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PubMed2005

Private medical services in the Italian public hospitals: the case for improving HRM.

This study explores how Italian public hospitals can use private medical activities run by their employed physicians as a human resources management (HRM) tool. It is based on field research in two acute-care hospitals and a review of Italian literature and laws. The Italian National Health Service (NHS) allows employed physicians to run private, patient-funded activities ("private beds", surgical operations, hospital outpatient clinics, etc.). Basic regulation is set at the national level, but it can be greatly improved at the hospital level. Private activities, if poorly managed, can damage efficiency, equity, quality of care, and public trust in the NHS. On the other hand, hospitals can also use them as leverage to improve HRM, with special attention to three issues: (1) professional evaluation, development, and training; (2) compensation policies; (3) competition for, and retention of, professionals in short supply. The two case studies presented here show great differences between the two hospitals in terms of regulation and organizational solutions that have been adopted to deal with such activities. However, in both hospitals, private activities do not seem to benefit HRM. Private activities are not systematically considered in compensation policies. Moreover, private revenues are strongly concentrated in a few physicians. Hospitals use very little of the information provided by the private activities to improve knowledge management, career development, or training planning. Finally, hospitals do not use private activities management as a tool for competing in the labor market for health professionals who are in short supply.

Health Services↗

PubMed2001

Quality of care and outcomes of adults with asthma treated by specialists and generalists in managed care.

BACKGROUND: The growth of managed health care in the United States has been accompanied by controls on access to specialty physician services. We examined the relationship of physician specialty to treatment and outcomes of patients with asthma in managed care plans. METHODS: We conducted a mail survey of adult asthma patients who were enrolled in 12 managed care organizations and had at least 2 contacts for asthma (International Classification of Diseases, Ninth Revision, Clinical Modification code 493.x) during the previous 24 months; we also surveyed their treating physicians. This report concerns 1954 patients and their 1078 corresponding physicians. Treatment indicators included use of corticosteroid inhalers, use of peak flow meters, allergy evaluation, discussion of triggers, and patient self-management knowledge. Outcome measures included canceled activities, hospitalization or emergency department visits, asthma attacks, workdays lost, asthma symptoms, physical and mental health, overall satisfaction with asthma care, and satisfaction with communication with physicians and nurses. RESULTS: Significant differences were noted for patients of specialists and experienced generalists compared with those of generalist physicians. Peak flow meter possession was reported by 41.9% of patients of generalists, 51.7% of patients of experienced generalists, and 53.8% of patients of pulmonologists or allergists. Compared with patients of generalists, outcomes were significantly better for patients of allergists with regard to canceled activities, hospitalizations and emergency department visits for asthma, quality of care ratings, and physical functioning. Patients of pulmonologists were more likely to rate improvement in symptoms as very good or excellent. CONCLUSIONS: In a managed health care setting, physicians' specialty training and self-reported expertise in treating asthma were related to better patient-reported care and outcomes.

Adolescent↗

PubMed1996

College health providers' knowledge, attitudes, and management practices of genital HPV infection.

This comparative survey of college health providers explored nurse practitioners' (N = 73) and physicians' (N = 70) knowledge, attitudes, and management practices related to genital human papillomavirus (HPV) infection in females. Both groups had adequate knowledge of basic issues of HPV epidemiology, diagnosis, and treatment. Divergent attitudes and management practices were reported among the providers, with generally low agreement with national STD treatment guidelines published by the Centers for Disease Control and Prevention (CDC). Generally, providers tended to practice a more aggressive management approach on several aspects of HPV infection than recommended by the CDC guidelines. The one major exception reported by the majority of providers was the conservative use of colposcopy for identifying subclinical HPV infection in patients with external genital warts, a finding consistent with CDC guidelines. The availability of colposcopy within a provider's health center was found to be associated with the reported use of colposcopy. Recommendation for future research and implications for college health and advanced nursing practice are addressed.

Adult↗

PubMed2006

Data mining and visualization for decision support and modeling of public health-care resources.

This paper proposes an innovative use of data mining and visualization techniques for decision support in planning and regional-level management of Slovenian public health-care. Data mining and statistical techniques were used to analyze databases collected by a regional Public Heath Institute. We also studied organizational aspects of public health resources in the selected Celje region with the objective to identify the areas that are atypical in terms of availability and accessibility of public health services for the population. The most important step was the detection of outliers and the analysis of availability and accessibility deviations. The results are applicable to health-care planning and support in decision making by local and regional health-care authorities. In addition to the practical results, which are directly useful for decision making in planning of the regional health-care system, the main methodological contribution of the paper are the developed visualization methods that can be used to facilitate knowledge management and decision making processes.

