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PubMed1977

Advances in the study of diffusion of innovation in health care organizations.

Federal government programs of the 1960s to rapidly diffuse technologies have been displaced on the '70s by efforts to constrain costly technological growth. As a guide to action, the understanding of reasons for adoption of innovation is essential; but the utility of available diffusion theory is limited by its focus on the speed of diffusion rather than any reasons for its adoption by organizations. In a practical sense, more is known about the administrator as decision maker than about those increasing situatiions in which physicians play a more central part. Until coherent, empirically grounded theories of organizational innovation are available, large-scale "tests" are premature and wasteful.

Creativity↗
PubMed1976

The large private hospital and neonatal intensive care.

The experiences of the Methodist Hospital of Indiana in integrating family physicians into neonatal intensive care are related, and some useful organizational innovations in neonatal nursing are suggested.

Economics, Hospital↗
PubMed2026

Factors influencing the enhancement of the new iron triangle in healthcare organisations.

PURPOSE: A new paradigm, "healthcare's new iron triangle," has been developed to emphasise the technological perspective of healthcare delivery, focusing on automation, value and empathy. The study aims to build a conceptual model and to identify factors for the enhancement of the new iron triangle in healthcare organisations. DESIGN/METHODOLOGY/APPROACH: The healthcare organisation is the primary focus point of the current study. To determine the factors, a survey of the literature and healthcare experts' opinions was conducted. The healthcare professionals validated the identified factors. Data for this study were gathered using a closed-ended questionnaire and scheduled interviews. The study employed "Total Interpretive Structural Modeling methodology and Matriced' Impacts Croise´s Multiplication Appliqué´ a UN Classement/Cross-Impact Matrix Multiplication Applied to a Classification (MICMAC) analysis" to address the "why" and "how" the factors interact and prioritise the identified factors. FINDINGS: The study found that organisational structure (F8), artificial intelligence (F1), innovation (F2) and human resources (F5) are the driving or key factors of the study. RESEARCH LIMITATIONS/IMPLICATIONS: The study primarily focused on identifying factors for the enhancement of a new iron triangle in healthcare organisations. The scope could eventually be expanded to explore more areas. PRACTICAL IMPLICATIONS: Academics and other stakeholders will have a better understanding of the key drivers for the enhancement of the new iron triangle in healthcare organisations. ORIGINALITY/VALUE: In this study, total interpretive structural modeling and cross-impact MICMAC analysis are proposed as an innovative approach to address the new iron triangle in healthcare organisations.

Humans↗
PubMed1977

Creating new consultation programs in community mental health centers: analysis of a case study.

A primary prevention program, initiated in a community mental health center, never became fully operational. Analysis suggests that failure to include recipients in initial planning, an unrealistic time table, insufficient institutional support for innovation, the project leader's organizational marginality, and the institutional constraints created by commitment to direct treatment of troubled individuals were factors that contributed to the project's failure. Several recommendations are presented. The most novel and important one is that systems-oriented, preventive mental health work should be based in a separate, distinct institution.

Community Mental Health Services↗
PubMed1976

Building a comprehensive geriatric health care system: a case study.

This case study focuses on the efforts of three urban medical care institutions--a Health Maintenance Organization, a nursing home, and a university hospital--to form an interorganizational relationship. The purpose of the relationship was to utilize the services of the three organizations in order to respond to the comprehensive health needs of an urban geriatric population. Movements in this triadic organizational relationship are described and analyzed in terms of four conceptual stages--exploration, negotiation, interaction and performance, and termination. Problems arising during these stages were not resolved and the relationship was terminated after approximately two years of existence. A sociological discussion of the case focuses on why the relationship failed. The organizational relationship was disrupted by three stresses that occurred during the four stages of the relationship. Stresses emerged for each organization in the areas of organizational integration, professional coordination, and environmental adaptation, making it difficult for the three to become integrated into an organizational system. As a result, the HMO, the nursing home, and the hospital did not benefit from relationships that could have enabled them to develop the multi-organizational system necessary to sustain an innovative, comprehansive geriatric health project. If, as Whitehead said, the greatest invention of the nineteenth century was the invention of the method of invention, the task of the succedding century has been to organize inventiveness. The difference is not in the nature of invention or of inventors, but in the manner in which the context of social institutions is organized for their support.

Aged↗
PubMed1979

Innovative adjuncts in hair transplantation.

After development of the technical, organizational, and esthetic phases, hair transplantation has progressed to a fourth stage. This is a comprehensive approach determined by the patient's degree of baldness and may require a combination of procedures to best correct the patient's defect. The punch autograft technique remains fundamental for most patients at this time, while scalp reduction, flaps, and various types of grafts may be selective adjuncts. "Individualization" is being achieved through these various ancillary modalities.

Adult↗
PubMed1976

The Imbrication Model for the integration of social services in a community.

An innovative model for organising social services in a community, the Imbrication Model, is contrasted with two traditional models, the Entrepreneurial and the Umbrella Agency. The structural characteristics and dynamics of the three models are illustrated with actual case histories. Imbrication Model calls for the interlocking of personnel from several agencies, with the purpose of redirecting the dysfunctional interagency rivalry prevalent in the traditional models. Imbrications at all organisational levels--Board of Directors, Administrators and Staff--facilitate adoption of the superordinate goal of providing clients with the best services available, regardless of which particular agency delivers the service. Few observers of the current social service scene would challenge the statement that needs for service are unlimited and resources limited. In the USA the imbalance between needs and resources persists despite a decade of massive governmental programmes intended to alleviate social ills. Recent substantial cutbacks in federal funds, moreover are not likely to improve the situation. The resource shortage involves more than a limitation of funds. Deliverers of service and competent programme administrators are also on critically short supply. These shortages are more often than not exacerbated by a chronic spirit of competition among agencies and programmes at the local level. Three organizational models for the delivery and administration of social services, two conventional and one of more recent date, are examined in this article. The innovative model, which has been named the Imbrication Model, explicitly calls for redirecting interagency rivalry and competition. Its ambitious goal is to integrate the efforts of those attempting to meet a community's social service needs.

