Adaptation of a psychiatric service to missile war.
Explore the source record for details and available documents.
Combat Disorders↗
SEARCH · PubMed Health
Results for “Hospital Restructuring”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
NHS reforms and resource management: whither the hospital?
This paper considers whether resource management (RM) as currently constituted in the National Health Service (NHS) is likely to fulfil its aim of efficiency. For the individual hospital RM has two key features: changes in managerial structure and changes in information systems. The paper assesses the extent to which the hospital behavioural model that implicitly underlies RM can be judged to reflect well the actual behaviour of hospitals. It is noteworthy that in the RM literature there is no explicit statement about the assumed underlying behaviour of the NHS hospital. Here the author selects the Harris model of hospital behaviour as providing the best explanation of internal hospital organisation. Harris represents the two lines of authority, physicians and administrators (managers in the present-day NHS), as two firms within the hospital structure, each with its own managers, objectives and constraints, making this model particularly appealing as a basis for analysing RM. Using this model the paper concludes that RM alone and as currently constituted will not be successful in promoting efficiency, because the structural and cultural mechanisms put in place by RM will not sufficiently affect physician behaviour.
Economic Competition↗
Public autonomous hospitals in sub-Saharan Africa: trends and issues.
Since the late 1980s, many countries in Africa have been granting increased autonomy to their main teaching hospitals. This policy has significant international support but has been evaluated little from either theoretical or empirical perspectives. This paper attempts to fill this gap by assembling evidence from policy documents, theoretical debates and empirical evidence of related policy changes in other contexts such as the development of trust hospitals in the UK NHS. The paper attempts to locate the policy in the broader context of the package of health sector reform measures proposed at international level, and to identify the role it is intended to play in the achievement of the implicit objectives of that package. The objectives identified are improvements in allocative efficiency and equity, improvements in internal efficiency and improvements in responsiveness, accountability and choice. Each of these objectives presents difficulties which suggest that only modest short-term expectations of the policy can be justified. Given the lack of evidence from existing experience, a research agenda is suggested, which aims to provide information to guide further implementation of the policy.
Africa South of the Sahara↗
Some limits to the hospital as a negotiated order.
This paper examines issues of freedom and constraint by employing the negotiated order perspective in an analysis of a merger of three health care institutions. The findings give support to the importance of negotiated order considerations in understanding the social organization of health care, for they suggest that there are some limits to negotiations which take place within medically dominated settings.
Attitude of Health Personnel↗
Quality circles as problem-solving tools in perioperative settings.
Explore the source record for details and available documents.
Hospital Restructuring↗
Specialized beds program: diversification options in skilled nursing facilities.
Serving patients in the SNF who need specialized, highly skilled care demands strong commitment, intensive planning, cooperative research, and continuous reassessment and evaluation. Specialty care programs are necessary to provide viable alternatives to acute care hospitalization for patients who need long term care. Health care organizations should continue their cooperative efforts to ensure the appropriate and cost effective use of services. Based on CCM's successful history of operating special care programs, providers should be encouraged to become leaders in developing specialized care alternatives. The appropriate use of long term care as well as acute care settings is in the best interest of patients, communities, and the health care industry itself.
Cost Control↗
A structure for organizing quality assurance activities.
Explore the source record for details and available documents.
Florida↗
Implementing state-level mental health policy reforms in Indiana: closing a state-operated psychiatric hospital and passing major mental health reform legislation.
Explore the source record for details and available documents.
Community Mental Health Services↗
Sense of place, organizational context and the strategic management of publicly funded hospitals.
