Sample records for care workforce effects

  1. Training a system-literate care coordination workforce. (United States)

    Naccarella, Lucio; Osborne, Richard H; Brooks, Peter M


    People with chronic complex conditions continue to experience increasing health system fragmentation and poor coordination. To reverse these trends, one solution has been an investment in effective models of care coordination that use a care coordinator workforce. Care coordinators are not a homogenous workforce - but an applied professional role, providing direct and indirect care, and is often undertaken by nurses, allied health professionals, social workers or general practitioners. In Australia, there is no training curriculum nor courses, nor nationally recognised professional quality standards for the care coordinator workforce. With the growing complexity and fragmentation of the health care system, health system literacy - shared understanding of the roles and contributions of the different workforce professions, organisations and systems, among patients and indeed the health workforce is required. Efforts to improve health system literacy among the health workforce are increasing at a policy, practice and research level. However, insufficient evidence exists about what are the health system literacy needs of care coordinators, and what is required for them to be most effective. Key areas to build a health system literate care coordination workforce are presented. Care coordination is more than an optional extra, but one of the only ways we are going to be able to provide equitable health services for people with chronic complex conditions. People with low health literacy require more support with the coordination of their care, therefore we need to build a high performing care coordinator workforce that upholds professional quality standards, and is health literacy responsive.

  2. Developing health care workforces for uncertain futures. (United States)

    Gorman, Des


    Conventional approaches to health care workforce planning are notoriously unreliable. In part, this is due to the uncertainty of the future health milieu. An approach to health care workforce planning that accommodates this uncertainty is not only possible but can also generate intelligence on which planning and consequent development can be reliably based. Drawing on the experience of Health Workforce New Zealand, the author outlines some of the approaches being used in New Zealand. Instead of relying simply on health care data, which provides a picture of current circumstances in health systems, the author argues that workforce planning should rely on health care intelligence--looking beyond the numbers to build understanding of how to achieve desired outcomes. As health care systems throughout the world respond to challenges such as reform efforts, aging populations of patients and providers, and maldistribution of physicians (to name a few), New Zealand's experience may offer a model for rethinking workforce planning to truly meet health care needs.

  3. Training a system-literate care coordination workforce

    DEFF Research Database (Denmark)

    Naccarella, Lucio; Osborne, Richard H.; Brooks, Peter M.


    People with chronic complex conditions continue to experience increasing health system fragmentation and poor coordination. To reverse these trends, one solution has been an investment in effective models of care coordination that use a care coordinator workforce. Care coordinators...... are not a homogenous workforce - but an applied professional role, providing direct and indirect care, and is often undertaken by nurses, allied health professionals, social workers or general practitioners. In Australia, there is no training curriculum nor courses, nor nationally recognised professional quality...... standards for the care coordinator workforce. With the growing complexity and fragmentation of the health care system, health system literacy - shared understanding of the roles and contributions of the different workforce professions, organisations and systems, among patients and indeed the health...

  4. New York's Health Care Workforce Recruitment and Retention Act: an investigation of the effects of nonrecurring increases in health worker wage on health worker supply. (United States)

    Patel, Kavin


    This article analyzes New York's Health Care Workforce Recruitment and Retention Act of 2002. The analysis comes in 4 parts: part 1 provides a brief overview of New York's economy as it relates to health care, a feel for the political climate at the time, and a detailed presentation of the chain of events that connect this climate to the birth of the Health Care Workforce Recruitment and Retention Act of 2002; part 2 consists of a breakdown of the provisions contained within bill, including major and minor goals, intended effects, and the mechanics behind raising supporting funds; part 3 explores what actually happened by evaluating available data to determine whether the bill's 2 major goals of workforce recruitment and retention were fulfilled; and finally, part 4 will take all the aforementioned information to determine the overall success of the bill, the implications, and specific suggestions for future policy changes that time has revealed since its inception.

  5. Workforce planning for urgent care services. (United States)

    Youd, Janet


    Due to major changes in how emergency care is delivered across different communities, one emergency department is no longer like another. Some have separate minor injury provision, some are general departments that cater for all types of patient, while others are designated major trauma centres. These differences in patient profile affect the required numbers and skill mix of nursing establishments so that the nursing workforce in each cannot be predicated on patient numbers alone. This article describes the development by the RCN Emergency Care Association of an evidence-based staffing tool and how it can be used in practice.

  6. Physician workforce planning in an era of health care reform. (United States)

    Grover, Atul; Niecko-Najjum, Lidia M


    Workforce planning in an era of health care reform is a challenge as both delivery systems and patient demographics change. Current workforce projections are based on a future health care system that is either an identified "ideal" or a modified version of the existing system. The desire to plan for such an "ideal system," however, may threaten access to necessary services if it does not come to fruition or is based on theoretical rather than empirical data.Historically, workforce planning that concentrated only on an "ideal system" has been centered on incorrect assumptions. Two examples of such failures presented in the 1980s when the Graduate Medical Education National Advisory Committee recommended a decrease in the physician workforce on the basis of predetermined "necessary and appropriate" services and in the 1990s, when planners expected managed care and health maintenance organizations to completely overhaul the existing health care system. Neither accounted for human behavior, demographic changes, and actual demand for health care services, leaving the nation ill-prepared to care for an aging population with chronic disease.In this article, the authors argue that workforce planning should begin with the current system and make adjustments based on empirical data that accurately reflect current trends. Actual health care use patterns will become evident as systemic changes are realized-or not-over time. No single approach will solve the looming physician shortage, but the danger of planning only for an ideal system is being unprepared for the actual needs of the population.

  7. Lessons from England's health care workforce redesign: no quick fixes. (United States)

    Bohmer, Richard M J; Imison, Candace


    In 2000 the English National Health Service (NHS) began a series of workforce redesign initiatives that increased the number of doctors and nurses serving patients, expanded existing staff roles and developed new ones, redistributed health care work, and invested in teamwork. The English workforce redesign experience offers important lessons for US policy makers. Redesigning the health care workforce is not a quick fix to control costs or improve the quality of care. A poorly planned redesign can even result in increased costs and decreased quality. Changes in skill mix and role definitions should be preceded by a detailed analysis and redesign of the work performed by health care professionals. New roles and responsibilities must be clearly defined in advance, and teamwork models that include factors common in successful redesigns such as leadership, shared objectives, and training should be promoted. The focus should be on retraining current staff instead of hiring new workers. Finally, any workforce redesign must overcome opposition from professional bodies, individual practitioners, and regulators. England's experience suggests that progress is possible if workforce redesigns are planned carefully and implemented with skill.

  8. Primary care workforce development in Europe.

    NARCIS (Netherlands)

    Groenewegen, P.; Heinemann, S.; Gress, S.; Schäfer, W.


    Background: There is a large variation in the organization of primary care in Europe. In some health care systems, primary care is the gatekeeper to more specialized care, whilst in others patients have the choice between a wide range of providers. Primary care has increasingly become teamwork. Meth

  9. Development of an interactive model for planning the care workforce for Alberta: case study

    Directory of Open Access Journals (Sweden)

    Bloom Judy


    Full Text Available Abstract Introduction In common with other jurisdictions, Alberta faces challenges in ensuring a balance in health worker supply and demand. As the provider organization with province-wide responsibility, Alberta Health Services needed to develop a forecasting tool to inform its position on key workforce parameters, in the first instance focused on modeling the situation for Registered Nurses, Licensed Practical Nurses and health care aides. This case study describes the development of the model, highlighting the choices involved in model development. Case description A workforce planning model was developed to test the effect of different assumptions (for instance about vacancy rates or retirement and different policy choices (for example about the size of intakes into universities and colleges, different composition of the workforce. This case study describes the choices involved in designing the model. The workforce planning model was used as part of a consultation process and to develop six scenarios (based on different policy choices. Discussion and evaluation The model outputs highlighted the problems with continuation of current workforce strategies and the impact of key policy choices on workforce parameters. Conclusions Models which allow for transparency of the underlying assumptions, and the ability to assess the sensitivity of assumptions and the impact of policy choices are required for effective workforce planning.

  10. Evidence-informed primary health care workforce policy: are we asking the right questions? (United States)

    Naccarella, Lucio; Buchan, Jim; Brooks, Peter


    Australia is facing a primary health care workforce shortage. To inform primary health care (PHC) workforce policy reforms, reflection is required on ways to strengthen the evidence base and its uptake into policy making. In 2008 the Australian Primary Health Care Research Institute funded the Australian Health Workforce Institute to host Professor James Buchan, Queen Margaret University, UK, an expert in health services policy research and health workforce planning. Professor Buchan's visit enabled over forty Australian PHC workforce mid-career and senior researchers and policy stakeholders to be involved in roundtable policy dialogue on issues influencing PHC workforce policy making. Six key thematic questions emerged. (1) What makes PHC workforce planning different? (2) Why does the PHC workforce need to be viewed in a global context? (3) What is the capacity of PHC workforce research? (4) What policy levers exist for PHC workforce planning? (5) What principles can guide PHC workforce planning? (6) What incentives exist to optimise the use of evidence in policy making? The emerging themes need to be discussed within the context of current PHC workforce policy reforms, which are focussed on increasing workforce supply (via education/training programs), changing the skill mix and extending the roles of health workers to meet patient needs. With the Australian government seeking to reform and strengthen the PHC workforce, key questions remain about ways to strengthen the PHC workforce evidence base and its uptake into PHC workforce policy making.

  11. Policy challenges for the pediatric rheumatology workforce: Part II. Health care system delivery and workforce supply

    Directory of Open Access Journals (Sweden)

    Henrickson Michael


    Full Text Available Abstract The United States pediatric population with chronic health conditions is expanding. Currently, this demographic comprises 12-18% of the American child and youth population. Affected children often receive fragmented, uncoordinated care. Overall, the American health care delivery system produces modest outcomes for this population. Poor, uninsured and minority children may be at increased risk for inferior coordination of services. Further, the United States health care delivery system is primarily organized for the diagnosis and treatment of acute conditions. For pediatric patients with chronic health conditions, the typical acute problem-oriented visit actually serves as a barrier to care. The biomedical model of patient education prevails, characterized by unilateral transfer of medical information. However, the evidence basis for improvement in disease outcomes supports the use of the chronic care model, initially proposed by Dr. Edward Wagner. Six inter-related elements distinguish the success of the chronic care model, which include self-management support and care coordination by a prepared, proactive team. United States health care lacks a coherent policy direction for the management of high cost chronic conditions, including rheumatic diseases. A fundamental restructure of United States health care delivery must urgently occur which places the patient at the center of care. For the pediatric rheumatology workforce, reimbursement policies and the actions of health plans and insurers are consistent barriers to chronic disease improvement. United States reimbursement policy and overall fragmentation of health care services pose specific challenges for widespread implementation of the chronic care model. Team-based multidisciplinary care, care coordination and self-management are integral to improve outcomes. Pediatric rheumatology demand in the United States far exceeds available workforce supply. This article reviews the career

  12. Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions (United States)

    Williams, L; Rycroft-Malone, J; Burton, C R; Edwards, S; Fisher, D; Hall, B; McCormack, B; Nutley, S M; Seddon, D; Williams, R


    Objectives This evidence review was conducted to understand how and why workforce development interventions can improve the skills and care standards of support workers in older people's services. Design Following recognised realist synthesis principles, the review was completed by (1) development of an initial programme theory; (2) retrieval, review and synthesis of evidence relating to interventions designed to develop the support workforce; (3) ‘testing out’ the synthesis findings to refine the programme theories, and establish their practical relevance/potential for implementation through stakeholder interviews; and (4) forming actionable recommendations. Participants Stakeholders who represented services, commissioners and older people were involved in workshops in an advisory capacity, and 10 participants were interviewed during the theory refinement process. Results Eight context–mechanism–outcome (CMO) configurations were identified which cumulatively comprise a new programme theory about ‘what works’ to support workforce development in older people's services. The CMOs indicate that the design and delivery of workforce development includes how to make it real to the work of those delivering support to older people; the individual support worker's personal starting points and expectations of the role; how to tap into support workers' motivations; the use of incentivisation; joining things up around workforce development; getting the right mix of people engaged in the design and delivery of workforce development programmes/interventions; taking a planned approach to workforce development, and the ways in which components of interventions reinforce one another, increasing the potential for impacts to embed and spread across organisations. Conclusions It is important to take a tailored approach to the design and delivery of workforce development that is mindful of the needs of older people, support workers, health and social care services and the

  13. Changing workforce demographics necessitates succession planning in health care. (United States)

    Collins, Sandra K; Collins, Kevin S


    Health care organizations continue to be plagued by labor shortage issues. Further complicating the already existing workforce challenges is an aging population poised to retire en masse within the next few years. With fewer cohorts in the age group of 25 to 44 years (Vital Speeches Day. 2004:71:23-27), a more mobile workforce (Grow Your Own Leaders: How to Identify, Develop, and Retain Leadership Talent, 2002), and an overall reduction in the number of individuals seeking employment in the health care field (J Healthc Manag. 2003:48:6-11), the industry could be faced with an unmanageable number of vacant positions throughout the organization. Bracing for the potential impact of these issues is crucial to the ongoing business continuity of health care organization. Many health care organizations have embraced succession planning to combat the potential labor famine. However, the health care industry as a whole seems to lag behind other industries in terms of succession planning efforts (Healthc Financ Manage. 2005;59:64-67). This article seeks to provide health care managers with a framework for improving the systematic preparation of the next generation of managers by analyzing the succession planning process. The proposition of these models is to initiate and simplify the gap reduction between theoretical concepts and future organizational application.

  14. Demands and Job Resources in the Child Care Workforce: Swiss Lead Teacher and Assistant Teacher Assessments (United States)

    Bloechliger, Olivia R.; Bauer, Georg F.


    Center-based child care has been struggling with poor health and high turnover rates of child care staff and their adverse impact on care quality for decades. Yet little is known about personal and structural antecedents of job resources and job demands that are valid predictors of health and turnover in the child care workforce. Research…

  15. Dynamic simulation for effective workforce management in new product development

    Directory of Open Access Journals (Sweden)

    M. Mutingi


    Full Text Available Effective planning and management of workforce for new product development (NPD projects is a great challenge to many organisations, especially in the presence of engineering changes during the product development process. The management objective in effective workforce management is to recruit, develop and deploy the right people at the right place at the right time so as to fulfill organizational objectives. In this paper, we propose a dynamic simulation model to address the workforce management problem in a typical NPD project consisting of design, prototyping, and production phases. We assume that workforce demand is a function of project work remaining and the current available skill pool. System dynamics simulation concepts are used to capture the causality relationships and feedback loops in the workforce system from a systems thinking. The evaluation of system dynamics simulation reveals the dynamic behaviour in NPD workforce management systems and shows how adaptive dynamic recruitment and training decisions can effectively balance the workforce system during the NPD process.

  16. Listening to the voices of children in foster care: youths speak out about child welfare workforce turnover and selection. (United States)

    Strolin-Goltzman, Jessica; Kollar, Sharon; Trinkle, Joanne


    Child welfare workforce turnover rates across private and public child welfare agencies are concerning. Although research about the causes of child welfare workforce turnover has been plentiful, empirical studies on the effects of turnover on child outcomes are sparse. Furthermore, the voices and experiences of youths within the system have been largely overlooked.The purpose ofthis study was, first, to explore the experiences and opinions about child welfare workforce turnover and retention of youths in the child welfare system; second, to explore a relationship between the number of caseworkers a youth has had and his or her number of foster care placements; and third, to harness the suggestions of youths in resolving the turnover problem. Youths in the child welfare system (N = 25) participated in focus groups and completed a small demographic survey. Findings suggest that youths experience multiple effects of workforce turnover, such as lack of stability; loss of trusting relationships; and, at times, second chances. The article concludes with suggestions for caseworkers, state trainers, local and state administrators, and social work researchers on engaging with youths in relationships that facilitate genuine systems change around social work practice and the child welfare workforce crisis.

  17. Career planning for the non-clinical workforce - an opportunity to develop a sustainable workforce in primary care. (United States)

    Tavabie, Jacqueline A; Simms, Jacqueline M


    Many health and social care systems worldwide have been developing a variety of navigator and signposting roles to help patients negotiate care through increasingly complex systems and multiple provider agencies. This UK project aims to explore, through a combination of job description review and workshops of stakeholders, the common competencies and features of non-clinical roles. The information is collated to develop common job descriptions at four key levels. These form the basis for a career pathway supported by portfolio-based educational programmes, embracing Apprenticeship Training Programmes. The programmes have the potential to support recruitment and retention of an increasingly skilled workforce to move between traditional health and social care provider boundaries. This offers the opportunity to release clinicians from significant administrative workload and support patients in an integrated care system.

  18. Health Care Workforce Development in Rural America: When Geriatrics Expertise Is 100 Miles Away (United States)

    Tumosa, Nina; Horvath, Kathy J.; Huh, Terri; Livote, Elayne E.; Howe, Judith L.; Jones, Lauren Ila; Kramer, B. Josea


    The Geriatric Scholar Program (GSP) is a Department of Veterans Affairs' (VA) workforce development program to infuse geriatrics competencies in primary care. This multimodal educational program is targeted to primary care providers and ancillary staff who work in VA's rural clinics. GSP consists of didactic education and training in geriatrics…

  19. A model linking clinical workforce skill mix planning to health and health care dynamics

    Directory of Open Access Journals (Sweden)

    McDonnell Geoff


    Full Text Available Abstract Background In an attempt to devise a simpler computable tool to assist workforce planners in determining what might be an appropriate mix of health service skills, our discussion led us to consider the implications of skill mixing and workforce composition beyond the 'stock and flow' approach of much workforce planning activity. Methods Taking a dynamic systems approach, we were able to address the interactions, delays and feedbacks that influence the balance between the major components of health and health care. Results We linked clinical workforce requirements to clinical workforce workload, taking into account the requisite facilities, technologies, other material resources and their funding to support clinical care microsystems; gave recognition to productivity and quality issues; took cognisance of policies, governance and power concerns in the establishment and operation of the health care system; and, going back to the individual, gave due attention to personal behaviour and biology within the socio-political family environment. Conclusion We have produced the broad endogenous systems model of health and health care which will enable human resource planners to operate within real world variables. We are now considering the development of simple, computable national versions of this model.

  20. An international review of the long-term care workforce: policies and shortages. (United States)

    Hussein, Shereen; Manthorpe, Jill


    The developed world's population is aging, due to trends of increased life expectancies and decreased fertility rates. These trends are predicted to increase demand on long-term care services. At the same time, the long-term care workforce is in shortage in most of the developed world. Moreover, such shortages are expected to increase due to parallel socio-demographic factors. The increase in demand for longterm care, coupled with shortage in supply of care workers, has promoted some attention from policymakers. The current paper provides an international review of institutional arrangements for long-term care in different developed countries and in particular explores different strategies used or proposed to resolve the shortage in the long-term care workforce.

  1. Understanding and improving communication processes in an increasingly multicultural aged care workforce. (United States)

    Nichols, Pam; Horner, Barbara; Fyfe, Katrina


    This study explored how culture shapes relationships in aged care and the extent to which the residential aged care sector supports a cohesive multicultural workforce. An exploratory methodology utilising semi-structured questionnaires collected data from 58 participants comprising: staff who provide direct care to residents; managers; and family members from six residential care facilities in Perth, Western Australia. Communication issues emerged as an over-arching theme, and included interpersonal communication, the effect of cultural norms on communication and the impact of informal and formal workplace policies relating to spoken and written language. Sixty percent of participants from a culturally and linguistically diverse (CaLD) background had experienced negative reactions from residents with dementia, linked to visible cultural difference. They used a range of coping strategies including ignoring, resilience and avoidance in such situations. CaLD participants also reported prejudicial treatment from non-CaLD staff. The findings highlight the need for organisations to incorporate explicit processes which address the multiple layers of influence on cross cultural communication: internalised beliefs and values; moderating effects of education, experience and social circumstance; and factors external to the individuals, including workplace culture and the broader political economy, to develop a cohesive multicultural workplace.

  2. An evidence-based health workforce model for primary and community care

    Directory of Open Access Journals (Sweden)

    Leach Matthew J


    Full Text Available Abstract Background The delivery of best practice care can markedly improve clinical outcomes in patients with chronic disease. While the provision of a skilled, multidisciplinary team is pivotal to the delivery of best practice care, the occupational or skill mix required to deliver this care is unclear; it is also uncertain whether such a team would have the capacity to adequately address the complex needs of the clinic population. This is the role of needs-based health workforce planning. The objective of this article is to describe the development of an evidence-informed, needs-based health workforce model to support the delivery of best-practice interdisciplinary chronic disease management in the primary and community care setting using diabetes as a case exemplar. Discussion Development of the workforce model was informed by a strategic review of the literature, critical appraisal of clinical practice guidelines, and a consensus elicitation technique using expert multidisciplinary clinical panels. Twenty-four distinct patient attributes that require unique clinical competencies for the management of diabetes in the primary care setting were identified. Patient attributes were grouped into four major themes and developed into a conceptual model: the Workforce Evidence-Based (WEB planning model. The four levels of the WEB model are (1 promotion, prevention, and screening of the general or high-risk population; (2 type or stage of disease; (3 complications; and (4 threats to self-care capacity. Given the number of potential combinations of attributes, the model can account for literally millions of individual patient types, each with a distinct clinical team need, which can be used to estimate the total health workforce requirement. Summary The WEB model was developed in a way that is not only reflective of the diversity in the community and clinic populations but also parsimonious and clear to present and operationalize. A key feature of the

  3. [Health workforce planning and training, with emphasis on primary care. SESPAS Report 2012]. (United States)

    González López-Valcárcel, Beatriz; Barber Pérez, Patricia


    The present article provides an overview of workforce planning for health professionals in Spain, with emphasis on physicians and primary care. We analyze trends, describe threats and make some suggestions. In Spain some structural imbalances remain endemic, such as the low number of nurses with respect to physicians, which may become a barrier to needed reforms. The new medical degree, with the rank of master, will not involve major changes to training. Nursing, which will require a university degree, leaves a gap that will be filled by nursing assistants.This domino effect ends in family medicine, which has no upgrading potential. Hence reasonable objectives for the system are to prioritize the post-specialization training of family physicians, enhance their research capacity and define a career that does not equate productivity with seniority. What is undergoing a crisis of identity and prestige is family medicine, not primary care. There is a risk that the specialty of family medicine will lose rank after the specialty of emergency medicine is approved. Today, about 40% of emergency physicians in the public network are specialists, most of them in family medicine. In 2010 a new fact emerged: an elite of foreign doctors obtained positions as resident medical interns in highly sought-after specialties through the national competitive examination. This phenomenon should be closely monitored and requires Spain to define the pattern of internationalization of health professionals in a clear and precise model.

  4. The adult day care workforce in England at a time of policy change: implications for learning disability support services. (United States)

    Hussein, Shereen; Manthorpe, Jill


    More people will receive personal budgets to pay for social care services in England. Such people may or may not continue using services such as adult day care centres. Many day centres are under threat of closure. These trends will affect those working in adult day care. This article examines the profile of this workforce, using recent NMDS-SC data and applying multinomial statistical modelling. We identified nearly 6000 adult day care workers, over half supporting adults with learning disability. The results of the analysis show significant variations between the adult day care, residential care and domiciliary workforces. At the personal level, day care workers are significantly older and less ethnically diverse than other workers. They tend to have been working in the sector for longer, and their work patterns are more stable. The findings are discussed within the context of policy changes affecting learning disabilities and social care workforce strategies.

  5. Primary care teams: are we there yet? Implications for workforce planning. (United States)

    Grover, Atul; Niecko-Najjum, Lidia M


    Recent studies suggest that team-based primary care models could contribute to eliminating the predicted physician shortages. In this article, the authors explore existing team-based clinical care delivery models, comparing specialist and primary care teams, that include patient-centered medical homes and accountable care organizations. Next, the authors describe the barriers to adopting these models on a large scale, particularly the regulatory, financial, and cultural factors as well as scope of practice considerations for nonphysician providers. The authors' aim is not to evaluate the merits of team-based primary care models but, rather, to ascertain whether such models should be at the center of current physician workforce planning policies. The authors argue that although emerging evidence indicates that primary care teams can improve patient outcomes, few data exist to suggest that these models will drastically reduce the need for additional physicians or other providers. Thus, the authors conclude that additional research is needed to evaluate the ability of such models to alleviate provider deficits. And, while policy makers should work toward their ideal health care system, they also must expand the physician workforce to meet the growing demand for health care services in the existing one.

  6. Building a health care workforce for the future: more physicians, professional reforms, and technological advances. (United States)

    Grover, Atul; Niecko-Najjum, Lidia M


    Traditionally, projections of US health care demand have been based upon a combination of existing trends in usage and idealized or expected delivery system changes. For example, 1990s health care demand projections were based upon an expectation that delivery models would move toward closed, tightly managed care networks and would greatly decrease the demand for subspecialty care. Today, however, a different equation is needed on which to base such projections. Realistic workforce planning must take into account the fact that expanded access to health care, a growing and aging population, increased comorbidity, and longer life expectancy will all increase the use of health care services per capita over the next few decades--at a time when the number of physicians per capita will begin to drop. New technologies and more aggressive screening may also change the equation. Strategies to address these increasing demands on the health system must include expanded physician training.

  7. New systems of care can leverage the health care workforce: how many doctors do we really need? (United States)

    Garson, Arthur


    Improving access to appropriate health care, currently inadequate for many Americans, is more complex than merely increasing the projected number of physicians and nurses. Any attainable increase in their numbers will not solve the problem. To bring supply and demand closer, new systems of care are required, leveraging every member of the health care workforce, permitting professionals to provide their unique contributions.To increase supply: Redefine the roles of physicians and nurse practitioners (NPs), assess how much primary care must be delivered by a physician, and provide support from other team members to let the physician deal with complex patients. NPs can deliver much primary care and some specialty care. Care must be delivered in integrated systems permitting new payment models (e.g., salary with bonus) and team-based care as well as maximum use of electronic health records. Teams must make better use of nonprofessionals, such as Grand-Aides, using telephone protocols and portable telemedicine with home visits and online direct reporting of every encounter. The goals are to improve health and reduce unnecessary clinic and emergency department visits, admissions, and readmissions.To decrease demand: Physician payment must foster quality and appropriate patient volume (if accompanied by high patient satisfaction). Patients must be part of the team, work to remain healthy, and reduce inappropriate demand.The nation may not need as many physicians and nurses if the systems can be changed to promote integration, leveraging every member of the workforce to perform at his or her maximum competency.

  8. The Compositional Effect of Rigorous Teacher Evaluation on Workforce Quality


    Cullen, Julie Berry; Koedel, Cory; Parsons, Eric


    Improving public sector workforce quality is challenging in sectors such as education where worker productivity is difficult to assess and manager incentives are muted by political and bureaucratic constraints. In this paper, we study how providing information to principals about teacher effectiveness and encouraging them to use the information in personnel decisions affects the composition of teacher turnovers. Our setting is the Houston Independent School District, which recently implemente...

  9. Skill mix, roles and remuneration in the primary care workforce: who are the healthcare professionals in the primary care teams across the world? (United States)

    Freund, Tobias; Everett, Christine; Griffiths, Peter; Hudon, Catherine; Naccarella, Lucio; Laurant, Miranda


    World-wide, shortages of primary care physicians and an increased demand for services have provided the impetus for delivering team-based primary care. The diversity of the primary care workforce is increasing to include a wider range of health professionals such as nurse practitioners, registered nurses and other clinical staff members. Although this development is observed internationally, skill mix in the primary care team and the speed of progress to deliver team-based care differs across countries. This work aims to provide an overview of education, tasks and remuneration of nurses and other primary care team members in six OECD countries. Based on a framework of team organization across the care continuum, six national experts compare skill-mix, education and training, tasks and remuneration of health professionals within primary care teams in the United States, Canada, Australia, England, Germany and the Netherlands. Nurses are the main non-physician health professional working along with doctors in most countries although types and roles in primary care vary considerably between countries. However, the number of allied health professionals and support workers, such as medical assistants, working in primary care is increasing. Shifting from 'task delegation' to 'team care' is a global trend but limited by traditional role concepts, legal frameworks and reimbursement schemes. In general, remuneration follows the complexity of medical tasks taken over by each profession. Clear definitions of each team-member's role may facilitate optimally shared responsibility for patient care within primary care teams. Skill mix changes in primary care may help to maintain access to primary care and quality of care delivery. Learning from experiences in other countries may inspire policy makers and researchers to work on efficient and effective teams care models worldwide.

  10. Effective leadership, teamwork and mentoring--essential elements in promoting generational cohesion in the nursing workforce and retaining nurses. (United States)

    Nelsey, Lorraine; Brownie, Sonya


    Despite recent increases in nurse recruitment in Australia, the current nursing workforce is still below the predicted numbers for the future demands. The combination of an ageing workforce, high nursing staff turnover and an inability to attract and retain nurses is eroding the capacity of the health care sector to appropriately respond to the care needs of the community. Currently, the nursing workforce may have as many as four generations working together. Differences in employment needs and values, work ethics, attitudes towards authority, and professional aspirations, contribute to some of the cross-generational problems that emerge and the turnover of nursing staff. Strategies to improve the retention rates of nurses need to focus on building a cohesive workforce by utilising the strengths and skill sets that characterise different generations of nurses, and creating the conditions in which nurses across all generations feel supported and valued. The aim of this article is to explain how effective leadership, teamwork and mentoring can assist efforts to promote generational cohesion and address the decline in the number of nurses in the workforce.

  11. Listening to the Voices of Children in Foster Care: Youths Speak out about Child Welfare Workforce Turnover and Selection (United States)

    Strolin-Goltzman, Jessica; Kollar, Sharon; Trinkle, Joanne


    Child welfare workforce turnover rates across private and public child welfare agencies are concerning. Although research about the causes of child welfare workforce turnover has been plentiful, empirical studies on the effects of turnover on child outcomes are sparse. Furthermore, the voices and experiences of youths within the system have been…

  12. Skill mix, roles and remuneration in the primary care workforce: who are the healthcare professionals in the primary care teams across the world?

    NARCIS (Netherlands)

    Freund, T.; Everett, C.; Griffiths, P.; Hudon, C.; Naccarella, L.; Laurant, M.G.H.


    World-wide, shortages of primary care physicians and an increased demand for services have provided the impetus for delivering team-based primary care. The diversity of the primary care workforce is increasing to include a wider range of health professionals such as nurse practitioners, registered n

  13. Planning and managing the physician workforce


    Schoenbaum Stephen C


    Abstract National planning and management of the physician workforce is a multifaceted, difficult, and even controversial activity. It is an important subset of overall health workforce planning and management, which contributes to a country's having an effective and efficient health care system. This commentary builds on a new survey of specialty considerations by Israeli medical students early in their clinical training, places it in the broader context of health workforce planning, and pro...

  14. A Statewide Train-the-Trainer Model for Effective Entrepreneurship and Workforce Readiness Programming (United States)

    Fields, Nia Imani; Brown, Mananmi; Piechocinski, Alganesh; Wells, Kendra


    A statewide youth and adult train-the-trainer model that integrates workforce readiness and entrepreneurship can have a profound effect on young people's academic performance, interest in college, and overall youth development. Participants in workforce and entrepreneurship programs develop personal resources that have value in school, in the…

  15. A Statewide Train-the-Trainer Model for Effective Entrepreneurship and Workforce Readiness Programming (United States)

    Fields, Nia Imani; Brown, Mananmi; Piechocinski, Alganesh; Wells, Kendra


    A statewide youth and adult train-the-trainer model that integrates workforce readiness and entrepreneurship can have a profound effect on young people's academic performance, interest in college, and overall youth development. Participants in workforce and entrepreneurship programs develop personal resources that have value in school, in the…

  16. Commentary: educating the present and future health care workforce to provide care to populations. (United States)

    Garr, David R; Margalit, Ruth; Jameton, Andrew; Cerra, Frank B


    The crisis of the rising cost of health care in the United States is stimulating major changes in the way care is being delivered. New models such as patient-centered medical homes and accountable care organizations are being developed with the expectation that health care professionals will address and improve the health of populations. Electronic health records and interprofessional teams will be critical to achieving the goal of better health. It is now time to bring together educators and clinicians at academic health centers, public health educators and practitioners, along with researchers, representatives from the health care delivery and financing systems, and community partners to reengineer health professions education to prepare health professions students for the health care system of the future.

  17. The Affordable Care Act's implications for a public health workforce agenda: taxonomy, enumeration, and the Standard Occupational Classification system. (United States)

    Montes, J Henry; Webb, Susan C


    The Affordable Care Act brings a renewed emphasis on the importance of public health services and those whose occupations are defined by performing the essential public health functions. The Affordable Care Act Prevention and Public Health Fund is a signal to the field that its work is important and critical to the health of the nation. Recent reports by the Institute of Medicine describe the changing dimensions of public health work in primary care integration and the need for enhanced financing of public health as investment. Gaining knowledge about the public health workforce, that is, how many workers there are and what they are doing, is of growing interest and concern for the field. Although enumeration of the public health workforce has been attempted several times by the federal government beginning as early as 1982, it was not until the year 2000 that a major effort was undertaken to obtain more complete information. Limitations that hampered Enumeration 2000 have persisted however. With implementation of the Affordable Care Act and other new ventures, key federal agencies are developing strategies to pursue a systemic and systematic enumeration and consistent taxonomy process. Included in these efforts is use of the Bureau of Labor Statistics, Standard Occupational Classification system. A clear and accurate understanding of the public health workforce and its characteristics is a major challenge. A well-constructed, systematic enumeration process can add to our understanding of the nature and functions of that workforce. In addition, discussion of enumeration must include the need for a consensus within the field that leads to a consistent taxonomy for the public health occupations. This article will provide a stage-setting brief of historical actions regarding enumeration, and it will examine selected enumeration activities taking place currently. It will discuss positive and negative implications facing public health and the potential for enhancing the

  18. Challenges and opportunities in building a sustainable rural primary care workforce in alignment with the Affordable Care Act: the WWAMI program as a case study. (United States)

    Allen, Suzanne M; Ballweg, Ruth A; Cosgrove, Ellen M; Engle, Kellie A; Robinson, Lawrence R; Rosenblatt, Roger A; Skillman, Susan M; Wenrich, Marjorie D


    The authors examine the potential impact of the Patient Protection and Affordable Care Act (ACA) on a large medical education program in the Northwest United States that builds the primary care workforce for its largely rural region. The 42-year-old Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) program, hosted by the University of Washington School of Medicine, is one of the nation's most successful models for rural health training. The program has expanded training and retention of primary care health professionals for the region through medical school education, graduate medical education, a physician assistant training program, and support for practicing health professionals.The ACA and resulting accountable care organizations (ACOs) present potential challenges for rural settings and health training programs like WWAMI that focus on building the health workforce for rural and underserved populations. As more Americans acquire health coverage, more health professionals will be needed, especially in primary care. Rural locations may face increased competition for these professionals. Medical schools are expanding their positions to meet the need, but limits on graduate medical education expansion may result in a bottleneck, with insufficient residency positions for graduating students. The development of ACOs may further challenge building a rural workforce by limiting training opportunities for health professionals because of competing demands and concerns about cost, efficiency, and safety associated with training. Medical education programs like WWAMI will need to increase efforts to train primary care physicians and increase their advocacy for student programs and additional graduate medical education for rural constituents.

  19. Health workforce development planning in the Sultanate of Oman: a case study

    Directory of Open Access Journals (Sweden)

    Ghosh Basu


    Full Text Available Abstract Introduction Oman's recent experience in health workforce development may be viewed against the backdrop of the situation just three or four decades ago, when it had just a few physicians and nurses (mostly expatriate. All workforce categories in Oman have grown substantially over the last two decades. Increased self-reliance was achieved despite substantial growth in workforce stocks. Stocks of physicians and nurses grew significantly during 1985–2007. This development was the outcome of well-considered national policies and plans. This case outlines how Oman is continuing to turn around its excessive dependence on expatriate workforce through strategic workforce development planning. Case description The Sultanate's early development initiatives focused on building a strong health care infrastructure by importing workforce. However, the policy-makers stressed national workforce development for a sustainable future. Beginning with the formulation of a strategic health workforce development plan in 1991, the stage was set for adopting workforce planning as an essential strategy for sustainable health development and workforce self-reliance. Oman continued to develop its educational infrastructure, and began to produce as much workforce as possible, in order to meet health care demands and achieve workforce self-reliance. Other policy initiatives with a beneficial impact on Oman's workforce development scenario were: regionalization of nursing institutes, active collaboration with universities and overseas specialty boards, qualitative improvement of the education system, development of a strong continuing professional development system, efforts to improve workforce management, planned change management and needs-based micro/macro-level studies. Strong political will and bold policy initiatives, dedicated workforce planning and educational endeavours have all contributed to help Oman to develop its health workforce stocks and gain

  20. Planning and managing the physician workforce

    Directory of Open Access Journals (Sweden)

    Schoenbaum Stephen C


    Full Text Available Abstract National planning and management of the physician workforce is a multifaceted, difficult, and even controversial activity. It is an important subset of overall health workforce planning and management, which contributes to a country's having an effective and efficient health care system. This commentary builds on a new survey of specialty considerations by Israeli medical students early in their clinical training, places it in the broader context of health workforce planning, and provides examples of some approaches and activities being taken in the United States that are applicable to other developed countries. This is a commentary on

  1. Innovative approaches to promote a culturally competent, diverse health care workforce in an institution serving Hispanic students. (United States)

    Ghaddar, Suad; Ronnau, John; Saladin, Shawn P; Martínez, Glenn


    The underrepresentation of minorities among health care providers and researchers is often considered one of the contributing factors to health disparities in these populations. Recent demographic shifts and the higher proportion of minorities anticipated among the newly insured under the Patient Protection and Affordable Care Act make the need for a more diverse and culturally competent health care workforce an urgent national priority.The authors describe current and future strategies that have been developed at the College of Health Sciences and Human Services at the University of Texas-Pan American (an institution with 89% Hispanic students in 2012) to prepare a culturally competent and ethnically diverse health care workforce that can meet the needs of a diverse population, especially in the college's own community. The college graduates approximately 650 students annually for careers in nursing, physician assistant studies, occupational therapy, pharmacy, rehabilitation services, clinical laboratory sciences, dietetics, and social work. The college's approach centers on enriching student education with research, service, and community-based experiences within a social-determinants-of-health framework. The approach is promoted through an interdisciplinary health disparities research center, multiple venues for community-based service learning, and an innovative approach to improve cultural and linguistic competence. Although the different components of the college's approach are at different developmental stages and will benefit from more formal evaluations, the college's overall vision has several strengths that promise to serve as a model for future academic health initiatives.

  2. The Supply and Demand of the Cardiovascular Workforce (United States)

    Narang, Akhil; Sinha, Shashank S.; Rajagopalan, Bharath; Ijioma, Nkechinyere N.; Jayaram, Natalie; Kithcart, Aaron P.; Tanguturi, Varsha K.; Cullen, Michael W.


    As the burden of cardiovascular disease in the United States continues to increase, uncertainty remains on how well-equipped the cardiovascular workforce is to meet the challenges that lie ahead. In a time when health care is rapidly shifting, numerous factors affect the supply and demand of the cardiovascular workforce. This Council Commentary critically examines several factors that influence the cardiovascular workforce. These include current workforce demographics and projections, evolving health care and practice environments, and the increasing burden of cardiovascular disease. Finally, we propose 3 strategies to optimize the workforce. These focus on cardiovascular disease prevention, the effective utilization of the cardiovascular care team, and alterations to the training pathway for cardiologists. PMID:27712782

  3. The Compositional Effect of Rigorous Teacher Evaluation on Workforce Quality. Working Paper 168 (United States)

    Cullen, Julie Berry; Koedel, Cory; Parsons, Eric


    Improving public sector workforce quality is challenging in sectors such as education where worker productivity is difficult to assess and manager incentives are muted by political and bureaucratic constraints. In this paper, we study how providing information to principals about teacher effectiveness and encouraging them to use the information in…


    Directory of Open Access Journals (Sweden)



    Full Text Available It is generally recognized that there is diversity in the workforce of any enterprise, be it business, government, or civil society. This study therefore seeks to find out the impact of workforce diversity on organizational effectiveness using a Nigerian bank for the study. We used the Blau’s1977 index of heterogeneity to measure the diversity index. While asset growth for the year 2008 and 2009, using 2007 and 2008 as base year was used to measure the growth strategy. To determine group diversity and performance outcomes moderated by workgroup context, a series of hierarchical regression analysis were conducted. The study finds significant correlation between some of the diversity variables as well as individual diversity variables with the measures of organizational effectiveness. Also it reveals that gender and ethnicity are negatively related to both employee productivity and performance bonus. In addition the study find that gender, age and tenure diversities are positively correlated and are significantly related. It is recommended that company executives use good strategies to effectively manage workforce diversity and collaborative research efforts should be done to ascertain the contextual variables that moderate workforce diversity to produce positive performance outcomes.

  5. Will they stay or will they go? Putting theory into practice to guide effective workforce retention mechanisms. (United States)

    Stilwell, Barbara


    Policy makers in healthcare in all countries are faced with challenges of designing and implementing strategies that will achieve three major and essential goals: produce enough health workers for a cost-effective skills mix to deliver high-quality care; attract trained health workers into the workforce; and deploy health workers where they are most needed and keep them there. Yet these apparently straightforward strategies are seldom wholly successful, and there is little clear evidence to guide the frustrated policy maker. This paper explores the reasons why it may be so difficult to come up with strategies that guarantee success and looks at what we do know about attracting, retaining and motivating health workers to get them and keep them working productively where they are most needed.

  6. Culture and language differences as a barrier to provision of quality care by the health workforce in Saudi Arabia (United States)

    Almutairi, Khalid M.


    Objectives: To identify, synthesize, and summarize issues and challenges related to the culture and language differences of the health workforce in Saudi Arabia. Methods: A comprehensive systematic review was conducted in May 2014 to locate published articles. Two independent researchers in consultation with several experts used 4 electronic databases (ISI Web of Knowledge, Science Direct, PubMed, and Cochrane) to scrutinize articles published from January 2000 - March 2014. Each of the studies was given a quality assessment rating of weak, moderate, or strong, and was evaluated for methodological soundness using Russell and Gregory’s criteria. Results: The online literature search identified 12 studies that met the inclusion criteria. Lack of knowledge of non-Muslim nurses or culture in Saudi Arabia, difficulties in achieving cultural competence, and culture shock were documented as cultural difference factors. Issues in language difference include the clarity of language use by health care providers in giving information and providing adequate explanation regarding their activities. Conclusion: The available information provided by this review study shows that there is a communication barrier between patients and health care workers such as healthcare workers demonstrate low cultural competency. Despite the fact that the government provides programs for expatriate healthcare workers, there is a need to further improve educational and orientation programs regarding the culture and language in Saudi Arabia. PMID:25828278

  7. Piecewise Linear Model for Multiskilled Workforce Scheduling Problems considering Learning Effect and Project Quality

    Directory of Open Access Journals (Sweden)

    Shujin Qin


    Full Text Available Workforce scheduling is an important and common task for projects with high labour intensities. It becomes particularly complex when employees have multiple skills and the employees’ productivity changes along with their learning of knowledge according to the tasks they are assigned to. Till now, in this context, only little work has considered the minimum quality limit of tasks and the quality learning effect. In this research, the workforce scheduling model is developed for assigning tasks to multiskilled workforce by considering learning of knowledge and requirements of project quality. By using piecewise linearization to learning curve, the mixed 0-1 nonlinear programming model (MNLP is transformed into a mixed 0-1 linear programming model (MLP. After that, the MLP model is further improved by taking account of the upper bound of employees’ experiences accumulation, and the stable performance of mature employees. Computational experiments are provided using randomly generated instances based on the investigation of a software company. The results demonstrate that the proposed MLPs can precisely approach the original MNLP model but can be calculated in much less time.

  8. Current realities and future vision: Developing an interprofessional, integrated health care workforce. (United States)

    Dubus, Nicole; Howard, Heather


    This article shares findings from an interprofessional symposium that took place in Boston in the spring of 2015. Educators and practitioners from various disciplines shared challenges, successes, and ideas on best interprofessional collaboration (IPC) and curricula development. The findings include the importance of patient-and-family-centered care, which includes the patient and his/her family in the decision-making process; increased education regarding IPC in universities and major hospitals; and educational opportunities within health care systems.

  9. A survey of the Queensland healthcare workforce: attitudes towards dementia care and training


    Travers, Catherine M; Beattie, Elizabeth; Martin-Khan, Melinda; Fielding, Elaine


    Background Positive attitudes of healthcare staff towards people with dementia promote higher quality care, although little is known about important factors that underlie positive attitudes. Key aims of this project were to explore the relationships between staff attitudes towards dementia, self-confidence in caring for people with dementia, experience and dementia education and training. Methods A brief online survey was developed and widely distributed to registered nurses and allied health...

  10. Role of AYUSH workforce, therapeutics, and principles in health care delivery with special reference to National Rural Health Mission. (United States)

    Samal, Janmejaya


    Decades back AYUSH systems of medicine were limited to their own field with few exceptions in some states as health in India is a state issue. This took a reverse turn after the initiation of National Rural Health Mission (NRHM) in 2005 which brought the concept of "Mainstreaming of AYUSH and Revitalization of Local Health Traditions" utilizing the untapped AYUSH workforces, therapeutics and principles for the management of community health problems. As on 31/03/2012 AYUSH facilities were co-located in 468 District Hospitals, 2483 Community Health Centers and 8520 Primary Health Centers in the country. Several therapeutics are currently in use and few drugs have been included in the ASHA drug kit to treat common ailments in the community. At the same time Government of India has recognized few principles and therapeutics of Ayurveda as modalities of intervention to some of the community health problems. These include Ksharasutra (medicine coated thread) therapy for ano-rectal surgeries and Rasayana Chikitsa (rejuvenative therapy) for senile degenerative disorders etc. Similarly respective principles and therapeutics can also be utilized from other systems of AYUSH such as Yoga and Naturopathy, Unani, Siddha and Homoeopathy. Akin to Ayurveda these principles and therapeutics can also help in managing community health problems if appropriately implemented. This paper is a review on the role of AYUSH, as a system, in the delivery of health care in India with special reference to National Rural Health Mission.

  11. Towards building the oral health care workforce: who are the new dental therapists? (United States)

    Blue, Christine M; Lopez, Naty


    In 2009, Minnesota Governor Pawlenty signed into law a bill approving the creation of a new dental team member: the dental therapist. The intent of this legislation was to address oral health disparities by creating a dental professional who would expand access to dental care in Minnesota. This study aimed to describe the characteristics of the first class of dental therapy students at the University of Minnesota and to ascertain the values and motivations that led them to choose a career in dental therapy. Four surveys were used to create the composite profile of the ten students in this first dental therapy class: 1) the California Critical Thinking Skills Test, 2) the Learning Type Measure, 3) the Attitudes Toward Healthcare Survey, and 4) a values and motivation survey that included demographic data. The results of the surveys revealed interacting influences of the students' background, personal self-concept, and environment leading to a career decision to pursue dental therapy.

  12. Workforce issues and consumer satisfaction in Medicaid personal assistance services. (United States)

    Anderson, Wayne L; Wiener, Joshua M; Khatutsky, Galina


    This study used a survey of older people and younger persons with disabilities who were receiving Medicaid-financed home and community-based services (HCBS) to assess the effect of workforce issues on consumer satisfaction. We found that recruitment problems had very strong negative and significant effects on consumer satisfaction. An interruption in service was a more important and significant indicator of consumer dissatisfaction than not having the same worker over time. We also found that problems with worker training and respect and treatment of consumers strongly and significantly affected satisfaction with paid care. Efforts to improve workforce issues are needed to improve the quality of care of these services.

  13. Timely and Effective Care - National (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - national data. This data set includes national-level data for measures of heart attack care, heart failure care, pneumonia care,...

  14. Timely and Effective Care - Hospital (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - provider data. This data set includes provider-level data for measures of heart attack care, heart failure care, pneumonia care,...

  15. Timely and Effective Care - State (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - state data. This data set includes state-level data for measures of heart attack care, heart failure care, pneumonia care,...

  16. Bureau of Health Workforce (United States)

    ... Center for Health Workforce Analysis National Practitioner Data Bank Health Workforce Development Health Workforce Training Grant Programs Health Workforce Loan & Scholarship Programs  About HRSA Leadership & Org Chart Budget ...

  17. Workforce strategies to improve children's oral health. (United States)

    Goodwin, Kristine


    (1) Tooth decay is the most common chronic disease for children. (2) As millions receive dental coverage under the Affordable Care Act, the demand for dental services is expected to strain the current workforce's ability to meet their needs. (3) States have adopted various workforce approaches to improve access to dental care for underserved populations.

  18. Sustaining the Rural Workforce: Nursing Perspectives on Worklife Challenges (United States)

    Hunsberger, Mabel; Baumann, Andrea; Blythe, Jennifer; Crea, Mary


    Context: Concerns have been raised about the sustainability of health care workforces in rural settings. According to the literature, rural nurses' work satisfaction varies with the resources and supports available to respond to specific challenges. Given the probable effects of stressors on retention, it is essential to understand the unique…

  19. The global nephrology workforce: emerging threats and potential solutions! (United States)

    Sharif, Muhammad U; Elsayed, Mohamed E; Stack, Austin G


    Amidst the rising tide of chronic kidney disease (CKD) burden, the global nephrology workforce has failed to expand in order to meet the growing healthcare needs of this vulnerable patient population. In truth, this shortage of nephrologists is seen in many parts of the world, including North America, Europe, Australia, New Zealand, Asia and the African continent. Moreover, expert groups on workforce planning as well as national and international professional organizations predict further reductions in the nephrology workforce over the next decade, with potentially serious implications. Although the full impact of this has not been clearly articulated, what is clear is that the delivery of care to patients with CKD may be threatened in many parts of the world unless effective country-specific workforce strategies are put in place and implemented. Multiple factors are responsible for this apparent shortage in the nephrology workforce and the underpinning reasons may vary across health systems and countries. Potential contributors include the increasing burden of CKD, aging workforce, declining interest in nephrology among trainees, lack of exposure to nephrology among students and residents, rising cost of medical education and specialist training, increasing cultural and ethnic disparities between patients and care providers, increasing reliance on foreign medical graduates, inflexible work schedules, erosion of nephrology practice scope by other specialists, inadequate training, reduced focus on scholarship and research funds, increased demand to meet quality of care standards and the development of new care delivery models. It is apparent from this list that the solution is not simple and that a comprehensive evaluation is required. Consequently, there is an urgent need for all countries to develop a policy framework for the provision of kidney disease services within their health systems, a framework that is based on accurate projections of disease burden, a

  20. Exponential growth of dental schools in Chile: effects on academic, economic and workforce issues. (United States)

    Cartes-Velásquez, Ricardo Andrés


    In the last 30 years, Chile has undergone noteworthy economic development and an exponential growth in the access of its population to higher education. The aim of this paper was to review the changes in academic, economic and workforce issues that occurred as a consequence of the growth in supply of undergraduate dental vacancies between 1997 and 2011. Data collected from the Consejo de Educación Superior - CES, Comisión Nacional de Acreditación - CNA, and Instituto Nacional de Estadísticas de Chile - INE included these variables: number of dental schools, school type (private or traditional, see explanation below), city where the school is located, entry vacancies, total student enrollment, admission scores, percentile rank of dentistry as a university career, tuition fees, accreditation status, and number of inhabitants. There was an exponential increase in dental schools in Chile (5 to 34) that occurred in association with the rise in tuition fees (US$ 3900 to US$ 9800), a deterioration in the academic level of dental students (650 to 550 points in admission scores) and a predicted 77.5% oversupply of dentists by 2025, according to WHO criteria. The exponential increase in dental schools in Chile brought about negative consequences, such as increasing career costs, deterioration in the academic level of dental students, and an oversupply of dentists, associated with lower incomes and possibly leading to unemployment. Additional research should be conducted to determine whether an increase in the number of dentists can improve the population's access to dental care and reduce the oral disease burden.

  1. Exponential growth of dental schools in Chile: effects on academic, economic and workforce issues

    Directory of Open Access Journals (Sweden)

    Ricardo Andres Cartes-Velasquez


    Full Text Available In the last 30 years, Chile has undergone noteworthy economic development and an exponential growth in the access of its population to higher education. The aim of this paper was to review the changes in academic, economic and workforce issues that occurred as a consequence of the growth in supply of undergraduate dental vacancies between 1997 and 2011. Data collected from the Consejo de Educación Superior - CES, Comisión Nacional de Acreditación - CNA, and Instituto Nacional de Estadísticas de Chile - INE included these variables: number of dental schools, school type (private or traditional, see explanation below, city where the school is located, entry vacancies, total student enrollment, admission scores, percentile rank of dentistry as a university career, tuition fees, accreditation status, and number of inhabitants. There was an exponential increase in dental schools in Chile (5 to 34 that occurred in association with the rise in tuition fees (US$ 3900 to US$ 9800, a deterioration in the academic level of dental students (650 to 550 points in admission scores and a predicted 77.5% oversupply of dentists by 2025, according to WHO criteria. The exponential increase in dental schools in Chile brought about negative consequences, such as increasing career costs, deterioration in the academic level of dental students, and an oversupply of dentists, associated with lower incomes and possibly leading to unemployment. Additional research should be conducted to determine whether an increase in the number of dentists can improve the population's access to dental care and reduce the oral disease burden.

  2. Health Care Evolution Is Driving Staffing Industry Transformation. (United States)

    Faller, Marcia; Gogek, Jim


    The powerful transformation in the health care industry is reshaping not only patient care delivery and the business of health care but also demanding new strategies from vendors who support the health care system. These new strategies may be most evident in workforce solutions and health care staffing services. Consolidation of the health care industry has created increased demand for these types of services. Accommodating a changing workforce and related pressures resulting from health care industry transformation has produced major change within the workforce solutions and staffing services sector. The effect of the growth strategy of mergers, acquisitions, and organic development has revealed organizational opportunities such as expanding capacity for placing physicians, nurses, and allied professionals, among other workforce solutions. This article shares insights into workforce challenges and solutions throughout the health care industry.