Database Management Systems↗

PubMed2006

Developing skills for evidence-based surgery: ensuring that patients make informed decisions.

Ensuring that the surgical decisions made by and with patients are fully informed is a challenge. Doctors and patients must work together, and to be successful they need support in the form of knowledge management and decision aids. This article emphasizes the importance of eliciting and honoring patients' personal valuations of alternative future health states, their attitudes to the specific risks and risk differences that are central to surgical decisions,and their attitudes to time trade-offs. The skills and habits necessary to accomplish this critical objective begin with nothing less than a genuine concern for patients and an ability to relate to the unique meaning that the present illness and its treatment have in their lives.

Decision Making↗

PubMedDate not supplied

The importance of knowledge transfer between specialist and generic services in improving health care: a cross-national study of dementia care in England and The Netherlands.

Knowledge transfer (KT) between specialist and generic services is widely seen as an important strategy for improving the quality of integrated dementia care. This article elaborates on intra- and inter-organizational features associated with successful KT. A provisional conceptual framework is suggested, based on literature about inter-organizational networks and knowledge management. Professional and organizational cultures, domain perceptions, perceived dependency and the availability of resources are suggested as significant influences upon the motivation and perceived capacity to engage in KT. Personal and organizational continuity is identified as an important process quality. Data from four local case studies in England and The Netherlands are used to develop and specify the provisional framework. A conceptual model is built to explain the relative success or failure of KT.

Delivery of Health Care, Integrated↗

PubMed1994

A model for the assessment of medical workstations for health care support.

The development of medical workstations for the support of patient care, the assessment of care, management support, and education is just at its beginning. During the Working Conference on the Health care Professional Workstation held in Washington DC, June 1993, several aspects of such workstations were discussed, but it was also recognized that prototyping or learning by experience could be a rich source to further promote the progress in this field. Eight such prototypes or already operational medical workstations were demonstrated and a preliminary user assessment was done to obtain a first insight in the advantages and the type of criteria of such evaluations. It was concluded that such assessments were of great value to (i) give feedback to the designers of medical workstations, (ii) indicate areas of strength and for further research, and (iii) to offer criteria to potential users of such workstations for making decisions on using such systems. The assessment criteria deal with functionality, architecture, user interfaces, communications and integration, and data and knowledge management.

Artificial Intelligence↗

PubMedDate not supplied

Managing in an age of modularity.

Modularity is a familiar principle in the computer industry. Different companies can independently design and produce components, suck as disk drives or operating software, and those modules will fit together into a complex and smoothly functioning product because the module makers obey a given set of design rules. Modularity in manufacturing is already common in many companies. But now a number of them are beginning to extend the approach into the design of their products and services. Modularity in design should tremendously boost the rate of innovation in many industries as it did in the computer industry. As businesses as diverse as auto manufacturing and financial services move toward modular designs, the authors say, competitive dynamics will change enormously. No longer will assemblers control the final product: suppliers of key modules will gain leverage and even take on responsibility for design rules. Companies will compete either by specifying the dominant design rules (as Microsoft does) or by producing excellent modules (as disk drive maker Quantum does). Leaders in a modular industry will control less, so they will have to watch the competitive environment closely for opportunities to link up with other module makers. They will also need to know more: engineering details that seemed trivial at the corporate level may now play a large part in strategic decisions. Leaders will also become knowledge managers internally because they will need to coordinate the efforts of development groups in order to keep them focused on the modular strategies the company is pursuing.

Computer Systems↗

PubMed2005

A generative response to palliative service capacity in Canada.

