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PubMedDate not supplied

[Quality in public health].

Based on the concepts of quality and public health and of public health organizations as service organizations, the advisability of establishing a reference model for quality in public health, incorporating objective criteria, indicators and standards, is discussed. The 2 main models of quality management in the field of service organizations, ISO 9001-2000 and EFQM, are reviewed and their advantages and disadvantages with respect to their application in public health services are contrasted. Based on the Institute of Medicine's definition of the functions of public health, we followed the approach of the Delphi study of the World Health Organization and the Assessment Protocol for Excellence in Public Health (APEX PH) model. The NPHPSP of the Centers for Disease Control is described in detail. We propose the use of this model as the reference model for quality management and improvement in public health organizations. Finally, we conclude that the approval of the Law of Cohesion and Quality of the National Health System by the Spanish parliament, which lays out the eight main health services that the National Health System should provide, would allow the NPHSPS to be adapted to our environment as a tool for quality management of Spanish public health services.

Europe↗
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↗
PubMed2005

Successful healthcare programs and projects: organization portfolio management essentials.

Many healthcare organization projects take more time and resources than planned and fail to deliver desired business outcomes. Healthcare IT is a major component of many projects and often undeservedly receives the blame for failure. Poor results are often not a result of faulty healthcare IT or poor project management or poor project execution alone. Many projects fail because of poor portfolio management--poor planning and management of the portfolio of initiatives designed to meet an organization's strategic goals. Because resources are limited, portfolio management enables organizations to more strategically allocate and manage their resources so care delivery, service delivery, and initiatives that advance organizations toward their strategic goals, including healthcare IT initiatives, can be accomplished at the levels of quality and service desired by an organization. Proper portfolio management is the essential foundation for program and project success and supports overall organization success. Without portfolio management, even programs and projects that execute flawlessly may not meet desired objectives. This article discusses the essential requirements for porfolio management. These include opportunity identification, return on investment (ROI) forecast, project prioritization, capacity planning (inclusive of human, financial, capital, and facilities resources), work scheduling, program and project management and execution, and project performance and value assessment. Portfolio management is essential to successful healthcare project execution. Theories are drawn from the Organizational Project Management Maturity Model (OPM3) work of the Project Management Institute and other leading strategy, planning, and organization change management research institutes.

Delivery of Health Care↗
PubMed1982

Strategy to effect change in pharmacy practice.

The formulation of a strategy for change in pharmacy practice is described. Pharmacy has focused more on improving efficiency for existing functions than on identifying and adapting to the changing needs of society. The survival of the profession will depend on its ability to meet the present and future needs of society. Structural and procedural aspects of strategy formulation should focus on building a consensus within the profession. Interests of professional leaders, educators, practitioners, and the public should be incorporated into the profession's strategy. A center for strategic planning, supported by national pharmacy organizations, is suggested. Formulation of a strategy for pharmacy should involve: (1) an assessment of health-care needs relevant to pharmacy; (2) comparative evaluations of methods for delivering needed services; (3) integration with other health-care services; (4) organization and management of pharmacy practice; (5) financing considerations; and (6) legislative and regulatory changes. Planned strategic change will provide pharmacy with a mechanism for channeling its future activity in a direction that can effectively and efficiently meet the needs of society.

Delivery of Health Care↗
PubMedDate not supplied

Confidentiality measures in mental health delivery settings: report of US health information managers.

Health and human service organizations are becoming increasingly liable for violations of patient privacy as a result of recent federal mandates at both state and federal levels of government. Under such conditions it would seem likely that managers would act to quickly implement such guidelines and mandates, especially in sensitive specialty areas such as mental health. This study sought to examine the degree and type of patient information confidentiality measures adopted in mental health delivery settings, through a national survey of accredited US health information managers. Results suggest that significant nonadoption of basic confidentiality measures continues to exist, despite federal mandates to the contrary. Further examined was the degree to which confidentiality management varies across adoption levels of computerized patient records. Significant variation was found in adoption of patient confidentiality measures between highly computerized and paper-based medical record functions. Similar levels of variation in adoption across practice settings was also discovered. Ramifications for national policy and patient information protection are discussed.

Confidentiality↗
PubMed1995

Management techniques at primary care health centers: the impact of management innovation.

Long-term financial viability was a goal of The Program to Strengthen Primary Care Health Centers. To accomplish this, it was expected that participant centers would increase their management capabilities. We evaluated 32 management techniques in five principal areas: budgeting, strategic planning, general financial management, collections, and general health services management. Eight of the techniques showed change over the course of the demonstration (six increases and two decreases). It appears that there was somewhat more improvement among study centers than in a comparison group. Management sophistication has been expanding among health centers in general; Program participation appears to have accelerated this growth.

