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Management competencies for medical practice executives: skills, knowledge and abilities required for the future.

The purpose of this study was to obtain a consensus of opinion from a large and diverse population of experienced ambulatory health care administrators regarding the essential ambulatory health care management competencies, and their related skills, knowledge and abilities (SKA) requirements, that will be required for successful management performance in ambulatory health care delivery settings in the next five years. A literature review suggests limited research in this essential and rapidly developing area for the health care community. The research design and methods employed the Delphi technique. Three hundred and twenty (320) Fellows of the American College of Medical Practice Executives (ACMPE) were asked to respond to two rounds of a Delphi mail survey. The results indicate that the essential ambulatory management competencies could be discretely grouped into six Management Domains, each with related SKAs. The respondents rated leadership and strategic management as the most important Management Domains. The highest rated SKA emphasized interpersonal skills with the next highest SKA relating to ethical and moral dimensions. Patient care management, as well as two SKAs relating to computer skills, were rated lowest.

Ambulatory Care↗

A survey of pain assessment and management practices among critical care nurses.

BACKGROUND: Postoperative pain is one of the major obstacles in the prevention of complications during patient recovery. Pain and its management have gained great interest among researchers, clinicians and policy-makers. PURPOSES: To explore the relationship between two variables in pain assessment (length of time after surgery and ventilator status) and medication decisions made by critical care nurses, and to identify nurses' concerns about opioid use. METHODS: A convenience sample of 71 critical care nurses participated in the survey. RESULTS: Certain patient conditions such as length of time after surgery and ventilator status affected nurses' assessment and management of pain. Nurses' knowledge about pain assessment and management may affect patient care and outcomes.

Adult↗

The effects of an aggressive behavior management program on nurses' levels of knowledge, confidence, and safety.

Violence in the workplace is increasing, and unfortunately, hospitals are not exempt from the problem. Nurses are the primary caregivers in hospitals and are more likely to encounter violence because of the amount of time spent in direct patient care. Many nurses have not been trained to manage explosive situations. This project was developed to provide a program titled, "Managing Aggressive Behavior," to nurses and to measure and compare the differences in levels of knowledge and feelings of safety and confidence among nurses who attended the workshop versus a group who did not. The data revealed a significant difference in knowledge in the program group (P < 0.001) but no significant changes in safety (P = 0.367) or confidence (P = 0.440). No significant changes were found among the variables in the treatment group. Suggestions for further research and teaching are given.

Education, Nursing, Continuing↗

Medical correlates and diabetic retinopathy screening.

A systematic ophthalmological, medical, and biochemical screening of a rural population of diabetics in Western Australia is being carried out. A team of ophthalmologists, physicians, and paramedical personnel establish regional screening centres on a voluntary basis at weekends. Every attempt is made to locate and examine all known diabetics. All patients are given a thorough ophthalmic examination including standard multiple field colour fundus photography. Thorough physical examination includes assessment of cardiovascular and neurological status. Biochemical parameters include random blood sugar, urine analysis, serum creatinine, glycosylated haemoglobin, cholesterol, and high density lipoprotein. A detailed questionnaire and interview is carried out to assess the historical degree of control and the patient's knowledge of the control and management of diabetes. The sample now comprises an unselected population of 400 diabetics living in rural areas and allows comparison of areas which have scarce medical services with centres that are well supplied with medical practitioners. Incidence of retinopathy varies from 25 to 36 per cent of the diabetic population. Positive correlations of retinopathy have been found with duration, age, hypertension, level of control assessed biochemically at the time of examination, presence of ischaemic heart disease, peripheral neuropathy, and renal disease. Smoking also correlates positively. The data provide a baseline by which attempts to alter diabetic knowledge, management, and control may be measured in follow-up studies.

Adolescent↗

Computerization: reengineering the lawyering process for the 21st century.

