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At least 37 records · Page 2Linked to original sources
PubMed2001

New roles and relationships in the NHS--barriers to change.

The incoming Labour Government's vision for reforming the NHS in Scotland was outlined in the White Paper Designed to Care. While bearing similarities to the proposals outlined for the rest of the UK, it also had distinctive differences. Organisational structures, roles, and relationships between the different parts of the NHS were to be fundamentally altered, particularly in primary and community care. This paper reports upon a series of interviews undertaken across several Health Board areas, with key stakeholders involved in the primary and community sectors. These interviews were intended to examine the development and evolution of the new organisational arrangements, and to identify potential barriers to the successful implementation of Designed to Care. Several barriers and sources of institutional resistance to the new roles and relationships were found during this study, and are discussed. Suggestions upon how these may be overcome and implementation improved are then made.

Community Health Services↗
PubMed2000

Developing a framework for comprehensive cancer prevention and control in the United States: an initiative of the Centers for Disease Control and Prevention.

The Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, is working with state health agency staff and other stakeholders to develop a comprehensive and integrated approach to cancer control. To help stakeholders visualize the approach, a graphic model was developed based on stakeholder input and a literature review of existing models. Phases of the model include setting optimal objectives (data driven), determining optimal strategies (science driven), establishing feasible priorities (capacity driven), and implementing effective strategies (outcome driven). The model currently is being validated through case studies of state-level cancer planning in six states.

Centers for Disease Control and Prevention, U.S.↗
PubMed1990

Planning and implementing health promotion in the workplace: a case study of the Du Pont Company experience.

This case study describes the needs assessment, design, implementation, and preliminary evaluation of a comprehensive workplace health promotion program. The company had 110,000 U.S. employees at more than 100 locations engaged in a variety of manufacturing, research, sales, and support occupations in 1980. The PRECEDE framework was used to focus program planning and evaluation on key areas of health knowledge, attitudes, and behavior. The needs assessment included use of company morbidity and mortality data, a survey of medical and human resources staff, and a survey of employees, spouses, and pensioners. An in-house network of lay committees, site medical personnel, and corporate health education, nutrition and fitness specialists was used to staff critical program functions. Interventions included: public health approaches to program kick-off and health risk assessment; group and self-directed lifestyle change activities; recognition and awards; and workplace climate changes such as smoking policies that favor nonsmokers. One pilot location experienced a 47.5% decline in hourly employee absenteeism over six years versus a 12.5% decline in the total Du Pont hourly workforce. A number of lessons are discussed on how to improve the planning, implementation, institutionalization, and evaluation of health promotion programs in large industrial companies. Four areas where future research and practice should be focused include: reaching spouses, sales personnel, shiftworkers, and employees at small sites; balancing what is popular with what reduces risks over the long-term; documenting program impacts when research resources are scarce; and integrating health promotion programs with workplace medical, safety, employee assistance and benefits programs.

Health Knowledge, Attitudes, Practice↗
PubMed2006

Developing a health and safety plan for hazardous field work in remote areas.

Developing health and safety plans (HASPs) is a common feature of occupational safety and health for many workplaces. Formal HASPs are a requirement for hazardous waste work, requiring the anticipation and identification of hazards and embodying the training, equipping, and evaluation of workers. Aside from OSHA, there are relatively few manuals or examples and virtually no papers that provide practical guidance in what a HASP should cover or how to create and implement one. Moreover, existing guidance refers to spatially circumscribed worksites. This article details development of a HASP to cover field researchers and ship personnel conducting scientific research in a remote area of the world (Amchitka Island in the western Aleutians), hundreds of kilometers from the nearest emergency room. It required characterizing the kinds of work to be performed and anticipating the hazards that could be encountered. It illustrates the meshing of a general HASP with a ship safety plan, a dive safety plan, and specialized topics, including stop-work authority, rock climbing, firearms, vehicle safety, and communication strategy. Remote area operations are a growing challenge facing the profession. An expedition of this sort requires extensive planning and experienced safety personnel and cannot rely on luck to ensure the safe return of participants.

