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Anaesthesia in institutional practice in Singapore.
Documentation of the early development of anaesthesia in Singapore is scanty. Before World War II the anaesthetic agents used were mainly chloroform, ether and ethyl-chloride. They were usually administered by the surgeons themselves or by apothecaries under the supervision of the operating surgeon. After World War II, anaesthetists were sent from the United Kingdom to be in charge of all anaesthetics administered in Singapore. From 1956 to 1971, local doctors were sent to the United Kingdom for training and to obtain the specialist degree FFARCS. From 1968 onwards, the Faculty of Anaesthetists of the Royal Australasian College of Surgeons held examinations in Singapore for candidates appearing for FFARACS. This continued until our M Med Anaesthesia examinations, which began in 1974, were well established. The number of specialists has increased over the years. With the decentralisation of the anaesthetic departments in the various hospitals in 1975, and the recent restructuring of Government hospitals, many changes have taken place in the anaesthetic scene. The long-awaited University Department of Anaesthesia was eventually established in 1985. Keeping pace with progress made in the various surgical disciplines, and in other fields of medicine, the duties of anaesthetists in institutional practice have increased enormously. They have extended beyond the operating theatre.
Hospitals: from center to periphery.
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Reinventing the American hospital.
The American hospital is being reinvented to conform with the forces that are replacing the acute, inpatient-oriented illness model of health care with a disease-prevention, health-promotion, primary-care one. Although hospitals will no longer conduct the "core business" of American health care, they can play a key role by empowering others and facilitating the integration of health services across the continuum of care. New management and governance structures will be required, as will population-based health status needs assessments, new relations with physicians, re-engineering of the clinical processes, organization-wide commitment to improving quality, information systems that link patients and providers, and creation of an overall community care management system. Despite major barriers, there are examples of progress.
Chicago. Market evolution gains momentum in the Windy City.
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Integrated delivery systems: one staff's experience.
Many hospitals and medical staffs have established a physician-hospital organization (PHO) or are discussing the development of one to facilitate contracting with managed care organizations. Physician leadership is essential in the establishment of a PHO in order for physicians to maintain control over patient care. This article describes how one medical staff--at Sewickley Valley Hospital--formed a PHO with its hospital and then a network with other PHOs. It also explains how physicians play an active role in the organization.
Women at work. Interview by Jill L. Sherer.
System redesign can work--just ask the staff at Sentara Norfolk (VA) General Hospital's Women's Health Pavilion. In 1991, Sentara implemented a new patient-focused care delivery system and has garnered some very impressive results all around. After almost two years, baseline comparisons show per-case cost decreases for obstetrical services ranging from 0.2 percent to 26.3 percent. Reimbursement per case has increased 14 percent, and decreases in lengths of stay ranged from 1.1 percent to 8.4 percent. But cost savings weren't the only benefits measured. After only one year, employee satisfaction went up; so did patient satisfaction (which in some instances increased by as much as 11 percent). Laboratory turnaround times decreased on the average by about 30 minutes--some by as much as 64 minutes. So how did the folks at Sentara do it? H&HN staff editor Jill L. Sherer posed that question to Megan R. Perry, who, at the time of the patient-focused care redesign (officially completed in 1992), was director of the women's pavilion. Today, Perry is vice president at Sentara Norfolk General Hospital.
Trading up. The right vehicle for the new integrated terrain.
Imagine the current health care system as a bus with a large inpatient capacity. Now imagine you have to redesign the vehicle into something like a lean Range Rover, while still on the road, to meet the challenges of a wholly new operational terrain. That's the situation facing health care organizations right now, and for many it's a daunting proposition. But research conducted by policy analysts at Northwestern University and KPMG Peat Marwick offers valuable insights that can help providers achieve both the functional integration and the physician/system integration that will be necessary steps in a long journey.
More than revving the engine. Systems take tangible steps toward physician & clinical integration.
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CEO Summit. Building the new health care delivery alliance, Part II. Roundtable discussion.
In cooperation with McManis Associates, Hospitals & Health Networks recently convened a CEO summit on physician/hospital integration activities. The summit was designed and facilitated by the senior staff of McManis Associates. Part I, which appeared in the May 5 issue, focused on the lessons being learned by those providers on the front lines of integration. This report focuses on aligning incentives and achieving cost-effectiveness.
The fading stand-alone hospital.
A new joint survey by Hospitals & Health Networks and Deloitte & Touche is confirming the shift toward integrated delivery: a majority of survey respondents say they either belong to or are developing an integrated delivery system. But are many integration initiatives all talk and little action? Data analysis reveals that many hospital executives believe they're far more integrated than they really are. Exactly how far has the reality progressed?
Reengineering health care. A new management tool aims to transform the organizational processes--and stir discussion.
Looking for improved clinical quality, reduced costs, streamlined operations? Advocates of business process reengineering say it can help achieve all those things. But what is reengineering in a health care context? Experts look at the conceptual, operational and information management challenges.
Great comebacks: sweet inspiration.
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Fast, flexible, and fluid: the continuing success of the Charlotte-Mecklenburg Hospital Authority in an era of public hospital crisis.
The changing face of health care delivery continues to challenge public hospitals, and many of these hospitals are in danger of closing. Increasing numbers of uninsured patients, coupled with state and federal cuts in Medicaid spending, threaten to worsen the situation. These facilities' survival may well depend upon their ability to create integrated delivery systems (IDSs). However, public hospitals are likely to face significant barriers in forming and participating in IDSs. This article present some of the barriers facing public hospitals as they attempt to form an IDS. Additionally, the authors present a brief case study of a public hospital whose successful efforts to form an IDS began before the IDS concept became popular. In forming an IDS this public hospital has strengthened its commitment to research, education, and the delivery of quality public health care.
Putting managed care in its place.
Take national data on dealings between doctors and hospitals, segment the numbers by the amount of managed care business, and what do you get? A few surprises. In markets highly penetrated by managed care, for instance, fewer hospitals and health systems had arrangements with doctors in salaried groups than with independent practice associations--just the opposite of what you'd expect. That finding and others come by comparing data from the American Hospital Association's 1996 survey of its members with 1996 market information from InterStudy Publications, Bloomington, Minn. In an exclusive to H&HN, researchers at the AHA's Healthcare InfoSource analyzed a sample of 2,837 hospitals, with 894 falling into high-penetration markets, 1,540 into medium markets, and 403 into the low category. Not surprisingly, higher levels of managed care seem to drive more activity between doctors and hospitals. Here's what they found.
Timeless destinations.
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Explain reasons, goals for restructuring.
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