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The World Bank's innovation market.

Large, tradition-bound organizations can make space for radical, low-cost (and therefore low-risk) innovations. Just ask executives at the World Bank. The story of this best practice begins in 1998, when a young new-products group at the international funding agency proposed holding an Innovation Marketplace to capture novel ideas within the Bank for alleviating poverty. The forum, which eventually was opened to external participants, let people informally present their antipoverty ideas to potential funding sources. Funders could move among hundreds of booths and evaluate proposals for, say, a program that would provide postdisaster reconstruction insurance in developing countries or a vaccination development initiative. The marketplace truncated the Bank's standard project-review processes, which often stretched to a year or more, and gave funders permission to make commitments in the tens of thousands of dollars, rather than in the tens of millions more typical of Bank-financed projects. The marketplace concept met with some skepticism at the beginning. Some senior executives at the Bank felt no group had the right to spend the agency's money without following its well-established resource allocations process. But the marketplace team believed an open process for allocating grants would produce more breakthrough ideas in the long run than a centralized one. In this article, the authors describe how the new-products team brainstormed to create a market for ideas, how it got senior management's support, and how it has expanded on the original concept for these innovation marketplaces. The program's success, they contend, offers hope both for the world's poor and for business leaders looking to find new ideas under the hard crust of corporate dogma, conformance, and bureaucracy.

Cooperative Behavior↗

Global budgeting in the OECD countries.

Many of the Organization for Economic Cooperation and Development countries use global budgeting to control all or certain portions of their health care expenditures. Although the use of global budgets as a cost-containment tool has not been implemented in the United States in any comprehensive way, recent health care reform initiatives have increased the need for research into such tools. In general, the structure, process, and effectiveness of global budgets vary enormously from country to country, in part because the underlying social welfare system of each country is unique.

Budgets↗

eGrants: University of Cincinnati's Digital grants preparation, workflow routing, and submission system.

Overabundance of largely unorganized and unfiltered information is the greatest information problem facing the faculty, staff, and students of the University of Cincinnati (UC). The goal of UC's IAIMS operations grant is to provide individuals with information that is organized, filtered, context -appropriate, and presented in personalized formats. This presentation will focus on one module, eGrants, of UC's IAIMS research administration system,which will fully digitize the pre-award, post-award, and compliance phases of the grant lifecycle . eGrants will streamline and reduce errors in the grant preparation, routing, and submittal process thus raising the overall quality of and consistency of grant submittals and greatly reducing the time and the cost of grant preparation.

Computers↗

Dancing with strangers: will U.S. substance abuse practice and research organizations build mutually productive relationships?

The scientific knowledge gained from research has not been extensively integrated into the U.S. substance abuse treatment system. A clear call to arms has been issued by the U.S. federal treatment and research agencies to bring research and practice together to create a better treatment system and a more responsive research agenda. The current federally sponsored initiatives to "close the gap" between research and practice are large and well funded. The field appears ready to change and realize the mutual benefits that can be achieved from the increased "bleeding" of research and practice. However, while the music has started and the partners seem willing, there are still many obstacles to a successful dance.

Ambulatory Care↗

Three strategies to promote sustainability of CEMOPLAF clinics in Ecuador. Céntros Médicos de Orientación y Planificación Familiar.

The continuing trend of donor attention and resources away from Latin America threatens the sustainability of nongovernmental family planning organizations in that region. Managers can improve sustainability through cost control, cost recovery, and income generation. The Population Council's INOPAL II and INOPAL III projects and Family Health International assisted CEMOPLAF, an Ecuadoran private voluntary organization, in carrying out operations research in each of these areas. Studies included cost-savings analysis from altering IUD revisit norms (cost control), an ability-to-pay study that showed potential gains from increased prices for reproductive health services (cost recovery), and a feasibility study to estimate income from ultrasound services (income generation). Results indicate that any one intervention will probably have a limited impact, and that managers likely will need to undertake several initiatives simultaneously to make significant progress toward sustainability.

Adolescent↗

National health systems as market interventions.

