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Results for “Models, Organizational”

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At least 307 records · Page 17Linked to original sources
PubMedDate not supplied

Pharmacy service alliances: a tool to reduce uncertainty and create new revenue streams.

OBJECTIVES: (1) Present conceptual support for a type of pharmacy network, a pharmacy service alliance (PSA), (2) describe the development of a PSA in eastern Iowa, and (3) discuss how other types of PSAs can be developed. DESIGN AND PARTICIPANTS: 12 independent pharmacies in eastern Iowa. SETTING: Community pharmacy practice. MAIN OUTCOME MEASURES: Formation of a PSA. RESULTS: Pharmacy members of the Certified Pharmaceutical Care Network, a PSA, have jointly developed new pharmacy services. Collaborative efforts have involved disease state management programs, group marketing activities, and a quality improvement process. CONCLUSION: PSAs offer an organizational model that pharmacies could use to successfully develop new pharmacy services.

Iowa↗
PubMed2003

Illustrative estimates of costs and effects of the use of Doppler ultrasonography in high-risk pregnancies.

OBJECTIVES: To examine the cost-effectiveness of Doppler ultrasonography in high-risk pregnancies. METHODS: An analysis was made of the cost-effectiveness of Doppler ultrasonography in high-risk pregnancies in relation to different organizational models. National costs of Doppler ultrasonography for singleton pregnancies with intrauterine growth retardation were estimated for three models. The cost-effectiveness analysis was based on results from a meta-analysis on clinical effects, patient costs, immediate health care costs, and costs per "saved" perinatal death. RESULTS: In the decentralized model (the current situation in Denmark), incremental health care costs were estimated to be 13.5 million DKK, with patient costs set at zero. In the regional and centralized models, the estimated costs were 9.3 million/0.9 million DKK and 3.4 million/2.6 million DKK, respectively. The incremental costs were more than outweighed by the savings made from significant reductions in obstetric interventions. The centralized model dominated the other two models in the cost-effective analysis. In the decentralized model, the costs of avoiding one perinatal death were estimated to be 1 million DKK. The sensitivity analysis suggested that the cost-effectiveness ratio differed considerably, depending on the assumptions used, although the rank order of the three models did not change. CONCLUSIONS: The cost-effectiveness analysis showed that a centralized model with five obstetric centers offering Doppler ultrasonography dominates the regional and decentralized models. However, even with the decentralized model (which reflects the current situation in Denmark), the costs of avoiding one perinatal death would seem to be reasonable. In view of the paucity of available cost and effects data and the sensitivity of the results to changes in the assumptions made, more reliable information is needed before a decision can be made regarding the organization of Doppler ultrasonography for high-risk pregnancies.

Cost-Benefit Analysis↗
PubMed1999

Patient flows and optimal health-care resource allocation at the macro-level: a dynamic linear programming approach.

In this paper we present a deterministic allocation model in which a patient's health-state changes due to health-care interventions. This change in a patient's health-state has a direct effect on the patient's expected future need for health-care. Hence, current allocation decisions determine to some extent the set of possible allocation decisions in the future. In order to take this into account we have formulated a dynamic linear programming version of a patient-flow system. This enables us to describe the effects of using different objective functions on the optimum level and composition of the provision of health services within given resource constraints. The linear programming approach enables the quantification of the health effects and therefore the desirability of the (re-)allocation of health-care resources. We provide some simulation results in order to illustrate the working of the model.

Health Care Rationing↗
PubMed1999

Burnout and leadership in community mental health systems.

This study investigated whether aspects of burnout in clinical staff in community mental health agencies were systematically related to aspects of leadership behavior and quality of supervision of clinical supervisors. Burnout was measured by the Maslach Burnout Inventory, leadership behavior was measured by the Leadership Practices Inventory, and clinical supervision by a scale constructed by the authors. Significant, though moderate relationships were found between the measures, and the implications for an organizational model of burnout, as well as prevention of burnout in mental health professionals are discussed.

Adult↗
PubMed2002

A developmental psychopathology perspective on adolescence.

