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PubMed2003

Physicians resources in Lithuania: change comes slowly.

AIM: To analyze the structure of the physician workforce in Lithuania at the time when the country gained independence, changes it has undergone since 1990, and physician resource planning activities. METHODS: National and international databases were examined to determine the changes in the structure of physician workforce after 1990. Studies and reports, funded by international and national governmental organizations, were reviewed to examine the recommendations for physician resource planning and the rate of their acceptance. Since there was no government plan, a study using Delphi technique was conducted to find consensus among practitioners and policy makers on the physician-to-population ratio needed in Lithuania. Medical residents and physicians in Lithuania were surveyed to assess their emigration intentions. RESULTS: In comparison with other Baltic countries, the number of physicians in Lithuania has remained high despite dramatic reductions in the number of students enrolled to medical schools. There is still a maldistribution of physician resources geographically and by specialty. The government has accepted few recommendations based on the international studies. None of the internal databases provided all the needed information on the physician workforce and the existing databases could not be linked to gain access to all required information. CONCLUSIONS: The physician-to-population ratio remained high after Lithuania had gained independence. There has been little planning at the government level to determine the number of physicians needed in a reformed health system. Changes in the number of students admitted to medical schools did not follow from a well thought-out long-term plan for physician workforce the country will need in the future. To develop a frequently updated database of physicians is essential for the successful planning of future physician workforce.

Databases as Topic↗
PubMedDate not supplied

Managing knowledge workers in clinical systems.

In Future Work, Coates and colleagues cite seven forces that are reshaping work and the workforce. One is the advent of "knowledge workers," who gather, distribute, and add value to information. In health care, the transition to integrated delivery systems, replete with care plans, critical paths, and assessment of clinical outcomes supported by information technology, is driving the need to reeducate for a knowledge-based workforce. Managers of clinical systems need to be familiar with the characteristics of knowledge workers affecting the delivery environment, organizational structure, and culture of an organization. These same managers will be expected to develop strategies to manage the transition to a knowledge-based workforce.

Clinical Laboratory Information Systems↗
PubMedDate not supplied

Projecting future medical care costs using four scenarios of lifestyle risk rates.

PURPOSE: This study predicts medical care expenditures over 10 years for Union Pacific Railroad (UPRR) under alternative health risk factor scenarios for the UPRR workforce. DESIGN: This paper describes the development of an economic forecasting model to predict medical care expenditures assuming four different scenarios of population risk. The variables used to predict medical care expenditures are employee demographics and health risk profiles. SETTING: UPRR is a transportation company with more than 56,000 employees in 25 states west and south of the Mississippi River. SUBJECTS: Employees of UPRR. MEASURES: Intermediate outcomes included health risk measures related to exercise patterns, body weight, eating habits, smoking, alcohol consumption, total cholesterol, blood glucose, blood pressure, stress, and depression. Major outcome measures included projected total annual payments by UPRR for medical care services for the decade following 1998. RESULTS: The UPRR work force is projected to grow by 500 employees per year over the 10-year study period. The average age is expected to increase from 44 to 48 years. Without further health promotion intervention, 7 of the 11 risk factors assessed would likely worsen among UPRR's workforce. Medical care cost increases are projected to range from $22.2 million to $99.6 million in constant 1998 dollars over the next decade, depending on the effectiveness of risk factor modification programs. With an expected health promotion budget averaging $1.9 million annually over 10 years, health risks must decline at least 0.09% per year for the program to pay for itself. CONCLUSIONS: Estimating various risk and cost scenarios can facilitate program planning and produce an economic justification for worksite health programs.

Adult↗
PubMed2004

Rethinking midwifery refresher programs as a recruitment strategy.

This paper presents a case study on an innovative Midwifery Refresher Program in the context of current midwifery workforce issues. The refresher program was developed specifically as a recruitment strategy to address a staffing crisis at the Mater Misericordiae Mothers' Hospital, a busy tertiary maternity hospital in Brisbane, Australia. Features of the program that contributed to its success include collaboration with an industry partner, high levels of clinical support for participants, flexibility for women with family responsibilities and low financial costs for all stakeholders. This type of recruitment strategy may be useful for health care services experiencing staff shortages.

Catholicism↗
PubMed2002

Targetting out of the workforce nurses: a promising local recruitment strategy.

A successful pilot program to attract and orient 'out of the workforce' nurses to a hospital outreach acute and post acute care service is described. Three new staff members attended a one-month education program prior to commencing supervised clinical activity. Survey and focus group methods were used to evaluate the initiative. Principal lessons learned were that preceptoring and preceptor support is central to a positive outcome for new and existing staff. We also learned that a tendency to underestimate the complexity of the post acute care nursing role in the initial advertising was unhelpful.

Australia↗
PubMed2003

Learning from lives: a model for health and social care education in the wider community context.

