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Results for “Models, Organizational”

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PubMed2002

Agent-based modeling as organizational and public policy simulators.

Agent-based models are an increasingly powerful tool for simulating social systems because they can represent important phenomenon difficult to capture in other mathematical formalisms. But, agent-based models have provided only limited support for policy-making because their distinctive abilities are often most useful in situations where the future is unpredictable. In such situations, the traditional analytic methods for applying simulation models to support decision-making are least effective. Fortunately, new analytic approaches for decision-making under conditions of deep uncertainty--emphasizing large ensembles of model-created scenarios and adaptive policies evaluated with the criteria of robustness, rather than with optimality or efficiency--can unleash the full potential of agent-based policy simulators.

Journal Article↗
PubMed1992

[A comparative clinico-economic study of 2 models of organizational forms of psychiatric care exemplified in schizophrenia].

The authors describe part of the results of a comparative clinico-economic analysis of the functioning of two models of organizational forms of psychiatric services with special reference to Moscow and Kaluga. The purpose of the given research fragment was to make a comparative analysis of expenditures on schizophrenic patients depending on the system of psychiatric services organization on the whole and between different types of services; to specify approaches to optimization of their functioning with the use of a clinico-economic approach. Based on a comparative investigation of the representative groups of schizophrenic patients (386 patients of a mental health center in Moscow and 531 patients of the Kaluga regional psychiatric hospital No. 1), it has been established that as a result of the proper organization and financing of psychiatric services in Kaluga, the "direct" expenditures on one schizophrenic patient per year could be 20% as reduced and the losses of the national income could be lowered more than 2-fold. It should necessarily be mentioned that the financing of extra hospital services in Kaluga exceeded that in Moscow more than 3-fold, reaching about 20.3% of all the expenditures on schizophrenic patients. Apparently, the organizational and financial experience gained in Kaluga with the design of the common complex and many-staged system of psychiatric services may turn fairly instrumental in elaborating approaches to optimization of the functioning of psychiatric services.

Costs and Cost Analysis↗
PubMed1991

The impaired nurse. Organizational and professional models of response.

1. Two models of response, organizational and professional, affect the impaired nurse, who is both an employee and a professional. 2. The organizational model of response uses an Employee Assistance Program (EAP) to detect and intervene with impaired employees. 3. The professional model of response involves mechanisms established through the board of nursing, including posttreatment monitoring. 4. When both models are available, linking mechanisms such as coordinators, policies, and reentry practices can combine the strengths of each model.

Humans↗
PubMed1988

A model of organizational power: analysis and significance to nursing.

In this article a causal model of the process of interorganizational power is presented with results of one test using survey data from 39 non-nursing organizations. The model argues that interaction strategies of organizations are outcomes of the relative basis and use of resources in interorganizational transactions. Multiple regression and multiple-partial correlation analyses were used to analyze the data. The findings partially support the model and indicate that it holds promise for development and refinement. Conclusions are that the model should be tested with nursing organizations and used to conceptualize additional aspects of the power process that nursing can foster.

Models, Theoretical↗
PubMed1998

Group Dynamics in Top Management Teams: Groupthink, Vigilance, and Alternative Models of Organizational Failure and Success.

This study explored the heuristic value of Janis' (1982) groupthink and vigilant decision making models as explanations of failure and success in top management team decision making using the Organizational Group Dynamics Q-sort (GDQ). Top management teams of seven Fortune 500 companies were examined at two historical junctures-one when the team was successful (defined as satisfying strategic constituencies) and one when the team was unsuccessful. Results strongly supported the notion that a group' decision making process is systematically related to the outcomes experienced by the team. Ideal-type Q-sorts organized around Janis' analysis of groupthink and vigilance were substantially correlated with Q-sorts of failing and successful groups, respectively. The fit was, however, far from perfect. Ideal-type Q-sorts derived from other frameworks correlated better with the failure-success classification than did the Janis-derived ideal types. Successful groups showed some indicators of groupthink (e.g., risk-taking, cohesion, and strong, opinionated leaders), whereas unsuccessful groups showed signs of vigilance (e.g., internal debate to the point of factionalism). The results illustrate the usefulness of the GDQ for developing and empirically testing theory in organizational behavior from historical cases. Copyright 1998 Academic Press.

Journal Article↗
PubMed2003

[A multidisciplinary organizational Emergency Department model for trauma patients in hypovolemic shock].

UNLABELLED: Hypovolemic shock in trauma patients causes high mortality because of exanguination, secondary brain damage, multiple organ disfunction. Good organization and operative protocols are vital to patients in need of a prompt and multidisciplinary treatment. PATIENTS AND METHODS: We collected data about resuscitative and diagnostic process, severity scores and outcome of all trauma patients in hypovolemic shock admitted to the Ospedale Maggiore in Bologna (Italy) after the organization of an Internal Trauma System. RESULTS: We obtained a reduction of both diagnostic and therapeutic times and mortality during the last 14 years. CONCLUSIONS: A valid internal organization can improve mortality of trauma patients without expenditure of extra resources.

