PhD Paper

Lenox Hill Hospital: Strategic Analysis

Contents

Introduction. 1

Mission. 2

Vision. 2

Situational Analysis- Internal 2

External Situational Analysis. 4

Demographics. 4

Economic Environment 6

Technological Environment 8

Socio-cultural Environment 10

Opportunities and threats. 12

Industry Analysis- Porters Model 13

Threat of the Entry of New Competitors. 13

The Bargaining Power of Suppliers. 14

Bargaining Power of Customers. 14

Threat of Substitute Products. 14

Competitor Analysis. 14

Market Similarities Vs. Market Commonality. 15

Strategy Analysis. 15

Business Level Strategies. 15

Corporate Level Strategy. 16

Conclusion. 17

Recommendations. 17

Works Cited. 17

 

Introduction

Lennox Hill Hospital first began its medical care provision way back in 1857 after a group of community leaders saw the need to provide medical care services especially the immigrant community. They therefore joined hands in forming the German Dispensary. Since its formation, Lennox Hill Hospital has been dedicated to taking care of all patients and with their caring and efficient staff, the hospital has earned a national reputation as one of the best caregivers in the country for its medical innovation and exceptional care.

Presently, the hospital has earned an international stature due to its excellence in the provision of an array of services such as sports medicine, orthopedic surgery, maternal and child heath, otolaryngology, ophthalmology, bariatric surgery as well as cardiovascular care. The institution has dedicated its efforts in providing medical education that is of the highest quality as well as innovative community outreach programs. It is estimated that the hospital, which is a 652-bed care center situated on Manhattan’s Upper East Side, treats over 325,000 patients every year.

 

Mission

The institution`s mission is to provide outstanding healthcare with compassion and respect. The hospital is also dedicated to promote wellness in all the surrounding communities and ultimately to advance the field of medicine through the provision of quality education and insightful research.

Vision

This institution seeks distinction and success in all their activities. They aspire to deliver premier services to a diverse patient population as well as nurturing an environment that can enable their staff and professionals to practice their trades as they learn new things and thrive.

Situational Analysis- Internal

Lenox Hill Hospital has various clinical departments that assist in offering a wide menu of medical and surgical specialties as well as primary healthcare. Some of these services include: cardiovascular services which involve the heart and circulatory system, medical specialties like dermatology and immunology, as well as maternal and child center for providing services like pediatrics, neonatology and obstetrics.

The hospital also has an eye treatment center named the Manhattan eye, ear and throat center. Other services include psychiatry, surgical specialties, radiology, nursing services, outpatient centers, emergency medicine centers and hospital based services like anesthesiology and pathology.

The hospital`s secondary activities include working together with donors and government institutions like the New York city council in building memorials and helping in the provision of treatments to serious diseases like HIV/AIDS, leukemia, Alzheimer’s, Parkinson’s, and cancer. Generally, due to the nature of its business, the organization is much oriented to providing healthcare more that it is dedicated to transforming service provision into revenue. However, it’s noted that the hospital has no withstanding debt in its over-a-century-and-a-half existence. Their tangible resources include state of the art facilities such as the prostate cancer center, the Manhattan ear, eye and throat center as well as the surgery departments. These facilities have proven to be very useful for ease of health care provision in the hospital.

Nevertheless, the hospital has in recent been going through financial struggles. These struggles culminated in the acquisition in 2010 by North Shore-Long Island Jewish Health System. The objective of this acquisition was not only to salvage the hospital financially but also to inject elements of scale and leverage that can only be achieved through a merger with a high-profile hospital.

One of the indicators that all was not well at Lenox Hill was its negative credit rating and a fiscal crisis that forced the hospital to lay off 45 employees (Caffarini 2). This trend was observed not just by Lenox Hill Hospital but also by other hospitals in Manhattan, including New York-Presbyterian, NYU Medical Center, and Mount Sinai Medical Center.

In terms of financials and stock prices, many details about Lenox Hill Hospital are lacking given the nature of its operations as a non-profit organization. However, a lot of information is accessible that provides pointers to the hospital’s financial position, key competences, and competitive advantage.

