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Results for “Models, Organizational”

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At least 127 records · Page 7Linked to original sources

PubMed2002

Mental health costs and access under alternative capitation systems in Colorado.

OBJECTIVE: To examine service cost and access for persons with severe mental illness under Medicaid mental health capitation payment in Colorado. Capitation contracts were made with two organizational models: community mental health centers (CMHCs) that manage and deliver services (direct capitation [DC]) and joint ventures between CMHCs and a for-profit managed care firm (managed behavioral health organization, [MBHO]) and compared to fee for service (F.F.S.). DATA SOURCES/STUDY SETTING: Both primary and secondary data were collected for the year prior to the new financing policy and the following two years (1995-1998). STUDY DESIGN: A stratified random sample of 522 severely mentally ill subjects was selected from comparable geographic areas within the capitated and FFS regions of Colorado. Major variables include service cost, utilization, and access (probability of service use) derived from secondary claims data, subject reported access collected at six-month intervals, and baseline outcomes (symptoms, functioning, and quality of life). PRINCIPAL FINDINGS: In comparison to the FFS area, cost per person was reduced in the capitated areas in each of the two years following implementation. By the end of year two, cost per person was reduced by two-thirds in the MBHO areas and by one-fifth in the DC areas. Reductions in access were found for both capitated areas, although reductions in utilization for those receiving service were found only in the MBHO model. CONCLUSIONS: Medicaid mental health capitation in Colorado resulted in cost reducing service changes for persons with severe mental illness. Assessment of outcome change is necessary to identify cost effectiveness.

Adolescent↗

PubMed1997

Improving general practitioner access to physiotherapy: a review of the economic evidence.

The provision of physiotherapy via general practitioner (GP) 'direct access' arrangements or in primary care itself has become increasingly common in the UK. Evidence on the economics and the cost-effectiveness of alternative methods of organizing access to physiotherapy services is reviewed, and the likely impacts of different organizational models are discussed. GP direct access physiotherapy and primary care provision appear to have a lower average cost than consultant access physiotherapy models, while GP direct access appears to minimize health care resource use per patient. Primary care physiotherapy provision appears to minimize the costs to patients of seeking care, and appears to generate a greater demand for service than other models. The extent to which physiotherapy provision in primary care can substitute for physiotherapy and other resources in the hospital sector is discussed, as is the extent to which patients may benefit from receiving physiotherapy in primary care. It is argued that continued expansion of access to physiotherapy should be critically appraised, and its ability to improve health status compared with that achievable in alternative patient groups who might benefit from physiotherapy in hospital or rehabilitation settings.

Cost-Benefit Analysis↗

PubMedDate not supplied

Transition to program management.

In their continuing pursuit of quality, effectiveness and efficiency, Canadian hospitals are adopting program management as an organizational model. West Park Hospital, a 406-bed continuing care and rehabilitation facility in Toronto, has recently introduced a comprehensive and decentralized program-management structure. This article describes West Park's five-year transition from a traditional administrative structure to program management.

Hospital Bed Capacity, 300 to 499↗

PubMed1993

Total quality, strategic planning, and community benefit: are they compatible or contradictory?

Strategic planning has traditionally been a business activity, in which an analysis of market forces and organizational mission leads to major business goals for the future, from new programs and services to entirely new facilities, systems, and even new organizational models. The integration of TQM principles focuses strategic planning more on meeting the needs and expectations of customers and less on emulating the competition, and it aligns strategic initiatives with improvement efforts. In this Perspective, William Corley says that, once TQM and strategic planning have been integrated, the next phase is both necessary and inevitable: focusing strategic planning and improvement efforts around community health needs. But what will it take to make the paradigm shift?

Community Health Services↗

PubMedDate not supplied

The organization of heart services. Part three: Building a cardiac PHO.

This article has examined some of the legal requirements for establishing a PHO or a SPHO. These guidelines have been presented in a generalized format. Legal counsel should be retained prior to developing a PHO to ensure that applicable legal statutes at the state, local and national level are met. Various organizational models have been presented for developing the PHO. The PHO entity allows the physicians and the hospital a single entity, representative of both parties, to locate, negotiate and enter into contracts on their behalf. The PHO can allocate revenues among the parties based on the amount of risk and services provided. There are some questions as to the long-term viability of PHOs given the regulatory changes occurring in the healthcare arena. Regardless of the regulatory changes that may occur, PHOs provide a vehicle for enhancing the relationship between a hospital and its physicians. PHOs are often a step in the process of developing a fully integrated healthcare organization. The PHO provides a forum for developing and enhancing trust and collaboration among the physicians and between the physicians and the hospital. Trust and collaboration will be key ingredients in the future as physicians and hospitals work more closely together in providing high-quality, cost-effective care that meets the patient market needs and expectations. Part Four of this series will discuss the fully integrated healthcare organization.

