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PubMed2002

Defining the cultural milieu for implementing faculty practice in Pakistan.

Faculty practice can promote a collaborative partnership mutually beneficial to both nursing education and service. However, little is known about its implementation in developing countries. The purpose of this study was to explore the potential for introducing faculty practice within the cultural milieu of Karachi, Pakistan. Focus groups of nursing faculty, staff and students were conducted in various settings: government, semigovernment and private institutions to elicit the data. Data analysis revealed that a more comprehensive definition of faculty practice is needed that will provide the foundation for a culturally acceptable model of faculty practice in Pakistan. Hierarchy dominates the current cultural milieu and must be addressed before faculty practice can be implemented.

Attitude of Health Personnel↗
PubMed2002

An innovative partnership in service.

OBJECTIVE: Stimulated by the need for better alignment of educational content and goals with evolving societal needs, practice patterns, and scientific developments, many medical schools are implementing new and creative educational experiences for students. Tulane University School of Medicine and Apple Computers have established an innovative partnership in which Apple laptop computers support and enhance students' service learning projects. The partnership also provides a unique opportunity to meet the Medical School Objectives Project (MSOP) objectives in Medical Informatics and Population Health, as outlined in Report II.(1) DESCRIPTION: Apple Computers has a commitment to the New Orleans community as part of its corporate strategic plan to support educational programs at all levels; Tulane has a longstanding commitment to and experience with student-led service learning as part of the Foundations in Medicine Course.(2) Senior administrative personnel from Tulane and Apple discussed these common interests, resulting in a partnership to enhance the potential impact on the community served. Apple agreed to donate 20 G3 Powerbooks and a complete set of the Apple Learning series of software to support new and ongoing service-learning projects. A committee of Tulane faculty and students, information technology staff, and an Apple representative developed the project. To maximize students' access to the laptops while managing the administration's liability, the laptops were identically configured with standardized software packages (database development and maintenance, Web access, word processing, presentation development and execution, automated backup, and individual project access to protected server space). To maximize the use of the laptops, students from the service-learning organizations can check out the laptops on a just-in-time basis, because the projects have different needs over time. Student-service leaders are currently defining and developing the exact uses for the laptops. We anticipate that this project will enhance the administrative management of service-learning programs (e.g., schedules, directions to sites), the presentation of educational programs (e.g., teaching in schools), the creation of new media to support programs (e.g., our restaurant choking program has a partnership with the American Heart Association to create a video and training manual to be used nationwide), and data tracking (e.g., sites and clients served, outcomes achieved). Students' use of the laptops should support the achievement of several of the MSOP Report II Medical Informatics objectives. To assess that, all first-year medical students are completing a pre- and post-project survey based on those objectives. DISCUSSION: The availability of laptops and software should significantly enhance the service-learning programs. The students participating should gain important skills in the use of computer technology related to their roles as lifelong learners, educators and communicators, researchers, and managers.(1) We plan to report the results of the pre- and post-project surveys once they have been completed. Students' feedback on the project has been very positive, and we hope it can serve as a model for other medical school, corporate, and community partnerships.

Health Services↗
PubMed2006

Information system support as a critical success factor for chronic disease management: Necessary but not sufficient.

UNLABELLED: Improvement of chronic disease management in primary care entails monitoring indicators of quality over time and across patients and practices. Informatics tools are needed, yet implementing them remains challenging. OBJECTIVE: To identify critical success factors enabling the translation of clinical and operational knowledge about effective and efficient chronic care management into primary care practice. DESIGN: A prospective case study of positive deviants using key informant interviews, process observation, and document review. SETTING: A chronic disease management (CDM) collaborative of primary care physicians with documented improvement in adherence to clinical practice guidelines using a web-based patient registry system with CDM guideline-based flow sheet. PARTICIPANTS: Thirty community-based physician participants using predominantly paper records, plus a project management team including the physician lead, project manager, evaluator and support team. ANALYSIS: A critical success factor (CSF) analysis of necessary and sufficient pathways to the translation of knowledge into clinical practice. RESULTS: A web-based CDM 'toolkit' was found to be a direct CSF that allowed this group of physicians to improve their practice by tracking patient care processes using evidence-based clinical practice guideline-based flow sheets. Moreover, the information and communication technology 'factor' was sufficient for success only as part of a set of seven direct CSF components including: health delivery system enhancements, organizational partnerships, funding mechanisms, project management, practice models, and formal knowledge translation practices. Indirect factors that orchestrated success through the direct factor components were also identified. A central insight of this analysis is that a comprehensive quality improvement model was the CSF that drew this set of factors into a functional framework for successful knowledge translation. CONCLUSIONS: In complex primary care settings environment where physicians have low adoption rates of electronic tools to support the care of patients with chronic conditions, successful implementation may require a set of interrelated system and technology factors.

