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PubMedDate not supplied

[Management trends that may lead nursing to new paths].

The changes in the economic and social context have led to the need of new management strategies for organizations. In the area of services, healthcare and nursing organizations have suffered the impact of these changes within their work processes. Our goal was to reflect on the new management trends and how they could influence the nursing work organization in healthcare services and the actions by managing nurses in strategies that meet the challenges of the profession in a changing social context. These new trends have pointed to the emphasis on the development or learning organizations, investment on human capital, inclusion of new knowledge and skills, searching for an open, flexible and participatory administrative practice, based on reason, creativity, sensitivity and intuition.

Decision Making, Organizational↗
PubMed1994

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↗
PubMed1998

Qualitative evaluation of a health management education partnership.

Results of ongoing cooperation of four educational institutions in the field of Health Management Education in Slovakia are reviewed. The specific benefit of multilateral collaboration for the situation in central Europe is discussed in the context of a Health Management Education Partnership (HMEP). The project is based on a grant from the United States Agency for International Development (USAID) with assistance from the American International Health Alliance (AIHA). The U.S. partner is the University of Scranton, Scranton, Pennsylvania. Three organizations are involved in the partnership from the Slovak Republic: Trnava University, University of Matej Bel in Banska Bystrica and the Health Management School (HMS) in Bratislava, each having specific priority and focus in health management education. The HMEP program is designed to reach about 30 teachers of health administration as well as 200 undergraduates, senior and middle managers from health service organizations every year. The collaborative endeavor stimulates the communication and creation of personal and human relations, not only on an individual and institutional level, but on a community as well as national and international level. The project supports the development of knowledge and skills, professional identity and educational processes in health management. The emphasis is on increasing the quality of education and training in Slovakia through multilateral collaboration, curricula development, professional development, symposia, support of consultancies and accreditation. Specific areas of content are designed to address health policy, law, ethics, insurance and quality improvement.

Accreditation↗
PubMed1994

Brief therapy for managed mental health companies: becoming a learning organization.

Nearly all of the services offered through managed behavioral health care companies are brief or time effective in nature. It is often the view of these companies that many of their providers have insufficient backgrounds in doing such treatment and have been trained in longer, less efficient modes of service delivery. Although this is often the case, what is frequently not recognized is that most managed behavioral health care companies themselves lack knowledge and clarity about such therapies. We address the critical need for behavioral health care companies to become learning organizations focused on research and development and internal as well as external training in time-efficient therapies. Such activities will allow for creativity and enhancement of the substance abuse and mental health care areas.

Forecasting↗
PubMed1997

Consensus guidelines for coordinated outpatient oral anticoagulation therapy management. Anticoagulation Guidelines Task Force.

OBJECTIVE: To provide primary and referring healthcare practitioners with guidelines for the provision of safe and effective anticoagulation management in any venue to standardize and improve quality of care and to permit negotiation for reimbursement from third-party payers. DATA EXTRACTION AND SYNTHESIS: Data on the current practice of anticoagulation providers and outcomes related to anticoagulation clinic care were obtained through the literature, interviews with anticoagulation providers, and a focus group meeting of anticoagulation clinic stakeholders. This information collation process revealed that an anticoagulation service consists of three separate areas for which guidelines should be developed. Based on the consensus opinions of the committee members, the literature review, and the current practice of anticoagulation services providers, a draft guideline was developed and reviewed by an independent multidisciplinary panel of anticoagulation services providers whose comments were incorporated into the final guideline. CONCLUSIONS: Systematic outpatient anticoagulation services are systems of care designed to coordinate and optimize the delivery of anticoagulation therapy by (1) evaluating patient-specific risks and benefits to determine the appropriateness of therapy; (2) facilitating the management of anticoagulation dosages and prescription pick up or delivery; (3) providing ongoing education of the patient and other caregivers about warfarin and the importance of self-care behavior leading to optimal outcomes; (4) providing continuous systematic monitoring of patients, international normalized ratio results, diet, concomitant drug therapy, and disease states; and (5) communicating with other healthcare practitioners involved in the care of the patient. To create a reproducible framework for the provision of these services, guidelines for structure, process, and outcomes of coordinated outpatient anticoagulation management services were developed. Guidelines for organization and management include (1) qualifications for personnel, (2) supervision, (3) care management and coordination, (4) communication and documentation, and (5) laboratory monitoring. Guidelines for the process of patient care include (6) patient selection and assessment, (7) initiation of therapy, (8) maintenance and management of therapy, (9) patient education, and (10) management and triage of therapy-related and unrelated problems. Guidelines for the evaluation of patient outcomes include (11) organizational components and (12) patient outcomes. The impact of these 12 guidelines on patient care and reimbursement procurement will depend on their implementation and the perceived value of their use.

