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PubMed1994

Obstacles to real strategic marketing in health care: an experiential framework.

Accelerating technology, increasing competition, changing demographic trends, and fluctuating economic cycles are making it more difficult today to accurately assess a hospital's strategic opportunities and threats. To survive in a highly competitive marketplace, health care institutions must be able to identify and exploit major opportunities that complement their unique strengths, limitations, and clinical orientation. Without the ability to target key markets, satisfy VIP physicians and consumers, or integrate other business functions with its marketing programs, a health care institution could lose touch with its most important resource: its consumers. This article presents the what, why, and how of strategic marketing in health care by an analysis of the five most prevalent obstacles facing health care marketers and policy makers. Key concepts, suggestions, and strategies are offered to assist health care managers to overcome these obstacles and increase their institution's competitive edge. The JZMRS Model reflects the experiential base from which the article is derived.

Hospital Planning↗
PubMed2004

[Research utilization in health policy-making: obstacles and strategies].

Management of a health system requires knowledge of the health situation and administration, among other factors. The use of scientific knowledge by health policy-makers is thus recommendable. However, policy-making processes and scientific practices themselves often appear to pose obstacles to the actual utilization of research results. Many such obstacles result from reifying views of the decision-making process and objectivist conceptions of science. We propose a re-conceptualization of health policy-making and scientific practices based on the language game notion. The use of research results would thus become an exchange of significant metaphors between policy-makers and scientists. Adoption of pluralistic research systems and intensification of interfaces between researchers and policy-makers in a context of knowledge-sharing would be the main strategies to improve this exchange. Such strategies would be efficient to the extent that they succeeded in drawing science and common sense closer together, thereby transforming both.

Decision Making, Organizational↗
PubMed2006

Systems analysis of real-world obstacles to successful cervical cancer prevention in developing countries.

Papanicolaou screening is feasible anywhere that screening for cervical cancer, the leading cause of cancer-related death among women in developing countries, is appropriate. After documenting that the Vietnam War had contributed to the problem of cervical cancer in Vietnam, we participated in a grass roots effort to establish a nationwide cervical cancer prevention program in that country and performed root cause analyses of program deficiencies. We found that real-world obstacles to successful cervical cancer prevention in developing countries involve people far more than technology and that such obstacles can be appropriately managed through a systems approach focused on programmatic quality rather than through ideological commitments to technology. A focus on quality satisfies public health goals, whereas a focus on technology is compatible with market forces.

Developing Countries↗
PubMed1996

HIV risk behaviors and obstacles to condom use among Puerto Rican men in New York City who have sex with men.

OBJECTIVES: This paper describes the sexual risk behaviors of Puerto Rican men who have sex with men and their perceived obstacles to condom use. METHODS: Interviews were conducted with 182 Puerto Rican men living in New York, NY. RESULTS: Condoms were used inconsistently or not at all by half of the men who had anal sex with other men, by two thirds of the men who had vaginal sex, and by three fifths of those who had anal sex with women. Most of the men had had unprotected oral sex and more than one sexual partner in the previous year. Three of 10 were positive for the human immunodeficiency virus (HIV). Dislike of condoms was the most frequently cited obstacle, followed by perception of low risk, trust in and emotional connection with partner, unavailability and inconvenience of condom use, lack of control, and indifference. CONCLUSIONS: Barrier methods other than condoms, such as a microbicidal, gel, need to be developed.

Condoms↗
PubMed2004

Obstacles to cardiovascular prevention in general practice.

OBJECTIVE: In spite of a wide diffusion of the European guidelines for prevention of cardiovascular (CV) diseases, failures in both primary and secondary CV prevention are currently acknowledged. We wanted to uncover obstacles to CV prevention related to the general practitioner's (GP) knowledge and attitudes. METHODS AND RESULTS: A postal questionnaire was sent to a random sample of GPs from two Belgian provinces. 282 GPs (32%) answered the questionnaire. The proportion of adequate answers was calculated for each item. The main obstacles related to three domains. Regarding awareness of CV burden, 83% of the GPs underestimated the lethality of myocardial infarction and 41% underestimated the prevalence of high CV risk in the adult population. Regarding CV risk assessment, 80% thought that total cholesterol (TC) adequately reflected the individual CV risk; only 55% systematically registered the patient's CV risk factors in the medical record. A tool for global CV risk assessment was never used by 53% of the GPs. Regarding CV therapeutic attitudes, 66% systematically prescribed a lipid-lowering drug to patients with high TC while 62% did not take into account the evidence-based therapeutic targets in type 2 diabetic patients. CONCLUSIONS: This survey showed that these GPs underestimated the CV burden, lacked a systematic approach to global risk assessment and used to focus on cholesterol treatment rather than on global CV risk management.

Awareness↗
PubMed2005

Obstacle avoidance in novel visual environments improved by variable practice training.

