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PubMedDate not supplied

Professionalism is judged by appearances ... like it or not.

Exploring the larger subject of executive professionalism should include the whole range of behavior issues that affect others' perceptions of you. In this competitive environment, with limited time to manage relationships, physician executives must take control of all aspects affecting their credibility and communications. This is not to suggest that you become the stereotyped, air-brushed news anchor, all style and little substance, but that you create a total package, one in which the "inside" and the "outside" of your presentation are complementary. Focus your attention on how well you have developed these factors as a physician executive: Appearance; demeanor; professionalism; and integrity. To create a "total package," it is helpful to consider the following recommendations: Write "commercials" for yourself and your organization; use every interaction as a selling opportunity; make every context a platform; don't hide from criticism--seek it out; and use every opportunity that comes your way to listen.

Career Mobility↗
PubMed1999

[Hospital physicians in the light of letters of complaint].

In a competitive health-care system the quality of services and, closely related, customer satisfaction are significant success factors. Some patients or their relatives who are dissatisfied with the provided service express this in letters of complaint. Using the critical incident technique based on a sample of 54 letters of complaint regarding doctors' performance sent to the administration of the Inselspital of Berne we examined information such feedback contains. A total of 133 critical occurrences have been described. Seventy percent of the occurrences were related to medical treatment and 6% to the medical education and research process. The remaining 26% of the complaints concerned accommodation, care, administration or other areas. In the sphere of medical service procedures the dissatisfaction of patients centered on information provided to patients and their families (38%), followed by criticism concerning clinic organization (23%), interaction with the doctor (14%), his professional competence (13%) as well as the management of clinical data (12%). On average, 3 out of 10 letters allude to possible criminal or liability proceedings or seemed to have a potential for escalation in other areas. The situations as presented in these complaints is to be considered as objective and relevant. To continue the process of optimization and quality improvement it is therefore recommendable to take these signals seriously.

Humans↗
PubMedDate not supplied

Increasing the quality of patient care through performance counseling and written goal setting.

Patient care scores of staff nurses in seven Veterans Administration hospitals who used a performance counseling protocol that required written goal setting, coupled with head nurse modeling and support to achieve goals (experimental), were compared with scores of nurses who continued with usual practice (control). Staff nurses chose their own goals. One goal was to improve patient care and the other was to improve staff nurse professional competence. After six months, experimental group scores were higher on five patient care scales, one significantly. After 12 months, scores shifted in favor of the control group, one significantly. Experimental group scores were higher on patient interview questions after six months and made additional gains after 12 months. Experimental nurses generally were more satisfied with their nursing careers and described working relationships more positively. Some progress the experimental nurses made after six months was lost after 12 months. Nurses who received high patient care scores from outside observers described the hospital working environment in more positive terms. Relationships of three instruments that measure quality of patient care are presented.

Achievement↗
PubMed1999

The role of respiratory care practitioners in a changing healthcare system: emerging areas of clinical practice.

OBJECTIVE: To evaluate shifts in respiratory care practice in the context of changing healthcare system and market dynamics. STUDY DESIGN: Telephone survey, structured interview, and case studies. METHODS: We conducted a telephone survey of 471 respiratory care practitioners (RCPs), drawn from the membership database of the American Association for Respiratory Care. We also interviewed 10 employers of RCPs and conducted 2 in-depth case studies to supplement our survey results. We used several statistical techniques to analyze our data, including calculation of population-weighted descriptive statistics and multivariate regression models. RESULTS: Changes in the healthcare system have prompted RCPs to broaden their practice settings, skills, and responsibilities. Respiratory care practitioners are taking part in managed care-related activities, such as cost control and disease management. We found that the need for certain skills and responsibilities varies by practice setting. In our interviews, employers considered RCPs cost effective providers for certain services. CONCLUSIONS: The practice of respiratory care is evolving to meet the changing needs of the healthcare system. A key challenge is to ensure appropriate growth and development of the respiratory care profession, as well as the delivery of appropriate services under new care management settings and processes.

Allied Health Personnel↗
PubMed1999

[Hierarchy and authority].

Although the term hierarchy isn't in keeping with the times for secular spheres, the identical term ranking omnipresent and indispensable in a political way. Without ranking there ist no final but only a general responsibility. Ranking is based on authority--to be distinguished between professional competence an official authority. The latter one should be gained with inner agreement--by sanctions only when needed.

General Surgery↗
PubMed1999

Managing team activities toward success.

Although there are many definitions of a team and teamwork, Amgen, Inc., has defined a team as "a dynamic group of diverse people with common objectives but different responsibilities that is chartered with improving a process, a product or a service." Teamwork constitutes a blending of team dynamics with partnership; thus a new term was created to define teamwork at Amgen--"teamship."

Industry↗
PubMed1999

A system for the description of healthcare guidelines.

Contained costs and quality of treatment are two elements which have to be considered when planning and controlling both clinical and managerial activities of healthcare structures (HCSs). Each structure has to be marked by a high level of quality of treatment and by specific professional competencies and skills of its operators. It is therefore fundamental to provide a system which supports the management of processes and of guidelines which characterise an healthcare structure. In this paper we present a system able to describe processes of an HCS and in particular clinical guidelines. This system is based on a workflow conceptual model, able to represent clinical and managerial activities carried out in HCSs (the Atreus model).

Computer Simulation↗
PubMedDate not supplied

[Knowledge of health professionals about the prevention of cancer the cervix. Alternatives to medical education].

