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PubMedDate not supplied

Creating a future worth experiencing: nursing strategic planning in an integrated healthcare delivery system.

The application of a strategic planning methodology for the discipline of nursing is described in use by a large, nonprofit integrated healthcare system. The methodology uses a transformational leadership assessment tool, quality planning methods, and large group intervention to engage nurses in the implementation of strategies. Based on systems theory, the methodology outlined by the author has application at any level in an organization, from an entire delivery network, to a patient care unit. The author discusses getting started on a strategic planning journey, tools that are useful in the process, integrating already existing business plans into the strategies for nursing, preliminary measures to monitor progress, and lessons learned along the journey.

Decision Making, Organizational↗
PubMed1980

Designing for hospital growth.

This article describes and illustrates a planning methodology for accommodating the unpredictable pattern of hospital growth. The methodology is based on four concepts: overstated planning targets for every department; a circulation skeleton; a zoning pattern providing separate zones for major hospital functions; and a deliberate effort to design flexible, expandable physical space.

Health Facility Size↗
PubMedDate not supplied

Structured group interaction: An intervention strategy for the continued development of elderly populations.

Structured group interaction, through an emphasis on pre-group structuring, didactic presentations, experiential learning, and evaluation, provides a flexible approach to achieving a variety of goals while compensating for many of the problem characteristics of an aged institutionalized population. Structured groups are characterized by adherence to a rigorous intervention planning methodology, with a high degree of pre-planned group structure, explicit behaviorally stated performance goals, and a concern for transferring group behavior to everyday settings. After a consideration of literature support and some of the limitations and hazards involved in the approach, it is concluded that structured groups represent a useful tool for the applied gerontologist.

Aged↗
PubMed2004

3D CT-based high-dose-rate breast brachytherapy implants: treatment planning and quality assurance.

PURPOSE: Although accelerated partial breast irradiation (APBI) as the sole radiation modality after lumpectomy has shown promising results for select breast cancer patients, published experiences thus far have provided limited information on treatment planning methodology and quality assurance measures. A novel three-dimensional computed tomography (CT)-based treatment planning method for accurate delineation and geometric coverage of the target volume is presented. A correlation between treatment volume and irradiation time has also been studied for quality assurance purposes. METHODS AND MATERIALS: Between May 2002 and January 2003, 50 consecutive patients underwent an image-guided interstitial implant followed by CT-based treatment planning and were subsequently treated with APBI with a high-dose-rate (HDR) brachytherapy remote afterloader. Target volume was defined as the lumpectomy cavity +2 cm margin modified to >/=5 mm to the skin surface. Catheter reconstruction, geometric optimization, and manual adjustment of irradiation time were done to optimally cover the target volume while minimizing hot spots. Dose homogeneity index (DHI) and percent of target volume receiving 100% of the prescription dose (32 Gy in 8 fractions or 34 Gy in 10 fractions) was determined. Additionally, the correlation between the treatment volume and irradiation time, source strength, and dose was then analyzed for manual verification of the HDR computer calculation. RESULTS: In all cases, the lumpectomy cavity was covered 100%. Target volume coverage was excellent with a median of 96%, and DHI had a median value of 0.7. For each plan, source strength times the treatment time for every unit of prescribed dose had an excellent agreement of +/-7% to the Manchester volume implant table corrected for modern units. CONCLUSIONS: CT-based treatment planning allowed excellent visualization of the lumpectomy cavity and normal structures, thereby improving target volume delineation and optimal coverage, relative to conventional orthogonal film dosimetry. Using the Manchester volume implant table calculated irradiation time can be used as quality assurance for the HDR computed time. Thus dosimetric quality assurance and adequate target volume coverage can be concurrently confirmed, allowing prospective evaluation and optimization of implants.

Brachytherapy↗
PubMed2001

Impact of the Oregon Health Plan on children with special health care needs.

