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PubMed1996

Payer-hospital collaboration to improve patient satisfaction with hospital discharge.

BACKGROUND: Brigham and Women's Hospital, in Boston, and its major health maintenance organization (HMO), Harvard Community Health Plan, collected data in spring 1994 which revealed that patients were less satisfied with hospital discharge planning than with other elements of care. PROBLEM IDENTIFICATION PROCESS: An interdisciplinary team, formed in November 1994 and composed of eight members from the hospital and HMO, used data from the hospital's Patient Satisfaction Survey, flowcharting, and phone interviews with patients to identify discharge planning-related problems. For example, follow-up contact with patients after discharge was erratic and no clear signal of the successful "hand off" of care from the hospital team to the community team existed. IMPROVEMENT CYCLE 1: Eighty-three percent of the payer's patients that received the improvement strategy developed by the interdisciplinary team-a concierge service-rated discharge planning as excellent or very good, compared to 63% of control patients. IMPROVEMENT CYCLE 2: PLAN SOLUTIONS/STRATEGIES FOR IMPROVING HOSPITAL DISCHARGE PLANNING: The results of the team's Cycle 1 improvement provided information for the team to use in designing a second cycle of incremental improvement activity. For example, to address the lack of clarity about who was responsible for making decisions about discharge and follow-up care, the attending physician was designated the transition-of-care coordinator. Once all the improvements were implemented, Cycle 2 patients who received the intervention rated satisfaction with discharge higher (83% versus 73%) than the control group. CONCLUSIONS: Implications of hospitalwide implementation of discharge planning-related services attempted on one unit are being considered.

Ancillary Services, Hospital↗

PubMed1992

Health care markets as interorganizational fields: a conceptual perspective.

This paper examines the interorganizational (IO) field approach to the study of local health care markets. An IO field conceptualization focuses attention on organizational behavior and interorganizational relations among providers and purchasers and other health care organizations relevant to the field. This perspective is suitable for guiding evaluations of the multiple effects of pro-competition or regulative interventions on health care markets.

Catchment Area, Health↗

PubMed2006

Evaluating partnerships: a case study of integrated specialist mental health services.

Partnerships are designed to facilitate the negotiation and delivery of public programmes cutting across the boundaries of a fragmented organisational landscape. This paper makes an empirical contribution to the study of the outcomes of partnership working, reporting results from a detailed United Kingdom case study of mental health services integration. It considers the county-wide establishment of a range of partnerships between a county council and multiple National Health Service organisations under Section 31 of the Health Act (1999), relating to mental health, learning disability, drug and alcohol, and child and adolescent mental health services. Arrangements included: integrated county-wide provision via a partnership trust; pooled commissioning and provision budgets; and joint commissioning arrangements between eight primary care trusts and the county council at a joint commissioning partnership board, supported by a joint commissioning team of officers. The evaluation explores the impact of integrated provision on service users, carers and team staff between 2002 and 2004. A multimethod approach incorporating qualitative and quantitative data was used: individual semistructured interviews and focus groups with staff, users and carers (2004); and questionnaires to team staff to explore role clarity and job satisfaction (2002 and 2004). While users and carers were largely positive towards the new provision, a range of alternative frames of reference towards inpatient episodes were identified, including notions of sanctuary and asylum, as well as lack of privacy and fears over safety. Similarly, there was some ambivalence over the dual focus of the teams on both users and carers. Small improvements overall in team staff scores for role clarity and job satisfaction masked variations between localities; such differences seem less to do with prior experience of partnership working than with recruitment difficulties. Additionally, the study raises methodological issues of relevance to the evaluation of complex social interventions. While partnership forms are themselves relatively easy to define, the attribution of improved outcomes to such arrangements is less straightforward - they are complex social interventions requiring enactment by individuals within specific contexts, typically involving many service changes against a turbulent policy background. Some implications for partnership evaluations are considered.

Humans↗

PubMed2006

Determinants of health promotion action: comparative analysis of local voluntary associations in four municipalities in Finland.

