Social responsibility model proposed for organizational ethics.
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Ethics, Institutional↗
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How to make professional practice models work.
Professional practice models and shared governance have had much attention recently. They have been credited with being the answer to nurse retention, advancing the nursing profession, expanding nursing roles, and increasing autonomy for practice and work life. This article describes strategies for implementing and maintaining a professional practice model. Organizational support, nurse manager role change, unit readiness, salaried compensation, and incentives are areas that must be assessed before implementing a model. The models described are unit based and use the concepts of shared governance and group practice.
Humans↗
Hospital schools: a primer on management models and policy implications.
This three-part article, a primer on hospital schools for hospital administrators, discusses laws, student constituencies, epidemiologic trends, and hospital school services; describes hospital school organizational models; and discusses policy implications.
Adolescent↗
Healthcare partnerships for the 21st century.
Traditional business models employed over the last 30 years began breaking down during the '80s and are completely disintegrating during this decade. Traditional organizational models have led to underutilization, waste and unnecessary excess. For healthcare institutions to survive and thrive, a new management model must be implemented by employing business partnerships and alliances to optimize information, systems, products and resources.
Hospital Administration↗
Overcoming the challenges to consumer involvement in cancer research.
INTRODUCTION: Within the last decade, there have been many government initiatives to promote consumer involvement in research, especially in cancer. At the same time, the number and influence of consumer groups themselves have expanded. However, the organizational infrastructure necessary to facilitate consumer involvement has not been developed. Consequently, consumer involvement has tended to remain essentially localized and project driven, with no strategic or regional lead. OPPORTUNITIES FOR INVOLVEMENT AND IDENTIFICATION OF CONSUMERS: The opportunities for consumers to influence the research process at each stage of the research process are identified. The different types of consumer involvement are also examined. Novel ways of identifying and recruiting consumers that have been adopted by one cancer network are discussed. THE STRATEGIES USED IN ONE CANCER NETWORK: An organizational model designed by one cancer network for involving consumers in research is illustrated. Three innovations are examined in detail. First, how three open consumer conferences have increased awareness of research among service users. Second, the recruitment of consumers to sit on project steering groups and a committee that provides a strategic overview of current research. Third, the establishment of a Consumer Panel for Research where reimbursed, trained consumers are able to provide a considered consumer perspective in a range of settings. CONCLUSIONS: Cancer networks need to take the lead in the development of an organizational infrastructure to facilitate consumer involvement. The model developed in Sheffield could be generalizable to other diseases and other health-care settings.
Biomedical Research↗
[Hemodynamic and coronary angiographic performance at a center with medium-low activity: organization model, activity indicators, and costs].
BACKGROUND: In order to evaluate the cost-effectiveness of coronary angiography performed in a low volume Center, we examined our 1-year activity. METHODS: The organizational model of the multipurpose cardiac catheterization laboratory is described. In this type of facility both coronary angiographic and electrophysiological studies are performed. To evaluate the laboratory performance we examined the utilization level, the appropriateness of the studies, the complication rates and the number of studies that had to be repeated because of inadequate data or image quality. The costs were calculated for the in-house laboratory setting (the actual scenario) and for the 25 km distant laboratory setting (the historical scenario). RESULTS: The laboratory caseload of coronary angiography was 342 studies, 46% of the overall laboratory activity; 175 patients (51%) underwent non-pharmacological therapy, 129 patients (38%) were treated with medical therapy; the percentage of patients with normal coronary arteries was 11%. Two patients (0.58%) had vascular complications, 1 patient (0.29%) developed an acute myocardial infarction 2 hours after coronary angiography without any evidence of angiographic modifications at the repeated study. In no patient the study had to be repeated because of inadequate data or image quality. The mean cost of a coronary angiography was Lit. 512,000 (265 Euro) for the actual scenario; it would have been Lit. 694,000 (359 Euro) for the historical scenario, with Lit. 182,000 (94 Euro) saved. CONCLUSIONS: These findings are consistent with the accepted criteria of good laboratory performance and cost-effectiveness. Thus coronary angiography can be performed effectively and efficiently in a low volume Center.
Cardiac Care Facilities↗
[Organization of emergency surgical care to the children of rural districts].