  3. Comprehensive health workforce planning: re-consideration of the primary health care approach as a tool for addressing the human resource for health crisis in low and middle income countries. (United States)

    Munga, Michael A; Mwangu, Mughwira A


    Although the Human Resources for Health (HRH) crisis is apparently not new in the public health agenda of many countries, not many low and middle income countries are using Primary Health Care (PHC) as a tool for planning and addressing the crisis in a comprehensive manner. The aim of this paper is to appraise the inadequacies of the existing planning approaches in addressing the growing HRH crisis in resource limited settings. A descriptive literature review of selected case studies in middle and low income countries reinforced with the evidence from Tanzania was used. Consultations with experts in the field were also made. In this review, we propose a conceptual framework that describes planning may only be effective if it is structured to embrace the fundamental principles of PHC. We place the core principles of PHC at the centre of HRH planning as we acknowledge its major perspective that the effectiveness of any public health policy depends on the degree to which it envisages to address public health problems multi-dimensionally and comprehensively. The proponents of PHC approach in planning have identified inter-sectoral action and collaboration and comprehensive approach as the two basic principles that policies and plans should accentuate in order to make them effective in realizing their pre-determined goals. Two conclusions are made: Firstly, comprehensive health workforce planning is not widely known and thus not frequently used in HRH planning or analysis of health workforce issues; Secondly, comprehensiveness in HRH planning is important but not sufficient in ensuring that all the ingredients of HRH crisis are eliminated. In order to be effective and sustainable, the approach need to evoke three basic values namely effectiveness, efficiency and equity.

  4. Innovation in Workforce Incentives (United States)


    5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Defense Acquisition University ,9820 Belvoir Road ,Fort Belvoir,VA,22060 8... Performance • Superior weapon systems • Cost, Schedule, Performance challenges • Acquisition Improvement & Workforce Incentives • Academic ...Richard Clark & Harold Stolovitch in The Effects of Incentives on Workplace Performance : A Meta-analytic Review of Research Studies – Meta-analytic

  5. Empowering the dementia care workforce to manage behavioral symptoms of dementia: Development and training outcomes from the VOICE Dementia Care Program. (United States)

    Karlin, Bradley E; Young, David; Dash, Kim


    Nonpharmacological approaches for managing behavioral symptoms of dementia remain widely underutilized, due in part to near-universal training needs reported by dementia caregivers in recent research. This article examines the development, core components, and initial outcomes of an evidence-informed, competency-based training program in the prevention and management of behavioral symptoms of dementia among care managers and nurses within an aging services system. The Vital Outcomes Inspired by Caregiver Engagement (VOICE) Dementia Care Training Program was developed based on identification of state-of-the-art approaches to managing behaviors through expert review of the literature and structured needs assessment. Results reveal robust improvements in knowledge, attitudes, and self-efficacy among training participants, with largest effect sizes (d = 1.8) on domains of knowledge and self-efficacy to manage behaviors. Findings support the feasibility and effectiveness of training in improving the abilities and confidence of aging services providers in dementia care and, specifically, in the nonpharmacological management of dementia-related behaviors.

  6. Strengthening the Effectiveness of State-Level Community Health Worker Initiatives Through Ambulatory Care Partnerships (United States)

    Allen, Caitlin; Nell Brownstein, J.; Jayapaul-Philip, Bina; Matos, Sergio; Mirambeau, Alberta


    The transformation of the US health care system and the recognition of the effectiveness of community health workers (CHWs) have accelerated national, state, and local efforts to engage CHWs in the support of vulnerable populations. Much can be learned about how to successfully integrate CHWs into health care teams, how to maximize their impact on chronic disease self-management, and how to strengthen their role as emissaries between clinical services and community resources; we share examples of effective strategies. Ambulatory care staff members are key partners in statewide initiatives to build and sustain the CHW workforce and reduce health disparities. PMID:26049655

  7. An Innovative Program in the Science of Health Care Delivery: Workforce Diversity in the Business of Health. (United States)

    Essary, Alison C; Wade, Nathaniel L


    According to the most recent statistics from the National Center for Education Statistics, disparities in enrollment in undergraduate and graduate education are significant and not improving commensurate with the national population. Similarly, only 12% of graduating medical students and 13% of graduating physician assistant students are from underrepresented racial and ethnic groups. Established in 2012 to promote health care transformation at the organization and system levels, the School for the Science of Health Care Delivery is aligned with the university and college missions to create innovative, interdisciplinary curricula that meet the needs of our diverse patient and community populations. Three-year enrollment trends in the program exceed most national benchmarks, particularly among students who identify as Hispanic and American Indian/Alaska Native. The Science of Health Care Delivery program provides students a seamless learning experience that prepares them to be solutions-oriented leaders proficient in the business of health care, change management, innovation, and data-driven decision making. Defined as the study and design of systems, processes, leadership and management used to optimize health care delivery and health for all, the Science of Health Care Delivery will prepare the next generation of creative, diverse, pioneering leaders in health care.

  8. Work engagement supports nurse workforce stability and quality of care: nursing team-level analysis in psychiatric hospitals. (United States)

    Van Bogaert, P; Wouters, K; Willems, R; Mondelaers, M; Clarke, S


    Research in healthcare settings reveals important links between work environment factors, burnout and organizational outcomes. Recently, research focuses on work engagement, the opposite (positive) pole from burnout. The current study investigated the relationship of nurse practice environment aspects and work engagement (vigour, dedication and absorption) to job outcomes and nurse-reported quality of care variables within teams using a multilevel design in psychiatric inpatient settings. Validated survey instruments were used in a cross-sectional design. Team-level analyses were performed with staff members (n = 357) from 32 clinical units in two psychiatric hospitals in Belgium. Favourable nurse practice environment aspects were associated with work engagement dimensions, and in turn work engagement was associated with job satisfaction, intention to stay in the profession and favourable nurse-reported quality of care variables. The strongest multivariate models suggested that dedication predicted positive job outcomes whereas nurse management predicted perceptions of quality of care. In addition, reports of quality of care by the interdisciplinary team were predicted by dedication, absorption, nurse-physician relations and nurse management. The study findings suggest that differences in vigour, dedication and absorption across teams associated with practice environment characteristics impact nurse job satisfaction, intention to stay and perceptions of quality of care.

  9. The politics of medical practice license and its impact on primary care workforce: international developments and Indian perspective. (United States)

    Kumar, Raman


    As a country India has to her credit the largest number of medical colleges in the world. More than 40,000 seats of MBBS (Bachelor of Medicine and Bachelor of Surgery) are available annually but only a fraction would enter into primary health care vocation. It is a matter of common perception and also of great concern that a large majority of young Indian doctors are not willing to serve the rural, remote and underserved population. An observation on human resource policies of several developed countries reveals interesting patterns. Beyond willingness and interest of the medical students and young doctors, there are real factors which prohibit their engagement with the health care delivery system in India, especially in the area of primary health care.

  10. First Annual LGBT Health Workforce Conference: Empowering Our Health Workforce to Better Serve LGBT Communities. (United States)

    Sánchez, Nelson F; Sánchez, John Paul; Lunn, Mitchell R; Yehia, Baligh R; Callahan, Edward J


    The Institute of Medicine has identified significant health disparities and barriers to health care experienced by lesbian, gay, bisexual, and transgender (LGBT) populations. By lowering financial barriers to care, recent legislation and judicial decisions have created a remarkable opportunity for reducing disparities by making health care available to those who previously lacked access. However, the current health-care workforce lacks sufficient training on LGBT-specific health-care issues and delivery of culturally competent care to sexual orientation and gender identity minorities. The LGBT Healthcare Workforce Conference was developed to provide a yearly forum to address these deficiencies through the sharing of best practices in LGBT health-care delivery, creating LGBT-inclusive institutional environments, supporting LGBT personal and professional development, and peer-to-peer mentoring, with an emphasis on students and early career professionals in the health-care fields. This report summarizes the findings of the first annual LGBT Health Workforce Conference.

  11. Strengthening the Math-Related Teaching Practices of the Early Care and Education Workforce: Insights from Experts. Policy Report (United States)

    Ryan, Sharon; Whitebook, Marcy; Cassidy, Deborah


    As a growing body of evidence links school success and early mathematical experiences, there is increasing interest in offering young children opportunities to bridge their informal understanding of mathematics with more formal concepts and processes. At the same time, many teachers and caregivers in the early care and education (ECE) field may…

  12. An integrative review of global nursing workforce issues. (United States)

    Nichols, Barbara L; Davis, Catherine R; Richardson, Donna R


    Migration has been a way of life since the beginning of time, with migrants seeking other lands for personal and professional betterment. Today, in an era of globalization, trade agreements and technological advances, an increase in migration is inevitable. All professions have been affected, but the migration of health professionals, particularly nurses, has been the most dramatic. However, the migration of nurses across national and international borders comes with many challenges: systematic tracking of migration flows, harmonization of standards, recognition of professional credentials, fair and equitable distribution of the global health care workforce, and the effect of migration on the health care infrastructure of both source and destination countries. The international migration of nurses to address shortages in developed countries has, in some instances, left source countries with insufficient resources to address their own health care needs. The increasing complexity of health care delivery, aging of the population and the nursing workforce, and the escalating global demand for nurses create on-going challenges for policy makers. Strategically addressing global nursing workforce issues is paramount to sustaining the health of nations.

  13. The crisis in human resources for health care and the potential of a 'retired' workforce: case study of the independent midwifery sector in Tanzania. (United States)

    Rolfe, Ben; Leshabari, Sebalda; Rutta, Fredrik; Murray, Susan F


    The human resource crisis in health care is an important obstacle to attainment of the health-related targets for the Millennium Development Goals. One suggested strategy to alleviate the strain upon government services is to encourage new forms of non-government provision. Detail on implementation and consequences is often lacking, however. This article examines one new element of non-government provision in Tanzania: small-scale independent midwifery practices. A multiple case study analysis over nine districts explored their characteristics, and the drivers and inhibitors acting upon their development since permitted by legislative change. Private midwifery practices were found concentrated in a 'new' workforce of 'later life entrepreneurs': retired, or approaching retirement, government-employed nursing officers. Provision was entirely facility-based due to regulatory requirements, with approximately 60 'maternity homes' located mainly in rural or peri-urban areas. Motivational drivers included fear of poverty, desire to maintain professional status, and an ethos of community service. However, inhibitors to success were multiple. Start-up loans were scarce, business training lacking and registration processes bureaucratic. Cost of set-up and maintenance were prohibitively high, registration required levels of construction and equipping similar to government sector dispensaries. Communities were reluctant to pay for services that they expected from government. Thus, despite offering a quality of basic maternity care comparable to that in government facilities, often in poorly-served areas, most private maternity homes were under-utilized and struggling for sustainability. Because of their location and emphasis on personalized care, small-scale independent practices run by retired midwives could potentially increase rates of skilled attendance at delivery at peripheral level. The model also extends the working life of members of a professional group at a time of

  14. Public health workforce: challenges and policy issues

    Directory of Open Access Journals (Sweden)

    Beaglehole Robert


    Full Text Available Abstract This paper reviews the challenges facing the public health workforce in developing countries and the main policy issues that must be addressed in order to strengthen the public health workforce. The public health workforce is diverse and includes all those whose prime responsibility is the provision of core public health activities, irrespective of their organizational base. Although the public health workforce is central to the performance of health systems, very little is known about its composition, training or performance. The key policy question is: Should governments invest more in building and supporting the public health workforce and infrastructure to ensure the more effective functioning of health systems? Other questions concern: the nature of the public health workforce, including its size, composition, skills, training needs, current functions and performance; the appropriate roles of the workforce; and how the workforce can be strengthened to support new approaches to priority health problems. The available evidence to shed light on these policy issues is limited. The World Health Organization is supporting the development of evidence to inform discussion on the best approaches to strengthening public health capacity in developing countries. WHO's priorities are to build an evidence base on the size and structure of the public health workforce, beginning with ongoing data collection activities, and to map the current public health training programmes in developing countries and in Central and Eastern Europe. Other steps will include developing a consensus on the desired functions and activities of the public health workforce and developing a framework and methods for assisting countries to assess and enhance the performance of public health training institutions and of the public health workforce.

  15. Civil Service Workforce Market Supply and the Effect on Cost Estimating Relationship (CERS) that May Effect the Productivity Factors for Future NASA Missions (United States)

    Sterk, Steve; Chesley, Stephan


    The upcoming retirement of the Baby Boomers will leave a workforce age gap between the younger generation (the future NASA decision makers) and the gray beards. This paper will reflect on the average age of the workforce across NASA Centers, the Aerospace Industry and other Government Agencies, like DoD. This paper will dig into Productivity and Realization Factors and how they get applied to bi-monthly (payroll) data for true full-time equivalent (FTE) calculations that could be used at each of the NASA Centers and other business systems that are on the forefront in being implemented. This paper offers some comparative costs analysis/solutions, from simple FTE cost-estimating relationships (CERs) versus CERs for monthly time-phasing activities for small research projects that start and get completed within a government fiscal year. This paper will present the results of a parametric study investigating the cost-effectiveness of alternative performance-based CERs and how they get applied into the Center's forward pricing rate proposals (FPRP). True CERs based on the relationship of a younger aged workforce will have some effects on labor rates used in both commercial cost models and other internal home-grown cost models which may impact the productivity factors for future NASA missions.

  16. Organizational leadership for building effective health care teams. (United States)

    Taplin, Stephen H; Foster, Mary K; Shortell, Stephen M


    The movement toward accountable care organizations and patient-centered medical homes will increase with implementation of the Affordable Care Act (ACA). The ACA will therefore give further impetus to the growing importance of teams in health care. Teams typically involve 2 or more people embedded in a larger social system who differentiate their roles, share common goals, interact with each other, and perform tasks affecting others. Multiple team types fit within this definition, and they all need support from leadership to succeed. Teams have been invoked as a necessary tool to address the needs of patients with multiple chronic conditions and to address medical workforce shortages. Invoking teams, however, is much easier than making them function effectively, so we need to consider the implications of the growing emphasis on teams. Although the ACA will spur team development, organizational leadership must use what we know now to train, support, and incentivize team function. Meanwhile, we must also advance research regarding teams in health care to give those leaders more evidence to guide their work.

  17. North Carolina's nursing workforce: planning today for a reformed tomorrow. (United States)

    Fraher, Erin P; Jones, Cheryl B


    Nurses are the single largest component of North Carolina's health workforce, and nursing jobs are an essential driver of the state's economic recovery. We propose 5 recommendations for creating a nursing workforce system that, if implemented, would position the state to meet the future health care needs of North Carolinians.

  18. Cost effectiveness in trauma care. (United States)

    Elliott, D C; Rodriguez, A


    The above discussion brings together a vast body of data that together proclaim with fervent clarity: Traumatic injuries are expensive. The expense is paid in productive lives lost, in permanent disability, in pain and suffering, and in health care resources consumed. As local and regional trauma systems struggle for development and survival, competition for the health care dollar casts in the additional necessity of providing the service of trauma care with maximum efficiency. Despite the variety of cost-efficiency measures described above, a majority of trauma centers continue to operate "in the red." Such cannot continue indefinitely. Fiscal responsibility dictates that health care institutions must balance budgets in order to maintain operations. Four primary strategies for cost containment appear from the above discussion: 1. Improve reimbursement rates from trauma patients. 2. Increase outside funding from government sources. 3. Improve cost efficiency of diagnostic and therapeutic procedures used in trauma patient management. 4. Increase efforts aimed at primary prevention of intentional and unintentional injuries. In the final analysis, most authors agree that the last strategy offers the best hope. As stated in their article, "The Economic Impact of Injuries," Harlan and colleagues conclude that "the most effective medical and cost reduction strategy would be prevention." The same article goes on to detail how greater funding for research into optimal prevention modalities could reap societal and economic benefits far beyond the value of the initial outlay. Yet such research funding continues to be inadequate. For every dollar spent on medical care of cancer patients, nine cents is directed to research. For every dollar spent on trauma care, less than a penny is spent on research. Until the public recognizes the terrible toll trauma extracts in lives, livelihood, and money wasted and until it realizes the pre-eminent importance of prevention, care of the

  19. Public health workforce taxonomy. (United States)

    Boulton, Matthew L; Beck, Angela J; Coronado, Fátima; Merrill, Jacqueline A; Friedman, Charles P; Stamas, George D; Tyus, Nadra; Sellers, Katie; Moore, Jean; Tilson, Hugh H; Leep, Carolyn J


    Thoroughly characterizing and continuously monitoring the public health workforce is necessary for ensuring capacity to deliver public health services. A prerequisite for this is to develop a standardized methodology for classifying public health workers, permitting valid comparisons across agencies and over time, which does not exist for the public health workforce. An expert working group, all of whom are authors on this paper, was convened during 2012-2014 to develop a public health workforce taxonomy. The purpose of the taxonomy is to facilitate the systematic characterization of all public health workers while delineating a set of minimum data elements to be used in workforce surveys. The taxonomy will improve the comparability across surveys, assist with estimating duplicate counting of workers, provide a framework for describing the size and composition of the workforce, and address other challenges to workforce enumeration. The taxonomy consists of 12 axes, with each axis describing a key characteristic of public health workers. Within each axis are multiple categories, and sometimes subcategories, that further define that worker characteristic. The workforce taxonomy axes are occupation, workplace setting, employer, education, licensure, certification, job tasks, program area, public health specialization area, funding source, condition of employment, and demographics. The taxonomy is not intended to serve as a replacement for occupational classifications but rather is a tool for systematically categorizing worker characteristics. The taxonomy will continue to evolve as organizations implement it and recommend ways to improve this tool for more accurate workforce data collection.

  20. Pharmacists belong in accountable care organizations and integrated care teams. (United States)

    Smith, Marie; Bates, David W; Bodenheimer, Thomas S


    Effective health care workforce development requires the adoption of team-based care delivery models, in which participating professionals practice at the full extent of their training in pursuit of care quality and cost goals. The proliferation of such new models as medical homes, accountable care organizations, and community-based care teams is creating new opportunities for pharmacists to assume roles and responsibilities commensurate with their capabilities. Some challenges to including pharmacists in team-based care delivery models, including the lack of payment mechanisms that explicitly provide for pharmacist services, have yet to be fully addressed by policy makers and others. Nevertheless, evolving models and strategies reveal a variety of ways to draw on pharmacists' expertise in such critical areas as medication management for high-risk patients. As Affordable Care Act provisions are implemented, health care workforce projections need to consider the growing number of pharmacists expected to play an increasing role in delivering primary care services.

  1. Parents and the High Cost of Child Care: 2014 Report (United States)

    Wood, Stephen; Fraga, Lynette; McCready, Michelle


    Eleven million children younger than age five are in some form of child care in the United States. The "Parents and the High Cost of Child Care: 2014 Report" summarizes the cost of child care across the country, examines the importance of child care as a workforce support and as an early learning program, and explores the effect of high…

  2. Parents and the High Cost of Child Care: 2015 Report (United States)

    Fraga, Lynette; Dobbins, Dionne; McCready, Michelle


    Eleven million children younger than age five are in some form of child care in the United States. The "Parents and the High Cost of Child Care: 2015 Report" summarizes the cost of child care across the country, examines the importance of child care as a workforce support and as an early learning program, and explores the effect of high…

  3. Specialist nursing framework for New Zealand: a missing link in workforce planning. (United States)

    Holloway, Kathy; Baker, Jacqueline; Lumby, Judy


    The current global nursing shortage challenges the provision of a well qualified and sustainable health workforce to meet future population health needs. An identified area of concern for New Zealand reaching health policy targets in chronic conditions management and primary health care is an adequate specialist nurse workforce supply. This article explores the New Zealand context underpinning this concern and contends that effective workforce planning would be supported by the development of a single unified framework for specialist nursing practice in New Zealand. A consistent national framework has the potential to support accurate data collection and enable service providers to identify and plan transparent and transferable pathways for specialist nursing service provision and development. Advanced practice nursing frameworks assist in increasing productivity through building an evidence base about advanced practice, enhancing consistency and equity of expertise; supporting a reduction in role duplication; and enabling succession planning and sustainability.

  4. Civil Service Workforce Market Supply and the Effect on the Cost Estimating Relationships (CERs) that may effect the Productivity Factors for Future NASA Missions (United States)

    Sterk, Steve; Chesley, Stephen


    The upcoming retirement of the Baby Boomers on the horizon will leave a performance gap between younger generation (the future NASA decision makers) and the gray beards. This paper will reflect on the average age of workforce across NASA Centers, the Aerospace Industry and other Government Agencies, like DoD. This papers will dig into Productivity and Realization Factors and how they get applied to bimonthly (payroll data) for true FTE calculations that could be used at each of the NASA Centers and other business systems that are on the forefront in being implemented. This paper offers some comparative costs solutions, from simple - full time equivalent (FTE) cost estimating relationships CERs, to complex - CERs for monthly time-phasing activities for small research projects that start and get completed within a government fiscal year. This paper will present the results of a parametric study investigating the cost-effectiveness of different alternatives performance based cost estimating relationships (CERs) and how they get applied into the Center s forward pricing rate proposals (FPRP). True CERs based on the relationship of a younger aged workforce will have some effects on labor rates used in both commercial cost models and internal home-grown cost models which may impact the productivity factors for future NASA missions.

  5. The adverse effects of International Monetary Fund programs on the health and education workforce. (United States)

    Marphatia, Akanksha A


    Decades of underinvestment in public sectors and in teachers and health workers have adversely affected the health and educational outcomes of women. This is partly explained by a general lack of resources. However, the amount a country can spend on social sectors, including teachers and health workers, is also determined by its macroeconomic framework, which is set in agreement with the International Monetary Fund. There is now ample evidence of how IMF-imposed wage ceilings have constrained the ability of governments to hire adequate numbers of trained professionals and increase investment in social sectors. Though the IMF has recently removed wage ceilings from its basket of conditions, little change has taken place to ensure that women are better supported by macroeconomic policies or, at the least, are less adversely affected. Thus far, the IMF's neoliberal policies have either ignored gender concerns or instrumentalized equity, health, and education to support economic development. Unless macroeconomic policies are more flexible and deliberately take into account the different needs of women and men, social outcomes will continue to be poor and inequitable. Governments must pursue alternative, feminist policies that put the goals of social equity at the center of macroeconomic policy. These policies can facilitate increased investment in education and health care, which are vital measures for achieving gender equality and providing both women and men with the skills and training needed to soften the impact of the current economic crisis.

  6. The Medical Physics Workforce. (United States)

    Newhauser, Wayne D


    The medical physics workforce comprises approximately 24,000 workers worldwide and approximately 8,200 in the United States. The occupation is a recognized, established, and mature profession that is undergoing considerable growth and change, with many of these changes being driven by scientific, technical, and medical advances. Presently, the medical physics workforce is adequate to meet societal needs. However, data are emerging that suggest potential risks of shortages and other problems that could develop within a few years. Some of the governing factors are well established, such as the increasing number of incident cancers thereby increasing workload, while others, such as the future use of radiation treatments and changes in healthcare economic policies, are uncertain and make the future status of the workforce difficult to forecast beyond the next several years. This review examines some of the major factors that govern supply and demand for medical physicists, discusses published projections and their uncertainties, and presents other information that may help to inform short- and long-term planning of various aspects of the future workforce. It includes a description of the general characteristics of the workforce, including information on its size, educational attainment, certification, age distribution, etc. Because the supply of new workers is governed by educational and training pathways, graduate education, post-doctoral training, and residency training are reviewed, along with trends in state and federal support for research and education. Selected professional aspects of the field also are considered, including professional certification and compensation. We speculate on the future outlook of the workforce and provide recommendations regarding future actions pertaining to the future medical physics workforce.

  7. Engaging the Workforce - 12347

    Energy Technology Data Exchange (ETDEWEB)

    Gaden, Michael D. [Transuranic Waste Processing Center, Lenoir City, TN 37771 (United States); Wastren Advantage Inc. (United States)


    Likert, Covey, and a number of others studying and researching highly effective organizations have found that performing functions such as problem-solving, decision-making, safety analysis, planning, and continuous improvement as close to the working floor level as possible results in greater buy-in, feelings of ownership by the workers, and more effective use of resources. Empowering the workforce does several things: 1) people put more effort and thought into work for which they feel ownership, 2) the information they use for planning, analysis, problem-solving,and decision-making is more accurate, 3) these functions are performed in a more timely manner, and 4) the results of these functions have more credibility with those who must implement them. This act of delegation and empowerment also allows management more time to perform functions they are uniquely trained and qualified to perform, such as strategic planning, staff development, succession planning, and organizational improvement. To achieve this state in an organization, however, requires a very open, transparent culture in which accurate, timely, relevant, candid, and inoffensive communication flourishes, a situation that does not currently exist in a majority of organizations. (authors)

  8. Transportability of tertiary qualifications and CPD: A continuing challenge for the global health workforce

    Directory of Open Access Journals (Sweden)

    Saltman Deborah C


    Full Text Available Abstract Background In workforces that are traditionally mobile and have long lead times for new supply, such as health, effective global indicators of tertiary education are increasingly essential. Difficulties with transportability of qualifications and cross-accreditation are now recognised as key barriers to meeting the rapidly shifting international demands for health care providers. The plethora of mixed education and service arrangements poses challenges for employers and regulators, let alone patients; in determining equivalence of training and competency between individuals, institutions and geographical locations. Discussion This paper outlines the shortfall of the current indicators in assisting the process of global certification and competency recognition in the health care workforce. Using Organisation for Economic Cooperation and Development (OECD data we highlight how International standardisation in the tertiary education sector is problematic for the global health workforce. Through a series of case studies, we then describe a model which enables institutions to compare themselves internally and with others internationally using bespoke or prioritised parameters rather than standards. Summary The mobility of the global health workforce means that transportability of qualifications is an increasing area of concern. Valid qualifications based on workplace learning and assessment requires at least some variables to be benchmarked in order to judge performance.

  9. The accuracy of general practitioner workforce projections.

    NARCIS (Netherlands)

    Greuningen, M. van; Batenburg, R.S.; Velden, L.F.J. van der


    Background: Health workforce projections are important instruments to prevent imbalances in the health workforce. For both the tenability and further development of these projections, it is important to evaluate the accuracy of workforce projections. In the Netherlands, health workforce projections

  10. Human resource governance: what does governance mean for the health workforce in low- and middle-income countries?

    Directory of Open Access Journals (Sweden)

    Kaplan Avril D


    Full Text Available Abstract Background Research on practical and effective governance of the health workforce is limited. This paper examines health system strengthening as it occurs in the intersection between the health workforce and governance by presenting a framework to examine health workforce issues related to eight governance principles: strategic vision, accountability, transparency, information, efficiency, equity/fairness, responsiveness and citizen voice and participation. Methods This study builds off of a literature review that informed the development of a framework that describes linkages and assigns indicators between governance and the health workforce. A qualitative analysis of Health System Assessment (HSA data, a rapid indicator-based methodology that determines the key strengths and weaknesses of a health system using a set of internationally recognized indicators, was completed to determine how 20 low- and middle-income countries are operationalizing health governance to improve health workforce performance. Results/discussion The 20 countries assessed showed mixed progress in implementing the eight governance principles. Strengths highlighted include increasing the transparency of financial flows from sources to providers by implementing and institutionalizing the National Health Accounts methodology; increasing responsiveness to population health needs by training new cadres of health workers to address shortages and deliver care to remote and rural populations; having structures in place to register and provide licensure to medical professionals upon entry into the public sector; and implementing pilot programs that apply financial and non-financial incentives as a means to increase efficiency. Common weaknesses emerging in the HSAs include difficulties with developing, implementing and evaluating health workforce policies that outline a strategic vision for the health workforce; implementing continuous licensure and regulation systems to

  11. The Changing Global Context of Virtual Workforce

    Directory of Open Access Journals (Sweden)

    James A. Ejiwale


    Full Text Available The technological revolution occurring in today’s market place has made it possible for many companies to be innovative about the way and where work is done. To get the job done, due to digital revolution, companies have turned to virtual workforce to harness the benefits of connectivity and effective information sharing among stakeholders to get the job done. More important, the success of coordinating work among a virtual workforce for profitability in a rapidly changing global environment depends on “effective indirect communication” between the leadership and the virtual workforce. This article will address the importance of effective communication as a necessary tool for the success of e-leadership, productivity improvement in virtual work environment.

  12. Securing the Workforce

    DEFF Research Database (Denmark)

    Clausen, Lisbeth; Kruuse, Mikkel


    Japan is world renowned for its quality production and efficient management, lean. However, economic stagnation - and a bottom score in the OECD statistics on women participation in the workforce - has forced the Japanese government to focus on the economic benefits of diversity in Corporate Japan...

  13. STEM Workforce Pipeline (United States)


    Science Literacy, and the Innovation Workforce in America : In compiling this document, Bayer has identified key intersections of thought, belief...System t " The Animal Kingdom includes: Birds, Mammal, ano Reptiles Under the Sea includes: Deep Sea Exploration, Middle Sea, and The Shallows

  14. The State of the Psychology Health Service Provider Workforce (United States)

    Michalski, Daniel S.; Kohout, Jessica L.


    Numerous efforts to describe the health service provider or clinical workforce in psychology have been conducted during the past 30 years. The American Psychological Association (APA) has studied trends in the doctoral education pathway and the resultant effects on the broader psychology workforce. During this period, the creation and growth of…

  15. Changes in turnover and vacancy rates of care workers in England from 2008 to 2010: panel analysis of national workforce data. (United States)

    Hussein, Shereen; Ismail, Mohamed; Manthorpe, Jill


    The combination of growing demand for long-term care and higher expectations of care staff needs to be set in the context of long-standing concerns about the sustainability of recruitment and retention of front-line staff in the United Kingdom. Organisational and work environment factors are associated with vacancy levels and turnover rates. The aim of the current analysis was to investigate changes in turnover and vacancy rates over time experienced by a sample of social care employers in England. Taking a follow-up approach offers potentially more accurate estimates of changes in turnover and vacancy rates, and enables the identification of any different organisational characteristics which may be linked to reductions in these elements over time. The study constructed a panel of 2964 care providers (employers) using 18 separate data sets from the National Minimum Data Set for Social Care during 2008-2010. The findings indicate slight reductions in vacancy rates but the presence of enduring, high turnover rates among direct care workers over the study period. However, the experience of individual employers varied, with home-care providers experiencing significantly higher turnover rates than other parts of the sector. These findings raise questions around the quality and motivations of new recruits and methods of reducing specific vacancy levels. At a time of increased emphasis on care at home, it is worthwhile examining why care homes appear to have greater stability of staff and fewer vacancies than home-care agencies.

  16. Managing a scarce resource: addressing critical health workforce challenges.

    NARCIS (Netherlands)

    Giepmans. P.; Dussault, G.; Batenburg, R.; Frich, J.; Olivers, R.; Sermeus, W.


    With health care services significantly changing, the challenge is to initiate innovative, situational and integrated workforce forecasting and planning. Many health systems require a shift in mindset to move to the planning of skill mixes for health care professionals. This implies great challenges

  17. The globalization of the nursing workforce: Pulling the pieces together. (United States)

    Jones, Cheryl B; Sherwood, Gwen D


    The "globalization" of health care creates an increasingly interconnected workforce spanning international boundaries, systems, structures, and processes to provide care to and improve the health of peoples around the world. Because nurses comprise a large sector of the global health workforce, they are called upon to provide a significant portion of nursing and health care and thus play an integral role in the global health care economy. To meet global health care needs, nurses often move within and among countries, creating challenges and opportunities for the profession, health care organizations, communities, and nations. Researchers, policy makers, and industry and academic leaders must, in turn, grapple with the impacts of globalization on the nursing and health care workforce. Through this special issue, several key areas for discussion are raised. Although far from exhaustive, our intent is to expand and stimulate intra- and interprofessional conversations raising awareness of the issues, uncover unanticipated consequences, and offer solutions for shaping the nursing and health care workforce of the future.

  18. Labor and skills gap analysis of the biomedical research workforce. (United States)

    Mason, Julie L; Johnston, Elizabeth; Berndt, Sam; Segal, Katie; Lei, Ming; Wiest, Jonathan S


    The United States has experienced an unsustainable increase of the biomedical research workforce over the past 3 decades. This expansion has led to a myriad of consequences, including an imbalance in the number of researchers and available tenure-track faculty positions, extended postdoctoral training periods, increasing age of investigators at first U.S. National Institutes of Health R01 grant, and exodus of talented individuals seeking careers beyond traditional academe. Without accurate data on the biomedical research labor market, challenges will remain in resolving these problems and in advising trainees of viable career options and the skills necessary to be productive in their careers. We analyzed workforce trends, integrating both traditional labor market information and real-time job data. We generated a profile of the current biomedical research workforce, performed labor gap analyses of occupations in the workforce at regional and national levels, and assessed skill transferability between core and complementary occupations. We conclude that although supply into the workforce and the number of job postings for occupations within that workforce have grown over the past decade, supply continues to outstrip demand. Moreover, we identify practical skill sets from real-time job postings to optimally equip trainees for an array of careers to effectively meet future workforce demand.-Mason, J. L., Johnston, E., Berndt, S., Segal, K., Lei, M., Wiest, J. S. Labor and skills gap analysis of the biomedical research workforce.

  19. Health Workforce Planning: An overview and suggested approach in Oman. (United States)

    Al-Sawai, Abdulaziz; Al-Shishtawy, Moeness M


    In most countries, the lack of explicit health workforce planning has resulted in imbalances that threaten the capacity of healthcare systems to attain their objectives. This has directed attention towards the prospect of developing healthcare systems that are more responsive to the needs and expectations of the population by providing health planners with a systematic method to effectively manage human resources in this sector. This review analyses various approaches to health workforce planning and presents the Six-Step Methodology to Integrated Workforce Planning which highlights essential elements in workforce planning to ensure the quality of services. The purpose, scope and ownership of the approach is defined. Furthermore, developing an action plan for managing a health workforce is emphasised and a reviewing and monitoring process to guide corrective actions is suggested.

  20. Health Workforce Planning: An overview and suggested approach in Oman

    Directory of Open Access Journals (Sweden)

    Abdulaziz Al-Sawai


    Full Text Available In most countries, the lack of explicit health workforce planning has resulted in imbalances that threaten the capacity of healthcare systems to attain their objectives. This has directed attention towards the prospect of developing healthcare systems that are more responsive to the needs and expectations of the population by providing health planners with a systematic method to effectively manage human resources in this sector. This review analyses various approaches to health workforce planning and presents the Six-Step Methodology to Integrated Workforce Planning which highlights essential elements in workforce planning to ensure the quality of services. The purpose, scope and ownership of the approach is defined. Furthermore, developing an action plan for managing a health workforce is emphasised and a reviewing and monitoring process to guide corrective actions is suggested.

  1. CAM practitioners in the Australian health workforce: an underutilized resource

    Directory of Open Access Journals (Sweden)

    Grace Sandra


    Full Text Available Abstract Background CAM practitioners are a valuable but underutilizes resource in Australian health care. Despite increasing public support for complementary and alternative medicine (CAM little is known about the CAM workforce. Apart from the registered professions of chiropractic, osteopathy and Chinese medicine, accurate information about the number of CAM practitioners in the workforce has been difficult to obtain. It appears that many non-registered CAM practitioners, although highly qualified, are not working to their full capacity. Discussion Increasing public endorsement of CAM stands in contrast to the negative attitude toward the CAM workforce by some members of the medical and other health professions and by government policy makers. The marginalisation of the CAM workforce is evident in prejudicial attitudes held by some members of the medical and other health professions and its exclusion from government policy making. Inconsistent educational standards has meant that non-registered CAM practitioners, including highly qualified and competent ones, are frequently overlooked. Legitimising their contribution to the health workforce could alleviate workforce shortages and provide opportunities for redesigned job roles and new multidisciplinary teams. Priorities for better utilisation of the CAM workforce include establishing a guaranteed minimum education standard for more CAM occupation groups through national registration, providing interprofessional education that includes CAM practitioners, developing courses to upgrade CAM practitioners' professional skills in areas of indentified need, and increasing support for CAM research. Summary Marginalisation of the CAM workforce has disadvantaged those qualified and competent CAM practitioners who practise evidence-informed medicine on the basis of many years of university training. Legitimising and expanding the important contribution of CAM practitioners could alleviate projected health

  2. The accuracy of General Practitioner workforce projections.

    NARCIS (Netherlands)

    Greuningen, M. van; Batenburg, R.; Velden, L. van der


    Context: Health workforce projections are important to prevent imbalances in the health workforce. Matrix Insight provided an overview of health workforce planning in the EU, which shows that 13 countries are engaged in model-based workforce planning using workforce projections. However, in most cas

  3. Skills Development for a Diverse Older Workforce (United States)

    Ferrier, Fran; Burke, Gerald; Selby Smith, Chris


    In the context of aging populations, governments in Australia and in other Western nations fear that slower growth in the numbers of people of working age (15-64 years) will have a dampening effect on economic growth. They are thus considering how to encourage older workers to remain in the workforce beyond the point at which many currently…

  4. Geoscience and the 21st Century Workforce (United States)

    Manduca, C. A.; Bralower, T. J.; Blockstein, D.; Keane, C. M.; Kirk, K. B.; Schejbal, D.; Wilson, C. E.


    Geoscience knowledge and skills play new roles in the workforce as our society addresses the challenges of living safely and sustainably on Earth. As a result, we expect a wider range of future career opportunities for students with education in the geosciences and related fields. A workshop offered by the InTeGrate STEP Center on 'Geoscience and the 21st Century Workforce' brought together representatives from 24 programs with a substantial geoscience component, representatives from different employment sectors, and workforce scholars to explore the intersections between geoscience education and employment. As has been reported elsewhere, employment in energy, environmental and extractive sectors for geoscientists with core geology, quantitative and communication skills is expected to be robust over the next decade as demand for resources grow and a significant part of the current workforce retires. Relatively little is known about employment opportunities in emerging areas such as green energy or sustainability consulting. Employers at the workshop from all sectors are seeking the combination of strong technical, quantitative, communication, time management, and critical thinking skills. The specific technical skills are highly specific to the employer and employment needs. Thus there is not a single answer to the question 'What skills make a student employable?'. Employers at this workshop emphasized the value of data analysis, quantitative, and problem solving skills over broad awareness of policy issues. Employers value the ability to articulate an appropriate, effective, creative solution to problems. Employers are also very interested in enthusiasm and drive. Participants felt that the learning outcomes that their programs have in place were in line with the needs expressed by employers. Preparing students for the workforce requires attention to professional skills, as well as to the skills needed to identify career pathways and land a job. This critical

  5. Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives. (United States)

    Morris, Joanne; Grimmer, Karen; Gilmore, Lisa; Perera, Chandima; Waddington, Gordon; Kyle, Greg; Ashman, Bryan; Murphy, Karen


    Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy) in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable career pathways; developing, accrediting, and delivering a curriculum supporting physiotherapists to work outside of the usual scope; and progression from "a good idea" to established service. Health care facilities planning to implement new workforce initiatives that extend scope of usual practice should consider these issues before instigating workforce/model of care changes.

  6. Study of the effect of humanistic nursing care model wards in Children Caring Ward School on the nurses' caring ability

    Institute of Scientific and Technical Information of China (English)

    Jiao He; De-Ying Hu; Yi-Lan Liu; Li-Fen Wu; Lian Liu


    Objective: To understand the effect of humanistic nursing care model wards in Children Caring Ward School (CCWS) on the nurses' caring ability. Methods: Questionnaire 25 nurses of humanistic nursing care model wards in CCWS using the Nkongho Caring Ability Inventory (CAI) before and after implement the humanistic nursing care model, including reform the systems of nursing care, introduce humanistic care model, implement the humanistic care, to measure the nurses' caring ability. Results: The nurses' caring ability had significantly developed on total, cognition dimension, courage dimension and patience dimension after all measures considered (p Conclusions: The humanistic nursing care model wards in CCWS has a positive effect on the nurses' caring ability, not only to help build great relationships between nurses and patients but also to enhance the patients' satisfaction.

  7. 对医疗人员劳动力的认识和量化建议%Understanding and quantification of the workforce recommendations on health care

    Institute of Scientific and Technical Information of China (English)

    万怡; 郭杰


      新的“卫生医疗体制改革”和“关于分类推进事业单位改革的指导意见”相继出台,为我国医疗机构的体制改革和运营模式指出了明确的方针和系统规划,随之而来的就是医疗单位内部绩效工资制度的切实执行。但是由于医疗行业自身的特殊性决定了医疗服务的主体——医务人员的劳动力价值难以合理估价,至今未能形成科学的评价体系和量化标准。文中探讨如何公正、客观地体现医疗人员的劳动力价值,使他们的个人价值体现与他们的实际贡献相匹配,从而使他们的劳动付出得到合法的相应回报。%The new“health care reform”and“guidance on classification and promoting the reform of public institutions”have been introduced,system and operation mode of medical institutions in China pointed out that a clear policy and systems planning, follow is the medical unit of the effective implementation of pay-for-performance system. But due to the particularities of the medical industry's own decisions--the subject of a medical service labor value to a reasonable valuation of medical personnel,have been unable to form a scientific evaluation system and quantitative criteria. This article at how fair and objectively reflect the labor value of medical personnel,so that they match the personal value and their actual contribution,so as to allow their labor to pay to get a legitimate return.

  8. Rural pharmacy in Canada: pharmacist training, workforce capacity and research partnerships


    Soon, Judith A.; Levine, Marc


    Objectives. To characterize rural health care and pharmacy recruitment and retention issues explored in Canadian pharmacy strategic guidelines and Canadian Faculties of Pharmacy curricula; compare the availability of pharmacy workforce across Canadian jurisdictions; and identify models for potential collaborations between universities and rural pharmacies in the North. Methods. Review of Canadian pharmacy strategic documents, Canadian Faculty of Pharmacy websites, Canadian pharmacy workforce ...

  9. Primary care nurses: effects on secondary care referrals for diabetes?

    NARCIS (Netherlands)

    Dijk, C.E. van; Verheij, R.A.; Hansen, J.; Velden, L. van der; Nijpels, G.; Groenewegen, P.P.; Bakker, D.H. de


    BACKGROUND: Primary care nurses play an important role in diabetes care, and were introduced in GP-practice partly to shift care from hospital to primary care. The aim of this study was to assess whether the referral rate for hospital treatment for diabetes type II (T2DM) patients has changed with t

  10. Primary care nurses : effects on secondary care referrals for diabetes

    NARCIS (Netherlands)

    Dijk, C.E. van; Verheij, R.A.; Hansen, J.; Velden, L. van der; Nijpels, G.; Groenewegen, P.P.; Bakker, D.H. de


    Background: Primary care nurses play an important role in diabetes care, and were introduced in GP-practice partly to shift care from hospital to primary care. The aim of this study was to assess whether the referral rate for hospital treatment for diabetes type II (T2DM) patients has changed with t

  11. Seeking a State Workforce Strategy (United States)

    Fischer, David Jason; Mack, Melinda


    New York's workforce system is a complicated entity that engages nearly a dozen state agencies and myriad funding streams originating at the federal and state levels, and operates on the ground in ten economic development regions, 33 designated workforce investment areas, community-based organizations, labor unions and 62 counties. This report…

  12. Integrated Care and the Evolution of the Multidisciplinary Team. (United States)

    Dobbins, Mary Iftner; Thomas, Sheila A; Melton, Stacy L Stokes; Lee, Stacy


    The primary care medical home continues to adapt by applying new research to population health approaches to care. With the discovery that life experiences trigger a chain of biologic events linked to chronic illnesses, the role of patient-centered multidisciplinary care teams becomes of paramount importance. Subsequently, mental health professionals are being incorporated into the primary care setting, using their skills in nontraditional models to customize care for each patient. This "integration" of primary care and unique mental health services engenders opportunity for enhanced clinical care, professional workforce development and support, more effective population health initiatives, and informed health care policy.

  13. Redistributive effects in public health care financing. (United States)

    Honekamp, Ivonne; Possenriede, Daniel


    This article focuses on the redistributive effects of different measures to finance public health insurance. We analyse the implications of different financing options for public health insurance on the redistribution of income from good to bad health risks and from high-income to low-income individuals. The financing options considered are either income-related (namely income taxes, payroll taxes, and indirect taxes), health-related (co-insurance, deductibles, and no-claim), or neither (flat fee). We show that governments who treat access to health care as a basic right for everyone should consider redistributive effects when reforming health care financing.

  14. Effects of Co-Worker and Supervisor Support on Job Stress and Presenteeism in an Aging Workforce: A Structural Equation Modelling Approach

    Directory of Open Access Journals (Sweden)

    Tianan Yang


    Full Text Available We examined the effects of co-worker and supervisor support on job stress and presenteeism in an aging workforce. Structural equation modelling was used to evaluate data from the 2010 wave of the Health and Retirement Survey in the United States (n = 1649. The level of presenteeism was low and the level of job stress was moderate among aging US workers. SEM revealed that co-worker support and supervisor support were strongly correlated (β = 0.67; p < 0.001. Job stress had a significant direct positive effect on presenteeism (β = 0.30; p < 0.001. Co-worker support had a significant direct negative effect on job stress (β = −0.10; p < 0.001 and presenteeism (β = −0.11; p < 0.001. Supervisor support had a significant direct negative effect on job stress (β = −0.40; p < 0.001 but not presenteeism. The findings suggest that presenteeism is reduced by increased respect and concern for employee stress at the workplace, by necessary support at work from colleagues and employers, and by the presence of comfortable interpersonal relationships among colleagues and between employers and employees.

  15. Informed policies for Europe’s health workforce of tomorrow.

    NARCIS (Netherlands)

    Batenburg, R.


    Although it is widely acknowledged that health workforce planning is critical for health care systems, it is probably one of the least strategically planned resources. One could argue that there are good reasons for this: demand and supply of the health labour market are in constant flux, and policy

  16. Addressing the workforce pipeline challenge

    Energy Technology Data Exchange (ETDEWEB)

    Leonard Bond; Kevin Kostelnik; Richard Holman


    A secure and affordable energy supply is essential for achieving U.S. national security, in continuing U.S. prosperity and in laying the foundations to enable future economic growth. To meet this goal the next generation energy workforce in the U.S., in particular those needed to support instrumentation, controls and advanced operations and maintenance, is a critical element. The workforce is aging and a new workforce pipeline, to support both current generation and new build has yet to be established. The paper reviews the challenges and some actions being taken to address this need.

  17. Workforce issues in rural surgery. (United States)

    Lynge, Dana Christian; Larson, Eric H


    Almost one quarter of America's population and one third of its landmass are defined as rural and served by approximately 20% of the nation's general surgeons. General surgeons are the backbone of the rural health workforce. There is significant maldistribution of general surgeons across regions and different types of rural areas. Rural areas have markedly fewer surgeons per population than the national average. The demography of the rural general surgery workforce differs substantially from the urban general surgery workforce, raising concerns about the extent to which general surgical services can be maintained in rural areas of the United States.

  18. Evaluating the effectiveness of health care teams. (United States)

    Mickan, Sharon M


    While it is recognised that effective health care teams are associated with quality patient care, the literature is comparatively sparse in defining the outcomes of effective teamwork. This literature review of the range of organisational, team and individual benefits of teamwork complements an earlier article which summarised the antecedent conditions for (input) and team processes (throughput) of effective teams. This article summarises the evidence for a range of outcome measures of effective teams. Organisational benefits of teamwork include reduced hospitalisation time and costs, reduced unanticipated admissions, better accessibility for patients, and improved coordination of care. Team benefits include efficient use of health care services, enhanced communication and professional diversity. Patients report benefits of enhanced satisfaction, acceptance of treatment and improved health outcomes. Finally, team members report enhanced job satisfaction, greater role clarity and enhanced well-being. Due to the inherent complexity of teamwork, a constituency model of team evaluation is supported where key stakeholders identify and measure the intended benefits of a team.

  19. Palliative care teams: effective through moral reflection.

    NARCIS (Netherlands)

    Hermsen, M.A.; Have, H.A.M.J. ten


    Working as a multidisciplinary or interdisciplinary team is an essential condition to provide good palliative care. This widespread assumption is based on the idea that teamwork makes it possible to address the various needs of the patient and family more effectively. This article is about teamwork

  20. Ergonomic workforce scheduling under complex worker limitation and task requirements:

    Directory of Open Access Journals (Sweden)

    Tanuchporn Wongwien


    Full Text Available The ergonomic workforce scheduling problem (WPS is addressed in this paper. Unlike its previous related works, theproblem considers realistic worker limitation and task requirements that include heterogeneous workforce with limited taskflexibility, varying worker team sizes, and pre-defined task operation schedules. Its main objective is to find a daily rotatingwork schedule solution using a minimum number of workers such that all workers’ ergonomics hazard exposures do notexceed a permissible limit. Initially, the ergonomic WPS is explained. Its mathematical model and approximation procedure toobtain the workforce schedule solution are described. From the results of the computation experiment, it can be concludedthat the approximation procedure is both efficient and effective in solving large-sized ergonomic workforce schedulingproblems.

  1. Workforce Information Cubes for NASA (United States)

    National Aeronautics and Space Administration — Workforce Information Cubes for NASA, sourced from NASA's personnel/payroll system, gives data about who is working where and on what. Includes records for every...

  2. Wind Energy Workforce Development & Jobs

    Energy Technology Data Exchange (ETDEWEB)

    Tegen, Suzanne


    The United States needs a skilled and qualified wind energy workforce to produce domestic clean power. To assist with wind energy workforce development, the U.S. Department of Energy (DOE) and National Renewable Energy Laboratory are engaged with several efforts.This presentation by Suzanne Tegen describes these efforts, including a wind industry survey, DOE's Wind Career Map, the DOE Wind Vision report, and an in-depth discussion of the Jobs & Economic Development Impacts Model.

  3. An analysis on the predictive demand for health care workforce in health care facilities in the city of Karamay in Xinj iang%新疆克拉玛依市医疗机构卫生人员需求预测分析

    Institute of Scientific and Technical Information of China (English)

    白思敏; 欧阳静; 张建华; 许强; 杨良佩; 叶庆; 朱朝刚


    目的:探讨新疆克拉玛依市2006-2010年医疗机构提供医疗卫生服务以及社会发展情况,测算2011-2015年医疗机构的卫生技术人员数量和机构,为合理配置与规划医疗机构的发展提供有效的依据。方法根据2006-2010的卫生服务需求数据,利用等维灰数递补动态模型预测2011-2015年的卫生服务需求数据,再利用卫生服务需求法计算2011-2015年的医生数,最后利用相应的指标推算其他人员的数据量。结果根据卫生服务需求法测算2011年克市医疗卫生机构总人数应为3508名,其中医生926名、护士1111名,2015年为3663名,其中医生967名、护士1160名;截止2010年底卫生人员是2987名,与2011年测算的卫生人员总数相差521名,卫生技术人员2010年数量与2015年测算的卫生技术人员相差643名。结论克市医疗机构卫生人员总量不足,卫生人员结构不合理,工勤人员比例偏高,其他卫生技术人员比例偏低;2011-2015年克市卫生技术人才引进工作压力大。%Objective The number and structure of health care workforce in health care facilities over 2011 to 2015 in Karamay were predicted to provide the information of the rational allocation and scientific plan-ning for health care facilities′development,by analyzing the condition of health services provided by health care facilities and social development from 2006 to 2010 in Karamay.Methods Based on health services de-mand data during 2006 to 2010,a dimension gray recurrence dynamic model was developed to predict the health services demand from 2011 to 2015 in Karamay.Subsequently the calculation method of health serv-ices demand was used to estimate the number of physicians.Finally the corresponding indices were applied to obtain the number of the other workers.Results The estimated total number of health care workforce by 2011 was 3508,and among whom physicians and nurses were 926 and 1 111,respectively

  4. [Evaluation of the effectiveness of health care]. (United States)

    Strnad, L


    health workers and community as a whole. Besides the needful enlargement of sources, these complicated questions are resolvable in observing unity of medical, organizational and economical rationality on all levels of health service management and in all health institutions. This is also the way how to improve the efficiency of health care. The term of efficiency in relation to the health services. In economics, the efficiency is the ratio between the achieved result (effect) and the expenditure of a specified amount of resources. Mathematically, this ratio is expressed as follows: efficiency = end-result/costs Linked to the Health care, the efficiency may be understood also differently from its economic term.(ABSTRACT TRUNCATED AT 400 WORDS)

  5. A national action plan for workforce development in behavioral health. (United States)

    Hoge, Michael A; Morris, John A; Stuart, Gail W; Huey, Leighton Y; Bergeson, Sue; Flaherty, Michael T; Morgan, Oscar; Peterson, Janice; Daniels, Allen S; Paris, Manuel; Madenwald, Kappy


    Across all sectors of the behavioral health field there has been growing concern about a workforce crisis. Difficulties encompass the recruitment and retention of staff and the delivery of accessible and effective training in both initial, preservice training and continuing education settings. Concern about the crisis led to a multiphased, cross-sector collaboration known as the Annapolis Coalition on the Behavioral Health Workforce. With support from the Substance Abuse and Mental Health Services Administration, this public-private partnership crafted An Action Plan for Behavioral Health Workforce Development. Created with input from a dozen expert panels, the action plan outlines seven core strategic goals that are relevant to all sectors of the behavioral health field: expand the role of consumers and their families in the workforce, expand the role of communities in promoting behavioral health and wellness, use systematic recruitment and retention strategies, improve training and education, foster leadership development, enhance infrastructure to support workforce development, and implement a national research and evaluation agenda. Detailed implementation tables identify the action steps for diverse groups and organizations to take in order to achieve these goals. The action plan serves as a call to action and is being used to guide workforce initiatives across the nation.

  6. Redistributive effects of Swedish health care finance. (United States)

    Gerdtham, U G; Sundberg, G


    This paper investigates the redistributive effects of the Swedish health care financing system in 1980 and 1990 for four different financial sources: county council taxes, payroll taxes, direct payments and state grants. The redistributive effects are decomposed into vertical, horizontal and 'reranking' segments for each of the four financial sources. The data used are based on probability samples of the Swedish population, from the Level of Living Survey (LNU) from 1981 and 1991. The paper concludes that the Swedish health care financing system is weakly progressive, although direct payments are regressive. There is some horizontal inequity and 'reranking', which mainly comes from the county council taxes, since those tax rates vary for each county council. The implication is that, to some extent, people with equal incomes are treated unequally.