British Columbia↗
PubMed2003

Power imbalance between nurses and patients: a potential inhibitor of partnership in care.

The Patient's Charter identifies the need for nurses to respect patients' rights to influence their care, and contemporary nursing practice advocates that nurses work in partnership with patients. Hence nurses are encouraged to share their power and facilitate empowerment in their patients by giving them information and support. However, the literature indicates that nurses are not very successful in making patients feel empowered to make informed decisions. This study, conducted in 1998, provides some answers as to why this may be the case. The aim of the study was to explore and describe nurses' and patients' views regarding partnership in care in hospital. Using the grounded theory approach, participants were drawn from four hospitals in Western Australia. A purposive sample of 33 nurses and 32 patients were interviewed in-depth. Participant observation was also conducted and field notes were written. The interviews were transcribed verbatim and analysed using the constant comparative method. The findings showed that nurses viewed involving patients in care as requiring them to give patients information and to share their decision-making powers with them. With the exception of a few, the majority of nurses were unwilling to share their decision-making powers. This created a situation of power imbalance with subsequent little patient input. Factors identified included nurses' beliefs that they "know best", the view that patients lacked medical knowledge and the perceived need for nurses to hold onto their power and maintain control. If nurses and patients are to work as partners, it is important that nurses make every effort to equalize the power imbalance. One way to do this is for nurses to share and give information to patients readily and to be open in their communication with them.

Attitude of Health Personnel↗
PubMed1989

Interinstitutional collaboration for nursing excellence: Part 1, Creating the partnership.

A partnership between two unrelated public institutions was formed to enhance the quality of clinical learning for students and staff, promote exemplary care to patients, and foster expansion of nursing research. The critical nucleus of the partnership is the unit-based clinical nurse specialist who performs the multiple functions of professional nursing: practice, education, and research. This two-part series describes the collaboration effort. Part 1 focuses on the organizational structure created for the partnership, and part 2 reports the findings of a 15-week pilot study conducted to test the model.

Education, Nursing↗
PubMed2000

Identification of best practices in the delivery of patient food services through public/private sector partnerships.

This article describes the evolution of public/private sector partnership in patient food service delivery and identifies skills required by executives to manage partnerships effectively, features that may be generalized to other areas; and the importance of labour relations. Site visits conducted across Canada demonstrate that when partners understand each other's objectives, commit to providing strong leadership, and create meaningful labour relations and communications strategies, partnerships can be successful.

Benchmarking↗
PubMed2002

Patient autonomy: evolution of the doctor-patient relationship.

In recent years, much has been said about the shifting locus of control in clinical practice. This article discusses the influence on the physician-patient relationship of recent social and political history, patient culture and experience, and advances in medical practice. I suggest that effective partnerships between physicians and patients are possible in a supportive institutional environment in which the participants acknowledge and fulfil their roles and responsibilities in shared decision-making. While I recognize that there is considerable variability in practices across cultures and in individual behaviour, the scope of this article is based on literature and my knowledge, which is representative primarily of the North American experience.

Communication↗
PubMedDate not supplied

Transforming health care from the inside out: advancing evidence-based practice in the 21st century.

Health care is in need of change. Major professional and health care organizations as well as federal agencies and policy-making bodies are emphasizing the importance of evidence-based practice (EBP). Using this problem solving approach to clinical care that incorporates the conscientious use of current best evidence from well designed studies, a clinician's expertise, and patient values and preferences, nurses and other health care providers can provide care that goes beyond the status quo. Health care that is evidence-based and conducted in a caring context leads to better clinical decisions and patient outcomes. Gaining knowledge and skills in the EBP process provides nurses and other clinicians the tools needed to take ownership of their practices and transform health care. Key elements of a best practice culture are EBP mentors, partnerships between academic and clinical settings, EBP champions, clearly written research, time and resources, and administrative support. This article provides an overview of EBP and offers recommendations for accelerating the adoption of EBP as a culture in education, practice and research.

Benchmarking↗
PubMed2005

Implementation of a SNAP intervention in two divisions of general practice: a feasibility study.

"SNAP" is a model for the general practice management of four common behavioural risk factors: smoking, nutrition, alcohol and physical activity. The SNAP program was developed for the Australian Government in 2002. In 2003 and 2004, a feasibility study was conducted in one urban and one rural division of general practice (DGP) in NSW, in partnership with their local area health services. Information technology support and referral directories were developed, based on an initial needs assessment, SNAP guidelines, a clinical summary chart, patient education materials, and general practitioner and staff training. GPs reported that the SNAP approach fitted general practice consultations well. After its implementation, they were more confident in using motivational interviewing and SNAP interventions and referred more frequently. The impact and sustainability of the SNAP program were limited by a lack of effective practice teamwork, poor linkages with referral services, and the lack of a business model to support SNAP in the practices. DGPs could play an important role in providing practice visits and resources to improve communication, education and collaboration to support SNAP programs.

