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To ensure that a hospital operates 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 could be causing tensions between these groups? 2. As the nursing profession has grown through advanced degrees, specialization, and clinical practice, so have nurses’ salaries and responsibilities. Non-nurses are now used in hospitals in place of nurses for all but the most technical tasks. What does this mean for the nursing profession? Is it true that nurses have abandoned their traditional role of providing hands-on patient care, and if so, is this to their advantage or disadvantage? 3. Hospitals’ traditional management style has been hierarchical and internally focused.  4. The availability of hospital insurance eliminated a significant cost constraint on hospital services and charges. What were some of the positive and negative outcomes of this development? 5. Academic health centers’ promotion of specialization and sub-specialization is reflected in the organization and practices of modern hospitals. What were the benefits and drawbacks to patients of increasing the number of physicians who practice in narrower fields of medicine? 6. Given the significant oversupply of hospital beds in the United States, what is the justification for taxpayer support of the Department of Veterans Affairs’ separate and costly hospital systems?


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