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Into the mainstream. UPMC in venture merging cancer care, telemedicine.
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Right place, right time. Sutter Health turns co-hosting facility into data center.
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The community hospital purge.
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Life with monster. Working under managed care is a growing nightmare.
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Taking a gamble. Mayo Clinic may expand HMO into Las Vegas, even as it posts losses.
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Back to basics. Carolinas HealthCare System is looking to divest its money-losing HMO business.
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Perioperative supply chain management.
Faced with declining revenues and increasing operating expenses, hospitals are evaluating numerous mechanisms designed to reduce costs while simultaneously maintaining quality care. Many facilities have targeted initial cost reduction efforts in the reduction of labor expenses. Once labor expenses have been "right sized," facilities have continued to focus on service delivery improvements by the optimization of the "supply chain" process. This report presents a case study of the efforts of Vanderbilt University Medical Center in the redesign of its supply chain management process in the department of Perioperative Services. Utilizing a multidisciplinary project management structure, 3 work teams were established to complete the redesign process. To date, the project has reduced costs by $2.3 million and enhanced quality patient care by enhancing the delivery of appropriate clinical supplies during the perioperative experience.
Out with the old, in with the new!
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Acute coronary syndrome--factors causing delayed presentation at the Emergency Department.
INTRODUCTION: The aim of the study was to identify factors that contributed to delays in presentation of patients with acute coronary syndrome (ACS) at the Emergency Department (ED). MATERIALS AND METHODS: The study population comprised patients presenting with the signs and symptoms of ACS at the ED of 5 government and restructured hospitals in Singapore from 1 April to 31 May 1999. These patients were interviewed with a structured questionnaire which explored patient demographic data, risk factors, prehospital symptomatology, timing of chest pain, patient response to chest pain and mode of transport to the hospital. RESULTS: Three hundred and two patients who made 307 visits were recruited. More than three-quarters of the patients presented with central or left-sided chest pain. Forty-seven per cent had breathlessness and 42% had sweating. The commonest day of presentation was Monday. It took patients a median time of 2.1 hours from their worst chest pain to arrive at the ED. Past history of diabetes mellitus was associated with a longer delay in presentation. Most of the delay was due to patients awaiting symptom resolution. Forty per cent came by emergency ambulances to hospital. CONCLUSION: Our findings identified various patient characteristics that contributed to delay in presentation to hospital which should be addressed in future education campaigns.
The effect of governing board composition on rural hospitals' involvement in provider-sponsored managed care organizations.
Rural hospitals are actively pursuing various strategic alternatives to confront the dramatic changes taking place in the delivery, organization, and financing of healthcare. One of these strategic alternatives is involvement in provider-sponsored managed care organizations. Studies have argued that this form of managed care would enhance public trust and might improve the performance of hospitals. The changing healthcare environment has also increased the importance of the competence and composition of hospital boards. This article examines the effect of the governing board's composition on rural hospitals' involvement in provider-sponsored managed care organizations. The study sample consisted of 140 rural hospitals in Iowa and Nebraska whose CEOs responded to a survey conducted by the Center for Health Services Research at the University of Iowa between June and December 1997. The principal finding was that the likelihood of a hospital owning any form of managed care organization increases with the number of community leaders and health professionals on the board. The number of business leaders had no effect on the likelihood of involvement in such an arrangement. Other factors that affected the likelihood of owning a managed care organization were the health status of the population and ownership type. Key recommendations to managers are to (1) revisit the hospital board's composition before actively pursuing a strategic action, (2) examine the compatibility of the type of strategic activity pursued with the background of board members and the interests of the populations they represent, and (3) use the governing board as a resource in determining which new strategic activities to undertake.
Economism, efficiency, and the moral ecology of good nursing practice.
The free-market rhetoric dominating health-policy discussions today frames health-care goods and services as commodities that consumers will or will not buy at a given price. Health-care systems are being redesigned and hospitals restructured with a view to increased efficiency and productivity. Drawing on the experiences of clinical nurses in the United States, this paper shows how the application of economism to nursing may severely disrupt the ecology of good practice, leading to difficulties in meeting minimal standards of nursing care and severely constraining the acts of compassion called for by the human experiences of illness, loss, and death. Concerns about moral responsibility and conflicts between institutional and nursing goals are described. Increasing mistrust of health-care systems on the part of practitioners, patients, and families suggests that it is time to attend closely to the moral ecology of caring practices.
Money talks: an analysis of nonprofit hospital conversions to for-profit status.
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Opportunities for growth exist amid niche facilities.
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[Central sterilization clinical nurse. Interview by Eric Charles].
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PACS support: the radiology approach.
In 1999, Rex Healthcare, a 394-bed facility located in Raleigh, N.C., faced a growing problem. The radiology department was performing a total of 130,000 procedures a year, running out of space to store the film, and having trouble managing the file room. While the IT department was focused on the Y2K scare, radiology forged ahead with a plan to implement PACS on its own at Rex Hospital. Rex had installed a mini-PACS system for ultrasound in 1996, but there was no internal support for the system's hardware or software. Being the first in the area to implement PACS, Rex wasn't able to recruit anyone locally to support the system, so they decided to take two areas that PACS had a great impact on and use their own people. The director of radiology asked the RIS analyst and the Film Library manager, both of whom were registered technologists, to implement and support the PAC system. The key to PACS support is not computer knowledge, although it helps. The key is to understand the radiology department as a whole and the workflow from within, which makes it hard to fully support from an IT perspective. The current PACS team at Rex is composed of a PACS analyst, system support specialist and an electronic imaging center manager. When we went live with PACS, it was obvious that not all of the existing file room personnel would make the technology leap, which they realized themselves. We didn't push anybody out, but we did raise the bar of expectations. By redefining job descriptions and having the EITs (electronic imaging technologists) become more involved, increased respect was quite evident among the hospital staff. The clerks that once only hung and filed films are now troubleshooting CD burners, teaching physicians the PACS, and filming necessary exams. The final key to success is to take ownership of your system. By taking ownership, I mean that a PACS team should be established to do troubleshooting and first-line support, know the servers and application, and feel comfortable performing daily checks and tasks. Being an advanced radiology PACS site in our area, we have become an important facility for site visits. We take site visits very seriously, and have composed a package that includes information about the hospital, network/modality diagrams, EIT job descriptions, PACS information and various time studies that we have completed since going firmless. An administrator with a vision and strong support from within will get a PACS up and running, but ongoing upkeep requires a team that is dedicated to the success of the project. By taking ownership of the system and following the keys to success, a department has the ability to reengineer radiology workflow not just in the hospital, but in the community as well.