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At least 217 records · Page 12Linked to original sources
PubMed2000

"Happy Meals" in the Starship Enterprise: interpreting a moral geography of health care consumption.

This paper extends earlier explorations of the use of metaphor in the marketing of the Starship Children's Hospital in Auckland, New Zealand, by examining controversy surrounding the opening of an in-hospital McDonalds fast-food outlet. The golden arches have become a key element of many children's urban geographies and a potent symbol of the corporate colonisation of the New Zealand landscape. In 1997 a minor moral panic ensued when a proposal was unveiled to open a McDonald's restaurant within the Starship. Data collected from media coverage, advertising and interviews with hospital management are analysed to interpret competing discourses around the issue of fast food within a health care setting. We contend that the introduction of a McDonald's franchise has become the hospital's ultimate placial icon, adding ambivalence to the moral geography of health care consumption. We conclude that arguments concerning the unhealthy nature of McDonald's food obscure deeper discourses surrounding the unpalatable character of the health reforms, and a perceived 'Americanisation' of health care in New Zealand.

Adult↗
PubMed2000

Technical efficiency and economies of diversification in health care.

In national health services, where there is a tendency towards a lack of resources and a continuous increase in demand, it is necessary to implement decisions that promote efficiency. In this paper we focus on potential diversification economies as a strategy to increase efficiency levels. We evaluate the change in efficiency in Catalan hospitals between 1987 and 1992, and analyse the presence of possible diversification economies in each hospital. We use Data Envelopment Analysis, which does not need information on either input or output prices. The results are that the majority of hospitals could increase their efficiency and reduce their costs by diversification to the output-mix offered. Potential productivity gains are between 29% and 46%.

Benchmarking↗
PubMed1997

Clinical and human resource planning for the downsizing of psychiatric hospitals: the British Columbia experience.

Riverview Hospital, B.C.'s only and Canada's largest remaining provincial psychiatric hospital began a formal planned "downsizing" process in 1992. This initiative was an important element in the Province's strategic plan to shift to a more community-focused mental health system and to bring tertiary psychiatric services "closer to home" by redeveloping Riverview Hospital on three sites. The paper summarizes the literature pertaining to the "downsizing" of psychiatric hospital services in relation both to clinical and human resource planning. It describes the mental health system in B.C. and the service system context in which this exercise is occurring. It is based on the first three years of experience in identifying the major challenges and the strategies developed to meet these challenges. It draws some conclusions about the effectiveness of these strategies and it speculates about the likely future challenges as the "downsizing" process continues.

British Columbia↗
PubMed1997

Hospital downsizing and patients' assaults on staff.

Although the downsizing and closing of state mental hospitals is occurring with increasing frequency nationwide, there appears to be only one case study of the clinical impacts of downsizing state hospitals. In this study, Snyder reported a four-fold increase in frequency of assaults on staff as the hospital census decreased. The present paper is a second case study of state hospital downsizing and closing in which the frequency of assaults on staff decreased by 63%. Possible explanations for the two differing outcomes are considered, and some general guidelines for the downsizing and closing of state hospitals are proposed.

Adolescent↗
PubMed2001

Changes in general health and musculoskeletal outcomes in the workforce of a hospital undergoing rapid change: a longitudinal study.

This article aimed to examine changes in general health and time with back pain and neck pain and to identify predictors of any such changes. Hospital workers were studied longitudinally with surveys in 1995, 1996, and 1997 (N = 712). Back and neck pain were reported only at the 2nd and 3rd surveys. There was a significant decline in general health and significant increases in time with neck pain and back pain. Predictors of changes in these outcomes were mainly work-related variables (initial or change values), such as job interference with family, job influence, work psychological demands, and hours worked.

Adult↗
PubMed1999

Still attractive after all these years? Magnet hospitals in a changing health care environment.

This paper examines the research base for 'magnet hospitals'--hospitals that have a good reputation for recruitment and retention of registered nurses. It also assesses the extent to which the concept of the magnet hospital continues to have relevance to nursing in the United Kingdom (UK). The study reviews previous research, examines recent trends in nursing employment, and reports on case studies conducted as fieldwork research. The early research on magnet hospitals, conducted in the 1980s in the United States of America (USA), is reassessed in the light of subsequent cost containment driven changes in the USA nursing labour market and in the organization of USA hospitals. Many of these changes have impacted on nursing staff, with increases in workload, and with changes in skill mix, particularly as a result of increased use of care assistants. Similar developments have been happening in the UK. The paper examines the extent to which the concept of the magnet hospital can retain validity in this changing health care environment. Case studies in 14 USA magnet hospitals were conducted in 1997. The results highlight that, as a result of hospital reorganization and merger, some of these hospitals no longer exhibit core characteristics of 'magnetism', whilst others have retained these characteristics despite organizational change. The paper concludes by cautioning that the concept of the magnet hospital continues to have a relevance to the management of nursing resources, but that the research base, with some notable exceptions, continues to be weak and that there is a need for monitoring and a process of re- accreditation to maintain a 'live' register of magnet hospitals.

