tag:blogger.com,1999:blog-9551150.post5185319720165437636..comments2024-03-28T01:27:23.408-04:00Comments on Health Care Renewal: Why Have Governing Boards Forsaken Their Duties? - Ideas from Silverglate and MalchowRoy M. Poses MDhttp://www.blogger.com/profile/00497209843184497847noreply@blogger.comBlogger19125tag:blogger.com,1999:blog-9551150.post-22456453453329196412009-12-05T11:36:20.328-05:002009-12-05T11:36:20.328-05:00Harald K, whoever you are, your word games are get...Harald K, whoever you are, your word games are getting tedious:<br /><br />I was talking about alumni as a whole, and not arguing about the legitimacy of a particular alumni association. But you seem to want to do the latter.<br /><br />You try to knock down a straw-man when you argue that an alumni association is not identical with a board of directors. Who said it was?<br /><br />I surely am Roy M. Poses MDhttps://www.blogger.com/profile/00497209843184497847noreply@blogger.comtag:blogger.com,1999:blog-9551150.post-5343492681834064132009-12-04T19:22:44.433-05:002009-12-04T19:22:44.433-05:00I do indeed think of an alumni association as bein...I do indeed think of an alumni association as being an "interest group" outside of the university corporation. It lobbies and cajoles and in some cases has a formal relationship, but its officers are not identical with the board of directors an any example I have encountered. Do you know of a university that is owned by its alumni club? I can see Deep Springs College or some unusual Harald K.noreply@blogger.comtag:blogger.com,1999:blog-9551150.post-72631198127745691292009-10-24T11:51:15.311-04:002009-10-24T11:51:15.311-04:00Harald K -
The alumni of a university are an &qu...Harald K - <br /><br />The alumni of a university are an "outside interest group?" Really? Of course, this seems to go along with the view expressed by many executives of large organizations that only they know or ought to know what the organizations' interests are. It would seem that the alumni of a university have more of a long-term affiliation with the university than do Roy M. Poses MDhttps://www.blogger.com/profile/00497209843184497847noreply@blogger.comtag:blogger.com,1999:blog-9551150.post-78951065433933603732009-10-23T20:56:38.838-04:002009-10-23T20:56:38.838-04:00Issues of public policy are “potentially relevant”...Issues of public policy are “potentially relevant” to everything under the sun, aren't they? Public policy is not an issue in the lawsuit that is referenced in the paper, and this fiduciary question seems to be a late arrival trying to latch onto a prior legal tangle.<br /><br />The 1891 agreement is an attempt to give an outside interest group some influence over the board, so it does not Harald K.noreply@blogger.comtag:blogger.com,1999:blog-9551150.post-70019090681446418852009-10-23T15:51:25.329-04:002009-10-23T15:51:25.329-04:00Harald K -
An anonymous comment was forwarded to...Harald K - <br /><br />An anonymous comment was forwarded to me in reply to your comment above:<br /><br />"I think he missed the point of the article. It is relevant because issues of public policy are always potentially relevant to contract disputes. And Silverglate and Malchow's point is that independent trusteeship--as embodied in the 1891 agreement--further the state's goals Roy M. Poses MDhttps://www.blogger.com/profile/00497209843184497847noreply@blogger.comtag:blogger.com,1999:blog-9551150.post-7287865980485425002009-10-14T20:23:23.085-04:002009-10-14T20:23:23.085-04:00The article does not seem related to the November ...The article does not seem related to the November 2008 contract lawsuit it claims to address. It is not published in a reputable journal, as far as I can tell, and it does contain a few errors and reckless exaggerations. I wonder what makes it "important."<br /><br />I am puzzled by Health Care Renewal saying "So just to summarize, considerable discussion, scholarship, and I Harald K.noreply@blogger.comtag:blogger.com,1999:blog-9551150.post-71434386245127277082009-09-25T13:27:24.611-04:002009-09-25T13:27:24.611-04:00I ads:
What, exactly, is it that "individual...I ads:<br /><br />What, exactly, is it that "individuals with management training who do an outstanding job of educating themselves about clinical issues" are qualified to do?InformaticsMDhttps://www.blogger.com/profile/03994321680366572701noreply@blogger.comtag:blogger.com,1999:blog-9551150.post-51121405498417969832009-09-24T15:13:34.034-04:002009-09-24T15:13:34.034-04:00No. I've met individuals with management train...<i>No. I've met individuals with management training who do an outstanding job of educating themselves about clinical issues.</i><br /><br />Could they pass medical boards? Could they reasonably interpret a complex medical article in, say, The Annals?<br /><br />In an emergency could they provide medical care? (mot in the legal sense, just in the skills sense.)<br /><br />If not, why not, InformaticsMDhttps://www.blogger.com/profile/03994321680366572701noreply@blogger.comtag:blogger.com,1999:blog-9551150.post-67518123980858517582009-09-24T13:31:31.923-04:002009-09-24T13:31:31.923-04:00Anonymous, and a brief comment obviously cannot do...Anonymous, and a brief comment obviously cannot do justice to a quarter century of research either.<br /><br />If you insist on making your point about the prevalence of physicians on hospital boards, please provide some data, and a specific source for it. (Simply referring to 25 years of work by a single author who seems to have published hundreds of articles is not much help.)<br /><br />I Roy M. Poses MDhttps://www.blogger.com/profile/00497209843184497847noreply@blogger.comtag:blogger.com,1999:blog-9551150.post-48631697131779948652009-09-24T12:45:43.291-04:002009-09-24T12:45:43.291-04:00If you are going to make arguments based on data t...If you are going to make arguments based on data that isn't glaringly obvious, then either present the data, or give a citation for it.