OBJECTIVES: To develop and evaluate a model for medical education which draws upon the whole frontline workforce in primary care and which enables medical students to develop skills and competencies in patient-centred teamworking across organisational boundaries. METHODS: Over a period of 3 years, 517 undergraduate medical students undertook a 4-week community hospital-based attachment developed in partnership with frontline staff. Pre- and post-course questionnaires and qualitative evaluation were sought from students, patients, tutors and frontline staff. RESULTS: The performance of students in assessment was very good. Before receiving the assessment results, students perceived a high degree of achievement of the specified learning outcomes and reported significant changes in attitude. Qualitative comments were overwhelmingly positive, with clear indications that students appreciated the unique learning opportunities available in this model. Patients were very positive about continuing involvement and valued the opportunity to influence future doctors. Staff were enthusiastic and committed despite competing service pressures. CONCLUSIONS: We have successfully developed a partnership model of community-based education and shown that it leads to significant changes in attitude in students and enables them to learn in an active, patient-focused way about the complexities of delivery of care outside the secondary care environment. We have identified the key requirements for implementation of the model in other centres.

Clinical Competence↗
PubMed2003

Hospital downsizing and workforce reduction strategies: some inner workings.

Downsizing, manpower reductions, re-engineering, and resizing are used extensively in the United States to reduce cost and to evaluate the effectiveness and efficiency of various functions and processes. Published studies report that these managerial strategies result in a minimal impact on access to services, quality of care, and the ability to reduce costs. But, these approaches certainly alienate employees. These findings are usually explained by the significant difficulties experienced in eliminating nursing and other similar direct patient care-oriented positions and in terminating white-collar employees. Possibly an equally plausible reason why hospitals and physician practices react so poorly to these management strategies is their cost structure-high fixed (85%) and low variable (15%)-and that simply generating greater volume does not necessarily achieve economies of scale. More workable alternatives for health executives to effectuate cost reductions consist of simplifying prepayment, decreasing the overall availability and centralizing tertiary services at academic health centres, and closing superfluous hospitals and other health facilities. America's pluralistic values and these proposals having serious political repercussions for health executives and elected officials often present serious barriers in their implementation.

Attitude of Health Personnel↗
PubMed1989

Industrial production, health and disease in sub-Saharan Africa.

Industrial development in Africa has carried with it significant health costs. These costs are normally defined rather narrowly by those concerned about occupational or industrial health and safety and refer only to the health consequences of worker exposure to specific hazardous processes, materials or environmental conditions associated with the workplace. A more comprehensive measurement of industrial health costs, however, must also include an assessment of the impact which industrial development and the creation of an industrial workforce has on ecological relationships, environmental conditions and patterns of sickness and health in the areas surrounding industrial centers. Traditional definitions of occupational health also tend to focus attention on the immediate causal linkages which exist between the development of particular industrial processes and specific health hazards. Yet any attempt to fully understand the causes of industrial health problems in Africa must look beyond these immediate causal linkages and examine the wider political and economic forces which determine the shape of industrial development and the extent to which the health costs of this development are borne by industrial workers and their families, as well as by people who may not be directly or even indirectly connected to industrial development, but may, nonetheless, be exposed to its health risks. The paper surveys the direct and indirect health costs of mining, large scale agriculture, and manufacturing in Africa and examines the economic and political interests which have determined the distribution of these costs.

Africa, Central↗
PubMed2006

Critical care nursing: workforce issues and potential solutions.

OBJECTIVE: To review the history and development of critical care nurses, the supply and demand issues related to critical care nursing, critical care nursing's contribution to patient outcomes, and recommendations to ensure a steady and strong workforce. DATA SOURCE AND SELECTION: Information presented in this article is based on a review of past and current literature including international and U.S. government reports, professional publications, monographs, newspapers, and journal articles identified by MEDLINE and CINAHL databases. The Internet was used to contact international and national professional organizations and specialists. DATA EXTRACTION AND SYNTHESIS: Original and selected review articles and guideline documents were reviewed for references to critical care nurses and their role on the multiprofessional critical care team. CONCLUSIONS: Critical care nurses are an essential and vital aspect of the critical care team. Nurses contribute to improved patient outcomes, reduced morbidity and mortality, reduced complications and errors, and reduced overall costs. More than 400,000 nurses practice in critical care, and additional opportunities exist and will develop. The challenge is to ensure an adequate supply of appropriately trained staff.

Critical Care↗
PubMed1981

The necessity for trained advanced dental professionals.

The differentiation of the workforce in dentistry is discussed in terms of its history, the development of the specialties, and advanced education. The differentiations in the general practitioner workforce, through general practice residencies and the proposed advanced educational programs in general dentistry, are discussed. The possibility of further differentiation in the workforce by drastic changes in Section 18 of the Principles of Ethics of the American Dental Association (ADA) is analyzed and evaluated. The differentiations in the dental auxiliary workforce are noted and some conclusions and recommendations in all of these areas are presented.

Dental Auxiliaries↗
PubMed2000

Production-orientated education and training of the mentally disabled in sheltered employment (PIONIER).

