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PubMed2002

Managing the healthcare workforce: cost reduction or innovation.

Labour costs are the largest proportion of total costs in the health industry in developed countries and are a target in health sectory reform. The Kennett government in Victoria introduced policies based on competition and cost reduction and the decentralisation of industrial relations through enterprise bargaining. These policies directly impacted on the health workforce leading to work intensification, labour shortages and poor morale. The Bracks government has since returned to centralisation. This paper argues that it is time for a more innovative approach to health workforce management based on recognising staff as an asset rather than a cost.

Capitalism↗
PubMed2005

Health and safety measures available for young labourers in the cottage industries of Karachi.

OBJECTIVE: To determine the health problems faced by labourers, 18 years and under, working in the cottage industries of Karachi and know the safety measures available and utilized at these places. DESIGN: Cross-sectional study using two-stage cluster sampling. PLACE AND DURATION: From February 2002 to March 2003, 95 cottage industries from 10 different locations of five districts of Karachi were included. SUBJECTS AND METHODS: All workers, 18 years and below, present were interviewed. The environmental and safety gadgets present at the industry were inspected by the surveyors and the manager was interviewed for presence of health and safety benefits for the workers. RESULTS: A total of 280 workers were interviewed, 26 (9.3%) children were between 9-12 years, 82 (29.3%) were between 13-15 and 172 (61.4%) were between 16-18 years of age. Health benefit was given to only one 13-year-old worker in silk industry; appropriate gadgets were absent in 93 (97.8%) industries, present only in 2 industries (one silk and one loom). First Aid box was present in only one loom industry. Two hundred and forty workers (85.7%) were unaware of the materials they were using. One hundred and ninety-three (69%) children were working in improper light, 199(71%) workers experienced high level of noise, 232(83%) were working in high temperature and 155(55.3%) were working with improper ventilation. Health problems faced included joint pains (n=64, 22.85%), backache (n=85, 30.35%), vertigo (n=48, 17.14%), numbness of fingers (n=77, 27.5%) and fatigue experienced by 143 (51.07%) children. CONCLUSION: The children and adolescents employed in cottage industry are suffering from health problems due to lack of knowledge on their part, and improper ergonomics, environmental and safety conditions at the workplace. The cottage industry should be regulated and brought under labour law. The health sector non-governmental organizations should make concerted efforts for the rehabilitation of this workforce by creating awareness and providing opportunities for education and development of skills.

Accidents, Occupational↗
PubMed1993

Day-care supply by Dutch municipalities.

"In this article we report and discuss our investigation into differences in day-care supply among Dutch municipalities....A description of day care in the Netherlands in relation to female labour supply is given.... Attention is given to the comparison of the Netherlands with other European countries.... Hypotheses are formulated concerning differences in day-care supply among Dutch municipalities." (SUMMARY IN FRE)

Behavior↗
PubMed1991

The designated forensic professional program: a state government-university partnership to improve forensic mental health services.

As the law/mental health field has expanded and matured in the last 20 years, the sophistication required by mental health professionals in order to respond appropriately to legal questions has grown significantly. Courts and legislatures define a growing number of legal competencies. Judges and attorneys are more familiar with mental health law than they were 10 or 20 years ago.

Credentialing↗
PubMed2003

[Modern operating room management in the workflow of surgery. Spectrum of tasks and challenges of the future].

The operating unit is one of the cost-intensive facilities in a surgical clinic with a pacemaking function for most of the internal procedures. The power of performance of the operating unit is based on the cooperation of all disciplines and professions involved. The key to management of the operating unit is not only to coordinate the daily procedures, but also to interact with support personnel. To ensure successful OR management, the internal structure of the OR must fit the clinical tasks and the available quantity of personnel in each profession must be coordinated. Sufficient utilization of resources and equipment must be guaranteed without cost-intensive over-capacities and patient flow must be orientated to OR capacities. The development of such a business structure requires the management to clearly define the goal, to know the actual on-site data in detail with regard to the idiosyncratic workings of each specialty and to clearly assign the competence of each member of the team working in the OR. Coordination of the operating unit is the main task of OR management, which must ensure the following: transparent and coordinated schedule management in the various operative specialties, goal-directed changes of the schedule with incorporation of emergencies, as well as effective organization of staff. In order to realize these tasks, it is reasonable to implement interdisciplinary rules of procedures. In addition, the assignment of a neutral decision-making body within the OR and the creation of an information center for all OR personnel. The challenge of OR organization in the future is to implement more effective documentation systems and active controlling within the OR. One can ensure adequate utilization of resources in the OR with prospectively oriented planning. Better transparency of operations in the OR contributes to increased efficiency. Implementation of quality management is the foundation for a successfully operating surgical hospital. Not only the productivity of individual members of the staff, but also the precise documentation of the quality of results will become important parameters in a successful surgical hospital, whose nucleus is the OR.