Cardiology Service, Hospital↗

PubMed1994

Elements and strategies of an effective provider integration strategy.

Regardless of the outcome of the debate in our nation's capitol, a health care revolution is sweeping the nation. In fact, if the debate lasts much longer, policy makers will be playing catch-up and responding to policies already in place in the trenches. Everywhere we turn as health care leaders, there is evidence of major change on the horizon. Reimbursement methodologies are undergoing radical alteration, traditionally stable institutions are being challenged, new organizational models are evolving, the types and roles of providers best suited to provide care are being questioned, and consumer expectations are being heightened. One of the basic strategies that is receiving attention throughout the country as a response to all this change relates to the development of integrated delivery organizations (IDO), integrated delivery systems (IDS), or integrated delivery networks (lDN). This article discusses these emerging systems in terms of health care reform, describes the rationale for their creation, and provides some strategies for their successful development.

Group Practice↗

PubMedDate not supplied

Alternative cost-effective anesthesia care teams.

Private and public payers are increasingly seeking an overall per-diem or global surgery rates that put hospitals at significant financial risk for anesthesia services. Other payers are demanding deep discounts in anesthesia fees and negotiating global capitation rates that put both hospitals and physicians at risk for all care including anesthesia. This study examines some of the various organizational models for using physician anesthesiologist (MDA) and nurse anesthetist (CRNA) resources most cost effectively and safely. Variations in percentages of these practitioners can be seen in that California reportedly has 47 MDAs for every 10 CRNAs while Michigan has just 6 MDAs for every 10 CRNAs practicing in that more highly managed care environment. Four various anesthesia practice models are described in detail without declaring any one a universal model. The cost per year for MDAs averages $294,000 while the cost per year for CRNAs is less than half as much.

Anesthesiology↗

PubMed2003

[Psychiatric consultation-liaison in Sweden surveyed: A patchwork of reimbursement schemes, organizational structures and levels of ambition].

In order to make a survey of consultation-liaison (c-l) psychiatric activity a questionnaire was distributed to all psychiatric departments in Sweden. Questions were asked concerning organization, reimbursement and indicators of the quality level of services. 42 of 72 possible responders returned the questionnaire (58%). The department-affiliated services work with few exceptions at a basic level of consultation, and existing liaison activities seldom have any organizational connection to the psychiatric departments. There is no commonly accepted organizational model and the use of professional categories other than psychiatrists is rare. Five psychiatric departments have special c-l units and research is pursued almost exclusively at these. A majority of respondents express a need for expansion. So far, the services have been working at a level of gentlemen's agreement between clinics, but a number of compensatory schemes are under way.

Humans↗

PubMed1995

Advanced practice nursing: an administrative perspective.

Institutions have adopted various organizational models to incorporate the role of acute care nurse practitioners (ACNP). This article provides a review of various professional practice models for ACNPs, their scope of practice, institutional credentialing, and typical funding mechanisms for these practitioners working in hospital-based acute care settings.

Acute Disease↗

PubMed1993

The time-limited hot line.

Although long-term hot lines that focus on crisis intervention will undoubtedly dominate as an organizational model, time-limited approaches will be used with increasing frequency. The primary impetus behind their proliferation is the increasing visibility of the electronic media, particularly television, in investigating and reporting pressing health, mental health, and human services problems. As the mass media increasingly produces special reports, documentaries, and docudramas directed toward social problems and issues, local health and human services agencies will become increasingly motivated to provide a forum for public response. The time-limited issue- or problem-oriented hot line is the ideal vehicle for public response as well as for extending the human services network. This type of hot line also offers social workers a unique opportunity to share important mental health information through the media.

Adolescent↗

PubMedDate not supplied

Basic principles of information technology organization in health care institutions.

This paper focuses on the basic principles of information technology (IT) organization within health sciences centers. The paper considers the placement of the leader of the IT effort within the health sciences administrative structure and the organization of the IT unit. A case study of the University of Missouri-Columbia Health Sciences Center demonstrates how a role-based organizational model for IT support can be effective for determining the boundary between centralized and decentralized organizations. The conclusions are that the IT leader needs to be positioned with other institutional leaders who are making strategic decisions, and that the internal IT structure needs to be a role-based hybrid of centralized and decentralized units. The IT leader needs to understand the mission of the organization and actively use change-management techniques.

Health Facility Administration↗

PubMedDate not supplied

School of nursing closure: an example of congruence with Sutton's model of organizational death.

Literature concerning the closing of nursing schools is scarce. When faced with the task of closure, educational administrators are without guides because most nurses have had no experiences in implementing what can be termed "organizational death." The purpose of this article is to describe Sutton's Process Model of Organizational Death and its congruence with the closure of one nursing school. Process model knowledge and application may assist administrators, faculty, and all those connected with a nursing program in positively working through a school closure.