Alaska↗
PubMed1987

[Plans for the training of health personnel: basic considerations for its formulation].

This article presents the problem of "plans for human resources development"--formulated by some countries, but not always utilized. Although the term "development of human resources" has an ample, comprehensive meaning, the authors limit the discussion to the formative phase, leaving the utilization aspects for a future paper. The reasons for preparing such plans are analyzed within the context of the health strategies to reach the goal of HFA/2000, and the article brings up-to-date the meaning and interpretation, within that context, of some commonly used definitions and planning concepts. The authors establish a frame of reference for these plans, examining the influence of different factors in determining the course a plan may follow in its implementation. Included among these factors are: human resources policies; governmental priorities and planning measures; professional practices and how they influence the development and structure of the work force; teaching capacity, and availability of funds and of other resources. The process of formulating a plan comes next, outlining some premises and detailing the different components. The article concludes pointing out that a plan for the development of human resources is not a solution to existing problems, but should rather be used as a guideline. The authors insist as well on the flexibility of objectives and purpose, and the reason for this characteristic. Perhaps the most important conclusion is the warning that a plan for human resources development is not an isolated, independent instrument, but should be considered as an integral part of more comprehensive development plans within the health services infrastructure, and within the political, social and economic framework of a concrete reality.

Health Occupations↗
PubMed1994

Community-oriented primary care. Implementation of a national rural demonstration.

A major objective of community-oriented primary care (COPC) is to focus the clinical practice on the health care problems of the community that the practice serves. The COPC process defines the community of interest, identifies and prioritizes community health problems, and implements and evaluates interventions. Under sponsorship from the W. K. Kellogg Foundation, the COPC National Rural Demonstration Program was established to explore the feasibility of implementing COPC in 13 rural practices. An evaluation of the program found that local communities played critical roles in defining and implementing COPC interventions. These interventions were most often focused on health promotion/illness prevention activities. At most sites, clinical practices were limited in their ability to incorporate COPC activities by staff and physician turnover and the extensive patient demands on the time of rural primary care physicians. While the COPC process proceeded at different rates across the sites, after 2 1/2 years of grant funding, most sites continued to devote the majority of their resources to designing and implementing interventions. Thus, it appears that coordination by dedicated nonphysician staff and more than 2 years of effort are required to implement COPC concepts in rural practices in underserved areas.

Community Health Services↗
PubMed1994

The planning and implementation of government-sponsored community-based primary prevention: a case study.

Governments at all levels have become increasingly involved in initiating and funding projects within which community residents work collaboratively with local service providers in the development of programs for the betterment of themselves, their families, and their community. Inherent in these initiatives, however, are a number of possible sources of tension which, left unresolved, may hamper the intentions of governments to seed grass-roots solutions to community problems. A qualitative research methodology was used to examine the nature of the relationship between government and community representatives (both residents and local service providers) in establishing community-based primary prevention programs under the auspices of the Better Beginnings, Better Futures initiative of the Government of Ontario. We examine a number of issues and tensions that have arisen from this project, both during the development of the program model by the government, and through to its implementation in several communities in the province.

Affective Symptoms↗
PubMedDate not supplied

The prevention challenge and opportunity.

In the United States, more money is spent on treating diseases and their complications than on preventing them in the first place. Prevention is both undervalued and poorly supported in our health system. In this Perspective I discuss how the McKinlay model can be used to illustrate the three levels at which we need to increase our investment in prevention. I recognize the many challenges in implementing programs of prevention, but I also note that these programs represent opportunities to improve health, prevent unnecessary pain and suffering, and, in time, develop a health system that is balanced and affordable.

Health Plan Implementation↗
PubMed1995

Community care in Scotland: progress from a community care implementation unit perspective.