The World Health Organization makes a case for the importance of voluntary organizations in promoting health at local levels. The purpose of this paper is to contribute to understanding which factors explain local voluntary associations (LVAs) participation in health promotion in local contexts. It does so through (i) identifying indicators that represent determinants of health promotion action which were reported by LVAs and by (ii) comparing their actions with these determinants. The data reported are from a questionnaire survey of all registered LVAs in four municipalities in Finland. Principal component analysis revealed four determinants of health promotion action. Four factors in the final multivariate model explained over half of the variance of LVAs engagement in health promotion action: competence, values 'healthy' and also opportunities and municipality. There is some evidence to support a model of health promotion action which has not been tested empirically in relation to these types of organization. More detailed studies of determinants of health promotion action are needed to shape strategies in local communities.

Community Health Planning↗

PubMed2003

Broadening participation in community problem solving: a multidisciplinary model to support collaborative practice and research.

Over the last 40 years, thousands of communities-in the United States and internationally-have been working to broaden the involvement of people and organizations in addressing community-level problems related to health and other areas. Yet, in spite of this experience, many communities are having substantial difficulty achieving their collaborative objective, and many funders of community partnerships and participation initiatives are looking for ways to get more out of their investment. One of the reasons we are in this predicament is that the practitioners and researchers who are interested in community collaboration come from a variety of contexts, initiatives, and academic disciplines, and few of them have integrated their work with experiences or literatures beyond their own domain. In this article, we seek to overcome some of this fragmentation of effort by presenting a multidisciplinary model that lays out the pathways by which broadly participatory processes lead to more effective community problem solving and to improvements in community health. The model, which builds on a broad array of practical experience as well as conceptual and empirical work in multiple fields, is an outgrowth of a joint-learning work group that was organized to support nine communities in the Turning Point initiative. Following a detailed explication of the model, the article focuses on the implications of the model for research, practice, and policy. It describes how the model can help researchers answer the fundamental effectiveness and "how-to" questions related to community collaboration. In addition, the article explores differences between the model and current practice, suggesting strategies that can help the participants in, and funders of, community collaborations strengthen their efforts.

Community Health Planning↗

PubMedDate not supplied

Development of an academic consortium for nurse-managed primary care.

This article describes the development of an academic consortium comprised of four universities and their schools and colleges of nursing. The initial efforts at collaboration arose from the need to obtain funding and address policy issues related to advanced practice issues at the state level. The developmental stages of the Michigan Academic Consortium are described within a framework developed by Bailey and Koney (I).

Community Health Centers↗

PubMedDate not supplied

A nursing faculty practice for the severely mentally ill: merging practice with research.

This Faculty Practice developed in response to increasing medical complexity among severely mentally ill adults in community programs. It represents collaboration between an academic nursing program and Progress Foundation, a residential care provider in San Francisco for the severely mentally ill (SMI). Over ten years, the practice and research agenda have evolved together, through a commitment to mutual collaboration by clinicians and researchers from the University of California San Francisco (UCSF) School of Nursing, and the mental health community. Initial efforts at research focused on description of clients and practice. Research efforts have broadened and evolve to include an on-going clinical trial that tests the value of adding active health promotion to primary care. Factors contributing to success included trust among research and clinical faculty and community partners, use of clinical data in the service of practice and education, and relative freedom from fiscal administration. The merging of practice and research increases visibility of nursing contributions and will allow testing of models for care.

Adult↗

PubMed2003

Local health department perspectives on linkages among birthing hospitals.

OBJECTIVES: To describe perinatal linkages among hospitals, changes in their numbers and their impact on relationships among high-risk providers in local communities. STUDY DESIGN: Data were obtained about the organization of perinatal services in 1996-1999 from a cross-sectional study evaluating fetal and infant mortality review (FIMR) programs nationwide. Geographic areas were sampled based on region, population density, and the presence of a FIMR. A local health department representative was interviewed in 76% (N=193) of eligible communities; 188 provided data about hospitals. RESULTS: Linkages among all hospitals were reported in 143 communities and with a subspecialty hospital in 122. All but 12 communities had a maternity hospital, and changes in the number of hospitals occurred in 49 communities. Decreases in the number of Level II hospitals were related to changes in relationships among providers of high-risk care for mothers and newborns; they were associated with changing relationships only for mothers in Level I hospitals. These relations were noted only where established provider relationships existed. CONCLUSIONS: Decreases in the number of maternity hospitals affect provider relationships in communities, but only where there are established linkages among hospitals.

Critical Care↗

PubMed2001

Examining the process of community development.

