Healthcare Management Forum

In a product management structure, the management of separate products is moved down in the organization to achieve greater participatory management as well as greater effectiveness in the identification of factors most relevant to the survival of the product. For the business industry, managing products as separate entitites enables more effective competition in the marketplace.

This approach has been used in U.S. hospitals in managing programs and services. Described here are the initial attempts at program management undertaken at the Health Sciences Centre in Winnipeg, a highly specialized, provincial 1, 100-bed teaching and referral hospital. Some issues important in developing and implementing the program management approach are discussed.

A survey of doctors in Saskatchewan communities with fewer than 5,000 residents was conducted to determine which factors were important in maintaining job satisfaction. The response rate was 57 percent. A three-item measure of satisfaction linked the doctors' responses to a 62-item questionnaire covering professional and non-professional issues related to their rural practice. Individual variables of importance in explaining satisfaction were family factors ranging from spousal employment to children's education, availability of recreational facilities or activities and entertainment, the opportunity for social interaction, ability to have periodic rests, workload and compensation.

Despite a high percentage of female graduates from health services administration (HSA) programs since the late 1970s, there is little evidence that the increase has translated into greater employment for women in the top positions in Canadian hospitals. Results of an analysis of data from a 1987 study of chief executive officers (CEOs) in Canadian hospitals are reported relative to difference by gender. These data show that women CEOs are better educated, more experienced, older and likely to be more mobile than their male counterparts. Several suggestions to increase the acceptance of women into top health administrative positions in hospitals are offered.

This study examines the differences in workload estimates of three patient classification systems in nursing, within selected Case Mix Groups (CMGs). The amount of variation explained by selected patient-specific variables within CMGs on average nursing workload by each system is also analyzed. Results show that, when patient classification data are used to explain nursing time within the Diagnosis Related Group (DRG) context, absolute hours of care estimates of the various systems may not be equivalent. This inequality may result in biased budget review practices unless relational statements are developed between systems.

A terminally ill individual may sign a living will, which is a document requesting to be allowed to die a natural death, have it witnessed and address this wish to a relative, physician, lawyer or medical facility. No legislation, however, exists in Canada concerning living wills. Consequently, establishing the legal situation is based on both legislative and non-legislative sources.

This article explores implications of the Criminal Code, the application of rules of criminal and civil law, provisions of the Charter, living will legislation in the United States and the power of attorney approach regarding this controversial issue.