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Health care managers repeatedly come to realize that rarely does there seem to be sufficient time in which to be thorough in doing everything that needs to be done. One may even have a full appreciation of the importance of giving a particular problem or assignment the full time and attention it deserves and yet still give way to the pressures that encourage corner cutting.


The manager who believes in doing the best possible job is subject to constant time pressure. Often the pressure is so subtle that one is barely, if at all, conscious of its presence; sometimes the pressure is so obvious, so all pervasive, that it looms as the strongest factor in the environment.


One cannot be blamed for occasionally-and perhaps even frequently-giving in to the pressures of time. However, the occasions when one does so often turn out to be the occasions when things are most likely to go wrong. A problem may be treated once over lightly because there are a dozen other matters awaiting attention; it later comes back to haunt the problem solver, usually as a larger problem.


Time and again, a matter that was not given sufficient time on first handling later requires even more precious time to resolve. There never seems to be enough time to do a task thoroughly the first time, but somehow, when one is forced to find it, there is usually time available in which to fix it. One might be only vaguely aware at the moment that the "fix-it" time is made available only at the expense of other things that should be done.


There is an old proverb, "By losing present time we lose all time." A moment past is forever gone, but whether it is truly "lost" depends on whether one feels that something of worth was accomplished. To the health care manager, the measure of the worth of any expenditure of time is directly conveyed in one familiar word-priority.


Consideration of time reveals the major hitch in most of the good advice a manager receives in management classes and from management literature-doing something "right" invariably takes more time than giving it the once-over-lightly treatment. For example:


* In day-to-day communication, establishing and maintaining the manager-employee relationship can seem, when conscientiously pursued, to require more time than the manager can possibly devote. Yet a loose, uncertain relationship is sure to cause problems that take far more time to resolve.


* Performance appraisals and disciplinary actions can both seem inordinately time-consuming, yet when given hasty attention they will invariably lead to time lost after the fact.


* Delegation, the manager's capacity to get work done through others, is a most time-consuming process when properly performed. But the time "saved" by simply giving orders is usually paid back many times over while the manager also experiences the strains of "management by crisis."



Time has other effects as well. As time progresses, very little remains unchanged. One comes to feel comfortable with a problem-solving approach or with one's own technical knowledge, and then something happens to alter the nature of the problems or expand the field of technology. In the words of Antoine Rivaroli, "Opinions, theories, and systems pass by turns over the grindstone of time, which at first gives them brilliancy and sharpness, but finally wears them out."


We believe that in The Health Care Manager we are able to provide at least a small hedge against the pressures of time. In each issue, we endeavor to provide articles of interest to most health care managers and attempt to keep readers abreast of the changing health care environment.


This issue of The Health Care Manager (25:1, January-March 2006) offers the following for reader consideration:


* "The Implications of Herzberg's 'Motivation-Hygiene' Theory for Management in the Irish Health Sector" explores the extent to which the subject theory of motivation is applicable in addressing the needs of health care workers and their organizations in the Irish Health Service.


* "Not-For-Profit vs. For-Profit Health Care Providers: Comparing and Contrasting Their Records, Part II" builds upon the foundation established in Part I (HCM Issue 24:4) and offers actual comparisons of the 2 organizational structures using a number of disparate factors.


* "Certain Death: Ten Predictors of Hospital Information System Failure" presents a clear view of the common reasons for information system failure and suggests what can be done to avert system failure under a variety of circumstances.


* The Case in Health Care Management, "What to Do With the Squeaky Wheel?" asks readers to consider the problem presented by a key staff member who follows up a series of seemingly innocuous grumbles with a dramatic ultimatum.


* "The Influence of Financial Officers on the Decision-Making Process in Health Facilities: A Study in Ankara" reports on a study undertaken to assess the extent of financial officers' influence in organizational decision making and suggests that further definition of their presumed power and influence is necessary for complete understanding of their role as members of a management team.


* "Improving Retention of Older Employees Through Training and Development" suggests that appropriate training and development activities and timely and accurate performance feedback can lead directly to improved rates of retention for older employees.


* "Medicare's Operational History and Impact on Health Care" is the second in a series of 3 articles. This one explains the 4 apparent periods of Medicare's operational history: the era of communication, the period of reform and cost control, the period of budget deficits and control of Medicare costs, and balancing the federal budget and preserving Medicare.


* "Are You Born a Happy Person or Do You Have to Make It Happen?" suggests, among other things, that managers can affect their own happiness in the workplace by taking responsibility for happiness and providing meaningful rewards and recognition for staff.


* "Strategies for Identifying and Minimizing Medication Errors in Health Care Settings" examines the definition and assessment of medication errors, addresses emerging technologies used to alleviate such errors, and suggests how to improve certain related dimensions of pharmaceutical marketing.


* "Does Requiring Continuing Education Units for Professional Licensing Renewal Assure Quality Patient Care?" addresses the title question through an extensive review of the literature analyzing both the supportive and opposing views of mandatory continuing education units for license renewal.


* "Leadership for Cross-Cultural Respect Among Health Care Personnel" explores various aspects of organizational culture and offers an alternative view of culture that focuses on similarities among people rather than on differences.


* "Succession Planning: Valuable Process or Pointless Exercise?" stresses the importance of succession planning in both the macro sense (executive succession) and the micro sense (individual department manager succession), and addresses the value of this often maligned process.