  7. Effect of Organizational Culture on Patient Access, Care Continuity, and Experience of Primary Care. (United States)

    Hung, Dorothy; Chung, Sukyung; Martinez, Meghan; Tai-Seale, Ming


    This study examined relationships between organizational culture and patient-centered outcomes in primary care. Generalized least squares regression was used to analyze patient access, care continuity, and reported experiences of care among 357 physicians in 41 primary care departments. Compared with a "Group-oriented" culture, a "Rational" culture type was associated with longer appointment wait times, and both "Hierarchical" and "Developmental" culture types were associated with less care continuity, but better patient experiences with care. Understanding the unique effects of organizational culture can enhance the delivery of more patient-centered care.

  8. Informing mental health policies and services in the EMR: cost-effective deployment of human resources to deliver integrated community-based care. (United States)

    Ivbijaro, G; Patel, V; Chisholm, D; Goldberg, D; Khoja, T A M; Edwards, T M; Enum, Y; Kolkiewic, L A


    For EMR countries to deliver the expectations of the Global Mental Health Action Plan 2013-2020 & the ongoing move towards universal health coverage, all health & social care providers need to innovate and transform their services to provide evidence-based health care that is accessible, cost-effective & with the best patient outcomes. For the primary and community workforce, this includes general medical practitioners, practice & community nurses, community social workers, housing officers, lay health workers, nongovernmental organizations & civil society, including community spiritual leaders/healers. This paper brings together the current best evidence to support transformation & discusses key approaches to achieve this, including skill mix and/or task shifting and integrated care. The important factors that need to be in place to support skill mix/task shifting and good integrated care are outlined with reference to EMR countries.

  9. Index of Access: a new innovative and dynamic tool for rural health service and workforce planning. (United States)

    McGrail, Matthew R; Russell, Deborah J; Humphreys, John S


    Objective Improving access to primary health care (PHC) remains a key issue for rural residents and health service planners. This study aims to show that how access to PHC services is measured has important implications for rural health service and workforce planning.Methods A more sophisticated tool to measure access to PHC services is proposed, which can help health service planners overcome the shortcomings of existing measures and long-standing access barriers to PHC. Critically, the proposed Index of Access captures key components of access and uses a floating catchment approach to better define service areas and population accessibility levels. Moreover, as demonstrated through a case study, the Index of Access enables modelling of the effects of workforce supply variations.Results Hypothetical increases in supply are modelled for a range of regional centres, medium and small rural towns, with resulting changes of access scores valuable to informing health service and workforce planning decisions.Conclusions The availability and application of a specific 'fit-for-purpose' access measure enables a more accurate empirical basis for service planning and allocation of health resources. This measure has great potential for improved identification of PHC access inequities and guiding redistribution of PHC services to correct such inequities.What is known about the topic? Resource allocation and health service planning decisions for rural and remote health settings are currently based on either simple measures of access (e.g. provider-to-population ratios) or proxy measures of access (e.g. standard geographical classifications). Both approaches have substantial limitations for informing rural health service planning and decision making.What does this paper add? The adoption of a new improved tool to measure access to PHC services, the Index of Access, is proposed to assist health service and workforce planning. Its usefulness for health service planning is

  10. CAD/CAM at a Distance: Assessing the Effectiveness of Web-Based Instruction To Meet Workforce Development Needs. AIR 2000 Annual Forum Paper. (United States)

    Wilkerson, Joyce A.; Elkins, Susan A.

    This qualitative case study assessed web-based instruction in a computer-aided design/computer-assisted manufacturing (CAD/CAM) course designed for workforce development. The study examined students' and instructors' experience in a CAD/CAM course delivered exclusively on the Internet, evaluating course content and delivery, clarity of…

  11. The global pharmacy workforce: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Anderson Claire


    , complexity of medication therapy and increased prescriptions. To maintain and expand the future pharmacy workforce, increases in recruitment and retention will be essential, as will decreases in attrition, where possible. However, scaling up the global pharmacy workforce is a complex, multifactorial responsibility that requires coordinated action. Further research by means of prospective and comparative methods, not only surveys, is needed into feminization; decreasing demand for postgraduate training; graduate trends; job satisfaction and the impact of pharmacy technicians; and how effective existing interventions are at expanding the pharmacy workforce. More coordinated monitoring and modelling of the pharmacy workforce worldwide (particularly in developing countries is required.

  12. Transformation by design: nursing workforce innovation and reduction strategies in turbulent times of change. (United States)

    Palazzo, Mary O


    The evolution of care delivery from an acute care and inpatient standard to the outpatient setting and health promotion model is generating the need for innovative workforce and infrastructure adjustments to meet the new paradigm of population health management. Successful transformation of the nursing workforce necessitates a positive style of thinking that addresses rational concerns during times of difficult transition. Nurse leaders are called to recognize and appreciate the strengths of the nursing workforce by involving them in the course of change through collaboration, planning, and discussion. One unique way to plan and develop new care delivery models is to adopt the framework used in health facility planning and design for new services, units, or hospitals. This framework is flexible and can be adjusted easily to meet the objectives of a small nursing workforce innovation project or expanded to encompass the needs of a large-scale hospital transformation. Structured questioning further helps the team to identify barriers to care and allows for the development of new concepts that are objective and in accord with evidence-based practice and data. This article explores the advantages and disadvantages of implementing innovative workforce redesign and workforce reduction strategies.

  13. The Workforce Task Force report: clinical implications for neurology. (United States)

    Freeman, William D; Vatz, Kenneth A; Griggs, Robert C; Pedley, Timothy


    The American Academy of Neurology Workforce Task Force (WFTF) report predicts a future shortfall of neurologists in the United States. The WFTF data also suggest that for most states, the current demand for neurologist services already exceeds the supply, and by 2025 the demand for neurologists will be even higher. This future demand is fueled by the aging of the US population, the higher health care utilization rates of neurologic services, and by a greater number of patients gaining access to the health care system due to the Patient Protection and Affordable Care Act. Uncertainties in health care delivery and patient access exist due to looming concerns about further Medicare reimbursement cuts. This uncertainty is set against a backdrop of Congressional volatility on a variety of issues, including the repeal of the sustainable growth rate for physician reimbursement. The impact of these US health care changes on the neurology workforce, future increasing demands, reimbursement, and alternative health care delivery models including accountable care organizations, nonphysician providers such as nurse practitioners and physician assistants, and teleneurology for both stroke and general neurology are discussed. The data lead to the conclusion that neurologists will need to play an even larger role in caring for the aging US population by 2025. We propose solutions to increase the availability of neurologic services in the future and provide other ways of meeting the anticipated increased demand for neurologic care.

  14. 75 FR 14633 - Veterans Workforce Investment Program (United States)


    ...' Employment and Training Service Veterans Workforce Investment Program AGENCY: Veterans' Employment and...' Workforce Investment Program (VWIP) for Program Year (PY) 2010, as authorized under section 168 of the Workforce Investment Act (WIA) of 1998. This Solicitation for Grant Applications (SGA) notice contains...

  15. Can a single question effectively screen for burnout in Australian cancer care workers?

    Directory of Open Access Journals (Sweden)

    Girgis Afaf


    Full Text Available Abstract Background Burnout has important clinical and professional implications among health care workers, with high levels of burnout documented in oncology staff. The aim of this study was to ascertain how well a brief single-item measure could be used to screen for burnout in the Australian oncology workforce. Methods During 2007, 1322 members of the Clinical Oncological Society of Australia were invited to participate in a cross-sectional nationwide survey; 740 (56% of eligible members consented and completed the survey. Data from the 638 consenting members who reported that their work involved direct patient contact were included in the secondary analyses reported in this paper. Burnout was assessed using the MBI Human Services Survey Emotional Exhaustion sub-scale and a single-item self-defined burnout scale. Results Emotional exhaustion was "high" in 33% of the sample when assessed by the psychometrically validated MBI. The single-item burnout measure identified 28% of the sample who classified themselves as "definitely burning out", "having persistent symptoms of burnout", or "completely burned out". MBI Emotional Exhaustion was significantly correlated with the single-item burnout measure (r = 0.68, p 2 of 0.5 (p Conclusions The moderate to high correlation between the single-item self-defined burnout measure and the emotional exhaustion component of burnout suggest that this single item can effectively screen for burnout in health care settings which are time-poor for assessing burnout more comprehensively.

  16. Workforce utilization of visible and linguistic minorities in Canadian nursing. (United States)

    Premji, Stephanie; Etowa, Josephine B


    Aim  This study seeks to develop a diversity profile of the nursing workforce in Canada and its major cities. Background  There is ample evidence of ethnic and linguistic segregation in the Canadian labour market. However, it is unknown if there is equitable representation of visible and linguistic minorities in nursing professions. Methods  We cross-tabulated aggregate data from Statistics Canada's 2006 Census. Analyses examined the distribution of visible and linguistic minorities, including visible minority sub-groups, among health managers, head nurses, registered nurses, licensed nurses and nurse aides for Canada and major cities as well as by gender. Results  In Canada and its major cities, a pyramidal structure was found whereby visible and linguistic minorities, women in particular, were under-represented in managerial positions and over-represented in lower ranking positions. Blacks and Filipinos were generally well represented across nursing professions; however, other visible minority sub-groups lacked representation. Conclusions  Diversity initiatives at all levels can play a role in promoting better access to and quality of care for minority populations through the increased cultural and linguistic competence of care providers and organizations. Implications for Nursing Management  Efforts to increase diversity in nursing need to be accompanied by commitment and resources to effectively manage diversity within organizations.

  17. Today's Higher Education IT Workforce (United States)

    Bichsel, Jacqueline


    The professionals making up the current higher education IT workforce have been asked to adjust to a culture of increased IT consumerization, more sourcing options, broader interest in IT's transformative potential, and decreased resources. Disruptions that include the bring-your-own-everything era, cloud computing, new management practices,…

  18. Integration of the ageing workforce

    NARCIS (Netherlands)

    Krenn, M.; Oehlke, P.; Kees, H.; Leonard, L.; Wendelen, E.; Linkola, P.; Neubauer, G.; Vries, S. de; O'Kelly, K.P.


    The age structure in Europe and other industrialized countries is changing as a result of declining birth rates and continuous rise in life expectancy. This report shows the facts and figures of an ageing workforce. It also describes the predjudices, personnel policies and problems connected to the

  19. Health workforce governance in Italy. (United States)

    Vicarelli, Giovanna; Pavolini, Emmanuele


    More precise health workforce governance has become a prominent issue in healthcare systems. This issue is particularly important in Italy, given its strongly doctor-centered healthcare system and the dramatic aging of its physicians' labor force. Using different sources of information (statistical data, official planning documents and interviews with key informants), the article attempts to answer two questions. Why has the Italian healthcare systems found itself in the situation of a potential drastic reduction in the amount of doctors in the medium term without a rebalancing through a different mix of skills and professionals? How good is the capacity of the Italian healthcare system to plan healthcare workforce needs? The widespread presence of 'older' physicians is the result of the strong entry of doctors into the Italian healthcare system in the 1970s and 1980s. Institutional fragmentation, difficulties in drafting broad healthcare reforms, political instability and austerity measures explain why Italian health workforce forecasting and planning are still unsatisfactory, although recent developments indicate that changes are under way. In order to tackle these problems it is necessary to foster closer cooperation among a wide range of stakeholders, to move from uni-professional to multi-professional health workforce planning, and to partially re-centralise decision making.

  20. Cultural similarity, cultural competence, and nurse workforce diversity. (United States)

    McGinnis, Sandra L; Brush, Barbara L; Moore, Jean


    Proponents of health workforce diversity argue that increasing the number of minority health care providers will enhance cultural similarity between patients and providers as well as the health system's capacity to provide culturally competent care. Measuring cultural similarity has been difficult, however, given that current benchmarks of workforce diversity categorize health workers by major racial/ethnic classifications rather than by cultural measures. This study examined the use of national racial/ethnic categories in both patient and registered nurse (RN) populations and found them to be a poor indicator of cultural similarity. Rather, we found that cultural similarity between RN and patient populations needs to be established at the level of local labor markets and broadened to include other cultural parameters such as country of origin, primary language, and self-identified ancestry. Only then can the relationship between cultural similarity and cultural competence be accurately determined and its outcomes measured.

  1. Engaging rural preceptors in new longitudinal community clerkships during workforce shortage: a qualitative study

    Directory of Open Access Journals (Sweden)

    Weston Kathryn M


    Full Text Available Abstract Background In keeping with its mission to produce doctors for rural and regional Australia, the University of Wollongong, Graduate School of Medicine has established an innovative model of clinical education. This includes a 12-month integrated community-based clerkship in a regional or rural setting, offering senior students longitudinal participation in a 'community of practice' with access to continuity of patient care experiences, continuity of supervision and curriculum, and individualised personal and professional development. This required developing new teaching sites, based on attracting preceptors and providing them with educational and physical infrastructure. A major challenge was severe health workforce shortages. Methods Before the new clerkship started, we interviewed 28 general practitioners to determine why they engaged as clerkship preceptors. Independent researchers conducted semi-structured interviews. Responses were transcribed for inductive qualitative content analysis. Results The new model motivated preceptors to engage because it enhanced their opportunities to contribute to authentic learning when compared with the perceived limitations of short-term attachments. Preceptors appreciated the significant recognition of the value of general practice teaching and the honour of major involvement in the university. They predicted that the initiative would have positive effects on general practitioner morale and improve the quality of their practice. Other themes included the doctors' commitment to their profession, 'handing on' to the next generation and helping their community to attract doctors in the future. Conclusions Supervisors perceive that new models of clinical education offer alternative solutions to health care education, delivery and workforce. The longitudinal relationship between preceptor, student and community was seen as offering reciprocal benefits. General practitioners are committed to refining

  2. Veterans Health Administration Timely and Effective Care Data (United States)

    U.S. Department of Health & Human Services — A list of VHA hospitals with timely and effective care (process of care) measure data. VHA collects this information through a Quality Improvement Organization...

  3. Corruption in health-care systems and its effect on cancer care in Africa. (United States)

    Mostert, Saskia; Njuguna, Festus; Olbara, Gilbert; Sindano, Solomon; Sitaresmi, Mei Neni; Supriyadi, Eddy; Kaspers, Gertjan


    At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients.

  4. American Health Care Association (United States)

    ... Care Association Responds to Ruling on Injunction Delaying CMS Implementation of Arbitration Rule AHCA/NCAL Elects New ... Information Technology Integrity Medicaid Medicare Patient Privacy and Security Survey and Regulatory Therapy Services Workforce Events Calendar ...

  5. Cognitive effects of cancer systemic therapy: implications for the care of older patients and survivors. (United States)

    Mandelblatt, Jeanne S; Jacobsen, Paul B; Ahles, Tim


    The number of patients with cancer who are age 65 years or older (hereinafter "older") is increasing dramatically. One obvious aspect of cancer care for this group is that they are experiencing age-related changes in multiple organ systems, including the brain, which complicates decisions about systemic therapy and assessments of survivorship outcomes. There is a consistent body of evidence from studies that use neuropsychological testing and neuroimaging that supports the existence of impairment following systemic therapy in selected cognitive domains among some older patients with cancer. Impairment in one or more cognitive domains could have important effects in the daily lives of older patients. However, an imperfect understanding of the precise biologic mechanisms underlying cognitive impairment after systemic treatment precludes development of validated methods for predicting which older patients are at risk. From what is known, risks may include lifestyle factors such as smoking, genetic predisposition, and specific comorbidities such as diabetes and cardiovascular disease. Risk also interacts with physiologic and cognitive reserve, because even at the same chronological age and with the same number of illnesses, older patients vary from having high reserve (ie, biologically younger than their age) to being frail (biologically older than their age). Surveillance for the presence of cognitive impairment is also an important component of long-term survivorship care with older patients. Increasing the workforce of cancer care providers who have geriatrics training or who are working within multidisciplinary teams that have this type of expertise would be one avenue toward integrating assessment of the cognitive effects of cancer systemic therapy into routine clinical practice.

  6. Effects and side-effects of integrating care: the case of mental health care in the Netherlands

    Directory of Open Access Journals (Sweden)

    Giel J.M. Hutschemaekers


    Full Text Available Purpose Description and analysis of the effects and side-effects of integrated mental health care in the Netherlands. Context of case Due to a number of large-scale mergers, Dutch mental health care has become an illustration of integration and coherence of care services. This process of integration, however, has not only brought a better organisation of care but apparently has also resulted in a number of serious side-effects. This has raised the question whether integration is still the best way of reorganising mental health care. Data sources Literature, data books, patients and professionals, the advice of the Dutch Commission for Mental Health Care, and policy papers. Case description Despite its organisational and patient-centred integration, the problems in the Dutch mental health care system have not diminished: long waiting lists, insufficient fine tuning of care, public order problems with chronic psychiatric patients, etc. These problems are related to a sharp rise in the number of mental health care registrations in contrast with a decrease of registered patients in first-level services. This indicates that care for people with mental health problems has become solely a task for the mental health care services (monopolisation. At the same time, integrated institutions have developed in the direction of specialised medical care (homogenisation. Monopolisation and homogenisation together have put the integrated institutions into an impossible divided position. Conclusions and discussion Integration of care within the institutions in the Netherlands has resulted in withdrawal of other care providers. These side-effects lead to a new discussion on the real nature and benefits of an integrated mental health care system. Integration requires also a broadly shared vision on good care for the various target groups. This would require a radicalisation of the distinction between care providers as well as a recognition of the different goals of

  7. Multidisciplinary management of complex care. (United States)

    Schofield, Deborah; Fuller, Jeffrey; Wagner, Scott; Friis, Leanne; Tyrell, Bill


    Rural and remote areas of Australia are facing serious health workforce shortages. Multidisciplinary teams are one way of making the most of the rural workforce. In this paper, the advantages of multidisciplinary care in terms of patient outcomes, clinician satisfaction and system efficiency are considered with reference to an innovative rural multidisciplinary model that highlights how these positive outcomes can be achieved. Ways of developing the capacity of the future workforce for work in multidisciplinary teams are discussed.

  8. [Challenges to occupational medicine in view of the problem of work-related diseases and the aging of workforce. Directions for further development and intentional changes in preventive care of employees in Poland]. (United States)

    Marcinkiewicz, Andrzej; Walusiak-Skorupa, Jolanta; Wiszniewska, Marta; Rybacki, Marcin; Hanke, Wojciech; Rydzyński, Konrad

    The system of occupational health care in Poland, based on occupational medicine service, takes care of almost 12.5 million employees subjected to over 4.5 million obligatory periodic medical check ups. This form of providing prophylactic care comes down to examinations dictated by legal regulations, whose scope is not oriented towards a comprehensive workers' health assessment, but to the examination of the systems and organs critical to work-related dangers. Simultaneously, epidemiological data indicate a large number of chronic diseases, which may influence the professional activity, like hypertension or diabetes and a high percentage of patients not aware of their illness. Since patients participating in obligatory examinations usually feel healthy and do not use health care services on a daily basis, an occupational medicine physician has a unique opportunity to detect health disorders at an early stage, which can prevent the development of health complications affecting the condition of the patient, limiting their professional activity, but also causing additional costs of the health care system. The authors have proven the need to involve occupational medicine services in the prevention of chronic diseases and the need to introduce additional sources of financing for procedures enabling early detection of diseases the patient may not be aware of or control of the effectiveness of already diagnosed illnesses. They addressed the need to change the current legal form of establishing and announcing the range of examinations and directives for certifying the lack or presence of health contraindications to work to the specified and updated standards prepared by scientific research institutes and occupational medicine societies. Med Pr 2016;67(5):691-700.

  9. Rightsizing the Workforce: Changing Roles of Vocational Psychology (United States)

    Bingham, Rosie Phillips


    This article briefly defines rightsizing the workforce and discusses the rightsizing dilemma in relation to the current economic downturn in the United States, its disparate effects on citizens, and implications for potential shifting roles for vocational psychologists. Next, the discussion will highlight disenfranchised or marginalized groups…

  10. Patient attributes warranting consideration in clinical practice guidelines, health workforce planning and policy

    Directory of Open Access Journals (Sweden)

    Segal Leonie


    Full Text Available Abstract Background In order for clinical practice guidelines (CPGs to meet their broad objective of enhancing the quality of care and supporting improved patient outcomes, they must address the needs of diverse patient populations. We set out to explore the patient attributes that are likely to demand a unique approach to the management of chronic disease, and which are crucial if evidence or services planning is to reflect clinic populations. These were incorporated into a new conceptual framework; using diabetes mellitus as an exemplar. Methods The patient attributes that informed the framework were identified from CPGs, the diabetes literature, an expert academic panel, and two cross-disciplinary panels; and agreed upon using a modified nominal group technique. Results Full consensus was reached on twenty-four attributes. These factors fell into one of three themes: (1 type/stage of disease, (2 morbid events, and (3 factors impacting on capacity to self-care. These three themes were incorporated in a convenient way in the workforce evidence-based (WEB model. Conclusions While biomedical factors are frequently recognised in published clinical practice guidelines, little attention is given to attributes influencing a person's capacity to self-care. Paying explicit attention to predictable threats to effective self-care in clinical practice guidelines, by drawing on the WEB model, may assist in refinements that would address observed disparities in health outcomes across socio-economic groups. The WEB model also provides a framework to inform clinical training, and health services and workforce planning and research; including the assessment of healthcare needs, and the allocation of healthcare resources.

  11. Effectiveness the pharmaceutical care in diabetic patients*

    Directory of Open Access Journals (Sweden)

    Jorge E Machado -Alba


    Full Text Available Objective: To determine the effectiveness of pharmaceutical care to improve control of type-2 diabetes mellitus. Methods: We carried out pharmacotherapeutical intervention during 19 months on patients with type-2 diabetes mellitus who were affiliate members of the contributive regime of the General System for Healthcare and Social Security in  Bogotá and Cartagena. Through an interview and evaluation of medical records, we obtained information about antidiabetic medications used, doses, other medications, along with Hemoglobin A1c level, arterial pressure, serum low-density lipoprotein cholesterol level, nephropathy screening, retinal screening, foot exams in the last year and problems associated with medication use by means of the DADER method Negative Outcomes Associated with Medication (NOM. Results: The study had a sample of 143 patients (64 intervened and 79 controls with female predominance (67.1% and 53.1%, respectively, mean age of 63.9±11.2 years. The patients in both groups were taking an average of 6.0±2.7 medications. Initial HbA1c mean was 7.7% and 7.8%, without improvement by the end of the study (7.4% for those intervened and 7.8% for the control group. Hypertension (81.1% and dyslipidemia (62.9% were the most important comorbidities. About 50.4% of NOM were of effectiveness, follows 31.3% of necessity. The mean cost per patient in controls was 1.4 greater than for the intervened group. Conclusions: Increased effectiveness of the antidiabetic therapy was not demonstrated in patients intervened with pharmacotherapeutical monitoring, but we did obtain a reduction in healthcare costs.

  12. Interventions to facilitate health workforce restructure


    Duckett, SJ


    There are recognised shortages in most health professions in Australia. This is evidence that previous attempts at health workforce planning have failed. This paper argues that one reason for such failure is the lack of appropriate structures for health workforce planning. It also suggests that Australia needs to move beyond planning for particular professions and that health workforce planning needs to be based on identifying skill shortages as much as shortages in particular named professio...

  13. Cost-effectiveness of ruling out deep venous thrombosis in primary care versus care as usual

    NARCIS (Netherlands)

    A.J. ten Cate-Hoek; D.B. Toll; H.R. Büller; A.W. Hoes; K.G. Moons; R. Oudega; H.E. Stoffers; E.F. van der Velde; H.C. van Weert; M.H. Prins; M.A. Joore


    Background: Referral for ultrasound testing in all patients suspected of DVT is inefficient, because 80-90% have no DVT. Objective: To assess the incremental cost-effectiveness of a diagnostic strategy to select patients at first presentation in primary care based on a point of care D-dimer test com

  14. Caring for Mom and Neglecting Yourself? The Health Effects of Caring for an Elderly Parent

    NARCIS (Netherlands)

    Coe, N.B.; Van Houtven, C.H.


    We examine the physical and mental health effects of providing care to an elderly mother on the adult child caregiver. We address the endogeneity of the selection in and out of caregiving using an instrumental variable approach, and carefully control for baseline health and work status of the adult

  15. Engaging paediatricians in planning the training of our future workforce. (United States)

    Klaber, R E; Roland, D


    Fundamental reform to the way we train and develop our future workforce is planned. In order to successfully achieve change the engagement of those delivering care is necessary. In this study the authors used a novel participatory design to seek the opinions of medical students, foundation doctors, specialty trainees and consultants on some key statements regarding proposed improvements to postgraduate medical education. While there was overall agreement on many of the recommendations of the Temple report, some aspects were potentially divisive, with significant differences between the views of consultants and those more junior to them. This work emphasises the importance of engaging all members of the healthcare workforce, both present and future, in the reasons for, and outcomes of, healthcare reform.

  16. Multigenerational Challenges: Team-Building for Positive Clinical Workforce Outcomes (United States)

    Moore, Jill M; Everly, Marcee; Bauer, Renee


    Patient acuity in hospital settings continues to increase, and there is greater emphasis on patient outcomes. The current nursing workforce is comprised of four distinct generational cohorts that include veterans, baby boomers, millennials, and generation Xers. Each group has unique characteristics that add complexity to the workforce and this can add challenges to providing optimal patient care. Team building is one strategy to increase mutual understanding, communication, and respect, and thus potentially improve patient outcomes. In this article, we first briefly define generational cohorts by characteristics, and discuss differing expectations for work/life balance and potential negative outcomes. Our discussion offers team building strategies for positive outcomes, a case scenario, and concludes with resources for team building and organizational opportunities.

  17. Human resource governance: what does governance mean for the health workforce in low- and middle-income countries?



    Abstract Background Research on practical and effective governance of the health workforce is limited. This paper examines health system strengthening as it occurs in the intersection between the health workforce and governance by presenting a framework to examine health workforce issues related to eight governance principles: strategic vision, accountability, transparency, information, efficiency, equity/fairness, responsiveness and citizen voice and participation. Methods This study builds ...

  18. Training for impact: the socio-economic impact of a fit for purpose health workforce on communities. (United States)

    Pálsdóttir, Björg; Barry, Jean; Bruno, Andreia; Barr, Hugh; Clithero, Amy; Cobb, Nadia; De Maeseneer, Jan; Kiguli-Malwadde, Elsie; Neusy, André-Jacques; Reeves, Scott; Strasser, Roger; Worley, Paul


    Across the globe, a "fit for purpose" health professional workforce is needed to meet health needs and challenges while capitalizing on existing resources and strengths of communities. However, the socio-economic impact of educating and deploying a fit for purpose health workforce can be challenging to evaluate. In this paper, we provide a brief overview of six promising strategies and interventions that provide context-relevant health professional education within the health system. The strategies focused on in the paper are:1. Distributed community-engaged learning: Education occurs in or near underserved communities using a variety of educational modalities including distance learning. Communities served provide input into and actively participate in the education process.2. Curriculum aligned with health needs: The health and social needs of targeted communities guide education, research and service programmes.3. Fit for purpose workers: Education and career tracks are designed to meet the needs of the communities served. This includes cadres such as community health workers, accelerated medically trained clinicians and extended generalists.4. Gender and social empowerment: Ensuring a diverse workforce that includes women having equal opportunity in education and are supported in their delivery of health services.5. Interprofessional training: Teaching the knowledge, skills and attitudes for working in effective teams across professions.6. South-south and north-south partnerships: Sharing of best practices and resources within and between countries.In sum, the sharing of resources, the development of a diverse and interprofessional workforce, the advancement of primary care and a strong community focus all contribute to a world where transformational education improves community health and maximizes the social and economic return on investment.

  19. The Nation's Physician Workforce and Future Challenges. (United States)

    Grover, Atul; Orlowski, Janis M; Erikson, Clese E


    There is much debate about the adequacy of the U.S. physician workforce and projections of its future size, distribution and composition. Beginning with 3 observations about the workforce we believe are largely not subject to dispute, we address the debate by providing an overview of the current state of the workforce and Graduate Medical Education in the United States; a brief history of both calls for graduate medical education reform since 1910 and the recent, intense debate about the reliability of workforce projections; and a discussion of the challenges to understanding the physician workforce. We draw 3 concluding observations: (1) Precisely because projections can be unpredictable in their impact on both physician workforce behavior and public policy development, policy makers need to devote more attention to workforce projections, not less. (2) More research devoted specifically to the workforce implications of delivery and payment reforms is strongly needed. (3) Such research must be pursued with a sense of urgency, given the rapid aging of the Baby Boom generation, which will put a disproportionate demand on the nation's physician workforce.

  20. The Defense Acquisition Workforce Improvement Strategy. Appendix 1: DOD Strategic Human Capital Plan Update. The Defense Acquisition Workforce (United States)


    courses [e.g., mathematics (e.g., calculus , probability, and statistics), physical sciences, psychology, engineering, etc.]. Re-engineering of the...technical. The Acquisition Workforce must be properly staffed if DoN is to successfully deliver that capability and be effective stewards of the tax

  1. The South Australian Allied Health Workforce survey: helping to fill the evidence gap in primary health workforce planning. (United States)

    Whitford, Deirdre; Smith, Tony; Newbury, Jonathan


    There is a lack of detailed evidence about the allied health workforce to inform proposed health care reforms. The South Australian Allied Health Workforce (SAAHW) survey collected data about the demographic characteristics, employment, education and recruitment and retention of allied health professionals in South Australia. The SAAHW questionnaire was widely distributed and 1539 responses were received. The average age of the sample was 40 years; males were significantly older than females, the latter making up 82% of respondents. Three-quarters of the sample worked in the city; 60% worked full time and the remainder in part-time, casual or locum positions. 'Work-life balance' was the most common attraction to respondents' current jobs and 'Better career prospects' the most common reason for intending to leave. Practice in a rural location was influenced by rural background and rural experience during training. A greater proportion of Generation Y (1982-2000) respondents intended to leave within 2 years than Generation X (1961-81) or Baby Boomers (1943-60). Most respondents were satisfied with their job, although some reported lack of recognition of their knowledge and skills. Systematic, robust allied health workforce data are required for integrated and sustainable primary health care delivery.

  2. Assessing the effect of increased managed care on hospitals. (United States)

    Mowll, C A


    This study uses a new relative risk methodology developed by the author to assess and compare certain performance indicators to determine a hospital's relative degree of financial vulnerability, based on its location, to the effects of increased managed care market penetration. The study also compares nine financial measures to determine whether hospital in states with a high degree of managed-care market penetration experience lower levels of profitability, liquidity, debt service, and overall viability than hospitals in low managed care states. A Managed Care Relative Financial Risk Assessment methodology composed of nine measures of hospital financial and utilization performance is used to develop a high managed care state Composite Index and to determine the Relative Financial Risk and the Overall Risk Ratio for hospitals in a particular state. Additionally, financial performance of hospitals in the five highest managed care states is compared to hospitals in the five lowest states. While data from Colorado and Massachusetts indicates that hospital profitability diminishes as the level of managed care market penetration increases, the overall study results indicate that hospitals in high managed care states demonstrate a better cash position and higher profitability than hospitals in low managed care states. Hospitals in high managed care states are, however, more heavily indebted in relation to equity and have a weaker debt service coverage capacity. Moreover, the overall financial health and viability of hospitals in high managed care states is superior to that of hospitals in low managed care states.

  3. Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives

    Directory of Open Access Journals (Sweden)

    Morris J


    Full Text Available Joanne Morris,1 Karen Grimmer,2 Lisa Gilmore,1 Chandima Perera,3 Gordon Waddington,4 Greg Kyle,4 Bryan Ashman,5 Karen Murphy61The Physiotherapy Department, The Canberra Hospital, ACT Health, Canberra, ACT, Australia; 2International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia; 3Department of Rheumatology, The Canberra Hospital, Canberra, ACT, Australia; 4The Faculty of Health, University of Canberra, Canberra, ACT, Australia; 5Department of Surgical Services, The Canberra Hospital, Canberra, ACT, Australia; 6Office of Allied Health Advisor, ACT Health, Canberra, ACT, AustraliaAbstract: Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable

  4. Fusion in the Era of Burning Plasma Studies: Workforce Planning for 2004 to 2014. Final report to FESA C

    Energy Technology Data Exchange (ETDEWEB)



    This report has been prepared in response to Dr. R. Orbach’s request of the Fusion Energy Sciences Advisory Committee (FESAC) to “address the issue of workforce development in the U.S. fusion program.” The report addresses three key questions: what is the current status of the fusion science, technology, and engineering workforce; what is the workforce that will be needed and when it will be needed to ensure that the U.S. is an effective partner in ITER and to enable the U.S. to successfully carry out the fusion program; and, what can be done to ensure a qualified, diversified, and sufficiently large workforce and a pipeline to maintain that workforce? In addressing the charge, the Panel considers a workforce that allows for a vigorous national program of fusion energy research that includes participation in magnetic fusion (ITER) and inertial fusion (NIF) burning plasma experiments.

  5. Health workforce skill mix and task shifting in low income countries: a review of recent evidence

    Directory of Open Access Journals (Sweden)

    Auh Erica


    Full Text Available Abstract Background Health workforce needs-based shortages and skill mix imbalances are significant health workforce challenges. Task shifting, defined as delegating tasks to existing or new cadres with either less training or narrowly tailored training, is a potential strategy to address these challenges. This study uses an economics perspective to review the skill mix literature to determine its strength of the evidence, identify gaps in the evidence, and to propose a research agenda. Methods Studies primarily from low-income countries published between 2006 and September 2010 were found using Google Scholar and PubMed. Keywords included terms such as skill mix, task shifting, assistant medical officer, assistant clinical officer, assistant nurse, assistant pharmacist, and community health worker. Thirty-one studies were selected to analyze, based on the strength of evidence. Results First, the studies provide substantial evidence that task shifting is an important policy option to help alleviate workforce shortages and skill mix imbalances. For example, in Mozambique, surgically trained assistant medical officers, who were the key providers in district hospitals, produced similar patient outcomes at a significantly lower cost as compared to physician obstetricians and gynaecologists. Second, although task shifting is promising, it can present its own challenges. For example, a study analyzing task shifting in HIV/AIDS in sub-Saharan Africa noted quality and safety concerns, professional and institutional resistance, and the need to sustain motivation and performance. Third, most task shifting studies compare the results of the new cadre with the traditional cadre. Studies also need to compare the new cadre's results to the results from the care that would have been provided--if any care at all--had task shifting not occurred. Conclusions Task shifting is a promising policy option to increase the productive efficiency of the delivery of health

  6. Can We Help Care Providers Communicate More Effectively With Persons Having Dementia Living in Long-Term Care Homes? (United States)

    Rochon, Elizabeth; Sidani, Souraya; Shaw, Alexander; Ben-David, Boaz M.; Saragosa, Marianne; Boscart, Veronique M.; Wilson, Rozanne; Galimidi-Epstein, Karmit K.


    Background: Effective communication between residents with dementia and care providers in long-term care homes (LTCHs) is essential to resident-centered care. Purpose: To determine the effects of a communication intervention on residents’ quality of life (QOL) and care, as well as care providers’ perceived knowledge, mood, and burden. Method: The intervention included (1) individualized communication plans, (2) a dementia care workshop, and (3) a care provider support system. Pre- and postintervention scores were compared to evaluate the effects of the intervention. A total of 12 residents and 20 care providers in an LTCH participated in the feasibility study. Results: The rate of care providers’ adherence to the communication plans was 91%. Postintervention, residents experienced a significant increase in overall QOL. Care providers had significant improvement in mood and perceived reduced burden. Conclusion: The results suggest that the communication intervention demonstrates preliminary evidence of positive effects on residents’ QOL and care providers’ mood and burden. PMID:27899433

  7. Treatment of late-life mental disorders in primary care: we can do a better job. (United States)

    Moak, Gary S


    Health care services provided to older adults today are not as effective as they should be. The quality of care for late-life mental disorders often falls short of desired standards. The growth of the elderly population makes it imperative for the health care system to address late-life mental disorders more effectively. Intervention strategies based in primary care settings show the most promise, but effectiveness will depend on solving the geriatric psychiatry workforce crisis. Collaborative care is one promising model for improving geriatric mental health care delivery in primary care. Diffusion of collaborative care into the health care system and integrating geriatric psychiatry into other models such as geriatric medical homes will require redesign of the organization and financing of primary care and psychiatry to overcome current barriers. Public policy should reflect the essential role of psychiatry in geriatrics and promote the integration of geriatric psychiatry with primary care.

  8. North Dakota Energy Workforce Development

    Energy Technology Data Exchange (ETDEWEB)

    Carter, Drake [Bismarck State College, Bismarck, ND (United States)


    Bismarck State College, along with its partners (Williston State College, Minot State University and Dickinson State University), received funding to help address the labor and social impacts of rapid oilfield development in the Williston Basin of western North Dakota. Funding was used to develop and support both credit and non-credit workforce training as well as four major symposia designed to inform and educate the public; enhance communication and sense of partnership among citizens, local community leaders and industry; and identify and plan to ameliorate negative impacts of oil field development.

  9. Strategic workforce planning for a multihospital, integrated delivery system. (United States)

    Datz, David; Hallberg, Colleen; Harris, Kathy; Harrison, Lisa; Samples, Patience


    Banner Health has long recognized the need to anticipate, beyond the immediate operational realities or even the annual budgeting projection exercises, the necessary workforce needs of the future. Thus, in 2011, Banner implemented a workforce planning model that included structures, processes, and tools for predicting workforce needs, with particular focus on identified critical systemwide practice areas. The model represents the incorporation of labor management tools and processes with more strategic, broad-view, long-term assessment and planning mechanisms. The sequential tying of the workforce planning lifecycle with the organization's strategy and financial planning process supports alignment of goals, objectives, and resource allocation. Collaboration among strategy, finance, human resources, and operations has provided us with the ability to identify critical position groups based on 3-year strategic priorities. By engaging leaders from across the organization, focusing on activities at facility, regional, and system levels, and building in mechanisms for accountability, we are now engaged in continuous evaluations of our delivery models, the competencies and preparations necessary for the staff to effectively function within those delivery models, and developing and implementing action plans designed to ensure adequate numbers of the staff whose competencies will be suited to the work expected of them.

  10. Developing the HIV Workforce: The MATEC Clinician Scholars Program. (United States)

    Boehler, Malinda; Schechtman, Barbara; Rivero, Ricardo; Jacob, Beth-Anne; Sherer, Renslow; Wagner, Cornelia; Alabduljabbar, Salma A; Linsk, Nathan L


    Engaging new clinical providers in the HIV workforce is a critical need due to rapidly evolving treatment paradigms, aging out of existing providers, and special population needs. The 1-year competency-based Clinician Scholar Program for minority-serving providers with limited HIV care experience was individually tailored for each provider (n = 74), mostly nurse practitioners, physicians, and clinical pharmacists. Baseline and endpoint self-assessments of clinical knowledge and skills showed significant improvements in all 11 targeted competencies, particularly in managing antiretroviral medications, screening and testing methods, incorporating prevention into HIV care, understanding risk reduction methods, and describing current care standards. Faculty mentor assessments also showed significant improvement in most competencies. Additional benefits included ongoing access to mentorship and training, plus sustained engagement in local and statewide HIV care networks. Our intensive mentoring program model is replicable in other AIDS Education and Training Centers and in other structured training programs.

  11. Workshop: health workforce governance and integration.

    NARCIS (Netherlands)

    Batenburg, R.


    Background: Health workforce governance is increasingly recognized as a burning policy issue and focused on workforce shortages. Yet the most pressing problem is to solve maldistributions through governance and integration. Poor management of health 242 European Journal of Public Health, Vol. 24, S

  12. Employee Engagement: Motivating and Retaining Tomorrow's Workforce (United States)

    Shuck, Michael Bradley; Wollard, Karen Kelly


    Tomorrow's workforce is seeking more than a paycheck; they want their work to meet their needs for affiliation, meaning, and self-development. Companies willing to meet these demands will capture the enormous profit potential of a workforce of fully engaged workers. This piece explores what engagement is, why it matters, and how human resource…

  13. Workforce Competitiveness Collection. "LINCS" Resource Collection News (United States)

    Literacy Information and Communication System, 2011


    This edition of "'LINCS' Resource Collection News" features the Workforce Competitiveness Collection, covering the topics of workforce education, English language acquisition, and technology. Each month Collections News features one of the three "LINCS" (Literacy Information and Communication System) Resource Collections--Basic…

  14. Policy and Workforce Reform in England (United States)

    Gunter, Helen M.


    Current workforce reform, known as Remodelling the School Workforce, is part of an enduring policy process where there have been tensions between public and private sector structures and cultures. I show that the New Right and New Labour governments who have built and configured site based performance management over the past quarter of a century…

  15. Orthopedic workforce planning in Germany - an analysis of orthopedic accessibility. (United States)

    Bauer, Jan; Müller, Peter; Maier, Werner; Groneberg, David A


    In Germany, orthopedic workforce planning relies on population-to-provider-ratios represented by the 'official degree of care provision'. However, with geographic information systems (GIS), more sophisticated measurements are available. By utilizing GIS-based technologies we analyzed the current state of demand and supply of the orthopedic workforce in Germany (orthopedic accessibility) with the integrated Floating Catchment Area method. The analysis of n = 153,352,220 distances revealed significant geographical variations on national scale: 5,617,595 people (6.9% of total population) lived in an area with significant low orthopedic accessibility (average z-score = -4.0), whereas 31,748,161 people (39.0% of total population) lived in an area with significant high orthopedic accessibility (average z-score = 8.0). Accessibility was positively correlated with the degree of urbanization (r = 0.49; p<0.001) and the official degree of care provision (r = 0.33; p<0.001) and negatively correlated with regional social deprivation (r = -0.47; p<0.001). Despite advantages of simpler measures regarding implementation and acceptance in health policy, more sophisticated measures of accessibility have the potential to reduce costs as well as improve health care. With this study, significant geographical variations were revealed that show the need to reduce oversupply in less deprived urban areas in order to enable adequate care in more deprived rural areas.

  16. Age and gender effects of workforce composition on productivity and profits: Evidence from a new type of data for German enterprises

    Directory of Open Access Journals (Sweden)

    Christian Pfeifer


    Full Text Available This empirical paper documents the relationship between the composition of a firm’s workforce (with a special focus on age and gender and its performance (productivity and profitability for a large representative sample of enterprises from manufacturing industries in Germany using newly available, unique data. We find concave age-productivity profiles and a negative correlation of age on firms’ profitability. Moreover, our micro-econometric analysis reveals for the first time that the ceteris paribus lower level of productivity in firms with a higher share of female employees does not go hand in hand with a lower level of profitability in these firms.

  17. Finding the "Right-Size" Physical Therapy Workforce: International Perspective Across 4 Countries. (United States)

    Jesus, Tiago S; Koh, Gerald; Landry, Michel; Ong, Peck-Hoon; Lopes, António M F; Green, Peter L; Hoenig, Helen


    Finding the "right-size" physical therapy workforce is an increasingly important issue, but it has had limited study, particularly across nations. This perspective article provides a comprehensive examination of physical therapy workforce issues across 4 countries (United States, Singapore, Portugal, and Bangladesh), which were deliberately selected to allow consideration of key contextual factors. This investigation provides a theoretical model uniquely adapted to focus on variables most likely to affect physical therapy workforce needs. This theoretical model was used to guide acquisition of public domain data across the respective countries. The data then were used to provide a contextualized interpretation about the physical therapy workforce supply (ie, physical therapists per capita) across the 4 countries in light of the following factors: indicators of physical therapy need, financial and administrative barriers affecting physical therapy access and demand, the proportion of physical therapy graduates (with varying trends over time across the countries), and the role of emigration/immigration in supply inequalities among countries of lower and higher income. In addition, both the physical therapy workforce supply and scope of practice were analyzed in the context of other related professions across the 4 countries. This international comparison indicated that there may not be a "one-size-fits-all" recommendation for physical therapy workforce supply across countries or an ideal formula for its determination. The optimal, country-specific physical therapy workforce supply appears to be affected by discipline-specific health care and contextual factors that may vary across countries, and even within the same country. This article provides a conceptual framework and basis for such contextualized evaluations of the physical therapy workforce.

  18. Organizational effectiveness. Primary care and the congruence model. (United States)

    Eiser, A R; Eiser, B J


    The congruence model is a framework used to analyze organizational strengths and weaknesses and pinpoint specific areas for improving effectiveness. This article provides an overview of organizations as open systems, with examples in the primary care arena. It explains and applies the congruence model in the context of primary care issues and functions, including methods by which the model can be used to diagnose organizational problems and generate solutions. Changes needed in primary care due to the managed care environment, and areas of potential problems and sensitivities requiring organizational changes to meet market and regulatory demands now placed on PCOs are examined.

  19. Effects of Quality Improvement System for Child Care Centers (United States)

    Ma, Xin; Shen, Jianping; Kavanaugh, Amy; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Till, Lance; Watson, Grace


    Using multiple years of data collected from about 100 child care centers in Palm Beach County, Florida, the authors studied whether the Quality Improvement System (QIS) made a significant impact on quality of child care centers. Based on a pre- and postresearch design spanning a period of 13 months, QIS appeared to be effective in improving…

  20. Effect of intermediate care on mortality following emergency abdominal surgery. The InCare trial

    DEFF Research Database (Denmark)

    Vester-Andersen, Morten; Waldau, Tina; Wetterslev, Jørn


    . The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients.Methods and design: The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing emergency...... influence the survival of many high-risk surgical patients. As a pioneer trial in the area, it will provide important data on the feasibility of future large-scale randomised clinical trials evaluating different levels of postoperative care.Trial registration: identifier: NCT01209663....

  1. Capacity and Utilization in Health Care: The Effect of Empty Beds on Neonatal Intensive Care Admission. (United States)

    Freedman, Seth


    Because geographic variation in medical care utilization is jointly determined by both supply and demand, it is difficult to empirically estimate whether capacity itself has a causal impact on utilization in health care. In this paper, I exploit short-term variation in Neonatal Intensive Care Unit (NICU) capacity that is unlikely to be correlated with unobserved demand determinants. I find that available NICU beds have little to no effect on NICU utilization for the sickest infants, but do increase utilization for those in the range of birth weights where admission decisions are likely to be more discretionary.

  2. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

    NARCIS (Netherlands)

    W.M. Looman (Willemijn); I.N. Fabbricotti (Isabelle); R. Huijsman (Robbert)


    markdownabstract__Abstract__ Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months. Intervention: Frailty w

  3. Effective multidisciplinary working: the key to high-quality care. (United States)

    Ndoro, Samuel

    This article explores multidisciplinary team working, inter-disciplinary, trans-disciplinary and effective collaborative practice in order to provide high-quality patient care. It discusses different views on collaboration, some of the issues around cross-discipline and multi-agency working and concerns around promoting 'high-quality' care. It also discusses the importance of evidence-based practice in multidisciplinary teams. Issues around good-quality care, clinical governance and the audit cycle in MDTs are addressed. The article highlights the importance of the 6Cs (care, compassion, competence, communication, courage and commitment) in MDTs if quality care is to be achieved. The article also explores advantages and limitations of multidisciplinary team working, trans-disciplinary working and inter-professional working in developing and delivering high-quality patient-centred care. Further research is needed on how clinical audits can help to improve how MDTs function in order improve the quality of service provided to clients.

  4. Forging partnerships to solve the global health workforce crisis and achieve the health MDGs. (United States)

    Cometto, Giorgio; Sheikh, Mubashar


    The health workforce is in many countries the weakest link in the effective and equitable delivery of quality health services, and the largest impediment to the achievement of health Millennium Development Goals. The Kampala Declaration and Agenda for Global Action, championed by the Global Health Workforce Alliance, provide an effective overarching framework for the bold, concerted and sustained action which is required at the international, national and local level.

  5. Student perceptions: the influence of a Nursing Workforce Diversity Grant on retention. (United States)

    Evans, Bronwynne C


    This article reports the perceptions of Hispanic/Latino and American Indian students concerning the influence of a Nursing Workforce Diversity Grant (ALCANCE) on their educational experiences in a baccalaureate nursing program. The grant provided an educational pipeline for these students, supporting them financially, personally, and academically from middle school through graduation from the nursing program. Fifteen students receiving grant services during the upper-division nursing major completed a 76-item questionnaire assessing the influence of such services at the end of each of four semesters in the nursing program. Analysis of these questionnaires and examination of responses to open-ended questions at the end of each instrument indicated a generally positive influence of ALCANCE on student experiences. However, there remains a need for the creation of additional caring educational environments and further research to better understand effective strategies for addressing recruitment and retention in American Indian and Hispanic/Latino nursing students.

  6. Effective factors in providing holistic care: A qualitative study

    Directory of Open Access Journals (Sweden)

    Vahid Zamanzadeh


    Full Text Available Background: Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses′ provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring. Materials and Methods: A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis software. Results: Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits. Conclusion: Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.

  7. Innovation amidst radical cost containment in health care. (United States)

    Beard, Edward L; Sharkey, Kim


    The changing health care environment is requiring nurse executives within a hospital setting to design and implement innovative workforce practices that will both improve patient outcomes and lower costs. Since registered nurses comprise the largest percentage of a hospital's workforce, finding ways to incorporate them in these efforts is essential. The Magnet Recognition Program through the American Nurses Credentialing Center is one successful evidence-based strategy that can be adopted to engage nurses in quality improvement processes. This article describes how two community hospitals used the principles of the Magnet Recognition Program to develop and implement new approaches to meet the health care imperative of providing safer, high-quality, cost-effective care.

  8. [Dentists' workforce in Hungary and international migration]. (United States)

    Balázs, Péter


    In Hungary, cross-national migration in dental care was performed rather by patients from abroad instead of the domestic dentists' migration for working abroad. Actually, this tacitly realized and so-called dental tourism experienced two basic changes. The National Medical Tourism Ltd. arranged the First Conference for Development of Dental Tourism on 21 April 2011. Hungary's prime minister addressed the meeting and finally signed an agreement with the organizing Ltd. about governmental financial support for development of dental tourism. On the other hand, Germany and Austria deleted all restrictions against the free cross-national workforce migration since 1 May this year. For understanding and prognosis of dentists' future migration, it is inevitable to collect and analyse relevant data of the previous years. This study is presenting data obtained from January 1, 2006 to December 31, 2010. According to the net outcome, the dentists' human resource system was balanced down to the end of 2010. However, this state is unsure even for the near future, thus preventing the deficit of dentists all necessary measures must be taken to keep up the present level of the domestic dentral service.

  9. Team effectiveness in academic primary health care teams. (United States)

    Delva, Dianne; Jamieson, Margaret; Lemieux, Melissa


    Primary health care is undergoing significant organizational change, including the development of interdisciplinary health care teams. Understanding how teams function effectively in primary care will assist training programs in teaching effective interprofessional practices. This study aimed to explore the views of members of primary health care teams regarding what constitutes a team, team effectiveness and the factors that affect team effectiveness in primary care. Focus group consultations from six teams in the Department of Family Medicine at Queen's University were recorded and transcribed and qualitative analysis was used to identify themes. Twelve themes were identified that related to the impact of dual goals/obligations of education and clinical/patient practice on team relationships and learners; the challenges of determining team membership including nonattendance of allied health professionals except nurses; and facilitators and barriers to effective team function. This study provides insight into some of the challenges of developing effective primary care teams in an academic department of family medicine. Clear goals and attention to teamwork at all levels of collaboration is needed if effective interprofessional education is to be achieved. Future research should clarify how best to support the changes required for increasingly effective teamwork.

  10. Reforming dental workforce education and practice in the USA. (United States)

    Davidson, P L; Nakazono, T T; Carreon, D C; Gutierrez, J J; Shahedi, S; Andersen, R M


    The USA dental education programmes are facing challenges similar to those confronting countries around the globe, particularly amongst the industrialised nations. The purpose of this study was to evaluate the educational programmes of 15 USA dental schools to determine their impact on improving workforce diversity and oral health care access. The study investigates the predictors of public service plans of dental school seniors in Pipeline and non-Pipeline Program dental schools. We analysed baseline and post-intervention data collected in the American Dental Education Association (ADEA) Annual Survey of Dental School Seniors and a set of contextual variables. Public service plans (dependent variable) was predicted by four types of independent variables: intervention, contextual, community-based dental education (CBDE), and student characteristics. Findings from the study show that access to a state or federally sponsored loan repayment program was the most significant predictor of public service plans and that increasing educational debt was the most significant barrier. In the short-term we may be able to sustain the USA loan repayment programs to motivate senior dental students to provide public service to address the oral health care access crisis. However, in the long-term, a new workforce development initiative will be required to transform dental education and practice, modelled after the well-respected licensure programmes for Physician Assistants and/or Advanced Practice Registered Nurses, to expand oral health care access, particularly amongst vulnerable population subgroups, such as low-income children and families.