Accidents, Traffic↗
PubMed1981

[Structure of medical care services].

This paper analyzes in detail the principal patterns of the organization or structure of medical care observed in Latin American countries. It reviews the salient features of their structures and examines the major strategies adopted for reorganizing them to respond to new operating requirements. The authors state the conceptual basis and the components of the structure of medical care services and their nature, and then discuss different organizational models both of health systems as a whole and of operating units within them. The four organizational models considered are public or government service, social security, group medicine, and private medicine. The aspects selected for review in these four models are financing, remunerations, the investment in technology, the local service units, the formal structure of the services, the user's participation, information for decision-making, equity and economic efficiency, and the capacity to deliver benefits. The paper emphasizes throughout the patent need for change at all levels of the structure of the services so as to attain the goals of coverage expansion and health for all by the year 2000. These changes must take account of factors deriving from population growth and the changes in the systems made necessary by the present state of the services. A few considerations are also presented on the principal problems that will confront health services in the process and, lastly, there is emphasis on the importance of health services research to establish the facts in each particular situation, and on the need to redirect the training of the manpower needed to attain the established goals.

Health Maintenance Organizations↗
PubMed1987

A life-cycle model of organizational federations: the case of hospitals.

Hospital federations are a form of multiorganizational collaboration in which a management group coordinates and directs the activities of three or more organizations. This paper introduces a life-cycle model of federations that focuses on factors that influence the transition from one stage to another.

Hospital Shared Services↗
PubMedDate not supplied

[Systems analysis and modeling of organizational management processes of the regional public health system].

Scanty budgetary resources generate a need for optimally distributing the funds among different lines of expenditure in order to achieve the greatest possible social impact by taking into account the interests of different parties. A cognitive map and mathematical optimization models are proposed to control budgetary funds for financing the public health system.

Budgets↗
PubMed2006

Gene flow in complex landscapes: testing multiple hypotheses with causal modeling.

Predicting population-level effects of landscape change depends on identifying factors that influence population connectivity in complex landscapes. However, most putative movement corridors and barriers have not been based on empirical data. In this study, we identify factors that influence connectivity by comparing patterns of genetic similarity among 146 black bears (Ursus americanus), sampled across a 3,000-km(2) study area in northern Idaho, with 110 landscape-resistance hypotheses. Genetic similarities were based on the pairwise percentage dissimilarity among all individuals based on nine microsatellite loci (average expected heterozygosity=0.79). Landscape-resistance hypotheses describe a range of potential relationships between movement cost and land cover, slope, elevation, roads, Euclidean distance, and a putative movement barrier. These hypotheses were divided into seven organizational models in which the influences of barriers, distance, and landscape features were statistically separated using partial Mantel tests. Only one of the competing organizational models was fully supported: patterns of genetic structure are primarily related to landscape gradients of land cover and elevation. The alternative landscape models, isolation by barriers and isolation by distance, are not supported. In this black bear population, gene flow is facilitated by contiguous forest cover at middle elevations.

Animals↗
PubMed2000

The organizational pendulum--healthcare management in Sweden 1865-1998.

In recent years, there have been a number of large-scale changes in the organization of healthcare in Sweden, as in many other countries. From a longer time perspective, however, there has been a more or less permanent oscillation between centralization and decentralization, and also between competition and co-operation, in Swedish healthcare organizations. In fact, there seems to be something like a pendulum moving all the time between opposite forms of organization. The frequency of these changes has been increasing during the last fifteen years, as different organizational models have replaced each other at shorter and shorter intervals. This development is partly due to the increasing rate of change in modern society, but partly also due to an element of fashion in the area of management. There is, however, a growing change fatigue in many healthcare organizations, and also increasing demands for empirical evidence on the efficiency and effectiveness of different organizational models before they are introduced into the healthcare system.

Delivery of Health Care↗
PubMed1994

Toward an organizational-relational model of open adoption.

Clinicians and social scientists have attempted to demonstrate the advisability of open versus closed adoption (communication and/or contact vs. no communication and/or contact between biological and adoptive parents) from a variety of theoretical perspectives. In our article, we seek a conceptual framework that will (a) elaborate how such divergent conclusions about openness versus confidentiality have heretofore been drawn, and (b) provide a comprehensive analysis of the behavior and experiences of all members of the adoption triad (birthparents, adoptive parents, adoptees). Employing structural aspects of organismic-developmental theory (Werner, 1957) and dynamic aspects of self-in-relation theory (Miller, 1976), we propose an organizational-relational approach to open adoption. Preliminary research findings are also provided.

Adaptation, Psychological↗
PubMed1997

Screening for developmental dysplasia of the hip: from theory to practice. Collaborative Group DDH Project.

