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At least 1,765 records · Page 98Linked to original sources
PubMed2006

The effect of physicians' long-term use of CPOE on their test management work practices.

OBJECTIVE: To explore physicians' work practices in relation to their long-term use of a computerized physician order entry system (CPOE). DESIGN: A cross-sectional qualitative study was conducted in four clinical units in two large Australian teaching hospitals. One hospital had used CPOE for over 10 years to order all clinical laboratory and radiology tests and view test results and the other had used the computerized viewing facility of the system for over seven years with tests ordered manually. Data were collected by non-participatory observations of physicians (55 sessions) and 28 interviews. MEASUREMENTS: Content analysis of the observation field notes, reflections on observations and interview transcripts were conducted by two researchers independently. A thematic grounded theory approach was used to derive key themes that would explain physicians work practices associated with CPOE use. RESULTS: Three themes relating to physicians' established use of CPOE were identified: (1) the effect of the hospital and clinical environment; (2) changes to work practices; and (3) physicians' management of information. Physicians' test management work practices using CPOE were related to diversity between: the hospitals; the clinical units' environment, and the users of the system. CONCLUSION: Hospitals need to understand and analyze physicians' test management work practices prior to and during the implementation of CPOE to accommodate their diverse ways of working with computerized information systems. In the current mixed media environment, physicians' use of manual and computerized information systems for sourcing and recording information impacts on efficiency and patient safety.

Attitude of Health Personnel↗
PubMed1989

Legal aspects of orthodontic practice: risk management concepts. Periodontal disease in orthodontic practice.

In this and succeeding issues of the American Journal of Orthodontics and Dentofacial Orthopedics, factual risk management scenarios will be presented. These scenarios are based on composites of actual court cases that have been tried to verdict or decision. Valuable risk management lessons may be learned from careful analysis of the course of the events described. Please be advised that the standard of care determined in any case is specific for that jurisdiction and that set of facts as established by expert testimony for the prevailing party.

Adult↗
PubMed1996

Health service structures, management and professional practice: beyond clinical management.

At the heart of the operation of the health system is the relationship between managers and the various professionals who provide clinical services. While there is an inherent conflict between these two groups, this conflict has been avoided in the past by the managers playing a supporting rather than a controlling role. However, the current demands of cost-control are placing managers and professionals into direct conflict; a situation that many organisations are addressing by putting clinicians into management roles. This measure has had initial success in some situations, but it is argued that this success will be limited because clinical departments are not able to address many of the broader issues that affect the performance of health services. This paper proposes an alternative approach that will enable these broader issues to be effectively addressed, and also reduce the structural conflict.

Australia↗
PubMed1995

Developing group practices: a management challenge.

The advantages and disadvantages of forming larger professional practices are often debated. This paper reports an exploration of the issues through three case studies involving clusters of Sydney general medical practitioners who had expressed a desire to amalgamate their solo or small group practices. Their most frequently stated goals were to reduce financial overheads, to improve the range of services offered to their patients and to improve the opportunities for recreational and study leave. Several barriers to successful amalgamation were identified, and methods of overcoming these were explored. Practices can successfully amalgamate, but only where there is a group of like-minded general practitioners who are willing to invest time to achieve mutually agreed objectives. Amalgamation will not be appropriate in all circumstances. Larger group practices should benefit from the employment of a professional practice manager. These findings may be relevant to veterinary and dental practices.

Animals↗
PubMedDate not supplied

Performance management in small practices.

Performance management, variably referred to as corporate, business, or enterprise performance management, has traditionally been viewed as a strategy to achieve an optimum mix of solvency, quality, safety, and patient satisfaction in large healthcare organizations. Now, however, with the readily available data from government and nonprofit organizations promoting quality health care and affordable business intelligence tools, small practices can adopt management strategies, tools, and techniques once limited to corporate executives. With a modest investment in self-assessment and affordable analysis tools, a small practice can benefit from a scaled-down version of the performance management initiatives in place at the leading health-care organizations.

