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Biomedical subjects

A D Kaluzny

Publications and source records attributed to A D Kaluzny.

At least 19 recordsLinked to original sources
PubMed1999

Continuous quality improvement in contract research organizations--the customer focus.

The challenge of quality improvement extends beyond traditional service delivery organizations. This is the first of a two-part series on the application of continuous quality improvement (CQI) to contract research organizations associated with the pharmaceutical and biotechnology industry. The challenges and processes of clinical trials research, and the role of CQI within that process, are presented. The importance of customer focus, which is a key element of CQI, is described here as the foundation of the CQI process among contract research organizations (CROs) and as a major contributing factor to their success in recent years.

Biotechnology↗
PubMed1998

Collaboration to improve community health: trends and alternative models.

BACKGROUND: Many health care organizations have begun to pursue collaborative approaches for addressing community-level health issues. To understand how these community health alliances develop and operate, a descriptive study was conducted within a nationally selected group of 60 local communities and supplemented by detailed case studies in 8 communities. ALLIANCE MODELS: A broad array of organizations were found to participate in community health alliances. Moreover, alliances were found to vary considerably. Strategically, alliances focused on one of three primary objectives: acquiring needed organizational knowledge and skills; addressing common resource needs; and pursuing a shared organizational mission. Functionally, alliances were observed in the areas of service delivery, planning and policy development, surveillance and assessment, and education and outreach. Structurally, alliances were found to operate through one of four interorganizational arrangements; informal collaboration, contractual agreements, shared governance, and shared ownership. ALLIANCE DEVELOPMENT: Organizational characteristics such as ownership type, organizational proximity, and market share appear to be important in the development of community health alliances. Community and market characteristics--including health resource availability, HMO penetration, and market consolidation--also appear to be influential in alliance development. Longitudinal observations suggest that alliances evolve over time in response to changing community health needs and organizational objectives. ALLIANCE MANAGEMENT: Several managerial tasks appear to be important to successful alliance operations, including developing a shared vision of collaboration; devising explicit strategies for addressing participation constraints; ensuring the compatibility of organizational incentives; managing communication and information flows across organizations; and developing appropriate processes for performance monitoring. CONCLUSIONS: The observed variation in alliance structures and functions appears healthy rather than problematic, as organizations develop arrangements to fit community needs, organizational capacities, and market conditions.

Community Health Planning↗
PubMed1998

Developing an AHC-MCO alliance for research and care.

Academic health centers (AHCs) and managed care organizations (MCOs) appear to be on a collision course. Is it possible to develop a partnership to enable both parties to achieve their respective goals and objectives? The Kimmel Cancer Center of Thomas Jefferson University and AEtna US Healthcare, one of the nation's largest MCOs, have developed an alliance designed to generate cancer prevention and control research. This arrangement engages the participants in a collaborative effort that is aimed at creating new knowledge that can be used to enhance the provision of health care to a defined population.

Academic Medical Centers↗
PubMed1998

Interorganizational factors affecting the delivery of primary care to older Americans.

OBJECTIVE: To discuss different types and forms of interorganizational linkages involved in the provision of primary care to older Americans, along with their distinguishing characteristics. RESEARCH STRATEGY: To take advantage of these linkage characteristics. The strategy requires a partnership with health services organizations and providers actually involved in the provision of services along with a planned sequence of activities involving hypotheses and methods development, intervention trials, and finally, demonstration and implementation. CONCLUSION: Because older Americans are frequent users of health services, their need for continuity and access provides an opportunity to examine changes to the delivery system and to monitor the system's capability for meeting their healthcare needs.

Aged↗
PubMed1997

Privatizing health services: alternative models and emerging issues for public health and quality management.

Concerns about the cost, quality, and efficiency of services provided within public sector health care systems are leading policy makers and health care administrators to reinvent government and develop alternative methods for the delivery of services traditionally offered in the public sector. Privatization structures that incorporate strong quality management principles, both through formal accountability systems and through financial risk-sharing arrangements, appear to hold the greatest promise for achieving quality and efficiency goals.

