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PubMed1999

Creativity: the fuel of innovation.

Market-leveled changes occurring in the health care industry require new and creative models of organization, management, and service delivery. One of today's primary management challenges is the development of organizational cultures that value innovation, change, and creativity. The adoption of an ethic of innovativeness allows the organization to stretch the limits of individual and collective knowledge, skill, and ability to meet complex consumer needs. Creativity within organizations is influenced by management practices in conjunction with creativity-relevant work group skills. A common wisdom exists that professional nurses are creative in finding solutions for complex patient care needs. The expansion of this creativity within organizational systems will allow for the evolution of professional nursing practice, improvement in care delivery, and organizational performance.

Creativity↗
PubMed1998

Use of services by diabetes patients in managed care organizations. Development of a diabetes surveillance system. CDC Diabetes in Managed Care Work Group.

OBJECTIVE: To develop a diabetes surveillance system that estimates the prevalence of diabetes and characterizes service use in diverse managed care organizations (MCOs). RESEARCH DESIGN AND METHODS: Computerized inpatient, pharmacy, outpatient, and laboratory records were used to develop an algorithm to identify diabetes patients and to develop surveillance indicators common to the three participating MCOs. Using 1993 data, the availability, specifications, and limitations of various surveillance indicators were determined. RESULTS: An extensive set of diabetes surveillance indicators was identified from the four sources of data. Consistent data specifications across MCOs needed to consider variation in the type of data collected, a lack of documentation on level of coverage, differences in coding data, and different models of health care delivery. A total of 16,363 diabetes patients were identified. The age-adjusted prevalence of diabetes ranged from 24 to 29 per 1,000 enrollees. Approximately one-third of patients with diabetes (32-34%) were taking insulin. The majority had one or more visits to a primary care physician during the year (72-94%). Visits to specialists were less frequent. Ophthalmologists and optometrists were the most commonly used specialists: 29-60% of the patients with diabetes at the three MCOs had visited an ophthalmologist or optometrist. About one-fifth had an overnight hospital stay during the year. CONCLUSIONS: This diabetes surveillance system is a useful tool for MCOs to track trends in prevalence of diabetes, use of health services, and delivery of preventive care to individuals with diabetes. This system may also be useful for health care planning and for assessing use changes after new developments in diabetes care or new quality management initiatives.

Adolescent↗
PubMed1989

A village health worker programme in Nigeria.

A study was made of the training and performance of village health workers near Lagos, and of the management of the scheme to which they belonged. Among the deficiencies observed were inadequate drug control and poor record-keeping. Nevertheless, the scheme led to a significant extension of primary health care coverage.

Adult↗
PubMed1986

Managing organizational problems in alternative service organizations.

Alternative Service Organizations--hotlines, shelters, crisis centers, etc.--are a growing and essential part of the overall human service delivery system. These organizations face predictable problems which arise from their unique history, structure, and mission. Using a political economy perspective, the common issues and professionalization, funding, and formalization are discussed and procedures for effectively managing resulting problems are suggested.

Community Health Centers↗
PubMed1998

Primary care physician compensation method in medical groups: does it influence the use and cost of health services for enrollees in managed care organizations?

CONTEXT: Growth of at-risk managed care contracts between health plans and medical groups has been well documented, but less is known about the nature of financial incentives within those medical groups or their effects on health care utilization. OBJECTIVE: To test whether utilization and cost of health services per enrollee were influenced independently by the compensation method of the enrollee's primary care physician. DESIGN: Survey of medical groups contracting with selected managed care health plans, linked to 1994 plan enrollment and utilization data for adult enrollees. SETTING: Medical groups, major managed care health plans, and their patients/enrollees in the state of Washington. STUDY PARTICIPANTS: Sixty medical groups in Washington, 865 primary care physicians (internal medicine, pediatrics, family practice, or general practice) from those groups and affiliated with 1 or more of 4 managed care health plans, and 200 931 adult plan enrollees. INTERVENTION: The effect of method of primary care physician's compensation on the utilization and cost of health services was analyzed by weighted least squares and random effects regression. MAIN OUTCOME MEASURES: Total visits, hospital days, and per member per year estimated costs. RESULTS: Compensation method was not significantly (P>.30) related to utilization and cost in any multivariate analyses. Patient age (P<.001), female gender (P<.001), and plan benefit level (P<.001) were significantly positively related to visits, hospital days, and per member per year costs. The primary care physician's age was significantly negatively related (P<.001) to all 3 dependent measures. CONCLUSIONS: Compensation method was not significantly related to use and cost of health services per person. Enrollee, physician, and health plan benefit factors were the prime determinants of utilization and cost of health services.