Group Practice↗
PubMed1990

Legal aspects of orthodontic practice: risk management concepts. Excellent diagnostic informed consent practice and record keeping make a difference.

In this and succeeding issues of the American Journal of Orthodontics and Dentofacial Orthopedics, factual risk management scenarios will be presented. These scenarios are based on composites of actual court cases that have been tried to verdict or decision. Valuable risk management lessons may be learned from careful analysis of the course of the events described. Please be advised that the standard of care determined in any case is specific for that jurisdiction and that set of facts as established by expert testimony for the prevailing party. Readers' comments may be addressed to Dr. Donald E. Machen, 5801 Beacon St., Pittsburgh, PA 15217.

Adult↗
PubMed1998

Health at work in the general practice.

BACKGROUND: Poor mental health and high stress levels have been reported in staff working in general practice. Little is known about how practices are tackling these and other issues of health at work in the absence of an established occupational healthcare service. AIM: To establish the extent of knowledge and good practice of health at work policies for staff working in general practice. METHOD: Practice managers in 450 randomly selected general practices in England were interviewed by telephone, and the general practitioner (GP) with lead responsibility for workplace health in the same practice was surveyed by postal questionnaire. We surveyed the existence and implementation of practice policies, causes and effects of stress on practice staff, and agreement between practice managers and GPs on these issues. RESULTS: Seventy-one per cent of GPs and 76% of practice managers responded, with at least one reply from 408 (91%) practices and responses from both the practice manager and GPs from 252 (56%) practices. Seventy-nine per cent of practices had a policy on monitoring risks and hazards. The proportion of practices with other workplace health policies ranged from 21% (policy to minimize stress) to 91% (policy on staff smoking). There was a tendency for practices to have policies but not to implement them. The three causes of stress for practice staff most commonly cites by both GP and practice manager responders were 'patient demands', 'too much work', and 'patient abuse/aggression'. Sixty-five per cent of GPs felt that stress had caused mistakes in their practices. Although there was general agreement between the two groups, there was a considerable lack of agreement between responders working in the same practices. CONCLUSIONS: The study revealed substantial neglect of workplace health issues with many practices falling foul of health and safety legislation. This report should help general practices identify issues to tackle to improve their workplace health, and the Health at Work in the NHS project to focus on areas where their targeted help will be most worthwhile.

Family Practice↗
PubMedDate not supplied

Linking outcomes management and practice improvement. The link between outcomes management and JCAHO functions.

Staff participating in the CABG outcomes management program continue to examine the effectiveness and efficiency of care processes and to redesign care to improve patient and organizational outcomes. In fact, this quality enhancement program is neverending as we strive continually to improve the care of CABG patients. The success, measured through improved process and outcome variables, has promoted the implementation of similar programs for other patient populations. Using foresight in the development of outcomes management programs to ensure inclusiveness of regulatory body or agency criteria encourages comprehensive programs that yield positive outcomes for both patients and organizations.

Coronary Artery Bypass↗
PubMedDate not supplied

Ion cycling in hemlock-northern hardwood forests of the southern Lake Superior region: a preliminary study.

Upland forests of the southern Lake Superior region are diverse and contain a shifting mosaic of eastern hemlock [Tsuga canadensis (L.) Carr.] and northern hardwood forests dominated by sugar maple (Acer saccharum Marsh.). In this study, we survey the relative effects of management practice (old growth vs. managed), forest cover type (hemlock vs. northern hardwood), and soil great group (Entic Haplorthod vs. Alfic Oxyaquic Fragiorthod) on ion cycling as a precursor to a longer-term, more detailed study. Bulk precipitation, throughfall, and soil leachates at three depths were collected for two growing seasons in eight stands on the Ottawa National Forest in the Upper Peninsula of Michigan. A total of 1210 solutions were analyzed for pH, Na, K, Mg, Ca, Cl, NO3, and SO4. Losses of base cations (Ca, Mg, K) and SO4 from the bottom of the rooting zone generally were greater in old-growth than in managed northern hardwoods on both fragic and nonfragic soils. Leaching losses of base cations and NO3 usually were greater beneath old-growth northern hardwoods than beneath old-growth hemlock on both soil types and for both forest cover types and management practices on fragic than nonfragic soils. Management practice, forest cover type, and soil type all appear to affect ion cycling within these forests. All of the stands featured striking losses of base cations that probably are influenced strongly by NO3 and SO4 in atmospheric deposition.

