Article Type: Editorial
Subject: Medical care, Cost of (Social aspects)
Health care industry (Economic aspects)
Author: O'Connor, Stephen J.
Pub Date: 01/01/2012
Publication: Name: Journal of Healthcare Management Publisher: American College of Healthcare Executives Audience: Trade Format: Magazine/Journal Subject: Business; Health care industry Copyright: COPYRIGHT 2012 American College of Healthcare Executives ISSN: 1096-9012
Issue: Date: Jan-Feb, 2012 Source Volume: 57 Source Issue: 1
Topic: Event Code: 290 Public affairs Computer Subject: Health care industry
Product: SIC Code: 8000 HEALTH SERVICES
Accession Number: 279261874
Full Text: During the mid-1990s, scholars described healthcare in the United States as "in a state of hyperturbulence characterized by accumulated waves of change in payment systems, delivery systems, technology, professional relations, and societal expectations" and compared it to "an earthquake in its relative unpredictability, lack of a sense of control, and resulting anxiety" (Shortell, Gillies, and Devers 1995). This hyperturbulence has become the norm for healthcare. Unfortunately, the most notable changes of the past 20 years have been declines in population health metrics and a rapid and unsustainable escalation in healthcare costs. These negative trends have led other scholars to conclude that the contemporary healthcare environment is more accurately one of "hyperdysfunction" (Hernandez and Shewchuk 2011). This dysfunction can be attributed to personal, political, and economic self-interests that lead people to resist efforts to improve healthcare organization and delivery. Whether the nation will be able to eventually resolve the many challenges confronting healthcare is far from certain. However, our failure to overcome these challenges is likely to have dire consequences for the health and welfare of this nation (Kaufman 2011).

Although he is concerned about such challenges, this issue's interview subject, Scott E. Armstrong, FACHE, president and CEO of Group Health Cooperative, presents a guardedly optimistic perspective. The ideas Mr. Armstrong advances, which his organization has long exemplified, address some of the seemingly intractable issues confronting healthcare today. Group Health's success stems from a unique culture of accountability, consumer orientation, and cooperative spirit. Mr. Armstrong calls for new performance metrics based on health outcomes and reimbursement instead of continuing to "feed the fee-for-service dragon."

While nurses make up the largest segment of the healthcare workforce, healthcare governing boards continue to include relatively few nurses. Trends columnists Susan Hassmiller, PhD, RN, and John Combes, MD, examine the reasons behind this phenomenon and argue for increased representation from the nursing profession in these essential leadership roles.

In this issue's Reform column, Meta Jordan, FACHE, examines the regulatory considerations healthcare organizations face when acquiring physician practices and integrating them into their operations. Raising awareness of these issues is particularly timely as hospitals begin to organize themselves into accountable care organizations.

The evolution of hospital structures in response to new environmental demands is the focus of a piece by Federico Lega, PhD, and Stefano Calciolari, PhD, that originates from Italy. The authors identify "ultra-elderly" frail patients--distinguished by chronic conditions, severe health problems, and complex social situations--as a rapidly growing share of hospital populations in developed countries. The authors present and discuss structural design innovations that are consistent with the needs of this population.

As accountable care organizations and medical home models are advanced through the Affordable Care Act, hospitals and health systems will play a greater role as care coordination hubs and consumer information sources. These organizations will find a useful and up-to-date web presence indispensable in strengthening connections with consumers. Eric Ford, PhD, and colleagues present an initial systematic assessment of US hospital and health system websites in terms of accessibility, content, marketing, and technology and offer suggestions for improving website effectiveness.

As hospital tax exemption and community benefit continue to face scrutiny, lames Byrd and Amy Landry, PhD, examine hospital community benefits through the conceptual lens of institutional theory and the results of a 2006 IRS study of tax-exempt hospitals. The authors put forward a model of hospital community benefit that differentiates cost-quantifiable benefits appropriate for tax exemption from less quantifiable benefits that contribute only to hospitals' legitimacy in their communities.

Racial and ethnic health disparities have garnered much recent interest, but healthcare leaders may not be fully leveraging diversity efforts to aid in reducing disparities. Ebbin Dotson, PhD, and Amani Nuru-leter, PhD, establish a justification for investing in leadership diversity and develop three strategies for making the business case for such investments.


Hernandez, S. R., and R. M. Shewchuk. 2011. "Working Toward Effective Change in Healthcare." Journal of Health Administration Education 28 (4): 253-56.

Kaufman, N. S. 2011. "Three 'Brutal Facts' That Provide Strategic Direction for Healthcare Delivery Systems: Preparing for the End of the Healthcare Bubble." Journal of Healthcare Management 56 (3): 163-68.

Shortell, S. M., R. R. Gillies, and K. J. Devers. 1995. "Reinventing the American Hospital." Milbank Quarterly 73 (2): 131.

Stephen J. O'Connor, PhD, FACHE

Gale Copyright: Copyright 2012 Gale, Cengage Learning. All rights reserved.