Description
Engineering a Hospital Turnaround Proven Strategies for Reinvigorating Financial and Operating Performance.
B o o k R e v i e w s
Engi ne e ri ng a Ho s pi tal
Turnaro und: Pro v e n
Strate gi e s fo r R e i nv i go -
rati ng Fi nanci al and
Ope rati ng Pe rfo rmance
R i chard A. B ae hr, e di to r
American Hospital Publishing, Chicago, 1993,
228 pp., $36 (AHA members), S45 (nonmem-
bers) (paperback)
POTENTIAL READERS MAY BE PUT OFF BY
t he title of t he book Engineering a
Hospital Turnaround, and in some ways
the title hides the gems that it contains.
The book' s subtitle, Proven Strategies
for Reinvigorating Financial and
Operating Performance, is a bet t er
reflection of its breadth and audiences.
It really is about operational assessment
and improvement and covers this broad
subject qui t e well. As the healthcare
deliver)' system evolves, these issues are
becomi ng more relevant t o a greater
number of hospitals.
The book is aimed at institutional
managers, board members, and medical
staff members who are commi t t ed t o
supporting and strengthening their hos-
pitals. Also, any senior executive assum-
ing a new role as chief operating officer
could use the book as a tool for assessing
the institution's operational aspects.
Engineering a Hospital Turnaround
is a compilation of chapters written by a
number of different authors. The breadth
of experience they bring to the task adds
to the book' s interest and depth. It is
easy to read, well organized, thorough,
and full of valuable information. A brief
summary at t he end of each chapt er
would be useful for experienced health-
care executives, who woul d not find
much new in some of the chapters.
The first chapter provides an overview,
states the purpose, and indicates the tar-
get ed audi ence. The second chapt er
identifies the characteristics of a financial-
ly distressed hospital. Because it is so ele-
mentary, the first two-thirds of the sec-
ond chapter would not be of interest to a
well-informed executive. But the last sec-
tion of this chapter provides such a thor-
ough review of the characteristics of a
financially stressed hospital that it would
be especially pertinent for senior nonfi-
nancial executives, board members, and
medical staff leaders.
The third chapter, on strategic reposi-
t i oni ng, is comprehensive and full of
insights into how to assess the hospital's
current position and change its course.
The fourth chapter covers an extremely
important and often overlooked topic:
How can we affect the institution's cul-
ture and support the people who have to
carry out t he change process? The
authors of this chapter did a good job in
limited space, but it would have been
more helpful if they had provided more
in-depth information about how to deal
with some of the issues that usually sur-
face during a turnaround situation, such
B OOK B R I E F S
Death in the Family: Orphans of the
HIV Epidemic
Carol Levine, ed., United Hospital
Fund, New York City 1993, 159 pp.,
$10 plus $3.50 shipping (paperback)
By the year 2000 as many as 125,000
children will be orphaned by AIDS. The
nation's foster care and social services sys-
tems must be revamped if they are to
deliver the mental healthcare, social ser-
vices, and financial and legal support that
these chi l dren will need. The book
includes presentations by healthcare pro-
fessionals and persons personally affected
by AI DS, given at a 1992 conference
sponsored by the Orphan Project and the
United Hospital Fund. Topics include
the dimensions of the problem, family
members' experiences, coping with illness
and death, and new service models.
Aging and God: Spiritual Pathways to
Mental Health in Midlife and Later
Years
Harold G. Koenig, Haworth Press,
Ringhamton, NT, 1994, 503 pp., $29.95
(paperback)
Koeni g, a professor of psychiatry at
Duke University, examines the rela-
tionship between religion and mental
health in ol der peopl e. The aut hor
begins by discussing Western medical
psychology' and the hostility it has tra-
ditionally shown the claims of religion.
Then, in a presentation of research he
and his col l eagues have done wi t h
aging patients, he shows that religion
can in fact often help the mentally ill.
The author predicts that a "near-epi-
demi c of drug use, depressi on, and
ot her mental-health problems in t he
baby-boom cohor t " will soon over-
whelm the present healthcare system,
making religion even more therapeuti-
cally important than it is now.
Hospital-Physician Integration:
Strategies for Success
Terence M. Murphy and C. Tljompson
Hardy, American Hospital Publishing,
Chicago, 1994, 217 pp., $46 (AHA mem-
ben), $57.50 (nonmembers) (paperback)
In 13 chapters the authors offer advice
to physicians and hospitals considering
some form of integration. The first half
of the book discusses the affiliation pro-
cess, integration structures and models,
basic business issues, and legal issues.
The second half, based on seven case
studies, addresses the various aspects of
hospi t al - physi ci an i nt egr at i on. Al-
t hough the aut hors focus on highly
5 8 • DECEMBER 1994 HEALTH PROGRESS
as how to change an organization's cul-
ture and how to communicate openly
and honestly in ways that will not make
matters worse.
