Governing IDFS's: the changing role of governing boards. One big board, or a board with sub-boards. Governance issues: today and tomorrow.
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Consumer Behavior↗
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From corporate governance to hospital governance. Authority, transparency and accountability of Belgian non-profit hospitals' board and management.
As a result of multiple developments in health care and health care policy, hospital administrators, policy makers and researchers are increasingly challenged to reflect on the meaning of good hospital governance and how they can implement it in the hospital organisations. The question arises whether and to what extent governance models that have been developed within the corporate world can be valuable for these reflections. Due to the unique societal position of hospitals--which involves a large diversity of stakeholders--the claim for autonomy of various highly professional groups and the lack of clear business objectives, principles of corporate governance cannot be translated into the hospital sector without specific adjustments. However, irrespective of these contextual differences, corporate governance can provide for a comprehensive 'frame of reference', to which the hospital sector will have to give its own interpretation. A multidisciplinary research unit of the university of Leuven has taken the initiative to develop a governance model for Belgian hospitals. As part of the preliminary research work a survey has been performed among 82 hospitals of the Flemish Community on their governance structure, the composition of the governance entities, the partition of competencies and the relationship between management and medical staff.
Belgium↗
Measuring progress in clinical governance: assessing the reliability and validity of the Clinical Governance Climate Questionnaire.
Despite a lack of conceptual clarity, the importance of cultural change to clinical governance is widely accepted. While generic measures of organizational performance, culture and climate are available, their relationship to clinical governance is unclear. Consequently, there is currently no valid and reliable measure of clinical governance climate. This study aimed to address the deficiency by reducing a pool of clinical governance climate indicators developed via previous qualitative research, describing a latent factor structure and assessing the internal consistency and external validity of the factor model. The resultant instrument, the Clinical Governance Climate Questionnaire (CGCQ), attained high internal consistency and external (discriminant and construct) validity in a study population of healthcare Trust staff. It consists of 60 items distributed across six sub-scales of clinical governance: planned and integrated quality improvement; proactive risk management; absence of unjust blame and punishment; working with colleagues; training and development; and organizational learning. The measure enables those charged with leading the clinical governance agenda in UK healthcare organizations to assess the progress of organizational development initiatives, highlighting areas requiring particular attention. They might also be of interest to those concerned about the negative unintended consequences of performance management.
Adult↗
alpha-Oxymethyl Ketone Enolates for the Asymmetric Mannich Reaction. From Acetylene and N-Alkoxycarbonylimines to beta-Amino Acids This work was supported by the University of the Basque Country, the Basque Government (Projects UPV 170.215-G47/98, EX-1998-124) and in part by M. E. C. (Project PB 98-0549). Grants to A.S. and M.C.G. from the Basque Government, and to C.L. from the Government of Navarra and M.E.C. are acknowledged.
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Journal Article↗
Principles to govern clinical governance.
Clinical governance--a new NHS concept that seeks, through clinical guidelines and national service frameworks, to encourage and enforce compliance with nationally-devised evidence based clinical policies--has manifold and complex implications. This paper reasons that clinical governance is actually a means to promote excellent practice of a particular kind and that non-compliance does not necessarily equate to bad practice. Therefore, separate means must be utilized to address bad practice. The paper proposes and supports in turn a series of principles to ensure that the potential benefits of clinical governance are maximized and the potential harms are diminished. A similar set of principles is proposed to help govern the management of bad practice. The complementary conclusions of the reasoning are that a) doctors should willingly embrace clinical governance and b) the NHS should not rigidly enforce it. However, as clinical governance restricts clinical freedom and patient choice it is important that ethical principles, such as those proposed, are followed in order to avoid or manage some unhappy conflicts.
Evidence-Based Medicine↗
Can nurses govern in a government agency?
A shared governance model was implemented within the nursing service of the Durham Veterans Affairs Medical Center in 1997. In 1999, members of the Nursing Quality/Staff Education/Research Council examined facility nurses' perceptions of governance to determine the degree to which the model had been implemented. Results of the study indicate that although imperatives at the organizational level were incompatible with three aspects of shared governance, there were three shared governance dimensions pertaining to basic nursing practice that reached or surpassed governance thresholds. This study highlights the potential of nursing management innovation within highly bureaucratic organizations.
Academic Medical Centers↗
Rule-governed versus contingency-governed behavior in a self-control task: effects of changes in contingencies.
Rule-governed behavior is typically acquired faster than contingency-governed behavior but is less sensitive than contingency-governed behavior to unverbalized contingency changes. The present study investigated these relationships in a computer task frequently used to study human self-control. Instructions for one group of participants contained a hint about how to maximize long-term reinforcement; the other group performed the task without the hint. Participants given the hint came closer to maximizing reinforcement in the long term, but their behavior was less sensitive to an unsignaled contingency change than that of those not given the hint. The study shows that, like other complex behaviors, self-control may be contingency-governed or rule-governed.