Career Mobility↗
PubMed2002

Nurses' altered conceptions of work in a ward with all-RN staffing.

1. The aim of this study was to investigate how nurses' conceptions of their patients and work changed after reorganization to all RN-staffing and the adoption of a patient-in-focus philosophy on the ward. 2. The study builds on the perspective that the individual's conception of work precedes and forms the basis for the development of knowledge, skills and attributes used in accomplishing work. 3. The findings are based on a secondary analysis of two open interviews with 22 nurses on the ward. These interviews were conducted on two occasions with an interval of 2 years. The third interview was carried out 6 months later, when 10 nurses were asked to talk about a patient's care episode in a narrative form. 4. The nurses' conceptions changed towards a holistic view of the patient, they developed a new approach to work and they used the altered circumstances in their work.

Attitude of Health Personnel↗
PubMed1998

Merger management: a challenge to nursing leadership.

AIM: The article reviews the merger process of two obstetric divisions. BACKGROUND: Mergers of acute care facilities are becoming common due to the need to move towards a market orientation. There is a growing emphasis on corporations, competition, and profit and cost control. Nursing leadership in managing merger processes is crucial. METHODS: Information originated from administrative decisions, feelings expressed by the staff, author observations, and statistical data. Data was analysed by illustrating the merger phases, compared to the literature and research studies. KEY ISSUES: Issues related to planning and preparing the process, the management of human resources, the development of organizational culture, and the physical changes, are vital. CONCLUSIONS: Planning ahead, involving all partners from the early stages, extensive dialogue among colleagues and strong nursing leadership are key elements for a smooth transition.

Decision Making, Organizational↗
PubMed1999

External change and its impact on nurse management: a case study.

AIMS: This paper sets out to identify major changes in the tasks and responsibilities of the nurse manager at a small postgraduate unit in central London as it and its parent hospital group became subject to major changes in the policy and financial environment. What happened to the nurse manager's function could well make transparent some of the important changes still affecting nurse management more generally today. BACKGROUND: The article adds to the somewhat meagre academic literature which considers the middle management role in nursing. METHODS: The paper is based on a single yet detailed case study and the data were gathered by one of the authors over the period of change. The pros and cons of the dual researcher/participant role need to be considered along with the possibly wider significance of the case study. FINDINGS: The overriding conclusion is that nurse management in the specialist unit is evolving from a classic bureaucratic mode in which managerial authority, information and decision making were highly centralized to a much more devolved set of arrangements. Clearly a host of factors--e.g. the culture and history of the organization, and the personality types of the key players--could affect such change. However, this article concentrates on showing how the earlier, more centralized style was increasingly problematic in the rapidly changing circumstances faced by the unit. CONCLUSIONS: In understanding the wider significance of this particular case study, it seems important to understand the strengths and weaknesses of the methodology. If such changes in nurse management are widespread, they represent a new era for nursing in action and one perhaps more consonant with a profession whose status is being enhanced by developments such as diploma and graduate education and the development of specialist roles.

Hospital Restructuring↗
PubMed2003

Participation of professional categories when reorganizing two hospitals--a comparative study and an evaluation.

BACKGROUND: At one University Hospital in Sweden (Hospital A) a new organization had been in effect for 4 years. The main characteristics were patient care departments managed by nurses, consisting of five wards serving organ-specific centres, which were organized in specialized departments managed by physicians. At another University Hospital (Hospital B) a reorganization was in the final planning process. DESIGN: This qualitative study evaluated and compared the process of planning and preparing reorganization at the two hospitals and evaluated the new organization at Hospital A. FINDINGS: Results show that all professional categories were involved all through the planning and preparing process at Hospital A. At Hospital B only physicians were involved. The goals set by the group planning the new organization at Hospital A had been achieved regarding cost effectiveness, personnel development, quality improvement in nursing care as well as other aspects. Nurses and nurse assistants were, for the most part, satisfied with the new organization and if unsatisfied, this was because of other factors. Physicians, in most cases, wanted a physician as manager on the level between the patient care department and the director.

Attitude of Health Personnel↗
PubMed2003

Management of change through force field analysis.

Today's NHS is rapidly changing, placing more emphasis on the managerial responsibilities of ward managers. Managing change is seen as being skilled at creating, acquiring and transferring knowledge to reflect new knowledge and insights. Defining core concepts is often difficult and requires the drawing on models/theories of change for guidance. Guidance from Lewin's (1951) force field analysis demonstrates the complexities of the change process and how driving and resisting forces were incorporated within the planning and implementation phases. Findings outline the benefits of a small scale change for staff, patients and the organization when successfully used to introduce a change of shift pattern within a progressively busy haematology day unit, in order to meet service demands without additional funding. Conclusions have been drawn in relation to the process and recommendations for practice made to further enhance care delivery within the unit.

Attitude of Health Personnel↗
PubMed2003

Redesigning mental health services: lessons on user involvement from the Mental Health Collaborative.

