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At least 199 records · Page 11Linked to original sources
PubMed1998

Management service organizations: effective strategy to assume and manage full risk agreements?

A management services organization (MSO) has emerged as one structure to manage professional and hospital risk agreements. Health plans and direct payers are transferring traditional functions to medical groups and health systems under these agreements. How does a hospital and affiliated medical group develop a strategy to assume, manage, and mutually benefit from these agreements? When do market forces dictate whether an MSO is the most appropriate organizational model to utilize? The development of an MSO can offer an effective organizational strategy to capture capitated contracts and assume responsibility for population-based medical services. This article explores the features of such an organization, areas for potential collaboration between the medical group and hospital, as well as the impact on patient care.

Capitation Fee↗
PubMed2005

Geriatric-palliative care units model for improvement of elderly care.

The aim of this research was to indicate the necessity of a new organizational model of health and social care system for the geriatric population in Croatia. Modern geriatrics puts special emphasis on the idea that the care of the elderly should be performed through home care or long-term care institutions, rather than in the acute care hospital departments. The social healthcare of the elderly requires a multidisciplinary approach, as well as teamwork and coordination of institutional and non-institutional departments. Founding of palliative care units is clearly absent from the existing elderly care system. 33% of the total deceased geriatric population within the target area (2000-2002) has passed away in institutions (Dubrovnik General Hospital and nursing homes), what clearly indicates a need for organized palliative care on the stationary level. Nursing homes in Croatia should accept about 4% of the total number of older population (according to the gerontology research). Nevertheless, this research shows that the available capacity of the nursing homes in the Dubrovansko-Neretvanska County is 50% of the projected percentage. The solution might be setting up of palliative-geriatric units in already existing institutions, as shown by the SWOT analysis.

Aged↗
PubMed2000

[Primary nursing: adapting a new working model at the surgical nursing service of the Clinics Hospital of Porto Alegre].

The present article reports the evolution of organizational models of health care in the hospital area, portraying part of this process at the Surgical Nursing Service of the Hospital de Clínicas de Porto Alegre. The different kinds of care are discussed on how they interfere on the Nursing duties. We approached Primary Nursing concepts and its repercussion in the nurse-patient relationship proposing alternatives to move our current work close to this trend.

Brazil↗
PubMedDate not supplied

Competing in the new health care paradigm: a novel personnel compensation model, Part I.

Operational issues in health care ultimately lead to discussions concerning personnel. Adequate staffing, "rightsizing," compensation, scheduling, morale, supervision, and organizational structure were subjects of the questions the Clinical Pathology Laboratories at the University of Virginia Medical Center asked in 1994. The answers were found in the design of a new skill-based personnel organizational model and compensation plan.

Delivery of Health Care↗
PubMed2005

A global view on ARAMIS, a risk assessment methodology for industries in the framework of the SEVESO II directive.

The ARAMIS methodology was developed in an European project co-funded in the fifth Framework Programme of the European Commission with the objective to answer the specific requirements of the SEVESO II directive. It offers an alternative to purely deterministic and probabilistic approaches to risk assessment of process plants. It also answers the needs of the various stakeholders interested by the results of the risk assessment for land use or emergency planning, enforcement or, more generally, public decision-making. The methodology is divided into the following major steps: identification of major accident hazards (MIMAH), identification of the safety barriers and assessment of their performances, evaluation of safety management efficiency to barrier reliability, identification of reference accident scenarios (MIRAS), assessment and mapping of the risk severity of reference scenarios and of the vulnerability of the plant surroundings. The methodology was tested during five case studies, which provided useful information about the applicability of the method and, by identifying the most sensitive parts of it opened way to new research activity for an improved industrial safety.

Causality↗
PubMed1999

Adapting to managed care by becoming a learning organization.

In the tumultuous and chaotic environment of managed health care, hospital-based mental health providers need to change in fundamental ways. The traditional view of mental health organizations is a professional-bureaucratic one where actions and outcomes of planning are thought to be highly predictable. The author proposes an alternative paradigm for viewing mental health provider organizations, one based on learning theory, which accepts that the future is unknowable because of its complexity and the probabilistic nature of the world. Within this perspective, mental health care providers need to become "learning organizations" to successfully adapt to the new and evolving conditions.

Hospitals, Community↗
PubMed2000

Information technology adoption in health care: when organisations and technology collide.

The implementation of advanced information systems is enabling great social and organisational changes. However, health care has been one of the slowest sectors to adopt and implement information technology (IT). This paper investigates why this is so, reviewing innovation diffusion theory and its application to both health organisations and information technology. Innovation diffusion theory identifies variables that influence the 'innovativeness' of organisations and the rate at which a technology diffuses. When analysed, these variables show why IT implementation has progressed at a slower rate in health compared with other industry sectors. The complexity of health organisations and their fragmented internal structure constrain their ability to adopt organisation wide IT. This is further impacted upon by the relative immaturity of strategic health IT which is complicated and unable to show quantifiable benefits. Both organisational and technological factors lead to the slow adoption of strategic IT. On the other hand, localised IT solutions and those providing measurable cost reductions have diffused well.

Diffusion of Innovation↗
PubMedDate not supplied

Event Analysis of Systemic Teamwork (EAST): a novel integration of ergonomics methods to analyse C4i activity.

