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PubMed2002

Management and governance processes in community health coalitions: a procedural justice perspective.

Community-based coalitions are a popular strategy for promoting community health despite the fact that coalitions often fail to achieve measurable results. Using a procedural justice framework, this study seeks to advance knowledge about the relationship between coalition governance and management processes and indicators of coalition functioning. Member survey data from 25 coalitions participating in the Community Care Network Demonstration Program were analyzed using two-stage least squares regression. Results show that personal influence in decision making. decision process clarity, and collaborative conflict resolution were significantly associated with procedural fairness perceptions. Procedural fairness perceptions, in turn, were positively associated with member satisfaction with coalition decisions, but not personal engagement in the coalition or organizational integration of coalition goals and activities. Personal influence in decision making and collaborative conflict resolution also exhibited direct relationships with all three indicators of coalition functioning examined in the study.

Community Health Planning↗
PubMed2004

Radiology as a part of a comprehensive telemedicine and eHealth network in Northern Finland.

Oulu University Hospital is the northernmost tertiary hospital in Finland and its responsibility area is the largest in the country, covering nearly half of the Finnish territory, also including the arctic regions. Because of vast distances and a sparse population, Oulu has been a forerunner in developing telemedicine and eHealth services in the country. The development started in 1990 and has resulted in the establishment of teleradiology and televideoconferencing services, distance education and a multimedia medical record with remote access capabilities. Wireless technology has been a special focus area, as has the development of an efficient communication between primary care and secondary care. This review highlights some of the key success elements.

Arctic Regions↗
PubMedDate not supplied

When is a physician network a group?

Developing a network of physicians into a high-performing group requires a cultural transformation. The hallmarks, as well as the obstacles, to achieving this are reviewed by two experienced consultants. The requirements of highly successful physician organizations range from sharing a common mission, vision, and values to developing an effective infrastructure to having visionary leadership. Barriers to successful physician groups include a lack of clarity of purpose and goals, lack of quality standards, and an absence of shared learning. A blueprint on how to become a successful physician group is provided.

Community Networks↗
PubMed2005

[Clinical genetics for hereditary cancers: from the viewpoint of physicians working at a hospital specialized in cancer].

In our daily practice, we provide clinical genetic consultation for patients at risk for hereditary cancers. The clinical characteristics of hereditary cancer syndromes in adults differ from those of hereditary diseases in children, although both involve genetic disease. One major difference is the difficulty in diagnosing hereditary cancers. Genetic testing has enabled us to diagnose HNPCC and familial breast and ovarian cancers. Another difference is the possibility to improve the outcomes of hereditary cancer syndromes by medical intervention. Intentional surveillance thus plays a key role in the management of hereditary cancer syndromes. These features make genetic counseling essential for hereditary cancer syndromes, including genetic testing and lifelong disease management. Networking among genetic disease specialists is particularly necessary. Clinical geneticists should be responsible for not only genetic disease but also for genomic information about cancer, with the ultimate goal of providing "order-made" medical consultation and services. Another important goal is the establishment of systems for the comprehensive care of patients and for the career development of specialists to provide regional-based care for persons who have or are at risk for hereditary cancers, including future generations.

Adult↗
PubMed2002

Characterizing the structure of small-world networks.

We give exact relations for small-world networks (SWN's) which are independent of the "degree distribution," i.e., the distribution of nearest-neighbor connections. For the original SWN model, we illustrate how these exact relations can be used to obtain approximations for the corresponding basic probability distribution. In the limit of large system sizes and small disorder, we use numerical studies to obtain a functional fit for this distribution. Finally, we obtain the scaling properties for the mean-square displacement of a random walker, which are determined by the scaling behavior of the underlying SWN.

Community Networks↗
PubMed2005

Families' experiences of support provided by resource-oriented family professionals in Finland.

