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PubMedDate not supplied

Managing variances in case management.

Timely management of variances is vital for cost effective patient care. A multifaceted approach that involves the healthcare team, patient, and family facilitates the identification and management of variances as they occur. The critical path can be used to monitor variances that influence fiscal outcomes in select patient populations. Strategies are described that can be used to monitor and manage variances, including developing a mechanism for monitoring and managing variances, implementing that mechanism, and evaluating the process for usability. Monitoring variances includes choosing tools that will be used and staff who will assume primary responsibility, and initiating an outcome analysis program. Managing variances comprises organizing an interdisciplinary committee, establishing a communication plan, creating strategies, and using continuous quality improvement teams.

Case Management↗

PubMed1997

Classic nursing management skills and disease management: something old, something new.

With the advent of managed care, nursing has the opportunity to shine through the current chaos in the health care industry because of its steadfast use and necessary expertise in the five classic management skills: planning, coordinating, controlling, delegating, and communicating. The new focus on disease management provides nursing with the best chance ever to position itself as the most skilled and pivotal player in an incredibly competitive arena. The five skills will be described in the new context of disease management, with the hope that nurses in diverse roles will demonstrate that excellent management of clinical care is a patient's best chance for achieving optimal outcomes and a health care system's best chance at achieving value.

Disease Management↗

PubMed1999

Reengineering outcomes management: an integrated approach to managing data, systems, and processes.

The integration of outcomes management into organizational reengineering projects is often overlooked or marginalized in proportion to the entire project. Incorporation of an integrated outcomes management program strengthens the overall quality of reengineering projects and enhances their sustainability. This article presents a case study in which data, systems, and processes were reengineered to form an effective Outcomes Management program as a component of the organization's overall project. The authors describe eight steps to develop and monitor an integrated outcomes management program. An example of an integrated report format is included.

Attitude of Health Personnel↗

PubMed1994

Anticipated changes in the doctor-patient relationship in the managed care and managed competition of the Health Security Act of 1993.

The doctor-patient relationship is the cornerstone of medical ethics, yet the relationship will change significantly under the Health Security Act of 1993. In a way, managed care and managed competition are a return to the old medical ethics: doing everything reasonable and probably beneficial for all, instead of going all out for each. Five central questions may help physicians and policy makers anticipate a paradigm shift in ethics. An analysis of these questions suggests that managed care and managed competition challenge physicians' roles as trustworthy patient advocates. Fortifying doctor-patient relationships in managed care would be prudent and wise and would help to achieve the ethical allocation of limited resources. By protecting patients' personal medical interests and empowering patients to do the same, doctors can attempt to safeguard trust. Both doctors and patients want to have strong, personal, values-oriented relationships. Whether such relationships are possible under the Health Security Act remains to be seen.

Competitive Medical Plans↗

PubMedDate not supplied

'Managing the cracks': management development for health care interfaces.

The realm of public policy (including health policy) is, in many ways, more complex than that of decision-making within the corporate organisations found in the private sector. The range of stakeholders is generally wider; many of the ways of influencing action are more subtle and indirect; and, arrangements for representation, accountability and consultation are correspondingly more elaborate. A future of this complexity in healthcare systems is the presence of numerous organisational and managerial interfaces. The paper considers three key sectors and the interfaces between them: primary health care, hospital care, and community care. Proposals for reforming the British National Health Service and community care services are destined to multiply the interfaces to be managed since they are predicated upon a split between purchasing services and providing them. The intention is to encourage a plurality of providers who will compete for contracts. The paper argues that the challenge posed by interface management is probably greater than any other in healthcare management. The requisite skills for successful interface management are reviewed. The paper concludes that these network skills are in short supply and that those responsible for management development in the NHS must tackle this lacuna as a matter of some urgency.

Administrative Personnel↗

PubMed2001

Benefits of collaborative learning for environmental management: applying the integrated systems for knowledge management approach to support animal pest control.

