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PubMedDate not supplied

Teamwork in health care: opportunities for gains in quality, productivity, and competitive advantage. What works, what doesn't, and why.

Wholesale political, economic, and social change is pressuring health-care organizations to reinvent themselves as they enter a new arena of managed competition. Survival is at stake. Will belt-tightening efforts, combined with structural changes and strategic alliances, achieve the necessary improvements in efficiency and help to secure an adequate patient base? It seems reasonable to expect that health-care institutions can realize the major gains in quality, productivity, efficiency, and competitive edge that organizations in the manufacturing and service industries have enjoyed for the past several years. It seems like a logical next step for health-care organizations to deploy proven methods--such as work redesign, team-based structures, and empowered workforces--that have helped to restore competitiveness to many industrial and service firms. This article describes how to organize teams at all levels and accelerate their development to achieve important organizational objectives--such as improving quality, productivity, and efficiency--while increasing employee satisfaction. Pioneering workplace innovations are reviewed to demonstrate how high-involvement teams integrating strategic planning, research, and health-care delivery processes are not only possible but highly desirable. Enhanced quality, improved productivity, greater efficiency, and employee satisfaction all translate to an undeniable competitive advantage.

Decision Making, Organizational↗
PubMed2000

Exploration of a group model in fieldwork education.

OBJECTIVE: Organizational changes, such as program management and managed care, and fluctuations in resources present challenges to the effective provision of fieldwork placements. This study compared an innovative group model with a traditional 1:1 supervision model to determine their effect on students and supervisors. METHOD: The two models were implemented at an urban clinical facility in several areas of practice over a 2 year period. Questionnaires were used to assess student skill development, student and supervising therapist satisfaction, and impact on supervising therapists' use of time. Focus groups were used to explore the advantages and disadvantages of each model. RESULTS: There were few statistically significant differences in students' (n = 26) and supervising therapists' (n = 28) ratings when the two models were compared. The qualitative findings suggest that the advantages of one model often relate to the disadvantages of the other model. In addition, supervising therapists and students offered several suggestions for how to improve implementation of the group model. CONCLUSION: When the results of the study are compared to the objectives established for the group model, it appears that many of the objectives outlined for the model were partially achieved. Several issues, such as the student-supervisor relationship and the evaluation process, need to be addressed with participants to ensure successful implementation of the group model.

Data Collection↗
PubMed1994

Educating executives to integrate information management with quality improvement: a case study.

BACKGROUND: Hamot Health Foundation has been committed to and active in continuous quality improvement (CQI) since 1990. These activities have progressed from introductory quality education to application of practical CQI initiatives with the overall objective to improve the quality of patient care. During 1993, the CQI process began to focus on identifying processes requiring care at Hamot. It took shape as a five-step action planning process that focused on data to identify goals and areas for improvement. To accomplish our goal of improving the delivery of care by trimming unnecessary processes, educating Hamot's leaders in information management and decision support became a critical component in the quality improvement effort. CASE STUDY: This article describes the educational program established for vice presidents and service line managers who report to the executive vice president. It also describes how the program was designed to stimulate the use of decision support tools to meet organizational objectives. As a result of this program's success, all service lines are using decision support to support continuous quality improvement.

Computer User Training↗
PubMedDate not supplied

Are you sure you want to be a manager?

Management has a substantial effect on organizational outcome and is critical for the organization in terms of obtaining long-term goals. Therefore, the selection of successful managers is crucial to attaining organizational objectives. However, a staff technologist who functions very successfully in his or her present role may not have the characteristics needed for successful management. Unfortunately, success in one's current, nonsupervisory position is usually the very attribute that is considered when a management position is offered. Because of this, there are many who fail miserably in the management role. These managers are ill-suited for the duties they must perform, unhappy in the position, disliked and seen as ineffectual by their subordinates and colleagues. It is essential that any individual who is offered a management position critically evaluate his or her abilities and personality before accepting the offer. For a candidate who is unsure of his or her abilities, tests are available that can assist in measuring attributes such as leadership behavior, power management, power orientation, conflict management, perceptions of organizational climate and the individual's "organizational fit" with the organization offering the position. These instruments should be used with caution because their reliability and validity in predicting management success depend on a wide variety of factors. Ultimately, it is the prospective manager's personal judgment that must be the final determinant of whether a management position is the best choice.

