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Biomedical subjects

M T Rabkin

Publications and source records attributed to M T Rabkin.

At least 19 recordsLinked to original sources
PubMed1998

A paradigm shift in academic medicine?

The author states that one definition of "paradigm shift" is "the process whereby a governing conceptual framework becomes destabilized and is eventually replaced, more or less wholesale, by a new conceptual consensus." He asks whether recent fundamental changes in academic medicine amount to a paradigm shift, and then briefly describes and comments on 25 changes under way in academic medicine (e.g., the growing importance of cost considerations; focus on episodic care of the acutely ill individual moving instead toward clinical and fiscal responsibility for the health of a population; relative autonomy of the physician evolving to increasing interdependence, both clinical and financial). The author maintains that the basic conceptual framework of academic medicine's core mission--patient care, teaching, and research--remains the same, and that this mission's capacity for good has greatly grown in recent decades. Over the same interval the core business of academic medicine (i.e., its financing) and how that relates to the core mission have indeed become destabilized. These also comprise a "conceptual framework" by which academic medicine has functioned, and that framework is being replaced, compellingly, by what amounts to a new conceptual consensus--in short, a paradigm shift. He urges his colleagues in academic medicine to be clear-eyed, responsive, and innovative, and never to give up as they work to forge a new and sustainable system that maintains and strengthens scholarship and service.

Academic Medical Centers↗
PubMed1997

How one teaching hospital system and one medical school are jointly affirming their academic mission.

The economic forces that are reshaping the practice of medicine and the funding of medical research will have great impact on clinical education and research in teaching hospitals and their associated medical schools. Changes in the setting of and approach to medical education will need to be made in order to continue to train physicians at the same high level as in the past and to maintain the productivity of our national biomedical research enterprise and its contributions to health. Academic leaders, such as department chiefs who have clinical service responsibilities, are finding it more and more difficult to manage simultaneously the demands of the clinical business, education, and research. In an effort to organize a teaching hospital and a medical school in a manner that would position them to maintain more effectively their common academic mission front and center with the clinical business, Harvard Medical School and the Beth Israel Hospital created a joint venture in 1996. The new nonprofit Institute for Education and Research has education and research as its top (and only) mission. It is designed to provide additional and specific academic leadership and to enable the joint venture to undertake strategic planning for the academic mission. In addition to the challenges it faces from changes in the external environment, the Institute for Education and Research will need to establish a new pattern of interactions internally within the parent institutions. Collaborations with department chairs and faculty are an essential ingredient for its success. It is hoped that this structure will prove to be a useful template for organizing other medical school-hospital collaborations on behalf of the academic mission.

Administrative Personnel↗
PubMed1995

What lies ahead for medical management?

The consensus is that, in spite of a reluctance in Washington to undertake any drastic reform of the health care financing and delivery system, the changes that are already in place in individual organizations and that are in place or being contemplated at the state level are certain to make the health care system of tomorrow very different from that of today. Physician executives can play an important role in the transition that will be required, but they will have to use a flexible, especially nondogmatic approach if they wish to cope successfully in this increasingly whirling environment. For such physicians, the author says, the opportunities, though unknown, are enormous.

Economics, Medical↗
PubMed1992

Participatory management at Boston's Beth Israel Hospital.

In the mid-1980s, the senior management of Boston's Beth Israel Hospital became concerned that continuous cost-cutting efforts could lower the quality of the hospital's services and the morale of its staff. This led them to investigate organizational approaches to "participatory management" to determine whether any of these might be of value to the hospital. They decided that an approach developed in the 1930s called the "Scanlon Plan" would be compatible with the workplace culture of Beth Israel, could help the hospital meet the ongoing problems of change, and could help the staff at all levels develop a sense that they owned the problems of quality, productivity, and efficiency, which would motivate them to address these problems constructively in the face of necessary budget constraints. This plan has two mechanisms to foster employees' positive participation: (1) a process to ensure that all members of the organization have the opportunity to improve productivity, primarily through an open suggestion system and a responsive committee structure, and (2) a means of providing equitable rewards for all members of the organization as productivity and quality improve. This essay describes in some detail the plan and why it was selected, explains how it was adapted, prepared for, and finally implemented in 1989, and reports its success, lessons learned, and future plans as of early 1992. The authors believe Beth Israel's experience with the Scanlon Plan is noteworthy as an example of a leading teaching hospital's taking a quality improvement program seriously and making it work.

Attitude of Health Personnel↗
PubMed1986

Coronary angioplasty under the prospective payment system: the need for a severity-adjusted payment scheme.

To evaluate the adequacy of Diagnosis Related Group prospective payment for percutaneous transluminal coronary angioplasty, the clinical characteristics, length of stay and hospital charges of all patients undergoing this procedure at Boston's Beth Israel Hospital during a 100 day period were examined. Of 113 such patients, the 61 patients in whom nonelective dilation was performed for unstable or postinfarction angina had a significantly greater length of stay and total hospital charge (10 +/- 6 days and $14,700 +/- $7,400, respectively) than did the 52 patients in whom elective dilation was performed (6 +/- 5 days and $8,500 +/- $7,700, respectively, p less than 0.0001). Under the current prospective payment system, however, these two groups of patients would have been placed in the same Diagnosis Related Group, and would have thus commanded equal institutional reimbursement. One potential revision of the payment system is presented to help to deal with this disparity.

Adult↗