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PubMed2001

[The effectiveness of implementing an unit-based shared governance model].

The purpose of the nonequivalent control group study was to establish a regional unit-based shared governance model. Fifty-three subjects distributing to experimental (n = 29) and control (n = 24) groups-age, working years, and education were matched statistically-were selected by "purposeful sampling" of Index of Professional Nurse Governance pretest mean scores from six units at a nursing department. Based on Martin's "systematic" evaluation model for shared governance, the study collected: (1) manager's and staff's perception of existing governance using open-ended questions, (2) measure of organizational efficiency using the IPNG and the Index of Working Satisfaction, and (3) the research team's assessment of the unit's willingness to continue this model in the future. The reliability and validity of the questionnaires were established. Intervention of the model was approximately four months, including: preparatory and evaluating phase: data was collected; educative phase: empowering managers and staff were educated in the shared governance concepts; implementing phase: shared governance team was built up. Two-tailed t and chi 2 tests were used to detect differences between the two groups. Results showed, after establishing the unit-based model, (1) an increase in the nursing professional governance and work satisfaction among nurses; (2) an enhanced partnership between managers and nurses; (3) staff nurses perceived increased autonomy, authority, and more frequently expressed their opinions to managers; (4) managers perceived their staff to have more potential competence, then task pushed effectively. The findings suggest that managers and nurses need to refine their professional roles based on the organizational mission, as well as to expand nurses' representation and participation in current organization-wide committees by trust and full delegation from their managers.

Female↗
PubMed1992

Implementing shared governance: a false start.

A case study of the implementation of shared governance in a large teaching hospital in Western Canada has been presented. The project was placed in jeopardy due to two major contingencies: turnover in the chief nursing executive position, and a sudden reduction in the operating budget of the nursing division necessitating significant layoffs. Other factors that threatened the survival of shared governance included lack of systematic, long-range planning; the number and diversity of major changes introduced concurrently in the nursing division; and insufficient support systems to sustain organizational change. In particular, some senior and first-line managers could not adapt to or accept the radical philosophical change and so they were unable to empower their staff and to provide the necessary reinforcement needed to ensure the success of shared governance. This combination of these factors contributed to the loss of momentum in the implementation of shared governance. Lowered morale in the wake of layoffs, together with union grievances, and lack of clarity of the role to be played by union representatives in shared governance produced conflict and confrontation within the nursing division and between union and management. Despite the difficulties encountered, there remains optimism and commitment to the challenge of making shared governance succeed. As this article goes to press, remarkable strides have been made in addressing the described issues. A task force composed primarily of staff nurses has developed a "customized" model of governance that meets the needs of the hospital and deals with the identified flaws of the first implementation attempt. The organization is optimistic that by taking time to develop a solid foundation for the proposed change and tending carefully to the details of decision-making processes, an effective structure to support the professional role of the nursing staff will be a reality.

Attitude of Health Personnel↗
PubMed1989

Shared governance: what it means to those involved.

Nurses saw shared governance as both a management philosophy and an organizational structure that changes the organizational culture and belief system. Because of these two aspects of shared governance, its implementation is an evolutionary process in which former roles are examined and new roles are learned. Power shifts during the implementation of shared governance create role conflicts and confusion in the decision domains of staff and managerial nurses. Shared governance is highly valued by participants as a mechanism to enhance commitment to the organization, accountability for nursing practice, and the professionalism of both the clinical and managerial staff. The participants valued the opportunities for growth and development of leadership skills that shared governance provided. While negative perspective were shared, they seemed to be secondary to the overall satisfaction with shared governance. Some of the negative perspectives seemed to relate to the length of experience with shared governance, whereas others seemed to be essential elements of the experience.

Decision Making, Organizational↗
PubMed2004

The roles of government in improving health care quality and safety.