Contract Services↗
PubMed1997

Not-so-strange bedfellows: models of interaction between managed care plans and public health agencies.

Alliances between managed care plans and public health agencies are a growing phenomenon in local health care markets, with profound implications for health care quality, cost, and accessibility. A typology of interorganizational relations between managed care plans and local public health agencies is drawn from observations of over 60 public health jurisdictions. Relations are described along three dimensions corresponding to the strategic intent, functional operation, and structural design of each alliance type. The identified models of interaction reveal the motivations for forming alliances, the mechanics of their operation, and the possible outcomes. These alliances suggest that a wide range of interorganizational strategies is possible in order to pursue the shared interests of local public health agencies and managed care plans. Nonetheless, public health agencies may face challenges in forging managed care alliances that benefit community-wide populations and that are open to participation by the full spectrum of health care providers in the community.

Contract Services↗
PubMed1997

Strategic alliances in healthcare: opportunities for the Veterans Affairs healthcare system.

Strategic alliances are proving to be effective strategies for responding and adapting to changing environments, and as such they offer the U.S. Department of Veterans Affairs (VA) healthcare system valuable opportunities for accomplishing the goals of its major reorganization effort. This article begins with an examination of basic strategic-alliance structures that are employed across many different types of industries. Next, consideration is given to the ways in which these basic alliance structures may be adapted to the unique organizations and individuals that serve as providers, purchasers, and consumers of health services. Finally, this article explores how models of strategic alliance in healthcare can be tailored to the specific needs and constraints of the VA healthcare system through an examination of existing and potential alliance opportunities.

Delivery of Health Care, Integrated↗
PubMed1997

Developing leaders in public health: the role of executive training programs.

The growing complexity of the nation's health care system is creating new challenges and opportunities for public health officials, and a renewed concern for leadership training among these officials. A focus group conducted with public health officials at local, state, and national levels reveals perceptions about the predominant trends effecting public health practice, the leadership skills required for effective public health practice, and the strategies that are needed for providing appropriate leadership training to public health executives. Officials indicate that public health practice is undergoing substantial changes in response to the growth of managed care and integrated delivery systems, changes in public health funding sources and levels, and efforts to privatize the delivery of public health services. The skills identified as critical for effective leadership in this environment include the ability to guide organizational behavior and cultivate interorganizational relationships; apply scientific knowledge to public health problems, and build and sustain community coalitions. In light of these skills, public health officials identify four essential components of an optimally effective executive training program in public health leadership: exposure to the core scientific disciplines within public health; exposure to organization theory and management science; training in community development and empowerment; and training in ethics and social justice. All of the officials agree with the need for distance learning programs for executives in public health leadership, and most officials also support the need for doctoral-level training in public health practice.

Community Participation↗
PubMed1997

Total quality management issues in managed care.

The implementation of total quality management (TQM) in health care has gone on in parallel with the growth of managed care. What is the interaction between the two? Key issues are the ascendance of cost control over quality in many areas, erosion of employee commitment and loyalty, and a short-run orientation. Associated with this is an emphasis on organizational learning rather than learning by autonomous professionals. Both TQM and managed care acknowledge the dynamic nature of clinical processes and the ability and responsibility of both institutions and clinicians to improve their processes. Both are consistent with efforts to identify and implement best practices. However, these similarities should not mask fundamental differences. Continuous improvement must shift its focus from avoiding unnecessary variation to facilitating rapid organizational learning and institutionalizing mass customization into the delivery of health services.

Humans↗
PubMed1996

Improvement strategy for local health departments.

Local public health departments face unprecedented challenges in today's changing health care market: movement toward Medicaid managed care, privatization of public health services, and resource shortages. Internal weaknesses include divergence from the core public health mission, an unfavorable public image, inefficiency in work processes, and inadequate data management. Quality management offers health departments a strategy for addressing these challenges through heightened service effectiveness and improved resource utilization.