PURPOSE: The development and realization of a production-orientated education and training system for mentally disabled people in sheltered employment in the course of the project PIONIER. It focuses on the metal and electronic branches of a workshop with a mentally disabled workforce in Alsdorf, Germany. METHODS: For the development of the modules an assessment tool called MELBA was used to determine the abilities of the disabled people and the requirements of the tasks. Methods for the collection of this information was: observation, questionnaires and documents. RESULTS: Three months after the introduction of educational measures the improvements of the capacity for learning and education of disabled persons was visible. In the same way the development of their self-reliance and social abilities was recorded. The metal working branch was capable of fulfilling every task with respect to quality issues and within set delivery times. The electro working branch was accomplished enough to create new workplaces and to get orders from the computer industry. CONCLUSIONS: By the use of a qualification system like PIONIER the tasks of the disabled employees have been enlarged and enriched. In order to cope with the increase competition sheltered workshops have to realize new ways of vocational training for mentally disabled employees.

Education of Persons with Intellectual Disabilitie↗
PubMed1997

Teaching residents to teach. An instructional program for training pediatric residents to precept third-year medical students in the ambulatory clinic.

OBJECTIVE: To provide second- and third-year pediatric residents with practical teaching skills for precepting third-year medical students in the outpatient clinic. DESIGN: Educational intervention with 3-month follow-up of participants. SETTING: University teaching hospital. PARTICIPANTS: Second- and third-year pediatric residents. INTERVENTION: A curriculum for a half-day workshop to provide residents with 6 key clinical teaching skills. Residents participated in the workshop and then were observed by trained faculty as they precepted third-year medical students in the pediatric clinic. MAIN OUTCOME MEASURE: Direct observation of resident-student precepting encounters, noting the presence or absence of their use of clinical teaching skills taught in the workshop. RESULTS: Twenty-one of 23 pediatric residents participated in the workshop. Observation of 56 resident teaching encounters before and after the workshop showed that the residents improved their clinical teaching skills. Residents valued the workshop, and many suggested it should also be considered for faculty development. CONCLUSIONS: Residents can be taught clinical teaching skills in a half-day workshop. These skills also are applicable in various clinical venues. With the increasing interest in using community-based primary care physicians for student and resident education, this curriculum is well suited for training practicing clinicians to teach in their own practice sites.

Adult↗
PubMed2003

Peer coaching as a technique to foster professional development in clinical ambulatory settings.

INTRODUCTION: Few studies have examined how peer coaching is an effective educational and development technique in contexts outside the classroom. This research focused on peer coaching as a platform to study the process of professional development for physicians. The purpose was to identify perceived benefits coaches received from a coaching encounter and how this relates to their own process of professional development. METHODS: Critical incident interviews with 13 physician coaches were conducted and tape recorded. Themes were identified using a thematic analysis technique. RESULTS: Themes emerged clustering around two distinct benefit orientations. Group 1, reflection and teaching coaches, tended to focus on others and discuss how positively they experienced the encounter. Group 2, personal learning and change coaches, expressed benefits along more personal lines. DISCUSSION: Peer coaching contributes to physicians' professional development by encouraging reflection time and learning. Peer coaching affords positive impact to those who coach in addition to those who receive the coaching. The two clusters of benefits support the performance, learning, and development theory in that there are multiple modes to describe adult growth and development. Programs of this type should be considered in medical faculty development activities associated with medical education.

Adult↗
PubMed1995

Mental health leadership training: a survey of state directors.

There is periodic support in the mental health literature for increased training opportunities in the area of management and leadership. The purpose of this study was to verify the need for such training as perceived by state directors of mental health and mental retardation/developmental disabilities programs and to explore related issues. The results confirmed a perception of need and provided insights into ways that such training might be successfully provided to states.

Administrative Personnel↗
PubMed1987

The viability of the concept of a primary health care team in developing countries.

The concept of a team approach in primary health care (PHC) is an integral part of the overall PHC strategy and is advocated at many occasions. Its theoretical advantages are multiple, even though very few sound studies exist on the effectiveness of PHC team. The viability of the concept of PHC teams is affected by two groups of factors. The first group is related to (health) manpower problems in developing countries with its underlying economic causes. The second group of factors is associated with the viability of the PHC concept in general. This pertains to decentralization, intersectoral collaboration and community participation which all affect the viability of the concept of PHC teams.

Africa↗
PubMed1989

Towards an epidemiology of political violence in the Third World.

Political violence is distressingly widespread in many parts of the world. This paper reviews the forms and effects of political violence and devotes particular attention to experiences from Central America and Southern Africa. The forms of violence vary from those which are extensive such as civil unrest and war, to those which are intensive, such as assassinations, disappearances and torture. The effects of violence on health may be direct, such as deaths, disabilities, psychological stress and the destruction of health services, or indirect such as the erosion of innovative health policies in favour of increased military expenditure. Health workers have a role to play in opposing political violence, providing care for those affected by violence, and documenting and analysing its impact on health. Research needs include documenting the impact of different forms of violence on health, and analysing the social and political factors which promote and support political violence. It is hoped that increasing recognition of political violence and man-made violence as being of major public health concern will play a part in promoting a more peaceful world.

Developing Countries↗