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PubMed1994

Models for medical practice integration.

Decreased physician income, increased administrative burdens, and interference with the compassionate delivery of high-quality medical care are threatening the independent practice of medicine in solo and small group practices. Many established physicians, and the hospitals with which they relate, are searching for organizational models that, by integrating some or all aspects of their practices, will preserve incomes and reduce regulatory and administrative burdens. This article will describe several "practice integration models," pointing out advantages and disadvantages to physicians in established practices. (Many of the same arguments could be made for physicians new to practice, with different emphasis). The continuum of integration models is shown in figure 1, page 19. The group practice without walls and its two submodels, the independent group practice without walls (IGWW) and the affiliated medical practice corporation (AMPC) are more recent and more effective models and will be covered in depth in the article.

Cost-Benefit Analysis↗
PubMed1994

Reengineering the organization: an approach for discontinuous change.

Improvement will be constrained by the function-based organizational model found in most health care organizations. Most components of the typical organization are driven by the concept of division of labor. The organization needs to challenge the underlying assumptions and reengineer from top to bottom. Reengineering, a disciplined approach to breakthrough change, is complementary to continuous improvement but has several major differences. This article explores the need for reengineering, the essential components of reengineering, how it relates to other approaches to change, ideas on when reengineering is necessary, and the challenges related to reengineering an organization.

Efficiency, Organizational↗
PubMedDate not supplied

Service models in community-based health: some findings from a literature review.

The findings from a review of the literature on community-based health services in Canada in 1991 indicate that two systems of health care exist side by side: the clinical care of the sick and the supportive care of those seeking to keep well. Organizational models of clinical care have not altered much since the introduction of health insurance. The medical profession has been resistant to changing traditional forms of practice organization from fee-for-service businesses treating individuals in isolation to components of an integrated comprehensive health care system. Traditional public health departments offering supportive and preventive care have been more ready to adapt to change. They are now working closely with provincial continuing-care organizers to provide home care for those who might otherwise need institutional care; however they are not closely linked with the clinical care services. More recently, public health departments have engaged in the health promotion movement to give citizens increased control over the conditions affecting their health. Yet we perceived a conflict between the rhetoric and the reality of their work.

Canada↗
PubMed1995

Reengineering medical treatment facilities for TRICARE: the Medical Group Practice Model.

The purpose of this article is to propose a model for reengineering military community hospitals, as well as medical centers, to adapt to the extraordinarily rapid and complex changes that are being made to the Military Health Services System. This article analyzes the changes taking place and discusses how a particular organizational model, the Medical Group Practice Model, can enhance quality and patient satisfaction in a capitated managed care environment. The phased implementation, structure, and performance management of the model are described, as is the model's advantages and disadvantages.

Group Practice↗
PubMedDate not supplied

Assessing the extent of integration achieved through physician-hospital arrangements.

In this article we examine management service organizations (MSOs), physician-hospital organizations (PHOs), hospital-affiliated independent practice associations (IPAs), and hospital-sponsored "group practices without walls" (GPWWs) that allow physicians to retain their practices and link hospitals and health systems to physicians through contractual arrangements. Also examined were medical foundations (MFs), integrated salary models (ISMs), and integrated health organizations (IHOs) that own the physical assets of physician practices and contract with payors for physician and hospital services. The research provides several new insights for understanding the structure and process of physician-hospital integration. It was found that the extent of processual integration in physician-hospital organizational arrangements can be measured along six dimensions: administrative and practice management services; physician financial risk-sharing; joint ventures to create new services; computer linkages; physician involvement in strategic planning; and salaried physician arrangements. These dimensions are consistent with the conceptual and empirical dimensions developed by others. These findings refute the notion raised by some industry observers that the new physician-hospital organizational models simply formalize integrative activities already in place. Earlier studies from the 1980s reported that hospitals integrated physicians through involvement in governance, capital planning, and the provision of practice management services. In contrast, we found that current integration.

