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PubMed1996

Structural change in hospitals: the implications for research.

This paper begins by considering briefly the interdependent nature of the health care sector and suggests that most research on structural change in the hospital system has ignored that obvious fact. It then goes on to argue that this failure will become even more significant in the face of the large scale changes that are expected in the way health services are delivered. Its central proposal is that the research horizons should be widened, particularly if change on the scale that appears likely is to be properly evaluated. How that may be done is considered in the final section.

Health Care Sector↗
PubMed2003

Why hospitals offer health promotion: perspectives for collaborating with health promotion practitioners.

Most hospitals have expanded their services in recent years to become involved with health promotion programs and activities. A hospital might offer health promotion services to promote health and to raise the health status of its community. However, it might provide health promotion for other reasons, such as to improve the hospital's cost-effectiveness, competitive strategy, organizational legitimacy, or tax exemption. Health promotion practitioners who collaborate with a hospital for health promotion should understand the hospital's reasons for providing health promotion. Furthermore, they should understand that different reasons may lead to different priority populations, resource commitments, organizational structures, work processes, and health outcomes.

Community Health Planning↗
PubMed2003

Hospital health promotion: swimming or sinking in an upstream business?

Healthy People 2000 (HP 2000) calls on hospitals to offer health promotion programs addressing priority health needs of the community. Historically, this upstream initiative has not been present in health care. With the increasing provision of these programs, this case study examined their content to further understand potential public health impact. The health promotion programs offered to the community--both the general public and corporate employees--by an urban Midwest hospital were assessed over 1 year. This article presents a content analysis of 216 programs that was conducted by measuring seven variables: target group, presentation format, fee, health focus, program providers, contact frequency, and activity. Based on this single case study, hospitals appear to be addressing objectives set forth by HP 2000 for community hospitals. Although moving upstream with health promotion, an analysis of program content suggests modifications may be necessary in order to serve as effective interventions for health priorities.

Academic Medical Centers↗
PubMed2006

Community hospitals--the place of local service provision in a modernising NHS: an integrative thematic literature review.

BACKGROUND: Recent developments within the United Kingdom's (UK) health care system have re-awakened interest in community hospitals (CHs) and their role in the provision of health care. This integrative literature review sought to identify and assess the current evidence base for CHs. METHODS: A range of electronic reference databases were searched from January 1984 to either December 2004 or February 2005: Medline, Embase, Web of Knowledge, BNI, CINAHL, HMIC, ASSIA, PsychInfo, SIGLE, Dissertation Abstracts, Cochrane Library, Kings Fund website, using both keywords and text words. Thematic analysis identified recurrent themes across the literature; narrative analyses were written for each theme, identifying unifying concepts and discrepant issues. RESULTS: The search strategy identified over 16,000 international references. We included papers of any study design focussing on hospitals in which care was led principally by general practitioners or nurses. Papers from developing countries were excluded. A review of titles revealed 641 potentially relevant references; abstract appraisal identified 161 references for review. During data extraction, a further 48 papers were excluded, leaving 113 papers in the final review. The most common methodological approaches were cross-sectional/descriptive studies, commentaries and expert opinion. There were few experimental studies, systematic reviews, economic studies or studies that reported on longer-term outcomes. The key themes identified were origin and location of CHs; their place in the continuum of care; services provided; effectiveness, efficiency and equity of CHs; and views of patients and staff. In general, there was a lack of robust evidence for the role of CHs, which is partly due to the ad hoc nature of their development and lack of clear strategic vision for their future. Evidence for the effectiveness and efficiency of the services provided was limited. Most people admitted to CHs appeared to be older, suggesting that admittance to CHs was age-related rather than condition-related. CONCLUSION: Overall the literature surveyed was long on opinion and short of robust studies on CHs. While lack of evidence on CHs does not imply lack of effect, there is an urgent need to develop a research agenda that addresses the key issues of health care delivery in the CH setting.

Health Services Research↗
PubMed2001

Theoretical and perceived balance of power inside Spanish public hospitals.

