[Hospital management and role of nursing profession. Hospital management should learn from Japanese industrial management system].
Explore the source record for details and available documents.
Hospital Administration↗
SEARCH · PubMed Health
Results for “Management”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Toward adaptive management: the impacts of different management strategies on fish stocks and fisheries in a large regulated lake.
We applied the adaptive management approach to analyze the demand and feasibility of adaptive management of fish stocks in a large regulated lake, Oulujärvi, in northern Finland. The process consisted of four phases: (1) analysis of the current state of the fisheries system (fishers, related markets and industry, fisheries researches and authorities, related organizations, etc.); (2) analysis of the objectives of different stakeholders; (3) the composition of alternative management strategies and assessment of their impacts; and (4) recommendations for future management. We used catch statistics from the period 1973-1995 to analyze fish stocks and fishing. Fish species involved were brown trout (Salmo trutta L.), whitefish [Coregonus lavaretus (L.) sl.], vendace (Coregonus albula L.); and pikeperch (Stizostedion lucioperca L.). Questionnaires and interviews were applied to ascertain the opinions of different groups of fishermen. Several models and cost-benefit analysis were used to assess the ecological, economic, and social impacts of three alternative management strategies. The results emphasize that when determining stocking levels and fishing regulations, the system should be considered as a whole, and impacts on major fish species and different groups of fishermen should be assessed. The stocking policy and fishing regulations should also be flexible to accommodate changing biotic and societal conditions. The key questions in applying the adaptive management process in Oulujärvi fisheries are how to determine clear objectives for fisheries management, find a fisheries management structure that provides workable interactions between different stakeholders, and arrange cost-effective monitoring. The lessons learned from the Oulujärvi experience and recommendations for fisheries management are relevant to other lakes with conflicting objectives of different stakeholders.
Animal Husbandry↗
Risk management of sediment stress: a framework for sediment risk management research.
Research related to the ecological risk management of sediment stress in watersheds is placed under a common conceptual framework in order to help promote the timely advance of decision support methods for aquatic resource managers and watershed-level planning. The proposed risk management research program relies heavily on model development and verification, and should be applied under an adaptive management approach. The framework is centered on using best management practices (BMPs), including eco-restoration. It is designed to encourage the development of numerical representations of the performance of these management options, the integration of this information into sediment transport simulation models that account for uncertainty in both input and output, and would use strategic environmental monitoring to guide sediment-related risk management decisions for mixed land use watersheds. The goal of this project was to provide a sound scientific framework based on recent state of the practice in sediment-related risk assessment and management for research and regulatory activities. As a result, shortcomings in the extant data and measurement and modeling tools were identified that can help determine future research direction. The compilation of information is beneficial to the coordination of related work being conducted within and across entities responsible for managing watershed-scale risks to aquatic ecosystems.
Conservation of Natural Resources↗
Management of lone star ticks (Acari: Ixodidae) in recreational areas with acaricide applications, vegetative management, and exclusion of white-tailed deer.
A project on management of lone star ticks, Amblyomma americanum (L.), at Land Between the Lakes, a Tennessee Valley Authority recreational area in Kentucky-Tennessee, during 1984-1988, demonstrated the effectiveness and economics of three control technologies. Acaricide applications (chlorpyrifos at 0.28 kg [AI]/ha), vegetative management (mowing and removal of 40% overstory and 90-100% of midstory, understory, and leaf litter), and host management (white-tailed deer exclusion from a 71-ha campground with a single-line fence) provided 75, 70, and 64% mean controls of all life stages of the lone star tick, respectively. Combinations of acaricide applications + vegetative management, acaricide applications + host management, and acaricide applications + vegetative management + host management produced 94, 89, and 96% mean control of all life stages, respectively. The costs of acaricide applications (two per year), vegetative management (two mowings per year), and white-tailed deer exclusion (single-line fence) were $45, $150, and $30/ha/yr, respectively. Results of this project are used to design management strategies that could be considered for use against lone star ticks in recreational areas.
Analysis of Variance↗
Changing patterns in the management of splenic trauma: the impact of nonoperative management.