Since its acquisition by North Shore Long Island Jewish Health System, the hospital’s bond rating was raised. This raise was based on the assumption that North Shore would immediately start providing it with the necessary managerial and financial resources to enable it improve its clinical services, make adequate capital investments, and increase profitability.

Lenox Hill Hospital’s financial woes have been contributed to partly by the extremely high level of competitiveness in the New York hospital industry. The main challenges for the hospital include expense containment, rates and terms for managed care contracts, and the need for a larger market share within Manhattan and Queens. In 2011, the hospital’s operating revenue stood at $665 million. The hospital also projected that it would lose $15 million in 2012. A growth in market share coupled with cost containment and better contract terms may enable the hospital break even in 2013.

External Situational Analysis

An analysis of the external factors enables an organization to determine the possible risks, threats and changes that may occur in the market. This analysis entails carrying out several activities in order to familiarize with the market setting. These processes include scanning, monitoring forecasting, and accessing all the external factors (Ginter, Duncan, and Swayne 248).

Demographics

This institution has survived through three centuries: nineteenth, twentieth, and twenty first centuries. It is estimated that the facility treats about 325, 000 patients annually from all over the globe (Rapoport 18). Due to the dedication the hospital has offered over the years, their services and highly recommended and this is what made it gain the international stature (Ginter, Duncan, and Swayne 652). It is notable that the hospital renders its services to all patients regardless of their ethnicity. However, most of the targeted “customers” include the wealthy and the mighty. Its location is also in the wealthy side of New York.

To understand the demographics of the hospital industry better, it is imperative for focus to be on aspects of patient volume, cost of care, and average length of stay (Robinson 338). These factors are of utmost relevance in creating a better understanding of the market forces that are driving inflation in hospital costs. Increased competition has also contributed to the introduction of specialized clinical services whose costs are perpetually increasing. According to Robinson, one should not rule out the influence other factors such as non-price competition in influencing demographics especially the attraction of patients and physicians (341).

In most cases, the main yardstick used for measure demographics in the hospital business is cost per patient. In some cases, the cost per patient day is also used. Differences tend to occur in terms of the competitiveness of the environment in which various hospitals in the U.S. operate. These differences are normally reflected in demographic trends. In environments where the level of competitiveness is higher, the costs of production tend to be correspondingly higher.

Horwitz points out that aspects of demographics in the U.S. hospital industry should be categorized into for-profit, non-profit, and government hospitals (792). Such categorization may not be easy to establish simply by looking at the types of services that the hospitals provide. It is evident, though, that profitability of different services tends to affect specialization. In this case, services may be categorized as either profitable or unprofitable. In most cases, government hospitals tend to exhibit the highest likelihood of providing the services that are widely considered relatively unprofitable. In many cases, non-profits such as Lenox Hill Hospital tend to fall in the middle. In contrast, for-profits are normally the most responsive to change.

Economic Environment

The hospital was named among the top ten best healthcare providers in the city of New York in the recently published press release. This places it among the highest earners when it comes to health care provision. Another factor that aids its economic growth is the location the hospital stands in (Ginter, Duncan, and Swayne 89). Most of its patients are from affluent backgrounds given that it is located in the Upper East Side of Manhattan.

An in-depth view of the financial performance of hospitals operating in the non-profit sectors such as this one shows that the economic environment has not been very impressive. This is also evident in the negative credit ratings that the hospitals have been receiving (Caffarini 2). In early 2009, rating agencies expected hospital systems to continue struggling throughout the year and well into early 2010.

This unfavorable economic environment is also reflected in the volatile stock market as well as a flagging economy. The reason the credit ratings expected this poor credit rating to continue was simply because the hospitals would be compelled to pay a higher rate for borrowing in future or higher interest rates on their outstanding debt, or both.