BACKGROUND: The hierarchical pyramid inside Spanish public hospitals was radically changed by the Health Reform Law promulgated in 1986. According to it, the manpower of the hospitals was divided into three divisions (Medical, Nursing, General Services/Administration), which from then on occupied the same level, only subject to the general manager. Ten years after the implementation of the law, the present study was designed in order to investigate if the legal changes had indeed produced a real change in the balance of power inside the hospitals, as perceived by the different workers within them. MATERIALS AND METHODS: A questionnaire was administered to 1,027 workers from four different public hospitals (two university-based and two district hospitals). The participants belonged to all divisions, and to all three operative levels (staff, supervisory and managerial) within them. The questionnaire inquired about the perceived power inside each division and hierarchical level, as well as about that of the other divisions and hierarchical levels. RESULTS: Every division attributed the least power to itself. The Nursing and the Administrative division attributed the highest power to the physicians, and these attributed the highest power to the General Services/Administrative division. All hierarchical levels (including the formal top of the pyramid) attributed significantly more power to the other than to them. CONCLUSIONS: More than ten years after the implementation of the new law, the majority of workers still perceive that the real power within the hospitals is held by the physicians (whereas these feel that it has shifted to the administrators). No division or hierarchical level believes it holds any significant degree of power, and this carries with it the danger of also not accepting any responsibility.

Attitude of Health Personnel↗
PubMed2006

Door to thrombolysis: ER reorganization and reduced delays to acute stroke treatment.

The authors reorganized the emergency room (ER) by moving CT to the ER and streamlining triage by prenotification by emergency medical services (EMS), which reduced in-hospital delays and enhanced access to stroke thrombolysis. CT delay dropped from 1 hour 3 minutes +/- 14 minutes in 1999 to 7 +/- 2 minutes in 2004 (p < 0.0001). Door-to-needle time dropped from 1 hour 28 minutes +/- 7 minutes to 50 +/- 3 minutes (p < 0.001), while symptom-to-needle time dropped from 2 hours 44 minutes +/- 6 minutes to 2 hours 5 minutes +/- 4 minutes (p < 0.0001). From 23 patients in 1999, thrombolysis access was increased to 100 patients in 2004 and 183 patients in 2005.

Acute Disease↗
PubMed2002

Emerging factors shaping the future of the Veterans' Health Administration: a strategic analysis.

In response to societal and industry-wide forces, the Veterans' Health Administration (VHA) has undertaken a re-engineering process, changing the operational and management structure from individual, independent, and often competing large hospital centres into 22 integrated service networks or VISNs to provide structural incentives for efficiency, quality and improved access as well as transitioning the system to one that is grounded in ambulatory and primary care (Ashton et al., 1998). This paper presents a framework for evaluating the successes and/or failures of the recent re-organization efforts of the VHA in bringing together this multitude of medical care 'parts' or modules into an integrated, cost-effective healthcare delivery system. In total, this paper attempts to delineate an analytical framework by which the threats and opportunities as well as the strengths and weaknesses of the VHA are identified. More specifically, this paper addresses the external pressures driving reform in the VHA system and how the Veterans' Administration can respond to these pressures. Implications for the future of the VHA if its reform efforts are not successful are examined.

Delivery of Health Care, Integrated↗
PubMed2004

Lessons from New Zealand for England's NHS Foundation Trusts.

The legislation to devolve responsibility for the management and operation of England's top-performing NHS hospitals to community-owned NHS Foundation Trusts raises several issues relating to the challenges posed to governance structures by private non-profit ownership and control of assets used to provide government-financed services. Building upon the lessons learned from devolution of public hospital governance in New Zealand to boards at arm's-length from central control during the 1990s, this paper analyses the English NHS hospital changes. Whilst local political accountability and competition between hospitals indicate that the English reforms may be more successful in meeting patients' needs more efficiently than the New Zealand reforms, the English proposals may be compromised by the ability of staff to become members of Trusts, boards bearing risks of decisions outside their control whilst simultaneously being insulated from the consequences of their decisions by a 'soft budget constraint', and conflicts of interest as boards simultaneously act as agents of both central regulators and local beneficiaries.

Decision Making, Organizational↗
PubMed2005

New strategies for monitoring the health of Canadian nurses: results of collaborations with key stakeholders.

