t the "core business" of health care, but rather to empower others to perform this function and to facilitate the integration of health services across the continuum of care (Shortell, Gillies, & Devers, 1995, p. 131). Hospitals, to prepare for the future, require new management and governance structures, new relations with professional providers, re-engineering of the clinical processes, organization-wide commitment to improving quality, and creation of an overall community care management system.
Traditionally, the responsibility for treating illness and injury has been that of the personal health services system anchored by professional providers and hospitals (Shortell, Gillies, & Devers, 1995, p. 136). Similarly, the responsibility for preventing disease and injury and promoting wellness has been that of the public health system, anchored by local and state health departments. "In the emerging world of capitated payment and care for populations, incentives are created both for merging public and personal health services and for reaching out to schools, police departments, and social welfare agencies" (Rundall, 1994, p. 4). The goal is to organize the entire continuum of care·from health promotion and disease prevention to primary and secondary acute care, tertiary care, long-term care, home health care, and hospice care·as to maximize effectiveness "across episodes of illness and pathways of wellness. A premium is placed on integration and holistic care, not fragmentation and specialist care" (Shortell, Gillies, & Devers, 1995, p. 136). Effective community-oriented primary care is essential for achieving successful population-based health care under capitated budgets. The role of the acute care hospital in such a system is a "peripheral back-stopping role for treating the breakdowns in the lines of offense and defense that promote individual and community well-being. In brief, hospitals are the goal keepers of America...