OBJECTIVE: The recognition that splenectomy renders patients susceptible to lifelong risks of septic complications has led to routine attempts at splenic conservation after trauma. In 1990, the authors reported that over an 11-year study period involving 193 patients, splenorrhaphy was the most common splenic salvage method (66% overall) noted, with nonoperative management employed in only 13% of blunt splenic injuries. This report describes changing patterns of therapy in 190 consecutive patients with splenic injuries seen during a subsequent 6-year period (1990 to 1996). An algorithmic approach for patient management and pitfalls to be avoided to ensure safe nonoperative management are detailed. METHODS: Nonoperative management criteria included hemodynamic stability and computed tomographic examination without shattered spleen or other injuries requiring celiotomy. RESULTS: Of 190 consecutive patients, 102 (54%) were managed nonoperatively: 96 (65%) of 147 patients with blunt splenic injuries, which included 15 patients with intrinsic splenic pathology, and 6 hemodynamically stable patients with isolated stab wounds (24% of all splenic stab wounds). Fifty-six patients underwent splenectomy (29%) and 32 splenorrhaphy (17%). The mean transfusion requirement was 6 units for splenectomy survivors and 0.8 units for nonoperative therapy (85% received no transfusions). Fifteen of the 16 major infectious complications that occurred followed splenectomy. Two patients failed nonoperative therapy (2%) and underwent splenectomy, and one patient required splenectomy after partial splenic resection. There no missed enteric injuries in patients managed nonoperatively. The overall mortality rate was 5.2%, with no deaths following nonoperative management. CONCLUSIONS: Nonoperative management of blunt splenic injuries has replaced splenorrhaphy as the most common method of splenic conservation. The criteria have been extended to include patients previously excluded from this form of therapy. As a result, 65% of all blunt splenic injuries and select stab wounds can be managed with minimal transfusions, morbidity, or mortality, with a success rate of 98%. Splenectomy, when necessary, continues to be associated with excessive transfusion and an inordinately high postoperative sepsis rate.
Adolescent↗
Managing today's complex healthcare business enterprise: reflections on distinctive requirements of healthcare management education.
In early 2001, the community of educational programs offering master's-level education in healthcare management began an odyssey to modernize its approach to the organization and delivery of healthcare management education. The community recognized that cumulative long-term changes within healthcare management practice required a careful examination of healthcare management context and manpower requirements. This article suggests an evidence-based rationale for defining the distinctive elements of healthcare management, thus suggesting a basis for review and transformation of master's-level healthcare management curricula. It also suggests ways to modernize these curricula in a manner that recognizes the distinctiveness of the healthcare business enterprise as well as the changing management roles and careers within these complex organizations and systems. Through such efforts, the healthcare management master's-level education community would be better prepared to meet current and future challenges, to increase its relevance to the management practice community, and to allocate scarce faculty and program resources more effectively.
Accreditation↗
[Hospital management: quality and economy as management challenges for the physicians].
As a consequence of the Gesundheitsstrukturgesetz (GSG-Health Structure Act) hospitals are called upon to organize the processes of medical, nursing care and administrative services more economically, without there being any reduction in either the social quality or the quality of the process or result of the task of caring for patients. Fulfilling the task of caring for patients professionally entails providing medical efficiency and economy (section 109 SGB V). The hospital management is called upon to harmonize supposedly conflicting objectives such as "increasing the quality whilst reducing the costs" through intelligent organization and leadership concepts. The maxims up to now were: "quality costs money", "innovations need time and money", "a shorter stay can only be guaranteed with additional capacity" etc. The new management paradigm demands: "higher quality and patient-effective innovations (e.g. minimally invasive procedures, out-patient operations) can be realized in a shorter time with a tendency towards falling costs" and "a shorter stay is achieved with less capacity through better organization". To guarantee these standards the doctor in particular is required to be a high performer because the responsibility for medical quality cannot be separated from the responsibility for economical work processes to achieve this quality. Every senior doctor when making his decision about the type and intensity of diagnosis and treatment automatically also makes a decision about executing these processes of medical services in a way which is tailored to suit the needs and economical requests. This management challenge for the doctor presents itself in several areas: --as a manager of the care cascade --as a manager of the services in the regional health network --as a manager of standardization in the field of logistics (e.g. steering of medical products like heart catheters from the point of manufacturing to the point of use) --as a manager who knows how to mobilize the problem-solving knowledge of his employees through delegation-orientated leadership; the concept of the management of wastefulness as an organization and management approach is particularly suitable for hospitals.