Career Choice↗
PubMed1998

Recommended practices for surveillance. Association for Professionals in Infection Control and Epidemiology, Inc. Surveillance Initiative working Group.

Demonstration of quality health care includes documentation of outcomes of care. Surveillance is a comprehensive method of measuring outcomes and related processes of care, analyzing the data, and providing information to members of the health care team to assist in improving those outcomes. Surveillance is an essential component of effective clinical programs designed to reduce the frequency of adverse events such as infection or injury. Although there is no single or "right" method of surveillance design or implementation, sound epidemiologic principles must form the foundation of effective systems and must be understood by key participants in the surveillance program and supported by senior management. Teamwork and collaboration across the health care spectrum are important for the development of surveillance plans. Each health care organization must tailor its surveillance systems to maximize resources by focusing on population characteristics, outcome priorities, and organizational objectives. To ensure quality of surveillance, the following elements must be incorporated: A written plan should serve as the foundation of any surveillance program. The plan should outline important objectives and elements of the surveillance process so that resources can be targeted appropriately. Thoroughness or intensity of surveillance for an area of interest must be maintained at the same level over time. Fluctuations of a surveillance rate have no meaning unless the same level of data collection is maintained. External rate comparisons are meaningless unless the systems used have comparable intensity. All the elements of surveillance should be used with consistency over time. This includes application of surveillance definitions and rate calculation methods. Personnel resources need to be appropriate for the type of surveillance being performed. This includes trained professionals who understand epidemiology and who have access to continuing professional education opportunities. Other resources essential to surveillance include computer support, information and technology services, clerical services, and administrative understanding and support to maintain a quality program. As a means of quality control and to ensure accuracy, the data and process of surveillance should undergo periodic evaluation and validation. This document is intended to assist professionals who plan and conduct surveillance programs as well as those who assure that there is appropriate organizational support to accomplish appropriate surveillance. While design of surveillance systems must be unique for each organization, incorporation of these seven core Recommended Practices for Surveillance provides a scientific framework to approach surveillance programs.

Cross Infection↗
PubMed2006

Building IT capability in health-care organizations.

While computer technology has revolutionized industries such as banking and airlines, it has done little for health care so far. Most of the health-care organizations continue the early-computer-era practice of buying the latest technology without knowing how it might effectively be employed in achieving business goals. By investing merely in information technology (IT) rather than in IT capabilities they acquire IT components--primarily hardware, software, and vendor-provided services--which they do not understand and, as a result, are not capable of fully utilizing for achieving organizational objectives. In the absence of internal IT capabilities, health-care organizations have relied heavily on the fragmented IT vendor market in which vendors do not offer an open architecture, and are unwilling to offer electronic interfaces that would make their 'closed' systems compatible with those of other vendors. They are hamstrung as a result because they have implemented so many different technologies and databases that information stays in silos. Health systems can meet this challenge by developing internal IT capabilities that would allow them to seamlessly integrate clinical and business IT systems and develop innovative uses of IT. This paper develops a comprehensive conception of IT capability grounded in the resource-based theory of the firm as a remedy to the woes of IT investments in health care.

Commerce↗
PubMed1998

Worker health and safety training: assessing impact among responders.

A mail survey was conducted among emergency responders who received training at the New Jersey/New York Hazardous Materials Worker Training Center. Responses indicate that technical topics are extremely important (i.e., decontamination, personal protection); that the vast preponderance of trainees felt confident in their ability to recall specific critical concepts in a crisis; and that 42% of respondents (75) had experienced an incident that would have resulted in injury or death without training. Phone surveys for details of specific incidents reported by 43 of the 75 mail survey respondents revealed that anecdotal data provide powerful evidence of the value of training; that extensive and uniform training is needed across jurisdictions; that training should emphasize the technical aspects of health and safety, and should include demonstration and hands-on techniques; and that integrated organizational support for implementation of health and safety practices is critical.

Decontamination↗
PubMed1991

A living systems analysis of organizational pathology.