American Hospital Association↗
PubMed2003

Cancer survivorship and agency model: implications for patient choice, decision making, and influence.

Relative to other types of health communication research (acute care physician patient communication, communication campaigns, compliance episodes, etc.), investigations of patient communication following the diagnosis of cancer are infrequent. Theoretically driven, empirical research is desperately needed in such postdiagnostic communication processes as survivorship, quality of life, palliative and hospice care, and loss, bereavement, and grief for those millions of people who have been diagnosed with the second leading cause of death in our nation. An organizational model of patient communication is needed that identifies and describes salient issues and processes involved when cancer patients attempt to negotiate the difficult courses of action following the diagnosis of cancer. The cancer survivorship and agency model (CSAM) proposes both general and specific strategies that serve as options for patients seeking to take greater control of the decision-making process related to their treatment and care of cancer. Although seemingly practical in its offering, CSAM is intended to serve as a heuristic springboard for theoretically based, applied communication research focusing exclusively on post diagnostic cancer processes.

Communication↗
PubMed2004

From bedside to boardroom - nursing shared governance.

A brand-new nursing shortage is revitalizing shared governance. This innovative organizational model gives staff nurses control over their practice and can extend their influence into administrative areas previously controlled only by managers. But nursing shared governance is hard to define. Its structures and processes are different in every organization; and its implementation is like pinning Jell-O to a wall. Is it appropriate for every situation? Is it worth the price? And can it really measure up to its glowing reputation? This article presents an overview of nursing shared governance, looking at themes and experiences from its rich 25-year tradition. The author identifies its essential elements, provides guidance for professionals who wish to embark on the journey, and describes the current status of shared governance as of 2004.

Cost-Benefit Analysis↗
PubMed1992

Hospital-physician integration: case studies of community hospitals.

Hospitals are attempting more meaningfully to involve physicians in management as one approach to increasing the efficiency and effectiveness of their operations. The purpose of this research was to explore the relationship between the structure of the medical staff organization, the extent to which physicians are integrated into hospital decision making and the hospital's financial performance. A measure of hospital-physician integration was developed based on Alexander et al's (1986) dimensions of hospital-physician integration which were based on Scott's (1982) organizational models, ie, autonomous, heteronomous and conjoint. A multiple case study design, which comprised eight community non-teaching hospitals over 200 beds located in the Province of Ontario, Canada, was used to examine the relationship between variables. Study results suggest that there is variation among community hospitals on both contextual and organization factors. Hospitals with high levels of hospital-physician integration were located in highly populated areas, had formulated and implemented a strategic plan, had highly structured medical staff organizations, and had no budgetary deficit. In contrast, hospitals with moderate or low levels of integration were more likely to be located in lowly populated areas, had little planning activity, had a moderately structured medical staff organization, and had deficit budgeting. Suggested areas for future research include examining the role of the Board of Trustees in determining physicians' organizational roles and identifying differences in commitments, characteristics, and motivations of physicians working in rural versus urban hospitals and their impact on integrative strategies.

Attitude of Health Personnel↗
PubMed2004

The Appalachia Cancer Network: cancer control research among a rural, medically underserved population.

Residents of Appalachia, especially those in rural Appalachia, are generally considered to be medically underserved. In fact, cancer mortality in Appalachia, especially in rural Appalachia, is higher than it is in the remainder of the United States. Developing from the Appalachia Leadership Initiative on Cancer, the Appalachia Cancer Network (ACN) is a network of academic and community organizations that seek to conduct surveillance, intervention, and dissemination research to reduce this excess cancer burden in Appalachia. The purpose of this report is to (1) describe the approach to cancer control research in ACN, a Special Population Network, among the medically underserved of Appalachia, and (2) to put forward observations from this experience to enhance the research of other academic and community networks among underserved populations. ACN has instituted a conceptual model, organizational structure, and other methods to foster this research and to develop junior and community-based investigators. Important issues and questions related to the effectiveness of such research networks have also been articulated.

