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PubMed1996

[Organizational models for the hematology areas of the district hospitals of Catalonia].

PURPOSE: The haematological assistance in Catalonia is based upon the district hospitals, in the first step, and the stage III hospitals located usually in higher population nuclei, in the second step. The purpose of this work was to analyse the resources of the "primary haematological assistance" network provided by the district hospitals, to evaluate them and to propose a model for their organisation. MATERIAL AND METHODS: An enquiry was carried out to all members of the Grup de Treball d'Hospitals Comarcals de Catalunya (Catalonia's District Hospitals Task Force). The evaluable data included demographic figures of the population assisted, personnel of each haematological area, organising structure, clinical activity, cytomorphology, blood banks, laboratories and continuous formation activities. RESULTS: The enquiry was answered by 15 of the 21 district hospitals (71.4%) with haematologists in Catalonia. The population assisted in those hospitals is 2,100,000 (ranging between 55,000 an 450,000). All centres are integrated in the National Health network. Eleven of the hospitals analysed have only one haematologist (73.3%). If his dedication is 100% of the time, this would represent a doctor for 105,000 people. The time devoted to work is 690 hours a week for all the population, with a mean of 3,043. Four patients assisted per hour. The total number of hospital beds is 3,353 (50-450), with a mean number of 1 haematologist for every 167.6 beds. The number of patients hospitalized due to blood diseases ranges between 3 and 13 per month. Six of the 15 centres are adjunct to the outpatient clinic. Two centres have a blood bank and 7 have developed an autotransfusion programme. All the centres but one perform oral anticoagulant treatment follow-up, the number of patients assisted ranging from 20 to 210 per week. None of the hospitals has a separate Haematology Service; in most of them haematology is structurally and functionally dependent from Laboratories and in some there is a mixed Laboratory/Internal Medicine functional organisation, depending of the Medical Direction. No haematologist is ever on call specifically for his specialty. Continuous formation activities are carried out in 9 of the 15 centres (60%). COMMENT: Several measures are proposed to improve the haematological assistance, acting on different levels: continuous formation, patient flows and circuits, resident doctors training, anticoagulant treatment network, organisation models, credit cards from the Spanish Association of Haematology.

Adult↗
PubMed1998

An organizational model of choice: a theoretical analysis differentiating choice, personal control, and self-determination.

Individuals experience choice when they select one option from among meaningful alternatives that possess relatively equal attractiveness and some degree of indeterminacy. Choice has been found to influence important psychological and behavioral outcomes. After differentiating among choice, personal control, and self-determination, the author offers a model of choice, with self-determination as the key mechanism regulating how choice influences intrinsic motivation. The model suggests specific types of choice-relevant information that should affect whether choice results in an internal (self-determined) or external (controlled) locus of causality. The individual characteristics of locus of control, self-presentation, self-esteem, and Type A personality are suggested as possible moderators of the effects of choice. Finally, the implications of the choice model for organizations and further areas of research are discussed.

Choice Behavior↗
PubMed1993

Hospital survival in a competitive environment: the competitive constituency model.

Organizational theory is extended to develop a method for administrators to assess hospital effectiveness in a competitive environment. First, the literature pertaining to organizational effectiveness and survival is synthesized to show the lack of consideration for the effects of competition. Second, the article integrates the effects of competition on organizational effectiveness through a competitive constituency model. A step-by-step procedure is proposed to apply the theory in an organizational setting. The model explicitly addresses differences in power relations between hospitals, their competition, and their stakeholders. The relative nature of effectiveness is explored by comparing the hospital to its competition using criteria developed through specific goals of stakeholders. The distinction between managerial and organizational effectiveness constructs is clarified. Finally, the practical application of this model is demonstrated by assessing the effectiveness of a hospital in the competitive environment of Seattle, Washington, where two hospitals have recently closed.

Analysis of Variance↗
PubMed2000

Pilot test of an organizational culture model in a medical setting.

The authors conducted a pilot test of the organizational culture model in a health care setting. The study was based on a questionnaire with mixed quantitative and qualitative analysis. Quantitative analysis confirmed the expected distribution of responses among the subcultures for all three questions, with significant differences in two of the three. Qualitative analysis further strengthened these results. The authors believe the organizational culture model may be a useful tool for making subcultural differences explicit, showing opportunities for better information exchange and opening dialogue between groups. These data should be confirmed with larger studies using psychometrically sound outcome instruments.

Attitude of Health Personnel↗
PubMed2000

Hospice: an organizational systems model for the integration of acute and long-term care.

In recent years, the realization of a need for increased integration of acute care and long-term care (LTC) systems has grown. For the most part, however, a person requiring both types of care is treated as though he or she is two discrete individuals with separate needs. Organizations that have the integration of acute and LTC as a goal serve relatively small numbers of people. Integration efforts could be facilitated through the identification and application of an organizational systems model. Hospice can provide such a model. The hospice interdisciplinary team integrates not only multiple disciplines but also acute care and LTC. The hospice model is also appropriate from a financial standpoint in that Medicare hospice funding has employed a prospective payment system (PPS) since the inception of the Medicare Hospice Benefit. In this article, the application of the hospice model to the integration of the acute care and LTC systems in the U.S. is demonstrated, using a subsystem approach.