National health systems have developed in all countries; their features have been shaped largely by organized interventions in the free market of health service. Any health system can be characterized through analysis of five major components: (1) its production of resources, (2) organization of programs (including a residual private market), (3) sources of economic support, (4) modes of management, and (5) patterns of providing services. The diverse types of health systems in the world may be categorized in a matrix derived from two dimensions: (a) the economic level (four steps), and (b) the political ideology of the health system, scaled (also four steps) from highly entrepreneurial (minor market intervention) to socialist (nearly complete market intervention). Every national health system would fit into one of the 16 cells of this matrix, although positions change as a result of economic and political dynamics.

Delivery of Health Care↗

International Task Force on Volunteer Cleft Missions.

The International Task Force on Volunteer Cleft Missions was set up to provide a report to be presented at the Eighth International Congress of Cleft Palate and Associated Craniofacial Anomalies on September 12, 1997, in Singapore. The aim of the report was to provide data from a wide range of different international teams performing volunteer cleft missions and, thereafter, based on the collected data, to identify common goals and aims of such missions. Thirteen different groups actively participating in volunteer cleft missions worldwide were selected from the International Confederation of Plastic and Reconstructive Surgery's list of teams actively participating in volunteer cleft missions. Because of the time frame within which the committee had to work, three groups that did not respond by the stipulated deadline were omitted from the committee. The represented members and their respective institutions have undertaken more than 50 volunteer cleft missions to underdeveloped nations worldwide within the last 3 years. They have visited over 20 different countries, treating more than 3,500 patients worldwide. Based on the data collected and by consensus, the committee outlined recommendations for future volunteer cleft missions based on 1) mission objectives, 2) organization, 3) personal health and liability, 4) funding, 5) trainees in volunteer cleft missions, and 6) public relations. The task force believed that all volunteer cleft missions should have well-defined objectives, preferably with long-term plans. The task force also decided that it was impossible to achieve a successful mission without good organization and close coordination. All efforts should be made, and care taken, to ensure that there is minimal morbidity and no mortality. Finally, as ambassadors of goodwill and humanitarian aid, the participants must make every effort to understand and respect local customs and protocol. The main aims are to provide top-quality surgical service, train local doctors and staff, develop and nurture fledgling cleft programs, and, finally, make new friends.

Cleft Palate↗

The capacity-building approach to intervention maintenance implemented by the Stanford Five-City Project.

Increasingly, agencies supporting community health promotion interventions require participating communities and evaluators to specify how the intervention will be maintained once agency funding ends. The Stanford Five-City Project (FCP) implemented two different strategies to maintain its heart disease education program, with the second strategy designed to overcome the barriers to implementation that were encountered by the first. This paper provides a practice-oriented description of the initial 'community network' maintenance strategy of the FCP, the barriers that were encountered as this network strategy was implemented, the alternative 'capacity-building' strategy directed at local health educators and the successful implementation of this alternative. Also discussed are the community organization issues underlying the shift in intervention maintenance strategies and the specific components of the capacity-building strategy, including its focus on health educators, and its application of a training of trainers model and cooperative learning methods to provide professional development, technical assistance and other resources to a target group of community health educators. Our experience indicates that capacity-building is a viable method for intervention maintenance and that it may also facilitate efforts to disseminate model health promotion programs to communities lacking experience in community health promotion intervention.

California↗

Auditing research studies.

BACKGROUND: Recognizing the increasing attention being given to reports of misconduct, fraud, and unethical behavior in biomedical research, it appears timely for nurse researchers to engage in an organized method of peer review. OBJECTIVES: To describe an auditing process for funded research grants, the guidelines used to conduct the research audit, and the results to date. METHODS: The audit encompassed National Institutes of Health (NIH)-funded projects and their respective research teams, 12 faculty auditors using an audit worksheet developed by the Center for Nursing Research. RESULTS: Overall, auditing of research grants was viewed positively by both investigators and faculty auditors. Minor problems were identified that could be corrected. Only one grant required a second review. CONCLUSIONS: Specific guidelines are proposed for future audits that include level of funding and timing of audits.

Financing, Organized↗

Primary care in Australia.