OBJECTIVE: Several studies have shown the importance of health care professionals as predictors of the use of cervical cancer screening (CCS). MATERIAL AND METHODS: A cross-sectional study of 520 health care professionals in the State of Morelos during 1998, in order to evaluate and quantify their level of knowledge on the impact, etiology, screening, diagnosis and treatment of cervical cancer. A 1 to 10 scale questionnaire was given, and the sample included family medicine specialists, general practitioners, specialist and general nurses, and social workers. Statistical analysis included analysis of variance and 95% confidence intervals. RESULTS: A knowledge mean of 4.74 (95% CI 4.57-4.88) was observed for a scale of 10; specialist physicians scored higher (mean 5.21, 95% CI 4.81-5.60) than social workers (mean 3.07, 95% CI 2.31-3.82). Periodicity of the Pap test in most cases was less than 1 year and there was poor consensus about the age period during which the Pap test should be obtained. The knowledge level was lower when trying to identify etiologic aspects and treatment perspectives. CONCLUSIONS: The results of this study show that, besides the improvement of undergraduate academic programs, it is necessary to improve educational interventions for health care professionals through the updating, recycling, training, health education, and continuing medical education, among others, to promote professional competence and thus improve the quality of medical care.

Clinical Competence↗
PubMed1999

The WOMB (Women's views of birth) antenatal satisfaction questionnaire: development, dimensions, internal reliability, and validity.

BACKGROUND: Antenatal services continue to change, stimulated by the Changing Childbirth report. Women's views should be an important component of assessing the quality of such services. To date, no published quantitative multidimensional assessment instrument has been available to measure their satisfaction with care. AIM: To develop a valid, reliable, multidimensional questionnaire to assess quality of antenatal care. METHOD: A multidimensional satisfaction questionnaire was developed using psychometric methods. Following fieldwork to pilot a questionnaire, three successive versions of it were given by midwives to pregnant women in their final trimester in nine trusts in the old South Western region of England. Their replies were analysed by principal components analysis (PCA) with varimax rotation; internal reliability was assessed by Cronbach's alpha. Face, content, and construct validity were all assessed during development. RESULTS: Out of 196 women, 134 (68.4%) returned the pilot questionnaires. One hundred and seventy-two (57.3%) out of 300 women returned version 1 of the WOMB (WOMen's views of Birth) antenatal satisfaction questionnaire proper, 283 (56.6%) out of 500 returned version 2, and 328 (65.6%) out of 500 returned the final development version. This final version consisted of 11 dimensions in addition to a general satisfaction one. These were [Cronbach's alpha]: five related to antenatal clinic characteristics (travelling to clinic [0.75], waiting at clinic [0.90], clinic environment [0.69], timing of appointment [0.78], car parking [0.85]), three 'professional' characteristics (professional competence [0.80], knowing carers [0.79], information provided [0.81]), antenatal classes [0.76], social support from other pregnant women [0.83], checking for the baby's heart beat [0.63]. There were significant moderate correlations (range = 0.24 to 0.77) between individual dimensions and the general satisfaction dimension. Women's dimension scores were significantly related to age, parity, social class, and best educational achievement. CONCLUSION: This multidimensional satisfaction instrument has good face, content, and construct validity, and excellent internal reliability. It could be used to generally assess antenatal services or to screen them to detect areas where further in-depth qualitative enquiry is merited. Its sensitivity to change over time, external reliability, and transferability to non-Caucasian groups needs to be assessed.

Adult↗
PubMed2000

[From university pedagogy to medical pedagogy: some reflections].

Recent studies have shown that an appropriate pedagogic training, characterized by a high specificity, is necessary for teaching in universities. However, the time when it should be initiated and whether it should be a compulsory or a optional formation are still debated. Furthermore, the specificity of medical training is at the origin of a new expending discipline, medical pedagogy, that must take into account the necessity to provide the students with a basic professional competence. Finally, postgraduate continuous medical education has its own methods that also require a preliminary pedagogic training.

Clinical Competence↗
PubMedDate not supplied

[Diagnosis of malaria in non-endemic countries : value, limitations and complementarity of existing methods].

The biological diagnosis of malaria is urgent to avoid rapid and fatal outcome. Every year in France, 5,000 imported malaria cases are observed. Thin stained blood smear microscopical examination remains the reference method of diagnosis; however its performance is linked to the professional competence of the biologists. Thus easier methods have been developed (QBC test). Some of them, limited to the diagnosis of malaria due to Plasmodium falciparum do not require highly skilled personal to perform or interpret (antigen detection on dipsticks, tests Parasight or cardboard, ICT Malaria Pf), but limitations and errors occurred. These different tests must be complementary methods of traditional diagnosis. In association with microscopical examinations, they provide rapid and efficient diagnosis of malaria in non-endemic areas. Relying on our experience, the best association is: QBC + thin blood smear and depending of results antigen detection (ParaSight F, ICT Malaria Pf).

France↗
PubMed2000

Provider terminations: strategies for risk management.

Managed care organizations should protect themselves from possible legal action by providers whom they have terminated, whether because of professional incompetence or for reasons related to the organization's business goals. Risk management begins by being aware of state and Federal laws regarding contracts, peer review, restraint of trade, discrimination, and retaliation against a provider. Managed care organizations should adopt a set of criteria for providers' professional competence as well as a list of business objectives that might necessitate the deselection of a provider. Because some courts have upheld a provider's right to a "fair procedure," managed care organizations also should consider offering providers an opportunity to respond to the termination decision.

Documentation↗