Journal Article↗
Home is where the governing is: social capital and regional health governance.
The relationship between the civic nature of a community and effective political governance by regional health boards in Canada is explored. A model is proposed that identifies components of social capital such as trust, commitment and identity, associationalism, civic participation and collaborative problem-solving. These concepts are then theoretically linked to effective governance, in particular to reflection of health needs, policy implementation, population health, fiscal responsibility and administrative efficiency. The generalizability of this model is discussed, as are current research directions and policy implications for governments. The conclusion is that governments might want to incorporate a dual perspective encompassing both the political institutions and the community structure.
Canada↗
Should the government pay? Caregiver views of government responsibility and feelings of stigma about financial support.
Financial support strategies to assist informal caregivers of the elderly have been implemented and/or experimented with in several states. Little is known about how receptive caregiving families are to receiving financial support from the government to assist with in-home care, particularly whether they feel stigmatized. Few existing programs have assessed caregivers' views. In examining caregivers' reactions to receiving means-tested financial assistance, it is important to assess whether they consider support of the disabled a government responsibility as well as a possible stigma. Caregivers (N = 155) of disabled veterans aged 65 and older who receive Veterans' Administration disability allowances (Aid and Attendance) were surveyed. Results indicate that caregivers feel the government is primarily responsible for supporting the long-term disabled who are cared for at home. For the most part, these caregivers did not feel stigmatized or uncomfortable receiving means-tested government assistance to support in-home care. An important implication of this study is that financial support can be a workable component of an integrated service delivery system to support informal caregiving.
Aged↗
Exploring the possible reasons why the UK Government commended the EFQM (European Foundation for Quality Management) excellence model as the framework for delivering governance in the new NHS.
A brief introduction into recent developments of the EFQM Excellence Model and the United Kingdom (UK) Government's agenda for ensuring that quality is at the heart of all decision making is given. In view of the Government explicitly commending the use of the EFQM Excellence Model to all organisations within the National Health Service, the author decides to explore the possible reasons behind the commendation. When comparing the EFQM Excellence Model with the Government's vision for quality, the former emerges as a more than ideal tool for any organisation wishing to commence or strengthen their journey on the road to quality and/or excellence; particularly as the EFQM Excellence Model is based on the principles of self-assessment, continuous improvement, learning and innovation, teamwork and a culture totally focused on the customer. Finally, ten possible reasons behind the Government commending the use of the Model are given.
Benchmarking↗
Uniform administrative requirements for grants and agreements with institutions of higher education, hospitals and other non-profit organizations, and with commercial organizations, foreign governments, organizations under the jurisdiction of foreign governments, and international organizations--DOL. Final rule.
The Department of Labor is issuing these regulations pursuant to the requirements of the Office of Management and Budget (OMB) Circular No. A-110 (Revised), which provides standards for obtaining consistency and uniformity among Federal agencies in the administration of grants and agreements with institutions of higher education, hospitals, and other non-profit organizations. This rule also applies to the Department of Labor's grants to commercial organizations, foreign governments, organizations under the jurisdiction of foreign governments and international organizations. OMB issued Circular A-110 in 1976 and, except for a minor revision in February 1987, the Circular remained unchanged until revised in 1993. To update the Circular, OMB established an interagency task force to review the Circular. The task force solicited suggestions for changes to the Circular from university groups, non-profit organizations and other interested parties and compared for consistency the provisions of similar provisions applied to State and local governments. The revised Circular and these regulations reflect the results of these efforts.
Economics, Hospital↗
Can the government govern? Lessons from the formation of the Veterans Administration.
The federal hospital system for veterans, established in the aftermath of World War I in a context of decentralization, privatization, and rejection of compulsory health insurance, seems an anomaly in health care policy-making. It is actually a good case of how the federal government achieves results in an area fraught with conflict: via normalization of crisis, containment of political decision making, and the association of the program with previously accepted goals (in this instance, workers' compensation). In the veterans' case, political judgments were transformed into scientific and bureaucratic decisions via the pragmatic use of experts. The system worked; the federal government governed.
Government Agencies↗
How are primary care groups approaching clinical governance? A review of clinical governance plans from primary care groups in London.
BACKGROUND: The aim of this study was to investigate how primary care groups (PCGs) were implementing clinical governance in their first year. METHODS: A structured review was carried out of clinical governance plans of 57 PCGs in London. RESULTS: There was considerable variation in content of the plans. Priority areas were generally based on national service frameworks and local health improvement plans. The most commonly included clinical topic was coronary heart disease. Plans tended to focus on quality improvement rather than on dealing with poor performance. There was generally little information on how quality would be monitored, the data required and methods to change clinical practice. CONCLUSION: Clinical governance plans provide the main public record of PCGs' attempts to improve quality but there is considerable variation in the content of these reports. Plans should provide reliable and comparable data on progress in implementing quality improvement strategies and dealing with poor performance.
Group Practice↗
Foods provided through U.S. Government Emergency Food Aid Programs: policies and customs governing their formulation, selection and distribution.
