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Biomedical subjects

Sandra J Hartman

Publications and source records attributed to Sandra J Hartman.

17 recordsLinked to original sources
PubMed2005

A description of morbidly obese state employees requesting a bariatric operation.

BACKGROUND: The federal government, the medical insurance industry, and the academic medical community have disagreed over what treatments are appropriate and cost effective for morbid obesity. This debate is hindered by inadequate data regarding the true costs of diseases and who chooses an operation as a treatment option. The purpose of this study was to obtain these costs and to describe this population. METHODS: Louisiana's managed medical insurance program created primarily for its civil service employees contracted to offer a small random group of morbidly obese employees the option of a bariatric operation. This observational study examined the subpopulation who requested consideration for the operation. We present historic cost data from all medical expenses paid by the insurance company, a telephone survey of the volunteers in the study to determine their medical problems, and diagnostic evaluation data on those employees randomized to proceed for possible bariatric operation. RESULTS: A total of 911 of 189,398 adult members of the insurance plan wanted to be considered for this study. Only 397, however, completed the informed-consent process. Of the 248 employees who met the age requirement, body mass index criteria, and health criteria to be considered for a bariatric operation and were randomized, 20 withdrew before obtaining 40 committed operative candidates. The 773 morbidly obese female members had used a mean of dollar 11,145 in medical insurance expenses in the year 2003 versus a mean of dollar 8,096 for the other 106,908 adult women. Similar values for the men were dollar 16,720 for the 138 morbidly obese men versus dollar 5,943 for the other 82,490 men. CONCLUSIONS: The morbidly obese members of this medical insurance plan who requested a bariatric operation are costing their plan 1.4 to 2.8 times the yearly amount of the other adult members in medical expenses. The yearly mean amount the insurance plan spends on these members suggests that operative treatment would pay for itself in a relatively few number of years if it could significantly reduce these costs. Even in those who consider bariatric operation, many withdraw, further limiting the costs of operative therapy.

Adult↗
PubMed2005

An expedited model for health care administration programs at the graduate level.

In this paper, we report the development of a theoretical model for health care administration programs at the graduate level. Our model development was prompted by recently-expressed concerns that the training available to managers and executives in health care fields is encountering a number of problems: it is typically lengthy and expensive, and involves too many prerequisites. In terms of content, the training available may be too narrowly focused on performing functions, such as accounting, rather than managing the functions. We begin development by conducting a content analysis of several highly-regarded programs with commonly identified features. We next describe how those features can be incorporated into a fast-track, 33 hour program without prerequisites which is consistent with accreditation guidelines. Implications for executive education and research are discussed.

Curriculum↗
PubMed2005

Key tasks in healthcare marketing: assessing importance and current level of knowledge.

When examining the healthcare industry, the need for continuing education in internal functions (i.e., HR management) has been documented. However, equally important to success in the healthcare industry are external functions such as marketing. In an expansion of research on internally focused functions, we report findings from an exploratory study designed to examine the perceptions of executives about managerial skill needs in the externally focused area of marketing. Specifically, we examine eight key tasks in marketing and ask executives to rate the level of knowledge required for each and then to assess current, or actual, levels of knowledge in the field. Findings suggest that pricing strategy, product strategy, and segmentation and targeting were the tasks that require the most knowledge for healthcare marketers, and that they do, in fact, perceive various gaps in all of the areas examined. Implications and suggestions for future research are provided.

Education, Continuing↗
PubMed2005

The impact of the pervasive information age on healthcare organizations.

New information technologies place data on integrated information systems, and provide access via pervasive computing technologies. Pervasive computing puts computing power in the hands of all employees, available wherever it is needed. Integrated systems offer seamless data and process integration over diverse information systems. In this paper we look at the impact of these technologies on healthcare organizations in the future.

Delivery of Health Care↗
PubMed2005

Sexual harassment in the workplace: guidelines for educating healthcare managers.

Actionable sexual harassment is defined as a violation of Title VII of the Civil Rights Act of 1964. In recent years, there have been a number of significant developments in sexual harassment case law and litigation including: (1) nationwide legal recognition for same-sex sexual harassment; (2) increased standards on employer liability for sexual harassment perpetrated by supervisory and managerial personnel; and (3) guidelines for mitigating damages when employers are found liable. These developments are of particular concern in those professions such as healthcare in which women historically have been represented as a significant portion of the workforce. Moreover, because management and supervisory relationships in healthcare are often cloudy, harassment by "supervisors" in healthcare settings can be an issue of special concern. In this article, we review relevant issues related to sexual harassment and provide guidance in dealing with the issue in the workplace.

Delivery of Health Care↗
PubMed2003

A prescription for the rogue doctor: part I--begin with diagnosis.

