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PubMed1994

Meeting the change challenge: managing growth in the nonprofit and public human services sectors.

The current economic climate has been particularly hard on non-profit and public human services organizations, frequently resulting in managing organizational decline. The authors believe that the dominant concern should be with fostering organizational growth. To this end, they suggest that nonprofit board members and executives, as well as public sector leaders, need to concern themselves with the concurrent management of two agendas: Running the Shop and Meeting the Change Challenge. This can be done effectively through the use of strategic issue management, which is a set of techniques that represents a blend of traditional strategic management and change management approaches.

Efficiency, Organizational↗
PubMed2000

Customer service: the key to remaining competitive in managed care.

The health care industry is undergoing a rapid transformation to meet the ever-increasing needs and demands of its patient population. Employers and managed care organizations are demanding better service and higher quality care, while providers are trying to tackle reimbursement cutbacks, streamlining of services, and serving a diverse population. Providers have begun to realize that to overcome these obstacles and meet the needs of their health plans and consumers, they must focus on the demands of their customers. Health care organizations have found they can meet the demands of both the consumer and the managed care industry through initiating and maintaining a customer service program. This essay explains the importance of customer service and its link to success in the managed care environment.

Consumer Behavior↗
PubMed2003

[Animal health in organic agriculture: new guidelines and perspectives for food animal practitioners].

In the last decade, the organic agriculture in Switzerland has been substantially increased due to the interest of consumer and financial incentives of the federation. Ruminants take directly or indirectly the largest part from grassland used within the organic managed surfaces. As the contacts between veterinary practice and organic agriculture has increased, the potential for veterinary activity in this area has developed considerably. The organic agriculture guidelines stipulate that all the preventive measures should be taken in feeding, keeping and breeding to insure animal health safety. This requires veterinary services for herd management. The organic status of a farm affects veterinary practice also in the form of alternative therapy/drugs administration and measures like dehorning and tail-docking. An important point in organic managed herds requests that treatment of animals should depend on alternative medical preparations or procedures based on veterinarian's experience and also on the therapeutic effect on the animal species concerned as well as on the disease. However, there are no restrictions on the veterinarian to use registered drugs as long as no alternative therapy, according to experience and possible success, is available to treat the animals. The prophylactic administration of allopathic veterinary drugs is not permissible. Further features in organic farms regarding the use of drugs are the keeping of withholding/withdrawal time, the documentation and the treatment frequency tolerated by organic marketing. Despite the above measures, the animal health has a priority regardless of its organic status. Although management of organic farms represent a unique responsibility, there are still obvious deficits in the education of veterinary practitioners for this new situation. However, in the future the extension of veterinary activity to include the alternative medical therapy should be regarded for the practitioner as a challenge and an opportunity at the same time.

Agriculture↗
PubMed2001

Are female managers quitters? The relationships of gender, promotions, and family leaves of absence to voluntary turnover.

This study examined the relationships of gender, promotions, and leaves of absence to voluntary turnover for 26,359 managers in a financial services organization. Using Cox regression analyses and controlling for human capital, the authors found that, contrary to their prediction, female managers' voluntary turnover rates were slightly lower than those of their male counterparts. Managers who had been promoted were less likely to resign than nonpromoted managers only if the promotion had occurred within the past 11 months, and promoted women were less likely to resign than promoted men. The authors also found that managers who had taken family leaves had higher voluntary turnover rates than managers who had not taken leaves, and among family leave takers, managers with graduate degrees were less likely to resign than managers with less education.

Adult↗
PubMed1999

Information needs in a changing health care system: capitation and the need for a population-oriented view.

Information systems needed for managing the health care of populations under at-risk (capitation) contracts must be designed differently than those used in fee-for-service practice. Under capitation, providers must deliver health care to enrollees with financial resources that are fixed in advance. Therefore, the information systems they use must enable them to understand the health status of health plan enrollees and how health care is provided. These systems should facilitate the detection of underservice and of inadequate quality of health care as well as overuse of health care resources. They should permit clinical-epidemiologic and statistical analysis; facilitate disease management and the adoption of preventive programs, and lend themselves to use by planners, group leaders, and practicing physicians.

Ambulatory Care Information Systems↗
PubMed1997

Nurse-managed healthcare. New York's Community Nursing Organization.

The Visiting Nurse Service of New York's Community Nursing Organization was developed to test the effectiveness of community-focused nursing case management services with elderly enrollees in a capitated reimbursement system. After 3 years of operation, it is evident that the long-term relationship between the nurse and the enrollee was the key to financial and clinical success.

Aged↗
PubMed1999

Health sector reform in the Republic of Macedonia.

