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PubMed1997

The future is no longer what it used to be. Managing health telematics projects.

Future used to mean global progress and convergence of science and technology and society. Today, we observe the decoupling of the two poles of knowledge formation and application (i.e. science and technology, and culture and society, respectively) and also fierce confrontation between them. The key issue to reconcile the two poles is to re-invent the link between them. The new future lies in the development of mental and technical capacities for change and the creation of new forms of solidarity. We propose, as a general attitude, to reactivate and develop the four principles of efficacy-effectiveness-efficiency, hospitality, responsibility and pertinence. Translated into driving forces for the development of health care telematic projects, they amount to the acceptance of and capacity for enterprise-wide solutions, hospitality and capacity to acquire outside knowledge, self-managed, multi-functional team work spirit, reengineering mentality to achieve pertinent technico-cultural solutions.

Attitude↗
PubMed1997

Building healthcare delivery and management systems centred on information about the human aspects.

The importance of modern information systems to manage healthcare delivery at the macro level--particularly through purchasing--is increasingly being recognised. There is also increasing investment in electronic patient record systems to aid care delivery. Both are intended to benefit the individual, yet neither gives full consideration to the human aspects and values--largely because of the under development of appropriate terms and structures. It is important to identify and structure the human facets as the determinants and principal components of healthcare delivery systems, to improve the information structure of these components, and then to use them as the building blocks of macro-management systems, so as to fuel the whole dynamic with one set of person-based values.

Delivery of Health Care↗
PubMed1998

Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: A consensus panel report. Society for Healthcare Epidemiology of America.

The scientific basis for claims of efficacy of nosocomial infection surveillance and control programs was established by the Study on the Efficacy of Nosocomial Infection Control project. Subsequent analyses have demonstrated nosocomial infection prevention and control programs to be not only clinically effective but also cost-effective. Although governmental and professional organizations have developed a wide variety of useful recommendations and guidelines for infection control, and apart from general guidance provided by the Joint Commission on Accreditation of Healthcare Organizations, there are surprisingly few recommendations on infrastructure and essential activities for infection control and epidemiology programs. In April 1996, the Society for Healthcare Epidemiology of America established a consensus panel to develop recommendations for optimal infrastructure and essential activities of infection control and epidemiology programs in hospitals. The following report represents the consensus panel's best assessment of needs for a healthy and effective hospital-based infection control and epidemiology program. The recommendations fall into eight categories: managing critical data and information; setting and recommending policies and procedures; compliance with regulations, guidelines, and accreditation requirements; employee health; direct intervention to prevent transmission of infectious diseases; education and training of healthcare workers; personnel resources; and nonpersonnel resources. The consensus panel used an evidence-based approach and categorized recommendations according to modifications of the scheme developed by the Clinical Affairs Committee of the Infectious Diseases Society of America and the Centers for Disease Control and Prevention's Hospital Infection Control Practices Advisory Committee.

Accreditation↗
PubMed2002

Shared treatment decision making in a collectively funded health care system: possible conflicts and some potential solutions.

In recent years there has been a growth in the advocacy of shared decision making (SDM) between clinicians and patients as a way of practicing medicine. Although there is a range of perspectives on what SDM means, in essence it refers to greater involvement of the individual patient in deliberations about appropriate forms of clinical management. The patient's perception of the role of the doctor in SDM is crucial: for it to work successfully, the patient needs to be able to be confident that the doctor is focused on which treatment will generate the greatest benefit for them. However, the doctor also has responsibilities to others, in particular to other patients and potential patients within the collectively funded health care system. This dual responsibility can create a range of dilemmas for the clinician in the context of SDM: Should they inform patients about all effective treatments or just those that the health care system considers cost-effective? Do they risk losing patients from their books if they inform patients about their responsibilities to the health care system? SDM also raises questions about the wider principles of the health care system: Are its equity principles consistent with SDM? Should patients with a strong preference for an effective but non-cost-effective treatment be permitted to pay for it privately? This paper describes the nature of the conflicts that are likely to emerge if SDM diffuses within collectively funded health care systems, and considers a range of policy responses. It argues that the risk of conflict may be reduced by making a clear distinction between clinical guidelines (focusing on effectiveness) and system guidelines (focusing on cost-effectiveness).

Communication↗
PubMed2000

The Harvard Joint Center for Radiation Therapy, 1968-1999: a unique concept and its relationship to the prevailing times in academic medicine.

PURPOSE: Institutional structure, function, and philosophy reflect the organizational needs, and tend to mirror societal values of the times. For many years, the field of radiation oncology had among its major academic centers, an organization that served as a model for collaboration among health care institutions in an effort to serve the common good of its patients, hospitals, professional colleagues, and community. For over three decades, the Joint Center for Radiation Therapy (JCRT) was a leader in developing new organizational approaches for academic and clinical radiation oncology through the philosophy of collaboration in patient care, education, and research. METHODS AND RESULTS: In tracing the development and changes in organizational philosophy and structure of the JCRT, one can see the impact on academic oncology and cancer care through the emergence of both radiation and medical oncology as independent subspecialties, the importance of the National Cancer Act of 1971 accompanied by the growth of the NIH research and training programs and, more recently, the effect of the changing attitudes and approaches of hospitals, academicians, practitioners, and policy makers to health care delivery, structures, and cooperation. CONCLUSION: Lessons learned from the 31-year history of the JCRT may help provide organizational insight useful in guiding academic oncology and academic medical centers through periods of change.

Boston↗
PubMed2004

Structure and function of the emergency department: matching emergency department choices to the emergency department mission.

Emergency caregivers experience considerable new challenges to the provision of competent, compassionate care. The good news is there are ample new approaches and new technologies to meet those new challenges.ED leaders who understand the ED mission and the resources available today and who engage vigorously in the change process will turn that mission into immensely beneficial action.

