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The voluntary hospital trustee has traditionally seen issues of medical care, including those of patient safety, as falling within the delegated sphere of the medical staff. This customary distancing of the trustee from direct involvement in patient safety issues is now challenged by unprecedented scrutiny of hospital safety results through voluntary disclosure or mandatory public reporting. This new climate, fostered by the Institute of Medicine's To Err is Human and the Institute for Healthcare Improvement's 100,000 Lives campaign, has complicated the role of the trustee in satisfying the traditional “prudent person” test for meeting fiduciary obligation as the trustee's breadth of involvement expands. Viewed theoretically, Mintzberg models the hospital as a case of a professional bureaucracy, in which the professional staff is responsible for standard setting and regulation. This traditional role of the professional staff is potentially assumed by others lacking technical background. Trustees are now asked to examine reports identifying physician compliance in attaining safety standards without education in the practice supporting those standards. Physician board members, whose numbers have increased in the past decade, are often sought to take the lead on interpretation of patient safety standards and results. The very public nature of patient safety reporting and its reflection on the reputation of the organization for which the trustee is ultimately accountable create a new level of tension and workload that challenges the dominant voluntary model of trusteeship in the United States health system.

Globalization of health care services is becoming an alternative or complementary strategy for some U.S. health care organizations due to increased competition, a stagnant health care market, and nationally imposed cost constraints in the U.S. Additionally, entrepreneurial U.S. firms may see globalization as an opportunity to promote their services in new countries with increasing demand for advanced technological services. If an ambitious American health care firm decides to globalize its product or service lines, what might be some of the primary strategies it would use to enter an international market? To investigate this question, this chapter considers the strategies of two American firms that have entered the Beijing and Shanghai markets since 2000. We conducted numerous telephone conversations and interviews with executives of these firms in an attempt to understand their market entry and early development strategies. These firms’ market entry strategies range from “greenfield” operations, where the hospital does little to change its corporate and managerial style from what it uses domestically, to a “glocalization” strategy, where the firm is quite sensitive to fitting into the Chinese culture and being accepted by the Chinese government. The strategic challenges for international hospital organization developments in China are many, but the potential rewards from becoming among the leading firms in a large nation with an expanding economy are tremendous. What we learn from the experiences of enterprising American hospital firms in Chinese may well portend the future for international developments by many other American-based health organizations.

This chapter reviews significant advances in health sciences librarianship, highlighting developments between 1970 and 2005. During this time Advances in Librarianship published two chapters that dealt with health sciences librarianship. The first appeared in 1971 with volume two. Written by David Bishop (1971), then at the University of Arizona, it focused on developments in the 1960s and provided a review of the MEDLARS (Medical Literature Analysis and Retrieval System) system, the beginnings of the regional medical library (RML) program and advances in library services and information resources. The second chapter devoted to health sciences libraries appeared in the ninth volume of Advances in Librarianship. In it Donald Hendricks (1979) from the University of New Orleans highlighted collaborative programs among health sciences libraries, the growing reliance on computer applications, professional development programs, clinical medical librarian services and the accomplishments of the Medical Library Association (MLA).

Correctional library staff are essential to fulfilling the rehabilitative mission of prisons, but their work is too often misunderstood and neglected. The Colorado Department of Corrections (CDOC) Libraries have a 272% turnover rate and struggle with many long-term vacancies. Despite being the lowest-paid staff in CDOC, library staff are asked to fulfill two distinct sets of responsibilities: that of running a library, and facility safety and security tasks.

Based upon original research, the Colorado State Library (CSL) has created a standard for minimum staffing levels for CDOC Libraries and a formula that can be applied no matter what service model a correctional library uses. CSL has found that to improve recruitment and retention of its library staff, CDOC needs to (1) improve pay and the librarian promotional path by changing staff to a class series which more appropriately reflects the job duties and level of decision-making and (2) create more library staff positions statewide in order to meet the minimum staffing levels.

This study looks at board governance in Ontario hospitals.

We conducted a research of the hospitals’ websites and a survey of board directors to study the board structure and examine governance practice in Ontario hospitals.

The findings suggest that the board structure and process in Ontario hospitals are in compliance with Accreditation Canada’s Governance Standards, and such administrative controls are appropriate. Ontario hospital boards, in general, have fulfilled their key functions of governance in terms of working as an effective board; developing a clear direction; supporting the organization to achieve its mandate; maintaining positive relationships with external stakeholders; and being accountable and achieving sustainable results. Building knowledge through information is an area where improvement is needed.