PURPOSE: This paper situates a large-scale learning and service development capacity-building initiative for hospice palliative care services within the current Canadian policy context for use by international readers. DESIGN/METHODOLOGY/APPROACH: In 2000 a national initiative using action research as its design was crafted to support continuing professional development and knowledge management in primary-health care environments. FINDINGS: The Canadian health policy context is complex and requires innovative solutions to achieve desired changes in response to emerging population health demands for quality end-of-life care. Employment of educational and social science constructs, including complexity theory, communities of practice, transformative learning theory, and workplace learning methods, has proven helpful in supporting the creation of national capacity for hospice palliative care. RESEARCH LIMITATIONS/IMPLICATIONS: There is a significant contribution for social scientists to make in aiding a better understanding of the complexity in health systems. At the same time, an aging population in industrial countries demands more active engagement of legal and bioethical scholars in a range of emerging policy and legislative questions about quality end-of-life care. Educational research is also required to understand better and reform curricula to prepare an emerging generation of health science practitioners for the demands of an aging population. PRACTICAL IMPLICATIONS: Changing health service delivery environments demand rethinking of the knowledge and skills leaders require to influence desired change. A broader understanding of where and how learning takes place is essential for enhancing the quality of patient care. ORIGINALITY/VALUE: The Pallium Project represents a generative response to facilitating learning and building longer-term system capacity. The journey of project development to date illustrates some important lessons that can be adopted from hospice palliative care to inform other primary-health care initiatives, including, potentially, mental health, cardiology, diabetes, geriatrics, where productive change can result from productively linking specialists and primary-care colleagues.

Canada↗

PubMed1998

A randomized controlled trial to evaluate the efficacy of community based physical therapy in the treatment of people with rheumatoid arthritis.

OBJECTIVE: To evaluate the short term efficacy of a community based physical therapy (PT) program for people with rheumatoid arthritis (RA) through a single blind randomized controlled trial. METHODS: Adults with active RA were referred by their physician for community based PT. Participants were randomized to either an immediate intervention group [experimental group (EG)] or a wait list control group (CG). The intervention was a standardized program of education and exercise consisting of at least 4 visits or 3 h of PT over 6 weeks. Baseline, 6, and 12 week assessments were by a blinded independent assessor. The primary outcome instrument was the Stanford Arthritis Self-Efficacy Scale (SES) and secondary outcome measures included the ACREU Rheumatoid Arthritis Knowledge Questionnaire (KQ) and visual analog scale for pain (VAS). Duration of morning stiffness, grip strength, and tender joint count were also collected at each assessment. Outcome analysis was conducted using analysis of variance. RESULTS: Of 150 eligible and randomized participants, 127 completed the study according to protocol. Baseline analysis showed no differences between the EG and CG for demographics, disease status, or other characteristics. At the 6 week assessment, primary outcome analysis for those who completed the protocol identified a mean change (improvement) of 13.5% in the EG and 5.8% in the CG, representing a 7.7% difference in change scores between the 2 groups [F(1,121) = 6.03; p = 0.015]. A statistically significant difference in change scores was also identified for the KQ [F(1,120) = 6.67; p = 0.011], but not for the VAS. Disease status measures did not change, except for duration of morning stiffness, which improved by 68.8 min in the EG and 8.3 min in the CG (F(1,121) = 4.50; p = 0.036]. CONCLUSION: Four hours of a community based PT intervention delivered over 6 weeks significantly improved self-efficacy, disease management knowledge and morning stiffness in people with RA.

Adult↗

PubMed2004

The World Health Channel: an innovation for health and development.

The issues of the digital divide and of accessing health information in areas of greatest need has been addressed by many. It has been a key component of the discussion of the World Summit for the Information Society and also the focus of an important new initiative, the Global Review for Health Information. Only approximately 1 in 700 people in Africa have internet access compared to a rate worldwide of approximately 10%. Access to essential health information and knowledge management for health care has been deemed a priority for the development of health systems and for the care of patients in areas with limited resources, prompting recent efforts by international organisations and by both governmental and non-governmental agencies (see Godlee et al, 2004 and McConnell, 2004). Health care in developing countries can be limited by many different resources: lack of health care workers with sufficient training, lack of diagnostic equipment, lack of treatment facilities or essential pharmaceuticals; and lack of education or expertise in many relevant areas. Much of the health care done in developing countries is by local lay persons or practitioners or by volunteers working with a variety of NGOs. These volunteers are often very dedicated young people with a vision of health-for-all that is often frustrated in the limited time they are able to spend in these areas and further constrained by meager resources (including availability of appropriate information). The availability of medical expertise and consultation depends largely on the geographical location of the health practitioner and of the patient as well as the level of integration with local practitioners and extent of outside agency involvement. Futhermore, there are often many NGOs working simultaneously on similar projects in the same region without knowledge of each other's activities. Often this occurs simply because a lack of communication exists between organisations, resulting in unnecessary duplication of effort. The availability of medical expertise and consultation depends largely on the geographical location of the health practitioner and of the patient as well as the level of integration with local practitioners and extent of outside agency involvement. The health care worker in developing countries is frequently faced with a paucity of information appropriate to the clinical situations on hand as well as a lack of locally available expertise. The lack of access to health care and other vital resources is one factor in the much lower (by approximately 1/3) life expectancy in the least developed countries campared to industrialised nations. In many developing countries there is only one doctor for 5-10,00 people, compared to a ratio of 1:200 in many developed countries. Textbooks, if they exist, may be 10-20 years out of date and are often directed more at the needs of developed countries. There is thus a growing need for wider availability of training and information on health care in developing countries and support for health care workers. There is also a need for increased communication and collaboration between governmental and non-governmental organisations working in international health to share education, resources and to coordinate efforts in areas supporting improved health care delivery. In recognition of this, the Institute for Sustainable Health Education and Development (www.ished.org) is launching the World Health Channel (WHC) in the spring of 2005 in collaboration with WorldSpace. This will allow access to critical health information in developing countries and place the emphasis on issues important for clinical care for front line health workers in these areas.

