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PubMedDate not supplied

Process drift: preventing the adulteration of management methods in clinical practices.

This article discusses methods of mapping and standardizing processes in physician offices and ambulatory settings. It reviews the phenomenon of process shift: how a process, once established, changes over time and loses its effectiveness. The article presents the importance of this shift and how it leads to poor performance, along with methods to prevent it from occurring. The author details the development of process measures and internal benchmarking as a way of ensuring the ongoing integrity of office operations and maintenance of a high-performing office. The author also reviews the need to link job descriptions to process flowcharts.

Appointments and Schedules↗
PubMed2004

Shell-shocked. Looking out for the well-being of physicians--particularly in this malpractice environment--is the mark of a professional medical practice manager.

Practice administrators often find that an unwritten part of their job descriptions is running interference when one of the group's physicians faces a malpractice lawsuit. Supporting the doctor in the work environment and encouraging open discussion about malpractice long before lawsuits occur is a key part of running an effective organization.

Cost Savings↗
PubMedDate not supplied

Game on: creating competitive advantages.

Whether you are opening a new imaging center or trying to keep an existing center competitive, there are 3 critical factors: customer service, marketing, and a "what's next?" attitude. Customer service: Outstanding customer service is what sticks in the minds of referring physicians and patients. Not only does providing better service differentiate you from the competition, but it also boosts employee morale and motivates people to acquire new skills. Marketing: From the front office staff to the radiologists,promoting the center should be part of every employee's job description. Simply paying lip service to the concept of marketing will not cut it. A "what's next?" attitude: Complacency is a luxury that does not exist in today's competitive health care arena. Three facilities provide examples of how these factors applied to their success.

Ambulatory Care Facilities↗
PubMed1992

Detection of polycyclic aromatic hydrocarbon-DNA adducts in white blood cells from coke oven workers: correlation with job categories.

Polycyclic aromatic hydrocarbon (PAH)-DNA adducts were quantitatively determined by ultrasensitive radioimmunoassay (USERIA) and 32P postlabeling in 128 DNA samples from WBCs of 68 coke oven workers and a local control group of 13 workers. Forty-four samples had a detectable adduct level by USERIA, with a mean of 0.390 fmol adducts/micrograms DNA (12.9 adducts/10(8) nucleotides) in the exposed group compared to a mean of 0.316 fmol adducts/micrograms DNA (10.4 adducts/10(8) nucleotides) in the control group. The mean adduct level with 32P postlabeling was 0.05 fmol/micrograms DNA (1.67 adducts/10(8) nucleotides) for the exposed group and 0.046 fmol/microgram DNA (1.54 adducts/10(8) nucleotides for the control group. Based on job description the workers were divided in 4 groups: control, low-, medium-, and high-exposure group. Both methods produced a positive correlation coefficient between estimated exposure and PAH-DNA adduct levels. The significance levels determined with Kendall rank correlation were P = 0.0145 for USERIA and P = 0.0594 for 32P postlabeling. Adduct levels determined by 32P postlabeling showed a correlation with tobacco smoking in the control group. No significant correlation between PAH-DNA adduct levels measured by USERIA and 32P postlabeling was found. These results show that these methods recognize different parts of the complex exposures in a coke oven plant.

Coke↗
PubMedDate not supplied

[Professional stress and blood pressure reactivity to stress do not predict blood pressure at 5 years].

High job strain has been reported to be associated with higher blood pressure. Job strain could lead to hypertension if individual perception of stress or cardiovascular reactivity to stress are high. We report the results of the first five-year follow up study, which aimed to assess the respective influences of perception of professional strain and cardiovascular reactivity to a mental stress test on BP. A cohort of 292 healthy subjects (mean +/- SEM, 38 +/- 1 years) was followed for progression to hypertension outcome which was defined as an increase in SBP or DBP higher than 7 mmHg or a DBP higher than 95 mmHg during the follow-up. The high strain (HS) group representing 20.9% of the subjects was compared with the remaining subjects (NHS). Similarly the 20.9% subjects with the highest BP stress reactivity (HR) were compared with the remaining subjects (NHR). The Kaplan-Meier survival estimates revealed that neither high job strain, nor high stress reactivity, increased incidence of progression to hypertension. Age, alcohol, salt diet, BMI, and occupation did not interfere with our results. In conclusion, high stress cardiovascular reactivity and high job strain do not appear to be major risk markers for future high BP in healthy young adults. Stress could be associated with high BP at a short term and could explain high blood pressure in a long run only in stress-sensible subjects.