In the rural administrative region a functional organizational model of emergency surgical care system for children's population has been developed through the elaboration and introduction of activities of planned organizational and clinico-tactical nature. The dynamic observation over the quality of emergency surgical care provided to children in this region with the help of expert evaluation method during 13 years confirmed the advisability of this system of care including the rational approach to the planning of needs for emergency surgical beds for children, centralization of hospital care in central regional hospital, unification of clinico-tactical principles at all stages of care, the regulation of populations of patients and the amount of care required at all stages, continuity of hospital and posthospital stages in the rehabilitation of disability and other aspects.
Child↗
Developing and maintaining state-wide adolescent pregnancy prevention coalitions: a preliminary investigation.
This paper presents the results of a study of state-wide adolescent pregnancy prevention coalitions. Key informants in five states throughout the southern United States were given semi-structured interviews regarding the adolescent pregnancy prevention coalitions in their states. From these interviews and other documents, conclusions were drawn regarding the nature and importance of the environments within which these coalitions operate, the universe of activities in which coalitions engage, and the stages of development of these coalitions. Katz and Kahn's model of social organizations served as the basis for understanding coalitions in terms of these three considerations. Future research should consider the utility of organizational models that can explain more fully the organization--committee hybrid structure that tends to characterize these coalitions.
Adolescent↗
Merger as marriage: communication issues in postmerger integration.
Many health care organizations have found themselves involved in mergers, acquisitions, alliances, networks, and other forms of structural change in order to reduce costs, improve utilization and service breadth, increase market leverage, and reduce variation in demand. This article examines three levels of communication issues that interact with one another and impact the likelihood of successful postmerger integration: affect, discursive frame, and negotiating position.
Affect↗
Dignity and psychotherapeutic considerations in end-of-life care.
The basic tenets of palliative care are frequently subsumed under the goal of helping patients to die with dignity. Our research group has studied the issue of dignity, with dying patients serving as the primary informants. This paper reviews some of our findings, including an overview of the Dignity Model that derives from our empirical work. Furthermore, this paper summarizes various psychotherapeutic approaches which have been considered for this vulnerable patient population. Finally, we provide the rationale based on the Dignity Model for a psychotherapeutic intervention we have coined Dignity Therapy. This brief, individualized therapeutic approach has been informed by our dignity work, and specifically designed for application in patients nearing death.
Attitude to Death↗
The child welfare system: through the eyes of public health nurses.
OBJECTIVE: This qualitative descriptive study investigates how public health nurses working within the child welfare system view the organization and the organization's effect on their case management practice. DESIGN: Semistructured interviews were conducted utilizing the Bolman-Deal Organizational Model. This model identifies four frames of an organization: symbolic, human resources, political, and structural. SAMPLE: A purposive sample of nine nurses and one social worker was selected to participate in comprehensive interviews. RESULTS: Data analysis identified two main themes. The first theme was the presence of organizational structural barriers to providing case management. The second theme was the lack of political influence by the nurses to change the structure of the organization; hence, their skills could be more completely utilized. CONCLUSIONS: Public health nurses who work in child welfare will need to systematically analyze their role within the organization and understand how to work in "host settings." Nursing educators need to prepare public health nurses to work in non-health care settings by teaching organizational analysis.
Attitude of Health Personnel↗
Reforming health care for the elderly--the example of Vorarlberg.
Vorarlberg--Austria's most western province with a population of about 325,000--has always implemented forms of social policy in which the principles of subsidiarity and solidarity play an important role. This is reflected in the structure of the organizations traditionally providing social services as well as in the more recent programmes the government has developed for social policy. This paper discusses two cases in point: the private associations for home care (Krankenpflegerverbände)--which now exist in 65 Vorarlberg communities and cover 85% of the population in the province--offering nursing services at home to members or to persons who are willing to join the organization when they need care, and the new organizational model, called Gesunder Lebensraum Vorarlberg (GLV), which is successfully operating in a few pilot communities. GLV has spawned umbrella organizations, run by volunteers, and offering a variety of social services relevant to the elderly, for example visiting services or neighbourhood help in case of emergencies. The volunteers get organizational help from a profit-making firm financed by the government. The Vorarlberg models can be interpreted as a step towards demedicalization and deinstitutionalization of health care for the elderly. Nevertheless, they also show the problems that arise when professionals and volunteers must cooperate. The models may lead to savings for the governments involved, although details are still subject to future empirical investigations.