The fifth chapter, on revenue and cash
management enhancement, is complete
and useful for those unfamiliar with hos-
pital operations. It certainly would be a
good review for experienced healthcare
executives in a difficult turnaround situa-
tion, but would not add to their store of
knowledge.
The sixth chapter offers i mport ant
integrated relationships, they also dis-
cuss looser forms such as physician-hos-
pital organizations, which they claim are
often preludes to more tightly integrat-
ed models.
Hidden Spr i ng: The Spi r i t ual
Dimension of Therapy
Thomas Hart, Paulist Press, Malnvah,
NJ, 1994, 160pp., $11.95 (paperback)
The time for collaboration and integra-
tion between psychology and spirituali-
ty has arrived. Psychotherapy, which
seeks t o pr omot e human heal i ng,
growth, and fulfillment, can be aided by
spirituality, which seeks the same end
but in a more ultimate way. Hidden
Spring begins on the theoretical plane,
describing the presence of God in ordi-
nary life, the relationship between psy-
chology and spirituality, and the con-
tours of a healthy spirituality. Then,
t hr ough six case studies of t herapy,
Hait relates how spirituality integrates
with psychology in practice.
BOOKS RECEIVED
Crossi ng the Threshol d of Hope,
John Paul II, Vittorio Messori, ed. ,
Alfred A. Knopf, New York City, 1994
advice on cost reduction and quality
improvement, especially on a system' s
approach to dealing with cost and quali-
ty while focusing on the consumer. One
particularly good point is the use of
compar at i ve dat a t o speed up t he
turnaround. The chapter fails to men-
tion, however, that sometimes these data
are difficult to get in a way that is useful
to the managers in a position to affect
the outcome.
The seventh chapt er bri ngs in t he
importance of establishing a close work-
The Fetal Tissue Issue: Medical and
Ethical Aspects, Peter J. Cataldo and
Albeit S. Moraczewski, eds., Pope John
Center, Braintree, MA, 1994
The Grayi ng of the Worl d: Who
Will Care for t he Frail Elderly?
Laura Katz Olson, ed., Haworth Press,
Binghamton, NY, 1994
How Can I Help? Twelve Things to
Do When So me o ne You Know
Suf f ers a Los s , James E. Mi l l er,
Willowgreen Publishing, Fort Wavne,
IN, 1994
Prayers and Devoti ons from Pope
John Paul II: 365 Daily Medi ta-
t i ons, Pet er Canisius Johannes van
Lierde, Viking, New York City, 1994
Three Realms of Ethics: Theoretical
Model and Case Studies, John W.
Glaser, Sheed & Ward, Kansas City,
MO, 1994
Pas t oral Care o f t he Me nt al l y
Di sabl ed: Advanci ng Care of the
Whole Person, Sally K. Severino and
Richard Liew, eds., Haworth Pastoral
Press, Binghamton, NY, 1994
St rong Medi ci ne, George C. Hal-
vorson, Random House, New York
City, 1993
ing relationship between the executive
staff and the medical staff to successfully
complete the turnaround process.
Fr om chapt ers 8 t hr ough 10, t he
direction changes from turnaround to
more drastic solutions such as phaseout
and bankruptcy. These chapters provide
good information on a subject unfamil-
iar to most healthcare executives. The
phaseout section is particularly valuable,
calling at t ent i on t o Medi care rul es,
which can be important in deciding the
course of action. The chapter on capital
restructuring has a good series of review
questions addressed at specific problem
areas. This chapter is the first to mention
the need for outside help. Chapter 10
gives an overview of the issues raised if
an i nst i t ut i on chooses t o File for
bankruptcy, as well as the kinds of fil-
ings, the control of the process, and how
the outcome can be affected by all the
paities involved. It offers a good expla-
nation of the differences in the types of
bankrupt cy and t he requi rement s of
each, as well as t he pr obl ems t o be
addressed.
The last two chapters of the book are
case studies of t urnaround situations.
These chapters, written by people who
have actually experienced the process,
woul d be most helpful t o anyone
involved in a turnaround. One interest-
ing topic not covered is why the hospi-
tals needed a turnaround. My guess is
t here are some common underl yi ng
t hreads. It would have been helpful,
based on the aut hors' experience, t o
have an analysis of the causes of decline
of hospitals in general terms.
Although I have 30 years' experience
as a healthcare executive. Engineering a
Hospital Turnaround brought out some
new and useful information. I would
recommend it for anyone in a difficult
position. Many others will find it a useful
tool to assist with operational review.
Mark Dundon
Chief Executive Officer
Sisters of Charity of
Nazareth Health Corporation
Nazareth, KT
HEALTH PROGRESS
DECEMBER 1994 • 59
doc_207225503.pdf
Engineering a Hospital Turnaround Proven Strategies for Reinvigorating Financial and Operating Performance.