BACKGROUND: Discussions surrounding the role of government have been and continue to be a favorite American pastime. A framework is provided for understanding the 10 roles that government plays in improving health care quality and safety in the United States. Examples of proposed federal actions to reduce medical errors and enhance patient safety are provided to illustrate the 10 roles: (1) purchase health care, (2) provide health care, (3) ensure access to quality care for vulnerable populations, (4) regulate health care markets, (5) support acquisition of new knowledge, (6) develop and evaluate health technologies and practices, (7) monitor health care quality, (8) inform health care decision makers, (9) develop the health care workforce, and (10) convene stakeholders from across the health care system. CONCLUSION: Government's responsibility to protect and advance the interests of society includes the delivery of high-quality health care. Because the market alone cannot ensure all Americans access to quality health care, the government must preserve the interests of its citizens by supplementing the market where there are gaps and regulating the market where there is inefficiency or unfairness. The ultimate goal of achieving high quality of care will require strong partnerships among federal, state, and local governments and the private sector. Translating general principles regarding the appropriate role of government into specific actions within a rapidly changing, decentralized delivery system will require the combined efforts of the public and private sectors.

Federal Government↗
PubMed2001

Health promotion and the First Amendment: government control of the informational environment.

Government efforts to protect public health often include controlling health information. The government may proscribe messages conveyed by commercial entities (e.g., false or misleading), recommend messages from commercial entities (e.g., warnings and safety instructions), and convey health messages (e.g., health communication campaigns). Through well-developed, albeit evolving, case law, government control of private speech has been constrained to avoid impinging on such values as free expression, truthfulness, and autonomous decision making. No simple legal framework has been developed for the government's own health messages to mediate between the legitimate goals of health protection and these other values. Nevertheless, government recommendations on matters of health raise difficult social and ethical questions and involve important societal trade-offs. Accordingly, this article proposes legal and ethical principles relating to government control of the health information environment.

Advertising↗
PubMed1994

Change of government and health services policy in Victoria, 1992-93 [see comment].

Although constrained by Federal financial dominance, State governments can, nevertheless, significantly shape a number of aspects of health policy within their own jurisdiction. New governments often seek to implement both substantive and symbolic policy changes. This is often also accompanied by alterations to organisational structures and personnel with a view to making implementation more effective. This article chronicles the continuities and changes in health services policy in the first year of the Liberal-National Coalition State Government in Victoria. These include institutional changes, key ministerial and bureaucratic appointments, health workforce issues, health services funding decisions, public and community health, and relations with the Federal Government. The decision-making style of the new government is also discussed. The authors regard the economic imperatives of Victoria's severe deficit as the dominant influence in all areas of public policy, including health services policy, although certain ideological predilections have also been evident. They further argue that the new government has primarily sought legitimacy by appealing to what it regards as its mandate to rectify Victoria's 'economic crisis' by reducing public expenditure and reforming managerial practices in the public sector.

Community Health Planning↗
PubMed2006

Genetic screening as a technique of government: the case of neonatal screening for cystic fibrosis in France.

The biomedicalization process and the rise of genetics that have occurred in the last few decades raise political issues concerning the ability of subjects in biomedicine to act and make choices. My work examines these issues through a study of the process by which neonatal screening for the genetic disease of cystic fibrosis (CF) was set up in France. It draws on qualitative interviews with 25 national officials making use of the Foucauldian notion of government, which implies power relations among entities recognized as subjects of action. I examine how different agents (or groups) came to form either governing or governable entities within this health policy, and by what means governance in this area is exercised. The study positions relations between governors and the governed in the dynamics specific to them, showing that screening for CF is, to a large degree, a political technique for governing self and others based on a biomedical technique. Two types of subject (a professionals' association and a patients' association) are seen to be constituted in different ways and endowed with more or less extensive power. More generally, the study raises the question of the form of the political, through the example of genetic screening.

Cystic Fibrosis↗
PubMed1997

Collaboration with government leaders to promote sustainability, Cross River State, Nigeria. The Calabar PMM Team.