Adolescent↗
PubMed2004

The return to work experiences of colorectal cancer survivors.

During the past 15 years, the number of colorectal cancer survivors has risen dramatically. While it is unclear how many colorectal cancer survivors were employed at the time of diagnosis, it is reasonable to expect a significant proportion of these survivors were temporarily displaced from the work force. This article describes the return to work experiences of 250 colorectal cancer survivors. The majority (80%) of the survivors were employed at diagnosis and 89% returned to work. Of those who returned to work, 81% sustained employment 5 years postdiagnosis. Results indicate survivors were successful in their attempt to return to work and sustain employment. However, 34% of survivors delayed their return beyond 2 months postdiagnosis. After controlling for ethnicity, education, and disease severity, the reason for delay was related to chemotherapy treatment. Prospective studies of colorectal cancer survivors to document barriers to work return can guide interventions and occupational services to keep survivors healthy and in the workplace.

Adaptation, Psychological↗
PubMed2004

[What do dental students think about their future career practice? Differences between men and women].

Aim of this study was to get more insight into the career choice, plans and expectations, and practice pattern preferences of male and female dental students in The Netherlands. A structured questionnaire was sent out to all 5th year dental students in The Netherlands in the academic year 2001/2002 (n = 258). The overall response was 65%. Both male and female students prefered working in a group practice environment rather than a solo practice, in which significant more males prefered ownership. Only 23% of the males and 7% of the females expected to work full time in the future. An important factor was leisure time, but for the female students 'taking care for children' was still decisive. The new job description 'oral physician' for the future dentist as advocated by Dutch health authorities was found less attractive than the present profession 'dentist'. Only a quarter of the females and half of the males is interested to serve as manager of a team of dental health professionals. It is concluded that male and female dental students differ in their plans and expectations with respect to their future career choices and practice pattern preferences. As the majority of the present dental students is female this will have a major impact on the dental profession.

Adult↗
PubMed2004

[A quantitative and qualitative study on effective information flow for infectious disease control in welfare facilities for the elderly].

OBJECTIVES: To clarify factors associated with effective information tranges among staff of welfare facilities for the elderly, and to propose measures for an appropriate information flow system in welfare facilities and public health centers, communication channels and methods, and encouraging factors and barriers were investigated in terms of a printed medium on the control and management of scabies infections. METHODS: A self-administered questionnaire survey and an interview survey were conducted with the staff of welfare facilities for the elderly where "Control and management manual of scabies infection" had been distributed by the Tama-Tachikawa Public Health Center in Tokyo. A self-administered questionnaire was sent to managers and chief practitioners of 66 facilities. Respondents were obtained from 66 managers and chief practitioners (response rate: 84.8%), and 831 practitioners (response rate: 53.1%). The questionnaire consisted of 20 items for managers and 18 items for chief practitioners, including experience of scabies epidemics in facilities, training experience for the use of "Control and management manual of scabies infection," measures for information gathering, and current information flow within the facility. A semi-structured interview survey was conducted with the manager and/or chief practitioner and practitioners in five facilities. The number of respondents was 10. The interview questions included job description, scabies control measures, dissemination of the manual to the staff, use of the manual, flows of health-related information, and factors associated with information flows. Summarized codes were extracted from the transcriptions from tape recording and were categorized repeatedly according to similarity. RESULTS: In the questionnaire survey, differences of Community information flow by types of facilities and professional backgrounds were found. Variation was detected in measures for information gathering and focuses in information management between managers/chief practitioners and practitioners. Practitioners wanted opportunities for information exchange while managers/chief practitioners mainly focused on prioritization of information collected. In addition, many respondents felt that information networks outside the facilities were poorly organized. From the interview survey, three major categories were extracted, that is, 'Information flow system,' 'Personal qualification,' and 'Factors related to the information flow system.' As factors related to the information flow system, the following 7 subcategories were extracted. 1. Interest in information; 2. Working style and workload; 3. Information networks outside the facility; 4. Information management in the facility; 5. Environment for information sharing; 6. Budget for the information system; and 7. Interpersonal communication. CONCLUSIONS: For an effective information system, welfare facilities for the elderly should work on staff training, building their own information flow systems and improving the environment for information sharing and networking with specialized agencies, such as public health centers. At the same time, public health centers should support networking, interpersonal two-way communication and training of welfare-facility workers.

