t increasingly difficult to manage managed care. As Waters and Young (1997) noted, public hospitals are often more dependent upon public health insurance funding and payment reg9imens than private hospitals and, consequently, face special skill and knowledge requirements for their administrators and staff members.
Managerial theories impacting upon metropolitan public hospitals derive from the field of public administration, which positions public institutions as non-profit institutions that are focused on a mission that does not include maximization of a bottom line or stockholder interest (Drucker, 1997). Such institutions, according to Drucker (1997), experience some difficulties in attracting and retaining skilled managerial, administrative and professional staff due to the probability that such workers will garner limited financial rewards for their work when compared to peers in for-=profit institutional work settings. This requires the development of a system of rewards, benefits and motivational items that will foster job satisfaction and reduce staff turnover. For many worker sin such institutions, Drucker (1997) suggests that the overarching service mission and charitable focus of the public hospital may serve as a source of inspiration and motivation.
Given this, management theories that are employed in metropolitan public hospitals can run the gamut from Taylor's Scientific Management to Herzbergs's Two-Factor Theory to Total Quality Management to Management by Objectives and so on (Berman, 1998). There are as many theories of effective management and managerial leadership at work in public hospitals as there are in for-profit businesses and industries. What is needed, according to Berman (1998), is the recognition that there is no "one size fits all" theory of management that can motivate public hospital staff to productivity and performance improvements.
Nevertheless, a driving force in public hospital ...