B o o k R e v i e w s
Engi ne e ri ng a Ho s pi tal
Turnaro und: Pro v e n
Strate gi e s fo r R e i nv i go -
rati ng Fi nanci al and
Ope rati ng Pe rfo rmance
R i chard A. B ae hr, e di to r
American Hospital Publishing, Chicago, 1993,
228 pp., $36 (AHA members), S45 (nonmem-
bers) (paperback)
POTENTIAL READERS MAY BE PUT OFF BY
t he title of t he book Engineering a
Hospital Turnaround, and in some ways
the title hides the gems that it contains.
The book' s subtitle, Proven Strategies
for Reinvigorating Financial and
Operating Performance, is a bet t er
reflection of its breadth and audiences.
It really is about operational assessment
and improvement and covers this broad
subject qui t e well. As the healthcare
deliver)' system evolves, these issues are
becomi ng more relevant t o a greater
number of hospitals.
The book is aimed at institutional
managers, board members, and medical
staff members who are commi t t ed t o
supporting and strengthening their hos-
pitals. Also, any senior executive assum-
ing a new role as chief operating officer
could use the book as a tool for assessing
the institution's operational aspects.
Engineering a Hospital Turnaround
is a compilation of chapters written by a
number of different authors. The breadth
of experience they bring to the task adds
to the book' s interest and depth. It is
easy to read, well organized, thorough,
and full of valuable information. A brief
summary at t he end of each chapt er
would be useful for experienced health-
care executives, who woul d not find
much new in some of the chapters.
The first chapter provides an overview,
states the purpose, and indicates the tar-
get ed audi ence. The second chapt er
identifies the characteristics of a financial-
ly distressed hospital. Because it is so ele-
mentary, the first two-thirds of the sec-
ond chapter would not be of interest to a
well-informed executive. But the last sec-
tion of this chapter provides such a thor-
ough review of the characteristics of a
financially stressed hospital that it would
be especially pertinent for senior nonfi-
nancial executives, board members, and
medical staff leaders.
The third chapter, on strategic reposi-
t i oni ng, is comprehensive and full of
insights into how to assess the hospital's
current position and change its course.
The fourth chapter covers an extremely
important and often overlooked topic:
How can we affect the institution's cul-
ture and support the people who have to
carry out t he change process? The
authors of this chapter did a good job in
limited space, but it would have been
more helpful if they had provided more
in-depth information about how to deal
with some of the issues that usually sur-
face during a turnaround situation, such
B OOK B R I E F S
Death in the Family: Orphans of the
HIV Epidemic
Carol Levine, ed., United Hospital
Fund, New York City 1993, 159 pp.,
$10 plus $3.50 shipping (paperback)
By the year 2000 as many as 125,000
children will be orphaned by AIDS. The
nation's foster care and social services sys-
tems must be revamped if they are to
deliver the mental healthcare, social ser-
vices, and financial and legal support that
these chi l dren will need. The book
includes presentations by healthcare pro-
fessionals and persons personally affected
by AI DS, given at a 1992 conference
sponsored by the Orphan Project and the
United Hospital Fund. Topics include
the dimensions of the problem, family
members' experiences, coping with illness
and death, and new service models.
Aging and God: Spiritual Pathways to
Mental Health in Midlife and Later
Years
Harold G. Koenig, Haworth Press,
Ringhamton, NT, 1994, 503 pp., $29.95
(paperback)
Koeni g, a professor of psychiatry at
Duke University, examines the rela-
tionship between religion and mental
health in ol der peopl e. The aut hor
begins by discussing Western medical
psychology' and the hostility it has tra-
ditionally shown the claims of religion.
Then, in a presentation of research he
and his col l eagues have done wi t h
aging patients, he shows that religion
can in fact often help the mentally ill.
The author predicts that a "near-epi-
demi c of drug use, depressi on, and
ot her mental-health problems in t he
baby-boom cohor t " will soon over-
whelm the present healthcare system,
making religion even more therapeuti-
cally important than it is now.
Hospital-Physician Integration:
Strategies for Success
Terence M. Murphy and C. Tljompson
Hardy, American Hospital Publishing,
Chicago, 1994, 217 pp., $46 (AHA mem-
ben), $57.50 (nonmembers) (paperback)
In 13 chapters the authors offer advice
to physicians and hospitals considering
some form of integration. The first half
of the book discusses the affiliation pro-
cess, integration structures and models,
basic business issues, and legal issues.
The second half, based on seven case
studies, addresses the various aspects of
hospi t al - physi ci an i nt egr at i on. Al-
t hough the aut hors focus on highly
5 8 • DECEMBER 1994 HEALTH PROGRESS
as how to change an organization's cul-
ture and how to communicate openly
and honestly in ways that will not make
matters worse.