Organizations have essentially the same subsystem processes as living systems at other levels. All of them adjust subsystem variables to changing environmental and internal circumstances. Pathology exists in any system when a subsystem variable remains out of its steady-state range for an extended period. The same classes of pathology can be found at all levels. This article analyzes the various forms of pathology that exist in living systems at the level of organizations and describes living systems process analysis. Studies of several types of organizations including U.S. Army battalions, a corporation, a hospital, and a possible space station or lunar base, are discussed.

Animals↗
PubMed1999

Electronic imaging and clinical implementation: work group approach at Mayo Clinic, Rochester.

Electronic imaging clinical implementation strategies and principles need to be developed as we move toward replacement of film-based radiology practices. During an 8-month period (1998 to 1999), an Electronic Imaging Clinical Implementation Work Group (EICIWG) was formed from sections of our department: Informatics Lab, Finance Committee, Management Section, Regional Practice Group, as well as several organ and image modality sections of the Department of Diagnostic Radiology. This group was formed to study and implement policies and strategies regarding implementation of electronic imaging into our practice. The following clinical practice issues were identified as key focus areas: (1) optimal electronic worklist organization; (2) how and when to link images with reports; (3) how to redistribute technical and professional relative value units (RVU); (4) how to facilitate future practice changes within our department regarding physical location and work redistribution; and (5) how to integrate off-campus imaging into on-campus workflow. The EICIWG divided their efforts into two phases. Phase I consisted of Fact finding and review of current practice patterns and current economic models, as well as radiology consulting needs. Phase II involved the development of recommendations, policies, and strategies for reengineering the radiology department to maintain current practice goals and use electronic imaging to improve practice patterns. The EICIWG concluded that electronic images should only be released with a formal report, except in emergent situations. Electronic worklists should support and maintain the physical presence of radiologists in critical areas and direct imaging to targeted subspecialists when possible. Case tools should be developed and used in radiology and hospital information systems (RIS/HIS) to monitor a number of parameters, including professional and technical RVU data. As communication standards improve, proper staffing models must be developed to facilitate electronic on-campus and off-campus consultation.

Diagnostic Imaging↗
PubMed2001

Ethics and engineering courses at Delft University of Technology: contents, educational setup and experiences.

This article reports on the development and teaching of compulsory courses on ethics and engineering at Delft University of Technology (DUT). Attention is paid to the teaching goals, the educational setup and methods, the contents of the courses, involvement of staff from engineering schools, experiences to date, and challenges for the future. The choices made with respect to the development and teaching of the courses are placed within the European and Dutch context and are compared and contrasted with the American situation and experiences.

Curriculum↗
PubMed1991

Organizing multicenter trials: lessons from the cooperative oncology groups.

The execution of cancer clinical therapy trials has evolved over the past 45 years and is centered in the Clinical Oncology Group mechanism. The organization, statistical and administrative support, protocol development, and quality control systems have been worked out well and can be described in detail through the Eastern Cooperative Oncology Group. Prevention trials, on the other hand, are larger and fewer and take longer to complete. They involve people who are healthy or not as motivated to take pills or change lifestyle habits as those who are ill. The problems of compliance, toxicity, and costs become major issues. The practice of medicine is organized to take care of sick people and not healthy volunteers. We describe potential roles for Clinical Oncology Groups. These include preliminary tests of prevention agents for safety and toxicity much like Phase 1 trials with cytotoxic agents. A second important possible involvement would be to provide patients at high risk for developing second cancers, treatment- or non-treatment-induced, for prevention trials. A third set of individuals that can be recruited through current group resources are relatives of cancer patients who themselves might be highly motivated to participate in prevention trials. While the Clinical Oncology Groups may not have primary roles in prevention trials, they do represent a resource that has trial discipline and willingness and could facilitate the research efforts in chemoprevention.

Clinical Protocols↗
PubMed1994

How to produce a hospital disinfection policy.

The steps required to produce and implement a hospital disinfection policy are discussed including: the formation of the team responsible for the policy; the investigation and compilation of current methods of decontamination; assessment of these methods and selection of the best options by reference to model disinfection policies; planning and producing the policy; choosing the best format; implementation of the policy and staff training; and auditing and updating the policy. Guidance is given on the selection of suitable procedures for decontamination of the environment, the skin and mucous membranes, and endoscopes and other items.

Disinfection↗