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PubMed1995

Health transition and needs-based technology planning and implementation.

Investment in health can offer additional benefits to development independent of economic improvement. Many technologies have been useful in improving the health of the people in the past. However, rapid and often unpredictable change has contributed to the inequity, inefficiency, and rising cost of health care. This paper outlines why a needs-based approach to assessing any new technology in the health sector is essential. To respond to changing needs, capacities within the health care system, several of which are described here, must be strengthened. Needs-based technology planning and implementation is affordable and feasible and is crucial in order that both health as a basic human right and good health at low cost can be attained.

Cost-Benefit Analysis↗
PubMed1995

Reforming Georgia's mental health system.

Legislation passed in 1993 makes sweeping administrative structural changes in Georgia's mental health system. Underlying these changes is the core value that consumers and families should be empowered to participate in the design, contracting, and evaluation of services. The key structural component is the creation of regional boards, comprised of at least 50% consumers and family members, which have the capacity to plan and contract for services and to evaluate the outcomes of those services. This paper describes Georgia's mental health system before these changes, the development of the initiative for reform, the process and problems associated with the passage of the legislation, and the current status of the implementation of the legislation.

Community Mental Health Services↗
PubMed1980

Social work practice and community health: a planning-implementation model.

This paper describes the functions and roles performed by the author as a social worker in the Department of Community Medicine, Mount Sinai School of Medicine of the City University of New York. The material is presented within the context of current controversies in the health care field and the department's assumption of responsibility to help improve the health care delivery system. Examples are provided to illustrate ways in which social work practice can enhance the ability of an agency or institution to use its won resources to educate and encourage a community and attendant health delivery systems therein to identify needs and to work in partnership in order to solve some of the problems. Discussion of the philosophical and knowledge base from which specific principles and techniques emerge highlights the applicability of this material to urban, nonurban, and rural areas.

Community Medicine↗
PubMed1987

Identifying health care stakeholders: a key to strategic implementation.

As the number and complexity of stakeholders for health care organizations has increased, health care managers have become more aware of the ability of these groups to thwart or facilitate the implementation of strategic plans. Most stakeholder models have focused on identification of groups within the usual, global definition of affecting or being affected by an organization's actions. The authors argue that stakeholders management is critical to the implementation of strategic plans. They provide a narrower, more operationally useful stakeholder definition and present a framework for assessing the relative importance of each stakeholder for a given situation. The situational evaluation of stakeholders is critical to successful implementation of strategy.

Decision Making, Organizational↗
PubMed1992

The utilization of qualitative and quantitative data for health education program planning, implementation, and evaluation: a spiral approach.

The process of development of a Dutch smoking prevention project is described. An essential feature of the project is the combination and interaction of qualitative and quantitative research methods. It is advocated that each method has its own contribution and can be considered as a separate methodology contributing to social science in general and health education research in particular. Combining the two approaches in a spiral approach will result in a synergistic effect, because of the interaction of both approaches. The results of both methods suggest that qualitative methods enhanced the generation of ideas and theories. Qualitative methods were used to formulate ideas for improving quantitative data gathering, analyzing and comparing ideas with respect to program development, and for testing the internal validity of a quantitative design. The quantitative method enabled testing of results in different groups and detecting detailed differences. It also provided information that one of the assumptions of the program, the development of a teacher independent program, was not completely realized. The major advantage of using both methods is that this provides feedback between assumptions and data, thus enhancing comparison of results and critical reflection during the whole project.

Health Education↗
PubMedDate not supplied

New partnership for health? Business groups on health and health systems agencies.

The experience of the Central Massachusetts Health Systems Agency (CMHSA) and the Central Massachusetts Business Group on Health (CMBGH) demonstrates the feasibility of cooperation between HSAs and BGHs. Objectives and strategies of the two groups in carrying out community health planning and working for health systems change are compared. Nearly two decades of government-sponsored community health planning programs, first through comprehensive health planning agencies and then through HSAs, have had less impact than many had anticipated because neither the technical nor political basis for such planning was sufficiently established. The CMHSA experience is typical, although it is credited with developing a hospital systems plan that is based on sound planning methods and statistical data. It is in the implementation of plans that the CMHSA has made slow progress, reflecting its inadequate community power base. The CMBGH, 1 of more than 90 groups that have developed recently across the country to attack high health care costs, was formed in 1981 by business leaders to address these rising costs. The principal strategy adopted by the CMBGH involves fostering a competitive health care market by creating a critical number of competing health plans. The providers in each plan will then have incentives to provide effective care in an efficient manner to keep the premium competitive and attract enrollees. Cooperation between the CMBGH and CMHSA is based on each organization's emphasizing its strengths. The CMHSA's data base and analyses have been the primary resources used by the CMBGH to identify problems. Each organization has developed its own set of goals and objectives, while keeping in mind those of the other organization. The CMBGH adopted a subset of theCMHSA's goals-those that focus on hospital capacity and utilization. Although the CMHSA's regulatory strategies differ greatly from the CMBGH's competition strategies, they do not necessarily conflict.Actually, each organization is supporting the other's strategies without deemphasizing its own.The CMBGH currently has a decisive advantage over the CMHSA in implementing activities because the business leaders are an integral part of the community power structure. Also, their companies' willingness to offer additional health plans to their employees is the prime incentive to develop such plans.