Community Health Centers↗
PubMed1999

Projecting future drug expenditures--1999.

Drug cost projections for 1999 and factors that are likely to influence drug costs are discussed. The producer price index indicates that the prices of drugs and pharmaceuticals increased sharply, by an average of 10.2%, during the first 10 months of 1998, compared with just 2.1% for all of 1997; the price of pharmaceutical prescription preparations increased by an average of 17.4% in the first 10 months of 1998-an increase of more than six times the average increase for 1997. In the first quarter of 1998, many generic drugs had major price increases. All these increases may be a sign of considerably higher drug costs in 1999. Group purchasing organizations predict price increases in 1999 of 3% for contracted drugs, 5% for noncontracted drugs, and 8% for current and newly marketed drug products. FDA has been able to decrease the time necessary to approve new drugs under the Prescription Drug User Fee Act of 1992 and will be expected to decrease the time even further under the FDA Modernization Act of 1997. Increases of 10-12% or more in managed health care coverage rates are being predicted for 1999, with even larger increases expected for fee-for-service plans. Managed care organizations point to the cost of prescription drugs as the major reason for their rate increases. Last year's prediction that we may be entering a period of smaller increases in drug costs was not fulfilled in 1998; all signs point to even higher drug costs in 1999.

Drug Approval↗
PubMedDate not supplied

Redesigning case management in managed care: an eclectic approach: from city to ranch.

Case management programs are a common approach to managing the quality and cost of services in managed care organizations. Once developed these programs may grow stagnate as the managed care member population grows and changes. This article presents a redesign project initiated by a managed care organization located in a rural Southwest region of the United States. Nursing theory and case management standards of practice form the basis of the redesign project and will be discussed. The case management model, including roles and responsibilities of staff, are presented. Results and future implications are identified.

Case Management↗
PubMedDate not supplied

[Difficulties with conducting clinical trials in France].

France ranks third among European countries as regards the level of investment in clinical R&D and, overall, accounts for a contributive effort proportional to the size of its population and pharmaceutical market respectively. However, there is a trend for phase II and III studies to become proportionally fewer than in the past, while the number of phase IV studies is increasing. In a growing proportion of the mega-trials, which are instrumental for establishing evidence-based practice, French experts, investigators and, even more seriously, French patients, are insufficiently represented. Though studies in France are initiated relatively fast due to a clear regulatory framework and perform equally well as far as quantitative and qualitative factors are concerned, compared with most European countries involved in clinical research the costs incurred per completed patient are higher than those recorded in the other countries. Academic research shares most of these constraints and suffers from a lack of financial and human resources, while it faces additional delays in implementing studies because of longer administrative processes. Given the stakes in play, specific solutions should be implemented to maintain and further develop French competitiveness in clinical R&D. At the patient level, positive perception and awareness of the usefulness and safety of participating in clinical trials need to be emphasized. Education at the school level and using the lay media should be developed. Intervention of institutional and government officials is much needed. Direct patient recruitment should be developed through advertisement and the Internet, as well as within doctors' offices and through collaboration with patients' organizations. Patient information and consent forms should be made much simpler than those imposed within the framework of global studies because of FDA requirements. The French health system discourages the recruitment of patients by investigators who are not the family doctor or the usual care provider. Thus, motivation and education of general practitioners and hospital doctors may be increased by involving them during the trial design phase and in the publication process. Specific administrative solutions, within private or public institutions, need to be developed for investigators who do not personally wish to receive investigation fees. Because of lack of availability, investigators need to be assisted with study nurse services and site management organizations, particularly within hospitals and clinics, using the model of the Clinical Investigation Centres. Networks of clinical investigation centres and of individual investigators need to be created. Implementing these solutions should lead to better implications for and reputation of French clinical research.

Clinical Trials as Topic↗
PubMedDate not supplied

[On activities of sanitary-epidemiological services under new economic conditions. The data of sociological study].

The paper deals with a pressing problem: activities of centers of sanitary and epidemiological survey under new economic conditions. The authors discuss problems of centralization and adaptation of sanitary epidemiological service under present-day economic conditions. They analyze the opinions of heads of sanitary epidemiological institutions from various regions of Russia on the present-day status of organization and management of the service. Assessment of the sources of additional financing of the institutions, of new forms of labor organization of departments and specialists, of distribution of additional allotments at sanitary epidemiological institutions is presented. Suggestions on improvement of the activities of institutions engaged in sanitary epidemiological survey under conditions of reformation of sanitary epidemiological service are offered.