Alcoholism↗
PubMed1997

Staying single in the 1990s: single-handed practitioners in the new National Health Service.

The U.K. health care system is organised around independent medical practitioners who work in community settings and act as gatekeepers for acute health interventions. Recent developments in U.K. health policy have revolutionised the environment within which all general medical practitioners (GPs) operate. The last five years in the U.K. have seen the most fundamental health service reforms since the inception of the National Health Service (NHS) in 1946: namely, the development of the internal market, an increasing emphasis on primary health care, and changes to the GP Contract in 1990. Single-handed GPs (practitioners not in partnership with other GPs) traditionally work in the most deprived areas with the greatest health and social problems. The current restructuring and the subsequent organisational and policy initiatives present particular problems for single-handed practitioners. How single-handed practitioners respond to the reforms raises particularly important debates that are significant both for themselves and for the populations they serve. Drawing upon a range of sources, this paper discusses three central issues that emerge. First, how do single-handed practices relate to the more managerial role envisaged for authorities responsible for supporting primary health care? Second, given the development of the internal market, how do single-handed practices fare in influencing local policy and priority setting? Third, to what extent can single-handed practitioners take advantage of the opportunities to hold their own budgets? Overall, in the context of recent U.K. health care reforms, what is the future for "staying single in the 1990s"?

Family Practice↗
PubMedDate not supplied

Collaboration: aligning resources to create and sustain partnerships.

Academic-service partnerships are the future. These partnerships require a new paradigm and new practice models that necessitate change in how and where decisions are made as well as who is accountable for both the decisions and the outcomes of those decisions. The role of organizational leaders in this new paradigm becomes aligning resources to create and sustain partnerships. Partnerships are relationships and are only as effective as the communication between all entities. Decision-making is an important outcome of partnerships, yet there is little research regarding specific behavioral strategies that promote quality problem solving and decision-making. This paper extends the work of organizational theorist Ralph Stacey by proposing an event-driven typology of behavioral strategies for problem solving. The typology can assist organizational leaders to align resources for best practices in academic-service partnerships and be used as a framework for future research.

Benchmarking↗
PubMed1997

Development of a heart failure center: a medical center and cardiology practice join forces to improve care and reduce costs .

Congestive heart failure (CHF) is a rapidly growing and expensive cardiovascular disorder. Conventional care for CHF is ineffective and results in a cycle of "crisis management" that includes repeated emergency department visits, hospitalizations, and physician visits. Recently, a number of outpatient coronary care centers that provide consistent, aggressive outpatient therapies and extensive patient education have emerged and are successfully breaking this cycle of dependence on hospital services. One such effort is the Heart Institute's Heart Failure Center, the result of a partnership between a private-practice cardiology group and our tertiary-care medical center. Our program includes not only patient education and outpatient infusions of inotropic agents, but an electronic linkage to the emergency department and home healthcare services. Preliminary data show that 16 months after the program was initiated, hospital admissions decreased by 30%, hospital days by 42% and average length of stay by 17%. An effective outpatient heart failure program can alleviate the economic burden of CHF and improve the quality of patient care.

Cardiology↗
PubMed2002

University students with learning disabilities advocating for change.

PURPOSE: In recent decades Western psychology has conceptualized learning disabilities (LD) in terms of deficits and such related 'social emotional issues' as insecurity, low self-esteem and social isolation that can be rehabilitated through combined remedial teaching and psychological intervention. With increasing advocacy and legislation on behalf of people with disabilities in the US, UK and Australia, more resources are being made available to students with LD in institutions of higher education. Due to this increase in the quantity of services, written programmes and accommodations made to their needs, increased numbers of students with LD have been graduating successfully from institutions of higher education. This paper describes an option for treating students with LD that is based on a theoretical perspective that understands these students as an excluded population and emphasizes the importance of their empowerment. METHOD: A project involving social work students with LD at Hebrew University in Jerusalem is presented as a case study. Case-study investigation, one of the common methods of qualitative research, explores social and human problems in their natural context. A 6-year evaluation of this project was conducted based on questionnaires, focus groups, documentation of all activities related to the project, in-depth interviews and outcome measures. RESULTS: The results suggest that the project developed in three stages: raising awareness, building partnerships, and lobbying for rights and services. Outcome measures indicate that the project was successful in lowering dropout rates and improving students' academic achievement. Analysis of interviews with students suggests that the project positively affected the students' perceptions by helping them reframe the social and emotional connotations of their learning disability. Students reported marked social and emotional change, including reduced stress and anxiety levels and increased self-esteem. CONCLUSIONS: Empowerment practices that are based on partnership, participation, advocacy and social change provide an alternative to rehabilitation via individual therapy.

