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PubMedDate not supplied

Maximizing resources: the S.H.A.R.E. model of collaboration.

This article describes the S.H.A.R.E. model for collaborative programming that evolved from the joint Clarion, Edinboro, and Slippery Rock Universities graduate nursing programs. The five components of the model--students, administrative support, resources, educational technology, humor--are presented in relation to current organizational and leadership concepts that serve as their basis. The authors focus on the use of the model as a framework for meeting the educational and health care needs of rural Pennsylvanians through collaboration and shared interests.

Administrative Personnel↗
PubMed1999

The impact of relational activities on HMO organizational outcomes.

OBJECTIVE: To report the findings of an empirical study of health maintenance organization (HMO) organizational outcomes and relational activities in HMO-pharmaceutical manufacturer relations. STUDY DESIGN: A mailed survey of a national random sample of 273 HMOs. SUBJECTS AND METHODS: Data were obtained from 111 HMOs regarding their inter-organizational relations with a pharmaceutical manufacturer. Respondents reported on 3 relational activities (initiating behavior, flexibility, bidirectional communication) and 4 HMO organizational outcomes (long-term orientation, equity in sharing costs and benefits, commitment between partners, financial performance). Also, 3 control variables were assessed: number of enrolled beneficiaries, HMO type, and estimated annual acquisition costs of pharmaceuticals. Four multiple regression analyses were performed, each with one organizational outcome variable as the dependent variable. Measures of relational activities and the control variables were the independent variables in the regressions. RESULTS: The response rate was 40.7%. All 3 relational activities showed significant associations with HMO organizational outcomes. Two relational activities (bidirectional communication, initiating behavior) showed significant and positive associations with a long-term orientation. Independent practice association (IPA)-model HMOs were less likely to report a long-term orientation toward a pharmaceutical manufacturer than other types of HMOs (adjusted R2 = 0.40). Bidirectional communication and flexibility were significantly and positively associated with the equity of costs and benefits (adjusted R2 = 0.29). Commitment had significant positive associations with all 3 relational activities (adjusted R2 = 0.50). All 3 relational activities had significant positive associations with financial performance. HMOs with an annual acquisition cost > $2 million were less likely to report favorable financial performance associated with a pharmaceutical manufacturer than were HMOs with lower costs (adjusted R2 = 0.42). CONCLUSION: Relational activities, such as initiating behavior, flexibility, and bidirectional communication, can facilitate positive outcomes for HMOs. It is important for all parties interested in healthcare to recognize that managing care creates a tension between achieving patient outcomes and organizational outcomes.

Communication↗
PubMed2005

[Present status in post-graduate psychiatry education for residencies at the general hospital without psychiatric ward].

Senior psychiatrists at general hospital without psychiatric ward are usually so short of both manpower and time that they should easily lose incentives to collaborate with residents who would come at least one month under 2004 reform of residency. In this article, the author argue that the handicaps where residents should serve outpatient clinic and consultation-liaison-service at the hospital and experience other hospitals or institutions for relatively short term (mainly only one month at most) are not handicaps at all but features. Supervision during overall period of residency which concerns residents' career development and mental health, peer-supervision using live cameras or video recording, qualitative approach which utilizing weekly problem solution tasks were introduced to maintain incentives to collaboration.

Education, Medical, Graduate↗
PubMed1991

[The exercise of partnership: an exploratory analysis throughout the development of a crisis intervention service in the Haut-Richelieu territory].

This article analyzes the concept, the implementation process and the objective of a crisis intervention center in the Haut-Richelieu area. It examines the driving and resisting forces to the practice of partnership as established by the Quebec government in its official policy for mental health. The authors describe the practice of partnership during the different phases of the project's implementation by showing the impact of this approach on the risks involved or on the potential for misdirection. In addition, the authors identify some of the weaknesses related to this approach. Following this description of how the project has progressed, the authors discuss the constraints and success factors of this type of partnership in order to compare the logic and obligations of this approach with an approach originating from the common desire and collective will to meet familiar needs.

Crisis Intervention↗
PubMedDate not supplied

[The specialty certification boards].

