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PubMed2000

What do case managers do? An investigation of case manager interventions and their relationship to client outcome.

BACKGROUND: The aim of the present study, which forms part of a wider case management multicenter study, was to explore the content of case managers' work, service patterns, and their relationship to client outcome. METHODS: Client background characteristics were registered at admission, and needs of care and psychosocial functioning were assessed at admission to the service and after 18 months. In seven of the services an extended follow-up was performed, which included assessments regarding quality of life, level of symptoms and social network. The study comprised 176 severely mentally ill clients, of whom 153 participated in a general 18-month follow-up (87%), with 113 clients out of 134 participating in an extended follow-up sample (84%). RESULTS: The investigation of service patterns showed that clients received services in a great variety of life areas using a number of different types of interventions. The results support the assumption that severely mentally ill clients are in need of case management services that offer more than brokerage services and coordination. A more active rehabilitation-oriented approach was found towards younger clients and clients who had a job, which may reflect a higher level of ambition in assisting younger clients to gain access to and stay in education and the labor market. Several types of intervention were related to client outcome. Brokerage, intervention planning and more interventions in the area of skills relating to activities of daily living were related to a more pronounced decrease in needs of care. More time spent on indirect work on behalf of the clients was related to a better outcome with regard to psychiatric symptoms and social network. CONCLUSIONS: The results indicate that specific service components have a more obvious distinct impact than others on outcome, and that this increase in effectiveness varies with the outcome targeted.

Adult↗

PubMed1981

Manager behavior in a social context: the impact of impression management on attributions and disciplinary actions.

Two experimental studies were run to test the effects of subordinate impression management on the appraisals and responses of a manager, following an incident of poor performance. Two common impression management tactics, accounts and apologies, were manipulated in each of the studies. Subjects in both studies were experienced nursing supervisors. On the basis of the "discounting effect" reported in the attributional literature it was hypothesized that accounts of external causes for poor performance, i.e., excuses, would lead subjects to (1) attribute less responsibility to the subordinate, (2) be less personal in their responses, and (3) be less punitive in their responses. Apologies, because of their "equity restoration" effects, were expected to influence subjects' disciplinary responses to the poor performance, without necessarily affecting their attributions of responsibility. Experiment 1. which employed written stimulus materials and a repeated-measures design, provided strong support for all hypotheses. Experiment 2. which employed a film stimulus and between-subjects design, provided strong support for the accounts hypotheses but only minimal support for the apology hypotheses. The results highlight the importance of social information cues in the appraisal of performance.

Employee Performance Appraisal↗

PubMed1992

Clinicians' quick reference guide to acute pain management in infants, children, and adolescents: operative and medical procedures. Pain Management Guideline Panel. Agency for Health Care Policy and Research, US Department of Health and Human Services.

The management of pain is an important part of a health professional's role. The challenge for clinicians is to balance pain control with concern for patient safety and side effects of pain treatments. This is the second of two articles presenting the clinical highlights of the Agency for Health Care Policy and Research's Panel to develop clinical practice guidelines for pain management. This article presents the clinical highlights related to the assessment and management of pain in infants and children.

Acute Disease↗

PubMed2006

Institutionalizing effective pain management practices: practice change programs to improve the quality of pain management in small health care organizations.

The Resource Center of the American Alliance of Cancer Pain Initiatives provided templates, faculty, and ongoing consultation to assist seven state pain initiatives to implement programs to improve pain management practices. A total of 113 health care organizations participated. Each organization committed to support a team of two to three staff through a 10-month pain quality improvement process, which included a site visit, two educational conferences, pre- and postprogram analyses of the organizational structures in place to support pain assessment and management, quality improvement work plan development, and patient survey data collection. Postprogram results showed statistically significant increases in the presence of structural elements that are critical to effective pain management, as well as statistically significant, though modest, decreases in the percentage of patients who reported pain of any severity, and specifically moderate to severe pain, in the previous 24 hours. The largest changes occurred in long-term care facilities. Nevertheless, the percentage of patients in moderate to severe pain remained unacceptably high.

Delivery of Health Care↗

PubMed2004

Waste management models and their application to sustainable waste management.

The purpose of this paper is to review the types of models that are currently being used in the area of municipal waste management and to highlight some major shortcomings of these models. Most of the municipal waste models identified in the literature are decision support models and for the purposes of this research, are divided into three categories-those based on cost benefit analysis, those based on life cycle assessment and those based on multicriteria decision making. Shortcomings of current waste management models include that they are concerned with refinements of the evaluation steps (e.g. stage four of AHP or the improvement of weight allocations in ELECTRE) rather than addressing the decision making process itself. In addition, while many models recognise that for a waste management model to be sustainable, it must consider environmental, economic and social aspects, no model examined considered all three aspects together in the application of the model.

