Quotes from Students Papers 1999
           University of Minnesota, Carlson School of Management
           Topics in Health Economics
           Masters in Health Administration MHA 6-755 and Public Health 8-796

The major leadership processes are the leadership-follower influence process, the leader-context relational process, and the context-follower relational process.  (Conger and Kanungo ’98).  This assumption is demonstrated through the combat model, “leaders need to take risks, be innovative, take charge, maintain high expectations, a positive attitude and above all—get out in front.”  (Cohen, 1990).  General MacArthur’s contention that the leader “gets out in front” demonstrates the bond the leader must have between the basic dynamics of self and the influence that can be used to motivate followers.

 An illustration of the above assumption and the complexity of the dynamics are reviewed in the story of a tightrope walker.  The walker was achieving an amazing feat by walking a tightrope over an open canyon.  A bystander, amazed by the accomplishment, asked the tightrope walker if she could do it blindfolded.  She responds in the affirmative and stated “I can cross this canyon blindfolded and pushing a wheelbarrow.”  The bystander exclaims: “Wonderful, let me see.”  The performer responds by saying: “OK, get in.”  What dedication and faith in the leader one would possess in order to get in the wheelbarrow, and ride across the tightrope with the blindfolded leader.

—Mitzie T. Erway,

Leadership—May the Force Be With You

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Employees’ personal sense of mission makes it possible for organizations to carry out their missions.  It is absolutely imperative now to bring that part (our soul, or sense of how we belong in the world) to the workplace, because it can sustain us through stressful times” (David Whyte).

Laura Beth Jones, in her book “the Path,” says that mission statements should have these three simple elements:

1.      They should be no more than a single sentence long

2.      It should be easily understood by a 12 year old

3.      It should be able to be recited by memory at gunpoint (David Whyte).

“Good people, serving good food to customers in a fun, family atmosphere”( mission statement, TGIF,  Lincoln, Nebraska).

Unsuccessful mission statements have common traits:

1.      They are uninspiring

2.      They are for the benefit of one person or one party only

3.      They are unintelligible by “outsiders”

4.       They are full of trite or ordinary phrases, such as “we are here to serve the customers.”

—David J. Hartberg,

Mission and Vision:

The Core Components of Not-For- Profit Health Care Financial Viability

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Information has an empowering effect for patients.  Clinicians have traditionally spent a large amount of time with patients in educating them on their particular condition.  As more patients assume a self-educating role, the physician can focus on the human aspects of the communications bringing greater depth and meaning to the interaction.  The physician’s role shifts from teacher to healer.

 In the world of Internet medicine, economic and clinical profiles of providers will drive consumer choices.  Aetna U.S. Healthcare has ten million patient records.  Mining these data will enable them to identify ways to improve care; select the providers with the best clinical outcomes; and contract with organizations with the lowest cost per episode of care.  Members of the Aetna U.S. Healthcare plans will be able to use these data to make informed choices about their healthcare providers.  Ultimately, these provider report cards will serve as a means of eliminating inefficient and ineffective practitioners.  Accountability is a natural consequence of improved information.

 —Janet Twehill,

Medicine.com:

 The Internet and the Future of Medicine

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 Speaking at the 16^th Annual Strategy Forum, Carol Boston, a leader in work transformation noted that hospitals spend 75% of labor “caring for the system” versus 25% “caring for the patient.”  Organizations need to redesign services around patients versus patients around services.

 Examples of initiatives taken to improve productivity in hospitals:

• Utilize “utility players” by cross-training staff

• Identify and eliminate/reduce idle time

• Revise the schedule and scheduling—staff and patients

• Identify overlapping and/or duplicative functions

• Determine “If I were not doing it, would I start doing it”

• Attempt to eliminate the “Bureaucratic Machine.”

—    Michael Anderson,

Productivity… The First Test of Management’s Competence

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 “In most communities, hospitals are at a critical stage in their existence.  Profits have been squeezed dramatically, lengths of stay are down, numbers of patients are going down, negative press is increasing, capital requirements are skyrocketing, and generally, the business future is bleak” (Hillestad and Berkowitz).

 “As the saying goes, you can’t be everything to everybody.  So why not stand for something for somebody?” (Hillestad and Berkowitz).

 The entrepreneurial model is defined as every man for himself.  The theory of social opportunities uses no man is an island approach.  The adaptive theory is one of continual change and adaptation:

Vertical Integration    ->        Out-sourcing

Diversification            ->        Focused

Hospital Advantage   ->        Physician Advantage

Consumer at mercy    ->        Consumer in control

Teammate                   ->        Adversary

Cost-plus                    ->        Prospective Payment System

Fee-for-service             ->        Capitation

            Generic                      ->        Niche Market

Advocate                     ->        Allocator     (Coddington and Moore, 1987)

—Susan Smith,

Niche Markets—Whose Interest Do They Serve?