Cost Control↗
Occupational health and safety management in polish enterprises implementing total quality management systems.
Total Quality Management (TQM) is defined as the management approach of the organization aimed at long-term success through client satisfaction, and which benefits all members of the organization and society (ISO 8402; International Organization for Standardization, 1994a). The objective of the study was to evaluate management methods applied to improve working conditions in Polish enterprises implementing TQM. The investigation was conducted in the form of interviews, which covered relevant connections between the TQM concept and occupational health and safety (OHS) systematic management rules. The results revealed that the criteria adopted in investigated enterprises for OHS management systems, as well as the implemented management methods and tools, can be evaluated positively. However, many require significant improvement in order to ensure better compliance with the existing law provisions. Elements of OHS management systems also require better integration with the overall management system of the enterprise.
Evaluation Studies as Topic↗
The role of the case manager in a disease management program.
Disease management programs provide new opportunities and roles for case managers to provide population-based healthcare to the chronically ill. This article identifies common components of disease management programs and examines roles assumed by case managers in disease management programs such as baseline assessment, performing economic analyses of diseases and their respective associated resource utilization, developing and/or implementing care guidelines or algorithms, educational interventions, disease management program implementation, and outcomes assessment. Areas of expertise needed to be an effective case manager in a disease management program are also identified.
Algorithms↗
Risk management: a management-oriented program implemented through the medical director's office.
General management approaches can be applied effectively to a medical facility's risk management program. By centralizing organizational structure, anticipating and controlling risk, investigating claims liabilities, and educating the medical and administrative staffs and other hospital employees, the risk management staff at Geisinger Medical Center has established a solid base for an effective program. Moreover, the risk manager "makes rounds" throughout the institution to obtain a firsthand view of risk control in action. Conversely, physicians and nurses "rotate" through the risk manager's office to learn more about the program and their vital roles in its success. Even though the concept of risk management is fairly new, the staff at Geisinger Medical Center already is using the information generated by incident reports, medical care evaluations, utilization reports, and claims investigations to enhance its understanding of the risk control program. By encouraging the involvement and the support of medical and administrative staffs, and by using a management-oriented approach, the administration of the Geisinger Medical Center believes its risk management program has a solid foundation and a strong framework for success.
Financial Management↗
The management for tuberculosis control in Greater London in comparison with that in Osaka City: lessons for improvement of TB control management in Osaka City urban setting.