Capitation Fee↗
PubMed1989

Managing the market. Focusing on a select group of customers can keep an organization competitive.

The real challenge in healthcare marketing today is managing markets, focusing on selected groups of customers rather than on the organization or its services. Market management includes three distinct but related levels: Strategic market management assesses current and potential markets and chooses those the organization can serve best; segment management focuses on the needs and wants of subsets of chosen customers; and customer management reinforces long-term commitments to the organization. The patient care experience can be broken down into specific contacts with each staff member. The key to managing the experience is to identify and achieve standards of performance for each contact by examining what each event means to the patients and how patients judge each staff member, as well as the overall care experience. Regular feedback helps. An unavoidable risk in market management is that a given segment may decline in size, in need for services, or in cohesiveness as a segment. Yet those organizations which can identify the right segments and "manage" them effectively will have an advantage in a competitive market.

Consumer Behavior↗
PubMed1995

Breaking with tradition and redefining the disability equation: the Southern Californian Edison experience.

Southern California Edison formed a single, new disability prevention and management organization: Employee Services. This department aggregated the formerly scattered programs dealing with the entire disability continuum from injury prevention through claims and rehabilitation to Occupational Safety and Health Administration (OSHA) compliance and occupation research.

Accident Prevention↗
PubMed1995

A descriptive study of ninety-two hospital libraries in Mexico.

This work reports on the existing situation of ninety-two hospital libraries, located at Mexico's Social Security Institute (IMSS). A descriptive, systems approach was used to explore the physical structure and space of the libraries, staff, furniture, equipment, collections, services, organization and management, and users. Structured interviews were applied to each hospital library, and a questionnaire was used as a tool to collect data. A "control" system, designed to measure the status of each library, was applied through the assignment of values to several indicators, derived from IMSS policy manuals. This procedure helped to identify which library was "more" or "less" adequate to IMSS standards. Within the rank of 10 to 1 (10 = optimum; 1 = minimum), the mean rank of IMSS hospital libraries was 6. The major deficiencies found were those related to furniture (ranked 4) and services (ranked 5) and the lack of library professionals found in 92% of the libraries.

Academies and Institutes↗
PubMed1997

Do we understand the effects of 'managed care' in ophthalmology? A review and analysis.

Little has been published that directly assesses the effect of structures for providing managed care or the effects of capitated, prepaid financing on the cost and quality of eye care services. Managed care organizations use fewer ophthalmologists and may provide more screening for diabetic retinopathy. Studies of nonophthalmologic care show lower patient satisfaction with care, and mixed effects on cost, quality of care, and access to care, but are difficult to generalize to eye care. We reviewed the published peer-reviewed literature about this topic. Notable gaps exist in the knowledge of critical elements of the influence of managed care on providing eye care and on patient outcomes. Existing measures of quality, cost, satisfaction, and access could easily be adapted for use in evaluating the influence of managed care and guiding health care policy.

Cost Control↗
PubMed1997

Incentives and the management of physician behavior in health service organizations.

The performance of a health services organization is affected by the cumulative behavior of physicians out of proportion to their numbers or the economic value of their services. Managers are challenged to optimize physician behavior and to change it in concert with the evolving expectations of health service customers. Incentives are the tools available for this effort. This article discusses the interrelation of physician behavior, physician needs, and the major classes of incentives: economic, noneconomic, and rules. While most organizations recognize and use financial incentives, few utilize noneconomic incentives systematically. Given the financial restrictions of advanced markets, managers should understand the role of rules and the value of noneconomic issues to physicians when developing incentive programs.

Behavior↗
PubMed1997

Improving the delivery of clinical preventive services to women in managed care organizations: a case study analysis.