This study describes the support provided by resource-oriented family workers in Finland and the prerequisites for such support. Family workers consisted of professionals such as public health nurses, nurses, social educators, psychologists, kindergarten teachers, and social workers. The overall research project consisted of four separate studies carried out within the Families With Children Project. The findings of the four studies were aggregated and submitted to a secondary analysis. Interview data from 51 parents across 44 families with young children were included in the analysis. The families reported that they received emotional, cognitive, instrumental, and community and network support from the family workers. The work of resource-oriented family professionals was facilitated by the arrangements and orientation of the service model and by the quality of interaction between the family worker and the family. The families' experiences of support underlined the multiple dimensions of the cooperative relationship and the usefulness of the supportive interaction. The findings extend the understanding of resource-oriented family work from the perspective of families and offer important implications for the caring of families with young children.

Adolescent↗
PubMed2001

[Network of care for breast cancers: a prospective survey among general practitioners].

OBJECTIVE: To clarify the general practitioner (GP)'s current perception on a network dedicated to mammary cancers in a rural department. METHODS: A survey by questionnaire was carried out from March to September 1999. This questionnaire made of 3 different sheets and 4 parts entitled "your practice in oncology", the "partnership", "GPs and network", "expectations" respectively, was mailed to 233 GPs board certified by the Conseil Départemental de l'Ordre des Médecins. Questionnaire included space for free comments and a specification sheet. There was no letter of reminder following the first mail. RESULTS: The rate of spontaneous answers was 48% (112/233). Representativeness of the sample was considered coherent with age, sex-ratio, mean duration of setting up, practice modalities in the department of Aube. GPs took care, on annual average, over 6 patients with breast cancer. They generally referred their patients to the oncologist team at the Centre hospitalier général. Such a choice was mainly sustained by the quality of patient reception, the psychological support and the fraternal relationship. GPs were mostly concerned (76%) by the management of both chemotherapy side effects and psychological problems occurring in their patients. By popular request, they wished the setting up of a hot line and a systematic historical reminder of the adverse effects joined to the mail. As far as the network was concerned, 83% of the GPs thought it could be helpful, but only 60% would actively participate. Reasons for such a discrepancy are discussed taking free comments into account. CONCLUSIONS: GPs in the Aube department seem eager to practice in a more collective way, which places the patient in the heart of the medical approach. However they demand to play a key role according both to their knowledge of the whole file and to the trust the patients are putting on them.

Adult↗
PubMed1996

Why will physicians in this new environment replace MHAs?

The competitive forces of managed care, capitated payment, cost constraints, and the formation of health networks are among the major precipitating factors leading to the employment of additional executives and middle managers with clinical backgrounds. These factors will require our health leaders to know how to cut costs without seriously impinging on the accessibility and quality of patient care. Physicians with leadership and management skills, and with prior hands-on patient care expertise, will continue to be sought after in the foreseeable future by various types of health organizations. With this scenario, health services management generalists are predicted to experience increasing difficulties to secure senior positions in the health industry,

Canada↗
PubMed2004

Improving America's access to care: The National Institute of Dental and Craniofacial Research addresses oral health disparities.

BACKGROUND AND OVERVIEW: The National Institute of Dental and Craniofacial Research, or NIDCR, in 2001 sponsored the establishment of Centers for Research to Reduce Oral Health Disparities. The centers are based at Boston University; New York University; the University of Michigan; the University of Washington; and the University of California, San Francisco. Reflecting the importance of research to reduce disparities, the centers, along with related grants, represent one of the largest financial commitments ever made by the NIDCR. The centers are sponsored in part by the National Center on Minority Health and Health Disparities, or NCMHHD. Each of the five centers has forged partnerships that include ties with dental societies, state and local health agencies, community and migrant health centers, American Indian tribal nations and institutions that serve other diverse patient populations. CONCLUSIONS AND CLINICAL IMPLICATIONS: This network is attempting to address the needs of communities with poor oral health. A major part of the effort of these new centers is to build community networks and establish long-term relationships. Center investigators also recognize that solutions to these vexing problems must be built on an understanding of the social, economic, racial, educational, political and behavioral factors that affect most health care issues.

