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There are many voices urging health care organizations to adopt aggressive competitive warfare, but a careful look at the dynamics affecting health care suggests that partnership may be at least as promising a strategy as warfare to promote mission and survival.
The movement toward total quality management (TQM) is not only overturning the old ways of doing things within hospitals, it's transforming working relationships with vendors as well. A number of institutions are trying innovative approaches to purchasing, including vendor certification programs.
An experience in managing a lodging house for young psychotic girls is described. Model is referred to the relational theory. Meetings with families and educators, institutional crises and results are considered. Results pointed out the importance of managing on the Department territory in order to treat and rehabilitize psychotic patients.
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In response to poor coordination among health and social service providers, health care consortia have emerged in many areas of the United States. Consortia link multiple providers in a common structure to create comprehensive systems of care. They can be formally structured or informal combinations of providers that engage in coordination but otherwise do not comprise an independent organization. The functions most common among all types of consortia are shared services and service coordination; however, a number of consortia also operate outreach/education programs. Consortia represent an innovative response to the need both for vertical integration--case management of all levels of care--and horizontal integration to prevent duplication among primary care providers. We outline the history of consortia in which federally-funded community health centers have participated. We also suggest an analytical framework for the various types of consortia; discuss lessons learned about building and maintaining consortia; and provide preliminary outcome data.
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Latinos who present for health services often suffer from a complex interaction of medical and mental health needs, requiring a multifaceted intervention. An essential element of this multilevel approach is cultural and linguistic sensitivity on the part of health providers. New, innovative models of health service organization are needed to address the unique needs of the Latino population. Some of the key characteristics these models need to focus on include interagency collaboration rather than competition for resources, interdisciplinary teams of primary-care providers that also involve other nonmedical professional members, centralized case coordination and decentralized service delivery, flexibility and adaptability to changing priorities, continuity of care for all patients, and mutual support among providers to minimize the effects of stress and burnout.
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Salem County (NJ) Memorial Hospital cooperated in an areawide disaster drill and found that it took large doses of planning and cooperation to coordinate the effort.
Serious problems have been identified in the prescribing of medications for elderly patients and use of prescription and nonprescription drugs by older persons. Overuse, underuse, and inappropriate use of drugs by the elderly have been widely documented, and the harmful consequences have been described. This paper reviews information concerning the need for action to improve health professionals' knowledge and skills with respect to drugs and the elderly and activities being undertaken by geriatric education centers (GECs) to enhance these capacities. Grant support for the centers from the Health Resources and Services Administration, a Public Health Service component agency, began in 1983. In fiscal year 1992 there are 31 centers operating in 26 States. The centers are multi-institutional and conduct four types of educational activities. These include review of pharmacological issues for multidisciplinary groups, specialized training for pharmacists, discipline-specific programs focusing on medication issues, and activities aimed at educating the public. Examples of the GECs' educational activities are given.
Policy-oriented investigations into public health care delivery have been limited, especially during the Reagan era of competition and profit-based health care, when the inner city was essentially forgotten. In this study, policymakers toured five urban public health care systems in different parts of the country to promote consideration of a new governance for Chicago and Cook County's complicated and uncoordinated care for the medically indigent. A comparison of patterns of governance revealed strengths and weaknesses of each model. Local leadership and the political will to evolve a system of care, with clear connections between the public and private sectors, account for each city's relative success in addressing mounting needs of inner-city populations.
In response to today's health care environment, a metropolitan area association of hospices developed a collaborative hospital liaison program to educate and maximize referral sources, improve patient access to services and assist in ensuring the long-term survival of hospice care. Five hospices participated in the study, analyzing data on the numbers, sources and appropriateness of referrals and admissions, liaison staff expense and hospice relations with hospital staff. Recommendations were made for further collaborative efforts.
The "Healthy Children Ready to Learn" initiative starts with the underlying concept that health is a critical partner to optimum education. All children have a right to be healthy. At a minimum, this right assumes promoting optimum use of available and effective preventive measures, such as ensuring compliance with immunization recommendations; promoting measures to prevent injuries; ensuring opportunities to identify disease and disabilities early; and providing prompt treatment when needed. Families must receive the support and assistance they need to raise healthy and educated children. Activities directed toward National Education Goals and the related National Health Promotion and Disease Prevention Objectives can advance progress toward school readiness, focus attention and available resources on needed programs and services, and thus help the nation in achieving its goal of having all children arriving at school each day healthy, well nourished, and ready to learn. To realize these goals and objectives, the two critical systems of greatest importance to children, those providing health services and education, need to collaborate, not only among themselves, but also with social services. A range of critical health problems will require our attention if the goals are to be met, such as availability of prenatal care, infant mortality, inadequate nutrition during pregnancy or early childhood, or both, disease prevention by immunization, infants who have been exposed to drugs, fetal alcohol syndrome, and the emotional and mental disorders of early childhood, to name a few. At any one time, any family may be in need of appropriate services. To address the health and well-being of their young children, a continuum of appropriate, accessible services must be available in the community. The first steps toward successful achievement of the readiness goal will require the identification of health, education, and social service programs that serve young children and their families, and the creation of a climate that fosters innovative and effective collaboration between programs at the Federal and State levels, especially as it pertains to the community. Policies and programs should be built around the needs of families. In this regard, the critical role that parents play in shaping a healthy environment conducive to school readiness must be recognized as a key element in shaping the strategies that should help in achieving the readiness goal. Similarly important is the need to engage professional organizations and other private sector groups involved with health, education, and other children's issues to work with government and families to achieve the school readiness goal and its related health objectives.
Providing good, comprehensive, accessible maternity care to the underserved can help solve a hospital's declining OB census and can support a pro-life philosophy.
In the Federal Republic of Germany, responsibilities for health and education are held by the 11 German states. Particularly in the health system, a number of tasks are delegated to private organizations under governmental control. In this review, general characteristics of both the public health and education systems are delineated. An overview of school health programs, including instruction, health services, environment, and school-community relations, and school-based research, also are presented.