Decision Making↗

PubMed1997

Managing risk in the city: the role of welfare professionals in managing risks arising from vulnerable individuals in cities.

Modern cities depend on individualism and the process of contracting. Contracts between individuals contribute to stability and order in cities. However, this is challenged by risks and uncertainties especially those relating to vulnerable individuals who are unable or unwilling to enter into contractual relations. This paper focuses on the role of caring professions and the impact of new strategies for managing risks related to vulnerable adults and children, especially the shift from managing risk in institutions to managing risk in the community. This paper is based on research funded through the ESRC Risk and Human Behaviour Programme.

Adult↗

PubMed2001

Managing managed care: habitus, hysteresis and the end(s) of psychotherapy.

In this paper we examine how clinicians at a community mental health center are responding to the beginnings of changes in the health care delivery system, changes that are designated under the rubric of "managed care." We describe how clinicians' attitudes about good mental health care are embodied in what sociologist Pierre Bourdieu calls their habitus, i.e., their professional habits and sense of good practice. Viewed in this light, their moral outrage and sense of threat, as well as their strategic attempts to resist or subvert the dictates of managed care agencies, become a function of what Bourdieu terms the hysteresis effect. The paper is based on ethnographic fieldwork conducted by a team of researchers at the mental health and substance abuse service of a hospital-affiliated, storefront clinic which serves residents of several neighborhoods in a large northeastern city. Data consist primarily of observations of meetings and interviews with staff members. We describe four aspects of the clinicians' professional habitus: a focus on cases as narratives of character and relationship, an imperative of authenticity, a distinctive orientation towards time, and an ethic of ambiguity. We then chronicle practices that have emerged in response to the limits on care imposed by managed care protocols, which are experienced by clinicians as violating the integrity of their work. These are discussed in relation to the concept of hysteresis.

Attitude of Health Personnel↗

PubMed1997

Styles of case management: the philosophy and practice of case managers.

A great deal of discussion and research has gone into defining and clarifying the role of "case manager" (CM) for persons with severe mental illness. This three state survey examines the philosophy and activities of practicing CMs in an attempt to identify current styles of case management. A cluster analysis based on CM rankings of five CM functions suggested four styles of case management: "supportive social workers", "individual therapist", "therapist broker", and "community advocate". Overall, CMs rated supportive interventions as most important and formal psychotherapy as relatively unimportant. CM style was related to CM activity (i.e., distribution of effort). Differences between states are noted and implications for future research are discussed.

Adult↗

PubMed1997

Case management: a week in the life of a clinical case management team.

This paper describes the work of a clinical case management core team (four nurses and an occupational therapist) during the course of a week. Information was gathered through non-participant observation of the team by two independent researchers. Transcripts produced from the data recorded were examined. From this, seven categories of activity were identified: planned client contact; unplanned client contact; family/carer contact; liaison; administration; team information sharing and supervision, training and personal development. These categories were felt to encompass the range of activities practised by the team. The amount of time that case managers spent engaged in these core functions was calculated. Detailed examples are presented. Results are discussed with reference to Kanter's components and principles of clinical case management.

Adult↗

PubMed2006

Integrated management of childhood illness: an emphasis on the management of infectious diseases.

The Integrated Management of Childhood Illness (IMCI) strategy has helped strengthen the application and expand coverage of key child survival interventions aimed at preventing deaths from infectious disease, respiratory illness, and malnutrition, whether at the health services, in the community, or at home. IMCI covers the prevention, treatment, and follow-up of the leading causes of mortality, which are responsible for at least two-thirds of deaths of children younger than 5 years in the countries of the Americas. The IMCI clinical guidelines take an evidence-based, syndrome approach to case managment that supports the rational, effective, and affordable use of drugs and diagnostic tools. When clinical resources are limited, the syndrome approach is a more realistic and cost-effective way to manage patients. Careful and systematic assessment of common symptoms and well-selected clinical signs provide sufficient information to guide effective actions.

Ambulatory Care↗

PubMed2002

[Data management in an ICU: Experiences with ICM (Intensive Care Manager)].

OBJECTIVE: Experience with implementation and operation of a patient data management system on an intensive care unit. METHODS: Patient data management system "Intensive Care Manager" (ICM, Dräger Medical). Anaesthesiologic ICU (surgical patients only) of an academic teaching hospital. RESULTS: ICM was installed without problems and is used in routine patient treatment. The system is running reliably, availability was 99.87 % during the last 8 months. CONCLUSION: Documentation has become better and more detailed with comparable time spent. More secondary diagnoses have been recorded since ICM was implemented. Special "views" related to organ systems allow to monitor organ dysfunction more easily and facilitate treatment decisions. Review of textual information needs to be further optimised. Writing of medical reports is ideally supported by ICM. Using ICM is advantageous for doctors, nurses and patients.