Ambulatory Care↗
PubMed1983

Motivating the client/employee system as a service production strategy.

Productivity improvement in service organizations is of major concern to managers as one way of countering escalating costs. In service organizations in which the client/customer is directly involved in the production function, improved performance can be secured by viewing the client/customer as a "partial" employee. This proposition in turn leads to the suggestion that productivity gains can be realized for services by expanding conventional motivation concepts to include the client/customer.

Efficiency↗
PubMed1996

Clinical practice development and research activities in four district health authorities.

This review is based on findings from a postal survey undertaken between March and September 1993 to elicit information from nurses in four district health authorities regarding development and research activity in which they were involved. The objectives of the review were to obtain baseline information on the extent, variety and scope of work being carried out, to provide staff with a mechanism for networking good practice and to identify any areas of replication. A snowball sampling technique was used to obtain information from nursing personnel. A total of 141 responses were received out of which 4% (n = 5) reported no activity. Response rates varied between organizations and specialist groups but were similar in terms of the number of small-scale clinical practice developments undertaken without identified support or supervision. Fifty-five per cent (n = 75) of the reported developments related to the organization and management of services while 11% (n = 15) focused on consumer-related issues. Few studies identified dissemination strategies and there was generally a lack of clarity over expected benefits of the study in terms of measurable outcomes to the organization, nursing staff or patients. Funding for clinical practice development and research in nursing was found to be very sparse; the reasons for this were not identified. Overall the review confirmed statements from other sources (DoH, 1993 a,b) that nursing development and research tends to be small scale and unsupported with nursing staff trying hard to implement research findings or be innovative in their practice without the necessary expertise and support. Such findings have implications for the current drive to implement research into practice.

Clinical Nursing Research↗
PubMed2006

Differences in self-management behaviors and use of preventive services among diabetes management enrollees by race and ethnicity.

We assessed the degree that managed care organization (MCO) enrollees used preventive services and engaged in diabetes self-management behaviors by race/ethnicity. A 40-item selfadministered survey was mailed to 19,483 diabetic MCO enrollees. The survey measured use of eight preventive services and engagement in four self-management behaviors among enrollees who self-identified as black, white, or Hispanic. Of the 6,035 surveys analyzed, 4,623 respondents (76.6%) were white, 984 (16.3%) were black, and 428 (7.0%) were Hispanic. Black and Hispanic respondents reported more healthcare visits (mean of 7.0 and 6.5, respectively) in the past year compared to whites (mean, 5.7; p < 0.0001). However, compared to whites, blacks had significantly lower utilization of five of the eight preventive services measured, and Hispanics had significantly lower utilization of seven of the eight preventive services (p < 0.005). With regard to self-management behaviors, blacks were significantly less likely than whites to monitor their diet (65.9% vs. 73.7%, p < 0.0001), exercise (46.4% vs. 52.8%; p = 0.0004) and not smoke (85.1% vs. 89.3%; p = 0.0002); while Hispanics were less likely to monitor their diet (67.3% vs. 73.7%, p = 0.0051). All racial/ethnic groups had low levels of selfmanagement behaviors. Further research is warranted to identify why disparities remain in settings where services are universally available, and to find practical ways to eliminate disparities in a group with routine healthcare encounters.

Black or African American↗
PubMed2003

The complete "how to" guide for selecting a disease management vendor.

Decision-makers in health plans, large medical groups, and self-insured employers face many challenges in selecting and implementing disease management programs. One strategy is the "buy" approach, utilizing one or more of the many vendors to provide disease management services for the purchasing organization. As a relatively new field, the disease management vendor landscape is continually changing, uncovering the many uncertainties about demonstrating outcomes, corporate stability, or successful business models. Given the large investment an organization may make in each disease management program (many cost 1 million dollars or more in annual fees for a moderately sized population), careful consideration must be given in selecting a disease management partner. This paper describes, in detail, the specific steps necessary and the issues to consider in achieving a successful contract with a vendor for full-service disease management.

Contract Services↗
PubMed2005

Managed care for AIDS patients: is bigger better?

