AUGUST 1998, VOL 68, NO 2

BOOK REVIEWS

ESSENTIALS OF MANAGED HEALTH CARE, second ed By Peter R. Kongstvedt 1997,572 p p $49, paperback

his book is written by a physician for anyone interest- T ed in the workings of man-

aged health care. The information given is based on the firsthand and observed experiences of man- agers and experienced consul- tants. The book includes informa- tion on contracting, capitation and compensation, fee setting, quality improvement, and utilization management.

Each chapter is prefaced with objectives and ends with a conclu- sion and study questions. A glos- sary lists the acronyms and terms used in the book. There are numerous graphs and charts throughout the book.

The book does not discuss any nursing aspects, despite the fact that a nurse is listed as a contribu- tor to one chapter. It is for this rea- son that I think this book would not appeal to nurses.

GWENDOLYN LAMPKINS RN, CNOR

VETERANS AFFAIRS MEDICAL CENTER STAFF NURSE

HOUSTON, TEX

REINVENTING YOUR NURSING CAREER: A HANDBOOK FOR SUCCESS IN THE AGE OF MANAGED CARE By Michael Newell, Mario Pinardo 1998,253 pp $21, paperback

T d a y , health care presents a chailenge at all levels of 1 delivery. One arena that con-

tinues to be directly affected is the department of nursing services. First organizational “downsizing” and now “rightsizing” has ulti- mately resulted in the displace- ment of nursing personnel.

This book requires some in- depth thought on the part of the reader. It is designed for nurses who wish to prepare for the future. Gone is the environment of expected security, automatic reward, and support for profes- sional practice. The current mar- ketplace that nurses are now fac- ing is one of competition, conflict, angst, and uncertainty. Although all this change opens the doors for abundant opportunities, only nurs- es who are prepared will be able to take advantage of them.

By combining their diverse expertise, the authors have orga- nized this book to assist nurses and other health care practition- ers. They address how and why the health system works the way it does and how providers can realize their personal and profes- sional visions about what health care can be.

We are experiencing a shift in health care from a nonprofit, sin- gle-provider, fee-for-service model to a giant enterprise con- nected by computers and prepaid by employers and government. Nursing comprises the largest sin- gle group of health providers, resulting in nurses’ feeling the biggest impact from these changes. Many nurses have become paralyzed by the realities of lost jobs and involuntary shifts in their employment situations. By the same token, the new breed of professional-the renaissance nurse-has emerged to thrive.

This book is not an academic text. It educates the reader about why the health care system is

changing, how to use the informa- tion to reinvent their career path, and how to fuli7ll professional and personal needs. It provides a self- help format to view the new reali- ties of health care, self-evaluation tools, and references for those who want to explore further. Although there are no promises, the steps to follow are set out and should lead to encouragement for nursing in the future.

this book, two very distinct divi- sions are presented. Part I explores the dynamics of a “dis- integrating health cafe system.” The chapters are meant to provide a sophisticated overview of what is happening, why, and what nurs- es can do now. Additionally, the chapters assist in understanding changes in the finance, technolo- gy, and public expectations dri- ving changes in the health care industry. Ultimately, this section was designed to induce a sense of constructive discontent in the reader, a sense of restlessness that will motivate reading and work- ing with the real substance of this book. Part I1 looks at the dynam- ics of personal empowerment and is designed to guide readers through the steps of change, or the transition from old selves to new beings. The methods described require groundwork and careful consideration over time to enhance the value of innovative thinking that the reader can devel- op. Each person has an ideal life and work situation, which can become real if the necessary work is accomplished. These suggested guidelines, along with personal support systems, have worked for many people.

Granted, the long-term goals and prognosis appear good for nursing. Nurses are in a perfect

As the reader begins to explore

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position to move forward and tit into the new emerging paradigms. Unfortunately, not all nurses will fit into the new corporate model of health care delivery. The challenge is to be ready. There is an increas- ing preference by consumers to seek out services that provide what industrialized medicine has not been able to provide: a sense of meaning, a sense of connectedness, and help with healing.

Nurses need to take the initia- tive to develop the skills, attitudes, and vision that the new system will require. They should assist employers in meeting the demands of a public that expects the best health care in the world. Additionally, they need to look to the major focus of moving deliv- ery from hospital acute care to freestanding/ambulatory centers, home health services, and inde- pendent advanced nurse practice.

This book is available from Aspen Publishers, Inc, 200 Orchard Ridge Dr, Suite 200, Gaithersburg, MD 20878; (800) 234-1660.

NORRIE 1. MAcILRAITH RN, MS, CNS

CONSULTAN1 N. MAC LIMITED: NURSINQ FACETS

MASON CIN, IOWA

MANAGING OUTCOMES, PROCESS, AND COST IN A MANAGED CARE ENVIRONMENT By Roey Kirk 1 9 9 7 , 2 6 0 ~ ~ $60 spiralbound

ertainly, the advent of man- aged care has challenged the c “old” ways of doing business

or managing. Managers are expected to plan and lead through process and system designs. The management objective is to achieve outcomes efficiently and

effectively. The measurement and performance assessment of these outcomes will require data. Data and the management of that data will determine the successful health care manager.

In the past few years, a pletho- ra of books and articles have been written regarding the management of data. The techniques revolve around the changing environment and how to plan, design, measure, and assess. The goal of this book was to simplify this variety of methods to give managers a vari- ety of options.

bound book follow the integrated quality management model for data or outcome improvement. Chapter 1 provides a quick, but in- depth, review of the total quality management model. This model combines concepts from many different models and theories. It includes information about improving organization perfor- mance, integrated and supportive systems, individual ownership and accountability, customer-driven care, service, leadership, culture, mission, vision, and communica- tion, all the buzzwords and ele- ments being discussed and acted on today. The chapter gives exam- ples of employee empowerment and customer interviews and pro- vides a worksheet with examples of care or service indicators, per- formance or process indicators, and financial indicators.

process must be dependable, affordable, and reimbursable. Examples of successful process designs and worksheets for deter- mining the financial aspects are given. Data-driven management must not only design a system that reliably delivers high-quality care at the lowest possible cost but also

The five chapters of this spiral-

Chapter 2 explains that the best

must verify and document the extent of the success.

Data collection, display, and analysis are explained in Chapter 3. Assessment and analysis turn data into information. The use of the indicator assessment plan con- tinues in this chapter. Data trends and pattern’s, costbenefit analysis, diagrams, and benchmarking are a few of the terms clarified.

The core of management is the improvement of performance. The objective of process outcomes and the use of data is reflected in the pursuit of continually improving performance results. This is the last step in the model, but the one that plans for the future by decid- ing the results of the design, col- lection, measurement, and analy- sis of the process. Chapter 5 explains what to do if the indica- tors are met, not met, or exceeded. The book’s appendix provides examples, checklists, worksheets, assessments, and hints regarding facilitator and group processes.

The author has written an excellent guidebook for data-dri- ven management tools. It is easy and fun to read. The examples are relevant. The worksheets apd for- mats are applicable in any setting. Various quotations and sketches are used throughout the book. I have referred this book to depart- ment managers to use in introduc- ing change and process improve- ment to their units and to clinical improvement departments as an easy-to-use reference.

This book is available from Aspen Publishing, Inc, 200 Orchard Ridge Dr, Gaithersburg, Md 20878; (800) 234-1660.

SUSAN PHILLIPS RN, MHA, CNOR

ALLEOIANCE HEMIWARE CLINICAL PROJECT MAMAQER

&ERflElD, IU

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