Database Management Systems↗

PubMedDate not supplied

Transforming an EPA QA/R-2 quality management plan into an ISO 9002 quality management system.

The Environmental Protection Agency's (EPA) Office of Emergency and Remedial Response (OERR) requires environmental data of known quality to support Superfund hazardous waste site projects. The Quality Assurance Technical Support (QATS) Program is operated by Shaw Environmental and Infrastructure, Inc. to provide EPA's Analytical Operations Center (AOC) with performance evaluation samples, reference materials, on-site laboratory auditing capabilities, data audits (including electronic media data audits), methods development, and other support services. The new QATS contract awarded in November 2000 required that the QATS Program become ISO 9000 certified. In a first for an EPA contractor, the QATS staff and management successfully transformed EPA's QA/R-2 type Quality Management Plan into a Quality Management System (QMS) that complies with the requirements of the internationally recognized ISO 9002 standard and achieved certification in the United States, Canada, and throughout Europe. The presentation describes how quality system elements of ISO 9002 were implemented on an already existing quality system. The psychological and organizational challenges of the culture change in QATS' day-to-day operations will be discussed for the benefit of other ISO 9000 aspirants.

Environmental Monitoring↗

PubMed1998

Can ethical management and managed care coexist?

The growth of for-profit managed care organizations raises serious ethical questions for managers in these settings, such as whether contemporary business ethics are most appropriate for health care organizations or how the principles of biomedical ethics can be integrated into profit-seeking firms. A model is proposed that seeks to consolidate both business ethics and biomedical ethics into a form that is useful to health service managers.

Conflict of Interest↗

PubMed2005

The use of 'as-needed' range orders for opioid analgesics in the management of acute pain: a consensus statement of the American Society for Pain Management Nursing and the American Pain Society.

The use of "as-needed" or "PRN" range orders for opioid analgesics in the management of acute pain is a common clinical practice. This approach provides flexibility in dosing to meet individual patients' unique analgesic requirements. Range orders enable necessary and safe dose adjustments based on an individual's response to treatment. This paper presents the consensus statement of the American Society for Pain Management Nursing and the American Pain Society on the use of "as-needed" range orders for opioid analgesics in the management of acute pain.

Acute Disease↗

PubMed1997

From managed competition to managed cooperation: theory and lessons from the British experience.

The United Kingdom led the world in transforming the largest single health care system from a publicly administered service to a set of interlocking contracts. Policy lessons that can be adapted by employers, nations, and other large payers are identified. These lessons are drawn from the improvements that the British made over the design of managed competition, the mistakes and problems they experienced, the underlying trends toward privatization and class discrimination, and the limitations to competition that have led the British toward managed cooperation in collaborative purchasing for the health needs of communities. Yet market reform and the rhetoric of efficiency have justified the shrinking of health services, the shift of costs to household budgets, and the use of public moneys to support private services and investors at greater expense by moving properties and services off the public ledger. In these ways, managed competition can Americanize health care and pose fundamental questions about what policy goals are really being pursued.

Cooperative Behavior↗

PubMed2000

Managing patient trust in managed care.

Patient trust has been identified as an important element in the patient-physician relationship. However, common features of managed care, such as risk-sharing, utilization review, and limitations on benefits, may erode the traditionally high trust that patients have in their physicians. High trust is not always justified; rather, an optimal level of trust arises from the level of interdependence between patients and physicians. This analysis of the interrelationship between patient-physician trust and some of the key facets of managed care has important implications for managed care. A return to high levels of trust may be impracticable, and new strategies for balancing trust-building efforts by caregivers with checking mechanisms accessible to patients are recommended.

Confidentiality↗

PubMed1991

'Shadowing' a manager: an exercise in senior registrar management training.

A senior registrar 'shadowed' a district general manager and a unit general manager for one week each as a management training exercise. The three principal participants describe the exercise from their different perspectives. Consequent issues and the value of such 'shadowing' as a mode of training are discussed.

Attitude of Health Personnel↗

PubMed2003

Psychosocial aspects of pain management: a conceptual framework for social workers on pain management teams.

To have a significant impact in the arena of pain management, social workers must be able to articulate social work values and concepts clearly, productively, and compellingly as assets in overcoming identified barriers to pain relief. A literature review concerning vulnerable populations, identified barriers, and related social policies explores alternative perspectives that social workers can bring to a multi-disciplinary team's efforts to improve the delivery of pain management technology. The article offers a beginning framework for discussions about the profession's potential contributions. The goal of these discussions is to contribute to encouraging a more pronounced involvement of social workers in pain management issues.

Health Services Research↗