Access to Information↗

PubMed2005

Information needs of United Kingdom primary care clinicians.

BACKGROUND: The scope of primary care makes knowledge management in this context very challenging, especially as access to information increases and the role of primary care within the NHS expands. OBJECTIVES: This paper reviews the literature on the information needs of primary care clinicians to enable evidence-based decision making. Drawing on the literature, and using a specific example of a clinical informaticist service, some lessons are drawn on the role of information professionals in facilitating evidence-based health care. METHODS: Literature review. Case study of clinical informaticist service. CONCLUSIONS: There are numerous barriers to clinicians engaging with evidence-based practice. However, providing evidence-based information to clinicians' questions in a user-friendly format has the potential to facilitate changes in practice. The successful implementation of information services requires attention to both academic and service dimensions, fostering closer working relationships between clinicians and information professionals.

Attitude of Health Personnel↗

PubMed2004

Telling tales.

A carefully chosen story can help the leader of an organization translate an abstract concept into a meaningful mandate for employees. The key is to know which narrative strategies are right for what circumstances. Knowledge management expert Stephen Denning explains that, for optimal effect, form should follow function. Challenging one professional storyteller's view that more is better, Denning points out that it's not always desirable (or practical) to launch into an epic that's jam-packed with complex characters, cleverly placed plot points, an intricate rising action, and a neatly resolved denouement. True, if listeners have time and interest, a narrative-savvy leader can use a vividly rendered tale to promote communication between management and staff, for instance, or even to foster collaboration--especially when the story is emotionally moving. However, if the aim is to motivate people to act when they might not be inclined to do so, it's best to take an approach that's light on detail. Otherwise, the particulars can bog listeners down and prevent them from focusing on the message. Drawing on his experiences at the World Bank and observations made elsewhere, the author provides several dos and don'ts for organizational storytellers, along with examples of narratives that get results. The sidebar "A Storytelling Catalog" presents seven distinct types of stories, the situations in which they should be told, and tips on how to tell them. Many of these aren't even stories in the "well-told" sense--they run the rhetorical gamut from one-liners to full-blown speeches--but they succeed because they're tailored to fit the situation. So even though it's common in business to favor the analytical over the anecdotal, leaders with the strength to push past some initial skepticism about the enterprise of storytelling will find that the creative effort pays off.

Cooperative Behavior↗

PubMedDate not supplied

Assessment of nurses' attitudes and knowledge regarding pain management.

BACKGROUND: RNs in North Carolina were surveyed to determine their current knowledge and to determine if educational preparation, practice setting, or clinical specialty influenced their knowledge levels and attitudes. METHOD: A stratified random sample of 1,000 practicing RNs in North Carolina were surveyed using the Nurses' Knowledge and Attitudes Survey Instrument developed by McCaffery and Ferrell. RESULTS: The mean score was 64.58 based on the percentage of correct responses from the 260 subjects who participated. No statistically significant difference was found in scores based on educational preparation, practice setting, or clinical specialty. CONCLUSION: The findings of this study support the concern of inadequate knowledge and inappropriate attitudes regarding pain management. It reveals the need for intensive continuing education and staff development.

Adult↗

PubMed2006

[Knowledge identification and management in a surgery department].

