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PubMed1999

Structure and provision of services in Black churches in New Haven, Connecticut.

Historically, Black (or African American) churches have played a central role as a center of religious and political life and also as a provider of human services and a healing community. This article examined the extent to which African American churches in 1 Northeastern urban environment are involved in the delivery of health and human service programs to their communities. It also explored how comfortable Black clergy are in referring their parishioners to the formal mental health system and identified the actual level of referrals. In addition, the analyses considered the individual and organizational characteristics that predict variations in the levels of support services and the likelihood of referral. Analyses revealed that African American churches deliver a broad range of services to the community. More than two thirds of the clergy feel comfortable in making a referral to a mental health agency or professional, and more than half have actually made a referral. Both service delivery and referral levels varied by several clergy and congregational characteristics. The implications of these findings for research and health policy are considered.

Adult↗
PubMed2004

Adoption, reach, and implementation of a novel smoking control program: analysis of a public utility-research organization partnership.

Interventions to reach and assist smokers and families of smokers have generally reached a plateau in terms of participation and success rates. This study reports on recruitment and implementation issues involved in a novel partnership with public utilities. The goal of the project is to use information on the synergistic risks of smoking and home radon exposure to motivate and assist smoking families to create smoke-free homes or to stop smoking. We report on recruitment, participation rates, and representativeness at both the utility and the individual or family level. This project recruited 55% of utilities approached and an estimated 11% of smoking families served by these utilities. Lessons learned for recruitment and implementation activities are discussed, and recommendations are made for the conduct and evaluation of future programs using innovative partnerships with public and population-based organizations to reach smokers and reduce exposure to environmental tobacco smoke.

Community-Institutional Relations↗
PubMed2005

Making a home in the community for the academic medical center.

Academic medical centers (AMCs) have traditionally provided primary care for low-income and other underserved populations. However, they have had difficulty developing lasting partnerships with other organizations serving the same populations. This article describes an exception to the rule, in which an academic division was created at Duke University Medical Center to develop effective collaborations with health care and social service providers in Durham, North Carolina, including both public agencies and private organizations. Together, the division and its partners have created and operate programs that improve health outcomes and access to care for those at risk. These programs share a number of characteristics: they are designed to meet the needs of the patient, not the provider; they are based in the community, not in the AMC; they bring services to people's homes, schools, and neighborhoods; they are multidisciplinary, combining health, social, and even mental health services; and, once established, they are revenue-generating and can be made self-supporting when grant funding ends. These programs are also innovative. They are designed to model and test new ways of organizing and delivering care. Preliminary indications suggest that they also strengthen the AMC's relationships with the surrounding community.

Academic Medical Centers↗
PubMed2005

Responsibly managing the medical school--teaching hospital power relationship.

The relationship between medical schools and their teaching hospitals involves a complex and variable mixture of monopoly and monopsony power, which has not been previously been ethically analyzed. As a consequence, there is currently no ethical framework to guide leaders of both institutions in the responsible management of this complex power relationship. The authors define these two forms of power and, using economic concepts, analyze the nature of such power in the medical school-teaching hospital relationship, emphasizing the potential for exploitation. Using concepts from both business ethics and medical ethics, the authors analyze the nature of transparency and co-fiduciary responsibility in this relationship. On the basis of both rational self-interest, drawn from business ethics, and co-fiduciary responsibility, drawn from medical ethics, they argue for the centrality of transparency in the medical school-teaching hospital relationship. Understanding the ethics of monopoly and monopsony power is essential for the responsible management of the complex relationship between medical schools and their teaching hospitals and can assist the leadership of academic health centers in carrying out one of their major responsibilities: to prevent the exploitation of monopoly power and monopsony power in this relationship.

Academic Medical Centers↗
PubMed2002

Evaluating stakeholder management performance using a stakeholder report card: the next step in theory and practice.

In the highly competitive health care environment, the survival of an organization may depend on how well powerful stakeholders are managed. Yet, the existing strategic stakeholder management process does not include evaluation of stakeholder management performance. To address this critical gap, this paper proposes a systematic method for evaluation using a stakeholder report card. An example of a physician report card based on this methodology is presented.

Evaluation Studies as Topic↗
PubMedDate not supplied

Partnering essentials.

"The Management Moment" is a regular column within the Journal of Public Health Management and Practice. Janet Porter, PhD, and Edward Baker, MD, MPH, MSc, are serving as The Management Moment Editors. Dr. Porter is Associate Dean for Executive Education, The North Carolina Institute for Public Health, School of Public Health, at the University of North Carolina at Chapel Hill, and Dr. Baker is Director of the North Carolina Institute for Public Health, School of Public Health, at the University of North Carolina at Chapel Hill. This column provides commentary and guidance on timely management issues commonly encountered in public health practice.

