospitals have been criticized for failing to address the postdischarge needs of elderly patients with chronic health problems. An influential essay in The New England Journal of Medicine observed that “most of these institutions have no comprehensive geriatric program geared to the long-term medical, rehabilitative, and social needs that are linked to acute illness. To provide quality care, hospitals must make a commitment to long-term care for the chronically ill elderly patient. It is becoming apparent that no one else can.” As part of a strategy for addressing this perceived shortcoming, the authors argued, “Unlike other providers, hospitals could offer comprehensive case management of patients, from home care to acute care, thus ensuring continuity of services.” Under this approach, hospital-based case managers would identify clients, assess their needs, develop care plans, coordinate service delivery, and monitor results. Since many of these activities would take place after the patient left the hospital, hospital-based case management would be a considerable extension of hospitals’ typical discharge planning activities. In part, it was expected that the costs of hospital-based case management programs would be covered through user fees. If the hospital also offered long-term care services, hospital-based case management could generate additional revenues through increased use of these services. If it facilitated the earlier discharge of Medicare patients and reduced Medi-

A New Recruitment and Training Scheme for Senior Hospital Administrators

Public AdministrationVolume 34, Issue 4 p. 425-425 A New Recruitment and Training Scheme for Senior Hospital Administrators Professor T. E. Chester, Professor T. E. ChesterSearch for more papers by this author Professor T. E. Chester, Professor T. E. ChesterSearch for more papers by this author First published: December 1956 https://doi.org/10.1111/j.1467-9299.1956.tb01503.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume34, Issue4December 1956Pages 425-425 RelatedInformation