Motor performance on simple tasks improves after training in variable practice. We asked if locomotor skill during an obstacle-avoidance task in a novel sensorimotor environment improved through training in variable practice on other complex tasks. 40 normal adults practiced gross motor skills while wearing either sham lenses, one of several visual distortion lens (constant practice), or three different visual distortion lenses (variable practice). Posttests on obstacle avoidance with novel lenses showed significantly better scores with variable practice and one of the constant groups vs sham lenses. Constant and variable practice groups did not differ. Thus, performance in a novel environment improves after training on similar type novelty, even when practice and test conditions differ. Constant practice was effective only if the subjects used the lens efficacious in training. Variable practice increases the likelihood of efficacious training when adaptive performance is required in a novel environment.

Adult↗
PubMed1983

Obstacles to the delivery of psychiatric care to transplant recipients and dialysis patients.

Despite treatment gains in knowledge about the psychological difficulties of patients with end-stage-renal disease, the psychiatric morbidity of this patient population remains critically high. This paper explores in detail and with several clinical illustrations the variety of "resistances" that stand as obstacles to the effective delivery of psychiatric care to transplant recipients and dialysis patients. These obstacles can be classified in three broad areas: 1) resistances posed by the ESRD patients, 2) interferences created by the medical staff, and 3) those resistances created by psychiatrists themselves. In addition to providing many examples of these resistances, this paper explores the underlying dynamic issues that are involved and suggests ways by which the delivery of psychiatric care to ESRD patients can be improved.

Adaptation, Psychological↗
PubMed1987

Obstacles to the utilization of vocational services: an analysis of the literature.

While employment has been linked to positive clinical outcomes with drug abusers, research suggests that many treatment programs do not emphasize vocational services and under-utilize vocational resources. This article summarizes potential client-, program-, and societal-level obstacles to vocational rehabilitation service delivery identified in past studies with both substance abusers and other related client groups. Obstacles identified for related groups are integrated with issues relevant to drug treatment clients. This analysis is based on literature published over the last 20 years.

Counseling↗
PubMed1994

Overcoming the obstacles to research-based clinical practice.

The utilization of research findings in the practice of critical care nursing is essential to obtain optimal patient outcomes. However, the speed and extent to which new research-based findings are applied to clinical practice falls short of expectations. The authors identify obstacles to the timely utilization of research. Strategies to overcome the obstacles to research-based clinical practice are presented.

Clinical Nursing Research↗
PubMed1992

Primary mental health care: indications and obstacles.

This paper considers indications and obstacles for the development of primary mental health care practice in both developed and under-developed countries. Both are considered as this represents the South African reality. While a significant body of literature has documented the need for primary mental health care, the obstacles (especially in terms of the co-modification of health) to its fruition are seldom addressed.

Attitude to Health↗
PubMed2001

Overcoming obstacles in becoming a reflective nurse and person.

As a practical approach to overcoming obstacles in being a reflective nurse and person, this article confirms the personhood of nurses, and describes some types and methods of reflection, and their uses at work and in everyday home life. Practical and theoretical obstacles are identified, and strategies are offered for overcoming them.

Humans↗
PubMed1976

[The epistemological obstacle in the constitution of social sciences].

I. General conception. The author contends that the constitution of science requires the completion of two different tasks: a) a negative-critical one, i.e. the clearing of the theoretical field through expurgating all pre-scientific ideologies jeopardizing the growth of scientific concepts; and b) a positive-constructive one, or the actual building up of a science through the production of the formal-abstract object, using ontically indeterminate raw material. Those tasks have characteristics that differ from the formal and factic-natural sciences to the social sciences. The reasons for the differences are: a) the former two have established objects, whereas the latter ones have their objects in the process of undergoing constitution, and thus possessing and oscillating ambiguity; b) the former two sciences have specific methods related to their specific objects, whereas the latter ones have a host of methods, all of them advocating scientific status; c) the former two sciences integrate their concepts into systems so as to constitute the unity of their meaning, whereas the latter ones lack a systematic integration. The consequence is that sciences already constituted (formal and factic-natural sciences) have, by the same token, established the co-implication of both moments (negative-critical and positive-constructive), to the extent that they are in the midst of universes admitting some law-system. Social sciences, on the contrary, set a double register of problems: a) "in-themselves", as they suppose the opening of a new way to approach the object; and b) "for-themselves", as long as that opening is performed at the expense of pre-scientific ideologies that bar the developments to be done "in-themselves". Furthermore, the double task is not accomplished in the same fashion in logic-formal sciences and factic-natural ones, both groups having an apodictic adequation (absolute in the first group, relative in the second one) between the context of discovery and the context of justification, be it formal or experimental, whereas in social sciences there is no such adequation, as they are still searching and trying to establish the mutually foundating relationship between both contexts. II. The epistemological obstacle in Psychology. Psychology, belonging to the general class of social sciences, is subject to two kinds of epistemological obstacles: a) those stemming from "common sense", born and nourished in the naïve, day-to-day experience, and being used as a general canon for usual as well as entirely new situations; they reach the status of a pre-critical "knowing", based solely on beliefs, and advocating to provide the grounds for our opinion on singular and general subjects; and b) those stemming from the "speculative discourse", understood as a system of notions encircling themselves and pretending to have an analogical reference to real objects, when analogy only actualizes objects that are absent...

