[Organized pharmacy management work in effecting drug service to the population].
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Community Pharmacy Services↗
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[10-year experience with the organization, management and results of mass screening services].
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Evaluation Studies as Topic↗
[Problems in the organization and management of the therapeutic exercise service in the Republic of Kazakhstan].
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Ambulatory Care↗
Managed care plans' requirements for screening for alcohol, drug, and mental health problems in primary care.
OBJECTIVE: To determine managed care organizations' (MCOs) requirements for screening for alcohol, drug, or mental health problems in primary care settings. STUDY DESIGN: A telephone survey was used to gather information on the 3 largest commercial products offered by MCOs. Products included health maintenance organizations, preferred provider organizations, and point-of-service plans. METHODS: Managed care organizations were asked whether their products required screening for alcohol, drug, or mental health problems in primary care settings. Chi-square tests were performed to ascertain whether screening requirements, the distribution of practice guidelines, and the topics addressed in those guidelines varied by product type and contracting with specialty behavioral health vendors. The data were weighted to produce national estimates. RESULTS: Only 14.9% of the products surveyed required any alcohol, drug, or mental health screening by primary care practitioners. Slightly more than half of all the products surveyed distributed practice guidelines that addressed mental illness, and about one third distributed substance abuse practice guidelines. CONCLUSIONS: Although the feasibility, utility, and effectiveness of screening are increasingly recognized, few MCOs currently require alcohol, drug, or mental health screening by primary care physicians in any of their product types.
Health Care Surveys↗
Changing nature of physician satisfaction with health maintenance organization and fee-for-service practices.
BACKGROUND: Managed care practice arrangements, or health maintenance organizations (HMOs), are sufficiently mature to examine whether physicians' level of satisfaction has changed as managed care has developed. This study compares Dane County, Wisconsin, physicians' satisfaction with HMO and fee-for-service (FFS) practices in 1986 with that of 1993 and examines factors that contribute to satisfaction in an HMO-dominated environment. METHODS: Cross-sectional surveys were mailed to all Dane County physicians in active practice in 1986 and 1993. Physician overall support for HMO development and satisfaction with work situation was measured with single items. Overall satisfaction and clinical freedom within HMO and FFS practices were measured using statistically reliable scales. RESULTS: Significantly more physicians were supportive of the development of HMOs in 1993 than in 1986, and more than two thirds of physicians in 1993 were satisfied in their current work situation. Primary care physicians were significantly more satisfied than subspecialists across most dimensions of satisfaction. Perceived clinical freedom and satisfaction with income continued to be major predictors of satisfaction in 1993 as in 1986. While physicians' satisfaction with HMO practice remained stable, their satisfaction with FFS practice was significantly lower in 1993 than in 1986. Satisfaction with Medicare practice, which was not measured in 1986, was significantly less than with HMO or FFS practice in 1993. CONCLUSIONS: Analyses suggest that primary care physicians are more satisfied than subspecialists with their HMO practice because of their greater satisfaction with HMO-generated income and the expanded clinical freedom they have in HMO practice. An across-the-board decline in satisfaction with FFS practice may be attributable to diminishing clinical freedom resulting from indemnity carriers' increasing micromanagement of patient care.
Cross-Sectional Studies↗
Management is performance: strategies for client-centered practice in social service organizations.
The political nature of human services is a given. The multiple constituency dilemma coupled with the retrenchment of the 1970s and 1980s has led to a great gulf separating managers from clients, and managers from front-line personnel. These political factors have been reinforced by management theory and the blind adoption of "state-of-the-art" management technologies developed in business and the military, and the separation has gained legitimacy. The result is less than optimal service, a dissatisfied workforce, and continued attacks for being inefficient, self-serving, and ineffective. The purpose of this article is to portray an alternative form of human service management. Its vision places clients center stage in our organizations and places the manager as the director and producer. It accepts the premises that "management is the principle engine of progress" (Levitt, 1976) and that management is performance. It then lays a foundation for client-centered management by presenting four principles for social service administrators who desire to adopt this perspective in their daily practice. An elaboration of the skills and methods of client-centered management can be found in a recently published text (Rapp & Poertner, 1991).
Administrative Personnel↗
Managing managed care through accreditation standards.
Accreditation is emerging as a dominant strategy for ensuring accountability and basic quality of services in managed care organizations. Knowledge of accreditation standards can help social workers interact effectively with managed care companies when requesting services for clients and appealing denials. Familiarity with patient's rights protections, the appeals process, and provider credentialing guidelines can help protect social workers as well as clients from unfair decisions by managed care organizations. This article provides an overview of managed care accreditation standards and strategies for integrating this knowledge into advocacy efforts.
Accreditation↗
Quality assessment in contracting for tertiary care services by HMOs: a case study of three markets.