Resource management issues continually change over time in response to coevolving social, economic, and ecological systems. Under these conditions adaptive management, or "learning by doing," offers an opportunity for more proactive and collaborative approaches to resolving environmental problems. In turn, this will require the implementation of learning-based extension approaches alongside more traditional linear technology transfer approaches within the area of environmental extension. In this paper the Integrated Systems for Knowledge Management (ISKM) approach is presented to illustrate how such learning-based approaches can be used to help communities develop, apply, and refine technical information within a larger context of shared understanding. To outline how this works in practice, we use a case study involving pest management. Particular attention is paid to the issues that emerge as a result of multiple stakeholder involvement within environmental problem situations. Finally, the potential role of the Internet in supporting and disseminating the experience gained through ongoing adaptive management processes is examined.

Animals↗

PubMed2005

Safety culture and crisis resource management in airway management: general principles to enhance patient safety in critical airway situations.

Airway management is a cornerstone of patient safety in anaesthesiology and in emergency and critical care medicine. Deficiencies in airway management could have catastrophic results for the patient. In anaesthesia patients, in particular, a high level of safety should be expected. It has been proven in other high-risk and complex industrial fields that obtaining very high levels of safety requires special strategies and safety philosophies in order to guarantee long-term low-risk production. The concept of safety culture has invaded many industries, more recently including medicine. Concepts of the high reliability organizations (HROs) are now ready to be adapted to medicine and offer promising improvements in health care. This paper applies some of the HRO principles to airway management and illustrates how to transform more general strategies to practical application in the clinical world. This includes the use of key elements of crisis resource management (CRM) and the development of a checklist for safety in airway management.

Anesthesiology↗

PubMed2004

Infertility practice management. I. Leadership and management style: results from the 2002 survey of 374 Society for Assisted Reproductive Technology member centers.

OBJECTIVES: To identify current trends in management and leadership styles in Society for Assisted Reproductive Technology (SART) member infertility centers; and to understand the similarities and disparities that exist in physicians', administrators', and staff perceptions of management and leadership styles in these centers. MATERIALS AND METHODS: Questionnaires were developed to collect information on the leadership and management styles in place in SART member infertility centers. Survey instruments were distributed to the 374 SART centers. Survey instruments for one physician, the center administrator, and six staff members (two each in nursing, laboratory, and administration) were issued to the SART liaison in each of the SART member centers. Respondents included physicians, practice administrators, nurses, technicians, patient services, billing, and support staff. RESULTS AND DISCUSSION: Analysis of respondents' answers revealed that surveyed staff members reported a fairly high degree of job satisfaction. Physician and administrator management styles seemed to fall between interactive and directive styles; however, physicians and administrators perceived themselves as being more interactive than other staff members viewed them. Overall, extreme differences were unlikely, given the reported high degree of job satisfaction. Finally, survey outcome data were compared with responding centers' ART outcome rates as published by the Centers for Disease Control and Prevention (CDC). CONCLUSIONS: Overall, although employee job satisfaction seemed to be high, there were statistical differences between groups for several questions; the disparities in responses for these questions are indicators for potential management and leadership consideration. In addition, statistical correlations were found between the responses for several questions and the centers' respective CDC-published ART outcome rates.

Adult↗

PubMed2003

Process safety management in the pipeline industry: parallels and differences between the pipeline integrity management (IMP) rule of the Office of Pipeline Safety and the PSM/RMP approach for process facilities.

In 2001, the Federal Office of Pipeline Safety promulgated its pipeline integrity management rule for hazardous liquid pipelines. A notice of proposed rule making for a similar rule for gas pipelines was issued in January 2003. A final rule must be in place by the end of 2003. These rules derive from formal risk management initiatives of both the pipeline industry and the regulators beginning in the early to mid-1990s. The initiatives and resulting rules built on many of the process safety and risk management concepts and frameworks of the process industries, as modified for pipelines. Looking closely at the parallels and the differences is an interesting study of how the technical, public and industry-specific requirements affect the types of regulations, supporting management system frameworks and the technical activities for improving hazardous materials process safety. This paper is based on the experience of the author in project work with federal and state regulators and with industry groups and companies, in both the process and pipeline industries over the last 17 years. It provides insights into various alternative pathways for communicating process safety concepts and improving process safety as the concepts are translated into specific company and even individual employee actions. It specifically highlights how the commonalities and differences in the types and configurations of physical assets and operating practices of the pipeline companies and process facilities affect respective cultures, language and actions for process safety management.

Communication↗

PubMed2004

The use of "as-needed" range orders for opioid analgesics in the management of acute pain: a consensus statement of the American Society for Pain Management Nursing and the American Pain Society.

