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PubMed1994

Managed care. An opportunity for home care agencies.

It is clear, even in the future of health care reform, that home care is a growing component of the health care industry. For many years, fee for service was the model reimbursement method. Today we are in a changing health care system that requires a greater emphasis on home care cost containment. New methods of reimbursement are a part of the change. Progressive home care agencies see this as an opportunity to become leaders. This approach does not come without certain risks, however. In taking the risks, it is imperative to minimize the chances for problems, obstacles, and compromising the quality of patient care. It requires that the agency develop a strategy, set a course, and then devote the resources necessary to meet these challenges. Resources may mean investing in upgraded information systems, hiring clinical specialists to develop care plans and protocols, or developing in-house case management staff to allow the agency to monitor use and quality. One thing is clear--the old way of doing business, cost-based fee for service, has a limited life span, and agencies need to embrace these changes, not ignore them.

Delivery of Health Care↗
PubMed1993

Advanced human resources planning.

Programs developed to advance the careers of pharmacy staff members are important tools to attract and retain qualified staff members. Integration of career development with the advancement of the department's efforts to achieve pharmaceutical care are integral for the future success of the department. Design of programs for all major positions/classifications should be considered. These programs must be developed in concert with the employees affected. In the future, these programs can demonstrate enhanced outcomes for patient care by ensuring appropriately trained and credentialed employees. This will require a commitment to advanced human resources planning.

Career Mobility↗
PubMed2006

Developing a health and safety plan for hazardous field work in remote areas.

Developing health and safety plans (HASPs) is a common feature of occupational safety and health for many workplaces. Formal HASPs are a requirement for hazardous waste work, requiring the anticipation and identification of hazards and embodying the training, equipping, and evaluation of workers. Aside from OSHA, there are relatively few manuals or examples and virtually no papers that provide practical guidance in what a HASP should cover or how to create and implement one. Moreover, existing guidance refers to spatially circumscribed worksites. This article details development of a HASP to cover field researchers and ship personnel conducting scientific research in a remote area of the world (Amchitka Island in the western Aleutians), hundreds of kilometers from the nearest emergency room. It required characterizing the kinds of work to be performed and anticipating the hazards that could be encountered. It illustrates the meshing of a general HASP with a ship safety plan, a dive safety plan, and specialized topics, including stop-work authority, rock climbing, firearms, vehicle safety, and communication strategy. Remote area operations are a growing challenge facing the profession. An expedition of this sort requires extensive planning and experienced safety personnel and cannot rely on luck to ensure the safe return of participants.

Alaska↗
PubMed2006

Development of a statewide hospital plan for radiologic emergencies.

Although general guidelines have been developed for triage of victims in the field and for hospitals to plan for a radiologic event, specific information for clinicians and administrators is not available for guidance in efficient management of radiation victims during their early encounter in the hospital. A consensus document was developed by staff members of four Connecticut hospitals, two institutions of higher learning, and the State of Connecticut Department of Environmental Protection and Office of Emergency Preparedness, with assistance of the American Society for Therapeutic Radiology and Oncology. The objective was to write a practical manual for clinicians (including radiation oncologists, emergency room physicians, and nursing staff), hospital administrators, radiation safety officers, and other individuals knowledgeable in radiation monitoring that would be useful for evaluation and management of radiation injury. The rationale for and process by which the radiation response plan was developed and implemented in the State of Connecticut are reviewed. Hospital admission pathways are described, based on classification of victims as exposed, contaminated, and/or physically injured. This manual will be of value to those involved in planning the health care response to a radiologic event.

Connecticut↗
PubMed2005

Information technology strategic planning: art or science?