A synthesis of the historical background of the councils for specialty certification in Mexico is presented. A comment is made on the role of the National Academy of Medicine and on its relation to the councils. Some statistical data are given on the councils endorsed by the Academy, which up to April 1992 grouped 29,093 physicians throughout the country. Finally, a brief comment is made on the future of these organization in Mexico and the increasing influence they will exert on the regulation of specialized medical practice.

Academies and Institutes↗
PubMed2002

Collaboration and importance of federally sponsored Superfund research programs.

Numerous studies have shown that the release of hazardous substances in the environment impact the environment and human health. Communities want to know if they have been exposed, if their health is affected, and how they can protect themselves. For environmental impacts the concerns include how best to clean up and manage the contamination, and protect the environment. The answers to these questions are complex and many times unknown. Three federal agencies conduct Superfund-related research to answer a wide range of questions from identifying contaminants of concern and health risks to determining effective cleanup and prevention strategies. This article discusses the research programs for the Agency for Toxic Substances and Disease Registry, U.S. Environmental Protection Agency (Office of Research and Development), and National Institute of Environmental Health Sciences (Superfund Basic Research Program). The three agencies collaborate on their research programs and research agenda setting activities. This introduction to Superfund-related research provides a foundation and context for the scientific articles in this special edition of the journal. Because of the magnitude of environmental and human health concerns, there is a critical need for additional research to address many challenging questions involving exposures, biological responses, and environmental technologies.

Environmental Pollution↗
PubMedDate not supplied

A socioecological analysis of the determinants of national public health nutrition work force capacity: Australia as a case study.

This article uses a socioecological analytical approach to assess the capacity of the public health nutrition work force in Australia as a prelude to work force development strategy planning. It demonstrates how the socioecological model can be used to assess and inform the development of the infrastructure required for effective public health nutrition effort. An interpretive case study method was used involving triangular analysis of quantitative and qualitative data from multiple sources including semistructured interviews with advanced-level practitioners, literature review, a cross-sectional national work force survey, and position description audit and consensus development using a Delphi study. The findings of this analysis indicate that the Australian public health nutrition work force's capacity to effectively address priority nutrition issues is limited by determinants that can be categorized as relating to human resource infrastructure, organizational and policy environments, intelligence access and use, practice improvement and learning systems, and work force preparation. This socioecological analysis supports an intelligence-based focus for work force development effort in Australia and a conceptual framework for work force capacity assessment with potential applications in other countries.

Adult↗
PubMed2006

Targeting evaluations of youth development-oriented community partnerships.

Community-based partnerships (CBPs) focused on youth development (YD) have the potential to improve public health outcomes. These partnerships also present opportunities for the design and implementation of innovative, community-level change strategies, which ultimately may result in new capacities for positive YD. Evaluation-driven learning and improvement frameworks facilitate the achievement of these partnership-related benefits. Partnerships are complex because they embody multiple levels of intervention (eg, youth-serving programs, youth participation as partners or evaluators, network development for collaborative projects and resource sharing, YD-oriented organizational or community policy change). This inherent complexity transfers to evaluations of CBPs. This article provides resources for meeting evaluation-related challenges. It includes a framework for articulating relevant evaluation questions for YD-oriented CBPs, a summary of relevant types of evaluation studies, and practical solutions to common evaluation problems using targeted evaluation studies. Concrete examples of relevant, small-scale evaluation studies are provided throughout.

Adolescent↗
PubMed2001

Disaster mitigation and preparedness on the Nicaraguan post-Mitch agenda.

Nicaragua provides an example of how a major disaster, in this case Hurricane Mitch, can transform the national agenda for disaster mitigation and preparedness. Hurricane Mitch was a reminder of how extremely disaster prone Nicaragua is, and also how neoliberal reforms have weakened governmental response capacity. In the face of critiques of how governmental policies had affected preparedness and response, discussions of this transformation became a highly politicised process where the debate over alternative development models tended to overshadow the original calls to strengthen risk management. Progress can be seen in some areas, such as disaster mitigation through environmental management. This study of NGO roles, and their relations with other key actors, draws attention to the need to anchor improved risk management in local-level NGO-government collaboration. Structures are being put into place to achieve this aim, but dependence on donor financing raises questions regarding the longer-term sustainability of these efforts.

