Managing the Metropolitan Public Hospital

Many of the nation's public hospitals, especially those in urban areas, are in a state of crisis. Some have been or will be privatized, some are being sold to for-profit companies, and others have simply been closed as funds disappear and staff exits for more lucrative positions elsewhere (Waters & Young, 1997). In the health care industry of today, numerous threats exist that can negatively impact upon the viability of public hospitals in metropolitan areas where they often represent the primary source of service for un- and underinsured individuals, the poor, the elderly, and the disabled. Consequently, management and administration issues in the context of these vital institutions are of new and special significance.

The Joint Center for Political and Economic Studies (2000) examined the status and future of urban public hospitals, noting that these institutions serve America's most vulnerable populations and provide essential services such a trauma care and burn units to the entire population of major metropolitan areas. Such institutions depend heavily upon Medicaid and Medicare populations, and upon these federal programs as well as state and local governments for financial solvency. Driven by the quality improvement movement and constrained by competition and limited funding, such institutions face myriad challenges related to workforce issues as well as service issues.

Several factors impact upon management and

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ers, strive to produce services right the first time, use systematic analysis to evaluate and improve service delivery, and consistently support workers in their efforts to improve quality and to meet customer needs. In a discussion of the governance change for metropolitan public hospitals, Edward Stolzenberg (2000) stated that public hospitals demonstrate their value to the nation's healthcare systems by filling service gaps and caring for vulnerable populations. The traditional governance of the public hospital where it is operated as an arm of government is seen by Stolzenberg (2000) as anachronistic in an environment dominated by competition and business-driven imperatives. The Medicaid population, once considered the major target population of the public hospital, has become a target for both for-profit and non-profit systems because of Medicaid-managed care. This is leading public hospital institutions to restructure governance mechanisms to create a model free of operational constraints that characterize its structure. Stolzenberg (2000) believes that public hospitals must gain greater access to capital, achieve extraction from the body politic, acquire financial management autonomy, and develop the capacity to netw

Category: Medical - M