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The word power is filled with meaning. It can't be spoken without creating some type of reaction. Power is a key issue in our lives. Authors Mikel Lynch and Seth Allcorn, Ph.D., look at power and authority through a scenario involving a physician and an administrator to show how it can be used effectively in a group practice setting.
Working in a busy intensive therapy unit can be psychologically demanding. A reflective practice group was set up to provide staff with a forum for discussion and support in an effort to manage the stress of caring in such an environment. There was no planned agenda and staff were encouraged to speak freely about both the rewarding and exacting aspects of the job. The weekly sessions were facilitated by staff from outside and unit. Their approach encouraged staff to develop and share their insights and experiences and helped to generate new ways of coping with the personal, interpersonal and professional demands of their work.
Understanding employees' values and considerations is important in undergoing major organizational change. This research provides an insight of the business and financial aspects vs. the human relations aspects of acquiring a medical group practice. The five employees interviewed in this analysis provide insight as to the factors that employees consider in resisting change. Considering how employees feel through communicating will have a significant impact on efficiency, effectiveness and turnover.
Seeking support in the face of RBRVS, physicians are demanding more support services and more cooperation from hospitals in developing pricing mechanisms for direct contracting. But organizational models intended to meet these needs won't work because of the deep chasm that typically exists between hospitals and physicians. Rather, a strong physician group practice aids in their success.
Inpatients' use of medical care and their satisfaction with their physicians were examined comparing the patients of three part-time physicians and five full-time physicians in an internal medicine group practice at the Columbia-Presbyterian Medical Center. In one study, by chart review over a seven-month period in 1988, each patient's length of stay and severity of illness were measured. A total of 58 cases were reviewed: 34 from full-time physicians and 24 from part-time physicians. When matched for severity of illness, there was no difference in lengths of stay between the patients of the part-time and those of the full-time physicians. In a second study, on interviewer-administered questionnaires completed over a ten-month period in 1986-1987, 60 patients gave satisfaction ratings of their primary physicians: 36 with full-time physicians and 24 with part-time physicians. Patients' satisfaction was equally high for both groups of physicians. The authors suggest that since more women physicians in internal medicine are demanding part-time work, and since part-time arrangements have been criticized as having adverse effects on patient care, their findings may contribute to more enlightened attitudes towards physicians who choose part-time status.
An evaluation of process and outcomes from learning through reflective practice groups on a post-registration nursing course Small groups were set up purposefully on a part-time post-registration Diploma in Professional Studies in Nursing programme to enable students to reflect on and learn from experience. The use of these groups was qualitatively evaluated by the use of in-depth interviews. Although there were many barriers to such learning, some students made significant developments in their critical thinking ability and underwent perspective transformations that led to changes in attitudes and behaviour. These are identified as an increased professionalism, greater autonomy in decision making, more self-confidence to challenge the status quo and make their own judgements, and a less rule-bound approach to their practice. The processes by which these changes occurred are identified as support and challenge within the groups offered by both the facilitators and other group members.
This prospective study, carried out over an eight-week period in 1990, compared the amount of time required for 468 outpatients in an academic group practice (pediatric orthopedics) to be evaluated by an attending surgeon working with a resident with the time required for 216 patients in the same practice to be evaluated by the attending surgeon only. On the average, 24.2 minutes were added when a resident was involved: 12.6 of these for the resident's examination of the patient and the remaining 11.6 for the resident's discussion of the case with the attending surgeon. These findings suggest that the education process builds in a time cost not only for the patient but for the attending surgeon, who has less time to see additional outpatients than does a private practitioner or a physician in a health maintenance organization.
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During the course of daily patient care, the need for clinical laboratory facilities presents itself over and over again. Many advantages can be realized by developing an in-house laboratory in the group practice setting: rapid test results, patient convenience, improved patient care, increased revenue, physician convenience, physician management, and prestige. An in-house clinical laboratory that is staffed by competent technicians, has a thorough quality control program, and is responsive to technological changes can play a very important role in the effective delivery of health care.