The use of "as needed" or "PRN" range orders for opioid analgesics in the management of acute pain is a common clinical practice. This approach provides flexibility in dosing to meet individual patients' unique analgesic requirements. Range orders enable necessary and safe dose adjustments based on an individual's response to treatment. The purpose of this paper is to present the consensus statement of the American Society for Pain Management Nursing and the American Pain Society on the use of "as-needed" range orders for opioid analgesics in the management of acute pain. The implementation of this statement should promote quality pain management through safe medication practices and the appropriate use of range orders for opioid analgesics in acute pain management.

Acute Disease↗

PubMed2000

Cholesterol management in the era of managed care.

Several large controlled clinical trials have documented that cholesterol lowering causes a marked reduction in major coronary events in patients with established coronary heart disease. Cholesterol lowering thus joins other proven therapies for risk reduction in secondary prevention. The need to include cholesterol-lowering therapy in secondary prevention has been endorsed as a new practice measure in the Health Plan Employer Data Information Set. This endorsement ensures that managed care will get behind the effort to better control cholesterol in patients with coronary heart disease. The next issue is whether managed care will support cholesterol-lowering therapy in primary-prevention patients. The patients at highest risk for developing coronary heart disease are those with noncoronary forms of atherosclerotic disease, type 2 diabetes, multiple risk factors, and risk factors plus evidence of advanced subclinical atherosclerosis. Such patients can be said to have coronary heart disease risk equivalents. These patients should be good candidates for aggressive cholesterol management. A strong case can be made for managed-care support for this approach. Support for treatment of patients at lower risk may be open to some question, but the current guidelines of the National Cholesterol Education Program provide a strong rationale for cholesterol management for primary prevention in the medical setting.

Anticholesteremic Agents↗

PubMed2002

Improving the quality of anticoagulation of patients with atrial fibrillation in managed care organizations: results of the managing anticoagulation services trial.

Randomized trials have indicated that well-managed anticoagulation with warfarin could prevent more than half of the strokes related to atrial fibrillation. However, many patients with atrial fibrillation who are eligible for this therapy either do not receive it or are not maintained within an optimal prothrombin time-international normalized ratio (INR) range. We sought to determine whether an anticoagulation service within a managed care organization would be a feasible alternative for providing anticoagulation care. We performed a multi-site randomized trial in six large managed care organizations in the United States. Subjects were aged 65 years or older and had nonvalvular atrial fibrillation. At each site, physician practices were divided into two geographically defined practice clusters; each site was randomly assigned to have one intervention and one control cluster. The intervention cluster received an anticoagulation service that satisfied specifications for high-quality anticoagulation care and was coordinated through the managed care organization. Control clusters continued with their usual provider-based care. We measured the proportion of time that warfarin-treated patients in each of the clusters (intervention and control) were in the target range for the INR at baseline, and again during a follow-up period. Five of the six selected sites succeeded at developing an anticoagulation service. Patients in the intervention and control clusters had similar demographic characteristics, contraindications to warfarin, and risk factors for stroke. Among patients (n = 144 in the intervention clusters; n = 118 in the control clusters) for whom data were available during the baseline and follow-up periods, the changes in percentages of time in the target range were similar for those in the intervention clusters (baseline: 47.7%; follow-up: 55.6%) and in the control clusters (baseline: 49.1%; follow-up: 52.3%; intervention effect: 5%; 95% confidence interval: -5% to 14%; P = 0.32). Although it was feasible in a managed care organization to implement anticoagulation services that were tailored to local circumstances, provision of this service did not improve anticoagulation care compared with usual care. The effect of the anticoagulation service was limited by the utilization of the service, the degree to which the referring physician supports strict adherence to recommended target ranges for the INR, and the ability of the anticoagulation service to identify and to respond to out-of-range values promptly.

Aged↗

PubMed2003

The problem and management of sickness absence in the NHS: considerations for nurse managers.