It had been almost a decade since the hospitals that make up the Daughters of Charity Health System (DCHS) had engaged in a formal information technology strategic planning process. In the summer of 2002, as the health system re-formed, there was a unique opportunity to introduce a planning process that reflected the governance style of the new health system. DCHS embarked on this journey, with the CIO initiating and formally sponsoring the information technology strategic planning process in a dynamic and collaborative manner The system sought to develop a plan tailored to encompass both enterprise-wide and local requirements; to develop a governance model to engage the members of the local health ministries in plan development, both now and in the future; and to conduct the process in a manner that reflected the values of the Daughters of Charity. The DCHS CIO outlined a premise that the CIO would guide and be continuously involved in the development of this tailored process, in conjunction with an external resource. Together, there would be joint responsibility for introducing a flexible information technology strategic planning methodology; providing an education on the current state of healthcare IT, including future trends and success factors; facilitating support to tap into existing internal talent; cultivating a collaborative process to support both current requirements and future vision; and developing a well-functioning governance structure that would enable the plan to evolve and reflect user community requirements. This article highlights the planning process, including the lessons learned, the benchmarking during and in post-planning, and finally, but most importantly, the unexpected benefit that resulted from this planning process.

Catholicism↗
PubMed1990

[A study on the development of standardized nursing care plans for computerized nursing service].

A central issue in the development of nursing practice is to describe the phenomenon with which nursing is concerned. To identify the health problems which can be diagnosed and managed by the nurse is the first step to organize and ensure the development of nursing science. Therefore the academic world has been discussing the application of the nursing diagnosis in nursing practice as a means of improving quality of care. The objectives of this study were to develop a standardized nursing care plan for ten selected nursing diagnoses to form a database for computerized nursing service. The research approach used in the study was (1) the selection of the ten nursing diagnoses which occur most frequently on medical-surgical wards, (2) the development of a standardized nursing care plan for the ten selected nursing diagnoses, (3) application of the plan to hospitalized patients and evaluation of the content validity by the nurses, and (4) evaluation of the clinical effects after the use of the standardized nursing care plans. The subjects were 56 nurses and 395 hospitalized patients on two medical and two surgical unit. The results of this study were as follows: 1) The ten selected nursing diagnoses for the development of the standardized nursing care plans were "PAIN, SLEEP DISTURBANCE, ALTERED HEALTH MAINTENANCE, ALTERATION IN NUTRITION, ANXIETY, CONSTIPATION, ALTERED PATTERNS OF URINARY ELIMINATION, DISTURBANCE IN BODY IMAGE, POTENTIAL FOR ACTIVITY INTOLERANCE AND ACTIVITY INTOLERANCE". 2. The developed standardized nursing care plans included the nursing diagnosis, definition, defining characteristics, etiologic or related factors that contribute to the condition, recording pattern, desired outcomes and nursing orders (nursing interventions). 3. The plan was used with hospitalized patients on medical-surgical wards to test for content validity. The patient's satisfaction with the nursing care and nurses' job satisfaction were investigated to evaluate the clinical effects after the use of the standardized nursing care plans. A comparison of patient satisfaction with nursing care before and after the introduction of the standardized nursing care plans showed a statistically significant higher level of satisfaction with the standardized care plans. There was no difference in the level of job satisfaction expressed by the nursing staff before and after the standardized nursing care plans were introduced. However, when opinions about the use of the standardized nursing care plans were examined it was found that there was a positive effect on clarity in defining the nursing problems, determining nursing cost, more feasible goal setting, effective and systematic nursing records and indications for nursing research.(ABSTRACT TRUNCATED AT 400 WORDS)

Humans↗
PubMed2004

Ecological risk assessment and problem formulation for Lake Uluabat, a Ramsar State in Turkey.

Unlike the United States and the European Union, developing countries do not have sufficiently structured legal and institutional systems to apply certain environmental management tools such as ecological risk assessment. However, it is important for countries with valuable environmental and ecological resources to have appropriate tools and to strengthen their environmental management capabilities and capacities for the sake of those resources. The case study described in this paper attempts to be a case study towards developing environmental management plans, especially in developing countries. The problem formulation step of Ecological Risk Assessment applied in this study contributed to the basic elements of an environmental management plan including the following: the partnership-building process, prioritization of the problems and issues of the ecosystem, and development of the action plan. Based on the information provided by participants from a series of workshops held to develop an environmental management plan for Uluabat Lake, ecosystem risks were ranked and an action plan was formed. The results obtained with the aid of fuzzy set theory provided a base for identification of the action steps by allowing scientific information to be included in the process. The degree to which Uluabat Lake's problem formulation fits into the existing legal framework of Turkey is also analyzed in this paper.