OBJECTIVE: Although an increasing number of Medicaid children are enrolled in Medicaid managed care plans, little is known about how children with special health care needs fare under such programs. Of particular concern is the ability of such children to navigate a managed care system and gain access to specialty and other services. This study compares the managed care experiences of children with and without special care needs in the Oregon Health Plan. METHODOLOGY: Telephone surveys were conducted with a sample of parents of children enrolled in the Oregon Health Plan. Three groups of children were sampled: Supplemental Security Income (SSI) children with disabilities, children with asthma, and children without special health care needs. Descriptive and multivariate analyses were conducted to determine the impact of Medicaid managed care on access and satisfaction. RESULTS: Children with disabilities in managed care plans did not experience any more difficulty accessing needed specialty care than did those without special health care needs. Children with asthma, however, reported higher levels of unmet need. There were no differences in access between children with disabilities enrolled in managed care and those children with disabilities remaining in fee-for-service. CONCLUSIONS: Unlike SSI children with disabilities, children who were not SSI-eligible but had asthma seemed to have difficulty obtaining some services. These children were not eligible for the same consumer protections afforded SSI children by Oregon. If states want to enroll all children with special health care needs into managed care programs, they must develop mechanisms for identifying such children and ensuring that they receive medically necessary services.

Asthma↗
PubMed1981

Risk factors for child abuse: methodologic standards in case-control studies.

To determine whether the findings of case-control studies of risk factors for child abuse may have been biased because of inattention to scientific principles of research design, 22-case-control studies were reviewed investigating either of two risk factors: (1) prematurity or low birth weight of the abused child or (2) young maternal age of the mother of the abused child. Each study was examined to determine compliance with seven methodologic standards that would minimize bias or distortion of the results. No study satisfied all seven standards. Two standards, choice of a specific control group and adjustment for differences in clinical and demographic susceptibility factors, most often affected the results. Studies complying with both of these standards indicated that prematurity or low birth weight is not a risk factor for abuse and that young maternal age at the birth of the abused child is likely to be a risk factor. Few studies complied with the standard concerned with avoidance of detection bias; this failure may have a major effect on the direction bias; this failure may have a major effect on the direction of the results of certain studies. Previous case-control studies of child abuse have important methodologic flaws that can affect the validity of the results. The standards presented should be helpful in planning methodologically rigorous studies.

Age Factors↗
PubMed1985

Strategic planning for health care management information systems.

Using a planning methodology and a structured design technique for analyzing data and data flow, information requirements can be derived to produce a strategic plan for a management information system. Such a long-range plan classifies information groups and assigns them priorities according to the goals of the organization. The approach emphasizes user involvement.

Financial Management↗
PubMed2003

Using burden of disease information for health planning in developing countries: the experience from Uganda.

Given the growing interest in both the use of evidence in planning and in using the burden of disease measure (BOD) and cost-effectiveness analysis, we explored health planners' perception of the usefulness of the BOD in priority setting and planning in developing countries, using Uganda as an example. An exploratory qualitative approach involving in-depth interviews with key policy makers in health at district and national levels was employed. Interviews were supplemented with a review of relevant documents. Analysis involved identification of key concepts from the interviews. Concepts were grouped into categories, namely, the appeal of quantitative data, data limitations, opaque methodology, planning as a political process and opportunity costs. These form the basis of this article. We found that the BOD study results have been used as the basis for the national health policy and in defining the contents of the national essential health care package. The quantification and ranking of disease burden is appreciated by politicians and used for advocacy, resource mobilization and re-allocation. The results have also provided information for priority setting and strategic planning. Limitations to its use included poor understanding of the methodology, poor quality of data in-puts, low involvement of stakeholders, inability of the methodology to capture key non-economic issues, and the costs of carrying out the study. There is commitment, by Ugandan planners to using evidence in priority setting. Since this was an exploratory study, there is a need for more studies in developing countries to document their experiences with the use of evidence, and specifically, the BOD approach in planning and priority setting. Such information would contribute to further synthesis of the approach.

Cost of Illness↗
PubMed2003

Increasing clinical, satisfaction, and financial performance through nurse-driven process improvement.

Providers and regulatory agencies are increasing their demands for hospitals to document clinical quality and customer satisfaction at a decreased cost. Nurse leaders search for ways to meet these requirements while retaining their most valuable resource: healthcare workers (especially nurses). First-line leadership struggles with balancing quality, cost-effectiveness, and staff retention. The author discusses the planning, methodology, implementation, and outcomes of a staff driven process improvement initiative.

Cost Control↗
PubMed1993

A comprehensive framework for I/S strategic planning.

Too often hospital information services departments fail to create a strategic plan or make, at best, a half-hearted attempt at it. And many times, sincere efforts are waylaid by poor preparation or inadequate communication with users and management. By applying a systematic planning methodology, however, many pitfalls can be avoided.