BACKGROUND: Few studies have examined the provision of tertiary care services by managed care organizations (MCOs). Moreover, little is known about the role of quality assessment and quality assurance mechanisms in the contracting process. Site visits were conducted in 1995 in three geographic areas to describe and evaluate the contracting processes for tertiary care services, especially neonatal intensive care and coronary artery bypass graft surgery, of health maintenance organizations (HMOs). METHODS: Three market areas in the United States, each with differing levels of "maturity", as primarily defined in terms of managed care penetration, were selected for study. Interviews were conducted with HMO and hospital managers about the processes for identifying potential tertiary care hospitals and mechanisms for quality assessment and quality improvement (QI) that are considered in the contracting process. FINDINGS: The most sophisticated contracting arrangements were found in the most mature market-where HMOs select hospitals for tertiary care services based on both the price and quality of services, with quality assessed through both objective and subjective data. Yet in all three markets, quality assessment was the least well-developed component of tertiary care contracting. Even in the mature market, we found inconsistent use of even validated quality or outcomes measures in hospital contracting. CONCLUSION: The potential of MCOs to increase quality depends on their ability to identify high-quality hospitals and their willingness to direct enrollees to those hospitals. Yet inconsistent evidence was found that mechanisms for evaluating and rewarding quality are being fully adopted in the three markets studied.
Catchment Area, Health↗
Quality improvement--emerging issues to controlling medical costs.
While quality evaluation issues are very important to providers and managed care organizations in marketing their service and managing the care provided, they should also be a focus of any employer or other plan sponsor that is financially responsible for providing managed care benefits. Certainly employers can begin to use information regarding the quality of managed care networks to help determine the better networks to offer participants. In addition, managed care networks are employing a variety of techniques to improve the quality of service that employers can and should try to emulate--and that are explored in this article.
Health Benefit Plans, Employee↗
Professional liability insurance for health care organizations--several significant considerations.
The purchase of professional liability insurance coverage represents one of the more important financial and administrative decisions in terms of managing a health services organization. This manuscript outlines a decision process for evaluating and determining the most viable option(s). Also addressed are some significant caveats in assessing the strengths and weaknesses of various coverage options.
Decision Making, Organizational↗
Policies and procedures in the workplace: how health care organizations compare.
Many organizations are implementing programs and services to manage the human and economic costs of stress. A mail survey was conducted of 500 randomly selected Canadian organizations having at least 500 employees. The survey tapped four major areas: organizational policies and procedures for managing stress; programs and services offered; perceived benefits and constraints for the organization; and projected future directions in this area. Analyses of returns from 210 organizations-43 health and 167 non-health-revealed various findings. For example, over half of health care organizations have policies and procedures as opposed to less than half of non-health care organizations. Also, health care organizations place greater emphasis on smoking cessation, weight control programs and on stress management training. Although some Canadian organizations are addressing stress, much more could and should be done, especially by organizations that do not yet recognize the impact of stress on employees and their work performance.
Canada↗
Managing the education function.
The challenge of hospital-based education is to motivate change in the participant to benefit the organization as a whole, while increasing individual competence and positively affecting the quality of service. Enabling people to transfer learning into effective work behavior is the goal of hospital education staff. To ensure a successful future, the manager of the education function needs to be passionately committed to service of the organization. The manager must be able, be seen as able, and be unafraid to assume the evolving role. On the cover of Jim Lundy's book, Lead, Follow or Get Out of the Way, he addresses a memo to those who lead or aspire to lead. He recommends the following: Share your goals and aspirations. Let the implementers be involved in the planning. Achieve clear understanding of expected results. Evaluate progress periodically and fairly. Reinforce the importance of others. Coach your subordinates for growth. Emphasize and reemphasize teamwork. Search constantly for improvement in understanding, performance, and results! (Lundy, 1986) These leadership strategies will serve the manager of the education function well. Choose to lead, follow, or get out of the way! Marilyn Ferguson shared in her 1986 address to the ASHET annual conference, "We can fear the future . . . or by taking courage from each other and tapping our hidden resources, we can help create it" (Ferguson, 1986).
Education Department, Hospital↗
Organization of health care in Croatia: needs and priorities.
AIM: Description and analysis of the present situation of health care system in Croatia, and its characteristics in the transitional process of restructuring. METHODS: A descriptive method was used. The data from the regular statistical publications were used for the analysis. RESULTS: Croatia is faced with problems similar to those in other countries of the Central and Eastern Europe (CEE), such as control of health expenditure, balancing the development of different segments of health care services, stabilization of effectiveness and quality of care, transition from one-party system to pluralistic democracy, introduction of a free market economy, war devastations, etc. On the other hand, the Croatian experience in the development of a decentralized and integrated primary health care, decentralized health insurance system, education of general/family practitioners, and a tradition in the implementation and development of public health measures, have facilitated and contributed positively to the whole process of transition. CONCLUSION: In contrast to the economic difficulties, war devastations, and changing the social system, the Croatian health care system proved its stability and sustainability. The highest priority and needs are now related to coping with unhealthy behavior of the population, such as smoking, accidents, physical inactivity, and nutritional problems, which should be solved and controlled by the implementation of preventive programs, organization and management of public health services, and further focusing onto the integrated type of primary health care in the organization of services. Hospital services need more intensive and skilled management, as well as support measures for better quality of work.
