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PubMed2001

[Hospital reform project, objectives, implementation, results and training].

Face to structural adjustments of the economy, the Tunisian public system of health, confronted with internal inefficiencies and to an inadequate financing, makes the object of a reform targeting teaching hospitals. Its objectives are to institute an autonomy of management and to exploit an integrated system of information that, associated to economic studies, will allow the Government to revise modes of financing of the health sector. This reform has modified the legal structure of university hospitals ending to a management of performances, based on the participation of the intervening, in an environment demarcated by the Government, by contracting multi-annual programs. By its impact, by reactions and surrounding opportunities, its viability and its sustainability are warranted especially if one minimizes potential risks linked to the exercise of the tutelage and to the adaptation to reforms of the other systems, notably the health insurance in order that a project of reform has been adopted and will be put in application soon. The strategy of implementation steady has allowed to reach convincing results to consolidate and to diagnose insufficiencies to fulfill, especially that an adapted extension of this reform is anticipated, to the level of regional hospitals, secondary care level.

Health Care Reform↗
PubMedDate not supplied

Philly physician executive combats big city blight.

Despite no money for college and little encouragement from his teachers, Eric Mitchell was determined to make something of himself. Ever since he got that plastic doctor kit when he was 7, he dreamed of becoming a physician. Learn how he achieved that goal--and so much more.

Career Mobility↗
PubMedDate not supplied

Promoting, building and sustaining a regional laboratory network in a changing environment.

The Queen's University Department of Pathology and its affiliated hospital laboratories (Kingston, Canada) have operated a successful laboratory outreach program for more than a decade in Southeastern Ontario. The outreach program provides high quality reference testing and technical and professional expertise in laboratory medicine to largely rural and small urban community hospitals. As a consequence of dramatic cuts to the publicly funded health-care system in the Province of Ontario, the environment in which laboratory medicine is practiced has altered irrevocably. This article discusses some of the difficult internal and external challenges faced by the outreach program within the region and how they were effectively managed, not only to maintain but to enhance the program's services. The result has been a continued improvement in the quality of laboratory services in the region with significantly increased cost-effectiveness, largely through reengineering and consolidation.

Budgets↗
PubMed2001

Rebirth of the university hospital: the Finnish strategy.

Like the academic hospitals worldwide, the Finnish university hospitals are under increasing economical pressures seeking ways to re-assess their traditional missions. It is strongly felt that new solutions within the field of evaluative sciences could bring added value to university hospitals. In this vein, university hospitals must take a leading position in assessing efficacy, (cost-)effectiveness and, ultimately, cost-utility of both traditional and emerging clinical technologies. This will affect the research culture of university hospitals both profoundly and permanently.

Cost-Benefit Analysis↗
PubMed2002

Hepatolithiasis--a case series.

INTRODUCTION: Hepatolithiasis is an uncommon entity in Singapore. We reviewed the cases presented to our institution (a 1200-bedded restructured hospital) over a 5-year period. MATERIAL AND METHODS: Twelve cases of hepatolithiasis were treated between December 1995 and July 2000 representing 0.77% of gallstone disease operated on in the same period. The clinical presentation, investigations, treatment and subsequent progress are presented. RESULTS: The patients' ages ranged from 28 to 82 years. There was a male to female ratio of 5:7. All patients had upper abdominal pain at presentation; 10 patients had clinical evidence of cholangitis. Ultrasound was the commonest first line investigation but additional investigations, such as computed tomographic (CT) scan and various forms of cholangiography, were frequently necessary for complete delineation of the biliary disease. The intrahepatic stones were located predominantly in the left lobe of the liver. Parenchymal atrophy was seen in 83% of patients. Two patients underwent a biliary bypass operation only, 5 had a hepatic resection only, and 5 had combined procedures. Follow-up ranged from 4 to 50 months. Postoperative recovery was generally unremarkable. Complications included subphrenic abscess (1 patient), recurrent stricture (1 patient) and recurrent stones (1 patient). One patient had an elevated serum CA 19-9 preoperatively; a small villous adenoma was noted at the biliary stricture in the resected left lateral segment of the liver. There was no operative mortality. CONCLUSION: Hepatolithiasis is uncommon in Singapore. Complete diagnosis requires a combination of imaging modalities. Surgery remains the mainstay of definitive treatment. With adequate treatment, good outcome is possible.

Adult↗
PubMedDate not supplied

Beyond the acute care setting: community-based nonacute care nursing-sensitive indicators.

In 1994, concerns about the effects of hospital restructuring on patient care resulted in the American Nurses Association (ANA) undertaking a major, long-term initiative. Nursing's Safety & Quality Initiative (the Initiative) was designed to measure the impact of such changes on patient care. The Initiative has three major foci: research, continuing education, and legislation/policy. This article addresses a recent development in the research component of the Initiative, involving the identification of nursing-sensitive indicators for community-based nonacute care.

Community Health Nursing↗
PubMed2001

Downsizing-initiated job transfer of hospital nurses: how do the job transferees fare?

In this longitudinal panel study, the authors compared the reactions to hospital amalgamation of 66 nurses who had been transferred to a different unit for a downsizing-related reason (bumped/displaced, unit closed, redundancy) with the reactions of 181 nurses who remained on their same unit. Prior to any job transfers, the two groups perceived comparable levels of support and held similar attitudes towards their job and the hospital. Two years later, after job transfers had taken place, transferred nurses perceived significantly lower coworker support. They also reported a significantly greater decrease in organizational commitment than nurses who were not transferred. However, both groups reported a significant decrease between time a and time 2 in perceived organizational support, satisfaction with amount of work and career future, hospital identification, and organization trust. Overall, the results indicate that the downsizing associated with the amalgamation of the hospitals had a highly negative effects not only on those nurses who were transferred because of the downsizing but also on those nurses who remained on their original unit.

Attitude of Health Personnel↗
PubMed2002

Taking parking protection to the next level.

Because of neighborhood crime problems, the Johns Hopkins Medical Institutions decided to undertake security improvement projects aimed at enhancing security/safety at the campus. This article focuses on the security changes and improvements to the parking structures and surface parking lots that have helped make the campus a safer place for patients, visitors, and staff.

Baltimore↗
PubMed2002

The influence of a move to program management on physical therapist practice.

BACKGROUND AND PURPOSE: The purpose of this qualitative study was to examine how a move to program management (PM) from a traditional department structure affected the professional practice of physical therapists in a large Canadian teaching hospital. SUBJECTS: Twenty-five physical therapists participated in 1 of 5 focus groups, and 4 physical therapists participated in individual interviews. METHODS: Focus groups and structured interviews were conducted by an experienced facilitator who was not a physical therapist. All focus groups and interviews were audiotaped and transcribed. Using an open-coding technique, 2 investigators undertook line-by-line analysis of each transcript to identify and code specific events related to the physical therapists' experiences. The investigators reached a consensus on all coding categories and then identified themes. RESULTS: Seven themes that addressed issues of affect (a sense of loss, low morale, and positive coping), professional practice (loss of professional development activities, professional advantages, the assuming of multiple roles), and patient care were identified. DISCUSSION AND CONCLUSION: Physical therapists who were deployed from a department to a program described both positive and negative effects of the move to PM on their practice. There were reported influences on their personal affect, professional practice, and patient care. Staff and physical therapy administrators need to be aware of potential implications of an organization's move to PM on the professional practice of frontline staff.

Adaptation, Psychological↗