Adaptation, Psychological↗

PubMed2001

A trickle-down model of organizational justice: relating employees' and customers' perceptions of and reactions to fairness.

This study developed and tested a trickle-down model of organizational justice that hypothesized that employees' perceptions of fairness should affect their attitudes toward the organization, subsequently influencing their behaviors toward customers. In turn, customers should interpret these behaviors as signals of fair treatment, causing them to react positively to both the employee and the organization. The model was tested on a sample of 187 instructors and their students. The results revealed that instructors who perceived high distributive and procedural justice reported higher organizational commitment. In turn, their students reported higher levels of instructor effort, prosocial behaviors, and fairness, as well as more positive reactions to the instructor. Overall, the results imply that fair treatment of employees has important organizational consequences because of customers' attitudes and future intentions toward key service employees.

Adult↗

PubMed1996

Assessing the congruence of nursing models with organizational culture: a quality improvement perspective.

Model-based practice was identified by the Nursing Department at Riverview Health Centre, a 320-bed long-term care facility located in Winnipeg, Manitoba, as having the potential to enhance care quality significantly. To achieve real impact in the clinical setting, however, the model selected would need to reflect closely the culture and values of the department. It was decided to explore these phenomena using cross-method triangulation involving a cultural assessment survey (the Nursing Unit Cultural Assessment Tool) and focus groups. Patient comfort and empathy emerged consistently as core values for staff. Greater appreciation of the depth and complexity of the nursing department culture and values has provided invaluable direction vis-à-vis conceptual model selection.

Chi-Square Distribution↗

PubMed1984

Optimal and dysfunctional turnover: toward an organizational level model.

Dysfunctional turnover is defined here as the level that produces a divergence between the organization's optimal balance of costs associated with turnover and the costs associated with retaining employees. Under this approach, the optimal level of aggregate turnover for most organizations will be (1) greater than zero and (2) variable across organizations, contingent on particular factors influencing retention costs and quit propensities. The model presented posits that individual, organizational, and environmental attributes influence individual quit propensities of employees and, hence, expected turnover rates for the organization.

Models, Theoretical↗

PubMed2003

A reflective model for organizational assessment and interventions.

A visionary academic medical center in Colombia, South America, engaged the Institute for Nursing Healthcare Leadership in a multifaceted project for the overall goal of strengthening the model of professional practice. The authors describe a reflective model for organizational assessment that steered the in-depth assessment of the organization. The model combines the constructs of culture, theory, patterns, and phenomenon with an iterative process. The organizational reflection process is applied to assessing key nursing roles and the nursing care delivery system. Recommendations and interventions that emerged from the assessment are included.

Colombia↗

PubMed1982

A management science approach to contingency models of organizational structure.

This study demonstrates the applicability of a quantitative modeling approach, specifically goal programming, in operationalizing the relationship between environmental variables and specific organizational structural variables for optimal goal attainment. A goal programming model is developed to analyze and determine the optimal relationships for goal attainment.

Analysis of Variance↗

PubMed2006

Are physician reimbursement strategies associated with processes of care and patient satisfaction for patients with diabetes in managed care?

OBJECTIVE: To examine associations between physician reimbursement incentives and diabetes care processes and explore potential confounding with physician organizational model. DATA SOURCES: Primary data collected during 2000-2001 in 10 managed care plans. STUDY DESIGN: Multilevel logistic regressions were used to estimate associations between reimbursement incentives and process measures, including the receipt of dilated eye exams, foot exams, influenza immunizations, advice to take aspirin, and assessments of glycemic control, proteinuria, and lipid profile. Reimbursement measures included the proportions of compensation received from salary, capitation, fee-for-service (FFS), and performance-based payment; the performance-based payment criteria used; and interactions of these criteria with the strength of the performance-based payment incentive. DATA COLLECTION: Patient, provider group, and health plan surveys and medical record reviews were conducted for 6,194 patients with diabetes. PRINCIPAL FINDINGS: Without controlling for physician organizational model, care processes were better when physician compensation was based primarily on direct salary rather than FFS reimbursement (four of seven processes were better, with relative risks ranging from 1.13 to 1.23) or capitation (six were better, with relative risks from 1.06 to 1.36); and when quality/satisfaction scores influenced physician compensation (three were better, with relative risks from 1.17 to 1.26). However, these associations were substantially confounded by organizational model. CONCLUSIONS: Physician reimbursement strategies are associated with diabetes care processes, although their independent contributions are difficult to assess, due to high correlation with physician organizational model. Regardless of causality, a group's use of quality/satisfaction scores to determine physician compensation may indicate delivery of high-quality diabetes care.

Diabetes Mellitus↗