Communication↗
PubMed2004

Customer satisfaction in the emergency department.

Patient satisfaction is not merely a "smile and be nice" set of behaviors. It is a philosophy that is founded in the concept that the patient's experience of care is important and ultimately translates into their actual response to care. The improved response to care that patients exhibit makes patient satisfaction important from a clinical vantage point. That point alone is enough to justify implementation of and commitment to a customer satisfaction program. There are, however, other compelling reasons also. Customer satisfaction has profound ramifications for the financial status of the institution and for its professional reputation in the community. The caregivers who participate in a system of good customer satisfaction experience fewer malpractice suits than their counterparts. And they enjoy a work environment that is more stable and pleasant than other institutions. The implementation of a meaningful customer service program is a huge task. It is a fundamental culture change that requires vision, long-term commitment, and constant surveillance. The single most critical factor in the successful implementation of a program that produces all the gains that it promises is leadership. Leadership must set the stage, create the atmosphere,demand that staff meet expectations, reward success, provide an example,and shape the new culture. Without strong, clear leadership, any customer service initiative will be simply a hospital-wide exercise, and those staff members who harbor a cynical viewpoint will be proved right in the end.One major difference between a successful customer service initiative and an unsuccessful one is the level of sincerity the hospital and its staff have about the care they express for their patients. If the whole process is merely an exercise to improve scores, the success will be limited and without deep roots. If the push is to establish an atmosphere of genuine care and interest for patients, however, the results are more meaningful, longer lasting, and more appreciated by patients and staff.

Emergency Service, Hospital↗
PubMed2001

The challenge of effectively addressing tobacco control within a health promoting NHS Trust.

As part of its participation in the international network of health promoting hospitals (HPH), South Tyneside Health Care NHS Trust has initiated a series of sub-projects that are informed by the contemporary evidence-base and the principles of the HPH programme. This paper concerns the first of these sub-projects, whose aim is to establish an equitable and effective Trust-wide system to address smoking in South Tyneside. The ambition is to build a framework for, and foster a culture within which, individuals will be treated considerately, whilst managing "unhealthy" behaviour in such a way as to have a long-term positive impact within the organisation and the surrounding community. This paper will briefly outline the key activities underway, and the manner in which it is hoped this approach to undertaking a HPH sub-project will contribute to sustainable local health improvement, while also supporting the Trust's broader transformation into a truly health promoting organisation.

Community Health Planning↗
PubMed1992

Management training: how Canadian health care organizations compare.

Management training has been receiving increasing attention over the past decade. The present study reports on a survey of 1,000 randomly selected Canadian organizations having at least 500 employees. Analysis of returns from 56 health care organizations and 169 other Canadian organizations yielded many notable findings. Only 36 percent of health care and 37 percent of other organizations report formal policies and procedures for management training. Fortunately, many health care organizations are evolving toward a more articulated and comprehensive approach to management training; however, the constraint of limited funds for training is frequently cited. Overall, both health care and other Canadian organizations recognize the importance of management training for achieving organizational goals and they are striving to improve such training.

Attitude of Health Personnel↗
PubMed2002

Houston, we've had a problem: when do we override rules?

As important as rules are in health care, the authors explain why it is sometimes necessary to deviate from them to maximize patient outcomes. They then provide a framework for documenting, discussing, and teaching the importance of making exceptions and changing rules.

Diagnostic Errors↗
PubMed2004

Mary Lanning Memorial Hospital: communication is key.

BACKGROUND: Mary Lanning Memorial Hospital (MLMH) defines a culture of safety "as a pattern of behavior, both individual and organizational, and an underlying philosophy that seeks to minimize hazards and harm to patients that result from the processes of care." The hospital's strategic plan designates quality of care as its first priority, and one of its two priority goals is "To continue to identify and implement patient safety initiatives that will positively affect care delivery processes while minimizing patient safety errors, defects, and sentinel events, and striving for zero defects." PATIENT SAFETY AS A LEADERSHIP AND ORGANIZATIONAL PRIORITY: An occurrence in 2000 highlighted the need for a standardized medication administration process. It is anticipated that the ongoing bar-code point-of-care technology project will significantly reduce medication administration errors as they relate to the five rights, better capture near-miss data for further analysis, and increase nursing personnel time efficiency. CHALLENGES AND LESSONS LEARNED: MLMH has experienced three significant challenges in implementing and sustaining a culture of safety. First, as the central component of all patient safety activities, communication requires constant vigilance. Second, on the basis of the experience, for example, with the bar-code point-of-care technology project, introducing technology presents a variety of challenges. Third, although many patient safety initiatives can be accomplished with minimal funding, large-scale initiatives usually necessitate a significant financial commitment.

Communication↗
PubMed1992

Development of a hospital ethics committee: lessons from five years of case consultations.

The development and consultation experience of an ethics committee in an urban community hospital has been presented, and various approaches to case consultation have been considered. Our committee has concentrated on the clinical evaluation model. As expected, most consultations have centered on issues of withdrawing or limiting medical care. Most patients evaluated have been unable to clearly express their wishes concerning further treatments, highlighting the need for promoting advance directives. When resorting to substituted judgment, our committee has supported continued care in a majority of cases. Limitation of the consultation process to the attending physician has, in our experience, actually served to increase the credibility of the committee and has promoted acceptance of its recommendations. The committee's most useful function seems to be in assisting physicians and their patients in defining realistic goals and limitations of treatment. Within this context, the coming decade may find ethics committees concerned less with promoting the autonomous wishes of individual patients than with defining the limits of that autonomy against the competing demands of the larger society. Such a shift should be approached with caution.

Advance Directives↗