BACKGROUND: In February-October 1996 a case study analysis was conducted to examine the key features of prevention programs for women in six managed care plans and one group medical practice. These programs, which use either data-based or office-based strategies, are considered by experts in the field to be exemplary. METHODS: Prevention programs for the case study were identified through a literature review and discussions with knowledgeable individuals about prevention programs and managed care. Information was collected about breast and cervical cancer prevention programs through written materials and telephone interviews with staff. Given limited and noncomparable information, relative program effectiveness was not assessed. CASE STUDIES: The case study programs use many types of data to support prevention strategies such as patient reminders and performance feedback to providers. Successful programs require substantial resources and planning; are population based; gain the support of providers and patients early; have clear, established systems for collecting and using data; and have a monitoring and evaluation component. The challenges that remain for managed care plans are balancing the need for prevention programs with limited resources, using imperfect data to support interventions, developing effective strategies for reaching high-risk populations, and working with large networks of providers. DISCUSSION: Managed care plans have great potential to use their information systems and organizational structure to support prevention efforts. The extent to which these opportunities are realized depends on managed care plans' progress in developing their broader information management systems and on purchasers' demands for these types of programs.

Breast Neoplasms↗
PubMed2000

The application of quality systems in ART programs.

A quality control (QC) system is needed in ART units to assure reproducibility of all methods and competence in all duties performed by the personnel. The necessity of a quality control system becomes even clearer when considering the possible risks of ART. It is therefore essential to have a system to assure that everybody knows exactly how everything should be done. Furthermore, a QC system should bring about improvements such as making activities and procedures clearer to the staff and making the working methods more flexible. QC was initially created for the industry, and has later been applied to other types of activities such as management of organizations, services like health care including different types of clinical testing laboratories. To maintain a high standard in our IVF laboratory, and to assure reproducibility of the methods used we decided to apply for accreditation according to the European Norm (EN) 45001 and requirements for the competence of testing laboratories ISO/IEC Guide 25. A process was started where all routines and methods within the laboratory were documented and finally the QC system was described in a quality manual. Application for accreditation was submitted to the Swedish board for accreditation and conformity assessment (SWEDAC). Our ART laboratory finally became accredited according to the EN 45001 and requirements for the competence of testing laboratories ISO/IEC Guide 25. Introducing and fully implementing a quality control system in our laboratory has standardized the methods and the way that the embryologists perform their work in the laboratory. It has also optimized the environment in which the patient's gametes and embryos are handled.

Accreditation↗
PubMedDate not supplied

Inpatient management of hyperglycemia: the Northwestern experience.

OBJECTIVE: To describe a novel method of safe and effective intensive management of inpatient hyperglycemia with use of cost-effective protocols directed by a glucose management service (GMS). METHODS: An intravenous insulin protocol was designed to achieve a glycemic target of 80 to 110 mg/dL. When stable inpatients were transferred from the intravenous protocol to a subcutaneous insulin protocol, which consisted of basal long-acting and prandial and supplemental rapid-acting insulins, the blood glucose target was 80 to 150 mg/dL. Glucose levels were reviewed by the GMS at least daily for protocol adjustments, when necessary. RESULTS: The intravenous insulin protocol was used in 276 patients, and 4,058 capillary blood glucose levels were recorded. Glycemic target levels (80 to 110 mg/dL) were achieved, on average, 10.6 +/- 5.2 hours after initiation of insulin drip therapy. The mean capillary blood glucose level during the study interval was 135.3 +/- 49.9 mg/dL. Hypoglycemia (< or = 60 mg/dL) was recorded in 1.5% of glucose values, and hyperglycemia (> or = 400 mg/dL) was recorded in only 0.06%. The subcutaneous insulin protocol was used in 922 patients, and 18,067 capillary glucose levels were documented. The mean blood glucose level was 145.6 +/- 55.8 mg/dL during the study period. The blood glucose target of 80 to 150 mg/dL was achieved in 58.6%, whereas 74.3% of glycemic values were in the clinically acceptable range (80 to 180 mg/dL). Hypoglycemia (< or = 60 mg/dL) occurred in 1.3% of capillary blood glucose values, and hyperglycemia (> or = 400 mg/dL) occurred in 0.4% of values. CONCLUSION: Validated protocols dedicated to the achievement of strict glycemic goals were implemented by a GMS and resulted in substantial improvements in glycemic control on the surgical inpatient services, with a reduced frequency of hypoglycemia. The protocols and the GMS have been well received by the inpatient nursing and surgical staff members, and all of this has been done in a cost-effective manner.

Aged↗
PubMed2006

Hospital-physician joint ventures: maximizing the potential.

Four primary hospital-physician models are per-click service agreements, management services agreements, gainsharing, and equity joint ventures. Four key attributes needed for successful joint ventures are clinical quality, customer satisfaction, operational effectiveness, and financial soundness. Hospitals and physicians need to approach joint ventures with expectations of high performance.

Efficiency, Organizational↗