[New organizational models for health systems: competition or rationing?].
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Delivery of Health Care↗
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Results for “Models, Organizational”
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Organizational models of veterinary colleges in the Americas.
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Canada↗
Understanding partial hospitalization through organizational models.
This paper discusses three interrelated organizational models relevant to partial hospitalization. Such a management perspective can play an important role in the planning of effective mental health-care delivery structures.
Day Care, Medical↗
Mass casualties: an organizational model of a hospital information center in Tel Aviv.
The article describes an organizational model of an information center, developed by the social work department of Tel Aviv Sourasky Medical Center. The information center is designed to provide information when mass casualties are brought to the hospital following terrorist attacks or other catastrophes. The information center is comprised of a number of interrelated units within the hospital and is in contact with a range of organizations in the community. The structure and activities of the various units is described. The article also discusses a number of aspects relevant to personnel organization in crisis intervention.
Communication↗
[LARS Research Project. Nursing Research Laboratory of the Health Regional Agency of the Friuli Venezia Giulia Region. Observational study on the outcomes of organizative models of medical wards on nurses, patients and organization].
UNLABELLED: No large scale studies have been conducted in Italy to assess factors that influence hospital nurses' satisfaction. AIMS: To explore the relationship between participative organizative models and outcomes on nurses (work satisfaction, burnout, intention to stay), patients (satisfaction with quality of care) and organization (nurses turnover). MATERIALS AND METHODS: This multicentre regional study involves 20 acute medical wards and more than 500 nurses. Data on the organizative model adopted in the ward will be collected with an ad hoc questionnaire with scores from 7 (scarce-limited involvement of nurses in decision making) to 35 (nurses take decisions on the management of the ward). Nurses satisfaction with their work is measured with the Nursing Work Index Revised; burnout with the Maslack Burnout Inventory; patients satisfaction with the Experiences of Nursing Care Scale Newcastle Satisfaction with Nursing Scale. The outcomes considered for the organization will be turnover, absences from work, injuries. RESULTS: The study is ongoing. The association of each outcome to the organizzative model will be explored. Multivariate regression model will be adjusted for casemix index of the previuos year. T test and chi square tests will be used and a p value of 0.05 will be considered significant.
Humans↗
An organizational model of transcription factor binding sites for a histone promoter in D. melanogaster.
The Drosophila H2A-H2B histone spacer, a small region that functions as a bidirectional promoter for the gene pair, was used as a test sequence for generation of a computationally derived organizational model of transcription factor (TF) binding sites. Expression studies of the spacer revealed that it contains the necessary sequences to confer replication-dependent transcription in partially synchronized cells in culture. Informatics analysis of the spacer uncovered a number of binding sites for specific TFs, none of which had been previously associated with this particular promoter. Each of the TFs in the promoter organizational model are also known to participate in stages of fly development that are characterized by DNA replication and/or cell division, thus providing a biologically functional rationale for an association. Moreover, phylogenetic analysis of the binding sites provides evidence for evolutionary conservation of the essential features of the organizational model. The model, if correct, provides information about the molecules that couple developmental specific demands and histone gene transcription.
Animals↗
Organizational models: from institutional to supra-national responsibility for health information systems.
Internationally as well as within a given national environment, there are many variations in the organization of health care, hospitals and hospital information systems. This paper attempts to structure the diversity by examining determinants of organizational models. These show an increasing need for inter-institutional coordination and cooperation. An examination of organizational components shows that those at the institutional level are increasingly complemented by components at the national, international and global levels. Hence, organizational models do not only have to be dynamically responsive to changing requirements arising from changes in determinants, but more importantly, inter-institutional and supra-institutional organizational structures gain in importance.
