Hospital topics
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Hospitals need to assure themselves that advance directives are available to caregivers, especially physicians, and that the patient's wishes expressed in them are being followed. This can be done only with data collection and analysis and improvement of the processes that support availability and use of advance directives. On a broader, societal perspective, it has been suggested that wide-spread use of advance directives such as natural death act declarations might encourage systematic rationing of healthcare to the elderly. ⋯ Regardless of true motives, such suggestions are often seen as motivated by economics. The hospital must be alert to the ethical issues of advance directives, which are present regardless of a natural death act statute or a living will. Hospitals and their managers must consider these issues prospectively and develop policies that enable them to respect and meet patients' wishes, consistent with the organizational philosophy.
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Review
Managing hospital quality performance in two related areas: patient care and customer service.
The Joint Commission on Accreditation of Healthcare Organization's new emphasis on continuous quality improvement provides hospitals with an opportunity to enhance both customer service as well as patient care. Both are expected by patients and delivered by providers. Patient care is the core product; customer service augments it by adding value and providing the opportunity for a competitive advantage. This article discusses issues for administrators to consider before including customer service as a component of continuous quality improvement and then presents methods for bringing about change.
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Hospitals face very dynamic environments and must meet diverse needs in the communities they serve and respond to multiple expectations imposed by their stakeholders. Coupled with these variables, the fact that leadership in these organizations is a shared phenomenon makes organizational leadership in them very complicated. An integrative overview of the organizational leadership role of CEOs in hospitals is presented, and determinants of success in playing this role are discussed.