The fifth chapter, on revenue and cash
management enhancement, is complete
and useful for those unfamiliar with hos-
pital operations. It certainly would be a
good review for experienced healthcare
executives in a difficult turnaround situa-
tion, but would not add to their store of
knowledge.
The sixth chapter offers i mport ant
integrated relationships, they also dis-
cuss looser forms such as physician-hos-
pital organizations, which they claim are
often preludes to more tightly integrat-
ed models.
Hidden Spr i ng: The Spi r i t ual
Dimension of Therapy
Thomas Hart, Paulist Press, Malnvah,
NJ, 1994, 160pp., $11.95 (paperback)
The time for collaboration and integra-
tion between psychology and spirituali-
ty has arrived. Psychotherapy, which
seeks t o pr omot e human heal i ng,
growth, and fulfillment, can be aided by
spirituality, which seeks the same end
but in a more ultimate way. Hidden
Spring begins on the theoretical plane,
describing the presence of God in ordi-
nary life, the relationship between psy-
chology and spirituality, and the con-
tours of a healthy spirituality. Then,
t hr ough six case studies of t herapy,
Hait relates how spirituality integrates
with psychology in practice.
BOOKS RECEIVED
Crossi ng the Threshol d of Hope,
John Paul II, Vittorio Messori, ed. ,
Alfred A. Knopf, New York City, 1994
advice on cost reduction and quality
improvement, especially on a system' s
approach to dealing with cost and quali-
ty while focusing on the consumer. One
particularly good point is the use of
compar at i ve dat a t o speed up t he
turnaround. The chapter fails to men-
tion, however, that sometimes these data
are difficult to get in a way that is useful
to the managers in a position to affect
the outcome.
The seventh chapt er bri ngs in t he
importance of establishing a close work-
The Fetal Tissue Issue: Medical and
Ethical Aspects, Peter J. Cataldo and
Albeit S. Moraczewski, eds., Pope John
Center, Braintree, MA, 1994
The Grayi ng of the Worl d: Who
Will Care for t he Frail Elderly?
Laura Katz Olson, ed., Haworth Press,
Binghamton, NY, 1994
How Can I Help? Twelve Things to
Do When So me o ne You Know
Suf f ers a Los s , James E. Mi l l er,
Willowgreen Publishing, Fort Wavne,
IN, 1994
Prayers and Devoti ons from Pope
John Paul II: 365 Daily Medi ta-
t i ons, Pet er Canisius Johannes van
Lierde, Viking, New York City, 1994
Three Realms of Ethics: Theoretical
Model and Case Studies, John W.
Glaser, Sheed & Ward, Kansas City,
MO, 1994
Pas t oral Care o f t he Me nt al l y
Di sabl ed: Advanci ng Care of the
Whole Person, Sally K. Severino and
Richard Liew, eds., Haworth Pastoral
Press, Binghamton, NY, 1994
St rong Medi ci ne, George C. Hal-
vorson, Random House, New York
City, 1993
ing relationship between the executive
staff and the medical staff to successfully
complete the turnaround process.
Fr om chapt ers 8 t hr ough 10, t he
direction changes from turnaround to
more drastic solutions such as phaseout
and bankruptcy. These chapters provide
good information on a subject unfamil-
iar to most healthcare executives. The
phaseout section is particularly valuable,
calling at t ent i on t o Medi care rul es,
which can be important in deciding the
course of action. The chapter on capital
restructuring has a good series of review
questions addressed at specific problem
areas. This chapter is the first to mention
the need for outside help. Chapter 10
gives an overview of the issues raised if
an i nst i t ut i on chooses t o File for
bankruptcy, as well as the kinds of fil-
ings, the control of the process, and how
the outcome can be affected by all the
paities involved. It offers a good expla-
nation of the differences in the types of
bankrupt cy and t he requi rement s of
each, as well as t he pr obl ems t o be
addressed.
The last two chapters of the book are
case studies of t urnaround situations.
These chapters, written by people who
have actually experienced the process,
woul d be most helpful t o anyone
involved in a turnaround. One interest-
ing topic not covered is why the hospi-
tals needed a turnaround. My guess is
t here are some common underl yi ng
t hreads. It would have been helpful,
based on the aut hors' experience, t o
have an analysis of the causes of decline
of hospitals in general terms.
Although I have 30 years' experience
as a healthcare executive. Engineering a
Hospital Turnaround brought out some
new and useful information. I would
recommend it for anyone in a difficult
position. Many others will find it a useful
tool to assist with operational review.
Mark Dundon
Chief Executive Officer
Sisters of Charity of
Nazareth Health Corporation
Nazareth, KT
HEALTH PROGRESS
DECEMBER 1994 • 59
doc_207225503.pdf