Canada↗
The use of hierarchies as organizational models in systematics
A hierarchy is an abstract organizational model of inter-level relationships among entities. When isomorphic with nature, hierarchies are useful for organizing and manipulating our knowledge. Hierarchies have been used in biological systematics to represent several distinct, but interrelated, facets of the evolution of life with different organizational properties, and these distinctions have been confused by the rubric «the hierarchy of life». Evolution, as descent with modification, is inherently dualistic. The organizational structure of a hierarchy can be used to represent dualistic properties as inter-level relationships. Cladistics is monistic, with a singular focus on patterns of descent. Descent has conceptual priority over modification, but the organizational relationship is not exclusive. «Cladistic classification» is an oxymoron because cladistics lacks the class concepts needed to construct a classification, a point recognized by those who suggest abandoning Linnaean classification in favour of a newly devised monophyletic systematization. Cladistic analysis of descent can be supplemented with an analysis of modification that provides the class concepts needed to construct an evolutionary/phylogenetic classification. When a strong monophyletic pattern of modification is detected (in addition to its monophyletic pattern of descent), the criterion of subsequent modification provides the basis for formally recognizing a certain monophyletic group at a given rank, as opposed to a group that is one node more inclusive or one node less. The criterion of subsequent modification also permits detection of strong paraphyletic patterns of modification, when they exist. By setting standards of evidence needed to recognize paraphyletic groups, one concomitantly strengthens the basis for formally recognizing selective monophyletic groups.Copyright 1998 The Linnean Society of London
Journal Article↗
[Organizational model and clinical evaluation in Day Surgery: our experience].
Surgical treatments in Day Surgery (DS) are characterised by limited hospitalisation during daytime on the base of an organizational model established by appropriate protocols. According to it, the patient at low operational risk and the patient whose post-operative management is easy is admitted to the programme. The Authors report their experience of DS focusing on the surgical and anaesthesiological qualifications that help to control the risk factors reducing the complications and thus guaranteeing the safety and effectiveness of the service.
Ambulatory Surgical Procedures↗
A realistic approach to the evaluation of the quality management movement in health care systems: a comparison between European and African contexts based on Mintzberg's organizational models.
The quality movement is gaining momentum worldwide in the field of health care. Initiated in industrialized countries, it steadily grows in Africa. However, there is no evidence that approaches designed to address issues in a given organizational context have the same effect in another one where issues present differently. Along the epistemological paradigm of realistic evaluation proposed by Pawson and Tilley, we use Mintzberg's organizational models to compare the configurations of European and African health care organizations and the trends followed by the quality management movement in both contexts. We illustrate how European health systems traditionally emphasize professional autonomy while African health systems are structured as command and control hierarchical systems. We illustrate how the quality movement in Europe emphasizes standardization of procedures, a characteristic of a mechanistic organization, while excessive standardization is part of the quality problem in Africa. We suggest that instilling professionalism may be a way forward for the quality movement in Africa to improve patient focus and responsiveness of responsible professionals. We also suggest that our interpretation of broad trends and contrasts may be used as a useful departure point to study the wide contextual diversity of the African experience with quality management.
Africa↗
Development of a new nursing organizational model.
In 1992, the Shands Hospital embarked on a cost management program that targeted the department of nursing and patient services (DNPS) for a $4.1 million budget reduction. Vital to achieving this goal was the reorganization of the DNPS and developing a new nursing organizational model. After 1 year, reorganization not only saved $1.2 million of the target, but provided additional leadership support to areas that needed it.
Academic Medical Centers↗
Organizational models and functions of occupational health services in countries in socioeconomic transition: present state and perspectives. Summary report on a WHO meeting, Lodz, Poland, 15-17 December 1994.
In the context of the WHO health for all policy, a meeting was convened to review the present models and functions of occupational health services in the countries of central and eastern Europe and the newly independent states of the former Soviet Union and to discuss trends in anticipated modifications to the organizational model. The participants recognized that the progress of socioeconomic transition varied widely in the 25 countries involved and that such transition substantially affects the organization, conditions of operation and needs of occupational health. To facilitate the transition process and help identify priorities, find new solutions and provide professional and information support to individuals and institutions in occupational health, the meeting proposed the establishment of a subregional WHO network of occupational health institutions in these countries.
Europe, Eastern↗
The organizational model of the interregional transplant agency Organizzazione Centro-Sud Trapianti.
In Italy, all donation and transplant activities were officially disciplined in 1999 by the law 91 of April 1, 1999. This law enacted a coordinator-based model of transplantation, instituted the National Center for Transplantation (Centro Nazionale Trapianti-CNT), and endorsed the existing interregional transplant agencies (ITA), such as the Nord Italia Transplant program (NITp), the Associazione InterRegionale Trapianti (AIRT), and the Organizzazione Centro-Sud Trapianti (OCST). Within its borders each ITA has adopted its own organizational model; there is no overt centralized control exerted by the CNT according to the law 91/1999. The aim of the current work is to report on the organizational model adopted by OCST, the ITA gathering the Italian regions of Abruzzo, Basilicata, Calabria, Campania, Latium, Molise, Sardinia, Sicily, and Umbria.