Alvin and Heidi Toffler, describe the benefits of "informationware" and how one of the most tradition-bound organizations, the armed forces, has substantially changed its operations. According to the authors, mere knowledge is not sufficient to prevail; how one manages or uses knowledge separates winners from losers. Further, the authors say "...basically add new elements or create new combinations of old elements within an existing 'game.' A true revolution goes beyond that to change the game itself, including its rules, its equipment, the size and organization of the 'teams,' their training, doctrine, tactics, and just about everything else. Even more important, it changes the relationship of the game to society itself." Application of this theory to today's litigation is obvious and compelling. The ways in which clients and defense counsel obtain, analyze, and strategically apply evidence and legal principles must change to incorporate the informationware this society uses in other lines of business. This means more extensive and appropriate usage of computer hardware in a software environment that fully supports emerging client and defense counsel needs. The computer system must provide case direction, helpful suggestions, and direct, rapid access to data bases containing information presently available only through person-to-person networking.

Computer Systems↗

Disease management strategies: managing care giving in managed care.

The rapid rate of change in health care delivery systems has challenged and troubled health care providers. Some new health care delivery systems primarily emphasize the economics of medical care and leave providers with a sense that their profession has strayed from its mission. In addition, there is an increasing demand by payers and the public for public accountability for the quality and expense of clinical services. One response to these changes in health care is the use of disease management strategies. There is a growing body of knowledge regarding disease management strategies and practice guidelines in the literature. This article discusses how a provider group can implement improvement in the clinical process successfully by applying techniques of disease management.

Chronic Disease↗

The CCMC's national study of case manager job descriptions: an understanding of the activities, role relationships, knowledges, skills, and abilities.

Defining the roles and functions of case managers is crucial in today's healthcare environment and necessary for the case management field. One way to address this issue is through the examination of case managers' job descriptions used in various healthcare organizations. The study reported herein used qualitative analysis procedures and the latent class cluster analysis method to examine a national sample of 1028 job descriptions of case managers. The study identified the activities, role relationships, knowledge, skills, and abilities of case managers working in varied settings. It also described the changes that occurred in the practice of case management, based on these job descriptions, over 5 years: from the mid-1990s until the early 2000s. One benefit of this study was a change in one eligibility criterion of the CCM credential. Another was the development of a taxonomy of case managers' roles and functions that can be used as a step toward standardization of case managers' job descriptions.

Attitude of Health Personnel↗

Evaluation of a patient education manual.

A randomised controlled trial has shown that introducing a health education booklet describing the management of six common symptoms resulted in fewer consultations for the symptoms described by families receiving this booklet compared with a control group. A sample of the mothers in each group was subsequently followed up by an interview, at which a questionnaire was administered. This was designed to measure the mother's knowledge of the management of the symptoms described. The booklet did not lead to any increase in knowledge in the mothers receiving it. The questionnaire did, however, show that 76% of the mother had consulted the booklet at some time in the year of the study and 28% had consulted it in the three months before interview. The important result was a fall in the new request for care for the symptoms described in the booklet. This may be interpreted as indicating that what patients need to respond appropriately to common symptoms of illness is a simple reference manual rather than an educational programme designed to increase their knowledge about the management of illness.

Attitude to Health↗

Update on issues for HIV management.

During the past 12 months, there have been major advances in knowledge about HIV. With this new knowledge comes better management. In a very short period of time, both doctors and patients have swung from a mood of deep despondency to optimism and hopefulness. There have been several factors in this changed outlook: the availability of viral load testing; the licensing of new more potent anti retroviral drugs (particularly the protease inhibitors), and the demonstration (for the first time) that combination anti retroviral therapy offers benefit, not only in controlled clinical trials, but in the everyday lives of people living with HIV/AIDS.

Acquired Immunodeficiency Syndrome↗

Integrating knowledge and behavior: development of a management and career development program for graduate health administration education.