Developmental psychopathology offers an integrative framework for conceptualizing the course of development during adolescence, with particular relevance for understanding continuity and the emergence of psychopathology during this and subsequent developmental periods. In this article, the utility of a developmental psychopathology perspective for informing the design of research, prevention, and intervention is highlighted. Interdisciplinary, organizational models of development, emphasizing the dynamic relations between the developing individual and internal and external contexts, are discussed. Examination of boundaries between abnormal and normal development during adolescence offers important vantage points for articulating diversity in the developmental course during this period. Conceptualizing divergence and convergence in developmental pathways, continuity and discontinuity in development, and the transactions of risk and protective processes leading to maladaptation, psychopathology, and resilience are highlighted.

Adolescent↗
PubMed2003

Is job a viable unit of analysis? A multilevel analysis of demand-control-support models.

The literature has ignored the fact that the demand-control (DC) and demand-control-support (DCS) models of stress are about jobs and not individuals' perceptions of their jobs. Using multilevel modeling, the authors report results of individual- and job-level analyses from a study of over 6,700 people in 81 different jobs. Support for additive versions of the models came when individuals were the unit of analysis. DC and DCS models are only helpful for understanding the effects of individual perceptions of jobs and their relationship to psychological states. When job perceptions are aggregated and their relationship to the collective experience of jobholders is assessed, the models prove of little value. Role set may be a better unit of analysis.

Administrative Personnel↗
PubMed2004

Organizational challenges in clinical genomic research.

Genome sequence data are enabling clinical genomic investigation, in which the characteristics of human patients are explored using comprehensive inventories of biomolecules. Successful investigators must navigate rapid technological change, collect and analyse large volumes of data, and engage systems of clinical care. Such projects will increasingly rely on fully integrated multidisciplinary teams, demanding new organizational models in academic biomedical research.

Academies and Institutes↗
PubMedDate not supplied

Advancing newborn health and survival in developing countries: a conceptual framework.

Four million newborns die every year at home, often without skilled care at delivery or any other contact with the formal health system. Improved household practices and use of services, often in the community, should improve survival. We developed a conceptual framework for household and community newborn and maternal care that acknowledges the inseparability of the mother and neonate, yet stresses elements relating to the newborn, heretofore underemphasized in safe motherhood and child-survival programs. The framework identifies five paths that, if implemented well, would generally improve newborn outcomes: (1) use of routine maternal and newborn care and good-quality services; (2) response to maternal danger signs; (3) response to the nonbreathing newborn; (4) care for the low birth weight baby; and (5) response to newborn danger signs, particularly those of infection. This model, balancing preventive (19 routine behaviors) and curative care (14 special behaviors), is rooted in the community, bridges safe motherhood and child survival, and provides a framework for newborn health research, programmatic, and advocacy agendas for developing countries.

Child Health Services↗
PubMed2004

Advanced home care: patients' opinions on quality compared with those of family members.

BACKGROUND: Advanced medical care in the patient's home setting is becoming more common. Many of the patients who receive this kind of care have severe illnesses and are unable to respond to questions about the quality of care. The research question was: are the patients' opinions congruent with those of family members? AIM: To explore and compare the relationship between patients' perception of the quality of care and close family members' perception of this care as well as their perception of the patients' perception. METHODS: Sixty-seven patients receiving advanced home care, 82 family members (54 matched patient + family member pairs) participated. Data were collected using a short version of the quality from the patient's perspective questionnaire modified to advanced home care. RESULTS: A high degree of perceptual congruence was found between patients and their family members. The similarity was also high between family members' own opinion and their appraisal of how the patient perceived the care. A subgroup of family members who met the patient once a week or less often deviated from this pattern. CONCLUSION: Patients' views on the quality of care are congruent with the opinions of family members if they meet every day (live together) and share the same everyday and care-related experiences. The results can be understood in the light of empathic accuracy theory. RELEVANCE TO CLINICAL PRACTICE: The findings of this study have important implications for clinical nursing practice. Family members' perception of the quality of care may be a valuable data source for nurses in the case of advanced home care if the patient and family member share the same everyday, care-related experiences, otherwise family members' perception tend to be more critical than those of the patients themselves.

Adolescent↗
PubMed2002

Clinical evaluation: constructing a new model for post-normal medicine.

