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PubMed1990

A social work practice model of case management: the case management grid.

Case management is a major component of the current mainstream of social work practice. Nevertheless, the field has failed to adequately conceptualize case management. The first step in defining case management practice is to separate it from the administrative structure that forms the context of practice. The next step is to delineate the two basic dimensions of case management--enabling and facilitating. The role of the social work case manager is to integrate formal systems of care with the activities of families and primary groups. Case management practice focuses on enabling individuals and primary groups to reach their full potential and on facilitating more effective interaction with the larger social environment. The case management grid illustrates how social work practitioners integrate enabling and facilitating into their practice approaches.

Humans↗
PubMed1977

The physician as manager. "What" and HOW" OF PRACTICE MANAGEMENT EDUCATION.

Management science and application play a pivotal role in preparing physicians for effective and efficient office practice. Integration of management theory into practice management education of family physicians may be accomplished by developing and maintaining a well-organized model practice, involving residents directly in management decisions and problem solving, using a variety of resource people in and outside the model unit, and providing quantitative analysis of practice performance. After three years of development, the Family Practice Center of Akron City Hospital has instituted a practice management curriculum whereby residents become actively involved in the management and supervision of the model practice, conduct research study into management problems, and receive training and supervision as they develop leadership and organizational skills.

Audiovisual Aids↗
PubMed1996

Managed care and total quality management: a necessary integration.

The process of quality improvement/total quality management (QI/TQM) plays a key role in the delivery of health care in a managed care system. The concepts and ideas surrounding QI/TQM and managed care are interrelated, and the success of health care delivery depends on the integration and coexistence of these two philosophies. In looking more closely at these concepts, it becomes clear that the principles of QI/TQM must underlie strategic decisions involved in the implementation of a managed care system. Nurses play a key role in the success of this integration as nurse case managers, nurse practitioners, and nurse administrators. They have a direct impact on the many variables and goals of both QI/TQM and managed care.

Case Management↗
PubMed2001

Outcomes for men with clinically nonmetastatic prostate carcinoma managed with radical prostactectomy, external beam radiotherapy, or expectant management: a retrospective analysis.

BACKGROUND: With a lack of data from randomized trials, the optimal management of men with nonmetastatic prostate carcinoma is controversial. The authors sought to define the outcomes of three common strategies for managing patients with nonmetastatic prostate carcinoma: expectant management, radiotherapy, and radical prostatectomy. METHODS: The authors conducted a retrospective cohort study with standardized collection of key prognostic data, including centralized assignment of Gleason grades from original biopsy specimens. Participants included all Connecticut hospitals (the expectant management cohort) and three academic medical centers in other states (the radiotherapy and surgery cohorts). Two thousand three hundred eleven consecutive men ages 55-74 years who were diagnosed during 1971-1984 with nonmetastatic prostate carcinoma and were treated at the participating sites were included. RESULTS: Kaplan-Meier estimates with 95% confidence intervals (95% CI) of overall survival at 10 years for each cohort were as follows: expectant management cohort, 42% of patients (95% CI, 38-46%); radiotherapy cohort, 52% of patients (95% CI, 46-58%); and radical prostatectomy cohort, 69% of patients (95% CI, 67-71%); for disease specific mortality, the estimates were as follows: expectant management cohort, 75% of patients (95% CI, 71-79%); radiotherapy cohort, 67% of patients (95% CI, 61-73%); and radical prostatectomy cohort, 86% of patients (95% CI, 84-88%). There were large differences in distributions of important prognostic factors among men in the different treatment groups. CONCLUSIONS: These data provide precise estimates of the outcomes of patients who have been treated with different modalities for nonmetastatic prostate carcinoma in the recent past. Direct comparisons of outcomes between treatment groups are inadvisable because of the different characteristics of patients who select these alternative management strategies.

Aged↗
PubMed2000

Managing Environmental Stress: An Evaluation of Environmental Management of the Long Point Sandy Barrier, Lake Erie, Canada.

