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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↗

PubMed2001

Family-centered maternity care in the new millennium: is it real or is it imagined?

Family-centered maternity care (FCMC) has become a familiar phrase in today's maternity services; however, the actual implementation in many hospitals is likely to be more "staff-centered" than "family-centered." This article gives an overview of the historical development of family-centered care and the importance of this model of care to a new or growing family's ability to adapt to the stress of birth and parenting. The current status of FCMC is reviewed in relation to prenatal education, intrapartum care, mother-baby nursing, and family visitation. Many lessons have been learned about implementing FCMC over the past 20 years. Suggestions are provided regarding the development of a vision and mission, the institutional culture, systems and clinical management, staff attitudes, and involvement of families.

Adaptation, Psychological↗

PubMed2005

Hardiness scales in Iranian managers: evidence of incremental validity in relationships with the five factor model and with organizational and psychological adjustment.

This study examined the incremental validity of Hardiness scales in a sample of Iranian managers. Along with measures of the Five Factor Model and of Organizational and Psychological Adjustment, Hardiness scales were administered to 159 male managers (M age = 39.9, SD = 7.5) who had worked in their organizations for 7.9 yr. (SD=5.4). Hardiness predicted greater Job Satisfaction, higher Organization-based Self-esteem, and perceptions of the work environment as being less stressful and constraining. Hardiness also correlated positively with Assertiveness, Emotional Stability, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness and negatively with Depression, Anxiety, Perceived Stress, Chance External Control, and a Powerful Others External Control. Evidence of incremental validity was obtained when the Hardiness scales supplemented the Five Factor Model in predicting organizational and psychological adjustment. These data documented the incremental validity of the Hardiness scales in a non-Western sample and thus confirmed once again that Hardiness has a relevance that extends beyond the culture in which it was developed.

Adaptation, Psychological↗

PubMed1996

Developing a cooperative provider-based statewide peer review service: early experience.

The purpose of this study was to demonstrate the feasibility of a model of overcoming local barriers to physician peer review through development of a statewide provider-based physician peer review service. For this purpose, the cooperative demonstration project of the Institute for Quality Healthcare, The University of Iowa and The Robert Wood Johnson Foundation, was used. A consortium of 43 Iowa hospitals developed a physician peer review service utilizing a pool of physician reviewers from member hospitals. Thirty-six peer reviews were conducted in 23 different hospitals by 37 different reviewers throughout the state of Iowa in the first 2 years of operation. Reviews of surgical specialists, psychiatrists, and psychiatric services were requested most frequently. The satisfaction of hospitals with the physician peer review service has thus far been gratifying. The long-term financial viability of the physician peer review service has yet to be demonstrated. This cooperative organizational model of a provider-based physician peer review service may be reproducible and valuable to health care providers in other parts of the United States.

Academies and Institutes↗

PubMed1985

A clinical nurse specialist in a line management position.

The authors describe their experiences utilizing a clinical nurse specialist in a middle management role in an organizational framework to support primary nursing. They describe the original design and planning of the organizational model 12 years ago, the administrative supports that have been added in the intervening years, and how professional and administrative authority are integrated by the clinical nurse specialist in a line position.

Administrative Personnel↗

PubMed2004

Developing research management and governance capacity in primary care organizations: transferable learning from a qualitative evaluation of UK pilot sites.

BACKGROUND: The capacity and capabilities for undertaking primary care research have increased both within and outside of the UK in recent years. The UK Department of Health aims to facilitate this further by establishing a national network of primary care organizations (PCOs) ready to act as hosts for shared research governance systems. However, it is unclear which models offer the most effective option. In addition, there is confusion over new processes and concern that researchers may be deterred from addressing important questions. OBJECTIVES: The research ascertains how PCOs selected as pilot sites have organized research management and governance (RM&G). METHODS: We adopted a case study approach involving interviews with key informants in a purposive sample of eight pilot PCO (RM&G) sites. RESULTS: Motivating factors for PCOs to host RM&G included the possibility of additional resources and more effective use of research to improve service delivery. A range of organizational models were adopted, often reflecting existing strategic alliances. It is envisaged that it will not be effective or cost-effective for many PCOs to make individual arrangements for RM&G, and so models are already developing among groups of PCOs and partner organizations. The extent of partnerships between PCOs varied with concern over critical mass and dilution of expertise in larger groupings. The development and implementation of systems in pilot sites was facilitated by the support of the wider PCO in recognizing research as a valued and integral part of the organization; the effective management of relationships and the establishment of equal partnership arrangements for RM&G, and the effective use of existing R&D infrastructure and expertise. CONCLUSIONS: RM&G partnerships vary according to local circumstances. It is likely that groupings will develop in the future with increasing co-terminosity and across wider health organization boundaries, such as Strategic Heath Authorities (in the UK) or primary care research networks. Critical mass of RM&G arrangements is likely to be linked to levels of research activity. There are real concerns over the levels of bureaucracy associated with the implementation of research governance; however, those PCOs that develop as RM&G sites have the opportunity to enrich their organizations and expand clinically relevant R&D. Partnership working within PCOs and with primary care research networks, academic departments or acute trusts, may be the key to success. Those undertaking research within primary care settings outside of the UK can learn important lessons from the UK experience and ensure development of high quality research that informs improvements in patient care.