The current paradigm in medicine is served by an explanatory model based on scientific positivism. We argue that there are inherent weaknesses in this model: its basis on reductionism, its reliance on linear thinking and its failure to incorporate human values invite a revision of our thinking about knowledge in medicine. We propose that a fresh explanatory model should be based on complexity theory, and argue that this better suits the new era of post-normal medicine, where analytical and predictive power are obtained by stepping back and looking at the relationships and overall context of a system rather than forcing reality into a preferred disciplinary framework. Better at times to be vaguely right, we argue, rather than precisely wrong.

Medicine↗
PubMed1999

The clinical skills resource: a review of current practice.

This review is based on the findings of the Southampton Clinical Skills Project, which was a needs assessment and feasibility study to consider the development of a multiprofessional Clinical Skills Resource at Southampton. The project spanned a period of 18 months and used a range of methods of data collection, including visits to 12 clinical skills facilities in the UK. Most existing clinical skills centres have developed in response to changing healthcare policy, curricular initiatives and increasing emphasis on the quality of assessments and competencies. There is also increasing recognition that clinicians are no longer able to teach effectively all skills to students in the traditional ways, and that clinical skills training and assessment, particularly for undergraduates, is an area of deficiency. The potential scope of clinical skills centres is broad and encompasses not only clinical and communication skills but medical informatics, computer assisted learning, multiprofessional learning and assessment. Skills centres can also promote self directed and lifelong learning methods. The planning of skills centres involves a variety of stakeholders and users, including undergraduates, postgraduates, acute and community Trusts, Postgraduate Deans and medical schools. A successful skills centre needs to be flexible in its design, integral to the curriculum and relevant to educational and training requirements. This requires planning, organization and resources. Different organizational models can be used, depending on local factors. The management of skills centres involves consideration of issues such as security, safety, supervision of learners and staff development, informed by a network of experts and everyday users. The development of skills centres should include ongoing educational evaluation of outcomes and educational research. The use of a clinical skills centre has potential benefits for staff and students, including the provision of a safe environment in which to learn and practise skills before using them in the real clinical setting. This can reduce anxiety in students and protect patients from novice practice. Clinical skills centres provide a setting for structured learning with feedback as well as assessment of competence. The limitations of a skills centre are that it can only provide simulated experiences which are an adjunct to, but can never replace real clinical experience.

Clinical Competence↗
PubMedDate not supplied

Training oncology camp volunteers. A developmental and strengths approach.

PURPOSE: This article examines the training of oncology camp volunteers using a developmental and strengths perspective as a theoretical orientation. The literature on oncology camping, both empirical and anecdotal, is examined and relevant studies cited. OVERVIEW: The selection of volunteers, the benefits of the oncology camp experience, and a training model are discussed. It is the contention of the author that camp volunteers need an orientation for working with the campers, one that incorporates both a developmental framework and a perspective that highlights capacity and strength. Both orientations are explored, and their applications are highlighted. CLINICAL IMPLICATIONS: The training of volunteers is a critical aspect of the oncology camp. In almost all oncology camps, volunteers form the staff complement. As such, their training and orientation to the campers is central to the summer experience for campers, volunteers, and staff. Administrators and camp directors are urged to incorporate some of the suggestions offered in this report to help ensure a positive summer experience.

Adaptation, Psychological↗
PubMed1999

Cost of umbilical cord blood units released for transplantation.

BACKGROUND: A large number of institutions have started programs banking umbilical cord blood (UCB) for allogeneic unrelated-donor and related-donor transplantation. However, limited information is available on the financial issues surrounding these activities. STUDY DESIGN AND METHODS: The aim of this study was to determine the fee per UCB unit released for transplantation that would allow cost recovery after 10 years. Three organizational models were considered suitable to provide units for five UCB transplants per 1 million population per year, a figure that would translate into an annual need for 280 units in Italy. Models A, B, and C included, respectively, seven networked banks, each with an inventory of 1,500 units; two networked banks, each with an inventory of 5,000 units; and one bank with an inventory of 10,000 units. It was estimated that it would take 3 years to develop the cryopreserved inventory and that approximately 3 percent of the inventory could be released and replaced each year during the 7-year interval between the fourth and tenth years of activity. The data on the costs of labor, reagents and diagnostics, disposables, depreciation and maintenance, laboratory tests, and overhead, as well as the operational data used in the analysis were collected at the Milano Cord Blood Bank in 1996. RESULTS: Fees of US $15,061, $12,666, and $11,602 per unit released during the fourth through the tenth years of activity allow full cost recovery (principle and interest) under Models A, B, and C, respectively. CONCLUSION: Although UCB procurement costs compare favorably with those of other hematopoietic cell sources, these results and the current fee of US $15,300 used in some institutions show that UCB is an expensive resource. Therefore, judicious planning of banking programs with high quality standards is necessary to prevent economic losses. The advantages of lower fees associated with the centralized banking approach of Model C should be balanced with the more flexible collection offered by Model A.