Environmental Monitoring↗
PubMedDate not supplied

Management issues in the organization and delivery of family planning services.

Statewide family planning programs have been developed primarily in the Southeast and in a few other States of the nation. They are managed by State public health agencies with a few exceptions. This paper presents issues which are of importance to persons and agencies interested in developing a statewide family planning program; namely State support, allocation of funds, setting goals based on impact rather than efficiency of services, secondary sources of funding, and patient data systems. Arguments for a statewide program include the maximum use of available resources (for example, title V maternal and child health funds), the opportunity to distribute resources equitably throughout the State, the development of a statewide third-party reimbursement system, the opportunity to develop evaluation mechanisms, support for starting a system of fee collection, and the use of a statewide patient data system. Arguments against a State program include some loss of local control of a project, possible organizational battles within State agencies, State political domination of program policy, and a possible shift of funding away from existing strong projects. In the early 1970s, development of statewide systems was coupled with a rapid increase of funding when broad coverage of services and accessibility were key factors. At the present, categorical funding is no longer increasing, and efficiency and maximization of resources are becoming more important.

Adolescent↗
PubMed1983

Managing medical care for special children.

The organized management of medical services provided to special children can influence: The development of a coordinated follow-up plan for each child; reduced costs for parents by avoiding the duplication of tests and unnecessary trips to the doctor; and, increased referrals once it becomes known that services are being provided with the consumer in mind.

Adolescent↗
PubMed2003

Resources, use, and regionalization of pediatric cardiac services.

Care for children with congenital heart disease requires specialized services and various healthcare resources. The purpose of this article is to provide an updated overview of healthcare resources for infants and children with heart disease. In 2001, there were 1609 certified pediatric cardiologists in the United States. The ratio was approximately 45,000 children younger than 18 years per pediatric cardiologist. It is estimated that more than 19,000 cardiac surgeries are performed in children younger than 18 years in the United States each year. This article also reviews the effect of patient characteristics on access to healthcare and use of pediatric cardiac services, and discusses issues related to optimal use of these resources and the development of an organized approach toward service management by regionalization. The authors believe that improved access to high-quality facilities and providers coupled with thoughtful changes in the healthcare delivery system represent an excellent opportunity for optimizing outcomes for children with heart disease.

Cardiac Surgical Procedures↗
PubMed2005

Epidemiology of status epilepticus in a rural area of northern Italy: a 2-year population-based study.

We performed a 2-year population-based study on status epilepticus (SE) in adults in the rural area of Lugo di Romagna, northern Italy, to verify whether an area of low-level urbanization has a lower risk of occurrence of SE (as recently suggested), different clinical features and short-term prognosis than areas of high-level urbanization. We found crude and age- and sex-adjusted annual incidence rates of SE of 16.5/100 000 and 11.6/100 000, respectively. In patients under 60 years crude incidence was 2.9/100 000 and in the elderly (>/=60 years) 38.6/100 000. Acute symptomatic SE accounted for 30% and a cerebrovascular pathology was the most frequently associated etiologic condition (60%). A history of seizures was reported in 41% of patients. The first therapeutic intervention was mainly benzodiazepines (lorazepam 46%; diazepam 33%). The 30-day case fatality was 7%. We observed that the adult population of an area with a low level of urbanization has the same risk for SE, clinical features and short-term prognosis as European urban areas. The only contrasting result is the 30-day case fatality of 7% against the 39% found in the other Italian study (Bologna), despite the similarity of the SE features in these two areas of the same region. We infer that the short-term prognosis of SE could also be considerably influenced by differences in health service organization (and hence management) possibly due to different levels of urbanization.

Adult↗
PubMed2000

The value of a psychodynamic approach in the managed care setting.

The managed care setting presents significant challenges to all psychotherapists. Psychodynamic therapists, however, experience specific difficulties in this environment. Despite managed care's general hostility toward psychodynamic theory and practice, psychodynamic therapists provide unique and significant opportunities for patients. Psychodynamic training, with its emphasis on careful evaluation, exploration of unconscious conflict, transference and countertransference, and other therapeutic phenomena, enables clinicians to provide an invaluable service to managed care organizations. The case of K., a 45-year-old man, is used to illustrate the ways in which psychodynamic elements of a brief treatment contributed to a successful outcome. The importance of including psychodynamic treatment in managed care settings is discussed.

Health Maintenance Organizations↗