An era of managerialism in health care delivery systems is now well ensconced throughout the nations of the OECD. This development has occurred, in large part, as a response to funding pressures in institutionally based health care delivery imposed by principal third party insurers. In the case of publicly funded hospitals, the more traditional concerns for stewardship and appeasement of professional groups is being replaced by a greater emphasis on cost consciousness and corporate-style leadership as these organizations seek to reposition themselves in new funding and regulatory environments. While institutional theory and strategic management perspectives help illuminate these issues, this paper argues that a place-based perspective is also needed to understand the changes currently underway in health care delivery and publicly funded human services more generally. This is illustrated with reference to developments in the strategic management of public hospitals in the province of Ontario. Evidence from a survey of senior administrators of public hospitals, distributed at the height of these policy reform initiatives, is examined to shed light on local level management responses to changing policy and fiscal pressures. The data suggest that the latest policy directions in the province of Ontario will 'encourage' hospital executives in particular community settings to steer their organizations in very unfamiliar directions. The findings suggest a need for greater attention to context and setting in health services research and policy.
Canada↗
From retreat to health centre: legislation, commercial opportunity and the repositioning of a Victorian private asylum.
This paper examines the interplay of commercial imperatives and health care legislation in the survival of a privately owned psychiatric hospital in Guelph, Ontario, Canada. Using documentary and archival evidence, we show how the Homewood Retreat (later Sanitarium, and eventually Health Centre) was able to respond to and anticipate legislative developments through the agency of successive medical superintendents and the structural positioning of the institution as an inextricably integrated element in local and provincial mental health provision. Our case study is used to draw out wider lessons concerning agency, legislative context and treatment modality in the determination of organizational histories. We conclude by noting the important role of the private sector in ensuring the continued provision of an asylum form of mental health care.
Facility Regulation and Control↗
Revolutionary versus evolutionary change: the experience of a university hospital department of psychiatry.
In the spring of 1991, the Department of Psychiatry at Sunnybrook Health Science Centre chose to undergo a major reorganization in an attempt to better meet the needs of patients as well as the academic and research requirements of the University of Toronto. This brief report describes the circumstances leading up to the decision to make a "revolutionary" change, the department's experiences during the period of radical change and the impacts of the change process.
Canada↗
New management structures at Sunnybrook Health Science Centre: identifying patient groupings.
An important step in re-engineering to achieve patient focused care is to define operational units of patients with like needs. This paper describes one process-oriented approach for this task. The approach allowed early and significant involvement of the staff in the re-engineering project.
Delphi Technique↗
Devolution to whom?
Explore the source record for details and available documents.
Delivery of Health Care, Integrated↗
Organizational renewal and strategic planning: a winning combination.
Several approaches to organizational renewal have been described, but few are reported for health care institutions in Canada. In contrast, approaches to strategic planning in health care facilities have been well documented. From our experience over the past six years, the theory and practice of organizational renewal complement the focused activities of strategic planning. This combination can be an effective means to enhance organizational performance, employee commitment and a shared vision among the various stakeholders within the hospital and community. This article outlines the process and benefits that can accrue through such efforts. It demonstrates how the investment of organizational renewal strategies can produce sustainable, operational and strategic planning benefits for community hospitals.
Hospital Restructuring↗
Reengineering a cardiovascular surgery service.
BACKGROUND: Reengineering, involving the radical redesign of business processes, has been used successfully in a variety of health care settings. In 1994 New York University (NYU) Medical Center (MC) launched its first reengineering team, whose purpose was to redesign the entire process of caring for patients-from referral to discharge-on the cardiovascular (CV) surgery service. REENIGINEERING TEAM: The multidisciplinary CV Surgery Reengineering Team was charged with two goals: improving customer (patient, family, and referring physician) satisfaction and improving profitability. The methodology to be used was based on a reengineering philosophy-discarding basic assumptions and designing the patient care process from the ground up. THE TRANSFER-IN INITIATIVE: A survey of NYU cardiologists, distributed in April 1994, suggested that the organization was considered a difficult place to transfer patients. The team's recommendations led to a new, streamlined transfer-in policy. The average waiting time from when a referring physician requested a patient transfer and the time when an NYUMC physician accepted the transfer decreased from an average of 9 hours under the old system to immediate acceptance. OTHER INITIATIVES: Three customer satisfaction task forces implemented multiple programs to make the service more user friendly. In addition, referrals increased and length of stay decreased, without an adverse impact on the mortality rate. CONCLUSION: For the first time at NYUMC, a multidisciplinary team was given the mandate to achieve major changes in an entire patient care process. Similar projects are now underway.