Adolescent↗
PubMed1996

Regulating health insurance: the challenges of managed networks.

The role of the regulator in health insurance is examined in the context of the change in nature of regulatory oversight necessary to monitor the activities of the regulated parties. Health insurance to this point has been largely regulated by insurance departments that have historically focused on monitoring the solvency and meeting the contractually required reimbursements for indemnity carriers. Now as the indemnity carrier has either migrated to managed care or faced a declining book of business, the historic role of regulation must change to match the new environment. This article examines the role of the health insurance/managed care regulator department under this new paradigm and identifies where and how the regulator can exert influence in such a system.

Bankruptcy↗
PubMed1996

[The relative importance of independent living for the social functioning of the elderly].

This article confronts the belief that, among elderly persons, living (in)dependently is equivalent to functioning (in)dependently. It has been examined to what degree the living situation of elderly persons (either living independently or in a residential home) affects the degree of social functioning (as indicated by the size of the personal network, participation in voluntary organizations, outdoor mobility and loneliness), when the differences in need for care and background characteristics are taken into account. Respondents were 2523 older persons between 68 and 90 years of age, who took part in the main survey of the NESTOR-programme "Living arrangements and social networks of elderly'. Using a LISREL-model the direct effects of the living situation on the four aspects of social functioning are examined. The results indicate that, controlled for the need for care and the background characteristics, older persons living in a residential home have smaller networks, participate less in voluntary organizations, and have a lower outdoor mobility compared to independently living older adults, but are not more or less lonely. The relatively low degree of social functioning of older persons living in a residential home can also be explained by factors as the need for care, age and partner status. The general conclusion is that living independently contributes to the maintenance of social functioning outside the home, whereas the social life of older adults in residential homes remains to a large degree "indoors'.

Activities of Daily Living↗
PubMedDate not supplied

Initiating a pediatric office-based quality improvement program.

This article describes a pediatric primary care network's initiative to implement an office-based quality improvement (QI) program. First, network physicians determined their priorities for quality improvement. Then primary care practitioners on the Quality Committee (QC), representing each local group practice, were educated about a physician-led QI process. The four steps of this process are as follows: (1) Set quality aims, (2) determine measurements of improvements, (3) generate ideas for change, and (4) test changes. Next, the QC selected two initial projects--office preparedness for pediatric emergencies and asthma management--and corresponding subcommittees were formed. The pediatricians identified QI practice changes they believed could be implemented successfully to make a measurable difference in children's healthcare.

Asthma↗
PubMed1995

The transformation of hospital laboratories: why regionalization, consolidation, and reengineering will lead laboratories into the 21st century.

In 1990 we predicted that the growth of prospective payment and fixed reimbursement plans would force hospitals to transform the hospital laboratory into a cost center. The need to create alternative modes of care would further lead hospitals to create regional laboratory consortia. This would include the "commercialization" of the laboratory so that it could become a regional resource and expand outreach activities. This report updates events since 1990. Indeed, the arrival of prospective payment and fixed reimbursement has caused a radical upheaval among health care providers in every part of the country. The transformation was more rapid than we expected, particularly in two areas. First, the commercial laboratory industry devoured itself. By 1995 the consolidation movement ended and three huge national laboratory chains now provide laboratory services throughout the United States. Second, not only did prospective payment arrive in the form of capitated contracts for laboratory services, but it arrived with remarkable speed. It was coupled with the absolute decline for three years in Medicare reimbursement for lab services. Such changes to reimbursement levels have seriously undercut the financial viability of the laboratory industry. Hospital-based laboratories are responding to these pressures with three strategies: reengineering, consolidation, and networking. Six identifiable trends will drive the transformation of laboratories into regional provider consortia between now and the year 2000. We predict that the speed of this transformation will be even faster than that experienced by the consolidation of commercial laboratories. This will occur because hospital labs are already a component within integrated delivery systems. As these systems transform and evolve, the laboratories must transform in concert. Our experience indicates that laboratory consolidation delivers economic benefits that are considerably greater than either networking or reengineering. Consolidation, accompanied by new testing technologies and tighter data links, will lead the transformation of today's hospital laboratory into a "virtual" laboratory. Such laboratories will be self-sufficient, capable of performing all but esoteric tests in-house. It will be a "laboratory without walls," emphasizing testing performed at the point of care, be it bedside, physician's office, clinic, nursing home, ambulance, workplace, or patients' homes. A combination of economic and organizational pressures will cause hospital-based laboratories to adopt some form of regionalization within the next two to three years.

