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Biomedical subjects

J Barnsley

Publications and source records attributed to J Barnsley.

18 recordsLinked to original sources
PubMed1999

Physician characteristics and the physician-patient relationship. Impact of sex, year of graduation, and specialty.

OBJECTIVE: To examine the association of physician sex, medical specialty, and year of graduation from medical school with attitudes and behaviours that define physician-patient relationships. Hypotheses tested are that women physicians, family physicians, and recent graduates spend more time discussing lifestyle and general health issues during patients' first visits; are more likely to report behaviours that are empathetic and that encourage communication with patients; are less likely to view their role as directive and problem-oriented; and are more supportive of patients' rights to information and participation in decision making. DESIGN: A survey was mailed to a stratified random sample of physicians between February and June 1996. SETTING: Physician practices in Ontario. PARTICIPANTS: Of 714 practising Ontario physicians, 405 (57%) responded. MAIN OUTCOME MEASURES: Proportion of time and actual time spent discussing a patient's lifestyle during a first visit, communication style, attitudes regarding a directive approach to care, and attitudes regarding patients' rights. RESULTS: Women physicians and family physicians spent significantly more time discussing lifestyle during a first visit. Women, family physicians, and recent graduates were significantly more likely to report an empathetic communication style. Women and recent graduates were significantly less likely to have a directive, problem-oriented approach to care. Family physicians were significantly less supportive of patients' rights than medical and surgical specialists were. CONCLUSIONS: Physicians in this study reported empathetic communication styles and attitudes that support information sharing and patients' rights.

Adult↗
PubMed1999

The effects of fee bundling on dental utilization.

OBJECTIVE: To examine dental utilization following an adjustment to the provincial fee schedule in which preventive maintenance (recall) services were bundled at lower fees. DATA SOURCES/STUDY SETTING: Blue Cross dental insurance claims for claimants associated with four major Ontario employers using a common insurance plan over the period 1987-1990. STUDY DESIGN: This before-and-after design analyzes the dental claims experience over a four-year period for 4,455 individuals 18 years of age and older one year prior to the bundling of services, one year concurrent with the change, and two years after the introduction of bundling. The dependent variable is the annual adjusted payment per user. DATA COLLECTION/EXTRACTION METHODS: The analysis was based on all claims submitted by adult users for services received at recall visits and who reported at least one visit of this type between 1987 and 1990. In these data, 26,177 services were provided by 1,214 dentists and represent 41 percent of all adult service claims submitted over the four years of observation. PRINCIPAL FINDINGS: Real per capita payment for adult recall services decreased by 0.3 percent in the year bundling was implemented (1988), but by the end of the study period such payments had increased 4.8 percent relative to pre-bundling levels. Multiple regression analysis assessed the role of patient and provider variables in the upward trend of per capita payments. The following variables were significant in explaining 37 percent of the variation in utilization over the period of observation: subscriber employment location; ever having received periodontal scaling or ever having received restorative services; regular user; dentist's school of graduation; and interactions involving year, service type, and regular user status. CONCLUSIONS: The volume and intensity of services received by adult patients increased when fee constraints were imposed on dentists. Future efforts to contain dental expenditures through fee schedule design will need to take this into consideration. Issues for future dental services research include provider billing practices, utilization among frequent attenders, and outcomes evaluation particularly with regard to periodontal care and replacement of restorations.

Adolescent↗
PubMed1999

Women and men managers in pharmacy: gender issues.

This paper examines the backgrounds, behaviours, and attitudes of a representative sample of male and female pharmacy managers in Ontario, Canada. It shows that the female managers are younger than their male colleagues, and spend significantly more time on childcare activities. There were no differences between the male and female managers in terms of work commitment and job responsibilities, but the female managers spent more time in direct patient contact, an activity that the qualitative analysis indicated was important to them. Female managers were also more supportive of strategies that would encourage additional patient counseling. For faculty in health administration programs, the results suggest that the importance that females place on the psycho-social aspects of their jobs as managers needs to be recognized and supported in the development and delivery of courses of study.

Administrative Personnel↗
PubMed1998

Integrating learning into integrated delivery systems.

Integrated delivery systems that promote learning and flexibility will be better prepared to face the challenges imposed by a complex and competitive environment. The integration of learning into these systems requires a shared vision, facilitative leadership, and highly functioning communication channels within an organic structure. Strategies that promote positive attitudes toward change are necessary for learning as is the provision of resources, training, incentives, and rewards that support learning, and feedback on how new administrative and clinical practices advance the mission and goals of the system.

Communication↗
PubMed1998

A review of organizational performance assessment in health care.

As health care organizations look for ways to ensure cost-effective, high quality service delivery while still meeting patient needs, organizational performance assessment (OPA) is useful in focusing improvement efforts. In addition, organizational performance assessment is essential for ongoing management decision-making, operational effectiveness and strategy formulation. In this paper, the roles and impact of OPA models in use in health care are reviewed, and areas of potential abuse, such as myopia, tunnel vision and gaming, are identified. The review shows that most existing OPA models were developed primarily as sources of information for purchasers or consumers, or to enable providers to identify areas for improvement. However, there was little conclusive evidence evaluating their impact. This review of existing OPA models enabled the establishment of principles for the development, implementation and prevention of abuse of OPA specific to health care. The OPA models currently in use in health care may provide managers with false confidence in their ability to monitor organizational performance. To further enhance the field of OPA, areas for future research are identified.