The aim of this descriptive study was to help policy- and decision-makers enhance the health of the Canadian nursing workforce by highlighting key factors of concern and exploring options for collecting and utilizing nurses' health data. This paper describes the views of 62 nursing stakeholders from a diverse spectrum of professional, labour, management and government perspectives from across Canada, regarding key factors contributing to work-related health problems in the nursing profession, particularly those relating to the work environment and hospital restructuring. The results were combined with a synthesis of existing information sources about the health of nurses in Canada. With respect to the key concerns, musculoskeletal conditions/injuries and stress and burnout were identified as nurses' major work-related health problems. An examination of the data synthesis inventory revealed that no existing data sources can adequately profile nurses' health, especially in relation to the components of the Conceptual Model of Nurses' Health developed in the study. Three strategies for monitoring nurses' health are proposed.

Age Factors↗
PubMed2001

Redesigning geriatric healthcare: how cross-functional teams and process improvement provide a competitive advantage.

This study examines the consequences of adding a geriatric subacute unit to the traditional health care mix offered by a nonprofit hospital. Historically, geriatric health care offerings have been limited to either acute care units or long-term care facilities. The study's findings demonstrate that the addition of a subacute unit that is operated by an interdisciplinary team is a competitively rational move for two reasons. First, it provides a continuum of care that integrates services and departments, thereby reducing costs. Second, it provides a supportive environment for patients and their families. As a consequence patients have a higher probability of returning home than patients who are assigned to more traditional modes of care.

Activities of Daily Living↗
PubMed2001

Geriatric services offered by hospitals: predicting services by internal and external community characteristics.

This article explores the role of hospitals in providing geriatric services and identifies associated community and hospital characteristics. The sample is 4571 community hospitals responding to the 1995 American Hospital Association (AHA) Annual Survey. Most hospitals offer some geriatric services; the mean is 3.3. The dependent variable is an index of 13 geriatric services created from the AHA data. Independent variables are taken from the AHA survey, Area Resource File, and census data. Regression analysis explains fifteen percent of the variance. Hospital characteristics predicting provision of geriatric services are non-profit tax status, hospital bed size and system membership. Community characteristics predicting provision of geriatric services included higher population density, high percentage of county aged, and county nursing facility beds. Hospital characteristics yielded slightly higher predictive ability than did community characteristics. The findings suggest policies to increase hospital leadership in providing access to senior services require a multi-dimensional approach.

Aged↗
PubMed2004

Health care for older persons in Singapore: integrating state and community provisions with individual support.

Health care policy in Singapore is similar to that in the United States and the United Kingdom, where a residualist strategy is used to pass health care costs to individuals and their families, the rationale being that this enables the state to concentrate on devolution of care to the community and ensure efficient and affordable service to all Singaporeans. The services include public restructured hospitals and outpatient poly-clinics as well as community services such as community hospitals and hospitals for the chronically ill, nursing homes, day care centers, and home help services. Availability does not translate into optimum usage because current and potential users and their families are not able to match their financial and social resources with the services. Instead, the state acts as the case manager and places parameters on what individuals can access.

Aged↗
PubMed1995

Health care in the future may be as close as your neighborhood retail store: the case of Mount Sinai Hospital, Chicago.

The hospital industry nationwide has undergone tremendous changes over the past several years. As a result, hospitals have had to develop new marketing strategies for survival, diversifying their services and seeking new non-hospital sources of revenue. This case study focuses on the successful development of the Family Health Corners, a pair of primary care medical practices sponsored by Mount Sinai Medical Center (Chicago) and located inside Zayre Department Stores.

Ambulatory Care Facilities↗
PubMed1996

Hospitals in a changing health care system.

Health system change is happening locally, and hospitals are at the center of this change. This paper, which presents data from a 1995 study of fifteen diverse communities, sketches the broad economic and organizational forces affecting hospitals in these communities and the hospitals' responses. Within these larger trends, local flavors and differences emerge. These appear to reflect variations in each community's employment base and health care purchasing experience, in the history and political strength of health system stakeholders, and in regional issues of culture or religious affiliation for some hospitals.

Delivery of Health Care↗