How one hospital broke its inflation fever

The Johns Hopkins Hospital has demonstrated that hospital costs can be decreased without governmental intervention (controls). From 1975 to 1978, the hospital inflation rate was cut by half. One key factor, according to Solomon, was a move to decentralize management which was accompanied by a detailed system for monitoring costs. Also instrumental were administration's consistent reminders to physicians and managers about keeping costs down. The hospital was reorganized from a system of clinical departments that behaved, says Solomon, like "fiefdoms" into 14 autonomous departments that function under their own budgets. Each department controls about 85% of its costs (up from 30%), and is set up to function "like a small business." A breakdown of where cost reductions took place shows a savings of $5 million in overhead and $1.5 million in malpractice claims (Hopkins self-insured). Individual departments have also achieved some dramatic reductions: the Department of Medicine decreased the number of laboratory tests ordered; and the Department of Gynecology and Obstetrics built a new facility with fewer beds than the old one.     

Using FTE and RVU performance measures to assess financial viability of academic nurse-managed centers

Financial performance measures are essential to improve the fiscal management of academic nurse-managed centers (ANMCs). Measures are compared among six ANMCs in a consortium and against an external, self-sustainable, profitable ANMC and national data for family practice physicians. Performance measures help identify a center's strengths and weaknesses facilitating the development of strategies aimed at a variety of targets (business practices related to revenue and costs) to improve financial viability. Using a variety of financial performance measures to inform decision making will aid ANMCs in keeping their doors open for business.     

The very real dangers of executive coaching

A personal coach to help your most promising executives reach their potential--sounds good, doesn't it? But, according to Steven Berglas, executive coaches can make a bad situation worse. Because of their backgrounds and biases, they ignore psychological problems they don't understand. Companies need to consider psychotherapeutic intervention when the symptoms plaguing an executive are stubborn or severe. Executives with issues that require more than coaching come in many shapes and sizes. Consider Rob Bernstein, an executive vice president of sales at an automotive parts distributor. According to the CEO, Bernstein had just the right touch with clients but caused personnel problems inside the company. The last straw came when Bernstein publicly humiliated a mail clerk who had interrupted a meeting to ask someone to sign for a package. At that point, the CEO assigned Tom Davis to coach Bernstein. Davis, a former corporate lawyer, worked with Bernstein for four years. But Davis only exacerbated the problem by teaching Bernstein techniques for "handling" employees--methods that were condescending at best. While Bernstein appeared to be improving, he was in fact getting worse. Bernstein's real problems went undetected, and when his boss left the company, he was picked as the successor. Soon enough, Bernstein was again in trouble, suspected of embezzlement. This time, the CEO didn't call Davis; instead, he turned to the author, a trained psychotherapist, for help. Berglas soon realized that Bernstein had a serious narcissistic personality disorder and executive coaching could not help him. As that tale and others in the article teach us, executives to be coached should at the very least first receive a psychological evaluation. And company leaders should beware that executive coaches given free rein can end up wreaking personnel havoc.