/ This paper assesses the extent to which key geomorphic components, processes, and stresses have been reflected in the management of a coastal sandy barrier environment. The management policies and practices of selected agencies responsible for Long Point, a World Biosphere Reserve along Lake Erie, Canada, were evaluated for consistency with these principles of environmental management for sandy barriers: maintaining natural stresses essential to sandy barrier development and maintenance;protecting sediment sources, transfers, and storage; recognizing spatial variability and cyclicity of natural stresses, such as barrier overwash events; and accepting and planning for long-term evolutionary changes in the sandy barrier environment. Generally, management policies and practices have not respected the dynamic and sensitive environment of Long Point because of limited mandates of the agencies involved, inconsistent policies, and failure to apply or enforce existing policies. This is particularly evident with local municipalities and less so for the Canadian Wildlife Service, the federal agency responsible for managing National Wildlife Areas at the point. In the developed areas of Long Point, landward sediment transfers and sediment storage in dunes have been impacted by cottage development, shore protection, and maintenance of roads and parking lots. Additionally, agencies responsible for managing Long Point have no jurisdiction over sediment sources as far as 95 km away. Evolutionary change of sandy barriers poses the greatest challenge to environmental managers.

Journal Article↗
PubMed1990

Service management: New Zealand's model of resource management.

The health system in New Zealand, which in many respects is similar to that of the United Kingdom NHS, is currently undergoing massive change. In 1989 fourteen area health boards were formed, each board being accountable to the minister of health for achieving health goals and providing comprehensive health services for its defined population. This process has been assisted by the promulgation of a set of national health goals and a national health charter. Within area health boards the principle of general management is being implemented. Organisational structures are moving away from hospitals to services in a process which is being called service management which may be defined as the decentralisation of general management to the clinical workface. Similar in many respects to the resource management initiatives in the NHS it brings together medical, nursing and business management at the operational level with one person being accountable for the achievement of quality of care objectives within a budgetary framework. Budgetary restraints in excess of 10% have been achieved in the last 12 months partly through the service management process. Service management is seen to be a major paradigm shift in health services organisation and could be of international significance in its potential for achieving medical accountability for cost containment and quality assurance, and for coordinating care across agency and disciplinary boundaries.

Governing Board↗
PubMed1999

Education and certification influence the nutrition and management knowledge of long-term-care foodservice managers.

OBJECTIVES: To describe nutrition knowledge, attitude toward nutrition, and management knowledge of long-term-care foodservice managers and to determine the relationship between these variables and the foodservice managers' personal and facility characteristics. DESIGN: Nutrition knowledge, management knowledge, and attitudes toward nutrition were measured using survey methodology designed for this study by modifying an instrument developed by the Nutrition Education Training Program for the Texas Department of Human Services. SUBJECTS/SETTING: Surveys were mailed to a random sample of 300 long-term-care foodservice directors from the 1,092 directors listed in the 1996 Ohio Department of Health Directory of Nursing Homes. The participants were 123 of the 300 foodservice directors (41%). STATISTICAL ANALYSES PERFORMED: Descriptive statistics, Spearman rank correlations, 1-way analysis of variance, and post hoc variance were calculated. RESULTS: Mean scores of respondents were 21.2 out of a possible 29 (73%) for the nutrition knowledge assessment, and 18.2 out of 26 (70%) for management knowledge. Dietitians and dietetic technicians scored significantly better than others on these tests. The mean score of attitudes toward nutrition was 4 on a 5-point scale (where 1 = strongly disagree to 5 = strongly agree). All participants requested more training in computers, nutrition terminology, and preparing appealing foods. APPLICATIONS: Dietitians and dietetic technicians are prepared with a wide scope of knowledge in nutrition and management. Thus, they are in an ideal position to take advantage of job opportunities in the area of foodservice management.

Adult↗
PubMed2004

Patient-appraised couple emotion management and disease management among Chinese American patients with type 2 diabetes.

Family context exerts a strong influence on disease management among patients with chronic disease, but it is not clear which aspects of family life are most influential. This study examined the linkages between patient-appraised couple emotion management (conflict resolution, expressiveness, and respect) and disease management (biological, morale/depression, quality of life, and behavioral) among a relatively understudied group, Chinese American patients with type 2 diabetes. Significant main effects were found between patient-appraised couple emotion management, especially conflict resolution, and the morale component of disease management, but not the biological or behavioral components; both diabetes-specific and general relationship qualities (marital satisfaction) were independently linked to disease management. Acculturation did not qualify the findings. Similarities among ethnic groups in family and disease management relationships may be more common than differences.

Acculturation↗
PubMed2000

Management challenges faced by managers of New Zealand long-term care facilities.

