Management of Hospitals and Health Services: Strategic
Issues and Performance
By Rockwell Schulz and Alton C. Johnson
2003/07 - Beard Books
1587981742 - Paperback - Reprint - 343 pp.
A provocative and useful compendium of ideas and historic perspectives that are still current and applicable.
Health care is a highly dynamic and changing industry. While the hospital still occupies a major position in the system, more specialized organizations have increased significantly in number and importance, such as health maintenance organizations, clinics, long-term care institutions, laboratories, and outpatient units such as surgicenters. This probing and incisive book aims to educate administrators to relate not only to the environment of their particular organization, but to others that have both direct and indirect relationships. Changes in governmental regulations and societal changes are reviewed in detail, with a view to showing their impact on the industry. Managerial issues and functions covering a panoply of major responsibilities form the core of the book.
From the back cover blurb:
... In outlining their strategies, the authors have boldly selected the approaches that they felt would be most helpful to managers in improving their performance. However, they never lose sight that the overriding mission is to provide access to high quality health care while containing the costs.
From Henry Berry,
The modern hospital is an intricate web of relationships, interests, responsibilities, and goals. For a hospital to operate effectively, its senior managers must be adept at balancing all of these parts. High-level hospital administrators have always had to attend to internal factors such as staffing, facilities, and patient care, but in recent decades with the growth of the population and its increased diversity, external factors have come to be a part in the operations and position of hospitals. Among these external factors are government regulations, community relations, and policies and goals of HMOs and other corporate healthcare organizations.
Because of these external factors, the role of the hospital CEO is now "best described as that of chief strategist," says Rockwell Schulz and Alton Johnson co-authors of Management of Hospitals and Health Services -- Strategic Issues and Performance.
While hospital CEOS remain the final decisionmakers, the main work of the CEO -- and the work that requires the greatest skill -- is being attuned to and providing for the interests of physicians, employees, unions, patients, community leaders, and trustees. These diverse interest groups often have competing objectives, which puts pressure on the smooth operation of a hospital. The ongoing challenge of hospital administrators is to navigate a way through the straits of such competing interests.
As Schulz and Johnson describe it, this is accomplished by "creating the general culture or ambiance of the organization, negotiating and resolving conflicts with major stakeholder groups and developing the forward or strategic plan." Most hospital administrators agree that their objective is "to efficiently improve patient outcomes and community health and to provide access to high quality health care for those in need." These universal objectives can be compromised or even abandoned, however, by "inverting ends and means of the organization [or] managing symbolically rather than to achieve outcomes." Examples of means "inverting" ends include an obsessive concern over career advancement, which results in employees spending an inordinate time on networking and creating contacts outside of one's area of responsibility. It also results in managers having a myopic focus on management itself rather than outcomes or progress.
The irrelevance of such behavior to patient care and stakeholders' interests is apparent. Holding pointless meetings, endlessly collecting data, and reflexively forming committees are all indicative of "symbolic management" in lieu of providing leadership and substantively addressing issues.
Schulz and Johnson set different ends for the hospital administrator -- offering optimal patient care, maintaining an appealing work environment, and creating a good reputation that is necessary to attract physicians and inspire the community's confidence in the hospital.
The different paths that must be pursued in tandem comprise the five main parts of the text. These parts address the broad social and economic environment a hospital has to work in; the elements of strategic management applicable to hospital operations; specific health service organization issues, especially pertaining to doctors and nurses; group dynamics, quality control, human resources, relationships with unions, and other pragmatic, day-to-day management issues; and lastly, future challenges and ethics.
Two codes of ethics for CEOs and other top executives, as well as for managers, consultants, and similar health industry professionals are also reproduced in this book. These codes of conduct emphasize guidelines for ethical standards in pursuing the primary end of fine patient care - the achievement of which necessarily involves good community relations and good working relationships between the various interest groups and between employees and upper-level administrators and managers. The first code is "Statement on Ethical Conduct for Health Care Institutions," developed by the American Hospital Association Advisory Committee on Biomedical Ethics as a model for all hospitals and healthcare organizations. The other code is the "American College of Healthcare Executives Code of Ethics." Together these codes of ethics cover the two primary areas of responsibility for an upper-level healthcare organization executive or manager -- namely, the operating standards of the hospital and the standards of behavior of the top, most visible, and most representative employees. The ethical standards of the top employees are particularly important because they serve as standards for all of an organization's employees. Such ethical standards are also essential in creating an organization's "culture or ambiance" within which all operations take place and relationships develop and where external and internal factors come together positively or problematically for the healthcare organization. A comprehensive, relevant code of ethics is not only a pronouncement of ethical standards to staff members, employees, and members of the surrounding community, but is also tells the administrator and his associates what to focus on and what should guide the central activity of an organization.
Hospital administrators, managers, and others who desire to bring people and institutions together in a way that is responsive to the "human need" of the enjoyment of good health will find Schulz's and Johnson's work, first published in 1990, instructive.
Rockwell Schulz is the founder and former director the Health Services Administration program of the University of Wisconsin's Medical School. Before this, he was a hospital administrator and was associated with the medical schools at Tulane and Texas universities. Alton C. Johnson (d. 1998) was chairman of the Management Department at the University of Wisconsin.
From David L. Everhart, President Emeritus
"It is a provocative and useful compendium of ideas and historic perspectives that are current and applicable. It is a worthy contribution to the health care literature."
Rockwell Schulz is Professor Emeritus at the University of Wisconsin Medical School, where he founded and directed the programs in Health Services Administration. He received a Masters in Hospital Administration from the University of Minnesota and a Ph.D. from the University of Wisconsin. Before his academic career, he served as a hospital administrator and as Assistant and Associate Dean at Tulane University Medical School and the University of Texas Medical School.
Alton C. Johnson also received his Ph.D. from the University of Wisconsin, where he served as Chairman of the Management Department. He had numerous publications in management and health services. He was an Earhardt Foundation Fellow and research grantee of the Ford Foundation. He died in 1998.