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PubMed1996

The changing roles of health care personnel in health and health care management.

Health care reform has become a global phenomenon. Countries are experiencing similar problems with their health care systems and are reaching for similar solutions. Management is seen as crucial in many countries as the principal means of securing supply-side reforms. Many of these centre on establishing a new relationship between professionals, notably the medical profession, and the state. The aim has been to exercise greater influence over how professionals practice and use resources. The application of new public management principles based on industrial sector practices and concepts of management has created tensions within professional groups who feel themselves, and their craft, to be under attack. But the new managerialism has to be seen within a context of rapid social and economic change. It is not possible to predict what the impact of such change is likely to be on health services in the future or on those who provide them. The paper offers an overview of health care reforms and assesses how it is shaping, or re-shaping, the roles and tasks of health care personnel. One conclusion is the mismatch between the management style favoured by policy-makers and reformers and the necessary flexibility required in skill mix and organization of work. High-trust relations lie at the heart of professional forms of organisation whereas the new managerialism appears to be based on the expectation of low-trust relations. The paper concludes with a brief look at the implications of all these developments for training and education and finds that there is still a long way to go before there is any real prospect of providing and equipping health care personnel with the requisite skills to enable them to meet the complex challenges that are a common characteristic of health care systems.

Delivery of Health Care↗

PubMed1995

Can national surveys be funded successfully from local NHS resources? Evidence from the Regional Study of Care for the Dying.

In the current economic climate, obtaining funding for large-scale national health services research surveys can be very difficult. In this paper we describe how the funding for a national survey, in which a random sample of 3696 bereaved relatives were interviewed, was obtained through collaboration with health regions and districts, and we consider the advantages and disadvantages of this approach. Although researchers considering using joint funding with the NHS may have to make compromises between ideal study design and what is feasible given local needs and the geographical spread of participating districts or NHS units, we conclude that collaboration can benefit both parties.

Bereavement↗

PubMedDate not supplied

The value of the VaNTH Engineering Research Center.

This article summaries some of the project-level assessment and evaluation activities that have been used to assess the value added for innovations that incorporate learning science principles and learning technology underlying the HPL model proposed by Bransford et al. [1]. Based on a counterfactual model of causal analysis, VaNTH investigators have been encouraged to use experimental and quasi-experimental research designs to estimate the "value added" for their innovations. Although some studies have been undertaken with little difficulty, practical constraints have resulted in the need to allow quasi-experimental designs to emerge over time and institutions. By applying the logic, principles, and criteria of a counterfactual causal model, as opposed to a "cookbook" application of designs and statistical procedures, VaNTH investigators have begun to develop a firm knowledge base about the relative effectiveness of their HPL-inspired innovations. The overall effects and differences among studies are being investigated through the use of a statistical technique known as meta-analysis. This article demonstrates that it is possible to assess and evaluate, in a quantitative way, the relative effects of educational innovations in engineering courses. It also demonstrates, albeit in a preliminary fashion, that a broader assessment of the HPL model underlying VaNTH can be undertaken by systematically looking across studies within VaNTH. By implication, the knowledge gained about engineering education from A&E efforts within VaNTH should be much greater than the sum of its parts.

Biomedical Engineering↗

PubMed1999

Assessment of an itinerant medical evaluation program for school dysfunction.

This paper describes an itinerant medical evaluation (IME) project and reports on the outcome of 108 consecutive referrals made in the first year. Subjects were of ages 5 to 17 years. Most students had been evaluated by the schools but were not receiving special education or related services. IME led to clinical diagnosis of ADHD in 70% of the sample, and specific learning disabilities were diagnosed in 26%. Several other clinically significant and educationally relevant diagnoses were made. As a result of the IME, many students were placed in special education and/or began to receive related services. At three-month follow-up, classroom accommodations were being made for 97% of the students. Teachers reported they felt more capable of teaching challenging students as a result of the IME. Significant improvements occurred in hyperactivity, conduct problems, and inattention, and grades improved in 31% of the sample. Reasons for the project's success are discussed.

Adolescent↗

PubMedDate not supplied

Ally or adversary? Using media systems for public health.

The media system controls information resources that public health agencies may wish to use to accomplish their goals, particularly in a crisis. The resources of the public health system sometimes are prized by the media system, and this provides opportunities for public health agencies to gain access to the media. This paper reviews the goals and resources of the media system as they relate to the mission of public health agencies in the periods before, during, and after a public health crisis. The various media are reviewed with attention to the role each can play for different purposes and at different stages of a crisis. The importance of presenting health information in the form of stories is emphasized, with specific advice regarding the attributes of an effective story.

Communication↗

PubMed2006

Strategies to implement tobacco control policy and advocacy initiatives.

Critical care nursing organizations and individual critical care nurses can have an important impact on tobacco-related health policies. This article reviews the importance of critical care nursing involvement in policy efforts to achieve tobacco control goals, barriers to such involvement, and strategies to implement successful tobacco control policy initiatives. The involvement of the Association of Critical-Care Nurses and other nursing organizations in the Nursing Leadership in Tobacco Control Task Force is described.