PRELIMINARY STUDIES: Focus group studies and facility reviews revealed poorly equipped and under-utilized emergency obstetric facilities in two rural communities in Cross River State, Nigeria. INTERUENTIONS: Beginning in late 1992, state and local government leaders were contacted to sensitize them to the problem of maternal mortality and enlist their cooperation in activities to upgrade obstetric services. RESULTS: A maternal health unit was created in the State Ministry of Health. Government officials were instrumental in upgrading hospital and polyclinic facilities, correcting staff shortages, repairing an ambulance, establishing a blood bank, granting leave to midwives for participation in skills workshops and facilitating dissemination of information. COSTS: Nineteen visits to government officials required approximately 33 person-days of the team's time. Transportation, communication and per diems were also paid. Government contributed a considerable amount in staff time and provided venues for workshops. CONCLUSIONS: A great deal can be achieved to improve emergency obstetric services through collaboration with government. Support and cooperation of government leaders can also enhance sustainability of interventions.

Community Health Centers↗
PubMed1999

Rural health prepayment schemes in China: towards a more active role for government.

A large majority of China's rural population were members of health prepayment schemes in the 1970's. Most of these schemes collapsed during the transition to a market economy. Some localities subsequently reestablished schemes. In early 1997 a new government policy identified health prepayment as a major potential source of rural health finance. This paper draws on the experience of existing schemes to explore how government can support implementation of this policy. The decision to support the establishment of health prepayment schemes is part of the government's effort to establish new sources of finance for social services. It believes that individuals are more likely to accept voluntary contributions to a prepayment scheme than tax increases. The voluntary nature of the contributions limits the possibilities for risk-sharing and redistribution between rich and poor. This underlines the need for the government to fund a substantial share of health expenditure out of general revenues, particularly in poor localities. The paper notes that many successful prepayment schemes depend on close supervision by local political leaders. It argues that the national programme will have to translate these measures into a regulatory system which defines the responsibilities of scheme management bodies and local governments. A number of prepayment schemes have collapsed because members did not feel they got value for money. Local health bureaux will have to cooperate with prepayment schemes to ensure that health facilities provide good quality services at a reasonable cost. Users' representatives can also monitor performance. The paper concludes that government needs to clarify the relationship between health prepayment schemes and other actors in rural localities in order to increase the chance that schemes will become a major source rural health finance.

China↗
PubMed1997

Governing integrated health delivery systems: meeting accountability requirements.

Many Canadian provincial governments are exploring methods to increase the integration of health services in an effort to improve the care provided, while maintaining or reducing the costs. Integrated health delivery systems are being implemented in the United States, Britain and other European countries. Such systems aim to provide a full continuum of care to a defined target population under a financing system of capitation. This article explores the issues associated with the governance accountabilities of an IDS. A review of potential governance models is completed, and the factors that influence the choice of a governance model for an integrated delivery system are presented. In 1987. Ewell identified governing boards as the weakest link in the integrated health care systems of the United States. It is suggested that early attention to governance in the development of IDS models in Canada may improve the effectiveness of these systems.

Canada↗
PubMed1994

The government's role in hospital accountability for quality of care.

BACKGROUND: The role of the U.S. government in the accountability of hospitals for quality of care involves shaping the community of those interested in quality, developing methods and infrastructure, standardizing information, providing information and technical assistance, and enforcing standards. The federal government's role in shaping an atmosphere of trust or distrust is critical but underestimated. The research and development of methods and infrastructure is widely acknowledged and many health systems' reform proposals emphasize it. Several state governments have begun standardizing and providing quality information, and this role is also assigned to the federal government in several reform proposals. Enforcing standards, including licensure and certification, is the most widely understood governmental role; states license whereas the federal government certifies compliance with Medicare conditions of participation either directly or through accreditation by the Joint Commission. These standards are evolving rapidly. Only recently has government taken on the role of providing technical assistance for quality improvement. ISSUES: Health system reform legislation may shape hospital accountability by (a) mandating uniform quality performance measurement and disclosure, (b) replacing emphasis on minimum standards with emphasis on improvement, (c) changing the structure of certification requirements, (d) requiring participation in quality improvement activities, and (e) funding new quality improvement structures. Some support a federal role in developing and implementing measures, but there is disagreement on the feasible pace, the uses of the resulting information, and the federal role in quality improvement. There is also disagreement about the future form of Medicare-based federal quality improvement efforts.