C4i is defined as the management infrastructure needed for the execution of a common goal supported by multiple agents in multiple locations and technology. In order to extract data from complex and diverse C4i scenarios a descriptive methodology called Event Analysis for Systemic Teamwork (EAST) has been developed. With over 90 existing ergonomics methodologies already available, the approach taken was to integrate a hierarchical task analysis, a coordination demand analysis, a communications usage diagram, a social network analysis, and the critical decision method. The outputs of these methods provide two summary representations in the form of an enhanced operation sequence diagram and a propositional network. These offer multiple overlapping perspectives on key descriptive constructs including who the agents are in a scenario, when tasks occur, where agents are located, how agents collaborate and communicate, what information is used, and what knowledge is shared. The application of these methods to live data drawn from the UK rail industry demonstrates how alternative scenarios can be compared on key metrics, how multiple perspectives on the same data can be taken, and what further detailed insights can be extracted. The ultimate aim of EAST is, by applying it across a number of scenarios in different civil and military domains, to provide data to develop generic models of C4i activity and to improve the design of systems aimed at enhancing this management infrastructure.

Communication↗
PubMed2002

Balancing professional and team boundaries in mental health services: pursuing the holy grail in Somerset.

The overcoming of professional boundaries to collaboration in patient care has become one of the goals of mental health service policy in England over the past 25 years, predominantly through the creation of community mental health teams. However, research has shown that these boundaries have been slow to come down, and some commentators have pointed to the benefits of appropriate boundaries. This paper introduces a theoretical framework, which seeks to categorise boundary activity in organisations and then examines the boundary activity of professional groups and community teams during the integration of mental health and social care service provision in one locality in the southwest of England. The paper identifies the ways in which this integration impacted on boundary activity and draws out the messages for mental health policy and practice that emerge.

Adaptation, Psychological↗
PubMed2003

Creating a therapeutic psychosocial environment in dementia care. A preliminary framework.

Research in dementia care during the past few years has focused on identifying and designing therapeutic physical environments while the psychosocial environment has remained a largely unexplored domain. More recently, discussions regarding the effect of the social environment on individuals with dementia have increased in the literature. Nevertheless, the authors suggest the term "social environment" does not adequately represent the critical psychological and emotional effect social interaction has on individuals with cognitive impairment. Through an examination of the literature, three conceptual frameworks, and clinical observations of several special care units (SCUs), the authors suggest that the psychosocial environment is the most important element of institutional dementia care. A preliminary conceptualization is offered which identifies the elements necessary to facilitate a supportive psychosocial environment in long-term care. The potential benefits of implementing such a model include preservation of personhood, simple recognition of remaining abilities and a decreased focus on disabilities, and reduction of pharmacologic therapy for disruptive behavior resulting in overall improvement in quality of life.

Aged↗
PubMed1999

Conflicting values and the patient-provider relationship in managed care.

By definition, value in health care is a function of the quality of care received and the costs associated with providing the care. One method used to optimize the value function is managed care. Unfortunately, some mechanisms of managed care have created an environment where the values of primary stakeholders are in conflict with one another. One such area is the patient-provider relationship. We first explore five patient-provider relationship models and review pressures created by managed care and their impact on the patient-provider relationship. Finally, examples of proposed, pending, and passed legislation to protect the patient-provider relationship are reviewed along with characteristics of the ideal model of patient-provider interaction.

Conflict of Interest↗
PubMedDate not supplied

Co-production dynamics and time dollar programs in community-based child welfare initiatives for hard-to-serve youth and families.

Hard-to-serve youth and families residing in high-poverty communities often have multiple, interlocking needs. These needs necessitate complex service models. The complex model described in this article combines a unique approach to wraparound services with a coproduction framework and related theories. The model aims to improve outcomes for vulnerable youth and their families, simultaneously strengthening communities by employing residents and engaging participants in community service. Examples derived from current pilot projects illustrate co-production's importance for other child welfare initiatives.

Child↗
PubMed2002

[Organizational and managerial model for the patient with chronic heart failure].

Patients with chronic heart failure show a range of care and global therapeutic management problems. The main elements for an efficient management are: hospital-territory integration based on a structured mode of operating and on the healthcare professional/patient relationship; rational continuity in the treatment; multi-disciplinarity of the interventions; the patient's active participation. In the light of these considerations the authors report their own direct experience describing the organizational and management model for patients with chronic heart failure during the various phases of treatment, from the global functional evaluation and treatment program to homecare management integrated with the general practitioner.

Aged↗
PubMed2006

The theory-practice gap: impact of professional-bureaucratic work conflict on newly-qualified nurses.

AIM: This paper reports the findings from a naturalistic enquiry undertaken in the United Kingdom into the extent to which the ideals and values of the preregistration nursing course are adopted by individual newly educated Registered Nurses. BACKGROUND: Research in several countries provides consistent evidence of the existence of a theory-practice gap in nursing. Clear disparities have been demonstrated between the best practice ideals and values that are taught and those actually encountered in everyday practice. Nurse education 'Project 2000' reforms in the United Kingdom were designed, in part, to address this issue. Few studies to date have examined the impact of these reforms on newly qualified Registered Nurses' ability to translate theory into practice. METHODS: A longitudinal study was carried out in three educational institutions in the United Kingdom from 1997 to 2000. Final year nursing students (n = 72) in three colleges of nursing completed questionnaires to elicit views on their ideals and values for practice. In-depth interviews with a purposive subsample of 26 participants (at 4-6 and 11-15 months postqualification) indicated the extent to which these ideals and values were adopted in practice. Interviews were tape-recorded, transcribed, and data were analysed using constant comparison and negative case analysis. FINDINGS: Although new nurses emerged from their programmes with a strong set of nursing values, a number of professional and organizational factors effectively sabotaged implementation. Professional sabotage includes obeying covert rules, lack of support and poor nursing role models. Organizational sabotage includes structural and organizational constraints such as time pressures, role constraints, staff shortages and work overload. CONCLUSION: The disparity between nursing as taught and as practised may have profound implications for the future of the profession both in the United Kingdom and internationally, in terms of morale, job satisfaction and retention. Measures to improve resources and reduce the professional-bureaucratic work conflict are discussed.

Attitude of Health Personnel↗