  11. Effects of online palliative care training on knowledge, attitude and satisfaction of primary care physicians

    Directory of Open Access Journals (Sweden)

    Agra Yolanda


    Full Text Available Abstract Background The Spanish Palliative Care Strategy recommends an intermediate level of training for primary care physicians in order to provide them with knowledge and skills. Most of the training involves face-to-face courses but increasing pressures on physicians have resulted in fewer opportunities for provision of and attendance to this type of training. The effectiveness of on-line continuing medical education in terms of its impact on clinical practice has been scarcely studied. Its effect in relation to palliative care for primary care physicians is currently unknown, in terms of improvement in patient's quality of life and main caregiver's satisfaction. There is uncertainty too in terms of any potential benefits of asynchronous communication and interaction among on-line education participants, as well as of the effect of the learning process. The authors have developed an on-line educational model for palliative care which has been applied to primary care physicians in order to measure its effectiveness regarding knowledge, attitude towards palliative care, and physician's satisfaction in comparison with a control group. The effectiveness evaluation at 18 months and the impact on the quality of life of patients managed by the physicians, and the main caregiver's satisfaction will be addressed in a different paper. Methods Randomized controlled educational trial to compared, on a first stage, the knowledge and attitude of primary care physicians regarding palliative care for advanced cancer patients, as well as satisfaction in those who followed an on-line palliative care training program with tutorship, using a Moodle Platform vs. traditional education. Results 169 physicians were included, 85 in the intervention group and 84 in the control group, of which five were excluded. Finally 82 participants per group were analyzed. There were significant differences in favor of the intervention group, in terms of knowledge (mean 4.6; CI

  12. An Ecological Perspective on Early Years Workforce Competences in Italian ECEC Settings (United States)

    Migliorini, Laura; Rania, Nadia; Tassara, Tatiana


    Based on an ecological perspective on competence, this study analyzed the attitudes, skills, and knowledge of practitioners in educational services for 0-6-years-old children in Italy, examining competence profiles in the Early Childhood Education and Care (ECEC) workforce. Our study considered three areas of competence, which previously have…

  13. Do interoperable national information systems enhance availability of data to assess the effect of scale-up of HIV services on health workforce deployment in resource-limited countries? (United States)

    Oluoch, Tom; Muturi, David; Kiriinya, Rose; Waruru, Anthony; Lanyo, Kevin; Nguni, Robert; Ojwang, James; Waters, Keith P; Richards, Janise


    Sub-Saharan Africa (SSA) bears the heaviest burden of the HIV epidemic. Health workers play a critical role in the scale-up of HIV programs. SSA also has the weakest information and communication technology (ICT) infrastructure globally. Implementing interoperable national health information systems (HIS) is a challenge, even in developed countries. Countries in resource-limited settings have yet to demonstrate that interoperable systems can be achieved, and can improve quality of healthcare through enhanced data availability and use in the deployment of the health workforce. We established interoperable HIS integrating a Master Facility List (MFL), District Health Information Software (DHIS2), and Human Resources Information Systems (HRIS) through application programmers interfaces (API). We abstracted data on HIV care, health workers deployment, and health facilities geo-coordinates. Over 95% of data elements were exchanged between the MFL-DHIS and HRIS-DHIS. The correlation between the number of HIV-positive clients and nurses and clinical officers in 2013 was R2=0.251 and R2=0.261 respectively. Wrong MFL codes, data type mis-match and hyphens in legacy data were key causes of data transmission errors. Lack of information exchange standards for aggregate data made programming time-consuming.

  14. People deliver eye care: managing human resources

    Directory of Open Access Journals (Sweden)

    Kayode Odusote


    Full Text Available People deliver health. Effective health care needs an efficient and motivated health workforce, which is the totality of individuals who directly or indirectly contribute to the promotion, protection and improvement of the health of the population.Community eye health is about providing eye health care to the people as close as possible to where they live and as much as possible at a price they can afford. It promotes people-centred care rather than the traditional disease-centred eye care services. In order to provide effective and efficient eye care services, we need an adequate number of well-qualified, well-motivated and equitably distributed eye health workers (EHWs.

  15. Redesigning Systems of Care for Older Adults with Alzheimer' Disease (United States)

    Callahan, Christopher M.; Sachs, Greg A.; LaMantia, Michael A.; Unroe, Kathleen T.; Arling, Greg A.; Boustani, Malaz A.


    The basic principle of care for patients with Alzheimer's disease is support for a patient-caregiver dyad. Any model of care seeking to improve the quality, efficiency, or cost of care for persons with Alzheimer's disease must attend to this principle. Models of care seeking to support this dyad began with strategies focusing mainly on the family caregiver. These models have grown in complexity to encompass team-based care that seeks to coordinate care across settings and providers of care for a defined population of patients. Most Americans in most communities, however, do not have access to these best practices models. While the effectiveness of new models of care is evidence-based, there are multiple barriers to widespread adoption including workforce limitations and the cost of practice redesign. We review the origins and content of current models and describe early efforts to improve their implementation on a broader scale. PMID:24711324

  16. Cost-effectiveness of collaborative care for depression in UK primary care: economic evaluation of a randomised controlled trial (CADET.

    Directory of Open Access Journals (Sweden)

    Colin Green

    Full Text Available Collaborative care is an effective treatment for the management of depression but evidence on its cost-effectiveness in the UK is lacking.To assess the cost-effectiveness of collaborative care in a UK primary care setting.An economic evaluation alongside a multi-centre cluster randomised controlled trial comparing collaborative care with usual primary care for adults with depression (n = 581. Costs, quality-adjusted life-years (QALYs, and incremental cost-effectiveness ratios (ICER were calculated over a 12-month follow-up, from the perspective of the UK National Health Service and Personal Social Services (i.e. Third Party Payer. Sensitivity analyses are reported, and uncertainty is presented using the cost-effectiveness acceptability curve (CEAC and the cost-effectiveness plane.The collaborative care intervention had a mean cost of £272.50 per participant. Health and social care service use, excluding collaborative care, indicated a similar profile of resource use between collaborative care and usual care participants. Collaborative care offered a mean incremental gain of 0.02 (95% CI: -0.02, 0.06 quality-adjusted life-years over 12 months, at a mean incremental cost of £270.72 (95% CI: -202.98, 886.04, and resulted in an estimated mean cost per QALY of £14,248. Where costs associated with informal care are considered in sensitivity analyses collaborative care is expected to be less costly and more effective, thereby dominating treatment as usual.Collaborative care offers health gains at a relatively low cost, and is cost-effective compared with usual care against a decision-maker willingness to pay threshold of £20,000 per QALY gained. Results here support the commissioning of collaborative care in a UK primary care setting.

  17. Influence of Workforce Ageing on Human Capital Formation


    Stonawski, M.


    This paper addresses the question of how workforce ageing influences human capital formation, human capital deterioration, and future productivity growth. The method presented in this paper focuses on the magnitude of human capital that has been accumulated in an individual. It takes into consideration education, acquiring knowledge and experience, knowledge becoming obsolete or forgotten, as well as the impact of health. The estimated human capital curve (based on the net effect of the vario...

  18. Ten years of health workforce planning in the Netherlands: a tentative evaluation of GP planning as an example.

    NARCIS (Netherlands)

    Greuningen, M. van; Batenburg, R.S.; Velden, L.F.J. van der


    INTRODUCTION: In many countries, health-care labour markets are constantly being challenged by an alternation of shortage and oversupply. Avoiding these cyclic variations is a major challenge. In the Netherlands, a workforce planning model has been used in health care for ten years. Case description

  19. Should I stay or should I go? The impact of working time and wages on retention in the health workforce

    NARCIS (Netherlands)

    Steinmetz, S.; de Vries, D.H.; Tijdens, K.G.


    Background: Turnover in the health workforce is a concern as it is costly and detrimental to organizational performance and quality of care. Most studies have focused on the influence of individual and organizational factors on the intention to quit. Based on the observation that providing care is b

  20. Effects of managed care contracting on physician labor supply. (United States)

    Libby, A M; Thurston, N K


    We examine the effect of managed care contracting on physician labor supply for office-based medical practices. We extend the standard labor supply model to incorporate choices regarding the patient base. Empirical tests use data from the 1985 and 1988 national HCFA Physician Practice Costs and Income Surveys and InterStudy Managed Care Surveys. We use physician-level information on participation in managed care contracting to estimate changes in work hours. Managed care contracting is generally associated with lower physician work hours. However, accounting for motivations to participate in contracts and the extent of contracting, the effect on hours is reduced in magnitude and significance. We conclude that relying on broad aggregate measures for policy analysis will likely be misleading as underlying motivations and contracting incentives change over time.

  1. Are we using Placebo effects in specialized Palliative Care?

    DEFF Research Database (Denmark)

    Sigaard, Jarl Voss; Dinesen, Birthe Irene

    and other symptoms in terminally ill cancer patients. Aim: The aim of this study was to explore whether and/or how a Specialized Palliative Care Team might contribute to the creation of placebo effects. Methods: The study was conducted as a qualitative study using a phenomenological/ hermeneutic approach......Background: Placebo effects are positive treatment effects that occur because of the psycho-social context around the therapy. Such effects are well documented in pain treatment, as well as in the treatment of other common symptoms. Specialized Palliative Care focuses on the relief of pain....... A literature review was carried out to identify state-of-the-art knowledge about placebo effects. A triangulation of data collection techniques was used, including participant observations (n= 8.6 hours) and a focus group interview with 7 members of the Specialized Palliative Care Team. Observations from six...

  2. The Future SSC Pacific Civil Service Workforce (United States)


    TECHNICAL REPORT 1971 August 2008 The Future SSC Pacific Civil Service Workforce P. Shigley G. Pennoyer J. Carreño Approved for... Shigley G. Pennoyer J. Carreño Approved for public release; distribution is unlimited. SSC San Diego San Diego, CA 92152-5001 SB...Prescribed by ANSI Std. Z39.18 08–2008 Final THE FUTURE SSC PACIFIC CIVIL SERVICE WORKFORCE P. Shigley G. Pennoyer J

  3. Effects of an Integrated Care System on quality of care and satisfaction for children with special health care needs. (United States)

    Knapp, Caprice; Madden, Vanessa; Sloyer, Phyllis; Shenkman, Elizabeth


    To assess the effects of an Integrated Care System (ICS) on parent-reported quality of care and satisfaction for Children with Special Health Care Needs (CSHCN). In 2006 Florida reformed its Medicaid program in Broward and Duval counties. Children's Medical Services Network (CMSN) chose to participate in the reform and developed an ICS for CSHCN. The ICS ushered in several changes such as more prior approval requirements and closing of the provider network. Telephone surveys were conducted with CMSN parents whose children reside in the reform counties and parents whose children reside outside of the reform counties in 2006 and 2007 (n = 1,727). Results from multivariate quasi-experimental models show that one component of parent-report quality of care, customer service, increased. Following implementation of the ICS, customer service increased by 0.22 points. After implementation of the ICS, parent-reported quality and satisfaction were generally unaffected. Although significant increases were not seen in the majority of the quality and satisfaction domains, it is nonetheless encouraging that parents did not report negative experiences with the ICS. It is important to present these interim findings so that progress can be monitored and decision-makers can begin to consider if the program should be expanded statewide.

  4. Civilian Workforce Planning in the Department of Defense. Different Levels, Different Roles (United States)


    6Jump down to document THE ARTS CHILD POLICY CIVIL JUSTICE EDUCATION ENERGY AND ENVIRONMENT HEALTH AND HEALTH CARE INTERNATIONAL AFFAIRS NATIONAL...Holland, Mike Hurley, Ellen James, Sherry Kabin, Brian Kern, Peter Kolakowski, Sharon Lacey, Michael Laney, Cynthia Lenning, Norma Lloyd, Carol Madonna , Jim...Workforce Planning in the Department of Defense Zellman, Gail L., and Susan M. Gates, Examining the Cost of Military Child Care, Santa Monica, Calif.: RAND Corporation, MR-1415-OSD, 2002.

  5. Workforce insights on how health promotion is practised in an Aboriginal Community Controlled Health Service. (United States)

    McFarlane, Kathryn; Devine, Sue; Judd, Jenni; Nichols, Nina; Watt, Kerrianne


    Aboriginal Community Controlled Health Services deliver holistic and culturally appropriate primary health care to over 150 communities in Australia. Health promotion is a core function of comprehensive primary health care; however, little has been published on what enables or challenges health promotion practice in an Aboriginal Community Controlled Health Service. Apunipima Cape York Health Council (Apunipima) delivers primary health care to 11 remote north Queensland communities. The workforce includes medical, allied health, Aboriginal and Torres Strait Islander health workers and health practitioners and corporate support staff. This study aimed to identify current health promotion practices at Apunipima, and the enablers and challenges identified by the workforce, which support or hinder health promotion practice. Sixty-three staff from across this workforce completed an online survey in February 2015 (42% response rate). Key findings were: (1) health promotion is delivered across a continuum of one-on-one approaches through to population advocacy and policy change efforts; (2) the attitude towards health promotion was very positive; and (3) health promotion capacity can be enhanced at both individual and organisational levels. Workforce insights have identified areas for continued support and areas that, now identified, can be targeted to strengthen the health promotion capacity of Apunipima.

  6. Analysis of the nursing workforce crisis: a call to action. (United States)

    Bleich, Michael R; Hewlett, Peggy O; Santos, Susan R; Rice, Rebecca B; Cox, Karen S; Richmeier, Sheila


    In our integrative review of reports on the health care workforce shortage, we examined 15 reports that focused primarily on nursing and were conducted by various stakeholders. We studied these reports objectively, identifying problems and solutions as described by the authors, which we then categorized by theme. We found problems at both the national and institutional levels and noted that the reports contained similar problem and solution "themes." Yet we also found gaps between these-some problems had no solutions and some solutions didn't address any of the suggested problems. Gaps occurred among problems and solutions listed in the following theme categories: demand, health care economics, workforce planning, research and data support, and technology. Despite the urgent need, we still lack a national strategy designed to avert the nursing shortage. This review may provide a foundation for such a plan.We present the results of our analysis and our recommendations to the federal government and national organizations, to institutions, and to nurses. These recommendations don't provide a comprehensive strategy for averting the nursing shortage, but they do offer a basis upon which one may be created.

  7. Generational differences of the frontline nursing workforce in relation to job satisfaction: what does the literature reveal? (United States)

    Saber, Deborah A


    The job satisfaction of registered nurses has been found to be associated with retention, organizational commitment, workforce safety, and cost savings to health care organizations. Satisfaction of the workforce is vital because nursing turnover can be detrimental for a labor force that is growing older. However, the summation of the most important variables that are linked to job satisfaction has been difficult to discern in part because the workforce includes 3 main generations (ie, Baby Boomers, Gen Xers, and Millennials) with unique work values that drive their job satisfiers. This article provides a review of existing literature to examine the differences in variables that are linked to job satisfaction that exist between the generational cohorts. Differences in stress sources, need for work-life balance, and compensation are discussed. The knowledge about generationally driven variables that influence job satisfaction can help managers develop strategies to maintain a diverse nursing workforce.

  8. Disruptive innovation in community pharmacy - Impact of automation on the pharmacist workforce. (United States)

    Spinks, Jean; Jackson, John; Kirkpatrick, Carl M; Wheeler, Amanda J

    Pharmacy workforce planning has been relatively static for many decades. However, like all industries, health care is exposed to potentially disruptive technological changes. Automated dispensing systems have been available to pharmacy for over a decade and have been applied to a range of repetitive technical processes which are at risk of error, including record keeping, item selection, labeling and dose packing. To date, most applications of this technology have been at the local level, such as hospital pharmacies or single-site community pharmacies. However, widespread implementation of a more centralized automated dispensing model, such as the 'hub and spoke' model currently being debated in the United Kingdom, could cause a 'technology shock,' delivering industry-wide efficiencies, improving medication accessibility and lowering costs to consumers and funding agencies. Some of pharmacists' historical roles may be made redundant, and new roles may be created, decoupling pharmacists to a certain extent from the dispensing and supply process. It may also create an additional opportunity for pharmacists to be acknowledged and renumerated for professional services that extend beyond the dispensary. Such a change would have significant implications for the organization and funding of community pharmacy services as well as pharmacy workforce planning. This paper discusses the prospect of centralized automated dispensing systems and how this may impact on the pharmacy workforce. It concludes that more work needs to be done in the realm of pharmacy workforce planning to ensure that the introduction of any new technology delivers optimal outcomes to consumers, insurers and the pharmacy workforce.

  9. Workforce scheduling: A new model incorporating human factors

    Directory of Open Access Journals (Sweden)

    Mohammed Othman


    Full Text Available Purpose: The majority of a company’s improvement comes when the right workers with the right skills, behaviors and capacities are deployed appropriately throughout a company. This paper considers a workforce scheduling model including human aspects such as skills, training, workers’ personalities, workers’ breaks and workers’ fatigue and recovery levels. This model helps to minimize the hiring, firing, training and overtime costs, minimize the number of fired workers with high performance, minimize the break time and minimize the average worker’s fatigue level.Design/methodology/approach: To achieve this objective, a multi objective mixed integer programming model is developed to determine the amount of hiring, firing, training and overtime for each worker type.Findings: The results indicate that the worker differences should be considered in workforce scheduling to generate realistic plans with minimum costs. This paper also investigates the effects of human fatigue and recovery on the performance of the production systems.Research limitations/implications: In this research, there are some assumptions that might affect the accuracy of the model such as the assumption of certainty of the demand in each period, and the linearity function of Fatigue accumulation and recovery curves. These assumptions can be relaxed in future work.Originality/value: In this research, a new model for integrating workers’ differences with workforce scheduling is proposed. To the authors' knowledge, it is the first time to study the effects of different important human factors such as human personality, skills and fatigue and recovery in the workforce scheduling process. This research shows that considering both technical and human factors together can reduce the costs in manufacturing systems and ensure the safety of the workers.

  10. Effectiveness of "palliative care information booklet" in enhancing nurses′ knowledge

    Directory of Open Access Journals (Sweden)

    Anita David


    Full Text Available Context: Patients diagnosed with a disease like cancer require not only physical control of disease but also they need psychological reassurance, social and spiritual support in coming to terms with their disease. Nurses working in the specialized cancer hospitals play a significant role in the care of terminally ill patients. They must be knowledgeable, skilled and sensitive to the needs of these patients and their families in order to provide active, holistic care. Aims: In this study, we attempted to assess the level of knowledge about palliative care among nurses working in the oncology department using a self administered structured questionnaire and also to assess the effectiveness of information booklet designed on various aspects of palliative care on their knowledge. Settings and Design: Indo American Cancer Hospital, Hyderabad, AP, India. The design adopted for this study was One Group pretest - posttest, pre - experimental design. Materials and Methods: Hundred nurses working in Indo American Cancer Hospital, Hyderabad, AP, India were selected by using the non probability purposive sampling technique. A structured self administered questionnaire was prepared and administered as a pretest. An information booklet was developed pertaining to the general concepts of palliative care, care components (physical, social, emotional and spiritual and role of the nurse in palliative care and it was given to the participants. As a post test, the same questionnaire was re-administered after four days to the same study subjects. Pretest and post test knowledge scores were compared and the findings were analyzed statistically. Statistical analysis used : Microsoft Excel and Statistical Package for Social Science package. Results: The post test scores were significantly higher than the pretest knowledge scores, which indicate that the developed information booklet regarding palliative care was highly effective in enhancing the knowledge levels of the

  11. The effect of foster care placement on paternal welfare dependency

    DEFF Research Database (Denmark)

    Fallesen, Peter

    The arrival of a child profoundly alters the life-course for men. Yet, children could change men's lives not only by arriving in them, but also by departing from them. In this article, I test how one such departure-foster care placement-affects men's labor market attachment, and in so doing I...... provide a novel parallel to existing research on how fatherhood affects men, which focuses almost exclusively on a child's arrival. Using population panel data from Denmark that include all first time fathers whose children were placed in foster care from 1995-2005, I find that having a child placed...... in foster care is associated with up to a 12 percentage point increase in welfare dependency. This result persists in analyses that control for individual and family level fixed effects, unobserved heterogeneity, and selection into having a child placed in foster care....

  12. Aligning career development with organizational goals: working towards the development of a strong and sustainable workforce. (United States)

    Saxe-Braithwaite, Marcy; Carlton, Sandra; Bass, Brenda


    The rapidly changing world of healthcare is faced with many challenges, not the least of which is a diminishing workforce. Healthcare organizations must develop multiple strategies, not only to attract and retain employees, but also to ensure that workers are prepared for continuous change in the workplace, are working at their full scope of practice and are committed to, and accountable for, the provision of high-quality care. There is evidence that by creating a healthier workplace, improved patient care will follow. Aligning Healthy Workplace Initiatives with an organization's strategic goals, corporate culture and vision reinforces their importance within the organization. In this paper, we describe an innovative pilot to assess a career development program, one of multiple Healthy Workplace Initiatives taking place at Providence Care in Kingston, Ontario in support of our three strategic goals. The results of the pilot were very encouraging; subsequent success in obtaining funding from HealthForceOntario has allowed the implementation of a sustainable program of career development within the organization. More work is required to evaluate its long-term effectiveness.

  13. How policy can help develop and sustain workforce capacity in UK dementia research: insights from a career tracking analysis and stakeholder interviews (United States)

    Marjanovic, Sonja; Robin, Enora; Harte, Emma; MacLure, Calum; Walton, Clare; Pickett, James


    Objectives To identify research support strategies likely to be effective for strengthening the UK's dementia research landscape and ensuring a sustainable and competitive workforce. Design Interviews and qualitative analysis; systematic internet search to track the careers of 1500 holders of UK doctoral degrees in dementia, awarded during 1970–2013, to examine retention in this research field and provide a proxy profile of the research workforce. Setting and participants 40 interviewees based in the UK, whose primary role is or has been in dementia research (34 individuals), health or social care (3) or research funding (3). Interviewees represented diverse fields, career stages and sectors. Results While the UK has diverse strengths in dementia research, needs persist for multidisciplinary collaboration, investment in care-related research, supporting research-active clinicians and translation of research findings. There is also a need to better support junior and midlevel career opportunities to ensure a sustainable research pipeline and future leadership. From a sample of 1500 UK doctorate holders who completed a dementia-related thesis in 1970–2013, we identified current positions for 829 (55%). 651 (43% of 1500) could be traced and identified as still active in research (any field) and 315 (21%) as active in dementia research. Among recent doctoral graduates, nearly 70% left dementia research within 4–6 years of graduation. Conclusions A dementia research workforce blueprint should consider support for individuals, institutions and networks. A mix of policy interventions are needed, aiming to attract and retain researchers; tackle bottlenecks in career pathways, particularly at early and midcareer stages (eg, scaling-up fellowship opportunities, rising star programmes, bridge-funding, flexible clinical fellowships, leadership training); and encourage research networks (eg, doctoral training centres, succession and sustainability planning

  14. The effect of pediatric knowledge on hospice care costs. (United States)

    Lindley, Lisa C; Mixer, Sandra J; Cozad, Melanie J


    The cost of hospice care is rising. Although providing care for children at end of life may be costly for hospices, it is unclear whether or not gaining pediatric knowledge and even establishing a pediatric program may be done cost effectively. The purpose of our study was to examine the effect of possessing pediatric knowledge (i.e., pediatric program, pediatric experience) on core hospice care costs. Using 2002 to 2008 California hospice data, the findings of the regression analysis suggest that having pediatric knowledge does not significantly increase nursing, physician, and medical social service costs. Having a pediatric program was related to increased counseling costs. Our findings shed important light on the minimal costs incurred when hospices decide to develop pediatric knowledge.

  15. Responding to the Marketplace: Workforce Balance and Financial Risk at Academic Health Centers. (United States)

    Retchin, Sheldon M


    Elsewhere in this issue, Welch and Bindman present research demonstrating that academic health centers (AHCs) continue to disproportionately comprise specialists and subspecialist faculty physicians compared with community-based physician groups. This workforce composition has served AHCs well through the years-specialists fuel the clinical engine of the major tertiary and quaternary missions of AHCs, and they also dominate much of the clinical and translational research enterprise. AHCs are not alone-less than one-third of U.S. physicians practice primary care. However, health reform has prompted many health systems to reconsider this configuration. Payers, employers, and policy makers are shifting away from fee-for-service toward value-based care. Large community-based physician groups and their parent health systems appear to be far ahead of AHCs with a more balanced physician workforce. Many are leveraging their emphasis on primary care to participate in population health initiatives, such as accountable care organizations, and some own their own health plans. These approaches largely assume some element of financial risk and require both a more balanced workforce and an infrastructure to accommodate the management of covered lives. It remains to be seen whether AHCs will reconsider their own physician specialty composition to emphasize primary care-and, if they do, whether the traditional academic model, or a more community-based approach, will prevail.

  16. The new radiology workforce: changing expectations. (United States)

    Cronan, John J


    The zeitgeist of the new radiology workforce can best be described by a Bob Dylan song title: "The Times They Are A-Changin'." The new generation of physicians, although embracing the same foundations of medical practice as previous generations, places greater emphasis on personal satisfaction than its predecessors. Gone are the days when physicians operated as sole practitioners; today's workforce member is content to function in the role of "employee" in a trade-off for more lifestyle flexibility. This change has occurred not because of one specific factor but because of a change in the profession of medicine coupled with a combination of factors; familial responsibilities, avocational activities, and personal satisfaction have surfaced as motivating factors in choosing a profession. Today's workforce has a personal perception of success that may not be fulfilled solely by the contemporary practice of medicine. With the radiologist shortages that are now occurring and anticipated increased demand for staff radiologists, today's radiology workforce has helped shape the specialty into one that is altering its structure to attract and retain its workforce.

  17. Architectural firms: workforce, business strategy and performance

    Directory of Open Access Journals (Sweden)

    Adedapo Adewunmi Oluwatayo


    Full Text Available The intent of this research was to investigate the relationship between the workforce, business strategy and performance of architectural firms. Data was collected from 92 firms randomly selected from the cities where architectural firms were most concentrated in Nigeria using questionnaires. Hierarchical regression analysis was carried out to investigate the direct and indirect impacts of the workforce of architectural firms on their performance. The findings confirm the significant positive impact. With business strategy controlled, the specific characteristics of the workforce and its management which influenced performance were the number of architects, the work structure, and the age and experience of the principal partners. The impact of the number of non- architecture professionals and staff participation in decision-making on performance was moderated by the business strategy adopted by the firms. The results suggest that workforce characteristics are more important than the management of the workforce in determining performance of architectural firms. This is contrary to the results of previous studies which suggest higher importance of the management. This probably indicates the peculiarity of architectural firm as a professional service firm in the construction industry.

  18. Primary Care Nurse Practitioner Practice Characteristics: Barriers and Opportunities for Interprofessional Teamwork. (United States)

    Poghosyan, Lusine; Norful, Allison A; Martsolf, Grant R

    Developing team-based care models and expanding nurse practitioner (NP) workforce in primary care are recommended by policy makers to meet demand. Little is known how to promote interprofessional teamwork. Using a mixed-methods design, we analyzed qualitative interview and quantitative survey data from primary care NPs to explore practice characteristics important for teamwork. The Interprofessional Teamwork for Health and Social Care Framework guided the study. We identified NP-physician and NP-administration relationships; organizational support and governance; time and space for teamwork; and regulations and economic impact as important. Practice and policy change addressing these factors is needed for effective interprofessional teamwork.

  19. The effectiveness of preventive care at reducing curative care risk for the Taiwanese elderly under National Health Insurance. (United States)

    Chen, Chin-Shyan; Peng, Yu-I; Lee, Ping-Chang; Liu, Tsai-Ching


    Whether provision of free preventive care for the elderly under National Health Insurance has reduced the risk for curative care use raises much concern in Taiwan. This study analyzes the relationship by examining the impact of health examination utilization on the utilizations of outpatient care and inpatient care. Data come from the 2005 National Health Interview Survey and National Health Insurance Research Database. A two-stage method is used in the estimation. We found a negative relationship between the utilization of preventive care and hospitalization care in terms of length of stay and medical expenditures. On average, the elderly people who used preventive care tended to have 16 shorter hospitalization stays and NTD64,220 lower hospitalization expenditures than their counterparts. In order to improve the health of the elderly and reduce the escalation of medical expenditures due to aging, including preventive care in the health insurance is a very effective strategy.

  20. Effect of the Goals of Care Intervention for Advanced Dementia (United States)

    Hanson, Laura C.; Zimmerman, Sheryl; Song, Mi-Kyung; Lin, Feng-Chang; Rosemond, Cherie; Carey, Timothy S.; Mitchell, Susan L.


    preferences, symptom management, and quality of care did not differ. Residents in the intervention group had more palliative care content in treatment plans (5.6 vs 4.7, P = .02), MOST order sets (35% vs 16%, P = .05), and half as many hospital transfers (0.078 vs 0.163 per 90 person-days; RR, 0.47; 95% CI, 0.26–0.88). Survival at 9 months was unaffected (adjusted hazard ratio [aHR], 0.76; 95% CI, 0.54–1.08; P = .13). CONCLUSIONS AND RELEVANCE The GOC decision aid intervention is effective to improve end-of-life communication for nursing home residents with advanced dementia and enhance palliative care plans while reducing hospital transfers. TRIAL REGISTRATION Identifier: NCT01565642 PMID:27893884


    Directory of Open Access Journals (Sweden)

    Monica Boldea


    Full Text Available Each day presents a new set of challenges and risks to companies operating in this age ofboth a global economy and of multiculturalism, i.e. a fast-changing marketplace. Globalcompetition and escalating economic pressures make the business environment bothdynamic and difficult, especially given the workforce diversity which has to be managed soas to achieve the highest levels of task performance and job satisfaction; managers must beprepared to respect alternative cultures and value diversity. Based on this background ourpaper has as starting point the consideration that organizations are seeking out methods torefine their operations in order to navigate often-difficult economic terrain effectively,analyzing the organizations’ ability to being responsive to changing market conditions,competitive threats, and new market opportunities, therefore focusing on an organization’screative and innovative ability, highlighting the people component of a business process, aswith so much emphasis on automation, it’s easy to overlook the human element, anoversight which – in most cases – hinders efficient business process management.Considering that processes don’t do work, but people do, our research highlights the factthat a “want to motivate” attitude by the employee can be encouraged, even if pastmanagerial efforts have rather concentrated on “how to motivate” the employee, trying toshed some light on how BPM with a hint of the Six Sigma method offers a clearer path toan increasing number of organizations hoping to best the challenges they have to face, thisoften translating into workforce motivation and retention, by creating positive workenvironments in which the cultural and demographic diversity of members helps to createcompetitive advantage.

  2. Health workforce changes and the roles of information technology associated with these changes. "The Times They Are A-Changin' " (Bob Dylan, 1964). (United States)

    Hannan, T; Brooks, P


    Healthcare is considered a service profession and most of what clinicians do is manage information. Thus, information is not a necessary adjunct to care. It is care and effective patient management that require effective management of patients' clinical data. This perspective is supported by the World Health Organisation in its use of the quotation from Gonzalo Vecina Neto, head of the Brazilian National Health Regulatory Agency, 'There is no health without management, and there is no management without information'. This opinion paper discusses how traditional clinical decision-making led 'by the doctor' is unsustainable in the modern era and how e-technologies will facilitate distributed effective decision-making and new divisions of labour across the health workforce.

  3. National Wildlife Refuge System : Strategic Workforce Planning Report (United States)

    US Fish and Wildlife Service, Department of the Interior — The purpose of this report is to describe the current and future workforce challenges and workforce development efforts underway by the Refuge System to address...

  4. Health workforce planning in Europe: Creating learning country clusters. (United States)

    Batenburg, Ronald


    In this article, the different dimensions and determinants of health workforce planning (HWF) are investigated to improve context-sensitivity and mutual learning among groups of countries with similar HWF characteristics. A novel approach to scoring countries according to their HFW characteristics and type of planning is introduced using data collected in 2012 by a large European Union project involving 35 European countries (the 'Matrix Study' [8]). HWF planning is measured in terms of three major dimensions: (1) data infrastructure to monitor the capacities and dynamics of health workforces, (2) the institutions involved in defining and implementing labour market regulations, and (3) the availability of models to estimate supply-demand gaps and to forecast imbalances. The result shows that the three dimensions of HWF planning are weakly interrelated, indicating that countries invest in HWF in different ways. Determinant analysis shows that countries with larger health labour markets, National Healthcare Service (NHS), mobility, and strong primary health care score higher on HWF planning dimensions than others. Consequently, the results suggest that clustering countries with similar conditions in terms of HWF planning is a way forward towards mutual and contextual learning.

  5. Geriatric Workforce Capacity: A Pending Crisis for Nursing Home Residents

    Directory of Open Access Journals (Sweden)

    Wei Chen eLee


    Full Text Available Introduction: The nursing home (NH population in the U.S. has grown to 1.6 million people and is expected to double by 2030. While 88.3% of NH residents are over 65, the elders aged 85 and more have become the principal group. This demographic change has increased the already high rates of chronic diseases and functional disabilities in NH residents. Methods: This study reviewed the supply of geriatricians in addressing the growing healthcare needs of NH residents. Results: English-written articles between 1989 and 2012 were reviewed. Trend data demonstrate that the geriatrician workforce has decreased from 10,270 in 2000 to 8,502 in 2010. Further, the pipeline analysis of physicians projected to receive board certification in geriatrics (and maintain this certification indicates a worsening of the already insufficient supply of geriatricians for this vulnerable population. Conclusion: Strategies to attract and maintain a geriatrician workforce are imperative to avert a mounting crisis in the geriatric care in NH and, by extension, other living settings.

  6. Integrated and interprofessional care

    Directory of Open Access Journals (Sweden)

    Hugh Barr


    Full Text Available No wonder two movements described in such similar terms are so often confused. One strives to knit services together, the other to cultivate collaborative practice amongst their workers.  Dedicated though both of them are to the improvement of health and social care, integrated care falters without engaging the workforce actively as partners in change whilst interprofessional care falters without organisational support. Neither stands alone. Each depends on the other.

  7. Stepped care for depression and anxiety: from primary care to specialized mental health care: a randomised controlled trial testing the effectiveness of a stepped care program among primary care patients with mood or anxiety disorders

    Directory of Open Access Journals (Sweden)

    Seekles Wike


    Full Text Available Abstract Background Mood and anxiety disorders are highly prevalent and have a large impact on the lives of the affected individuals. Therefore, optimal treatment of these disorders is highly important. In this study we will examine the effectiveness of a stepped care program for primary care patients with mood and anxiety disorders. A stepped care program is characterized by different treatment steps that are arranged in order of increasing intensity. Methods This study is a randomised controlled trial with two conditions: stepped care and care as usual, whereby the latter forms the control group. The stepped care program consists of four evidence based interventions: (1 Watchful waiting, (2 Guided self-help, (3 Problem Solving Treatment and (4 Medication and/or specialized mental health care. The study population consists of primary care attendees aged 18–65 years. Screeners are sent to all patients of the participating general practitioners. Individuals with a Diagnostic and Statistical Manual of mental disorders (DSM diagnosis of major depression, dysthymia, panic disorder (with or without agoraphobia, generalized anxiety disorder, or social phobia are included as well as individuals with minor depression and anxiety disorders. Primary focus is the reduction of depressive and anxiety symptoms. Both conditions are monitored at 8, 16 and 24 weeks. Discussion This study evaluates the effectiveness of a stepped care program for patients with depressive and anxiety disorder. If effective, a stepped care program can form a worthwhile alternative for care as usual. Strengths and limitations of this study are discussed. Trial Registration Current Controlled Trails: ISRCTN17831610.

  8. The non-medical workforce and its role in surgical training: Consensus recommendations by the Association of Surgeons in Training. (United States)

    Gokani, Vimal J; Peckham-Cooper, Adam; Bunting, David; Beamish, Andrew J; Williams, Adam; Harries, Rhiannon L


    Changes in the delivery of the healthcare structure have led to the expansion of the non-medical workforce (NMW). The non-medical practitioner in surgery (a healthcare professional without a medical degree who undertakes specialist training) is a valuable addition to a surgical firm. However, there are a number of challenges regarding the successful widespread implementation of this role. This paper outlines a number of these concerns, and makes recommendations to aid the realisation of the non-medical practitioner as a normal part of the surgical team. In summary, the Association of Surgeons in Training welcomes the development of the non-medical workforce as part of the surgical team in order to promote enhanced patient care and improved surgical training opportunities. However, establishing a workforce of independent/semi-independent practitioners who compete for the same training opportunities as surgeons in training may threaten the UK surgical training system, and therefore the care of our future patients.

  9. 77 FR 36549 - Nursing Workforce Diversity Invitational Summit-“Nursing in 3D: Workforce Diversity, Health... (United States)


    ... HUMAN SERVICES Health Resources and Services Administration Nursing Workforce Diversity Invitational Summit--``Nursing in 3D: Workforce Diversity, Health Disparities, and Social Determinants of Health...). ACTION: Notice of meeting. SUMMARY: HRSA's Bureau of Health Professions, Division of Nursing, will...

  10. Research use and support needs, and research activity in social care: a cross-sectional survey in two councils with social services responsibilities in the UK. (United States)

    Cooke, Jo; Bacigalupo, Ruth; Halladay, Linsay; Norwood, Hayley


    The purpose of this study was to investigate the level of research activity, research use, research interests and research skills in the social care workforce in two UK councils with social service responsibilities (CSSRs). A cross-sectional survey was conducted of the social care workforce in two CSSRs (n = 1512) in 2005. The sample was identified in partnership with the councils, and included employees with professional qualifications (social workers and occupational therapists); staff who have a role to assess, plan and monitor care; service managers; commissioners of services; and those involved with social care policy, information management and training. The survey achieved a response rate of 24% (n = 368). The Internet was reported as an effective source of research information; conversely, research-based guidelines were reported to have a low impact on practice. Significant differences were found in research use, by work location, and postgraduate training. Most respondents saw research as useful for practice (69%), and wanted to collaborate in research (68%), but only 11% were planning to do research within the next 12 months. Having a master's degree was associated with a greater desire to lead or collaborate in research. A range of research training needs, and the preferred modes of delivery were identified. Support to increase research activity includes protected time and mentorship. The study concludes that a range of mechanisms to make research available for the social care workforce needs to be in place to support evidence-informed practice. Continual professional development to a postgraduate level supports the use and production of evidence in the social care workforce, and promotes the development of a research culture. The term research is used to include service user consultations, needs assessment and service evaluation. The findings highlight a relatively large body of the social care workforce willing to collaborate and conduct research

  11. 78 FR 55731 - Health Workforce Research Center Cooperative Agreement Program (United States)


    ... workforce policy and planning questions. Though the FOA indicated the intent to fund only one cooperative... HUMAN SERVICES Health Resources and Services Administration Health Workforce Research Center Cooperative...: The Bureau of Health Professions (BHPr) is announcing a change to its Health Workforce Research...

  12. Creating and Sustaining an Interdisciplinary Infant Mental Health Workforce (United States)

    Hogan, Anne E.; Dillon, Colleen O.; Fernandes, Sherira; Spieker, Susan; ZeanahTulane, Paula D.


    Developing a sustainable, competent workforce is an urgent and challenging task for the Infant Mental Health (IMH) field. In this article, the authors share their experiences and perspectives on the importance of and challenges in the development of the IMH workforce. The broad view of both workforce members and professional development…

  13. Strategic management of the health workforce in developing countries: what have we learned?

    Directory of Open Access Journals (Sweden)

    Fritzen Scott A


    Full Text Available Abstract The study of the health workforce has gained in prominence in recent years, as the dynamic interconnections between human resource issues and health system effectiveness have come into sharper focus. This paper reviews lessons relating to strategic management challenges emerging from the growing literature in this area. Workforce issues are strategic: they affect overall system performance as well as the feasibility and sustainability of health reforms. Viewing workforce issues strategically forces health authorities to confront the yawning gaps between policy and implementation in many developing countries. Lessons emerge in four areas. One concerns imbalances in workforce structure, whether from a functional specialization, geographical or facility lens. These imbalances pose a strategic challenge in that authorities must attempt to steer workforce distribution over time using a limited range of policy tools. A second group of lessons concerns the difficulties of central-level steering of the health workforce, often critically weak due to the lack of proper information systems and the complexities of public sector decentralization and service commercialization trends affecting the grassroots. A third cluster examines worker capacity and motivation, often shaped in developing countries as much by the informal norms and incentives as by formal attempts to support workers or to hold them accountable. Finally, a range of reforms centering on service contracting and improvements to human resource management are emerging. Since these have as a necessary (but not sufficient condition some flexibility in personnel practices, recent trends towards the sharing of such functions with local authorities are promising. The paper identifies a number of current lines of productive research, focusing on the relationship between health policy reforms and the local institutional environments in which the workforce, both public and private, is deployed.

  14. Planning the Dutch GP workforce.

    NARCIS (Netherlands)

    Batenburg, R.; Velden, L. van der; Greuningen, M. van


    CONTEXT: For a long time, shortages of health care personnel have been a major worldwide concern of health policy makers, professional bodies and patient organisations (cf. OECD, 2008). It is commonly acknowledged that manpower planning can be an important instrument to control shortages (and oversu

  15. Workforce, learners, competencies, and the learning environment: Research in Medical Education 2014 and the way forward. (United States)

    West, Daniel C; Robins, Lynne; Gruppen, Larry D


    Medicine in the United States is changing as a result of many factors, including the needs and demands of 21st-century society. In this commentary, the authors review the 2014 Research in Medical Education (RIME) articles in the context of these changes and with an eye toward the future. The authors organized the 12 RIME articles into four broad themes: career development and workforce issues; competency and assessment; admissions, wellness, and the learning environment; and intended and unintended learning. Although the articles represent a broad range of issues, the authors identified three key take-home points from the collection: (1) Schools may be able to address the looming shortage of primary care physicians through admission selection criteria and targeted curricular activities; (2) better understanding of the competencies required to perform complex physician tasks could lead to more effective ways to teach and assess these tasks; and (3) the intended and unintended learning that take place in the medical learning environment require careful attention in order to produce physicians who are both skilled enough and well enough to meet the needs of society.

  16. Engagement of Traditional Healers and Birth Attendants as a Controversial Proposal to Extend the HIV Health Workforce. (United States)

    Audet, Carolyn M; Hamilton, Erin; Hughart, Leighann; Salato, Jose


    "Medical pluralism" is the use of multiple health systems and is common among people living with HIV/AIDS in sub-Saharan Africa. Healers and traditional birth attendants (TBAs) often are a patient's first and/or preferred line of treatment; this often results in delayed, interrupted, or abandoned diagnosis and therapy. Literature from the study of medical pluralism suggests that HIV care and treatment programs are infrequently and inconsistently engaging healers around the world. Mistrust and misunderstanding among patients, clinical providers, and traditional practitioners make the development of effective partnerships difficult, particularly regarding early HIV diagnosis and antiretroviral therapy. We provide recommendations for the development of successful collaboration health workforce efforts based on both published articles and case studies from our work in rural Mozambique.

  17. Defense Acquisition Workforce: Actions Needed to Guide Planning Efforts and Improve Workforce Capability (United States)


    past, some hiring decisions made by DOD components using the Defense Acquisition Workforce Development Fund exceeded initial 2010 career field...contracting and engineering career fields are largely the result of high attrition rates and difficulty in hiring qualified personnel. Despite these...revised career field goals or issued guidance on the use of the Defense Acquisition Workforce Development Fund to guide future hiring decisions . In

  18. Evaluating Number Sense in Workforce Students (United States)

    Steinke, Dorothea A.


    Earlier institution-sponsored research revealed that about 20% of students in community college basic math and pre-algebra programs lacked a sense of part-whole relationships with whole numbers. Using the same tool with a group of 86 workforce students, about 75% placed five whole numbers on an empty number line in a way that indicated lack of…

  19. Information Literacy and the Workforce: A Review (United States)

    Weiner, Sharon


    This paper is a review of reports on information literacy and the workforce. There is a substantial body of literature on information literacy in K-16 educational settings, but there is much less literature on implications for the workplace and job-related lifelong learning. The topical categories of the reports are: the importance of information…

  20. Wind Energy Technology: Training a Sustainable Workforce (United States)

    Krull, Kimberly W.; Graham, Bruce; Underbakke, Richard


    Through innovative teaching and technology, industry and educational institution partnerships, Cloud County Community College is preparing a qualified workforce for the emerging wind industry estimated to create 80,000 jobs by 2020. The curriculum blends on-campus, on-line and distance learning, land-lab, and field training opportunities for…

  1. Growing Our Workforce through Business and Education (United States)

    Pauley, Douglas R.; Davidchik, Daniel


    In 2004, Central Community College (CCC) established the Mechatronics Education Center (MEC), a regional center of excellence, to help the state address the shortage of skilled technicians in the area of industrial automation. The MEC addresses the needs of the current and future workforce through the implementation of its three main components:…

  2. Skills Governance and the Workforce Development Programme (United States)

    Hordern, Jim


    In the United Kingdom higher education environment, government may make efforts to encourage institutions to engage in governance structures to secure policy objectives through a steering approach. In this article connections between skills governance structures and the recent Higher Education Funding Council for England workforce development…

  3. Workforce planning for DOE/EM: Assessing workforce demand and supply

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, R.E.; Ulibarri, C.A.


    The US Department of Energy (DOE) has committed to bringing its facilities into regulatory compliance and restoring the environment of sites under its control by the year 2019. Responsibility for accomplishing this goal is vested with the Office of Environmental Restoration and Waste Management (EM). Concerns regarding the availability of workers with the necessary technical skills and the prospect of retraining workers from other programs within DOE or other industries are addressed in this report in several ways. First, various workforce projections relevant to EM occupations are compared to determine common findings and resolve inconsistencies. Second, case studies, interviews, and published data are used to examine the potential availability of workers for these occupations via occupational mobility, training/retraining options, and salary adjustments. Third, demand and supply factors are integrated in a framework useful for structuring workforce analyses. The analyses demonstrate that workforce skills are not anticipated to change due to the change in mission; science, engineering, and technician occupations tend to be mobile within and across occupational categories; experience and on-the-job training are more crucial to issues of worker supply than education; and, the clarity of an organization`s mission, budget allocation process, work implementation and task assignment systems are critical determinants of both workforce need and supply. DOE is encouraged to create a more stable platform for workforce planning by resolving organizational and institutional hindrances to accomplishing work and capitalizing on workforce characteristics besides labor {open_quotes}supply{close_quotes} and demographics.

  4. Augmenting health care failure modes and effects analysis with simulation

    DEFF Research Database (Denmark)

    Staub-Nielsen, Ditte Emilie; Dieckmann, Peter; Mohr, Marlene;


    This study explores whether simulation plays a role in health care failure mode and effects analysis (HFMEA); it does this by evaluating whether additional data are found when a traditional HFMEA is augmented with simulation. Two multidisciplinary teams identified vulnerabilities in a process...... for deeper analysis. The study indicates that simulation has a role in HFMEA. Both ways of using simulation seemed feasible, and our results are not conclusive in selecting one over the other....

  5. CARES: Carbonaceous Aerosol and Radiative Effects Study Science Plan

    Energy Technology Data Exchange (ETDEWEB)

    Zaveri, RA; Shaw, WJ; Cziczo, DJ


    Carbonaceous aerosol components, which include black carbon (BC), urban primary organic aerosols (POA), biomass burning aerosols, and secondary organic aerosols (SOA) from both urban and biogenic precursors, have been previously shown to play a major role in the direct and indirect radiative forcing of climate. The primary objective of the CARES 2010 intensive field study is to investigate the evolution of carbonaceous aerosols of different types and their effects on optical and cloud formation properties.

  6. Comparative effectiveness research and health care reform in C hina

    Institute of Scientific and Technical Information of China (English)

    Yilong Wang; Yongjun Wang


    China has made significant progress in modernizing its healthcare system in the past 20 years. However, there are some issues that are difficult to solve on the current healthcare status, including the lack of medical care satisfaction in rural areas and urban areas, excessive consumption of medical resources, conflict and tension between the healthcare provider and patients, and the problems caused by the change of model of healthcare. Therefore, the State Council in-troduced the Opinions of the CPC Central Committee and the State Council on Deepening the Health Care System Reform in 2009 in order to provide basic, safe, effective, convenient and affordable healthcare for all residents. Despite the goals and policies set by the gov-ernment, how to implement them remains to be chal-lenging. Like evidence-based medicine, comparative effective research ( CER ) which started in the US in 2000 ’s can provide diagnosis and treatment information for patients, doctors, and health policy makers to make decisions on the effective ways of caring for both indi-vidual and population. It also may apply to the condi-tions of healthcare reform in China. And there are op-portunities and challenges of conducting CER in our country. We suggest that the government should estab-lish the national-level CER research institute, CER Leadership Committee and relevant standards, fund the CER projects, and begin CER in certain disciplines.

  7. Reconfiguring health workforce: a case-based comparative study explaining the increasingly diverse professional roles in Europe

    NARCIS (Netherlands)

    A.A. de Bont (Antoinette); N.J.A. van Exel (Job); Coretti, S. (Silvia); Ökem, Z.G. (Zeynep Güldem); Janssen, M. (Maarten); Hope, K.L. (Kristin Lofthus); Ludwicki, T. (Tomasz); Zander, B. (Britta); Zvonickova, M. (Marie); C.M. Bond (Christine); I. Wallenburg (Iris)


    textabstractBackground: Over the past decade the healthcare workforce has diversified in several directions with formalised roles for health care assistants, specialised roles for nurses and technicians, advanced roles for physician associates and nurse practitioners and new professions for new serv

  8. Reconfiguring health workforce: A case-based comparative study explaining the increasingly diverse professional roles in Europe

    NARCIS (Netherlands)

    A.A. de Bont (Antoinette); N.J.A. van Exel (Job); Coretti, S.; Guldem Okem, Z.; M. Janssen (Maarten); Lofthus Hope, K.; Ludwicki, T.; Zvonickova, M.; Zander, B.; Bond, C.M.; I. Wallenburg (Iris)


    textabstractBackground Over the past decade the healthcare workforce has diversified in several directions with formalised roles for health care assistants, specialised roles for nurses and technicians, advanced roles for physician associates and nurse practitioners and new professions for new serv

  9. Impact of the primary care curriculum and its teaching formats on medical students’ perception of primary care: a cross-sectional study


    Chung, Christopher; Maisonneuve, Hubert; Pfarrwaller, Eva; Audétat, Marie-Claude; Birchmeier, Alain; Herzig, Lilli; Bischoff, Thomas; Sommer, Johanna; Haller, Dagmar M


    Background Switzerland is facing an impending primary care workforce crisis since almost half of all primary care physicians are expected to retire in the next decade. Only a minority of medical students choose a primary care specialty, further deepening the workforce shortage. It is therefore essential to identify ways to promote the choice of a primary care career. The aim of the present study was to explore students’ views about the undergraduate primary care teaching curriculum and differ...

  10. Nursing assistants' behavior during morning care: effects of the implementation of snoezelen, integrated in 24-hours dementia care.

    NARCIS (Netherlands)

    Weert, J.C.M. van; Janssen, B.M.; Dulmen, A.M. van; Spreeuwenberg, P.M.M.; Bensing, J.M.; Ribbe, M.W.


    Aim: This paper reports an investigation of the effects of the implementation of snoezelen, or multisensory stimulation, on the quality of nursing assistants' behaviour during morning care. Background: Nursing assistants in long-term dementia care are often unaware of the impact of their behaviour o

  11. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

    Directory of Open Access Journals (Sweden)

    Wilhelmina Mijntje Looman


    Full Text Available Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months.Intervention: Frailty was preventively detected in elderly living at home with the Groningen Frailty Indicator. Geriatric nurse practitioners and secondary care geriatric nursing specialists were assigned as case managers and co-ordinated the care agreed upon in a multidisciplinary meeting. The general practitioner practice functions as a single entry point and supervises the co-ordination of care. The intervention encompasses task reassignment between nurses and doctors and consultations between primary, secondary and tertiary care providers. The entire process was supported by multidisciplinary protocols and web-based patient files.Methods: The design of this study was quasi-experimental. In this study, 205 frail elderly patients of three general practitioner practices that implemented the integrated care model were compared with 212 frail elderly patients of five general practitioner practices that provided usual care. The outcomes were assessed using questionnaires. Baseline measures were compared with a three-month follow-up by chi-square tests, t-tests and regression analysis.Results and conclusion: In the short term, the integrated care model had a significant effect on the attachment aspect of quality of life. The frail elderly patients were better able to obtain the love and friendship they desire. The use of care did not differ despite the preventive element and the need for assessments followed up with case management in the integrated care model. In the short term, there were no significant changes in health. As frailty is a progressive state, it is assumed that three months are too short to influence changes in health with integrated care models. A more longitudinal approach is required

  12. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

    Directory of Open Access Journals (Sweden)

    Wilhelmina Mijntje Looman


    Full Text Available Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months. Intervention: Frailty was preventively detected in elderly living at home with the Groningen Frailty Indicator. Geriatric nurse practitioners and secondary care geriatric nursing specialists were assigned as case managers and co-ordinated the care agreed upon in a multidisciplinary meeting. The general practitioner practice functions as a single entry point and supervises the co-ordination of care. The intervention encompasses task reassignment between nurses and doctors and consultations between primary, secondary and tertiary care providers. The entire process was supported by multidisciplinary protocols and web-based patient files. Methods: The design of this study was quasi-experimental. In this study, 205 frail elderly patients of three general practitioner practices that implemented the integrated care model were compared with 212 frail elderly patients of five general practitioner practices that provided usual care. The outcomes were assessed using questionnaires. Baseline measures were compared with a three-month follow-up by chi-square tests, t-tests and regression analysis. Results and conclusion: In the short term, the integrated care model had a significant effect on the attachment aspect of quality of life. The frail elderly patients were better able to obtain the love and friendship they desire. The use of care did not differ despite the preventive element and the need for assessments followed up with case management in the integrated care model. In the short term, there were no significant changes in health. As frailty is a progressive state, it is assumed that three months are too short to influence changes in health with integrated care models. A more longitudinal approach is

  13. "Unpaid and Paid Care: The Effects of Child Care and Elder Care on the Standard of Living"


    Kim, Kijong; Antonopoulos, Rania


    Transforming care for children and the elderly from a private to a public domain engenders a series of benefits to the economy that improve our standard of living. We assess the positive impacts of social care from both receivers' and providers' points of view. The benefits to care receivers are various, ranging from private, higher returns to education to enhancing subjective well-being and health outcomes. The economy-wide spillovers of the benefits are noteworthy. Early childhood education...

  14. The effect of managed care on use of health care services: results from two contemporaneous household surveys. (United States)

    Deb, Partha; Li, Chenghui; Trivedi, Pravin K; Zimmer, David M


    This paper estimates treatment effects of managed care plans on the utilization of health care services using data from two contemporaneous, nationally representative household surveys from the USA. The paper exploits recent advances in simulation-based econometrics to take the endogeneity of enrollment into managed care plans into account and identify the causal relationship between managed care enrollment and utilization. Overall, results from the two surveys are remarkably similar, lending credibility to their external validity and to the econometric model and estimation methods. There is significant evidence of self-selection into managed care plans. After accounting for selection, an individual enrolled in an health maintenance organization (HMO) plan has 2 more visits to a doctor and has 0.1 more visits to the emergency room per year than would the same individual enrolled in a nonmanaged care plan.