Economic Competition↗
PubMed1996

Performing public health functions: the perceived contribution of public health and other community agencies.

As public health struggles to define its role within health care reform, the need to examine carefully the component organizations providing and/or supporting health care for the public appears critical. This article identifies the nature and extent of involvement by agencies other than the official local public health department in performing public health practices and functions within 63 local public health jurisdictions. Adequacy of overall public health performance is significantly related to the extent of participation of outside agencies. Outside agencies contribute over 26 percent to the total public health performance for the jurisdictions surveyed. Other agencies of government, both at the state and local level, are the predominant outside contributors to public health practice. Private and voluntary agencies are perceived as minor contributors. Little variation exists among communities in which outside agencies tend to perform particular public health activities. Findings suggest that local public health departments can maximize their impact by understanding better the nature of working relationships within multi-institutional arrangements, encouraging greater levels of collaboration and integration and acting as catalysts for increased support of public health activities.

Community Health Centers↗
PubMed1996

Practice setting and physician influences on judgments of colon cancer treatment by community physicians.

OBJECTIVE: This article compares judgments about the treatment of Dukes' B2 and C colon cancer made by general surgeons to those of internists and family practitioners. Physician and practice variables were specialty, affiliation with a Community Clinical Oncology Program (CCOP) hospital, time in practice, professional centrality (level of participation in cancer information networks), solo practice, and number of colon cancer patients. DATA COLLECTION METHODS: Data are combined from national probability samples of CCOP- and non-CCOP-affiliated physicians. This study focused on 1,138 internists, family physicians, and general surgeons who participated in decision making for patients diagnosed with Dukes' B2 or C stage colon cancer. Judgments were elicited using brief vignettes. METHODS OF ANALYSIS: Judgments of adjuvant therapy are classified as (a) consistent with the National Institutes of Health Consensus Conference recommendations (experimental for Dukes' B2, accepted for Dukes' C); (b) accepted treatment for both stages; or (c) experimental for both stages. Multinomial logit analyses were used to examine the association of practice setting and physician characteristics to judgments of treatment. RESULTS: Surgeons and CCOP-affiliated physicians were more likely to endorse the NIH consensus conference position. Surgeons, younger physicians, and those in group practice were more likely to approve of chemotherapy for both cancer stages. The most common position (chemotherapy experimental) was more likely from nonsurgeons, solo practitioners, and non-CCOP physicians. CONCLUSION: Physician and practice setting characteristics, including organized structures such as the CCOP, are possible mediating structures that can facilitate dissemination of standards of treatment.

Clinical Protocols↗
PubMed1995

Accrual to the Breast Cancer Prevention Trial by participating Community Clinical Oncology Programs: a panel data analysis.

In 1992 patient accrual to the National Cancer Institute-sponsored Breast Cancer Prevention Trial was initiated in the United States and Canada. The Trial will involve 16,000 women who are evaluated to be at high risk of developing breast cancer. Nearly 250 health care organizations are participating in the Trial, including over 40 Community Clinical Oncology Program (CCOP) organizations, which are a component of the NCI's national clinical trials program. A previous NCI-funded evaluation conducted by the University of North Carolina showed the CCOP program to be an effective means of transferring the latest cancer technology, particularly cancer treatments, to the community setting. This paper describes a study designed to evaluate the performance of CCOP organizations in the Breast Cancer Prevention Trial. Using data from the first fifteen months of the Trial, the ability of CCOPs to accrue women is assessed using panel data estimation techniques. An attempt is made to predict accrual by structural, process, and environmental characteristics of participating CCOPs. Factors predictive of accrual include month in which accrual occurred and the extent of competition for trial participants in the CCOP service area. The hypothesized model explains slightly over 19 percent of the variation in accrual performance. The analysis demonstrates the utility of a panel data approach to modeling the dynamics of CCOP participation in a chemoprevention clinical trial.

Breast Neoplasms↗