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For a hospital to function efficiently and effectively, the three major influences in its governance, the medical staff, the board of trustees, and the administration, must work in reasonable harmony. What factors might contribute to tensions between these groups? 2. As the nursing profession has grown through advanced degrees, specialization, and clinical practice, nurses’ salaries and responsibilities have grown as well. Non-nurses are now used in hospitals to perform all but the most technical tasks in place of nurses. What are the implications for the nursing profession? Is it true that nurses have lost their traditional role of providing hands-on patient care, and if so, is this to their advantage or disadvantage? 3. Hospital management has traditionally been hierarchical and internally focused. What are the three most significant challenges that hospitals face in order to meet new payer and consumer expectations? 4. The availability of hospital insurance removed a significant cost constraint from hospital services and charges. What were some of the positive and negative consequences of this development? 5. The organization and practices of modern hospitals reflect academic health centers’ promotion of specialization and sub-specialization. What were the benefits and drawbacks to patients of increasing the number of physicians who limited their activities to narrower fields of practice? 6. Given the significant oversupply of hospital beds in the United States, what is the rationale for taxpayer support of the Department of Veterans Affairs’ separate and costly hospital system?


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