In 2009, upgrades in the credit ratings of non-profit hospitals affected debts amounting to $13.1 billion while downgrades affected debts totaling $9.2 billion (Caffarini 2). From these figures, it is evident that more total debt was upgraded than downgraded. In spite of this impressive gap, hospitals were affected by negative credit ratings. This simply shows that the affected hospitals, such as Lenox Hill Hospital, were already in deep financial problems even before the onset of the recession. Many hospitals were also negatively affected simply because they had a high percentage of indigent and uninsured patients.

Meanwhile, the non-profit health sector seems to be going through tough economic times. This may partly be attributed to the weakened US economy. Because of poor performance by the economy, uncompensated care has increased, few elective procedures are being undertaken, and hospitals incur huge investment losses. For the hospitals struggling to improve their credit rating, the greatest challenges include extreme deterioration, capital spending commitments, precarious debt structures, and overly-aggressive investment allocations.

In some cases, a majority of the hospitals going through tough economic times tend to be situated in poorer neighborhoods. In this regard, the implication is that Lenox Hill Hospital is likely to be better off financially by virtue of being situated in an affluent New York neighborhood. However, the truth of this claim may need to be verified through an analysis of the number of indigent and uninsured patients visiting the hospital. Nevertheless, given the high-profile nature of the hospital’s operations, that number is highly likely to be low. The threat of uninsured patients creates an impetus for Lenox Hill Hospital to adopt an aggressive approach to the search for payor relationships.

Lenox Hill was one of the hospitals that were compelled to lay off some of its employees in the heat of the economic and market turmoil. The most affected employees were those undertaking administrative and clerical duties. For some hospitals, it was necessary for employed physicians to be laid off as well. This tended to happen whenever money-losing departments needed to be closed down. For other hospitals, physicians were requested to pay cuts equivalent to those taken by senior executives. In the meantime, many hospitals have been scrapping plans for new income-generating projects, citing lack of access to credit and high cost of borrowing.

For for-profit hospitals, economic performance has been more positive. Many of them continued to thrive even during the economic crisis. This enabled them to buy some of the nonprofits that were struggling financially. Their impressive performance was evident in their unused capacity for credit and good liquidity, which they could freely use to make those purchases. However, questions remain on whether acquisition is the right path for for-profit to follow in their quest for growth. The questions arise mainly because of the weak market conditions in which hospitals are operating today. The main reason why for-profits seem to be doing better than non-profit hospitals is that the former are not highly dependent on short-term financing. In light of this analysis, Lenox Hill Hospital should focus on long-term sources of finance in order to compete favorably in today’s weak economic conditions. such sources will enable the hospital undertake more income-generating activities, thereby widening its resource base.

Technological Environment

The hospital, in its efforts to utilize technology to increase efficiency in its activities, has set up an online resources center which helps the patients access their services from their backyards. The hospital has also purchased the modern health care equipments that facilitate easier provision of services. However, these efforts are not unique to Lenox Hill; Hospitals across the US have in recent years been adopting innovative technologies to enhance efficiency in service delivery and increase revenues.

By offering technologically advanced healthcare services, today’s hospitals attract many “customers”. At Lenox Hill, some of the specialized services that are being offered through the help of sophisticated technologies include orthopedic surgery, internal medicine, otolaryngology, and ophthalmology. These services make the hospital attractive to patients from New York as well as other states and countries.

In efforts to adopt technology, hospitals face numerous challenges. Today, only 17 percent of hospitals registered with the American Hospital Association have implemented comprehensive electronic-records systems in all their clinical units (Jha 1630). Only an additional 7.6 percent of these hospitals have introduced a basic system in at least one of their clinical units (Jha 1630). The general trend is for larger hospitals situated in urban areas to be in the forefront in the adoption of technology. Teaching hospitals also have a penchant for adoption of innovative technologies aimed at enhancing the delivery of health services.

In all areas of technological environment, one of the main barriers is high implementation costs. According to Devaraj, this challenge is more likely to be pointed out by those hospitals that have put information technology systems in place (12). The patient billing function is normally one of the most affected areas. This is because hospital managers must look for ways of introducing new technologies in environments where services are continually being expanded. Other challenges include staffing adjustments and regulatory changes. These challenges put pressure on the ability by hospitals to achieve goals relating to the adoption of technology in issues such as patient invoices, account receivables, and patient satisfaction.

