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There is a strong tradition of integration in rural community hospitals which has been largely unrecognised in the past. The national strategy for health in England now gives community hospitals a central role in providing integrated health and social care, in a policy referred to as ‘care closer to home’. The evidence emerging from international and national studies is demonstrating the benefit of the community hospital model of care. Public support for community hospitals over their 100‐year history has been strong, with value being placed on accessibility, quality and continuity. There is, however, a tension between the national policy and the current financial pressures to close or reduce services in one in three community hospitals in England. Innovative ways of owning and managing these services are being put forward by communities who are actively seeking to maintain and develop their local hospitals. The challenge is to demonstrate that community hospital services are valued models of person‐centred integrated care, and to demonstrate their contribution to the health and well‐being of their communities.

The purpose of this paper is to explore the presence and nature of integrated care in community hospitals.

Staff reported their views and experiences of integrated care in 48 questionnaires for a Community Hospitals Association programme. An analytical framework was developed based on eight types of integration, and the community hospital services concerned were grouped into nine service categories.

Staff reported multiple types of integration, averaging four types (median), with a range of two to eight (of the eight types studied). The types of integration most frequently reported were multidisciplinary care, and community hospital/secondary care and community hospital/primary care. Integration with communities, patients and the third sector featured in many of the services. Integration with social care and local authorities were least frequently reported. Services with the highest number of types of integration (5+) included palliative care, maternity services and health promotion. Staff reported that commitment was a positive factor whilst a lack of staff resources hindered partnership working.

Staff volunteered to be part of the programme which promoted good practice, and although the findings from the study cannot be generalised, they do contribute knowledge on key partnerships in local hospitals. Further research on the types, levels and outcomes of integrated care in a larger sample of community hospitals would build on this study and enable further exploration of partnership working.

The analytical framework developed for the study is being applied by staff and community groups as a tool to help assess appropriate partnership working and help identify the scope for further developing integrated care. The evidence of integrated working is available to inform those commissioning and providing community health services.

This study has shown that integrated working is present in community hospitals. This research provides new knowledge on the types of integrated care present in a range of community hospital services. The study shows a tradition of joint working, the presence of multiple simultaneous types of integration and demonstrated that integrated care can be provided in a range of services to patients of all ages in local communities.

Public hospitals have long been major players in the US health care delivery system. However, many public hospitals have privatized during the past few decades. The purpose of this chapter was to investigate the impact of public hospitals' privatization on community orientation (CO). This longitudinal study used a national sample of nonfederal acute-care public hospitals (1997–2010). Negative binomial regression models with hospital-level and year fixed effects were used to estimate the relationships. Our findings suggested that privatization was associated with a 14% increase in the number of CO activities, on average, compared with the number of CO activities prior to privatization. Public hospitals privatizing to for-profit status exhibited a 29% increase in the number of CO activities, relative to an insignificant 9% increase for public hospitals privatizing to not-for-profit status.

States that it seems self‐evident that a hospital should be a healing environment, a healthy place to work, should not harm the health of the environment and should contribute to and be a source of health in the community, but argues that hospitals have not paid a great deal of attention to many of these issues until recently. Suggests that in recent years, a new and broader understanding of health promotion has led to a re‐examination of the ways in which hospitals can be both healthy and health‐promoting. Begins by exploring the broader concepts of health promotion that lay the foundation for the creation of healthy and health‐promoting hospitals and provides some examples of how these approaches are being applied.

The purpose of this paper is to add to the stream of research examining the difference between the amount of taxes waived for nonprofit hospitals and the amount of charity care they provide.

The study is an archival study.

Almost all nonprofit hospitals in the sample provide enough charity care to cover their waived taxes. Almost none provide enough charity care at the level that has been proposed to the federal government for hospitals to maintain their nonprofit status.

As with most hospital research, a limitation is this study’s focus on a single state to control for regulatory differences among states.

The data on the new Form 990 allow better measurement and transparency regarding a nonprofit hospital’s charity care. For legislators, regulators, and taxpayers, the results from this study raise questions about: the large variations in the amount of charity care provided among nonprofit hospitals and whether enough is being done in terms of providing charity care.

There is great variation among nonprofit hospitals as to the amount of charity care provided. Relying upon a nonprofit hospital’s altruistic nature may not be enough to ensure that they act in the best interest of society.

This study is unique because, for the first time, a true measure of taxes waived is used in the analysis. All previous research has had to proxy taxes.