AIM: To evaluate the results of current reforms in Macedonian health sector. METHOD: Description and situation analysis, covering the period 1991-1997, are focused on demographic and vital indicators, morbidity and mortality data, elements of health care system, legislation, health insurance, health care financing, and elements of health care reforms. RESULTS: The Republic of Macedonia experienced changes in the social and economic situation, similar to those in other countries in transition. The growing number of dependents (young and old persons) impact high health expenditures. High priority health problems were infant and premature adult mortality. As an inheritance of the former political system, the development of different parts of health care services was unbalanced and insurance and local network of health facilities were highly decentralized. The reforms addressed health financing and reimbursement, organization and management of health services, and pharmaceutical policies and supply. The legislation was revised, but new revision is needed. CONCLUSIONS: Health care reforms were needed in Republic of Macedonia in order to overcome the problems associated with early phase of transition. The disadvantages of the current reforms are: lack of proper political will for the implementation of activities according to the planned schedule, initial over-utilization of hospital care, and no significant changes in financing of the public sector facilities. The advantages are that the health system did not disintegrate, universal access to health services was maintained, free choice of physician was promoted, and public/private mix of services was established and financed by the Health Insurance Fund.

Delivery of Health Care↗
PubMed1989

Evaluating the effectiveness of countywide mental health care systems.

This study evaluates the effectiveness of eight (four urban and four rural) Community Support Program (CSP) delivery systems located in a state in the northwest United States. Data were collected from 364 respondents: 156 service organization directors, 49 case managers, 77 family members, and 82 seriously mentally ill clients. Four measures of effectiveness were used: comprehensiveness (number of key services for the seriously mentally ill available), coverage (proportion of persons served who needed services), quality of services on a six-point scale, and services coordination (six-item scale). The four performance measures were found to significantly differentiate the eight counties. In five of six cases the measures were positively intercorrelated thereby confirming CSP claims that the key services are an integrated set and that it is feasible to provide a full range of services without sacrificing quality or hindering coordination.

Adult↗
PubMed1995

Implementation of management innovation at primary care health centers: qualitative assessments.

This article describes the implementation of innovations at health centers participating in The Robert Wood Johnson Foundation Program to Strengthen Primary Care Health Centers. Relatively successful approaches to management innovation are described and common obstacles to innovation are considered. Key issues include poor physician retention, inadequate or inappropriate space, the complexities of automation, difficulty in the recruitment of staff and consultants (particularly in rural areas), and disruptions caused by internal promotions.

Community Health Centers↗
PubMed1998

Medicaid managed care and STD prevention: opportunities and risks.

The shift from fee-for-service reimbursement to Medicaid managed care is intended to expand access to the uninsured and simultaneously control costs. Specific attention must be paid to sexually transmitted disease (STD) prevention because the Medicaid population and STD at-risk groups overlap in their demographic descriptions. Costly, long-term sequelae can be avoided by early treatment of many STDs. Specific agreements between Medicaid and public health agencies may encourage managed care organizations to improve service in the areas that have traditionally been the territory of public health.

Female↗
PubMed1990

Barriers to the care of persons with dual diagnoses: organizational and financing issues.

Among the frustrations of managing the dual disorders of chronic mental illness and alcohol and drug abuse is the fact that knowing what to do (by way of special programming) is insufficient to address the problem. The system problems are at least as intractable as the chronic illnesses themselves. Organizing and financing care of patients with comorbities is complicated. At issue are the ways in which we administer mental health and alcohol and drug treatment as well as finance that care. Separate administrative divisions and funding pools, while appropriate for political expediency, visibility, and administrative efficiency, have compounded the problems inherent in serving persons with multiple disabilities. Arbitrary service divisions and categorical boundaries at the State level prevent local governments and programs from organizing joint projects or creatively managing patients across service boundaries. When patients cannot adapt to the way services are organized, we risk reinforcing their overutilization of inpatient and emergency services, which are ineffective mechanisms for delivering the care these patients need. This article reviews the barriers in organization and financing of care (categoric and third party financing, including the special problem of diagnosis-related groups limitations) and proposes strategies to enhance the delivery of appropriate treatment.

Alcoholism↗
PubMed1991

The WAMI Rural Hospital Project. Part 1: Historical and theoretical underpinnings.

This set of six manuscripts describes the content and impact of the WAMI Rural Hospital Project (RHP), a research and development effort supported by the W.K. Kellogg Foundation, designed to improve the delivery of health services in six rural communities in the Pacific Northwest and Alaska. The major objective of the RHP--an activity which spanned a four-year period from 1985 through 1988--was to assist the project communities in improving the financial stability and quality of care of their local health care systems. Special attention was directed at helping the communities determine and implement an appropriate scope of health services, improve management and governance of the local health care enterprise, recruit and retain additional health personnel, and increase the extent to which community residents used local health services. In this first section we discuss the historical antecedents and conceptual underpinnings of the RHP and describe the five principal phases of the project. These include: (1) selection of communities for participation in the RHP, (2) comprehensive analysis of the health care system in each community, (3) community health services planning, including the development of comprehensive strategic plans, (4) implementation of techniques to improve local health services, and (5) project dissemination and evaluation. A pre-test, post-test model was employed to assess qualitative and quantitative changes in a variety of key measures of health system performance, including organization and management, scope of services, fiscal viability of the rural hospital, and utilization and patient satisfaction with health services in each community. The results of this evaluation constitute the balance of this report.

Alaska↗