Aged↗
PubMed2005

Two executives, one career.

For six years, Cynthia Cunningham and Shelley Murray shared an executive job at Fleet Bank. One desk, one chair, one computer, one telephone, and one voice-mail account. To their clients and colleagues, they were effectively one person, though one person with the strengths and ideas of two, seamlessly handing projects back and forth. Although their department was dissolved after the bank merged with Bank of America, the two continue to consider themselves a package-they have one resume, and they are seeking their next opportunity together. Their choice to share a job was not only a quality-of-life decision but one intended to keep their careers on course: "Taking two separate part-time jobs would have thrown us completely off track" they write in this first-person account."We're both ambitious people, and neither of us wanted just a job. We wanted careers" In this article, the two highly motivated women reveal their determination to manage the demands of both family and career. Flextime,telecommuting, and compressed workweeks are just some of the options open to executives seeking greater work/ life balance, and the job share, as described by Cunningham and Murray, could well be the next solution for those wishing to avoid major trade-offs between their personal and professional lives. Cunningham and Murray describe in vivid detail how they structured their unusual arrangement, how they sold themselves to management, and the hurdles they faced along the way. Theirs is a win-win story, for the company and for them.

Administrative Personnel↗
PubMed2005

What do midwifery healthcare assistants do? Investigating the role of the trained healthcare assistant.

There has been relatively little discussion in the literature regarding the role of the healthcare assistant (HCA) in midwifery. The study examines and contrasts HCA duties in one maternity department in the Republic of Ireland. Observations of six trained HCAs were undertaken to evaluate if they have the relevant repertoire of skills as taught in a national training programme, and to assess if they are using these skills competently. Findings indicate that HCAs carried out more indirect patient care activities than direct care activities. Findings show that the HCA provided support to qualified staff by assisting them in a range of care activities. This was consistent with the specified job description and with their training programme. This exploratory study helps to further understand the role of the HCA. It identifies the activities that HCAs undertake in support of qualified staff in maternity settings. The findings highlight the need for further investigation to determine the relationship between the role of the trained HCA and the qualified midwife.

Adult↗
PubMed2005

What great managers do.

Much has been written about the qualities that make a great manager, but most of the literature overlooks a fundamental question: What does a great manager actually do? While there are countless management styles, one thing underpins the behavior of all great managers. Above all, an exceptional manager comes to know and value the particular quirks and abilities of her employees. She figures out how to capitalize on her staffers' strengths and tweaks her environment to meet her larger goals. Such a specialized approach may seem like a lot of work. But in fact, capitalizing on each person's uniqueness can save time. Rather than encourage employees to conform to strict job descriptions that may include tasks they don't enjoy and aren't good at, a manager who develops positions for his staff members based on their unique abilities will be rewarded with behaviors that are far more efficient and effective than they would be otherwise. This focus on individuals also makes employees more accountable. Because staffers are evaluated on their particular strengths and weaknesses, they are challenged to take responsibility for their abilities and to hone them. Capitalizing on a person's uniqueness also builds a stronger sense of team. By taking the time to understand what makes each employee tick, a great manager shows that he sees his people for who they are. This personal investment not only motivates individuals but also galvanizes the entire team. Finally, this approach shakes up existing hierarchies, which leads to more creative thinking. To take great managing from theory to practice, the author says, you must know three things about a person: her strengths, the triggers that activate those strengths, and how she learns. By asking the right questions, squeezing the right triggers, and becoming aware of your employees' learning styles, you will discover what motivates each person to excel.

