October 7th, 2011 by admin in Opinion, Research
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It’s been more than five years since Henry Mintzberg released the enlightening book ‘Managers, not MBAs’, a well-reasoned criticism of prevailing management education that basically revolves around Master in Business Administration (MBA) programs. Financial crisis was not even in sight but Mintzberg, a professor at McGill University in Montreal and one of the most important guiding lights in the questionable field of management, already pointed out that it was a serious danger for modern organizations to rely on professionals that had just finished their MBAs as the prime source for senior managerial positions.
Mintzberg focused his criticism on two essential aspects. First, most programs are aimed at people with no previous experience or knowledge about organizations and how they look like from the inside… and these same people then storm into companies believing that the real world works exactly as business school taught them it does. The second point is that many of these business schools spread a perverted set of values, such as the hunt for short-term profit, the belief that a good aim justifies any means and the urge to translate all human behaviors into accountable figures (the ‘countophrenia’ depicted by Vincent de Gaulejac in his must-read ‘La Société Malade de la Gestion’).
Then the crisis rose, and many CEOs of the biggest organizations had their share of responsibility for it, as they were enjoying multi-million dollar bonuses while taking their companies to the edge of bankrupcy. Most of them came from the most famous business schools in the world. I have outlined in the past the outrageous conflict of interests of many of these institutions, starting with Harvard, as Charles Ferguson perfectly displayed in his brilliant documentary ‘Inside Job’.
‘Social Science and Medicine’ published in its August issue a very interesting work by Amanda Godall, professor at the IZA Institute for the Study of Labor in Bonn, Germany. Godall’s is the first empirical research on the correlation between hospital results and having MDs in their top managerial positions. Read more »
*This blog post was originally published at Diario Medico*
August 19th, 2011 by MotherJonesRN in Research, True Stories
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I wonder how many cups of coffee an average night nurse consumes during their shift. Look, there’s someone we can ask, although it looks like her caffeine buzz is wearing off. Notice the telltale chin to chest head tip that gives sleep deprived nurses away. She may look like she’s charting, but she really is in a twilight sleep.
Working nights isn’t for wimps. Neither is working holidays and weekends. You are always short of help, and BIG things seem to go wrong just as the day shift staff heads out the door. I always thought that I was just paranoid about working the off shifts, but Muhammad Saleem from RN Central sent me some information that validated my observations. I’ve posted their research results below. I’ve lived through a lot of these situations. I’ve seen seasoned nurses nod off at the desk at 3AM because they’ve been working their butts off, and I’ve worked with doctors who don’t answer pages promptly during evening hours and on weekends even though they are on call. I’ve also worked with new residences who are unable to write coherent orders until the third week of their rotation. Sometimes I’ve wondered why more things don’t go wrong in a hospital.
I think their information looks accurate. What do you think? Read more »
*This blog post was originally published at Nurse Ratched's Place*
August 16th, 2011 by Happy Hospitalist in Opinion, Research
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Association of Hospitalist Care With Medical Utilization After Discharge: Evidence of Cost Shift From a Cohort Study.
That’s the title of the latest medical study making the viral rounds. I had an opportunity to read the study in full. I called Happy’s hospital library and Judy had the pdf article in my email in less than 24 hours. Now, that’s amazing. Thanks Judy for a job well done. You deserve a raise.
Presented in the August 2nd, 2011 edition of the journal Annals of Internal Medicine, Volume 155 Number 3 Page 152-159, the study concludes that decreased length of stay and hospital costs associated with hospitalist care are offset by higher medical utilization and costs after discharge.
In summary, hosptitalist patients had an adjusted length of stay 0.64 days shorter and $282 less than patients cared for by primary care physicians, but total 30 day post discharge costs were $332 higher. These additional charges were defined as 59% from rehospitalization, 19% from skilled-nursing facilities, and 22% from professional and other services.
OK fair enough. Let’s come to that conclusion. Let’s say Read more »
*This blog post was originally published at The Happy Hospitalist*
August 3rd, 2011 by Happy Hospitalist in Opinion, True Stories
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Childbirth hospital costs these days aren’t cheap. Some studies suggest the cost of raising a child exceeds $200,000, not including education expenses. Most insurance companies charge women of childbearing age more for their insurance because the actuarial tables say so. Mrs Happy and I now have a 3 month old Zachary in our wings. He is a cute little peanut. His two brothers, Marty and Cooper adore him.
Forty-two days after his April 21st, 2011 delivery, we still had not received our explanation of benefits from Blue Cross Blue Shield for the midwife charge. I had previously received a statement from them saying the charge was under review. Perhaps they believed that delivering Zachary was not medically necessary. I can’t explain it.
When I called to ask them why this charge had not been approved, they said they could not give me a reason why my explanation of benefits statement had not been finalized after 42 days. I pressed for more information, but to no avail. I was given no reason other than to say that they had a lot of claims to review. That’s not an acceptable reason to delay a payment of a claim. Read more »
*This blog post was originally published at The Happy Hospitalist*
June 10th, 2011 by Happy Hospitalist in Health Policy
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Hospital costs are out of control. We have an aging population living longer with more complicated presentation of disease. We have an insurance driven platform instead of a health driven accountability. The long term sustainability of that architecture is one of guaranteed insolvency.
One way or another hospitals are going to find their lifeline cut off. Medicaid is bankrupt. Hospital profit margins from Medicare have been negative for almost a decade. In addition, the rapid rise in private insurance premiums and industry’s gradual but accelerating exit from the health insurance benefit market all tell me that hospitals must find a way to reduce the cost of providing care.
There are many ways hospital costs can be reduced. Administrators are paid handsomely to make it happen. Either they do or they don’t succeed. Either they survive the coming Armageddon of hospital funding or they don’t. The hospitals least able to reduce their expenses in a market of decreasing payment will fold and other hospitals will become too big to fail. You want to be too big to fail. That’s the goal. If you can survive the coming tsunami, you will be saved and bailed out when you are the only one left standing. That is what history has taught us.
So, how can hospital costs be reduced? One way is to Read more »
*This blog post was originally published at The Happy Hospitalist*