Computer Systems↗
PubMed2003

Integrated urban water planning: big picture planning is good for the wallet and the environment.

The demands on governments and local authorities are changing in response to community expectations for environmentally sustainable outcomes. To reverse declining water quality in rivers and ensure sustainable use in the 21st century, the State Government in New South Wales has introduced a package of Water Reforms. The introduction of integrated water, sewerage and drainage planning is one of the Water Reform initiatives. Traditionally, government and local authorities have managed their water supply, sewerage and stormwater drainage systems as separate entities. Integrated urban water planning is a structured planning process to evaluate concurrently the opportunities to improve the management of water, sewerage and drainage services within an urban area in ways which are consistent with broader catchment and river management objectives. The New South Wales Department of Land & Water Conservation (DLWC) has developed an integrated urban water planning process through a number of recent pilot studies. The process links urban water management objectives to overall catchment and river management objectives. DLWC is currently developing a set of guidelines for integrated urban water plans. DLWC has developed the Integrated Urban Water Planning methodology through three pilot studies in the New South Wales towns of Finley, Goulburn and Bombala. The pilot studies have shown that an integrated approach to water, sewerage and stormwater planning can identify opportunities that are not apparent when separate strategies are developed for each service. The result is better-integrated, more sustainable solutions, and substantial cost savings for local communities.

Cities↗
PubMed2000

A planning framework for community empowerment goals within health promotion.

Health promotion often comprises a tension between 'bottom-up' and 'top-down' programming. The former, more associated with concepts of community empowerment, begins on issues of concern to particular groups or individuals, and regards some improvement in their overall power or capacity as the important health outcome. The latter, more associated with disease prevention efforts, begins by seeking to involve particular groups or individuals in issues and activities largely defined by health agencies, and regards improvement in particular behaviours as the important health outcome. Community empowerment is viewed more instrumentally as a means to the end of health behaviour change. The tension between these two approaches is not unresolvable, but this requires a different orientation on the part of those responsible for planning more conventional, top-down programmes. This article presents a framework intended to assist planners, implementers and evaluators to systematically consider community empowerment goals within top-down health promotion programming. The framework 'unpacks' the tensions in health promotion at each stage of the more conventional, top-down programme cycle, by presenting a parallel 'empowerment' track. The framework also presents a new technology for the assessment and strategic planning of nine identified 'domains' that represent the organizational influences on the process of community empowerment. Future papers analyze the design of this assessment and planning methodology, and discuss the findings of its field-testing in rural communities in Fiji.

Community Health Planning↗
PubMed2005

Four-dimensional radiotherapy planning for DMLC-based respiratory motion tracking.

Four-dimensional (4D) radiotherapy is the explicit inclusion of the temporal changes in anatomy during the imaging, planning, and delivery of radiotherapy. Temporal anatomic changes can occur for many reasons, though the focus of the current investigation is respiration motion for lung tumors. The aim of this study was to develop 4D radiotherapy treatment-planning methodology for DMLC-based respiratory motion tracking. A 4D computed tomography (CT) scan consisting of a series of eight 3D CT image sets acquired at different respiratory phases was used for treatment planning. Deformable image registration was performed to map each CT set from the peak-inhale respiration phase to the CT image sets corresponding to subsequent respiration phases. Deformable registration allows the contours defined on the peak-inhale CT to be automatically transferred to the other respiratory phase CT image sets. Treatment planning was simultaneously performed on each of the eight 3D image sets via automated scripts in which the MLC-defined beam aperture conforms to the PTV (which in this case equaled the GTV due to CT scan length limitations) plus a penumbral margin at each respiratory phase. The dose distribution from each respiratory phase CT image set was mapped back to the peak-inhale CT image set for analysis. The treatment intent of 4D planning is that the radiation beam defined by the DMLC tracks the respiration-induced target motion based on a feedback loop including the respiration signal to a real-time MLC controller. Deformation with respiration was observed for the lung tumor and normal tissues. This deformation was verified by examining the mapping of high contrast objects, such as the lungs and cord, between image sets. For the test case, dosimetric reductions for the cord, heart, and lungs were found for 4D planning compared with 3D planning. 4D radiotherapy planning for DMLC-based respiratory motion tracking is feasible and may offer tumor dose escalation and/or a reduction in treatment-related complications. However, 4D planning requires new planning tools, such as deformable registration and automated treatment planning on multiple CT image sets.

Dose-Response Relationship, Radiation↗