Accreditation↗
PubMed2002

Supportive environments for physical activity and the local government agenda: a South Australian example.

In the promotion of moderate physical activity it is increasingly argued that a supportive physical environment is a key factor, and that local government is ideally placed to play an important role. This study reports on the factors that led one local government to take such a leading role. A semi-structured interview was conducted to find out why a chief executive officer of a local government decided that the creation of supportive environments for physical activity was the core business of council. The results show that key ingredients were that local government should take a strategic rather than an operational focus on the issue, that there should be open organisational structures to allow the various functions of local government to work together, and that there must be appropriate leadership. The findings suggest ways for engaging local government as a key partner in promoting supportive environments that are consistent with literature on policy, organisational structure and leadership theory.

Exercise↗
PubMed2005

Advocacy for mental health: roles for consumer and family organizations and governments.

The World Health Organization urges countries to become more active in advocacy efforts to put mental health on governments' agendas. Health policy makers, planners and managers, advocacy groups, consumer and family organizations, through their different roles and actions, can move the mental health agenda forward. This paper outlines the importance of the advocacy movement, describes some of the roles and functions of the different groups and identifies some specific actions that can be adopted by Ministries of Health. The mental health advocacy movement has developed over the last 30 years as a means of combating stigma and prejudice against people with mental disorders and improving services. Consumer and family organizations and related NGOs have been able to influence governments on mental health policies and laws and educating the public on social integration of people with mental disorders. Governments can promote the development of a strong mental health advocacy sector without compromising this sector's independence. For instance, they can publish and distribute a directory of mental health advocacy groups, include them in their mental health activities and help fledgling groups become more established. There are also some advocacy functions that government officials can, and indeed, should perform themselves. Officials in the ministry of health can persuade officials in other branches of government to make mental health more of a priority, support advocacy activities with both general health workers and mental health workers and carry out public information campaigns about mental disorders and how to maintain good mental health. In conclusion, the World Health Organization believes mental health advocacy is one of the pillars to improve mental health care and the human rights of people with mental disorders. It is hoped that the recommendations in this article will help government officials and activists to strengthen national advocacy movements.

Consumer Organizations↗
PubMed2006

Does governance matter? Board configuration and performance in not-for-profit hospitals.

As performance accountabilities, external oversight, and market competition among not-for-profit (NFP) hospitals have grown, governing boards have been given a more central leadership role. This article examines these boards' effectiveness, particularly how their configuration influenced a range of performance outcomes in NFP community hospitals. Results indicate that hospitals governed by boards using a corporate governance model, versus hospitals governed by philanthropic-style boards, were likely to be more efficient and have more admissions and a larger share of the local market. Occupancy and cash flow were generally unrelated to hospitals' governing board configuration. However, effects of governance configuration were more pronounced in freestanding and public NFP hospitals compared with system-affiliated and private NFP hospitals, respectively.

Cross-Sectional Studies↗
PubMed2006

The effects of governing board configuration on profound organizational change in hospitals.

This study extends the literature on governing boards and organizational change by examining how governing board configurations have influenced profound organizational change in U.S. hospitals, and the conditions under which such change occurs. Hospitals governed by boards that more closely resembled a corporate governance model were more likely to experience positive changes such as diversification and merger and less likely to undergo negative changes such as closure. Organizational performance influenced change, but largely independent of governance configurations. Only in the case of closure did we find that governance configuration operated jointly with organizational performance.

Data Collection↗
PubMed2005

The role of local government in physical activity: employee perceptions.

