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PubMedDate not supplied

Strategic positioning: a case study in governance and management.

This case describes the experience of the Detroit Medical Center (DMC) in restructuring its governance and management. It provides a background on the DMC, examines the driving forces that led to modification of its structure, identifies key principles in guiding the change, and describes the strategies and specific steps taken in managing structural change. Finally, the critical lessons learned about leadership style, communication, agenda development, and relations with the board, medical staff, and management are discussed. This case study will help reduce the learning curve for any large, complex organization undertaking board and management restructuring to better meet its mission. At the time of DMC's restructuring there were no models to guide the effort. This case study attempts to reduce the gap in research on the management of structural change.

Consumer Behavior↗
PubMed1998

Patient-focused care and its implications for nutrition practice.

Patient-focused care is a central element in work redesign and restructuring of health-care delivery systems. It affects all levels of dietetics practice. Patient-focused care poses potential benefits and challenges for nutrition professionals, including opportunities to expand the scope of practice and to share traditional nutrition duties with others. This article provides a brief overview of the basic components and terms of patient-focused care and reviews a case study that illustrates how implementation of patient-focused care in a community hospital has influenced the hospital's organizational structure and delivery of nutrition care and services. A review of the initial goals of patient-focused care in relation to long-term outcomes provides perspective for those beginning or in the midst of the reengineering process.

Dietetics↗
PubMed1998

Decentralizing unit coordinator services.

Restructuring unit coordinator/unit clerk services by decentralizing this staff and having them report directly to nurse managers can totally integrate them into the functions and activities of a patient-centered team. This article describes how nurse managers can evaluate the feasibility of decentralizing unit coordinators in their own institutions.

Administrative Personnel↗
PubMed1996

Restructuring the clinical nurse specialist position to a unit-based role.

Role restructuring can be the key to maximizing efficiency, productivity, and operational effectiveness. The clinical nurse specialist role was restructured from a divisional project focus to a unit-based design to enhance the care of specific patient populations. The authors describe the process used to make this change, the outcomes achieved, and the lessons learned.

Efficiency, Organizational↗
PubMed1997

Transforming the National Health Service. The challenge for career management.

Claims that, for the 1990s, images of careers are multidimensional and individualistic. Notes that employees are encouraged to take responsibility for their own self-development, incorporate horizontal as well as vertical moves and forge careers based on "employability", i.e. learning, networking and reputation. Bases its arguments on the findings of a study into senior executives in the NHS, and explores the consequences of organizational restructuring for the careers of clinical, general and functional managers. Suggests that organizational and professional barriers exist to undermine the notion of the multidimensional career. Argues that prescriptive approaches to career self-development need to take account of organizational context and that, to meet the challenges of careers in the 1990s, both the organization and the individual need to become more willing to take risks.

Attitude of Health Personnel↗
PubMedDate not supplied

Alienation and administration. System restructuring often entails four types of canonical acts.

When applying canon law to healthcare transactions, difficulties often arise in determining whether the transaction or restructuring in question constitutes a canonical act of alienation or an act of administration. Changes in system governance may leave local property titles untouched, suggesting that no alienation has taken place, but loss of Catholic identity or a reduced ability to carry out the Church's mission may indeed constitute alienation. Often in restructurings, four types of canonical acts are involved: alienation of property (alienation in the strict sense), acts that can jeopardize the stable patrimony (sometimes called alienation in the broad sense), acts of ordinary administration, and acts of extraordinary administration. While alienation concerns the divestiture of ownership, the general purpose of administration is to preserve goods. Acts of extraordinary administration require certain formalities of consent before they can be carried out. However, the intervention of the Holy See is not required, as it is for acts of alienation. The permission may be granted in principle, before a formal offer is received; after an offer is received; or, in some cases, by a "blanket" indult. A restructuring can amount to an alienation unless care is taken to verify to maintain certain reserved powers, thus ensuring that the work is still under the direction or canonical control of the sponsoring religious institute or diocese. Joint ventures, however, seldom involve insoluble canonical problems. Each situation must be evaluated individually and care taken to ensure that the requirements of both eccleslastical and secular law are met.

Canada↗
PubMed1996

Restructuring VA ambulatory care and medical education: the PACE model of primary care.

The Veterans Health Administration (VHA) Western Region and associated medical schools formulated a set of recommendations for an improved ambulatory health care delivery system during a 1988 strategic planning conference. As a result, the Department of Veterans Affairs (VA) Medical Center in Sepulveda, California, initiated the Pilot (now Primary) Ambulatory Care and Education (PACE) program in 1990 to implement and evaluate a model program. The PACE program represents a significant departure from traditional VA and non-VA academic medical center care, shifting the focus of care from the inpatient to the outpatient setting. From its inception, the PACE program has used an interdisciplinary team approach with three independent global care firms. Each firm is interdisciplinary in composition, with a matrix management structure that expands role function and empowers team members. Emphasis is on managed primary care, stressing a biopsychosocial approach and cost-effective comprehensive care emphasizing prevention and health maintenance. Information management is provided through a network of personal computers that serve as a front end to the VHA Decentralized Hospital Computer Program (DHCP) mainframe. In addition to providing comprehensive and cost-effective care, the PACE program educates trainees in all health care disciplines, conducts research, and disseminates information about important procedures and outcomes. Undergraduate and graduate trainees from 11 health care disciplines rotate through the PACE program to learn an integrated approach to managed ambulatory care delivery. All trainees are involved in a problem-based approach to learning that emphasizes shared training experiences among health care disciplines. This paper describes the transitional phases of the PACE program (strategic planning, reorganization, and quality improvement) that are relevant for other institutions that are shifting to training programs emphasizing primary and ambulatory care.

Ambulatory Care↗