Community Participation↗
PubMed2001

Integrating cancer rehabilitation into medical care at a cancer hospital.

In spite of national health care legislative and model program initiatives, cancer rehabilitation has not kept pace with rehabilitation for patients with other medical problems. This article discusses, from a historical perspective, unsuccessful health care legislation related to cancer and problems in establishing and expanding cancer rehabilitation programs. The attempts to establish a cancer rehabilitation program at the Texas Medical Center and the University of Texas M. D. Anderson Cancer Center are reviewed. Lessons learned over past 40 years and strategies for maintaining the success of a cancer rehabilitation program are discussed.

Cancer Care Facilities↗
PubMed2001

The partnership imperative: joint working between social services and health.

This paper explores the partnership between social services and primary care, in one geographical area, in relation to five potential types of obstacle: structural; procedural; financial; professional; and status and legitimacy. It examines the theory of partnership and the Government's attitude towards it. It uses semi-structured interviews with a range of stakeholders to study partnership in practice. Finally, it highlights some of the challenges for the future.

Cooperative Behavior↗
PubMed1993

Activating communities for health promotion: a process evaluation method.

OBJECTIVES: To date, evaluations of community-based prevention programs have focused on assessing outcomes, not the process of organizing communities for health promotion. An approach was developed to analyze community organization efforts aimed at advancing community health objectives. These organizational processes are referred to as community activation. METHODS: Information was gathered from 762 informants through a key informant survey conducted in 28 western communities. The data collected included informant ratings of community activation and information about interorganizational activities analyzed through network analytic techniques. RESULTS: Activation levels, as measured by informant ratings, varied across communities. Program coordination, as measured by network analysis, occurred, on average, approximately 30% of the time. Higher income communities tended to be more activated than lower income communities. CONCLUSIONS: There is a widely recognized need for improved information about health-related community organization activities. It appears possible to gather such information through key informant surveys and to develop measures of community organization status that can be used in the evaluation of community health promotion programs.

Community Participation↗
PubMed2004

Interorganizational relationships within state tobacco control networks: a social network analysis.

INTRODUCTION: State tobacco control programs are implemented by networks of public and private agencies with a common goal to reduce tobacco use. The degree of a program's comprehensiveness depends on the scope of its activities and the variety of agencies involved in the network. Structural aspects of these networks could help describe the process of implementing a state's tobacco control program, but have not yet been examined. METHODS: Social network analysis was used to examine the structure of five state tobacco control networks. Semi-structured interviews with key agencies collected quantitative and qualitative data on frequency of contact among network partners, money flow, relationship productivity, level of network effectiveness, and methods for improvement. RESULTS: Most states had hierarchical communication structures in which partner agencies had frequent contact with one or two central agencies. Lead agencies had the highest control over network communication. Networks with denser communication structures had denser productivity structures. Lead agencies had the highest financial influence within the networks, while statewide coalitions were financially influenced by others. Lead agencies had highly productive relationships with others, while agencies with narrow roles had fewer productive relationships. Statewide coalitions that received Robert Wood Johnson Foundation funding had more highly productive relationships than coalitions that did not receive the funding. CONCLUSION: Results suggest that frequent communication among network partners is related to more highly productive relationships. Results also highlight the importance of lead agencies and statewide coalitions in implementing a comprehensive state tobacco control program. Network analysis could be useful in developing process indicators for state tobacco control programs.

Academies and Institutes↗
PubMed2006

Different approaches to contracting in health systems.