Appalachian Region↗
PubMed1979

A proposed network to improve access to high-quality health care for Medicaid-eligible families.

There is today both a need and an opportunity to develop and test a variety of models--organizational and financial--for improving the delivery of health care services. This article describes the structure and functioning of one such model and highlights the organizational problems expected to arise during its implementation. The proposed health plan is intended to facilitate the access of Medicaid-eligible, inner-city families to already available health services. The central hypothesis is that in low-income urban areas the elementary schools offer an organizational focus for the development of a health plan. As a prepaid, community-based model, this plan is designed to address the issues of accessibility, equity, accountability, continuity of care, and consumer participation, primarily through the development of a coordinating agency, the health plan office (HPO), which assures the linking of consumers and providers of health care. Adapted from the Kaiser-Permanente model, the HPO also assumes responsibility for marketing, enrollment, coordination of services, consumer advocacy, and quality surveillance.

Child↗
PubMed1997

Measuring competencies of temporary staff.

Strategic staffing requires an understanding of a new model, what Charles Handy has named the "Shamrock Organizational Model," in which you have three equally valuable groups of staff a minimal core of full-time staff; a short-term contingency workforce; and a supplemental workforce for long-range temporary staffing needs. Ensuring the competency of all three is a nontransferable, although shared, responsibility of both the hospital and the supplemental staffing company.

Clinical Competence↗
PubMedDate not supplied

A rehabilitation programmatic model: the clinical nurse specialist perspective.

Some facilities are adopting a new organizational model to deliver rehabilitation services: the programmatic model. The premise of this model is the delivery of completely integrated services. The programmatic model differs from the traditional service model in many aspects, including philosophy, governance, clinical practice standards, and identification of patient care goals. There are five phases involved in moving from a pure service model to a programmatic model: commitment, enmeshment, product orientation, integration, and maintenance and growth. This article describes the clinical nurse specialist role and experiences in implementing a programmatic model in a rehabilitation hospital.

Humans↗
PubMed1998

Planning and conducting a multi-institutional project on fatigue.

PURPOSE/OBJECTIVES: To describe the process used in proposal development and study implementation for a complex multisite project on cancer treatment-related fatigue (CRF), identify strategies used to manage the project, and provide recommendations for teams planning multisite research. DATA SOURCES: Information derived from project team meeting records, correspondence, proposals, and personal recollection. DATA SYNTHESIS: The project was built on preexisting relationships among the three site investigators who then built a team including faculty, research coordinators, staff nurses, and students. Study sites had a range of organizational models, and the proposal was designed to capitalize on the organizational and resource strengths of each setting. Three team members drawn from outside oncology nursing provided expertise in measurement and experience with fatigue in other populations. Planning meetings were critical to the success of the project. Conference calls, fax technology, and electronic mail were used for communication. Flexibility was important in managing crises and shifting responsibility for specific components of the work. The team documented and evaluated the process used for multisite research, completed a major instrumentation study, and developed a cognitive-behavioral intervention for CRF. CONCLUSIONS: Accomplishments during the one-year planning grant exceeded initial expectations. The process of conducting multisite research is complex, especially when the starting point is a planning grant with specific research protocols to be developed and implemented over one year. Explicit planning for decision-making processes to be used throughout the project, acknowledging the differences among the study settings and planning the protocols to capitalize upon those differences, and recruiting a strong research team that included a member with planning grant and team-building expertise were essential elements for success. IMPLICATIONS FOR NURSING PRACTICE: Specific recommendations for others planning multisite research are related to team-building, team membership, communication, behavioral norms, role flexibility, resources, feedback, problem management, and shared recognition.

Communication↗
PubMedDate not supplied

The power of virtual integration: an interview with Dell Computer's Michael Dell. Interview by Joan Magretta.

