1. Issel, L. Michele PhD, RN

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At the end of 2009, both the U.S. House and Senate passed health reform bills. These monumental, both in scope and in importance, bills will have consequences for all Americans and most certainly for health care administrators. I reviewed the summary of the bills provided by the Kaiser Family Foundation (2010) in early January, with an eye toward possible, specific implications for health care administrators and researchers. The following summary represents one possible interpretation of some of the key provisions that are likely to survive the conference committee process. My interpretation is offered to stimulate both dialogue and research.

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Several provisions could affect the strategic thinking of many health care organizations. For example, the changes in financing to disproportionate share hospitals may require a revision to the mission statement of hospitals that have long thought of themselves as the local safety net hospital. Such a shift will require strong leadership and fresh strategic thinking. Similarly, the inclusion in the legislation of home care demonstration projects for Medicare patients may lead some hospitals or health systems to consider adding or enhancing their home care services. This too might be a strategic shift requiring flexibility among workers and leadership across the organizational levels. A third provision affecting strategy is the award of grants to small employers that establish a health wellness program. Given that many health organizations already provide wellness programs to their employees or to residents in their community, some health care organizations will see the wellness grant provision as a strategic opportunity to work with small employers to provide the wellness programs. What is known about moving from reactor to prospector (Miles & Snow, 1978) can help administrators shepherd their organizations toward stronger market positions.


Other provisions address quality and patient outcomes that will make quality improvement systems essential to organizational viability. One provision is to reduce Medicare payments for preventable rehospitalizations. To prevent rehospitalizations, hospitals will need to develop more adept systems to monitor and prevent posthospitalization complications. The implication is that quality improvement systems continue to be more and more central to the business of providing care. The proposed development of a national quality strategy will result in uniform measures of quality of care and patient outcomes. This measure will necessarily be a key focus of quality improvement teams. However, once the measures have been established, having information and documentation systems that collect these measures will require chief information officers to be well connected to the sources that disseminate the new measures as well as to those who will be documenting and analyzing the data. This may require some reorganization within the health care organization, among other possible consequences. The growing body of knowledge about adoption and use of medical records can be used to make the informatics a strong and cohesive force throughout the organization. Existing research on quality improvement processes and adoption of electronic records can assist health administrators, but more research is needed about ways in which both quality improvement and information systems can be even more effective in guiding health professionals toward the best possible decisions.


The provisions regarding Medicaid expansion, mandated health insurance coverage, and creation of accountable health organization will surely confuse the public, especially during the initial implementation. Health care organizations will need to have new systems and approaches for guiding patients through the new options and requirements. Doing such has rarely been an explicit mission of health care organizations, although it may be a strategically wise move. Yet, we have sparse administrative research on how organizations can be responsive in this way.


My final observation is that as the previously uninsured gain coverage, a surge will occur in the demand for primary and chronic care for both adults and children. Being poised to be responsive to such a surge will be important to maintain high quality of care and to be efficient with human resources. Again, research is lacking that could guide health administrators toward development and implementation of flexible systems.


At the Health Care Management Review Web page (, we have added topical collections on mission statements, strategy, and quality improvement to the already existing topical collections that include information technology. We hope these collections will assist our readers in quickly reviewing the literature that might be pertinent. I fully expect that in the coming years, the Health Care Management Review will receive and publish manuscripts related to the Health Care Reform Act, in whatever its final configuration. I look forward to receiving studies that benefit the health care system through attention to improving administration of our health care organizations.


L. Michele Issel, PhD, RN






Kaiser Family Foundation. (2010). Focus on health reform; side-by-side comparison of major health care reform proposals. Retrieved January 4, 2010, from[Context Link]


Miles, R. E., & Snow, C. C. (1978). Organizational strategy, structure, and process. New York: McGraw-Hill. [Context Link]