AIM: This paper examines the topic of sickness absence management in the context of the healthcare sector. BACKGROUND: National Health Service (NHS) employee absenteeism is an expensive and difficult problem. Nurse managers need to assess the extent and characteristics of absenteeism, be aware of their organization's sickness policies, evaluate the effectiveness of these policies and contribute to the development of related initiatives to ensure prudent management of sickness absence. METHOD: A literature review has been undertaken, providing a broad conceptual context by which the problem of sickness absence in the NHS can be examined. The focus of this paper is to examine the accumulation of research based knowledge to provide a healthcare perspective on the problem of sickness absence management. CONCLUSION: Sickness absence management within the NHS is challenging but provides opportunities to improve the working lives of NHS employees. Sickness absence cannot be eradicated but it can be reduced by a selection of measures that reflect the uniqueness of the NHS. The many and diverse causes of sickness absence need acknowledgement, when devising strategies that can effectively provide solutions to the problems of sickness absence.

Absenteeism↗

PubMed2002

The Blood Stocks Management Scheme, a partnership venture between the National Blood Service of England and North Wales and participating hospitals for maximizing blood supply chain management.

BACKGROUND AND OBJECTIVES: The Blood Stocks Management Scheme (BSMS) has been established as a joint venture between the National Blood Service (NBS) in England and North Wales and participating hospitals to monitor the blood supply chain. MATERIALS AND METHODS: Stock and wastage data are submitted to a web-based data-management system, facilitating continuous and complete red cell data collection and 'real time' data extraction. RESULTS: The data-management system enables peer review of performance in respect of stock holding levels and red cell wastage. CONCLUSIONS: The BSMS has developed an innovative web-based data-management system that enables data collection and benchmarking of practice, which should drive changes in stock management practice, therefore optimizing the use of donated blood.

Blood Banks↗

PubMed2001

Preparing to practice and manage: A program for educating orthodontic residents in practice management.

The purpose of this article is to describe how the integration of practice management principles into orthodontic graduate programs can help young practitioners avoid many of the mistakes commonly made in developing an orthodontic practice and to provide guidelines and resources for starting off in the right direction. This article also describes how practice management education was integrated as one of the 4 principal components of contemporary orthodontic education at a California university. Specific goals, concepts, and components of a comprehensive practice management program are outlined. A structured practice management curriculum can provide opportunities for residents and alumni to learn some of the latest developments and techniques in orthodontic practice management.

Curriculum↗

PubMed1997

Impact of a management assessment centre in developing proficient health managers.

There is growing use of management assessment centres within parts of New South Wales Health. The present study examined outcome benefits from managers who participated in the Australasian Management Competencies Assessment Centre, some 123 staff from one rural and one metropolitan area health service. Results confirmed greater use of personal development plans and increased attendance at continuing professional development among participants compared with like managers who had not participated. The paper argues strongly in favour of widespread use of management competencies assessment centres as a way to implement planned cultural change.

Adult↗

PubMed2000

Introducing residents to a career in management: the Physician Management Pathway.

To prepare their students and residents for the practice of medicine in a rapidly changing environment, medical educators must teach the business of medicine as well as the science and art of medicine. Recognizing the value of and demand for physician leaders, the authors sought to introduce residents to diverse aspects of medical administration within the context of an academically rigorous internal medicine residency program. The Physician Management Pathway (PMP) was developed in 1997 to expose interested residents to the management concepts employed by physician managers; to help physician trainees begin to develop the leadership and technical skills they will use as physician managers; to provide career mentoring; to provide experiences that enrich the resident's training in clinical medicine; to enhance resident-directed educational activities; and to produce physicians who can successfully work in any health care environment. The PMP curriculum consists of a monthly seminar series, a preceptorship experience in the second year of residency, and a supervised project in the third year. The program was not designed to provide competency in management, but rather is intended to provide an opportunity for new physicians to explore options in this exciting and changing profession.

Curriculum↗

PubMed1980

A comparison of contract-managed and traditionally managed nonprofit hospitals.

During the past five years, contract management of nonprofit hospitals by for-profit corporations has increased markedly. However, while a number of studies have been conducted on investor-owned hospitals and proprietary hospital systems, contract-managed hospitals have not been evaluated systematically. This paper reports a pilot study which compares a sample of 32 nonprofit hospitals under management contracts with matched hospitals uneder traditional in-house management. Although few major differences were found between the study hospitals, the findings indicate that contract-managed hospitals tend to offer a somewhat broader range of services, especially in the outpatient area, younger, more highly educated administrators, and show lower cost per patient stay largely due to somewhat lower employee-to-bed and payroll-to-total expense ratios and shorter lengths of stay.

Contract Services↗