Overcoming language barriers: making a start.
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Clinical practice guidelines can improve health care outcomes, but they are only as effective as their implementation. We present a framework for implementing practice guidelines that begins by identifying the forces driving and restraining the adoption of the guideline. Strategies for changing physician behavior that strengthen the driving forces and weaken the restraining forces can then be incorporated into a comprehensive implementation program. Nine strategies for changing physician behavior are presented, based on a review of the literature and organizational experience at Group Health Cooperative of Puget Sound. In designing an implementation strategy, it is essential that the resources allocated to implementation are commensurate with the improvement in outcomes expected from the successful implementation of the guideline. All implementation programs should include plans for measuring outcomes to allow for continuing improvement. Guideline implementation, evaluation and improvement efforts are most likely to be successful when they are part of an explicit, evidence-based process for evaluating and improving clinical practice.
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Dina Starks is the culinary apprentice coordinator at Opryland Hotel Convention Center in Nashville, Tenn. Her apprentices have the unique opportunity to practice the culinary arts at the largest hotel convention center in the world, in a setting that has 15 restaurants and nearly 3,000 rooms.
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It is difficult, if not impossible, to pick up a health care magazine today without finding an article concerning the shortage of health care professionals. Creative ideas for recruiting new hires, sign on bonuses and employee referral programs are commonplace. However, one significant solution is rarely reviewed--developing genuine partnerships with educational institutions to assist with employee advancement programs.
Health care organizations are searching for a cure. As organizations merge, acquire and struggle to manage costs, many view technology as a panacea. But without a full checkup, do they really know what's ailing them?
According to the US Department of Labor, company costs for replacing an employee equal one-third of a new hire's annual salary. Normal turnover costs' effect on a home care agency's bottom line is currently compounded by the fact that beyond the media hype, the nursing shortage is very real. Home Health Services of Dallas has a successful strategy for staff retention that has assisted in retaining many of the home health aides and other staff since the agency opened in 1974.
"Each year about 180,000 Norwegians move from one local government area to another. Further, a relatively large proportion of the workforce consists of commuters. Recent developments in the labour market have given the question of geographical mobility a new relevance. After definition of the relevant terms, migration and commuting streams of recent years are described; some causes and effects of geographic mobility are discussed."
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