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An analysis of survey data offered by nurse administrators regarding productivity and nonproductivity of nurses employed by Los Angeles, CA-based hospitals is offered. Additional information on the key factors affecting productivity/nonproductivity of nurses functioning in a health care environment is included.

Survey data on physician-hospital integrated delivery systems are analyzed. Additional information on the emergent areas of physician-hospital integration process is included.

Staffing cuts and skill-mix reductions do not necessarily translate to hospital cost savings. It should be noted that the quality of hospital care rather than the volume of medical personnel exact a significant toll on payroll expense. The patients' severity of illness as well as the level of skill of caregivers are other variables which impact the cost of care. Understaffing may minimize expenses in the short run but will ultimately cost the company.

Hospital administration problems such as unclear and ineffective mission statements, divisiveness of efforts, difficulties of supplementing external advocacy with internal reconciliation in the senior manager's job as well as the lack of open communication with board members can be surmounted provided hospital staff undertake a change in mindset. Effecting lasting and genuine change is possible not through a rearrangement of authority but rather through specific actions geared toward improving personal responsibility.

The growth of managed care, the resulting unsteadiness of physicians' salaries plus the fact that physicians are most comfortable working solo or in small groups have spurred the growth of physician practice management companies (PPMCs). The success of PPMCs, however, would largely depend on the managerial skills of its administrators and whether they could actually integrate healthcare delivery. It is also imperative that these PPMCs be able to add real value to physicians' practices in terms of practice administration and reduced administrative hassle.

Medical care managers can enhance job satisfaction among nurses by influencing hospitals' ethical climate. The types of ethical climate may be characterized by professionalism, caring, rules, instrumental, efficiency or independence. Job satisfaction covers satisfaction with pay, promotion, coworkers, supervisors and work. Survey shows that 36% of respondent nurses were dissatisfied with supervisors, while 62% were dissatisfied with promotion opportunities.

There is a need to improve the quality of nursing care in rural hospitals amidst growing concerns for the health of rural citizens. Response to this need depends to a large extent on the ability of rural hospitals to develop programs to advance professional rural nursing practice. A research and demonstration project to improve nursing practice in a rural hospital is presented.

The move towards health care reform has taken its toll on acute care hospitals. To remain competitive and to increase employee productivity at reduced costs, these hospitals introduced the gain-sharing program. Under this program, employees are given regular cash bonuses for participating in the cost reduction and quality improvement programs of hospitals. An evaluation of the program showed that in general, hospital-based gain-sharing programs increased employees' productivity. In cases wherein the program did not measurably increased productivity, it provided lasting improvements in labor and management relations.

Work force diversity can be the cause of conflict and maltreatment of people in hospitals. As such, hospital administrators must be able to anticipate problems associated with diversity and must know how to effectively deal with these problems. They must develop various discrimination control strategies and prejudice reduction approaches. Essentially, changing work force demographics in hospitals has become a well-accepted reality in multi-ethnic American society.