EDITORIAL

As a graduate student in the late 1980s, I attended a presentation given by then-executive director of the Australian Healthcare and Hospitals Association Dr. Errol Pickering. During his lecture, Pickering, who later served as director general of the International Hospital Federation, talked about various aspects of healthcare delivery in Australia and in other countries. When an audience member asked how the US healthcare system compared with that of other countries, Pickering responded, “The US health system is both superlative and abysmal.” I was quite surprised by his assessment. Superlative, sure, but abysmal? No way. How could such a remarkably expensive system, rich in advanced technologies and research, full of splendid facilities, and replete with highly trained workers, ever be considered abysmal? Over time and with greater understanding, however, I grew more comfortable with this ambiguous, paradoxical view. While parts of the system are clearly world class, overall quality continues to be uneven, and the system just doesn't work well for many people. The sheer expense of our currently structured system, and the demands facing it, threaten not only the viability of our healthcare institutions but also our health and economic stability. Where is our health system heading? Will it continue to be an expensive paradox, will it go into decline, will it implode and bankrupt us, or will it improve to affordable perfection? While the Journal of Healthcare Management cannot answer these questions with certainty, its articles provide an evidencebased record of research results that can generate discussion, offer direction, and advance understanding for our readers. In this issue's interview, Patrick Charmel, FACHE, discusses a variety of topics, including how his relatively small institution, Griffin Hospital, became an influential leader in the field. He speaks of the hospital's innovative and entrepreneurial spirit and its atypical commitment to community health, health promotion, and wellness. He further describes the patient-centered Planetree model, which originated in California, and how it found its way to Connecticut, eventually becoming part of Griffin Health Services. Finally, he comments on the hospital's strong emphasis on employee pride and the leadership skills necessary to create and enhance it. Medicare's recovery audit contract (RAC) audit program is the focus of the Trends column by Alan Goldberg and Linda Young. They provide an overview of the program, key RAC review and appeal issues for providers, and advice for monitoring this looming element of the revenue cycle. In his Reform column, Nathan Kaufman describes the existence of a healthcare bubble that he believes will eventually burst due to unsustainable levels of spending on health services. He offers three strategic directions to help healthcare leaders prepare for such a possibility. Employing a qualitative case study of ambulatory electronic health record (EHR) system implementation, Paula Song, PhD, and colleagues explore the extent to which a business case analysis can support investment decisions about adopting EHR systems by providing a clearer picture of resource needs, clinical and financial indicators to watch, and a foundation for continued organizational support. Nir Menachemi, PhD, and colleagues longitudinally examine practice- and physician-related characteristics of EHR usage among Florida physicians in outpatient settings. They find significant increases in levels of EHR adoption between 2005 and 2008. Over this time, medical practices appeared better able to surmount the cost and logistical obstacles associated with EHR adoption. The findings reported have significant implications for healthcare management and policy makers. For instance, as the HITECH Act seeks to encourage EHR adoption by incentivizing physicians through Medicare and Medicaid, the relationship of those two government programs to level and rate of EHR adoption is particularly important. Frank Roger Tortorella, JD, MBA, FACHE, and colleagues examine hospital patient transfers to The University of Texas MD Anderson Cancer Center and the issues surrounding an overhaul to the processes their transfer center employed in accepting patients. The authors describe the problems motivating the need for change in the transfer center, the interventions undertaken to address these problems, and the specific positive outcomes resulting from these initiatives. We conclude this issue with an Academy of Management abstract by Michael Leiter, PhD, and colleagues that examines the rationales used by Canadian nurses to justify rude behavior at work. The authors developed a rudeness rationale scale that can be used to assess the level of civility and respect within a healthcare setting. Stephen J. O'Connor PhD, FACHE Editor Corrections: In Volume 56, Number 1, author name Kevin J. Bozic was printed without his middle initial. In Volume 56, Number 2, author name Beatrice Kalisch was abbreviated and author name Dana Tschannen was misspelled.

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