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Rural palliative care volunteer education and support program.

The present paper looks at the challenges of palliative care delivery in rural and remote areas and proposes the establishment, education and coordination of a network of palliative care volunteers to assist in the delivery of non-clinical services. The development of a rural palliative care volunteer education and support training package is documented, together with details of the trailing of the package and its evaluation. Possible benefits of the program and some key issues to be considered when establishing a volunteer network are raised.

Attitude of Health Personnel

The provision of general surgical services in rural South Australia: a new model for rural surgery.

BACKGROUND: Rural South Australia (SA), like other rural areas in Australia, faces a crisis in the medical workforce. It is also generally assumed that the same applies to rural surgical services but finding evidence to support this is scarce. METHODS: All hospitals situated outside the outer metropolitan area of SA were surveyed about surgical services (n = 57). Questions were asked about the frequency of emergency and elective theatre usage and which surgeons provided surgical services. RESULTS: Operating theatre facilities were in active use in 39 of the 57 hospitals studied. At the time of the study there were seven specialist general surgeons resident in rural SA. General practitioners continued to have a major input in the provision of surgical services, either by providing the general anaesthetic (34/39) or by performing the surgical procedures (26/39). CONCLUSIONS: The Department of Surgery at the University of Adelaide is instituting various measures to counter the rural surgical workforce problem and is developing a model that serves either the individual or the two-person surgical practice. Metropolitan teaching hospitals can play an important role in supporting current rural surgeons and can foster an increased commitment to the future of rural general surgery.

Humans

Positions and training of the indigenous health workforce.

A survey of community-controlled and state health services was conducted in 1995 as part of a needs assessment for a tertiary training initiative in applied epidemiology. Information for 792 Indigenous people in health-related occupations was obtained. Mean time in the current position was 4.8 years, 75% were in designated Aboriginal positions and 44% were health workers. Of the total, 49% had a diploma or certificate, but only 3% had a bachelors degree. The latter compares with 75% of the public health workforce generally which has a bachelors degree or higher. The high proportions of health worker and designated Aboriginal positions, short tenure and low level of degree training suggest that there are a range of employment and training issues which need to be addressed if an appropriate level of Indigenous workforce participation is to be achieved and Indigenous health professionals are to have access to the same vertical and lateral employment mobility as non-Indigenous workers. In particular, there is a huge need to enhance Indigenous participation in health workforce training, and to develop strategies for certification and recognition of the wide range of non-course-based training being undertaken.

Adolescent

Implications of the Health Security Act for mental health services for children and adolescents.

Lack of adequate insurance coverage is one reason that the percentage of children who currently utilize mental health services is significantly lower than the estimated percentage of children with serious mental disorders. Principles of a reformed health care system with particular relevance for children's mental health services include coverage of a broad array of home- and community-based services, provision of organized systems of care for children with serious and persistent mental illness, mechanisms to ensure appropriate utilization of services, and provision of mental health services on the same terms and conditions as other health services. The Clinton Administration's proposed Health Security Act embodied many of these principles. In addition, its call for universal coverage and for elimination of insurance exclusions for preexisting conditions would extend mental health coverage to children who are currently uninsured or underinsured; the plan would also expand the range of services covered to include state-of-the-art approaches such as intensive nonresidential services and other alternatives to hospitalization. Implementation of the proposed plan would require developing the service and workforce capacity to provide a full continuum of services, ensuring availability of existing services, integrating existing and new systems of care, guarding against underserving children with serious mental illness, and planning for the role of Medicaid funding in the reformed health care system.

Adolescent

Empowering employees to take charge of their performances.

To retain staff and operate effectively, an agency must reward and develop its personnel. One Wisconsin agency worked with its staff to develop a review tool that enabled the staff to take part in their own evaluation and thus perform to their best abilities.

Employee Incentive Plans

Staff empowerment: a medical record department's preliminary experiences with continuous quality improvement.

After observing the results of continuous quality improvement, no one would argue against its value in the workplace. However, learning to apply the concepts requires change on everyone's part, and the challenge lies in effecting this change. Not everyone will want to work in this type of environment and, if the organization is truly committed to continuous quality improvement, those individuals may have to make hard decisions as to whether the organization is the right place for them to work. Certain skills are required for staff empowerment to be successful, and training in these skills is essential. The medical record department staff learned early in this process that, although the group possessed job skills, interaction and team skills were lacking. The Development Dimensions International program helped the managers and staff identify the weaknesses of the group and provided educational tools for improvement. The changes often are so subtle, the group does not realize anything has changed. It was not until recently, when the medical record department staff was requested by administration to identify department quality improvement projects, that the group looked back at where the process started and realized how different things are today from three years ago--now staff members lead team meetings, work-groups are redesigning their job processes, and teams update the rest of the department staff on its progress at department meetings. Everyone expressed a sense of pride and accomplishment that the group had indeed responded to the challenge. The experiences of the medical record department thus far clearly support empowerment of employees.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel

A home care nurse residency program.

Hiring new graduate nurses into the home care setting is no longer a taboo. With a carefully scheduled learning program and ongoing supervision and support, this program has shown that recently graduated nurses can be good home care clinicians.

Community Health Nursing

An evidence-based approach to evaluating and improving clinical practice: implementing practice guidelines.

Clinical practice guidelines can improve health care outcomes, but they are only as effective as their implementation. We present a framework for implementing practice guidelines that begins by identifying the forces driving and restraining the adoption of the guideline. Strategies for changing physician behavior that strengthen the driving forces and weaken the restraining forces can then be incorporated into a comprehensive implementation program. Nine strategies for changing physician behavior are presented, based on a review of the literature and organizational experience at Group Health Cooperative of Puget Sound. In designing an implementation strategy, it is essential that the resources allocated to implementation are commensurate with the improvement in outcomes expected from the successful implementation of the guideline. All implementation programs should include plans for measuring outcomes to allow for continuing improvement. Guideline implementation, evaluation and improvement efforts are most likely to be successful when they are part of an explicit, evidence-based process for evaluating and improving clinical practice.

Decision Making

Training future chefs at Opryland.

Dina Starks is the culinary apprentice coordinator at Opryland Hotel Convention Center in Nashville, Tenn. Her apprentices have the unique opportunity to practice the culinary arts at the largest hotel convention center in the world, in a setting that has 15 restaurants and nearly 3,000 rooms.

Commerce