Electronic health records are increasingly being used in U.S. hospitals (Jha 1631). However, the level of adoption remains low (Jha 1631). This creates the impression that policymakers continue to face serious challenges in efforts to achieve performance goals that are dependent on health information technology. To speed up the adoption of systems for handling electronic records in the U.S., a coherent policy strategy should be adopted. According to Jha, this policy should focus on interoperability, training of technical staff, and financial interoperability (1634).

Socio-cultural Environment

The hospital believes in equality and in that sense, it has gone forward to provide healthcare for society “rejects” from the LGBT community. It is for this reason that the institution was awarded a Human Rights Award for its healthcare equality in early 2013. According to Kimberly, the socio-cultural environment in which Lenox Hill Hospital operates can best be understood at individual, contextual, and organizational levels (694). This way, one can succeed in appreciating the various efforts being undertaken by the U.S. hospital industry to reach out to people of diverse social and cultural backgrounds.

In contrast, Austin defines the socio-cultural environment of non-profit hospitals in terms of social entrepreneurship (9). He compares this notion with that of commercial entrepreneurship (10). According to Austin, this comparison is necessary in creating a better understanding of the social and cultural issues affecting service delivery in the U.S healthcare industry (15). To respond appropriately to challenges inherent in the business environment, non-profits are compelled to adopt an entrepreneurial approach to service delivery. This approach has in recent years been spurring growth in the social sector. A systematic approach to social entrepreneurship can enable stakeholders in the hospital industry respond more proactively to social and cultural challenges.

With the recent surge in non-profit healthcare organizations in the U.S. Lenox Hill is bound to face still competition in terms of efforts to address the needs of certain groups. Initially, the hospital was primarily for people of German origin. Today, it serves patients from diverse social and cultural backgrounds. The bottom line is for the top executives of the hospital to ensure that all the social objectives enshrined in the mission statement are achieved satisfactorily.

In literature, one of the explanations for the existence of the non-profit sector focuses on market failure. This is implies that for these sector to succeed, it must address all the factors that led to market failure to start with. This means that the sector must address certain social needs. Hospitals operating in this sector are faced with the need to create social value while at the same time endeavoring to meet all their financial targets for purposes of ensuring efficiency and survival.

Resource mobilization in the hospital industry in the U.S. remains a major challenge. For non-profits, focus must always on social purpose for which they were established. This requirement imposes constraints on non-profit hospitals since in most cases, they cannot tap into the same capital markets as for-profit hospitals without attracting criticism. The same case applies with regard to performance measurement. In non-profit hospitals, some measures of performance are based on intangible variables that cannot be quantified through financial indicators. The bottom line though is for these hospitals to ensure that patients from diverse social and cultural backgrounds have access to quality healthcare.

Unfortunately, racial disparities are common in the U.S. healthcare system (William 329). Worse still, these disparities tend to be reflected in health outcomes across the U.S. As a non-profit hospital with a heritage dating back for more than a century, Lenox Hill Hospital has always had to contend with this problem. The same thing may be said regarding other hospitals that were established many decades ago. The issue of race has far-reaching social and cultural connotations that influence the way stakeholders go about the task of problem-solving through public policy. According to William, race is the most significant socio-cultural variable influencing the market dynamics of the U.S. hospital industry (331).

Today, we live in a world of social contagion as far as the adoption of technology is concerned. According to Angst, the phenomenon of social contagion is unfolding in the hospital industry as well (1228). It influences the way information is transmitted within and among departments through technology. This is mostly evident in medical records sections of various hospitals. Direct contact and observation are both crucial elements of social contagion. They influence the mechanisms that influence the ultimate transfer of information through information technology. Some administrators consider it important for the views of prior implementers and users to be sought to avoiding repeating mistakes.