Acute Disease↗
PubMed2000

The mental health organizations.

The mental health organizations in the mental health phase-in were Oregon's pioneers moving into public managed care. A delicate balance between county mental health authority and private expertise was struck locally to yield a variety of organizational models across the state.

Health Maintenance Organizations↗
PubMed1994

Program management and health care informatics: defining relationships.

The program management (PM) structure is a relatively well-known organizational model for hospitals. A variation of the matrix structure, it allows for an interdisciplinary team of health care providers to facilitate patient care delivery. However, providing such focused care results in a complex, highly information-dependent operational environment. To meet the information needs of such an environment, careful planning in selecting and implementing technology is required. Along with supporting patient care, the technology will also help in managing costs, human resources, quality and utilization, as well as in monitoring performance and outcomes measurement. Focusing specifically on the information technology environment, this article addresses health care informatics (the diverse categories of information and systems) needed to support clinical program managers, executives and others in a PM organization. Examples from both a university-affiliated and a community-based program managed hospital illustrate their approach to PM and information technology.

Decision Support Systems, Management↗
PubMed2001

Palliative medicine and medical oncology.

Traditionally, medical oncology and palliative care have been considered two distinct and separate disciplines, both as regards treatment objectives and delivery times. Palliative care in terminal stages, aimed exclusively at evaluating and improving quality of life, followed antitumor therapies, which concentrated solely on quantitative results (cure, prolongation of life, tumoral mass shrinkage). Over the years, more modern concepts have developed on the subject. Medical oncology, dealing with the skills and strategic co-ordination of oncologic interventions from primary prevention to terminal phases, should also include assessment and treatment of patients' subjective needs. Anticancer therapies should be evaluated in terms of both the quantitative and qualititative impact on patients' lives. Hence, the traditional view of palliative care has to be modified: it constitutes a philosophical and methodological approach to be adopted from the early phases of illness. It is not the evident cultural necessity of integrating medical oncology with palliative medicine that may be a matter of argument, but rather the organizational models needed to put this combined care into practice: should continuous care be guaranteed by a single figure, the medical oncologist, or rather by an interdisciplinary providers' team, including full-time doctors well-equipped for palliative care? In this paper the needs of cancer patients and the part that a complete oncologist should play to deal with such difficult and far-reaching problems are firstly described. Then, as mild provocation, data and critical considerations on the ever increasing needs of palliative care, the present shortcomings in quality of life and pain assessment and management by medical oncologists, and the uncertain efficacy of interventional programmes to change clinical practice are described. Finally, a model of therapeutic continuity is presented. which in our view is realistic and feasible: an Oncologic Programme as the unifying process, and the Comprehensive Cancer Centre, or the Oncologic Department, the delivering structure.

Humans↗
PubMed1998

Sexual harassment: identifying risk factors.

A new model of the etiology of sexual harassment, the four-factor model, is presented and compared with several models of sexual harassment including the biological model, the organizational model, the sociocultural model, and the sex role spillover model. A number of risk factors associated with sexually harassing behavior are examined within the framework of the four-factor model of sexual harassment. These include characteristics of the work environment (e.g., sexist attitudes among co-workers, unprofessional work environment, skewed sex ratios in the workplace, knowledge of grievance procedures for sexual harassment incidents) as well as personal characteristics of the subject (e.g., physical attractiveness, job status, sex-role). Subjects were 266 university female faculty, staff, and students who completed the Sexual Experience Questionnaire to assess the experience of sexual harassment and a questionnaire designed to assess the risk factors stated above. Results indicated that the four-factor model is a better predictor of sexual harassment than the alternative models. The risk factors most strongly associated with sexual harassment were an unprofessional environment in the workplace, sexist atmosphere, and lack of knowledge about the organization's formal grievance procedures.

Adult↗
PubMed2000

Managed care and service capacity development in a public mental health system.

Developing a continuum of care is considered to be one of the first steps in the process of implementing managed care strategies. This study summarizes the results of a final survey that focused on the ability of Colorado community mental health centers (CMHCs) to build service capacity and create new programs as a result of Medicaid capitation financing. Capitated agencies, compared to those that remained fee-for-service during the study period, reported a much greater ability to develop services as a result of capitation. Decreases in services were minimal for all agencies. Some differences in managed care organizational models were noted, as were differences in the speed of implementation. Gaps in some services still remain. These findings point to important program implementation issues for publicly funded managed care.

Capitation Fee↗
PubMed1999

Stress and residential staff who work with people who have an intellectual disability: a factor analytic study.