Change in ownership among U.S. community hospitals has been frequent and, not surprisingly, remains an important issue for both researchers and public policy makers. In the past, investor-owned hospitals were long suspected of pursuing financial over other goals, culminating in several reviews that found few differences between for-profit and nonprofit forms (Gray, 1986; Sloan, 2000; Sloan, Picone, Taylor, & Chou, 2001). Nevertheless, continuing to the present day, several states prohibit investor-ownership of community hospitals. Conversions to investor-ownership are only one of six types of ownership change, however, with relatively less attention paid to the other types (e.g., for-profit to nonprofit, public to nonprofit). This study has two parts. We first review the literature on the various types of ownership conversion among community hospitals. This review includes the rate at which conversions occur over time, the relative frequency in conversions between specific ownership categories and the observed effects of conversion on hospital operations (e.g., strategic direction and decision-making processes) and performance (e.g., access, quality, and cost). Overall, we find that the impact of ownership conversion on the different measures is mixed, with slightly greater evidence for positive effects on hospital efficiency. As one explanation for these findings, we suggest that the impact of ownership conversion on hospital performance may be mediated by changes in the hospital's strategic content and process. Such a hypothesis has not been proposed or examined in the literature. To address this gap, we next study the role of strategic reorientation following hospital conversion in a field study. We conceptualize ownership conversion within a strategic adaptation framework, and then analyze the changes in strategy content and process across sixteen hospitals that have undergone ownership conversions from nonprofit to for-profit, public to for-profit, public to nonprofit, and for-profit to nonprofit. The field study findings delineate the strategic paths and processes implemented by new owners post-conversion. We find remarkable similarity in the content of strategies undertaken but differences in the process of strategic decision making associated with different types of ownership changes. We also find three main performance effects: hospitals change ownership for financial reasons, experience increases in revenues and capital investment post-conversion, and pursue labor force reductions post-conversion. Membership in a multi-hospital system, however, may be a major determinant of both strategy content and decision-making process that is confounded with ownership change. That is, ownership conversion may mask the impact of system membership on a hospital's strategic actions. These findings may explain the pattern of performance effects observed in the literature on ownership conversions.

Describes an audit of inter‐profession communications among hospital, community health and social services concerning hospital admission. Information from 150 patient admissions (50 from each of three general practices after a target date) was gathered from both community and hospital sources. The results were used to audit the transfer policy operated by Airedale NHS Trust. The audit design incorporated an element of research, the results of which were used to inform the interpretation of the audit results and to suggest appropriate recommendations for change. Recommendations included the introduction of a pre‐admissions checklist, specific changes to the nursing documentation, measures to improve the speed of information transfer, and the clarification of responsibilities for initiating contact across the hospital‐community interface when patients with existing contacts in community services are admitted to hospital. Concludes that the introduction of supplementary research to an otherwise traditional audit cycle strengthened the resulting recommendations.

The purpose of this paper is to build insight into how the local community impacts an organization’s ability to develop an inclusive culture. The paper introduces the concept of inclusion disconnects as incongruent experiences of inclusion between an organization and its community. Then, using the case of teaching hospitals, the paper empirically demonstrates how individuals and organizations experience and deal with inclusion disconnects across the boundaries of organization and community.

A multi-method qualitative study was conducted in hospitals located in the same city. Focus groups were conducted with 11 medical trainees from underrepresented backgrounds and semi-structured interviews were conducted with ten leaders involved with diversity efforts at two hospitals. Data analysis followed an iterative approach built from Miles and Huberman (1994).

The findings demonstrate how boundary conflicts arise from disconnected experiences of organizational and community inclusiveness. Such disconnects create challenges for leaders in retaining and supporting minority individuals, and for trainees in feeling like they could build a life within, and outside of, their organizations. Based on findings from the data, the paper offers insights into how organizations can build their capacity to address these challenges by engaging in boundary work across organizational and community domains.

Future research should build upon this work by further examining how inclusion disconnects between communities and organizations impact individuals and organizations.

The paper includes in-depth insight into how organizations can build their capacity to address such a deep-rooted challenge that comes from a less inclusive community.

This paper contributes to an understanding of how forces from the community outside an organization can shape internal efforts toward fostering inclusion and individuals’ experiences of inclusion.

Reexamination and reinterpretation of the process of deinstitutionalization of public mental hospital inpatients.

A comprehensive review of related research is presented and lessons learned for the sociology of mental health are identified.

The processes of both institutionalization and deinstitutionalization were motivated by belief in the influence of the social environment on the course of mental illness, but while in the early 19th century the social environment of the mental hospital was seen as therapeutic, later in the 20th century the now primarily custodial social environment of large state mental hospitals was seen as iatrogenic. Nonetheless, research in both periods indicated the benefit of socially supportive environments in the hospital, while research on programs for deinstitutionalized patients and for homeless persons indicated the value of comparable features in community programs.

While the process of deinstitutionalization is largely concluded, research should focus on identifying features of the social environment that can maximize rehabilitation.

The debate over the merits of hospital-based and community-based mental health services is misplaced; policies should instead focus on the alternatives for providing socially supportive environments. Deinstitutionalization in the absence of socially supportive programs has been associated with increased rates of homelessness and incarceration among those most chronically ill.

A comprehensive analysis of deinstitutionalization that highlights flaws in prior sociological perspectives and charts a new direction for scholarship.