OBJECTIVE: To evaluate an organizational model for neonatal population screening for developmental dysplasia of the hip. METHODS: In 4648 neonates born in six hospitals of the Lombardy region, screening for developmental dysplasia of the hip was done using the Ortolani-Barlow maneuver and ultrasonography. RESULTS: The frequency of positive results of clinical and ultrasound examinations carried out in the hospitals varied considerably as a result of difficulties in the Ortolani-Barlow test reproducibility and in the low sensitivity of the clinical examination when compared to ultrasonography. Neonatal screening results implied a large number of subjects with a IIa hip, according to Graf's system; as these subjects require follow-up, the cost of this type of screening is high. Ultrasound findings were normal at 69 days of life in 88% and 75% of subjects, respectively, with unilateral and bilateral type IIa hip. CONCLUSION: This study evaluated various organizational models for screening (for different time periods and for selected populations) in relation to the cost-benefit ratio and demonstrated the different problems that still impede identification of a correct screening model.

Hip Dislocation, Congenital↗
PubMed1982

Models for evaluating services at community mental health centers.

Models for evaluating mental health treatment include the organizational model, the care-process model, the consumer-evaluation model, the efficacy model, and the community-impact model. Although organizational data (such as type of programs, number of personnel, amount of available funds, and quality of practitioners' training) are most frequently used to assess mental health centers, the author discusses the data generated by each of the other models. He also examines the advantages and disadvantages of applying such data to the evaluation of mental health services.

Community Mental Health Centers↗
PubMedDate not supplied

[Hospital at home: assessment of early discharge in terms of patients mortality and satisfaction].

New organizational models are essentials for European Hospitals because of restraining budget and ageing of population. Hospital at home is an alternative to inpatient care, effective both in clinical and economic ground. The aim of our study was to evaluate the impact of Hospital at Home in terms of decreased mortality and patient satisfaction. We carried out a meta-analysis of the literature about hospital at home interventions. We searched Medline (to December 2002), the Cochrane Controlled Trials Register (to October 2002) and other bibliographical databases, with a supplementary handsearching of literature. We used the following keywords: hospital at home, home hospitalization, mortality, patient satisfaction, cost, acute hospital care, conventional hospitalization. We included studies respecting the following criteria: analytical or experimental studies aimed at compare early discharge to hospital at home and continued care in an acute hospital. Review Manager 4.2 software was used to collect data and perform statistical analysis. We found 2420 articles searching for the chosen keywords. Twelve studies (2048 patients) were included for death outcome and six studies (1382 patients) were included for satisfaction outcome. The selected studies indicated a greater effect size of patient satisfaction in home patients than hospitalized ones (Odds Ratio: 1.58 95% CI: 1.25, 2.00) and showed no difference in terms of mortality (Risk Difference: -0.01 95% CI: -0.03, 0.02). Our results underline the effectiveness of this organizational model, as an alternative to continued care in an acute hospital. Further useful considerations could be drawn by economic evaluation studies carried out on field.

Controlled Clinical Trials as Topic↗
PubMed2005

Home-like versus conventional institutional settings for birth.

BACKGROUND: Home-like birth settings have been established in or near conventional labour wards for the care of pregnant women who prefer and require little or no medical intervention during labour and birth. OBJECTIVES: Primary: to assess the effects of care in a home-like birth environment compared to care in a conventional labour ward. Secondary: to determine if the effects of birth settings are influenced by staffing or organizational models or geographical location of the birth centre. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (18 May 2004) and handsearched eight journals and two published conference proceedings. SELECTION CRITERIA: All randomized or quasi-randomized controlled trials that compared the effects of a home-like institutional birth environment to conventional hospital care. DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group were used. Two review authors evaluated methodological quality. Double data entry was performed. Results are presented using relative risks and 95% confidence intervals. MAIN RESULTS: Six trials involving 8677 women were included. No trials of freestanding birth centres were found. Between 29% and 67% of women allocated to home-like settings were transferred to standard care before or during labour. Allocation to a home-like setting significantly increased the likelihood of: no intrapartum analgesia/anaesthesia (four trials; n = 6703; relative risk (RR) 1.19, 95% confidence interval (CI) 1.01 to 1.40), spontaneous vaginal birth (five trials; n = 8529; RR 1.03, 95% CI 1.01 to 1.06), vaginal/perineal tears (four trials; n = 8415; RR 1.08, 95% CI 1.03 to 1.13), preference for the same setting the next time (one trial; n = 1230; RR 1.81, 95% CI 1.65 to 1.98), satisfaction with intrapartum care (one trial; n = 2844; RR 1.14, 95% CI 1.07 to 1.21), and breastfeeding initiation (two trials; n = 1431; RR 1.05, 95% CI 1.02 to 1.09) and continuation to six to eight weeks (two trials; n = 1431; RR 1.06, 95% CI 1.02 to 1.10). Allocation to a home-like setting decreased the likelihood of episiotomy (five trials; n = 8529; RR 0.85, 95% CI 0.74 to 0.99). There was a trend towards higher perinatal mortality in the home-like setting (five trials; n = 8529; RR 1.83, 95% CI 0.99 to 3.38). No firm conclusions could be drawn regarding the effects of staffing or organizational models. AUTHORS' CONCLUSIONS: When compared to conventional institutional settings, home-like settings for childbirth are associated with modest benefits, including reduced medical interventions and increased maternal satisfaction. Caregivers and clients should be vigilant for signs of complications.

Birthing Centers↗