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At least 325 records · Page 18Linked to original sources
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↗
PubMed1978

Assessing personal, role, and organizational predictors of managerial commitment.

Using a role and exchange theory framework, this study examines the commitment to their organization and to the federal service of 634 managers in 71 federal government organizations. Results indicate that certain role factors such as tenure and work overload and personal factors such as attitude toward change and job involvement are strong influences on commitment. Implications of the findings and the need for further theoretical and methodological refinements are discussed.

Administrative Personnel↗
PubMed1993

PPO and HMO performance factors: insurance company evaluation criteria.

A venture into managed care should be done only following the proper amount of due diligence. The goal should be to select the most effective managed care organization with the flexibility to meet long-term needs and the mission to work on an ongoing basis to improve service and managed care performance. Unfortunately, all too often purchasers do not demand critical information from managed care service providers. As a result, poor quality organizations have prospered and delivered less than satisfactory results. In fact, it is not unusual that savings from discounts are more than offset by increased use of health care services because of poor utilization management. It is important to be aware that use of the appropriate selection methods and monitoring performance on an ongoing basis are best done by dedicated professionals. They are also resource intensive and require a sophisticated systems capability. Since resources and systems involve significant investment, the most appropriate course for purchasers is to play the role of educated consumers. Detailed documentation should be demanded from all potential service providers to ensure that due diligence and ongoing management are in fact performed. The health care management staff at ITT Hartford is often told by managed care vendors that few other purchasers perform thorough review. It is imperative that managed care be scrutinized at least as closely as any important business venture.

Contract Services↗
PubMedDate not supplied

[Role of the Services for Prevention Safety at the Working Setting (SPSAL) in the application of the Ministerial Decree of July 15, 2003, No. 388 (regulation on the organization of first aid in the construction sector].

Article 15 of the D.Lgs. 626/94 and D.M. 388/2003, performance regulations, have codified of the new modalities of management and organization of the Service of Ready business Aid. I previewed in the new approach, entrusted main tasks to the employer, they are of organizational and formative type.

First Aid↗
PubMedDate not supplied

Manage your human sigma.

If sales and service organizations are to improve, they must learn to measure and manage the quality of the employee-customer encounter. Quality improvement methodologies such as Six Sigma are extremely useful in manufacturing contexts, but they're less useful when it comes to human interactions. To address this problem, the authors have developed a quality improvement approach they refer to as Human Sigma. It weaves together a consistent method for assessing the employee-customer encounter and a disciplined process for managing and improving it. There are several core principles for measuring and managing the employee-customer encounter: It's important not to think like an economist or an engineer when assessing interactions because emotions inform both sides' judgments and behavior. The employee-customer encounter must be measured and managed locally, because there are enormous variations in quality at the work-group and individual levels. And to improve the quality of the employee-customer interaction, organizations must conduct both short-term, transactional interventions and long-term, transformational ones. Employee engagement and customer engagement are intimately connected--and, taken together, they have an outsized effect on financial performance. They therefore need to be managed holistically. That is, the responsibility for measuring and monitoring the health of employee-customer relationships must reside within a single organizational structure, with an executive champion who has the authority to initiate and manage change. Nevertheless, the local manager remains the single most important factor in local group performance. A local manager whose work group shows suboptimal performance should be encouraged to conduct interventions, such as targeted training, performance reviews, action learning, and individual coaching.

Behavioral Sciences↗
PubMed1998

Service-line management/bottom-line management.

To survive in the sturm und drang of health care administration, hospitals and health care systems will have to restructure themselves in ways that emphasize their specific clinical strengths, control their costs, and manage the delivery and outcomes of care. Structuring the organization along clinical lines of service (e.g., oncology, cardiology, rehabilitation) cedes total bottom-line authority for all aspects of that service to the service, or product, line manager. This article discusses the qualifications, compensation, and responsibilities of service-line managers in well-integrated health care systems and describes how they and managed care organizations view each other. It also suggests which organizations will, and will not, benefit from restructuring along service lines.

Financial Management, Hospital↗
PubMed1991

Formal strategy in public hospitals.

This paper suggests that the difficulties associated with the application of formal strategic planning in public professional service organizations may have been underestimated in much of the literature. A survey of written strategic plans produced by Canadian hospitals showed that these plans were often heavily oriented towards expansion, ambiguous and rather loosely integrated, leading to questions concerning their realism and utility as a basis for strategic decisions. This phenomenon seems symptomatic of the complex (and often highly political) decision making environment faced by hospital administrators (and by managers of other professional service organizations such as universities and social service agencies). It is concluded that the benefits of formal planning may be different and less tangible for these organizations than for private business.

Canada↗
PubMedDate not supplied

Responding to the challenges of the new healthcare marketplace: organizing for creativity and innovation.

The health services industry is undergoing a revolution. Changing reimbursement and competitive dynamics are creating new incentives and constraints that demand different organizational responses. To survive, let alone thrive, health service organizations must enhance their level of creativity and innovation. This article describes the process of creativity and innovation, discusses barriers that impede the development of new services and products, and explores strategies for enhancing the creative and innovative potential of these organizations. Health service organizations that effectively and efficiently manage the generation and development of new ideas will have a significant competitive edge in the years to come. Organizational creativity and innovation will become the new "high ground" in the health services industry.

Capital Financing↗
PubMed2002

The research agenda for improving health policy, systems performance, and service delivery for tuberculosis control: a WHO perspective.

The development of WHO's DOTS strategy for the control of tuberculosis (TB) in 1995 led to the expansion, adaptation and improvement of operational research in this area. From being a patchwork of small-scale studies concerned with aspects of service delivery, TB operational research shifted to larger-scale, often multicountry projects that were also concerned with health policy and the needs of health systems. The results are now being put into practice by national TB control programmes. In 1998 an ad hoc committee identified the chief factors inhibiting the expansion of DOTS: lack of political will and commitment, poor financial support for TB control, poor organization and management of health services, inadequate human resources, irregular drug supplies, the HIV epidemic, and the rise of multidrug resistance. An analysis of current operational research on TB is presented on the basis of these constraints, and examples of successful projects are outlined in the article. We discuss the prerequisites for success, the shortcomings of this WHO- supported programme, and future challenges and needs.

Antitubercular Agents↗