AIM OF THE STUDY: To present the results of evaluation research investigating a successful community development project. RATIONALE: Many governments, health care agencies, and organizations require community participation in health care. As a result, nurses and other health professionals are often required to practice using a philosophy of community development. Although the theoretical, philosophical, and practical components of community development are well articulated, there is little evidence that exemplifies the experience of initiating and participating in a community development project. This paper provides evidence of how one organization successfully engaged the broader community on a respite care project. METHOD: Using qualitative research methods and guided by the principles and practices of participatory action research, this evaluation engaged with the community in data collection, analysis, dissemination of finding, and in promoting effective change. RESULTS: Four themes emerged that provide insight into how one HIV/AIDS organization successfully undertook community development. These themes include: (a) identifying a community need; (b) addressing the various components identified in the community development process; (c) highlighting the strategies used to engage in successful community development; and (d) attending to factors that influence community development. CONCLUSION: The results of this research contribute to the body of knowledge related to engaging in the process of community development. By highlighting the experiences of one community group, it is hoped that nurses can learn and incorporate this knowledge into practice.

Attitude to Health↗

PubMed1999

Adapting health care institutions and medical schools to societies' needs.

Although societies and the priorities of stakeholders within them differ, four universal values regarding health care exist: quality, equity, relevance, and cost-effectiveness. The first two of these values can be viewed as poles of "the dream axis" and the second two as poles of "the reality axis." Medical schools and other stakeholders can pursue optimal patterns of health care most effectively through partnerships with one another. With regard to improving the health care system, medical schools can be characterized as neutral, reactive, or proactive. A socially responsible medical school perceives the needs of society and reacts accordingly, and a socially accountable school also consults society about priorities and provides evidence of impact of its deeds. A grid for assessing the social accountability of medical schools has been developed. With this grid, a school's activities in education, research, and service are evaluated relative to the four universal values of quality, equity, relevance, and cost-effectiveness of health care; activities also are characterized as "planning," "doing," or "impacting." Assessment can promote greater social accountability of medical schools.

Cooperative Behavior↗

PubMed2006

Using networks to enhance health services delivery: perspectives, paradoxes and propositions.

There is a growing need to better understand and address the consequences of an increasing reliance on networks used to enhance health services delivery. Networks seem to have emerged as the definitive solution for tackling complex healthcare problems together that we have not been able to adequately address separately. Emphasizing the collective and the collaborative, networks are assumed to address healthcare issues in ways that are superior to previous service-delivery models. While this assumption would appear to be sound theoretically, we have little empirical information available to actually understand what networks are, what they do and whether they achieve their stated goals--truly making a difference in the delivery of care and the maintenance of health. With a diversity of networks within Canada focused on health services delivery, this paper offers a multi-dimensional framework for conceptualizing how these complex inter-organizational relationships generate both challenges and opportunities. We identify six paradoxes that the networks create when used to enhance the delivery of health services and posit several propositions concerning the evaluative work that needs to be done to enhance our understanding of and confidence in this inter-organizational form. Unless these paradoxes are adequately recognized and addressed, the value and costs associated with developing and using networks in healthcare contexts will remain unclear at best. Given the broad interest in and use of networks proliferating in health-related arenas, it is time to amass the evidence and than align the perspectives. Are networks here to stay in healthcare because they make a difference or because we got tired of talking about the need for greater collaboration and so gave it a new name and frame? At the very least, it will be important to build on what we have already learned through research into collaboration in healthcare and related fields, and even more critical to be mindful of the pitfalls and possibilities of using networks as the solution of choice as we move forward.

Canada↗

PubMed1989

[Integral approach to the prevention of major chronic non-infectious diseases].

The essence and the necessity of an integral approach to prevention of major chronic noncommunicable diseases (CNCD) is described proceeding from the example of the integral CNCD prevention programme in one of Moscow districts. The aims and basic directions of preventive activities are demonstrated along with possible ways of integrating medical services with various district nonmedical institutions. The findings of the sample study of the adult population (25-64 years) of the district are provided. The study has been carried out prior to the preventive activities and touched upon information supply of the population in relation to healthy mode of life, prevalence of major risk factors (arterial hypertension, smoking, excessive body weight, hypercholesterolemia) and some CNCD (IHD, chronic bronchitis, diabetes mellitus).

Adult↗

PubMedDate not supplied

The benefits of serving on a hospital ethics committee: a faculty perspective.

Community hospitals ethics committees rarely have formal support from persons within the academic community. The author discusses a liaison between a suburban hospital system and a nearby university school of nursing that garners positive educational, service, and programmatic benefits, related to ethics, for both. The lessons learned and insights gained by a faculty member serving on the ethics committee are examined.