Conservation of Natural Resources↗
PubMed1993

[Methodical nursing care with a written nursing care plan as basis].

A written nursing care plan enables quality nursing care. It is essential for primary nursing. As nurses we are on different levels of expert knowledge and we have different ways of being committed to our work. If a nurse doesn't recognize her basic task it is not possible to recognize it meaningful to provide a written nursing care plan. The development of written nursing care plan needs professional discussion and evaluation. The skill for written nursing care plan needs practising, self-evaluation and feedback. The study of written nursing care plans used earlier on the ward reveals professional development. The documented needs and problems are now more individual. The problems are solved using means of nursing more creatively. Some nursing care plans reveals the need for training to obtain more knowledge.

Documentation↗
PubMed2004

Odour management plans: a risk-based approach using stakeholder data.

Annoyance is a familiar reaction to odours arising from wastewater treatment sites, a reaction which can result in complaints and prosecutions. Odour management plans can be used to assess the extent of nuisance caused and prioritise mitigation measures. Often, these plans have been developed purely on the basis of technical assessments of emission and dispersion, with the general aim of limiting odour concentrations to a specific threshold at some distance from the works. They have often been prepared with inconsistent communication between the site staff and consultant during the development process, and may not directly refer to the affected population. This paper describes a risk-based approach to developing odour management plans, in which mitigation measures are assessed and prioritised on the basis of the likely frequency and intensity of odour exposure. A key element of the approach is the use of knowledge from data gained from key stakeholder groups: customers, staff, and regulators. Emphasis is placed on the development of clear communications between these groups, which helps both in terms of raising awareness amongst operators as to the significance of odour problems, and also in managing the expectations of customers and regulators. The practical application of this approach is demonstrated by the development of odour management plans for wastewater treatment sites by Yorkshire Water Services Ltd. These have used data from staff, customers and regulators to develop risk grids, which are then used to prioritise remediation measures. Involving staff in the data collection operations has been successful in raising awareness of the significance of odours, and has in turn led to low-cost emission reductions through improved housekeeping. Improved communications between operators, customers and regulators has led to more realistic expectations with regard to odour problems, a situation which can reduce conflict and prevent the imposition of stringent and sometimes unrealistic odour standards.

Communication↗
PubMed2003

Improving communication between hospitals and care homes: the development of a daily living plan for older people.

The present study describes a practice development project that produced a user-led daily living plan (DLP), which was developed in partnership with older people, and staff from health and social care settings. The DLP was designed to facilitate communication of the daily living preferences of older people, ensuring that continuity of care and support could be maintained and that their future care can be planned on an individualised basis when they move from hospital to a care home. In the process of developing and implementing the DLP, more effective person-centred communication between hospitals and care homes was achieved, and some of the hospital staff's ideas about care homes changed.

Activities of Daily Living↗
PubMed1998

Assessing outcomes of an academic computing initiative.