Delivery of Health Care↗

PubMed1988

[Need for social psychiatric services--a management model in scientific evaluation].

Social-psychiatric services have for a long time been a focus in the controversial discussion about the further development of outpatient mental health care. Presented is the Baden-Württemberg Social Psychiatric Services model, which is oriented towards outpatient social welfare provision of persons with chronic mental illness, complementing the medical-psychiatric treatment provided by office-practice psychiatrists. Evaluation of the Social Psychiatric Service for its first year of full operation, 1984, has shown that this type of service delivery organization is capable, above all, of reaching persons with "recently" chronic mental illness, who are serviced in the framework of community mental health care systems mainly on an outpatient basis. Provision of care, i.e. of social welfare and counselling measures, may in this group constitute an efficient contribution towards their social rehabilitation. Effective functioning of this organizational model presupposes sufficiently well-established cooperation with other facilities and services involved in service provision, which, as the Baden-Württemberg trial has shown, can in actual fact be ensured.

Chronic Disease↗

PubMed1996

Nurse teacher's clinical work: a survey report.

This paper reports on the results of a survey of nurse teachers in four colleges of nursing in England (n = 126). Data were collected using a questionnaire survey. In this survey a five-point Likert scale was developed from an earlier study, to explore nurse teachers' perception of this clinical role. The findings indicate that a number of factors may be influential in the way in which nurse teachers approach their clinical activity. This includes personal factors such as age, educational grade and the length of time spent working in nurse education. Organizational factors also appear to make a difference in the teacher who worked in an organizational model which ensured a smaller number link ward areas were more likely to exhibit a positive and orientation towards clinical work. Factor analysis of the clinical scale resulted in loading of items relating to confidence in clinical role, preparation for the role, influence in clinical area and supervision of students in clinical areas. The implications of these findings are discussed.

Adult↗

PubMedDate not supplied

[Vertical integration and contracting-out in generic hospital services in Spain].

OBJECTIVES: This study examines the factors that influence make or buy decisions corresponding to four generic services (housekeeping, laundry, food services, and maintenance and security) in Spanish hospitals (3,160 transactions in 790 hospitals). METHODS: The empirical estimation of a logistic model based on hospital utility maximization is presented. Factors included in the model are not only those related to transaction costs, but also those related to public intervention and the political dimension. RESULTS: A total of 55.7% of hospitals contracted-out at least one of the generic services. The services most frequently contracted-out were housekeeping and maintenance and security(45.1 and 32.5%, respectively). In contrast, the services (94.3% and 80.1%, respectively). Hospital size (economies of scale), measured by the number of beds, was one of the most important factors influencing make or buy decisions. CONCLUSIONS: We find evidence that economies of scale are related to a higher level of vertical integration, while specialization and for-profit objectives favor the decision to contract-out. The choice of organizational model for laundry services presents a different pattern from that of the other three services. Empirical results show that some asset specificity could be present in laundry services.

Food Service, Hospital↗

PubMed1976

The Imbrication Model for the integration of social services in a community.

An innovative model for organising social services in a community, the Imbrication Model, is contrasted with two traditional models, the Entrepreneurial and the Umbrella Agency. The structural characteristics and dynamics of the three models are illustrated with actual case histories. Imbrication Model calls for the interlocking of personnel from several agencies, with the purpose of redirecting the dysfunctional interagency rivalry prevalent in the traditional models. Imbrications at all organisational levels--Board of Directors, Administrators and Staff--facilitate adoption of the superordinate goal of providing clients with the best services available, regardless of which particular agency delivers the service. Few observers of the current social service scene would challenge the statement that needs for service are unlimited and resources limited. In the USA the imbalance between needs and resources persists despite a decade of massive governmental programmes intended to alleviate social ills. Recent substantial cutbacks in federal funds, moreover are not likely to improve the situation. The resource shortage involves more than a limitation of funds. Deliverers of service and competent programme administrators are also on critically short supply. These shortages are more often than not exacerbated by a chronic spirit of competition among agencies and programmes at the local level. Three organizational models for the delivery and administration of social services, two conventional and one of more recent date, are examined in this article. The innovative model, which has been named the Imbrication Model, explicitly calls for redirecting interagency rivalry and competition. Its ambitious goal is to integrate the efforts of those attempting to meet a community's social service needs.