How best to integrate cognitive learning and behavioral skills in health administration education has been a concern of both academics and practitioners for many years. Charged with the education of health care administrators, graduate programs are expected to produce persons who are both knowledgeable about the field in which they plan to be employed and skilled in carrying out the many tasks associated with successful performance in their future roles. This article describes the theoretical basis and design of the management and career development offering (MCDO) of Widener University's Graduate Program in Health and Medical Services Administration, the key objectives of which are to integrate cognitive learning with practical experience and to provide a mechanism for the development of needed professional skills in a low-risk academic atmosphere. It was clear that these objectives could not be achieved entirely within a traditional academic curriculum, nor were they always appropriately treated there. However, the complexity of the health care field, the growing demands placed on administrators, and conflicts arising within and between roles increase the necessity to integrate these theoretical and behavioral skills.

Behavior↗

Teenagers with type 1 diabetes--a phenomenological study of the transition towards autonomy in self-management.

BACKGROUND: Becoming autonomous is an important aspect of teenagers' psychosocial development, and this is especially true of teenagers with type 1 diabetes. Previous studies exploring the everyday problems of teenagers with diabetes have focused on adherence to self-care management, how self-determination affects metabolic control, and the perception of social support. OBJECTIVE: The aim of the study was to elucidate lived experiences, focusing on the transition towards autonomy in diabetes self-management among teenagers with type 1 diabetes. DESIGN AND METHOD: Data were collected using interviews, and a qualitative phenomenological approach was chosen for the analysis. PARTICIPANTS: Thirty-two teenagers (18 females and 14 males) were interviewed about their individual experiences of self-management of diabetes. FINDINGS: The lived experiences of the transition towards autonomy in self-management were characterized by the over-riding theme "hovering between individual actions and support of others". The findings indicate that individual self-reliance and confirmation of others are helpful in the transition process. Growth through individual self-reliance was viewed as a developmental process of making one's own decisions; psychological maturity enabled increased responsibility and freedom; motivation was related to wellbeing and how well the diabetes could be managed. The theme "confirmation of others" showed that parental encouragement increased the certainty of teenagers' standpoints; peers' acceptance of diabetes facilitated incorporation of daily self-management activities; support from the diabetes team strengthened teenagers' self-esteem. CONCLUSION: In striving for autonomy, teenagers needed distance from others, but still to retain the support of others. A stable foundation for self-management includes having the knowledge required to practice diabetes management and handle different situations.

Adaptation, Psychological↗

Management needs of head nurses and supervisors: designing a continuing education course.

Studies have confirmed the need for continuing education (CE) management courses for hospital nurse managers facing new challenges as decentralization has occurred. Increased problem-solving and decision-making skills are necessary as middle nurse managers attempt to manage more effectively in the current healthcare climate. Head nurses and supervisors may well have the most stressful positions in hospitals. A needs assessment of these individuals was conducted in order to design a management course to provide practical knowledge for contemporary nurse managers.

Curriculum↗

The seven S's for successful management.

Becoming a successful manager in a health care agency is, for most new managers, an awesome goal. Successful management is more than knowledge of leadership roles and management functions that can be learned in school or educational workshops. Successful management involves effective use of both the manager's affective and cognitive domains. Mentoring and apprenticeship with a successful nurse leader is for many novice managers a highly valuable way to learn management skills since this allows for techniques with a successful nurse manager to be visualized and then modeled. "Seven S's" that provide a framework for managerial success are discussed.

Goals↗

Reading skills and family planning knowledge and practices in a low-income managed-care population.

OBJECTIVE: To examine the relationship between reading ability and family planning knowledge and practices among Medicaid managed care enrollees. METHODS: A total of 406 women age 19-45 years enrolled in TennCare and members of Prudential HealthCare Community Plan in Memphis, Tennessee were interviewed to determine their methods of contraception, desire for additional information about contraceptives, and knowledge about the time in menstrual cycle they are at highest risk for pregnancy. Patient reading ability was assessed by an abbreviated version of the Test of Functional Health Literacy of Adults. The independent associations between reading ability, desire for additional contraceptive information, and knowledge about the highest risk time for pregnancy were assessed with logistic regression. RESULTS: Almost 10% of the respondents had low reading skills. Women who had used an intrauterine device, douching, rhythm, or levonorgestrel implants as methods of birth control had higher rates of low reading skills than women who used other methods of birth control. Compared with women with good reading skills, women with low reading skills were 2.2 times (95% confidence interval [CI] 1.1, 4.4) more likely to want to know more about birth control methods and 4.4 times (95% CI 2.2, 9.0) more likely to have incorrect knowledge about when they were most likely to get pregnant. These relationships were significant even after controlling for age, race, and marital status. CONCLUSION: Health providers and organizations that serve historically underserved populations must understand that some individuals have a low level of reading ability that limits family planning education.