Administrative Personnel↗
PubMedDate not supplied

Nursing career fulfillment: statistics and statements from registered nurses.

A state-level survey of registered nurses confirmed national findings and raised new issues. Findings revealed that while nurses love the intrinsic reward of nursing, they report workplace, relationship, and stress issues which contribute to frustration and exhaustion. These issues may prevent registered nurses from giving the nursing care they desire to deliver, hastening preventable retirement and costly turnover decisions.

Adult↗
PubMedDate not supplied

Preparing a cultural strategy for PACS.

Health Central Hospital in Ocoee, FL, performs in excess of 100,000 studies per year. In September 2003, it was determined that a picture archiving and communication system (PACS)--already an agenda item set for the current fiscal year-would have a go-live date of no later than July 1, 2004. That meant 9 months to research, develop, and implement the project. The objective was to bring PACS to fruition quickly and smoothly, have buy-in from all parties concerned, and not interrupt the daily flow of patient care in the process. The first step in the project was to select the vendors to be considered. Working closely with the radiology leadership team, a list of physicians who most frequently requested film was compiled. Among them, the team targeted 3 or 4 that it was believed would help champion the effort with their fellow physicians. Along with these pieces, the radiologists, physicians on staff at the hospital, and, of course, the nursing and administrative teams would be an integral part of the project. The groundwork was laid for hiring a consultant to assist in the process. A PACS coordinator job description was created. Then, a staff meeting was called to discuss routine business issues and bring PACS to the table. It is extremely important to bring all relative new data to the staff throughout the project. After that initial meeting, PACS was a regular agenda item. A project team was comprised of 6 persons from radiology, information systems (IS), and administration, as well as a radiologist. Each member was required to make all 4 site visits, give a brief written evaluation of the product seen, and provide a brief narrative for and against the equipment. The vendor was selected, a final proposal was obtained, and contract details were negotiated. A PACS Steering Committee was appointed, and a PACS coordinator and consultant were hired. The PACS was installed, and a computed radiography (CR) system was purchased and integrated with the PACS. Training was paramount to the project's success. The PACS coordinator had experience educating physicians on using the technology; therefore, Health Central was able to provide the staff, radiologists, and hospital physicians with on-site, hands-on training. The hospital's culture has changed since PACS. Complaints have been reduced, and the number of exams waiting for radiologists to read each morning has been reduced by more than 50%.

Consultants↗
PubMed2005

[Disability caused by essential hypertension complications in Sarajevo Canton in the period 1998-1999].

The aim of this study was to assess working ability of persons suffering from some of essential hypertension (EH) complications in Canton Sarajevo in the period of two years (01.01.1998-31.12.1999). Recorded complications included: congestive heart failure (CHF), heart attack (HA), angina pectoris (AP) and cerebrovascular disease (CVD). The study included 606 persons with EH with clinically verified complications, out of whom there were 416 males of average age of 53.4 (+/- 14.7) years, and 190 females of average age of 50.3 (+/- 12.8) years. There were 377 (62.2%) persons assessed with complete loss of working capability, 126 (20.8%) with limited working capability and only 103 (16.9%) were found without disability in regard to the tasks required in their job description. It was confirmed that EH complications have significant impact to disability among insurants in their most productive working age. CHF is the leading cause of complete loss of working capability, particularly in the group of labour workers with low qualification structure, followed by CVD, HA and AP. Disability-loss and limited working capability was dependant on sex, age, type of complication, qualification structure and the type of occupation. The results of this study indicate urgent need for establishing a more efficient concept of primary prevention as well as better and comprehensive treatment of the EH in order to reduce morbidity and disability among the working age population.

Adult↗