Appointments and Schedules↗
PubMed2006

Challenges in developing paediatric surgery in Sub-Saharan Africa.

The aim of the present study is to report on the difficulties in developing paediatric surgery in a teaching hospital in Tanzania. The methods are as follows: (1) information on the demography and health services of Tanzania were obtained from the Ministry of Health and the 1998 consensus report; (2) hospital data was obtained from the Medical Director's Office and analysed; (3) the current delivery of surgical services for children at the Tumaini University Hospital and Kilimanjaro Christian Medical Centre (KCMC) is reported; (4) the local, national and international support for the development of surgical services for children is noted; (5) the teaching, training and research programmes are proposed. The results showed that (1) Tanzania has a population of 31 million with a total health expenditure of 10%. There is 1 doctor for 23,000 inhabitants and 1 hospital bed per 940. The infant mortality is 173 per thousand life births. (2) The bed capacity at KCMC is 500 with a staff of 40 consultants, 294 nurses, 246 health attendants and 38 clinical officers. (3) Forty-two percent of admissions to the surgical ward and 50% of surgical outpatients are children. Surgical newborns are cared for in the special care baby unit and there are no neonatal or paediatric ventilators. (4) Support to develop surgical services for children has been pledged for locally, nationally and internationally; however, delivery of the service has not had the equivalent momentum. (5) The proposed teaching and training programme has been approved by the University. There is a need for surgical services for children with encouraging support for this venture; however, the challenges remain in delivering the service.

Child↗
PubMedDate not supplied

Curriculum resources for training direct care providers in public sector mental health.

Direct care personnel who do not have graduate-level professional degrees provide a substantial amount of client care in mental health organizations across the nation. Training for them is minimal in many settings. This shortcoming may negatively affect client care, staff recruitment and retention, and the effective use of scarce resources. In this paper, we identify and review curriculum resources available to mental health organizations interested in implementing or enhancing training programs for direct care personnel. These include two relevant competency sets and six portable training curricula, as well as information on how to access these resources.

Behavioral Medicine↗
PubMed1995

Development and experience of a university-based, freestanding birthing center.

OBJECTIVE: To describe our experience with a freestanding birthing center established in conjunction with a university medical center, and to determine the safety and effectiveness of such a program. METHODS: The University of California Irvine Medical Center opened a freestanding birthing center 2 miles from the hospital. The unit provides prenatal, labor, delivery, postpartum and well-baby care 24 hours/day. All direct patient care is provided by certified nurse-midwives. Data were collected prospectively to provide a descriptive account and to evaluate maternal and perinatal morbidity and mortality to determine the safety and efficacy of this approach. RESULTS: During the first 20 months of operation, the University of California Irvine Birthing Center cared for 1830 patients. Approximately 90% were indigent, 85% were Hispanic, and 35% were nulliparas. Of the total patients, 12% were transferred antenatally for high-risk conditions and 19% were transferred intrapartum. The cesarean rate for all patients was 10% (6.5% for those whose intrapartum care began at the birthing center). The perinatal mortality rate was six per 1000. Neonatal morbidity rates, neonatal intensive care unit admissions, and maternal complications were not greater than expected. CONCLUSION: The first 20 months of experience with a university-based, freestanding birthing center suggests that this alternative is safe for delivering obstetric and newborn care to low-risk patients.

Adolescent↗
PubMed1987

Age at marriage in Malaysia: a hazard model of marriage timing.

"This paper estimates a proportional hazards model for the timing of age at marriage of women in Malaysia. We hypothesize that age at marriage responds significantly to differences in male and female occupations, race, and age. We find considerable empirical support for the relevance of economic variables in determining age at marriage as well as evidence of strong differences in marriage patterns across races."

Age Factors↗
PubMed2006

Succession planning.

This article provides the reader with an appreciation of the diverse elements that go into a buy-sell, affiliation, or merger situation for veterinary practices. In the changing market place of American veterinary medicine, old paradigms no longer hold comfort. The generational differences are briefly explored herein as well as the new economic realities. A few examples are offered to illustrate just how much variability exists in the current business of veterinary medicine and the subsequent practice transitions needed to enhance value. Functioning models are explored, as well as affiliation and merger options. Practice valuation is discussed in general terms, referencing the cutting-edge factors. The six-point summary provides almost all practices a solid operational base for daily operations and succession planning.

Economic Competition↗