  15. Goal setting: an integral component of effective diabetes care. (United States)

    Miller, Carla K; Bauman, Jennifer


    Goal setting is a widely used behavior change tool in diabetes education and training. Prior research found specific relatively difficult but attainable goals set within a specific timeframe improved performance in sports and at the workplace. However, the impact of goal setting in diabetes self-care has not received extensive attention. This review examined the mechanisms underlying behavioral change according to goal setting theory and evaluated the impact of goal setting in diabetes intervention studies. Eight studies were identified, which incorporated goal setting as the primary strategy to promote behavioral change in individual, group-based, and primary care settings among patients with type 2 diabetes. Improvements in diabetes-related self-efficacy, dietary intake, physical activity, and A1c were observed in some but not all studies. More systematic research is needed to determine the conditions and behaviors for which goal setting is most effective. Initial recommendations for using goal setting in diabetes patient encounters are offered.

  16. [Effects of IT usage on the nursing-care stress of stay-at-home caregivers]. (United States)

    Kubota, Masakazu; Kinoshita, Ayae


    We examined the effects of blog post on the stress reduction of stay-at-home care givers who posted their nursing-care blog on the Internet. Fourteen bloggers filled out the attached questionnaires. In the examination of questionnaires about intercommunication among the care givers, we suggest that IT literacy is found to be useful for reducing the burden of nursing care.

  17. Defragmenting care: testing an intervention to increase the effectiveness of interdisciplinary health care teams. (United States)

    Kilgore, Rachel V; Langford, Rae W


    Few studies in the literature have examined the outcomes of health care interdisciplinary teams. Most existing studies have measured attributes of health care teams; however, none have implemented and examined outcomes of a team development intervention. This study was conducted to determine whether a development intervention used with an existing interdisciplinary team would reduce the length of stay for patients in an acute care setting. A quasi-experimental single-subject time series design was conducted with multiple measures of length of stay collected across baseline, intervention, and reversal phases of the study. Bronstein's Model for Interdisciplinary Collaboration provided the framework for this study. The components of this model were used to guide a team development intervention comprised of 4 consecutive weeks of classroom development sessions and 4 consecutive weeks of booster messaging. Length of stay (LOS) data were collected for each of the study phases to examine preintervention LOS and compare these data with LOS during the intervention and reversal phases. The results of this study revealed that the interdisciplinary team development intervention had no positive effect on the length of stay data. Baseline mean LOS across 12 baseline months was 4.83 days (SD=0.65) with monthly means ranging from 4.1 to 6.3 days. The mean LOS was 5.1 and 4.6 days for the intervention months of May and June and 6.0, 6.5, 5.7, and 5.4 days for the reversal months of July to October, respectively. All means in the intervention and reversal phases were higher than comparable months in the baseline phase. The pattern of the graphed trend was closely aligned with the seasonal variations seen during the baseline months. Although these results showed that the team development intervention provided for this interdisciplinary team had no positive effect on the LOS, there are many factors that may have influenced the results and may provide insights useful for future

  18. Promoting a motivational workforce in nursing practice

    Directory of Open Access Journals (Sweden)

    Karien Jooste


    Full Text Available The motivation of nurses is a crucial contributing factor to effective health care organisations in South Africa. Opsomming Die motivering van verpleegkundiges is ’n kritiese aangeleentheid wat as bydraend tot effektiewe gesondheidsorgorganisasies in Suid-Afrika gesien kan word. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

  19. Conditions underpinning success in joint service-education workforce planning

    Directory of Open Access Journals (Sweden)

    Styles Laureen


    Full Text Available Abstract Vancouver Island lies just off the southwest coast of Canada. Separated from the large urban area of Greater Vancouver (estimated population 2.17 million by the Georgia Strait, this geographical location poses unique challenges in delivering health care to a mixed urban, rural and remote population of approximately 730 000 people living on the main island and the surrounding Gulf Islands. These challenges are offset by opportunities for the Vancouver Island Health Authority (VIHA to collaborate with four publicly funded post-secondary institutions in planning and implementing responses to existing and emerging health care workforce needs. In this commentary, we outline strategies we have found successful in aligning health education and training with local health needs in ways that demonstrate socially accountable outcomes. Challenges encountered through this process (i.e. regulatory reform, post-secondary policy reform, impacts of an ageing population, impact of private, for-profit educational institutions have placed demands on us to establish and build on open and collaborative working relationships. Some of our successes can be attributed to evidence-informed decision-making. Other successes result from less tangible but no less important factors. We argue that both rational and "accidental" factors are significant – and that strategic use of "accidental" features may prove most significant in our efforts to ensure the delivery of high-quality health care to our communities.

  20. Cost-effectiveness of collaborative care for the treatment of depressive disorders in primary care: a systematic review.

    Directory of Open Access Journals (Sweden)

    Thomas Grochtdreis

    Full Text Available For the treatment of depressive disorders, the framework of collaborative care has been recommended, which showed improved outcomes in the primary care sector. Yet, an earlier literature review did not find sufficient evidence to draw robust conclusions on the cost-effectiveness of collaborative care.To systematically review studies on the cost-effectiveness of collaborative care, compared with usual care for the treatment of patients with depressive disorders in primary care.A systematic literature search in major databases was conducted. Risk of bias was assessed using the Cochrane Collaboration's tool. Methodological quality of the articles was assessed using the Consensus on Health Economic Criteria (CHEC list. To ensure comparability across studies, cost data were inflated to the year 2012 using country-specific gross domestic product inflation rates, and were adjusted to international dollars using purchasing power parities (PPP.In total, 19 cost-effectiveness analyses were reviewed. The included studies had sample sizes between n = 65 to n = 1,801, and time horizons between six to 24 months. Between 42% and 89% of the CHEC quality criteria were fulfilled, and in only one study no risk of bias was identified. A societal perspective was used by five studies. Incremental costs per depression-free day ranged from dominance to US$PPP 64.89, and incremental costs per QALY from dominance to US$PPP 874,562.Despite our review improved the comparability of study results, cost-effectiveness of collaborative care compared with usual care for the treatment of patients with depressive disorders in primary care is ambiguous depending on willingness to pay. A still considerable uncertainty, due to inconsistent methodological quality and results among included studies, suggests further cost-effectiveness analyses using QALYs as effect measures and a time horizon of at least 1 year.

  1. Safeguards Workforce Repatriation, Retention and Utilization

    Energy Technology Data Exchange (ETDEWEB)

    Gallucci, Nicholas [Brookhaven National Lab. (BNL), Upton, NY (United States); Poe, Sarah [Brookhaven National Lab. (BNL), Upton, NY (United States)


    Brookhaven National Laboratory was tasked by NA-241 to assess the transition of former IAEA employees back to the United States, investigating the rate of retention and overall smoothness of the repatriation process among returning safeguards professionals. Upon conducting several phone interviews, study authors found that the repatriation process went smoothly for the vast majority and that workforce retention was high. However, several respondents expressed irritation over the minimal extent to which their safeguards expertise had been leveraged in their current positions. This sentiment was pervasive enough to prompt a follow-on study focusing on questions relating to the utilization rather than the retention of safeguards professionals. A second, web-based survey was conducted, soliciting responses from a larger sample pool. Results suggest that the safeguards workforce may be oversaturated, and that young professionals returning to the United States from Agency positions may soon encounter difficulties finding jobs in the field.

  2. Workforce mobility: Contributing towards smart city (United States)

    Nor, N. M.; Wahap, N. A.


    Smart cities gained importance as a means of making ICT enabled services and applications available to the citizens, companies and authorities that form part of a city's system. It aims at increasing citizen's quality of life, and improving the efficiency and quality of the services provided by governing entities and businesses. This perspective requires an integrated vision of a city and of its infrastructures in all components. One of the characteristics of a smart city is mobility. The concept of mobility, especially for the workforce, is studied through a research carried out on a daily work undertaken as a prototype in the administrative town of Putrajaya, Malaysia. Utilizing the location track from GNSS integrated with mobile devices platform, information on movement and mobility was analysed for quality and efficiency of services rendered. This paper will highlight the research and outcomes that were successfully carried out and will suggest that workforce mobility management can benefit the authorities towards implementing a smart city concept.

  3. On your time: online training for the public health workforce. (United States)

    Kenefick, Hope Worden; Ravid, Sharon; MacVarish, Kathleen; Tsoi, Jennifer; Weill, Kenny; Faye, Elizabeth; Fidler, Anne


    The need for competency-based training for the public health workforce is well documented. However, human and financial resource limitations within public health agencies often make it difficult for public health practitioners to attend classroom-based training programs. The Internet is an increasingly popular way of extending training beyond the workforce. Although research describes attributes of effective online learning modules, much of the available training delivered via the Internet does not incorporate such attributes. The authors describe the On Your Time training series, an effective distance education program and training model for public health practitioners, which includes a standardized process for development, review, evaluation, and continuous quality improvement. On Your Time is a series of awareness-level (i.e., addressing what practitioners should know), competency-based training modules that address topics related to regulatory responsibilities of public health practitioners (e.g., assuring compliance with codes and regulations governing housing, retail food safety, private water supplies, hazardous and solid waste, on-site wastewater systems, etc.), public health surveillance, case investigation, disease prevention, health promotion, and emergency preparedness. The replicable model incorporates what is known about best practices for online training and maximizes available resources in the interests of sustainability.

  4. Workforce Development and Wind for Schools (Poster)

    Energy Technology Data Exchange (ETDEWEB)

    Newcomb, C.; Baring-Gould, I.


    As the United States dramatically expands wind energy deployment, the industry is faced with the need to quickly develop a skilled workforce and to address public acceptance. Wind Powering America's Wind for Schools project addresses these challenges. This poster, produced for the American Wind Energy Association's annual WINDPOWER conference, provides an overview of the project, including objectives, methods, and results.

  5. Identification of Key Barriers in Workforce Development

    Energy Technology Data Exchange (ETDEWEB)



    This report documents the identification of key barriers in the development of an adequate national security workforce as part of the National Security Preparedness Project, being performed under a Department of Energy/National Nuclear Security Administration grant. Many barriers exist that prevent the development of an adequate number of propertly trained national security personnel. Some barriers can be eliminated in a short-term manner, whereas others will involve a long-term strategy that takes into account public policy.

  6. Army Contracting Command Workforce Model Analysis (United States)


    College), and he has taught visiting seminars at American University in Cairo, and Instituto de Empresas in Madrid. Dr. Reed retired after 21 years...Advisory Panel, 2007, p. 7) not only points toward a strained workforce that lacks the requisite market expertise, but also to other factors that...mlpqdo^ar^qb=p`elli= Spyropoulos, D. (2005, March). Analysis of career progression and job performance in internal labor markets : The case of

  7. Family meetings in palliative care: are they effective? (United States)

    Hudson, P; Thomas, T; Quinn, K; Aranda, S


    Despite the promotion of family meetings as an essential tool for information sharing and planning in palliative care, minimal evidence exists to show their effectiveness. We sought to rectify this gap in evidence-based practice by evaluating recently developed clinical guidelines for facilitating family meetings. Palliative care nurses were trained to conduct family meetings using the guidelines. To assess the effectiveness of the guidelines, primary family carers who attended a family meeting completed a self-report instrument to measure unmet needs at three time periods: immediately before the meeting (T1), immediately after the meeting (T2) and two days after the meeting (T3). Phone interviews with carers were also conducted at T3. Patients, health professionals and family meeting facilitators were also invited to complete an evaluation form at T2. A focus group was conducted at the end of the project to gain reflections from the family meeting facilitators about their role, re-evaluate the family meeting clinical guidelines and discuss barriers and facilitators for ongoing implementation. Twenty family meetings were conducted at St Vincent's Hospital (Melbourne, Australia). A total of 42 participants were involved, including 20 family carers, 4 patients and 18 health professionals. Family carers reported a statistically significant increase in having their care needs met, from T1 to T2, which was maintained at T3; they also reported that the meetings were useful. Health professionals and patients advised that the meetings were well facilitated. The results from this pilot study indicate that family meetings, conducted using specific clinical practice guidelines, were useful and effective. However, more research is required to confirm these findings. Strategies for implementation and further research are outlined.

  8. A theoretical model to address organizational human conflict and disruptive behavior in health care organizations. (United States)

    Piper, Llewellyn E


    This article proposes a theoretical model for leaders to use to address organizational human conflict and disruptive behavior in health care organizations. Leadership is needed to improve interpersonal relationships within the workforce. A workforce with a culture of internal conflict will be unable to achieve its full potential to delivery quality patient care.

  9. A strategic approach to public health workforce development and capacity building. (United States)

    Dean, Hazel D; Myles, Ranell L; Spears-Jones, Crystal; Bishop-Cline, Audriene; Fenton, Kevin A


    In February 2010, CDC's National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease (STD), and Tuberculosis (TB) Prevention (NCHHSTP) formally institutionalized workforce development and capacity building (WDCB) as one of six overarching goals in its 2010-2015 Strategic Plan. Annually, workforce team members finalize an action plan that lays the foundation for programs to be implemented for NCHHSTP's workforce that year. This paper describes selected WDCB programs implemented by NCHHSTP during the last 4 years in the three strategic goal areas: (1) attracting, recruiting, and retaining a diverse and sustainable workforce; (2) providing staff with development opportunities to ensure the effective and innovative delivery of NCHHSTP programs; and (3) continuously recognizing performance and achievements of staff and creating an atmosphere that promotes a healthy work-life balance. Programs have included but are not limited to an Ambassador Program for new hires, career development training for all staff, leadership and coaching for mid-level managers, and a Laboratory Workforce Development Initiative for laboratory scientists. Additionally, the paper discusses three overarching areas-employee communication, evaluation and continuous review to guide program development, and the implementation of key organizational and leadership structures to ensure accountability and continuity of programs. Since 2010, many lessons have been learned regarding strategic approaches to scaling up organization-wide public health workforce development and capacity building. Perhaps the most important is the value of ensuring the high-level strategic prioritization of this issue, demonstrating to staff and partners the importance of this imperative in achieving NCHHSTP's mission.

  10. Structure and organization of primary care.

    NARCIS (Netherlands)

    Lember, M.; Cartier, T.; Bourgueil, Y.; Dedeu, T.; Hutchinson, A.; Kringos, D.


    The way primary care is structured establishes important conditions for both the process of care and its outcomes. In this chapter, the structure of primary care will be discussed according to three dimensions: governance, economic conditions and workforce development. Governance refers to the visi

  11. The organization and administration of community college non-credit workforce education and training cuts (United States)

    Kozachyn, Karen P.

    Community colleges are struggling financially due to underfunding. Recent state budget cuts coupled with the elimination of federal stimulus money has exacerbated the issue as these funding streams had contributed to operating costs (Moltz, 2011). In response to these budget cuts, community colleges are challenged to improve, increase, and develop revenue producing programs. These factors heighten the need for community colleges to examine their non-credit workforce organizations. The community college units charged with delivering non-credit workforce education and training programs are historically ancillary to the academic divisions that deliver certificate, technical degree, and transfer degree programs. The perceptions of these units are that they are the community college's 'step child' (Grubb, Bradway, and Bell, 2002). This case study examined the organization and administration of community college non-credit workforce education and training units, utilizing observation, interviews, and document analysis. Observational data focused on the physical campus and the unit. Interviews were conducted onsite with decision-making personnel of the division units that deliver non-credit workforce education and training within each community college. Document analysis included college catalogues, program guides, marketing material, and website information. The study was grounded in the review of literature associated with the evolution of the community college, as well as the development of workforce education and training including funding, organizational structure and models, management philosophies, and effectiveness. The findings of the study report that all five units were self-contained and were organized and operated uniquely within the organization. Effectiveness was measured differently by each institution. However, two common benchmarks were revenue and student evaluations. Another outcome of this study is the perceived lack of college-wide alignment between

  12. Introducing managed care to the medical school curriculum: effect on student attitudes. (United States)

    Field, T S; Baldor, R A; Casey, L M; Chuman, A; Lasser, D; Ehrlich, A; Gurwitz, J H


    In order to assess the effect of clinical training and didactic instruction on medical student attitudes toward managed care, we conducted a survey of all medical students at the midpoint of their third year clerkships at the University of Massachusetts Medical School. The students were exposed to clinical training in managed care settings and a 2-day required course on the principles underlying managed care. The main outcome measures were student attitudes toward the concepts of managed care, managed care organizations, and future careers in managed care. Students also assessed the attitudes of medical faculty toward managed care. Attitudes of students with previous clinical training in managed care settings did not differ from those of students without such exposure toward the concepts underlying managed care or managed care organizations and were less positive about careers in managed care. Student responses before and after the 2-day course on managed care demonstrated that attitudes moved in a significantly positive direction. Seventy-one percent of students reported that the opinions they had heard from medical faculty about managed care were negative. Preparing medical students to practice medicine effectively in managed care settings will require focused attention on managed care issues in the medical school curriculum and the combined efforts of academic health centers and managed care organizations.

  13. Anticipating the effect of the Patient Protection and Affordable Care Act for patients with urologic cancer. (United States)

    Ellimoottil, Chandy; Miller, David C


    The Affordable Care Act seeks to overhaul the US health care system by providing insurance for more Americans, improving the quality of health care delivery, and reducing health care expenditures. Although the law's intent is clear, its implementation and effect on patient care remains largely undefined. Herein, we discuss major components of the Affordable Care Act, including the proposed insurance expansion, payment and delivery system reforms (e.g., bundled payments and Accountable Care Organizations), and other reforms relevant to the field of urologic oncology. We also discuss how these proposed reforms may affect patients with urologic cancers.

  14. Using Workforce Strategy to Address Academic Casualisation: A University of Newcastle Case Study (United States)

    Crawford, Tina; Germov, John


    Casual and sessional academic staff have traditionally been on the margins of institutional life despite the expansion of this cohort across the university sector. This paper details a project to address this lack of recognition through a workforce strategy to engage, support and effectively manage this often neglected cohort of the academic…

  15. Investment in Graduate and Professional Degree Education: Evidence of State Workforce Productivity Growth (United States)

    Fatima, Nasrin


    The purpose of this study was to estimate the effects of investment in graduate and professional education on the subsequent growth in state workforce productivity. The independent variables of this study were investment in master's degree education, investment in doctoral degree education, investment in professional degree education, initial…

  16. Health workforce responses to global health initiatives funding: a comparison of Malawi and Zambia

    NARCIS (Netherlands)

    R. Brugha; J. Kadzandira; J. Simbaya; P. Dicker; V. Mwapasa; A. Walsh


    Background Shortages of health workers are obstacles to utilising global health initiative (GHI) funds effectively in Africa. This paper reports and analyses two countries' health workforce responses during a period of large increases in GHI funds. Methods Health facility record reviews were conduct

  17. Investing in People: A Strategy to Address America's Workforce Crisis. Background Papers. Vols. I-II. (United States)

    Department of Labor, Washington, DC. Commission on Workforce Quality and Labor Market Efficiency.

    The 49 papers in these two volumes were prepared to assist the Commission on Workforce Quality and Labor Market Efficiency in making recommendations for improving the U.S. work force. The papers summarize existing research and make recommendations on subjects reflecting seven Commission tasks: (1) examine the roles and effectiveness of privately…

  18. Building the Social Work Workforce: Saving Lives and Families

    Directory of Open Access Journals (Sweden)

    Katharine Briar-Lawson


    Full Text Available This article depicts a journey over the decades to address some of the needs of children and families in the child welfare system. Recounting a few key milestones and challenges in the past 40 years, it is argued that workforce development is one key to improved outcomes for abused and neglected children and their families. Major events and several turning points are chronicled. Emerging workforce needs in aging are also cited as lessons learned from child welfare have implications for building a gero savvy social work workforce. Funding streams involving IV-E and Medicaid are discussed. It is argued that workforce development can be a life and death issue for some of these most vulnerable populations. Thus, the workforce development agenda must be at the forefront of the social work profession for the 21st century. Key funding streams are needed to foster investments in building and sustaining the social work workforce.

  19. The US pediatric nephrology workforce: a report commissioned by the American Academy of Pediatrics. (United States)

    Primack, William A; Meyers, Kevin E; Kirkwood, Suzanne J; Ruch-Ross, Holly S; Radabaugh, Carrie L; Greenbaum, Larry A


    The US pediatric nephrology workforce is poorly characterized. This report describes clinical and nonclinical activities, motivations and disincentives to a career in pediatric nephrology, future workforce needs, trainee recruitment, and possible explanations for personnel shortages. An e-mail survey was sent in 2013 to all identified US-trained or -practicing pediatric nephrologists. Of 504 respondents, 51% are men, 66% are US graduates, and 73% work in an academic setting. About 20% of trained pediatric nephrologists no longer practice pediatric nephrology. Among the 384 respondents practicing pediatric nephrology full or part-time in the United States, the mean work week was 56.1±14.3 hours, with time divided between patient care (59%), administration (13%), teaching (10%), clinical research (9%), basic research (6%), and other medical activities (3%). Most (>85%) care for dialysis and transplantation patients. The median number of weeks annually on call is 16, and 29% work with one or no partner. One-third of US pediatric nephrologists (n=126) plan to reduce or stop clinical nephrology practice in the next 5 years, and 53% plan to fully or partially retire. Almost half the division chiefs (47%) report inadequate physician staffing. Ongoing efforts to monitor and address pediatric nephrology workforce issues are needed.

  20. VA Health Care: Improved Monitoring Needed for Effective Oversight of Care for Women Veterans (United States)


    Congressional Requesters December 2016 GAO-17-52 United States Government Accountability Office United States Government Accountability Office...2VA health care systems are made up of multiple VAMCs. Established under the Veterans Access, Choice, and Accountability Act of 2014, Choice...on VA’s Provision of Health Care Services to Women Veterans, GAO-09-884T (Washington, D.C.: July 14, 2009) and VA Health Care: Preliminary Findings

  1. District nursing workforce planning: a review of the methods. (United States)

    Reid, Bernie; Kane, Kay; Curran, Carol


    District nursing services in Northern Ireland face increasing demands and challenges which may be responded to by effective and efficient workforce planning and development. The aim of this paper is to critically analyse district nursing workforce planning and development methods, in an attempt to find a suitable method for Northern Ireland. A systematic analysis of the literature reveals four methods: professional judgement; population-based health needs; caseload analysis and dependency-acuity. Each method has strengths and weaknesses. Professional judgement offers a 'belt and braces' approach but lacks sensitivity to fluctuating patient numbers. Population-based health needs methods develop staffing algorithms that reflect deprivation and geographical spread, but are poorly understood by district nurses. Caseload analysis promotes equitable workloads but poorly performing district nursing localities may continue if benchmarking processes only consider local data. Dependency-acuity methods provide a means of equalizing and prioritizing workload but are prone to district nurses overstating factors in patient dependency or understating carers' capability. In summary a mixed method approach is advocated to evaluate and adjust the size and mix of district nursing teams using empirically determined patient dependency and activity-based variables based on the population's health needs.

  2. Effects of dementia-care mapping on residents and staff of care homes: a pragmatic cluster-randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Geertje van de Ven

    Full Text Available BACKGROUND: The effectiveness of dementia-care mapping (DCM for institutionalised people with dementia has been demonstrated in an explanatory cluster-randomised controlled trial (cRCT with two DCM researchers carrying out the DCM intervention. In order to be able to inform daily practice, we studied DCM effectiveness in a pragmatic cRCT involving a wide range of care homes with trained nursing staff carrying out the intervention. METHODS: Dementia special care units were randomly assigned to DCM or usual care. Nurses from the intervention care homes received DCM training and conducted the 4-months DCM-intervention twice during the study. The primary outcome was agitation, measured with the Cohen-Mansfield agitation inventory (CMAI. The secondary outcomes included residents' neuropsychiatric symptoms (NPSs and quality of life, and staff stress and job satisfaction. The nursing staff made all measurements at baseline and two follow-ups at 4-month intervals. We used linear mixed-effect models to test treatment and time effects. RESULTS: 34 units from 11 care homes, including 434 residents and 382 nursing staff members, were randomly assigned. Ten nurses from the intervention units completed the basic and advanced DCM training. Intention-to-treat analysis showed no statistically significant effect on the CMAI (mean difference between groups 2·4, 95% CI -2·7 to 7·6; p = 0·34. More NPSs were reported in the intervention group than in usual care (p = 0·02. Intervention staff reported fewer negative and more positive emotional reactions during work (p = 0·02. There were no other significant effects. CONCLUSIONS: Our pragmatic findings did not confirm the effect on the primary outcome of agitation in the explanatory study. Perhaps the variability of the extent of implementation of DCM may explain the lack of effect. TRIAL REGISTRATION: Dutch Trials Registry NTR2314.

  3. Strategies for enhancing perioperative safety: promoting joy and meaning in the workforce. (United States)

    Morath, Julianne; Filipp, Rhonda; Cull, Michael


    Workforce safety is a precondition of patient safety, and safety from both physical and psychological harm in the workplace is the foundation for an environment in which joy and meaning can exist. Achieving joy and meaning in the workplace allows health care workers to continuously improve the care they provide. This requires an environment in which disrespectful and harmful behaviors are not tolerated or ignored. Health care leaders have an obligation to create workplace cultures that are characterized by respect, transparency, accountability, learning, and quality care. Evidence suggests, however, that health care settings are rife with disrespectful behavior, poor teamwork, and unsafe working conditions. Solutions for addressing workplace safety problems include defining core values, tasking leaders to act as role models, and committing to becoming a high-reliability organization.

  4. The effect of multidisciplinary team care on cancer management. (United States)

    Abdulrahman, Ganiy Opeyemi


    Over the past 15 years, the multidisciplinary team management of many medical conditions especially cancers has increasingly taken a prominent role in patient management in many hospitals and medical centres in the developed countries. In the United Kingdom, it began to gain prominence following the Calman-Heine report in 1995 which suggested that each Cancer Unit in a hospital should have in place arrangements for non-surgical oncological input into services, with a role for a non-surgical oncologist. The report further suggested that a lead clinician with a well established interest in cancer care should be appointed to organise and coordinate the whole range of cancer services provided within the Cancer Unit. Many people have argued that the multidisciplinary team management of patients has resulted in better care and improved survival. However, there are barriers to the optimal effectiveness of the multidisciplinary team. This paper aims to review various studies on the effectiveness of the multidisciplinary team in the management of cancer patients and also discuss some of the barriers to the multidisciplinary team.

  5. Review of the Effectiveness of the Nutrition Care Process. (United States)

    Ichimasa, Akiko


    This author (A.I.) has witnessed the introduction of the Nutrition Care Process (NCP) and its subsequent adjustment over 10 y of her career in an acute and critical setting. A.I. observed that the NCP went through several revisions to better suit the actual clinical practices and the NCP was gradually incorporated into everyday work and accepted in a clinical setting. The NCP helped ensure that all practicing registered dietitians (RDs, RDNs) have up-to-date skill sets. The NCP is a systematic problem-solving tool with four distinct and interrelated steps that help RDs to improve critical thinking and address practice-related problems so that RDs can more effectively intervene and evaluate. In summary, RDs using the NCP are producing consistent and easy-to-read documentation of clinical practices that benefit other healthcare members. The intention to provide diagnosis-oriented assessment and to treat nutrition problems with intervention plans opens up opportunities for communication within healthcare teams and clients. The best practice requires interactive and ongoing communication with healthcare teams and clients. The NCP has resulted in improved productivity as the RDs are writing diagnosis- focused documentation with specific plans for intervention. In addition, analysis of common problems and nutrition diagnoses resolution rates appear to be in process in some facilities and may further promote RD roles in practice settings. In conclusion, the NCP is an effective tool to provide improved nutrition care.

  6. Workforce Transition Modeling Environment user`s guide

    Energy Technology Data Exchange (ETDEWEB)

    Stahlman, E.J.; Oens, M.A.; Lewis, R.E.


    The Pacific Northwest Laboratory (PNL) was tasked by the US Department of Energy Albuquerque Field Office (DOE-AL) to develop a workforce assessment and transition planning tool to support integrated decision making at a single DOE installation. The planning tool permits coordinated, integrated workforce planning to manage growth, decline, or transition within a DOE installation. The tool enhances the links and provides commonality between strategic, programmatic, and operations planners and human resources. Successful development and subsequent complex-wide implementation of the model also will facilitate planning at the national level by enforcing a consistent format on data that are now collected by installations in corporate-specific formats that are not amenable to national-level analyses. The workforce assessment and transition planning tool, the Workforce Transition Modeling Environment (WFTME), consists of two components: the Workforce Transition Model and the Workforce Budget Constraint Model. The Workforce Transition Model, the preponderant of the two, assists decision makers identify and evaluate alternatives for transitioning the current workforce to meet the skills required to support projected workforce requirements. The Workforce Budget Constraint Model helps estimate the number of personnel that will be affected by a given workforce budget increase or decrease and assists in identifying how the corresponding hirings or layoffs should be distributed across the Common Occupation Classification System (COCS) occupations. This user`s guide describes the use and operation of the WFTME. This includes the functions of modifying data and running models, interpreting output reports, and an approach for using the WFTME to evaluate various workforce transition scenarios.

  7. 20 CFR 702.422 - Effect of failure to report on medical care after initial authorization. (United States)


    ... obtained in accordance with these regulations, a finding by the Director that a medical care provider has... authorization of such medical care provider. The effect of a final finding to this effect operates to release... award for the reasonable value of such medical care. Debarment of Physicians and Other Providers...

  8. Direct Care Workers in the National Drug Abuse Treatment Clinical Trials Network: Characteristics, Opinions, and Beliefs (United States)

    McCarty, Dennis; Fuller, Bret E.; Arfken, Cynthia; Miller, Michael; Nunes, Edward V.; Edmundson, Eldon; Copersino, Marc; Floyd, Anthony; Forman, Robert; Laws, Reesa; Magruder, Kathy M.; Oyama, Mark; Sindelar, Jody; Wendt, William W.


    Objective Individuals with direct care responsibilities in 348 drug abuse treatment units were surveyed to obtain a description of the workforce and to assess support for evidence-based therapies. Methods Surveys were distributed to 112 programs participating in the National Drug Abuse Treatment Clinical Trials Network (CTN). Descriptive analyses characterized the workforce. Analyses of covariance tested the effects of job category (counselors, medical staff, manager-supervisors, and support staff) on opinions about evidence-based practices and controlled for the effects of education, modality (outpatient or residential), race, and gender. Results Women made up two-thirds of the CTN workforce. One-third of the workforce had a master’s or doctoral degree. Responses from 1,757 counselors, 908 support staff, 522 managers-supervisors, and 511 medical staff (71% of eligible participants) suggested that the variables that most consistently influenced responses were job category (19 of 22 items) and education (20 of 22 items). Managers-supervisors were the most supportive of evidence-based therapies, and support staff were the least supportive. Generally, individuals with graduate degrees had more positive opinions about evidence-based therapies. Support for using medications and contingency management was modest across job categories. Conclusions The relatively traditional beliefs of support staff could inhibit the introduction of evidence-based practices. Programs initiating changes in therapeutic approaches may benefit from including all employees in change efforts. PMID:17287373

  9. Palliative care in low- and medium-resource countries. (United States)

    Basu, Arnab; Mittag-Leffler, Barbro Norrström; Miller, Kenneth


    Low- and medium-resource countries are facing a significant increase in the incidence of noncommunicable diseases such as cancer. Unfortunately, the majority of patients with cancer present with advanced disease, and disease-directed treatment may be unlikely to be effective and/or not available. Globally, there will be a growing need for palliative care services. There has been significant progress in the provision and integration of palliative care into the health care policy and systems. Nonetheless, palliative care services vary significantly between regions of the world and also between countries in the same region. Some common barriers to care include the lack of a trained workforce to provide palliative care, lack of availability of opioids or the restriction of their use, cultural attitudes of physicians and patients, and also funding. Despite these challenges, there are examples of low- and medium-resource countries that are providing excellent palliative care that is being integrated into the health care system and the cancer care continuum. This article provides an overview of the progress in providing palliative care in low- and medium-resource countries. In addition, more specific information is provided on palliative care in low-resource countries in Latin America, Asia, and Africa. Finally, a more personal perspective is presented on the development of palliative care in Ethiopia, as an example.

  10. Workload and workforce planning: taking a national approach. (United States)

    Lockhart, Karen; Barkby, Irene; Kellagher, Mairi


    In response to an Audit Scotland report, the Scottish Executive, now the Scottish Government, set up the national Nursing and Midwifery Workload and Workforce Planning (NMWWP) programme to define workload and workforce needs, and to analyse the use of bank and agency staff. After extensive research, a systematic, national approach to nursing and midwifery workload and workforce planning was recommended. This article, the first in a series of five on this topic, describes the legislation and policies that underpin the NMWWP programme, and highlights the demographic issues that are pertinent to the nursing and midwifery workforce in Scotland.

  11. Towards best practice in national health workforce planning. (United States)

    McCarty, Maureen V; Fenech, Bethany J


    Health Workforce Australia (HWA) was established by the Council of Australian Governments through its 2008 National Partnership Agreement on Hospital and Health Workforce Reform, as the national agency to progress health workforce reform and address the challenges of providing a skilled, innovative and flexible health workforce in Australia. The Australian Health Ministers' Conference commissioned HWA to undertake a workforce planning exercise for doctors, nurses and midwives over a planning horizon to 2025. Health Workforce 2025 (HW 2025) was conducted in two phases: developing projections for the size and type of the health workforce (doctors, nurses and midwives) needed to meet future service requirements from 2012 to 2025; and modelling the training pipeline necessary to meet the size and type of this health workforce. HWA has used a number of key principles in developing HW 2025 to ensure the projections are robust and able to be applied nationally. HW 2025 is not a one-off project. Projections will be updated as new data become available, and methodology and assumptions underpinning the projections will be periodically reviewed. To also ensure the continued improvement of national health workforce planning, HWA is pursuing other areas for improvement, including better national data collections and improved estimation methodology for demand. Results of HW 2025 were presented to the Australian Health Ministers (through the Standing Council on Health) in April 2012.

  12. Policy challenges for the pediatric rheumatology workforce: Part III. the international situation

    Directory of Open Access Journals (Sweden)

    Henrickson Michael


    Full Text Available Abstract Survival dominates current pediatric global health priorities. Diseases of poverty largely contribute to overall mortality in children under 5 years of age. Infectious diseases and injuries account for 75% of cause-specific mortality among children ages 5-14 years. Twenty percent of the world's population lives in extreme poverty (income below US $1.25/day. Within this population, essential services and basic needs are not met, including clean water, sanitation, adequate nutrition, shelter, access to health care, medicines and education. In this context, musculoskeletal disease comprises 0.1% of all-cause mortality in children ages 5-14 years. Worldwide morbidity from musculoskeletal disease remains generally unknown in the pediatric age group. This epidemiologic data is not routinely surveyed by international agencies, including the World Health Organization. The prevalence of pediatric rheumatic diseases based on data from developed nations is in the range of 2,500 - 3,000 cases per million children. Developing countries' needs for musculoskeletal morbidity are undergoing an epidemiologic shift to chronic conditions, as leading causes of pediatric mortality are slowly quelled. A global crisis of health care providers and human resources stems from insufficient workforce production, inability to retain workers in areas of greatest need, distribution disparity and poor management of both health care systems and health workforce. Internationally, the pediatric rheumatology workforce will also be in very short supply for the foreseeable future relative to projected demand. Physician extenders are an essential resource to meet this demand in underserved regions. They can be trained in common aspects of musculoskeletal medicine and rheumatic conditions. Innovative strategies have been introduced in the United Kingdom to address musculoskeletal medicine educational deficiencies. Telemedicine offers an important capacity to improve access to

  13. Policy challenges for the pediatric rheumatology workforce: Part III. the international situation. (United States)

    Henrickson, Michael


    Survival dominates current pediatric global health priorities. Diseases of poverty largely contribute to overall mortality in children under 5 years of age. Infectious diseases and injuries account for 75% of cause-specific mortality among children ages 5-14 years. Twenty percent of the world's population lives in extreme poverty (income below US $1.25/day). Within this population, essential services and basic needs are not met, including clean water, sanitation, adequate nutrition, shelter, access to health care, medicines and education. In this context, musculoskeletal disease comprises 0.1% of all-cause mortality in children ages 5-14 years. Worldwide morbidity from musculoskeletal disease remains generally unknown in the pediatric age group. This epidemiologic data is not routinely surveyed by international agencies, including the World Health Organization. The prevalence of pediatric rheumatic diseases based on data from developed nations is in the range of 2,500 - 3,000 cases per million children. Developing countries' needs for musculoskeletal morbidity are undergoing an epidemiologic shift to chronic conditions, as leading causes of pediatric mortality are slowly quelled.A global crisis of health care providers and human resources stems from insufficient workforce production, inability to retain workers in areas of greatest need, distribution disparity and poor management of both health care systems and health workforce. Internationally, the pediatric rheumatology workforce will also be in very short supply for the foreseeable future relative to projected demand. Physician extenders are an essential resource to meet this demand in underserved regions. They can be trained in common aspects of musculoskeletal medicine and rheumatic conditions. Innovative strategies have been introduced in the United Kingdom to address musculoskeletal medicine educational deficiencies. Telemedicine offers an important capacity to improve access to care despite distance

  14. Putting the 'care' back into aged care. (United States)

    Beadnell, Cathy


    Aged care is well and truly back on the political agenda in Australia. While the mainstream media has recently exposed a number of horrific cases of alleged abuse in aged care facilities it has done little to highlight the failings of social policy over time or to foster debate on how to improve the care of older Australians. What are the barriers to providing safe and quality aged care to a growing number of our citizens and how do we overcome them? If you relied on the recent media coverage for your impression of aged care you could be forgiven for thinking it is all bad news. But there are facilities providing high quality care and stories of nurses working wonders in the face of adversity. Cathy Beadnell considers some of the broader cultural and workforce issues in aged care.

  15. Effect of opioid prescribing guidelines in primary care. (United States)

    Chen, Jonathan H; Hom, Jason; Richman, Ilana; Asch, Steven M; Podchiyska, Tanya; Johansen, Nawal Atwan


    Long-term opioid use for noncancer pain is increasingly prevalent yet controversial given the risks of addiction, diversion, and overdose. Prior literature has identified the problem and proposed management guidelines, but limited evidence exists on the actual effectiveness of implementing such guidelines in a primary care setting.A multidisciplinary working group of institutional experts assembled comprehensive guidelines for chronic opioid prescribing, including monitoring and referral recommendations. The guidelines were disseminated in September 2013 to our medical center's primary care clinics via in person and electronic education.We extracted electronic medical records for patients with noncancer pain receiving opioid prescriptions (Rxs) in seasonally matched preintervention (11/1/2012-6/1/2013) and postintervention (11/1/2013-6/1/2014) periods. For patients receiving chronic (3 or more) opioid Rxs, we assessed the rates of drug screening, specialty referrals, clinic visits, emergency room visits, and quantity of opioids prescribed.After disseminating guidelines, the percentage of noncancer clinic patients receiving any opioid Rxs dropped from 3.9% to 3.4% (P = 0.02). The percentage of noncancer patients receiving chronic opioid Rxs decreased from 2.0% to 1.6% (P = 0.03). The rate of urine drug screening increased from 9.2% to 17.3% (P = 0.005) amongst noncancer chronic opioid patients. No significant differences were detected for other metrics or demographics assessed.An educational intervention for primary care opioid prescribing is feasible and was temporally associated with a modest reduction in overall opioid Rx rates. Provider use of routine drug screening increased, but overall rates of screening and specialty referral remained low despite the intervention. Despite national pressures to introduce opioid prescribing guidelines for chronic pain, doing so alone does not necessarily yield substantial changes in clinical practice.

  16. The nurse specialist as main care-provider for patients with type 2 diabetes in a primary care setting : effects on patient outcomes

    NARCIS (Netherlands)

    Vrijhoef, HJM; Diederiks, JPM; Spreeuwenberg, C; Wolffenbuttel, BHR; van Wilderen, LJGP


    A solution to safeguard high quality diabetes care may be to allocate care to the nurse specialist. By using a one group pretest-posttest design with additional comparisons, this study evaluated effects on patient outcomes of a shared care model with the diabetes nurse as main care-provider for pati

  17. A scoping review of the nurse practitioner workforce in oncology. (United States)

    Coombs, Lorinda A; Hunt, Lauren; Cataldo, Janine


    The quality of cancer care may be compromised in the near future because of work force issues. Several factors will impact the oncology health provider work force: an aging population, an increase in the number of cancer survivors, and expansion of health care coverage for the previously uninsured. Between October 2014 and March 2015, an electronic literature search of English language articles was conducted using PubMed(®) , the Cumulative Index to Nursing and Allied Health Sciences (CINAHL(®) ), Web of Science, Journal Storage (JSTOR(®) ), Google Scholar, and SCOPUS(®) . Using the scoping review criteria, the research question was identified "How much care in oncology is provided by nurse practitioners (NPs)?" Key search terms were kept broad and included: "NP" AND "oncology" AND "workforce". The literature was searched between 2005 and 2015, using the inclusion and exclusion criteria, 29 studies were identified, further review resulted in 10 relevant studies that met all criteria. Results demonstrated that NPs are utilized in both inpatient and outpatient settings, across all malignancy types and in a variety of roles. Academic institutions were strongly represented in all relevant studies, a finding that may reflect the Accreditation Council for Graduate Medical Education (ACGME) duty work hour limitations. There was no pattern associated with state scope of practice and NP representation in this scoping review. Many of the studies reviewed relied on subjective information, or represented a very small number of NPs. There is an obvious need for an objective analysis of the amount of care provided by oncology NPs.

  18. Effects of a spiritual care training for nurses

    NARCIS (Netherlands)

    Vlasblom, J.P.; Steen, van der J.T.; Knol, D.L.; Jochemsen, H.


    Despite the fact that spiritual care is an essential part of nursing care according to many nursing definitions, it appears to be quite different in practice. A spirituality training for nurses may be necessary to give spiritual care the attention it deserves. In a trial a pre-tested “spirituality a

  19. [Influenza vaccination in health-care workers: an effective method to reduce the consequences of influenza in health care users]. (United States)

    de Jong, J C


    Only few usable studies into the effect of influenza vaccination of health-care workers on sick leave and influenza among their patients are available in the literature. However, together these studies provide consistent evidence that this vaccination is effective and cost effective, reducing the death rate from all causes of residents of nursing homes for the elderly by 27-44%. Therefore, measures to raise the vaccination rate among health-care workers, which is at present under 25%, are highly recommended. However, more studies in this field are needed.

  20. Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain

    DEFF Research Database (Denmark)

    Blanchette, Marc-André; Stochkendahl, Mette Jensen; Borges Da Silva, Roxane;


    evidence regarding the effectiveness and economic evaluation of care offered by these provider groups. PURPOSE: To estimate the clinical effectiveness and to systematically review the literature of full economic evaluation of chiropractic care compared to other commonly used care approaches among adult...... patients with non-specific LBP. STUDY DESIGN: Systematic reviews of interventions and economic evaluations. METHODS: A comprehensive search strategy was conducted to identify 1) pragmatic randomized controlled trials (RCTs) and/or 2) full economic evaluations of chiropractic care for low back pain compared...... were scientifically admissible. Five RCTs with low risk of bias compared chiropractic care to exercise therapy (n = 1), physical therapy (n = 3) and medical care (n = 1). Overall, we found similar effects for chiropractic care and the other types of care and no reports of serious adverse events. Three...

  1. Health workforce development in the European Union: A matrix for comparing trajectories of change in the professions. (United States)

    Pavolini, Emmanuele; Kuhlmann, Ellen


    This article assesses professional development trajectories in top-, middle- and basic-level health workforce groups (doctors, nurses, care assistants) in different European Union countries using available international databases. Three theoretical strands (labour market, welfare state, and professions studies) were connected to explore ideal types and to develop a matrix for comparison. With a focus on larger EU-15 countries and four different types of healthcare systems, Germany, Italy, Sweden and the United Kingdom serve as empirical test cases. The analysis draws on selected indicators from public statistics/OECD data and micro-data from the EU Labour Force Survey. Five ideal typical trajectories of professional development were identified from the literature, which served as a matrix to compare developments in the three health workforce groups. The results reveal country-specific trajectories with uneven professional development and bring opportunities for policy interventions into view. First, there is a need for integrated health labour market monitoring systems to improve data on the skills mix of the health workforce. Second, a relevant number of health workers with fixed contracts and involuntary part-time reveals an important source for better recruitment and retention strategies. Third, a general trend towards increasing numbers while worsening working conditions was identified across our country cases. This trend hits care assistants, partly also nurses, the most. The research illustrates how public data sources may serve to create new knowledge and promote more sustainable health workforce policy.

  2. Instruction via Web-Based Modules in Early Childhood Personnel Preparation: A Mixed-Methods Study of Effectiveness and Learner Perspectives (United States)

    Hollingsworth, Heidi L.; Lim, Chih-Ing


    Effective personnel preparation is critical to the development of a high quality early childhood workforce that provides optimal care and education for young children. This mixed-methods study examined the effectiveness of, and learner perspectives on, instruction via web-based modules within face-to-face early childhood personnel preparation…

  3. Training competent and effective Primary Health Care Workers to fill a void in the outer islands health service delivery of the Marshall Islands of Micronesia

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    Keni Bhalachandra H


    Full Text Available Abstract Background Human resources for health are non-existent in many parts of the world and the outer islands of Marshall Islands in Micronesia are prime examples. While the more populated islands with hospital facilities are often successful in recruiting qualified health professionals from overseas, the outer islands generally have very limited health resources, and are thus less successful. In an attempt to provide reasonable health services to these islands, indigenous people were trained as Health Assistants (HA to service their local communities. In an effort to remedy the effectiveness of health care delivery to these islands, a program to train mid-level health care workers (Hospital Assistants was developed and implemented by the Ministry of Health in conjunction with the hospital in Majuro, the capital city of the Marshall Islands. Methods A physician instructor with experience and expertise in primary health care in these regions conducted the program. The curriculum included training in basic health science, essentials of endemic disorders and their clinical management appropriate to the outer islands. Emphasis was given to prevention and health promotion as well as to the curative aspects. For clinical observation, the candidates were assigned to clinical departments of the Majuro hospital for 1 year during their training, as assistants to the nursing staff. This paper discusses the details of the training, the modalities used to groom the candidates, and an assessment of the ultimate effectiveness of the program. Results Out of 16 boys who began training, 14 candidates were successful in completing the program. In 1998 a similar program was conducted exclusively for women under the auspices of Asian Development Bank funding, hence women were not part of this program. Conclusion For developing countries of the Pacific, appropriately trained human resources are an essential component of economic progress, and the health workforce

  4. The problems related to confidentiality and effectiveness of health care. (United States)

    Scherrer, J R


    The problem of the impact of confidentiality on health effectiveness is discussed along five points: (1) Communication facilities between health departments are main features of health information systems. (2) Efforts, costs, limits of data protection. The privacy violation risks have to be related to the data protection costs. (3) Paradox of the fundamental rights to confidentiality regarding privacy of the individual and the preponderant interest of the State. (4) Facing the increasing health costs, the need for medical and hospital control systems is assessed. (5) New benefits in medicine and in the quality of care are partly the results of more or less extensive studies in epidemiology at national levels. The general conclusion is concerned with the risks that the computer could become an instrumental substitute for human reason with the progressive drop out of responsibility of health officers.

  5. Evidence-based practice profiles of physiotherapists transitioning into the workforce: a study of two cohorts

    Directory of Open Access Journals (Sweden)

    McEvoy Maureen P


    Full Text Available Abstract Background Training in the five steps of evidence-based practice (EBP has been recommended for inclusion in entry-level health professional training. The effectiveness of EBP education has been explored predominantly in the medical and nursing professions and more commonly in post-graduate than entry-level students. Few studies have investigated longitudinal changes in EBP attitudes and behaviours. This study aimed to assess the changes in EBP knowledge, attitudes and behaviours in entry-level physiotherapy students transitioning into the workforce. Methods A prospective, observational, longitudinal design was used, with two cohorts. From 2008, 29 participants were tested in their final year in a physiotherapy program, and after the first and second workforce years. From 2009, 76 participants were tested in their final entry-level and first workforce years. Participants completed an Evidence-Based Practice Profile questionnaire (EBP2, which includes self-report EBP domains [Relevance, Terminology (knowledge of EBP concepts, Confidence, Practice (EBP implementation, Sympathy (disposition towards EBP]. Mixed model analysis with sequential Bonferroni adjustment was used to analyse the matched data. Effect sizes (ES (95% CI were calculated for all changes. Results Effect sizes of the changes in EBP domains were small (ES range 0.02 to 0.42. While most changes were not significant there was a consistent pattern of decline in scores for Relevance in the first workforce year (ES -0.42 to -0.29 followed by an improvement in the second year (ES +0.27. Scores in Terminology improved (ES +0.19 to +0.26 in each of the first two workforce years, while Practice scores declined (ES -0.23 to -0.19 in the first year and improved minimally in the second year (ES +0.04. Confidence scores improved during the second workforce year (ES +0.27. Scores for Sympathy showed little change. Conclusions During the first two years in the workforce, there was a

  6. Priority Setting, Cost-Effectiveness, and the Affordable Care Act. (United States)

    Persad, Govind


    The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA's provisions concerning priority setting and their developing interpretations, this Article attempts to defend three substantive propositions. First, I argue that the ACA is neither uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality. Second, I argue that the ACA does not take a single, unified approach to priority setting; rather, its guidance varies depending on the aspect of the healthcare system at issue (Patient Centered Outcomes Research Institute, Medicare, essential health benefits) and the factors being excluded from priority setting (age, disability, life expectancy). Third, I argue that cost-effectiveness can be achieved within the ACA's constraints, but that doing so will require adopting new approaches to cost-effectiveness and priority setting. By limiting the use of standard cost-effectiveness analysis, the ACA makes the need for workable rivals to cost-effectiveness analysis a pressing practical concern rather than a mere theoretical worry.

  7. Tracking the Health of the Geoscience Workforce (United States)

    Gonzales, L. M.; Keane, C. M.; Martinez, C. M.


    Increased demands for resources and environmental activities, relative declines in college students entering technical fields, and expectations of growth commensurate with society as a whole challenge the competitiveness of the U.S. geoscience workforce. Because of prior business cycles, more than 50% of the workforce needed in natural resource industries in 10 years is currently not in the workforce. This issue is even more acute in government at all levels and in academic institutions. Here, we present a snapshot of the current status of the geoscience profession that spans geoscientists in training to geoscience professionals in government, industry, and academia to understand the disparity between the supply of and demand for geoscientists. Since 1996, only 1% of high school SAT test takers plan to major in geosciences at college. Although the total number of geoscience degrees granted at community colleges have increased by 9% since 1996 , the number of geoscience undergraduate degrees has decreased by 7%. The number of geoscience master's and doctoral degrees have increased 4% and 14% respectively in the same time period. However, by 2005, 68 geoscience departments were consolidated or closed in U.S. universities. Students who graduate with geoscience degrees command competitive salaries. Recent bachelors geoscience graduates earned an average salary of 31,366, whereas recent master's recipients earned an average of 81,300. New geosciences doctorates commanded an average salary of 72,600. Also, fFederal funding for geoscience research has increase steadily from 485 million in 1970 to $3.5 billion in 2005. Economic indicators suggest continued growth in geoscience commodity output and in market capitalization of geoscience industries. Additionally, the Bureau of Labor Statistics projects a 19% increase in the number of geoscience jobs from 2006 to 2016. Despite the increased demand for geoscientists and increase in federal funding of geoscience research

  8. Effectiveness of interventions to provide culturally appropriate maternity care in increasing uptake of skilled maternity care: a systematic review (United States)

    Coast, Ernestina; Jones, Eleri; Lattof, Samantha R; Portela, Anayda


    Addressing cultural factors that affect uptake of skilled maternity care is recognized as an important step in improving maternal and newborn health. This article describes a systematic review to examine the evidence available on the effects of interventions to provide culturally appropriate maternity care on the use of skilled maternity care during pregnancy, for birth or in the postpartum period. Items published in English, French and/or Spanish between 1 January 1990 and 31 March 2014 were considered. Fifteen studies describing a range of interventions met the inclusion criteria. Data were extracted on population and intervention characteristics; study design; definitions and data for relevant outcomes; and the contexts and conditions in which interventions occurred. Because most of the included studies focus on antenatal care outcomes, evidence of impact is particularly limited for care seeking for birth and after birth. Evidence in this review is clustered within a small number of countries, and evidence from low- and middle-income countries is notably lacking. Interventions largely had positive effects on uptake of skilled maternity care. Cultural factors are often not the sole factor affecting populations’ use of maternity care services. Broader social, economic, geographical and political factors interacted with cultural factors to affect targeted populations’ access to services in included studies. Programmes and policies should seek to establish an enabling environment and support respectful dialogue with communities to improve use of skilled maternity care. Whilst issues of culture are being recognized by programmes and researchers as being important, interventions that explicitly incorporate issues of culture are rarely evaluated. PMID:27190222

  9. Enabling the NSW health workforce to provide evidence-based smoking-cessation advice through competency-based training delivered via video conferencing. (United States)

    Mitchell, Elayne N; Hawkshaw, Barbara N; Naylor, Carlie-Jane; Soewido, Dias; Sanders, John M


    Tobacco-related disease is estimated to cost the NSW health system more than $476 million in direct health care costs annually. Population-based smoking-cessation interventions, including brief intervention by health professionals, are effective and cost effective. As the prevalence of smoking in the general community declines, more highly dependent 'treatment-resistant' smokers may present a challenge to the health system. International guidelines recommend that health systems invest in training for health professionals in best practice smoking cessation. As part of the NSW Tobacco Action Plan 2005-2009, NSW Department of Health developed national competency standards in smoking cessation, designed learning and assessment materials and delivered training to more than 300 health professionals via video conference. Building the capacity of the NSW Health workforce to address smoking cessation as part of their routine practice is essential for addressing future challenges in tobacco control.