Academic computing initiatives rank high on the list of priorities of many dental schools. However, outcomes of academic computing initiatives have not been presented. The objectives of this program evaluation were to: 1) document a strategic initiative for academic computing over a five-year period; 2) assess outcomes; and 3) demonstrate how outcomes assessment changed strategic goals for the future. In 1992, Temple University School of Dentistry developed an academic computing plan. The plan proposed to develop the computer literacy of faculty, teach students the computer skills they need to be successful in their careers, and introduce computer-aided instruction as a new teaching tool. Before a new five-year plan was developed in 1997, the original plan's outcomes were summarily assessed. Assessment instruments included faculty and student surveys, budgets, inventory records, and utilization statistics. The school has reached two of three goals of the 1992 plan. Eighty percent of all full-time faculty have computers, are computer literate, and use computers for a variety of purposes. The school has implemented a comprehensive predoctoral dental informatics curriculum. However, the implementation of computer-aided instruction has not met expectations. Goals of the 1998-2003 plan include establishing an online learning infrastructure, improving student access, implementing computer-based oral health records, and further improving the computer literacy of faculty and students. Planning and supporting academic computing initiatives is a substantial challenge. Factors such as institutional culture, capital investment, ongoing support, and technological change influence plans and their success. While process and structure can be assessed relatively easily, measures for changed educational outcomes are still lacking.

Budgets↗
PubMed1990

Toward a national strategic plan for quality assurance and utilization review education.

This article discusses the need for a national plan for quality assurance and utilization review (QA/UR) education. Six points are addressed: the rationale for planning; the developments in quality assurance urging plan creation; external pressures on the QA field; internal interests in educational program development; a beginning vision of an educational future; and strategies for realizing the future. Additional planning and policy tasks are defined.

Curriculum↗
PubMedDate not supplied

CT-resolution regional hyperthermia treatment planning.

Recent development of quasistatic zooming has enabled the computation of mm-resolution SAR distributions within reasonable computation times. These high-resolution SAR distributions proved to be completely dissimilar from the cm-resolution distributions. To study the impact of high-resolution SAR modelling on regional hyperthermia treatment planning (HTP), a conventional, low-resolution treatment plan is compared to an high-resolution plan. This comparison shows that the high-resolution plan yields totally different SAR and temperature distributions when compared to the conventional plan. Both SAR and temperature maxima predicted by the low-resolution plan are not predicted by the high-resolution plan and, even worse, the low-resolution plan fails to predict maxima that are predicted by the high-resolution plan. Furthermore, it appears that small-scale SAR maxima can result in temperature maxima which may cause treatment-limiting hot spots. These small-scale SAR maxima appear to be highly determined by the dielectric geometry of the patient. This demonstrates the need for an accurate, high-resolution description of this dielectric geometry. Moreover, it suggests that it may be very difficult to reduce potential treatment-limiting hot spots in clinical practice. This study demonstrates the need for high-resolution regional hyperthermia treatment planning.

Hyperthermia, Induced↗
PubMed1980

[Thoughts on a psychological model of optimal development].

Developmental planning and intervention involves technical decisions as well as decisions about developmental goals. The view that empirically oriented psychologists can only contribute to technical decisions is widely accepted but is seen to be open to serious question after a closer examination of some general characteristics of decision processes. It is argued that psychologists can also significantly contribute to decisions about developmental goals, especially if a "human-oriented" developmental planning is attempted, which takes human needs, interests and developmental motives into account. After regarding some basic problems in empirically substantiating hypotheses about individual needs and interests, arguments are advanced against "closed" developmental models, which are based on restrictive need-theoretical assumptions. Finally, some characteristics of an "open" model of optimal development are outlined.

Adult↗
PubMed2002

Refinement of facial reconstructive surgery by stereo-model planning.

The development of rapid prototyping has evolved from crude milled models to laser polymerized stereolithographic models of excellent accuracy. The technology was advanced further with the recent introduction of fused deposition modelling and a three-dimensional ink-jet printing technique in stereo-model fabrication. The concept of using a three-dimensional model in planning the operation has amazed maxillofacial surgeons since its first application in grafting a skull defect in 1995. It was followed by many bright ideas for applications in the field of facial reconstructive surgery. Stereo-models may assist in diagnosis of facial fractures, joint ankylosis and even impacted teeth. The surgery can be simulated prior the operation of complex craniofacial syndromes, facial asymmetry and distraction osteogenesis. The stereo-model can be used for preparation of reconstructive plate or joint prostheses. It is of enormous value for educational teaching and as a patient information tool when obtaining the consent for surgery.

Ankylosis↗