Adolescent↗

PubMed1996

Family physicians' involvement in two hospitals. Two different models of inpatient care.

OBJECTIVE: To describe the roles of family physicians in two hospitals with different models of inpatient care. DESIGN: Cross-sectional descriptive study of a random sample of 11528 patients admitted to two hospitals between 1985 and 1988. SETTING: Two acute-care community hospitals in suburban Montreal, Que. SUBJECTS: Family physicians providing inpatient care at the two hospitals. MAIN OUTCOME MEASURE: How often family physicians were attending physicians (attending responsibility); what percentage of patients were visited by at least one family physician (case load); and what percentage of bedside visits were made by family physicians (workload). RESULTS: In one hospital, where family physicians were actively promoted as primary care providers, they were frequently attending physicians, had heavier case loads, and made more patient visits. Also, they collaborated more often with specialists. In the other hospital, family physicians tended to care for specific populations of patients. CONCLUSION: When hospitals promote different organizational models of medical care, family physicians' roles are affected.

Hospitals, Community↗

PubMed2005

[The development of an organizational socialization process model for new nurses using a system dynamics approach].

PURPOSE: The purpose of this study was to examine the problems and relevant variables for effective Organizational Socialization of new nurses, to produce a causal map, to build up a simulation model and to test its validity. METHOD: The basic data was collected from Sep. 2002 to July 2003. The Organizational Socialization process of new nurses was analyzed through a model simulation. The VENSIM 5.0b DSS program was used to develop the study model. RESULT: This Model shows interrelation of these result variables: organizational commitment, job satisfaction, job performance, intention of leaving the work setting, decision making ability, and general results of Organizational Socialization. The model's factors are characteristic of organization and individual values, task-related knowledge and skills, and emotion and communication that affects new nurses' socialization process. These elements go through processes of anticipatory socialization, encounter, change and acquisition. The Model was devised to induce effective Organizational Socialization results within 24 months of its implementation. The basic model is the most efficient and will also contribute to the development of knowledge in the body of nursing. CONCLUSION: This study will provide proper direction for new Nurse's Organizational Socialization. Therefore, developing an Organizational Socialization Process Model is meaningful in a sense that it could provide a framework that could create effective Organizational Socialization for new nurses.

Adult↗

PubMed1991

Establishing a rural hospital cooperative: a case study.

Rural hospitals have traditionally been the providers of health services in rural areas. In recent years, however, rural hospitals have come under increasing economic and regulatory stress. Rural hospital cooperatives represent a new level of shared management that addresses mutual problems using a horizontal organizational model. In 1987, the Western New York Rural Health Care Cooperative was established by building on fragments of associations that had existed previously. Triggered by an opportunity for grant funding, a major regional cooperative evolved which has demonstrated effective responses to a variety of problems inherent in providing rural health care. Particularly successful programs have such features as a quality assurance plan that uses cooperative-wide peer review, nursing and allied health education, physician recruitment, and the active involvement of a university medical school. This paper is a case study of the development and success of the Western New York Rural Health Care Cooperative.

Hospitals, Rural↗

PubMedDate not supplied

Healthcare on the horizon: getting ready for a preferred future.

The untenable cost of health service entitlements and the indefensible per-unit cost of service have provided the impetus for radical changes in healthcare service provision, including managed care. In a managed care environment, focusing solely on sickness care threatens the viability of the organization. Careful assessment of service structures should occur, a shift in the strategic efforts of the system is defined and a refocusing of the design of service is a central component of the organizations work. A more integrated organizational model and a broader understanding of health care service are the keys to survival. Changes we have seen so far lay the groundwork for a large-scale evolution that will take place over the next two decades. Developments that remain ahead include increased emphasis on health maintenance and growing effort to bring health services into the community itself. Wise health professionals will be thinking in terms of a career rather than a job. Education, breadth of talents, portability of skills and mobility of role become central to the ability to thrive in the new decade. Today's unpredictable atmosphere demands insight, fluidity and willingness to change and grow.

Career Mobility↗

PubMed1976

[Experiences from a function as consultant of geriatrics in a district schwerin (author's transl)].