Among the most serious problems a doctor can have may be those which are the result of a defect of character or a flaw in ethics. Under these circumstances, unacceptable behavior patterns may arise. Examples of unacceptable patterns of behavior include dishonesty, intentionally harming a patient, sexual harassment, and substance abuse. For years, doctors who have these patterns have been handled with kid gloves by those who educate, train, and supervise professionals in the healthcare industry. Counseling, coaching, training, supervising, transfers to less critical disciplines, disciplinary warnings, and offering opportunities to resign have been the typical protocols. Traditionally, outright firing of residents and doctors has been relatively taboo and too radical for the medical profession. Why has this been the case? Reasons may include unwillingness to get involved or to deal with the stress of disciplining a colleague, an unwillingness which often is grounded in fears of retaliation. In a litigious society, fears of slander lawsuits, for example, may be all-too-real. However, the implied paternalism and the practice of protecting doctors' careers by preserving their professional status as practicing doctors have become increasingly problematic. Aside from the fact that it is unethical, allowing problem doctors to continue to practice medicine may have an adverse impact on the well-being of patients and therefore may represent an enormous legal liability for organizations that employ them. In this first of a two-part series, problems that now exist and implementation of a performance management system as a starting point for removing rogues from the system are discussed. A subsequent paper will detail how such a system operates.

Ethics, Medical↗
PubMed2003

A prescription for the rogue doctor: part II ready, aim, fire.

As discussed in Part I of this series, rogue doctors have serious sociopathic behavioral deficiencies which may be the result of a defect of character or a flaw in ethics. Under these circumstances, unacceptable behavior patterns will arise. For years, counseling, coaching, training, supervising, transfers to less critical disciplines, disciplinary warnings, and offering opportunities to resign have been the typical approaches in dealing with rogues; the outright firing of residents and doctors has been relatively taboo. However, preserving a rogue's professional status as a practicing doctor has become increasingly problematic. In Part II of this two-part series, implementation of a performance management system to remove rogues from the system is discussed. This paper will detail exactly how such a system can work.

Documentation↗
PubMed2002

The educational needs of healthcare managers and executives in the key strategic areas of healthcare.

Management approaches used by many healthcare organizations lag behind those of similar competitive industries. The authors of this article report findings from an exploratory study of executives' perceptions of training needs in managerial strategy. The authors asked executives to rate the level of knowledge required for each of five key areas in strategic management and then to assess actual levels of knowledge in the field. They found that (a) strategic management is vital in this competitive industry, (b) there is a disconnect between what healthcare managers should know and what they actually know about the tasks of strategic management, and (c) more resources need to be devoted to strategic management training and the development of managers at all levels of healthcare organizations.

Attitude of Health Personnel↗
PubMed2002

Organizational culture: its impact on employee relations and discipline in health care organizations.

Organizations need to examine their cultures at the level of the "shop floor"--in health care, the point where health care workers deal with patients--to determine if the culture is consistent with management policies and will permit an effective program of reward and discipline. This article describes a case where organizational culture was a major imperative in the outcome of an arbitration case. Discussed is a shop-floor situation in manufacturing holding implications for health care, a setting in which management, by countenancing counterproductive aspects of the culture, made it impossible to apply discipline as needed. The conclusion is that health care organizations that neglect the detrimental elements of their culture may find themselves not only at risk of poor employee relations, but also unable to apply discipline effectively.

Aggression↗
PubMed2002

Executive development in healthcare during times of turbulence: top management perceptions and recommendations.

In this research we report an analysis of comments from managers and executives in healthcare organizations to provide insights into the strategic management needs of healthcare organizations. The comments were obtained as part of a survey that asked upper-level managers and executives to identify strategic management skill and knowledge needs in healthcare organizations. After completing the survey, the respondents were given the opportunity to comment on any topics of concern to them. A total of 67 comments, many of them extensive and insightful, were obtained. In this paper, we review the literature dealing with educational and developmental needs of healthcare managers. Much of this literature is academic in nature and permits an interesting comparison to the perspective of management and executive practitioners. Emerging from the literature was a concern for environmental turbulence and a recognition that healthcare managers are at risk of falling behind in terms of skill development under such conditions. Respondent comments suggested a recognition of the potential problems. The comments are classified into four major categories: needs and skills in turbulent conditions; program and educational needs; issue clarification; and additional comments. Moreover, the first two categories appeared to break out into a set of six additional themes, which we suggest will be important to those designing programs for executive development in healthcare during turbulent times. While the source of this research is healthcare settings in Canada and the USA, the findings should be applicable to international healthcare organizations that use strategic management concepts and practices.

Attitude of Health Personnel↗
PubMedDate not supplied

A case study of organizational decline: lessons for health care organizations.