Acer↗
PubMed1997

Medicine and management: a conflict facing general practice?

Partners and practice managers are beginning to understand implications of management issues raised by recent reforms. Practices involved in this study agree the need for improvement, but partners and managers were often unable to define improvements needed. Demonstrates that effective management structure is vital to future success for general practice. To achieve this involves understanding new managerial challenges practices must meet and different organizational competences required. To change requires a radical restructure of many practice roles and several options are considered. Regardless of the chosen option the question of training remains. There is a need to involve consultants, managers, and doctors already advancing the boundaries of practice development, in a dialogue with institutions providing management training, to design suitable programmes. Academic institutions too often produce management programmes geared towards the old environment, whereas managerial skills which changes in the NHS demand from future practice managers are now required.

Budgets↗
PubMed2001

EMR to the rescue. An ambulatory care pilot project shows that data sharing equals cost shaving.

PROBLEM: Inefficiencies in managing office practices and costs. SOLUTION: Installation of an EMR in ambulatory practices to integrate clinical data from patient visits and use it to improve efficiencies "downstream". RESULTS: Marked reduction in costs of ambulatory practice management and major improvements in revenue capture, improved patient satisfaction. KEYS TO SUCCESS: Analysis of workflow, documentation of progress with benchmarking.

Academic Medical Centers↗
PubMedDate not supplied

[Differentiated methodological approach in practical classes of nursing management].

This work tells the experience of a proposal of nursing management practical classes, with a differentiated methodological approach, elaborated by students of the Post-graduation in Nursing of UFSC in Stage of Teaching. It has as objective, to fortify the integration between graduation and post-graduation, developing with seventh phase academics of the Course of Graduation in Nursing of UFSC, the capacity to play the administrative and assistencial functions of the nurse, through an methodological approach modeled in the planning, execution, reflection and evaluation of the nursing management, using observation guides of the activities developed by the nursing team members, based on the Law of the Professional Exercise of Nursing, Nursing Professionals' Ethical Code, Resolution COFEN 189, and documents related.

Brazil↗
PubMed1998

Financial incentives and primary care provision in Britain: do general practitioners maximise their income?

The system of remunerating general practitioners (GPs) in Britain underwent significant changes in April 1990 with the implementation of a new contract between individual GPs and health authorities. The changes were a precursor to a wide-ranging programme of reforms of the British National Health Service. This paper investigates the relationship between financial incentives and the provision of primary health care services in Britain. A comprehensive anonymized data set was used, comprising information on 208 general practices in Scotland which serve just under one million people. An econometric model was tested to identify the determinants of cross-practice variation in the magnitude of the changes in GPs' remuneration levels between the two contracts. A linear programming model was used to examine the GPs' response to the financial incentives built into the new contract. The results of the econometric model indicated that the main beneficiaries of the 1990 contract were the practices which had expanded over the 1989-92 period, re-structured the GPs' partnership and made use of managerial skills by employing a practice manager; those practices also had larger lists in 1992 and relatively more patients attracting deprivation payments. The linear programming model showed that only a small minority of the practices (4.8%) maximised the remuneration from the new contract. Optimal solutions concerning income maximization strategies identified financial disincentives in the fee structure of the remuneration system associated with the provision of selected services and the care of particular groups of patients. The successful adoption of these strategies would involve cream skimming and selective service provision. However, there is no conclusive evidence of British GPs engaging in such activities.

Age Factors↗