Of necessity, this account of progress has been presented in summary form and has related to the particular focus of the CCIU's work. Significant progress has been achieved in many respects and many of the initial teething problems have been overcome. However, there is scope for improvement in the delivery of quality services for vulnerable people in our communities as we strive to offer real choice to them and their families in the provision of community care. Achieving this will be assisted greatly by agencies getting better at developing and implementing jointly their strategic thinking, working more closely on the 'joins' in the system and recognising the strengths of other players.

Community Health Services↗
PubMed2000

Approaches to eliminating sociocultural disparities in health.

The recent flurry of studies documenting the presence of racial, ethnic, and socioeconomic disparities in health care and health have outpaced articles that describe effective strategies to eliminate disparities. Through literature review and informal interviews with research, policy, and program experts, we developed a framework of programs that address disparities through targeting clinicians, patients and communities, and health systems. We found that the lack of technical expertise, resources, and sensitive tools are all common barriers to evaluating programs. To stimulate more effective programs and rigorous evaluations, we describe specialized implementation and evaluation techniques programs can use, and make recommendations for future efforts.

Cultural Diversity↗
PubMed2005

The World Health Organization European Health in Prisons Project after 10 years: persistent barriers and achievements.

The recognition that good prison health is important to general public health has led 28 countries in the European Region of the World Health Organization (WHO) to join a WHO network dedicated to improving health within prisons. Within the 10 years since that time, vital actions have been taken and important policy documents have been produced. A key factor in making progress is breaking down the isolation of prison health services and bringing them into closer collaboration with the country's public health services.However, barriers to progress remain. A continuing challenge is how best to move from policy recommendations to implementation, so that the network's fundamental aim of noticeable improvements in the health and care of prisoners is further achieved.

Benchmarking↗
PubMed2005

Using the State Plan Index to evaluate the quality of state plans to prevent obesity and other chronic diseases.

INTRODUCTION: Implicit in public health planning models is the assumption that good public health plans lead to good programs, and good programs lead to desired health outcomes. Despite considerable resources that are devoted to developing plans, public health agencies and organizations have lacked a tool for evaluating the finished product of their planning efforts -- the written plan itself -- as an important indicator of progress. To address the need for an instrument to assess the quality of state plans designed to prevent and control chronic diseases, we created and tested the State Plan Index and used it to evaluate the quality of nine state plans aimed at preventing and reducing obesity. METHODS: The State Plan Index was developed under the auspices of the Centers for Disease Control and Prevention (CDC) in collaboration with public health experts in federal, state, and academic settings. The State Plan Index included 55 items related to plan quality arranged into nine components. Each item was rated on a Likert scale from 0 to 5, with 5 being the highest rating. Each plan also received a separate overall plan quality score using the same scale. Each state plan was evaluated by four or five raters using the State Plan Index. For each plan, the 55 items were averaged to calculate an item average score, and a subscore was calculated for each State Plan Index component. Finally, five states also self-rated their own plans (self score). RESULTS: The mean item average score for all plans was 2.4 out of 5.0. The range of item average scores was 1.0 to 3.0. The component of the State Plan Index with the highest mean component score (3.3) was Presentation of Epidemiologic Data on Disease Burden. The components with the lowest component scores were Resources for Plan Implementation (0.7); Integration of Obesity Efforts with Other Chronic Disease Efforts (1.7); and Program Evaluation (2.0). Plan quality was rated higher when based on the single overall plan quality score assigned by raters. In addition, self scores were consistently and substantially higher than rater-assigned scores. CONCLUSION: Evaluation of plans early in the life of programs can be used to strengthen existing programs and to guide programs newly engaged in chronic disease prevention planning. The CDC has used the State Plan Index evaluation results to guide technical assistance, plan training sessions, and enhance communication with state staff about plan content, quality, and public health approach. Some state program directors self-evaluated their obesity draft plan and used the evaluation results to strengthen their planning process and to guide plan revisions. Other states have adapted the State Plan Index as a framework for new planning efforts to prevent obesity as well as other chronic diseases.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

Healthy cities: overview of a WHO international program.