The U.S. also seems to have entrenched a culture of leadership in science, technology, and innovation. This, coupled with the entrepreneurial spirit of the American people, contributes to the emergence of a thriving hospital industry that is characterized by competitiveness and entrepreneurship. According to Angst, data gathered from 4,000 U.S. hospitals between 1975 and 2005 suggests that if specific attention was given to socio-cultural factors, diffusion of technology, innovation, and social entrepreneurship would be accelerated (1229).

Opportunities and threats

The hospital has established a strong network of affiliates, partners, and associates in its long history of excellence in healthcare. It holds a leadership position in the healthcare industry. This enables the hospital to be strategically positioned to forge business relations with other healthcare providers and business entities. The ability to leverage on this network presents Lenox Hill Hospital with a unique opportunity.

Additionally, through affiliation with North Shore-Long Island Jewish Health System, Lenox Hill Hospital has an opportunity, for the first time, of expanding beyond Staten Island, Long Island, and Queens. About thirty percent of the hospital’s patients come from western Queens and north Brooklyn. By partnering with North Shore-Long Island Jewish Health System, the hospital stands a good chance of strengthening its competitive positioning in New York.

On the other hand, the hospital faces the threat of relying too much on volunteer workforce. This is largely because it is a non-profit organization. Moreover, by ceasing to provide paramedic services, the hospital risks exposing itself to negative perception by those who have for many years continued to hold it in high regard. Moreover, given the sensitive nature of the business, the hospital also faces the threat of lawsuits by patients who may not be satisfied with the services offered. The possibility of lawsuits is higher among the affluent segment that the hospital targets. The financial might of affluent patients might easily drive them into the pursuit of lawsuits that may be potentially damaging to the hospital’s fortunes.

Industry Analysis- Porters Model

This model enables any business entity to evaluate all the possible ways to deal with any changes in the market, whether directly or indirectly.

Threat of the Entry of New Competitors

In such a field, new entrants may have a limited chance of competing with the hospital given its current stature as well as the years it has been in operation. However, this does not mean that new competitors may not have an impact. Some new entrants may decide to focus on one field such as cancer treatment, something may subsequently dent the market share. Other hospitals may seek to engage in service differentiation as well as the creation of a unique environment for the patients, including adherence to all the government policies as per the medical care provisions regulations (Ginter, Duncan, and Swayne 9). Therefore, an evaluation of the possible threats in this regard should be carried by the hospital (Ginter, Duncan, and Swayne 95).

The Bargaining Power of Suppliers

The only kind of suppliers in this setting would be the medicine suppliers. For a hospital of this stature, decreasing the reliance on the suppliers may be done by setting up centers that would involve doing researches and coming up with the necessary treatments for various ailments. This may help in decreasing costs and subsequently increasing the control over suppliers.

Bargaining Power of Customers

In this specific setting, the customers “patients” have limited control of the prices or service charges for that matter. Patients will be attracted by the policy of providing charity and uninsured care for all regardless of their ability to pay for their full medical care expenses that exists in this hospital. Haggling for charges will rarely occur in this hospital (Ginter, Duncan, and Swayne 321).

Threat of Substitute Products

The only risk that can happen in regard to this factor entails efforts to open new centers that specialize in the treatment of one disease such as cancer or eye/ear treatment. This creates the need for the hospital to ensure that it aligns all its services together to create an attractive and satisfying experience for all patients (Ginter, Duncan, and Swayne 304).

Competitor Analysis

Competition in such a setting can be broad; it may involve enticing patients or even the medical practitioners. Lenox Hill Hospital faces competition from healthcare centers like St. Vincent Catholic Medical Center, Long Island Jewish Center, Mount Sinai medical center, Memorial Sloan-Kettering Center and the New York Presbyterian Center. In recent times, some of these hospitals have attempted to woo away some of the best physicians at Lenox  Hill Hospital. Lenox hill, however, is committed to providing education for most of these health care professionals thus making them hard to move (Ginter, Duncan, and Swayne 474). Lenox hill attracts most of these professionals in strategic areas. Its other stronghold is the ability to attract star doctors who restore much faith to the patients attracting even the famous. Recently, pop star Beyonce delivered her baby Blue Ivy there.