<br /><br />I'd suggest a start by reading the last 25 years of work on hospital governance by Jeff Alexander and his colleagues. Some of their work confims your bias. The rest highlights greater complexities. Boards have grown in physician Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-9551150.post-11249466518392052922009-09-24T12:41:45.800-04:002009-09-24T12:41:45.800-04:00Nor does HC MBA training. Can we, however, agree t...Nor does HC MBA training. Can we, however, agree that those who lack clinical training are medical dilettantes?<br /><br />No. I've met individuals with management training who do an outstanding job of educating themselves about clinical issues. And I've met individuals with clinical training who do an outstanding job of educating themselves about management and business issues.<br /><Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-9551150.post-88090175960120619652009-09-23T22:10:46.790-04:002009-09-23T22:10:46.790-04:00I am curios if anyone here could comment on my sit...I am curios if anyone here could comment on my situation of that being an investment advisor and financial planner, both subject to a legal fiduciary duty as well as an ethical fiduciary duty. who suffered a mental illness. In my case it is bipolar disorder and attention deficit disorder. <br /><br />After several years, I finally realized the cognitive impairments I was having(memory deficits, BipolarPorchhttps://www.blogger.com/profile/04075232692440617747noreply@blogger.comtag:blogger.com,1999:blog-9551150.post-14967033743032876742009-09-23T21:19:28.051-04:002009-09-23T21:19:28.051-04:00Anonymous writes:
Clinical training provides no &...Anonymous writes:<br /><br /><i>Clinical training provides no "shrink-wrap" protection for conflicts of interest, profiteering, or fiduciary malpractice.</i><br /><br />Nor does HC MBA training. Can we, however, agree that those who lack clinical training are medical dilettantes?<br /><br />-- SSInformaticsMDhttps://www.blogger.com/profile/03994321680366572701noreply@blogger.comtag:blogger.com,1999:blog-9551150.post-48637199786766977782009-09-23T21:12:53.624-04:002009-09-23T21:12:53.624-04:00I would also argue that in many hospitals, the pow...<i>I would also argue that in many hospitals, the power of the medical staff as a whole has decreased relative to the hired (usually non-physician) managers.</i><br /><br />I believe the poor health IT being forced upon hospital physicians by those administrations, with inadequate physician say, and the dominance of the IT personnel in hospitals over such decisions is consistent with the decreaseInformaticsMDhttps://www.blogger.com/profile/03994321680366572701noreply@blogger.comtag:blogger.com,1999:blog-9551150.post-61544604245961438282009-09-23T17:19:04.396-04:002009-09-23T17:19:04.396-04:00Anonymous,
If you are going to make arguments ba...Anonymous, <br /><br />If you are going to make arguments based on data that isn't glaringly obvious, then either present the data, or give a citation for it.<br /><br />But if the boards actually exert little oversight and mainly just defer to the hired executives, what is the point of your data on physician representation?<br /><br />You seem to suggest that increasing physician Roy M. Poses MDhttps://www.blogger.com/profile/00497209843184497847noreply@blogger.comtag:blogger.com,1999:blog-9551150.post-48153370234364404672009-09-23T17:06:54.404-04:002009-09-23T17:06:54.404-04:00You might argue that, but you'd have a fun tim...You might argue that, but you'd have a fun time trying to reconcile that with data. Data like the fact that for-profit hospitals have twice as high a representation of physicians of their boards as nonprofit hospitals. Data like the fact that during this period when hospitals were supposed to be increasingly under the control of non-physicians, the representation of physicians on boards Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-9551150.post-7784349586582806772009-09-23T16:10:08.264-04:002009-09-23T16:10:08.264-04:00To anonymous above,
granted that hospitals did no...To anonymous above,<br /><br />granted that hospitals did not historically get that much money from donations, I still believe most of the quote is generally relevant to health care not-for-profits.<br /><br />See Ludmerer's Time to Heal for more discussion about how academic medical centers acted more and more like for-profit corporations.<br /><br />I would also argue that in many hospitalsRoy M. Poses MDhttps://www.blogger.com/profile/00497209843184497847noreply@blogger.comtag:blogger.com,1999:blog-9551150.post-55641110848296287032009-09-23T14:53:34.075-04:002009-09-23T14:53:34.075-04:00The problem with the analysis, both here and in Si...The problem with the analysis, both here and in Silverglate and Malchow, is that it doesn't fit the historical facts in health care. Health care organizations NEVER received a lot of their income from donations--in other words, the following statement "During the 1980s, traditional nonprofit organizations supported by donations and governed by donors and volunteers..." has not beenAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-9551150.post-8906695510106145802009-09-23T13:58:22.901-04:002009-09-23T13:58:22.901-04:00In Canton, Ohio we have Aultman Health Foundation ...In Canton, Ohio we have Aultman Health Foundation (Aultman Hospital), a nonprofit, owning AultCare Insurance, a for profit. There have been a series of law suits questioning Aultman's business practices regarding fair competition, with respect to other hospital organizations in the area. Aultman uses a legal strategy of delay and cost escalation to hold these suits at bay relying on a greaterAnonymousnoreply@blogger.com