A key component in the promotion of health-related physical activity at the community level is the formation of key partnerships with traditional and nontraditional providers of physical activity. Local government, in particular, has a significant investment in the health and well-being of the community through their contribution to the development of infrastructure and the build environment. However, local government perceptions of how this investment, commitment, and partnership translate to the promotion of physical activity is less known. To identify the role and perceptions of local government in the promotion of physical activity, a series of focus groups were conducted within six key departments of the Rockhampton City Council. The findings show that although physical activity is not considered the core business of local government, there was a clear understanding of the role that local government has in the provision of facilities and infrastructure that support that community's ability to be active. The focus groups identified emerging patterns concerning physical infrastructure, liability and safety, responsibility within the organizational structure, and community partnerships. These results inform physical activity community initiatives and enhance future collaboration between the community and local government in Rockhampton.

Attitude to Health↗
PubMedDate not supplied

Unique governance for a national ministry. Catholic Health Initiatives' board structure empowers laity, supports mission.

The three original founding healthcare systems and 10 sponsoring religious institutes of Catholic Health Initiatives (CHI) have developed an unprecedented governance model to support their vision of a national Catholic health ministry in the twenty-first century. The new organization spans 22 states; annual revenues exceed $4.7 billion. Religious institutes choose either active or honorary status before consolidating with CHI, depending on their desired involvement in the organization. Currently, nine are active and two are honorary. CHI's civil corporation comprises one representative from each active congregation. These representatives approve major changes in mission or philosophical direction. They control board membership by appointing three to five congregation representatives as sponsorship trustees, who are responsible for approving the remaining members of the Board of Stewardship Trustees. This half-religious, half-lay governing board is responsible for leading CHI. CHI has only two levels of governance, a national board and boards of market-based organizations, for instance a network of facilities with one management structure, or a community board of an individual facility. This avoids multiple administrative layers and approval processes. The organization has a civil identity as CHI and a canonical identity as a public juridic person of pontifical right, called Catholic Health Care Federation (CHCF). The governing board members of CHI, as members of CHCF, serve as the religious sponsors for all CHI health facilities. Some facilities have already been "alienated" (turned over) to CHI by their religious institutes; others will be alienated in the future. CHI's recent consolidation with Sisters of Charity of Nazareth Health System added an 11th sponsor, a sixth geographic region, and two members--one religious and one lay--to the governing board. The governance model assists such growth through the appeal of an equal religious-lay partnership and a flexible sponsorship model.

Catholicism↗
PubMedDate not supplied

Surveys explore critical governance relationship.

The transition in religious-sponsored health care from a ministry of direct service to one of governance has generated serious and penetrating questions, analyses, and retrenchment. Emphasis on and demand for value-laden leadership development programs are growing at the same time that sponsoring groups are becoming more actively involved in the governance and oversight of their corporate ministries. Two recent Catholic Health Association (CHA) studies focused on the critical governance relationship between the sponsoring group and its incorporated ministries. The first study asked religious institutes and dioceses that were sponsors of CHA member health care freestanding facilities and systems to describe their current governance structure. The second study represented an initial attempt to identify qualitative components of effective governance or sponsorship and asked 19 major superiors and system chief executive officers (CEOs) to characterize an ideal relationship between sponsor and ministry. The studies' findings included the following: In freestanding facilities, lay-religious governing boards have all but replaced the all-sponsor and all-lay advisory boards of the past. Trustee orientation, development, and evaluation were not equally stressed in the three groups surveyed, with trustee evaluation programs lagging behind in all three. Major superiors and CEOs had remarkably similar expectations relating to accountability for mission, relationships between sponsor and corporation, communication, and leadership development. Both major superiors and CEOs looked for greater collaboration in defining roles, translating mission into "business plan", and developing formation programs for leadership. Major superiors' emphasized simplicity of life-style, whereas the CEOs stressed stable commitment to corporate ministry.

Catholicism↗