CONTEXT: Medicaid provides funds for the majority of AIDS-related health care services in the United States. In an effort to stabilize steeply rising Medicaid costs, managed care programs are replacing traditional fee-for-service Medicaid services. OBJECTIVE: To assess the impact of patient volume on the quality of care received by AIDS patients within a state's Medicaid managed care system. DESIGN: Cohort study of AIDS patients who were enrolled in Medicaid at any time from July 1997 through December 1998. Patient charts were reviewed and abstracted. Additional information on the AIDS patients' mode of exposure, date of AIDS diagnosis, and vital status were obtained from the state's HIV/AIDS surveillance database. PATIENTS AND SETTING: All known AIDS patients enrolled in the Maryland Medicaid managed care program were eligible. A total of 1052 of 1585 patient records were reviewed and analyzed. MAIN OUTCOME MEASURES: CD4 and viral load tests; preventive health care including screening for sexually transmitted infections; placement of tuberculin purified protein derivative (PPDs); hepatitis B and C screening; vaccination for hepatitis B; vaccination for pneumococcal pneumonia; Papanicolaou test screening; medication utilization including receipt of antiretroviral therapy and prophylaxis against Pneumocystis carinii pneumonia; case management services; and mortality. RESULTS: Health care quality indicators were examined by comparing the performance of clinical sites that saw a low volume of Medicaid AIDS patients per site (1-15 patients), a medium volume (16-100 patients), and a high volume (101-500 patients). High-volume sites performed better on virtually all quality indicators. There were few differences in performance between low- and medium-volume sites. High-volume sites experienced a greater number of patient deaths; this was true after adjusting for potential confounders such as age, use of antiretrovirals, time since AIDS diagnosis, appropriate laboratory monitoring, and hospitalizations. CONCLUSIONS: Variations in quality of care for AIDS patients were observed in a statewide managed care system. These variations existed despite provisions to ensure quality care such as an enhanced payment system for managed care organizations providing services for AIDS. High-volume sites were more likely to adhere to Public Health Service guidelines and may offer the best opportunity to provide high-quality AIDS care.

Acquired Immunodeficiency Syndrome↗
PubMed1995

High-risk vulnerable populations and volunteers: a model of education and service collaboration.

Extending our earlier work (Hutchison & Quartaro, 1993) describing a training program for volunteers caring for high-risk vulnerable populations, we identify and explicate factors contributing to the successful collaboration of education and service organizations. Addressing the management of linkages essential to mutual goal setting and shared responsibility for planning, implementation, and evaluation of patient/client outcomes, each factor is discussed with specific reference to improving caregiving to persons with AIDS and their families through well-trained volunteer services. The model has been applied to training for service to homeless persons and to the frail elderly and may be more broadly applicable to other high-risk vulnerable populations.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Group excellence: a model for the application of Japanese management to mental health centers.

Mental health centers and other government sponsored service organizations need highly effective management techniques. In this era of tightening budgets, the Japanese Management System may be a way of increasing both excellence and employee satisfaction. Managers who choose to explore this system may need a concise, written model as a guide to the ingenious, extensive, and paradoxical Japanese Management System. The System centers around quality control circles--autonomous problem-solving groups that strive for excellence. Composed of hierarchically interlocking groups, it uses a wide selection of group cohesion techniques to inspire esprit de corps, and an interlocking set of rewards governs behavior at every level. Decision making is collective (although supervisors retain veto power), and execution of ideas, once agreed upon, is quick and consistent. The System operates holistically, enthusiastically, with a high degree of excellence and mutual concern.

Community Mental Health Centers↗
PubMed2005

Donor agencies' involvement in reproductive health: saying one thing and doing another?

The debates about what services constitute reproductive health, how these services should be organized, managed, and delivered, and what the role of donor agencies' support should be mirror the long-standing debates on how best to implement primary health care. After briefly reviewing the development of the discourse on primary health care and reproductive health, the authors present results of qualitative research in Ghana, Kenya, and Zambia that indicate a range of factors influencing and explaining the way donors operate in these countries and consider the implications of these results for the delivery of comprehensive reproductive health services. These findings are compared with South Africa, a country with limited donor activity. In the light of the complex interplay of factors, the authors suggest that donors' words and actions frequently do not correlate. Conclusions are drawn as to the potential for donor support for integrated reproductive health service delivery in sub-Saharan Africa, drawing on the research to provide lessons and a reappraisal of the role of donors in health sector aid.

Comprehensive Health Care↗