The epigram introducing the first chapter of this book states: "The beginning of the 21st century beckons both with

challenge and opportunity for improved health of Americans." From now until then, and most likely well beyond,

health services managers will be confronted with change--a constant that will challenge them to improve the

organization, delivery, and financing of health services. Our purpose in preparing this book is to help managers

meet these demands and seize the opportunities; by doing so they will make a major contribution to improv-

ing health.

This book is most beneficial for two types of users: 1) students engaged in the formal study of health services

management, and 2) current managers who wish to supplement their experience and refresh their knowledge of

applied management theory. It is about managing organizations that deliver health services. Historically, hospitals

and nursing facilities have been the most prominent health services organizations (HSOs). Others that have become

important more recently include managed care organizations (including HMOs and PPOs), multiorganizational

systems, ambulatory care organizations, home health agencies, birth centers, and hospices. All face new environ-

ments--a mosaic of external forces including new rules and technologies; changing demography; increased com-

petition, public scrutiny, and expectations; greater accountability; and more constraints on resources. Managerial

excellence makes a difference in the efficient and effective delivery of health services. HSO managers must be

prepared if they are to respond to these and other challenges. We hope this book will aid in their preparation.