Community Health Planning↗
PubMed2004

The story behind the story of collaborative networks -- relationships do matter!

This study reports data about the real story behind the current trend of mandated interorganizational collaboration of health and human service agencies. By means of qualitative design (N-22), public health managers were interviewed about the extent and nature of their collaborative efforts in the Healthy Babies, Healthy Children (HBHC) Program in Ontario, Canada. Using a conceptual framework of resource exchange theory, this study found that relational processes specifically: (a) previous relationships with other agencies and (b) interpersonal relations namely: informality, local community, open communication and resolving conflicts were the reasons for successful collaborations. Implications are directed toward: health and social planners, administrators, board members, funding bodies and policy-makers. The study offers new knowledge about a subject which has received minimal attention in the literature.

Community-Institutional Relations↗
PubMed1991

Four ways to build cooperative recruitment alliances.

Cooperative recruitment programs or recruitment by networking can improve the quality and cost of hiring. Four strategies involve alliances with employee leasing firms, community-based organizations, educational institutions and competitors.

Community-Institutional Relations↗
PubMedDate not supplied

Partnering for the community's well-being.

Health care organizations throughout Michigan continue to adjust to tightening budgets. Even so, there is a growing need to understand and act upon the more global and vexing health issues facing local communities. Managed care has greatly impacted community hospitals as well as community health agencies. The need to do more with less, and to do it more effectively whenever possible, has become a challenge for all involved in the health delivery system.

Community Health Planning↗
PubMed2001

Telemedicine in vascular surgery: does it work?

Telemedicine (TM) using closed-circuit television systems allows specialists to evaluate patients at remote sites. Because an integral part of the vascular examination involves palpation of peripheral pulses the applicability of TM for the evaluation of vascular surgery patients is open to question. This study was carried out to test the hypothesis that TM is as effective as direct patient examination for the development of a care plan in vascular patients. Sixty-four vascular evaluations were done in 32 patients. The patients presented with a variety of vascular problems and were seen in regularly scheduled rural outreach vascular clinics. Two faculty vascular surgeons evaluated each patient; one was on site and the second, using TM, remained at the medical center. Each surgeon was blinded to the other's findings. The TM physician was aided by a nonphysician assistant, who obtained blood pressures, utilized a continuous-wave Doppler probe, positioned the patient, and operated the TM equipment. The results of each surgeon's evaluations were compared. Patient and physician satisfaction with the TM evaluation was appraised by questionnaires. Eight patients were seen for initial evaluations; 24 patients were seen for follow-up visits. Patients were seen with a variety of diagnoses, including aneurysm (seven), cerebrovascular disease (five), lower extremity occlusive disease (13), multiple vascular problems (three), and other disease (four). The average duration for the TM and on-site evaluations were 20.6+/-1.4 and 19.0+/-1.3 minutes, respectively (P = not significant). Physician concordance, as determined by treatment recommendations, was the same in 29 (91%) patients. Physician confidence in the ability to obtain an accurate history via TM was rated as excellent in 97 per cent; confidence in the TM physical examination was rated as excellent in 70 per cent. All patients rated the TM evaluation as the "same as" or "better than" the on-site examination, and all indicated a preference for being seen locally using TM as opposed to traveling to a regional medical center. We conclude that the TM evaluation of vascular patients is accurate and is as effective as on-site evaluations for a variety of vascular problems. Important adjuncts to enhance the success of a TM evaluation are physician experience with the technology and the presence of a knowledgeable on-site assistant. This technology can be easily adapted to other clinical situations.

Academic Medical Centers↗
PubMed1992

Health care consortia: a mechanism for increasing access for the medically indigent.

In response to poor coordination among health and social service providers, health care consortia have emerged in many areas of the United States. Consortia link multiple providers in a common structure to create comprehensive systems of care. They can be formally structured or informal combinations of providers that engage in coordination but otherwise do not comprise an independent organization. The functions most common among all types of consortia are shared services and service coordination; however, a number of consortia also operate outreach/education programs. Consortia represent an innovative response to the need both for vertical integration--case management of all levels of care--and horizontal integration to prevent duplication among primary care providers. We outline the history of consortia in which federally-funded community health centers have participated. We also suggest an analytical framework for the various types of consortia; discuss lessons learned about building and maintaining consortia; and provide preliminary outcome data.

Community Health Centers↗