Adult↗

What general practitioners and paediatricians think about their patients' asthma.

The Asthma Insight and Reality in Europe (AIRE) study showed that the current management and treatment of asthma in Europe falls short of the goals set in the GINA guidelines. Patient care may be negatively influenced by the physicians' underestimation of their patients' disease state, and overestimation of their patients' knowledge of asthma management. We interviewed 118 paediatricians and 152 general practitioners (response rate 70 and 86%, respectively) in order to get an insight into the physicians view on his patients' asthma management. A questionnaire containing similar items to those used in the AIRE study was used. Dutch physicians believe that the asthma of the majority of their patients is well controlled and underestimate the prevalence of daytime symptoms. They believe that their patients are aware of the differences between reliever medication and maintenance medication and overestimate the number of patients in possession of a written action plan. Dutch paediatricians and general practitioners underestimate the severity of their patients' disease state and overestimate their patients' knowledge of disease management.

Absenteeism↗

Effecting and leading change in health care organizations.

BACKGROUND: Understanding change is crucial to implementing quality improvement (QI) initiatives. Widespread change will be required to correct what many consider to be outmoded and deficient systems of care. This article summarizes the current literature--within both health care and the fields of business and management--regarding how change occurs at the individual and organizational levels. Part 1 focuses on changing clinician behavior, which is instrumental to any effort directed in the health care setting. Part 2 examines the culture of change. Part 3 addresses issues of leadership, along with the necessary steps to guide change in an organization. Part 4 summarizes key elements of change. Finally, Part 5 provides three case examples of QI initiatives reported in the recent literature to illustrate how the application of the knowledge of change management can assist in the successful implementation of QI programs. KEY ELEMENTS OF CHANGE: The knowledge base regarding successful change in health care organizations can be summarized in eight crucial strategies or principles: (1) develop a vision for change, (2) focus on the change process, (3) analyze which individuals in the organization must respond to the proposed change and what barriers exist, (4) build partnerships between physicians and the administration, (5) create a culture of continuous commitment to change, (6) ensure that change begins with leadership, (7) ensure that change is well communicated, and (8) build in accountability for change. CONCLUSION: A knowledge of change management can help leaders of QI programs in health care organizations successfully apply these concepts to bring about much-needed transformations in health care.

California↗

Towards a science of Alzheimer's disease management: a model based upon current knowledge of retrogenesis.

BACKGROUND: General relationships between dotage and infancy and childhood have been acknowledged for more than two millennia. Recent findings indicate precise relationships between functional, praxic, and feeding changes in the course of the degenerative dementia of Alzheimer's disease (AD) and inverse corresponding developmental sequences. Similar inverse relationships between AD and human development can be described for cognition and language skills; for physiologic measures of electroencephalographic activity, brain glucose metabolism, and developmental neurologic reflex changes; and for the neuropathologic and neuroanatomic progression of these processes. In AD, these processes may be termed "retrogenesis." The relevance of the retrogenesis model for AD management is explored. METHOD: The functional stages of AD can be translated into developmental age equivalents that can be utilized to explicate observed changes in the disease. RESULTS: The retrogenesis-based developmental age model can usefully inform an understanding of the general care needs, emotional and behavioral changes, and activity needs of the AD patient. This model must be amended by necessary caveats regarding physical differences, variations in age-associated pathology, differences in social and societal reactions, and differences in background between AD patients and their developmental age "peers." CONCLUSIONS: Knowledge of retrogenesis and the developmental age of the AD patient can form a nidus for the development of a nascent science of disease management. Such a science must ultimately incorporate not only appropriate caveats but also relevant universal human needs, such as those for dignity, love, and movement.

Adolescent↗