Should physician-owned single-specialty hospitals continue to exist?

Physician-owned single-specialty hospitals (SSHs) account for only about 200 hospitals out of approximately 5500 hospitals nationwide, and yet they are at the center of a raging debate. The ability of community SSHs to lower costs and improve quality while threatening the viability and existence of community full-service hospitals is at the center of the hotly contested debate. A review of prior studies on this issue does not reveal competitiveness in the marketplace between SSHs and community full-service hospitals.

The culture of silence: disruptive and impaired physicians.

An experienced hospital CEO examines the emergence of disruptive and impaired physicians as an overwhelming problem for hospital medical staff nurses, and administrators. The poor behavior ranges from aggressive acts of yelling, swearing, or pushing to passive ones of being chronically late or providing inadequate chart notes. The Joint Commission on the Accreditation of Healthcare Organizations and the American Medical Association have standards and guidelines to minimize unprofessional behavior that negatively impacts hospital patient care.

Questionable hospital financial relationships with physicians.

Hospital and physician financial relationships are coming under even more scrutiny by the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General. Clearly, CMS intends to audit vastly more hospital-physician financial relationships as part of Stark compliance. CMS has already begun sending a Disclosure of Financial Relationship Report to 400 hospitals as part of enforcing the Deficit Reduction Act.

Improving patient satisfaction through the consistent use of scripting by the nursing staff.

An exploratory developmental model proposes a new method for responding to patient satisfaction on the basis of the hospital nurse obtaining subjective patient information at the patient's bedside during the first 24 hours of hospital admission and the day before discharge. The personal interview by the nurse uses a guided script, the Voice of the Patient (Figure 1), which is the front sheet in the medical record and a part of the critical medical care documents common to all hospital medical records. The information recorded in the Voice of the Patient actually comprises one-sentence quotes from the patient used by the hospital caregivers in responding to patient satisfaction during hospitalization, when care flaws can be corrected.

Group practice contracting with managed care: Part 2.

Managed care contracts are complex and require understanding of market characteristics, legal considerations, and the needs of both the managed care organization and the practice. This article (the second in the series) provides a framework for administrators and practices to consider when approaching negotiations for such contracts.

Group practice contracting with managed care: Part 1.

Managed care contracts are complex and require understanding of market characteristics, legal considerations, and the needs of both the managed care organization and the practice. This article provides a framework for administrators and practices to consider when approaching negotiations for such contracts.

The culture of patient safety.

Hospital patient safety culture is examined as a critical component of quality where preventable and identifiable adverse and sentinel events should not occur. The author, a former hospital executive, illustrates how culture helps illuminate patient safety practices using examples from hospital situations he encountered as a consultant. These cases demonstrate the hospital nurses' focuses on job requirements and training as opposed to actually doing the "right thing" at the "right time.

Caring and competency.

The long-term crisis in nursing, particularly in acute care hospitals, is demonstrated in studies on negligence by the Institute of Medicine in To Err is Human: Building a Safer Health System1 and Crossing the Quality Chasm: A New Health System for the 21st Century.2 A review of the nursing literature reflects unclear definitions of competency and its component caring, and no single theory of competency has been adopted from the literature and used in the education of nurses. The American Nurses 2001 Code of Ethics does not resolve this confusion, because it does not correct the individual acts of nursing incompetencies in acute care hospitals.