Critical Care↗

PubMed2001

Interorganizational relationships among HIV/AIDS service organizations in Baltimore: a network analysis.

A wide variety of organizations has become involved in providing medical and social services to people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Although there is much interest among policymakers, service providers, and clients in coordination among HIV/AIDS service organizations, few studies have used network analytic tools to examine existing systems of HIV-related care. In an effort to fill this gap, this study used network analysis methods to describe several aspects of the interorganizational relationships among 30 HIV/AIDS service agencies in Baltimore, Maryland. Client referrals to other organizations, client referrals from other organizations, exchange of information about shared clients, formal written linkage agreements for client referrals, and joint programs were each examined as a distinct type of network tie, with each the basis of a separate network among these 30 organizations. All of the networks except the one based on joint programs were relatively well connected, with most organizations either directly or indirectly linked. Most of the interorganizational collaboration occurred on a rather ad hoc basis for the purposes of meeting the more immediate needs presented by clients. Highly structured coordination involving substantial investment of resources and ongoing interagency activities appeared to be less common. The findings from this study also suggest that the providers in Baltimore tend to work directly with others as client needs arise rather than negotiating through "clearinghouse" types of organizations. Of the 30 HIV/AIDS service organizations, 5 were highly central in at least four of the five different types of networks. These five organizations--each having a critical role in the continuum of care--may be considered the most central core of the HIV/AIDS service delivery network in Baltimore. These organizations tend to be those that have been created specifically to provide HIV-related services or that specialize in HIV/AIDS care. This research can help policymakers understand how an HIV-related service delivery network may function and delineate key features of a network. In all communities, this type of assessment is critical to designing interventions to promote collaboration that are feasible within the context of existing interorganizational relationships. This type of data also has implications for informing activities to build the capacity of HIV/AIDS service organizations.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Active personal dosemeters for individual monitoring and other new developments.

In this paper, we will present a first (but not complete) status description of active personal dosemeters (APDs) and their implementation in European countries. In modern radiation protection practices, APDs are becoming absolutely necessary operational tools for satisfying the ALARA principle. Despite their success, they are relatively new for individual monitoring of workers. Regulation, legal requirements and calibration procedures are different in European member states. A catalogue of commercially available and prototype devices is presented. Improvement on devices and in implementation of calibration method are expected in the forthcoming years. End-user feedback experience and requirements are reported.

Body Burden↗

PubMed2004

Fee-for-service revenue for school mental health through a partnership with an outpatient mental health center.

School mental health programs are increasingly prominent in the United States and in other countries, but funding remains tentative. This article describes a partnership between a school mental health program and an outpatient mental health center, and considers the larger goal of promoting sustainability and increasing revenue. Issues related to using fee-for-service revenue to support school mental health are explored, and strategies for promoting effective partnerships are discussed. Recommendations for programs facing the challenge of incorporating fee-for-service activities into their current model of service provision are provided.

Adolescent↗

PubMed2000

The Ohio Substance Abuse Monitoring Network: constructing and operating a statewide epidemiologic intelligence system.

Working with the Ohio Department of Alcohol and Drug Addiction Services (ODADAS) and researchers at the University of Akron, Wright State University's Center for Interventions, Treatment, and Addictions Research developed the Ohio Substance Abuse Monitoring (OSAM) Network to provide a statewide summary of substance abuse trends. Ten key informants across the state collect qualitative and statistical data on substance abuse trends in their regions and prepare biannual reports. The OSAM network has a rapid response capability through which key informants can investigate special issues related to substance abuse identified by ODADAS and provide policymakers with timely, statewide reports. Within 12 months after operations began, the key informants produced reports on drug abuse trends and rapid response issues for the state. These reports prepared policymakers to respond more effectively to prevention and substance abuse treatment needs.

Costs and Cost Analysis↗

PubMed1995

Health status of populations as a measure of health system performance.

This article describes the assessment of self-reported health status as one indicator of the performance of health care delivery systems. This work took place in the context of a larger effort to measure performance in health care. The Consortium Research on Indicators of System Performance (CRISP) project is developing measures of the performance of integrated health care systems, rather than plans or providers. The system focus leads to measurement of the health status of defined populations and an analysis of health care episodes and processes extending beyond the physician's office or hospital that relate directly to patient outcomes and satisfaction. This focus provides opportunities for application of performance measures to quality improvement efforts, since outcomes can be logically linked to identifiable and measurable processes. After a discussion of the purpose and the history of CRISP and how populations were defined within the systems, some preliminary data on the health status of populations are presented.

Comprehensive Health Care↗

PubMed2005

International comparison and review of a health technology assessment skills program.