This report describes the food commodities that are used in U.S. emergency food aid programs and outlines issues in their distribution, selection and formulation that may limit their ability to meet the nutrition needs of recipients. Issues are being raised at this time because the U.S. Congress plans to renew the authorizing legislation by the end of 2002. The author summarizes quantity and quality problems with food aid contributions and the difficulties experienced with the coordination of food aid with related needs of disaster victims. He identifies the foods supplied for emergency feeding by the U.S. Government and the World Food Program, and describes the limited applications of nutrition science to the formulation of the processed foods provided through U.S. food programs. The core of the report outlines the dominant nonnutritional priorities, stemming from the linkages to U.S. agricultural supply markets, U.S. commercial food interests, food aid pledging customs and difficulties in U.S. Government humanitarian response coordination. The presentation concludes with a review of issues, emphasizing the need for further studies, and some suggestions for shaping future food aid programs and policy with a strengthened capacity for protecting and promoting the nutritional status of disaster victims.
Financing, Government↗
The role of state government, local government, and nongovernmental organizations in medical innovative readiness training.
This article describes the Medical Innovative Readiness Training program of the Wisconsin Army National Guard. State government coordinates the various entities involved, and local government does most of the planning for the actual medical care that will be rendered. Funding is through the National Guard Bureau. The bulk of the medical professional manpower comes from National Guard medical units.
Humans↗
Relative efficiency of government and non-government organisations in implementing a nutrition intervention programme--a case study from Bangladesh.
OBJECTIVE: The Bangladesh Integrated Nutrition Programme (BINP) experimented with two models of delivery: the first model uses the Government of Bangladesh's (GOB) own management structure and the second uses the non-government organisations (NGOs) working in the local community. This study compares the relative efficiency of GOB and NGO management in the provision of nutrition services. DESIGN: A detailed costing survey was carried out to estimate the cost of delivering nutrition services from the Community Nutrition Centres (CNCs). The number of individuals enrolled, the number actually participating in the programme and person-days of service delivered were used as effectiveness measures. SETTING: Thirty-five CNCs were randomly selected from five BINP areas, of which 21 were in GOB-run areas and 14 in NGO-run areas. RESULTS: The cost of providing nutrition services per enrolee was US dollars 24.43 for GOB-run CNCs and US dollars 29.78 for NGO-run CNCs. CONCLUSIONS: Contrary to the widely held view, the analysis implies that the NGO facilities are not more efficient in the delivery of nutrition services when cost per person-days of service delivered is considered. The food cost component of BINP is so high that, irrespective of the delivery mode, policy makers should examine carefully the components of BINP in order to find the most cost-effective mix of services.
Adult↗
Radiation protection information: can you trust the government's risks or risk the government's trust?: 1997 G. William Morgan lecture.
Public acceptance of information concerning radiation risks has been impacted by the erosion of trust in government agencies and by societal images that personify radiation or its effects in terms of monsters and ogres. The loss of trust in government agencies, particularly the Atomic Energy Commission and later the Department of Energy, has been influenced by a number of key events and individuals. Examples of these are given, including the anti-Viet Nam war movement, the Watergate incident, the activities of the Union of Concerned Scientists, Ralph Nader and the Critical Mass movement, the claims of Ernest Sternglass, and the widely publicized views of John Gofman and Arthur Tamplin. The use of negative images, pictures, and symbols in the mass media has reinforced the public perception of radiation as a thing to be feared. There is growing evidence that the public perception of radiation risks is related more to mistrust and negative images than it is to the technical information health physicists provide or to the issue of whether or not the linear no-threshold theory of radiation risks is correct. Attempts by federal agencies to regain public trust in radiation risk information generated by health physicists or other radiation scientists appear to be largely unsuccessful. If health physicists hope to be successful in changing such public perceptions, they may have to focus efforts on the next generation and concentrate on assuring that elementary and secondary school children receive sound instruction on radiation risks. Additional research at the molecular biology level is needed to elucidate the risks, if any, at low doses so that the practice of extrapolating low dose responses from high dose data can be eliminated.
Fear↗
Government relations, government regulations: jumping through the hoops.
Over the last decade, telehealth in Australia has been primarily facilitated and driven by government funding. The government now has a major policy initiative in online health. However, in pursuing the broad initiative there is a danger that some of the smaller components can get lost, and this is probably what has happened to telehealth. There appear to be a number of steps required if telehealth in Australia is to keep up the pace of development that occurred in the 1990s, as we move into what is now being called the era of e-health, involving broadband Internet health service delivery. This area is changing extremely rapidly and is increasingly migrating away from the public sector in Australia, where most of the developmental work has occurred, and into the private sector. Many of the issues that require consideration within the domain of e-health in Australia are also relevant to other countries. E-health will significantly change the way that health-care is practised in future, and it is clear that it is the human factors that are more difficult to overcome, rather than the technological ones.
Australia↗