This article reports on a postal survey of 78 long-term care managers in one region of New Zealand, of whom 45 (58%) responded. Most long-term care managers (73.2%) were middle-aged females holding nursing but not management qualifications. Most long-term care facilities (69%) tended to be stand-alone facilities providing a single type of care (rest home or continuing care hospital). The most prominent issues facing managers were considered to be inadequate funding to match the growing costs of providing long-term care and occupancy levels. Managers believed that political/regulatory, economic and social factors influenced these issues. Despite a turbulent health care environment and the challenges facing managers, long-term care managers reported they were coping well and valued networking.

Female↗
PubMed2002

Pain management autobiographies and reluctance to use opioids for cancer pain management.

Although pain management education results in improved pain control for some patients, it does not work for all patients because some patients remain reluctant or unwilling to use prescribed analgesics to their optimal effect. In a randomized clinical trial that tested the effectiveness of the PRO-SELF Pain Control Program, 11 patients declined to increase their analgesic use despite moderate to severe pain. These patients were selected for a qualitative analysis of their audiotaped discussions about pain management with their intervention nurses. This analysis revealed that these patients often spontaneously provided detailed explanations about why they were reluctant or unwilling to take analgesics in general or opioids in particular. We termed these explanatory accounts pain management autobiographies because of their narrative character and multilayered, richly detailed quality. Pain management autobiographies included stories about (1) previous experience with chronic pain management, including stigmatizing interactions with clinicians and family members; (2) bad experiences with cancer pain management, including severe constipation; and 3) strongly held conventions about medication use, including the belief that all medications are "toxins" that should be avoided. The study findings suggest that a small subset of patients with cancer pain may need interventions such as individual or family counseling or alternative pain management strategies to augment education about opioids.

Adult↗
PubMedDate not supplied

Evaluating the impact of the Management Academy for Public Health: developing entrepreneurial managers and organizations.

The Management Academy for Public Health is a management development program with the goals of helping public health managers learn to manage people, data, and finance, to think and plan like entrepreneurs, and to strengthen public health organizations. Managers enroll as teams and develop business plans in the Academy's extensive project-based learning component. Extensive internal and external evaluation shows that the program improves managers' knowledge, skills, and confidence in key curriculum areas; that participants apply many of the skills in their jobs; that many of the business plans receive funding, resulting in new public health programs; that the training experience helped agencies respond and plan after September 11, 2001; and that many participants report beginning to think more like entrepreneurs through activities like teaming, partnering, innovating, negotiating, finding funds, and generating revenue. The program demonstrates that robust training including extensive work-based project work with coaching can help public health managers gain many skills needed for the drive to "reinvent" government.

Entrepreneurship↗
PubMed2005

Developing a nursing management degree programme to meet the needs of Irish nurse managers.

BACKGROUND: The study is placed within the context of the Irish health care system, which has undergone tremendous change, at the dawn of the new millennium, in particular from the nursing management and leadership viewpoint. AIM OF THE STUDY: The aim of this study is to explore nurses' expectations of the content and delivery of a nursing management degree programme. METHODS: This is an on-going action research study. Data has been collected using a focus group interview, questionnaire, document analysis and a reflective diary. Data was analysed using thematic analysis and SPSS as appropriate to qualitative and quantitative data respectively. To date two action research cycles are near completion and a total sample of 117 students have taken part in the study. FINDINGS: Nurses commencing the programme were unsure of their education and training needs, as they had not yet taken on board the recommendations of the Irish Commission on Nursing (Government of Ireland 1998). The findings suggest that nurse managers may not know what they need to know in light of the many current changes taking place in the Irish health system. The introduction of personal development planning (PDP) is among new strategies taking place as part of the second action research cycle. PDP can help nurse managers to reflect on their current responsibilities and plan for their future career pathways. CONCLUSIONS: The findings are presented in the context of one institution. Action research, which nests comfortably with certain management styles, has proved suitable as a tool for developing and changing this programme. The need for university teachers to focus on management development skills as well as the transmission of management theory is supported.

Education, Nursing, Baccalaureate↗
PubMedDate not supplied

When management works: an organizational culture that facilitates learning to self-manage type 2 diabetes.