The tuberculosis (TB) notification in Osaka City has been persistently high compared with other urban areas in Japan. Although the TB notification in Greater London has kept much lower level compared with that in Osaka City, it has been also persistently high compared with other urban areas in the UK. Nonetheless, the contexts of the two cities relating TB control programme as well as the epidemiological situation greatly vary; there must be some lessons to be learnt from each other to improve each TB control programme to tackle against TB more effectively. Comparing the epidemiological situation of TB in both cities, it is obvious that Osaka City suffers TB more than Greater London in terms of the TB notification rate. Concerning the context of the TB control programme, Osaka City has centralised approach with strong local government commitment; Greater London, on the other hand, has an approach that is greatly fragmented but coordinated through voluntary TB Networks. This paper aims to draw some constructive and practical lessons from Greater London TB control management for further improvement of Osaka City TB control management through literature review and interview to health professionals. TB epidemiology in Greater London shows distinct features in the extent of TB in new entrants and TB co-infected with HIV in comparison with those in Osaka City. TB epidemiology in Osaka City is to a great extent specifically related to homeless people whereas in Greater London, this relationship occurs to a lesser extent. Both areas have relatively high TB-notification rates compared with national figures, and they have "TB hot spots" where remarkably high TB-notification rates exist. TB control in Greater London is characterised with decentralised and devolved services to local government health authorities supplemented with co-ordinating bodies across sectors as well as across Greater London. Sector-wide TB Network as well as London TB Group (LTBG) and London TB Nurses Network are major key functioning bodies to involve relevant professionals as wide as possible. The specialist TB nurses play key roles for TB case management across Greater London, while in Osaka City, TB control is characterised with strong leadership and commitment of Osaka City Government for the TB control programme. The Osaka City Public Health Centre (PHC) takes initiatives to expand "Cohort Analysis and Case Management Conferences" at each of the 24 Ward Health and Welfare Centres as well as "DOTS Conferences" at hospitals for improvement of case management by physicians and nurses at hospitals as well as by the health centre staff. Public health nurses (PHNs) play very important roles for TB case management as frontline in Osaka City. Comparing the TB control in both cities, the following suggested recommendations are made to both cities for further improvement. Four suggested recommendations to Osaka City are: more resource re-allocation to community-based TB care than to hospital-based TB care should be done; Cohort Analysis and Case Management Conferences should be strengthened through involving more multi-disciplinary sectors; specialist TB PHN at each of the 24 Ward Health and Welfare Centres should be assigned in order to concentrate more on TB control activities; and accessibility to laboratory data such as drug susceptibility test for health centre staff should be improved. Two suggested recommendations to Greater London are: screening for TB high-risk group like homeless people should be strengthened, and regular sector-wide multi-disciplinary case conferences for proper case management should be strengthened.
AIDS-Related Opportunistic Infections↗
Preparing nurses for the acute care case manager role: educational needs identified by existing case managers.
BACKGROUND: There is little in the literature about how best to prepare nurses for case manager roles. METHOD: Twenty acute care case managers were asked to identify skills and knowledge that would be of value to nurses new to case manager roles. RESULTS: Community resources, discharge planning, and third party reimbursement were the top three educational needs identified by all case managers. Baccalaureate prepared case managers identified clinical issues to be of value, such as family coping, patient education, quality of life, and social support, while master's prepared nurses identified only system-related issues. CONCLUSION: Educational programs preparing baccalaureate prepared case managers could focus on both clinical and system issues, while programs preparing master's educated case managers could focus primarily on managing system issues. Staff development professionals may also call on experts inside and outside the institution to assist in teaching about health care finance and reimbursement issues.
Acute Disease↗
The new nurse manager: partner in managing costs and quality.
Today's nurse manager is a leader in the 1990s health care delivery system. Collaborating with managers throughout the organization, the nurse manager calls upon skills and advanced education to carry out functions in the areas of clinical systems management, human resource management, environmental management, and financial management. This article describes this health care management role and presents case studies where collaboration with other disciplines was successful.
Cost Control↗
The health-care manager's guide to managing change in challenging times.
Fifteen years ago, Bill Gates was a college dropout working for a four-member, fledgling company in New Mexico. Today, he is the richest man in America and the head of perhaps the most powerful company in recent corporate history. Ten years ago, managed health care was merely a concept discussed in academic and industry observer circles. Now it is a norm in almost every health-care organization nationally. Five years ago, health-care professionals in every discipline believed the maxim that, ¿as long as people get sick, health-care professionals will have jobs.¿ In 1995, health-care executives have alternately referred to the widescale process of laying off employees as reengineering, rightsizing, downsizing, or RIF (reduction in force). With this massive amount of change, both societally and professionally, health-care managers have been contending with the change management process. Although a breadth of concepts borrowed from other industries and a plethora of conceptual practicums have entered the health-care educational realm, a straightforward, immediately useful approach to managing change is probably more beneficial, as the need to manage change quickly and effectively becomes the paramount criterion for health-care management success in the second half of this decade of change. In this article we will explore the four areas where mistakes are made most frequently by leaders in the change process, and we will provide specific strategies to not only avoid these mistakes but moreover reduce resistance to change, activate positive action, and ultimately improve performance through optimum staff contribution. The four critical areas we will explore are the reasons for resistance to change, the management of the proactive phase of change, creating staff interdependence, and key leadership roles for change management.