Contracting is one of the tools increasingly being used to enhance the performance of health systems in both developed and developing countries; it takes different forms and cannot be limited to the mere purchase of services. Actors adopt contracting to formalize all kinds of relations established between them. A typology for this approach will demonstrate its diversity and provide a better understanding of the various issues raised by contracting. In recent years the way health systems are organized has changed significantly. To remedy the under-performance of their health systems, most countries have undertaken reforms that have resulted in major institutional overhaul, including decentralization of health and administrative services, autonomy for public service providers, separation of funding bodies and service providers, expansion of health financing options and the development of the profit or nonprofit private sector. These institutional reshuffles lead not only to multiplication and diversification of the actors involved, but also to greater separation of the service provision and administrative functions. Health systems are becoming more complex and can no longer operate in isolation. Actors are gradually realizing that they need to forge relations. The simplest way to do that is through dialogue, although some prefer a more formal commitment. Interaction between actors may take various forms and be on different scales. There are several types of contractual relations: some are based on the nature of the contract (public or private), others on the parties involved and yet others on the scope of the contract. Here they are classified into three categories according to the object of the contract: delegation of responsibility, act of purchase of services, or cooperation.

Contract Services↗
PubMed1991

Monopolistic competition and the health care sector.

The model of monopolistic competition is appropriate for describing the behavior of the health care sector in the United States. Uncertainty about quality of medical and related services promotes product differentiation especially when consumers do not bear the full costs of care. New technologies can be used to signal quality even when their clinical usefulness is unproven. Recent cost containment measures may reduce employment of ineffective technologies but may also inhibit the adaptation of genuinely useful developments.

Costs and Cost Analysis↗
PubMed2006

Finding common ground in team-based qualitative research using the convergent interviewing method.

Research councils, agencies, and researchers recognize the benefits of team-based health research. However, researchers involved in large-scale team-based research projects face multiple challenges as they seek to identify epistemological and ontological common ground. Typically, these challenges occur between quantitative and qualitative researchers but can occur between qualitative researchers, particularly when the project involves multiple disciplinary perspectives. The authors use the convergent interviewing technique in their multidisciplinary research project to overcome these challenges. This technique assists them in developing common epistemological and ontological ground while enabling swift and detailed data collection and analysis. Although convergent interviewing is a relatively new method described primarily in marketing research, it compares and contrasts well with grounded theory and other techniques. The authors argue that this process provides a rigorous method to structure and refine research projects and requires researchers to identify and be accountable for developing a common epistemological and ontological position.

Cooperative Behavior↗
PubMed2003

Developing community health promotion interventions: selecting partners and fostering collaboration.

Although an often desired goal, true partnership between community members and university researchers can be difficult to achieve. Strategies implemented in a diabetes prevention and control program in a Latino community may be effective in overcoming hurdles to collaborative research. The development of selection criteria can be useful for objectively choosing a community organization as a partner agency. The implementation of formal partnership principles is proposed as a strategy for building a successful partnership. Partnership principles are a powerful mechanism to assure ethical relations between collaborators. As a strategy for process evaluation, they can help organize data on the extent to which intent has translated into action. They provide a structure for project stability that can outlast individual commitments and a mechanism to keep project commitment on course and maintain active engagement.

Chicago↗
PubMedDate not supplied

Sharing international experiences in disasters: summary and action plan.

INTRODUCTION: The discussions in this theme provided an opportunity to share specific experiences with disasters that occurred outside of the Asia-Pacific Rim. METHODS: Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 7 and Theme 3 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates. RESULTS: The main points developed during the presentations and discussion included: (1) disaster response planning, (2) predetermined command and organizational structure, (3) rapid response capability, (4) mitigation, and (5) communications and alternatives. DISCUSSION: The action plans presented are in common with those presented by Theme 3, and include: (1) plan disaster responses including the different types, identification of hazards, training based on experiences, and provision of public education; (2) improving coordination and control; (3) maintaining communications assuming infrastructure breakdown; (4) maximizing mitigation through standardized evaluations, creation of a legal framework, and recognition of advocacy and public participation; and (5) providing resources and knowledge through access to existing therapies, using the media, and increasing decentralization of hospital inventories. CONCLUSIONS: Most of the problems that occurred outside the Asia-Pacific rim relative to disaster management are similar to those experienced within it. They should be addressed in common with the rest of the world.

Communication↗