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Biomedical subjects

D Kindig

Publications and source records attributed to D Kindig.

14 recordsLinked to original sources
PubMed2000

Collaboration and peer review in medical schools' strategic planning.

The management of medical schools has never been so difficult, but can be facilitated by using a well-developed, broadly accepted strategic plan. While the concept of strategic planning has been reasonably well accepted by both faculty and leaders at most medical schools, using the strategic plan to allocate resources has proved to be a challenge. Achieving "buy-in" by all parties involved can help meet this challenge and can be critical to the success of strategic planning and management. The authors describe the collaborative planning process that the University of Wisconsin Medical School used to develop its 1998-2000 strategic plan. This unique effort culminated in using a peer-review process--similar to that used by the National Institutes of Health (NIH)--and developing criteria to select a limited number of program priorities. This selection occurred after a school-wide process to solicit strategic program proposals had taken place. Over 130 faculty from most departments throughout the school helped develop and revise the strategic plan. There was frequent communication and engagement with faculty at all levels, which was important in gaining the faculty's acceptance and, indeed, endorsement of the process and its outcomes. Because the process was effective in achieving consensus about the school's strategic priorities, it enabled the school to reach a firmer end-point and implementation plan than had been possible with the previous strategic plan. It also identified important weaknesses in some areas of the medical school; the resulting attention to those areas will help strengthen the school. Finally, the process moved much more swiftly than the previous effort. The authors recommend that such an approach be used by other medical schools, and be carried out before a school implements mission-aligned budgeting and management of its fiscal resources.

Curriculum↗
PubMed1998

Skill mix changes: substitution or service development?

An extensive review of published studies where doctors were replaced by other health professions demonstrates considerable scope for alterations in skill mix. However, the studies reported are often dated and have design deficiencies. In health services world-wide there is a policy focus which emphasises the substitution of nurses in particular for doctors. However, this substitution may not be real and increased roles for non-physician personnel may result in service development/enhancement rather than labour substitution. Further study of skill mix changes and whether non-physician personnel are being used as substitutes or complements for doctors is required urgently.

Clinical Competence↗
PubMed1995

The substitution of physician assistants and nurse practitioners for physician residents in teaching hospitals.

This study documents features of clinical departments in teaching hospitals that are using physician assistants (PAs) and nurse practitioners (NPs) to perform some tasks previously done by medical or surgical residents. More than 60 percent of teaching hospital medical directors surveyed reported experience with substitution in their hospitals. The experience overall appears to be positive; one-third of the departments are planning to increase the number of PAs and NPs they use. The results imply that some of the services lost in house-staff reductions called for in many physician workforce reform proposals could be provided by alternative health professionals.

Data Collection↗
PubMed1995

Medical staff consolidation issues and concerns.

In the past decade there have been increases in health care consolidations. While the literature on hospital mergers is abundant, there is little on mergers of medical staffs. In this study, we interviewed senior administrators in 22 midwestern medical institutions that had consolidated between 1987 and 1990. Our study is an exploration of topics of concern that administrators have encountered during processes of medical staff consolidation. Administrators stated that the medical staff was most concerned about relationships with nursing and support staff, "turf" issues, and a sense of loss. They recommended that increased attention be paid to specific local issues and that there be active involvement and communication between medical staff and administrators at all phases of the consolidation process.

Communication↗
PubMed1992

Diphenylhydantoin is not genotoxic in a battery of short-term cytogenetic assays.

5,5-Diphenylhydantoin (DPH) is an antiepileptic drug associated with an increase in malformations in infants born to women taking DPH during pregnancy. Positive and negative results have been reported by various investigators for in vivo and in vitro chromosome aberration (CAB) assays, in vivo and in vitro sister chromatid exchange (SCE) assays, and in vivo micronucleus tests (MNT). In this laboratory, DPH was tested in an in vitro CAB assay using Chinese hamster ovary cells with and without an S-9 activation system, an in vivo SCE assay in female CD-1 mice, an in vivo MNT, using both male and female CD-1 mice, and a transplacental micronucleus test. The results from this comprehensive battery of cytogenetic tests were uniformly negative and support a conclusion that the known teratogen, DPH, is not clastogenic.

Animals↗
PubMed1989

Medical practice and satisfaction of physicians in sparsely populated rural countries of the United States: results of a 1988 survey.

The results are reported from a mail survey to a 25 percent sample of all allopathic and osteopathic physicians practicing in countries less than 10,000 population in 1988. Overall, 71 percent of respondents indicated that they were satisfied with their practice in those areas but 23 percent indicated dissatisfaction and 26 percent planned to leave those areas within five years. Factors associated with practice dissatisfaction included lower income, long hours worked, increase in patients with inadequate medical insurance and distance from a major referral center. Thirty-two percent of respondents indicated that there were too few physicians in their counties and in aggregate projected a need for 1,100 additional physicians, or approximately a 50 percent increase relative to the current supply of physicians in such counties. Seventy-four percent of those indicating a need for more physicians stated that in their opinion the community in which they were practicing could support such additions. The survey results indicate an underlying satisfaction with rural practice but suggest the need for ongoing educational and financial incentives for such practices if the delivery of health care services in rural areas is to be improved.

Career Choice↗
PubMed1975

Task analysis in National Health Service Corps field stations: a methodological evaluation.

An occupational survey using a task inventory as survey instrument was conducted at four National Health Service Corps clinics providing primary ambulatory care. The prime objective of the study was to determine whether the methodology of task analysis could validly be applied to obtain data of potential value in improving personnel management in clinics. It is concluded that the taskinventory could generate such data. A first level analysis provides some interpretations of task interrelationships and role definition among clinic staff. In the clinics studied, no staff member's role was sufficiently well defined for efficient utilization of his capabilities. In particular, many tasks performed by the physicians and nurses could also be performed by less well-trained personnel. A number of steps are suggested for examining the task profiles of clinic staff and identifying areas of potential task redistribution. Also discussed are ways of improving the presentation of data obtained through task analysis to enhance the data's usefulness to local clinic management.

Community Health Services↗
PubMedDate not supplied

Elements of the American Health Security Act of 1993.

Over the past several decades, there has been a plethora of proposals that were developed in response to the ongoing debate on how best to solve the problems of the American health care delivery system. In the past decade, calls for modification of our health system have become even more resonant, as measures to control rising costs were unsuccessful and access to basic services was diminished for many Americans. The most recent addition to the list of proposals for modifying the health care system is the American Health Security Act of 1993, introduced by President Clinton in September 1993. This article will examine the position of the Clinton Administration on health reform and the core elements of the reform package.

Competitive Medical Plans↗
PubMedDate not supplied

Challenges to Native American health care.

Native American health care programs face complex and unprecedented challenges resulting from the increased assumption of clinical operations by tribal authorities, shortfalls in Federal funding, modifications in state and Federal health and welfare programs, and intensifying involvement with managed care organizations. These challenges are further complicated by service populations that are increasing at a faster rate than the growth in funding. The authors conducted onsite surveys of 39 Native American health programs in 10 states in order to assess the organizational and management problems they faced. The trend toward transfer of health programs from the Indian Health Service to tribal operation seems likely to continue and accelerate. The survey results indicate that in order for programs to be effective in the long run, they will need to be guided by skilled managers able to adapt to these powerful changes in the health care environment.

Contract Services↗