Objective: Among women attempting a trial of labor (TOL) after a prior abdominal delivery, 60-80% accomplish a vaginal birth after cesarean (VBAC). McMahon and coworkers (N Engl J Med, 1996) have indicated that at a 60% success level for TOL, the remaining 40% incurred enough major complications that the scheduled repeat cesarean section group was less morbid overall. The same authors speculated that a success rate of 80% might be necessary for the TOL group's morbidity to be superior. We sought to review our group's patient selection experience during an interval when successful TOL consistently exceeded 80%.Methods: The study interval ranged from January 1995 through June 1997 and was limited to patients with one previous low transverse cesarean section. Rather than using administrative or charge-related diagnoses, we analyzed a departmental database that included each delivering physician's selection of one of four VBAC categories: successful VBAC, unsuccessful VBAC, patient declined trial of labor, or physician advised against trial of labor. All deliveries were at a single institution and were performed by one of seven obstetricians in a group practice.Results: During the study interval, 332 women provided a history of a single previous cesarean delivery. Of these 332, a total of 173 attempted a TOL and 150 of the 173 (87%) were successful. Fifty-eight of the 332 (18%) declined a trial of labor despite being assessed as excellent candidates, and 101 (30%) were advised against a TOL by their physician. Most common reasons for physicians discouraging labor included malpresentation, fetal macrosomia, and clinically small pelvis. Complications for the 23 of 173 (13%) experiencing a failed TOL included 1 asymptomatic partial separation of a uterine scar and 4 cases of puerperal fever; neither transfusion nor hysterectomy was required.Conclusions: This study demonstrates that in a population of women with one prior cesarean delivery, it is possible for a group practice to achieve a TOL success rate exceeding 80%. In our opinion the managing physician selecting out those patients least likely to attain a successful TOL contributes to a low failed TOL rate. We speculate that an analysis for best practice patterns within our group might reveal information of value for future practice guidelines.
This paper describes the technical assistance role and the functions assumed by the Department of Community Medicine of the Mount Sinai School of Medicine in a planning process that led to the development of a group practice in the Department of Medicine of the Mount Sinai Hospital. Three distinct phases are identified in the process: how the planning was planned, how the plan was prepared, and how the implementation was planned. The role of Community Medicine in each phase is analyzed.
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The purpose of this cohort pilot study was to compare the resource utilization and economic outcomes associated with the use of risperidone versus haloperidol in a naturalistic setting. Patient charts from a large psychiatric group practice were reviewed, and hospital billing data were obtained. Patients meeting the inclusion criteria were placed into one of two cohorts depending on their medication history. Thirty patients treated with risperidone met the selection criteria, and a random quota sampling technique was used to allow for a matched control cohort of 30 patients treated with haloperidol. In the haloperidol and risperidone cohorts, 24 and 28 patients, respectively, were evaluated statistically. Mean utilization rates and costs per patient per month for each service were estimated by using regression analysis. Patients in the risperidone cohort had significantly fewer hospitalizations than did those in the haloperidol cohort (P = 0.004). Likewise, risperidone patients had significantly lower hospitalization costs than haloperidol patients (P = 0.005). Conversely, patients treated with risperidone visited the physician more frequently than did those treated with haloperidol (P = 0.0005). Estimated mean total monthly costs were $123.34 lower (95% confidence interval = $464, $217) per patient in the risperidone cohort than in the haloperidol cohort ($1,636.11 vs $1759.45; P = 0.4693). Significant reductions in hospital costs in the risperidone cohort offset higher medication and physician costs. Overall, total monthly costs were similar for the two cohorts.
Changes in the distribution of ambulatory care between physicians and new health practitioners (NHP) are examined in the pediatric and adult medicine departments of a prepaid group practice program. The study covers a three-year period during which NHP were extensively introduced to provide a broad range of ambulatory care. The source of data is a routine data information system that utilizes an encounter form to capture a minimal data set on every patient visit, including the provider's statement of diagnosis. Based on these data, changes in staffing are related to changes in workload and content of practice of both physicians and NHP.
This paper examines factors affecting children's use of physician services in a prepaid group practice. The independent measures come from questions asked of mothers in a survey interview, while the utilization data come from their children's medical records. All independent variables were measured prior to the period of utilization studied. The results provide some evidence in support of the view that physician utilization for children is affected by characteristics of the mother, as well as the child's age and health status. Somewhat different variables were related to whether health services were used at all as compared with magnitude of use. Special consideration is given to the effect of the mother's level of psychological distress on her propensity to use medical services for children. The results suggest that distress was relevant, but only for the white families included in the sample. Also, distress was more important in explaining extent of use than accounting for whether utilization occurred at all. Various hypotheses are examined to explore white-nonwhite differences.
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Internal controls are the methods and procedures used by any business to prevent or detect errors, safeguard assets (especially cash) from being misappropriated, and encourage staff adherence to prescribed managerial policies. Internal controls in a medical practice differ depending on the size and complexity of the practice. The key, however, is that they prevent or detect errors and efforts to circumvent the established policies and procedures of the organization. How good are the internal controls in your group practice? This article identifies ten questions you should use to evaluate your risk of asset misappropriation.
In order to improve patient care, provide better teaching in an ambulatory setting, and establish research opportunities for faculty staff, the medical clinic of the Children's Hospital of Philadelphia has been developed into a group practice. The entire house staff is involved in this project, and it appears that the endeavor has resulted in improved patient care and house officers who are better prepared for outpatient problems. Some of the difficulties are discussed.