Metropolitan Public Hospital

Many American overt hospitals atomic number 18 closely tied to academic medicine, and as such, digest a complex mission that extends beyond patient caution to imply teaching, research and serving the poor. Sustaining this mission in argus-eyed of declining funds and strict regulatory oversight of reimbursement policies and practices has become gruelling (Waters & Young, 1997). Additionally, some man hospitals in metropolitan areas find it progressively difficult to manage managed care. As Waters and Young (1997) noted, worldly concern hospitals are often more dependent upon cosmos health insurance funding and payment reg9imens than private hospitals and, consequently, face especial(a) skill and knowledge requirements for their administrators and staff members.

Managerial theories impacting upon metropolitan common hospitals derive from the field of public validation, 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 prospect that such spirters 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 w

mutual Center for Political and Economic Studies. (2000).

www.jointcenter.org/selpaper/urban.htm.

The overarching theory shaping focus and administration in public hospitals is, said Berman (1998), the grapheme paradigm. summarize quality management or TQM is regarded as more of a management philosophy than an all-encompassing single strategy. Continuous quality improvement, the empowerment of all stakeholders, a customer orientation, reengineering, and benchmarking are the strategies run aground within this paradigm.

The core of values in the quality paradigm influencing these and other nonprofits, said Berman (1998), is to identify, meet, and exceed the needs of stakeholders, strive to discover services right the first time, use systematic epitome to evaluate and improve service delivery, and consistently support workers in their efforts to improve quality and to meet customer needs.

In discussing public hospitals, John O'Looney (1999) noted that the existence of independent public regime has traditionally presented a unique challenge to the field of public administration. Public hospitals are quasi-governmental or government entities that have been created for a special rather than a general purpose. Unlike many public sector agencies or institutions, hospitals face unique challenges. They must(prenominal) deliver services that are comparable to those available in for-profit private hospitals. They must attract, train, develop, and retain professional staff members in a competitive environment in which funds are declining. They must manage the shift from inpatient to outpatient services, navigate the amnionic fluid of managed care, and even compete for the Medicare/Medicaid populations that were once their nearly exclusive purview.

Nevertheless, a driving force in public hospital administration from a theoretical as well as a practical perspective is the quality movement. Edwards, Austin, and Altpeter (1998) pointed out that accreditation and commissioning o
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