Altruism↗

PubMed1989

Medical education in prepaid settings. Synthesis of the literature using the case survey method.

Reports in the literature that describe the use of prepaid settings for medical education are typically anecdotal. Synthesis of this information was accomplished using the case survey method, an approach that uses a common conceptual framework to combine case studies. A total of 18 references published between 1973 and 1986, describing the educational activities in 12 HMOs, were identified. Each reference was analyzed using a checklist composed of forced-choice items grouped into five categories: classification of HMO, type and extent of teaching program, organizational relationship between HMO and medical school, "scholarly" focus of HMO, and involvement of trainees in monitoring resource utilization. Many gaps were identified in the literature, especially those related to the mechanisms of financing the educational program and the types of organizational linkages between the medical school and the HMO. These gaps indicate the need for more systematic research to aid planners of future educational programs.

Clinical Clerkship↗

PubMedDate not supplied

The Nurse Reinvestment Act: the impact of governmental and nongovernmental administrative tools.

The Nurse Reinvestment Act has ushered in a new wave of federal involvement intended to address the issue of the critical nursing shortage. To implement this act, administrators will rely on a series of governance tools often called upon to address issues related to the social welfare of the country. Included among these tools are grants and loans through which the intent of the legislation will be formalized. The purpose of this analysis is to provide an overview of the characteristics associated with these tools, specifically as they relate to nursing education. Consideration will be given to the political environment through which funding, and thus the ability to implement the Nurse Reinvestment Act, will be realized, and the potential obstacles when executing federal programs in a market-driven economy.

Community Participation↗

PubMed2004

Assessing interagency collaboration through perceptions of families.

The purpose of the study reported in this article was to describe the perceptions of families about services they received from multiple health and social service agencies. The conceptual framework of the Interagency Collaboration Model was used to guide the descriptive study. Face-to-face interviews were conducted with 12 families who had received services from at least 3 agencies in the year before data collection. Results of the study showed that families had an average of 5.6 services over the year before the interviews were conducted. Family incomes ranged from totally inadequate to mostly adequate. Education of the participants ranged from 6th grade to some college. Most services were health-related. Interviews revealed that agency personnel were aware of other agencies, according to families' reports. Domain similarity did not appear to be a characteristic of the agencies in this study.

Attitude to Health↗

PubMed2006

New roles to support practice learning - can they facilitate expansion of placement capacity?

The National Health Service (NHS) Plan [Department of Health, 2000. The NHS Plan: A Plan for Investment, a Plan for Reform, The Stationery Office, London] set out an ambitious programme of growth for the number of students undertaking health professional education programmes. To meet this demand there is a growing and widely acknowledged need to increase the number of clinical placements needed by these students. This paper outlines the findings from a regional project that aimed to map the current pattern and availability of clinical placements for healthcare students by the collection of quantitative placement data (such as location, specialty, and number of mentors) as well as in-depth interviews with Clinical Placement Managers (CPMs). This article will focus on the findings from interviews with CPMs and their views and experiences of what role they can play in increasing placement capacity. The study revealed that the introduction of this role had facilitated the development and expansion of placement capacity, as the CPMs filled a gap in the form of up-to-date local knowledge about the clinical areas. The CPMs provided a much needed 'bridge' between the Higher Education Institution (HEI), the student and the clinical area. Recommendations are made in relation to future introduction of similar roles that aim to support student learning in practice. Furthermore, useful insights for ongoing policy implementation and development are highlighted.

Attitude of Health Personnel↗

PubMedDate not supplied

The integration of family planning and childhood immunization services in Togo.

Improvements in the constellation of services in the African context are largely addressed through attaining better measures of service integration, which can be achieved through improved referral across categories of health programs. The use of an unobtrusive referral message that linked family planning and the Expanded Program of Immunizations (EPI) services was tested in an operations research study in Togo. The introduction of the referral message was accompanied by an 18-percent increase in awareness of available family planning services and an increase in the average monthly number of new family planning clients of 54 percent. These positive results indicate that the use of referral can have a significant and dramatic impact on family planning services in a relatively short time. In Togo, no evidence existed of a negative impact on EPI services, and a majority of the EPI providers reported satisfaction with the effect of the referral message at the close of the study.

Child Health Services↗