Achievement↗
PubMed1990

Factors of importance for the use of PAP-SMEAR in a Danish county without systematic screening.

Do various General Practice factors influence the participation rate (PR) in the cytological investigation for preventing cancer of the cervix uteri in counties without systematized screening? This was studied in the county of Aarhus, Denmark, where there are no systematic cytological examinations (CE). We studied a random sample of 2023 women aged 27.5 years to 47.5 years. Essential differences in PR depended on various practice characteristics. Practices with the highest average use of CE services, as counted by the Regional Health Authorities, also had the best PR. The relative chance of being sufficiently examined was almost twice as great among patients in active practices compared with other practices. Furthermore, practices with at least one female practitioner and practices that wanted the introduction of systematic screening had a significantly higher PR. There was a slightly higher PR for patients in large practices. Type of practice, i.e. whether single or partnership, and the individual practitioner's attitude to the efficiency of the present opportunistic screening were not related to the PR. Finally, a slightly lower PR was found among patients in the city of Aarhus, whereas the PR in the major cities of the county as a whole did not differ from the coverage rate in the county in general. It is concluded that the Health Authorities' average figure for CE-use/1000 women in the individual practice is the most significant factor that determines the CE rate for any given patient. Variation in the PR in different practices is unacceptably large if all the women are to receive a uniform CE screening offer.

Adult↗
PubMedDate not supplied

A consolidated approach to physician/hospital bonding--Ramsey Clinic style.

This article describes the results made by Ramsey Clinic during the second year following consolidation of the Clinic with a Hospital (St. Paul-Ramsey Medical Center); a medical education/research Foundation (Ramsey Foundation) into a public benefit corporation (Ramsey HealthCare, Inc.). Many issues inspired Ramsey Clinic to examine ways and means to stabilize its growth and development as a multi-specialty physician and dentist group practice in the highly competitive health care environment of Minneapolis-St. Paul, MN. Influencing the need to change were such elements as shrinking reimbursement for physicians from government and other third party payers; increasing malpractice and general liability premiums; as well as, escalating competition among area health care providers reflected by significant variations in charges for similar services and exclusivity agreements with HMO's and PPO's for select services. In the fall of 1987, Ramsey Clinic consummated its consolidation as a subsidiary member of Ramsey HealthCare, Inc., a public benefit corporation established by an Act of the Legislature of the State of Minnesota, 1986 Laws of Minnesota, Chapter 462. As a public benefit corporation, Ramsey HealthCare, Inc. was chartered to "engage in the provision and delivery of health care and related services." Ramsey Clinic serves as the physician organization for the corporation. An article appeared in the March/April 1989 issue of the Group Practice Journal titled "A Natural Partnership" which described the Ramsey approach and illustrated 1988 results following consolidation. Continued change has resulted in further integration of services among the subsidiaries with a focus on expense reduction, revenue enhancement and increased operating efficiencies. This article provides a longitudinal follow-up on operational amalgamations and 1989 results.

Charities↗
PubMed1994

Endoscopic ambulatory surgery centers and the corporate partner.

The number of practice-based endoscopic ambulatory endoscopy centers has increased dramatically in the last 5 years as gastroenterologists have recognized the advantages of these centers both for their practice and their patients. A new trend of joining with a corporate partner in ownership of the center is emerging. Such a partnership has clear benefit for physicians, their practice, their patients, and the corporation. Many existing and most forming practice-based endoscopy centers are giving serious consideration to these physician/corporate partnerships. Reasons to consider such a partnership, as well as the risks, are discussed.

Certification↗
PubMedDate not supplied

Improving perceptions of patient care--a nursing education and nursing practice initiative.

In January 2005, the University of Texas Medical Branch (UTMB) School of Nursing and the UTMB Hospitals and Clinics launched the first phase of a project to improve perceptions of patient care on the part of nursing faculty and nursing clinicians. A finding on the UTMB annual employee satisfaction survey that nursing faculty and clinicians tended to rate quality of UTMB patient care lower than other UTMB employees provided the impetus for the initiative. When UTMB colleagues noticed the findings, various entities including human resources and the Faculty Senate called for explanations from the dean of the School of Nursing, the chief nursing officer, and the CEO for the hospitals and clinics. In the process of attempting to give reasons for the findings, each of us determined we would take definitive action to address the situation. This article describes our accomplishments for Phase 1 of the initiative. Beginning with a vision for a productive professional community characterized by a pedagogical partnership between nursing education and practice, we share the processes we followed to (1) achieve mutual understanding among task force members, (2) obtain input on perceptions from nursing colleagues, (3) identify the clinical and nursing education aspects of the perceptions, (4) reach consensus on target perceptions for Phase 2 of the project, and (5) outline the next steps for the project.

Academic Medical Centers↗