249). The mere fact of having more choice benefits some patients by giving them more say in their care. Patient-focused care involves a method for containing in-patient costs for hospitals and for improving quality by "restructuring services so that more of them take place on nursing units rather than in specialized units in other hospital locations, and by cross-training staff on the nursing units so that they can do several 'jobs' for the same small group of patients rather then one 'job' for a large number of patients" (Kovner, 1995, p. 186). Kovner notes a number of barriers to this type of care. One reason has been that hospitals have not had to control costs to receive adequate reimbursement. However, costs are rising rapidly and creating anger in the public, and hospitals today have to consider ways of reducing costs before legislators step in and force change. Hospitals have an ethical responsibility to think of patients over reimbursement and need to take this into account and make the changes that will reduce costs and serve patients at the same time. Hospital interest groups serve as a barrier because they are made up of doctors and nurses who oppose change and because they do not foster champions who will bring about the changes needed. Again, doctors and nurses have to think of patients and of making the system more responsive rather than of protecting their existing bailiwick from all change. Another barrier is the fact that change often requires physical plant renovations, which might be costly. A careful analysis will show if the benefits would outweigh the costs, in which case this barrier can be overcome as well (Kovner, 1995, pp. 186-187).

Such barriers are not insurmountable, but the will to make changes is required, along with leadership to get things done and to bring a clear idea of what is needed to bear and to get people to support Shane. A lack of leadership is perhaps the greatest barrier to achieving these changes.

6. Froeschle and Donahue (1998) note the state of health care today and the need for change, indicating that this also means that there is a need for new leadership skills:

Communicating a vision and persuading others to work toward this ideal is the responsibility of an effective leader. Prevailing over adversities unique to academic medical centers requires strong leadership and stakeholder support (Froeschle & Donahue, 1998, p. 60).

The authors note that the health care model is changing, from a traditional emphasis on autonomy and rewarding individual achievement to a system that supports a larger community interest, a change brought about by technological advances, delivery system innovations, and changes in demographics. The essential mission of health care remains the same, however, that being to improve the health of the public through education,...

The task of the leader is to motivate subordinates to make the necessary changes to meet new challenges and a new environment and to do so effectively and thoroughly.
However, such leadership is difficult to find in most areas, including hospital administration. The government regulates how hospitals are administered, and this system has many problems, including a lack of political will to make the changes needed. As one commentator notes of the health insurance issue,

The major barrier to decision and change is fear: fear that the price tag to cover medical care for the uninsured will be too high and impossible to control (Moore, 1991, p. 2108).

Such fear prevents many changes from being made to control costs. However, if the government were not involved, there is still no clear incentive for hospital administrators to do what is needed. They have the opportunity to make innovative changes today, government regulation or no, and they do little. They also fear change and fear public reaction, so they tend to wait and see what happens. If they are responsive to the community today it is because they are forced to listen. Those who see a free market as the answer to everything need to look closely at the medical system and the barriers to change that exist within it, barriers that will not disappear if government regulation disappears. The public has some confidence in hospitals today because the public knows that there is oversight. Indeed, the public most often complains that this oversight does not go far enough, and there is no general will to unlash administrators to do what they want.

Administrators might wish to have more control over what they do, but they have to demonstrate community responsibility before they are, likely to get that added capability. Until costs are more under control, such added capability is not likely to be granted.