The Australian health care delivery system is reviewed in this article, with special comment on the implications of the financial components of the system and government concerns regarding costs and over-servicing. General practitioners' perception of their role is not significantly different from the expectation of patients, yet the reality may not match the idealized view. There are problems related to availability and there are developments which seem to pose some threat to the continuing care of patients. New developments have occurred in the way in which practice is organized which give an emphasis to continual availability over 24 hour periods, and these developments pose a challenge to the way in which doctors have organized their practices. Population features--Aborigines, migrants, and the elderly--present significant problems that are not always well met, and the concept of total patient care thereby suffers. The general practitioner's apparent failure to fill the expected role in co-ordination of services is discussed, as is the need for general practitioners to become more actively involved in health education and promotion. The hope for the future lies in the Family Medicine Programme of The Royal Australian College of General Practitioners, which represents a major attempt to provide appropriate vocational training for general practice.

Aged↗

FIDELIS--innovative approaches to increasing global case detection of tuberculosis.

Tuberculosis was declared a global public health emergency in 1993. In 2003, only 45% of the world's estimated new smear-positive tuberculosis cases were detected-well below the 70% global case detection target set by the World Health Organization. The FIDELIS (Fund for Innovative DOTS Expansion Through Local Initiatives to Stop TB) initiative is a new global disease control initiative that has been developed to rapidly assess and implement innovative approaches to increase tuberculosis case detection. To date, 32 projects have been approved-covering approximately 378 million people in 13 countries-24 (75%) of which are in the world's 6 highest-burden countries. A wide range of target populations and interventions have been incorporated into successful FIDELIS projects. The FIDELIS initiative may serve as a model to discover best practices to address other urgent global public health problems.

Antitubercular Agents↗

The route to a national health policy lies through the states.

National health program legislation has been becalmed in the Congress for almost 80 years. Despite periodic cries of "crisis," legislation never emerges from committee. Periodically, campaigns have been mounted without success. Tactical efforts to circumvent direct action by legislating bits and pieces of related programs, Medicare and Medicaid, health maintenance organization support, and pre-budgeting, have complicated operation of the medical care system and stimulated intractable cost inflation. For the first 150 years of American history, responsibility for public health and welfare legislation rested with the states. Most public health policies originated in a state or a few states and then later became national legislation. The state efforts were, in effect, natural experiments. After the Depression and the flood of funding from the federal government in subsequent years, the states faded as innovators. It is proposed that funding a few state models to restimulate state initiative in this regard will provide a more effective route to a national health program.

Animals↗

Using the Baldrige management system framework in health care: the Veterans Health Administration experience.

BACKGROUND: In 1998 the Veterans Health Administration (VHA) developed the Quality Achievement Recognition Grant, a competitive grant application open to all Veterans Integrated Service Networks (VISNs) within the VHA system and based on the Baldrige management framework. Eight of the 22 VISNs attended the educational programs and initiated the grant application process; 7 completed applications. Team award experts from VHA and external sources reviewed, scored, and wrote feedback reports to all applicants and conducted four site visits. IDENTIFICATION OF BEST PRACTICES AND RECOMMENDATIONS FOR FUTURE APPLICANTS: Each application was compared to examples of ideal applications to identify areas of excellence and areas for improvement. In general, the best applicants identified and described key processes and articulated the methods used to evaluate and improve processes. For example, they were able to identify the process used to incorporate key constituents into the strategy development process. One applicant developed a series of management advisory committees, the membership of which includes veterans' service organizations, academic affiliates, community members, and congressional delegates, which were tapped to develop a strategic plan. Leading applicants in the future are likely to be able to demonstrate evidence of deployment and constant review of the strategy and to emphasize the human resources plan into the strategic planning and deployment. CONCLUSIONS: The Baldrige management framework is a useful tool for identification of areas of achievement and areas for improvement within the VHA. Potential applicants for the award could benefit from ensuring coherence across the application, placing a greater emphasis on work systems, and incorporating more extensive analysis of market conditions.

Awards and Prizes↗

Prevention of malaria during pregnancy in West Africa: policy change and the power of subregional action.