  10. The Effect of Spiritual Care on Stress Levels of Mothers in NICU. (United States)

    Küçük Alemdar, Dilek; Kardaş Özdemir, Funda; Güdücü Tüfekci, Fatma


    Hospitalization of an infant is a difficult situation for the family, and parents require support from the health care team during this difficult time. The aim of this study was to investigate the effect of spiritual care on levels of stress in mothers with infants in a neonatal intensive care unit. This spiritual care study was performed by comparing control and spiritual care pre- and posttest groups. The study population included 62 mothers. The Mother-Baby Introductory Information Form and the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) were used for data collection. Prior to spiritual care, no significant difference was found between the mothers' PSS:NICU scores, whereas following spiritual care, there was a significant difference between PSS:NICU scores of the mothers, in favor of the spiritual care group ( p spiritual needs of mothers and must identify and meet these needs.

  11. Policy challenges for the pediatric rheumatology workforce: Part I. Education and economics

    Directory of Open Access Journals (Sweden)

    Henrickson Michael


    Full Text Available Abstract For children with rheumatic conditions, the available pediatric rheumatology workforce mitigates their access to care. While the subspecialty experiences steady growth, a critical workforce shortage constrains access. This three-part review proposes both national and international interim policy solutions for the multiple causes of the existing unacceptable shortfall. Part I explores the impact of current educational deficits and economic obstacles which constrain appropriate access to care. Proposed policy solutions follow each identified barrier. Challenges consequent to obsolete, limited or unavailable exposure to pediatric rheumatology include: absent or inadequate recognition or awareness of rheumatic disease; referral patterns that commonly foster delays in timely diagnosis; and primary care providers' inappropriate or outdated perception of outcomes. Varying models of pediatric rheumatology care delivery consequent to market competition, inadequate reimbursement and uneven institutional support serve as additional barriers to care. A large proportion of pediatrics residency programs offer pediatric rheumatology rotations. However, a minority of pediatrics residents participate. The current generalist pediatrician workforce has relatively poor musculoskeletal physical examination skills, lacking basic competency in musculoskeletal medicine. To compensate, many primary care providers rely on blood tests, generating referrals that divert scarce resources away from patients who merit accelerated access to care for rheumatic disease. Pediatric rheumatology exposure could be enhanced during residency by providing a mandatory musculoskeletal medicine rotation that includes related musculoskeletal subspecialties. An important step is the progressive improvement of many providers' fixed referral and laboratory testing patterns in lieu of sound physical examination skills. Changing demographics and persistent reimbursement disparities will

  12. The workforce for health in a globalized context--global shortages and international migration. (United States)

    Aluttis, Christoph; Bishaw, Tewabech; Frank, Martina W


    The 'crisis in human resources' in the health sector has been described as one of the most pressing global health issues of our time. The World Health Organization (WHO) estimates that the world faces a global shortage of almost 4.3 million doctors, midwives, nurses, and other healthcare professionals. A global undersupply of these threatens the quality and sustainability of health systems worldwide. This undersupply is concurrent with globalization and the resulting liberalization of markets, which allow health workers to offer their services in countries other than those of their origin. The opportunities of health workers to seek employment abroad has led to a complex migration pattern, characterized by a flow of health professionals from low- to high-income countries. This global migration pattern has sparked a broad international debate about the consequences for health systems worldwide, including questions about sustainability, justice, and global social accountabilities. This article provides a review of this phenomenon and gives an overview of the current scope of health workforce migration patterns. It further focuses on the scientific discourse regarding health workforce migration and its effects on both high- and low-income countries in an interdependent world. The article also reviews the internal and external factors that fuel health worker migration and illustrates how health workforce migration is a classic global health issue of our time. Accordingly, it elaborates on the international community's approach to solving the workforce crisis, focusing in particular on the WHO Code of Practice, established in 2010.

  13. Effectiveness of a Care Coordination Model for Stroke Survivors: A Randomized Study (United States)

    Claiborne, Nancy


    This study evaluated the effectiveness of systematically integrating biopsychosocial interventions with coordinated delivery of care for outpatients recovering from stroke. Care coordination coordinates resources across the health care system and routinely addresses the psychological and social risks affecting patient outcomes, while monitoring…

  14. Experts Foresee a Major Shift From Inpatient to Ambulatory Care


    Beans, Bruce E.


    An American Society of Health-System Pharmacists Research and Education Foundation report predicts trends in health care delivery and financing, drug development and therapeutics, pharmaceutical marketplace, pharmacy workforce, and more.

  15. Teacher Workforce Data and Planning Processes in Australia (United States)

    Owen, Susanne; Kos, Julie; McKenzie, Phillip


    Workforce planning is essential to ensure sufficient numbers of well-qualified teachers and leaders to meet the emerging needs of schools in the 21st century. Given the current ageing workforce profile in Australia, there are concerns about teacher shortage, especially in some specialist subject areas, in rural and remote locations and in…

  16. The public health workforce: An assessment in the Netherlands

    NARCIS (Netherlands)

    Jambroes, M.


    The public health workforce is a key resource of population health. How many people work in public health in the Netherlands, what are their characteristics and who does what? Remarkably, such information about the size and composition of the public health workforce in the Netherlands is lacking. A

  17. Using Workforce Information for Degree Program Planning in Texas (United States)

    Goldman, Charles A.; Butterfield, Lindsay; Lavery, Diana; Miller, Trey; Daugherty, Lindsay; Beleche, Trinidad; Han, Bing


    In May 2013, the Texas Legislature passed House Bill 1296, requiring a report on Texas's future workforce needs that would help inform decisions to develop or expand postsecondary education programs. Educators and policymakers in Texas and elsewhere have a wide variety of quantitative and qualitative workforce information available for planning…

  18. Workforce cultural factors in TQM/CQI implementation in hospitals. (United States)

    Huq, Z; Martin, T N


    One of the major obstacles to successful implementation of TQM/CQI in hospitals has been management's failure to consider the workforce cultural situation. This quasi-qualitative study investigates eight workforce cultural factors in seven midwestern hospitals. Results reveal only one of the seven hospitals successfully implementing TQM/CQI.

  19. Skilling a Seasonal Workforce: A Way Forward for Rural Regions (United States)

    Kilpatrick, Sue; Bound, Helen


    Seasonal work is crucial for the many rural regions reliant on seasonal industries such as agriculture, forestry, aquaculture and tourism. This report examines the diverse nature of the seasonal workforce in two locations and the approaches used in their training. The report finds that the seasonal workforce is diverse and has varied training…

  20. The Expanding Federal Role in Teacher Workforce Policy (United States)

    Superfine, Benjamin M.; Gottlieb, Jessica J.; Smylie, Mark A.


    This article examines the recent expansion of the federal role into teacher workforce policy, primarily as embodied by the Race to the Top Fund of the American Recovery and Reinvestment Act. Such recent federal teacher workforce policy reflects an important expansion of the federal role into a policy domain that deserves more attention. The…

  1. Operational workforce planning for check-in counters at airports

    DEFF Research Database (Denmark)

    Stolletz, Raik


    This paper addresses operation models for workforce planning for check-in systems at airports. We characterize different tasks of the hierarchical workforce planning problem with time-dependent demand. A binary linear programming formulation is developed for the fortnightly tour scheduling problem...

  2. Information and Communication Technology Workforce Employability in Malaysia (United States)

    Suhaimi, Mohammed Adam; Hasan, Muhammad; Hussin, Husnayati; Shah, Asadullah


    Purpose: The purposes of the study are to understand ICT workforce employability in Malaysia, to identify the causes that influence the growth of skill gaps in the ICT workforce, and to determine ways to reduce these gaps. Design/methodology/approach: The methodology of the study comprised project reports and a literature review. Findings: The…

  3. A Workforce Design Model: Providing Energy to Organizations in Transition (United States)

    Halm, Barry J.


    The purpose of this qualitative study was to examine the change in performance realized by a professional services organization, which resulted in the Life Giving Workforce Design (LGWD) model through a grounded theory research design. This study produced a workforce design model characterized as an organizational blueprint that provides virtuous…

  4. Implementing the Workforce Investment Act of 1998. A White Paper. (United States)

    Employment and Training Administration (DOL), Washington, DC.

    The Workforce Investment Act represents a total customer-driven overhaul of the U.S. job training system that will help employers obtain needed workers and empower job seekers to obtain the training needed for the jobs they want. The Department of Labor will implement the Workforce Investment Act in cooperation with the Department of Education.…

  5. Orthopedic workforce planning in Germany – an analysis of orthopedic accessibility (United States)

    Müller, Peter; Maier, Werner; Groneberg, David A.


    In Germany, orthopedic workforce planning relies on population-to-provider-ratios represented by the ‘official degree of care provision’. However, with geographic information systems (GIS), more sophisticated measurements are available. By utilizing GIS-based technologies we analyzed the current state of demand and supply of the orthopedic workforce in Germany (orthopedic accessibility) with the integrated Floating Catchment Area method. The analysis of n = 153,352,220 distances revealed significant geographical variations on national scale: 5,617,595 people (6.9% of total population) lived in an area with significant low orthopedic accessibility (average z-score = -4.0), whereas 31,748,161 people (39.0% of total population) lived in an area with significant high orthopedic accessibility (average z-score = 8.0). Accessibility was positively correlated with the degree of urbanization (r = 0.49; p<0.001) and the official degree of care provision (r = 0.33; p<0.001) and negatively correlated with regional social deprivation (r = -0.47; p<0.001). Despite advantages of simpler measures regarding implementation and acceptance in health policy, more sophisticated measures of accessibility have the potential to reduce costs as well as improve health care. With this study, significant geographical variations were revealed that show the need to reduce oversupply in less deprived urban areas in order to enable adequate care in more deprived rural areas. PMID:28178335

  6. Bringing them home: a Gippsland mental health workforce recruitment strategy. (United States)

    Sutton, Keith; Maybery, Darryl; Moore, Terry


    This paper reports on preliminary findings of a novel program piloted in 2010 to address rural mental health workforce shortages. The program involved exposing allied health and nursing students from rural backgrounds studying in Melbourne to mental health service employment opportunities in Gippsland. A longitudinal study is underway to evaluate the effect and outcomes of the program and includes surveying participants' interest in rural mental health work through an online questionnaire immediately prior to and following the program; and surveying career decisions at 6 months and yearly intervals. Paired sample t-tests were used to analyse participants' level of interest in rural work (pre-event 4.67 (1.50); post-event 5.93 (0.96); P=0.001), career in a rural setting (pre-event 4.67 (1.63); post-event 5.67 (1.23); P=0.006), mental health work (pre-event 4.73 (1.39); post-event 6.07 (0.80); P<0.000) and rural mental health career (pre-event 4.73 (1.33); post-event 5.80 (1.21); P=0.002). These findings indicate a significant increase from pre- to post-event and are supported by strong effect sizes suggesting that the program had a significant effect on participant interest in rural mental health work. Longer-term evaluation will determine whether the program influences participant career decisions and thereby addressing mental health workforce shortages in Gippsland.

  7. Effects of the Affordable Care Act on Consumer Health Care Spending and Risk of Catastrophic Health Costs. (United States)

    Nowak, Sarah A; Eibner, Christine; Adamson, David M; Saltzman, Evan


    This study examines the likely effects of the Affordable Care Act (ACA) on average annual consumer health care spending and the risk of catastrophic medical costs for the United States overall and in two large states that have decided not to expand their Medicaid programs (Texas and Florida). The ACA will have varied impacts on individuals' and families' spending on health care, depending on income level and on estimated 2016 insurance status without the ACA. The authors find that average out-of-pocket spending is expected to decrease for all groups considered in the analysis, although decreases in out-of-pocket spending will be largest for those who would otherwise be uninsured. People who would otherwise be uninsured who transition to the individual market under the ACA will have higher total health care spending on average after implementation of the ACA because they will now incur the cost of health insurance premiums. The authors also find that risk of catastrophic health care spending will decrease for individuals of all income levels for the insurance transitions considered; decreases will be greatest for those at the lowest income levels. Case studies found that in Texas and Florida, Medicaid expansion would substantially reduce out-of-pocket and total health care spending for those with incomes below 100 percent of the federal poverty level, compared with a scenario in which the ACA is implemented without Medicaid expansion. Expansion would reduce the risk of high medical spending for those covered under Medicaid who would remain uninsured without expansion.

  8. Integrated Workforce Planning Model: A Proof of Concept (United States)

    Guruvadoo, Eranna K.


    Recently, the Workforce and Diversity Management Office at KSC have launched a major initiative to develop and implement a competency/skill approach to Human Resource management. As the competency/skill dictionary is being elaborated, the need for a competency-based workforce-planning model is recognized. A proof of concept for such a model is presented using a multidimensional data model that can provide the data infrastructure necessary to drive intelligent decision support systems for workforce planing. The components of competency-driven workforce planning model are explained. The data model is presented and several schemes that would support the workforce-planning model are presented. Some directions and recommendations for future work are given.

  9. Employee motivation and employee performance in child care : the effects of the introduction of market forces on employees in the Dutch child-care sector

    NARCIS (Netherlands)

    Plantinga, Mirjam


    Employee Motivation and Employee Performance in Child Care: The Effects of the Introduction of Market Focus on Employees in the Dutch Child-Care Sector Mirjam Plantinga (RUG) This research describes and explains the effects of the introduction of market forces in the Dutch child-care sector on emplo

  10. An Aging Workforce: Employment Opportunities and Obstacles

    Directory of Open Access Journals (Sweden)

    Full Professor, Institute of Economic Sciences


    Full Text Available The last decade has witnessed significant changes in the structure of unemployment in the global labour market. This is corroborated by the fact that the global workforce is rapidly aging and the share of people aged 50 and over in the structure of the labour market is increasing. In line with this trend, unemployment issues should be considered as a global problem that cannot be fully resolved at the level of any individual country separately.The main objective of this paper is to throw some light on the aging workforce and the elderly population’s opportunity to realise their right to work and be treated equally with younger age groups. Hence, the paper simultaneously focuses on the age and gender discrimination of elderly population in terms of their employment prospects. The aim of our research is not only to point out certain stereotypes concerning the elderly labour force, but also to stress that unless preconditions for overcoming these stereotypes are created and employment opportunities are given to this segment of the labour force, full employment as an ultimate goal of global economic policy cannot be achieved. It is in accordance with these considerations that we offer a model to achieve this goal.

  11. Geriatric medicine workforce planning: a giant geriatric problem or has the tide turned? (United States)

    Fisher, James M; Garside, Mark; Hunt, Kelly; Lo, Nelson


    The UK's population is ageing and an adequately staffed geriatric medicine workforce is essential for high quality care. We evaluated the current and future geriatric medicine workforce, drawing on data relating to the UK population, current geriatric medicine consultants and trainees, recruitment into the specialty and trainee career progression. Data were derived from various sources, including the British Geriatrics Society Education and Training Committee biannual survey of training posts. The demographic of consultant geriatricians is changing and so too are their job plans, with more opting to work less than full time. The number of applicants to geriatric medicine training is increasing, yet increasing numbers of posts remain unfilled (4.7% in November 2010 and 14.1% in May 2013). The majority of geriatric medicine trainees secure a substantive consultant post within 6 months of obtaining their certificate of completion of training This work highlights challenges for the future: potential barriers to trainee recruitment, unfilled training posts and an ageing population and workforce.

  12. Effectiveness of a stepped care intervention for anxiety and depression in people with diabetes, asthma or COPD in primary care

    DEFF Research Database (Denmark)

    Stoop, C H; Nefs, Giesje; Pommer, A M


    BACKGROUND: Depression and anxiety are common in people with a chronic somatic disease. Although guidelines recommend stepped care, the effectiveness of this approach has not been evaluated in people with diabetes, asthma, or COPD in primary care. METHODS: 3559 People were sent screening question......BACKGROUND: Depression and anxiety are common in people with a chronic somatic disease. Although guidelines recommend stepped care, the effectiveness of this approach has not been evaluated in people with diabetes, asthma, or COPD in primary care. METHODS: 3559 People were sent screening...... had a significantly lower level of anxiety symptoms at the end of the program (GAD-7 6 ± 6 vs. 9 ± 6; Cohen's d = 0.61). This effect was still present six months post intervention. The effect on depression was statistically significant in the first model (PHQ-9 6 ± 4 vs. 9 ± 6; p = 0.......035), but not in the fully adjusted model (p = 0.099), despite a large effect size (d = 0.63). At six months post intervention there was no statistically significant difference in symptoms of depression between the two groups although the difference in symptoms was still clinically significant (Cohen's d = 0...

  13. Effect of crew resource management on diabetes care and patient outcomes in an inner‐city primary care clinic (United States)

    Taylor, Cathy R; Hepworth, Joseph T; Buerhaus, Peter I; Dittus, Robert; Speroff, Theodore


    Background Diabetes care in our inner‐city primary care clinic was suboptimal, despite provider education and performance feedback targeting improved adherence to evidence‐based clinical guidelines. A crew resource management (CRM) intervention (communication and teamwork, process and workflow organisation, and standardised information debriefings) was implemented to improve diabetes care and patient outcomes. Objective To assess the effect of the CRM intervention on adherence to evidence‐based diabetes care standards, work processes, standardised clinical communication and patient outcomes. Methods Time‐series analysis was used to assess the effect on the delivery of standard diabetes services and patient outcomes among medically indigent adults (n = 619). Results The CRM principles were translated into useful process redesign and standardised care approaches. Significant improvements in microalbumin testing and associated patient outcome measures were attributed to the intervention. Conclusions The CRM approach provided tools for management that, in the short term, enabled reorganisation and prevention of service omissions and, in the long term, can produce change in the organisational culture for continuous improvement. PMID:17693668

  14. Effects of Increased Competition on Quality of Primary Care in Sweden

    DEFF Research Database (Denmark)

    Dietrichson, Jens; Ellegård, Lina Maria; Kjellsson, Gustav

    In the last decades, many health systems have implemented policies to make care providers engage in quality competition. But care quality is a multi-dimensional concept, and competition may have different impacts on different dimensions of quality. The empirical evidence on competition and care...... quality is scarce, in particular regarding primary care. This paper adds evidence from recent reforms of Swedish primary care that affected competition in municipal markets differently depending on the pre- reform market structure. Using a difference-in-differences strategy, we demonstrate...... that the reforms led to substantially more entry of private care providers in municipalities where there were many patients per provider before the reforms. The effects on primary care quality in these municipalities are modest: we find small improvements in subjective measures of overall care quality...

  15. Diabetes Care Protocol : effects on patient-important outcomes. A cluster randomized, non-inferiority trial in primary care

    NARCIS (Netherlands)

    Cleveringa, F. G. W.; Minkman, M. H.; Gorter, K. J.; van den Donk, M.; Rutten, G. E. H. M.


    P>Aims The Diabetes Care Protocol (DCP) combines task delegation, intensification of diabetes treatment and feedback. It reduces cardiovascular risk in Type 2 diabetes (T2DM) patients. This study determines the effects of DCP on patient-important outcomes. Methods A cluster randomized, non-inferiori

  16. Effects of Dementia-Care Mapping on Residents and Staff of Care Homes : A Pragmatic Cluster-Randomised Controlled Trial

    NARCIS (Netherlands)

    van de Ven, Geertje; Draskovic, Irena; Adang, Eddy M. M.; Donders, Rogier; Zuidema, Sytse U.; Koopmans, Raymond T. C. M.; Vernooij-Dassen, Myrra J. F. J.


    Background: The effectiveness of dementia-care mapping (DCM) for institutionalised people with dementia has been demonstrated in an explanatory cluster-randomised controlled trial (cRCT) with two DCM researchers carrying out the DCM intervention. In order to be able to inform daily practice, we stud

  17. The effects of selective decontamination in Dutch Intensive Care Units

    NARCIS (Netherlands)

    Oostdijk, E.A.N.


    Infections are an important complication in the treatment of critical ill patients in Intensive Care Units (ICUs) and are associated with increased mortality, morbidity and health care costs. Selective Decontamination of the Digestive Tract (SDD) and Selective Oropharyngeal Decontamination (SOD) are

  18. The Halo Effect: An Unintended Benefit of Care Pathways. (United States)

    Barber, Collin; Fraser, James F; Mendez, Guillermo G; Bradley, Barrie; Loftus, Terry J; Jacofsky, David J


    The objective of this study was to determine if implementation of a simplified care pathway for total knee arthroplasty (TKA) would affect outcomes of total hip arthroplasty (THA) patients in the same health care system. Data were collected from a total of 5,095 consecutive THA patients in the year before and 2 years after implementation of the care pathway for TKA patients. Postimplementation increases were observed in both early activity (p < 0.0001) and continuous urinary catheter avoidance (p < 0.0001) among THA patients. These improvements in protocol adherence were associated with decreased complications (p < 0.0001), fewer 30-day readmissions (p < 0.0019), and decreased hospital length of stay (p < 0.0001). Based on these results, the implementation of a simplified care pathway for TKA patients can also improve outcomes for THA patients in the same health care system.

  19. Approaches to Sustainable Capacity Building for Cardiovascular Disease Care in Kenya. (United States)

    Barasa, Felix A; Vedanthan, Rajesh; Pastakia, Sonak D; Crowe, Susie J; Aruasa, Wilson; Sugut, Wilson K; White, Russ; Ogola, Elijah S; Bloomfield, Gerald S; Velazquez, Eric J


    Cardiovascular diseases are approaching epidemic levels in Kenya and other low- and middle-income countries without accompanying effective preventive and therapeutic strategies. This is happening in the background of residual and emerging infections and other diseases of poverty, and increasing physical injuries from traffic accidents and noncommunicable diseases. Investments to create a skilled workforce and health care infrastructure are needed. Improving diagnostic capacity, access to high-quality medications, health care, appropriate legislation, and proper coordination are key components to ensuring the reversal of the epidemic and a healthy citizenry. Strong partnerships with the developed countries also crucial.

  20. Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care (United States)

    Wu, Qunhong; Liu, Chaojie; Jiao, Mingli; Hao, Yanhua; Han, Yuzhen; Gao, Lijun; Hao, Jiejing; Wang, Lan; Xu, Weilan; Ren, Jiaojiao


    Objective Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. Methods We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. Findings About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736–1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215–0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust—the most significant predictor of patient satisfaction—is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. Conclusion At the core of high levels of patient dissatisfaction

  1. Using pressure and support to create a qualified workforce.

    Directory of Open Access Journals (Sweden)

    Sharon Ryan


    Full Text Available In order for any new initiative to be implemented, it is generally assumed that policy actors need both motivation to comply with a new initiative and adequate assistance to implement the required change successfully. The study reported here examined the impact of a system of pressure and supports created to encourage preschool teachers working in public school, Head Start, and child care settings to obtain a teaching credential by a court imposed deadline. Findings from the sample of 689 teachers indicate that the court mandate, in combination with a scholarship program and an accessible number of certification programs, motivated many preschool teachers to improve their qualifications. Paradoxically, it was also found that the mandate may contribute to a depletion of the workforce if teachers who obtain a qualification move out of preschool into higher status positions. Findings of this study suggest that policymakers should consider systems of pressure and support not only to achieve short term goals, but to maintain outcomes over the long term, as well.

  2. The future nephrology workforce: will there be one? (United States)

    Parker, Mark G; Ibrahim, Tod; Shaffer, Rachel; Rosner, Mitchell H; Molitoris, Bruce A


    Interest in nephrology as a career is declining and has been on the decline for nearly one decade. From 2002 to 2009, all internal medicine subspecialties except geriatric medicine increased the number of available fellowship positions. However, only two subspecialties attracted fewer United States medical graduates (USMGs) in 2009 than in 2002: geriatric medicine and nephrology. This drop occurred at a time when demand for nephrologists is increasing and when the specialty is having a harder time benefiting from the substantial contribution of international medical graduates (IMGs). Today's USMGs possess fundamentally different career and personal goals from their teachers and mentors. Medical students report receiving minimal exposure to nephrology in clinical rotations, and they perceive that the specialty is too complex, uninteresting, and lacks professional opportunity. Meanwhile, the demographics of kidney disease in the United States, as well as recent national health policy developments, indicate a growing need for nephrologists. Efforts to improve the educational continuum in nephrology and enhance mentorship are essential to restoring interest in nephrology for USMGs, maintaining its appeal among IMGs, and developing a workforce sufficient to meet future demand for renal care.

  3. Why we need interprofessional education to improve the delivery of safe and effective care

    Directory of Open Access Journals (Sweden)

    Scott Reeves


    Full Text Available Interprofessional education (IPE is an activity that involves two or more professions who learn interactively together to improve collaboration and the quality of care. Research has continually revealed that health and social care professionals encounter a range of problems with interprofessional coordination and collaboration which impact on the quality and safety of care. This empirical work resulted in policymakers across health care education and practice to invest in IPE to help resolve this collaborative failures. It is anticipated that IPE will provide health and social care professionals with the abilities required to work together effectively in providing safe high quality care to patients. Through a discussion of a range of key professional, educational and organization issues related to IPE, this paper argues that this form of education is an important strategy to improve the delivery of safe and effective care

  4. Telepsychiatry: Effective, Evidence-Based, and at a Tipping Point in Health Care Delivery? (United States)

    Hilty, Donald; Yellowlees, Peter M; Parrish, Michelle B; Chan, Steven


    Patient-centered health care questions how to deliver quality, affordable, and timely care in a variety of settings. Telemedicine empowers patients, increases administrative efficiency, and ensures expertise gets to the place it is most needed--the patient. Telepsychiatry or telemental health is effective, well accepted, and comparable to in-person care. E-models of care offer variety, flexibility, and positive outcomes in most settings, and clinicians are increasingly interested in using technology for care, so much so that telepsychiatry is now being widely introduced around the world.



    Monica Boldea; Ionuţ Drăgoi


    Each day presents a new set of challenges and risks to companies operating in this age ofboth a global economy and of multiculturalism, i.e. a fast-changing marketplace. Globalcompetition and escalating economic pressures make the business environment bothdynamic and difficult, especially given the workforce diversity which has to be managed soas to achieve the highest levels of task performance and job satisfaction; managers must beprepared to respect alternative cultures and value diversity...

  6. Effect of the Uganda Newborn Study on care-seeking and care practices: a cluster-randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Peter Waiswa


    Full Text Available Background: Care for women and babies before, during, and after the time of birth is a sensitive measure of the functionality of any health system. Engaging communities in preventing newborn deaths is a promising strategy to achieve further progress in child survival in sub-Saharan Africa. Objective: To assess the effect of a home visit strategy combined with health facility strengthening on uptake of newborn care-seeking, practices and services, and to link the results to national policy and scale-up in Uganda. Design: The Uganda Newborn Study (UNEST was a two-arm cluster-randomised controlled trial in rural eastern Uganda. In intervention villages volunteer community health workers (CHWs were trained to identify pregnant women and make five home visits (two during pregnancy and three in the first week after birth to offer preventive and promotive care and counselling, with extra visits for sick and small newborns to assess and refer. Health facility strengthening was done in all facilities to improve quality of care. Primary outcomes were coverage of key essential newborn care behaviours (breastfeeding, thermal care, and cord care. Analyses were by intention to treat. This study is registered as a clinical trial, number ISRCTN50321130. Results: The intervention significantly improved essential newborn care practices, although many interventions saw major increases in both arms over the study period. Immediate breastfeeding after birth and exclusive breastfeeding were significantly higher in the intervention arm compared to the control arm (72.6% vs. 66.0%; p=0.016 and 81.8% vs. 75.9%, p=0.042, respectively. Skin-to-skin care immediately after birth and cord cutting with a clean instrument were marginally higher in the intervention arm versus the control arm (80.7% vs. 72.2%; p=0.071 and 88.1% vs. 84.4%; p=0.023, respectively. Half (49.6% of the mothers in the intervention arm waited more than 24 hours to bathe the baby, compared to 35.5% in

  7. Strengthening health workforce capacity through work-based training

    Directory of Open Access Journals (Sweden)

    Matovu Joseph KB


    Full Text Available Abstract Background Although much attention has been given to increasing the number of health workers, less focus has been directed at developing models of training that address real-life workplace needs. Makerere University School of Public Health (MakSPH with funding support from the Centers for Disease Control and Prevention (CDC developed an eight-month modular, in-service work-based training program aimed at strengthening the capacity for monitoring and evaluation (M&E and continuous quality improvement (CQI in health service delivery. Methods This capacity building program, initiated in 2008, is offered to in-service health professionals working in Uganda. The purpose of the training is to strengthen the capacity to provide quality health services through hands-on training that allows for skills building with minimum work disruptions while encouraging greater involvement of other institutional staff to enhance continuity and sustainability. The hands-on training uses practical gaps and challenges at the workplace through a highly participatory process. Trainees work with other staff to design and implement ‘projects’ meant to address work-related priority problems, working closely with mentors. Trainees’ knowledge and skills are enhanced through short courses offered at specific intervals throughout the course. Results Overall, 143 trainees were admitted between 2008 and 2011. Of these, 120 (84% from 66 institutions completed the training successfully. Of the trainees, 37% were Social Scientists, 34% were Medical/Nursing/Clinical Officers, 5.8% were Statisticians, while 23% belonged to other professions. Majority of the trainees (80% were employed by Non-Government Organizations while 20% worked with the public health sector. Trainees implemented 66 projects which addressed issues such as improving access to health care services; reducing waiting time for patients; strengthening M&E systems; and improving data collection and

  8. An empirical investigation of the efficiency effects of integrated care models in Switzerland

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    Oliver Reich


    Full Text Available Introduction: This study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency. Methods: The empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006 to 2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model. Results: Our estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5% respectively of the variation in total health care expenditure can be attributed to the effects of selection. Conclusions: Integrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care.

  9. An empirical investigation of the efficiency effects of integrated care models in Switzerland

    Directory of Open Access Journals (Sweden)

    Oliver Reich


    Full Text Available Introduction: This study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency.Methods: The empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006 to 2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model.Results: Our estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5% respectively of the variation in total health care expenditure can be attributed to the effects of selection.Conclusions: Integrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care.

  10. Training the next generation's nephrology workforce. (United States)

    Berns, Jeffrey S; Ellison, David H; Linas, Stuart L; Rosner, Mitchell H


    The subspecialty of nephrology faces several critical challenges, including declining interest among medical students and internal medicine residents and worrisome declines in the number of applicants for nephrology fellowships. There is an urgent need to more clearly define the subspecialty and its scope of practice, reinvigorate meaningful research training and activities among trainees, and ensure that fellows who complete training and enter the practice of nephrology are experts in the broad scope of nephrology. This need requires a critical look at fellowship training programs and training requirements. A new workforce analysis is also needed that is not focused on primarily meeting estimated future clinical needs but rather, ensuring that there is alignment of supply and demand for nephrology trainees, which will ensure that those entering nephrology fellowships are highly qualified and capable of becoming outstanding nephrologists and that there are desirable employment opportunities for them when they complete their training.

  11. Clean Technology Evaluation & Workforce Development Program

    Energy Technology Data Exchange (ETDEWEB)

    Patricia Glaza


    The overall objective of the Clean Technology Evaluation portion of the award was to design a process to speed up the identification of new clean energy technologies and match organizations to testing and early adoption partners. The project was successful in identifying new technologies targeted to utilities and utility technology integrators, in developing a process to review and rank the new technologies, and in facilitating new partnerships for technology testing and adoption. The purpose of the Workforce Development portion of the award was to create an education outreach program for middle & high-school students focused on clean technology science and engineering. While originally targeting San Diego, California and Cambridge, Massachusetts, the scope of the program was expanded to include a major clean technology speaking series and expo as part of the USA Science & Engineering Festival on the National Mall in Washington, D.C.

  12. Striving to Diversify the Geosciences Workforce (United States)

    Velasco, Aaron A.; Jaurrieta de Velasco, Edith


    The geosciences continue to lag far behind other sciences in recruiting and retaining diverse populations [Czujko and Henley, 2003; Huntoon and Lane, 2007]. As a result, the U.S. capacity for preparedness in natural geohazards mitigation, natural resource management and development, national security, and geosciences education is being undermined and is losing its competitive edge in the global market. Two key populations must be considered as the United States looks to build the future geosciences workforce and optimize worker productivity: the nation's youth and its growing underrepresented minority (URM) community. By focusing on both of these demographics, the United States can address the identified shortage of high-quality candidates for knowledge-intensive jobs in the geosciences, helping to develop the innovative enterprises that lead to discovery and new technology [see National Research Council (NRCd), 2007].

  13. 'Who does what' in the orthodontic workforce. (United States)

    Hodge, T; Parkin, N


    The contraction of the economy in the United Kingdom and constraints on the National Health Service (NHS) together with new opportunities for the delivery of orthodontic treatment has resulted in an increasing number of dental personnel across the different registrant groups. This article focuses on the changes that have taken place in the orthodontic workforce over the past decade. Although others help deliver orthodontic services such as material suppliers, treatment coordinators and those involved in marketing, this article will restrict itself to informing the reader specifically about which dental registrants are doing what at the clinical interface. How health professionals have developed their skills to undertake the role they play within the team and possible threats arising because of these changes are also discussed.

  14. Medical workforce education and training: A failed decentralisation attempt to reform organisation, financing, and planning in England. (United States)

    Ovseiko, Pavel V; Buchan, Alastair M


    The 2010-2015 Conservative and Liberal Democrat coalition government proposed introducing a radical decentralisation reform of the organisation, financing, and planning of medical workforce education and training in England. However, following public deliberation and parliamentary scrutiny of the government's proposals, it had to abandon and alter its original proposals to the extent that they failed to achieve their original decentralisation objectives. This failed decentralisation attempt provides important lessons about the policy process and content of both workforce governance and health system reforms in Europe and beyond. The organisation, financing, and planning of medical workforce education is as an issue of national importance and should remain in the stewardship of the national government. Future reform efforts seeking to enhance the skills of the workforce needed to deliver high-quality care for patients in the 21st century will have a greater chance of succeeding if they are clearly articulated through engagement with stakeholders, and focus on the delivery of undergraduate and postgraduate multi-professional education and training in universities and teaching hospitals.

  15. Preparing a 21st century workforce: is it time to consider clinically based, competency-based training of health practitioners? (United States)

    Nancarrow, Susan A; Moran, Anna M; Graham, Iain


    Health workforce training in the 21st century is still based largely on 20th century healthcare paradigms that emphasise professionalisation at the expense of patient-focussed care. This is illustrated by the paradox of increased training times for health workers that have corresponded with workforce shortages, the limited career options and pathways for paraprofessional workers, and inefficient clinical training models that detract from, rather than add to, service capacity. We propose instead that a 21st century health workforce training model should be: situated in the clinical setting and supported by outsourced university training (not the other way around); based on the achievement of specific milestones rather than being time-defined; and incorporate para-professional career pathways that allow trainees to 'step-off' with a useable qualification following the achievement of specific competencies. Such a model could be facilitated by existing technology and clinical training infrastructure, with enormous potential for economies of scale in the provision of formal training. The benefits of a clinically based, competency-based model include an increase in clinical service capacity, and clinical training resources become a resource for the delivery of healthcare, not just education. Existing training models are unsustainable, and are not preparing a workforce with the flexibility the 21st century demands.

  16. Do Effects of Early Child Care Extend to Age 15 Years? Results from the NICHD Study of Early Child Care and Youth Development (United States)

    Vandell, Deborah Lowe; Belsky, Jay; Burchinal, Margaret; Steinberg, Laurence; Vandergrift, Nathan


    Relations between nonrelative child care (birth to 4 1/2 years) and functioning at age 15 were examined (N = 1,364). Both quality and quantity of child care were linked to adolescent functioning. Effects were similar in size as those observed at younger ages. Higher quality care predicted higher cognitive-academic achievement at age 15, with…

  17. Employee Motivation and Employee Performance in Child Care : The effects of the Introduction of Market Forces on Employees in the Dutch Child-Care Sector

    NARCIS (Netherlands)

    Plantinga, Mirjam


    This research describes and explains the effects of the introduction of market forces in the Dutch child-care sector on employee governance, motivation and performance. The Dutch child-care sector is transitioning from a welfare sector into a market sector. The transition process in child care is co

  18. Written and computerized care plans. Organizational processes and effect on patient outcomes. (United States)

    Daly, Jeanette M; Buckwalter, Kathleen; Maas, Meridean


    The purpose of this study was to determine how use of a standardized nomenclature for nursing diagnosis and intervention statements on the computerized nursing care plan in a long-term care (LTC) facility would affect patient outcomes, as well as organizational processes and outcomes. An experimental design was used to compare the effects of two methods of documentation: Computer care plan and paper care plan. Twenty participants (10 in each group) were randomly assigned to either group. No statistically significant differences were found by group for demographic data. Repeated measures ANOVA was computed for each of the study variables with type of care plan, written or computerized, as the independent variable. There were no statistically significant differences between participants, group (care plan), within subjects (across time), or interaction (group and time) effects for the dependent variables: Level of care, activities of daily living, perception of pain, cognitive abilities, number of medications, number of bowel medications, number of constipation episodes, weight, percent of meals eaten, and incidence of alteration in skin integrity. There were significantly more nursing interventions and activities on the computerized care plan, although this care plan took longer to develop at each of the three time periods. Results from this study suggest that use of a computerized plan of care increases the number of documented nursing activities and interventions, but further research is warranted to determine if this potential advantage can be translated into improved patient and organizational outcomes in the long-term care setting.

  19. [Characteristics of the medical workforce in the Province of Cabinda, Angola]. (United States)

    Oliveira, Miguel Dos Santos de; Artmann, Elizabeth


    This article presents the results of a study on the public health system's medical workforce in the Province of Cabinda, Angola. The objective was to study the characteristics of medical personnel, seeking to help define strategies to expand access and improve quality of care. The study covered the period from 2001 to 2004 and used secondary data, semi-structured interviews with health professionals, direct observation, and comparison with the literature. Quality of medical care in Cabinda was low, with one physician per 3,356 inhabitants. There were communities with more than 35,000 inhabitants and not a single physician. Working conditions were poor, and physicians suffered from low motivation. The study concluded that formulation and implementation of policies envisioning improvements in the management of medical professionals in the sector could help enhance the quality of care in the Province, but it would require involvement by relevant actors and additional research on the other health professions.

  20. The personnel economics approach to public workforce research. (United States)

    Gibbs, Michael


    This article argues that the relatively new field of personnel economics (PE) holds strong potential as a tool for studying public sector workforces. This subfield of labor economics is based on a strong foundation of microeconomics, which provides a robust theoretical foundation for studying workforce and organizational design issues. PE has evolved on this foundation to a strong practical emphasis, with theoretical insights designed for practical use and with strong focus on empirical research. The field is also characterized by creative data entrepreneurship. The types of datasets that personnel economists use are described. If similar datasets can be obtained for public sector workforces, PE should be a very useful approach for studying them.

  1. Status of Educational Efforts in National Security Workforce

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    This report documents the status of educational efforts for the preparation of a national security workforce as part of the National Security Preparedness Project, being performed by the Arrowhead Center of New Mexico State University under a DOE/NNSA grant. The need to adequately train and educate a national security workforce is at a critical juncture. Even though there are an increasing number of college graduates in the appropriate fields, many of these graduates choose to work in the private sector because of more desirable salary and benefit packages. This report includes an assessment of the current educational situation for the national security workforce.

  2. Partnership and empowerment program: a model for patient-centered, comprehensive, and cost-effective care. (United States)

    Brown, Corinne; Bornstein, Elizabeth; Wilcox, Catina


    The Partnership and Empowerment Program model offers a comprehensive, patient-centered, and cost-effective template for coordinating care for underinsured and uninsured patients with cancer. Attention to effective coordination, including use of internal and external resources, may result in decreased costs of care and improved patient compliance and health outcomes.

  3. The Association between Freedom of Choice and Effectiveness of Home Care Services

    Directory of Open Access Journals (Sweden)

    Marina Steffansson


    Full Text Available Objectives: The aim of this paper is to study home care clients’ freedom to choose their services, as well the association between the effectiveness of home care services and freedom of choice, among other factors. Methods: A structured postal survey was conducted among regular home care clients ('n' = 2096 aged 65 or older in three towns in Finland. Freedom of choice was studied based on clients’ subjective experiences. The effectiveness of the services was evaluated by means of changes in the social-care-related quality of life. Regression analyses were used to test associations. Results: As much as 62% of home care recipients reported having some choice regarding their services. Choosing meals and visiting times for the care worker were associated with better effectiveness. The basic model, which included needs and other factors expected to have an impact on quality of life, explained 15.4% of the changes in quality of life, while the extended model, which included the freedom-of-choice variables, explained 17.4%. The inclusion of freedom-of-choice variables increased the adjusted coefficient of determination by 2%. There was a significant positive association between freedom of choice and the effectiveness of public home care services. Conclusion: Freedom of choice does not exist for all clients of home care who desire it. By changing social welfare activities and structures, it is possible to show respect for clients’ opinions and to thereby improve the effectiveness of home care services.


    Directory of Open Access Journals (Sweden)

    Pascale M. Le Blanc


    Full Text Available Workforce sustainability is of vital utmost importance for the viability and competitive advantage of contemporary organizations. Therefore, and in parallel with the rise of positive organizational psychology, organizations have become increasingly interested in how to enhance their employees’ positive psychological well being. In this paper, amplition interventions – i.e. interventions aimed at enhancing positive work-related well being - are presented as a valuable tool to increase workforce sustainability. In the past decade, some work-related interventions focused on amplition have been developed and tested for their effectiveness. In this paper, we will first outline some important preconditions for successful interventions and briefly discuss the intervention process itself. Next, we will give an overview of empirical work on amplition interventions, focusing on interventions that are aimed at enhancing employee work engagement. Future research should focus on testing the effects of these type of interventions on outcomes at the team and organizational level.

  5. Workforce Diversity And Organizational Communication: Analysis Of Human Capital Performance And Productivity

    Directory of Open Access Journals (Sweden)

    Ephraim A. Okoro


    Full Text Available The twenty-first century organizations are increasingly becoming multicultural workplaces for communication. This paper explores recent literature on the increasing global influence of workforce diversity and its affect on workplace communication. It provides a model for the discussion of the opportunities and challenges of diversity in the workplace. The paper then provides an analytical framework that guides readers with practical ideas that can assist them in their endeavors to effectively communicate in a globally diverse work environment.  The paper stresses that effective communication in a diverse workforce ensures a high level of performance and productivity for human and intellectual capital and   provides business organizations a competitive advantage in their expanded markets and in the global economy.

  6. Characteristics of effective, harm-free environments for children in out-of-home care. (United States)

    Daly, D L; Dowd, T P


    The history of out-of-home care is replete with documented examples of abusive and neglectful practices. Some scholars express concern that out-of-home care is de facto abusive. Certain elements, however, can foster effective and harm-free out-of-home care, such as caregiver support, a model of care, a focus on positive behavior, a consumer orientation, training, program evaluation, and an internal program audit. These elements work together to increase program effectiveness and reduce negative outcomes such as staff burnout. Furthermore, programs that use these elements can be cost efficient.

  7. Extensions to decomposition of the redistributive effect of health care finance. (United States)

    Zhong, Hai


    The total redistributive effect (RE) of health-care finance has been decomposed into vertical, horizontal and reranking effects. The vertical effect has been further decomposed into tax rate and tax structure effects. We extend this latter decomposition to the horizontal and reranking components of the RE. We also show how to measure the vertical, horizontal and reranking effects of each component of the redistributive system, allowing analysis of the RE of health-care finance in the context of that system. The methods are illustrated with application to the RE of health-care financing in Canada.

  8. Hospital churn and casemix instability: implications for planning and educating the nursing workforce. (United States)

    Chiarella, Mary; Roydhouse, Jessica K


    Health workforce planning is a priority for Australian governments at both state and federal levels. Nursing shortages are a significant problem and addressing these shortages is likely to be a component of any workforce plan. This paper looks at the case of hospital nursing and argues that casemix, workforce and management instability inhibit workforce planning for hospital nursing. These issues are related and any efforts to objectively plan the hospital nursing workforce must seek to address them in order to succeed.

  9. Child maltreatment and foster care: unpacking the effects of prenatal and postnatal parental substance use. (United States)

    Smith, Dana K; Johnson, Amber B; Pears, Katherine C; Fisher, Philip A; DeGarmo, David S


    Parental substance use is a well-documented risk for children. However, little is known about specific effects of prenatal and postnatal substance use on child maltreatment and foster care placement transitions. In this study, the authors unpacked unique effects of (a) prenatal and postnatal parental alcohol and drug use and (b) maternal and paternal substance use as predictors of child maltreatment and foster care placement transitions in a sample of 117 maltreated foster care children. Models were tested with structural equation path modeling. Results indicated that prenatal maternal alcohol use predicted child maltreatment and that combined prenatal maternal alcohol and drug use predicted foster care placement transitions. Prenatal maternal alcohol and drug use also predicted postnatal paternal alcohol and drug use, which in turn predicted foster care placement transitions. Findings highlight the potential integrative role that maternal and paternal substance use has on the risk for child maltreatment and foster care placement transitions.

  10. Scaling-up the medical workforce in Timor-Leste: challenges of a great leap forward. (United States)

    Cabral, Jorge; Dussault, Gilles; Buchan, James; Ferrinho, Paulo


    The health services system of Timor-Leste (T-L) will, by 2015, add 800 physicians, most of them trained in Cuba, to the 233 employed by the national health system in 2010-2011. The need for more physicians is not in discussion: poor health indicators, low coverage and utilization of services, and poor quality of services are well documented in T-L. However, the choice of this scaling-up, with a relatively narrow focus on the medical workforce, needs to be assessed for its relevance to the health profile of the country, for its comprehensiveness in terms of other complementary measures needed to make it effective. This article discusses the potential effects of the rapid scaling-up of the medical workforce, and the organizational capacity needed to monitor the process and eventually mitigate any deleterious consequences. The analysis is based on a review of documentation collected on site (T-L) and on interviews with key-informants conducted in 2011. We stress that any workforce scaling-up is not simply a matter of increasing numbers of professionals, but should combine improved training, distribution, working conditions, management and motivation, as a means towards better performing health services' systems. This is a major challenge in a context of limited organizational and managerial capacity, underdeveloped information systems, limited training and research capacity, and dependency on foreign aid and technical assistance. Potential risks are associated with funding the additional costs of recruiting more personnel, associated expenditures on infrastructure, equipment and consumables, the impact on current staff mix, and the expected increased demand for services. We conclude that failing to manage effectively the forthcoming "great leap forward" will have long term effects: formal policies and plans for the balanced development of the health workforce, as well as strengthened institutions are urgently needed.

  11. A Study of Critical Thinking Training in the Army Contracting Workforce (United States)


    curriculum to determine if the current curriculum was effective in teaching critical thinking skills and if improvements are warranted. The objective of... teach interest-based negotiations; • explore Program Manger interests and decision making; • craft creative acquisition strategies; and • explore...innovation in DoD acquisitions all require the Army’s acquisition workforce to think critically about programs and to craft sound acquisition decisions

  12. Advanced practice nursing, health care teams, and perceptions of team effectiveness. (United States)

    Kilpatrick, Kelley; Lavoie-Tremblay, Mélanie; Ritchie, Judith A; Lamothe, Lise


    This article summarizes the results of an extensive review of the organizational and health care literature of advanced practice nursing (APN) roles, health care teams, and perceptions of team effectiveness. Teams have a long history in health care. Managers play an important role in mobilizing resources, guiding expectations of APN roles in teams and within organizations, and facilitating team process. Researchers have identified a number of advantages to the addition of APN roles in health care teams. The process within health care teams are dynamic and responsive to their surrounding environment. It appears that teams and perceptions of team effectiveness need to be understood in the broader context in which the teams are situated. Key team process are identified for team members to perceive their team as effective. The concepts of teamwork, perceptions of team effectiveness, and the introduction of APN roles in teams have been studied disparately. An exploration of the links between these concepts may further our understanding the health care team's perceptions of team effectiveness when APN roles are introduced. Such knowledge could contribute to the effective deployment of APN roles in health care teams and improve the delivery of health care services to patients and families.

  13. Oral Health of Drug Abusers: A Review of Health Effects and Care

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    Hamed Ekhtiari


    Full Text Available Oral health problems, among the most prevalent comorbidities related to addiction, require more attention by both clinicians and policy-makers. Our aims were to review oral complications associated with drugs, oral health care in addiction rehabilitation, health services available, and barriers against oral health promotion among addicts. Drug abuse is associated with serious oral health problems including generalized dental caries, periodontal diseases, mucosal dysplasia, xerostomia, bruxism, tooth wear, and tooth loss. Oral health care has positive effects in recovery from drug abuse: patients’ need for pain control, destigmatization, and HIV transmission. Health care systems worldwide deliver services for addicts, but most lack oral health care programs. Barriers against oral health promotion among addicts include difficulty in accessing addicts as a target population, lack of appropriate settings and of valid assessment protocols for conducting oral health studies, and poor collaboration between dental and general health care sectors serving addicts. These interfere with an accurate picture of the situation. Moreover, lack of appropriate policies to improve access to dental services, lack of comprehensive knowledge of and interest among dental professionals in treating addicts, and low demand for non-emergency dental care affect provision of effective interventions. Management of drug addiction as a multi-organ disease requires a multidisciplinary approach. Health care programs usually lack oral health care elements. Published evidence on oral complications related to addiction emphasizes that regardless of these barriers, oral health care at various levels including education, prevention, and treatment should be integrated into general care services for addicts.

  14. DOE Advanced Scientific Advisory Committee (ASCAC): Workforce Subcommittee Letter

    Energy Technology Data Exchange (ETDEWEB)

    Chapman, Barbara [University of Houston; Calandra, Henri [Total SA; Crivelli, Silvia [Lawrence Berkeley National Laboratory, University of California, Davis; Dongarra, Jack [University of Tennessee; Hittinger, Jeffrey [Lawrence Livermore National Laboratory; Lathrop, Scott A. [NCSA, University of Illinois Urbana-Champaign; Sarkar, Vivek [Rice University; Stahlberg, Eric [Advanced Biomedical Computing Center; Vetter, Jeffrey S. [Oak Ridge National Laboratory; Williams, Dean [Lawrence Livermore National Laboratory


    Simulation and computing are essential to much of the research conducted at the DOE national laboratories. Experts in the ASCR ¬relevant Computing Sciences, which encompass a range of disciplines including Computer Science, Applied Mathematics, Statistics and domain Computational Sciences, are an essential element of the workforce in nearly all of the DOE national laboratories. This report seeks to identify the gaps and challenges facing DOE with respect to this workforce. This letter is ASCAC’s response to the charge of February 19, 2014 to identify disciplines in which significantly greater emphasis in workforce training at the graduate or postdoctoral levels is necessary to address workforce gaps in current and future Office of Science mission needs.

  15. Networking and Information Technology Workforce Study: Final Report (United States)

    Networking and Information Technology Research and Development, Executive Office of the President — This report presents the results of a study of the global Networking and Information Technology NIT workforce undertaken for the Networking and Information...

  16. Tracking and monitoring the health workforce: a new human resources information system (HRIS in Uganda

    Directory of Open Access Journals (Sweden)

    McQuide Pamela A


    Full Text Available Abstract Background Health workforce planning is important in ensuring that the recruitment, training and deployment of health workers are conducted in the most efficient way possible. However, in many developing countries, human resources for health data are limited, inconsistent, out-dated, or unavailable. Consequently, policy-makers are unable to use reliable data to make informed decisions about the health workforce. Computerized human resources information systems (HRIS enable countries to collect, maintain, and analyze health workforce data. Methods The purpose of this article is twofold. First, we describe Uganda's transition from a paper filing system to an electronic HRIS capable of providing information about country-specific health workforce questions. We examine the ongoing five-step HRIS strengthening process used to implement an HRIS that tracks health worker data at the Uganda Nurses and Midwives Council (UNMC. Secondly, we describe how HRIS data can be used to address workforce planning questions via an initial analysis of the UNMC training, licensure and registration records from 1970 through May 2009. Results The data indicate that, for the 25 482 nurses and midwives who entered training before 2006, 72% graduated, 66% obtained a council registration, and 28% obtained a license to practice. Of the 17 405 nurses and midwives who obtained a council registration as of May 2009, 96% are of Ugandan nationality and just 3% received their training outside of the country. Thirteen per cent obtained a registration for more than one type of training. Most (34% trainings with a council registration are for the enrolled nurse training, followed by enrolled midwife (25%, registered (more advanced nurse (21%, registered midwife (11%, and more specialized trainings (9%. Conclusion The UNMC database is valuable in monitoring and reviewing information about nurses and midwives. However, information obtained from this system is also important in

  17. The cost-effectiveness of managed care regarding chronic medicine prescriptions in a selected medical scheme

    Directory of Open Access Journals (Sweden)

    K. Day


    Full Text Available The purpose of the study was to examine the cost-effectiveness of managed care interventions with respect to prescriptions for chronic illness sufferers enrolled with a specific medical scheme. The illnesses included, were epilepsy, hypertension, diabetes and asthma. The managed care interventions applied were a primary discount; the use of preferred provider pharmacies, and drug utilization review. It was concluded that the managed care interventions resulted in some real cost savings.

  18. Comparative effectiveness of psychological treatments for depressive disorders in primary care: network meta-analysis



    Background A variety of psychological interventions to treat depressive disorders have been developed and are used in primary care. In a systematic review, we compared the effectiveness of psychological treatments grouped by theoretical background, intensity of contact with the health care professional, and delivery mode for depressed patients in this setting. Methods Randomized trials comparing a psychological treatment with usual care, placebo, another psychological treatment, pharmacothera...

  19. A Forgotten Issue: Distributional Effects of Day Care Subsidies in Germany


    Kreyenfeld, Michaela; Spieß, Christa Katharina; Wagner, Gert G.


    In general child care subsidies are widely accepted as a means to create equal chances for mothers in the labour market as well as for children. Although there is a general consensus that the use of child care should be publicly supported, there is no consensus on how this should be done. Moreover, there is little knowledge on the distributional effects of child care subsidies. In order to assess whether public expenditures are targeted efficiently, it is, however, vital to know which social ...