Commerce↗
PubMedDate not supplied

Health planning in Pakistan: a case study.

Health planning is an essential function of the state. For it to be successful, a number of conditions need to be satisfied. In particular it needs to be flexible, participative and integrated with other decision processes. Despite some strengths, the health planning system in Pakistan has generally failed to provide the framework to allow such an approach. Links between strategic and operational planning have been weak; decision-making has been very centralized; there has been a lack of functional clarity; the respective roles of bureaucrats and politicians have been unclear; and, links between capital and recurrent budgets and between planning and implementation have been weak. As a result, there is a number of imbalances in the allocation of resources. The introduction of a revised health planning system for Pakistan is discussed. The constraints on such a system and an initial assessment of its success are presented.

Budgets↗
PubMed2006

A multidimensional integrative medicine intervention to improve cardiovascular risk.

BACKGROUND: Integrative medicine is an individualized, patient-centered approach to health, combining a whole-person model with evidence-based medicine. Interventions based in integrative medicine theory have not been tested as cardiovascular risk-reduction strategies. Our objective was to determine whether personalized health planning (PHP), an intervention based on the theories and principles underlying integrative medicine, reduces 10-year risk of coronary heart disease (CHD). METHODS: We conducted a randomized, controlled trial among 154 outpatients age 45 or over, with 1 or more known cardiovascular risk factors. Subjects were enrolled from primary care practices near an academic medical center, and the intervention was delivered at a university Center for Integrative Medicine. Following a health risk assessment, each subject in the intervention arm worked with a health coach and a medical provider to construct a personalized health plan. The plan identified specific health behaviors important for each subject to modify; the choice of behaviors was driven both by cardiovascular risk reduction and the interests of each individual subject. The coach then assisted each subject in implementing her/his health plan. Techniques used in implementation included mindfulness meditation, relaxation training, stress management, motivational techniques, and health education and coaching. Subjects randomized to the comparison group received usual care (UC) without access to the intervention. Our primary outcome measure was 10-year risk of CHD, as measured by a standard Framingham risk score, and assessed at baseline, 5, and 10 months. Differences between arms were assessed by linear mixed effects modeling, with time and study arm as independent variables. RESULTS: Baseline 10-year risk of CHD was 11.1% for subjects randomized to UC (n=77), and 9.3% for subjects randomized to PHP (n=77). Over 10 months of the intervention, CHD risk decreased to 9.8% for UC subjects and 7.8% for intervention subjects. Based on a linear mixed-effects model, there was a statistically significant difference in the rate of risk improvement between the 2 arms (P=.04). In secondary analyses, subjects in the PHP arm were found to have increased days of exercise per week compared with UC (3.7 vs 2.4, P=.002), and subjects who were overweight on entry into the study had greater weight loss in the PHP arm compared with UC (P=.06). CONCLUSIONS: A multidimensional intervention based on integrative medicine principles reduced risk of CHD, possibly by increasing exercise and improving weight loss.

Aged↗
PubMed1989

The district concept for primary health care planning: attempts at implementation in The Netherlands.

Strengthening district-level primary health care systems has high priority in the WHO's 'Health for All' strategy. This article reviews governmental efforts to implement district health care systems in the Netherlands. Up to 1987, these activities corresponded to the WHO objectives, but their impact was limited. In 1987, government policy drifted away from these goals; the regulation of market forces and the increased influence of financing institutions have replaced planning by local government. Attempts to implement the district concept have, in fact, set primary health care planning back without offering the prospect of a leap forward.

Catchment Area, Health↗
PubMed1984

Maximizing school health services in a time of fiscal restraint.

This case study reports a communitywide effort to reduce the fragmentation and duplication of child health services in Boston. Consensus was first reached on what basic health services should be offered and where--school or community--they would be most efficiently and effectively delivered. The planning group then developed strategies to coordinate a network for the delivery of these services. Implementation has begun. The Boston experience offers a mechanism to maximize school health services as available funding for them declines.

Boston↗