Croatia↗
Overview and implications of Medicaid managed care for people with developmental disabilities.
The inclusion of people with developmental disabilities in managed care as part of general efforts by states to enroll and Medicaid recipients in such plans was reviewed. Managed care was defined and the processes by which managed care organizations deliver services were explained. Escalating costs and utilization were discussed as the primary reason for the shift to managed care. The use of Medicaid Section 1115 waivers by states to include Medicaid recipients was explored. The relation between acute health care and long-term care, and the utilization patterns in each, were briefly described. Finally, elements of managed care that are particularly important to people with developmental disabilities, such as care coordination, maintenance of quality, and individual and family support, were discussed.
Developmental Disabilities↗
Hospital and community health: going from stakeholder management to stakeholder collaboration.
Leaders of hospitals and other health service organizations often use stakeholder management capabilities to analyze, understand, and transact business with their stakeholders in order to achieve organizational goals. When these leaders and their organizations become involved in community health improvement, they have new and different types of stakeholders than for traditional medical care. In the community health domain, these leaders should modify their approach toward stakeholders so that they collaborate with stakeholders rather than try to manage them. Recommendations for how to do this include giving up some control, building trusting relationships, and emphasizing community goals.
Community Health Planning↗
The functions of the nurse in an integrated national health service.
The British National Health Service was reorganized in 1974 when the hospital services and the community health services, previously administered separately, were brought together into one organization: the Area Health Authority. The reorganization was a culmination of developments triggered off as long ago as 1589 when the first Poor Law Act was passed, but more particularly, the reorganization was the natural outcome of a number of important government and professional nursing reports published during the past 30 years. From 1974 the community and hospital nursing services have, therefore, been amalgamated under the direction of one head of the nursing services: a district (or area) nursing officer, who, together with medical, administrative and financial colleagues, manages the health services on a day-to-day basis in a team managing by consensus. The nurse's role in the management teams is both executive and professional: the nurse's unique contribution is that he/she brings a nursing perspective to management. The new nursing service organization has provided new opportunities for reorientating middle nurse managers to a clinical role. It has also provided opportunities for innovating integrated teams of community and hospital nurses and for developing specialist nursing roles. Nurses are also now able to make other additional contributions to health care by their involvement in health care planning team activities and by their membership of the statutory area and regional nursing and midwifery advisory committees. But, on the whole, changes and influence on health care have been brought about chiefly by changes in the managerial structure of British nursing, which is a perspective of the British nursing profession that seems to have been all pervasive since Florence Nightingale's reforms and which is perpetuated by the powerfully socializing agent of British nurse training. As health care and nursing service organizations should be means towards the end of good patient care, it may be timely to focus on the suggestion of autonomous nurse practitioners supported by a separately organized administrative structure.
Continuity of Patient Care↗
Audit of care of newly diagnosed children with diabetes mellitus in East Anglia.
The aim of this study was to audit the organization of services and management at diagnosis of Type 1 diabetes mellitus (IDDM) in children in the eight districts of East Anglia. Representatives of each district met and agreed indicators of good practice. Service organization was assessed by questionnaire. Provision of care was audited using a proforma completed prospectively for every newly diagnosed child. Outcomes were audited by an anonymous questionnaire to families at the first outpatient appointment to assess satisfaction with care, the education received, and confidence in basic skills needed for home care of diabetes. All districts had a designated paediatric diabetic clinic, all but one led by a paediatrician. All had nurse specialists, but the posts varied widely. Only three units had joint clinics for adolescents. In total, 75% of the families returned the questionnaire. Satisfaction with support by health professionals was high. Education was good for injection technique, blood testing and diet management. Home visits by nurses were variable. Contact with schools and introduction to support groups was poor. Confidence in management was best when there was a dedicated paediatric specialist nurse with adequate cover within the team to allow home and school visits. Following peer review and implementation of an action plan, reaudit was undertaken one year later. Modest improvements were achieved in problem areas; solutions varied in different districts. Collaborative, multi-district audit allows comparison between demographically similar districts. Audit encourages improved practice within existing teams and allows an informed bid for scarce resources.
Adolescent↗
Assessing employee attitudes in a community-based AIDS service organization.
This study surveyed employees of the Comprehensive AIDS Program of Palm Beach County, Florida, a community-based AIDS service organization, to understand employees' motives for working for the organization and their attitudes toward their jobs, the organization, its clients (persons with AIDS), and governments. The study revealed that the primary reasons employees work for the organization are a desire for personal involvement in the AIDS fight and the personal lifestyle and/or feeling of each employee. These employees were highly motivated, showing some very positive attitudes toward their jobs, organization, and clients. On the other side, these employees reported concern for future funding of their organization and unhappiness with both federal and state governments' role in the fight against AIDS. Based on these findings, the authors discuss implications for the management of AIDS service organizations, the quality of the AIDS service delivery system, and the future development of AIDS service organizations.
Acquired Immunodeficiency Syndrome↗