Mark Slyter, DSc, FACHE

This paper describes how Dignity Health East Valley was able to optimize the use of existing performance improvement resources and deploy an accelerated improvement structure to achieve rapid gains, followed by incremental improvement to both sustain and further the gains made. The approach included mentoring middle managers to become adaptive change agents and achieve 5 per cent improvement in margins in six months. The burst method described in this paper is based on the findings from the… Show more

This paper describes how Dignity Health East Valley was able to optimize the use of existing performance improvement resources and deploy an accelerated improvement structure to achieve rapid gains, followed by incremental improvement to both sustain and further the gains made. The approach included mentoring middle managers to become adaptive change agents and achieve 5 per cent improvement in margins in six months. The burst method described in this paper is based on the findings from the research undertaken by top-performing hospitals that identified five essential characteristics that healthcare’s frontline leaders are expected to possess and which are a clear mark of their leadership skills and competence [Caldwell, C., Cook, K., (2020), ‘Achieving speed, spread, scalability, and sustainability in health systems’, American College of Healthcare Executives-Cluster Session, Clearwater, FL, 17–20th January]. The paper presents the background to this research as well as the structure that builds these top-performer capabilities in the front-line team in order for them to lead change and drive its implementation. The positive results that emerged from the leadership training provided to frontline leaders are substantial, including improved margin, higher patient experience and higher employee engagement. Show less

There is a near-universal assumption in both practice and literature that greater accuracy and management of the budget improves profitability (Libby & Lindsay, 2010; Umapathy, 1987). Prior to this study, this assumption has gone untested, and we know little about the wisdom of such an assumption.

The results of this study indicate greater accuracy in forecasting and/or tighter management to the budget, or favorably exceeding it, are associated with improved profitability. More… Show more

There is a near-universal assumption in both practice and literature that greater accuracy and management of the budget improves profitability (Libby & Lindsay, 2010; Umapathy, 1987). Prior to this study, this assumption has gone untested, and we know little about the wisdom of such an assumption.

The results of this study indicate greater accuracy in forecasting and/or tighter management to the budget, or favorably exceeding it, are associated with improved profitability. More specifically, smaller unfavorable budget variances are associated with greater operating margins as are greater favorable budget variances. A single standard deviation reduction in unfavorable revenue and expense are associated with higher operating margins of 5.2% and 6.3%, respectively. An equivalent favorable deviation in revenue and expense are associated with higher operating margins of 3.2% and 2.7%, respectively. Managers can improve hospitals' operating margins by first prioritizing the reduction and/or eliminating unfavorable variances, and second increasing favorable variances. Show less

There is increasing pressure in the United States to control healthcare costs. Effective use of an annual operating budget to control expenditures while achieving financial performance outcomes is critical for the long-term survival of these organizations. This study examined the relationship between hospital budget variances and profitability by addressing the following question: Are smaller budget variances (more accurate forecasting and/or tighter management) associated with greater… Show more

There is increasing pressure in the United States to control healthcare costs. Effective use of an annual operating budget to control expenditures while achieving financial performance outcomes is critical for the long-term survival of these organizations. This study examined the relationship between hospital budget variances and profitability by addressing the following question: Are smaller budget variances (more accurate forecasting and/or tighter management) associated with greater operating margins? A more in-depth understanding of budget variance influences on profitability could aid hospitals in setting and adjusting day-to-day operational performance. This study used a state of Washington longitudinal dataset for the years 1987-2013 (27 years) which contained budget and year-end audited financial reports for 115 acute care hospitals. Analysis affirmed that greater accuracy in forecasting and/or tighter management to, or favorably exceeding, the budget improves profitability. The study also provided an expected and measurable impact of these budget variances on the operating margin. In the study, almost 70% of the hospital expense budget variances were unfavorable. Managers would benefit from greater attention to unfavorable expense variances because of the impact on operating margin. Areas for additional research are suggested. Show less

There is a near-universal assumption in both practice and literature that greater accuracy and management to the budget improves profitability (Libby & Lindsay, 2010; Umapathy, 1987). Prior to the dissertation study “How Well Do Hospital’s Budget Operating Results? The Relationship Between Budget Variances and Operating Margin,” by Mark Slyter, this assumption has gone untested and we know little about the wisdom of such an assumption.

There is a near-universal assumption in both practice and literature that greater accuracy and management to the budget improves profitability (Libby & Lindsay, 2010; Umapathy, 1987). Prior to this study, this assumption has gone untested and we know little about the wisdom of such an assumption.
The results of this study indicate greater accuracy in forecasting and/or tighter management to the budget, or favorably exceeding it, leads to improved profitability. More specifically, smaller… Show more

There is a near-universal assumption in both practice and literature that greater accuracy and management to the budget improves profitability (Libby & Lindsay, 2010; Umapathy, 1987). Prior to this study, this assumption has gone untested and we know little about the wisdom of such an assumption.
The results of this study indicate greater accuracy in forecasting and/or tighter management to the budget, or favorably exceeding it, leads to improved profitability. More specifically, smaller unfavorable budget variances are associated with greater operating margins while greater favorable budget variances are associated with greater operating margins. A single standard deviation reduction in unfavorable revenue and expense increases operating margin by 5.2% and 6.3%, respectively. An equivalent favorable deviation in revenue and expense increases operating margin by 3.2% and 2.7%, respectively. Managers can improve hospitals’ operating margins by first prioritizing the reduction and/or eliminating unfavorable variances, and second increasing favorable variances. Show less

What happens outside the hospital is increasingly important to success, so healthcare leaders need to influence or control care across the continuum.

Closing or keeping open a money-losing hospital can be a career-limiting event. So one smart CEO and his board chose a third option.

A Baton Rouge hospital is closing the only emergency room on the city’s impoverished north side, a real-world ripple effect of the ideological clash over President Barack Obama’s health-care law.

A team of professionals at Baptist Health—a five-facility institution—has developed a collaborative, methodical process for imaging investments. Here’s your chance to “TAP” into their expertise.

Of the more than 1,000 hospitals recently surveyed by the American Hospital Association, 80% have cut administrative expenses, 48% have reduced staff, and 22% have cut services in response to the current economic crisis; however, 70% are still reporting a decline in overall financial health… Show more

A team of professionals at Baptist Health—a five-facility institution—has developed a collaborative, methodical process for imaging investments. Here’s your chance to “TAP” into their expertise.

Of the more than 1,000 hospitals recently surveyed by the American Hospital Association, 80% have cut administrative expenses, 48% have reduced staff, and 22% have cut services in response to the current economic crisis; however, 70% are still reporting a decline in overall financial health. Hospitals also face limited access to capital and higher cost of capital compared to previous years, both of which restrict a hospital’s ability to fund improvements. One area particularly hard-hit by the economic crisis is clinical technology, with 70% of surveyed hospitals stopping, postponing, or scaling back clinical technology projects planned or already in progress.

In 2004, Baptist Health implemented the Technology Assessment Process—a collaborative, methodical approach to managing imaging technology across the system. The Technology Assessment Process has allowed Baptist Health to evaluate its imaging technology relative to industry best practices, base decisions about equipment on concrete data, allocate capital in support of clinical technology that is aligned with growth and strategic plans, and enhance the organization’s ability to meet provider requirements and improve patient care.

As a direct result of this process, Baptist Health has advanced its imaging technology portfolio by streamlining inventory, decreasing the average age of equipment, improving the overall condition of equipment, and elevating its level of imaging technology. The purpose of this article is to explain the Technology Assessment Process, convey how it is managed, discuss how and why it has been successful, and demonstrate how the process can be replicated at other organizations to produce similar outcomes. Show less