Aged↗
Organization of nursing care as a determinant of job satisfaction among hospital nurses.
This study examined the relationship between methods of organizing nursing and employee satisfaction. Data were collected from 26 ward sisters and 568 nurses working in 26 bed wards with different stabilized nursing models. Methods of organizing nursing, such as primary, modular, team and functional nursing, were associated with job satisfaction. However, this association involved only certain features of these organizational models and specific components of satisfaction. After the effects of demographic and ward characteristics were partialed out, hierarchical regression analyses showed that patient-focused work allocation, opportunity to write nursing notes and accountability for patient care contributed to nurses' satisfaction with supervision and personal growth. The relationships of duty rota and liaison with other discipline to job satisfaction were weaker or non-existing.
Attitude of Health Personnel↗
[Avoidable perinatal deaths and obstetric health care structure in the public health care system: a case study in a city in greater metropolitan Rio de Janeiro].
This paper investigates the occurrence of potentially avoidable perinatal deaths by associating failures in obstetric care with structural deficiencies in four maternity hospital comprising the local health care system in a city in Greater Metropolitan Rio de Janeiro in 1994. Information sources were a questionnaire, interview, observation, and hospital records. A theoretical organizational model was applied in data analysis. The four maternity hospitals showed problems in the three groups of factors used in this study: physical infrastructure, services, and equipment; organizational and administrative characteristics; and professional organization. In two maternity hospitals, the delay in cesarean deliveries was explained by deficiencies in the group of factors that includes facilities, services, and equipment. Health care failures directly associated with the physician were explained by high percentages of negative predisposing factors (mainly in the two private hospital), skill-related problems (more clearly in the two public hospitals), and by absence of measures for redirecting practice.
Brazil↗
[Organizational technologies and management of the organs and institutions of the State Sanitary and Epidemiological Surveillance in the Russian Federation].
The authors offer a scientifically-based rationale for the system of management of the State Sanitary and Epidemiological Service and its institutions under modern socioeconomic conditions in Russia. Organizational models of the structure of State Sanitary and Epidemiological Surveillance Centers are offered and their functions determined for various levels of management. A concept of development and organizational structure of the service and its institutions is proposed, aimed at provision of sanitary and epidemiological well-being in the Russian Federation.
Epidemiology↗
The behavioral medicine service. An administrative model for biopsychosocial medical care, teaching, and research.
The biopsychosocial model has been promoted for its advantages in many important health problems. However, the lack of administrative practice models specifically designed to develop and promote the model hinder the development of systematic clinical applications. This article describes a successful clinical teaching and research practice, The Behavioral Medicine Service, that was conceptualized and developed based on the biopsychosocial model. Systematic planning enabled the service to take advantage of clinical, research, and teaching opportunities and to reduce the constraints imposed on development from within psychiatry and the institution. Advantages of the organizational model include multidisciplinary treatment teams, a systematic method of biopsychosocial assessment and management planning, and continuity of care between several settings: the medical-surgical wards of a general hospital; a behavioral medicine inpatient unit; and outpatient subspecialty clinics for chronic pain, chronic medical illness, anxiety and stress-related disorders, and drug and alcohol abuse. The Human Behavioral Pharmacology Laboratory forms the research arm of the service. Referrals of a diversity of medical and psychiatric problems create a unique learning opportunity for residents. Billing for multimodal team treatment, training residents, establishing clinical research, and managing a plethora of referrals were developmental challenges addressed by the service.
Behavioral Medicine↗
Redesigning case management in managed care: an eclectic approach: from city to ranch.
Case management programs are a common approach to managing the quality and cost of services in managed care organizations. Once developed these programs may grow stagnate as the managed care member population grows and changes. This article presents a redesign project initiated by a managed care organization located in a rural Southwest region of the United States. Nursing theory and case management standards of practice form the basis of the redesign project and will be discussed. The case management model, including roles and responsibilities of staff, are presented. Results and future implications are identified.
Case Management↗
Strategic management of a continuum of care.
Why would an organization want to undertake the changes required to be a continuum of care? Because providers of residential and long-term nursing care that continue to function in isolation may survive, but they will not thrive in the 21st century.
Aged↗