Ontario hospitals have implemented appropriate administrative controls in terms of board composition and committee structure. The results of a survey of 99 board directors from over 25 hospitals suggest that directors, in general, have a good understanding of their governance role and relationship with senior management as well as the government. The findings are also supportive of good governance practice where executives manage and nonexecutive directors monitor the performance of the executives. According to the respondents, Ontario’s hospital boards are actively involved in setting the mission, strategic goals and objectives of their organizations, and they take appropriate steps to ensure that risk management, client safety, and quality improvements are incorporated in their governance and strategic planning process. In order to discharge their fiduciary duty effectively, respondents would like to have more information from different sources. This is an area where management accounting professionals can become involved such that relevant information from a variety of sources, especially external sources, are provided to board directors for decision making.

Ontario’s hospital sector has undertaken initiatives through research and publications to promote good governance practice. Such leadership is critical to ensure that directors have the competence and skills to discharge their duties and responsibilities diligently. Hospital boards should focus on renewal while ensuring that board directors are equipped for the challenging task of governing through professional development and continuing education.

Limitations related to the use of questionnaire applies to this research study. Self-selection bias and low response rate limit the generalizability of the findings. Future research can examine the behavior of directors in the boardroom and the impact of governance variables on hospital performance, such as quality of care and patient safety.

Since Jan. 1, 2019, the Centers for Medicare and Medicaid Services' (CMS) rule requiring hospitals publish their “standard charges” (also called “charge description masters” or “chargemasters”) in a public, machine-readable format has been in effect. The research at hand assesses hospital compliance with the federal regulation. In addition, a sentiment analysis of the chargemaster webpages compared to hospital homepages is performed to assess the consumer friendliness of the content in terms of language usage. A stratified sample of 212 hospitals was used to conduct observations. Strata were based on patient satisfaction scores drawn from the Hospital Consumer Assessment of health care Providers and Systems survey, and controls for hospital bed size and geographic US census region were utilized from the American Hospital Association Annual Survey. Descriptive statistics are presented, and chi-square testing is used to test for statistically significant differences. Key results are presented for compliance and sentiment. Most hospitals' websites are not presenting chargemaster data in a way that is readily collectable or comparable to other facilities. In addition, the tone of language used on chargemaster transparency webpages is generally more negative than that of hospitals' homepages. In particular, the messaging on transparency pages routinely suggests consumers to not use the data for decision-making purposes.

Hospital nurse managers are in the middle. Their supervisors expect that they will monitor and discipline nurses who commit errors, while also asking them to create a culture that fosters reporting of errors. Their staff nurses expect the managers to support them after errors occur. Drawing on interviews with 20 nurse managers from three tertiary care hospitals, the study identifies key exemplars that illustrate how managers monitor nursing errors. The exemplars examine how nurse managers: (1) sent mixed messages to staff nurses about incident reporting, (2) kept two sets of books for recording errors, and (3) developed routines for classifying potentially harmful errors into non-reportable categories. These exemplars highlight two tensions: the application of bureaucratic rule-based standards to professional tasks, and maintaining accountability for errors while also learning from them. We discuss how these fundamental tensions influence organizational learning and suggest theoretical and practical research questions and a conceptual framework.

This paper empirically tests whether the nonprofit hospital is influenced by the community benefit standard by analyzing differences in nonprofit and for-profit hospital inpatient Medicaid share, while controlling for the effects of hospital market competition. Hospital specific data for this study are from the 1991 American Hospital Association Annual Survey of Hospitals and the 1991 Medicare Minimum Cost Report by the Health Care Financing Administration. The sample includes 192 for-profit, 899 nonprofit and 221 government-owned general acute care hospitals. Key variables in the multivariate analysis include hospital inpatient Medicaid share as the dependent variable and Medicaid demand, market competition and input quality as independent variables. The principal findings are that nonprofit hospitals serve a larger share of Medicaid inpatients than for-profit hospitals although the greater the presence of for-profit hospitals in the market (one measure of market competition) the smaller the nonprofit hospital Medicaid share. It is concluded that nonprofit hospitals reduce their level of community benefit, where community benefit is measured as a hospital's percent Medicaid share, in markets with a greater presence of for-profit hospitals.