Adolescent↗
PubMedDate not supplied

Changing perceptions of organizational communication: can short-term intervention help?

An intervention activity commensurate with specific organizational goals, directed to short-term change efforts to alter employee perceptions about their satisfaction, about such work activitiesas communication, and about opportunities to make job-related innovations was implemented for emergency room personnel in a large West Coast metropolitan hospital. When evaluated, using a research design which reduced validity threats in interpreting results, perceptions about some aspects of work were found to be more susceptible to change through short interventions than were others.

California↗
PubMedDate not supplied

Problems of organizational consultation in the Army.

Psychiatrists in the U. S. Army have received official sanction as organizational consultants. In common with other bureaucratic organizations, several obstacles impede their full effectiveness in this role. These include communication breakdowns and negative attitudes toward change. These attitudes are divided into four subgroups: Conspiracy of Silence, Fear of Innovation, Cult of Personality, and "Good Old Common Sense." While these obstacles are not inconsiderable, the possibility for effective consultation still exists.

Attitude↗
PubMedDate not supplied

[New strategies for prevention in adolescents and young adults].

For various reasons, it is justified to revise the classical strategies of intervention concerning medical and social action to help young people. New behaviours such as drug addiction, for instance, have emphasized the inadequacies of the conventional means of treatment. Since 1970, Youth Advisory Services have appeared in Europe. Their aims may be various: information, counselling, lodging, social and educative help, medical assistance. These services which were created by the community have such ethical and organizational features that it is easy to discern them among the conventional administrative services. Their users are mainly teenagers and young adults whose reasons for consultation are due to various causes. The originality of the methods, facilities and principles of these innovating services may be considered as a decisive contribution to the research of new prevention strategies to help young people.

Adolescent↗
PubMed2026

Investing in Canada's nursing workforce: a comprehensive review to inform policy innovations and directions.

BACKGROUND: Health systems worldwide face persistent health workers challenges including nursing shortages, workforce strain, and inequities. In Canada, these challenges have prompted renewed national and provincial reforms to strengthen recruitment, retention, leadership, and sustainability. This paper compares nursing workforce policy directions across Canada, and international jurisdictions to inform policy and planning. METHODS: A cross-country comparative analysis of policies building on a comprehensive national funded review that included an umbrella review of 69 systematic reviews, a comparative policy review of nursing workforce strategies in five jurisdictions, and validation through national horizon-scanning and policy dialogues (n >100). Evidence was analyzed across system, organizational, and individual levels. RESULTS: At the system level, international jurisdictions demonstrate comprehensive, legislated approaches integrating data, governance, and multi-year funding have advanced key nursing strategies. In Canada, the advances show the importance of strategies to have national and provincial/territorial alignment emphasizing leadership, flexibility, and inclusion as key levers. Organizational and individual-level reforms such as mentorship, leadership development, and wellness initiatives are expanding but remain variably evaluated. Experts identified national workforce data strategies and policy integration with embedded evaluation as key enablers to inform scalability and sustainability of implemented strategies. CONCLUSIONS: Canada's nursing workforce reforms are advancing toward coordinated, equity-driven, and evidence-informed strategies. Continued investment in evaluation, leadership, and national integrated data systems along with integrating nursing workforce planning within broader intersectoral planning will consolidate these gains and position Canada as an international leader in sustainable nursing workforce policy.

Canada↗
PubMed1976

Citizen participation and health care: problems of government induced participation.

In this paper we trace the implications of some common contradictions in government-inspired efforts to increase citizen participation in health care delivery. We cover general problems of generating citizen participation, specific difficulties in community organization resulting when issues of health are the organizing focus, and the benefits that were thought to result from efforts to increase citizen participation in social programs in the 1960's. When programs focused on increased citizen participation were initiated program administrators attempted to maximize citizen involvement quickly by: projecting an image of maximal social impact; minimizing or ignoring questions of long-term fiscal uncertainty; projecting an image of maximal control by citizens; and projecting images of institutional solidarity and of experimentation and innovation. They tended to recruit to the staff social activists taken to be representative of the community (although they might not be), promising opportunities for upward mobility. They also tended to adopt conciliatory administrative styles in keeping with their experimental non-elitist orientations. These tendencies characteristic of the initiation phase of projects conflicted with the demands placed upon programs in later phases of program implementation. These demands resulted from later perceived needs to: evaluate programs; limit spending; counter internal organizational opposition; and respond to sponsors' shifting interests. Paraprofessionals recruited to the staff tended to lose their "community" orientation, and administrative style tended to focus considerably more on program accountability. These shifting program demands substantially account for what otherwise appears to be the failure of efforts to increase citizens' participation in health delivery programs, and, by extension, in other areas where the impetus for increased citizen participation comes from government initiatives.

Community Health Services↗
PubMed1979

Innovative program keeps them 'down on the farm'.

A shortage of nurses continues to be felt in rural areas of the country. In an experimental program conducted by a college department of nursing in a small rural hospital, nurses received training and were retained by the rural hospital. All training was conducted at the hospital, and all graduates received high marks on the RN examination.

Career Mobility↗