Humans↗
PubMed1982

Legal obstacles to alternative work-force designs.

GIven the changing industrial realities we now face, more and more employers and their employees are becoming involved in cooperative work ventures such as work teams, quality circles, and joint employer-employee committees. Successful ventures of ths sort minimize the adversary nature of the relationship between management and labor and enhance employees' sense of responsibility and authority. The result is better working relationships and increased productivity. In both union and nonunion settings, however, employers face legal obstacles to work-force redesign. In the following article, the author discusses these obstacles and offers some suggestions on how they may be avoided.

Governing Board↗
PubMed2000

Factors that appear as obstacles to the control of high blood pressure.

Blood pressure control at the population level is not what it should be, given the results of therapeutic trials and the current knowledge on risk factors for hypertension. Awareness and treatment of hypertension, as well as blood pressure control under treatment, are low, whether looking at results in the general population or in groups of people with little education, lower socioeconomic status or of ethnic origin. Financial and cultural obstacles have been described in the literature in relation to patient characteristics. Considering the poor blood pressure control achieved among treated hypertensive subjects, the interaction between health professionals and patients also needs to be better understood. From a primary prevention perspective, a non-drug approach seems moderately successful, particularly among lower socioeconomic groups and ethnic minorities. However, a contradiction between individual counseling and societal economic values placed on food seems to create an obstacle to this approach. To achieve good blood pressure control in the entire population and particularly underprivileged groups, policies on public health approaches (including nutrition) to combat risk factors for hypertension are necessary.

Health Promotion↗
PubMed2000

Validation of the Service Obstacles Scale for the traumatic brain injury population.

Traumatic brain injury is a leading cause of death and disability in the United States. Limited access to specialized medical and rehabilitation services has been linked to poor outcomes. Literature provides little guidance for assessment of service obstacles and satisfaction with community resources. The present investigation describes the development of a specialized scale to evaluate caregivers' perceptions of brain injury services in the community. Results indicate good internal consistency and criterion-related validity of the Service Obstacles Scale. Lack of money for services and lack of adequate community resources were the greatest concerns voiced by respondents, while lack of transportation was the least problematic. Comparisons are made with regard to family needs and respondents' post-injury life quality. Implications for future research are discussed.

Journal Article↗
PubMed1993

[The Quebec asylum and the obstacles to medicalizing insanity (1845-1890)].

In 1845, the first true asylum for the mentally insane was founded at Beauport. Despite appearances and in spite of what some recent historians have claimed, the process of the medicalization of the insane encountered numerous obstacles in Québec including the private ownership of asylums, the weak role of the state, and also problems with the management of these institutions. Indeed, the asylum did not become a medical institution until 1890. This article outlines the obstacles met in this process, noting the marginal role of physicians and the general lack of what may be termed clinical psychiatry.

Canada↗
PubMed2001

Obstacles to prostate cancer screening in African-American men.

The purpose of this correlational study was to measure structural obstacles to a free prostate cancer screening. The sample consisted of 549 men, 69% who were African-American. The men attended a prostate cancer educational program and were offered free prostate cancer screening at their physician of choice. Structural obstacles that were predictors in screening participation were "making an appointment" (p = 0.02), "planning for an appointment" (p = 0.05), and "reminders of prostate cancer screening" (p = 0.02). The demographic variables of race and marital status were also predictors of screening participation. Implications for health education are given.

Adult↗
PubMed2002

Rubber matting on an obstacle course causes anterior cruciate ligament ruptures and its removal eliminates them.

In June 1998, six unexpected anterior cruciate ligament (ACL) ruptures within 12 months were detected by routine injury surveillance in a cohort of Australian Army recruits. Local investigation, reported separately as a Case Report in this issue, suggested the cause to be an excessive coefficient of friction between rubber boot soles and newly laid rubber matting on one obstacle course, creating excessive knee torques. The matting was removed progressively, but not before two more ruptures occurred on one remaining section. In this retrospective study, chi 2 analyses were used to compare the incidence of ACL rupture in prehazard, hazard-exposed, and postintervention cohorts, and the average costs to the institution of each ACL rupture were determined. Zero, eight, and zero ACL ruptures occurred in the prehazard, hazard-exposed, and postintervention cohorts, respectively (chi 2 > 4.75 for 1 df, p < 0.03 for each change in incidence). The temporal relationships between hazard introduction or removal and changes in the incidence of ACL rupture were strong. The average institutional cost of each ACL rupture was AU$54,627 or US$34,322. Rubber matting on obstacle courses increases the risk of ACL rupture in the presence of speed and rubber-soled footwear. Routine injury surveillance and simple preventive processes save money and personnel.

Anterior Cruciate Ligament Injuries↗