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 It has been reported by Elkin and Rosch (1980) that U.S. industry loses about 550 million working days per year due to absenteeism, with 54% of these absences related to stress.

 When stress is experienced, either through internal or external initiation, a series of physiological responses begins, commonly referred to as the fight or flight syndrome.  It is interesting to note that very different stimuli (heat, cold, anger and jealousy) produce the exact same response.  These biological responses are the body’s attempt to return stability and normalcy to the body.

 The phases of the General Adaptive Syndrome are the alarm reaction, stage of resistance, and the stage of exhaustion.  In the alarm reaction, the body exhibits changes to the stressor.  The stage of resistance is distinguished by attempts of the body to resist the stressor with continued exposure.  Finally, in the stage of exhaustion, adaptation energy is exhausted, the signs of the alarm phase reappear, are irreversible, and the individual dies.  After a period of chronic exposure to stressors, individuals can experience exhaustion, ulcers, migraine headaches, viral infections, heart disease and other manifestations.

 The effects of stress and its relationship to illness are widely documented (Chrousos and Gold, 1992; Kasl, 1984) in conditions such as diabetes, hypertension, migraine headaches, multiple sclerosis, mental disorders, herpes infections, injuries due to accidents, and cancer.  Stress has been associated with heart malfunctions (Goldberg et. al., 1996) and coronary artery disease (Miller, 1978).  It has been documented that chronic stress in animals results in gastric ulceration in experimental animals (Selye, 1974). Peters and Richardson (1983) later reported a distinct relationship between ulcers and stress in humans.  Finally, stressful conditions have been shown to alter the immune system, making individuals more susceptible to infections and viruses (Schleifer, Keller and Stein, 1985).

—    Elizabeth McAllister,

Stress — What Is It? What Can You Do About It?

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A reduction in reimbursement levels resulted in a negative income effect on physicians, which was then offset by the substitution effect of increasing the number of procedures.  The overall resulting effect was positive for physicians as their income continued to increase.

 Lee (1987) indicates that not only does capitated reimbursement influence the volume of services provided, it also encourages increased efficiencies through greater productivity levels.  Lee referred to a 1991 Medicare Demonstration study of coronary artery bypass graft (CABG) surgery patients conducted at seven major hospitals across the country where all reimbursement for the surgery was lumped into a single payment.  The single payment included a pooling of the institution’s payment and the professional service payment (physician services).  The reimbursement methodology used here is in sharp contrast to the standard lump sum Medicare payment for a DRG (diagnostic related group) to the hospital provider and a separate fee-for-service payment for physician services.  The first three years of this demonstration project yielded the following key changes in the medical regimen: (1) The beginning of same day admissions; (2) The use of a less expensive dye solution; (3) Standardization of surgical supplies; (4) A decrease in operating room time; (5) Greater use of generic medications; (6) Quicker extubation for the patient, leading to less time in the expensive intensive care unit; (7) Introduction of clinical pathways for post-op treatment plans; (8) Greater use of nurse specialties in managing the care of the patient; (9) Fewer requests for mechanical consultations; and (10) Decreased overall length of stay. 

The results from this demonstration project showed a substantial decrease in the cost of providing care to this patient type and no evidence of adverse effect to patients.

Ibid., page 9.

 Some of the typical DRGs first chosen for inclusion in practice standards were the expensive and high volume total joint procedures (total hips and total knees), complicated pneumonia, congestive heart disease, and fractured hips.  Such standards provide clinical guidance for all healthcare disciplines involved in the treatment regimen for that particular diagnosis.  In practice, institutions where interdisciplinary teams have been cohesive units and worked together in support of these standards, tremendous cost savings have been realized.  In addition, patients have experienced higher satisfaction with their care and their knowledge about that care.  Likewise, outcomes of that care have proven to be as good or better than care delivered without the constraints of the guidelines.

—    Linda Sartore,

The Effect of Physician Practice Patterns on Healthcare Costs

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It is easier to live our own lives, to be unaware of our fellow citizen’s suffering.  It is painful to notice—to notice may cause us to look at ourselves in the mirror and notice that “we” may not be different from “them”.  A silent epidemic is spreading through this country—an epidemic of medical indigence—and the only way to stop its spread is not to look the other way.

—Shelly Russ,

Can We Achieve a Healthier Society?

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