Market Similarities Vs. Market Commonality

In 2011, Lenox hill appointed Dr. Peter Constantino from Continuum Health Partners in a $3 to $5 million investment project (Benson 1). This demonstrates the environment of high competitiveness in which these healthcare centers operate; they offer the same services and patients mostly follow them according to their reputation and stature in the market (Ginter, Duncan, and Swayne 140).

Strategy Analysis

Business Level Strategies

The first strategy entails forming relationships with physicians. This may discourage the physicians from moving to other hospitals. This calls for ways to leverage these physicians, like providing training for them and making them feel indebted to the hospital. This helps in the expansion of the market share since these physicians are the main source of patient referrals. It also helps in improving the hospital quality.

Another strategy that can prevail is the pursuit payor relationships and new revenue models. Any hospital that seeks to reduce its costs and improve the quality of its services forms the relationships that involve formalizing the coordination of care thus rewarding value (Ginter, Duncan, and Swayne 40). In payor relationships, arrangements are made for other entities apart from the patient to reimburse or finance the cost of the health services provided. The most common payors include third-party entities, insurance carriers, and health plan sponsors such as employers and unions.

For efforts to promote payor relationships to succeed, physicians working at the hospital may consider liaising with insurance companies in efforts to access data required for proper definition of specific quality measures and cost controls demanded within the physician market place. This liaison is critical given the fact that traditionally, payors have had better access to quality data and opportunities for utilization than physicians. Through such managed care negotiations, Lenox Hill Hospital can succeed in retaining physicians.

Similarly, the adoption of new revenue models may enable physicians at the hospital go about their professional duties more efficiently. They are able to identify a wide range of opportunities for cost-saving and quality improvement. By identifying areas where improvement in quality of care can be undertaken, the physicians feel that they are an integral component of the scheme of things at the hospital. The important for administrators at the hospital is to approach payors and seek opportunities for the establishment of reimbursement arrangements. Such arrangements create a platform for physicians to be rewarded for achieving the specific goals that manifest themselves in emerging opportunities.

A particularly attractive approach entails the establishment of a physician-led committee in change of managed care. Such a committee would undertake the important work of identifying as many managed-care opportunities as possible and then exploring them with the assistance of practice payors. In this way, physicians can contribute to efforts aimed at ensuring that all the high-cost services being provided in the market are identified and that strategies of reducing those costs are sought. At the same time, efforts can be made to measure improvements in cost and quality, thereby creating opportunities for them to be tracked.

The adoption of new revenue models is of utmost important for Lenox Hill Hospital. Such models should be based on measurable and achievable goals for cost and quality improvement especially in the case of managed care payors. Ordinarily, payors are interested in seeing empirical evidence of quality improvements and achievable savings before any negotiations can start. For this reason, it may be necessary for physicians and administrators at Lenox Hill to develop and document several case studies that document the proposals of their practice.

In terms of technology action, Lenox Hill Hospital has already entered into a partnership with MedMatica Consulting Associates with a view to establish an action plan in response to various challenges facing the organization. The main areas of focus in this partnership include registration, patient management applications, hospital’s master files, electronic billing capabilities for payors, and standardized reports. Other areas issues that should form a core component of the hospital’s technology strategy include systems for knowledge transfer from consultants to the personnel of the hospital, patient registration services, and systems for ongoing improvements in cash collection.

Corporate Level Strategy

For a non-profit hospital like Lenox Hill, the ideal corporate level strategy entails collaboration with the community and other organizations to coordinate healthcare services more efficiently (Ginter, Duncan, and Swayne 678). This can enable the hospitals to manage transitions of care through collaborating with nursing homes and other long-term care centers. The other main benefit relates to the sharing of data with the community thus managing the population health (Ginter, Duncan, and Swayne 678).