Consultant of geriatric, district. There is given an organizational model in complex care of the elderly in the district of Schwerin. The continuous care of the elderly, adequate to their requirements, wishes, problems, and difficulties by complex measures is an important part for the realization of the social-political tasks of the SED and government. Especially in the district of Schwerin there are a lot of initiatives and already good results of effects in principle. For the further improvement of the medical and social care for the aged is based in a foundation of a special working groups of general practioners in the district of Schwerin which coordinates all activities in this field. In this working group and its activities participate all local geriatrics (Kreisfachberater für Geriatrie) under the chiefment of the district consultant of geriatrics.

Aged↗

PubMedDate not supplied

Networked incubators. Hothouses of the new economy.

Business incubators such as Hotbank, CMGI, and Idealab! are a booming industry. Offering office space, funding, and basic services to start-ups, these organizations have become the hottest way to nurture and grow fledgling businesses. But are incubators a fleeting phenomenon born of an overheated stock market, or are they an important and lasting way of creating value and wealth in the new economy? The authors argue that one type of incubator, called a networked incubator, represents a fundamentally new and enduring organizational model uniquely suited to growing businesses in the Internet economy. It shares certain features with other incubators--mainly, it fosters a spirit of entrepreneurship and offers economies of scale. But its key distinguishing feature is its ability to give start-ups preferential access to a network of potential partners. Such incubators institutionalize their networking--they have systems in place to encourage networking, helping start-ups, for example, to meet with potential business allies. That doesn't mean incubatees get preferential treatment; it means only that they have built-in access to partnerships that might not have existed without the incubator. Even with this advantage, however, networked incubators can easily follow the road to ruin. To avoid failure, they must create a portfolio of companies and advisers that their incubatees can leverage. That can be done by strategically investing in portfolio firms and by enlisting a large set of business allies. It can also be done by establishing connections and relationships that are anchored more to the incubator than to particular individuals.

Cooperative Behavior↗

PubMed2004

Behavioural disorders induced by external globus pallidus dysfunction in primates: I. Behavioural study.

The current model of basal ganglia organization postulates the existence of a functional partitioning into sensorimotor, associative and limbic territories, implicated in motor, cognitive and emotional aspects of behaviour, respectively. This organization was proposed initially on the basis of the cortico-striatal projections and was extended to the various structures of the basal ganglia. While there is a considerable body of experimental evidence in support of an involvement of the basal ganglia sensorimotor territory in basic control of movements, evidence for the functional relevance of the non-motor territories has had to be based on a growing number of clinical observations due to the paucity of relevant animal studies. Previous studies in monkeys have, however, shown that a reversible and focal dysfunction induced by microinjections of bicuculline in the sensorimotor territory of the external globus pallidus (GPe) can generate abnormal movements. We therefore hypothesized that the same approach applied to the associative and limbic territories of the GPe would induce behavioural disorders rather than abnormal movements. To address this hypothesis, we performed microinjections of bicuculline, using the same concentration in each of the sensorimotor, associative and limbic territories of the GPe, as defined by striato-pallidal projections. Spontaneous behaviour and performance of a simple food-retrieving task during the effects of these microinjections were compared with data obtained in control conditions in the same monkeys. We found that bicuculline microinjections induced stereotypy when performed in the limbic part of the GPe, and attention deficit and/or hyperactivity when performed in the associative part. No movement disorders were observed during these behavioural disturbances. As previously described, abnormal movements were observed when bicuculline was injected into the sensorimotor territory of the GPe. The relationship between the localization of microinjection sites and the type of behavioural effect was similar for the three monkeys. Control microinjections of bicuculline into surrounding structures (striatum and internal globus pallidus) and saline injections into the GPe failed to induce any observable effect. These results support the hypotheses of functional diversity and territorial specificity in the GPe, in agreement with the parallel circuits organizational model of the basal ganglia. Furthermore, the behavioural effects shared similar features with symptoms observed in Tourette's syndrome, attention deficit/hyperactivity and compulsive disorders. Thus, our study provides experimental evidence for the involvement of the associative and limbic parts of the basal ganglia in these pathologies. These results may provide the basis for a primate model of these disorders.

Animals↗

PubMed1998

Surgery in Sweden.

Sweden has 9 university and regional hospitals and about 75 county hospitals. These hospitals are funded by counties that directly tax their inhabitants. In addition, the university hospitals use state money for education and research. The private sector performing major surgical procedures is small but slowly increasing. Reorganizations and closings of smaller hospitals are continually occurring, and various organizational models are being tested. Surgical care for inpatients is free for Swedish citizens; however, there is a small fee for outpatient care (US $10-$20 per visit). Education in surgery is changing rapidly with the introduction of new methods. Clinical research closely connected to basic sciences will be of profound importance for future development. The present article is confined mainly to general surgery in Sweden, but it also covers some general aspects of medicine in Sweden.

General Surgery↗