Canada↗
PubMed1998

A conceptual framework for the analysis of health care organizations' performance.

Organizational performance remains an elusive concept despite its importance to health care organizations' (HCOs') management and analysis. This paper uses Parsons' social system action theory to develop a comprehensive theoretically grounded framework by which to overcome the current fragmented approach to HCO performance management. The Parsonian perspective focuses on four fundamental functions that an HCO needs to ensure its survival. Organizational performance is determined by the dynamic equilibrium resulting from the continual interaction of, and interchange among, these four functions. The alignment interchanges allow the creation of bridges between traditional models of organizational performance that are usually used as independent and competing models. The attraction of the Parsonian model lies in its capacity to: (1) embody the various dominant models of organizational performance; (2) present a strong integrative framework in which the complementarity of various HCO performance perspectives are well integrated while their specificity is still well preserved; and (3) enrich the performance concept by making visible several dimensions of HCO performance that are usually neglected. A secondary objective of this paper is to lay the foundation for an integrative process of arbitration among competing indicators and perspectives which is absolutely necessary to make operational the Parsonian model of HCO performance. In this matter, we make reference to the theory of communicative action elaborated by Habermas. It offers, we think, a challenging and refreshing perspective on how to manage HCO performance evaluation processes.

Canada↗
PubMed1997

Innovation theory and its applicability to our understanding of the diffusion of new management practices in health care organizations.

There has been a longstanding interest in understanding how new management practices and organizational structures are diffused through the health care system. This article reviews current literature on innovation and diffusion to provide insight into how new management practices and organizational structures are introduced into the system. Understanding the process may help in accommodating new developments and provide managerial opportunities to take a more active role in encouraging or discouraging their further evolution.

Canada↗
PubMed1996

Selecting clinical outcome indicators for monitoring quality of care.

Clinical outcome indicators are used to identify opportunities for improvement in patient care processes. This paper focuses on issues specific to the selection of clinical outcome indicators for use in assessing performance within and between hospitals. The issues and examples are based on the experiences of a university research team that worked in collaboration with a group of teaching hospitals to develop and monitor clinical outcome indicators. Four sets of issues are discussed: the intended use, and end users of indicator information; aspects of indicator validity; data quality; and dissemination and use of indicator information. Recommendations are made that apply to individual hospitals, groups of hospitals and health care systems.

Abstracting and Indexing↗
PubMed1994

Physicians in health care management: 9. Strategic alliances and relationships between organizations.

Health care organizations must increasingly develop strategic alliances with other groups and organizations. A variety of interorganizational relationships are possible: shared services, joint programs, umbrella organizations, health agency networks and mergers. As governments try to control health care costs, physicians will play an important role in developing and implementing these alliances. They will be expected to advocate on behalf of patients and communities to ensure that these new organizational arrangements facilitate coordinated care.

Canada↗
PubMed1994

Careers in health care management, Part 1: Attainment, expectations and aspirations.

The authors conducted a questionnaire survey of health care managers in Canada to learn more about their careers, work experiences and attitudes; and to determine whether their careers differed by such factors as sector of employment, gender, years of experience, education and family status. Major findings include: in teaching and community hospitals, men are more likely to fill chief executive officer (CEO) positions and women tend to be in middle management positions. More men than women in CEO positions reported incomes in the top range ($105,000). Men in CEO and senior management positions are more likely to be married and have children under 16 years of age living at home. Slightly more women than men were clinicians before becoming managers. Most respondents aspired to CEO or senior management positions. Implications for human resources practices are discussed.

Canada↗
PubMed1989

Characteristics of established group practices in Ontario.

Established group practices in Ontario were surveyed to determine their structure, characteristics and attitudes toward government assistance in the development of group practice. The degree of organization of the groups surveyed was related to size and less than that reported in surveys of United States group practices. Group size and years of operation were strongly associated. Night, weekend and vacation coverage, the use of a unit patient record and the employment of non-physician administrators were reported frequently, and were more common in older and larger groups. As well, fringe benefits, except for professional organization dues, were not commonly provided.

Attitude of Health Personnel↗
PubMedDate not supplied

Continuous quality improvement in Canadian health care organizations.

A survey of Canadian health care organizations indicates growing interest in the philosophy and methods of continuous quality improvement (CQI). Most organizations are still in the early stages of learning and applying CQI. Although CEOs have been learning about CQI and have been participating in quality councils, they are less involved in using and teaching CQI techniques. Major obstacles reported in developing quality improvement are lack of time, limited resources, lack of training, and pressures to deal with other changes. Only a few organizations question the value of developing quality improvement, and many who have not yet adopted CQI say they intend to do so.

Canada↗
PubMedDate not supplied

Board evaluation and effectiveness: models, components and perspectives.

Health facility boards are being challenged to increase their effectiveness in the face of the changing health care environment. To this end, accreditation standards require boards to develop methods of evaluating their governing function and performance. During a survey of governance issues, the authors interviewed a group of health service executives with respect to board evaluation at their facilities. The responses yielded insights relating to models and components of evaluation, board missions and policies, mentoring programs and trustee education and orientation.

Attitude of Health Personnel↗