THE MANAGER AS REPRESENTATIVE OF THE HEALTH CARE SYSTEM
Two managers from an urban hospital, a human resources practitioner and a clinical laboratory supervisor, attended a 1-day management education program of the kind frequently held at hotels and conference centers. The subject of the program was generic in the sense that it was not limited to health care or any other specific industry; the topic was one that affects management in any setting. The 2 hospital managers soon discovered they were the only health care personnel present.
The hospital human resources practitioner encountered among the attendees 3 acquaintances who were employed in other industries. These 4 found themselves involved in an informal discussion with a few others during an afternoon break.
Just before the break, Workers' Compensation had been mentioned, and the rising costs of this statutory benefit provided the subject for much of the conversation. A manager from a retail grocery chain remarked that his company's premiums for Workers' Compensation were increasing at an alarming rate, and he asked the health care managers if the hospital was experiencing similar increases. The human resources person explained that as a not-for-profit corporation under state law the hospital did not pay premiums but was instead required to pay its Workers' Compensation costs in full as they occurred.
The grocery manager's immediate reaction was "As a 'what' corporation?" This manager did not know that the majority of hospitals are incorporated as not-for-profit institutions; he expressed the belief that "churches and charities" were the only not-for-profit organizations.
Actually, of the several people involved in the discussion, only the 2 hospital managers knew that all of the hospitals in their county-7 voluntaries and 1 municipal-were incorporated as not-for-profit entities. Someone then asked, "Then who gets all that money?" Others likewise voiced the belief that their local hospitals generated significant profits. "They've got to be making lots of money," one said. "Look at how much everything costs at one of those places." There seemed no appreciation of the extent of government regulation of hospitals throughout the state and no knowledge of the fact that in any recent year at least 2 or 3 of the local hospitals lost money on operations.
Certainly, health care costs throughout the country have been escalating for a number of years. But because some individuals cannot readily see where the money is going, they assume that profits are being made. As costs increase nationwide, many people make assumptions about hospital profitability. However, hospital operating environments vary from state to state: Given the same volume of business, a hospital in one state might make a handsome profit (or "surplus," as it is customarily designated for the not-for-profit corporation), whereas a hospital in a neighboring state might suffer dramatic losses, and one in a third state might barely break even.
The forces shaping the future of the American health care system include public perceptions and the credibility of many individuals and entities working within the system. An individual manager is in a position to influence public perceptions in a small but noticeable way and thus enhance the credibility of at least one's own health care organization.
Mixing with other managers professionally and attending conferences and other activities that cross industry lines can aid in fostering more realistic perceptions of the state of health care delivery. Taking the opportunity provided by exposure to managers working in other industries, an individual manager can help correct some erroneous perceptions of the manner in which the health care system operates.
Every manager is a public relations representative for his or her own organization and occupation. As such, it should be regarded as part of the management role to take full advantage of all opportunities to influence public perceptions and enhance understanding of how the health care system operates.
This issue of The Health Care Manager provides the following articles for the reader's consideration:
* "Contribution of the Psychosocial Work Environment to Psychological Distress Among Health Care Professionals Before and During a Major Organizational Change" reports on a study undertaken to investigate the relationships between the dimensions of the psychosocial work environment among health professionals as well as their psychological distress during reorganizing.
* "Restructuring With the Middle-Management Advantage" describes an examination of the strategic roles, enabling conditions and intermediate outcomes concerning middle managers during a period of restructuring, and addresses some of the effects of drastic reorganizing on middle managers.
* "Technological Trends in Health Care: Electronic Health Record" suggests that, based on government directives, the electronic health record is a high-priority technological intervention in health care organizations and that reduction of Medicare payments may result for facilities that fail to meet the timetable for electronic health record implementation.
* "Exemplary Physicians' Strategies for Avoiding Burnout" reports on research undertaken to determine how outstanding physicians avoid burnout through a study involving doctors who have become skilled at recognizing the signs of burnout and countering its effects.
* "The American Recovery and Reinvestment Act: Lessons Learned From Physicians Who Have Gone Electronic" outlines the provisions of the act and associated incentives available to providers, addresses the advantages and barriers related to upgrading to an electronic records system, and provides examples of implementation in small group medical practices.
* "Corporate Social Responsibility and the Future Health Care Manager" reports on a study conducted to determine what corporate social responsibility orientation and viewpoint future health care managers may hold, suggesting that future managers may hold patient care in high regard as opposed to profit maximization.
* Case in Health Care Management: "What Can I Do in Just One Hour?" asks the reader to consider some alternatives that may or may not be applicable in prioritizing tasks and utilizing time when time itself is severely limited.
* "Changing Trends in Health Care Tourism" reports on an empirical investigation of the medical tourism consumer market, providing the demographic profile, motivations, and value perceptions of health care consumers who traveled abroad specifically to receive medical care.
* "Dietary and Fluid Adherence in Iranian Hemodialysis Patients" reports on a study aimed at assessing the factors related to adherence of uremic patients on hemodialysis, addressing information gathered from 200 hemodialysis patients combined with values acquired from the patients' medical records.
* "Change Can Work for You or Against You: It's Your Choice" addresses natural resistance to today's rapidly changing social and technological environment, calling upon individual managers to become true change agents and make essential change acceptable to their employees as well as to themselves.
* A Manager Asks: "The Manager in the Middle: Frustration From Above and Below" addresses a number of questions asked by managers concerning the bidirectional nature of the problems they face; that is, problems from above (superiors) as well as problems from below (subordinates).