Attitude of Health Personnel↗
Role of medical, technical, and administrative leadership in the human resource management life cycle: a team approach to laboratory management.
We believe the team approach to laboratory management achieves the best outcomes. Laboratory management requires the integration of medical, technical, and administrative expertise to achieve optimal service, quality, and cost performance. Usually, a management team of two or more individuals must be assembled to achieve all of these critical leadership functions. The individual members of the management team must possess the requisite expertise in clinical medicine, laboratory science, technology management, and administration. They also must work together in a unified and collaborative manner, regardless of where individual team members appear on the organizational chart. The management team members share in executing the entire human resource management life cycle, creating the proper environment to maximize human performance. Above all, the management team provides visionary and credible leadership.
Administrative Personnel↗
The value of case management in the publicly funded substance abuse treatment system. The perspective of program directors, case managers and clients.
The many purposes of this article is to understand the role and value of case management from the perspective of program directors, case managers and clients. A survey of program directors from publicly funded substance abuse treatment programs in Boston was administered, and in-depth interviews with a sample of program directors, case managers, and clients were conducted. Case management allowed programs to serve more complex clients and increased time available for counselors to focus on the clinical needs of clients. From the perspective of case managers and clients, much of the value of case management came from educating clients about steps they could take to meet their needs and then supporting them in their efforts as they took these steps. Successful steps taken to deal with these needs helped lay the foundation necessary to confront the challenges of treatment. Program directors, case managers, and clients considered case management a valuable enhancement to substance abuse treatment.
Attitude of Health Personnel↗
Management training of physician executives, their leadership style, and care management performance: an empirical study.
OBJECTIVE: To examine associations between management training of physician executives and their leadership styles, as well as effectiveness in achieving disease management goals. STUDY DESIGN: Cross-sectional national survey. METHODS: Executive directors of community health centers (269 respondents; response rate = 40.9%) were surveyed regarding their perceptions of the medical director's leadership, and for quantitative information on the center's achievement of clinical (mostly disease management) goals. The dependent variables were the medical director's scores (as perceived by the executive director) on transformational, transactional, and laissez-faire leadership, effectiveness, satisfaction with the leader, and subordinate extra effort, using an adapted Multifactor Leadership Questionnaire (43 items; 5-point Likert scale). The independent variable was the medical director's management training status. RESULTS: Compared with medical directors with < 30 days of inservice training, medical directors with an MHA, MPH, or MBA, or > or =30 days of in-service training, had 0.32, 0.35, 0.30, 0.36, and 0.37 higher scores on transformational leadership, transactional leadership, rated effectiveness, satisfaction, and subordinate extra effort, respectively, and 0.31 lower score on laissez-faire leadership (all P < .001). Medical directors without management degrees but with > or =30 days of in-service training had 0.34, 0.36, 0.50, and 0.47 higher scores on transformational leadership, transactional leadership, rated effectiveness, and satisfaction with the leader (all P < .02). Our data previously had demonstrated that medical directors' transformational leadership significantly influences achievement of disease management goals. CONCLUSION: Training may enable physician executives to develop leadership styles that are effective in influencing clinical providers' adoption of disease management guidelines under managed care.
Adult↗
Managing costs and managing care.
With a defined population served, contracted provider panels and the nature of care delivery integration, managed care has provided a solution, though not a panacea, to provide equitable services, standardized and prevention oriented cares to its enrolled members. Combined with the earmarked capitation reimbursement system and a series of cost containment and utilization review techniques, managed care has also demonstrated potently its capacity in cost-saving and quality promotion. Presents steps and measures related to managed care that federal government has taken to manage care and contain cost. It is crucial to identify and promulgate best practices continually, while managing utilization of resources for improving health care, containing cost, and equalizing medical care access to a greater proportion of the population. Concludes that it may take time for a universal adoption of managed care. However, Americans may actually benefit more from having a standard level of health care that managed care could achieve and provide.
Cost Control↗