This case study reports on an organizational decline situation involving a historically well-known and respected professional organization outside the health care field, with the intention of pointing to several implications for health care. We begin by discussing the results of a survey that involved both members of the organization and "outsiders." Our primary finding, both in the survey and in presenting the results to the membership, was that while those outside the organization perceived the organization as increasingly irrelevant and in decline, those inside it reacted with defensiveness to "meddling by outsiders." We then reviewed the literature on decline, with emphasis upon important findings by Guy, to further understand our results and to make recommendations. We then turn to the situation in health care organizations and point out why some organizations may be at risk and conclude with a series of recommendations with emphasis on health care.

Data Collection↗
PubMedDate not supplied

Responding to threats of workplace violence: the effects of culture and moral panic.

Healthcare organizations, like all organizations, are increasingly more concerned about workplace violence. This paper discusses the collision of a cultural context that encourages macho posturing and moral panic related to highly publicized violence in schools and workplaces. At issue is the need for healthcare organizations to react to evidence of potential workplace violence but not to overreact.

Adult↗
PubMedDate not supplied

Nurse attrition as a process.

Problems with attracting and retaining nurses during a tight labor market are exacerbated by the fundamental issues related to attrition from the field. Many individuals leave the field prior to graduation or between graduation and placement. Significant attrition occurs during the first 5 years in the profession. One out of every 3 hospital nurses under the age of 30 is planning to leave the current job in the next year [Nursing Shortage Fact Sheet (March 2002). American College of Nursing. Available at: www.aacn.nche.edu/media/backgrounders/shortagefacts.htmaacn.nche.edu. Accessed January 3, 2003]. In this situation, it is of concern that we have been unable to identify any research which takes a holistic approach to issues of attrition. Instead, research is fragmentary, anecdotal, and treats problems in isolation. In this article, we take a conceptual approach and attempt to consider what is being said in the literature about the forms which nurse attrition takes at varying stages in the nursing career. Specifically, we begin a step-by-step examination of the process through which the individual first considers nursing as a career, to the application and acceptance processes, through the educational process and the nursing curriculum in general, to graduation and initial placement, and finally, to the fifth year when the nurse is fully engaged as a practicing nurse. At each stage, we discuss potential issues which may lead to attrition and develop hypotheses to guide further research.

Career Mobility↗
PubMedDate not supplied

Attrition in nursing: perspectives from the national survey of college graduates.

Problems with attracting and retaining nurses during a tight labor market are compounded by some fundamental issues related to attrition from the field. It is important to recognize that, of the students who graduate from nursing schools each year and enter the field of nursing, significant attrition occurs during the first 5 years in the profession [www.aacn.nche.edu/media/backgrounders/shortagefacts.htmaacn.nche.edu (2002)]. This article uses data from the National Science Foundation's National Survey of College Graduates to examine various scenarios and possible reasons for why some nurses abandon their careers [www.nsf.gov/sbe/srs/snscg/start.htm (2003)]. In doing so, we consider entry into, and attrition from, the nursing profession at various stages. Using data from the National Survey of College Graduates, the initial evaluation suggests that, at points during the career, the individual confronts potential problems and issues which can lead to career attrition.

Data Collection↗
PubMedDate not supplied

Satisfaction for health care employees: a quest for the Holy Grail?

This article proposes that, across industries, too much has been made of the importance of job satisfaction and its impact on organizational effectiveness. In addition, so much attention has been directed toward satisfaction that many health care employees, particularly nurses, now expect job satisfaction from their employers as an entitlement. In nursing, feelings about job satisfaction may, in fact, be exacerbated by the idealism which leads the young person entering the field to expect to be in a "helping profession" where workers almost automatically encounter the satisfaction that comes from giving the help which the patient desperately needs. Faced with the realities of long hours, grueling and often menial tasks, and sometimes churlish patients and physicians, the young nurse may, in fact, enter a period of deep dissatisfaction and of questioning nursing as a career choice. This situation is not unique to nurses. Many health care professionals face equally dissatisfying aspects of their jobs. Our focus is primarily on reducing job dissatisfaction, rather than improving job satisfaction, through practical solutions for those charged with attracting and retaining health care employees during tight labor markets.

Attitude of Health Personnel↗
PubMedDate not supplied

Legal and regulatory education and training needs in the healthcare industry.

As in any other industry, laws and regulations significantly impact the functioning of the healthcare industry. Some laws, such as those relating to malpractice and social insurance systems, affect the manner in which the industry operates. Other laws, such as those regulating antitrust and employment practices, affect the organization and the environment in which the industry operates. It is increasingly important that practitioners and managers be cognizant of this complex and dynamic legal minefield. This study examined healthcare managers and executives' knowledge of 9 key issues in the legal and regulatory environment of the healthcare industry. Specifically, the study focused on knowledge concerning tort and contract liability, insurance law, labor and employment regulation, criminal and ethical responsibility, antitrust regulation, the law governing business associations and recent developments. Findings suggest that the levels of knowledge required to manage legal and regulatory issues are much greater than the existing levels of knowledge.

Antitrust Laws↗