Michael Dell started his computer company in 1984 with a simple business insight. He could bypass the dealer channel through which personal computers were then being sold and sell directly to customers, building products to order. Dell's direct model eliminated the dealer's markup and the risks associated with carrying large inventories of finished goods. In this interview, Michael Dell provides a detailed description of how his company is pushing that business model one step further, toward what he calls virtual integration. Dell is using technology and information to blur the traditional boundaries in the value chain between suppliers, manufacturers, and customers. The individual pieces of Dell's strategy--customer focus, supplier partnerships, mass customization, just-in-time manufacturing--may be all be familiar. But Michael Dell's business insight into how to combine them is highly innovative. Direct relationships with customers create valuable information, which in turn allows the company to coordinate its entire value chain back through manufacturing to product design. Dell describes how his company has come to achieve this tight coordination without the "drag effect" of ownership. Dell reaps the advantages of being vertically integrated without incurring the costs, all the while achieving the focus, agility, and speed of a virtual organization. As envisioned by Michael Dell, virtual integration may well become a new organizational model for the information age.

Community Participation↗
PubMedDate not supplied

Flattening the hierarchy. A hospital streamlines managerial layers to meet market demands.

In the early 1990s it became clear to the leaders of St. Edward Mercy Medical Center, Fort Smith, AR, that the traditional ¿functional¿ model of organization, on which their hospital was based, did not allow it to meet new market demands. A core group of managers was formed to design a new organizational model and engineer the move toward it. Analyzing the hospital's structure, the core group found that it had too many administrative layers above too many specialized departments. In 1994 the group decided to adopt a span-of-control model of organization, which would give St. Edward a higher ratio of workers per manager. In 1995 the core group streamlined the hospital's managerial layers, deciding there would be no more than five. It reduced the number of supervisory positions by 36, including one vice president's slot. No manager was fired, though some were reassigned. St. Edward's reorganization continues at present. The new structure, which has cut personnel costs, fosters more open communication and empowers its workers, leading them to think in terms of ¿us and our hospital¿ rather than ¿me and my department.¿

Arkansas↗
PubMed1984

How to make an affiliate model work--a case history.

The North Shore Community Mental Health Center has an unusual mental health delivery system. "Out-stationed" staff work in affiliated agencies, yet are employees of the NSCMHC. This service configuration is the result of an arduous planning process which weighed the advantages of several organizational models. On one extreme was a "Centralized" model, wherein one organization was solely responsible for delivering mental health services. On the other extreme was an "Umbrella" model, wherein the organization acted as a fiscal conduit to several service providers. Somewhere in the middle a compromise was found with a "Lead Agency" model. Here, an organization provides the administrative structure, provides some services, and subcontracts the remaining services. The North Shore Community Mental Health Center adapted this system one step further. Rather than subcontracting services, it outstationed CMHC staff to affiliate agencies. United Cerebral Palsy Association of the North Shore is one of the CMHC's affiliates. The service need for family and play therapists resulted in two CMHC therapists being outstationed at UCP. The affiliation agreement between the two organizations specify the responsibilities and roles each have. The hiring process between the two organizations is an example of the duality of the system. Both agencies had interviewing roles, yet the final hiring decision was the affiliate's, since the employee would spend the majority of his/her time outstationed at the affiliate side. Outstationed staff integration to the North Shore Community Mental Health Center presented problems, however. Since these were new staff hired with federal funds, and since their visibility at the Center was minimal, they had some difficulty being identified as Center staff by existing employees.(ABSTRACT TRUNCATED AT 250 WORDS)

Community Mental Health Services↗
PubMed1999

Organizational factors, nurses' job satisfaction, and patient satisfaction with nursing care.

For this research study, the authors explored differences and relationships among the job satisfaction of registered nurses, patient satisfaction with nursing care, nursing care delivery models, organizational structure, and organizational culture. There were no differences in nurses job satisfaction or patient satisfaction with nursing care in different organizational structures or where different nursing care delivery models were used. A supportive environment was most important to the job satisfaction of nurses.

Adult↗