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PubMedDate not supplied

Managing change within the healthcare environment.

In the healthcare environment, there are many catalysts for change, including federal and state regulations, increased utilization, patients' expectations, competition, declining reimbursement and the technologist shortage. Regardless of what organization you work in, change creates pressure internally. This is especially true of organizations that have not had to deal with much change. The three most common responses are: 1) senior managers tend to isolate themselves from the effects of change on staff members; 2) middle managers tend to feel squeezed between the need to implement change and the need to support staff members; and 3) employees tend to feel attacked and betrayed by change. The following five steps will help you work with your staff as you introduce and implement change: prepare your employees, plan thoroughly, develop a transitional line of authority, stay flexible during implementation, and encourage self-management, acknowledging those who helped make the change work. When change is implemented, it is important to understand that people will move through four stages of reaction: denial, resistance, exploration and commitment. As a general rule, individuals will go through all four stages, but the speed at which they move through them will be different. Managers need to assist employees who get stuck in certain stages. To implement change as successfully as possible, follow these four steps: communicate about change, deal with resistance, increase team involvement, and use visionary leadership.

Adaptation, Psychological↗
PubMed1992

[The medal collection of the Tijdschrift].

A short survey is presented of academic and medical medals, with specimens dating from the 17th century onward, in the collection of the Society 'Nederlands Tijdschrift voor Geneeskunde'. With respect to the old medals, the existing clusters of interest (academical and medical medals) are served by selective acquisition rather than by the quest for completeness. The evolution of medical science, medical institutes and practice in and after World War II merits documentation by extending the collection to the present days. The motives to commemorate, to celebrate and to honour facts or persons still stand, and Dutch artists are clearly interested and able to express these sentiments in medals.

Netherlands↗
PubMed2003

[Authorization, institutional services, hospital-based practices and cooperation in the hospital--from the perspective of the hospital-based physician].

The partitioning of patient care into an ambulatory and stationary sector, which has been in existence for decades, was wanted from a general political and economic point of view and has since been a guarantee for high-quality care in both sectors. The demographic development and scientific medical advances leading to higher life expectancy in the face of increasingly sparse resources have made us recognise that there might be a considerable cost-saving potential in promoting stronger integration of stationary and ambulatory care. The trend towards increased specialisation of the medical profession, but also the emergence of new professions within the health care sector require increasing efforts to ensure consistent courses of treatment and the necessary interdisciplinary and interprofessional continuity. But given insufficient budgets and the resultant distribution conflicts within this system the situation will become more critical. Integration does not simply happen, it must be wanted, designed and organised. It is dependent on crossborder co-operation and interface competence, especially general conditions promoting instead of inhibiting co-operation and integration. This requires an integrative system of patient care opening its borders on both sides. If this system which is intended to ensure an open and holistic concept of care is to be directed towards the individual patient, the transfer of care between the ambulatory and stationary sectors must not be system-related and thus imply that the patient will have to change his doctor(s) without being asked. Integrative care can and will be successful if general conditions are established that allow the medical profession to meet the challenges of integration and interface organisation, the lack of which is the result of misguided health care policy and not a failure that can be blamed on health care providers.

Germany↗
PubMed2004

The evidence for noninvasive positive-pressure ventilation in the care of patients in acute respiratory failure: a systematic review of the literature.

Noninvasive positive-pressure ventilation (NPPV) is increasingly being used in the care of patients suffering acute respiratory failure. High-level evidence supports the use of NPPV to treat exacerbation of chronic obstructive pulmonary disease (COPD). NPPV has also been successfully used with selected patients suffering acute hypoxemic respiratory failure and to allow earlier extubation of mechanically ventilated COPD patients. The evidence for NPPV for acute cardiogenic pulmonary edema is inconclusive. With selected patients NPPV decreases the rate of intubation, mortality, and nosocomial pneumonia. Predictors of NPPV failure include greater severity of illness, lower level of consciousness, lower pH, more air leak around the patient-mask interface, greater quantity of secretions, poor initial response to NPPV, and the presence of pneumonia. NPPV obviates intubation in > 50% of appropriately selected patients. Both nasal and oronasal interfaces have been successfully used to apply NPPV, but the oronasal interface is often preferred for acute respiratory failure. Any ventilator and ventilator mode can be used to apply NPPV, but portable pressure ventilators and pressure-support mode are most commonly used. Inhaled bronchodilators can be administered during NPPV, and NPPV can be delivered with helium-oxygen mixture. Institution-specific practice guidelines may be useful to improve NPPV success.

Acute Disease↗
PubMed2004

Temptation of academic medicine: second alma mater and "shared employment' concepts as possible way out?

Apparently, in developing and in well-developed societies we are confronted with a crisis of academic medicine in all aspects: health care, teaching, and research. Health care providers in teaching hospitals are under pressure to generate revenues, academic research is pressed to keep pace with institutions devoted solely to research, and teaching is often understood not as privilege and honor but as burden and nuisance. The key problem and the principal cause of the crisis are low interest of the best young graduates to follow an academic career in a world where the benefits and values of the private sector are prevailing. Confronted with these circumstances and the continuous perils of permanent brain-drain, we developed an innovative concept of "shared employment' where two academic institutions (one in a developed and one in a developing country) will collaborate in development and support of fresh talents, building elite academic staff. Most academic exchange programs developed so far have proved to be ineffective and of poor vitality, in spite of loud exclamations, high expectations, and a huge amount of good will involved. In contrast, the suggested cooperation will be based exclusively on mutual interest and clearly defined benefits for all involved parties.

Academic Medical Centers↗
PubMed2004

Two cheers for physicians' conflicts of interest.

This paper will attempt to demonstrate that conflict of interest is an unavoidable feature of medical practice, medical institutions, medical publications, and medical research. It also seeks to show how and why current regulations are ineffective in curbing fraud and abuse. The paper goes on to argue that, in light of the incentives incorporated into current reimbursement arrangements, physicians have to learn how to manage the conflicts they face and keep true their fiduciary responsibility to patients.

Conflict of Interest↗
PubMedDate not supplied

Narrative pedagogy: teaching geriatric content with stories and the "Make a Difference" project .

As the elderly population increases in number, the need to integrate innovative teaching strategies in geriatric education becomes more apparent. Teaching with stories promotes knowledge and values to students and is appealing and enjoyable. This article describes a geriatric nursing course in which stories in films and literature are used to teach content and values promoted by the Hartford Institute best practices curriculum. Stories are also used for the service-learning component of the course as students participate in a "Make a Difference" project with elderly people.

Aged↗