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In a small hospital, an employee opinion survey was conducted at the same time the employees were experiencing a flurry of changes related to the hospital's merger with another institution. In the written responses accompanying the checked-off levels of opinion, 1 employee commented on a department's shared management as follows: "We now have a single manager over the departments in 2 places. He comes here, he goes there, and half the time he's at some place called the system. Even when he's here he's always meeting with the higher-ups, so we hardly ever get to see him. How are we supposed to get an answer from the boss when we really need one?"


Few if any readers of this journal are unaware of the sweeping changes that continue to plague health care. Most working managers have probably been exposed to some aspect of "merger mania," have gone through "reengineering" or an undisguised reduction in force, or have seen their organizations' structures "flattened" such that layers of management and some specific management positions have been eliminated, leaving the survivors with more than ever to manage.


The changes in some managers' roles have had the effect of reducing their day-today presence in the work group. The pressures to face toward higher management, to spend more time on organizational issues, on strategic planning and such, are undeniable. Some managers readily give way to these pressures, perhaps believing that these higher-level involvements should take precedence in this era of rapid change. However, while the manager is participating in what are perceived to be high-level activities, some vital aspects of the management task are likely to go unaddressed.


Visibility and availability will forever remain among the important elements of a manager's job, most especially for those first-line managers who supervise the people doing the hands-on work. Despite the ever-changing emphasis on the mix of tasks that should command management's attention, the fact remains that certain aspects of a department's functioning are better served by the manager's presence than by the manager's absence. Some may believe that appropriately empowered employees need not have the manager close at hand at all times. True, but empowerment goes only so far. There are decisions to be made that are the province of the manager only. Also, the manager's all-important coaching, counseling, and instructing functions are not served in the manager's absence.


The manager who may now be spread thinner than before, who may actually oversee multiple groups in multiple locations, will have to make a conscious effort to remain equally visible and available in all necessary places. There will always be demands that necessitate being here or there or elsewhere at any given time. It may be wise, therefore, to consider simple visibility and availability as demands in themselves; sometimes you may have no specific reason for being present in the work group except for your presence itself. That is more than enough real reason for being there.


This issue of The Health Care Manager (34:2, April-June 2015) offers the following articles for the reader's consideration.


* "Using a Facilitation Model to Achieve Patient-Centered Medical Home Recognition" describes how a facilitation model that included a partnership between a Community Care of North Carolina network and undergraduates at a regional university supported rural primary care practices in transforming their practices to become National Committee for Quality Assurance-recognized patient-centered medical homes.


* "Has Competition Increased Hospital Technical Efficiency?" demonstrates how use of the hospital efficiency score as a dependent variable facilitates analysis of the effects of hospital competition on hospital efficiency, concluding that when a hospital is located in a less competitive market in 2003, its technical efficiency score is lower than those in a more competitive market.


* "Manager-Employee Interaction in Ambulance Services: An Exploratory Study of Employee Perspectives on Management Communication" presents an exploratory study of how paramedics experience challenges in communication with station leaders, addressing the issue from a dialogue perspective by way of interviews in both one-to-one encounters and focus group settings.


* "International Classification of Diseases, 10th Revision Coding for Prematurity: Need for Standardized Nomenclature" describes the importance of the need for specificity of the codes and emphasizes the role of training in preparing for implementation of the ICD-10 coding system; an example is made for the need for accuracy in ICD-10 codes for prematurity as regards defining the premature population using standardized nomenclature.


* "Robotic Joint Replacement Surgery: Does Technology Improve Outcomes?" reports on a study undertaken to examine whether component misalignment leads to failure of total joint replacement and concludes that although computer navigation enhances the precision of component alignment, the addition of robotic guidance can provide a higher level of accuracy.


* Case in Health Care Management: "Where Does the Time Go?" asks the reader a common management concern: the effective use of time and what individual practices can be changed to improve one's employment of this unrenewable resource.


* "Health Care Leader Competencies and the Relevance of Emotional Intelligence" reports on a study undertaken to develop a better understanding of what relationship, if any, can be identified between health care leader competencies and emotional intelligence.


* Community Health Needs Assessment: A Pathway to the Future and a Vision for Leaders" stresses the need to implement evidence-based public health practices that integrate targeted and specific strategies and actions with community preferences to improve the health of populations via the community health needs assessment.


* "Hospital Budget Increase for Information Technology During Phase 1 Meaningful Use" reports on a study of nonfederal hospital information technology budgets during the years 2009 to 2011, finding that increases in the percentage of operating budgets allocated to information technology in the years leading up to federal incentives were most pronounced among hospitals receiving high proportions of their reimbursements from Medicaid and Medicare, suggesting a possible budget shift toward more information technology spending to achieve "meaningful use" policy guidelines.


* "The Manager and the Merger: Adjusting to Functioning in a Blended Organization" suggests that as a result of organizational combinations such as mergers, affiliations, and the creation and expansion of health care systems, areas of responsibility are becoming broader, the groups overseen by individual managers are becoming larger, and many of the older "principles" of management are being tested and strained.