Capitation Fee↗
PubMed2004

Reexamining organizational configurations: an update, validation, and expansion of the taxonomy of health networks and systems.

OBJECTIVES: To (a) assess how the original cluster categories of hospital-led health networks and systems have changed over time; (b) identify any new patterns of cluster configurations; and (c) demonstrate how additional data can be used to refine and enhance the taxonomy measures. DATA SOURCES; 1994 and 1998 American Hospital Association (AHA) Annual Survey of Hospitals. STUDY DESIGN: As in the original taxonomy, separate cluster solutions are identified for health networks and health systems by applying three strategic/structural dimensions (differentiation, integration, and centralization) to three components of the health service/product continuum (hospital services, physician arrangements, and provider-based insurance activities). DATA EXTRACTION METHODS: Factor, cluster, and discriminant analyses are used to analyze the 1998 data. Descriptive and comparative methods are used to analyze the updated 1998 taxonomy relative to the original 1994 version. PRINCIPAL FINDINGS: The 1998 cluster categories are similar to the original taxonomy, however, they reveal some new organizational configurations. For the health networks, centralization of product/service lines is occurring more selectively than in the past. For the health systems, participation has grown in and dispersed across a more diverse set of decentralized organizational forms. For both networks and systems, the definition of centralization has changed over time. CONCLUSIONS: In its updated form, the taxonomy continues to provide policymakers and practitioners with a descriptive and contextual framework against which to assess organizational programs and policies. There is a need to continue to revisit the taxonomy from time to time because of the persistent evolution of the U.S. health care industry and the consequent shifting of organizational configurations in this arena. There is also value in continuing to move the taxonomy in the direction of refinement/expansion as new opportunities become available.

American Hospital Association↗
PubMed2004

The Latin-American network of human genetics.

The Latin-American Network of Human Genetics (RELAGH) is an internet-based federation of human and medical genetic societies of Latin America constituted in 2001. Member societies include the Mexican Association of Human Genetics, the Brazilian Society of Clinical Genetics, the Human Genetics Section of the Argentinean Society of Genetics, the Colombian Society of Human Genetics and the Panamanian Human Genetics Society. RELAGH is a full member of the steering committee of the International Federation of Human Genetics Societies. A core activity of RELAGH is to become a platform for the integration and collaboration of human geneticists across Latin America regarding training, services and research in medical genetics in the region.

Community Networks↗
PubMed1999

A taxonomy of health networks and systems: bringing order out of chaos.