The hospital is an enterprise in which the surgery department represents a specific healthcare unit. The purpose of the surgery department, like that of any other enterprise, is assumed to be indefinite survival; to that end, it must be able to achieve and maintain a competitive advantage in the long term. Nevertheless, each surgery department, like each enterprise, can precisely define the scope of the above-mentioned terms, the main source of an enterprise's competitive advantage being its knowledge stock. Knowledge is recognized as being the basis of competitive success among institutions. This article presents the concept and classification of knowledge and discusses how it should be identified, inventoried, and managed. Special emphasis is placed on healthcare activity, since this sector presents certain characteristics distinguishing it from other sectors of economic and business activity.

Information Management↗

PubMed1984

Rate of growth of intraabdominal metastases from colorectal cancer.

Monitoring the progression or regression of intraabdominal metastatic disease is required for knowledgeable management of chemotherapeutic regimens designed to treat metastases. Computerized tomography (CT) and CT with EOE-13, a liver contrast agent, allowed precise measurement of metastatic disease. The tumor doubling time of colorectal metastases in four patients was determined from serial CT scans of individual patients. Tumor doubling times of untreated patients varied from 50 to 95 days, and were in the same range for hepatic, lymph node, or intraperitoneal metastatic disease. These data may indicate that metastatic disease of colorectal cancer progresses at a faster rate in the peritoneal cavity than is reported for colorectal cancer metastatic to the lungs. The response to chemotherapy or progression of disease was also determined in treated patients. High resolution CT scanning with EOE-13 allowed calculation of tumor doubling times, and therefore more precise management of cancer patients with metastases.

Cell Division↗

PubMed2005

Action plans for chronic obstructive pulmonary disease.

BACKGROUND: The effectiveness of action plans as treatment for chronic obstructive pulmonary disease (COPD) is not known. OBJECTIVES: To assess the efficacy of action plans in the management of COPD. SEARCH STRATEGY: We searched the Cochrane Airways Group Specialised Register, CENTRAL, MEDLINE, CINAHL and the National Research Register of Ongoing Trials. We also searched reference lists of identified studies. The search was completed in August 2004. SELECTION CRITERIA: Randomised controlled trials of action plans in COPD. Studies with a primary diagnosis of asthma excluded. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Investigators were contacted for additional information when necessary. Study results were combined in meta-analyses using the Cochrane Collaboration software RevMan. MAIN RESULTS: There was evidence of a positive effect of action plans on self-management knowledge. The mean difference (MD) for recognition of a severe exacerbation was 2.50; 95% confidence interval 1.04 to 3.96, for self-action in severe exacerbations MD 1.50; 95% confidence interval 0.62 to 2.38 and the use of antibiotics MD 6.00; 95% confidence interval 2.68 to 9.32. There was also evidence of a positive effect on the initiation of antibiotics (odds ratio (OR) 10.16; 95% confidence interval 2.02 to 51.09) and/or oral steroids (OR 6.58; 95% confidence interval 1.29 to 33.62). However, there was no evidence of significant effects on healthcare utilisation, health-related quality of life, lung function, functional capacity, symptom scores, mortality, anxiety, or depression. No trials used as outcomes: number of exacerbations, length of exacerbations, or days lost from work. AUTHORS' CONCLUSIONS: This review shows there is evidence that action plans aid people with COPD in recognising and reacting appropriately to an exacerbation of their symptoms via the self-initiation of antibiotics or steroids. Further research needs to be completed with more comprehensive outcomes measures in order to ascertain whether this results in significantly decreased morbidity and/or mortality.

Behavior Therapy↗

PubMed2006

In silico classification of HERG channel blockers: a knowledge-based strategy.

The blockage of the hERG potassium channel by a wide number of diverse compounds has become a major pharmacological safety concern as it can lead to sudden cardiac death. In silico models can be potent tools to screen out potential hERG blockers as early as possible during the drug-discovery process. In this study, predictive models developed using the recursive partitioning method and created using diverse datasets from 203 molecules tested on the hERG channel are described. The first model was built with hERG compounds grouped into two classes, with a separation limit set at an IC50 value of 1 microm, and reaches an overall accuracy of 81%. The misclassification of molecules having a range of activity between 1 and 10 microM led to the generation of a tri-class model able to correctly classify high, moderate, and weak hERG blockers with an overall accuracy of 90%. Another model, constructed with the high and weak hERG-blocker categories, successfully increases the accuracy to 96%. The results reported herein indicate that a combination of precise, knowledge management resources and powerful modeling tools are invaluable to assessing potential cardiotoxic side effects related to hERG blockage.

Drug Design↗