Health is the outcome of all the factors and activities impinging upon the lives of individuals and communities. The last decade has seen an emerging understanding within development circles that living conditions are greatly affected by local action, by the work of local government, and by community groups and organizations. In addressing health and environmental issues and making interventions, an integrated approach, based on 'settings', exemplified in the Healthy Cities approach, has proved most effective. A Healthy City project can involve people and organizations in the programs and activities that are needed for better health, and enables a city or neighborhood to mobilize the human and financial resources required to address many health and quality of life issues. The WHO program involves implementating city projects and networks in all regions of the world and serves as a vehicle for many health programs, including major disease control initiatives. Healthy City projects allow Ministries of Health to develop stronger partnerships with local government organizations (such as the Union of Local Authorities and its members, "Local Agenda 21" initiatives, and others). One focus for the program is the development of 'multi-'multi-city action plans' for major global priority issues, including AIDS, sanitation, women's health, and violence, to ensure that major public health programs are strengthened by wider community participation. It is recognized that city networking--at national, regional, and international levels--now must be better exploited by individual cities and municipalities to solve local health problems.

Environmental Health↗
PubMed2002

How do we translate science into public health policy and law?

Scientific knowledge concerning effective preventive measures to preserve and protect the health of the public continues to grow exponentially. Methods for assessing the impact of population-based interventions such as policies and laws have also greatly increased in the past decade, including systematic approaches that allow general findings to be drawn from various studies, especially those developed as part of the Guide to Community Preventive Services (Community Guide). However, the translation of the collected scientific evidence gathered to date has been spotty and problematic. Success stories do exist, including community water fluoridation, a significant factor in improvements in reduction of tooth decay over the past 50 years. Even for interventions with a strong science base, such as community water fluoridation, significant barriers to implementation of effective strategies discovered through research remain. Barriers include public misunderstanding of health issues and proposed solutions such as fluoridation; lack of engagement on the part of the media in communicating known effective strategies; and reluctance on the part of policymakers to champion approaches that concern but may not be advocated by their constituencies. The increasing burden of chronic disease places public policymakers into non-traditional roles, such as advocating behavior change as a preventive measure. Science is a critical tool to help legislators and policymakers "connect the dots" between public policies. For example, the elimination or degrading of physical education programs in schools is an important factor in addressing the national epidemic of childhood overweight and obesity in addition to the increase in rates of Type II diabetes among children. This article provides an overview of the past, present, and future associated with translating science into public health policy and law, including a review of tools and strategies to address existing and expanding public health challenges. The article also provides and discusses examples of translating and implementing science-based solutions to address public health problems effectively.

Chronic Disease↗
PubMedDate not supplied

Prevention in Poland: health care system reform.

Despite the political and economic reforms that have swept Eastern Europe in the past 5 years, there has been little change in Poland's health care system. The Ministry of Health and Social Welfare has targeted preventive care as a priority, yet the enactment of legislation to meet this goal has been slow. The process of reform has been hindered by political stagnation, economic crisis, and a lack of delineation of responsibility for implementing the reforms. Despite the delays in reform, recent developments indicate that a realistic, sustainable restructuring of the health care system is possible, with a focus on preventive services. Recent proposals for change have centered on applying national goals to limited geographic areas, with both local and international support. Regional pilot projects to restructure health care delivery at a community level, local health education and disease prevention initiatives, and a national training program for primary care and family physicians and nurses are being planned. Through regionalization, an increase in responsibility for both the physician and the patient, and redefinition of primary health care and the role of family physicians, isolated local movements and pilot projects have shown promise in achieving these goals, even under the current budgetary constraints.

Health Care Reform↗