Blood Banks↗
PubMed2002

Describing functional requirements for knowledge sharing communities.

Human collaboration in distributed knowledge sharing groups depends on the functionality of information and communication technologies (ICT) to support performance. Since many of these dynamic environments are constrained by time limits, knowledge must be shared efficiently by adapting the level of information detail to the specific situation. This paper focuses on the process of knowledge and context sharing with and without mediation by ICT, as well as issues to be resolved when determining appropriate ICT channels. Both technology-rich and non-technology examples are discussed.

Communication↗
PubMed1991

Reliability and validity of the Work-Related Strain Inventory among health professionals.

This article provides evidence from five samples of different health professionals (family physicians, emergency medical technicians, hospital nurses, flight nurses, and emergency medicine residents) for the reliability and validity of the Work-Related Strain Inventory (WRSI). The inventory consists of 18 items and was designed to measure perceptions of strain in occupational settings. Internal consistency reliability ranged from .85 to .90 and, as predicted, was correlated with the Maslach Burnout Inventory and measures of depression, role ambiguity, job satisfaction, and work-group functioning. When compared with different measures of depression symptoms (eg, Zung Self-Rating of Depression Scale, Center for Epidemiologic Studies Depression Scale), the Work-Related Strain Inventory was found to measure a different and independent construct. This inventory, a short, easily administered measure with good reliability, may be useful for appraising levels of work-related strain in behavioral and organizational models of the consequences of stress in different work environments.

Adult↗
PubMed2006

Disease management interventions II: What else is in the black box?

The success of any disease management (DM) program ultimately depends upon the ability and willingness of participants to change and maintain desired health behaviors. To achieve those results, DM program administrators have several issues to consider, including the type of behavioral change desired, the scope of intervention that the organization is willing and capable of implementing, and whether the appropriate support structures are available to ensure successful achievement of program goals. An understanding of these issues will assist program designers in selecting the appropriate change models. This paper serves as an extension of our prior paper in which eight core psychosocial behavioral change models were described. Here, five more recently developed theory-based approaches are introduced, providing readers with up-to-date information in this area.

Community Networks↗
PubMed1997

Mathematical modeling of pharmacy systems.

Mathematical modeling and its potential applications in pharmacy are discussed. A model is a simplified representation of the real world. As an experimental approach, modeling minimizes expense, risk, and disruption, but its validity can be hard to ascertain. Mathematical models describe numerically the relationships among elements of a system and are a powerful tool in making decisions affecting that system. There are two types of mathematical models: analytical models, which directly describe the relationships between system inputs and outputs using mathematical equations (such as pharmacokinetic models), and simulation models, which involve the replication, usually with a computer, of events as they occur in the real world. Analytical models are easier to develop but are not appropriate for describing highly complex systems. In continuous-time simulation, the system is represented as an uninterrupted flow of material; in discrete-event simulation, it is assumed that events occur only at distinct times. Various simulation programs are commercially available. The stages of a mathematical modeling study are (1) formulate the problem, (2) determine the model's structure, (3) collect and analyze initial data, (4) develop the model further, (5) validate the model, (6) experiment using the model, and (7) use the results. There have been many applications of modeling in health care, but relatively few have involved the study of pharmacy systems. Mathematical modeling offers pharmacists a low-risk, low-cost tool for aiding decisions about pharmacy systems by predicting alternative futures.

Models, Organizational↗