Humans↗
Nursing research organizational models.
Nursing departments have a responsibility to promote nursing research activities. To attain this goal, they may select and/or adapt an organizational approach from existing models for nursing research. Research consortium, directorate, program, group, and single researcher, organizational models are described and discussed in this paper using examples from the literature and current practice. Issues which nurse administrators and researchers should consider when selecting and implementing organizational models are presented. These include the departmental perspective regarding nursing research, the nurse researcher role, and compatibility between model and departmental characteristics.
Hospitals, Teaching↗
Dynamics of the marketplace: key issues, new linkages, and successful organizational models in academic CME.
Following an initial description of the marketplace for CME, the article identifies and explores six key issues for the future of academic CME: evolution of the academic health center; practice changes and reimbursement; impact of technology; regulatory influences; proliferation of CME providers; and medical school leadership. The author then turns to a discussion of new ways to link CME with practitioners--through academic health centers, within various practice environments, through technology, in the regulatory arena, and by developing relationships with competing groups and organizations. Finally, the article suggests several organizational models with potential for expanding these linkages.
Academic Medical Centers↗
An organizational model for developing multidisciplinary clinical research in the academic medical center.
OBJECTIVE: To assess the impact of a new organizational model designed to stimulate multidisciplinary clinical research. METHODS: We conducted a prospective, 3 1/2-year followup of a research training program for residents, fellows, faculty, nurses, and allied health professionals in rheumatology and orthopedic surgery. Program components included a multidisciplinary clinical research conference, a clinical research methods curriculum, consultations, a patient registry, and regular meetings of a Research Methodology Core group. Measures included participation in each program component and the number of new investigators who developed funded clinical research projects. RESULTS: The multidisciplinary clinical research conference was attended by 369 new health professionals; 218 professionals participated in at least one of the courses; and 280 consultations were provided to 108 professionals. Thirteen new investigators developed 17 new grant proposals, of which 14 were externally funded. Investigators who successfully procured funding for new projects demonstrated significantly more participation in program components compared with those who did not (P < 0.001 overall). CONCLUSION: Participation in the program was significantly correlated with the development of new prospective patient-based studies. We conclude that our model has the potential to foster such research in other settings.
Academic Medical Centers↗
Organizational models of medical school relationships to the clinical enterprise.
The authors analyzed existing relationships between medical schools and clinical enterprises in order to develop models of these relationships. The conceptual framework for the models uses three variables to assess the nature of the relationships: (1) high academic control-high clinical enterprise control; (2) high academic influence-low academic influence; and (3) self-contained system-open system (i.e., the extent to which the resources needed for clinical education are provided by the relationship between the clinical enterprise and the medical school). The authors present four conceptual models of the relationship between the medical school and the clinical enterprise: (1) The "single ownership; owned integrated system" is characterized by a closed clinical delivery system owned or controlled by the academic institution. (2) The "general partner" organization emphasizes an open clinical environment in which the medical school forms alliances with clinical entities, and the school is a dominant partner. (3) The "limited partner" organization operates with an open clinical delivery system that the school relates to through affiliations and contractual relationships, and the school is a less dominant partner. (4) The "wholly owned, subsidiary" organization operates in a controlled clinical environment in which the medical school is a subsidiary of the larger integrated delivery system. Each model is presented in its pure organizational form, then augmented with descriptions of the different ways that the medical school and other components may relate to each other. Also, the advantages and disadvantages of each model for the medical school are discussed. The authors emphasize that no model is superior to the others; instead, the best choice for a medical school depends on the history, local circumstances, and leadership of the school and other organizations. The authors' intent is to assist the leaders of medical schools as they design strategies for the future relationships of their institutions.
Interinstitutional Relations↗
Hospitals and physicians: an organizational model for a changing healthcare environment.
New reimbursement methods are forcing hospitals and physicians to work more closely together to retain patients and improve efficiency. In the last 10 years, most academic medical centers have reorganized hospital-physician relationships to maximize revenues and assure a stable flow of patients. This article examines the organizational model adopted by Pacific Medical Center in Seattle (formerly the U.S. Public Health Service Hospital), when it was transferred from federal to community control in 1981. Planners analyzed the history and mission of the institution, the community being served, and the legal options in the state. The chosen organizational structure is outlined, and the authors present the strengths and weaknesses of the model. The implications for other healthcare institutions considering restructuring are discussed.
Governing Board↗