  20. Registered nurses in Israel - workforce employment characteristics and projected supply

    Directory of Open Access Journals (Sweden)

    Nirel Nurit


    Full Text Available Abstract Background Surveys of nursing supplies around the world have furnished a better understanding of the structure of the workforce, helped identify shortages, and plan professional training. This study aimed to examine the employment and workforce characteristics of registered nurses and the projected supply in Israel as a tool for planning. Methods 1. A survey of a national sample of 10% of the RNs of working age (3,200 nurses. 2. Analysis of administrative data from the Ministry of Health' Nursing Division and the Central Bureau of Statistics. Results Most registered nurses are employed (89% - 67% work full time. The workforce is mature (45% are above 45, trained (55% qualified beyond the basic course, 48% hold a BA, 18% hold an MA or PhD, and stable: few quit the profession altogether. The likelihood of "survival" in the profession after 10 years is 93%; after 20 years - 88%. 23% have made some transition in the last 10 years (most - a single transition. Most of the transitions are from hospital to community work. Supply projections show a decrease in the total number of RNs in the nursing workforce from 28,500 in 2008 to 21,201 in 2028 - i.e., of 25% by the end of the period. As for the ratio per 1,000 population, the drop is from 4 registered nurses/1,000 in 2008 to 2/1,000 in 2028. Conclusions The study findings provide more rigorous projections of supply than in the past on the declining rates of the nursing workforce in the coming decades, and contribute to decision making about the scope of training and recruitment. The study also points to the implications for policy decisions regarding the findings that the young nursing workforce is less stable, that there are advantages to recruiting a more mature workforce, and that post-basic education is connected with workforce stability.

  1. Responding to diversity: workforce intermediation in a transitioning regional economy


    Nichola J. Lowe


    In this paper I examine workforce intermediation as a tool for regional economic transition. While most studies of workforce intermediation in the United States focus on targeted programs that work with less-advantaged socioeconomic groups, I examine strategies adopted by state-funded community colleges that have a more encompassing or universalistic mandate. Through a case study of North Carolina’s BioWork initiative I examine college-level strategies for assisting two distinct groups of job...

  2. Employers’ View on Problems Related to Workforce Skills and Qualification


    Klimplová Lenka


    The aim of this exploratory study is to reveal employers’ views on problems related to workforce human capital (skills and qualification). Where do employers themselves view the core of difficulties with ensuring adequately skilled workforce? Do they assign them to technological and organizational changes (a functional concept of job-specific human capital obsolescence), or do they see these problems as a result of other circumstances, such as macro-structural conditions or institutional sett...

  3. Domestic Wind Energy Workforce; NREL (National Renewable Energy Laboratory)

    Energy Technology Data Exchange (ETDEWEB)

    Tegen, Suzanne


    A robust workforce is essential to growing domestic wind manufacturing capabilities. NREL researchers conducted research to better understand today's domestic wind workforce, projected needs for the future, and how existing and new education and training programs can meet future needs. This presentation provides an overview of this research and the accompanying industry survey, as well as the Energy Department's Career Maps, Jobs & Economic Development Impacts models, and the Wind for Schools project.

  4. Changing the Impact of Nursing Assistants’ Education in Seniors’ Care: the Living Classroom in Long-Term Care (United States)

    Boscart, Veronique M.; d’Avernas, Josie; Brown, Paul; Raasok, Marlene


    Background Evidence-informed care to support seniors is based on strong knowledge and skills of nursing assistants (NAs). Currently, there are insufficient NAs in the workforce, and new graduates are not always attracted to nursing home (NH) sectors because of limited exposure and lack of confidence. Innovative collaborative approaches are required to prepare NAs to care for seniors. Methods A 2009 collaboration between a NH group and a community college resulted in the Living Classroom (LC), a collaborative approach to integrated learning where NA students, college faculty, NH teams, residents, and families engage in a culture of learning. This approach situates the learner within the NH where knowledge, team dynamics, relationships, behaviours, and inter-professional (IP) practice are modelled. Results As of today, over 300 NA students have successfully completed this program. NA students indicate high satisfaction with the LC and have an increased intention to seek employment in NHs. Faculty, NH teams, residents, and families have increased positive beliefs towards educating students in a NH. Conclusion The LC is an effective learning approach with a positive and high impact learning experience for all. The LC is instrumental in contributing to a capable workforce caring for seniors.

  5. Estimating health workforce needs for antiretroviral therapy in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Fullem Andrew


    Full Text Available Abstract Background Efforts to increase access to life-saving treatment, including antiretroviral therapy (ART, for people living with HIV/AIDS in resource-limited settings has been the growing focus of international efforts. One of the greatest challenges to scaling up will be the limited supply of adequately trained human resources for health, including doctors, nurses, pharmacists and other skilled providers. As national treatment programmes are planned, better estimates of human resource needs and improved approaches to assessing the impact of different staffing models are critically needed. However there have been few systematic assessments of staffing patterns in existing programmes or of the estimates being used in planning larger programmes. Methods We reviewed the published literature and selected plans and scaling-up proposals, interviewed experts and collected data on staffing patterns at existing treatment sites through a structured survey and site visits. Results We found a wide range of staffing patterns and patient-provider ratios in existing and planned treatment programmes. Many factors influenced health workforce needs, including task assignments, delivery models, other staff responsibilities and programme size. Overall, the number of health care workers required to provide ART to 1000 patients included 1–2 physicians, 2–7 nurses, Discussion These data are consistent with other estimates of human resource requirements for antiretroviral therapy, but highlight the considerable variability of current staffing models and the importance of a broad range of factors in determining personnel needs. Few outcome or cost data are currently available to assess the effectiveness and efficiency of different staffing models, and it will be important to develop improved methods for gathering this information as treatment programmes are scaled up.

  6. Effect of a Comprehensive Health Care Program by Korean Medicine Doctors on Medical Care Utilization for Common Infectious Diseases in Child-Care Centers

    Directory of Open Access Journals (Sweden)

    Minjung Park


    Full Text Available As the role of traditional medicine in community health improvement increases, a comprehensive health care program for infectious diseases management in child-care centers by Korean medicine doctors was developed. The purpose of this study is to evaluate the effects of the program intervention on infection-related medical care utilization among children. The study used a quasi-experimental design with nonequivalent control group, comparing pre- and post-intervention data of the same children. The program implemented interventions in terms of management, education, and medical examination for the teachers, parents, and children in 12-week period. The frequency of utilization, cost, and prescription days of drugs and antibiotics due to infectious diseases prior to the intervention were compared with those during the 3-month intervention, using health insurance claim data. A panel analysis was also conducted to support the findings. A significant reduction (12% in infection-related visit days of hospitals was observed with the intervention (incident rate ratio = 0.88, P=0.01. And medical cost, drug prescription days, and antibiotics prescription days were decreased, although not statistically significant. A further cost-effectiveness analysis in terms of social perspectives, considering the opportunity costs for guardians to take children to medical institutions, would be needed.

  7. The butterfly effect of caring - clinical nursing teachers' understanding of self-compassion as a source to compassionate care. (United States)

    Wiklund Gustin, Lena; Wagner, Lynne


    This study has its roots in a clinical application project, focusing on the development of a teaching-learning model enabling participants to understand compassion. During that project four clinical nursing teachers met for a total of 12 hours of experiential and reflective work. This study aimed at exploring participants' understanding of self-compassion as a source to compassionate care. It was carried out as a phenomenological and hermeneutic interpretation of participants' written and oral reflections on the topic. Data were interpreted in the light of Watson's Theory of Human Caring. Five themes were identified: Being there, with self and others; respect for human vulnerability; being nonjudgmental; giving voice to things needed to be said and heard; and being able to accept the gift of compassion from others. A main metaphorical theme, 'the Butterfly effect of Caring', was identified, addressing interdependency and the ethics of the face and hand when caring for Other - the ethical stance where the Other's vulnerable face elicits a call for compassionate actions. The findings reveal that the development of a compassionate self and the ability to be sensitive, nonjudgmental and respectful towards oneself contributes to a compassionate approach towards others. It is concluded that compassionate care is not only something the caregiver does, nor is compassion reduced to a way of being with another person or a feeling. Rather, it is a way of becoming and belonging together with another person where both are mutually engaged and where the caregiver compassionately is able to acknowledge both self and Other's vulnerability and dignity.

  8. How Do We Ensure the Quality of the Public Health Workforce?

    Directory of Open Access Journals (Sweden)

    Stephen B. Thacker, MD, MSc


    Full Text Available The events of September 11, 2001, brought unprecedented attention to public health in the United States. The national response to these events included a large infusion of resources into the public health system that enhanced the capacity for the system to respond to terrorist threats and other public health emergencies. However, as illustrated by the emerging epidemics of obesity and diabetes in this country, a disproportionate burden of disease, death, and disability in this century will continue to be attributable to chronic disease. To address this burden effectively requires the development of a workforce with new skills in addition to maintenance of evolving traditional competencies. In 2002, the Institute of Medicine (IOM published a report, Who Will Keep the Public Healthy?, that targeted the training needs of the public health workforce in this century (1. The IOM report included a recommendation for federal agencies to provide incentives for developing academic–practice partnerships.

  9. Primary Care Behavioral Health Provider Training: Systematic Development and Implementation in a Large Medical System. (United States)

    Dobmeyer, Anne C; Hunter, Christopher L; Corso, Meghan L; Nielsen, Matthew K; Corso, Kent A; Polizzi, Nicholas C; Earles, Jay E


    The expansion of integrated, collaborative, behavioral health services in primary care requires a trained behavioral health workforce with specific competencies to deliver effective, evidence-informed, team-based care. Most behavioral health providers do not have training or experience working as primary care behavioral health consultants (BHCs), and require structured training to function effectively in this role. This article discusses one such training program developed to meet the needs of a large healthcare system initiating widespread implementation of the primary care behavioral health model of service delivery. It details the Department of Defense's experience in developing its extensive BHC training program, including challenges of addressing personnel selection and hiring issues, selecting a model for training, developing and implementing a phased training curriculum, and improving the training over time to address identified gaps. Future directions for training improvements and lessons learned in a large healthcare system are discussed.

  10. Effect of health insurance type on access to care. (United States)

    Froelich, John M; Beck, Ryan; Novicoff, Wendy M; Saleh, K J


    Growing orthopedic and nonorthopedic literature illustrates the point that having health insurance does not equal having access to care. The goal of this study was to evaluate the burden placed on patients to gain access to outpatient orthopedic care. For this study, burden was quantified as the distance traveled by the patient to be seen in clinic. This study was a retrospective review of all new patient encounters at an adult orthopedic outpatient clinic in an academic tertiary referral center over 1 calendar year. All patients were stratified into 4 categories: commercial/private insurance, Medic-aid, Medicare, and uninsured/private pay. The average distance traveled by each patient to the center was then calculated based on the patient's billing zip code. Patient visits were further stratified based on whether the patients were seen by 1 of 3 different categories of providers: general orthopedics/adult reconstruction, spine, and sports/upper extremity. The study group comprised 774 (31.1%) Medicaid patients, 653 (26.2%) Medicare patients, 917 (36.8%) commercial/private insurance patients, and 146 (5.9%) uninsured/private pay patients. The average 1-way distance traveled was 36.2 miles for Medicaid patients, 21.3 miles for Medicare patients, 24.1 miles for commercial/private insurance patients, and 25.3 miles for uninsured/private pay patients (Paccess to outpatient orthopedic care at a single institution. The specific burdens that each group faces to gain access to care are unclear.

  11. Preschool Center Care Quality Effects on Academic Achievement: An Instrumental Variables Analysis (United States)

    Auger, Anamarie; Farkas, George; Burchinal, Margaret R.; Duncan, Greg J.; Vandell, Deborah Lowe


    Much of child care research has focused on the effects of the quality of care in early childhood settings on children's school readiness skills. Although researchers increased the statistical rigor of their approaches over the past 15 years, researchers' ability to draw causal inferences has been limited because the studies are based on…

  12. Effects of the Program of All-Inclusive Care for the Elderly on Hospital Use (United States)

    Meret-Hanke, Louise A.


    Purpose of the Study: This study evaluates the effects of the Program of All-Inclusive Care for the Elderly (PACE) on hospital use. PACE's capitated financing creates incentives to reduce the use of costly services. Furthermore, its emphasis on preventative care and regular monitoring by provides a mechanism for reducing unnecessary hospital use…

  13. The effectiveness of integrated care for patients with hand eczema: Results of a randomized, controlled trial

    NARCIS (Netherlands)

    Gils, R.F. van; Boot, C.R.L.; Knol, D.L.; Rustemeyer, T.; Mechelen, W. van; Valk, P.G.M. van der; Anema, J.R.


    Objectives. To evaluate the effectiveness of integrated, multidisciplinary care as compared with usual care for patients with moderate to severe, chronic hand eczema after 26 weeks of follow-up. Background. This study was designed as a randomized, controlled trial. Methods. Patients who visited one

  14. Separate and Cumulative Effects of Adverse Childhood Experiences in Predicting Adult Health and Health Care Utilization (United States)

    Chartier, Mariette J.; Walker, John R.; Naimark, Barbara


    Objectives: Objectives of this population-based study were: (1) to examine the relative contribution of childhood abuse and other adverse childhood experiences to poor adult health and increased health care utilization and (2) to examine the cumulative effects of adverse childhood experiences on adult health and health care utilization. Methods:…

  15. The effect of deinstitutionalization on the longitudinal continuity of mental health care in the Netherlands

    NARCIS (Netherlands)

    Pijl, YJ; Sytema, S


    Background Deinstitutionalization has been accompanied by a decreasing continuity of care in a number of countries. This study evaluates the effects of the Dutch model for deinstitutionalizing mental health care. Methods Details of users and their use of community- and hospital-based services betwee

  16. The effectiveness of institutional youth care over the past three decades: a meta-analysis

    NARCIS (Netherlands)

    J.J.W. de Swart; H. van den Broek; G.J.J.M. Stams; J.J. Asscher; P.H. van der Laan; G.A. Holsbrink-Engels; G.H.P. van der Helm


    A meta-analysis of 27 controlled studies, including 17,038 youth, was conducted to examine the effectiveness of institutional youth care over the past three decades. We compared institutional evidence-based treatment (EBT) with non-institutional EBT, institutional care as usual (CAU) with non-instit

  17. Effects of Universal Child Care Participation on Pre-teen Skills and Risky Behaviors

    DEFF Research Database (Denmark)

    Gupta, Nabanita Datta; Simonsen, Marianne

    This paper uses a Danish panel data child survey merged with administrative records along with a pseudo-experiment that generates variation in the take-up of preschool across municipalities to investigate pre-teenage effects of child care participation at age three (either parental care, preschoo...

  18. Age at Adoption from Institutional Care as a Window into the Lasting Effects of Early Experiences (United States)

    Julian, Megan M.


    One of the major questions of human development is how early experience impacts the course of development years later. Children adopted from institutional care experience varying levels of deprivation in their early life followed by qualitatively better care in an adoptive home, providing a unique opportunity to study the lasting effects of early…

  19. Meta-analysis of the effectiveness of chronic care management for diabetes: Investigating heterogeneity in outcomes.

    NARCIS (Netherlands)

    Elissen, A.M.; Steuten, L.M.G.; Drewes, H.W.; Lemmens, L.C.; Meeuwissen, J.A.; Baan, C.A.; Vrijhoef, H.J.M.


    Purpose The study aims to support decision making on how best to redesign diabetes care by investigating three potential sources of heterogeneity in effectiveness across trials of diabetes care management. Methods Medline, CINAHL and PsycInfo were searched for systematic reviews and empirical stu

  20. The Effect of Physician Delegation to Other Health Care Providers on the Quality of Care for Geriatric Conditions (United States)

    Lichtenstein, Brian J.; Reuben, David B.; Karlamangla, Arun S.; Han, Weijuan; Roth, Carol P.; Wenger, Neil S.


    OBJECTIVES to examine the effects of delegation on quality of care that patients receive for three common geriatric conditions: dementia, falls, and incontinence. DESIGN pooled analysis of 8 the Assessing Care of Vulnerable Elders (ACOVE) projects from 1998 to 2010. SETTING 15 ambulatory practice sites across the United States PARTICIPANTS 4,776 patients age ≥ 65 years, of mixed demographic backgrounds who participated in ACOVE studies. INTERVENTION multivariate analysis of prior ACOVE observation and intervention studies was conducted, with in addition to two retrospectively defined variables: “intent to delegate” and “maximum delegation” for each ACOVE quality indicator (QI). MEASUREMENTS The primary outcome for the study was QI pass probability, by level of delegation, for 47 ACOVE quality indicators. RESULTS A total of 4,776 patients were evaluated, with 16,204 QIs included for analysis. Across all studies, QI pass probabilities were 0.36 for physician-performed tasks; 0.55 for nurse practitioner (NP), physician assistant (PA), and registered nurse (RN)-performed tasks; and 0.61 for medical assistant (MA), or licensed vocational nurse (LVN)-performed tasks. In multiply adjusted models, the independent pass-probability effect of delegation to NPs, PAs, or RNs was 1.37 (p = 0.055) CONCLUSIONS Delegation to non-physician providers is associated with higher quality of care for geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions among older adults. PMID:26480977

  1. The effect of managed care on quality: a review of recent evidence. (United States)

    Hellinger, F J


    This article reviews recent evidence about the relationship between managed care and quality. With one exception, the studies reviewed represent observation periods that extend through 1990 or a more recent year. The review has led to the conclusion that managed care has not decreased the overall effectiveness of care. However, evidence suggests that managed care may adversely affect the health of some vulnerable subpopulations. Evidence also suggests that enrollees in managed care plans are less satisfied with their care and have more problems accessing specialized services. In addition, younger, wealthier, and healthier persons were more satisfied with their health plans than older, poorer, and sicker persons, even after adjusting for the type of health plan.The findings of the studies reviewed do not provide definitive results about the effect of managed care on quality. Indeed, relatively few studies include data from the 1990s, and little is known about the newer types of health maintenance organizations that invest heavily in information systems and rely on financial incentives to alter practice patterns. Furthermore, managed care is not a uniform method that is applied identically by all health plans, and research studying the different dimensions of managed care also is needed.

  2. MINDFULNESS : Introduction of Meditation Technique & Effects with the Elderly in Home Care Services


    Nguyen, Tan


    Thesis Description: Research and analysis of the introduction of meditation techniques & their effects upon the elderly volunteer participants in home care services. Theoretical summary: To introduce meditation techniques and to examine the effects upon mental and physical health amongst elderly volunteers in home care. The hypothesis is that if elderly people are meditating regularly, stress and depressive effects will be reduced or greatly minimised, and may even disappear, with a view ...

  3. The cost-effectiveness of supportive periodontal care: a global perspective.



    Abstract Aim: To evaluate the cost-effectiveness of supportive periodontal care (SPC) provided in generalist and periodontal specialist practices under publicly subsidised or private dental care. Material and Methods: SPC cost data and the costs of replacing teeth were synthesised with estimates of the effectiveness of SPC in preventing attachment and tooth loss and adjusted for differences in clinician?s time. Incremental Cost-Effectiveness Ratios were calculated for both outc...

  4. A Two-Year Multidisciplinary Training Program for the Frontline Workforce in Community Treatment of Severe Mental Illness. (United States)

    Ruud, Torleif; Flage, Karin Blix; Kolbjørnsrud, Ole-Bjørn; Haugen, Gunnar Brox; Sørlie, Tore


    Since 1999, a national two-year multidisciplinary onsite training program has been in operation in Norway. The program trains frontline workforce personnel who provide community treatment to people with severe mental illness. A national network of mental health workers, consumers, caregivers, and others providing or supporting psychosocial treatment and rehabilitation for people with severe mental illness has organized local onsite part-time training programs in collaboration with community mental health centers (CMHCs), municipalities, and primary care providers. CMHC and primary care staff are trained together to increase collaboration. Nationwide dissemination has continued, with new local programs established every year. Evaluations have shown that the program is successful.

  5. A Partnership between the Dallas County Community College District and Texas Instruments: Using Total Quality Management to Reinvent Workforce Preparation. (United States)

    Wenrich, J. William


    Describes elements of a partnership between Dallas County Community College District and Texas Instruments that draws on the concepts and processes of Total Quality Management (TQM). Suggests that such partnerships have the net effect of significantly improving and reinventing cooperative efforts to prepare students for the workforce. (MAB)

  6. The Crossroads between Workforce and Education. (United States)

    Jackson, Kathryn; Lower, Christi L; Rudman, William J


    Concern is growing among industry leaders that students may not be obtaining the necessary skills for entry into the labor market. To gain an understanding of the perceived disconnect in the skill set of graduates entering the health information workforce, a survey was developed to examine the opinions of educators and employers related to graduate preparedness. The concern related to graduate preparedness is supported by findings in this research study, in which those working in industry and those in academia noted a disconnect between academic training and preparedness to enter the labor market. A statistically significant difference was found between labor leaders and academics in their assessment of graduates' preparation in the areas of technical, communication, and leadership skills. Educators noted higher levels of preparedness of students with regard to professional and technical skills and leadership skills, while both educators and industry respondents noted a need for improved employability skills (e.g., communication skills and workplace etiquette). No difference was found between the two groups with regard to the need to increase apprenticeships and professional practice experience to cover this gap in formal training. Finally, when asked how the federal government might assist with preparing students, more than half of the respondents noted the importance of apprenticeships and funding for these opportunities.

  7. Wind Energy Workforce Development: Engineering, Science, & Technology

    Energy Technology Data Exchange (ETDEWEB)

    Lesieutre, George A.; Stewart, Susan W.; Bridgen, Marc


    Broadly, this project involved the development and delivery of a new curriculum in wind energy engineering at the Pennsylvania State University; this includes enhancement of the Renewable Energy program at the Pennsylvania College of Technology. The new curricula at Penn State includes addition of wind energy-focused material in more than five existing courses in aerospace engineering, mechanical engineering, engineering science and mechanics and energy engineering, as well as three new online graduate courses. The online graduate courses represent a stand-alone Graduate Certificate in Wind Energy, and provide the core of a Wind Energy Option in an online intercollege professional Masters degree in Renewable Energy and Sustainability Systems. The Pennsylvania College of Technology erected a 10 kilowatt Xzeres wind turbine that is dedicated to educating the renewable energy workforce. The entire construction process was incorporated into the Renewable Energy A.A.S. degree program, the Building Science and Sustainable Design B.S. program, and other construction-related coursework throughout the School of Construction and Design Technologies. Follow-on outcomes include additional non-credit opportunities as well as secondary school career readiness events, community outreach activities, and public awareness postings.

  8. Educating the undergraduate nanomanufacturing workforce in the United States (United States)

    Elbadawi, Isam A.

    The National Nanotechnology Initiative (NNI) consensus shows that nanomanufacturing (NM) presents an opportunity for positively influencing the future development of the US economy. In order for this to happen, the outcomes and findings of nano-related research and science need to be effectively translated into innovative products by a qualified NM workforce. An effective workforce capable of handling nanoscale production is also essential to maintaining a competitive advantage in the international market. American universities are developing new ways to address the challenges that the evolution of NM and its emerging use in various industries present in terms of curricular design to the learning content. This study offered a proactive profile of a learning content for a standalone BS in NM in the United States. A BS in NM is defined as a bachelor of science that uses the term NM in a formal degree title. This delineation study aimed at validating and prioritizing the competency areas to be included in the learning content for a standalone BS in NM. The Delphi technique was employed to evaluate the collected data from nano-related programs in five US pioneering universities and to describe what experts from the industry and the academia consider to be important for students to know in order to become qualified in the discipline of NM. A number of experts from different NM-related areas were selected to serve on the Delphi panel. A convergence of opinion on the competency areas provided the basis for validating the body of knowledge for a standalone BS in NM. The study used recommendations made by the Delphi panelists, semi-formal interviews, structured internet searches, and existing nano-related degree programs from the course lists of five universities to identify a potentially appropriate learning content for a BS in NM. The majority of the panelists are directly involved in NM, whether from the academia or the industry. They agreed that a standalone BS in NM

  9. Care-seeking behavior of Japanese gynecological cancer survivors suffering from adverse effects

    Directory of Open Access Journals (Sweden)

    Oshima Sumiko


    Full Text Available Abstract Background Post-treatment follow-up visits for gynecological cancer survivors should provide opportunities for management of adverse physical/psychological effects of therapy and early recurrence detection. However, the adequacy of such visits in Japan is poorly documented. We qualitatively explored care-seeking experiences of Japanese gynecological cancer survivors and deduced factors influencing care-seeking behaviors and treatment access. Methods We conducted 4 semi-structured focus groups comprising altogether 28 Japanese gynecological cancer survivors to collect a variety of participants’ post-treatment care-seeking behaviors through active interaction with participants. Factors influencing access to treatment for adverse effects were analyzed qualitatively. Results Survivors sought care through specialty clinic visits when regular post-treatment gynecological follow-ups were inadequate or when symptoms seemed to be non-treatment related. Information provided by hospital staff during initial treatment influenced patients’ understanding and response to adverse effects. Lack of knowledge and inaccurate symptom interpretation delayed help-seeking, exacerbating symptoms. Gynecologists’ attitudes during follow-ups frequently led survivors to cope with symptoms on their own. Information from mass media, Internet, and support groups helped patients understand symptoms and facilitated care seeking. Conclusions Post-treatment adverse effects are often untreated during follow-up visits. Awareness of possible post-treatment adverse effects is important for gynecological cancer survivors in order to obtain appropriate care if the need arises. Consultation during the follow-up visit is essential for continuity in care.

  10. A technical framework for costing health workforce retention schemes in remote and rural areas

    Directory of Open Access Journals (Sweden)

    Stormont Laura


    Full Text Available Abstract Background Increasing the availability of health workers in remote and rural areas through improved health workforce recruitment and retention is crucial to population health. However, information about the costs of such policy interventions often appears incomplete, fragmented or missing, despite its importance for the sound selection, planning, implementation and evaluation of these policies. This lack of a systematic approach to costing poses a serious challenge for strong health policy decisions. Methods This paper proposes a framework for carrying out a costing analysis of interventions to increase the availability of health workers in rural and remote areas with the aim to help policy decision makers. It also underlines the importance of identifying key sources of financing and of assessing financial sustainability. The paper reviews the evidence on costing interventions to improve health workforce recruitment and retention in remote and rural areas, provides guidance to undertake a costing evaluation of such interventions and investigates the role and importance of costing to inform the broader assessment of how to improve health workforce planning and management. Results We show that while the debate on the effectiveness of policies and strategies to improve health workforce retention is gaining impetus and attention, there is still a significant lack of knowledge and evidence about the associated costs. To address the concerns stemming from this situation, key elements of a framework to undertake a cost analysis are proposed and discussed. Conclusions These key elements should help policy makers gain insight into the costs of policy interventions, to clearly identify and understand their financing sources and mechanisms, and to ensure their sustainability.

  11. A role for workforce competencies in evidence-based health promotion education. (United States)

    Talbot, Lyn; Graham, Melissa; James, Erica L


    Education programs should be based on research about the knowledge and skills required for practice, rather than on intuition or tradition, but there is limited published curriculum research on health promotion education. This paper describes a case study of how workforce competencies have been used to assist evidence-based health promotion education in the areas of curriculum design, selection of assessment tasks and continuous quality assurance processes in an undergraduate program at an Australian university. A curriculum-competency mapping process successfully identified gaps and areas of overlap in an existing program. Previously published health promotion workforce competencies were effectively used in the process of selecting assessment items, providing clear guidelines for curriculum revision and a useful method to objectively assess competency content in an evidence informed framework. These health promotion workforce competencies constituted an additional tool to assess course quality. We recommend other tertiary institutions consider curriculum-competency mapping and curriculum based assessment selection as quality and evidence based curriculum review strategies.

  12. Child Care and Development Fund (CCDF) Program. Final rule. (United States)


    This final rule makes regulatory changes to the Child Care and Development Fund (CCDF) based on the Child Care and Development Block Grant Act of 2014. These changes strengthen requirements to protect the health and safety of children in child care; help parents make informed consumer choices and access information to support child development; provide equal access to stable, high-quality child care for low-income children; and enhance the quality of child care and the early childhood workforce.

  13. Effect of healing touch training on self-care awareness in nurses (United States)

    Black, Pegi

    Nursing focuses on supporting clients' health and health behaviors; however, they tend to exhibit unproductive behaviors when it comes to caring for themselves. As nurses' self-neglect can undermine client care, supporting nurses' self-care practices are expected to translate into clients' self-care. Healing Touch (HT) is one option for supporting nurses' self-care, as it is an accepted nursing practice and studies suggest that HT may have beneficial effects for those delivering it. This study examined the impact of a 2-day HT training on awareness of the need for self-care in nurses. HT training was offered as continuing education for 45 nurses at a Veteran's Administration hospital in Long Beach, CA. This mixed-methods study used a pre/post-test design to measure the effects of HT Level 1 training on nurses' self-care self-awareness. Independent samples t-tests and analyses of variance were used to detect whether any significant differences emerged based on participant demographic data. Data were analyzed using paired t-tests to determine whether participants' self-awareness changed over the study period. Effect size for any differences were calculated using Cohen's d. Open-ended responses were reviewed and common themes were identified related to what participants believed they learned and how it affected their care for themselves and their clients. Two increases were found to be significant and of sufficient power when comparing pre- to delayed post-test scores: physical self-care awareness (mean difference = 0.956, t(44) = 5.085, p = .000, r = .61) and professional self-care awareness (mean difference = .955, t(43) = 5.277, p = .000, r = .63). Qualitative findings suggested that changes in their awareness, self-directed practices, and patient care practices are anticipated, evident, and sustained based upon themes across the three tests. Nurses are advised to take a course that teaches specific self-care techniques and strategies and continue practicing

  14. What are the current barriers to effective cancer care coordination? A qualitative study

    Directory of Open Access Journals (Sweden)

    Solomon Michael J


    Full Text Available Abstract Background National cancer policies identify the improvement of care coordination as a priority to improve the delivery of health services for people with cancer. Identification of the current barriers to effective cancer care coordination is needed to drive service improvement. Methods A qualitative study was undertaken in which semi-structured individual interviews and focus groups were conducted with those best placed to identify issues; patients who had been treated for a range of cancers and their carers as well as health professionals involved in providing cancer care. Data collection continued until saturation of concepts was reached. A grounded theory influenced approach was used to explore the participants' experiences and views of cancer care coordination. Results Overall, 20 patients, four carers and 29 health professionals participated. Barriers to cancer care coordination related to six aspects of care namely, recognising health professional roles and responsibilities, implementing comprehensive multidisciplinary team meetings, transitioning of care: falling through the cracks, inadequate communication between specialist and primary care, inequitable access to health services and managing scarce resources. Conclusions This study has identified a number of barriers to coordination of cancer care. Development and evaluation of interventions based on these findings is now required.

  15. Aligning health information technologies with effective service delivery models to improve chronic disease care (United States)

    Bauer, Amy M.; Thielke, Stephen M.; Katon, Wayne; Unützer, Jürgen; Areán, Patricia


    Objective Healthcare reforms in the United States, including the Affordable Care and HITECH Acts, and the NCQA criteria for the Patient Centered Medical Home have promoted health information technology (HIT) and the integration of general medical and mental health services. These developments, which aim to improve chronic disease care have largely occurred in parallel, with little attention to the need for coordination. In this article, the fundamental connections between HIT and improvements in chronic disease management are explored. We use the evidence-based collaborative care model as an example, with attention to health literacy improvement for supporting patient engagement in care. Method A review of the literature was conducted to identify how HIT and collaborative care, an evidence-based model of chronic disease care, support each other. Results Five key principles of effective collaborative care are outlined: care is patient-centered, evidence-based, measurement-based, population-based, and accountable. The potential role of HIT in implementing each principle is discussed. Key features of the mobile health paradigm are described, including how they can extend evidence-based treatment beyond traditional clinical settings. Conclusion HIT, and particularly mobile health, can enhance collaborative care interventions, and thus improve the health of individuals and populations when deployed in integrated delivery systems. PMID:24963895

  16. The effects of hospice-shared care for gastric cancer patients (United States)

    Huang, Kun-Siang; Wang, Shih-Ho; Chuah, Seng-Kee; Rau, Kun-Ming; Lin, Yu-Hung; Hsieh, Meng-Che; Shih, Li-Hsueh; Chen, Yen-Hao


    Background Hospice care has been proved to result in changes to the medical behaviors of terminally ill patients. The aim of this study was to evaluate the effects and medical behavior changes of hospice-shared care intervention among terminally ill gastric cancer patients. Methods A total of 174 patients who died of gastric cancer between 2012 and 2014 were identified. These patients were divided into two groups: a hospice-shared care group (n = 93) and a control group (n = 81). Results Among the 174 patients, 84% had advanced stage (stage III or stage IV) cancer. The females and the patients cared by medical oncologists had a higher percentage of hospice-shared care than the males (71% vs 44%, p = 0.001) and those cared by other physicians (63% vs 41%, p = 0.004). Compared to the control group, the hospice-shared care group underwent lower incidence of life sustaining or aggressive medical treatments, including intensive care unit admission (2% vs 26%, phospice-shared care group had a higher percentage of palliative treatments than the control group, including signed Do-Not-Resuscitate (DNR) orders (95% vs 37%, phospice care (16% vs 1%, phospice ward admission rate in the hospice-shared care group increased from 30% to 53% from 2012 to 2014. Conclusion The use of hospice-shared care for gastric cancer patients could increase the rate of signed DNR orders, decrease the use of life sustaining and aggressive/palliative treatments, and improve quality of life. PMID:28158232

  17. Improving the effectiveness of health care innovation implementation: middle managers as change agents. (United States)

    Birken, Sarah A; Lee, Shoou-Yih Daniel; Weiner, Bryan J; Chin, Marshall H; Schaefer, Cynthia T


    The rate of successful health care innovation implementation is dismal. Middle managers have a potentially important yet poorly understood role in health care innovation implementation. This study used self-administered surveys and interviews of middle managers in health centers that implemented an innovation to reduce health disparities to address the questions: Does middle managers' commitment to health care innovation implementation influence implementation effectiveness? If so, in what ways does their commitment influence implementation effectiveness? Although quantitative survey data analysis results suggest a weak relationship, qualitative interview data analysis results indicate that middle managers' commitment influences implementation effectiveness when middle managers are proactive. Scholars should account for middle managers' influence in implementation research, and health care executives may promote implementation effectiveness by hiring proactive middle managers and creating climates in which proactivity is rewarded, supported, and expected.

  18. Learning effects of thematic peer-review: A qualitative analysis of reflective journals on spiritual care

    NARCIS (Netherlands)

    Leeuwen, van L.J.; Tiesinga, L.J.; Jochemsen, H.


    This study describes the learning effects of thematic peer-review discussion groups (Hendriksen, 2000. Begeleid intervisie model, Collegiale advisering en probleemoplossing, Nelissen, Baarn.) on developing nursing students’ competence in providing spiritual care. It also discusses the factors that m

  19. Perceptions of team workers in youth care of what makes teamwork effective. (United States)

    Buljac-Samardzic, M; van Wijngaarden, J D H; van Wijk, K P; van Exel, N J A


    In youth care, little is known about what makes teamwork effective. What is known mostly reflects the view of managers in care organisations, as objective outcome measures are lacking. The objective of this article was to explore the views of youth care workers in different types of teams on the relative importance of characteristics of teamwork for its effectiveness. Q methodology was used. Fifty-one respondents rank-order 34 opinion statements regarding characteristics of teamwork. Individual Q sorts were analysed using by-person factor analysis. The resulting factors, which represented team workers' views of what is important for effective teamwork, were interpreted and described using composite rankings of the statements for each factor and corresponding team workers' explanations. We found three views of what makes teamwork effective. One view emphasised interaction between team members as most important for team effectiveness. A second view pointed to team characteristics that help sustain communication within teams as being most important. In the third view, the team characteristics that facilitate individuals to perform as a team member were put forward as most important for teamwork to be effective. In conclusion, different views exist on what makes a team effective in youth care. These views correspond with the different types of teams active in youth care as well as in other social care settings.

  20. Strategic information technology alliances for effective health-care supply chain management. (United States)

    Shih, Stephen C; Rivers, Patrick A; Hsu, H Y Sonya


    To gain and sustain competitive advantage, health-care providers have to continuously review and renovate their operational and information technology (IT) strategies through collaborative and cooperative endeavour with their supply chain channel members. This paper explores new ways of enhancing a health-care organization's responsiveness to changes and increasing its competitiveness through implementing strategic information technology alliances among channel members in a health-care supply chain network. An overview of issues and problems (e.g. bullwhip effect, negative externalities and free-riding phenomenon in multichannel supply chains) presented in the health-care supply chains is first delineated. This paper further goes over the issues of health-care supply chain coordination and integration for strategic IT alliances, followed by the discussion of the spillover effect of IT investments. A number of viable IT practices (such as information sharing and Internet-enabled supply chain portal) for effective health-care supply chain collaboration and coordination are then examined in this research. Finally, the paper discusses how strategic IT alliances can help improve the effectiveness of health-care supply chain management.

  1. Comparative effectiveness of group and individual prenatal care on gestational weight gain. (United States)

    Tanner-Smith, Emily E; Steinka-Fry, Katarzyna T; Gesell, Sabina B


    This study examined differences in gestational weight gain for women in CenteringPregnancy (CP) group prenatal care versus individually delivered prenatal care. We conducted a retrospective chart review and used propensity scores to form a matched sample of 393 women (76 % African-American, 13 % Latina, 11 % White; average age 22 years) receiving prenatal care at a community health center in the South. Women were matched on a wide range of demographic and medical background characteristics. Compared to the matched group of women receiving standard individual prenatal care, CP participants were less likely to have excessive gestational weight gain, regardless of their pre-pregnancy weight (b = -.99, 95 % CI [-1.92, -.06], RRR = .37). CP reduced the risk of excessive weight gain during pregnancy to 54 % of what it would have been in the standard model of prenatal care (NNT = 5). The beneficial effect of CP was largest for women who were overweight or obese prior to their pregnancy. Effects did not vary by gestational age at delivery. Post-hoc analyses provided no evidence of adverse effects on newborn birth weight outcomes. Group prenatal care had statistically and clinically significant beneficial effects on reducing excessive gestational weight gain relative to traditional individual prenatal care.

  2. Effects of different broiler production systems on health care costs in the Netherlands. (United States)

    Gocsik, É; Kortes, H E; Lansink, A G J M Oude; Saatkamp, H W


    This study analyzed the effects of different broiler production systems on health care costs in the Netherlands. In addition to the conventional production system, the analysis also included 5 alternative animal welfare systems representative of the Netherlands. The study was limited to the most prevalent and economically relevant endemic diseases in the broiler farms. Health care costs consisted of losses and expenditures. The study investigated whether higher animal welfare standards increased health care costs, in both absolute and relative terms, and also examined which cost components (losses or expenditures) were affected and, if so, to what extent. The results show that health care costs represent only a small proportion of total production costs in each production system. Losses account for the major part of health care costs, which makes it difficult to detect the actual effect of diseases on total health care costs. We conclude that, although differences in health care costs exist across production systems, health care costs only make a minor contribution to the total production costs relative to other costs, such as feed costs and purchase of 1-d-old chicks.

  3. The effectiveness of structured personal care of type 2 diabetes on recurrent outcomes

    DEFF Research Database (Denmark)

    Lundström, Hanna; Siersma, Volkert; Nielsen, Anni B Sternhagen;


    controlled trial, 1,381 patients newly diagnosed with type 2 diabetes were randomised to 6 years of structured personal care or routine care ( NCT01074762). The trial had 19 years of registry-based follow-up and was analysed with Cox regression models. Repeated occurrences in the same......AIMS/HYPOTHESIS: The estimation of effect size in clinical trials commonly disregards recurrent outcomes. We investigated the effectiveness of a complex intervention on recurrent outcomes in patients with type 2 diabetes. METHODS: In the Diabetes Care in General Practice (DCGP) randomised...

  4. The effect of medical treatment of attention deficit hyperactivity disorder (ADHD) on foster care caseloads

    DEFF Research Database (Denmark)

    Fallesen, Peter; Wildeman, Christopher


    = 157,938) in the period from 1998 to 2010 to show that increasing medical treatment of attention deficit hyperactivity disorder (ADHD) accounts for a substantial share of the decrease in foster care caseloads. According to our estimates, the decline in foster care caseloads during this period would...... have been 45% smaller absent increases in medical treatment of ADHD. These findings are especially provocative in light of recent research showing ambiguous effects of medical treatment of ADHD. Future research should be attentive to how medical treatment aimed at addressing children’s acute behavioral...... problems could also have a powerful effect on foster care caseloads....

  5. Effectiveness of service linkages in primary mental health care: a narrative review part 1


    Parker Sharon; Holdsworth Louise; Perkins David; Fuller Jeffrey D; Kelly Brian; Roberts Russell; Martinez Lee; Fragar Lyn


    Abstract Background With the move to community care and increased involvement of generalist health care providers in mental health, the need for health service partnerships has been emphasised in mental health policy. Within existing health system structures the active strategies that facilitate effective partnership linkages are not clear. The objective of this study was to examine the evidence from peer reviewed literature regarding the effectiveness of service linkages in primary mental he...

  6. Cost-effectiveness of cognitive behaviour therapy versus talking and usual care for depressed older people in primary care

    Directory of Open Access Journals (Sweden)

    Leurent Baptiste E


    Full Text Available Abstract Background Whilst evidence suggests cognitive behaviour therapy (CBT may be effective for depressed older people in a primary care setting, few studies have examined its cost-effectiveness. The aim of this study was to compare the cost-effectiveness of cognitive behaviour therapy (CBT, a talking control (TC and treatment as usual (TAU, delivered in a primary care setting, for older people with depression. Methods Cost data generated from a single blind randomised controlled trial of 204 people aged 65 years or more were offered only Treatment as Usual, or TAU plus up to twelve sessions of CBT or a talking control is presented. The Beck Depression Inventory II (BDI-II was the main outcome measure for depression. Direct treatment costs were compared with reductions in depression scores. Cost-effectiveness analysis was conducted using non-parametric bootstrapping. The primary analysis focussed on the cost-effectiveness of CBT compared with TAU at 10 months follow up. Results Complete cost data were available for 198 patients at 4 and 10 month follow up. There were no significant differences between groups in baseline costs. The majority of health service contacts at follow up were made with general practitioners. Fewer contacts with mental health services were recorded in patients allocated to CBT, though these differences were not significant. Overall total per patient costs (including intervention costs were significantly higher in the CBT group compared with the TAU group at 10 month follow up (difference £427, 95% CI: £56 - £787, p Conclusions CBT is significantly more costly than TAU alone or TAU plus TC, but more clinically effective. Based on current estimates, CBT is likely to be recommended as a cost-effective treatment option for this patient group if the value placed on a unit reduction in BDI-II is greater than £115. Trial Registration Identifier: ISRCTN18271323

  7. The effect of clothing care activities on textile formaldehyde content. (United States)

    Novick, Rachel M; Nelson, Mindy L; McKinley, Meg A; Anderson, Grace L; Keenan, James J


    Textiles are commonly treated with formaldehyde-based residues that may potentially induce allergic contact dermatitis in sensitive individuals. This study examined the initial formaldehyde content in clothing and resulting changes due to care activities. Twenty clothing articles were examined and 17 of them did not have detectable levels of formaldehyde. One shirt contained a formaldehyde concentration of 3172 ppm, and two pairs of pants had formaldehyde concentrations of 1391 ppm and 86 ppm. The two highest results represent formaldehyde levels that are up to 40-fold greater than international textile regulations. The two items with the greatest formaldehyde content were washed and dried in a manner similar to that used by consumers, including hand and machine washing in hot or cold water followed by air or machine drying. The washing and drying procedures reduced formaldehyde levels to between 26 and 72% of untreated controls. Differences in the temperature or type of washing and drying did not result in a clear trend in the subsequent formaldehyde content. In addition, samples were hot ironed, which did not affect the formaldehyde content as significantly. Understanding the formaldehyde content in clothing and its potential reduction through care activities may be useful for manufacturers and formaldehyde-sensitive individuals.

  8. CARES: Carbonaceous Aerosol and Radiative Effects Study Operations Plan

    Energy Technology Data Exchange (ETDEWEB)

    Zaveri, RA; Shaw, WJ; Cziczo, DJ


    The CARES field campaign is motivated by the scientific issues described in the CARES Science Plan. The primary objectives of this field campaign are to investigate the evolution and aging of carbonaceous aerosols and their climate-affecting properties in the urban plume of Sacramento, California, a mid-size, mid-latitude city that is located upwind of a biogenic volatile organic compound (VOC) emission region. Our basic observational strategy is to make comprehensive gas, aerosol, and meteorological measurements upwind, within, and downwind of the urban area with the DOE G-1 aircraft and at strategically located ground sites so as to study the evolution of urban aerosols as they age and mix with biogenic SOA precursors. The NASA B-200 aircraft, equipped with the High Spectral Resolution Lidar (HSRL), digital camera, and the Research Scanning Polarimeter (RSP), will be flown in coordination with the G-1 to characterize the vertical and horizontal distribution of aerosols and aerosol optical properties, and to provide the vertical context for the G-1 and ground in situ measurements.

  9. Attitudes towards older people among Swedish health care students and health care professionals working in elder care

    Directory of Open Access Journals (Sweden)

    Gabriella Engström


    Full Text Available The proportion of older people in the general population has increased and will continue to increase during the coming decade. Therefore, a positive attitude towards older people is important. The aim of the study was to gain knowledge about attitudes towards older people among health care students and health care staff in Swedish elder care settings. The study includes a convenience sample of 928 respondents comprised of health care students and three groups of professional caregivers [registered nurses (RNs with university degrees, certified nursing assistants (CNAs, nurses] in a variety of health care settings in Sweden. The participants completed the Kogan’s Old People (KOPS Scale with 17 positive (OP+ and 17 negative (OP– statements. The statements score ranged from 17 to 85 respectively. A significant (P<0.05 difference in both positive and negative scores was observed among the three professional caregiver groups. RNs had the highest positive score (OP+:64 as well as the lowest negative score (OP–:36. Health care students in semester one had the most unfavourable attitude toward older people (OP–:41 while students in semester two had the most favourable attitude toward older people (OP+:62. RNs reported both a higher positive score as well as lower negative score compared to nurses without an academic degree and CNAs. In addition, we found that progression in one’s health care education contributes to reduce unfavourable attitudes toward older people. Health care professionals need to have the right skills to manage a more demanding role in the future in order to offer effective services for older people. A skilled workforce of health professionals is therefore very necessary.

  10. Pensions, tax and the anaesthetist: significant implications for workforce planning. (United States)

    Pandit, J J


    This paper shows how recent tax changes to pensions (i.e. new lifetime and annual allowance contribution limits) mean that NHS consultants will need to adopt one of four rational strategies to work and financial planning. Two of those strategies (termed 'Earn Fast, Drop Out' and 'Never Enter') involve a break between work and pensions. The logical consequence of this break is that consultants may exercise options to maximise their total income, which in turn will result in less work within the NHS and more work in alternative higher paying (e.g. private) sectors. A third strategy ('Go Slow, Stay Low') also involves less-than-full-time NHS work. Only one option ('Do Nothing' as a result of the tax changes) has no effect. In short, the tax changes will predictably lead to future senior consultants devoting proportionately much less of their time to NHS work than before. The article discusses the important implications of this conclusion for NHS workforce planning.

  11. Caring for dying patients: Attitude of nursing students and effects of education

    Directory of Open Access Journals (Sweden)

    Mojtaba Jafari


    Full Text Available Background: Education about caring for dying patients could be effective in changing nursing students′ attitude toward caring for dying patients. Aim: The aim of the present study was to examine the nursing students′ attitude toward caring for dying patients and effects of education on their attitude. Materials and Methods: The present study enjoys a quasi-experimental method with using one-group pre-test/post-test design conducted in Bam in southeast of Iran. The attitude of nursing students was measured using Frommelt Attitude Toward Care of the Dying (FATCOD scale before and after an educational intervention. Data were analyzed using non-parametric tests in Statistical Package for the Social Sciences (SPSS 18 software. Results: Of 32 students, 30 participated in this study (response rate of 94%. Only 20% of the students reported previous experience of dying patients in their clinical courses. Students showed moderately negative to neutral attitudes toward caring for dying patients. Education has improved students′ attitude significantly (mean score of FATCOD before study were 3.5 ± 0.43 and after intervention were 4.7 ± 0.33 ( P < 0.001. Conclusion: Educational programs about death and caring for dying patients should be added to undergraduate nursing curricula. Further research recommended examining nursing students′ knowledge about caring for dying patients and the effect of education on their knowledge.

  12. The 'ripple effect': Towards researching improvisational music therapy in dementia care homes. (United States)

    Pavlicevic, Mercédès; Tsiris, Giorgos; Wood, Stuart; Powell, Harriet; Graham, Janet; Sanderson, Richard; Millman, Rachel; Gibson, Jane


    Increased interest in, and demand for, music therapy provision for persons with dementia prompted this study's exploration of music therapists' strategies for creating musical communities in dementia care settings, considering the needs and resources of people affected by dementia. Focus group discussions and detailed iterative study of improvisational music therapy work by six experienced practitioners clarify the contextual immediacy and socio-musical complexities of music therapy in dementia care homes. Music therapy's 'ripple effect', with resonances from micro (person-to-person musicking), to meso (musicking beyond 'session time') and macro level (within the care home and beyond), implies that all who are part of the dementia care ecology need opportunities for flourishing, shared participation, and for expanded self-identities; beyond 'staff', 'residents', or 'being in distress'. On such basis, managers and funders might consider an extended brief for music therapists' roles, to include generating and maintaining musical wellbeing throughout residential care settings.

  13. Seeing is believing - reducing misconceptions about children's hospice care through effective teaching with undergraduate nursing students. (United States)

    Price, Jayne; Dornan, Jean; Quail, Lorraine


    Children's palliative care has evolved in recent years and is now recognised as a distinct area of health and social care practice. Whilst children's hospices are viewed as central to quality care for these children and families, lack of knowledge regarding the exact nature of care they provide exists. Education can go part way to changing attitudes and knowledge about the key contribution of hospices, thus improving future care. Alternative and innovative strategies to stimulate meaningful learning are pivotal to children's nurse education and this paper examines one such innovation adopted with 2nd year children's nursing students. Aiming to help students explore the ethos of children's hospice an educational visit was arranged, followed by an on line discussion. Although some practical challenges were encountered, the visit heightened student awareness moving them from the readily held perception that children's hospices were exclusively for dying children and was viewed by students as more effective than a traditional classroom session.

  14. What are the effective ways to translate clinical leadership into health care quality improvement?

    Directory of Open Access Journals (Sweden)

    McSherry R


    Full Text Available Robert McSherry,1 Paddy Pearce2 1School of Health and Social Care, University of Teesside, Middlesbrough, 2PKP Consulting, Yarm, United Kingdom Abstract: The presence and/or absence of effective leaders in health care can have a stark consequence on the quality and outcomes of care. The delivery of safe, quality, compassionate health care is dependent on having effective clinical leaders at the frontline. In light of the Kirkup and Francis reports, this article explores some ways of translating clinical leadership into health care quality improvement. This is achieved by exploring what is clinical leadership and why and how this is important to health care quality improvement, clinical leadership, and a duty of candor, along with the importance clinical leadership plays in the provision of quality care improvement and outcomes. Clinical leaders are not predefined roles but emerge from the complex clinical setting by gaining an acquired expertise and from how they then internalize this to develop and facilitate sound relationships within a team. Clinical leaders are effective in facilitating innovation and change through improvement. This is achieved by recognizing, influencing, and empowering individuals through effective communication in order to share and learn from and with each other in practice. The challenge for health care organizations in regard to creating organizational cultures where a duty of candor exists is not to reinvent the wheel by turning something that is simple into something complex, which can become confusing to health care workers, patients, and the public. By focusing on the clinical leader's role and responsibilities we would argue they play a crucial and pivotal role in influencing, facilitating, supporting, and monitoring that this duty of candor happens in practice. This may be possible by highlighting where and how the duty of candor can be aligned within existing clinical governance frameworks. Keywords: governance

  15. Educational Attainment of the Public Health Workforce and Its Implications for Workforce Development (United States)

    Leider, Jonathon P.; Harper, Elizabeth; Bharthapudi, Kiran; Castrucci, Brian C.


    Context: Educational attainment is a critical issue in public health workforce development. However, relatively little is known about the actual attainment of staff in state health agencies (SHAs). Objective: Ascertain the levels of educational attainment among SHA employees, as well as the correlates of attainment. Design: Using a stratified sampling approaching, staff from SHAs were surveyed using the Public Health Workforce Interests and Needs Survey (PH WINS) instrument in late 2014. A nationally representative sample was drawn across 5 geographic (paired adjacent HHS) regions. Descriptive and inferential statistics were analyzed using balanced repeated replication weights to account for complex sampling. A logistic regression was conducted with attainment of a bachelor's degree as the dependent variable and age, region, supervisory status, race/ethnicity, gender, and staff type as independent variables. Setting and Participants: Web-based survey of SHA central office employees. Main Outcome Measure: Educational attainment overall, as well as receipt of a degree with a major in public health. Results: A total of 10 246 permanently-employed SHA central office staff participated in the survey (response rate 46%). Seventy-five percent (95% confidence interval [CI], 74-77) had a bachelor's degree, 38% (95% CI, 37-40) had a master's degree, and 9% (95% CI, 8%-10%) had a doctoral degree. A logistic regression showed Asian staff had the highest odds of having a bachelor's degree (odds ratio [OR] = 2.8; 95% CI, 2.2-3.7) compared with non-Hispanic whites, and Hispanic/Latino staff had lower odds (OR = 0.6; 95% CI, 0.4-0.8). Women had lower odds of having a bachelor's degree than men (OR = 0.5; 95% CI, 0.4-0.6). About 17% of the workforce (95% CI, 16-18) had a degree in public health at any level. Conclusions: Educational attainment among SHA central office staff is high, but relatively few have formal training of any sort in public health. This makes efforts to increase

  16. Effectiveness of an Interdisciplinary Palliative Care Intervention for Family Caregivers in Lung Cancer (United States)

    Sun, Virginia; Grant, Marcia; Koczywas, Marianna; Freeman, Bonnie; Zachariah, Finly; Fujinami, Rebecca; Del Ferraro, Catherine; Uman, Gwen; Ferrell, Betty


    Background Family caregivers (FCGs) experience significant deteriorations in quality of life while caring for lung cancer patients. This study tested the effectiveness of an interdisciplinary palliative care intervention for FCGs of patients diagnosed with stage I–IV non-small cell lung cancer (NSCLC). Methods FCGs who were identified by patients as the primary caregiver were enrolled in a prospective, quasi-experimental study whereby the usual care group was accrued first followed by the intervention group. FCGs in the intervention group were presented at interdisciplinary care meetings, and they also received four educational sessions organized in the physical, psychological, social, and spiritual domains. The sessions included self-care plans to support the FCG’s own needs. Caregiver burden, caregiving skills preparedness, psychological distress, and FCG QOL were assessed at baseline and 12 weeks using validated measures. Results A total of 366 FCGs were included in the primary analysis. FCGs who received the interdisciplinary palliative care intervention had significantly better scores for social well-being (5.84 vs. 6.86; pcaregiver burden compared to FCGs in the usual care group (p=.008). Conclusions An interdisciplinary approach to palliative care in lung cancer resulted in statistically significant improvements in the FCG’s social well-being, psychological distress, and less caregiver burden. PMID:26150131

  17. Teaching excellence in nursing education: a caring framework. (United States)

    Sawatzky, Jo-Ann V; Enns, Carol L; Ashcroft, Terri J; Davis, Penny L; Harder, B Nicole


    Nursing education plays a central role in the ability to practice effectively. It follows that an optimally educated nursing workforce begets optimal patient care. A framework for excellence in nursing education could guide the development of novice educators, establish the basis for evaluating teaching excellence, and provide the impetus for research in this area. However, a review of the social sciences and nursing literature as well as a search for existing models for teaching excellence revealed an apparent dearth of evidence specific to excellence in nursing education. Therefore, we developed the Caring Framework for Excellence in Nursing Education. This framework evolved from a review of the generic constructs that exemplify teaching excellence: excellence in teaching practice, teaching scholarship, and teaching leadership. Nursing is grounded in the ethic of caring. Hence, caring establishes the foundation for this uniquely nursing framework. Because a teaching philosophy is intimately intertwined with one's nursing philosophy and the ethic of caring, it is also fundamental to the caring framework. Ideally, this framework will contribute to excellence in nursing education and as a consequence excellence in nursing practice and optimal patient care.