OBJECTIVES: To explore the involvement of mental health service users in the redesign of in-patient mental health services in six Trusts participating in a multi-regional NHS modernization programme. DESIGN: Semi-structured interviews and observation of team meetings undertaken as part of an action research study. PARTICIPANTS AND SETTING: Users, clinical, medical and managerial staff from six mental health trusts which participated in the Northern & Yorkshire and Trent regions' Mental Health Collaborative (MHC). RESULTS AND CONCLUSIONS: Whilst there were some problems, user involvement was undoubtedly a strength of the MHC in comparison to other modernization programmes within the NHS we have studied. However, the particular challenges posed by the specific context of acute mental health services should not be overlooked. The initial approach taken in each of the sites was to simply invite a user or user representative to join the local project team. In the course of events, various changes were made to this initial mechanism for involving users in the ongoing work of the teams. These changes--and setbacks in some sites--make drawing firm conclusions as to the effectiveness of the various strategies employed problematic. However, our qualitative data suggest a number of broad lessons that will assist both those leading and participating in other redesign initiatives to maximize the benefits to be gained from service user involvement.

Community Participation↗
PubMed2001

Use of a modified Postanesthesia Recovery Score in phase II perianesthesia period of ambulatory surgery patients.

Use of discharge criteria in the ambulatory surgery setting has been the topic of many research studies and reviews. This article provides a discussion of a research utilization project regarding the use of a modified Postanesthesia Recovery Score for Ambulatory Patients (PARSAP) in Phase II recovery of a perianesthesia unit. The impetus for this project was the closure of a hospital's only inpatient ward, resulting in all surgery performed on an outpatient basis. Based on community standards and a review of literature, this project evaluated the use of the modified PARSAP on ambulatory surgery patients. The intent of the project was to improve the flow of patients through the recovery process in an effort to contain or reduce costs while still maintaining high-quality patient care standards. Results of the project showed a decreased inpatient length of stay without any increase in reports of postoperative complications. The favorable outcomes of the use of this scoring system have led to its implementation on a permanent basis. This is a U.S. government work. There are no restrictions on its use.

Ambulatory Surgical Procedures↗
PubMed2002

A critical ethnographic approach to facilitating cultural shift in midwifery.

OBJECTIVE: to improve understanding of local midwifery morale, inform development and reorganisation of a maternity unit, and enhance midwifery involvement in strategic planning. PARTICIPANTS: a randomised stratified sample of 20 midwives working in a UK National Health Service (NHS) hospital and its surrounding community area. METHOD: within a critical ethnographic framework, focus groups were tape-recorded and transcribed, and analysed using a thematic content analysis approach. FINDINGS: key areas affecting midwifery morale were identified, in particular staffing levels, working relationships and organisational issues. One year later, despite many changes having taken place, midwifery morale was still low but participants were more politically analytical of, and actively involved in changing their situation. The findings of the study indicate that there are complex and long-standing cultural inhibitions to the effective development of midwifery care but, if these are made explicit through a planned collaborative process, such as in this study, a process of cultural shift can be seen to begin. IMPLICATIONS FOR PRACTICE: focus groups can be a useful tool in moving midwifery culture forward within a local context.

Anecdotes as Topic↗
PubMed2001

The impact of managed care and current governmental policies on an urban academic health care center.

BACKGROUND: Managed care and governmental policies have restructured hospital reimbursement. We examined reimbursement trends in trauma care to assess the impact of this market driven change on an urban academic health center. METHODS: Patients injured between January 1997 and December 1999 were analyzed for Injury Severity Score (ISS), length of hospital stay, hospital cost, payer, and reimbursement. RESULTS: Between 1997 and 1999, the volume of patients with an ISS less than 9 increased and length of stay decreased. In addition, overall cost, payment, and profit margin increased. Commercially insured patients accounted for this margin increase, because the margins of managed care and government insured patients experienced double-digit decreases. Patients with ISS of 9 or greater also experienced a volume increase and a reduction in length of stay; however, costs within this group increased greater than payments, thereby reducing profit margin. Whereas commercially insured patients maintained their margin, managed care and government insured patients did not (double- and triple-digit decreases). CONCLUSIONS: Managed care and current governmental policies have a negative impact on urban academic health center reimbursement. Commercial insurers subsidize not only the uninsured but also the government insured and managed care patients as well. National awareness of this issue and policy action are paramount to urban academic health centers and may also benefit commercial insurers.

Academic Medical Centers↗
PubMed2000

Hospital board structure: changing form and changing issues.

Economic and social pressures are compelling many hospitals to consider their current board structure in an effort to position their hospital to meet changing demands. A national profile of the structures of hospital boards has been compiled from a questionnaire completed by hospital board representatives from both government and non-government sectors. Results show that hospital board structures are a hybrid of both philanthropic and corporate models. New structures may be required to meet future challenges. In developing new structures, consideration should be given to identifying the skills and processes required to undertake board business.

Australia↗