The present study describes the development of a questionnaire, and the subsequent collection of data, to gather information on the demands and supports which influence stress (as measured by anxiety and depression scales) in direct care staff who work with people with intellectual disability. The results from the questionnaire were also used to explore the relationships between the factors derived from the questionnaire and to consider how these may be influential in building organizational models. The questionnaire was specifically constructed to measure the demands and supports experienced by direct care staff. The participants included 216 staff working in community residential services for people with intellectual disability. These individuals included staff working for two British health trusts and similar staff working for one local authority. The questionnaire consisted of 33 demands items and 23 supports items. Separate factor analyses were conducted on the demands and supports scales. Analyses of the reliability and validity of the resulting factors were conducted. Stepwise multiple regressions were conducted to further explore the relationship of factors with the measures of anxiety and depression. Four factors were extracted from the demands scale and three factors from the support scale. There was some concern over levels of reliability and validity for individual factors; however, the reliability of the main scales appeared to be satisfactory. All but one support factor correlated significantly with levels of anxiety and depression. The factors explained a modest amount of the variance in the regressions. While there are some concerns about the psychometric properties of the questionnaire, it is argued that the scales and factors can be used to confirm and further understanding of the relationship between groups of demands, supports and stress in staff. The usefulness of the questionnaire as a means of diagnosing specific sources of demand and support is considered. It is suggested that the questionnaire could form the basis for assessment and subsequent intervention in houses where staff are reporting relatively high levels of anxiety and depression.

Adult↗
PubMed1997

How medical schools can maintain quality while adapting to resource constraints.

To gain a better understanding of the effects on medical schools of ongoing transformations in medical practice, science, and public expectations, the Association of American Medical Colleges (AAMC) formed the Advisory Panel on the Mission and Organization of Medical Schools (APMOMS) in 1994. Six working groups were appointed to address different issues of importance. This article is a report of the findings and recommendations of the Working Group on Adapting to Resource Constraints. That group was charged to consider how leaders in academic medicine can respond to the challenges of external forces and the anticipated diminishing of resources, and to focus on medical schools and how they can maintain quality while reengineering to effect needed changes. The group members developed their thinking within four categories: size of the academic enterprise; organizational models and their relationships to the clinical enterprise; faculty tenure and compensation; and partnerships with capital-intensive entities. Three recommendations for action, to which the APMOMS unanimously agreed, were made to the AAMC, which has already acted upon them in ways described in the article. The group also developed a series of "ideas for consideration," which represent a range of the members' perspectives. The working group did not seek (and probably could not have obtained) unanimous agreement on many of the issues that these ideas focus upon. The ideas are presented as a series of resolutions designed to stimulate discussion and foster better-informed planning.

Education, Medical↗
PubMed2003

How private colleges of osteopathic medicine reinvented themselves.

Starting in the last decade of the 20th century, private colleges of osteopathic medicine (COMs) began to restructure themselves in ways that represent a distinct departure from the past. Their new organizational model de-emphasizes many of the characteristics that distinguish allopathic medical schools today. The new emphasis centers on high enrollment, diversity of health-related programs, formation of universities of health science, expansion, and a retreat from involvement in clinical and postdoctoral education. Such changes reflect an admixture of entrepreneurship, an ability to respond quickly to changing environments, and an insularity that draws them away from traditional forms of clinical and postdoctoral medical education. The private COMs carved out their own niche in medical education and created a new model compatible with their institutional strengths and weaknesses and related to their economic, educational, and human resources. As an evolving educational model, the private COMs have undergone a remarkable transformation in a brief period; they bear watching for future developments and to assess their long-term viability.

Education, Medical↗
PubMedDate not supplied

On the integration of complementary and conventional medicine within health maintenance organizations.

The integration of complementary and alternative medicine (CAM) with conventional medicine continues across practice settings and modalities. Managed care is of particular interest to practitioners, policy makers, and researchers concerned with the evolution of CAM integration. Within health maintenance organizations (HMOs), availability, coverage, and support of CAM are variable. We present an organizational model within which we identify factors that influence the degree of CAM integration within HMOs. We describe avenues through which CAM is currently available within the Northwest Region of Kaiser Permanente (KPNW). We also describe research methods applicable to the study of CAM integration within HMOs.

Complementary Therapies↗
PubMedDate not supplied

Case management in public health screening programs: the experience of the national breast and cervical cancer early detection program.

This article describes a large public health screening program's early experience in adding case management as a formal program component. The results demonstrate that state and tribal programs participating in the National Breast and Cervical Cancer Early Detection Program have implemented a variety of organizational models for case management of women with abnormal screening results. Programs have different approaches to staffing and reimbursement of case management services, yet most programs have implemented a "patient navigator" or "medical" model of case management service delivery. Although a number of challenges were identified, a clear and positive finding is that case managers are playing an integral role in the transition between a cancer diagnosis through the program and enrollment in Medicaid for treatment services through the National Breast and Cervical Cancer Prevention and Treatment Act of 2000.

Breast Neoplasms↗