This study describes women's perspectives of provider and setting factors that support their ability to be effective self-managers of type 2 diabetes. A qualitative approach with focus-group interviews and document review was used. The 17 women in this study had been nominated as exemplars in self-management by experts from a diabetes treatment and research center in the Midwest. Data generated from four structured focus group sessions, investigator fieldnotes, and clinic records of participants yielded the following themes: (1) turning points facilitated the management experience along with certain obstacles and barriers, (2) an organizational culture of caring facilitated learning self-management, (3) major shifts in provider-patient relationships accompanied a phasic process of learning management, and (4) a set of personal characteristics most likely influenced the learning process. The knowledge and skills obtained through diabetes education are essential for initiating the self-management process. However, becoming an effective self-manager requires an organizational culture that supports elements of a role reversal in which patients can be experts and providers can be mentors.

Aged↗
PubMed2002

Life cycle inventory for municipal solid waste management. Part 2: MSW management scenarios and modeling.

Evaluating the environmental performance of municipal solid waste management options is a complex task. Part 1 of this study presents the municipal solid waste management program of the Pamplona Region in Spain and explores the operational, economic, and environmental factors of the program. In Part 2, alternative waste management scenarios that include the selective collection of organic material and composting are illustrated. The use of a Life Cycle Inventory model for waste management allows for the comparison of the environmental burdens of the different scenarios. This use of a Life Cycle Inventory model for solid waste management lets program managers and decision makers include energy use, final solid waste, and Greenhouse gas emissions in the decision making process. Additionally, the different management scenarios are evaluated on their ability to fulfil Pamplona regional objectives and meet European Packaging and Landfill Directive targets.

Cities↗
PubMed2005

Education and a standardized management protocol improve the assessment and management of asthma in the emergency department.

STUDY OBJECTIVE: To evaluate the effect of a standardized management protocol on acute asthma care in the emergency department (ED). METHOD: We conducted a before-after study regarding acute asthma management. Deficiencies in acute asthma care over a time period of 19 month (January 1997- October 1998) were identified. Subsequently a management protocol consisting of an assessment sheet and written guidelines for the initial management of acute asthma in the emergency department, was developed. In addition, physicians and nurses of the emergency department were informed about the recommendations given in the guidelines, and instructed in peak-flow meter use. The assessment sheet was introduced in January 2002 and posted at several locations in the emergency department. Between February 2002 and August 2003 the acute asthma consultations in the emergency department were consecutively registered. Data on medical history, physical examination and objective measurements of airflow obstruction, as well as data on treatment and assessment of the response to therapy were collected. In addition, medication and instructions at discharge were reviewed and compared with the results before the introduction of the assessment sheet. RESULTS: The first group consisted of patients seen between January 1997 and October 1998; the second group consisted of all patients seen between February 2002 and August 2003 (104 vs 273 patients respectively). Both groups had a similar gender distribution (56% females in the first group vs 53% females in the second group) and the mean age of both groups was also alike (median 33 vs 36 years). Most patients had a known history of asthma (76% in the first group vs 70% in the second group). The self-referral rate was high in both groups (86% vs 96% respectively). Blood pressure and pulse rate were reported in the majority of patients (95% vs 98% respectively), whereas the respiratory rates were reported in 14% of patients in the first group vs 65% of patients in the second group. The introduction of the assessment sheet led to an increased measurement of initial airflow obstruction (53% of patients in the first group vs 96% of patients in the second group) as well as repeated measures under treatment (36% of patients in the first group vs 85% of patients in the second group). Repeated inhalations with short-acting inhaled beta-agonists, and use of systemic corticosteroid therapy at admission and at discharge increased significantly (from 31% to 84%, 43% to 68% and 37% to 70% respectively). CONCLUSION: The assessment and management of patients presenting to the emergency department with acute asthma can be improved with a guideline based management protocol, and by educating physicians and nurses in the management of acute asthma.

Adult↗
PubMedDate not supplied

Facilities management contracting: the key to effective change management.

Facilities Management Contracting is a catalyst for developing high performance individuals and teams to deliver value for money in today's demanding funding environment. It is a key to unlocking individuals' creativity, and learning, through effective change management strategies, and to developing organisational processes and structures to promote this. Sarah Meads, General Manager of Serco Health Services, explores how health providers could make more effective use of Facilities Management Contracting to release the potential that already exists within their organisations by thinking of Facilities Management as a change management tool. Serco Health Services is the division of Serco Group NZ Limited responsible for assisting healthcare providers to review and manage a wide range of non-core support services.

Contract Services↗