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PubMed1994

[Structure and organization of ambulatory and day treatment in a non-university facility].

Though German hospitals are normally not built for day case surgery, this became a new challenge based on changed legal regulations. A stepwise adaptation of the present facilities to the altered necessities seems to be a relatively simple way to realise day case surgery also in hospitals. Preoperatively surgeons and anaesthetists offer office hours during the same time to avoid patients having to wait. On the day of surgery patients are admitted to the hospital and treated like inpatients with regular transport to the operating room for anaesthesia and surgery, followed by recovery room stay and transmission to the normal ward. At a fixed time in the afternoon patients are visited by the surgeon and the anaesthetist to clear the conditions for dismission. While anaesthesia, surgery and recovery take the same time as for inpatients, the pre- and postoperative procedures are more time consuming. With a rising number of outpatients a separate department for outpatient surgery with its own administration, operating theaters and day case ward should be developed.

Ambulatory Surgical Procedures↗
PubMed1994

Computer tools to support collaborative organization design: definition and analysis of the work at the Vanderbilt University Hospital and Clinic.

In November, 1993 The Vanderbilt University Hospital and Clinic (VUH/TVC) convened a 10-member Collaborative Organization Design (COD) team that represented a diagonal slice through the organization. This team, lead by Gelinas & James, an outside consulting firm, was charged to develop, recommend, and implement a new organizational design which would promote a stronger patient focus, increased efficiency, and lower costs. The COD process is structured to inspire and enable employees to rebuild their organization so that it can respond to the challenges and opportunities that exist within their environment, to customer needs, and their own aspirations. This manuscript describes several of the computer tools which were utilized in the definition and analysis of the work of patient care at VUH/TVC. Specific examples of the findings from this phase of the work are utilized to illustrate their use and value.

Computers↗
PubMed1994

Health care workforce priorities: what nursing should do now.

We provide an appraisal of the adequacy of the aggregate supply of nurses and the appropriateness of their educational mix in view of anticipated changes in health care. We view the supply as adequate, but the educational mix as deficient with regard to nurses with baccalaureate and higher degrees who will be in greatest demand in new and expanding roles. Five priority areas are identified in which nursing can make particularly important contributions to improving health and health care: restructuring hospitals, improving primary care availability, contributing to the viability of academic health centers, improving care of the underserved, and redesigning the role of public health in a reformed health care system.

Education, Nursing↗
PubMed1994

CEO summit. The new delivery & financing realities. Part III of III.

In cooperation with McManis Associates Inc., Washington, Hospitals & Health Networks recently convened a summit on the integration of financing and delivery in health care. This installment is the third of a three-part series on lessons learned by those on the front lines of integration activity. The session was designed and facilitated by senior associates at McManis. Among the issues summit participants discussed in the second segment: What level of understanding do purchasers have of the factors that differentiate quality in health care services? Can provider-driven integrated delivery systems compete with insurer-driven ones? And what happens when a large integrated delivery system merges with a dominant insurer, as happened in the Philadelphia market? Can that model be successfully replicated in other markets? In this final segment, participants talk about whether providers' deep connections to their communities will add value in a reformed delivery system; how incentives might be aligned among all the players in integrated networks and organizations; how the concept of community focus might be redefined under systems integration; and the process involved in preparing for constant, accelerated change. The second segment concluded with comments about the assets providers and insurers bring to integrated health systems, and whether the merger experience of Graduate Health System and QCC/Independence Blue Cross could be replicated in other markets or not.

Community-Institutional Relations↗
PubMed1994

Frugal philanthropy.

Systems integration and a re-emphasis on community needs are leading to changes in hospital philanthropy. Successful fund raising now generates capital to fund programs to improve community health status.

Community-Institutional Relations↗
PubMed1993

Measuring differences and similarities in hospital caseloads: a conceptual and empirical analysis.

OBJECTIVE: This article conceptually and empirically evaluates alternative index measures that have been used to distinguish among hospital caseloads. It introduces two new measures. DATA SOURCES/STUDY SETTING: The study relies on 1987 Medpar data, which provide a 100 percent sample of Medicare Part A claims for the calendar year. STUDY DESIGN: Descriptive statistics indicate the sensitivity of alternative caseload measures to hospital bed size, region, and urban/rural location. Multiple regression analysis then examines the ability of the caseload measures to distinguish among hospitals based on hospital- and area-specific characteristics. DATA COLLECTION/EXTRACTION METHODS: A provider level file containing the number of cases treated by each provider in each DRG was constructed from the Medpar data and merged with data from the American Hospital Association and the Area Resource File. PRINCIPAL FINDINGS: Different indexes purporting to measure hospital specialization are often evaluating very different aspects of the hospitals' caseloads. Prior work has indicated a specialization among hospitals during the period from 1980 to 1985. Replication of this work using other indexes could verify the increase in specialization and might provide a clearer picture of market or hospital characteristics associated with changing caseloads.

Catchment Area, Health↗
PubMed1993

Quality assurance in the training of primary health care doctors and specialists.

Training of doctors is expensive as it requires at least six years of supervision while on the job plus sponsorship for courses, examination and even overseas training. Quality assurance of training is essential to ensure maximum throughput of the required number of specialist doctors for national needs. First, there is competition for training posts at basic (three years) and advanced (three years) levels. Basic training prepares doctors to sit and pass the relevant postgraduate examinations. Fifty percent of each cohort of doctors are selected as Basic Trainees but 40% finally complete Advanced Training. Second, trainees complete a training programme under supervision and record their clinical and learning experience in log books which are checked and certified by appointed supervisors who are consultants in government and restructured hospitals or institutions. Third, supervisor reports are submitted six monthly to the respective bodies: Academy of Medicine, School of Postgraduate Medical Studies or the Ministry of Health and Training Committees which vet these with the aim to continue the training or to terminate the training. Fourth, Parts I and II of relevant examinations must be passed within stipulated time frames. By these measures, there is quality assurance in the postgraduate training of our doctors.

Consultants↗