BACKGROUND: Despite a broadening consensus about the effectiveness of intermittent preventive treatment (IPTp) in preventing the adverse outcomes of malaria during pregnancy, policy change to IPTp was initially limited to East Africa. In West Africa, where the policy change process for the prevention of malaria during pregnancy started much later, IPTp has been taken up swiftly. OBJECTIVE: To describe the factors that contributed to the rapid adoption of policies to prevent malaria during pregnancy in West Africa. RESULTS AND CONCLUSION: Several factors appear to have accelerated the process: (1) recognition of the extent of the problem of malaria during pregnancy and its adverse consequences; (2) a clear, evidence-based program strategy strongly articulated by an important multilateral organization (World Health Organization); (3) subregionally generated evidence to support the proposed strategy; (4) a subregional forum for dissemination of data and discussion regarding the proposed policy changes; (5) widespread availability of the proposed intervention drug (sulfadoxine-pyrimethamine); (6) technical support from reputable and respected institutions in drafting new policies and planning for implementation; (7) donor support for pilot experiences in integrating proposed policy change into a package of preventive services; and (8) financial support for scaling up the proposed interventions.

Africa, Western↗

World health system performance revisited: the impact of varying the relative importance of health system goals.

BACKGROUND: In 2002, the World Health Organization published a health system performance ranking for 191 member countries. The ranking was based on five indicators, with fixed weights common to all countries. METHODS: We investigate the feasibility and desirability of using mathematical programming techniques that allow weights to vary across countries to reflect their varying circumstances and objectives. RESULTS: By global distributional measures, scores and ranks are found to be not very sensitive to changes in weights, although differences can be large for individual countries. CONCLUSIONS: Building the flexibility of variable weights into calculation of the performance index is a useful way to respond to the debates and criticisms appearing since publication of the ranking.

Benchmarking↗

Organizations and structures that facilitate community research.

The Southwest Oncology Group has become a model for other oncology organizations in the way it facilitates participation of community physicians and their cancer patients in clinical trials. The Southwest Oncology Group accomplishes this through its Community Clinical Oncology Program and Cooperative Group Outreach Program. The Community Clinical Oncology Program brings state-of-the-art cancer treatment, prevention, and control research to the community hospital setting, where most cancer patients receive treatment. The Cooperative Group Outreach Program broadens community participation in clinical trials beyond the extent achievable through Community Clinical Oncology Program. Together, these programs have succeeded in increasing community physician participation in clinical trials and have shown that community physicians are capable of submitting data comparable in quality to those obtained in the academic setting.

Cancer Care Facilities↗

[The role of technical & financial cooperation to advance nursing profession in the area of demand reduction in Latin America: challenges and perspectives].

New framework of Technical & Financial Cooperation (TFC) has been used to develop a partnership between an international organization and universities in Latin America to advance the contribution of nursing profession in the area of demand reduction. TFC purpose is to support development on specific issues or areas that needs to produce impact within the society as a whole. The "Regional Research Capacity-Building Program" for nurses to study the drug phenomenon in Latin America represents an example of new framework of TFC to enhance nurses to use science and technology in areas of health promotion, prevention of drug use and abuse, and social integration in Latin America. TFC has becomes a powerful instrument to advance nursing professional in the area of demand reduction.

Financing, Organized↗

[Daytime admission and day care for the elderly. Current provisions in development].

The last five years day centres for the elderly have been developed on a large scale in the The Netherlands. In this article a number of characteristics of forty day centres is described. By means of a content analysis these characteristics were derived from written reports. There is a considerable variety in the denominations of the schemes, the accommodation that is used, the number of days per week during which the centres are open, the responsible organizations, admission procedures and costs per day. The objectives of the day care schemes are directed towards the visitors, their caregivers and towards the functioning of services as such. Usually visitors come to the day centre once or twice a week. The large majority is 70 years or older, often experiencing psychosocial problems. Besides social-recreational activities, in general an activating and/or therapeutical package of care is offered, in a number of cases together with personal care. Frequently both professional workers and volunteers carry out the work, with or without external support. There are indications of the existence of three types of schemes, varying in professionalism and care that is offered. In the discussion some relevant topics for future research are outlined.

Aged↗