Heavily investing in technology is another effective strategy, this assists to meet meaningful use requirements and efficient connection with the physicians. Lastly, merging with other hospitals and healthcare centers can be efficient. This has prevailed in recent years as more hospitals are using this strategy to attain the necessary capital for health IT investments, physician partnerships and building of other projects. In 2011, 90 deals of mergers and acquisitions targeting over 150 hospitals were recorded (Ginter, Duncan, and Swayne).

Conclusion

The acquisition in 2010 by North Shore-Long Island Jewish Health System came at a time when Lenox hill was the only independent non-specialty hospital. This partnership puts Lenox Hill Hospital at an advantageous position of benefiting from the North Shore’s financial managerial resources. However, the most important thing is for the hospital to take advantage of Long Shore market segment in New York to expand its competitive positioning by pushing the limits of its current market share in New York. Efforts towards cost containment and the pursuit of better contract terms will help improve the hospital’s financial position. Finally, massive investment in technology systems and payor relationships will also enable Lenox Hill Hospital break even in 2013.

Recommendations

Today, in order to achieve quality goals and reduced costs, especially in the ever changing healthcare environment, most hospitals ought to be more innovative and flexible in their strategies. First, Lenox Hill Hospital should align its strategies on population health management, as it is one of the core goals of healthcare reform. The hospital can achieve this goal by undergoing transformation to facilitate the adoption of value-based care. It can also achieve population health targets by forming strong and close relationships with physicians, embark on more collaboration efforts with organizations in the community and expand into preventative and outpatient care. Notably, in as much as these strategies implemented alone may accomplish some of the set goals, the hospital ought to apply other strategies in tandem to produce a long-term, meaningful change.

Secondly, Lenox Hill Hospital should focus on long-term sources of finance in order to compete favorably in today’s weak economic conditions. Such sources will enable the hospital undertake more income-generating activities, thereby widening its resource base. In situations where the hospital faces the need to manage transitions of care, collaboration with nursing homes and other long-term care centers may be an important strategic action.

 

Works Cited

Angst, Corey “Social Contagion and Information Technology Diffusion: The Adoption of Electronic Medical Records in U.S. Hospitals.” Management Science 56.8 (2010): 1219-1241.

Austin, James “Social and Commercial Entrepreneurship: Same, Different, or Both?” Entrepreneurship Theory and Practice 30.1 (2006) 1–22.

Benson, Barbara 2013. Surgeon to lead Lenox Hill’s Center for Vascular Birthmarks. May 26, 2013, retrieved from http://www.crainsnewyork.com/article/20130526/HEALTH_CARE/305269993  on September 8, 2013.

Caffarini, Karen 2009, Nonprofit hospitals face downgrades in credit ratings, February 18, 2009, retrieved from http://www.amednews.com/article/20090218/business/302189998/8/  on September 6, 2013.

Devaraj, S “Information Technology Payoff in the Health-Care Industry: A Longitudinal Study.” Journal of Management Information Systems 16.4 (2000) 1-67.

Ginter, Peter, Jack Duncan, and Linda Swayne Strategic Management of Health Care Organizations. San Francisco, CA: Jossey-Bass, 2013. Print.

Horwitz, Jill “Making Profits And Providing Care: Comparing Nonprofit, For-Profit, And Government Hospitals.” Health Affairs 24.3 (2005): 790-801.

Jha, Ashish “Use of Electronic Health Records in U.S. Hospitals.” New England Journal of Medicine 360(2009): 1628-1638.

Kimberly, John “Organizational Innovation: The Influence of Individual, Organizational, and Contextual Factors on Hospital Adoption of Technological and Administrative Innovations.” Academy of Management Journal, 24.4 (1981): 689-713

Rapoport, John “Diffusion of technological innovation among nonprofit firms: Acase study of radioisotopes in U. S. Hospitals”. Journal of Economics & Business 30.2 (2008): 12-47.

Robinson, James “The impact of hospital market structure on patient volume, average length of stay, and the cost of care.” Journal of Health Economics 4.4, (2005): 333–356.

Williams, David “Social Sources Of Racial Disparities In Health”, Health Affairs 24.2 (2005): 325-334.

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