OBJECTIVE: To use existing theory and data for empirical development of a taxonomy that identifies clusters of organizations sharing common strategic/structural features. DATA SOURCES: Data from the 1994 and 1995 American Hospital Association Annual Surveys, which provide extensive data on hospital involvement in hospital-led health networks and systems. STUDY DESIGN: Theories of organization behavior and industrial organization economics were used to identify three strategic/structural dimensions: differentiation, which refers to the number of different products/services along a healthcare continuum; integration, which refers to mechanisms used to achieve unity of effort across organizational components; and centralization, which relates to the extent to which activities take place at centralized versus dispersed locations. These dimensions were applied to three components of the health service/product continuum: hospital services, physician arrangements, and provider-based insurance activities. DATA EXTRACTION METHODS: We identified 295 health systems and 274 health networks across the United States in 1994, and 297 health systems and 306 health networks in 1995 using AHA data. Empirical measures aggregated individual hospital data to the health network and system level. PRINCIPAL FINDINGS: We identified a reliable, internally valid, and stable four-cluster solution for health networks and a five-cluster solution for health systems. We found that differentiation and centralization were particularly important in distinguishing unique clusters of organizations. High differentiation typically occurred with low centralization, which suggests that a broader scope of activity is more difficult to centrally coordinate. Integration was also important, but we found that health networks and systems typically engaged in both ownership-based and contractual-based integration or they were not integrated at all. CONCLUSIONS: Overall, we were able to classify approximately 70 percent of hospital-led health networks and 90 percent of hospital-led health systems into well-defined organizational clusters. Given the widespread perception that organizational change in healthcare has been chaotic, our research suggests that important and meaningful similarities exist across many evolving organizations. The resulting taxonomy provides a new lexicon for researchers, policymakers, and healthcare executives for characterizing key strategic and structural features of evolving organizations. The taxonomy also provides a framework for future inquiry about the relationships between organizational strategy, structure, and performance, and for assessing policy issues, such as Medicare Provider Sponsored Organizations, antitrust, and insurance regulation.

American Hospital Association↗
PubMed2006

Sectoral network on occupational health and safety in agriculture to support enterprises and family farms in Estonia.

A sectoral network on occupational health and safety in agriculture has been established in Estonia as part of a project that provided support for Estonian accession into European Union. Participating organizations represent farmers' unions at county level, agricultural enterprises, workers' representatives, universities and agricultural expert institutions, and government agencies. The purpose is to provide a shared infrastructure that combines information and other capacities of several organizations and provides a platform for dialogue and co-operation in order to make a greater impact with available resources. The network has a decentralized architecture and is technically managed by an institutionalized secretariat. The network's task forces have compiled a network directory, summarised the capacities and interests of member organizations, made an inventory of existing information and training materials, developed an overall strategy for information management, established an information repository on the Internet, prepared promotional materials, and devised a protocol for agricultural walk-though assessment. A profile on occupational health and safety in Estonian agriculture has been compiled with a rapid assessment approach that collected both quantitative and qualitative information from secondary sources (statistics, documents) and from focus group discussions. The profile is used as an instrument for taking occupational health and safety needs in agriculture into discussion on political arena.

Agriculture↗
PubMed2004

Meeting the challenges for gerontological nursing in Europe: The European Nursing Academy for Care of Older persons (ENACO).

In order to support the urgent need for proactive and targeted investments in care for older persons a group of geriatric nurse specialists from different European countries convened in Leuven (Belgium) in November 2002 to launch the European Nursing Academy for Care of Older persons (ENACO). The mission of ENACO is to enhance outcomes of older persons and their caregivers through strengthening gerontological clinical nursing care, education, research and health policy within an interdisciplinary context. Specific objectives of ENACO are: 1) providing up-to-date education and training by "teaching the teachers". More specifically, the target groups are master's prepared nurses specialized in gerontology who can contribute and guide the development of gerontological/geriatric nursing care in their own country; 2) developing a core curriculum for basic gerontological nursing education in Europe and; 3) developing an European network of gerontological nursing expertise. More specifically, a web page providing opportunities for interactive communication as well as a mentoring program will be developed for nurses interested in the deepening and fine-tuning of their professional experience in care for older persons. The fact that care for older persons is high on the European agenda, the collaboration with the European Academy for Medicine of Ageing (EAMA), and other professional organizations in Europe and other parts of the world, are promising elements in the development of ENACO.

Academies and Institutes↗