OBJECTIVES: A review of the Alberta Heritage Foundation for Medical Research's (AHFMR) 6-month Health Technology Skills Development Program was undertaken within an international context with the purpose of describing and assessing the current program, further formalizing the program based on identified opportunities for improvement, and enhancing collaborative linkages with other agencies. The objectives of the review were to (i) compare the AHFMR program with similar programs in other health technology assessment (HTA) agencies internationally; (ii) assess the value of the program; (iii) identify program strengths and opportunities for improvement; and (iv) review, critique, and recommend enhancements to the program model and role description. METHODS: The review involved a qualitative study design that included a survey of the Skills Development Program participants' experience and perceptions; semistructured interviews with program stakeholders, and a written survey of HTA agencies/programs in other Canadian and international jurisdictions. CONCLUSIONS: The review concluded that the program was successful and valued by participants, the Foundation, and stakeholders in the policy and research communities. Findings suggest participant products have a potential for broad influence, including impact on funding decisions related to technology diffusion, influence through publications and presentations, and knowledge transfer in the participants' disciplines and employment settings. The main opportunity for enhancement was to differentiate the program into two streams according to different needs of participants, specifically between those who desire to be HTA producers and/or make HTA their careers, and those who desire to apply HTA in their employment capacity as policy or clinical decision-makers.

Alberta↗

PubMed1998

Interorganizational collaboration: a cautionary note for tribal health nurses.

As the Indian Health Service restructures and more Indian tribes assume control for their health care services, more collaborative initiatives between Indian tribal health and other organizations may be anticipated. This paper addresses the topic of interorganizational collaboration and tribal health care. There are unique issues related to Indian tribal healthcare, and this paper provides a cautionary note to public health nurses who work with and for Indian tribes. Interorganizational collaboration and tribal health care will of be interest not only to the public health nurses working for a tribe, but also to the county and state public health nurses who may be entering into a collaborative effort with a tribal health care agency.

Community Health Nursing↗

PubMedDate not supplied

Looking backward toward our future: creating the nexus between community health nursing and palliative care.

Palliative care literature and practice have historically been dominated by end-of-life discussion, with palliative care often seen as the prequel to hospice care. As the population ages and previously fatal illnesses convert to chronic illnesses, the medically modeled, institutionally based care model is changing. Community health nurses (CHNs) are well equipped to play a role in this arena of care. They have a population-focused practice, experience with care in the community, an orientation to health, and skills related to advocacy and social justice. The authors outline salient issues in palliative care, exemplars of community-based palliative care programs, and the contributions CHNs can make toward development of an integrated model of care. A course of action is outlined for CHNs to pursue in this rapidly developing field and they are urged to participate in the next iteration of palliative care.

Clinical Competence↗

PubMed2003

Development of integrated care in England and the Netherlands: managing across public-private boundaries.

This paper addresses the impact of the public-private mix in the Dutch and English health and social care systems on the development and delivery of integrated care. Integrated care is conceived of as an organisational process of coordination which seeks to achieve seamless and continuous care, tailored to the patients' needs and based on a holistic view of the patient. We describe both systems' structures and characteristics from a historical perspective, which means that developments and processes within the systems are put in the spotlight. We demonstrate that the dividing- or fault-lines, such as the financial split between short-term and long-term care in the Netherlands and the divisions between health and social care as well as between the public, private and voluntary sectors in England have hindered integrated care development and delivery in both countries. Contradictory interests, differences in professional and organisational cultures, power relations, and mistrust between and within these sectors have had a clear impact on integrated care development and delivery within networks of public authorities and public and/or private providers. We explain these phenomena in terms of network theory as a basis for drawing lessons for policy makers and those developing integrated care networks.

Attitude to Health↗

PubMed2002

Communities of practice: an opportunity for interagency working.

A particular approach to collaborative interagency working is that of multiprofessional "communities of practice". Four such groups are described in the context of two action research projects, one relating to primary care and the other to outpatient services for dermatology and ENT. The facilitating features, and the challenges and the potential of working in this way, are discussed, both from the point of view of understanding how knowledge is used and valued in such groups and as a useful mechanism for the development of services that span different professional perspectives and involve consumer interests.

Ambulatory Care↗

PubMed2001

The changing emphasis of disasters in Bangladesh NGOs.

Bangladesh is one of the most disaster-prone countries in the world, affected by cyclones and floods, as well as chronic hazards such as arsenic poisoning. NGOs have played a major role in bringing concerns related to risk management on to the national agenda and promoting a shift of focus from mere relief response to disaster mitigation and preparedness. The government has, after earlier scepticism, now accepted NGOs as major partners in these tasks. Innovative approaches, such as the use of microfinance, have been applied; many of which are related to preserving the gains of development efforts as part of rehabilitation. NGOs have pressured for better coordination with government. Improved structures are now approved, but it is still too early to judge their impact. Despite progress, neither NGOs nor governmental agencies have clearly defined roles in the effort to link disaster management priorities. This will ensure that longer-term development efforts build on local capacities and reduce vulnerabilities.

Bangladesh↗

PubMed1988

Relationship marketing for health care providers.

A relatively new concept termed "relationship marketing" is examined in terms of its usefulness for providers targeting employers as direct purchasers of health care services. The discussion includes (1) a consideration of why employers' rhetoric about health care purchasing practices has so far exceeded the reality of change and (2) ways in which relationship marketing can be adopted by providers to influence the health care purchasing practices of organizational buyers.

Commerce↗