  18. Sequential Antibiotic Therapy: Effective Cost Management and Patient Care

    Directory of Open Access Journals (Sweden)

    Lionel A Mandell


    Full Text Available The escalating costs associated with antimicrobial chemotherapy have become of increasing concern to physicians, pharmacists and patients alike. A number of strategies have been developed to address this problem. This article focuses specifically on sequential antibiotic therapy (sat, which is the strategy of converting patients from intravenous to oral medication regardless of whether the same or a different class of drug is used. Advantages of sat include economic benefits, patient benefits and benefits to the health care provider. Potential disadvantages are cost to the consumer and the risk of therapeutic failure. A critical review of the published literature shows that evidence from randomized controlled trials supports the role of sat. However, it is also clear that further studies are necessary to determine the optimal time for intravenous to oral changeover and to identify the variables that may interfere with the use of oral drugs. Procedures necessary for the implementation of a sat program in the hospital setting are also discussed.

  19. Socially assistive robots in elderly care: a systematic review into effects and effectiveness. (United States)

    Bemelmans, Roger; Gelderblom, Gert Jan; Jonker, Pieter; de Witte, Luc


    The ongoing development of robotics on the one hand and, on the other hand, the foreseen relative growth in number of elderly individuals suffering from dementia, raises the question of which contribution robotics could have to rationalize and maintain, or even improve the quality of care. The objective of this review was to assess the published effects and effectiveness of robot interventions aiming at social assistance in elderly care. We searched, using Medical Subject Headings terms and free words, in the CINAHL, MEDLINE, Cochrane, BIOMED, PUBMED, PsycINFO, and EMBASE databases. Also the IEEE Digital Library was searched. No limitations were applied for the date of publication. Only articles written in English were taken into account. Collected publications went through a selection process. In the first step, publications were collected from major databases using a search query. In the second step, 3 reviewers independently selected publications on their title, using predefined selection criteria. In the third step, publications were judged based on their abstracts by the same reviewers, using the same selection criteria. In the fourth step, one reviewer made the final selection of publications based on complete content. Finally, 41 publications were included in the review, describing 17 studies involving 4 robot systems. Most studies reported positive effects of companion-type robots on (socio)psychological (eg, mood, loneliness, and social connections and communication) and physiological (eg, stress reduction) parameters. The methodological quality of the studies was, mostly, low. Although positive effects were reported, the scientific value of the evidence was limited. The positive results described, however, prompt further effectiveness research in this field.

  20. Sustainability and the Tourism and Hospitality Workforce: A Thematic Analysis

    Directory of Open Access Journals (Sweden)

    Tom Baum


    Full Text Available This paper is about the position of workforce and employment considerations within the sustainable tourism narrative. The paper aims to address the relative neglect of this area within the discourse of sustainable tourism and highlights references to the workforce within the United Nations’ 2030 Agenda for Sustainable Development. The discussion follows the emerging field of sustainable human resource management and the contribution that this can make to meeting both the UN Sustainable Development Goals and to enhancing the recognition of workforce and employment issues within the related debate in tourism. The body of the paper highlights examples of key dimensions of work and employment across varied tourism contexts, where sustainability is of increasing consequence and significance. The paper concludes by drawing together the implications of these “mini-cases” and locating them within key principles of the 2030 Agenda for Sustainable Development.

  1. Culture change, leadership and the grass-roots workforce. (United States)

    Edwards, Mark; Penlington, Clare; Kalidasan, Varadarajan; Kelly, Tony


    The NHS is arguably entering its most challenging era. It is being asked to do more for less and, in parallel, a cultural shift in response to its described weaknesses has been prescribed. The definition of culture, the form this change should take and the mechanism to achieve it are not well understood. The complexity of modern healthcare requires that we evolve our approach to the workforce and enhance our understanding of the styles of leadership that are required in order to bring about this cultural change. Identification of leaders within the workforce and dissemination of a purposeful and strategic quality improvement agenda, in part defined by the general workforce, are important components in establishing the change that the organisation currently requires. We are implementing this approach locally by identifying and developing grassroots networks linked to a portfolio of safety and quality projects.

  2. Optimum Production Control and Workforce Scheduling of Machining Project (United States)

    Lan, Tian-Syung; Lo, Chih-Yao; Hou, Cheng-I.

    Through the proposed model in this study, the production control with the consideration of workforce scheduling for advanced manufacturing systems becomes realistically and concretely solvable. This study not only meditates the concept of balancing machine productivity and human ability into the objective, but also implements Calculus of Variations to optimize the profit for a deterministic production quantity. In addition, the optimum solutions of dynamic productivity control and workforce scheduling are comprehensively provided. Moreover, the decision criteria for selecting the optimum solution and the sensitivity analysis of the critical variables are fully discussed. This study definitely contributes the applicable strategy to control the productivity and workforce in manufacturing and provides the valuable tool to conclusively optimize the profit of a machining project for operations research in today`s manufacturing industry with profound insight.

  3. What is the place of interprofessional education in supporting the continuum of care for patients?

    Directory of Open Access Journals (Sweden)

    Annette Solman


    Full Text Available Advances in science and technology mean more people are living longer, resulting in multimorbidity and increasingly complex presentations later in life. People require healthcare that may include hospital admission, community-based care, social care and private healthcare input to support integrated person-centred healthcare. The aim of integrated care is to improve the quality of care and patient outcomes, so interprofessional education is on today’s health agenda and research is required to establish how best to structure it in the undergraduate setting and for the existing workforce that provides healthcare and supportive services. Interprofessional education occurs when healthcare professionals from two or more disciplines learn about, from and with each other to promote effective collaboration and improve health outcomes (World Health Organization, 2010. The WHO has issued a call to action for undergraduate studies to include interprofessional learning, and to create a suitable workforce, a two-pronged approach is required. First, the inclusion of selected shared-subject learning across undergraduate education programmes, for example in communication and social sciences, and second, a focus on what the existing healthcare workforce requires to be able to work and learn in an interprofessional way across government and non-government agencies to achieve the best outcomes. The development of existing staff requires educational material and experiences that reflect their everyday practice and patient journeys. Such an approach will enable the building of links between the different agencies that support healthcare, and the creation of patient-centred healthcare systems within and across traditional healthcare boundaries.

  4. Developing Secure Power Systems Professional Competence: Alignment and Gaps in Workforce Development Programs—Summary Report

    Energy Technology Data Exchange (ETDEWEB)

    O' Neil, Lori Ross; Assante, Michael; Tobey, D. H.; Conway, T. J.; Vanderhorst, Jr, T. J.; Januszewski, III, J.; Leo, R.; Perman, K.


    This document is a summarization of the report, Developing Secure Power Systems Professional Competence: Alignment and Gaps in Workforce Development Programs, the final report for phase 2 of the SPSP (DOE workforce study) project.

  5. Effect of virtual reality on adolescent pain during burn wound care. (United States)

    Jeffs, Debra; Dorman, Dona; Brown, Susan; Files, Amber; Graves, Tamara; Kirk, Elizabeth; Meredith-Neve, Sandra; Sanders, Janise; White, Benjamin; Swearingen, Christopher J


    The objective of this study was to compare the effect of virtual reality to passive distraction and standard care on burn treatment pain in adolescents.This single-blinded, randomized controlled study enrolled 30 adolescents who were 10 to 17 years of age from the burn clinic of a large children's hospital. After providing informed consent/assent, these participants were randomly assigned to one of three groups during wound care: standard care, passive distraction watching a movie, or virtual reality (VR) using a tripod-arm device rather than an immersive helmet. Before wound care, participants completed the Spielberger's State-Trait Anxiety Inventory for Children and Pre-Procedure Questionnaire while blinded to group assignment. A total of 28 participants completed the study and rated treatment pain after wound care by using the Adolescent Pediatric Pain Tool and completed a Post-Procedure Questionnaire. The VR group reported less pain during wound care than either the passive distraction or standard care group as determined by multivariable linear regression adjusted for age, sex, preprocedure pain, state anxiety, opiate use, and treatment length. The VR group was the only group to have an estimated decrease in pain perception from baseline preprocedure pain to procedural pain reported. Adolescents pretreated with opiate analgesics and female adolescents reported more pain during wound care.This between-subjects clinical study provides further support for VR, even without requiring wearing of an immersive helmet, in lessening burn wound care pain in adolescents. Passive distraction by watching a movie may be less effective in reducing treatment pain. Additional between-subjects randomized controlled trials with larger samples of children and during other healthcare treatments may further support VR's effectiveness in pediatric procedural pain management.

  6. The effects of age, gender, and crash types on drivers' injury-related health care costs. (United States)

    Shen, Sijun; Neyens, David M


    There are many studies that evaluate the effects of age, gender, and crash types on crash related injury severity. However, few studies investigate the effects of those crash factors on the crash related health care costs for drivers that are transported to hospital. The purpose of this study is to examine the relationships between drivers' age, gender, and the crash types, as well as other crash characteristics (e.g., not wearing a seatbelt, weather condition, and fatigued driving), on the crash related health care costs. The South Carolina Crash Outcome Data Evaluation System (SC CODES) from 2005 to 2007 was used to construct six separate hierarchical linear regression models based on drivers' age and gender. The results suggest that older drivers have higher health care costs than younger drivers and male drivers tend to have higher health care costs than female drivers in the same age group. Overall, single vehicle crashes had the highest health care costs for all drivers. For males older than 64-years old sideswipe crashes are as costly as single vehicle crashes. In general, not wearing a seatbelt, airbag deployment, and speeding were found to be associated with higher health care costs. Distraction-related crashes are more likely to be associated with lower health care costs in most cases. Furthermore this study highlights the value of considering drivers in subgroups, as some factors have different effects on health care costs in different driver groups. Developing an understanding of longer term outcomes of crashes and their characteristics can lead to improvements in vehicle technology, educational materials, and interventions to reduce crash-related health care costs.

  7. Identifying potentially cost effective chronic care programs for people with COPD

    Directory of Open Access Journals (Sweden)

    L M G Steuten


    Full Text Available L M G Steuten1, K M M Lemmens2, A P Nieboer2, H JM Vrijhoef31Maastricht University Medical Centre, School for Care and Public Health Research, Department of Health, Organisation, Policy and Economics, Maastricht, The Netherlands; 2Erasmus University Medical Centre, Institute of Health Policy and Management, Rotterdam, The Netherlands; 3Maastricht University Medical Centre, School for Care and Public Health Research, Department of Integrated Care, Maastricht, The NetherlandsObjective: To review published evidence regarding the cost effectiveness of multi-component COPD programs and to illustrate how potentially cost effective programs can be identified.Methods: Systematic search of Medline and Cochrane databases for evaluations of multi-component disease management or chronic care programs for adults with COPD, describing process, intermediate, and end results of care. Data were independently extracted by two reviewers and descriptively summarized.Results: Twenty articles describing 17 unique COPD programs were included. There is little evidence for significant improvements in process and intermediate outcomes, except for increased provision of patient self-management education and improved disease-specific knowledge. Overall, the COPD programs generate end results equivalent to usual care, but programs containing ≥3 components show lower relative risks for hospitalization. There is limited scope for programs to break-even or save money.Conclusion: Identifying cost effective multi-component COPD programs remains a challenge due to scarce methodologically sound studies that demonstrate significant improvements on process, intermediate and end results of care. Estimations of potential cost effectiveness of specific programs illustrated in this paper can, in the absence of ‘perfect data’, support timely decision-making regarding these programs. Nevertheless, well-designed health economic studies are needed to decrease the current decision

  8. Modeling uncertainties in workforce disruptions from influenza pandemics using dynamic input-output analysis. (United States)

    El Haimar, Amine; Santos, Joost R


    Influenza pandemic is a serious disaster that can pose significant disruptions to the workforce and associated economic sectors. This article examines the impact of influenza pandemic on workforce availability within an interdependent set of economic sectors. We introduce a simulation model based on the dynamic input-output model to capture the propagation of pandemic consequences through the National Capital Region (NCR). The analysis conducted in this article is based on the 2009 H1N1 pandemic data. Two metrics were used to assess the impacts of the influenza pandemic on the economic sectors: (i) inoperability, which measures the percentage gap between the as-planned output and the actual output of a sector, and (ii) economic loss, which quantifies the associated monetary value of the degraded output. The inoperability and economic loss metrics generate two different rankings of the critical economic sectors. Results show that most of the critical sectors in terms of inoperability are sectors that are related to hospitals and health-care providers. On the other hand, most of the sectors that are critically ranked in terms of economic loss are sectors with significant total production outputs in the NCR such as federal government agencies. Therefore, policy recommendations relating to potential mitigation and recovery strategies should take into account the balance between the inoperability and economic loss metrics.

  9. Effect of an audit and feedback intervention on hospitalized oncology patients' perception of nurse practitioner care. (United States)

    Dulko, Dorothy; Mooney, Kathi


    Although patient satisfaction has been used traditionally as a measure of excellence, research has suggested that the perception of being well cared for is likely a more promising indicator of quality than satisfaction alone. Expectations, physical environment, communication, participation and involvement, technical competence, and the influence of healthcare organizations are factors that may impair patients' ability to distinguish nursing care from their overall healthcare experience. This study evaluated the effect of a nurse practitioner audit and feedback intervention on hospitalized patients' perception of care.

  10. Measuring the effects of reducing subsidies for private insurance on public expenditure for health care. (United States)

    Cheng, Terence Chai


    This paper investigates the effects of reducing subsidies for private health insurance on public sector expenditure for hospital care. An econometric framework using simultaneous equation models is developed to analyse the interrelated decisions on the intensity and type of health care use and private insurance. The framework is applied to the context of the mixed public-private system in Australia. The simulation projections show that reducing premium subsidies is expected to generate net cost savings. This arises because the cost savings achieved from reducing subsidies are larger than the potential increase in public expenditure on hospital care.

  11. The Effect of Horticultural Therapy on the Quality of Life of Palliative Care Patients. (United States)

    Lai, Claudia Kam-Yuk; Lau, Carmen Ka-Yan; Kan, Wai Yin; Lam, Wai Man; Fung, Connie Yuen Yee


    Palliative care patients experienced a variety of needs and perceived their quality of life as being only fair. This study adopted a single group repeated-measure design to investigate the effect of horticultural therapy on the quality of life of palliative care patients using the Quality of Life Concern in End of Life Questionnaire. Significant differences in the domains of "existential distress" and "health care concern" were observed immediately post-intervention and at four weeks post-intervention, respectively. No other significant differences were seen in the other domains or in the total mean score of the outcome measure.

  12. What do we know about health care team effectiveness? A review of the literature. (United States)

    Lemieux-Charles, Louise; McGuire, Wendy L


    This review of health care team effectiveness literature from 1985 to 2004 distinguishes among intervention studies that compare team with usual (nonteam) care; intervention studies that examine the impact of team redesign on team effectiveness; and field studies that explore relationships between team context, structure, processes, and outcomes. The authors use an Integrated Team Effectiveness Model (ITEM) to summarize research findings and to identify gaps in the literature. Their analysis suggests that the type and diversity of clinical expertise involved in team decision making largely accounts for improvements in patient care and organizational effectiveness. Collaboration, conflict resolution, participation, and cohesion are most likely to influence staff satisfaction and perceived team effectiveness. The studies examined here underscore the importance of considering the contexts in which teams are embedded. The ITEM provides a useful framework for conceptualizing relationships between multiple dimensions of team context, structure, processes, and outcomes.

  13. Implementing an interprofessional model of self-management support across a community workforce: A mixed-methods evaluation study. (United States)

    Kulnik, Stefan Tino; Pöstges, Heide; Brimicombe, Lucinda; Hammond, John; Jones, Fiona


    The importance of implementing self-management support (SMS) is now widely accepted, but questions remain as to how. In 2015, we facilitated the implementation of an interprofessional model of SMS (Bridges Self-Management) for people with complex multiple long-term conditions through community rehabilitation and social care services in one Southeast England locality. Over 90 professionals and support workers from this workforce received interprofessional training to integrate SMS into their care and rehabilitation interactions. This gave an opportunity to explore how SMS can be implemented in practice. We conducted a mixed-methods study with unequal weighting (qualitative emphasis), concurrent timing, and embedded design. Staff provided written feedback and case reflections, participated in group discussions, and completed a survey of self-management beliefs and attitudes. We recruited a convenience sample of 10 service users and conducted qualitative interviews and standardised questionnaires. Findings showed that staff appreciated and benefited from the interprofessional learning environment. Staff reported changes in their interactions with service users and colleagues and had gained knowledge and confidence to support individuals to self-manage. Data also highlighted the need to facilitate SMS practice at the level of service organisation. Service user data illustrated the impact of interactions with staff, and how SMS had increased service users' confidence and encouraged different skills to manage life with their conditions. This project has shown how multi-agency community teams can benefit from interprofessional training to enhance SMS for people living with long-term conditions, build a shared understanding of SMS, and integrate effective SMS strategies into everyday practices.

  14. The Department of Defense Acquisition Workforce: Background, Analysis, and Questions for Congress (United States)


    Acquisition Kathryn A. Francis Analyst in Government Organization and Management Charles V. O’Connor U.S. Department of Defense Fellow July 29, 2016...workforce is generally defined as uniformed and civilian government personnel, who are responsible for identifying, developing, buying, and managing goods...positioned the workforce for long- term success by strengthening early and mid-career workforce cohorts. The increase in the size of the workforce has

  15. Research Skills for the Future: Research Workforce Under the Spotlight

    Directory of Open Access Journals (Sweden)

    Eva Dobozy


    Full Text Available The value and training needs of the future research workforce is under the spotlight. In this article, I take up Ulrich and Dash's (2013 somewhat provocative invitation to engage in discussion and debate about current and future research. In my three-tiered response, I first discuss Ulrich and Dash's article, followed by my own observations about the APEC/Deloitte (2010 research report: "Skills and Competencies Needed in the Research Field: Objectives 2020," and finally, I explore, in some detail, challenges of building a twentyfirst-century research workforce.

  16. Quality and effectiveness of different approaches to primary care delivery in Brazil

    Directory of Open Access Journals (Sweden)

    Trindade Thiago G


    Full Text Available Abstract Background Since 1994, Brazil has developed a primary care system based on multidisciplinary teams which include not only a physician and a nurse, but also 4–6 lay community health workers. This system now consists of 26,650 teams, covering 46% of the Brazilian population. Yet relatively few investigations have examined its effectiveness, especially in contrast with that of the traditional multi-specialty physician team approach it is replacing, or that of other existing family medicine approaches placing less emphasis on lay community health workers. Primary health care can be defined through its domains of access to first contact, continuity, coordination, comprehensiveness, community orientation and family orientation. These attributes can be ascertained via instruments such as the Primary Care Assessment Tool (PCATool, and correlated with the effectiveness of care. The objectives of our study are to validate the adult version of this instrument in Portuguese, identify the extent (quality of primary care present in different models of primary care services, and correlate this extent with measures of process and outcomes in patients with diabetes, hypertension and coronary heart disease (CHD. Methods/Design We are conducting a population-based cross-sectional study of primary care in the municipality of Porto Alegre. We will interview a random sample totaling 3000 adults residing in geographic areas covered by four distinct models of primary care of the Brazilian national health system or, alternatively, by one nationally prominent complementary health care service, as well as the physicians and nurses of the health teams of these services. Interviews query perceived quality of care (PCATool-Adult Version, patient satisfaction, and process indicators of management of diabetes, hypertension and known CHD. We are measuring blood pressure, anthropometrics and, in adults with known diabetes, glycated hemoglobin. Discussion We hope to

  17. The Challenges of Providing Effective Pain Management for Children in the Pediatric Intensive Care Unit. (United States)

    Ismail, Ahmad


    Providing effective pain management is necessary for all patients in the intensive care unit (ICU). Because of developmental considerations, caring for children may provide additional challenges. The purpose of this literature review is to describe key challenges in providing effective pain management in pediatric intensive care units (PICUs), with the aim of bringing about a better understanding by health care providers caring for children. Challenges of providing effective pain management in the PICU can be categorized into four levels. These levels are informed by the Nursing Pain Management Model and include challenges (1) to be considered before pain assessment, (2) related to pain assessment, (3) related to pain treatment, and (4) related to post-treatment. This review mainly discusses the challenges of the first three levels because the fourth (post-treatment) relates to reassessment of pain, which shares the same challenges of level two, pain assessment. Key challenges of level one are related to health care provider's characteristics, patients and their families' factors, and PICU setting. The main challenges of the assessment and reassessment levels are the child's age and developmental level, ability to self-report, relying on behavioral and physiological indicators of pain, selecting the appropriate pain assessment scale, assessing pain while the patient is being treated with sedative and paralytic agents, mechanical ventilation, and changes in patients' level of consciousness. In the treatment level (level three), nonpharmacological interventions factors; alterations in the pharmacokinetics and pharmacodynamics of medications to be used for pain management in critically ill children; and the complexity of the administration of sedatives, analgesics, and paralytic agents in critically ill children are the main challenges. Health care providers can bear in mind such important challenges in order to provide effective pain management. Health care providers

  18. Bridging Language Barriers in Multilingual Care Encounters (United States)

    Jansson, Gunilla


    The present case study demonstrates how the multilingual practices of a linguistically diverse workforce contribute to the functioning of a modern workplace. Based on ethnographic fieldwork and recordings in a residential home for elderly people with dementia in Sweden, the article explores how multilingual immigrant care workers creatively use…

  19. Social Enterprises and Social Sector Workforces: Workforce Initiatives Discussion Paper #3 (United States)

    Academy for Educational Development, 2011


    Increasing evidence shows that investing in social sector supply, service, and value chains has exponentially stronger development impact than investments in other sectors. There are often severely lacking social services such as child care, elder care, health care delivery, prescription drug distribution, home schooling, and private sector…

  20. Effect of medicare payment on rural health care systems. (United States)

    McBride, Timothy D; Mueller, Keith J


    Medicare payments constitute a significant share of patient-generated revenues for rural providers, more so than for urban providers. Therefore, Medicare payment policies influence the behavior of rural providers and determine their financial viability. Health services researchers need to contribute to the understanding of the implications of changes in fee-for-service payment policy, prospects for change because of the payment to Medicare+Choice risk plans, and implications for rural providers inherent in any restructuring of the Medicare program. This article outlines the basic policy choices, implications for rural providers and Medicare beneficiaries, impacts of existing research, and suggestions for further research. Topics for further research include implications of the Critical Access Hospital program, understanding how changes in payment to rural hospitals affect patient care, developing improved formulas for paying rural hospitals, determining the payment-to-cost ratio for physicians, measuring the impact of changes in the payment methodology used to pay for services delivered by rural health clinics and federally qualified health centers, accounting for the reasons for differences in historical Medicare expenditures across rural counties and between rural and urban counties, explicating all reasons for Medicare+Choice plans withdrawing from some rural areas and entering others, measuring the rural impact of proposals to add a prescription drug benefit to the Medicare program, and measuring the impact of Medicare payment policies on rural economies.

  1. 34 CFR 361.23 - Requirements related to the statewide workforce investment system. (United States)


    ... statistics, job vacancies, career planning, and workforce investment activities; (iii) The use of customer... 34 Education 2 2010-07-01 2010-07-01 false Requirements related to the statewide workforce... Administration § 361.23 Requirements related to the statewide workforce investment system. (a)...

  2. 20 CFR 661.350 - What are the contents of the local workforce investment plan? (United States)


    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What are the contents of the local workforce..., DEPARTMENT OF LABOR STATEWIDE AND LOCAL GOVERNANCE OF THE WORKFORCE INVESTMENT SYSTEM UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT Local Governance Provisions § 661.350 What are the contents of the local...

  3. An Exploratory Study of the Philosophy and Teaching Styles of Georgia Workforce Educators and Entrepreneurship Instructors (United States)

    Floyd, Tuboise D.


    This exploratory study examines the adult educational philosophies and teaching styles of workforce educators and entrepreneurship instructors within the State of Georgia. A workforce educator is an educator teaching workforce skills; an entrepreneurship instructor is an educator who teaches entrepreneurship skills. Conti's Principles of Adult…

  4. 20 CFR 661.430 - Under what conditions may the Governor submit a Workforce Flexibility Plan? (United States)


    ... statutory provisions essential to the key reform principles embodied in the Workforce Investment Act... ADMINISTRATION, DEPARTMENT OF LABOR STATEWIDE AND LOCAL GOVERNANCE OF THE WORKFORCE INVESTMENT SYSTEM UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT Waivers and Work-Flex Waivers § 661.430 Under what conditions...

  5. Health Workforce and International Migration: Can New Zealand Compete? OECD Health Working Papers No. 33 (United States)

    Zurn, Pascal; Dumont, Jean-Christophe


    This paper examines health workforce and migration policies in New Zealand, with a special focus on the international recruitment of doctors and nurses. The health workforce in New Zealand, as in all OECD countries, plays a central role in the health system. Nonetheless, maybe more than for any other OECD country, the health workforce in New…

  6. Effect of new training technique on affinity of cynomolgus monkeys for animal care personnel. (United States)

    Nishimoto, Ai; Tachibana, Yuki; Takaura, Kaoru; Ochi, Takehiro; Koyama, Hironari


    To confirm our hypothesis that the sex and age of cynomolgus monkeys influences the effect of training, we employed a new training technique designed to increase the animal's affinity for animal care personnel. During 151 days of training, monkeys aged 2 to 10 years accepted each 3 raisins/3 times/day, and communicated with animal care personnel (5 times/day). Behavior was scored using integers between -1 and 5. Before training, 35 of the 61 monkeys refused raisins offered directly by animal care personnel (Score -1, 0 and 1). After training, 28 of these 35 monkeys (80%) accepted raisins offered directly by animal care personnel (>Score 2). The mean score of monkeys increased from 1.2 ± 0.1 to 4.3 ± 0.2. The minimum training period required for monkeys to reach Score 2 was longer for females than for males. After 151 days, 6 of the 31 females and 1 of the 30 males still refused raisins offered directly by animal care personnel. Beneficial effects of training were obtained in both young and adult monkeys. These results indicate that our new training technique markedly improves the affinity of monkeys for animal care personnel, and that these effects tend to vary by sex but not age. In addition, abnormal behavior and symptoms of monkeys were improved by this training.

  7. Mental health care and average happiness: strong effect in developed nations. (United States)

    Touburg, Giorgio; Veenhoven, Ruut


    Mental disorder is a main cause of unhappiness in modern society and investment in mental health care is therefore likely to add to average happiness. This prediction was checked in a comparison of 143 nations around 2005. Absolute investment in mental health care was measured using the per capita number of psychiatrists and psychologists working in mental health care. Relative investment was measured using the share of mental health care in the total health budget. Average happiness in nations was measured with responses to survey questions about life-satisfaction. Average happiness appeared to be higher in countries that invest more in mental health care, both absolutely and relative to investment in somatic medicine. A data split by level of development shows that this difference exists only among developed nations. Among these nations the link between mental health care and happiness is quite strong, both in an absolute sense and compared to other known societal determinants of happiness. The correlation between happiness and share of mental health care in the total health budget is twice as strong as the correlation between happiness and size of the health budget. A causal effect is likely, but cannot be proved in this cross-sectional analysis.

  8. A review on cost-effectiveness and cost-utility of psychosocial care in cancer patients

    Directory of Open Access Journals (Sweden)

    Femke Jansen


    Full Text Available Several psychosocial care interventions have been found effective in improving psychosocial outcomes in cancer patients. At present, there is increasingly being asked for information on the value for money of this type of intervention. This review therefore evaluates current evidence from studies investigating cost-effectiveness or cost-utility of psychosocial care in cancer patients. A systematic search was conducted in PubMed and Web of Science yielding 539 unique records, of which 11 studies were included in the study. Studies were mainly performed in breast cancer populations or mixed cancer populations. Studied interventions included collaborative care (four studies, group interventions (four studies, individual psychological support (two studies, and individual psycho-education (one study. Seven studies assessed the cost-utility of psychosocial care (based on quality-adjusted-life-years while three studies investigated its cost-effectiveness (based on profile of mood states [mood], Revised Impact of Events Scale [distress], 12-Item Health Survey [mental health], or Fear of Progression Questionnaire [fear of cancer progression]. One study did both. Costs included were intervention costs (three studies, intervention and direct medical costs (five studies, or intervention, direct medical, and direct nonmedical costs (three studies. In general, results indicated that psychosocial care is likely to be cost-effective at different, potentially acceptable, willingness-to-pay thresholds. Further research should be performed to provide more clear information as to which psychosocial care interventions are most cost-effective and for whom. In addition, more research should be performed encompassing potential important cost drivers from a societal perspective, such as productivity losses or informal care costs, in the analyses.

  9. Effect of PACS/CR on cost of care and length of stay in a medical intensive care unit (United States)

    Langlotz, Curtis P.; Kundel, Harold L.; Brikman, Inna; Pratt, Hugh M.; Redfern, Regina O.; Horii, Steven C.; Schwartz, J. Sanford


    Our purpose was to determine the economic effects associated with the introduction of PACS and computed radiology (CR) in a medical intensive care unit (MICU). Clinical and financial data were collected over a period of 6 months, both before and after the introduction of PACS/CR in our medical intensive care unit. Administrative claims data resulting from the MICU stay of each patient enrolled in our study were transferred online to our research database from the administrative databases of our hospital and its affiliated clinical practices. These data included all charge entries, sociodemographic data, admissions/discharge/transfer chronologies, ICD9 diagnostic and procedure codes, and diagnostic related groups. APACHE III scores and other case mix adjusters were computed from the diagnostic codes, and from the contemporaneous medical record. Departmental charge to cost ratios and the Medicare Resource-Based Relative Value Scale fee schedule were used to estimate costs from hospital and professional charges. Data were analyzed using both the patient and the exam as the unit of analysis. Univariate analyses by patient show that patients enrolled during the PACS periods were similar to those enrolled during the Film periods in age, sex, APACHE III score, and other measures of case mix. No significant differences in unadjusted median length of stay between the two Film and two PACS periods were detected. Likewise, no significant differences in unadjusted total hospital and professional costs were found between the Film and PACS periods. In our univariate analyses by exam, we focused on the subgroup of exams that had triggered primary clinical actions in any period. Those action-triggering exams were divided into two groups according to whether the referring clinician elected to obtain imaging results from the workstation or from the usual channels. Patients whose imaging results were obtain from the workstation had significantly lower professional costs in the 7 days

  10. Adapting online learning for Canada's Northern public health workforce

    Directory of Open Access Journals (Sweden)

    Marnie Bell


    Full Text Available Background . Canada's North is a diverse, sparsely populated land, where inequalities and public health issues are evident, particularly for Aboriginal people. The Northern public health workforce is a unique mix of professional and paraprofessional workers. Few have formal public health education. From 2009 to 2012, the Public Health Agency of Canada (PHAC collaborated with a Northern Advisory Group to develop and implement a strategy to strengthen public health capacity in Canada's 3 northern territories. Access to relevant, effective continuing education was identified as a key issue. Challenges include diverse educational and cultural backgrounds of public health workers, geographical isolation and variable technological infrastructure across the north. Methods . PHAC's Skills Online program offers Internet-based continuing education modules for public health professionals. In partnership with the Northern Advisory Group, PHAC conducted 3 pilots between 2008 and 2012 to assess the appropriateness of the Skills Online program for Northern/Aboriginal public health workers. Module content and delivery modalities were adapted for the pilots. Adaptations included adding Inuit and Northern public health examples and using video and teleconference discussions to augment the online self-study component. Results . Findings from the pilots were informative and similar to those from previous Skills Online pilots with learners in developing countries. Online learning is effective in bridging the geographical barriers in remote locations. Incorporating content on Northern and Aboriginal health issues facilitates engagement in learning. Employer support facilitates the recruitment and retention of learners in an online program. Facilitator assets included experience as a public health professional from the north, and flexibility to use modified approaches to support and measure knowledge acquisition and application, especially for First Nations, Inuit and

  11. Computerized clinical decision support systems for acute care management: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes

    Directory of Open Access Journals (Sweden)

    Sahota Navdeep


    Full Text Available Abstract Background Acute medical care often demands timely, accurate decisions in complex situations. Computerized clinical decision support systems (CCDSSs have many features that could help. However, as for any medical intervention, claims that CCDSSs improve care processes and patient outcomes need to be rigorously assessed. The objective of this review was to systematically review the effects of CCDSSs on process of care and patient outcomes for acute medical care. Methods We conducted a decision-maker-researcher partnership systematic review. MEDLINE, EMBASE, Evidence-Based Medicine Reviews databases (Cochrane Database of Systematic Reviews, DARE, ACP Journal Club, and others, and the Inspec bibliographic database were searched to January 2010, in all languages, for randomized controlled trials (RCTs of CCDSSs in all clinical areas. We included RCTs that evaluated the effect on process of care or patient outcomes of a CCDSS used for acute medical care compared with care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement if at least 50% of the relevant study outcomes were statistically significantly positive. Results Thirty-six studies met our inclusion criteria for acute medical care. The CCDSS improved process of care in 63% (22/35 of studies, including 64% (9/14 of medication dosing assistants, 82% (9/11 of management assistants using alerts/reminders, 38% (3/8 of management assistants using guidelines/algorithms, and 67% (2/3 of diagnostic assistants. Twenty studies evaluated patient outcomes, of which three (15% reported improvements, all of which were medication dosing assistants. Conclusion The majority of CCDSSs demonstrated improvements in process of care, but patient outcomes were less likely to be evaluated and far less likely to show positive results.

  12. Standard Care Impact on Effects of Highly Active Antiretroviral Therapy Adherence Interventions

    NARCIS (Netherlands)

    Bruin, de M.; Viechtbauer, W.; Schaalma, H.P.; Kok, G.; Abraham, C.; Hospers, H.J.


    BACKGROUND: Poor adherence to medication limits the effectiveness of treatment for human immunodeficiency virus. Systematic reviews can identify practical and effective interventions. Meta-analyses that control for variability in standard care provided to control groups may produce more accurate est

  13. Effectiveness of diclofenac versus paracetamol in knee osteoarthritis: A randomised controlled trial in primary care

    NARCIS (Netherlands)

    S.P.J. Verkleij (Saskia ); P.A.J. Luijsterburg (Pim); S.P. Willemsen (Sten); B.W. Koes (Bart); A.M. Bohnen (Arthur); S.M. Bierma-Zeinstra (Sita)


    textabstractBackground The effectiveness of diclofenac versus paracetamol in primary care patients with pain caused by knee osteoarthritis is unclear. Aim To assess the effectiveness of diclofenac compared with paracetamol over a period of 2, 4, and 12 weeks in patients with knee osteoarthritis. Des

  14. Migrant care workers or migrants working in long-term care? A review of Australian experience. (United States)

    Howe, Anna L


    Discussion of the role of migrant care workers in long-term care (LTC) that has gained increasing attention in the United States and other developed countries in recent years is of particular relevance to Australia, where 24% of the total population is overseas-born, two-thirds of them coming from countries where English is not the primary language. Issues of interest arise regarding meeting LTC workforce demands in general and responding to the particular cultural and linguistic needs of postwar immigrants who are now reaching old age in increasing numbers. This review begins with an account of the overseas-born components of the aged care workforce and then examines this representation with reference to the four factors identified as shaping international flows of care workers in the comparative study carried out for the AARP Public Policy Institute in 2005: migration policies, LTC financing arrangements, worker recruitment and training, and credentialing. The ways in which these factors play out in Australia mean that while overseas-born workers are overrepresented in the LTC workforce, migrant care workers are not identifiable as a marginalized group experiencing disadvantage in employment conditions, nor do they offer a solution to workforce shortages. The Australian experience is different from those of other countries in many respects, but it does show that the experience of migrant care workers is not unique to LTC and points to the need to extend the search for solutions to workforce shortages and improving conditions of all care workers well beyond LTC systems to wider policy settings.

  15. Ten years of health workforce planning in the Netherlands: a tentative evaluation of GP planning as an example

    Directory of Open Access Journals (Sweden)

    Van Greuningen Malou


    Full Text Available Abstract Introduction In many countries, health-care labour markets are constantly being challenged by an alternation of shortage and oversupply. Avoiding these cyclic variations is a major challenge. In the Netherlands, a workforce planning model has been used in health care for ten years. Case description Since 1970, the Dutch government has explored different approaches to determine the inflow in medical schools. In 2000, a simulation model for health workforce planning was developed to estimate the required and available capacity of health professionals in the Netherlands. In this paper, this model is explained, using the Dutch general practitioners as an example. After the different steps in the model are clarified, it is shown how elements can be added to arrive at different versions of the model, or ‘scenarios’. A comparison is made of the results of different scenarios for different years. In addition, the subsequent stakeholder decision-making process is considered. Discussion and evaluation Discussion of this paper shows that workforce planning in the Netherlands is a complex modelling task, which is sensitive to different developments influencing the balance between supply and demand. It seems plausible that workforce planning has resulted in a balance between supply and demand of general practitioners. Still, it remains important that the modelling process is accepted by the different stakeholders. Besides calculating the balance between supply and demand, there needs to be an agreement between the stakeholders to implement the advised training inflow. The Dutch simulation model was evaluated using six criteria to be met by models suitable for policy objectives. This model meets these criteria, as it is a comprehensive and parsimonious model that can include all relevant factors. Conclusion Over the last decade, health workforce planning in the Netherlands has become an accepted instrument for calculating the required supply of

  16. Evidence for the long term cost effectiveness of home care reablement programs

    Directory of Open Access Journals (Sweden)

    Lewin GF


    Full Text Available Gill F Lewin,1,2 Helman S Alfonso,3 Janine J Alan41Faculty of Health Sciences, Curtin University, Perth, WA, Australia; 2Research Department, Silver Chain Group, Perth, WA, Australia; 3School of Population Health, University of Western Australia, Perth, WA, Australia; 4Faculty of Health Sciences, Curtin University, Perth, WA, AustraliaBackground: The objectives of this study were to determine whether older individuals who participated in a reablement (restorative program rather than immediately receiving conventional home care services had a reduced need for ongoing support and lower home care costs over the next 57 months (nearly 5 years.Materials and methods: Data linkage was used to examine retrospectively the service records of older individuals who had received a reablement service versus a conventional home care service to ascertain their use of home care services over time.Results: Individuals who had received a reablement service were less likely to use a personal care service throughout the follow-up period or any other type of home care over the next 3 years. This reduced use of home care services was associated with median cost savings per person of approximately AU $12,500 over nearly 5 years.Conclusion: The inclusion of reablement as the starting point for individuals referred for home care within Australia's reformed aged care system could increase the system's cost effectiveness and ensure that all older Australians have the opportunity to maximize their independence as they age.Keywords: restorative, older adults, community dwelling, service costs

  17. [The effect of self-determination on time perspective and child-care anxiety]. (United States)

    Miyamoto, Junko


    This study examines the effect of self-determination on time perspectives and child-care anxiety from a viewpoint of life course. A total of 1,726 mothers with small children participated in a questionnaire survey. They were classified into four groups based on their planned life courses: mothers who work; mothers who stopped working, but plan on returning to work; mothers who don't want to work and plan to stay at home; and mothers who stopped working, but plan on returning to work when their children grow up. Child-care anxiety was classified into four categories: (a) sense of stagnation and sacrifice, (b) fatigue, (c) diffidence, (d) feeling disaffection. The results show that fulfillment associated with child-care anxiety exists for all groups and factors of child-care anxiety, and that fulfillment was influenced by differences between self-determination and self-determination desires. The effect of self-determination on time perspectives and child-care anxiety differed between groups. It is suggested that society should provide different support to mothers with small children and child-care anxiety related to their different planned life courses.


    Rubinstein, Dorit


    The increase in the number of older people in the world emphasizes the need to reevaluate and change health care policy and care services priorities. The provision of health care for this growing population has consequently become an important worldwide concern. The purpose of this article is to highlight the challenges stemming from the growing number of elderly people and their need for care. Collaborative and coordinated health care services for elderly people should be focused on the ethical issues deriving from the interpersonal relationships between the professional caregiver and the older person. Any discussion on ethics and aging should be focused on the roles of autonomy, informed consent, respect, advance directive, end of life decisions and privacy. In addition, such a discussion should stress the important role of effective communication and its effect on the older person's adherence with the recommended treatment. The desired consequence should be the empowerment of positive and successful experiences attained by the recipients of the health care services.

  19. Effectiveness of palliative care including physiotherapy in hiv patients a review of the literature

    Directory of Open Access Journals (Sweden)

    J. Uwimana


    Full Text Available It is estimated that 41 million people throughout the world are living with HIV/AIDS and of these 39 million are in sub-Saharan Africa(UNAIDS 2004.  The HIV/AIDS epidemic is devastating the African continent.In Africa poorly resourced health care infrastructure further impairs the quality of life in HIV sufferers. Palliative care is an approach that aims to improve the quality of life of people living with threatening diseases such as cancer and HIV/AIDS. This review aimed to determine the efficacy of palliative care. Complementary therapies such as Cognitive Behavioural Therapy, peer/counselling group therapy, massage  therapy, and exercise therapy constitute palliative care. Seventeen articles published in peer reviewed journals during the period 1990-2005 were reviewed. The findings of our review demonstrate that there are indications that palliative care can be effective in improving the quality of life in patients with life threatening diseases such HIV/AIDS. Research in this field is complicated by the heterogeneity of study samples, difficulty in patient recruitment, and death before the end of the intervention period. Future research in this area should aim to include larger study samples, using valid tools to assess quality of life and to employ qualitative methods in studies to assess the effectiveness of palliative care.

  20. Positive effects of experience in terminal care on nursing home staff in Japan. (United States)

    Abe, Koji; Ohashi, Akira


    This study aimed to examine the psychological effects of terminal care experience on nursing home staff and analyze the differences between staff who are experienced and those who are inexperienced in providing terminal care. A mailed survey was conducted in 2007. A total of 37% (N = 72) of the participants had experience in terminal care in nursing homes. Analysis of variance (ANOVA) revealed that the professional efficacy (a subscale of the Maslach Burnout Inventory-General Survey [MBI-GS]) and tenure (duration of service) of the experienced staff were significantly higher than those of the inexperienced staff. The high professional efficacy noted among the experienced staff suggests that the provision of terminal care in nursing homes does not necessarily lead to burnout among caregivers and may in fact serve as an important motivational factor.

  1. Health workforce planning in Europe: creating learning country clusters.

    NARCIS (Netherlands)

    Batenburg, R.


    In this article, the different dimensions and determinants of health workforce planning (HWF) are investigated to improve context-sensitivity and mutual learning among groups of countries with similar HWF characteristics. A novel approach to scoring countries according to their HFW characteristics a

  2. Workforce Motivation in 1983: a review for DOD policy implication


    Bisignano, Dallas A.


    Approved for public release, distribution unlimited This thesis investigates the theories, strategies and techniques for productivity enhancement via increasing workforce motivation. It reviews previous research which explored the factors of employee morale and job satisfaction. Different perspectives of the concepts of motivation and productivity are offered. It considers contemporary employee motivational problems in management and suggests improvements for DOD consi...

  3. Employers’ View on Problems Related to Workforce Skills and Qualification

    Directory of Open Access Journals (Sweden)

    Klimplová Lenka


    Full Text Available The aim of this exploratory study is to reveal employers’ views on problems related to workforce human capital (skills and qualification. Where do employers themselves view the core of difficulties with ensuring adequately skilled workforce? Do they assign them to technological and organizational changes (a functional concept of job-specific human capital obsolescence, or do they see these problems as a result of other circumstances, such as macro-structural conditions or institutional settings? To answer these questions selected employers in mechanical engineering and information technology sectors in the Czech Republic were interviewed. The results show that the employers see the problems: 1 on the side of workforce – insufficient abilities and skills, exaggerated demands and low motivation; 2 as inadequate capacities and capabilities of the organization itself; 3 at macro-level as institutional shortcomings in the initial educational system and social benefits system. The problems related to workforce skills and qualification cannot be, thus, interpreted only in the functionalist view as job-specific human capital obsolescence, but the formulation of the problems is significantly affected by the institutional framework.

  4. ORTEC Predicts the Payback Period for its Workforce Scheduling Software

    NARCIS (Netherlands)

    E. van Asperen (Eelco); R. Dekker (Rommert); P. van der Schalk (Patrick)


    textabstractORTEC is a Netherlands-based software company selling decision support systems based on operations research models. One of her products is HARMONY, a workforce scheduling package. We developed a model to predict its return on investment for a specific customer. The model uses a database

  5. Creating New Visions for Teacher Education: Education Workforce 2020 DVD (United States)

    American Association of Colleges for Teacher Education (NJ3), 2006


    This DVD begins a conversation about the education workforce for the year 2020. The video was shown as part of the 2006 Annual Meeting Opening Night Program and was followed by a panel discussion among teacher educators, moderated by the American Association of Colleges for Teacher Education (AACTE) President/CEO Sharon P. Robinson.

  6. The Global Workforce: Opportunities and the Value Chain. (United States)

    Martin, Tessie Sue; Flinn, Leslie


    Discusses the issues surrounding the value changes that impact opportunities for workforce development. Emerging technologies have changed the way labor is deployed. Offers exercises aimed at helping community colleges to understand the strengths and weaknesses of the industries they serve. Contains three figures and five references. (NB)

  7. Workforce and Economic Development Annual Report, 2011-2012 (United States)

    California Community Colleges, Chancellor's Office, 2013


    The California Community Colleges Workforce and Economic Development program (WED program) helps students, incumbent workers, business partners and industries develop skilled competencies in critical industry sectors. As a source for developing and implementing training and curriculum, the WED program is instrumental in helping the community…

  8. State Sector Strategies: The New Workforce Development in the USA (United States)

    Lakes, Richard D.


    Neoliberal governments consider global business competitiveness to be thwarted by costly bureaucratic regulation and programme duplication. In an effort to downsize the costs of operating a state, the governors now streamline job training functions via a coordinated workforce and economic development effort known as sector strategies, with…

  9. National Environmental/Energy Workforce Assessment for California. (United States)

    National Field Research Center Inc., Iowa City, IA.

    This report presents existing workforce levels, training programs and career potentials and develops staffing level projections (1976-1982) based on available information for the State of California. The study concerns itself with the environmental pollution control areas of air, noise, potable water, pesticides, radiation, solid waste,…

  10. Educational Credentialing of an Aging Workforce: Uneasy Conclusions (United States)

    Isopahkala-Bouret, Ulpukka


    This study investigates the educational attainment of an aging workforce from the perspective of educational credentialing. The research questions are defined as follows: Why are workers over age 50 attaining university degrees? How do they narratively construct the rational for pursuing well-recognized credentials in midlife? The specific focus…

  11. Treatment of Missing Data in Workforce Education Research (United States)

    Gemici, Sinan; Rojewski, Jay W.; Lee, In Heok


    Most quantitative analyses in workforce education are affected by missing data. Traditional approaches to remedy missing data problems often result in reduced statistical power and biased parameter estimates due to systematic differences between missing and observed values. This article examines the treatment of missing data in pertinent…

  12. Gender and professionalisation in the Danish ECE workforce

    DEFF Research Database (Denmark)

    Nielsen, Steen Baagøe

    and the linking of these strategies, which in the international literature is often considered two sides of the same coin. Through the narratives of men and women in the ECE workforce in Denmark the paper discusses experiences of men and women in ECE institutions, and consequences for training and the transition...

  13. Job Insecurity in the Younger Spanish Workforce: Causes and Consequences (United States)

    Peiro, Jose M.; Sora, Beatriz; Caballer, Amparo


    The Spanish labor market is currently an example of a flexible labor market. However, it involves a set of detrimental conditions for its workforce, such as lower employability in the labor market and underemployment (i.e. over-qualification and underemployment in time). In this study, we assume that all these conditions promote higher job…

  14. National Environmental/Energy Workforce Assessment for Texas. (United States)

    National Field Research Center Inc., Iowa City, IA.

    This report presents existing workforce levels, training programs and career potentials and develops staffing level projections (1976-1982) based on available information for the State of Texas. The study concerns itself with the environmental pollution control areas of air, noise, potable water, pesticides, radiation, solid waste, wastewater, and…





    2016 Employer Branding PT. Citibank Indonesia pada Kalangan Workforce di Makassar Ruzkyhaq Nurdjanah Hamid Shinta Dewi S. Tikson Jurusan Manajemen, Fakultas Ekonomi dan Bisnis, Universitas Hasanuddin JL. Perintis Kemerdekaan Km.10 Makassar, 90245 Sulawesi Selatan, Indonesia Penelitian ini bertujuan untuk mengetahui dan menganalisis pengaruh Employer Branding PT. Citibank Indonesia yang menghasilkan dua Atribut Daya Tarik yang terdiri dari Atribut Instrument...

  16. Let's Stop Playing Monopoly with the Child Welfare Workforce (United States)

    Perry, Robin Ernest


    Although the National Child Welfare Workforce Institute (NCWWI) is a specific focus of Stoesz's article, a more expansive and thought-provoking critique is made of the NCWWI within the context of a purported overreliance and dependency on the Children's Bureau, concerns regarding the quality of social work education, and the development of a…

  17. Helping Managers and Employees Cope with Work-Force Cutbacks. (United States)

    Morton, Gene L.


    Steps can be taken to reduce the need for work-force cutbacks and to prepare in advance by planning activities, defining severance awards, reducing anxiety, setting layoff criteria, providing outplacement services, and handling the timing, logistics, and aftermath of layoffs with sensitivity. (SK)

  18. The human factor: the critical importance of effective teamwork and communication in providing safe care. (United States)

    Leonard, M; Graham, S; Bonacum, D


    Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language" to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training and simulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit of such work are described.

  19. Teledentistry-assisted, affiliated practice for dental hygienists: an innovative oral health workforce model. (United States)

    Summerfelt, Fred F


    The 2010 U.S. Patient Protection and Affordable Care Act (PPACA) calls for training programs to develop mid-level dental health care providers to work in areas with underserved populations. In 2004, legislation was passed in Arizona allowing qualified dental hygienists to enter into an affiliated practice relationship with a dentist to provide oral health care services for underserved populations without general or direct supervision in public health settings. In response, the Northern Arizona University (NAU) Dental Hygiene Department developed a teledentistry-assisted, affiliated practice dental hygiene model that places a dental hygienist in the role of the mid-level practitioner as part of a digitally linked oral health care team. Utilizing current technologies, affiliated practice dental hygienists can digitally acquire and transmit diagnostic data to a distant dentist for triage, diagnosis, and patient referral in addition to providing preventive services permitted within the dental hygiene scope of practice. This article provides information about the PPACA and the Arizona affiliated practice dental hygiene model, defines teledentistry, identifies the digital equipment used in NAU's teledentistry model, give an overview of NAU's teledentistry training, describes NAU's first teledentistry clinical experience, presents statistical analyses and evaluation of NAU students' ability to acquire diagnostically efficacious digital data from remote locations, and summarizes details of remote applications of teledentistry-assisted, affiliated practice dental hygiene workforce model successes.

  20. Enhancing computer literacy and information retrieval skills: A rural and remote nursing and midwifery workforce study. (United States)

    Mills, Jane; Francis, Karen; McLeod, Margaret; Al-Motlaq, Mohammad


    Nurses and midwives collectively, represent the largest workforce category in rural and remote areas of Australia. Maintaining currency of practice and attaining annual licensure with the Australian Health Practitioners Regulatory Authority (AHPRA) present challenges for individual nurses and midwives and for their health service managers. Engagement with information and communication technologies, in order for geographically isolated clinicians to access ongoing education and training, is considered a useful strategy to address such challenges. This paper presents a pre- and post-test study design. It examines the impact of an online continuing professional development (CPD) program on Australian rural nurses and midwives. The aims of the program were to increase basic skill acquisition in the utilisation of common computer software, the use of the Internet and the enhancement of email communication. Findings from the study demonstrate that participants who complete a relevant CPD program gain confidence in the use of information and communication technologies. Further, increased confidence leads to increased access to contemporary, reliable and important health care information on the Internet, in addition to clinicians adopting email as a regular method of communication. Health care employers commonly assume employees are skilled users of information and communication technologies. However, findings from this study contradict such assumptions. It is argued in the recommendations that health care employees should be given regular access to CPD programs designed to introduce them to information and communication technologies. Developing knowledge and skills in this area has the potential to improve staff productivity, raise health care standards and improve patient outcomes.