Cardiology Service, Hospital↗
Building a framework for multiple improvement initiatives.
BACKGROUND: As health care organizations struggle to compete and even survive in today's turbulent marketplace, they often juggle a variety of initiatives addressing cost reduction, quality improvement, critical pathways, accreditation, clinical guidelines, strategic planning, and organizational development-each with its own priorities, advocates, methods, and language. EXAMPLE: One large health care system that had adopted continuous quality improvement (CQI) as a major strategy then responded to significant cost pressures with additional initiatives in reengineering, cost reduction, and physician guidelines, with varying connections to the quality language, principles, and methods. The senior leadership committee for the quality initiative undertook the development of a framework to explain the connections among the diverse projects and approaches-a framework still in use after two years. SUMMARY AND CONCLUSION: In this period of enormous change, health care leaders must quickly and effectively mobilize all available resources to optimize organizational effectiveness. Too often, management's response patterns have overemphasized a "splitting" tactic, managing multiple distinct initiatives. The creation of integrated delivery systems, mergers, acquisitions, and alliance exacerbates this problem, as the number of initiatives multiplies in the new organizations. Development and application of an integrating management framework will accelerate the pace of organizational improvement by increasing shared understanding of the current desired states of the organization; linking strategic, cultural, and method needs and behaviors; aligning various management initiatives in relation to organizational goals and one another; increasing the fit of management methods with specific situations; and providing a unifying perspective and language for organizational members to act and learn collaboratively.
Cost Control↗
Improving functional outcomes in older patients: lessons from an acute care for elders unit.
BACKGROUND: Hospitalization often marks the beginning, and may be partially responsible for, a downward trajectory characterized by declining function, worsening quality of life, placement in a long term care facility, and death. At the University Hospitals of Cleveland, an Acute Care for Elders (ACE) unit that reengineered the process of caring for older patients (> or = 70 years of age) to improve functional outcomes was established in September 1990. DESCRIPTION OF INTERVENTION: The general principles of ACE included an approach to care guided by the biopsychosocial model and recognition of the importance of fitting the hospital environment to the patient's needs. The design of the intervention was consistent with principles of comprehensive geriatric assessment and continuous quality improvement. Care, which focused on maintaining function, was directed by an interdisciplinary team that considered the patient's needs both at home and in the hospital. The major components of the ACE Unit intervention included patient-centered nursing care (daily assessment of functional needs by nursing, nursing-based protocols to improve outcomes, daily rounds by a multidisciplinary team), a prepared environment, planning for discharge, and medical care review. RESULTS: In a randomized trial comparing ACE with usual care, patients receiving ACE had improved functional outcomes at discharge. The costs to the hospital for ACE unit care were less than for usual care. The functional status of ACE and usual care patients was similar 90 days after discharge. FUTURE DIRECTIONS: The ACE unit intervention is being expanded to preserve the improvements observed during the hospitalization in the outpatient setting. In addition, needs other than function which are critical to patients' long-term quality of life are being considered.
Activities of Daily Living↗
Sharing in nursing governance: creating opportunities for change.
Shared governance has created a radical shift in the management and systems thinking of organisations by empowering employees through increased accountability, ownership and decision making. This paper outlines the process of introducing the concept of shared governance to the nursing division of a large not-for-profit private hospital in Victoria. The objectives for change and the philosophy of shared governance are explained so as to clarify the reasons for selection of the shared governance model. The steps involved in planning for the introduction of the change process, implementation and integration of the model at both organisational departmental levels, and the actual structure of the working model of shared governance are described.
Decision Making, Organizational↗